Elizabeth Deboo At Live Well 50, we believe in healthy living through Lifestyle Medicine. The 4 pillars of lifestyle medicine revolve around nutrition, exercises, restorative sleep, and stress reduction. Prescription medications are used as needed after we have first optimized our lifestyle.
My Journey Begins
In 1994, I was in my late 20’s, and Ed and I had just graduated from Physical Therapy school. We took off and started traveling domestically as traveling PTs. I had always taken care of myself and was fairly in tune with my body through seven grueling years of college. Bone loss in my future self was nothing I was thinking of.
I knew something wasn’t right
Something started to change in me in my late 20s. I felt it in my body as fatigue, tiredness that I had not perceived before, not even when pulling late-night study sessions and getting about as minimal sleep as one could and still be functional while in PT school be that from going out and whooping in it up on the weekend or pulling late-night study sessions.
At that point, there was already a strong family history of thyroid disease and it was on my radar. About every 3 months, Ed and I moved, changed jobs, and I felt a little more fatigued and exhausted. I really struggled with this because it didn’t fit my ideology of what I wanted to be doing and how I wanted to feel like a 27-year-old.
It seemed that each time we moved I consulted a doctor for thyroid labs. There was always some reluctance on the part of the physician to do the labs despite my family’s history. By family history I mean my mom. She had a goiter, which is an enlargement of the thyroid gland. There are some common causes of goiters including low iodine in your diet. But this was not the cause of hers. My moms was caused by Hashimoto’s which is an autoimmune disorder affecting the immune system where your body makes antibodies that attack the cells in your thyroid.
Physicians and thyroid disease
Now keep in mind this was in the early 90s. I am being generous here with the physicians because we do know so much more now about Thyroid disease now, but at the time I knew in my heart of hearts that something was off and I knew it was my Thyroid despite what the labs were saying. Each and every time I got thyroid labs taken it was only TSH, no full Thyroid panel including TSH, Free T3, and Free T4, and the docs parrotted the lab values without looking beyond for anything subclinical. No one palpated my thyroid. No one asked me about my hair, my skin, my mental state, my ability to sleep, my gut issues, or weight gain.
To be honest, I gave up and stopped seeking an answer, but still felt pretty low energy most of the time.
We traveled for a total of 2.5 years got married, and traveled to India and Thailand. Once we returned it was inevitable we get permanent jobs and start honest to goodness adulting. We decided to live in the Pacific Northwest, traveled up and down the I-5 corridor from northern Washington to southern Oregon interviewing, and visit small to medium-size communities in search of a place we both would like to settle down and live.
As it turns out we made a full circle back up to Bellingham, WA where Ed went to Western Washington University for his undergraduate degree. He had always loved it and we finally chose Bellingham.
This takes us to February 1997.
We rented an apartment and started new jobs. By June of 1997, I was as low as I had ever been, both energy-wise and emotionally. To be fair, the PNW was a big reach, a big stretch for me weather-wise. Having been born and raised in Iowa, I was accustomed to four seasons with lots and lots of sunshine throughout the year. I was also very lonely as I hadn’t met many friends yet and the weather was getting me very very down. Getting married, traveling, and making the big move to Bellingham starting a new life and new jobs I kind of forgot about my thyroid.
One day as I was treating one of my favorite patients, who happened to be an endocrinologist. She was a gem and always came bopping with her typical effervescence (and also tardiness) and laid down on MY table. We had so many good conversations. I treated her for an ongoing chronic issue.
A life-changing chance encounter
I am not sure what made her ask the way she did or what made me answer the way I did, but that day as he was lying relaxing and being treated on my table she stopped what she was saying and ask me how I was, as if concerned. Very out of the ordinary as I would never have told another patient this, but I told her I felt terrible and that I felt I was walking through thick mud every day all day. Her eyes popped open and she told me she was going to palpate my thyroid just as soon as she got off my table. I said sure, ok, that sounds good. To that point, while knowing her and treating her I had not thought once about my thyroid because remember I had closed that box, tucked it away, and just forgot about it.
