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Post by mookie333 on Dec 15, 2008 8:46:06 GMT -5
::)Chris-
Here are my latest labs. They Lost my aldosterone tube..it will have to be redrawn the next round. Remember, my husband will be treating me..if you think it would be best to discuss this over scype let me know. Otherwise please tell me how to proceed. I had a crash yesterday, went out of town and did too much now am on 40 mg. of cortef and will begin weaning starting tomorrow if I can. Also, I have a 9 yr. hx. of immune dysfunction and have not seen a white count over 3 in 9 ys. and w/ the cortef, it's amazing but my wbc's are 4 now. Unbelievable......but here it is:
Adrenal AB <20 -(normal <20) Thyr Microsom AB <10-(normal <35) IGF-1-213-(88-249) This # was 101 prior cortef Vitamin D=30-(30-200) Vitamin D2=<4 (deficiency) 25OH Vitamin D=30 Free Testosterone=1.22 (0.50-2.00) Total Testosterone=3.1 (0.1-6.4) FSH-2.3 (1.8-22.5) had hysterectomy DHEA-S=92 (19-231) Progesterone=16.3 (mid-luteal) 5.16-18.56 Estradiol=126 (mid-luteal) 49-291 Cortisol 8am= 12.1 ( 6-22.6) held early am cortef dose Renin=4.0 (0.65-4.0) T3-89.0L (97-219) Free T3=222 (210-219) TSH=1.939 (0.4-4.0) Free T4=0.8 (0.6-1.1)
Na=137 (137-145) K+=3.5(3.5-5.1) even on K supp's 20 meq Cl= 103 (101-111) Co2= 29 (22-32) Anion Gap= 5.0 L (7-16) Glucose= 84 (74-100) BUN= 15 (8-26) CREAT= 0.6 (0.6-1.0) Calcium= 8.6 L (8.9-10.3)
WBC=4.0 (4.8-10.8) last 8/2008=2.5 RBC=4.08 (4.0-5.2) last 8/2008=3.98 HGB= 13.7(12.0-5.2) '' " =13.3 HCT=38.1 (36-46) " "= 38.1 LYMPH%= 58.4H (15-45) last 8/08=59.2H MONO%= 19.9H (3-12) last 8/08=22.6H NEUTROPHIL%= 16.7L (42-78) last 8/08=10.9L improved EOSINOPHIL%=4.6H (0-4) last 8/08= 7.3H improved BASOPHIL = 3H (0.2)
I know I have to switch from cortef to something else like medrol or florinef too...but I was holding on til the labs came back....what do you make of all this...still feel crummy very hypo..all around. Thank you, thank you, thank you for looking at my labs and for suggestions....R.
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Post by mookie333 on Dec 16, 2008 17:00:53 GMT -5
OK can anybody look at my labs if Chris cant? R
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Post by Chris Jackson on Dec 16, 2008 19:36:06 GMT -5
You have to give us some time to get to you. Best to continue from your other thread. That way we can see what you've said and our responses to you.
You need to get the thyroid antibodies redone with actual values. If they are 19 and 9 you have hash's.
Igf-1 is still low. I use the old range of 150-350. Igf-1 is not totally dependable for predicting GH level.
DHEA-S is low enough that may be indicating secondary AI. Cortisol test worthless. I don't comment once steroid is started. Most people on 30 mg HC only register in the mid teens on the cortisol test which we consider at that level being AI of course. Once in a great while I'll see someone on 30 mg HC whose cortisol tests is about 30. Cortisol test is unreliable after steroid is started. If your AI symptoms weren't eliminated on 30 mg HC then you may need to try medrol (see sticky about when to switch to medrol (in more stickies, cortisol stickies I think)).
If you fasted salt then the range you want for the renin is 3-24. Ask for renin to be done again with the aldosterone. Sodium is pretty low, I would expect you to have salt wasting symptoms. Potassium is extremely low, so that indicates likely secondary AI.
If glucose was fasting it's high. You need fasting insulin though.
Did you have the acth stim test? How about acth?
