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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Racer on August 29, 2004, at 14:21:20
Since I'm being very defensive about everything right now, I'll say up front that I'm concerned but not worried about this right up front.
It seems as if I've been in a state of hyper-arousal for so long, with the pressure and stress just building and building and building, and no release for so long. I'm finally kinda coming to grips with how much of what I've always identified as "Depression" is actually in the "Anxiety" family -- man, sometimes I'm a little slow on the uptake -- and it got me wondering about how this has affected my stress system, and what that will mean for my future. So, can anyone tell me about the long term effects of chronic, unremitting stress over long periods on the HPA axis? I know that it's damaging to a lot of body systems -- and I know that I can look it up, and probably will when I can manage it, but I just can't right now. No matter how much I read about the concepts, it just doesn't match having someone tell *me*. Dunno, maybe because it adds the comfort of personal reassurance.
If one's HPA axis is in hyperdrive for a long time, and getting ramped up more and more, what effects will those wormholes cause in the fabric of the space/time continuum? (And what is the nature of the Q Continuum?) Man, I can't even ask the questions today. I guess what I'm asking is really this: how much chance is there that this whole nightmare, now lasting one year with The Agency Of Darkness and two years before that with the situational stressors that led to their involvement, has simply 'broken' that system? Will it leave me always more vulnerable to stress? Can it regenerate enough to compensate reasonably well? Is it possible that it has compromised my ability to respond to treatment for depression and/or anxiety?
Yeah, the whole gamut, guys. Am I broken? Can I be repaired? Can the doctor test for the effects to give me a more informed answer?
Thanks for anything you have to offer. Even -- or especially -- if it's just reassurance.
Posted by sb417 on August 29, 2004, at 21:28:15
In reply to HPA axis ?? SLS? Larry Hoover? (Dr Bob?), posted by Racer on August 29, 2004, at 14:21:20
I think the best thing to do at this point is to see an endocrinologist and have the doctor run some tests to check for "the usual suspects" that would indicate whether or not you have HPA axis dysfunction. One such test is 24-hour urinary cortisol. Others are plasma cortisol (probably not as reliable as the 24-hour urinary), the DST or dexamethasone suppression test, ACTH stimulation test, etc., and a few others. Often I see posts here with subject lines like, "How do I lower my cortisol?" Why would anyone want to lower their cortisol if it's not elevated? Cortisol is not "bad," and there's no need to lower it unless it is consistently too high. And the only way to find out whether it's elevated is to have a proper and thorough workup by a physician.
Posted by Racer on August 29, 2004, at 23:46:21
In reply to Re: HPA axis ?? SLS? Larry Hoover? (Dr Bob?) » Racer, posted by sb417 on August 29, 2004, at 21:28:15
LOL! I agree all the way -- I see the same posts and say the same thing.
In this case, since I don't 'know' if you and I have interacted before, let me clarify just a little, because I do know about the 24 urine, DST, etc -- and do know better than to try to adjust the levels of anything that is *supposed* to be in your body, as long as it's within normal limits. No details, but I have a fair familiarity with Cushing's Disease. (Not "syndrome," in this case, but disease.) I've seen what it can do, and it's really *that* that's worrying me. I've also been uninsured for a decade -- although that's a situation in flux right now -- so, while I absolutely agree with you about this being a "talk to your doctor" question, that's got to wait a bit right now. In the meantime, though, I am concerned about this enough to want to find out more about the sorts of damage that might be involved, which parts of the system seem to be most regenerative, etc.
Thank you for your information, by the way, especially the reminder that a lot of these 'science facts' that catch on as fads can be misleading, to say the least. The body's daily cortisol cycle is involved in so many things beyond weight problems -- and, frankly, I tend towards an impatience with all the 'quick fix' solutions, from the ads for pills to the 'diet' cookies. (Although, we do have sugar free treats in the house now and again -- then again, we also have a Type I diabetic in the house...) Nice to meet you.
Posted by Larry Hoover on August 31, 2004, at 8:47:21
In reply to HPA axis ?? SLS? Larry Hoover? (Dr Bob?), posted by Racer on August 29, 2004, at 14:21:20
> If one's HPA axis is in hyperdrive for a long time, and getting ramped up more and more, what effects will those wormholes cause in the fabric of the space/time continuum? (And what is the nature of the Q Continuum?) Man, I can't even ask the questions today. I guess what I'm asking is really this: how much chance is there that this whole nightmare, now lasting one year with The Agency Of Darkness and two years before that with the situational stressors that led to their involvement, has simply 'broken' that system? Will it leave me always more vulnerable to stress? Can it regenerate enough to compensate reasonably well? Is it possible that it has compromised my ability to respond to treatment for depression and/or anxiety?
