Pictures from September 2012 (too many)

We dropped the dog off at a kennel.  These were the conditions.  There are a few more dogs you can't see.  The room wasn't much bigger than what you can see in this picture.  Luckily, she only stayed a few hours.

Miami, FL

I need a turban.  Miami, FL

In Idaho, I was always taking pictures of abandoned snowmobiles.  In  Florida, abandoned jet ski (or something).

Dolphins humping

My Winn Dixie grocery store does not like kids.

I'm told this flower is called clitora.  Even if it's not, it's good for a little giggle.

Doesn't matter where I go, I get filthy

I will try this 4WD road on a different day.

This is what's in the puddles above

Pretty

This just cracked me up

A bug loves me, it carved this into some food I was cooking

Bob cat that lives in the bushes behind my house

The beautiful, local pool.  A source of peace.

We have lots of these ugly ducks around.  The babies all looked very different and were cute.

Impressive!  Palm trees being moved.  The guy walking behind was holding a rope and stabilizing the trees 

A visitor

August 2012 pictures

I didn't feel like running outside in August so there are not many pictures.  I have TONS of pictures of boobs and bad form from the gym but I am saving them all for another post.  NOTE:  If your boobies are going to hang out at the gym, I will take pictures of them.  Keep that in mind as you're getting the girls all lined up and  pushed out.  

Yes, I am a horrible person.  Maybe I am a good person.  Take a little lookie see here.  What do you see?  Do you find it attractive?  Am I just getting old?  This looks like an awful lot of fat squeezed up and out of pants that are too tight.  I'm trying to change the world, don't wear your pants under these circumstances.

Nancy came and visited me.  She took me to get a pedicure.  They gave us wine!  Fun!!

"Chiz"

Nancy and I went to Audubon-Pennington Park and walked around with Esther who told us lots and lots and lots of stuff

Nancy and I at the Tiki Bar at 2 in the afternoon in Punta Gorda

Pretty

Pretty again

Rant: Why is adrenal insufficiency mismanaged?

It's been so long since I've ranted.  Hold on to your hat!

So many people, especially the undiagnosed and newly diagnosed ask me, "Why didn't my doctor know what tests to do?  Why didn't he* tell me X, Y or Z?"

It's incredibly simple.  Your doctor doesn't know.  Your doc doesn't know the tests, how to interpret them, what other hormones to check for or how to instruct you to take your meds.**

How could your know anything about AI?  The incidence of AI in the general population is 40-60 cases of AI per million.  That's not many people.  The chances of your doctor having any experience with AI are very small.  More than likely, your doctor might have had someone who became secondary because of steroid treatment for a different disorder (like lupus) or because of an organ transplant.  Let's give your doctor the benefit of the doubt, he's got FIVE AI patients out of hundreds of other patients.  FIVE.  How much time can he spend researching and reading about AI?  Why would he?  He learned a little blurb in med school, give the patient steroids once or twice a day, they will have a poor quality of life but they will live.  If your quality of life is slightly above poor, he's not going to try to do more.  You are ahead of the curve why should your doctor do more?!!  Numerous studies say that people with AI have poor quality of life.  If your quality of life is poor, well, that's what happens with AI and it's acceptable.  Why do more?

How to avoid being a mismanaged AI patient.

This is going to be so boring for some of you.  Sorry.

• Learn about AI Adrenal Insufficiency & Addison's Owner's Manual
• Insist on an injection kit.  If your doctor won't give it to you, he wants you dead and you need to find a different doctor.  IN MOST STATES, EMTS AND PARAMEDICS ARE NOT PERMITTED TO CARRY OR INJECT THE LIFE SAVING SOLU-CORTEF.  
• Adrenal crisis in treated Addison's disease: a predictable but under-managed event.  CONCLUSION:  The endocrinologist has a responsibility to ensure that Addison's patients have adequate access to life-saving emergency injection materials and repeated, practical training sessions in how to use them, while the general practitioner plays a vital role as in arranging prompt emergency admissions.
• Join a forum that fits your needs and provides support.
• Replace all missing hormones in the appropriate order.
• Test and retest for comorbid conditions.
• Lose weight if you are fat and stop drinking all types of soda (OK, that's my personal bias)
• Get 30 minutes of exercise every day of the week to maintain some semblance of health, get more exercise if you want to be healthier.

So you've done everything above.

Now you know your shit.  You've got the AI info down, you know what your hormone status is.  You need to educate your doctor.  Be kind, be thoughtful, hand him info to put in your "file".  If you take the nice approach and this dude is totally unwilling to discuss the benefits of physiologic dosing, DHEA, or the basics that will keep you from keeling over, stop right there and either fire him or back out of the room.  Get another doctor who treats you like a living, breathing, intelligent human.

Next!

• Let's say you've found a good doctor.  
• Make sure you get copies of ALL of your radiology reports and blood work.  Put them in a neat binder by date.
• Read about AI, read, read.  Use reputable sources (medscape, pubmed, scholar.google.com).  Share the info on a forum. LEARN.  

IF YOU ARE THE EXPERT, YOU WILL SUCCEED!

*I'm not sexist.  Just using one pronoun instead of he/she.
**I'm SURE someone out there has a super fab doc that knows EVERYTHING and has done EVERYTHING right.  Please post his name, address and phone number in the comments section.  The very competent AI docs are few and far between.  If you're not comfortable posting publicly, post on my forum at www.addisonssupport.com or addisonssupport@googlegroups.com.