but what's PCOS?

haha...I just realised I haven't explained what PCOS is.

According to wikipedia, PCOS is an endocrine disorder, which can include adrenal, gluclose, metabolic, sexual hormone or thyroid disorder. They indicated more, you can read on wiki's endocrine disorder page.  Wiki also said that PCOS is the most common hormonal disorder among women of reproductive age, and is a leading cause of infertility.

The following info comes from PCOSupport's forum, which says PCOS is hormonal imbalance caused by Insulin Resistance (IR). IR occurs when the body's cells do not use insulin effectively, basically producing more insulin than is required. Insulin is a hormone that affects other hormones in the body, including the sex-hormones, which cause many of the PCOS symptoms such as high testosterone levels. IR also causes the body to become very efficient at storing glucose as fat, which leads to the excess body fat which many of us suffer from, as well as the inability to lose weight.

The forum has a heck of a lot more to say about PCOS and IR, so if you want further info, check out the link I've posted above; I've copied much as I can and edited where I can to make it a shorter read.

According to the forum, it can be tricky to diagnose, since the blood work seems "normal" but there's underlying issues that aren't typically noticed. So if the symptoms below fits but your dr says its nothing (happened to me and to many other people), go see an endocrinologist and ask to have you hormone levels, cholesterol levels and thyroid checked. Also do a 2 or 3 hour Glucose Tolerance Test, a Fasting Insulin level and Sex Hormone Binding Globulin, if possible. Some doctors (like my gyno) did an ultrasound to look for the cysts. Wiki says that the cause is yet unknown, but agree that IR, diabetes and obesity are related to PCOS.

Symptoms of PCOS include:

• excessive hunger (especially when you feel that you "shouldn't" be hungry),
• dizziness/headache,
• nausea,
• irritability and mood swings,
• the "shakes"
• exhaustion especially if you skip a meal.
• skin on neck that meets body is thicker, creased, and perhaps looks "dirty" even after having a shower
• persistent acne (on face, back and chest), oily skin and sabbhorhea (a form of eczema)
• hirsutism (excessive and increased hair growth on areas where men normally have hair eg face, legs, chest, stomach, back, toes)
• hair loss/male pattern baldness
• depression
• weight gain/obesity (usually around the waist)
• deepening of voice
• ireegular, few or absent menses
• skin discolouration
• infertility
• multiple ovarian cysts (not everyone with PCOS has this)
• sleep apnea (snoring or breathing stops at times when sleeping)

According to both, if left untreated, PCOS could lead to diabetes, female "cancer" or heart disease. There are also some women who have not gotten their menses for a few months, which may to endometrial, uterine, or cervical cancers.

According to PCOSupport.org, Birth Control Pills (BCP) like Diane-35 and Yaz/Yazmin aren't enough since it only takes care of the symptoms like oily skin, hair loss, hair growth, acne and eczema. Looks like they mostly recommend Metformin, which regulates your insulin rather than your hormones. Metformin seems especially good if you're thinking of getting pregnant (which is possible if PCOS is treated quickly). Dr Y, my gyno, recommended Androcur instead as this is apparently stronger than BCPs. I noted a few women are using this in addition to BCPs (first 10 days of menses), but my gyno recommended it as an alternative to Diane (hmmm....).

There are also women who choose to treat PCOS the natural way, which I'm too lazy and without discipline to do - low GI, high fibre high protein diet with plenty of exercise and resisting sugary stuff. Also, I think its always a nice thing to say 'let's go organic', but it doesn't always work, especially when it concerns something like Insulin Resistance, which makes the weight loss take too long, not to mentioned that losing weight can be difficult with PCOS.

Some people even take Cinnamon supplements since it apparently re-sensitizes one's insulin level. In addition to that, they learn to manage their diet and maintain an exercise regime that includes both cardiovascular and weight lifting.

Whatever it is, however you wish to treat it, if you have some of these symptoms, I suggest you see an endocrinologist just to confirm whether you have or don't have PCOS.
Apparently PCOS is underdiagnosed or misdiagnosed or even think its related simply based on the symptoms, even in the Western countries.
This was the case for me until I had my testerone level checked and ultrasound of my ovaries done; then immediately I was told I have PCOS.

