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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Racer on May 10, 2006, at 13:11:38
Oh my!
If my typing is weird, sorry -- wet fingernails. I decided to try a Girl Thing today...
Anyway, anxiety is a bit of a problem for me. (I can you some of you saying, "No? Really?" lol) There have been times when I know my body is just primed for take off -- a leaf dropping on the balcony will set off my adrenaline pumps. And then I have this fatigue/ennui thing going on. Someone mentioned adrenal exhaustion, maybe SLS? That struck me as something to maybe get checked out, to see if it would explain some of my current problems. Does anyone know what tests to ask to have run? My GP is resistant to running *any* tests -- says Americans want too many unnecessary tests, and didn't even want to check thyroid until I pointed out that it should be routine for people being treated for depression. And even then, he was kinda clear that he was only ordering the test to indulge me. (I like him a lot -- except that I think he forgets that some people are outliers, you know?)
Since I see my pdoc in a week, I thought I'd ask her to order thyroid, cholesterol, and something to check adrenal function. But I don't know what that would be? Anyone have any ideas?
Part of me says, "Let's do a dexamethasone suppresstion test, and see if it causes remission from depression for a while..." I don't know that's such a great idea for a test, though. But, I might bring it up.
So, can someone here educate me on adrenal testing?
Thanks!
Posted by blueberry on May 10, 2006, at 17:26:43
In reply to anxiety and adrenal function and wet fingernails.., posted by Racer on May 10, 2006, at 13:11:38
Hi Racer,
I've been through this whole process and can tell you a little about it.
Thyroid...the TSH test they give you is worthless. What you need is the full thyroid panel, which includes TSH, T3free, T4free, reverse T3, and the two thyroid antibodies. There can be all kinds of thyroid problems including autoimmune diseases and hidden conditions that will not show up with just TSH.
You can get a diurnal saliva test for cortisol and dhea done yourself from mailorder labs available on the web. A place I used was idealhealth.com, but there are others if you do a search. Idealhealth provided some neat graphs to show my 4 saliva test results and how they compared to average normal results. My results showed adrenal fatigue. My GP was skeptical but I think wanted to cover his butt, so he sent me to an endocrinologist for the suppression test. That came back normal.
The endocrinologist told me that contrary to what naturopaths say about adrenal fatigue being able to recover, he said it is usually permanent.
The saliva tests are actually a waste I think. Really all you need is the suppression test. That will show clearly whether anything is truly wrong or not, and if so, what the next step is. I had to really beg and plead my GP to send me for the test. I had to remind him it's my money and my body and I want this done. I think at that point he realized he had to cover his butt just in the remote case that something was wrong and he had refused my forceful requests. (they think in terms of lawsuits, and I'm convinced he sent me for the test to avoid guilt down the road if it was later discovered I really did have a problem)
Posted by Racer on May 10, 2006, at 17:37:37
In reply to Re: anxiety and adrenal function and wet fingernails.. » Racer, posted by blueberry on May 10, 2006, at 17:26:43
>
> Thyroid...the TSH test they give you is worthless. What you need is the full thyroid panel, which includes TSH, T3free, T4free, reverse T3, and the two thyroid antibodies.I'd read this, and actually asked my GP to order full thyroid -- but he said that if there was any problem at all, it would show up on the TSH. That's part of why I didn't have the tests he ordered done. (And, after I left his office, feeling about this high, I realized I was also due for a cholesterol test, too.) And his attitude about it, "American's want too many unnecessary tests/all women think their thyroid makes them fat, when they just need exercise/etc," just fed right into my own issues.
See, I am so afraid that a doctor will decide that I am a hypochondriac and stop taking me seriously, that I often downplay everything. It has happened to me, of course, which I swear is inevitable if you are a woman with a mood disorder, but trying to hide discomfort doesn't help me at all.
You know, I'm starting to cry right now, which tells me that it's time to thank you very much for this information, and then log off the computer for a while... (Hormones. And depression. And, you know, just plain yuckiness.)
Thanks, Blueberry. I appreciate your time and the information you offered, which I will take along to my pdoc next week.