>
> Yeah, the whole gamut, guys. Am I broken? Can I be repaired? Can the doctor test for the effects to give me a more informed answer?
>
> Thanks for anything you have to offer. Even -- or especially -- if it's just reassurance.I didn't see this post right away. I don't come to this board so often.
Running your stress system at overload for a while does a couple of important and nasty things. One, it makes your immune system go weird. Some things it doesn't do so well (like fighting off a cold), while others it does too well (like autoimmune disorders). The second is that it plays havoc with your vitamins and minerals. During high stress, you kidneys just dump too much good stuff into the urine. I don't know why they do that, exactly, but they do. And it happens at a time when you most need the nutrients and minerals.
Supplements are definitely in order. You can go to any store selling vitamins and you're going to see stress formulas. They aren't available by fluke.
Are you broken? Not enough info from you, yet. The first part of the HPA to falter, usually (or at least, the most noticeable), is the adrenals. Usually, before they shut down, they sputter. You get reasonably good days alternating with some really horrible days. If this continues too long, they just shut down altogether (sometimes called a nervous breakdown, but I think there's more than one kind of nervous breakdown). Adrenal fatigue turns into adrenal exhaustion. Now, most doctors will not recognize either state. Just a warning.
To assess the HPA, most tests involve the adrenals. The hypothalamus is the master gland. It directs all the other glands on what to do. The pituitary is more specialized, actually carrying out the orders of the hypothalamus. The adrenals are the work horse of the trio.
Most HPA tests, then, measure adrenal response. Total cortisol (24-hour sample), or morning cortisol (there is a diurnal variation), but best would be a 24-hour sample, and at least four samples during the day.
Then, there are the stimulus tests, like the ACTH challenge. Adreno-cortico-tropin hormone is a pituitary hormone, and the immediate response to an injected bit of it tells a lot. So does an injection of the hypothalamic hormone CRH.
If you're going to get a thorough analysis of the adrenal, via this cluster of tests, it makes sense to test other pituitary hormones, like LH, FSH, (and sex hormones like testosterone and precursors like DHEA and DHEA-S, which aren't pituitary, but affect pituitary effects). You can have resistance to adrenal hormones, just like insulin resistance. High levels, but low effects. There are many different permutations.
Getting all that testing to happen, though, takes a doctor who thinks you might benefit from that knowledge. Easier said than done.
You can do a quick and dirty inferential test of adrenal function, by taking licorice root for a few weeks. If you feel better, I can interpret that for you. Do not use DGL. You want the glycyrrhizin (spelling?).
Lar
Posted by Racer on August 31, 2004, at 10:54:29
In reply to Re: HPA axis ?? SLS? Larry Hoover? (Dr Bob?) » Racer, posted by Larry Hoover on August 31, 2004, at 8:47:21
Thank you so much for answering. I have two follow up questions, if you've got the time and energy at the same time.
The first is how adrenaline fits into the picture. I know it does, and I know I've looked it up in the past, but I don't seem to have it in me right now to look it up again.
Second is about me, right now, while I'm still recovering from something I think I can safely call a breakdown over the last couple of weeks. (I'm just in the process of trying to figure out what I'm feeling. The signs I associate with a panic attack -- racing heart, shallow breaths -- I never really experience, so never thought that was a problem. Now I'm learning that I do experience periods of very high arousal, shall we say, but the signs include very tight feeling around the diaphragm and slow, regular, deep breaths. So I'm weird, like that's news?) Now that things are settling down, I'm aware of what I am starting to recognize as adrenaline surges at almost any stimulus. Typing this post is enough to get my adrenaline up, talking to anyone, trying to do anything. Basically, the only time it doesn't seem to start ramping up is if I can just lie on the sofa and stare at the TV -- but that relaxed let down allows the depression to run rampant.
My question about that is whether that hyper-reactivity, that adrenaline prompt at even very slight stimulation, will settle down again, and how long it might take. I'm also wondering if that's part of your adrenal exhaustion meaning? And if there's anything -- besides time -- that can reduce it. (Trust me, NOT a feeling conducive to recovery.)
Thank you, Larry. If you want any other information about what it feels like, I think "YUCK!" just about covers it. ;-)
Posted by Racer on August 31, 2004, at 12:52:35
In reply to Re: HPA axis ?? SLS? Larry Hoover? (Dr Bob?) » Racer, posted by Larry Hoover on August 31, 2004, at 8:47:21
Here's a more basic question, in fewer words: is there any way of just turning down the adrenaline, quick and dirty, for a bit, so that the system can recover? Not long term treatments, but just a quick easing of this hyperarousal in hopes that will allow the new AD a chance to show whether its going to do its job?
