Question for Board Veterans on Saliva testing..........

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    Question Question for Board Veterans on Saliva testing..........


    Guys, just wanted to know which Lab is the best for the testing of adrenals, thyroid, test, etc.......via saliva testing............Is that the most accurate way to go via adrenals and thyroid???? I have read Great Smokies Lab and a few others, just want some current info from the Vets.........Thanks in advance........

    Also, does Dr John prefer saliva testing or is it mainly bloodwork through Quest Labs?????

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    Quote Originally Posted by Kingneptune40 View Post
    Guys, just wanted to know which Lab is the best for the testing of adrenals, thyroid, test, etc.......via saliva testing............Is that the most accurate way to go via adrenals and thyroid???? I have read Great Smokies Lab and a few others, just want some current info from the Vets.........Thanks in advance........

    Also, does Dr John prefer saliva testing or is it mainly bloodwork through Quest Labs?????
    Quest---blood work
    RheinLabs---urine-- mostly 2/16 estrogens
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    cortisol?
    •   
       

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    24hr urine then?? i hope my doctor knows how to this and tell me...i have no clue
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    WOw, thanks Dr John.........glad I waited on ordering the saliva tests until I visited your clinic on Friday.........Its very confusing with all of the information out there, but I am going to let you handle my case.........It will be nice to not have to add my 2 cents for a change.........I get frustrated trying to get my doctors to keep up with research..........I appreciate you commenting on this thread Dr J...........Peace
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    Dr. John, what then do you recommend for all those with cortisol and adrenal issues? and how important do you think they are? I havent seen you mention them that much, which has led me to be hesitant to switch to your services from my current doc. I KNOW i have cortisol/adrenal issues, and that the only way my armour has been able to increase to 2.75 grains from .5 grains without exhessive build up or pooling is with takin HC. but im now at 42.5mg of HC and would not like to go any higher.
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    Some of the self tests seem very good for checking adrenal fatigue. For instance the pupil test gives a clear indication of poorly functioning adrenals and a sodium/potassium imbalance. I would imagine the saliva tests would confirm this for cortisol and dhea-s along with complete bloodwork
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    Quote Originally Posted by Dr. John View Post
    This tells the story.
    are you saying that most adrenal diagnoses are just wrong? im still trying to understand your treatment of these conditions. im not expecting you to give a full analysis, just a brief of what you look for and what you do with adrenal issues?

    for example, my serum morning cortisol has ALWAYS been high. even higher than average. but i know from experience that cortef is one of the only things helping me these days.

    ill set up an appointment right now, and drive down to lansing if you think you can fix me up...especially getting me back into the gym and exercising in the next month or so. its been 4-5 of playing games and im sick and tired of 'slow' progress.
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    thanks. i read that. and my question still remains unanswered..or at least unclarified. are you saying that if my serum looks normal or even HIGH, than the cortisol medication is incorrect? im not going by saliva testing either...my saliva tests were started after i began isocort (OTC cortisol supplement) so i dont think they would be 'accurate' even if they did work. what i do know is that I could not handle .5 grain of armour until increasing my cortef dose and even know, my temp still fluctuates especially when i get stresssed out. and i am now on .1mg of florinef and 42.5mg of cortef. The question is....i really dont know where to turn. ive had batteries of labwork done.

    so the question is: I know TRT is your baby, and if that were my only issue I would ONLY go to you. But adrenals are something else. So, can you talk abit more about adrenal therapy from Dr. John's persective?
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    Quote Originally Posted by Dr. John View Post
    Here's a pretty good list:

