Extreme Cortisol Pumping: Pumping During Surgery

A few days ago, I had my 10th surgery. This one was different as opposed to the previous nine. For the first time I was permitted to wear my pump during the procedure.


So how did it go?


This was a fairly quick, laparoscopic abdominal surgery. Patients without comorbidities are usually back home in a few hours. Since I have adrenal insufficiency and some signs of pheochromocytoma, they did keep me a little longer as a precaution. 

Speaking of precautions, if you have adrenal insufficiency you MUST speak to your surgeon, endocrinologist and anesthesiologist about your steroid plan for surgery. Everyone needs to be on the same page. I can’t tell you how many times I’ve heard adrenal insufficient patients say, “oh the anesthesiologist knows what to do” DO NOT EVER MAKE THAT ASSUMPTION! They do tend to keep solu-cortef in the operating room, but that doesn’t mean they will dose it correctly. Some anesthesiologists deviate from the standard of care and come up with their own plan using less steroid. They think they’re doing you a favor, when really they are unknowingly endangering your life and hindering your recovery. DO NOT LEAVE THIS UP TO CHANCE! Make sure you’re on the same page!


As soon as surgery was mentioned, I made my concerns clear. I knew there would need to be special precautions because of the risk of adrenal crisis or hypertensive episodes due to pheo. I spoke to my surgeon and endo about this as well as two anesthesiologists. I had to have more tests than the norm in order to be cleared for surgery. I had to have any possible pheo activity blocked by taking blood pressure medication for a couple months. At this hospital they don’t assign an anesthesiologist until the night before the procedure. This makes communication a challenge, but by the time I actually met her, pretty much everyone including the nurses had already heard about my steroid plan and pheo concerns. When I discussed it with her, she had already heard my plan and was thankfully in agreement. I would receive 100mg of solu-cortef before and after the procedure and keep my pump running.

https://www.addisons.org.uk/files/file/4-adshg-surgical-guidelines/


This is where I made a mistake. I planned on running a straight 10mg/hr during the procedure. However I forgot to program that profile into my pump. I programmed it in pre-op and realized my settings only allowed me to go as high as 8mg/hr. I didn’t want to edit my settings at the last minute, so I programmed 8mg/hr. That would have worked just fine except I FORGOT TO SWITCH OVER TO THAT PROFILE. Yes, it is all well and good to program a profile, but you have to actually “run” said profile for it to work. Oops! So during the procedure I was running my normal every day basal program of 30.2mg/daily. 🤦‍♀️


I woke up being wheeled into recovery. My abdomen hurt so bad. They gave me IV pain medication, but the relief began to fade after a couple minutes. They gave me another dose. Then I watched the nurse give me 100mg of solu-cortef. 15 minutes later I was moved to a regular room. That’s when I realized there was a problem. The IV pain meds had worn off already. My pain was uncontrolled. I felt nauseous, but the nurse would not give me any oral pain medication until I ate something. I had a couple spoonfuls of pudding and felt sick. I was given IV zofran with minimal effect. Still sick. Every IV medication I’d been given seemed to metabolize way too fast. This has always been the case for me, and it’s the main reason I had to switch to the cortisol pump to begin with. 
There’s a familiar and unpleasant feeling I get when my cortisol isn’t sufficient. It’s an uneasy, almost panic feeling where I’m keenly aware that something isn’t right and I’m increasingly desperate to find relief or escape. It’s more like a primal instinct, “Something is wrong, help me!” I’ve unfortunately felt this enough times to realize it was cortisol related. I realized then my pump was still set on the measley 30mg profile. I immediately switched it to the 8mg/hr profile that I had programmed in pre-OP. The problem is it takes a while for pump rates to build your blood cortisol level. For whatever reason my body did not keep those 100mg IV solu-cortef boluses in my system very long. So I had to suffer while my rates caught up. Meanwhile the nurse had given me a couple doses of pain pills, and IV phenergan. Phenergan only helped the nausea for 5 minutes or so, but thankfully it made me extremely sleepy. I was able to sleep through the misery and give my pump some time to do its thing. A few hours later the nurse came in to check on me, by then the pain meds were working and my pump was kicking butt. I was still pretty knocked out from the phenergan, but I felt well enough to get dressed and go home. My nausea was gone and my appetite had returned. Yay for proper steroid dosing!


