Chronic Fatigue Question (detailed labs posted)

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    Chronic Fatigue Question (detailed labs posted)


    Hey Anabolic Minds,

    I'm hoping that I might be able to crowd-source some advice.

    I've been dealing with fatigue for the better part of 10 years now and in the last year it's become significantly worse.

    After doing a lot of reading here at Anabolic Minds (and some similar forums) and I've started approaching this problem with hard data (getting labs, measuring everything, etc).

    I've also been working with a doctor (an endocrinologist who is discussed here and on similar forums) for the last 8 months and have lots of lab work at this point.



    HISTORY:

    Last 10 years:
    - Fatigue

    Past year:
    - Extreme fatigue
    - Cold hands and feet
    - "Brain fog"/difficulty concentrating
    - Low libido
    - Low motivation
    - Memory loss (can't remember names, words, etc)


    The endocrinologist I'm working with diagnosed me with hypothyroidism (specifically, low free T3 and low Ft4)

    Went on 100 mcg T4. 2 months later had symptoms of hyperthyroid (very low TSH, insomnia, etc). We ran labs and found that I also had extremely high reverse T3 (RT3), though FT3 hadn't moved much.

    Endocrinologist diagnosed me with T4 to T3 conversion problem, and switched me to 25mcg of Cytomel (T3 medication).

    Since then, my fatigue has not improved. Did a sleep study and was prescribed Nuvigil (not by my endocrinologist; a separate sleep doctor prescribed the Nuvigil).

    Just ran new labs and several things are abnormal (very high Test, SHBG).



    SUPPLEMENTS:
    Iodine (lugols) 12 mg
    Selenium 200 mcg
    Vitamin C 1000 mg
    Krill Oil 600 mg
    B-complex 100 mg
    Zinc 50 mg
    Copper 2 mg
    Creatine 5 g
    Melatonin 3 mg



    CURRENT MEDICATIONS
    Cytomel 25 mcg
    Nuvigil 100 mg (I just cut the pill down because I was getting jittery at 150 mg)



    LABS (these are the most recent labs, drawn Oct 24-Oct26)

    metabolic panel
    Glucose, Serum 99 mg/dL 65-99
    Uric Acid, Serum 6.0 mg/dL 3.7-8.6
    BUN 19 mg/dL 6-20
    Creatinine, Serum 0.96 mg/dL 0.76-1.27
    eGFR If NonAfricn Am 104 mL/min/ 1.73 >59
    eGFR If Africn Am 120 mL/min/ 1.73 >59
    BUN/Creatinine Ratio 20 8-19 HIGH
    Sodium, Serum 140 mmol/L 134-144
    Potassium, Serum 5.0 mmol/L 3.5-5.2
    Chloride, Serum 103 mmol/L 97-108
    Carbon Dioxide, Total 27 mmol/L 20-32
    Calcium, Serum 9.4 mg/dL 8.7-10.2
    Phosphorus, Serum 3.7 mg/dL 2.5-4.5
    Protein, Total, Serum 6.4 g/dL 6.0-8.5
    Albumin, Serum 4.2 g/dL 3.5-5.5
    Globulin, Total 2.2 g/dL 1.5-4.5
    A/G Ratio 1.9 1.1-2.5
    Bilirubin, Total 0.3 mg/dL 0.0-1.2
    Alkaline Phosphatase, 57 IU/L 25-150
    LDH 140 IU/L 0-225
    AST (SGOT) 18 IU/L 0-40
    ALT (SGPT) 19 IU/L 0-55
    GGT 24 IU/L 0-65

    Hemoglobin A1c 5.1 % 4.8-5.6
    Insulin 7.6 uIU/mL 2.6-24.9

    lipids
    Cholesterol, Total 142 mg/dL 100-199
    Triglycerides 82 mg/dL 0-149
    HDL Cholesterol 53 mg/dL >39
    According to ATP-III Guidelines, HDL-C >59 mg/dL is considered a
    negative risk factor for CHD.
    LDL Cholesterol Calc 73 mg/dL 0-99
    T. Chol/HDL Ratio 2.7 0.0-5.0

    thyroid panel
    TSH 0.006 uIU/mL 0.450-4.500 LOW
    Thyroxine (T4) 9.0 ug/dL 4.5-12.0
    Triiodothyronine (T3) 145 ng/dL 71-180
    T3 Uptake 39 % 24-39
    T4,Free(Direct) 1.79 ng/dL 0.82-1.77 HIGH
    T3,Free,Serum 4.9 pg/mL 2.0-4.4 HIGH
    Reverse T3, Serum 36.5 ng/dL 9.2 - 24.1 HIGH
    Thyroid Peroxidase (TPO) Ab 8 IU/mL 0-34
    Antithyroglobulin Ab <20 IU/mL 0-40
    PTH, Intact 21 pg/mL 15-65

    iron panel
    Ferritin, Serum 296 ng/mL 30-400
    Iron, Serum 104 ug/dL 40-155
    Iron Bind.Cap.(TIBC) 238 ug/dL 250-450 LOW
    UIBC 134 ug/dL 150-375 LOW
    Iron Saturation 44 % 15-55

    steroid hormones and related
    Testosterone, Serum 1103 ng/dL 348-1197
    Free Test(Direct) 16.7 pg/mL 8.7-25.1
    Dihydrotestosterone 85 ng/dL 30 - 85
    SHBG, Serum 74.7 nmol/L 16.5-55.9 HIGH
    IGF-I 234 ng/mL 71-241
    DHEA-Sulfate 288.6 ug/dL 160.0-449.0
    Progesterone 0.9 ng/mL 0.2-1.4
    Estradiol 27.7 pg/mL 7.6-42.6
    (Roche ECLIA methodology)

    pituitary
    LH 7.2 mIU/mL 1.7-8.6
    FSH 2.5 mIU/mL 1.5-12.4
    Prolactin 13.9 ng/mL 4.0-15.2

    cortisol and related
    Pregnenolone, MS 196 ng/dL Adults: <151
    Cortisol - AM 23.9 ug/dL 6.2-19.4 HIGH
    ACTH, Plasma 96.7 pg/mL 7.2-63.3 HIGH

    inflammation
    C-Reactive Protein, 0.35 mg/L 0.00-3.00
    Relative Risk for Future Cardiovascular Event
    Low <1.00
    Average 1.00 - 3.00
    High >3.00

    vitamins
    Vitamin A, Serum 69 ug/dL 18-77
    Vitamin B12 782 pg/mL 211-946
    Folate (Folic Acid), Serum 15.6 ng/mL >3.0
    Vitamin D, 25-Hydroxy 66.3 ng/mL 30.0-100.0