What I have learned from these sites is that, though PCOS cannot be cured, it can be managed.

Sources:

Wikipedia
Healthy Lifestyle
PCOSupport.org
MedlinePlus
UpToDate
Womens Health - info from Monash Uni
There are also books on PCOS that you can read.

day 1 - 4

Its been 4 days since I started the pills.
Since I only need to take Diane and Ranitidine daily whereas Reductil and Pharmaton are to be taken every other day, I have attributed the constant nausea to either Diane or Ranitidine.
I don't wanna risk stopping Diane just to see whether its the Ranitidine or Diane that's causing the nausea, but I'll be done with Diane in a few weeks, but there's no rest with Ranitidine, so I can gauge which of the two is causing the nausea.
In the meantime, I guess I'll just have to use one of the home remedies like drinking peppermint tea or ginger ale.

The annoying this is that the nausea stays throughout the day.

Today (Reductil & Pharmaton free day), I took Ranitidine at 8am, had breakfast a few minutes after and took Diane after breakfast - around 9am.
By 9.15am, I felt nauseous, by around 10am I was pretty tired (both possible side effects of Diane) and went to bed.

I've been thinking its pretty odd, that I would feel tired (and possibly the nausea) with Diane, since that didn't happen when I took it in 2002, but I figured my body might've changed quite a bit since then.
On Tuesday I'm going for my general check up (blood test, urine test, BP etc) with my GP so I'm gonna check with her about this.

Anyway, when I woke up around 12.30pm, I felt pretty weak, shaky in fact and somewhat uncoordinated (which is normal when I haven't had a meal or am low on sugar).
Made myself something proper to eat and after that, I was ok.
Still feeling nauseous at this point and in fact it tends to be an underlying thing for me nowadays.

Normally its pretty 'light' nausea, meaning to say I don't actually start gagging or anything.
But today, that happened twice, but I didn't throw up - well I wouldn't since I took Diane at 9am and it hasn't been 6 hours since then yet...I don't wanna waste a pill and have to take it again..then go through another long cycle of feeling nauseated.

Other than the nausea, I've been having a slight (but annoying headache) from 6pm Thursday to around 4.30pm Friday. Went to bed on Thursday with the headache, woke up Friday with the headache.
Mentioned this in my previous blog.

Also experiencing tenderness of the tatas (experienced this when I took Diane in 2002), ab cramps (Diane - did not experience this in 02), bitter taste in my mouth (Reductil side effect) and some GERD-ing (normal for me actually).
The Ranitidine is meant to help with the GERD, so I think I'll just have to wait until the pill makes whatever it is in my stupid belly to settle down.
I cannot be sure if I feel hungry or its the nausea, but as of today, no more gastric pangs.

I've had something light around 4pm, just to make sure I don't start getting weak or anything - Nutella on white bread; surprisingly, Nutella has a low GI content. Awesome!
Dinner will be soon then I'm trying out the peppermint tea.

Oh I feel so vomitous!

2nd opinion

So after a most unsatisfactory diagnosis that lasted all of 5 minutes with no explanation on what I had and what it means, I decided I should at least google up Polycystic Ovarian Syndrome and find out what it meant.
I also decided to call up another ob-gyn (not my GP) for a second opinion; my appointment was the following day at 11am.


When I met the ob-gyn, Dr Y, I showed her blood test results and what the previous doctor diagnosed me with. Dr Y I asked whether any other tests were done to confirm I have PCOS and I said no.
So she said "Let's do an ultrasound and just check."
So we did an ultrasound and there they were, black masses in my ovaries, both sides.
Dr Y asked me if I was married and if I planned to get married and have kids. I said 'no' to the former and 'who knows what would happen in the future; I may meet someone', to the latter.
Then I told her I read that infertility could be an issue for people with PCOS - she said that was exactly why she asked me those questions and that if I planned on getting pregnant, we'd have to re-look the meds.