Thanks
Posted by owensmar on August 31, 2004, at 22:53:25
In reply to HPA axis ?? SLS? Larry Hoover? (Dr Bob?), posted by Racer on August 29, 2004, at 14:21:20
> Since I'm being very defensive about everything right now, I'll say up front that I'm concerned but not worried about this right up front.
>
> It seems as if I've been in a state of hyper-arousal for so long, with the pressure and stress just building and building and building, and no release for so long. I'm finally kinda coming to grips with how much of what I've always identified as "Depression" is actually in the "Anxiety" family -- man, sometimes I'm a little slow on the uptake -- and it got me wondering about how this has affected my stress system, and what that will mean for my future. So, can anyone tell me about the long term effects of chronic, unremitting stress over long periods on the HPA axis? I know that it's damaging to a lot of body systems -- and I know that I can look it up, and probably will when I can manage it, but I just can't right now. No matter how much I read about the concepts, it just doesn't match having someone tell *me*. Dunno, maybe because it adds the comfort of personal reassurance.
>
> If one's HPA axis is in hyperdrive for a long time, and getting ramped up more and more, what effects will those wormholes cause in the fabric of the space/time continuum? (And what is the nature of the Q Continuum?) Man, I can't even ask the questions today. I guess what I'm asking is really this: how much chance is there that this whole nightmare, now lasting one year with The Agency Of Darkness and two years before that with the situational stressors that led to their involvement, has simply 'broken' that system? Will it leave me always more vulnerable to stress? Can it regenerate enough to compensate reasonably well? Is it possible that it has compromised my ability to respond to treatment for depression and/or anxiety?
>
> Yeah, the whole gamut, guys. Am I broken? Can I be repaired? Can the doctor test for the effects to give me a more informed answer?
>
> Thanks for anything you have to offer. Even -- or especially -- if it's just reassurance.This goes double for me.
Racer, we need to talk. We share a lot of issues =chronic, unremitting stress, serious concern about the adrenal situation, and eating disorder (I'm assuming bulimia?)and depression/anxiety. Is it possible you have sleep issues as well?
Marsha
Posted by owensmar on August 31, 2004, at 23:09:17
In reply to Follow up ?? » Larry Hoover, posted by Racer on August 31, 2004, at 10:54:29
>> Second is about me, right now, while I'm still recovering from something I think I can safely call a breakdown over the last couple of weeks.
Me too. A breakdown.
(I'm just in the process of trying to figure out what I'm feeling. The signs I associate with a panic attack -- racing heart, shallow breaths -- I never really experience, so never thought that was a problem. Now I'm learning that I do experience periods of very high arousal, shall we say, but the signs include very tight feeling around the diaphragm and slow, regular, deep breaths. So I'm weird, like that's news?) Now that things are settling down, I'm aware of what I am starting to recognize as adrenaline surges at almost any stimulus. Typing this post is enough to get my adrenaline up, talking to anyone, trying to do anything. Basically, the only time it doesn't seem to start ramping up is if I can just lie on the sofa and stare at the TV -- but that relaxed let down allows the depression to run rampant.
Exactly. I have two speeds. There's adrenaline speed, which I have to get into to get anything done. Then there's lethary, lying on the couch speed. That's it. No in between.
> Thank you, Larry. If you want any other information about what it feels like, I think "YUCK!" just about covers it. ;-)
I'd add, apathy vs. nervous exhaustion. Pick one.
Marsha
Posted by Racer on August 31, 2004, at 23:38:42
In reply to Re: HPA axis ?? SLS? Larry Hoover? (Dr Bob?) » Racer, posted by owensmar on August 31, 2004, at 22:53:25
>
> This goes double for me.
>
> Racer, we need to talk. We share a lot of issues =chronic, unremitting stress, serious concern about the adrenal situation, and eating disorder (I'm assuming bulimia?)and depression/anxiety. Is it possible you have sleep issues as well?
>
> MarshaHi, Marsha. Not bulimia here. I restrict my intake a lot, and get a bit obsessive about my weight. I'm missing one cylinder for AN, so I guess it's ED NOS.
Let me know what I can tell you, and I'll be happy to try.
Posted by owensmar on September 1, 2004, at 14:54:42
In reply to Re: HPA axis ?? SLS? Larry Hoover? (Dr Bob?) » owensmar, posted by Racer on August 31, 2004, at 23:38:42
> >
> > This goes double for me.
> >
> > Racer, we need to talk. We share a lot of issues =chronic, unremitting stress, serious concern about the adrenal situation, and eating disorder (I'm assuming bulimia?)and depression/anxiety. Is it possible you have sleep issues as well?
> >
> > Marsha
>
> Hi, Marsha. Not bulimia here. I restrict my intake a lot, and get a bit obsessive about my weight. I'm missing one cylinder for AN, so I guess it's ED NOS.
>
> Let me know what I can tell you, and I'll be happy to try.