You're welcome, Chris
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Post by Lethal Lee on Dec 16, 2008 21:12:04 GMT -5
Also Vit D low & Calcium deficient. Hope you are supping both.
Blood CBC shows several elevations & several deficiencies. May have some systemic infection/inflammation going on. Was ESR tested? I suggest Homocysteine, hsCRP, Fibrinogen repeat CBC with ESR. Possibly ANA as well?
You need to increase your Potassium supping. Are you taking it once a day or more often? I would at least double the Potassium.
Sodium very low too. Are you supping unrefined Sea Salt? Strongly suggest Aldosterone Renin be tested.
Total Testosterone is suboptimal (optimal is top 25%) as was DHEAS. Free Testosterone probably very low.
You mention Hysterectomy are you doing Estrogen & Progesterone HRT? Have you tested them recently?
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Post by mookie333 on Dec 17, 2008 13:03:15 GMT -5
Lethal....... thank you for looking at my labs, my estrodiol is above and I've been on the vivelle dot...0.025mg I've been using it because when I stop it I sweat so much at night. Even though my FSH is normal. My Ana has been positive for 9 years now....weakly 1:80, my sed rates are always low. I've had neutropenia for 9 years...since the birth of mylast child. With this set of labs, my white count has been the highest I've seen it since then. I think it is due to taking the cortef.
My last esr was (9) and that's pretty low. I found a TPO antibody done July 2008 and it states 3.3 normal is less than 9. Does this mean that I have HASHIS? I drink the sea salt 2x a day in my water 1/4 tsp. and I just hate the taste of all salt for some reason. It's the celtic sea salt. I will up my potassium to 2x a day. I really bugs me that I constantly run low no matter what.
I still feel how overall, should I get some testosterone gel? I use progesterone. I have all my supplements listed. Should I be concerned about my parathyroid too? I don't what I should do anymore. I just feel like I need some guidance here. I feel pretty awful and I'm now weaning my cortef down to 35mg split 3x a day. I know I should convert to medrol? But have not done it yet? What do you think of spirilactone (sp) would this help?
Also, I have low NK cells and have been at a top university hospital to have this evaluated....their diagnosis immune dysregulation.
I'm increasing my vit d to 4000 mg /day and calcium too. I drink alot of the b12 too...What else can I do? Please help me. Thank you. R
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Post by Lethal Lee on Dec 29, 2008 4:48:02 GMT -5
Hi Mookie,
Just saw I missed some questions here. Hope you had a nice Xmas & not too stressful.
I found a TPO antibody done July 2008 and it states 3.3 normal is less than 9. Does this mean that I have HASHIS I would consider that Hashis. Remember up to an est 50% of Hashis dont even have positive Serum Abs !!!
I would ask Hubby to retest TPO & TG Abs again. Try to find a Lab that reports down to zero not just less than number.
I drink the sea salt 2x a day in my water 1/4 tsp. and I just hate the taste of all salt for some reason. It's the celtic sea salt. I will up my potassium to 2x a day. I really bugs me that I constantly run low no matter what It will be interesting to see Aldosterone results. You are testing Renin, Sodium & Potassium at same time I hope? If supping Sea Salt doent optimise Sodium & eliminate low Aldo symptoms then Florinef may be needed.
Should I be concerned about my Parathyroid too? When Vit D is low (as yopurs is) you do need to test PTH (Parathyroid Hormone), Corrected Calcium, ALP & Phosphorus as well & before starting Vit D supplementation. This is to make sure there is no contraindication to supping Vit D.
I don't what I should do anymore. I just feel like I need some guidance here. I feel pretty awful and I'm now weaning my cortef down to 35mg split 3x a day Meds: Cortef 15mg am, 10mg noon, 5 mg early eve How did you go with weaningg down from stress dosing? What amount are you on now? Three times a day dosing of HC may not be the best either. Many find a bedtime dose helps a lot. Others say 5 times dosing is even better.