    QUESTIONS:
    - Why do I still have high Ft4? Wouldn't the cytomel (and subsequent low TSH) suppress the formation of T4?
    - Why do I still have high reverse T3?
    - Why are my androgens so high? (back in the July, my TT was about 714)
    - How can I drive down SHBG (I'm guessing that the cytomel increased it.)
    - Why is my ACTH so high? Could the Cytomel do this?
    - What's causing my fatigue? My thyroid hormones are in range now ( they were not when I started) but I still feel worn out. Is this a RT3 issue?

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    I would suggest ferritin, and 4 point cortisol saliva to check for adrenal imbalances. I seem to think there are much deeper issues probably at the cellular levels as well immune compromise which is driving your SHBG (which thyroid can also drive it up.) When dealing with RT3 look to the source of the stress instead of trying to chance rt3 like most people do. The end result is they make matters worse. If you had a car sitting in a garage with the door down would you step on the gas? NO you would end up suffocating your self. This is the same scenario which is happening in your body. When your body is toxic it puts the brakes on so you do not burn the motor out or end up it. Your body does things for a certain reason. Over riding a protective mechanism with out identifying the stressor in the first place is only asking for trouble. I am working with some of the best Drs in regards to CFS, FM. It all comes down to basic common sense which is highly over looked which leads their patients to recovery. You need to look at the whole picture not bits and pieces problem with traditional medicine unfortunately..Suspect your problem may not be at the serum level, but rather at mitochondrion or even at genetic level..I see this all the time which medical professionals never explore...
    I am not a medical Dr, please keep in mind that this answer is for information purposes only, and is not intended to diagnose, treat or replace sound medical advice from your physician or health care provider.
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    Thanks for your reply, Matrix.

    Quote Originally Posted by The Matrix View Post
    I would suggest ferritin
    Do you mean to lower it? I've considered donating blood or going for a phlebotomy to lower it down to the 150 range. My endo said maybe, but he doesn't seem to think it's hemochromatosis yet.

    Do you think lowing it would help?

    Quote Originally Posted by The Matrix View Post
    4 point cortisol saliva to check for adrenal imbalances
    Agreed. Going to order.

    Quote Originally Posted by The Matrix View Post
    I seem to think there are much deeper issues probably at the cellular levels as well immune compromise which is driving your SHBG
    We did some testing on immune/autoimmune/gut related issues and it mostly came up clean:

    Tissue Transglutaminase (tTG), IgA, Negative
    Gliadin Antibody Profile (IgG, IgA), Negative
    ANA, Negative
    Rheumatoid Factor, Negative
    H. Pylori, Negative

    metal toxicity tests
    Aluminum, Negative
    Arsenic, Negative
    Cadmium, Negative
    Lead, Negative
    Mercury, Negative

    I did an ALCAT Food Intolerance panel and several things came up. That said, I'm sort of skeptical on food intolerance tests; they're pretty controversial and I haven't seen anything solid in the medical literature that supports their clinical use.

    Do you have thoughts on food testing Matrix?


    Quote Originally Posted by The Matrix View Post
    Suspect your problem may not be at the serum level, but rather at mitochondrion or even at genetic level
    MTHFR mutation?
    Difficulties strengthen the mind, as labor does the body.
    -Seneca
    •   
       

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    Did you test your HOMOCYSTEINE? You may be UNDERMETHYLATED.

    Reverse T3 is caused by taking too much T4. //tiredthyroid.com/rt3.html

    You are on too much T3, (TSH .000) This will cause high SHBG and can drive up cortisol.

    Your high DHT and low FT, is a mystery to me.

    Do you really need the Nuvigil??????
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    Quote Originally Posted by Mr.TT View Post
    Did you test your HOMOCYSTEINE? You may be UNDERMETHYLATED.
    Yeah, tested Homocysteine, 6/12/12:
    Homocyst(e)ine, Plasma 6.3 umol/L 0.0-15.0

    Quote Originally Posted by Mr.TT View Post
    Reverse T3 is caused by taking too much T4. //tiredthyroid.com/rt3.html
    That's a good find. Wouldn't my T4 have cleared out though? I stopped taking t4 medication about 9 weeks ago:

    July 2012 (on 100 mcg Levothyroxine)
    TSH 1.030 uIU/mL 0.450-4.500
    Thyroxine (T4) 7.7 ug/dL 4.5-12.0
    Triiodothyronine (T3) 75 ng/dL 71-180
    T4,Free(Direct) 1.63 ng/dL 0.82-1.77
    Triiodothyronine,Free,Serum 2.4 pg/mL 2.0-4.4
    Reverse T3, Serum 25.2 ng/dL 13.5-34.2


    Oct 2012 (on 25 mcg Cytomel)
    TSH 0.006 uIU/mL 0.450-4.500 LOW
    Thyroxine (T4) 9.0 ug/dL 4.5-12.0
    Triiodothyronine (T3) 145 ng/dL 71-180
    T4,Free(Direct) 1.79 ng/dL 0.82-1.77 HIGH
    T3,Free,Serum 4.9 pg/mL 2.0-4.4 HIGH
    Reverse T3, Serum 36.5 ng/dL 9.2 - 24.1 HIGH

    What's a bit strange is that my T4 and free T4 are both higher now, after stopping T4 medication and starting Cytomel.

