i should have called on friday, but i knew i wouldn't be able to find anything and instead tried to distract myself from it. i called a few places on saturday, before resigning myself to the reality and asked the spot that had it to package a small amount of generics, so i could get through the weekend and try on monday...
i tend to avoid biking in the salt and snow, so i took a walk on sunday afternoon that worked out to 19.3 km - from here to the pharmacy, to the walmart, to the metro, to the superstore, to the freshco, home, to the food basics, and home again.
the price for the red peppers at the whole sale club wasn't that impressive this time, although it has been previously. i wanted to check the walmart for soy, and they didn't have it; they had cheese and yogurt on sale, though. the metro at devonshire didn't have my soy, so i won't go back, but i got some strawberries at a good price. i wanted limes or red peppers at the superstore and was disappointed; i got both at the freshco, instead. and, then i got some chicken for the eggs, as mentioned - plus the kiwis were on sale.
you're excited.
when i got in at around 20:00, i took a deserved nap, got up and made some eggs and posted a few things on the internet, intending to make some calls..
.....and then fell asleep before i could. grargh.
so, i wake up around 14:00 and start making calls and i've got to the end of the list, now - i have called every pharmacy in the lower peninsula (and bicycled to the outlying towns of leamington, tilbury and amherstburg - something i greatly enjoyed, as it let me see and understand this area, which i didn't grow up in, quite a bit better) and am simply out of usable estrogen. there's no more, and what's left is probably expired.
to recall, the brand name estrace is imported by a company in mississaugua called acerus that buys it from a distributor in britain. that's the only distribution where i live. but, that company in britain has lost it's british license, meaning the drug cannot be imported any longer. due to the sad realities around property rights and pharmaceuticals, this has created a mess that may make it almost impossible to find this drug here for a very long time. what remains is the generic.
"but, the generic should be the same thing, just cheaper, you idiot."
see, i wish that was true, but it isn't in this case.
the generic uses a different delivery mechanism, which means what? well, your stomach acids are a vicious thing, and i'm always baffled by people that don't get this. they think we just absorb whatever we eat. in fact, your stomach acids want to rip everything you give it apart into the smallest pieces possible, where those pieces can either be attached to enzymes and absorbed, or discarded and shit out. so, if you're going to take something like estrogen orally, you want to make sure you give it a protective coating to stop it from being destroyed in your stomach.
bafflingly, the generic lupin-estradiol simply doesn't do that, while the brand name estrace does. so, when you take the brand name, you absorb the estrogen attached to an ester, which splits apart in your liver - and is lost largely on first pass but at least gets there. when you take the generic, it just dissolves in your stomach. it's crazy that they're even allowed to sell it at all.
the way around it is to take it under your tongue (or inject it...), but the thing i liked about the oral delivery is that it's just like being on the pill - you don't get mood swings, you just get constant estrone cycling, until it gets excreted. if you take it under your tongue, it's going to hit a peak fairly quickly and then fall very fast, which is not just a problem for mood swings, but also an increased cancer risk.
so, i've gone well out of my way to find the brand name, but i seem to be out and that's it. one store told me they threw out a bottle recently because it was expired. so, anything i could potentially find in distant rural villas is no doubt already destroyed.
around 18:00, i finally gave up and had to transfer the rx back to the local pharmacy and just get the generic. it's cheaper, at least. but, now what?
i got some more groceries done as well, which required another 21.7 km of walking, including the last 6.5 km with 15 kg of soy milk on my back. so, that's 41 km (25.5 miles, in backwards culture units) of walking in the last 36 hours. as i'm not going to need to go out to get more estrace until mid-month at the earliest (and potentially next month), i want to get everything done now, excluding inevitable quick mid-month fruit top-ups. so, i've got just about everything i could find - but i'll need to make another trip to food basics & the bulk barn in the morning. when i got in, i took a shower and need to eat an overdue fruit bowl, but i had to send a fax to the doctor:
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hi.
it's your old fax-sending friend jessica, again, back to write you another essay. muahahahaha. i actually didn't check if the phone works, as i need to get a letter to dr. --------, anyways. i still have a vm at 5199161358 and an email address at death.to.koalas@gmail.com.
so, i'm calling to ask for a boost in the estrace to 16 mg/day, and i'll explain why.