Armour 60 mg am, 30 mg eve T3 89.0L (97-219) Free T3 222 (210-219) TSH 1.939 (0.4-4.0) Free T4 0.8 (0.6-1.1)
Obviously you are still on a very low dose of thyroid meds. Are you still increasing your dose? Your FT4 is near bottom of range. Whats the correct FT3 range? TSH not being suppressed shows Armour dose is too low. You may want to test Reverse T3 next time with the Frees.
Other Supps Vit D 2000mg, Ca/mag, B12 liquid, Melatonin 30 eve, Progesterone cream 2x day-1/4 tsp., BIOIDENTICAL??? vivelle dot 1/wk 0.025mg, BIOIDENTICAL??? Dhea 5 mg, vit. c- 2gms, coQ12, Is this CO Q10? selenium-100, zinc 30, ribose powder 5 gm-2xday. HCL w/pepsin, sea salt-hate it.
Is the Melatonin 30 or 3 mg? Note it can lower Cortisol so may make things worse unless Cortisol is well supported/replaced. Does the Melatonin help your sleep?
If you really hate Sea Salt you can try something like Alkala N by Sanum. I use it instead of Sea Salt. It is a powder containing Sodium & Potassium Bicarb & it used as an Alkaliser. It has no taste at all. It is available in USA too.
I know I should convert to Medrol? But have not done it yet? If you can get HC to work at 30-35mg HC then you may not need Medrol. However if the HC doesnt last long enough for you, or the Mineralocorticoid properties of HC dont suit you then Medrol may indeed work better.
What do you think of spirilactone (sp) would this help? Why would you want to use it? It is a diuretic & you are already dehydrated as evidenced by your low Sodium & bottom of range Creatinine & deficient Anion Gap. A diuretic would make that even worse! It is also an Aniti-Androgen (will lower DHEA & Testosterone) and is used for PCOS. You are on DHEA supps & DHEAS still tests as low.
I'm increasing my vit d to 4000 mg /day and calcium too. I drink a lot of the b12 too I'm not at all sure about B12 liquid. I use Jarrow Methlycobalamin 5000mcg sublinguals. RTH strongly recommends them. I purchase through iHerb if interested. You can increase Vit D a lot more than that with your low levels. But I would recommend the other testing FIRST if not done already (PTH, Corrected Calcium, ALP, Phosphorus).
should I get some Testosterone gel? Your DHEA is still very low. I would suggest you try increasing the DHEA supp you are on first. The 5 mg DHEA currently is a low dose. If you convert to Testosterone OK then upping DHEA supp may be all you need.
...What else can I do? Please help me. Dont give up you still have a ways to go yet. You have Vit D, Electrolytes, Thyroid to optimise yet. Possibly some tweaking of HC timing & dosing too. I'm assuming Ferritin was tested & was optimal?
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Post by mookie333 on Dec 31, 2008 17:30:10 GMT -5
;D
I just got even more labs back. My aldosterone level was somehow contaminated at Quest Labs and was resent today. I am waiting on my T3 as well. I've had the TPO antibodies-but here they don't give the exact number...and that last result of 3.3 was in July. My labs today are as follows.....I am up to 3 grains armour and 30 mg Hc and below are my vitamin supps-----
Sodium 137-(137-145) on seasalt 1/4 tsp 2x day Potassium 3.5 (3.5-5.1) on 20 meq once a day - may up this to 2x day. Albumin-4.0(3.5-4.8) Alk Phosphatase 40-(32-91) Anion Gap 4.0 L (7-16) Calcium 8.9 (8.9-10.3) on 1000mg/day CO2- 28-(22-32) Chloride- 105 (101-111) Bun- 16-(8-26) Creatinine-0.6-(0.6-1.0) Glucose-87-(74-100) Phosphorus-3.2-(2.5-4.6) Magnesium- 2.4-(1.8-2.5) on 500mg/day sgot-18-(1-45) sgpt-15-(1-40) total bilirubin-1.0-(0.3-1.2) total protein-7.0-(6.1-7.0) Ferritin- 84-(11-307) T3--waiting on will let you know TSH- 0.137-(0.4-4.0) actually I don't feel hyper (held am dose) Parathyroid Hormone- 58-(12-88) 8am cortisol- 9.0 -(6-22.6) held am dose aldosterone--waiting on, renin was done recently. 4.0
wbc-3.4L-(4.8-10.8) rbc-4.26-(4.0-5.2) hgb-13.9-(12.0-16.0) hct-40.5-(36-46) lymph% 59.7H (15-45) mono% 21.9H (3-12) eos%5.8H (0-4) neutrophil absol 0.40L (1.4-6.6) seg nutrophil-16L (39-69) Lymphocyte 63H (24-44) monocyte-17H (2-6) eosinophil-4-(0-4)
My question is how can I keep up my sodium and potassium..Do I need to introduce florinef instead of medrol? I get a lot of pvc's and would like to calm them down a bit....but not a high heart rate.
