Hospitals, Health, and Healing – My New Life!

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If you’ve read my previous posts, you know that the past few weeks have been a wild ride, health-wise. However, they have been a blessing in disguise because I have truly redefined what ‘living’ means to me.

Pituitary Update

As some of you know from my previous post, I was working with doctors to determine whether I have a pituitary dysfunction that is causing my amenorrhea. The last few weeks involved an MRI scare – they found a little formation on my pituitary gland, the exact classification of which was TBD – followed by several blood and urine tests (delightful, I know).

The doctors were trying to determine whether I had a pituitary adenoma – a collection of cells that form a benign (non-cancerous) tumor, which often secretes some sort of hormone – or a Rathke’s Cleft cyst. A Rathke’s Cleft cyst is also a benign condition, but unlike a pituitary adenoma it does NOT secrete anything – it is likely something I was born with and is completely harmless, unless it grows in size (and affects my vision by putting pressure on the optic nerve), which is extremely unlikely. According to my doctor 1 in 5 people have this condition and it goes un-diagnosed; people with the cyst live completely normal and healthy lives, and it is often only discovered in an autopsy.

Now let’s come back to pituitary adenoma’s and how blood / urine tests are used to diagnose an adenoma vs. a cyst. There are 4 types of pituitary adenomas:

1. Prolactinoma – secretes prolactin (hormone that produces breast milk)
2. Growth hormone-secreting (IGF) pituitary adenoma
3. Cushing’s Disease (ACTH-secreting pituitary adenoma) – ACTH produces cortisol (the stress hormone)
4. Thyrotropinoma (TSH-secreting pituitary adenoma) – TSH is a thyroid hormone

The Results 

AMAZING NEWS – turns out I don’t have a pituitary adenoma:

1. NOT a Prolactinoma – normal prolactin levels
2. NOT a Growth Hormone-Secreting pituitary adenoma – normal IGF levels
3. NOT Cushing’s Disease (non ACTH-secreting pituitary adenoma) – normal ACTH and urine cortisol levels
4. NOT a Thyrotropinoma (TSH-secreting pituitary adenoma) – normal TSH

So the diagnosis is a cyst – it is benign and, thank GOD, will not affect me at all! I feel so INCREDIBLY blessed and grateful!

AND EVEN MORE GOOD NEWS – my estrogen and FSH levels are up, which means that I am making significant progress on the amenorrhea front too, and hope to get my period back soon!

My Life Forward

I have now learned to take a step back and put things into perspective. About a week ago, I weighed myself after a VERY long family vacation and no exercise. I was still eating between 1800 – 2000 calories per day, but had more variations – for example, I had one day of 2600, and another of 1450. I was pretty happy, because I take that this is what normal eaters do – intuitive eating with the occasional indulgence and no guilt.

However, the guilt came – I weighed myself and the scale showed 131.5 (I am about 5’6 and 3/4). Now granted (and I know this is TMI), but I have been a tad bit constipated, and fly weekly for work, so this number could have reflected water retention, but obviously I was upset. I had been maintaining at 127 for a while, and then saw a jump to 129 prior to my vacation, which I had made peace with. I did not take the 131.5 well!

That’s when I took a step back and replayed the past few weeks through my head – I had just experienced the scariest, potentially life-threatening, medical finding of my life. I had to be grateful for my normal pituitary results, and for the fact that I had made progress on the female hormone front. Sure, I’ve gained weight, but y’know what, I am NOT fat. Some people’s bodies just CANNOT handle low weights – we’re all so, so different! So I am happy; happy, grateful, and rejuvenated with positivism.

Lessons on Eating

I think I can finally say *knock on wood* that I am transitioning to becoming a ‘normal’ eater – I have days where I eat close to 2200, and others where I eat about 1600. I am LISTENING to my body and eating intuitively, without depriving myself. I am conscious of satisfying cravings when they hit, and luckily I never crave junk – my excess calories are usually from a Kit’s Organic Bar, 85% raw cacao dark chocolate, Greek yogurt, or nuts!

Here’s to being grateful for all that you have – you only have one body, so please love and respect it!

Happy healing!

Girl Guilt-Free

The Scariest Experience of my Life

A week ago, I experienced the most intense emotional roller coaster of my life.

Flashback 2 weeks – 

I scheduled an MRI – this was a precautionary test that my doctor had requested, just to make sure that my amenorrhea is not a result of any pituitary disfunction. My doctor was almost certain that my amenorrhea was a result of female athletes triad – restrictive eating and over-exercise – but she wanted to be safe.