She decided to let me stay on Diane, since she said they worked for me in the past (with regard to my skin condition). Her alternative med was Androcur, which was pretty pricey.
Since Diane made me (and will make me) put on weight, she also recommended I take Reductil, known as a 'diet' pil that basically suppresses your desire to eat and convinces you that you're full.
Later that day after some research on the side effects and lots of thinking, I decided Diane and Reductil it is, Androcur will have to wait.


Wednesday (day after consultation with Dr Y), I went to the clinic to pick up my prescription. There I realised that supressing my appetite could make my gastric worse, since I'll be eating less.
So the good dr prescribed me Ranitidine also, which would help with my gastric.


I went down to the clinic's pharmacy and found out that Ranitidine would cost me $150 in total (for 1 month's supply), but was advised by the pharmacist that regular pharmacies would carry them at a cheaper price.
So I took my Reductil, went to Caring and bought 2 months' supply of Ranitadine at $24 for a month.


At 1.30pm I popped Ranitidine and Reductil with water; 30 minutes later, I started feeling nauseous.
I had my lunch, popped Diane and Pharmaton for my low iron and ended up going to the toilet twice one hour apart. True to its warning, I experience dry mouth within 2hrs of popping my 1st Reductil .
My nausea stayed on until 7.45pm when I couldn't stand it anymore and threw up.
My stomach felt better really quickly.


That night for dinner around 10pm I had half a 6" of a Subway sandwich. Odd I already felt full when normally I could eat a whole 6" straight (no naughty jokes pls).
At 2am I was hungry again, so I had the rest of the sandwich.
The next morning I took the Ranitidine and Diane, since Dr Y informed me to take Pharmaton and Reductil only every other day.


I had a fairly good breakfast; neither too heavy or too light and around 1pm had lunch, also not too heavy, but quite good.
Probably less than 10tbs of rice and 1 small chicken.
Frankly, this would've been the amount of food I'd eat before I started taking Diane.


Around 2pm I started feeling really sleepy, which apparenly can be one of the side effects of Diane.
I woke up at 6pm with a slight headache, which I initially attributed to the sun (for some reason, whenever the sun shines directly on me, I get headaches or migraines, sometimes I even feel nauseous).
The headache was manageable, but I didn't wanna take any aspirin.
It lasted through the night and in the morning when I woke up, I still had the headache.
 
At 9am I had eggs and toast for breakfast (found out that PCOSers need loads of protein and fibre), with Diane and Ranitidine right after.
Around 3pm I went out, still with the headache and now starting to feel nauseous, too.
I went to La Village, straight to the pharmacy and after checking with the pharmacist, got meself some Actifast Panadol.
He also told me I could have a max of 2 Ranitidine if my tummy was bothering me, which it was.
So I took one more Ranitidine and after lunch, took 2 Panadols.
30min a bit of head massaging later, the headache finally went away, but the nausea remained.
 
Its now 6.50pm, almost 4 hrs after my last meal. If experience has taught me anything, its that I need to have something substantial in my belly every 4 hrs at least whenever my gastric is acting up, which it has been even before I started popping all these pills.
I hope toasted ham and cheese will do it; pointless to take Reductil when I'm still eating like a horse tho.
 
God save me....I hope the headaches won't last the whole week.

I know its not nothing

One thing I've learned about doctors in this country is that its always good to get a second opinion or to have another one just in case the first one takes your problems lightly.

I can't remember when it first started, but I've been battling oily but dehydrated skin, breakouts on my face, chest and back, along with persistent eczema, hair loss, headaches and shakiness/exhaustion when I skip a meal for quite some time.
I never realised I had eczema, always just thought it was rashes, so I never really bothered with it.
As for the hair loss and acne, I was told by a few dermatologists it was because I had oily skin which caused the breakouts, whereas the hair loss was due to bad genes. One prescribed me Diane-35 (in 2002) because he said my testerone level was too high. I was to take 1 1/2 pills for 8 months. I started putting on weight, but my skin was great and the acne and even scars cleared up. I cannot say much about my hair loss, since I never really paid attention to that.
After 8 months, I stopped (ran out of cash since I was not working at the time). 2 months later, my skin was back to oily, I was breaking out again and still putting on weight.

