Endocrinologist? (I found a winner -- thank you!)

As for Alamax (alpha lipoic acid and biotin) it is okay for use but I cannot determine if the alpha lipoic acid is only the R-isomer or a mixture of both the L and R forms. T he R form is the properly active one.

Supporting your metabolism's efforts at regenerating your endogenous antioxidant agents is absolutely a worthwhile endeavor. I cannot fault the doctor for suggesting you all do that. THis will work bets in combination with the right diet for you. There are other sources for those supplements though. Even GNC has a lot of these things in stock.

Well, thank you, mum. My specialty is more in the neuroscience arena but I do like to think I know everything. At least many folks would say that's what I think.

metaphysician said:

bikefixed said:

That may be the last resort in the immediate term but it will also reinforce the insulin resistance more than it would typically develop with uncontrolled blood glucose. Plus, the injection isn't like the normal pattern of insulin secretion. Is this 'regular' insulin or a longer acting (such as lente) formulation?

Not to mention the effect of insulin as a promoter of increased fat storage in adipose tissue, which is a common problem for many (though not all) Type II people.

I know, I know, and I think it's been a cause of a recent significant weight gain, so this definitely is not a long term solution.

Interesting to hear about Advani pushing supplements, as she was not when I was seeing her. I look askance at any doctor who sells and pushes their own product and can't imagine a case where I would stay under their care. (well, within reason, my podiatrist sells a delightful foot soak.)

drummerboy said:

Interesting to hear about Advani pushing supplements, as she was not when I was seeing her. I look askance at any doctor who sells and pushes their own product and can't imagine a case where I would stay under their care. (well, within reason, my podiatrist sells a delightful foot soak.)

WOO!

Not quite, leighan. There is some science to how supplements work (or don't but still say they do). It's more like with a lower case 'w' and maybe a 'u' instead of two 'o's. See that Chinese medicine joke I got in there?

and you think you're not on your game.....

bikefixed said:

Not quite, leighan. There is some science to how supplements work (or don't but still say they do). It's more like with a lower case 'w' and maybe a 'u' instead of two 'o's. See that Chinese medicine joke I got in there?

Supplements are one thing. The physician selling them from her office is quite another.

It reeks.

To be fair, many of the chiro folks do the same thing from their offices. They might have an account with the supplier but I really doubt they make much on the sales of these items. They believe in them, yes, but I would submit that they make less from those sales than the doctors who used to get all sorts of perks from Pharma pushers visting their offices. I have first hand experience with that game too.

I was very close to the chiropractor I saw in Chicagoland. I taught ESL with him and we did a lot of talking about medicine, mainly because I was practically the only mainstream medical guy who would listen to him for more than 30 seconds.

Just to weigh in here…

@bikefixed : I think u r more on than off ur game from reading your replies! So happy to see u posting and helping us again with your vast knowledge! It means u r on the road to recovery, despite lingering symptoms and ongoing challenges. U r ROCKing it, bikerman!

Q: Are yall you diabetic MOLers out there keeping completely 100% off sugar? Obviously, cookies and chips, crackers, pastries and white bread/pasta (most snacks and sweet desserts, I have ''the list'' ) are a no-no but r all other carbs off base? I ask because when I was in cardiac rehab, the RNs were pushing apple jiuce and graham crackers on me to keep my glucose higher than I had been taught was my safest and most desirable range. I have to work like mad to keep my sugar within that low range
and yet, these cardiac specialist nurses kept pushing the juice, etc which put my sugar over the top limit (the point at which m Doc had me take insulin.

I don't get it. They could not resolve my conflicted feelings over this practice. Blithely, they kept telling me: talk to your doctor, rather than explain it in terms I could understand. My sugar did not go very low during exercise but my body is highly reactive to any form of pure sugar whether it is apple juice or sweet tea, so I refused it every day. I ate an apple just prior to exercising, which is what my doc had suggested I do.

Thoughts please? Suggestions welcome.

@ bikefixed: are u still in touch with the chiro friend?

Yes. We email a bit.

As I mentioned above, I go to Dr. Advani for hypothyroidism, and she is the only local doctor I've found who prescribes Armour, which has been a godsend for me. She is also willing to overtreat a little if it makes me feel better -- both rare for an endocrinologist. I haven't encountered the supplements thing. Just wanted to stand up for her in case there's a desperate hypothyroid out there, as I once was, looking for a doctor who listens and is willing to use some unusual tools.

Thank you, mim. I am wondering if I should be taking more or different type of supplements. I am string enough to resist sales pitches but I do need someone extremely kind and open to alternative options. Some of what I was doing is no longer as effective for me, apparently.