Posted by Phillipa on May 10, 2006, at 20:02:31
In reply to Re: anxiety and adrenal function » blueberry, posted by Racer on May 10, 2006, at 17:37:37
Racer when you feel better you can do both with a referral to an endocrinologist. And yes you do need the full thyroid panel and the autoimmune antibodies. That's how I found out I have Hassimotos thyroiditis an autoimmune form of it. And that is why my ANA is always high. And once years ago I had that adreanal test done as my Mother died of Addisons disease adrenal function. At the time my test was fine but I feel I need it again. And if you need a mammogram yearly and a colonoscopy and get yelled at or chastised for not having them done tell them you didn't want to come off as being a hypochondriac. We have to be advocates for our health care. And to tell you the truth I could care less what the doc thinks I am. Since I've been in Charlotte where the medical care is good not the pdocs. I've had a colonoscopy, MRI of brain, neck and cervical vertebrae. Also a full cardiac work up including an angiogram. And my lymes titer since it is still positive referred to a rheumatologist. Next is the adrenal function test. I've already found the best in the area. And I'm calling him myself. And last time I saw my GP was after breaking my elbow and they said to see him within a week. He said why are you here. I said following directions. Oh and after the spinal MRI's was sent to a neurosurgeon. Having nerve conduction tests done on my arm. My neurologist said if I were in a car accident I could become paralyzed. Not so said the neurosurgeon. So if I'm been a bit testy on the board it's all this stuff and I call it stuff cause the healthiest people I met when working were the ones who never went to a doctor. Now with insurance being the way it is and my age I am getting tested for everything that could impact my mental health. Love Phillipa ps get the test and don't feel guilty you deserve them.
Posted by Phillipa on May 10, 2006, at 20:10:25
In reply to Re: anxiety and adrenal function » Racer, posted by Phillipa on May 10, 2006, at 20:02:31
Racer oh your pdoc will probably refer you back to your GP will say it's not his specialty. Unless you are very lucky. Mine won't. Love Phillipa
Posted by Emily Elizabeth on May 10, 2006, at 23:41:59
In reply to Re: anxiety and adrenal function, posted by Phillipa on May 10, 2006, at 20:10:25
Racer, consider getting a new GP. I find it really alarming how he dismissed your informed suggestions about your own healthcare. Also, if you are concerned that he will treat you like a woman who is over-reacting, perhaps a male GP isn't the best fit for you.
Also, you just reminded me that I wanted to paint my toenails so that I can wear sandals tomorrow. It's so late though. Such a quandry. :(
Best,
EE
Posted by blueberry on May 11, 2006, at 4:30:16
In reply to anxiety and adrenal function and wet fingernails.., posted by Racer on May 10, 2006, at 13:11:38
I don't see why any doctor should be concerned about how much money tests will cost or if they are a waste of money...I mean, it's your money not theirs. They should be concerned about your health. And if you want to spend money on tests, it's none of their business to be directing your financial affairs. That's how I see it anyway. So you go and spend $500 for a bunch of tests, they all turn out normal, and your doc says you wasted your money. No you didn't. You have peace of mind knowing that whatever you were suspect of is ok. Besides, it's your money not his.
Posted by cecilia on May 11, 2006, at 19:57:41
In reply to Re: anxiety and adrenal function and wet fingernails.. » Racer, posted by blueberry on May 11, 2006, at 4:30:16
> I don't see why any doctor should be concerned about how much money tests will cost or if they are a waste of money...I mean, it's your money not theirs. They should be concerned about your health. And if you want to spend money on tests, it's none of their business to be directing your financial affairs. That's how I see it anyway. So you go and spend $500 for a bunch of tests, they all turn out normal, and your doc says you wasted your money. No you didn't. You have peace of mind knowing that whatever you were suspect of is ok. Besides, it's your money not his.
>It depends what type of insurance you have, if any. Some HMO's and managed care companies will actually pay doctors bonuses if they don't order expensive tests and procedures! Cecilia
Posted by Phillipa on May 11, 2006, at 21:27:54
In reply to Re: anxiety and adrenal function and wet fingernails.., posted by cecilia on May 11, 2006, at 19:57:41
I will pay out of pocket if I have to. They can only charge you around $l0 a month forever if necessary. Your credit will not be hurt. And peace of mind hopefully is worth the money on meds you would pay to calm yourself down. And doctors make mistakes sometimes big ones that can cost you your life. My body tells me when something is wrong and so far that has never failed me. Love Phillipa ps soon insurance will be a thing of the past.And Medicaid pays for everything . Some people don't marry to have their children at no cost except to the people with insurance hence the insurance rises and no one will be able to afford it. That's why they tried HMO's. My Daughter had a cyst on her ovaries and the GP refused to refer her to an OB-Gyn.
Posted by Phillipa on May 11, 2006, at 21:39:24
In reply to Re: anxiety and adrenal function and wet fingernails.. » cecilia, posted by Phillipa on May 11, 2006, at 21:27:54
Oh and it gives you a baseline to compare down the road if you have them done again. I have copies of all my medical records minus to pdoc ones. Love Phillipa ps I have copies of all my lab work for years since l985. And old mammograns, and MRI's of the brain, pituitary, neck and spine.
Posted by Larry Hoover on May 12, 2006, at 7:58:58
In reply to anxiety and adrenal function and wet fingernails.., posted by Racer on May 10, 2006, at 13:11:38
> Someone mentioned adrenal exhaustion, maybe SLS? That struck me as something to maybe get checked out, to see if it would explain some of my current problems. Does anyone know what tests to ask to have run?
