A South Asian Woman’s (Un)healthy Journey of Discovery
By M. H.
In September 2016, as a representative for a wonderful forum called Autoimmune Mom, I had the great fortune to participate in Medicine X hosted at Stanford University, a premier gathering of innovators looking to disrupt the healthcare space through technology, services and thought leadership. As an overstressed working mother with multiple autoimmune disorders, it was an incredible experience to chat with progressive thinkers and doers who refuse to let their illness(es) define them. They have dedicated a significant portion of their lives to bridging gaps between patients and doctors through empowerment.
Everyone I met were knowledge seekers who wish to assimilate as much as possible and share with their respective communities. I met other women with Thyroiditis who were active and thriving; Brain Cancer survivors working on improving patient experiences; individuals living with Psoriatic Arthritis who now work on empowering other patients; patients with severe Cystic Fibrosis who chose to spend their time learning about ways to empower and improve the patient experience; Doctors who promote platforms for patient conversations; and so many other individuals and organizations who wish to disrupt the status quo in healthcare.
The energy across the sessions and all participants over the two day event inspired me to come out of my private shell and share my story. I received so many valuable insights into tweaks in attitude, possible research into my condition(s), resources available for better empowerment, that I thought maybe, just maybe, there might be some message in my story that will resonate with someone out there. Not everyone will have the opportunity to attend a Medicine X, but we can each choose to widen the footprint of what we know so that patients become better aware of what questions to ask. Autoimmune Mom is a great platform for this kind of information sharing.
Hence, with a blind trust in the greater good, here is a peek into deeply personal aspects of my life, which thus far I have kept out of the public domain. I hope it speaks to some of you.
…..
I was born in Bangladesh 6 years after the country became a sovereign nation at the end of a bloody war with Pakistan, in which my own grandfather was martyred, and two years after the new government was taken over in a military coup. Still reeling from the great famine of 1975, chaotic political systems trying to find its feet, and scarcity of resources, the nation was still working towards establishing good medical systems and other basic infrastructure. Amidst such turmoil, women’s health and needs not only took a backseat due to more fundamental challenges, it also got minimized due to a patriarchal and conservative Muslim society predisposed to various unfounded superstitions.
By the time I hit puberty, the economy was becoming stronger, Dhaka was becoming a more metropolitan city in which to live, but the cultural norms remained old-fashioned. Girls from an average middle-class family were still treated as beings who could be seen, but not heard. It was taboo to talk about a girl’s reproductive health in polite society. I still find it an odd expression when women in Bangladesh used to say “or shorir kharap” (meaning “she is in ill health”) to describe a girl/woman when expecting a baby or when having her menstrual period.
In Bangladesh, girl’s/women’s health did not start getting adequate attention until well into the 1980s. Since then, mostly to help control population growth, there have been aggressive programs run to teach village women about family planning and related health issues. It took time for the education to take root but it has paid handsome dividends on a national level. In the last two decades, the maternal mortality rate per 100,000 live births has fallen sharply, as has the average number of children per household (2.2 as of 2014). In fact, so much so, that Bangladesh is now leading in these indicators as compared to her neighbors in India and Pakistan, two countries that are economically much more progressive[1].
Interestingly, the same level of education and resources were not available to city-dwelling middle income families. I do not remember any of my teachers or guest speakers at school, who talked about reproductive health at my all-girls’ school. A visit to an OB/GYN only happened if your parents thought to do so; it wasn’t part of a suggested protocol.
This trend of overlooking women’s/ maternal health is not uncommon across societies, and to be expected in the poorer corners of the world. With my moves across different nations during my lifetime, what has surprised me is how disjointed and poor it can seem in some of the developed countries as well. The narrative that follows highlights my journey with my eventual diagnosis of Hypothyroidism, and various other related maladies. I hope that women from across the globe will benefit from the nuggets of information embedded in my experiences, and go on to make better, more informed decisions about their personal healthcare.