    Symptoms of adrenal fatigue:
     Morning fatigue -- You don't really seem to "wake up" until 10 a.m., even if you've been awake since 7 a.m.
     Afternoon "low" (feelings of sleepiness or clouded thinking) from 2 to 4 p.m.
     Burst of energy at 6 p.m. -- You finally feel better from your afternoon lull.
     Sleepiness at 9 to 10 p.m. -- However, you resist going to sleep.
     "Second wind" at 11 p.m. that lasts until about 1 a.m., when you finally go to sleep.
     Cravings for foods high in salt, sugar and fat
     Increased PMS or menopausal symptoms
     Mild depression
     Lack of energy
     Decreased ability to handle stress
     Muscular weakness
     Increased allergies
     Lightheadedness when getting up from a sitting or laying down position
     Decreased sex drive
     Frequent sighing
     Inability to handle foods high in potassium or carbohydrates unless they're combined with fats and protein
    my last answer ignored this post.

    well, I had pretty much all of those...and have gotten better on a number of them since starting the cortef/HC. Especially all the cyclical energy patterns....and the horrible insomnia if i dont get to bed by ten.

    we have started to treat those...but now, im up to 42.5mg of HC and still feel funky at times. Is it just a patience issue? just waiting to take time. And should i be able to exercise or not once i get the right cortef dosing. I know 20-25 is the general standard. so im almost double that now.

    i had an appointment scheduled with you before, then had it cancelled becasue family wanted me to stay with a doctor who 'handles this stuff' more locally. well, im not too confident in him and now thnk im about ready to make the drive to lansing....i just wanted to know your EXPERIENCE and results with adrenal issues.
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    No stim test. went to get one done at a couple different labs and they didnt have the equiment or some bs. I have had at least 2-3 serum tests.....one while on HC and one or two without. And my morning fasting cortisol was around 28 or so. also had one done randomly midday and it was around 16-17.

    i definetly have the toughness waking up. i get 10 hours of sleep and could always sleep more. also, ive mentioned this before but i get a weird crazy red facial flush that no one has been able to account for or even really look into. it gets worse when i feel worse, adn better/less noticeable when i am taking my meds and feeling good.

    for instance....my tests way back in end of august had am cortisol at 29.4. then mid october (non-fating non-am) they were at 17.4. my most recent while on at least 35mg of cortef was in the high 20's again i believe....despite stopping all strenuous activity and getting tremendous amounts of sleep and not trying to stress.
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    Quote Originally Posted by Dr. John View Post
    So all of your serum cortisol tests have been high? How many have you had? Have you had a Stim test?
    My serum cortisol was over the top, yet my saliva cortisol done at four different times during the day showed 3 of them below normal. I supplemented with hydrocortisone, which immediately alleviated my symptoms.
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    it alleviated all your symptoms? Im up to 42.5mg and still have a number of problems going on. Especially with the stomach/bowel movement stuff, and thats with taking a lot of soluble fiber, magnesium citrate, stool softener and florinef and it still is hard and problematic.
    also on 2.75grains of armour. that and the general tiredness, coldness (even while visiting here in AZ, at least indoors) and all the other bs.
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    Quote Originally Posted by Scottyo View Post
    it alleviated all your symptoms?
    When one has multiple hormonal deficiencies, taking just one hormone is not going to alleviate ALL symptoms. It did however stabilise my blood sugar better, gave me more energy, reduced my anxiety (because of unstable blood sugar). Other hormones (at the correct dosages) work synergistically with hydrocortisone to better stabilise blood sugar etc, eg. DHEA, T, pregnenolone.

    Quote Originally Posted by Scottyo View Post
    Im up to 42.5mg and still have a number of problems going on.
    I'm not sure why you are taking such a high dosage of hydrocortisone. I have never had to take more than 5-10mg per day personally. I imagine that it would be rare that one would need more than 20mg per day.

