Seven months (and then some) post-adrenalectomy.

The seven-month mark since the surgery has come and gone, and I don’t have a lot to add beyond my six-month report other than two cliches: (a) I still have no regrets, and (b) time flies, doesn’t it?

Instead of blood pressure and potassium, I’m finding myself far more focused on the nutrient malabsorption problem that is the likely culprit behind my vision issues. The Vitamin A supplements I’m supposed to be taking, like nearly everything I ingest that isn’t chicken, eggs, rice, spinach, or nuts, were making me sick. As in, stay close to the restroom sick. Use your imagination… So, in frustration last week I asked my doctor why not instead focus on keeping the nutrients I get from my food *in* me, rather than just keep taking more nutrients.

He did a quick bullet-pointed rundown of things that can cause malabsorption syndromes, the obvious ones being celiac disease and lactose intolerance. Check, and check – both present and accounted-for, as well as fructose intolerance, but I’ve been strictly gluten-, lactose-, and fructose-free for years. Why the sudden increase of symptoms?

On to the next theory: a bacterial infection, commonly known as SIBO (and getting a bit of non-scholarly press these days, making me an immediate skeptic, but still keeping an open mind). He wanted me to do a hydrogen test, which is how my lactose and fructose intolerances were diagnosed – and which, when I had it done in 2003, left me sick for two weeks afterward. No thanks. Instead he opted to go for an “empirical trial” of antibiotics – Xifaxan 550mg twice a day for 10 days.

The first day of the meds, I felt worse than ever. The second day – much better. And today, 4 days into the course of meds, my stomach seems to have calmed down more than – ever, really. As with most celiacs and others with food intolerances, I’ve had mysterious digestive issues my entire life, and this sudden feeling of, erm, inner peace is probably not something I’ve ever experienced before.

Unfortunately, this brings up more questions than answers, really. The fact that the antibiotic has done something to calm things down is pretty conclusive proof that I have some sort of bacterial infection; whether or not it’s officially SIBO remains unknown. Does that matter? I don’t know. Whether or not this is a permanent fix is also unknown; the SIBO info I’ve found online all seems to point toward repeated courses of antibiotics. Which I’m not thrilled about.

Besides antibiotic therapy, there are a few approaches to dietary intervention for SIBO: GAPS diet, Specific Carbohydrate Diet, and Low FODMAP Diet. Of these, the third is somewhat related to the fructose-free diet that I already follow, so I’m reading up a bit more on that. The downside for me is that all three of these rely heavily on animal products *and* home cooking – not my favorite combination, as I am the world’s most squeamish cook! Which means that really, nothing much will change – I’ll continue to live on chicken, eggs, rice, spinach, and nuts, but hopefully after the course of drugs is done, I’ll actually get some nutritional benefits from these things. Which is the whole point of eating, right?

Six months (!) post-adrenalectomy.

Yesterday – Friday the 13th! – marked the six-month mark since my surgery. Six months! I’m not sure how that happened. My memory of being in the hospital remains crazy-clear and so much more recent. I’m still pondering conversations I had with visiting friends. And wondering if I really *did* flash my scars to everyone who visited.

But. How am I doing? Just fine, thanks. I’m not really due for much in the way of bloodwork until the 1-year mark, but here are the numbers that seem to matter right now:

• Blood pressure: averaging 122/79. I’m not checking it obsessively as I once did, but am happy to report that when I do, the numbers are nearly always in the 120s/70s. Except immediately after drinking coffee, which is something I’m trying to determine if I should be doing at all any more.
• Weight: steady at 111, despite the fact that I’m eating rice pretty much daily. Or potatoes. Or hey, when I’m feeling really daring, sometimes both! Before the surgery, rice – the only grain I can eat, due to a miles-long list of food intolerances – made me pile on the pounds pretty easily, and gave me a bit more reactive hypoglycemia than I was comfortable with. Potatoes gave me really, really bad reactive hypoglycemia – full-on food coma, even in tiny amounts. Now neither one bothers me, which is my unscientific way of proving that (a) the tumor caused insulin resistance, and (b) now that the tumor is gone, so is the insulin resistance.