Puberty
When I got my menstrual period at the age of 11, after some swimming fun where my mother was not present, I did not know what it was about. When I came home and mentioned it to my mother, there was a shy smile on her face and I was told the basics of how to take care of it. Stocked with supplies, I was given the explanation that I needed to have the period so that I could have children. There were no good or satisfactory answers when I questioned if some of my aunts had never gotten their period as they could not have children? There were no books or other literature available to me.
It is customary in Bangladesh to have maids in the home. Some are hired as ayahs or nannies for the children. I had one such lady who had been with us since I was a year old. I asked my ayah what a period meant but given that she grew up in a village in the 50s/ 60s, and was never formally educated, her explanations were even more vague than those from my mother.
When my period was incredibly irregular, initially I didn’t think anything of it. Eventually my mother began to worry and we went to a famous OB/GYN who was a family friend. She looked me over, pressed on my stomach in a few places and gave me a clean bill of health. Her suggestion was that it would improve over time.
When I was 15, I moved to England for two years, where my baby brother was being treated for a rare form of cancer. In a sudden twist in our lives, I ended up in an all-girls school in London, while my brother fought for his life. I remember getting a physical examination through the school, where I mentioned my irregular period. At that time, for a handful of months, I was getting my period every 3 weeks. A physician took some time to explore this with me but eventually said some girls just have an irregular rhythm. This was a group of medical staff who had come to the school to do the physicals; perhaps a general physician or specialist would have been more thorough.
In 1993, we came back to Bangladesh after my brother’s passing. He was only three years old. It was a heart-wrenching time for the family, where each one of us lost our way in finding a meaningful path to healing. Only those who have gone through the trauma of having to bury a young one in the family will relate to the deep sense of grief and divisiveness that enters the fabric of the family life after such a tragic loss. One does not have the capacity to worry about other, petty health problems. But, that is its own story for another day.
It was not until about 3 years later, when we finally accepted that the mundane in life will continue to propel us into a new day even if we did not want it to, that my menstrual problems again came into the spotlight. At age 20, I was still not regular.
Middle class families in Bangladesh had little faith in the medical system in the country, and many who could afford to do so would travel to India, Thailand or Singapore to get a diagnosis for chronic problems, or treatment for acute illnesses. In 1997, we happened to be visiting Kolkata in India, which was known to have a better medical system than in Dhaka. We got a name of a doctor from friends, and made an appointment weeks in advance to coincide with our trip.
After long waits, bloodwork and urine tests, we met the doctor for a grand total of 10 minutes, to hear that there was something wrong with my thyroid and I would need to take medication for the rest of time. I do not remember hearing a good explanation.
Long-term allopathic therapy is discouraged in our culture and several natural remedies are usually sought instead. My parents were not supportive of getting me on life long medication. They took me to another pathologist who was a family friend and he did some more blood work, and this time we actually came to know that there were things called T3 and T4. He said my numbers were on the borderline, but he would not recommend going on medication. Thus, we did not really address the underlying issues and did not make the time to dig further.
Post Pregnancy #1: Austin, TX
Fast forward eight years to 2005. I am now married and living in Austin, Texas. The years have been marred with several high-stress situations and many episodes of fatigue, depression and massive hair loss. I have given birth to my wonderful daughter after a difficult pregnancy peppered with morning sickness, gestational diabetes, PUPPS (Pruritic Urticarial Papules and Plaques) and a 40 hour labor. Post-baby, my fatigue is unbearable but hard to separate from that of a new mother, solely responsible for the care of my child while my husband often travels for work. My thyroid has always seemed a little swollen, but now more so. Bloodwork again shows T3, T4 at borderline numbers but can be well due to the expected fluctuations for a new mother. Up to eight months after the baby, no matter what I eat or do not eat, my weight does not change from 150 lbs, a rather flabby weight for my 5’6” frame. Something suddenly shifts at 8 months, and my weight starts to drop drastically. My severe fatigue is still there, my brain fuzzy most of the time. I find it hard to fully bond with my child, and have several moments of feeling disenchanted with motherhood. The bouts with depression are getting more acute, and I am missing out on chunks of my life but it is hard to for me separate it from the environmental and emotional stresses of being a near single mom and socially isolated while my husband works tirelessly to establish our business. Finally, when my daughter is 3, my OB/GYN does a full physical examination and flags that my thyroid is low, which partially explains my fatigue/ depression but not my continued weight loss. I am now down to 130 lbs, lower than my pre-pregnancy weight. She puts me on Nature Throid, a naturally dessicated thyroid pill derived from pig thyroid, but does not suggest a time period where we need to play with dosage. She does not suggest a trip to the specialist, and I am too tired to fight the long-term prescription. I start on the allopathic therapy; thankfully, I do not react to the medication. However, after a few weeks, I stop because Nature Throid is not available on the market anymore.