I was not worried about the MRI – my family was in town, and it was just precautionary. I went into the lab center and, to my surprise, was told that they would be injecting a dye into me halfway through the MRI. Immediately I began to panic – no one had warned me of this!

Now, I do not get claustrophobic, but let me tell you that the MRI almost pushed me over edge – you’re basically in a confined space, with a weird plastic contraption and white sheet over your face (to hold your head still) for 20 minutes.

Anyway, the dye injection turned out to be painless (though it made me a tiny bit nauseous), and I walked out of the MRI center as my usual self.

Flash forward 1 week – 

My family had just flown out (they live overseas), and I received news from my doctor (via email) regarding my MRI results – turns out she had tried to call me, but I was at work and had missed a call.

THEY FOUND SOMETHING.

My doctor’s email said that the MRI indicated a very small Rathke’s Cleft Cyst. I was absolutely devastated, and spent the rest of the night oscillating between fear, sadness, despair, and anger.

I immediately scheduled follow-up visits and blood tests with my doctor, and scheduled an appointment with my endocrinologist. I was FREAKING out at the thought of a brain tumor – What did this mean for me? Would I be able to live a normal life? Would I need surgery? Would I be able to have children?

The Endocrinologist – 

Long story short, I went in to see the endocrinologist who put me at ease – turns out 20% of the population has some sort of pituitary growth / tumor / cyst (whatever you want to call it), and most people spend their entire lives without even knowing and without any health complications as a result of it. However, one thing did confuse me – the endocrinologist diagnosed the MRI reading as a Pituitary Adenoma.

Pituitary Adenoma vs. Rathke’s Cleft Cyst – 

Now, to my understanding (the doctors kind of confused me), a rathke’s cleft cyst is usually a liquid-filled, bubble (if you will), which is something that you are born with. It is harmless unless it expands and starts putting pressures on other structures in the brain, such as the optic chiasm, which can cause your peripheral vision to decrease. THANK THE LORD that in my case, the structure on my pituitary gland poses no threat.

By contrast; however, a pituitary adenoma is essentially a collection of cells. While both a pituitary adenoma and a cyst are benign (non-cancerous, and will not spread to the rest of the body), adenoma’s can sometimes secrete hormones. This prompted my endocrinologist to order some more blood tests in order to make sure that no extra hormones were being secreted.

Blood Test Results

Now, I am a results-oriented person, so my blood work speaks volumes. Two takeaways:

My estrogen levels are up to 19 (up from 14 last time) – this is a FABULOUS sign because this means my body is able to increase my levels on its own and that the pituitary adenoma / cyst is not causing my amenorrhea.

My cortisol levels (stress hormone) were super high (29 – normal range is 20-25 in the morning). While my doctor has ordered follow-up tests for this, she thinks the emotional roller coaster that I went through after learning about my MRI results is was prompted this spike in stress levels.

What I have learned –

My biggest takeaway from this crazy experience (as cliche as it may sound) is that life is short! It is SO important to take the time to be grateful for everything that we have – otherwise you have to learn it the hard way, when something goes wrong. I am so, incredibly grateful to be (generally) healthy, have a strong support system of incredible family and friends, and to be able to share my learning with you all!

If any of you have any questions, are experiencing a similar situation, or just want to talk, then please do not hesitate to reach out to girlguiltfree@gmail.com!

Stay happy; stay healthy!

Lots of love,

Girl Guilt-Free

“Do Whatever Makes You Feel Good”

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Sometimes I catch myself feeling guilty about blogging – I should be using every free moment I have (when I am not working) to study for my GMAT, right? (Ah yes, forgot to throw in that little detail about myself, haha). But, you know what? To hell with saying “should” – it is not about what you “should do,” but what you “want” to do, and what makes you feel good.

Blogging is cathartic for me; blogging lifts a huge load off of my chest, and actually makes me feel as though I am making an impact in the community by spreading awareness and maybe helping someone else in the same situation. So that’s the though of the day folks – “do whatever makes you feel good,” and I firmly believe that you will see things fall in to place. 🙂

Stay happy, stay positive!

Happy healing,

Girl Guilt-Free

A Grain of Salt and Reading Between The Lines – My Blood Test Results

If you’ve had a chance to read my previous blog post, then you will remember that I had my second set of blood tests (as a follow-up for my Hypothalamic Amenorrhea)done last Friday (June 5th). The doctor was testing to see if my hormone levels, specifically estrogen, had increased as a result of changes to my diet and exercise routine.

