In the door I explained to him my issues and handed him my labs.  He reviewed them and then asked why I was still alive?  After much discussion about how the different medications work and are made, I settled on trying Armour Thyroid from Forest Labs.  Made from organically grown pigs, I figured it was as close to natural as I could get.  We started out slow – but after the first dose, I could tell a difference.   Within six weeks I was stable on 2 grains a day and have been on that does since that point in time.

Recently a new product has hit the market from Acella Pharmaceuticals in Georgia.  My pharmacy tried to switch me to their version of naturally dissected thyroid, NP Thyroid, because of the cost – even though my doctor wrote the script “as written“.  I always check my medications upon pick-up, never leaving the pharmacy until I know they are right.  When they tried to switch me, I immediately told them no – fix it.  They did.  BUT they for some reason did not fix it in the computer system, so when I went to get my refill today – yup, it was NP Thyroid.

Now I understand saving on costs of medications and since Tri-Care is the one paying for my medications, they want to force a different product on me because its cheaper – without even knowing if it works! [Obamacare at its finest]  Anyone that has dealt with government programs for your medical care knows the last thing they worry about is the patient – its all about the bottom line.

Below is the break down of the two products.  Yes, they both appear to have the same levels of T4 and T3, but …  Are they made the same way?  Are the pigs organically grown or in a slop house – like a puppy mill?  These are questions thyroid patients have (especially those of us that need total replacement) because this medication keeps us alive and functioning. 

Will I try the new medication?  Not sure yet.  I don’t have a problem with using a cheaper medication if it provides the same support as the more expensive one.  But this is a new company, yet untested, and according to the DailyMed website, its marketing status is “unapproved drug other.” Hello? Unapproved?  Yeah, and Tri-Obama-care wants me to put my life in that company’s hands?

So here is the break-down of the two drugs.  You decide.

NP THYROID 60 (levothyroxine, liothyronine) tablet
NP Thyroid (thyroid tablets, USP) for oral use is a natural preparation derived from porcine thyroid glands. They contain both tetraiodothyronine sodium (T4 levothyroxine) and triiodothyronine sodium (T3 liothyronine) providing 38 mcg levothyroxine (T4) and 9 mcg liothyronine (T3) per grain of thyroid (or per 65 mg of the labeled amount of thyroid). The inactive ingredients are calcium stearate, dextrose monohydrate, maltodextrin and mineral oil.

ARMOUR THYROID (thyroid) tablet
Armour® Thyroid (thyroid tablets, USP) for oral use is a natural preparation derived from porcine thyroid glands and has a strong, characteristic odor. (T3 liothyronine is approximately four times as potent as T4 levothyroxine on a microgram for microgram basis.) They provide 38 mcg levothyroxine (T4) and 9 mcg liothyronine (T3) per grain of thyroid. The inactive ingredients are calcium stearate, dextrose, microcrystalline cellulose, sodium starch glycolate and opadry white.

Right off the bat, the levels of T4 and T3 are the same.  The main differences are the fillers.  Armour has a lot more and some people may have issues with them.   This is something each person has to decide upon. 

Again – I am not sure about switching yet.  I will talk to my doctor and pharamacist and check out each of the fillers.  Now Armour has dextrose and microcrystalline cellulose – both sugar substances.  I have expirmented and determined Armour does not spike my glucose levels.  But sugar is sugar for a diabetic, no matter the form of it. I have linked to various parts of the internet that describes what each inactive ingredient is (if you consider sugar inactive that is).

You decide for yourself.  I may try it yet after this research alone, but until today, was just simply afraid to change out to a medication I wasn’t sure of and with a company barely out of infancy.  This is MY health I’m dealing with. 

Cost be damned.

There is an Armour Thyroid Shortage.

Its my own fault. I haven’t been on thyroid.about.com in years. Not since I stabilized on Armour Thyroid in 2001 and my life went back to as normal as it could be on that medication. Then my diabetes hit and I focused on that. (In that area too, I haven’t been to diabetes.about.com either in a long time).

So when I went to renew my script in mid-December – I was met with silence from Walgreen’s. Yes, my doctor’s office has been known to miss a renewal script faxed to them from the pharmacy, so I called them first thing that Monday morning. I needed it filled that day. I called the pharmacy after lunch when I still hadn’t been notified it was filled and was told the medication refill was for 180 tablets and they only had 150, and besides, “Armour has been discontinued.” I yelled at the gal that it wasn’t!!!! She put me on hold and came back to inform me she was wrong, it wasn’t discontinued, it was out of stock – country wide. I asked them to fill it with what they had left, I’d talk to me doctor at my next appointment.