@mim: I am also hypothyroid and she put me back on Armour (which I had been on since 1998, courtesy of many different doctors, except for the then-prior 3 months when Dr. Kissin put me on Synthroid). I still don't feel it's enough because I have the same symptoms (they still ask me all the questions and my answers to all are "yes", e.g., significant hair loss, hot/cold, etc.). She won't up the meds for me, though.

I'm not bashing her, just discussing the problems I have with her. And it has led to a whole lot of good information from some very good people here. I'm happy if she works for you and others (her waiting room is always full), but it isn't working for me.

mim said:

As I mentioned above, I go to Dr. Advani for hypothyroidism, and she is the only local doctor I've found who prescribes Armour, which has been a godsend for me. She is also willing to overtreat a little if it makes me feel better -- both rare for an endocriniologist. I haven't encountered the supplements thing. Just wanted to stand up for her in case there's a desperate hypothyroid out there, as I once was, looking for a doctor who listens and is willing to use some unusual tools.

Just as an FYI, non-holistic endos will prescribe armour, but usually want to try standard meds first. My doc said he would have tried it, per my request, if dose mod didn't help my hypothyroidism. I know Armour is supposed to help your T3 level a lot. Luckily I'm in good shape now on levothyroxine.

Dr. Prus is NOT thorough and does not listen to your concerns. My daughter was a patient and went to her with a concern and she ignored her. Actually told her it was all in her head, thankfully my girl trusted her gut and switch to Dr. Vlad.

@debpod: I believe levothyroxine is generic Synthroid, which many doctors don't think is as effective as the brand name.

@mim I agree, she had done well for my hypothyroid and listens to my symptoms, doesn't just look at the blood test results. I will say I like the D supplement I get from her and she still gives me the script for vitamin d too.

@jersey123 and @hope4u: I sent you both PMs.

Yes, Synthroid is the brand name of the most widely known levothyroxine (T4) product. Sometimes it is written as
l-thyroxine. It is the purified preparation of the major form of thyroid hormone. The truly active form is T3 (triiodothyronine) and it is formed when circulating free T4 molecules have one iodine atom knocked off.

By the way, notice I stated 'free' circulating T4 does this. The total amount of T4 in a simple blood level test reports the combination of free T4 and all the T4 bound to circulating plasma proteins. It's in the blood, but when something is bound to a protein of some kind it is not really 'in the game' so to speak. It's like those molecules are on the bench and will eventually get into the action.

There are some situations where it is necessary to do a test that distinguishes the bound versus free levels of T4. That test is a lot more expensive than a total T4 test.
These situations are hard to diagnose and treat. This kind of crap is what makes diabetes and thyroid issues nightmares.

So if I have separate Free T3 (which is in the middle of the "normal spread" and Free T4 (right at the bottom of the "normal spread") and an abnormally low TSH, what does that mean?

Too many variables I don't know values for to make any kind of guess other than saying "a few different things".

TSH stands for Thyroid Stimulating Hormone or Thyrotropin, the substance released from the pituitary gland that goes out from the brain into the bloodstream and down to the thyroid gland. There it supports the growth of the glandular tissue but also important for keeping the gland healthy and functioning to produce T4. TSH is released in response to Thyrotropin Releasing Factor from the hypothalamus. This redundant regulation of the thyroid gland (like most other hormones are regulated) is highly tuned with special thyroid hormone receptors on those parts of the brain serving as the sensors in a biofeedback loop.

Except when it isn't - for a number of reasons - which is why I can't do anything but spout stuff about the way it's supposed to work. They all kinda suck though.

mumstheword said:

@debpod: I believe levothyroxine is generic Synthroid, which many doctors don't think is as effective as the brand name.

Levothyroxine is generic, and while It's essentially the same as Synthroid, the distinction is important to some. I can't take Synthroid. I had awful adverse reactions with my eyes. I'm now on the generic because Levoxyl hasn't been available for about a year. Yes, it's all levothyroxine, but the actual brand does make a difference for many.

hey bikefixed, I know you've probably mentioned this before, but what exactly is your background? Were you a doctor, or was it pharmacological related, or what? It must have been pretty deep to have all this info at your fingertips like this.

Umm, thank you, drummerboy. By the way, my first laugh of the day was just now as my phone's autocorrect made it into 'drunkenly' when I tried to Swype your name. I tried to redo it carefully but it insisted. It's well before 10AM ya know...

Anyway, my undergrad work was in pharmacy school in Boston. Well before I graduated I knew that I'd be bored to death in that job, especially since the pharmacist's role in helping patients was already being steadily getting edged out by the insurance companies by their terrible reimbursement rates and disrespect for dispensing fees (and thus not having any faith in the pharmacist's ability to educate patients). Couple that with economic pressures in the stores I felt like we were being miles into machines during my internship jobs. "Here sign this. OBRA 90, ass." There are other reasons but I just realized I'm ranting here.