I received an email from my Doctor this morning, and all it said was that my estrogen levels “are still low,” and that she would be requesting a bone density test (per my inquiry), and an MRI to check my pituitary function “to make sure there is no structural reason” why I am not getting my period.

My reaction to the news was as follows: worry; despair; sadness; crying; frustration, and eventually a “k sera sera” mentality that has left me feeling happy again.

A Grain of Salt

Perhaps this section could be more appropriately named as “finding the silver lining.” It is natural to assume the worst when a doctor wants to test for different types of diseases (my “pituitary tumor” alarm bells were ringing loud). Word of advice – DO NOT GOOGLE YOUR SYMPTOMS and let the results leave you distraught. Unfortunately, you will likely come away thinking that you have cancer, or another seriously, life-threatening condition. While, this is always a possibility, realize that your doctor may just be requesting tests as precautionary measures – requesting tests DOES NOT CONFIRM that you have a certain disease.

So, that’s how I overcame my absolute terror regarding the MRI request.

Reading Between The Lines

So my doctor told me that my “estrogen levels are still low;” however, I asked her to release the specific blood test results to me regardless. I then loaded the data in to Excel, and did my own analyses to find the following:

March June
Estradiol (this indicates my estrogen levels) <12 14
FSH 4.4 4.9
LH 0.2 0.8

Now, what the doctor failed to mention, was that there WAS AN INCREASE in my hormone levels, albeit relatively small. For those of you wondering what these numbers mean, here are some guidelines:

ESTRADIOL Reference Range (female):
Prepubertal:
Post-menopausal:
Follicular phase: 20-100 pg/mL
Mid-cycle: 80-400 pg/mL
Luteal phase: 30-220 pg/mL
FSH Reference Range:
Follicular phase: 2-8 mIU/mL 
Mid-cycle: 6-23 mIU/mL 
Luteal phase: 1-6 mIU/mL 
Post-menopausal: 21-106 mIU/mL 
Prepubertal Children: 1-6 mIU/mL 
Pregnant:
LH Reference Range: 
Adult Female: 
Follicular: 2-15 mIU/mL 
Mid-cycle: 10-91 mIU/mL 
Luteal: 1-15 mIU/mL 
Post-menopausal: 16-63 mIU/mL 
Prepubertal Children: 1-3 mIU/mL

Clearly, my increased caloric and fat intake, weight maintenance, and reduced exercise were working – YAY! The fact that my doctor had failed to mention this had sent me down a rabbit hole worries for no reason. Granted, is slow progress, but hey, it’s still progress.

Now, another thing that I found was that my white blood cell count had decreased slightly from my last blood test, as had my T3, which is a thyroid hormone. My doctor has not mentioned this either, so naturally I started panicking again. Naturally, Googling these symptoms freaked me out even more, so I paused and started to think about all of the dietary changes I had made in an effort to increase my estrogen.

Soy – BINGO! Through research, I had found that increasing soy intake can increase estrogen, so I went from drinking no soy milk, to drinking a soy latte every day. Remember what I had said about extremes and how maintenance and balance are key? Well, I may have just whacked my body out with the excess soy consumption. And my research confirmed this – soy, specifically the processed kind, can reduce white blood cell count through reduced zinc levels. Decreased zinc levels can also be reflected through decreased T3 levels – AHA!

Staying Positive

My plan forward? I am going to stay positive 🙂 NOTHING IS WRONG RIGHT NOW, and why should I worry about something that is not final? I am going to cut out soy for now, and just focus on maintaining a balanced diet – maybe I’ll have the occasional soy latte, but certainly not everyday. I was going to talk to the nutritional therapist (who now wants $90 for a 30-minute phone conversation), but I realized that would just stress me out more because she never references my blood test data points, and never actually gives me tangible advice other than “just keep eating more fats; keep doing what you’re doing.” I’m sorry Doc, but for that much money, I need to be getting a little more than half-hearted validation.

Happy healing!

Lots of love,

Girl Guilt-Free

First Steps to Recovery

Today I received an email from a beautiful young girl who wanted some advice. I realized that the questions she asked are likely questions that a lot of other lovely ladies may have, so I wanted to share my response.

So, you think you have Hypothalamic Amenorrhea, and you have NOT been on the pill, so you don’t think this is the cause. What should you do?