As I keep yammering on about over at the Yahoo board, I really, strongly believe that there is so much more to this disease than hypertension and low potassium. So. Much. More!!! I realize that those two things are the things that can kill, but so can insulin resistance/diabetes, which I am fully convinced goes hand in hand with this illness. And considering how common IR and T2 diabetes are in the U.S., I have to wonder if it’s really a “rare” disease. My mother, for example, is one of seven siblings – the only one not to develop T2 diabetes and die at a younger age than her mother (who lived to be close to 100; her mother’s mother made it to 103!). My mother’s father, on the other hand, died of a heart attack in his early 50s. My hypothesis: adrenal adenomas, all of them, passed down along the paternal line to all except for my mom, who seems to have won the genetic lottery in many ways. Perhaps it’s no coincidence that from a phenotypical point of view, she resembles her mother; I, on the other hand, am a carbon copy of her dad.

I’m also pretty certain that as long as this country’s health care system remains unchanged, this will remain a “rare” disease and people will continue to die young, of heart attacks and strokes and diabetic complications, or suffer compromised quality of life. There is so obscenely much profit in drugs for hypertension (none of which work in PA, but most doctors don’t know that), and even more profit in drugs for diabetes. If a relatively simple surgery like mine can fix the problem and eliminate the need for drugs entirely – imagine the losses the drug companies would suffer. As long as healthcare remains profit-oriented, this cycle is not going to end.

I’ve said all of this before, I know. And I’ve also stated my belief that I’m one of the lucky ones. Not a single day has passed in the last six months when I haven’t thought about this, how thankful I am for the circumstances that made me able to say this: the accident of where I live (5 minutes from a top medical school), the support of my friends (without whom I never would have had the balls to go through with a surgery that may or may not have worked), and my own darned stubbornness (if I don’t like the answer I am given, I keep asking until I do like it).

Jeepers, creepers.

I’ve got messed-up peepers!*

When we last saw our heroine, she had just visited the chief of retinal disorders at UCLA and was scheduled for further testing. Well, that testing took place yesterday. Let me preface my recap by saying that this has absolutely nothing to do with PA, but it is yet another installment in the story of Me as Medical Oddity. And I don’t like to leave a story unfinished, so here’s what I now know:

The tests I had were the Farnsworth Munsell 100 Hue Color Test, and electroretinography or ERG. The color test was actually fun – it reminded me of being a little kid, when my artist father would dump out the entire 64-color box of Crayolas on the floor and ask me to arrange them in correct chromatic order. And apparently I passed with, pun intended, flying colors… I don’t technically have any issues with differentiating colors. I didn’t think so, but now it’s official.

The ERG, on the other hand – not so much fun, although in the company of my dear friend C I’m pretty sure that I had a better time of it than most. The test begins by sitting in a dark room for 30 minutes – something that I think would have been complete agony alone, but was actually rather entertaining with a friend – while the dilating eyedrops work their magic. Then these plastic thingies are placed on the eyes that are sort of contact lenses that keep the eyelids from being able to close. Sounds kind of awful but really was not a big deal at all. The test itself involves looking into this dark enclosure while a series of lights flash on and off, and the response my rods and cones have to these lights is measured.

Despite my main complaint being night blindness, according to the test my night vision is normal. But the third part of the test, which measures reaction to light, was not normal. The short version is that while my eyes respond normally to light in terms of time, they do not respond normally in terms of amount, which is why bright sunlight – something I dearly love, by the way – hurts my eyes and I rarely go outdoors without sunglasses and often a hat. The official diagnosis is mild cone dysfunction with photophobia and impaired night vision. Is it progressive, is it genetic, is it degenerative – these are all unknowns.

Also unknown is the cause of the night vision problems. My vitamin A levels were borderline low, so I’m on 25,000 IUs of beta-carotene for the next 4 months to see if that makes any difference.

As for night driving – the directive I was given was “proceed with caution” and basically, the minute I start questioning my abilities at all means it’s time to stop driving at night. The truth is, I’ve been questioning those abilities for years now, so I’m not certain that I’ll be the best judge of that… if the vitamin A doesn’t make any difference, though, it may be time for me to start calling a taxi after the sun goes down.

So really, the story remains unfinished, but what can be concluded is this: I don’t have (as originally feared) any signs of ocular damage from prolonged uncontrolled hypertension. And as far as I’m concerned, that’s a good thing.

*Enormous apologies to Johnny Mercer and Harry Warren. I could not help myself.

The good news: I probably can’t blame the tumor.

The bad news? Hopefully there won’t be any, but that remains to be seen.

Last month I had my routine optometric exam, and as mentioned here, my optometrist thought he saw signs of vascular damage and early macular degeneration.