Now going to a new OB/GYN, she eventually puts me on levothyroxine and again does not suggest that I should consider seeing a specialist. I start to take the medication regularly, but I really do not feel well. I get frequent headaches, feel dizzy and after about 6 months, I decide to stop taking the medication. After two weeks of my stopping, my behavior is erratic and my depression is at its worst. There is not a lot of empathy or tolerance at home and after 4-6 weeks of such manic behavior, I go back to my OB/GYN, who prescribes Prosac (an anti-depressant that I resist taking) and I also ask her to put me back on Nature Throid. At least, I had not felt any of the side effects with Nature Throid. The brand is still unavailable on the market, and the OB/GYN finally suggests that I go to a specialist, because a specialist might have different access to brand name medication than primary care doctors.
It should have been evident from my medical history that my thyroid numbers were borderline for a long time and I now deeply question why my primary care doctors did not refer me to a specialist earlier. I cannot find a good reason other than a motive to maximize personal profit.
Since I was on a PPO health plan, I get to pick my own specialist. It is incredibly difficult to schedule an appointment with the Endocrinologist who had openings in her practice at the Texas Diabetes and Endocrinology. My first two trips are fielded by a physician’s assistant, who runs a battery of tests. Within the first few days, it was established that not only did I have hypothyroidism, but that I had Hashimoto’s, which I was most likely genetically predisposed to have. It is also likely to have gotten triggered during puberty. A lot in my medical history was now explained. I finally saw the specialist 10 weeks after my first call to the center, and it is during the first visit, as she is glancing through my results, does she say towards the end of my visit that ‘did anyone ever tell you that you have lumps on your thyroid?’ She sounds nonchalant, does not mention that it is a common occurrence for those with hypothyroidism, and I walk out not knowing how much I should worry. I had lost my brother to cancer when I was 16, my mother has had a lump removed from her thyroid when I was 11, and my maternal great-grandmother eventually succumbed to breast cancer at the age of 93 few years prior.
After the appointment, I fume at my endo’s insensitivity given that she had access to my medical/ family history and yet simply informed me of the lumps and sent me packing with a new prescription for Synthroid, asking me to come back for follow-up bloodwork/ thyroid scan a few months later. Given that I am still a young mother to a child under the age of five, I resort to researching thyroid cancer on my own and am somewhat relieved to find that it is highly treatable.
On regular Synthroid for a few months, I start to struggle with my weight again. My menstrual cycles, which had been regular for about 6 months post baby, is back to being irregular and the intervals between them are getting longer. An average of 40 days had been my new ‘normal’ but now it was extending to more than 60 days. After multiple negative pregnancy tests and onto my fourth month without a period, I go back to my OB/GYN, who sends me for an ultrasound. The technician suggests that there are cysts on my ovaries but cannot give any more information. Another few days of worrying about malignancy later, my OB/GYN suggests that I have PCOS (Polycystic Ovarian Syndrome). In her words, it is a common occurrence whereby for some unknown reason the body stops producing enough FSH (Follicle Stimulating Hormone) and I do not ovulate. This affects the menstrual cycle. She is quick to prescribe some progesterone pills to get my cycle going again, but does very little to offer long-term solutions.
My OB/GYN’s position suggests “too bad you have to live with it, but it’s not that uncommon”. For someone who has now been trying to have baby #2 for more than 2 years, this is heart-breaking. It is difficult to accept my body as a broken piece of furniture, which needs to remain functional with continued fixes of glue, tape and outer polish that hide the cracks within.