First Things First

Congratulations on commencing your journey to recovery – acceptance is the first step. I recommend that you start by seeing your primary care provider and having blood tests done. The doctor will check your Estradiol, LH, and FSH levels. You may also want to ask to have your thyroid function checked via the blood tests to make sure that thyroid issues are not the root cause of the amenorrhea. Vitamin D levels would also be good to get checked. Vitamin D helps our bones absorb calcium. In women with amenorrhea, the low levels of estrogen can prevent our bones from absorbing adequate calcium, making us more susceptible to osteoporosis.

What’s The Cause?

It is important to know that Amenorrhea can be at 4 levels:

1. Hypothalamic

– This is where my amenorrhea is rooted. Excessive exercise and restrictive eating cause our hypothalamus (the part of our brain that regulates hormone function) to panic. It essentially enters ‘survival mode’ due to lack of nutrition, and shuts off all ‘unnecessary functions’ in order to make sure the body survivors. Unfortunately, reproduction is not a function that is essential to our survival, so my hypothalamus just told my body to stop producing Estradiol, LH and FSH.

2. Pituitary / Thyroid

3. Ovarian

4. Uterine
Start With Your Doctor – Blood Tests
Starting with a blood test will help your doctors confirm that your amenorrhea is rooted in the excessive exercise and restrictive eating. I don’t want to scare you at all, and just want you to be aware, so it’ important to get the blood tests done to make sure that nothing else is the root cause – does that make sense? Honestly, when I went in, my doctor just checked for everything:
– Vitamin D 25 Hydroxy
– Estradiol
– Follicle Stimulating Hormone
– Luteinizing Hormone
– CBC and Platelet Count
– Lipid Panel
– Prolactin
– DHEA Sulfate
– Testosterone Total Free
– Hemoglobin A1C
– TSH with Reflex FT4, FT3
– Comprehensive Metabolic Panel
If you’re scared of blood tests, don’t worry, all of these tests were conducted with one sample set i.e. I did NOT have to get my blood drawn multiple times.
What You Can Do
Nutrition
Caloric Intake
If you have been restricting caloric intake, I would start by slowly increasing. I know a lot of HA blogs say “increase to 2500+ per day,” and as someone who has been so conscious about their weight, I know that’s hard. For example, i am about 5’7, and weigh between 125 – 129 lb. I was restrictive at 1200 for the longest time. I started by increasing by 150 per day, every week, so that after about 4 weeks I got close to 1900. I now eat between 1800 – 2000 (I still log, because it makes me feel less stressed) and I try to LISTEN to my body and hunger levels.
Macro-Nutrients
It is really important to make sure you are getting at least 60g of healthy fats per day. Incorporate nut butters, avocados, and seeds in to your daily intake. I also started taking a few supplements, which you can find on my blog. 🙂 I did NOT take a calcium supplement, because some research indicates that these can increase your risk of heart-disease. Instead I increased my intake of greek yogurt and dairy, and tracked my calcium intake using My Fitness Pal.
Estrogen-Boosting Foods
I wrote a post on my blog about this, so feel free to reference that!
Your doctor will likely refer you to a nutritionist or nutritional therapist. The one my doctor referred me to was SUPER EXPENSIVE, and basically did not tell me anything I did not know – limit exercise; eat 1800-2000; increase fat intake. However, what she did tell me is that I DON’T have to worry about gaining weight – I just need to maintain. She has also helped me transition towards being a normal eater. I plan to share these insights on future blog posts because I don’t want other girls to have to worry about paying $160 / hour like I did.
Keep in mind, don’t scare yourself, or let anyone scare you in to thinking that you “HAVE TO GAIN WEIGHT.” Let’s not worry about the weight part for now – I certainly have not. Getting your period back is about showing your brain what ‘balance’ means, and so for now i am focusing on maintaining my weight, and incorporating healthy fats in to my diet, along with an increased caloric intake.
Exercise
I would suggest taking a few weeks off from exercise. If this is really hard – you mentioned just walking has been really hard – then limit exercise to 3 times a week. I have a post on my blog about what exercises I do as well. Definitely lay off high-intensity cardio.
This journey requires patience. I should also let you know that it is COMPLETELY normal to have emotional fluctuations and breakdowns – in fact, this can be a sign that your hormones are kicking in. Don’t let your emotions scare you – let them out!
Happy healing!Lots of love,

Girl Guilt-Free

Check-in With Yourself – It’s Liberating

Today was a good day! 🙂

What I had been fearing – feeling just as crazy hungry as Monday and Tuesday, despite eating over 1900 kcal – did not happen! Today, I felt like a “normal” eater; I was not constantly thinking about food, and I stopped eating when I was full.