When I went to get the script at lunch – I had one pill left at home. When I got there it wasn’t Armour Thyroid, but a generic brand for T-4 only. Hello people WTF? The pharmacist said the doctor’s office called back and changed it to what they filled it with. I told the pharmacists there was no way – because I have to have both T4 & T3 – the meds they filled it with wouldn’t cut it. Since it was lunch time, I had to wait until 2 pm to talk to my doctor.

I opted for a face-to-face with the office nurse. No, they didn’t call and change it and she called the pharmacy back right then and there. The pharmacists informed her he had put the remaining Armour on hold for me and he was going to fill it right then with her phone call. We are still not sure who changed it, but I have my suspicions it was Tricare. (Gotta love government health insurance making medical decisions for you, but we will all know about that soon enough).

While I was sitting in the office fuming about the pharmacy/doctor situation, I logged into thyroid.about.com and learned that Armour Thyroid, along with a lot of other natural thyroid medications were running low all across the country. It appears (from what I’ve read), when Forest Labs reformulated Armour a while back, a lot of patients reacted badly. I didn’t except for the nasty taste of it now. When these patients started having problems, their doctors put them on other natural thyroid meds and then the shortage started rolling. One natural medication after another started falling short and Forest Labs, for some unknown reason, had slowed down the production of their product. I don’t know if they ran out of stock of the natural product (the pig’s thyroid) or if their distributor had taken a hit by a radical muslim group trying to kill off all pigs; or PETA wanting to save them all, but the product was running low on all sizes.

Yes, there options available to me – synthetic T4 & T3 – but there are also compounding pharmacies (one close by me thankfully), that can make me a mix with natural thyroid medications.

Lesson learned. I need to check into both support boards more regular and I would have been better prepared for what happened. Fortunately, it all worked out this time. But in three months, will I be scrambling to refill my script? Only time will tell.

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A couple days after the refill, I opened the new bottle, popped the little pill in my mouth, bit down and ran for the trash!  OMG — what had I put in my mouth, mud?

I turned on the lights, drug out the bottle and started inspecting the pills.  First thing I noticed was the normal Armour “pork” smell was gone.  But the markings were right, the bottle label was right, but this crap wasn’t right.

I took another and swallowed – then hit the Internet, specifically Thyroid.About.com.

There I found my answer…

Armour Thyroid’s Spring 2009 Reformulation Causing Problems

During the Spring of 2009, the natural desiccated thyroid drug, Armour Thyroid, apparently underwent a reformulation of fillers, including a decrease in the amount of dextrose, increase in cellulose, and the addition of cornstarch to the tablets.

…and from further down in the article ….

Some patients who had been using the medication sublingually (allowing it to dissolve under the tongue) have said that it no longer dissolves easily, and the lack of sweetness has made the taste intolerable. Some of those who continue to use the medication sublingually have said that it does not appear to be working as well as before.

That’s why my pills tasted like mud!

So if you have had the same problem and are also experiences TSH or hypo symptoms again, get the to your doctor!

I fortunately had been on a reduced dose, without a reduction in the pill strength prescribed, so after about four days I upped my dose back to 2 grains daily and the symptoms have subsided.

Yes people – the medication companies give a tinkers’ damn how you react to their shenanigans with the formulation of the medications you take.

You think its bad now?

Wait until Obamacare gets a hold of it! Mud will have tasted sweet then.

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My Doctor’s Notes on my BB show my A1C at 6.3 in April and then 6.8 my last visit this month. 

My weight stayed a nice plump 152 the whole year.  {What’s up with that?}

My blood pressure was up most of the year as I dealt with allergy issues to medication.

As for my cholesterol … haa haa haa … it just kept going up and up and the statins kept me sick. 

My TSH has gotten lower than the .20 that I feel best at, but I don’t feel bad.  We are reducing me to a grain and a half of Armour a day and see if that helps.  Could be another reason I was getting sick so much last year too.

I believe part of the issue with the higher A1C is being overweight.  Okay, I can hear some of you say 152 isn’t bad, well, not if you’re 6’1″.  My BMI puts me in the overweight category.

Other than finally getting my butt back to working out regular, what else can I do? 

Give up fried chicken? {fail} 
Only eat salads and green beans? {fail} 
Get on more medications? {fail}

I suppose a bit of all three would help … yes … but the last thing I want is more medication. So, I don’t have a game plan other than getting to the gym and increasing my walking distance for now.