Later in the year, in summer of 2011, we make a drastic and quick decision to move to the San Francisco Bay Area due to professional reasons. Before our departure, I go back to my endocrinologist who suggests that we need to do a biopsy of my thyroid lumps, which have grown in number and size over the years. Scheduling the biopsy, a several hundred dollar procedure that I have to pay out-of-pocket for due to my high deductibles, is the fastest scheduling at the practice in my multiple years there. With typical efficiency, the doctor is done with the procedure and out the door in less than 20 minutes and days later, the results are inconclusive, possibly because she did not extract enough sample. I am poorer financially, but no richer in knowledge.
Apart from the initial diagnosis that helped to validate many of my on-going problems, I got very little out of my time with Texas Diabetes and Endocrinology. It is an efficient machine to process maximum number of patients but, per my experience, certainly lacking in patient care.
Pregnancy # 2: Fremont, CA
After our move, I finally get on a HMO plan and end up with an Endocrinologist at the Palo Alto Medical Foundation in Fremont. On my first visit, I give her my known history with hypothyroidism, gestational diabetes, my seemingly growing intolerance of too much refined carbohydrates, my struggles with PCOS and my inability to get pregnant. She listens intently, and in plain English, explains that all my symptoms have an underlying theme: insulin resistance, where the body continues to produce insulin, sometimes more than necessary, but the body fails to use it effectively. As a result, the body does not absorb the glucose into the bloodstream. She considers me to be prediabetic and recommends that I get on 1000mg of Metformin, a drug used to treat diabetes that has been through multiple clinical studies and show few direct side effects. She also suggests that my dosage of Synthroid may not be sufficient and bumps me up to 50 mcg, which she eventually settles at 75 mcg after a few months of tweaking. We go well beyond our scheduled time for the appointment and for the first time in my medical journey, someone ties all my different ailments together. The hypothyroidism, PCOS, unexplained weight gain, irregular periods, gestational diabetes, and strong family history of diabetes, all connected to the insulin resistance. Even though this is less than perfect news for someone striving for a healthy lifestyle, at least I finally had a diagnosis that made sense. With the new medication and a cut back on simple carbohydrate consumption, I begin to feel a little more energetic. I also incorporate martial arts into my life, as part of my fitness regime.
Qi’Gong proves to be a wonderful addition, as it gives me a physical confidence I haven’t felt since I stopped playing competitive handball during my teenage years. I go on to lose nearly 20 pounds, and feel a sense of energy I haven’t felt in years.
In the meanwhile, our efforts to conceive remain unsuccessful and I finally go to a fertility specialist. After a battery of tests, it is obvious that I still have PCOS. She suggests acupuncture, regular intake of multivitamins, and to be cognizant of my intake of carbohydrates. If we still remain unsuccessful after these lifestyle changes, she talks through options for IUI and, eventually, IVF. I start incorporating the changes and after about 6 months, she wants to take measurements of my uterus and the size of the ovarian cysts caused by PCOS. As she inserts saline water into my uterine wall, I feel the pain of cramps from a bad period but the procedure is quick.
She confirms that my PCOS has been improving and that everything else is looking normal. We had plans for travel 6 weeks later, and we discussed options for an IUI after our return. I am not entirely satisfied with this answer, but continue to feel good about the fact that I was taking concrete steps towards reaching our goal.
4 weeks after the measurement procedure, an app I have been using to track my menstrual cycle suggests that I am 18 days late. I had been extremely busy at work, with domestic travel for a conference, and had not been paying attention to the ‘late’ notices. Upon settling back at home, I realize that 18 days seemed long whereas I had finally been fairly regular for the past 4 months, with an average interval of 40 days.
Knowing that the thyroid plays an important role in a baby’s development in the first few weeks after conception, I performed a pregnancy test yet again, fully expecting to rule it out as a possibility. After 4 years of trying, the stick finally said positive!