    Quote Originally Posted by Mr.TT View Post
    You are on too much T3, (TSH .000) This will cause high SHBG and can drive up cortisol.
    Agreed

    Quote Originally Posted by Mr.TT View Post
    Do you really need the Nuvigil??????
    It's not an exaggeration to say that I've had "crushing" fatigue on some days. Totally worn down, even after 12 hours of sleep. Not sleepy though.... just a feeling of not wanting to do anything. It got to a point where I wasn't getting enough done for work, so I went to the sleep doc and tried the Nuvigil as a stopgap.

    That said, I haven't discussed the Nuvigil with my endo yet. Our next appt is tomorrow, so he might have some thoughts on it.
    Difficulties strengthen the mind, as labor does the body.
    -Seneca
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    Quote Originally Posted by Mr.TT
    Did you test your HOMOCYSTEINE? You may be UNDERMETHYLATED.

    Reverse T3 is caused by taking too much T4. //tiredthyroid.com/rt3.html

    You are on too much T3, (TSH .000) This will cause high SHBG and can drive up cortisol.

    Your high DHT and low FT, is a mystery to me.

    Do you really need the Nuvigil??????
    You can have optimal homocysteine problems still.have 10 or.more.mutations. I.specialize in designing protocols based on epigenetics which are solely nutritional.based. The results have been.mind.blowing in.many cases of.cfs fm mold multiple chemical sensitivity and environment exposures where.other doctors have thrown up.their hands doing the best they can. These are real and they do.exist devastating peoples wellbeing
    I am not a medical Dr, please keep in mind that this answer is for information purposes only, and is not intended to diagnose, treat or replace sound medical advice from your physician or health care provider.
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    Your high cortisol will screw up your sleep.
    Almost everyone on my thyroid site has sleep issues, thyroid meds also screw up your sleep.
    Yes, your T4 levels indicate that something is driving your thyroid out put.
    So, the question is, " What came first, High LH?, High Cortisol?, Wonky Thyroid?
    Do you split up the T3 into 4 doses, spread out over the day?
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    Doesn't High Thyroid output, regardless of TSH levels, look like Graves or Thyroid Storms.

    I had been on 80mcg of T3 only, for 6 months, I had low TSH, LOW T4, still had LOW T3 (YES), and high cortisol like yours. 25mcg of T3
    is not that much, your thyroid is not shut down, only your TSH is.
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    Quote Originally Posted by Mr.TT View Post
    Doesn't High Thyroid output, regardless of TSH levels, look like Graves or Thyroid Storms.

    I had been on 80mcg of T3 only, for 6 months, I had low TSH, LOW T4, still had LOW T3 (YES), and high cortisol like yours. 25mcg of T3
    is not that much, your thyroid is not shut down, only your TSH is.
    Think this issues are just symptoms of a much deeper causes, chasing rt3 is not the way to go for a long term solution. IF you are taking generic t3 then now you know why your t3 is low..
    I am not a medical Dr, please keep in mind that this answer is for information purposes only, and is not intended to diagnose, treat or replace sound medical advice from your physician or health care provider.
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    Quote Originally Posted by Mr.TT View Post
    Yes, your T4 levels indicate that something is driving your thyroid out put.
    So, the question is, " What came first, High LH?, High Cortisol?, Wonky Thyroid?
    Thyroid dysfunction definitely came first (though there may have been some adrenal dysfunction on top of that....I hadn't run the adrenal tests before April 2012).

    I had gone in for a physical with my GP in March (which was after the extreme fatigue started, but before I started going to the endocrinologist). I had normal TSH, low-normal FT4, and low FT3:

    thyroid labs (March 2012, pre treatment ... i.e., no levothyroxine, no cytomel)
    TSH 1.1 .03-3.0
    Free T3 2.2 pg/mL 2.4-4.8
    Free T4 1.09 ng/dL .6-1.6
    anti-TPO, negative

    So basically, prior to treatment with any thyroid meds, I had low Free T3. My symptoms were consistent with this (cold hands and feet, fatigue, etc). I think that's why my endo started by treating my thyroid once I started seeing him in April.

    Quote Originally Posted by Mr.TT View Post
    Do you split up the T3 into 4 doses, spread out over the day?
    I take my T3 once per day in the morning.
    Difficulties strengthen the mind, as labor does the body.
    -Seneca
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    Quote Originally Posted by Mr.TT View Post
    Doesn't High Thyroid output, regardless of TSH levels, look like Graves or Thyroid Storms.

    I had been on 80mcg of T3 only, for 6 months, I had low TSH, LOW T4, still had LOW T3 (YES), and high cortisol like yours. 25mcg of T3
    is not that much, your thyroid is not shut down, only your TSH is.
    Could the Lugol's + Selenium be driving some excess T4 production?
    Difficulties strengthen the mind, as labor does the body.
    -Seneca
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    If I were a Dr., I would have looked at cortisol levels and nutritional issues first.
    Those thyroid test levels don't scream HYPOTHYROID.

    Few ppl can tolerate T3 dosing once a day. T3 has a 3 hour metabolic spike, in your body.
    Since I don't think you are hypothyroid, and you are blasting yourself with 25mcg of T3 once a day,
    this might cause weird hormone spikes.
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    Quote Originally Posted by Mr.TT View Post
    If I were a Dr., I would have looked at cortisol levels and nutritional issues first.
    Those thyroid test levels don't scream HYPOTHYROID.

    Few ppl can tolerate T3 dosing once a day. T3 has a 3 hour metabolic spike, in your body.
    Since I don't think you are hypothyroid, and you are blasting yourself with 25mcg of T3 once a day,
    this might cause weird hormone spikes.
    You hit the nail on the head. I would run a nutreval to look to see what is going on at the cellular level as well as looking at the Gut, liver and neuortransmitter.