    As Dr. John mentioned above, symptoms are the most important indicator of Adrenal Fatigue. Labs confirm the symptoms. I have used metametrix for saliva cortisol labs before, and they were fine http://www.metametrix.com/content/Home . I would not do saliva testing for anything else besides cortisol. I highly recommend the book:
    "Adrenal Fatigue: the 21st Century Stress Syndrome" - James Wilson

    I noticed that you have a thread with your latest labs. I will respond there to your other lab results.
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    Quote Originally Posted by 1cc View Post
    When one has multiple hormonal deficiencies, taking just one hormone is not going to alleviate ALL symptoms. It did however stabilise my blood sugar better, gave me more energy, reduced my anxiety (because of unstable blood sugar). Other hormones (at the correct dosages) work synergistically with hydrocortisone to better stabilise blood sugar etc, eg. DHEA, T, pregnenolone.



    I'm not sure why you are taking such a high dosage of hydrocortisone. I have never had to take more than 5-10mg per day personally. I imagine that it would be rare that one would need more than 20mg per day.

    As Dr. John mentioned above, symptoms are the most important indicator of Adrenal Fatigue. Labs confirm the symptoms. I have used metametrix for saliva cortisol labs before, and they were fine http://www.metametrix.com/content/Home . I would not do saliva testing for anything else besides cortisol. I highly recommend the book:
    "Adrenal Fatigue: the 21st Century Stress Syndrome" - James Wilson

    I noticed that you have a thread with your latest labs. I will respond there to your other lab results.
    thanks much. as ive said. I tried 20mg of cortef for a while. Did not do much. and couldnt raise my armour dosing until much higher dosing than that. i couldnt sleep and was just utterly wigged out. and that was on 1 grain of armour. im now up much higher but still always constipated and cold.
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    Quote Originally Posted by Dr. John View Post
    Here's a pretty good list:

    Symptoms of adrenal fatigue:
     Morning fatigue -- You don't really seem to "wake up" until 10 a.m., even if you've been awake since 7 a.m.
     Afternoon "low" (feelings of sleepiness or clouded thinking) from 2 to 4 p.m.
     Burst of energy at 6 p.m. -- You finally feel better from your afternoon lull.
     Sleepiness at 9 to 10 p.m. -- However, you resist going to sleep.
     "Second wind" at 11 p.m. that lasts until about 1 a.m., when you finally go to sleep.
     Cravings for foods high in salt, sugar and fat
     Increased PMS or menopausal symptoms
     Mild depression
     Lack of energy
     Decreased ability to handle stress
     Muscular weakness
     Increased allergies
     Lightheadedness when getting up from a sitting or laying down position
     Decreased sex drive
     Frequent sighing
     Inability to handle foods high in potassium or carbohydrates unless they're combined with fats and protein
    This is interesting. I have a friend, well more of an acquaintance, who at one point had most of these symptoms at the same time. (Plus some other ones not related to the ones spelled out above)

    I'll have to check with him if I can get in touch with him and see for sure, but I'd say that he had at least ten or eleven of the listed symptoms. What are those, like 15? And yet he had extremely high cortisol levels (both serum and urinary). I mean we are talking levels like 4 - 5 times the normal range maximum! He has some kind of disorder that causes the adrenal glands to secrete too much cortisol.

    It's ironic that he would have many of those same symptoms yet not have adrenal fatigue, but just the opposite, adrenal hypersecretion!

    I know he made a convert out of me. I went through some deals with salivary testing (not just on cortisol but also thy and Ts and Es) and basically ended up throwing my money away IMO. Like I was told, some tests pretty much demand a blood draw in order to show specifically what a level is right then, while for others a urinary is better as it is not only accurate also but that it shows a total output for a set time period - for example 24 hours.
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    These symptoms match me almost exactly yet my morning serum cortisol was 16. When I tried 5mg cortef it just made me feel worse. Only thing I've found to help me is coffee so far but I think long term use has made me worse. It's odd that I have all these exact symptoms yet the cortef made me feel worse. Ofcourse I am a diabetic and I think it's contraindicated for diabetics. So what else helps if I can't take cortef?