Friends, I can’t tell you enough how much sufficient steroid dosing will make or break a situation. Especially a high stakes situation like a surgery. It’s amazing how fast I went from utter misery in the hospital, to eating a sandwich at home. Steroids ya’ll! They’re a big deal! I stepped down to my 84mg/daily “sick” basal profile and kept it there until late evening. Note: your ability to lower your stress dose will be a case by case situation and depends on what type of surgery you had, how long it was and how invasive it was. Pain control is a major factor. Stay on top of your pain medication schedule. Do not let your meds lapse or try to suffer through it. This will increase your body’s cortisol need, hinder your ability to taper your steroid dose, and potentially prolong your recovery. You need sufficient steroid dosing to get pain under control and you need your pain meds to keep your cortisol need under control. They go hand in hand, don’t skimp on one or the other. 


Quick PSA: When you’re running high rates. YOU WILL need to change your inset more often. Pumping during surgery and recovery sounds pretty convenient compared to stress dosing with pills, and it was, but what I did not mention is all the stress that kind of volume puts on an infusion site. My site was leaking by bed time, which I totally expected to happen. This is EVEN MORE true if you run 2:1 dilution ratio in your pump because you are pumping twice the volume than those on 1:1 ratio. So yes, stress dosing and sick dosing with the pump is easier and more effective than pills, but DO NOT NEGLECT YOUR SITE! Don’t wait for it to start leaking either! When you’re ill/recovering your body needs cortisol the most, this is not the time to wait around for a site failure! I’ve changed my site DAILY while recovering from this procedure.


I’ve had 2 previous surgeries as a pumper, but the medical teams for those procedures were not familiar  with, or keen on the idea of pumping during surgery, and I didn’t push them for it. After my experience pumping during this latest procedure, I am going to push for my pump every time. Infection risk is minimal, it’s less than that of the actual surgery itself. The continuous delivery of the pump is ideal for recovery and superior to IV bolusing dosing only, especially since hospitals seem to think bolusing once every 8-12 hours is going to work fine. Its miserable. Continuous delivery is where it’s at! One day they’ll get with the times I hope.


At the time of writing it’s been nearly 48 hours since my surgery. I’m back on my normal profile plus a 200% increase (double dosing). My energy is good and my pain is well controlled as long as I keep up the pain medication schedule. My biggest problem at the moment is remembering not to over do it. I’m tempted to clean house, go on a walk, etc, and I dont feel like resting like I should. Steroid dosing makes a world of difference, and the pump makes this a much smoother experience. Just don’t neglect your infusion site or your pain meds! Happy healing friends!

❤Michelle

UPDATE: Please check out thecortisolpump.com a comprehensive and research based guide to cortisol pumping!

3 Years on the Cortisol Pump

What happens to your body after 3 years on the cortisol pump?

I lost my adrenal glands to cancer and became adrenal insufficient in September 2014. I was told by my endocrinologist at time it was no big deal. Just take two pills a day and you’ll be fine! (She’s not my Endo anymore btw.) I wasn’t fine. I was weak, sick and miserable. I tried 3 different oral steroids, and increasingly complicated dosing schedules attempting to replicate what healthy adrenal glands do. Nothing I tried was quite right. My health was declining. I was catching illness after illness. I spent nearly everyday in bed. I was watching life pass me by. I was 27, and elderly people had better quality of life than I did. This took a heavy physical and emotional toll on me. The most heart breaking part was how it affected my family. My children were very young and they were already getting used to mom not being involved in their lives. I was devastated.