    If a person is not committed to change their lifestyle and eating patterns then you will not heal plain and simple...
    I am not a medical Dr, please keep in mind that this answer is for information purposes only, and is not intended to diagnose, treat or replace sound medical advice from your physician or health care provider.
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    Do you take L-Carnitine?

    Do you get heart palps from the T3?
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    Quote Originally Posted by Mr.TT View Post
    Do you take L-Carnitine?

    Do you get heart palps from the T3?
    I had taken ALCAR 1000 mg earlier in the year but didn't feel any different, so I stopped.

    No heart palps from the T3. Doesn't make me feel any different.
    Difficulties strengthen the mind, as labor does the body.
    -Seneca
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    So, I think I have some idea of what's going on with my thyroid and androgens:

    As Mr. TT noted, increased T3 or a hyperthyroid state can increase SHBG significantly. There was a study (found the paper on another forum) that showed that T3 induced hyperthyroidism [1] can increase SHBG. The paper also suggested that this increased SHBG binds with testosterone, thus reducing metabolic deactivation of testosterone. This lead to a higher total testosterone (though I'm not sure if this rise is temporary or not).

    So, clearly my Cytomel is causing problems: it's making me hyperthyroid and messing with my steroid hormones.

    What's not clear is whether the adrenal labs (high ACTH, high cortisol) are related to the T3 medication, or if they are an entirely separate issue.

    It's also not clear what's causing the fatigue generally.

    Any ideas on those?



    [1] Lovejoy JC, Smith SR, Bray GA, Veldhuis JD, Rood JC, Tulley R. Effects of experimentally induced mild hyperthyroidism on growth hormone and insulin secretion and sex steroid levels in healthy young men. Metabolism. 1997 Dec;46(12):1424-8
    Difficulties strengthen the mind, as labor does the body.
    -Seneca
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    Quote Originally Posted by The Matrix View Post
    I seem to think there are much deeper issues probably at the cellular levels as well immune compromise which is driving your SHBG (which thyroid can also drive it up.)
    I'm definitely curious about the immune component, but I can say that all immune related tests came up clean:

    Low CRP
    Low Sed Rate
    ANA, Negative
    RF, negative
    Tissue Trans Glutaminase, negative
    H. Pylori, negative


    That said, the one time I felt great in the last few years was when I went on Prednisone for a week (for an ear infection).

    I've heard that Prednisone alters immune system function. Is the fact that I felt good on it a clue to what's causing the fatigue?
    Difficulties strengthen the mind, as labor does the body.
    -Seneca
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    Sorry you've been going through this. There was another thread on here about (what I refer to )adrenal fatigue syndrome and a lot of guy's chimed in, so hopefully they will on this one too
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    Still need to find out why adrenals are.depleted. I run.metametrix stool.testing on just about every client along with testing I suggest to.their Dr. We tend to find answerwith.minimal.testing. When adrenals.are the issue there is high probability of gut.imbalance.
    I am not a medical Dr, please keep in mind that this answer is for information purposes only, and is not intended to diagnose, treat or replace sound medical advice from your physician or health care provider.
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    Quote Originally Posted by Miss Q View Post
    Sorry you've been going through this. There was another thread on here about (what I refer to )adrenal fatigue syndrome and a lot of guy's chimed in, so hopefully they will on this one too
    Thanks Miss Q. I just did a search and a lot of threads came up related to adrenal fatigue. Do you have a specific one in mind?
    Difficulties strengthen the mind, as labor does the body.
    -Seneca
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    ALCAR 1000 .... could down regulate your thyroid.

    Prednisone (cortisol) could be pushing more T4 and T3 into your cells, making you feel better.

    Do you have histamine problems? Do Antihistamines also make you feel better?

    There are smart ppl on this site........
    There are REALLY SMART PPL on forums.phoenixrising.me/index.php?forums/detox-methylation-b12-glutathione-chelation.6/[/url]
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    Quote Originally Posted by Mr.TT View Post
    ALCAR 1000 .... could down regulate your thyroid.

    Prednisone (cortisol) could be pushing more T4 and T3 into your cells, making you feel better.

    Do you have histamine problems? Do Antihistamines also make you feel better?

    There are smart ppl on this site........
    There are REALLY SMART PPL on forums.phoenixrising.me/index.php?forums/detox-methylation-b12-glutathione-chelation.6/[/url]
    Yes I know most of them LOL..That is what I do is genetic testing then design make recommendations based off them. I know Rich very well..A great man a such a true loss. His passion to help people ended up being his downfall....
    I am not a medical Dr, please keep in mind that this answer is for information purposes only, and is not intended to diagnose, treat or replace sound medical advice from your physician or health care provider.
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    Quote Originally Posted by The Matrix View Post
    Yes I know most of them LOL..That is what I do is genetic testing then design make recommendations based off them. I know Rich very well..A great man a such a true loss. His passion to help people ended up being his downfall....
    That deserves repeating, Rich V. was an exceptional human being. His research is bleeding edge. And there are many many other
    brilliant ppl participating on that site. I feel better now....
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    Quote Originally Posted by Mr.TT View Post
    That deserves repeating, Rich V. was an exceptional human being. His research is bleeding edge. And there are many many other
    brilliant ppl participating on that site. I feel better now....
    Yes,
    I was studying methylation way back almost 8 years ago. People thought I was some quack with far out ideas and how healing the gut, balancing liver pathways was to get people better. Now I am in working my way up to the top working with some of the biggest names in CFS, FM, neuology, and detoxification specialist. I am one of co founders of MTHFRsupport group on facebook.
    I am not a medical Dr, please keep in mind that this answer is for information purposes only, and is not intended to diagnose, treat or replace sound medical advice from your physician or health care provider.
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    Update:

    My endocrinologist agrees that I'm a bit hyperthyroid at this point and he wants to decrease my Cytomel down to 10 mcg.

    He said my Total Test was "over the top" but said that since test can have anti-inflammatory properties, that I shouldn't worry about it, or work to lower it.

    Concerning ferritin: He thinks it's a little high, but hasn't recommended that I try to lower it yet. I'm still wondering if a blood donation might help things.