Today I had an appointment at UCLA with the chief of retinal disorders, who is pretty certain that I have neither. What I do have is some very slight spotting on my left retina that is probably nothing; I do have a family history of macular degeneration so apparently my optometrist concluded that was that. It isn’t. What it is remains unknown.

As for the “vascular damage,” the opthalmologist I saw today believes the optometrist saw that my ocular vein structure is “very thin” which is something that happens when there is vascular damage. The ophthalmologist doesn’t think it’s that; he just thinks like the rest of me, my veins are small. His words: “Your veins are very thin, but so is the rest of you.” Fair enough.

But. He ordered further testing for something completely different than what brought me in: cone dystrophy. I’ll be getting an electroretinography and color testing next month, hopefully to rule things out rather than to diagnose anything but we all know how that goes.

He also tested my blood levels of Vitamin A, B12, and folate, as a vitamin A deficiency is a common cause of some of the vision disturbances I’ve been having, and as someone with gluten and fructose intolerance it’s really likely that I have some vitamin malabsorption issues. This would be the best-case scenario and would probably be solved by injections of the stuff I can’t get from food. Easy enough.

Worst-case scenario: if I do indeed have some sort of cone dystrophy and it’s not a malnutrition issue, there is no cure.

While being screened for yet another “rare disease” is not what I hoped or expected would be the outcome of this appointment today, I have to say I’m relieved that what I’m getting tested for is in no way related to prolonged untreated hypertension or anything else related to the tumor. After the 9 years of clueless doctors who never ordered the tests for hyperaldosteronism, I will probably always be a little bit worried that somehow, something got damaged as a result. At least that isn’t the case this time.

Anyway – here’s hoping that lots of vitamin shots are in my future!

Moderation: just another word for “denial.”

In my last post, I briefly touched on the relationship between PA and insulin resistance – in short, that it can be caused by the potassium depletion from the PA. I’ve been thinking about this quite a bit lately – what it meant for me during the 10 years that I had untreated PA, what familial link there may be, and on a larger scale, where it might fit in to the nation’s diabetes epidemic.

In January 2003, when I was at my sickest (and my highest weight, a whopping 173 pounds), I was diagnosed with two of the three: insulin resistance and metabolic syndrome. With a strong maternal family history of diabetes and heart disease, this would have been enough to scare me into action, but I was lucky: I was also diagnosed with fructose intolerance at the same time. The end result of following a diet for fructose restriction was essentially a low-carbohydrate diet – no sugars, no grains, no fruits – which enabled me to lose 50 pounds in less than three months. I’m pretty certain that this saved my life – at the very least, it reversed many of the symptoms of metabolic syndrome – and thus, I am a big believer in carbohydrate restriction as a preferable treatment (over drugs) for insulin resistance.

My mother, age 86, is the middle child of seven siblings, and is the only surviving one except for the youngest. Of the five who have died, four of them have died from diabetic complications or heart disease (or a combination of both, as all were diabetic). All were obese. The youngest living sibling is also obese and diabetic. The only two of the seven not to become both obese and T2 diabetic are my mother and the one sister who died young (a suicide).

When one begins the diagnostic process for PA, there are a lot of questions about family history. I don’t have a lot of information, but based on what I was able to put together – mainly, the above paragraph – I came to two conclusions: first, while I have no proof of this and never will, I suspect that every one of the siblings above who died of diabetic complications had an adrenal tumor. And, second, if one becomes diabetic as an adult, the best things one can do are remove all sugar and grains, processed foods, and “eating for entertainment” from one’s diet; and get up off one’s butt and move. I am convinced that I reversed my insulin resistance early on because I refused to remain sick and fat (even if this could not reverse the tumor!), and I am convinced that my mother’s apparent immunity to these diseases is due to her lifelong habit of walking everywhere (she never learned to drive).

~ ~ ~

Even if my adrenalectomy has, at least for the time being, rescued me from the danger zone of developing diabetes, I remain extremely interested in the subject, and I have RSS feeds set up for news items about the disease. So even though I don’t watch television and could care less about celebrity chefs, the recent hubbub about Paula Deen’s diabetes diagnosis came across my radar. And I’m siding with Anthony Bourdain here – she really is the most dangerous woman in America.

Why? Not because she advocates eating bacon cheeseburgers sandwiched between two glazed donuts, but because she advocates moderation (WARNING: link with sound!). Loudly and emphatically. Sorry, Ms. Deen, but I’ve got news for you:

Moderation doesn’t work. And you are living proof of it.