The day I started my pump I was on 188mg of hydrocortisone. I had been sick with respiratory illness for 6 months straight, and could not seem to recover. Any less steroid would leave me unable to breathe and spiraling into adrenal crisis. I was suffering with symptoms of BOTH over and under replacement of cortisol. Something had to change.

This is where I was most of the time before the cortisol pump.

Though most people have a slight increase in their steroid dosage when they initially start the pump, I was able to reduce my dosage from 188mg to 84mg right away. (Side note– that dosage has continued to decrease as I have gotten healthier. I’m at 30.2 daily milligrams as of fall 2019.) My body was responding well to subcutaneous hydrocortisone.

I saw immediately improvement, but didn’t see dramatic results right away. The first day, I was able to get out of bed, do simple things around my house– cook dinner, spend time with my children, clean up the dishes. I felt different though– no more roller coaster of peaks and crashes as each pill kicked in and rapidly wore off.

The pump is not magic. It took tedious adjustment of the delivery rates, which was almost completely trial and error. The pump enabled me to get my tired body up and make myself exercise my atrophied muscles. It took work and determination. In time, I could drive myself, I could walk around the block. It took nearly a year of adjustments before I could sleep like “normal” people do. I still woke up with a pounding headache every morning, but even that was still an improvement.

So where am I now?

You can tell I’m sick in the first image. I was sedentary, had constant respiratory problems, and was about 30lbs heavier.

It’s important to realize that the pump will not cure adrenal insufficiency nor any of your other health conditions. I’m still battling cancer and I still deal with a few other issues, but my life had changed dramatically for the better. With years of hard work, titrating delivery rates, training my body I can now pass as a “normal” person. I can be active all day most days (there are always good days and bad days with any chronic illness). I can drive. I can exercise- I walk, run, bike, do yoga. I have a social life now. I volunteer at my kids’ school a few hours a week, I serve at my church, and we’re active in scouting.

It’s still a fight. The struggle doesn’t end when you switch to the pump. You’ll always have to deal with things like insurance companies and pharmacies fouling things up. I still occasionally see doctors that are completely clueless about this treatment. Most are intrigued, a few are critical of it. I’m happy to educate them! (Side note– they aren’t always happy to be educated, but I’m going to do it anyway! 😉)

I can see why the cortisol pump might not be right for everyone, but I truly feel that everyone with adrenal insufficiency should have this option available. Some of my doctors at both the National Institutes of Health, and at UT Southwestern have mentioned the possibility of opening a new study on the cortisol pump, and while I’m not going to hold my breath, even just the fact that they’re seeing the benefits is a huge step.

If there’s one thing you take away from this it’s that the pump is a tool. More like a musical instrument actually. If you buy a guitar for example, it does no good if you don’t learn how to play it. The more practice you have with your instrument the better it sounds. This concept holds true for the pump as well. It all comes down to how well you program and use it. If your basal rates are junk– you’ll feel like junk. If you refuse to bolus, or bolus too little too late, you’re still going to feel awful. The pump is a tool to help you manage your AI. It doesn’t do it for you.

I am grateful for the cortisol pump every day. It has given me my life back. No longer am I stuck withering away in bed while life passes me by. I’m up and out and making memories.

UPDATE: Please checkout thecortisolpump.com a comprehensive and research based guide to cortisol pumping!

Surviving the Heat with Adrenal Insufficiency

Heat is my nemesis, but it hasn’t always been this way. Actually, I really enjoy summer! My problems with heat started when I had my adrenal glands removed and I became adrenal insufficient. I’ve come to realise that I’m not alone. Most, if not all adrenal insufficient patients struggle with heat intolerance. To further complicate things, we are highly susceptible to dehydration because of hormone deficiencies.

So what is an adrenal insufficient patient like me to do? Stay indoors all summer and let life pass me by? If you know me, you know that’s not my style! I’m too stubborn to give up!