If Scott didn't mention it, I just did, in a reply to an earlier post of yours.
The sense that you are "primed" could come from something as simple as being magnesium deficient. 90% or more Americans don't get enough magnesium. There are a host of common medical disorders which are linked to magnesium deficiency effects, but you never see it even mentioned in the literature. It's all about new drugs, but no physical maintenance done on the body itself. Doctors give drugs. <sigh>
As for testing, I don't know that there's any specific testing you could do. You can do inferential analysis by studying 24-hour cortisol, and doing diurnal sampling (urine every three hours), to detect patterns in hormone release. Your DHEA level might infer something, too.
Really, the best test of adrenal function is to load the body with specific nutrients, and see if there is a positive response. As with magnesium levels, for example, you can have a normal blood test, but still be grossly deficient. The test for magnesium deficiency is magnesium loading. That's what it's called. You take a bunch of magnesium, and if symptoms remit.....
This is a subject for another board.
> My GP is resistant to running *any* tests -- says Americans want too many unnecessary tests, and didn't even want to check thyroid until I pointed out that it should be routine for people being treated for depression. And even then, he was kinda clear that he was only ordering the test to indulge me. (I like him a lot -- except that I think he forgets that some people are outliers, you know?)
Now we're talkin'. I betcha there's more than a few outliers here, at Babble.
> Since I see my pdoc in a week, I thought I'd ask her to order thyroid, cholesterol, and something to check adrenal function. But I don't know what that would be? Anyone have any ideas?
The typical one is the 24-hour cortisol sampling. But, total cortisol doesn't tell you the hour-by-hour change in hormone levels, which is also critical information to obtain. Some people are "inverted". They have their peak cortisol late in the day, instead of in the morning. A 24-hour sample would be unable to detect that. Others don't have a peak; stable cortisol all day is not good, either. It's hard to get a doctor to order such a test, the one that involves multiple samples.
> Part of me says, "Let's do a dexamethasone suppresstion test, and see if it causes remission from depression for a while..." I don't know that's such a great idea for a test, though. But, I might bring it up.ACTH challenge is sometimes done, too.
> So, can someone here educate me on adrenal testing?
>
> Thanks!That's all off the top of my head. I'll take a closer look later, 'kay?
Lar
Posted by Racer on May 12, 2006, at 10:41:05
In reply to Re: anxiety and adrenal function and wet fingernails.. » Racer, posted by Larry Hoover on May 12, 2006, at 7:58:58
> >
>
> The sense that you are "primed" could come from something as simple as being magnesium deficient. 90% or more Americans don't get enough magnesium.I take 750mg magnesium along with my 1500mg of calcium, every day. (I have osteopenia, and won't start bisphosphates until either I have a child or find out it really is impossible for me.) Is that enough?
The past few days, I've also had a weird dizziness going on: it kinda reminds me of the shaky feeling I get when I donate platelets, from the calcium depletion? Could that be related to magnesium deficiency? And, if so, any particular ideas about why, with that level of supplementation, I would still have troubles?
> I betcha there's more than a few outliers here, at Babble.LoL! You got that one right!
My GP actually said something, when I asked for a thyroid panel, about "women wanting to think their thyroid is responsible for their weight." Uh? Buddy? You mispronounce my name consistently, and apparently you've also forgotten that I've gained fifty pounds in the past year due to treatment for Anorexia Nervosa. I *know* what's responsible for my weight, and I *know* that my whole metabolism is truly screwed up beyond belief, due to years of self-starvation. (I'd also asked him about gastric motility -- I'd been having a lot of trouble with eating something and then continuing to feel full to overfull for up to eight hours afterwards. He wasn't impressed.) (Remembering that part, I think I will ask my pdoc for a referral to another GP...)
Thanks for your input, Lar -- always thought provoking and educational. You have given me a lot to think about, and I appreciate what I get from the top of your head...
Posted by honeybee on May 12, 2006, at 12:20:47
In reply to Re: anxiety and adrenal function and wet fingernai » Larry Hoover, posted by Racer on May 12, 2006, at 10:41:05
Hi, Racer,
When I stopped binging and purging, it took me several years to stop worrying about what I was eating (and count calories, surreptiously eat less, or worry about being fat). And it was six years before I had a moment when I was eating with my husband and thought. Wow, I don't care that I'm so full that my pants could use unbuttoning. And now all I want to do is gain weight, not lose it (depression-induced weight loss...quite frankly sucks). So, I just wanted to give you a vote of confidence that it will take a while to feel comfortable eating, but that it's worth it. Just stick with it.