    Concerning Rt3: He thinks this is a signal on an underlying inflammatory process (he's been saying this for a while), though what confuses me is that my inflammation biomarkers (HS-CRP, autoimmune tests, sed rate) are all low or negative.

    Concerning cortisol: He didn't think it was a problem. I was disapointed by this. Over the last few days, I've done some reading over at Jack Kruse's site, and Dr. Kruse claims that high cortisol and high ACTH can be the primary driver of a RT3 problem. If that's the case, we might be missing something.... lowering my cortisol (reducing stress?) might fix my T4 -> T3 conversion problem.

    As for the fatigue generally, he thinks inflammation is driving it.

    Thoughts?
    Difficulties strengthen the mind, as labor does the body.
    -Seneca
  26. Registered User
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    Quote Originally Posted by Mr.TT View Post
    There are REALLY SMART PPL on forums.phoenixrising.me/index.php?forums/detox-methylation-b12-glutathione-chelation.6/[/url]
    Quote Originally Posted by The Matrix View Post
    Yes,
    I was studying methylation way back almost 8 years ago. People thought I was some quack with far out ideas and how healing the gut, balancing liver pathways was to get people better. Now I am in working my way up to the top working with some of the biggest names in CFS, FM, neuology, and detoxification specialist. I am one of co founders of MTHFRsupport group on facebook.
    I just ordered a 23 and Me genome test to look at methylation defects and hemochromatosis.

    I'll also probably do a Nutreval from Genova to look at nutritional status (status of methylation related nutrients). I may wait at least a month or two though to let my thyroid settle down after the reduced Cytomel dosage.
    Difficulties strengthen the mind, as labor does the body.
    -Seneca
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    Quote Originally Posted by Ad Fortitudo View Post
    Update:

    My endocrinologist agrees that I'm a bit hyperthyroid at this point and he wants to decrease my Cytomel down to 10 mcg.

    He said my Total Test was "over the top" but said that since test can have anti-inflammatory properties, that I shouldn't worry about it, or work to lower it.

    Concerning ferritin: He thinks it's a little high, but hasn't recommended that I try to lower it yet. I'm still wondering if a blood donation might help things.

    Concerning Rt3: He thinks this is a signal on an underlying inflammatory process (he's been saying this for a while), though what confuses me is that my inflammation biomarkers (HS-CRP, autoimmune tests, sed rate) are all low or negative.

    Concerning cortisol: He didn't think it was a problem. I was disapointed by this. Over the last few days, I've done some reading over at Jack Kruse's site, and Dr. Kruse claims that high cortisol and high ACTH can be the primary driver of a RT3 problem. If that's the case, we might be missing something.... lowering my cortisol (reducing stress?) might fix my T4 -> T3 conversion problem.

    As for the fatigue generally, he thinks inflammation is driving it.

    Thoughts?
    What I have been saying all along about inflammation ?......
    Probably find your answer in a metametrix Gi effect stool test which you can get off line as I suggest my clients do..
    I am not a medical Dr, please keep in mind that this answer is for information purposes only, and is not intended to diagnose, treat or replace sound medical advice from your physician or health care provider.
  28. Registered User
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    Quote Originally Posted by The Matrix View Post
    What I have been saying all along about inflammation ?......
    Probably find your answer in a metametrix Gi effect stool test which you can get off line as I suggest my clients do..
    Matrix, do you prefer the Metametrix GI stool test over the Genova CDSA 2.0 w/Parasitology-Genova KIT Coprennsive stool analysis? (I'm not sure that it'll matter in a few months. Genova and Metametrix are merging .... they'll probably start offering one set of test for these sorts of things).
    Difficulties strengthen the mind, as labor does the body.
    -Seneca
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    Quote Originally Posted by Ad Fortitudo

    Matrix, do you prefer the Metametrix GI stool test over the Genova CDSA 2.0 w/Parasitology-Genova KIT Coprennsive stool analysis? (I'm not sure that it'll matter in a few months. Genova and Metametrix are merging .... they'll probably start offering one set of test for these sorts of things).
    Metametrix gi effects stool test is dna analysis and gold standard in testing Genova is not as accurate for.some reason. Be a year or so till you see changes in the company. I am in contact with our rep each month from genova to hear of.updates.
    I am not a medical Dr, please keep in mind that this answer is for information purposes only, and is not intended to diagnose, treat or replace sound medical advice from your physician or health care provider.
  30. Registered User
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    Quote Originally Posted by Ad Fortitudo View Post
    Hey Anabolic Minds,


    I'm hoping that I might be able to crowd-source some advice.


    I've been dealing with fatigue for the better part of 10 years now and in the last year it's become significantly worse.


    After doing a lot of reading here at Anabolic Minds (and some similar forums) and I've started approaching this problem with hard data (getting labs, measuring everything, etc).


    I've also been working with a doctor (an endocrinologist who is discussed here and on similar forums) for the last 8 months and have lots of lab work at this point.






    HISTORY:


    Last 10 years:
    - Fatigue


    Past year:
    - Extreme fatigue
    - Cold hands and feet
    - "Brain fog"/difficulty concentrating
    - Low libido
    - Low motivation
    - Memory loss (can't remember names, words, etc)




    The endocrinologist I'm working with diagnosed me with hypothyroidism (specifically, low free T3 and low Ft4)


    Went on 100 mcg T4. 2 months later had symptoms of hyperthyroid (very low TSH, insomnia, etc). We ran labs and found that I also had extremely high reverse T3 (RT3), though FT3 hadn't moved much.


    Endocrinologist diagnosed me with T4 to T3 conversion problem, and switched me to 25mcg of Cytomel (T3 medication).


    Since then, my fatigue has not improved. Did a sleep study and was prescribed Nuvigil (not by my endocrinologist; a separate sleep doctor prescribed the Nuvigil).


    Just ran new labs and several things are abnormal (very high Test, SHBG).