This past week my kids had their first ever scout day camp. I was obligated to attend with them as a walking den leader. I was terrified. So much could go wrong! Me, with my less than dependable health, out in 90 degree weather, all day long? I often get dehydrated even when I’m not in the heat. I get fatigued from just running errands some days. How in the heck am I going to pull this off?

The night before I was panicking. What if I couldn’t handle it? If I had a medical emergency I’d be so embarrassed! If I got dehydrated and fatigued, I’d be letting the other den leaders down, and they wouldn’t understand what was really happening to me. I was crying and even typed out a text to back out of the whole thing– I didn’t hit send though!

The first day of camp I showed up prepared as possible. Shorts, hiking boots, baseball cap, sunscreen, bug spray, TONS of water and my electrolyte drink of choice, coconut water, a liter of it! As prepared as I thought I was, the first day was brutal. I was feeling wiped out from the heat by the time we got to our first activity. Splitting headache from dehydration, despite drinking every bit of that giant bottle of coconut water. I was fatigued and feeling “out of it” my muscles were getting sore, again probably from dehydration. I use a cortisol pump, so I did my typical bolus amount, took an extra dose of fludrocortisone, a salt tablet, and some Advil for the muscle pain and headache. It got a little bit better in about an hour, but I was struggling until dinner time. After the rest and food at dinner, I felt a lot better.

Day two I knew I needed a better strategy. This time I brought a camping chair to sit in so I could rest a little during the instruction times at each activity. I also bought a wagon to carry it and all of the things the campers ask you to carry along the way (I should also add that my right arm is broken at the moment which makes carrying things kind of tough). It was a smart move, but STILL I was dealing with that fatigue and dehydration headache by the first activity! It didn’t seem to matter how much water and coconut water I drank! Again, I bolused, took extra fludrocortisone, salt tablet and Advil. I bounced back just a little bit quicker this time. Day 3 went about the same. What was I doing wrong? Maybe the killer headache and overwhleming fatigue were just unavoidable in this heat?

Well good news, day 4– I figured it out! We arrived at camp just like the previous days, but this time I bolused right there in my car, before I ever stepped foot into the heat. I changed my bolus strategy too. I took my typical bolus amout and DOUBLED it. I utilized the “dual wave” bolus feature on my pump (OmniPod and Tandem call this extended bolus, and Animus calls it combo bolus.) On my medtronic 630g you have to turn on this feature in your settings. Dual wave allows me to split up my bolus. You set a percentage to deliver immediately, and a percentage to be slowly delivered over a time period you chose. I delivered 50% of the amount (which would be my typical bolus) immediately, and had the other 50% delivered over the next hour (which happened to be the heat of the day). I also went ahead and took that extra fludrocortisone, salt tablet and Advil ahead of time. I went the entire day, active, alert, and symptom free! Day 5 was also symptom free!

It turns out the key is being prepared BEFORE you ever step into the heat. Don’t wait until you’re already sweating, don’t wait until you’re feeling wiped out and crappy! It’s going to take you all day, or even days to catch up at that point!

In summary, here’s what I learned:

If you know you’ll be in the heat, bolus (or updose) ahead of time! If you’re only going to be in the heat an hour or less and not physically active, a normal bolus (plus adequate hydration of course) is probably all you need. The important thing is that you do it BEFORE!

If you’re going to be in the heat for several hours, or plan on being physically active (such as yard work or a sport) you will need more steroid than you think. For me, I needed double my typical bolus amount. Splitting it using the dual wave feature was a huge help. I also needed to increase my basal rate signifcantly. I may not have needed to do this if I could have managed the first 3 days better, but by day 3, I was on my “sick” basal profile, and I stayed on that profile for the rest of camp.

HYDRATE! Don’t wait until you’re in the heat to hydrate, don’t wait until you’re thirsty, and don’t think that just water is going to do the job. You need electrolytes and you need to start drinking them HOURS before you go outside. You really can’t start the intense hydrating too early! As I said, my electrolyte drink of choice is coconut water, do what works for you.