I began doing research in one of the professor's labs and it was something I liked. I studied partial agonists at the alpha-1 receptor in arteries. The oxymetazoline in Afrin nose drops was one of those drugs. This guy was a pharmacologist and was interested in the way receptors all over the body behaved in the membranes to be the first step in translating the message a neurotransmitter was sending inside the cell. I could talk about that stuff for days. Anyway, that sealed my decision to go the grad school route into pharmacology. So I got my license in MA and MI and went out to Ann Arbor to get the shock of my life.

Grad school in basic science was HARRDDD when you went to pharmacy school instead of a more science oriented program like biology or biochemistry. The only thing I had easy was the already knowing the therapeutic side of things. The science behind the way we were learning how drugs worked (and when in some cases they couldn't work) was much deeper. I thought I knew physiology but I was a silly naive little boy. The next 2 years were hard but that was when it really got interesting. Now I was getting closer to the real details instead of just accepting the stuff I had to learn as facts to memorize.

I settled on studying how nerves and chromaffin cells released neurotransmitters in response to various stimuli. I mostly studied how the influx of calcium ions into nerve terminals triggered the fusion of the granules containing the neurotransmitters with the cell membrane. Once that happens they are free to float in the synapse and get over to the receptors on the next nerve ending or on the target cell like a muscle or something.

I wrote all that because it is the main way nerves 'talk' to other tissues in the body. That meant I wound up studying aaalllllll the ways it happened in the body. That along with having to learn about how anything affects the body - and I mean everything you can think of - leaves most pharmacologists believing they know everything. I also worked as a pharmacist while completing my research so it really got me deep into medicine now that I was working in the crop rows as well as the farmer's market as it were.

Once I got my doctorate in '95 I did a post doc in Boston where I studied the brain's dopamine receptors and how they may be involved in schizophrenia and other psychiatric conditions. This includes all the medicines used to try to treat them. That meant I also spent a lot of time looking at how antidepressants were mucking around up there too.

Anyway, I chucked all that and taught myself computer programming as my wife's career became a lot more important than mine. I'd trade brains with her in a heartbeat.

Oh, and if you tell this to anyone I'll deny every word of it.

Wait, what was your question?

lol. thanks for the deets though. It also means I kind of win a bet, as a friend of mine said you were a doctor, but I said I thought you were a pharmacist, so I guess I was closer.

I started life as a programmer myself before falling into the embarrassing role of database administrator.

bikefixed said:

I began doing research in one of the professor's labs and it was something I liked. I studied partial agonists at the alpha-1 receptor in arteries. The oxymetazoline in Afrin nose drops was one of those drugs.

When my mom would visit her relatives in Canada, she always stocked up on an OTC oxymetazoline nasal spray. It was many years before it became available down here.

bikefixed said:

Once I got my doctorate in '95 I did a post doc in Boston where I studied the brain's dopamine receptors and how they may be involved in schizophrenia and other psychiatric conditions. This includes all the medicines used to try to treat them. That meant I also spent a lot of time looking at how antidepressants were mucking around up there too.

I'm more than a bit aggravated at my dopamine receptors. There are a number of drugs approved for fibromyalgia that involve those receptors, but they all gave me the added bonus of unremitting nausea, and I mean 24/7. If I ever get Parkinson's, I'm screwed. Grrrr...


As the reigning local expert, BF, I might try to hold you responsible, if I can figure out a rationale for it.

You might need something like Zofran to block the sensitivity of your chemo-trigger zone while you take those meds. That's the part of your brain making you wanna woof your cookies. You may have heard of apomorphine. It's a dopamine D2 agonist (receptor stimulator) that it still used in animals to make them vomit poisonous stuff that is safe to bring back up. It's also sometimes used in Parkinson's and erectile dysfunction but that nausea dude effect limits its use. Anyway, with that compound they learned about various nerves and brain parts involved in how you get nauseous and throw up.

With that information lots of study went into figuring out how to get that whole mess to stop. They figured out that serotonin simulation of the 5HT3 receptors in the area postrema is a late step. Chemo often causes serotonin release from cells in that area so that's why it is so often used in cancer patients. However, it still can help other causes of nausea because it can block the reflex mechanism involved in throwing up. Even if some other cause of nausea is in effect, blocking this reflex is often enough to prevent vomiting. Most of the time anyway.

And stop with that reigning expert crap. I've been out of medicine for over 15 years. Kids in pharmacy school probably know more than I do at this point.