![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by dmlvt on January 4, 2007, at 9:15:40
Hi,
I see my pdoc tomorrow and I have a physical with my PCP next Tuesday. I am a male who has just turned 45. I am also an endurance athlete who competes in events that take 24 hours or longer to complete. Despite the long hours I spend in exercise, I constantly fight battles with my weight, and I am currently about 25 pounds heavier than I would like to be. I can easily gain weight while running 70 or more miles per week.
As part of my doc visits, I want to talk to both docs about looking for underlying physiological causes of my depression and anxiety. I think that low testosterone and hypothyroidism are both areas that should be examined. Possibly cortisol as well.
I was planning to ask the docs to do a TSH, T3, T4 and testosterone (free and total) test. I wasn't planning on asking them to look at LH, FSH, or SHBG levels right now.
I do clearly show some of the symptoms of low testosterone, but some of them could simply be side effects of the AD medication that I'm taking. I currently take a low dose of Cymbalta, a low dose of Ativan and some Ritalin daily. I would describe my mental state as stable, but sub-par, meaning that I would probably feel better with a higher dose of some of the medicines, but I'm trying to keep my meds to the bare minimum at present.
Does anyone else have any tests that they have found helpful in looking at potential root causes for depression and anxiety?
I may be grasping at straws here, but the concept that a hormonal problem could be behind my weight battles and depression is certainly appealing.
One last note - a CT scan of my sinuses a few years ago showed some small tumors on the hypothalamus and pituitary gland. The doc didn't think it was anything to be alarmed about and there was no concern about a prolactinoma.
Thanks in advance for any thoughts.
DML
Posted by notfred on January 4, 2007, at 9:46:34
In reply to Lab tests to look for underlying causes ..., posted by dmlvt on January 4, 2007, at 9:15:40
Doctors call this a differential diagnosis. Keep
in mind primary mental illness is quite common and no more or less a valid diagnosis than any other.Try a search:
http://www.google.com/search?hl=en&q=differential+diagnosis+depressionHere is one:
http://www.clevelandclinicmeded.com/diseasemanagement/psychiatry/depression/depression_table1.htmA good write up on why you just do not run every test known:
Posted by Phillipa on January 4, 2007, at 10:26:10
In reply to Re: Lab tests to look for underlying causes ..., posted by notfred on January 4, 2007, at 9:46:34
Well you may also be exhausted from all that excercise as the body ages less is frequently best as I've found with myself. But I highly recommend you have your thyroid tested with an edocrinolist as I do have hasimotos thyroidistis and it wasn't till I saw an endo ll years afer official diagnosis that it was found that mine is now hyper and responsible for a lot of the anxiety and depression and dose is being lowered. Also a lymes Western blot as it also is common throughout the world although there is a lot of controversary on how long one should be on antibiotics. I have chronic lymes. And I have the same type of tumor on pituitary and the endo tested it for lactation and also did a cortisol level. Also check your iron levels. Good luck. Seriously with all that excercise shows darn good functioning to me. Sounds like you're in great shape. Love Phillipa
Posted by dmlvt on January 4, 2007, at 11:26:10
In reply to Re: Lab tests to look for underlying causes ... » notfred, posted by Phillipa on January 4, 2007, at 10:26:10
> Well you may also be exhausted from all that
> excercise as the body ages less is frequently
> best as I've found with myself. But I highlyI don't doubt that the exercise is a stress inducer. At the levels that I exercise, cortisol is likely to be increased and testosterone likely to be decreased. I enjoy competing in the events that I do and I am not naive enough to believe it's completely healthy to exercise at that level. I hope it's healthier than doing nothing, but it is a major body stressor.
>recommend you have your thyroid tested with an
>edocrinolist as I do have hasimotosMy plan is to ask the PCP to do the tests and then refer me to the endocrinologist if anything looks off, including borderline values. There is really a significant amount of controversy these days in what should be considered normal for TSH and for total testosterone as well. Depending on the lab, the reference ranges used to allow values as high as 4.5 or so to be normal for TSH, but more and more often, the normal range is considered to end at 2.2 to 2.5 (I forget the units at the moment).
For total testosterone, I think the normal values go down to 300 or so, while a healthy 18-year old male is likely to have a value in the 800-100 range. Some endos will do further testing and consider treatment as values approach 350 or even 450, rather than using 300 as the cut-off.
The whole HPA axis is so complex and the number of tests that could be run is so huge.
>Also check your iron levels. Good luck.
That isn't one that I thought about. I deliberately take multi-vitamins without iron, as men seem more likely to get too much rather than not enough. I was a vegetarian for a year or so, but about a year ago, I resumed eating some meat, and I would bet that I'm getting enough iron.>Seriously with all that excercise shows darn
>good functioning to me. Sounds like you're in
>great shape. Love Phillipa
I do function reasonably well and I am in good shape. My PCP recently told me that I'm a difficult patient because I'm not satisfied to be in the 50th percentile. He said that most medical training is based on getting people's health to the 50th percentile and I constantly want to be at the 99th percentile. Perhaps my expectations are too high, and I probably am a challenging patient because of that. But, I often feel that the only way to get really good medical care is to be as educated as possible and to challenge the providers. I say this as someone who works in the health care industry, working with doctors every day.
DML
Posted by blueberry1 on January 4, 2007, at 15:06:50
In reply to Lab tests to look for underlying causes ..., posted by dmlvt on January 4, 2007, at 9:15:40
A quick easy way to get around the whole glandular thing is to try Maca supplements. It is a South American food usually for boosting sex drive, but has side effects of boosted mood, boosted energy without jitters, normalization of hypothalamus/pituitary/thyroid/adrenal glands.
You might have adrenal exhaustion.
Saliva cortisol testing might be helpful. DHEA levels might be helpful. If testerone is low, taking it to raise levels is self defeating...your body will produce even less of it to restore what it sees as balance. The problem with hormonal testing is it is expensive, the results don't often give the doctor a clear idea of what to do about it, and many doctors just simply don't know. Kind of like psychiatry.
The ultimate approach is to get the glands working their optimum. Instead of relying on what some whacko like me at pbabble has to say about it, do some research on Maca and its effects on menopause in men and women, weight, energy, mood, and glands. The cool thing is it is not an herb or medicine but a food and that it works fast...4 days to 4 weeks.
Just a simple idea to possibly save a ton of time, money and frustration.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.