Well, first thing you can tell me is what's AN and ED NOS.I'm new to this board and three weeks ago I'd never heard of the HPA axis, alpha numeric designations for specific neurotransmitter receptors, etc.
I started out anorexic and slid into bulimia over a couple of years. (That was when I was 17). I'm now 48 and after thirty years of bulimia--I'm in remission.
I guess I was just thinking we have a lot of the same issues...
Marsha
Posted by Larry Hoover on September 2, 2004, at 9:34:10
In reply to Follow up ?? » Larry Hoover, posted by Racer on August 31, 2004, at 10:54:29
> Thank you so much for answering. I have two follow up questions, if you've got the time and energy at the same time.
>
> The first is how adrenaline fits into the picture. I know it does, and I know I've looked it up in the past, but I don't seem to have it in me right now to look it up again.Adrenaline levels can remain chronically high if your cortisol levels are high as well. If that is the case, your adrenals have not yet begun to fail. This is a serious health factor, though. Sustained exposure to high cortisol and its associated hormones, such as adrenaline, is very hard on the body.
If you have days where you just crash and can't get up, you are entering into the realm where your adrenals have begun to fail, but they still work pretty well, most of the time.
The solution is the same, in all cases of adrenal stress. Nutrients to support the adrenals, and interventions to try and get the hypothalamus to settle down. That's the simple case, but a sustained sense of hypercortisolemia can be induced by e.g. a pituitary tumour. Most of those are benign (as compared to malignant cancers), but not benign in what they do to you. I really think some bloodwork would provide some useful information.
http://www.womentowomen.com/LIBadrenalfatigue.asp
http://www.digitalnaturopath.com/cond/C17649.html
(I don't agree with absolutely every thing on this site, but it's pretty darn accurate, over all. Note the nutrient recommendations at the bottom, and herbs to consider.)> Second is about me, right now, while I'm still recovering from something I think I can safely call a breakdown over the last couple of weeks. (I'm just in the process of trying to figure out what I'm feeling. The signs I associate with a panic attack -- racing heart, shallow breaths -- I never really experience, so never thought that was a problem. Now I'm learning that I do experience periods of very high arousal, shall we say, but the signs include very tight feeling around the diaphragm and slow, regular, deep breaths. So I'm weird, like that's news?) Now that things are settling down, I'm aware of what I am starting to recognize as adrenaline surges at almost any stimulus. Typing this post is enough to get my adrenaline up, talking to anyone, trying to do anything. Basically, the only time it doesn't seem to start ramping up is if I can just lie on the sofa and stare at the TV -- but that relaxed let down allows the depression to run rampant.
That's called hypervigilance, and is a physically-learned event. Your amygdala is in a bad habit, is one simple way to look at it. The amygdala processes new emotions, and is involved in retrieving old emotional memories. There's a bad feedback loop operating in you right now, I think. The thing is to intervene with nutrients. Fish oil, magnesium, pyridoxine, vitamin C, zinc, and a B-complex are probably the most critical interventions. Niacinamide too (500 mg, up to 4 times per day), when you're most symptomatic. You might also get a real calming effect from taurine (2 grams, as needed).
> My question about that is whether that hyper-reactivity, that adrenaline prompt at even very slight stimulation, will settle down again, and how long it might take.
It's not likely to settle down without some intervention on your part. During episodes of high cortisol, your kidneys get less selective, and you lose massive amounts of key nutrients in your urine. That's acceptable, if your daily intake is sufficient to replenish them. But if not, you go into a massive functional malnutrition. Without sufficient magnesium, zinc, pantothenate, and vitamin C (especially these), your body has lost a good part of its ability to stop being so reactive. You're in a vicious cycle, and you need to break the cycle.
> I'm also wondering if that's part of your adrenal exhaustion meaning?
If you're always hypervigilant, you're not there yet. If you're sort of getting an inconsistent state of hypervigilance (hyper most of the time, but also periods of deep exhaustion and cognitive dysfunction), then you're on the edge of the cliff already.
> And if there's anything -- besides time -- that can reduce it. (Trust me, NOT a feeling conducive to recovery.)
The two links above give some good ideas to think about.
> Thank you, Larry. If you want any other information about what it feels like, I think "YUCK!" just about covers it. ;-)
I hear you. It takes months to get your adrenals fully reined in again. It took months to get this way. There is no quick fix, but you can address the symptoms (magnesium, taurine, phophstidylserine, niacinamide).
Keep talking. Keep asking questions. You'll take in enough to get on the route to calmer waters.
Lar
Posted by Racer on September 2, 2004, at 12:17:46
In reply to Re: Follow up ?? » Racer, posted by Larry Hoover on September 2, 2004, at 9:34:10
This is the end of the thread.
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