I’m not making New Year resolutions, please … if you are resolved to do something, you don’t need New Year to implement them. No, I’m glad for where I am, know I can do better, and will put down easily obtainable goals so I don’t get burnt out.

First one I have is get to two miles on the treadmill under 30 minutes.

Make small plans for your health this year, or have you already started that direction?

Susan had chosen me because she had researched my education, read a paper I had written, determined my university affiliation and knew where I lived. It was a little too much — as if she knew how stinky and snorey I was last Sunday morning. Yes, she was simply researching important aspects of her own health care. Yes, who your surgeon is certainly affects what your surgeon does. But I was unnerved by how she brandished her information, too personal and just too rude on our first meeting.

Every doctor knows patients like this. They’re called “brainsuckers.” By the time they come in, they’ve visited many other docs already — somehow unable to stick with any of them. They have many complaints, which rarely translate to hard findings on any objective tests. They talk a lot. I often wonder, while waiting for them to pause, if there are patients like this in poor, war-torn countries where the need for doctors is more dire.

From his attitude, I get “Poor ‘ittle doctor got his feelings hurt because Susan was trying to manage her medical care!! How dare she ask questions, informed if she was from WebMD let’s say.   But I could be wrong.  Maybe he was just pissed off at her approach.    

She had brought her three-year-old to my office, but was ignoring the little monster as he ripped up magazines, threw fish crackers and Cheerios, and stomped them into my rug. I tried to ignore him too, which was hard as he dribbled chocolate milk from his sippy cup all over my upholstered chairs. Eventually his screeching made conversation impossible.

“This is not an acceptable form of behavior, not acceptable at all,” was Susan’s excruciatingly well-enunciated and perfunctory response to Junior’s screaming. The toddler’s defiant delight signaled that he understood just enough to ignore her back. Meanwhile, Mom launched into me with a barrage of excruciatingly well-informed questions. I soon felt like throwing Cheerios at her too.

[snip]

I knew full well what was wrong with this woman, and I could treat her, probably as well as anyone. But treating her condition, which was chronic patellofemoral pain, would test the mettle of patient and surgeon.

[snip]

I like to be straight — “It gets worse before it gets better” is what I tell them. Susan’s style, her history and, somehow, most telling, the way she treated her son said she was not going to make it through this. Not with me, anyway.

My question after reading this article is:  Just how did Susan approach this doctor with the information she had?  Was she rude?  Did she argue with him?  Did she say it was her way or the highway?   Why did she bring an undisciplined child to a doctor’s appointment and allow said child to be as destructive as he was?  Clearly, anyone in any profession is going to a tad bit upset with someone destroying their property.  Does he really just hate all his patients that Google their condition, or just Susan’s approach with said information and ill-mannered toddler?

When I was diagnosed with Graves Disease and opted for the treatment I did and then became Hypothyroid, I hit the internet for all the information I could find.  That is where I found thyroid.about.com and lived on that website, talking to other people, and absorbing as much information as I could.  When I approached my doctor with my documented symptons, my own paid for thyroid pane and a request for a different medication to see how it would work, I was tried like an office chair, patted on the head and told it was all in my head.  Because I was a Googler, I punted his ass to the curb and found another doctor, who I approached with the same information.  He agreed to let me try the other medication and I have been on it since.   He was not offended by my information and answered all my questions.

I did the same thing when my current doctor diagnosed me with Type 2 Diabetes.   I talked to others I wouldn’t have had an opportunity to do if not via the internet.  With information from others’ experiences and product websites, I approached my doctor with another treatment option.  He agreed.   And then tells me he likes that I’m organized when he gets in the office, knows what I need, and asks informed questions.

I think Dr. Haig had a major issue not so much with Susan’s information she Googled, but her approach to him with said information.

Oh, by the way, us Patient Googlers, we care not about your bathing or sleeping habits Dr. Haig – we want to know you are giving us the best care available and if you can’t, be man enough to send us to someone who can.

Additional Reading here and here at Thyroid.About.com

You all know I’m a diabetic if you’ve been around here for any length of time. Some of you may also be aware of the fact I’m hypothyroid due to RAI for Graves Disease. Didn’t? I’m not hurt. I barely talk about that condition as it has been under control for going on 4 years now. Wow — 4 years, amazing.