When she palpated my thyroid, which as most of you know is in the front part of the neck right around the “voicebox”, I nearly went through the roof. It was sensitive and like nothing I had ever felt before. She said, “well I guess I will see you in my office with some thyroid lab results”.
Yep, that was a very good idea! It all came back to me and I started wondering if my low mood and low energy perhaps were not just about the weather or being lonely.
Long story Long…
We started a journey that would take years to smooth out. My thyroid was inflamed and dysfunctional and not working well for my body at all. She diagnosed me with Hashimotos. It took a while to get me to a level of medication where I felt good. My mood lifted and my energy increased. I was happier in my new life and I saw my new endocrinologist regularly to keep a close watch on it.
She was an absolute dream of a doctor, the likes of which I have never had since. As a patient, she was always late. As my doctor, she was always late. She took late and waited in her office to be seen to a whole new level. But you know what? I had no qualms with this because she was literally the best doctor who pulled me from the dregs of my early adult life and gave me back my spark. Because she was a good doctor, she was special and a damn good endocrinologist she spent time with me, she looked at my hair, my skin, my nails, she always palpated my thyroid, she asked about my mood and my life. She paid very close attention to these subclinical aspects of my health. I had my vitamin D levels checked, which too were dangerously low, and not a wonder I was feeling some depression and affected by the weather. My B12 levels were where she wanted them….that is where I felt good.
A great point in this chapter of this long story long…. she assessed through the art and science of being a physician and did not just default to lab values. She put together all of these pieces of information, looked at MY clinical picture, and then identified the treatment.
This too is why I never batted an eye when she was sometimes hours late to see me. Could she have restructured her day so as not to be late for every patient, yes! But because I knew this was the time and care she was taking with each of her patients which, as we know, cannot fit into a 15 minutes time slot, I was very forgiving. We know this now more than ever as our visits with physicians are truncated and compartmentalized largely due to insurance company reimbursements. Very sad, but true and getting truer with each day.
Our medical system is broken. It is not health care, it is disease care. It is the model. So in that way, perhaps the system is not broken. This is what the system has to offer. We go to the doctor when we are sick and broken, and they get 15 minutes with us because that is what is billable.
But I digress….
Back to the story!
My experience with my thyroid happened pretty early in my adulting life. However, it taught me so much about advocating for myself, and then and as I had children, advocating for my children. It takes a lot more effort, but in the long run, it has always served me well. I am pretty sure the physicians I have had over the years have felt I was a pain in the rear. Most have not argued with me when I showed up with a reasonable, well-researched request. I love the physician who listens and works with me. Most are kind and respectful and are very good at what they do. They do not need to agree with me, but they do need to respect my perspective and be supportive.
Ed and I have some absolute favorites locally and we will never hesitate to share those with our patients. Not gonna lie, most of them are from a time when they could stop and talk to the patient and really get to know them, their family, and at least a few of the nuances in their life. They are harder to find, but remember this, if you find a doctor that is really and truly interested in YOU they will most likely work with you for almost any request and do what they can to help and support you.
Seek and search these artists out. Ask your friends for doctor recommendations. Seek out people who have perhaps had some health challenges. They will know! Then listen to their stories. There is such wisdom in others’ experiences. I don’t care if a doctor is fresh out of school or beyond the ages of retirement, if they listen to me, support me, and help me I will be loyal and tell the world about them. I encourage you to do the same.
That goes for anyone who has gifted you with their art, their expertise, their care and concern, their skill, and their gift of service. Be loyal to them and keep them on your team and in your tribe! We all need our people. If you don’t have a team, start building one.
3 children and 30 years later my health and well being, and that of my family are still of utmost importance to me.
Risk factors for bone loss and osteoporosis
What does all of this have to do with my DEXA you ask?
Well, thyroid disease just happens to be one of the risk factors for premature bone loss. At 54 without a risk factor and without my husband called Ed, I would probably not have sought a DEXA and you can be absolutely sure that my primary care doctor did not mention this in any visit I have ever had with her.