b
Posted by Phillipa on May 12, 2006, at 12:43:20
In reply to Re: anxiety and adrenal function and wet fingernai » Larry Hoover, posted by Racer on May 12, 2006, at 10:41:05
Where do you get an ACTH done? As that is what they treated my Mother with with the adrenal crisis? An Endo? Thanks Phillipa ps I take magnesium citrate with my calcium too. So how much magnesium should you take to find out? Thanks Lar
Posted by Catherine Sheel on May 14, 2006, at 0:24:29
In reply to Re: anxiety and adrenal function and wet fingernai, posted by Phillipa on May 12, 2006, at 12:43:20
While you're at it...get your estrogen and progesterone tested. Go to my thread "Wellbutrin and pitting edema for 3 months". Anyway, there's a situation going on for women called Estrogen Dominance...and a lot of women go through it for years and years (up to 15!) without it being diagnosed. It can cause tons and tons of symptoms. I'm not saying you have it...but as long as you're testing...if you read about Progesterone Low/Estrogen Dominance you're eyes are going to fly wide open and you're going to think "Why aren't more doctors ordering this simple saliva test for women?" You can even order the test online for 60$. However, I do NOT know when in your cycle you should take the test, or even if that is important...so I'm not advocating you take the test yourself....just FYI.
-c
Posted by Larry Hoover on May 14, 2006, at 12:22:59
In reply to Re: anxiety and adrenal function and wet fingernai » Larry Hoover, posted by Racer on May 12, 2006, at 10:41:05
> > >
> >
> > The sense that you are "primed" could come from something as simple as being magnesium deficient. 90% or more Americans don't get enough magnesium.
>
> I take 750mg magnesium along with my 1500mg of calcium, every day. (I have osteopenia, and won't start bisphosphates until either I have a child or find out it really is impossible for me.) Is that enough?It's hard to know if intake amounts to the same thing as uptake, for any individual. How much vitamin D do you take? Uptake is impossible, unless your parathyroid agrees with that idea, and you have the vitamin D to make it happen.
> The past few days, I've also had a weird dizziness going on: it kinda reminds me of the shaky feeling I get when I donate platelets, from the calcium depletion? Could that be related to magnesium deficiency? And, if so, any particular ideas about why, with that level of supplementation, I would still have troubles?
As I said, it is hard to know if intake equals uptake.
> > I betcha there's more than a few outliers here, at Babble.
>
> LoL! You got that one right!We should have our own board. Ooops, we already do.
> My GP actually said something, when I asked for a thyroid panel, about "women wanting to think their thyroid is responsible for their weight." Uh? Buddy? You mispronounce my name consistently, and apparently you've also forgotten that I've gained fifty pounds in the past year due to treatment for Anorexia Nervosa. I *know* what's responsible for my weight, and I *know* that my whole metabolism is truly screwed up beyond belief, due to years of self-starvation.Which, unfortunately, may still be the dominant theme. The screwed up part, I mean.
Unless you have a full thyroid panel, it is pointless to do any thyroid hormone testing. You can't interpret the results if you only have a fraction of the required information.
I think you might be better off finding a different doctor.
> (I'd also asked him about gastric motility -- I'd been having a lot of trouble with eating something and then continuing to feel full to overfull for up to eight hours afterwards. He wasn't impressed.) (Remembering that part, I think I will ask my pdoc for a referral to another GP...)
As I said....
Your motility can be influenced by a myriad of factors, and once again, the screwed upness thing is also in play. It is good that you have this depth of communication with your gut. It may yet prove to be the most useful characteristic of your relationship.
> Thanks for your input, Lar -- always thought provoking and educational. You have given me a lot to think about, and I appreciate what I get from the top of your head...You're very welcome. I need reminders, though, to continue producing useful information. I am absent-minded to the nth degree. Interrogate me, 'kay?
Lar
Posted by Larry Hoover on May 16, 2006, at 10:05:22
In reply to Re: anxiety and adrenal function and wet fingernai » Racer, posted by Larry Hoover on May 14, 2006, at 12:22:59
Did I miss something? Were you going to ask me some questions, or was I supposed to write an essay?
Lar
Posted by Racer on May 16, 2006, at 19:53:22
In reply to Re: Racer?, posted by Larry Hoover on May 16, 2006, at 10:05:22
> Did I miss something? Were you going to ask me some questions, or was I supposed to write an essay?
>
> LarI think you actually answered everything, Lar. At least, I can't think of anything else to ask right now.
That's a fib: two questions, and if you can't answer, don't worry about it. Not worth spraining your brain. And these two are kinda related and kinda not related to the last...
First is what sort of testing would show how much my metabolism is screwed up; second is where to find out what tests should have been run when I was dx'd with AN? Do you know where I'd find those answers?
I'm having a very hard time right now, because I have to see a doctor, and am very uncomfortable seeing my regular GP, but having a hard time finding another. Because as God is my witness, if one more doctor treats me that way, I will never go back to any doctor again for as long as I live.
Not that it has any effect on me, you know...
This is the end of the thread.
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