Shade is precious! The sun is BRUTAL! Stay in the shade as much as possible. If you get an oppotinty to sit and rest, don’t be too proud to take it! Try to find ways to exert less energy, maybe that means sitting, using a cart or wagon to carry heavy things, or humbling yourself and asking for help (which I did have to do at one point).

Sun protection/bug spray! I hate sunblock. It feels greasy and gross. Bug spray is stinky, yuck! Here’s the thing though– you don’t want to add any additional stressors to your body by getting sunburned or insect bites. On that note– dress appropriately! Dressing for the outdoors is not very stylish, but ou want to dress in a way that you stay cool, and protect yourself from sun, biting insects or itching plants.

It figures that my experience from scout camp basically amounts to “Be Prepared” which also happens to be the boy scout motto!

Stay safe and cool this summer!

A Forced Rest Day

I’ve said before that I feel like I live two lives. There is often this duality when juggling a medical condition. Its the struggle between “I’m not going to let anything stop me!” and, “I need to respect my limits and take care of myself.”

Part of me wants to do all the things. Anything I can physically do, I need to do it while I still can. My fear is that I can never stop, or I will begin to deteriorate. There is some truth to that. I can’t let cancer or chronic illness be my excuse. I have to push against it all the time.

Sometimes I get carried away. I over extend myself, ignore my limitations, and run myself straight into the ground. It happens to everyone at some point.

What happens then is what I call a “forced rest day”. A forced rest day is when your body just says “Nope, not today.” You can try to push through it, but the push back only gets stronger and stronger, and without adrenal glands to kick in and make the hormones I need to keep going, I will eventually be forced to rest.

A forced rest day means prioritising your tasks of the day to just the essentials. If it can be cancelled, cancel it. If it can wait, then let it wait. If its something I can’t cancel, I can increase my steroid dosage and drag myself out of bed, but that comes with consequences too. The more you keep pushing, the greater the back lash will be. Even with ever increasing medication, I will still slowly burn out like a dead battery. The rest day will not be ignored!

A graphic I made a couple years ago for AIC.

The hardest thing about forced rest days, is that they cannot be planned. They don’t fit conveniently into your schedule- ever. They just pop up unannounced and they don’t care about your plans. They don’t care if it’s a holiday or if you signed up for this or that. They don’t care how long ago you made a particular appointment or who might need your help. Your body just says, “I’m done.”

What can I do about forced rest days?

All bodies require us to care for them. Bodies with health conditions need a bit of extra care. Sometimes in our efforts to be “normal” we forget this. On a forced rest day, your focus should be caring for yourself, recovering so you can get back to doing life. Eat healthy food, drink lots of water, take your vitamins. Wear comfy clothes, and REST!

If you like my graphics, click to see more on my facebook page, HEARD.

I have a secret for you… If you can incorporate self-care into your “GO!GO!GO!” life, then you will have fewer forced rest days! The thing is, its easier said than done. It takes responsibility to say, “Woah, my schedule is overloaded here…I need to cancel something and make time for rest.” It seems selfish, lazy even, but far from it! You’re intentionally making time for “rest”. It doesn’t have to be actually laying down or sleeping. It can be spending an evening at home having a nice meal, rather than scarfing down a snack in between homework and a meeting. It can be catching up on a book and enjoying the peace and quiet, before heading out to a big event later. Its all about balance!

When we achieve that balance and tame our busy lives by adding these strategic rests to our schedule, the end result is less “burn out” and fewer “forced rest days”.