    Quote Originally Posted by Dr. John View Post
    Here's a pretty good list:

    Symptoms of adrenal fatigue:
     Morning fatigue -- You don't really seem to "wake up" until 10 a.m., even if you've been awake since 7 a.m.
     Afternoon "low" (feelings of sleepiness or clouded thinking) from 2 to 4 p.m.
     Burst of energy at 6 p.m. -- You finally feel better from your afternoon lull.
     Sleepiness at 9 to 10 p.m. -- However, you resist going to sleep.
     "Second wind" at 11 p.m. that lasts until about 1 a.m., when you finally go to sleep.
     Cravings for foods high in salt, sugar and fat
     Increased PMS or menopausal symptoms
     Mild depression
     Lack of energy
     Decreased ability to handle stress
     Muscular weakness
     Increased allergies
     Lightheadedness when getting up from a sitting or laying down position
     Decreased sex drive
     Frequent sighing
     Inability to handle foods high in potassium or carbohydrates unless they're combined with fats and protein
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    Thanks for posting this list by the way, Dr. John.


    Quote Originally Posted by Dr. John View Post
    Here's a pretty good list:

    Symptoms of adrenal fatigue:
     Morning fatigue -- You don't really seem to "wake up" until 10 a.m., even if you've been awake since 7 a.m.
     Afternoon "low" (feelings of sleepiness or clouded thinking) from 2 to 4 p.m.
     Burst of energy at 6 p.m. -- You finally feel better from your afternoon lull.
     Sleepiness at 9 to 10 p.m. -- However, you resist going to sleep.
     "Second wind" at 11 p.m. that lasts until about 1 a.m., when you finally go to sleep.
     Cravings for foods high in salt, sugar and fat
     Increased PMS or menopausal symptoms
     Mild depression
     Lack of energy
     Decreased ability to handle stress
     Muscular weakness
     Increased allergies
     Lightheadedness when getting up from a sitting or laying down position
     Decreased sex drive
     Frequent sighing
     Inability to handle foods high in potassium or carbohydrates unless they're combined with fats and protein
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    I know I came into this late, but I have to completely disagree with the statement about saliva tests. They have been very well validated over the years. I have my patients test before beginning HRT (mostly women) and during HRT when adjustments seem to be needed and the tests have become invaluable to me. I am sure, like anything, there are limitations and positives/negatives to weigh, but for ease of use, cost, and being albe to get a free hormone level I feel they are hard to beat
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    I have seen/heard most of those arguements before, and some seem to have validity. As always I have much to learn as well. Most difficult for me to understand is the results post transdermal therapy. I'll freely admit I can't explain those immediate fluctuations, however given proper timing after a dose the results seem to be come back in line. I do believe that ultimately blood is be best place to test hormones. The problem I have most often seen though is drs who simply will not take the time to do what you have, which is learn what and how to test. The vast majority of drs are either unaware or unwilling to test properly (eg testing only FSH or LH to "diagnose" menopause). Also, cost and availability of the proper tests seems to be an issue in our area according to local drs.
    As to "practicing medicine", most states now have collaborative practice aggrements that allow pharmacists to work under protocols with a dr and have limited prescriptive authority (essentially the dr outlines criteria and what he allows to be prescribed). In addition, many states allow patients to self-order labs, so no dr/pharmacist order is needed. So, no, I do not think I am a dr. However, I do think that I am much more educated in bioidentical HRT than most of the drs I work with, so my patients certainly benefit from the arrangement we have (I consider all of what you might call "customers" my patients, which is why I use that phrase). I highly respect the work you do and your opinions on all of these subjects. If only 10% of the practicing physicians would put forth the effort you obviously have to gain knowledge is the subject of HRT I would be thrilled. As always, I reserve the right to be wrong and have no problem being corrected by someone more edcuated than myself.
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    Dr. John, Do you know anything about the blood spot testing that ZRT and others are using? Just curious, because I don't know anything about the pros/cons or accuracy of this type of testing.
  

  
 

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