Anyway, the last 3 days I have been told by 2 different people they have been placed on metiformin for blood glucose control. One is a blogging acquaintance and another a co-worker. The post is mainly because of what went on between the co-worker and I.

She has Graves Disease also, but unfortunately is being treated by a ego maniac who specializes more in the diabetes part of the endocrine system than the thyroid. He poo pooed me when I told him I was taking Armour Thyroid, telling me that he’d only prescribed it when people where having “emotional” problems. Gag.

One of the things I learned first when I was treated and went hypo was numbers, lab numbers to be exact, count. As do numbers as a diabetic. But the numbers for a thyroid patient can vary from one to another in how we feel. I “feel” good with a TSH level of .5 to 2 and have stayed within that range since stabilizing on Armour 4 years ago. As a diabetic, the numbers I take every day tell me what I can eat, how much, and if I should go run around the back yard with Bubba. I can tell you right now without looking my last BG reading in the doctor’s office in October ’04 was 69, and I had to take a glucose tablet. My last TSH reading was 1.75 a year ago.

Here is what is sticking in my craw. When I asked the co-worker how her TSH levels where – she didn’t know. Then she told me she was placed on metiformin, so I asked her what her Fasting BG was and she didn’t know.

How in the HELL do you go around with a medical condition like we have and not know the most important aspects of what our lab results are?! When she said I don’t know, I almost lost my mind; but I smiled and told her she was eating a good diabetic meal and escaped out of the break room back to my desk — where I proceed to want to pound my head against it.

People, you may think I’m whacked, but if a doctor was prescribing medication based on lab results, you should know what they are, get a copy, and understand why he may be increasing or decreasing, or adding, medication.

Do I care more? Maybe. But then again, I was taught by the best bunch of thyroid patients on the planet at thyroid.about.com that lab results vary, doctors read them differently, and I need to refuse to be a lab rat and take control of my health.

Sure, I’m guilty of not listening to doctors. Maybe back in September ’03 when my PA at the time told me my Fasting BG was 97 and I needed to loose weight I had listened, I wouldn’t have gotten diabetes. But that is here nor there. I screwed the pooch on that one. But I have also learned that a lot of people with thyroid or diabetes conditions get the other having one, I figured it was going to happen anyway.

But I sat there in the break room the next day listening to this same co-worker talking about how she had to loose weight, while at the same time she’s chugging down her second Dr. Pepper of the day. Now, I have drank diet sodas for as long as I can remember, so that wasn’t a problem once I was diagnosed a diabetic. But her doctor told her to loose weight and watch her sugar intake, and here she is dumping straight sugar into her system. And I won’t go into the fact she was stuffing her face with baked Cheetos.

People — when your doctor tells you to loose weight and back off the sugar, and then gives you medication the majority of diabetics in this country have to take, it should be a wake up call.

And know your medical history and labs. Get copies of everything, especially of your lab results, from the doctor. Mine always gives me a copy without asking.

Know where you are — be aware — listen. Do.

I have a condition called “Hypothyroidism” but mine is due to the treatment I received for “Graves Disease“. I started out being treated with synthetic T4, which is simply put, taking one thyroid hormone to replace a gland that produced 4 different types. After loosing a year of my life because I was so hypo, I finally found a great doctor in Austin, Texas who put me on Armour Thyroid and it turned my life around. I have been taking 2 Grains a day since and my TSH, Free T3 and T4 have been right in line.

Over 27 million Americans have overactive or underactive thyroid glands, but more than half remain undiagnosed. To recognize Thyroid Awareness Month 2006 in January, the American Association of Clinical Endocrinologists (AACE), in cooperation with the American Thyroid Association (ATA), will highlight the importance of the TSH (thyroid-stimulating hormone) and Free T4 tests, simple blood tests that measures the appropriateness of the thyroid gland’s hormone production. It is very important for patients with thyroid imbalance to know their TSH and Free T4 numbers. The optimal TSH range is 0.3 to 3.0 mIU/L. Patients should talk to their doctors about their Free T4 numbers since laboratory ranges can vary.

I have listed some of my favorite places on the internet here for thyroid disease information. But if you are going to start somewhere, start at the Thyroid Support Area on About.com. Because of the wonderful work Mary Shomon has done, I was able to talk to other people with my condition and find out that maybe T4 alone wasn’t the best treatment for me.