First, moderation goes against human nature. We’re hardwired to survive, and survival, historically speaking, means beating famine. So, when presented with food, we eat. Simple enough.

And, second, as I noted above – when one has metabolic derangement, carbohydrate restriction can work wonders. And that means complete and total restriction of all processed foods, sugars, and grains. That doesn’t mean “once in a while,” that doesn’t mean “have a cheat day,” that doesn’t mean “a little bite won’t kill you.” Because it will. Maybe not today, but slowly and painfully, it will kill you. If you don’t believe me, do a Google image search for diabetic foot (WARNING: disgusting images!).

Moderation, in my opinion, is just another word for denial. The minute one is diagnosed with any form of metabolic derangement, be it insulin resistance, T2 diabetes, or metabolic syndrome, one’s life changes. Or perhaps more accurately, one has to change their life – that is, if one wants to take control of the situation and get healthy again. The choices are simple:

• Stop “eating for fun” – that means no cupcakes, no ice cream, no fast food, no corporate chain restaurants serving plates of ConAgra with a side of Monsanto – and get up off your butt and move.

OR:

• Practice “moderation” and expect to be feeling crappy, popping pills, and getting fatter and sicker for the rest of one’s life.

There are only two choices. It’s up to you.

~ ~ ~

If you have been diagnosed with insulin resistance, pre-diabetes, or metabolic syndrome, read this first. It’s a pretty decent overview of what each of the terms mean.

Once you have done that, head over to Blood Sugar 101 and read every word that Jenny has written. Chances are it will contradict everything your endocrinologist tells you. And, unlike what your endocrinologist tells you – moderation, lots of whole grains, and many expensive drugs – it will work and you will feel better. It’s worth a try, isn’t it?

Three months (and a few days) post-adrenalectomy.

A few notes:

• As of the first of the year, my doctor released me from the no yoga/no lifting/etc. directive and told me to get back to normal life. My pain from whatever I did to the incision site is, once again, almost completely gone. Here’s hoping it stays that way!
• Blood pressure remains textbook normal. 114/73 today. I’m having labs done on the 25th to check potassium and the other stuff that was really wonky before the surgery – cholesterol, HBA1c, CRP, and C-peptide.
• I had a haircut appointment yesterday for the first time since the surgery. My hair texture has completely changed and I’ve lost quite a lot of hair (as was evidenced by the previous week’s need to call the plumber to hydrojet my shower – never had to do that before!). I know that hair loss after surgery is really common, but of course this worries me. Mine all seems to have happened in the last month.
• I’m continuing to lose weight without trying. Down to 111, a low I haven’t seen since the late 1990s. So if someone asked me if PA effects weight – heck, someone did ask me last night – my answer is yes, absolutely. (ETA: a brief dialog with the doc over at the Yahoo hyperaldo board led to my understanding that this is how it works: low potassium causes insulin resistance; once the low potassium is corrected, the insulin resistance goes away. Apparently correcting low potassium via oral supplements, as I did pre-surgery, isn’t always going to achieve the same effect for a number of reasons; mainly, the levels that are monitored – plasma potassium – are not the most accurate reflection of true potassium levels in the body.)
• Had my first bit of bad news since the surgery. Last week I went to my optometrist for a routine prescription update. He dilated my eyes and noted that I have visible vascular damage. We discussed PA extensively and he understands what I’ve been through, but can’t really comment as to whether or not the damage he noted is reversible, or what, exactly, it means for me long-term. He also saw early signs of macular degeneration, which runs in my family (but usually doesn’t hit until age 70 or so – I’m only 46!). My mother has this, so I’ve always known that there was a good change I would eventually too. But from what I’ve read, uncontrolled hypertension – you know, that thing I had for 10 years while I was waiting for someone to diagnose my tumor – can also be a cause. I’m currently waiting for a referral to the chief of retinal disorders at UCLA to get to the bottom of this, and trying not to freak out. Or get too pissed off at the series of doctors who were unable to diagnose me all those years!

ETA: yeah, it was getting to me so I did a bit of Googling about the hair-loss-after-surgery thing. Apparently I’m right on schedule – the two-to-four month mark seems to be when it happens. A little disappointing since shedding was an annoying affect of the hyperaldo for me, and the surgery seemed to have stopped it. Oh well. It’s hair; it grows. I hope.

http://www.ehow.com/about_5390925_losing-hair-after-surgery.html

http://www.surviving-hairloss.com/post-surgery-sudden-hair-loss.html

http://ask.metafilter.com/137548/Help-save-my-hair

Two months (and a couple days) post-adrenalectomy.