The pregnancy is quite smooth and my endocrinologist readjusted my medication up to 100 mcg and took me off the Metformin, once I reached 12 weeks. Even though Metformin is a Class B medication, and it was classified as ‘safe’, it does pass through the breastmilk, and not enough studies have been done to track for after-effects on the child, if any. I hesitate to stop the medication given how well I had been doing, but choose not to take a risk with the baby. My thyroid also remains stable on 100 mcg, and I don’t have an occasion to visit the endocrinologist again. This time around, I get diagnosed with gestational diabetes within the first 15 weeks (as opposed to 6 months for my daughter) and go on a strict diet to manage my blood sugar, helped by the guidance from a nutritionist. I feel great throughout the pregnancy, and barely gain any weight due to the gestational diabetes. My beautiful son is born in January, 2014.
Breastfeeding
I had been fully prepared to breastfeed, as I had had a good experience with my daughter and nursed her for two years. The nurses helped with latching on but it is still painful, perhaps more so than my first time some nine years ago. In spite of personal challenges of having a sick mother at home who is recovering from a massive stroke, I try to focus fully on the baby and his needs. He seems to cry frequently and I seem to spend 80% of the day and night trying to feed him. On day 3, a little before we are to leave the hospital, it becomes obvious that he is not getting enough from me. He is sluggish, with his birth weight dropping by nearly 10%, and a blood test shows that his blood sugar has fallen drastically. Nurses swoop in with breast pumps and also start supplementing him with formula. He rebounds by the evening and we finally come home. The next few days are a blur of pump, feed baby, eat, pump. I can see that production is very low, in spite of the time spent pumping and having him latch on. He spends a lot of time at the breast, just sucking but not really pulling. I resort to pumping and then feeding from a bottle just so I know if he is getting enough. It is a painfully frustrating experience to spend so much of my time at the pump and not with my baby who by the second week only seems to want the breast for comfort sucking and not much more.
I take him to a mommy and me clinic run by a lactation consultant, where you weigh the baby before and after a feed. It confirms my fears that he is only getting 1/3 of what he should be getting from me and supplementation needs to continue. I ramped up my efforts with fenugreek pills, thistle teas and foods that are high in liquid content. Nothing seems to be helping. When I call the lactation consultants they just tell me to make sure that I am pumping for at least 20 minutes on each side right after a feed. I often wondered what kind of support system these nurses must have had when they had babies, because after a 40 minute feed, another 40 minutes of pumping and 40 minutes to get him to glug down the formula because he was a poor feeder, we are upon his next feeding time. This leaves me with no time to watch out for my older child or any of my other home responsibilities, including caring for my mom who is still slowly recovering from her stroke, or having the time to care for my own biological needs. In spite of this, I feel like I need to continue trying because of all the literature out there promoting all the benefits of breastmilk, and also because I come from a country where 98 percent of babies are breastfed and the average age of weaning is 33 months (source: WHO Global Data Bank on Infant and Young Child Feeding). In addition to these self-imposed pressures, there are also surrounding voices that insinuate, multiple times, that because of their breast-feeding capabilities, their children did great, hardly got sick and would have explosive bowel movements, whereas my son was struggling to go once a day. With all these social chatter, I feel that if I am unsuccessful with breast-feeding, I am only half a mother, and certainly a failure as a woman.
After about 3-4 weeks of this torture, I keep questioning whether this is normal. Since no one seems to understand the depth of my struggles, and pumping is the only answer I get from lactation consultants, I start my own investigations. I rationalize that since my last pregnancy, when I did breastfeed successfully, the major differences in my body were my hypothyroidism and PCOS. I start googling any correlations between breastfeeding and either or both of these issues. My screen lights up with many references that confirm a correlation with reduced milk production for patients who suffer from either of these illnesses; I had both. Never during my pregnancy, or post baby, was I informed that I should watch out for this and, in case it happened, what are some measures I could possibly take to help. This is in spite of the fact that there is plenty of literature out there that supports the correlation even if a full cause and effect, including full physiological explanations, have not been established. Here are a few references:
· Buckshee et al. found a lactation deficiency rate of 19.2% in their study of mothers with hypothyroidism despite hormone replacement treatment during pregnancy.
· Researchers have speculated that one reason why some women may have difficulty breast-feeding and producing an adequate milk supply for their infants is because of the many hormonal imbalances associated with PCOS. The hormonal aberrations in PCOS involve insulin, progesterone, prolactin, and estrogen, all of which are important to breast development and milk-secreting ability[2].