BUT, my naturopath, who has now been managing my thyroid and my hormones in general, did. Get some good folks on your team, my people! I implore you! Find the practitioner that is at least keeping up with your health if not a step or two ahead.
When I first request a DEXA from my primary doctor’s office the receptionist cautioned me that I would most likely have to pay out of pocket for it because they usually don’t refer women and insurance companies typically will not authorize it until women are 65 or older and men in their 70’s.
This is where I really want you to start paying attention like you would if you were reading a blog about making sourdough bread. Pay attention to the detail. Not nearly as many as making sourdough bread, but the details are important!
If you are 65 you will likely not run into any friction in asking for a DEXA referral from your physician. But you might need to ask for it. Unless you have fallen and fractured a bone they may not be paying attention, they may not make the recommendation. You will need to ask for it in this case.
If you are not yet 65, you will have to work a bit harder.
Know your risk factor when you approach your physician and ask them for a referral. If you have been through menopause, this is a good diagnosis to use. You can even suggest this to your doctor if they seem resistant or flummoxed about this process for you. Risk factors include a family history of osteoporosis, fracturing a bone from standing height, significant loss of height, history of corticosteroid use, gastrointestinal issues, eating disorders, alcohol abuse, smoking, and slight body frame are just a few of the risk factors.
When I was talking with my physician’s office all they needed to know was that I was at high risk due to my thyroid disease. If you have thyroid disease ask them to use that diagnosis and note how long you have been on medication. My primary doctor used Thyroid disease and then sent me to get a DEXA. I chose not to get the DEXA done there simply due to the inadequacy of how the imaging office was handling the referral and how long I was having to wait.
Meanwhile, my naturopath asked if I have ever had a DEXA and I said no but I have been trying to get one. She put the diagnosis of menopause on the referral for me and sent it over to the imaging center that day. I called, scheduled, and had my DEXA within 1.5 weeks.
So far the important things
- Have a supportive physician and if you don’t, go find one first because this is just one of many examples of when you will need one.
- Know your risk factor/s.
- Be prepared with a diagnosis based on your risk factor/s.
- Be prepared to kindly advocate for yourself.
Once I got to the imaging center it was extremely easy. You answer a few questions and lay down on a table that looks like this. The scanner as seen in the image glides up and down your body. Switch sides, same thing, and you are done.
For all the friction and time it takes to get the dang thing done, the ACTUAL procedure is fast. In fact, I had just done a hike and I wanted to just lay there a bit longer and relax.
The DEXA is low risk and high reward. There is very low risk as it is about as much exposure as a simple X-ray. The reward is knowledge, and knowledge is power when it comes to almost everything with healthcare no exception.
For 2022 the second quarter of the year at Livewell50 we have dedicated it to Bone Health. We will launch into our May challenge starting now. Each week in May we will give you a challenge to up your bone health game. We have dedicated the first week to DEXA Discovery so head over to our LW50 Facebook group to participate. It will be fun and insightful.
In June for LW50 members our Deep Dive will be about interpreting your DEXA results. We will start with mine and then move on to anyone who shows up live with their DEXA. From there we can interpret the result. Then get you started on a plan for maintaining or increasing your bone health.
Members of the Livewell50.com membership site stay tuned for the date and time of The DEXA Deep Dive. We will be doing it through zoom. Get your DEXA done between now and June so that we can take a look at it and support you.
Not a member of Live Well 50 yet? Consider becoming a member and joining us this month and take advantage of the Deep Dive and all the content on the membership site. We do a Deep Dive every quarter and the next one will be in September.
What to do next
Your 3-step plan for improving your health, loving your life again, and taking charge of your health!
- Schedule your next Physical Therapy visit with Bellingham’s premier Manual Therapy clinic, Integrative Physical Therapy today!
- Join our Facebook group for healthy aging tips, motivation, and a great online community
- Are you over 50 and ready to Love Your Life Again? Let’s do this | Live Well 50
Any questions? We have answers!
Cheers,
Elizabeth