    SUPPLEMENTS:
    Iodine (lugols) 12 mg
    Selenium 200 mcg
    Vitamin C 1000 mg
    Krill Oil 600 mg-----------------------------stop that
    B-complex 100 mg
    Zinc 50 mg
    Copper 2 mg
    Creatine 5 g
    Melatonin 3 mg






    CURRENT MEDICATIONS
    Cytomel 25 mcg
    Nuvigil 100 mg (I just cut the pill down because I was getting jittery at 150 mg)---------hopefully we will wean you out of this.






    LABS (these are the most recent labs, drawn Oct 24-Oct26)


    metabolic panel
    Glucose, Serum 99 mg/dL 65-99
    Uric Acid, Serum 6.0 mg/dL 3.7-8.6
    BUN 19 mg/dL 6-20
    Creatinine, Serum 0.96 mg/dL 0.76-1.27
    eGFR If NonAfricn Am 104 mL/min/ 1.73 >59
    eGFR If Africn Am 120 mL/min/ 1.73 >59
    BUN/Creatinine Ratio 20 8-19 HIGH
    Sodium, Serum 140 mmol/L 134-144
    Potassium, Serum 5.0 mmol/L 3.5-5.2
    Chloride, Serum 103 mmol/L 97-108
    Carbon Dioxide, Total 27 mmol/L 20-32
    Calcium, Serum 9.4 mg/dL 8.7-10.2
    Phosphorus, Serum 3.7 mg/dL 2.5-4.5
    Protein, Total, Serum 6.4 g/dL 6.0-8.5
    Albumin, Serum 4.2 g/dL 3.5-5.5
    Globulin, Total 2.2 g/dL 1.5-4.5
    A/G Ratio 1.9 1.1-2.5
    Bilirubin, Total 0.3 mg/dL 0.0-1.2
    Alkaline Phosphatase, 57 IU/L 25-150
    LDH 140 IU/L 0-225
    AST (SGOT) 18 IU/L 0-40
    ALT (SGPT) 19 IU/L 0-55
    GGT 24 IU/L 0-65


    Hemoglobin A1c 5.1 % 4.8-5.6
    Insulin 7.6 uIU/mL 2.6-24.9


    lipids
    Cholesterol, Total 142 mg/dL 100-199
    Triglycerides 82 mg/dL 0-149
    HDL Cholesterol 53 mg/dL >39
    According to ATP-III Guidelines, HDL-C >59 mg/dL is considered a
    negative risk factor for CHD.
    LDL Cholesterol Calc 73 mg/dL 0-99
    T. Chol/HDL Ratio 2.7 0.0-5.0


    thyroid panel
    TSH 0.006 uIU/mL 0.450-4.500 LOW
    Thyroxine (T4) 9.0 ug/dL 4.5-12.0
    Triiodothyronine (T3) 145 ng/dL 71-180
    T3 Uptake 39 % 24-39
    T4,Free(Direct) 1.79 ng/dL 0.82-1.77 HIGH
    T3,Free,Serum 4.9 pg/mL 2.0-4.4 HIGH
    Reverse T3, Serum 36.5 ng/dL 9.2 - 24.1 HIGH
    Thyroid Peroxidase (TPO) Ab 8 IU/mL 0-34
    Antithyroglobulin Ab <20 IU/mL 0-40
    PTH, Intact 21 pg/mL 15-65


    iron panel
    Ferritin, Serum 296 ng/mL 30-400
    Iron, Serum 104 ug/dL 40-155
    Iron Bind.Cap.(TIBC) 238 ug/dL 250-450 LOW
    UIBC 134 ug/dL 150-375 LOW
    Iron Saturation 44 % 15-55


    steroid hormones and related
    Testosterone, Serum 1103 ng/dL 348-1197
    Free Test(Direct) 16.7 pg/mL 8.7-25.1
    Dihydrotestosterone 85 ng/dL 30 - 85
    SHBG, Serum 74.7 nmol/L 16.5-55.9 HIGH
    IGF-I 234 ng/mL 71-241
    DHEA-Sulfate 288.6 ug/dL 160.0-449.0
    Progesterone 0.9 ng/mL 0.2-1.4
    Estradiol 27.7 pg/mL 7.6-42.6
    (Roche ECLIA methodology)


    pituitary
    LH 7.2 mIU/mL 1.7-8.6
    FSH 2.5 mIU/mL 1.5-12.4
    Prolactin 13.9 ng/mL 4.0-15.2


    cortisol and related
    Pregnenolone, MS 196 ng/dL Adults: <151
    Cortisol - AM 23.9 ug/dL 6.2-19.4 HIGH
    ACTH, Plasma 96.7 pg/mL 7.2-63.3 HIGH


    inflammation
    C-Reactive Protein, 0.35 mg/L 0.00-3.00
    Relative Risk for Future Cardiovascular Event
    Low <1.00
    Average 1.00 - 3.00
    High >3.00


    vitamins
    Vitamin A, Serum 69 ug/dL 18-77
    Vitamin B12 782 pg/mL 211-946
    Folate (Folic Acid), Serum 15.6 ng/mL >3.0
    Vitamin D, 25-Hydroxy 66.3 ng/mL 30.0-100.0






    QUESTIONS:
    - Why do I still have high Ft4? Wouldn't the cytomel (and subsequent low TSH) suppress the formation of T4?
    - Why do I still have high reverse T3?
    - Why are my androgens so high? (back in the July, my TT was about 714)
    - How can I drive down SHBG (I'm guessing that the cytomel increased it.)
    - Why is my ACTH so high? Could the Cytomel do this?
    - What's causing my fatigue? My thyroid hormones are in range now ( they were not when I started) but I still feel worn out. Is this a RT3 issue?