Hard to believe it, but my surgery was October 13 – that was over two months ago! And even though I’ve hit a bit of a bump in the road, I can still say with absolute certainty that it was the right decision. Not that I ever really had any doubts.

The good: The blood pressure remains in the normal range, so much so that I don’t really bother to obsessively track it as I once did. Next month I’ll be getting some bloodwork done to check the other stuff, mainly potassium, more in the name of science and documentation than to check for anything that may be amiss. Because really, the best test of potassium levels for me is headaches and muscle spasms – if I don’t have those (and I don’t, not a single one of either since the surgery) then I know everything is fine.

The bad: I’m still dealing with lingering pain at the incision sites. It ranges from dull-and-mostly-annoying to occasionally bringing a tear to my eye; when my doctor asked me to describe it on a scale of 1 to 10, I gave it 3 for actual pain and 6 for the annoyance factor. I’ve been getting it acupunctured, which seems to help. I was also given the option of an injection into the muscle for pain management – eep! You know, I’m fine with the acupuncture needles, but that… just sounds like a last resort to me, so I’m  not going there. Yet, anyway.

The… interesting: Very little is known about living with one adrenal gland, so I’m sort of keeping track of things that have changed since the surgery that don’t have a direct correlation to the renin-angiotensin-aldosterone system. Here are a few:

• Weight loss. I’ve heard from others that they lost about 15 pounds almost immediately after adrenalectomy; mostly due to the elimination of salt and water retention. But most of them were overweight to begin with; I wasn’t. I’ve lost close to 10 pounds; to do the math, this is 1/12 of my pre-surgery body weight. I’ve also lost half a shoe size; again, I’m guessing this was from edema of some sort. But the oddest thing? My belly is nearly flat for the first time in my life. Even at my thinnest – 89 pounds back in 1997 when I was first sick and nobody knew why – I had a pot belly. Even as a scrawny little kid, I had one. Now I don’t. Of course this makes me wonder if I’ve had PA for much longer than originally suspected.
• Eating. After a very long time of eating next to nothing at all because the sodium content made me so sick, I’ve been slowly introducing more… normal food back into my diet. It’s been hit-and-miss. I’ve eaten salty Indian restaurant food a couple times and been just fine. I’ve eaten salty Japanese restaurant food a couple of times and gotten really sick afterward. I think I know the culprit, and facing this kinda makes me want to cry: soy sauce. Specifically, soy sauce made with wheat, which is what is most commonly used in this country. While my tests for celiac were negative and I’ve always operated on the principle that I am gluten-intolerant but not true celiac, those tests were never accurate since I was already gluten-free when my biopsy was done. But my Japanese restaurant encounters have each resulted in full-blown celiac-like symptoms, so I think that kind of says it all. The other possibility is that I’ve developed a soy intolerance. Either way – good times! Only, not.
• Caffeine, carbohydrates, alcohol: Another post-adrenalectomy patient has written of issues with hypoglycemia as well as caffeine and alcohol. I’ve dealt with hypoglycemia since childhood and have been able to manage it pretty well since I don’t eat sugar and wheat to begin with – simple carbs are the worst thing for hypoglycemia. Since the surgery, I’ve eaten rice and potatoes in small quantities and had no problems, whereas before the surgery eating either would have put me into a food coma even at small amounts. My response to caffeine has been unpredictable – sometimes when I really need it to pick me up, I can have a cup of coffee and still feel like I could take a long nap directly afterwards. Other times I’ll have a half-cup and feel like I’m bouncing off the walls. Green tea seems to agree with me far better, so I’m drinking more of that and less coffee. As for alcohol – I’ve been scared to go near the stuff ever since I had a bad reaction to it last summer during my brief experiment with spironolactone. But I’d like to join in the holiday festivities of the next couple of weeks, so perhaps I’ll have more to say on the subject soon.
• Acne: My adult-onset acne issues seem to have relocated from my face and back, to just my back. While I was hoping for this to vanish completely, hey, I can live with this. I still think there is lingering hormonal stuff going on and am hopeful that time will take care of this.

So… all of that to say that the good still continues to outweigh the bad. The biggest challenge is navigating the unknown, which I suspect I’ll be doing for quite some time.

One year ago today.