· In 2003, Hapon et al. induced hypothyroidism in rats before mating and compared these rats to controls during lactation. They discovered no differences in suckling-induced prolactin release but did find a reduction in circulating oxytocin after suckling. The treated mothers released less milk than did control mothers, resulting in poor milk transfer and poor litter growth.
Armed with the information, I finally reach out to a lactation consultant with my concerns and she finds references in a book for things to try such as Goat’s Rue, being back on Metformin, Thistle tea. I take this information to my endocrinologist and she tests my levels of prolactin. The test results are measured within the following ranges of ‘normal’:
Nonpregnant 2.8-29.2
Pregnant 9.7-208.5
Post Menopausal 1.8-20.3
I clock in at 58.9 at 5 weeks post-partum and she declares my numbers to be OK enough to lactate successfully. She could not shed further light onto any physiological reasons for low milk production and suggests that sometimes it just happens to be low. Much later I realize that the benchmark table probably should have included more entries, such as:
· Non-pregnant, not lactating: <24ng/mL
· Pregnant, at term: 200 ng/ML
· Lactating, 7 days postpartum: 100 ng/ML
· Lactating, 3 months postpartum: 100 ng/ML
· Lactating menstruation not started before 180 days: 110 ng/ML
· Lactating, menstruation started before 180 days: 70 ng/ML
· Lactating, 6 months postpartum: 50 ng/ML
Source: http://kellymom.com/bf/normal/prolactin-levels/
Note that according to this table, my levels are nearly half of what it should be for something within 3 months postpartum. However, not knowing this at the time, I continue my insane regimen of pumping, drinking, taking pills and sleepless nights of pumping longer after he falls asleep. I also look into milk banks but they are prohibitively expensive for mothers without preemies.
In spite of all my efforts, my son needs to be supplemented with formula, and it breaks my heart to see that he continues to look for breastmilk after my meager offering is chugged down.
As it turns out, my son has a gag reflex stronger than average. He had issues latching on from the beginning but by week 6, he started gagging within seconds of latching. Feeding him through the bottle becomes the only way I can get him to drink breastmilk, and this robs me of one the most precious bonding moments I had shared with my daughter. As his needs grow, my production does not grow commensurately with it. I go from being able to make about 40% of his intake down to 10%. I feel like I am limping along even though my efforts to produce more had not abated. I finally break down and pump for the last time on the day he turns six months old. I cannot describe the sense of loss I felt, nor the frustration that my body, at the ripe old age of 37, had already started breaking in ways I was not prepared to deal with.
Breastfeeding Failure: Understanding and Internalizing
Once I had had the chance to calm down and have my son normalize on the formula, I started questioning my range of emotions I had gone through in the prior few months with regards to breastfeeding. Why did I feel like such a failure? Why could I not look at my child without guilt? Why could I not accept that my body had changed in the last decade? Partly, I think it was harder to accept because I had experienced the beauty of breastfeeding once and would want to give both my children the same chances. But more of these conflicting emotions were due to how society has created this notion that unless you choose to breastfeed your baby, you are shortchanging your child. This mantra is baked into our heads from multiple sources: widespread media espousing the benefits of breastmilk, the older women in our families, and even the Q’uran suggests that we breastfeed the child until they are two years old. Go to Google and put in ‘benefits of breastmilk’ and this is what pops up in bold:
“Breast milk contains antibodies that help your baby fight off viruses and bacteria. Breastfeeding lowers your baby's risk of having asthma or allergies. Plus, babies who are breastfed exclusively for the first 6 months, without any formula, have fewer ear infections, respiratory illnesses, and bouts of diarrhea.”
No wonder I felt like I had let my son down.