    Sorry for late answering your PM.
    I may be easier to reach me here.


    http://www.allthingsmale.com/forum/member.php?9-JanSz




    thyroid labs (March 2012, pre treatment ... i.e., no levothyroxine, no cytomel)
    TSH 1.1 .03-3.0
    Free T3 2.2 pg/mL 2.4-4.8
    Free T4 1.09 ng/dL .6-1.6
    anti-TPO, negative





    I would say that you suffer mostly from your Circadian Rhythm problems.
    Screwed melatonin/cortisol pattern.
    Also review of your blood work indicate that you likely need fatty acids and phospholipids support.
    Your insulin and glucose are high.
    I am assuming that your high TotalTestosterone is natural.
    You should not use any thyroid hormones supplementations, if you must, 1 grain of Natural thyroid Product.
    Instead
    Cold Thermogenesis per dr Kruse
    and 200mg 7ketoDHEA
    ----------------------------------
    Because of this blood indicators being out of range you may consider suggested supplements


    CHOL -38 Manganese
    CHOL -38 Coconut Oil
    CHOL -38 Bile Salts


    AlkPhs -25 Vitamin C
    AlkPhs -25 Zinc
    AlkPhs -25 Phosphatidylcholine
    Alk Phos -34--vit C
    Alk phos -34--vit D3
    Alk phos---below 60 anorgasmic -------(describe how tough or easy is for you to get orgasm)
    Alkaline Phosphatase, 57 IU/L 25-150

    Potassium (K+21)taken 1-2hrs AFTER meals to support digestion and pancreas. 2capsules(1000mg) 2x/daily(after meals)


    Glucose +68 --Biotin
    Glucose +68--multi vitamin
    Glucose +68--Niacinamide
    .Glucose +68--Vit B1
    Glucose +32 chromium
    Glucose +32 Evening Primrose Oil


    -----------------------------------------------------------------
    You have high ferritin and hith testosterone.
    Monitor you hemoglobin and hematocrit.
    --------------------------------------------------------------------


    High glucose & insulin & highish prolactin
    stop eating all grains, corn, potatoes
    take
    1000mg/day Metformin
    up to 6 pills/(wakeup) Cycloset 0.8mg (start slow, may cause nausea)(expensive, do not use generic)
    ---------------------------------------------------------------------
    To bring your screwed up Circadian Rhythm to oder will require
    strict
    adherence
    to dr Jack Kruse protocol.


    Highlights of that protocol:
    Work days shifts only.
    Work with daylight only, no artificial lighting after sundown.
    Sleep in official darkroom sometime within 10PM -8AM, keep bedroom cold, sleep naked uncovered
    At wakeup look at sun 5 minutes
    Eat big brekfast withn 30min to 1hr (50% daily food).
    Lunch
    Dinner within 4-6 hrs of bed time.
    No snacking
    Very low artificial light (use UV & green filter eyeglases.
    30min/day 5 days/week, ice cold bath up to the neck. (Cold Thermogenesis)(CT)
    I can't do CT, I take long cold showers, walk around in shorts and gym sleveless shirt at night (~30F now).
    When starting CT, apply it first to a throat area (communication with vagal nerve + brain)

    --------------------
    Eat EPI-Paleo diet as described by dr Jack Kruse


    Note, at my Shop-Rite dozen oysters $5.40, shucked oysters (about 2 dozens similar price).


    Total food intake =
    tap water as much as need
    solid food=70% fat +30 % protein (minimal, incidental carbohydrates but not in winter)
    protein part =more seafood than (pork, beef other mammals, no birds except eggs)
    whole eggs, bacon
    oysters


    preferably raw




    .............................. .......

    Get NutrEval (better but cost more) or
    Essential & Metabolic Fatty Acids Analysis (EMFA) by Genova Diagnostics
    http://www.healthremedies.com/essential_metabolic_fatty_acid s_analysis_emfa_genova_diagnos tics.html
    ----------------
    and

    Spectracell Comprehensive Nutritional Panel
    http://www.healthremedies.com/intracellular_vitamin_analysis _spectracell.html


    You should not be eating any supplemental fats.
    You are eating fish oils and krill oils, that is mistake.

    Stop that now.
    but
    if you are going to have fatty acid analysis now, then keep using the without changing dose.

    Supplemental fats =bad news unless protocol is guided by (good) fatty acid analysis.

    The fatty Acid Analysis from Genova are passable but not good.
    They do not have allowable upper range for EPA & DHA
    Those analysis will newer tell you that you eat too much Krill or fish oil.
    That is likely by design, they must be getting a cut from kril/fish oil industry


    For that reason I have misgivings about their NutrEval test.

    \\

    Off hand, the only fats you are eating are from the food, meats.

    lard
    beef tally
    other mammal fat
    butter
    coconut oil
    olive oil
    macadamia nuts
    avocado (whole)
    that's about all
    ============================== ============================== =========
    replace your selenium & iodine with this:

    2/day-->Super Selenium Complex, 200 mcg 100 capsules (lef.org)

    1 dropperfull/day=48mg/day
    Lugol's Iodine Family Pack -- 6 (2 fl. oz.) bottles Price: $73.90
    http://www.amazon.com/Lugols-Iodine-.../dp/B001RRP3FW
    recalculate dose if using other iodine/iodide source.

    BodyBio PC (Phosphatidylcholine)
    300 SoftGels (900mg)
    http://www.bodybio.com/storeproduct357.aspx
    4/day

    Doctor's Best Brain Enhancers (GPC) & (PS)
    2/day (possibly 4)

    4/day NAC (source of gluthatione)

    you may need IV gluthatione, check what comes out from Spectracell.