Or yesterday, depending on how you look at things – regardless, the actual date was December 10. I had a day off from work and I spent the morning playing ukulele with friends in the park; that afternoon I walked into a medical office having absolutely no idea that my life was about to change.

While October 13 is the anniversary date of my surgery, without the events of December 10 it never would have happened. So I can’t let today pass without a tip of the hat to the man who set the wheels in motion.

Thank you, Dr. Gordon.

 

Two steps forward…

…and better make that not one, but two, steps back.

Around the middle of last week I began complaining a bit of pain at the surgery site. With the holiday coming up I tried to not think about it too much; I knew that my doctors would be impossible to reach and I didn’t want to have to explain my whole medical story to somebody knew. I went about my business – busy-ness? – driving, walking, yoga-ing, and lifting (been in the midst of a downsizing-my-stuff frenzy).

By Saturday morning the “bit of pain” had become constant. I continued to ignore it, continued the driving, walking, yoga-ing, and lifting.

By Tuesday morning I was worried. Laughing hurt. Coughing hurt. Getting up, sitting down… yep, that too. Breathing hurt. So I finally made an appointment with my doctor, who I saw this morning. And not a moment too soon – I had been up, on and off, since 2am debating whether or not a trip to the ER was in order. I figured no fever, no emergency, right?

I was right. My doctor thinks I pulled a muscle, irritated some scar tissue, or ripped the internal stitches. Or all of the above, considering my pain level. It happens; its not uncommon, even this long after surgery. You can see it – the incision sites are looking a bit red and angry, and my left side is visibly swollen. So it’s ibuprofen and a heating pad for the rest of the day.

And orders to slow down a bit.

Who, me??

Six weeks post-adrenalectomy. And, thankful.

Happy Thanksgiving! Appropriately enough, I’ve posted a note of thanks, and a condensed version of my story, on my adrenal surgeon’s blog, here.

My adrenalectomy was six weeks ago today. I still have occasional pain on the left side near the largest incision, but aside from that, I just keep feeling better. I blame the pain on the long hours of sitting hunched over a computer in order to earn a paycheck, and am hoping to remedy this by getting a standing desk soon. After all the walking that I did during my time off right after surgery, I am more convinced than ever that sitting all day – what has become the norm in our post-industrial society – is really, really not good for you. The days that I don’t get a long walk in, my blood pressure runs higher – 120s/80s instead of 110s/70s – and that, in and of itself, is proof enough for me: we are meant to get up and MOVE!

The most notable recent change for me has been the sensation of cold. Yes, it’s practically winter in many parts of the world, but here in Southern California it’s not exactly freezing, and I have not been accustomed to feeling especially cold in previous years. But this year? Brrrrrrr. I’ve had to buy a few things like corduroy pants, instead of the dresses and skirts that I prefer to wear, and a “real” coat (instead of a lightweight jacket) because I can’t seem to stay warm when the temps drop even a little. And I’ve become very, very enamored of fleece. When I had the tumor I was always, always running warm, and often running an inexplicable low-grade fever, so this is quite a change and is taking some getting-used-to.

The other post-surgical change that seems to have become a permanent fixture is that my sleep patterns have completely reversed. Prior to the surgery, I had always had night-owl tendencies and rarely went to sleep before 1am. On weekends, if I didn’t have a compelling reason to get up, I would sleep until noon. Maybe later. While I quite enjoy the night-owl part of the equation, I wasn’t thrilled that I was sleeping half my weekend away, but any time I would try to get up earlier I would end up feeling really sleep-deprived. In the days immediately after the surgery, though, my sleep cycle was completely out of control – two hours of sleep followed by three hours awake, with an overwhelming need to nap at 2pm every day. Now that I’m back to work and on a schedule, this has evened out a bit and now looks like this: by 11pm I can hardly stay awake, so I turn in “early” (hey, that’s early for a night-owl!); I sleep through the night and find myself wide awake at 7am, completely without the grumpy, out-of-sorts feeling that the 7am hour brought prior to the surgery. I’m not sure how I feel about this, but on paper it certainly looks normal – hey, isn’t that that eight hours of sleep everyone is always telling us we should have?? I’m enjoying being up and out and about early in the morning on weekends, before everyone else is doing the same thing, but I miss those post-midnight hours and the clear focus and creativity that would come to me at that time. If I could only channel those things into the spare morning hours… Perhaps more coffee would help…

Still. Minor complaints. Not really complaints at all; observations. I remain confident that my decision to have surgery, six weeks ago today, was the right one. For me.

So. Yes, thankful.