after bicycling to tecumseh a few times, to leamington, to tilbury (!) and then to amherstburg several times, i have finally run out of options for brand name estrace in the lower peninsula. if there's any brand estrace from here to chatham, it has done an exceptionally good job of hiding itself, as i have called every pharmacy that google can find me.
it's gone. all of it.
i called the distributor, acerus, as well, at one point, and they explained that the problem is that the british government removed the license for the company that manufacturers it. they had an exclusive license. so, until somebody else licenses it in canada (and i'm not sure they can, if acerus has it) this is impossible to get, due to the actions of the british government. acerus might (and, i think should) win their lawsuit in the end, but even winning the lawsuit won't get the item back in circulation.
and, of course, the border is currently closed.
so, the only option is generic. i'm finally at the end.
i have explained before that i am apprehensive about the delivery mechanism in the lupin-estradiol. estradiol is famously weak, anyways; most of it gets destroyed on first pass, with only small amounts converting to estrone, which then cycles repeatedly before it's excreted. so, the brand name attaches the estrogen to an ester that is intended to help it a least get to the liver, where it breaks in half. the lupin-estradiol does not have this ester, meaning that it doesn't even make it to first pass, it merely gets destroyed in stomach acid. it's as good as a placebo, in practice.
it's been a while now; everybody's in the same boat. have your other patients noticed degrading effects after switching?
the way around this is to either inject it (i'm the last gen xer; i've watched everybody die of drug overdoses, i don't want to inject anything into me, ever. no needles. no way.) or to otherwise avoid swallowing it by taking it sublingually. but, i don't want to eliminate the hepatic process altogether, because i want to maintain some little bit of estrone cycling.
so, this is my proposal, and it is a large dosage increase, but let's talk about it:
- sublingual application of 2 mg every 6 hours +
- orally swallowing 4 mg every 12 hours (hoping that the large dosage gets a bit of it into the portal vein, at least - but realizing that this is mostly useless)
that would be 4*2 + 4*2 = 16 mg/day - a doubling of dosage. but, i've just halved the effectiveness. it's not a practical increase, but an adjustment to the delivery mechanism. i'm hoping it just balances out...
obviously, this isn't ideal. when i spoke to dr. ---------, he indicated that i was absorbing the estrogen. but, if i have to go further than chatham to get brand name, i'll have to wait until the spring. and, i'm not convinced it's there at all.
one of the last stores i spoke to was in lasalle, and they indicated they recently had to throw some of it out because it expired. so, any lingering supply may be unsellable, and this is consequently all there is to do.
if you'd like to book an appointment to talk, i have no schedule, so just leave a message at my vm to do so. give me like 36 hours notice or something. i'm empirically driven, so i see the value of testing it and adjusting to it, but i'm exceedingly apprehensive about this, and would rather come on strong and turn it down than come in low and turn it up.
that said, i've learned my lesson and will wait for a response. just please recognize that i can't wait too long for a response.
thanks,
jessica
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so, that's what's next.
i need to eat, first. after that, i need to finish my shopping - and also to mail a few things regarding court cases and fippas. and, then i will need to file a few things, after that.
i should hopefully be able to get back to what i'm doing tomorrow or the next day.
but, that was the last few days - 40+ km of walking to get grocery shopping done. and, i've got a few more to finish it up...
you can look at me like an idiot, if you want, i guess. why don't i get a car? or at least order a cab?
see, and i'm going to flip the question around - if you drive your car to the grocery store, what do you do for exercise? well, do you even exercise at all? 'cause if you just drive your car everywhere and sit on your ass all day, don't call me an idiot - go have a heart attack, instead. but, if you do take reasonable care of yourself, how do you do it?
do you spend $100/month to go to the gym? really? and you're calling me stupid?
do you run around in circles like a retarded horse?
this is what you probably do - you get in your car and drive to the grocery store (which costs money and produces emissions) and then get home and run laps like a gerbil, or go to the gym and pay through your nose to look sexy running on the spot. right?
well, if you did what my dumbass self does, you'd save hundreds of dollars a year on gym and gas costs, and help the planet by keeping pollution down - and be in better shape than you are now, on top of it.
in my estimation, running around in circles is borderline retarded, and i can't do it. i need to attach physical activity to functionally useful behaviour, like grocery shopping.
that said, i'd have cut my transit time by 75% if i had a bike, and i hope the weather's cleared up enough to allow for it by this time next month.
i need to eat...