These contextual pressures aside, I also felt let down by my medical team, a cumulative effect of several years of being fed misinformation or partial information. I felt that it took too long for someone to connect the dots in my medical history and arrive on my problems with insulin resistance; during my pregnancy the OB/GYN and my endocrinologist should have flagged possible breastfeeding issues before I had the baby so that I had a better understanding of what to expect; the nurses/ lactation consultants at the hospital should have been better aware of my medical history and taught me what to look for in my baby’s intake; society, family and friends need to be kinder when a mother is struggling; there should be better benchmarks to look at for lactating mothers with hypothyroidism and/or PCOS; and, most importantly, the medical care team from nurse to doctors should try to learn and grow with the various needs of diverse patients. Just as no one size fits all, no one solution is the definitive answer to a woman’s dilemma with hormonal issues or breastfeeding.
After I made the painful decision to stop nursing, my only solace came from a study done at the Ohio State University in 2014. It claimed that the benefits of breastmilk appear to be overstated. It contends that in families where siblings were differently fed (as opposed to comparing children across disparate demographics), in 10 out of 11 indicators of child health and well-being, the differences were not statistically significant. When I read it, I finally felt at peace with my decision to stop nursing. I sincerely hope that more mothers get to read this on time, before embarking on painful paths that are not meant to be successful.
It took me a long time to boldly tell myself that I did not chicken out and I did not short-change my son. If there was a rock to be milked, I milked it. I tried my utmost to treat him the same as I did my first born. I also came to accept that, with age, my body has morphed. Maybe more so than the average, but it bears the marks of many trials and tribulations more intense than the average as well.
Even though I truly have no reason to feel guilty, there remains a voice inside that seek social validation and acceptance of the path I had to take. I have now come to realize that, at the end of the day, I have to learn to be kinder to myself. That is harder to do than I had ever imagined but it is a journey worth completing because it truly helps to embrace the world with love, in spite of all its imperfections. And until I can reach this stage of being able to have my arms wide open to come what may, I truly cannot be as good a mother as I would want; one who is able to nurture another human being into becoming a responsible and contributing citizen of the world.
Infinity & Beyond
My thyroid numbers have been within normal ranges since I had my second baby, and the medication dosage has stabilized. I am now on 88 mcg of Synthroid 6 days a week, coupled with Metformin and Vitamin D. The vitamin D deficiency manifested itself after I had baby # 2, and the doctor suggests that it might be a contributing factor in my feeling depressed from time to time. There are too many external stressors in my life to squarely lay the blame of my maladies at the feet of my illnesses, but I can see that with better eating habits, and exercise, I do tend to do better. I am mindful of controlling the intake of refined sugars, and have cut back significantly on eating processed foods of any kind.
Nevertheless, there are still days I feel far from healthy. Even though he is nearly two years old, my son still craves my touch in the middle of the night, which means several hours of restless sleep for me every night. Some days, I feel so tired and exhausted that mind, body and soul desire that I curl up into a ball and remain on the sofa until I feel enough energy to move an inch. But, with a toddler and a 5th grader to chase after, not to mention the growing business I had co-founded with my husband, life is anything but static and restful. Amidst the busy schedule, I am trying to make conscious and good choices, as well as incorporating workouts whenever and however possible.
I hope that my medical team continues to grow with my needs, and continue to listen attentively. We all need to bear in mind that for the 2-3 days out of the year I get to see the doctor for an hour each, I spend thousands more reacting to the fluctuating functions in my body. When I am articulating my issues to my medical team, it is worth for us both to explore it fully instead of settling on a quick and easy path. I hope you will all do the same for you. At the end of the day, if your health fails you, everything else that we are striving for become rather insignificant.
About the Author
MH is a Bangladeshi American entrepreneur, philanthropist, small business evangelist and a mother of two. Struggling with hormonal imbalances from her pre-teen years, her medical saga has unfolded over decades, on several continents, each episode punctuated with misinformation or lack of information. In an effort to empower other women with autoimmune conditions tied to hormonal imbalances, she is publicly sharing her experience to help bring better transparency in information sharing and more vigilance from the medical care teams.
[1] http://www.aljazeera.com/indepth/features/2014/09/maternal-deaths-decline-sharply-bangladesh-20149975534783651.html
[2] See more at: http://www.pcosnutrition.com/links/blogs/breastfeeding-and-pcos-maximizing-success.html#sthash.gohZy8p8.dpuf
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