Take it easy,

😴Michelle

5 Reasons NOT to Get a Cortisol Pump

The Cortisol pump has the potential to dramatically improve the lives of patients with adrenal insufficiency. All current research studies indicate improvements in patient quality of life. With results like that, the pump seems like magic, right?
My own experience with the cortisol pump has been dramatic and highly successful. Positive patient testimonials such as mine, make others suffering with poor quality of life think the pump is the solution to all of their woes.
While I have raved about the merits of the pump, I’ve also been honest about how difficult it has been, and that pumping alone hasn’t fixed everything, nor did any of these changes come quickly.
I am not writing this to discourage anyone from using the cortisol pump. Personally, I love it, and I want this treatment to be an option for every adrenal insufficient patient. However, I don’t want to mislead anyone. I want patients to have a realistic idea of what pumping entails so they can make an educated decision about their treatment.

5 Reasons NOT to Get a Cortisol Pump!
1. You feel great on steroid pills.
This was never the case for me, and I don’t come across a whole lot of people that do, but there really are some patients out there that get by just fine on oral steroids. For these patients, it would not be worth the time and effort to switch to a pump and it would not be worth the extra work and expense to maintain it.
2. You are not a self advocate.
This is still an uncommon and relatively new treatment, (cortisol pumps have been in use about 13 years.) It’s likely you’ll have to search for a doctor that supports this treatment, and even when you find one, there is a good chance they will have very little to no experience with cortisol pumping. If you cannot gather research yourself, present your case to the doctor, be prepared to be rejected, and be willing to try again…it’s not going to work out. Even when you start the pump, you will have better success if you can work along with the doctor to keep track of your own symptoms and adjust your own delivery rates accordingly. You will never be able to just sit back and let someone else do this for you. If you’re not a persistent self-advocate, this is not the treatment for you.
3. Pills are too much hassle.
Yes, pills are a huge hassle. It’s terribly inconvenient to take pills 3-8 times daily. Yes, it’s annoying having alarms going off all the time for meds, and yes it totally sucks having to wake up in the middle of the night for doses.
You would think the pump is more convenient with it’s preset schedule and continuous delivery, and most of the time it is. However, the pump is not something you just set and forget. You will have to use syringes to mix Solu-cortef and refill your cartriges. You will have to change out your inset at least every 3 days following strict sanitation procedures. True, that’s better than taking pills every few hours every single day of your life, but there will be times your pump maintenance doesn’t go as planned. You might get a low units alarm at night when you just want to sleep. You might find yourself with a failed infusion set when you’re out in public. While these aren’t huge problems, it will take a bit more effort to fix than just swallowing another pill. My point is, if pump therapy seems appealing to you because of the convenience- you will be disappointed. Pumping ain’t easy! It’s totally doable, just know what you’re getting into before taking the plunge!
4. You’re afraid of needles.
Pump therapy involves inserting a Cannula into your skin with a small needle. It’s nearly painless when done correctly, but if this sounds like more than you can handle, then the pump isn’t for you. You should also know that the pump is ABSOLUTELY NOT AN ALTERNATIVE TO YOUR EMERGENCY INJECTION! You cannot rely on your pump to infuse 100mgs or more at a time. This will almost assuredly cause your infusion site to fail, which could make an emergency situation even worse. Even if you could infuse all 100mgs without it leaking, subcutaneous absorbtion will be slower than intramuscular. Also, there’s a chance you won’t even have 100mgs in your cartridge to deliver. So don’t think getting a pump will mean you never need an emergency injection.
5. You don’t want to talk to your insurance company.
Even if you’re willing to pay out of pocket for a pump or buy one second hand, you are going to have to contact your insurance company at some point. While the cost of a infusion pump brand new is thousands of dollars, the monthly Solu-Cortef can be the most costly item depending on your insurance coverage. You’ll want to know your DME benefits, be familiar with your prescription plan’s formulary list, and most importantly don’t be afraid to call and ask questions! Ask ask ask! Find out exactly what they can and can’t do, find out how to have an exception made, or how to appeal a decision. Don’t expect your insurance company to get everything right and work it all out for you, but at the same time, don’t just assume they won’t help at all. You don’t know until you try!
I encourage anyone with adrenal insufficiency, suffering with poor quality of life, to look into subcutaneous hydrocortisone infusion therapy. It has really changed my life for the better, but it has been an indescribable amount of work. Even when you start on the cortisol pump, the battle isn’t over. You will have to learn strategies to manage it…by yourself. You will have to ensure you always have a steady supply of Solu-Cortef and pump supplies, even when your insurance and financial situations change. You’ll have to be prepared to deal with unexpected maintenance and mishaps, handle them the best you can, and just keep on going. It helps to be strong willed, assertive, and stubborn. You will have to be resourceful and adaptive. There are times even the strongest, most resilient pumpers I know will get frustrated and want to quit, but ultimately, all of the work is worth it. We take a deep breath, pick ourselves up and keep pumping.