So I went to another doctor.
She recommended Roaccutane so that my oily skin would dry up.
After 3 months, I stopped because my skin was just TOO TOO dry - I even had nose bleeds cuz the insides of my nose dried up too (yeckh, I know).
Plus, Roaccutane could increase one's cholesterol level, which I didn't think I wanted since my mom's side has a history of heart disease and she herself has a high cholesterol level that just won't go down.

So I left things alone and decided to just look for products that would work for me.
Not easy, since I was not yet 25 and my skin was still settling down; I went from oily to dry to very dry that I could feel my skin stretch and itch, to oily but dehydrated until finally, when I turned 26 or so, it stayed at oily.
It was a whole mess of spending cash on the 'right' product only to find out it wasn't a few weeks/a month after use.
There was a couple of times when by chest acne would clear up, then flare up again whenever I had flu, asthma attacks or dry coughs.
My bacne stayed throughout clearing up only once in 2008, but that's a different matter altogether.

My weight continued to increase steadily, not that I cared really, I just didn't like having to spend money on new clothes that won't fit a few months later.
Course, I was also kinda in denial.
The different matter I mentioned in 2008 occured in Jan of that year - my menses went from a normal 5-7 days to only 1 day of very light flow.
This went on for a few months, which I was happy with since my acne cleared up, then May 2008 it went on for about  5 days.
My acne flared - huge with puss (I never had acne with puss before) on my cheeks, just under my cheekbones.
Apparently, this part will break out if you have problems with your 'lady parts'.

June 2008 til Oct 2008, it went back to one day a month.
My acne was just calming down when in Nov 08 I had another 5 day of light flow.
My acne flared up again - face, chest and back.
Then it went back to one day a month, but my acne just won't calm.
By this point, I was convinced something was wrong, so I told my GP, whose a non-practicing gyno.
She said that so long as the lack of flow was not occuring cuz of some raunchy physical activities, I have nothing to worry about.

I wasn't convinced, but how do you argue with an ob-gyn who has more knowledge than you, whereas for you its more about gut instincts.
As for my hair loss, GP insists there's nothing I can do by use Regain for at least 1 year, whereas the acne she insisted I had to face facts and just live with it, since there's no cure.
In fact, she informed me that all my problems would clear up once I lost weight, since my obesity is causing evereything to go haywire (doesn't explain the acne and hair loss though, since that's been going on since before I put on weight).
By the way, I went from 52kg in 2002 to 62kg in 2009 - apparently I'm slightly overweight, but not obese, but oh well...semantics.

In Aug of 09, it was 2 days worth of light flow followed by 5 days of spotting.
At this time, I'd gone to another doctor to see if she had a different suggestion.
I decided to start the first meet with simply informing her of all the symptoms I had, from hair loss to acne to eczema (the longest one I had from June 08) to sweating profusely at night in air-conditioned room WITH fan on to sweating immediately after getting out of the shower.
She decided to test my hormones since she thought it was something wrong with my thyroid.

2 weeks later I came back for the blood test; a week after that, I came in to check on my results.
After waiting 2 hours at the clinic (it was a very busy morning for the doctor), our five minute consultation went like this:

Dr : Your testerone level is very high. You have polycystic ovarian syndrome, but its not cancerous. Your iron is very low. That's why you have hair growth on your face and your body. (I've never noticed any manly hair growth on my face..no mustache or beard or anything, though).
Me : Oh! So the eostrogen and progesteron and other stuff are ok?
Dr : Yeah, your thyroid is ok too. Just your testerone and iron. You need to take Diane-35 for your testerone and Pharmaton for your iron. That should clear everything up.
Me : Oh ok. So is that it? No need to take the bio-identical hormones?
Dr : Yeah that's it. No need to take the bio-identical hormones.

I went off feeling having no idea what Polycystic Ovarian Syndrome  (PCOS) is and tons of questions, also, extremely unsatisfied.
So I sent her an SMS (2 since I realised after sending the 1st one I had a few more questions). She took about 4 hours to get back to me and her replies was damn short and unsatisfactory.

I get it...she was busy, but I am (or was) still her patient.
After waiting for 2 hours I think I deserved a little bit more than that.
At least a explanation about PCOS and what that meant, what the future would be, if I should be concerned, what my options are.


Honestly...doctors.