I also took time today to check-in with myself, and to remind myself that everything is okay by putting things in to perspective. I have been living with Hypothalamic Amenorrhea for a year; if my ignorance of it let me live stress-free, then why does my diagnosis of it have to change anything?

A Diagnosis is a Step Forward – Never Forget

Every time I feel overwhelmed, stressed, or hopeless about HA, I am going yo remind myself that I am only better off than I have ever been before: I don’t have to worry about being overweight; I have no other medical condition; I am no longer hungry all the time, and I am headed towards recovery. Sometimes it’s easy to lose perspective, so it’s important to remind yourself that you are in a much better place than ever before, so it can only get better from here on out.

I am grateful, and re-charged – no guilt; no stress.

Happy healing!

Lots of love,

Girl Guilt-Free

P.S. had a phenomenal burrito bowl from Chipotle, WITH GUAC!

Sometimes, you’re just hungry, and that’s OK!

Over-Snacking?

So I am trying my best to not constantly think about food, and one of my ways of doing this is to reduce how many times I eat in a day. I had got up to eating about 8-10 times per day. In doing so, I was trying to minimize my caloric intake at every meal. I did this because I was constantly afraid to be hungry and overeat at any given point in a day. I figured that eating smaller, more frequent meals, would help me curb my frequent hunger. The drawback? I began to constantly think about food; I was continuously planning my next meal, and this was because I would never fully satisfy my hunger.

Wholesome Nutrition

I am now making an effort to eat about 6, more wholesome meals in a given day – this way, I hope that I will stop thinking about food all the time. Food is an important component of our lives, but it certainly should not be on our minds all of the time. This is how food and eating become unnecessary stress. That being said, given that I am still tracking calories, I sometimes stress about eating closer to 2000 calories, and have caught myself feeling guilty if I exceed 1900 calories. It is important to understand and accept that on some days, we are just more hungry. I am trying to transition to a healthier mindset around food – if I am eating filling and nutritious foods, but my body still wants more, then I am going to listen to it and feed it up to 2000 calories a day. Who knows, I just may not be as hungry the next day, or the next week.

Guilt-Free Feeding

This is certainly a work-in-progress for me, but here’s a plug to, collectively, let-go of the fear and guilt associated with food. I catch myself, scared to gain weight, worrying about letting myself eat up to 2000 calories a day. “What if my body just gets used to 2000 calories and starts to want that every single day? That would put me at 1400 calories more per week than if I were eating only 1800 calories per day.” Well you know what, no one knows what tomorrow holds – if I feel just as hungry tomorrow, so be it, and if I don’t, so be it. Here’s to just letting go and not feeling guilty about eating the 2,000 calories!

My Typical Monday

One thing I wished more HA bloggers talked about is what their typical day looks like, in terms of food. After all, a huge part of the recovery process is rooted in nutrition. So here is my typical Monday:

5:00 AM (before heading to the airport): I woke up super hungry, and decided that I couldn’t wait till I got to the airport to eat breakfast, so I ate 1/2 cup of Nature’s Path Flax Plus cereal with 1/2 Cup whole Foods Unsweetened Soy Milk (108 kcal).

6:20 AM (at the airport): Organic steel-cute oatmeal with blueberries, and 1 cup of black coffee (228 kcal). I also had my multivitamin, fish oil, and biotin (18 kcal).

9:20 AM (in-flight): Kit’s Organic Dark Chocolate Peanut Bar (190 kcal).

12:45 PM (keep in mind, I had a +2 hour time zone change at the airport): Starbucks Tall Soy Misto and Subway 6-inch turkey on wheat with guacamole, lettuce, spinach, tomato, cucumbers, and peppers (420 kcal).

2:30 PM (in-flight): KIND Dark Chocolate Mocha Almond Bar (200 kcal).

4:30 PM (in-office): Medium organic pink lady apple, and an earl grey latte using the Tassimo Cappuccino creamer (140 kcal).

7:00 PM: Nonfat Greek yogurt with about 1.5 oz of mixed berries, and 6 raw almonds, all organic (160 kcal).

8:00 PM: Grilled 4 oz salmon with approx. 1/2 cup quinoa, 1/2 cup sauteed green beans, and a little local honey (473 kcal).

9:30 PM: I was craving a little chocolate, but wasn’t super hungry and didn’t want anything too sweet, so I had 5 Somersault cookies (50 kcal).

Daily Total: 1,987 kcal

Happy healing!

Lots of love,

Girl Guilt-Free