A Health Update: Where I’m at, and where I’m headed.

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One of the reasons I started this blog was to give health updates. I’ve yet to use it for this purpose, but today I am going to be more personal and talk openly and honestly about (part) of my health.

I was hospitalized over Christmas for a respiratory virus that was complicated by my adrenal insufficiency. This turned into pneumonia, which was thankfully cleared up with antibiotics. I seemed to improve after leaving the hospital, but I spoke too soon. Maybe I was too active? I wound up back in the ER new years eve. I am grateful I did not need to be admitted the second time. Truthfully I don’t think I could have handled two consecutive holidays in the hospital.

I’m dealing with some emotional baggage from all of this. I’m sick of being sick. I want to leave my house. I’d really like to enjoy the warm Florida winter walk the beach, and gather sea shells. Really at this point anywhere would be great, or even just having the ability to do normal household chores would be a welcome change. My husband is a saint and is taking care of me and the kids right now. Frankly though, I don’t want to be taken care of, I want to be healthy. I have to keep reminding myself that this is only temporary, discouraging, but temporary. Perhaps I should revisit my previous blog post and work on some self love.

On the the plus side, I woke up with an appetite today! I had the energy to make my kids a real, non-cereal, breakfast. I made myself a healthy high protein/high calorie meal too. I’ve lost 10lbs since my hospitalization at Christmas just a week ago. If we’ve ever met, you might have noticed I don’t have 10lbs to lose, especially that quickly. My steroid dose has more than tripled, which would normally cause weight gain so I’m stumped on this one. The appetite is an encouraging sign of improvement though.

I was prescribed a nebulizer to help my lungs. There was some difficulty getting the nebulizer delivered because of the holiday, but I was able to borrow one, and it seems to be helping. It works better than just a few little puffs on an inhaler.

I’ve been using my blog and my support groups as a distraction, and what a great distraction they are. Helping and encouraging others effectively gets my mind off my own problems. Maybe this is my purpose now?

I hope that very soon this will all be a distant memory. Another lesson to add to a ever growing list.

I do have something to look forward to this year. Next month, I will be visiting a new endocrinologist. I had a bad experience with the last one, and I do have some residual anxiety from that. However, I remain optimistic that a better endocrine doctor will translate into a better quality of life for me. I’ve got some scary questions hopefully he will be able to answer. I won’t go into that situation here yet, but good vibes are appreciated. I will also be making my case for subcutaneous hydrocortisone pump therapy at this appointment. For those who have never heard of this, it is a insulin pump that infuses the corticosteroid hydrocortisone, which is bio identical to natural cortisol. I have not been able to tolerate this medication orally, and this treatment would instead infuse the medication directly into my body. It could be a turning point for me if the doctor is cooperative. If not, I am not a quitter. This therapy is very new and even experienced doctors seem skittish about it, though studies are very promising. I cannot simply go find a doctor using this treatment as the patients are told not give out names. It will be a fight whether with the doctor, or with insurance, or learning the therapy itself, but this is my life and I am not backing down.

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Thanks to everyone for their love and support. You really keep me going and I am very grateful!

💕Michelle