Sometimes I feel like I take so many pills a day....I almost feel like I'm getting some irritation in my esophagus....I've had a little acid too....I've never had a stomach issue before-(heartburn)...
is my ferritin high enough? I have had so much weight gain...since being on armour and cortef I have gained 10 lbs! A ton for me since I am little and short??? Why is this? I feel like that I cannot wean my Hc at all I really need it.
Any suggestions regarding my blood counts? I will try to up the dhea to 10 to see how that makes me feel--
My progesterone is emeritus brand and is not compounded by the pharmacist. Is it suggested to have compounded only?
I've not noticed a big difference when I started the HC...I feel like 20% better but need more improvements..have no energy and stamina, but my brain fog has improved a whole lot. What else can I do? Mookie
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Post by fractal1 on Jan 1, 2009 3:37:00 GMT -5
Hi Mookie, Happy New Year As with the last lot of results, sodium is very low, suggesting salt wasting. Low potassium indicating secondary AI. It will be interesting to see aldo/renin. Maybe 'bump' the post when you edit them in so we know. I don't understand why they keep measuring cortisol ... it's a nonsense measure if you are taking steroid and a waist of money. Again your glucose is high if fasting but once again you need fasting insulin as well. My question is how can I keep up my sodium and potassium..Do I need to introduce florinef instead of medrol? I get a lot of pvc's and would like to calm them down a bit....but not a high heart rareFlorinef helps you to retain sodium, but also results in the 'dumping' of potassium. If you need florinef, you'd have to supplement potassium in a big way because it is already low. With florinef, Lethal Lee needs 3000mg RX Potassium to maintain levels. You should already be supping potassium. Sometimes I feel like I take so many pills a day....I almost feel like I'm getting some irritation in my esophagus....I've had a little acid too....I've never had a stomach issue before-(heartburn)...Are you takng HC with food? Is my ferritin high enough?Ferritin is good. We generally aim for 70-80. I have had so much weight gain...since being on armour and cortef I have gained 10 lbs! A ton for me since I am little and short??? Why is this? I feel like that I cannot wean my HC at all I really need it.An inability to wean HC is a good indication you might need medrol. See Chris' sticky on when to switch. Also, GET fasting glucose WITH insulin tested . My progesterone is emeritus brand and is not compounded by the pharmacist. Is it suggested to have compounded only?I do not know this progesterone... in fact, I can't even 'google' it. Does it just say progesterone on it or does it have some other name like medroxyprogesterone or Norethisterone, for example. Is it pill form, topical (cream) or troche? I've not noticed a big difference when I started the HC...I feel like 20% better but need more improvements..have no energy and stamina, but my brain fog has improved a whole lot. What else can I do? How fast have you gone up with with thyroid meds? If I'm reading it right, you've gone from 1 1/2 grains (180 mg) to 3 grains (360 mg) in two weeks! That's way too fast and would not help with energy and stamina at all. Also, in the future when you get thyroid tested, you should not take it 12 h before. As Lee mentioned, your last results showed that testosterone and DHEAS is suboptimal. Replacing these might help with energy and stamina. Cheers
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