One piece of advice: A lot of doctors simply treat by lab results and refuse to listen to symptoms you may have through talking to you. If you find you have a doctor that won’t listen to your symptoms, puts them off to “female issues”, or tells you that he only uses one medication — don’t walk, run out of there as fast as you can. Find another doctor. That’s what I had to do. I was dying before I finally realized my life was turning into a spiraling pit of hell. I fired him, went out of my pocket to pay for it, but I found a doctor that “listened” … my life changed that day for the better.

YOU are the one in control of YOUR health.

TSH is the thyroid stimulating hormone that is measured by your doctor to determine if you are having problems or not. For years the range of TSH was .5 to 5.0. Anything below that you were considered Hyperthyroid anything above that range you were considered to be Hypothyroid. But for years now, a growing group of doctors in the community have been coming to the conclusion these ranges need to be adjusted.

Currently, my TSH stays between .5 and 1 – and this is where I feel great at! If I start climbing up around 2 I feel like laying down and dying. Each person is different, but if the end range is too high, then people who are having problems with a TSH of 3 aren’t getting treated.

Read her whole article. I saved the PDF file so I can give to my doctor.

BALTIMORE — People who have an overactive or underactive thyroid can have significant problems.

Yup — been there, done that … for how many years I don’t know actually.

Classic symptoms of Graves’ disease include unexplained weight loss, fatigue, a racing heart or heart palpitations, feeling short of breath, skin changes, hair loss, eye changes and depression.

1 – Unexplained Weight Loss – No
2 – Fatigue – Yes
3 – Racing Heart – Yes, spent the night in the ER one time thinking I was having a heart attack. My thyroid wasn’t checked, but they said my heart was okay. Go figure – it was a military hospital.
4. Heart Palpitations – See #3.
5. Feeling short of breath – Yes.
6. Skin changes – No.
7. Hair loss – No.
8. Eye changes – Yes
9. Depression – Yes, mainly due to #2, #3 and #4. I couldn’t sleep, therefore I was fatigued, and then came depression due to lack of sleep.

The lady in the linked story is having Radioactive Iodine Treatments to get rid of her thyroid. That’s what I did. The doctors told me that my condition was so bad that I was looking at a massive heart attack within 6 months.

Two weeks after treatment I noticed a “marked” difference in how I felt. I was sleeping, therefore, I wasn’t as fatigued and the depression was lifting.

The only think I would warn the lady in the story about would be having an idiot doctor that will fail to treat her properly afterward. But that’s for another post.

If you think you have a thyroid problem, go here @ About.com.

She starts out talking about needing to speak to her physician about a prescription and having to wait on hold and finally asking the nurse if the doctor could be e-mailed.

There was a pause. “The doctor doesn’t have an e-mail address.”

No e-mail address? My doctor practices in the shadow of Silicon Valley.

Now about here I was like “HEY! What a great idea. Why can’t I e-mail my doctor?” I am on several medications at present for my diabetes and hypothyroidism, along with pain killers for my nasty gall bladder. There was a time a few months ago when I needed the pain killers refilled. After confusion with the answering service and the nurse I ended up getting ALL my meds refilled :? If could have e-mailed my doctor, or his nurse, the confusion wouldn’t have happened on their end.

The article goes on:

In a 2002 survey by Harris Interactive, 90% of adults with Internet access indicated they want to communicate with their physicians via e-mail. But a survey last year by Manhattan Research, a marketing information and services firm, found that less than 20% of physicians communicate via e-mail.

The top reason doctors give for withholding their e-mail address is the fear that it will lead to “too much access” and they will be barraged with messages about “trivial matters,” according to a Journal of Family Practice article in 2001.

Well heck, we can understand that. And can you imagine the junk they’d get? My doctor uses the latest equipment to handle patient records. Even though he still has a paper file on me, once we’re done with my appointment, he goes to a hand held computer and updates my electronic record.

The article has several points to make about Privacy, Liability, and Reimbursement, but a study showed the e-mail between a doctor and patient can work.

Last month, the journal Pediatrics confirmed what disgruntled patients have known for a long time: E-mail can save the doctor’s time, too. Researchers evaluated e-mails sent between two pediatricians and 54 parents of patients over six weeks. They found that of the 81 e-mails generated by parents, 70 required just one e-mail response. Most focused mostly on medical questions. And far from being deluged, the physicians said they spent an average 30 minutes a day responding to e-mails. Parents, as a result, reported fewer phone calls and appointments.

In this century, e-mailing your doctor’s office should be an option available to a patient. We could get confirmation e-mails on appointments, ask a simple question on a medication script, or even ask if you’re suppose to eat before a visit or not. Maybe I’ll mention it next time I’m in the office.