    ...........


    http://www.amazon.com/Allen-Company-.../dp/B003TWWT5A
    Allen Company Over-Prescription Shooting Glasses
    Price: $7.95



    .
  31. Registered User
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    Quote Originally Posted by JanSz View Post

    Sorry for late answering your PM.
    I may be easier to reach me here.

    http://www.allthingsmale.com/forum/member.php?9-JanSz

    I would say that you suffer mostly from your Circadian Rhythm problems.
    Screwed melatonin/cortisol pattern.
    Also review of your blood work indicate that you likely need fatty acids and phospholipids support.
    Your insulin and glucose are high.
    I am assuming that your high TotalTestosterone is natural.
    You should not use any thyroid hormones supplementations, if you must, 1 grain of Natural thyroid Product.
    Instead
    Cold Thermogenesis per dr Kruse
    and 200mg 7ketoDHEA
    ----------------------------------
    Because of this blood indicators being out of range you may consider suggested supplements

    CHOL -38 Manganese
    CHOL -38 Coconut Oil
    CHOL -38 Bile Salts

    AlkPhs -25 Vitamin C
    AlkPhs -25 Zinc
    AlkPhs -25 Phosphatidylcholine
    Alk Phos -34--vit C
    Alk phos -34--vit D3
    Alk phos---below 60 anorgasmic -------(describe how tough or easy is for you to get orgasm)
    Alkaline Phosphatase, 57 IU/L 25-150

    Potassium (K+21)taken 1-2hrs AFTER meals to support digestion and pancreas. 2capsules(1000mg) 2x/daily(after meals)

    Glucose +68 --Biotin
    Glucose +68--multi vitamin
    Glucose +68--Niacinamide
    .Glucose +68--Vit B1
    Glucose +32 chromium
    Glucose +32 Evening Primrose Oil

    -----------------------------------------------------------------
    You have high ferritin and hith testosterone.
    Monitor you hemoglobin and hematocrit.
    --------------------------------------------------------------------

    High glucose & insulin & highish prolactin
    stop eating all grains, corn, potatoes
    take
    1000mg/day Metformin
    up to 6 pills/(wakeup) Cycloset 0.8mg (start slow, may cause nausea)(expensive, do not use generic)
    ---------------------------------------------------------------------
    To bring your screwed up Circadian Rhythm to oder will require
    strict
    adherence
    to dr Jack Kruse protocol.

    Highlights of that protocol:
    Work days shifts only.
    Work with daylight only, no artificial lighting after sundown.
    Sleep in official darkroom sometime within 10PM -8AM, keep bedroom cold, sleep naked uncovered
    At wakeup look at sun 5 minutes
    Eat big brekfast withn 30min to 1hr (50% daily food).
    Lunch
    Dinner within 4-6 hrs of bed time.
    No snacking
    Very low artificial light (use UV & green filter eyeglases.
    30min/day 5 days/week, ice cold bath up to the neck. (Cold Thermogenesis)(CT)
    I can't do CT, I take long cold showers, walk around in shorts and gym sleveless shirt at night (~30F now).
    When starting CT, apply it first to a throat area (communication with vagal nerve + brain)

    --------------------
    Eat EPI-Paleo diet as described by dr Jack Kruse

    Note, at my Shop-Rite dozen oysters $5.40, shucked oysters (about 2 dozens similar price).

    Total food intake =
    tap water as much as need
    solid food=70% fat +30 % protein (minimal, incidental carbohydrates but not in winter)
    protein part =more seafood than (pork, beef other mammals, no birds except eggs)
    whole eggs, bacon
    oysters

    preferably raw

    .............................. .......

    Get NutrEval (better but cost more) or
    Essential & Metabolic Fatty Acids Analysis (EMFA) by Genova Diagnostics
    http://www.healthremedies.com/essential_metabolic_fatty_acid s_analysis_emfa_genova_diagnos tics.html
    ----------------
    and

    Spectracell Comprehensive Nutritional Panel
    http://www.healthremedies.com/intracellular_vitamin_analysis _spectracell.html

    You should not be eating any supplemental fats.
    You are eating fish oils and krill oils, that is mistake.

    Stop that now.
    but
    if you are going to have fatty acid analysis now, then keep using the without changing dose.

    Supplemental fats =bad news unless protocol is guided by (good) fatty acid analysis.

    The fatty Acid Analysis from Genova are passable but not good.
    They do not have allowable upper range for EPA & DHA
    Those analysis will newer tell you that you eat too much Krill or fish oil.
    That is likely by design, they must be getting a cut from kril/fish oil industry

    For that reason I have misgivings about their NutrEval test.

    \\

    Off hand, the only fats you are eating are from the food, meats.

    lard
    beef tally
    other mammal fat
    butter
    coconut oil
    olive oil
    macadamia nuts
    avocado (whole)
    that's about all
    ============================== ============================== =========
    replace your selenium & iodine with this:

    2/day-->Super Selenium Complex, 200 mcg 100 capsules (lef.org)

    1 dropperfull/day=48mg/day
    Lugol's Iodine Family Pack -- 6 (2 fl. oz.) bottles Price: $73.90
    http://www.amazon.com/Lugols-Iodine-.../dp/B001RRP3FW
    recalculate dose if using other iodine/iodide source.

    BodyBio PC (Phosphatidylcholine)
    300 SoftGels (900mg)
    http://www.bodybio.com/storeproduct357.aspx
    4/day

    Doctor's Best Brain Enhancers (GPC) & (PS)
    2/day (possibly 4)

    4/day NAC (source of gluthatione)

    you may need IV gluthatione, check what comes out from Spectracell.

    ...........

    http://www.amazon.com/Allen-Company-.../dp/B003TWWT5A
    Allen Company Over-Prescription Shooting Glasses
    Price: $7.95

    .
    These recommendations in a cfs patient are potentially dangerous due.to.their.bio individualality. Ideal with multiple cases of cfs lyme fm all week long. Majority of them are.made worse from drs following old school approaches Information i.use is cutting edge and from.latest research. I spend more time correcting imbalances from other uninformed medical professionals sad to say...
    I am not a medical Dr, please keep in mind that this answer is for information purposes only, and is not intended to diagnose, treat or replace sound medical advice from your physician or health care provider.
  32. Registered User
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    Its been a while since this discussion, but out of curiosity, did you ever get an MRI or see a neurologist? I'm not a doctor, I don't work in the medical field, but I was studying to work in the medical field until a condition with some of the same symptoms derailed everything (for now).
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