by Dr. Glenn B. Gero, N.D., D.Sc., M.H., M.E.S., C.L.C.<\/p>\n
It was the same damn dream.\u00a0 This was the third night in a row that she was jolted from a deep sleep and had to calm herself down.\u00a0 Her heart rate soared to nearly 120 beats a minute. \u201cThis isn\u2019t real,\u201d she kept telling herself, but this unrelenting nightmare had repeated itself for the third consecutive night.<\/p>\n
In her dream, she was just leaving the fitness facility where she trains twice a week with a personal trainer. \u00a0Laura Marx was driving west on Route 4 in Fair Lawn, NJ, toward her home in Clifton.\u00a0 There was a light snow covering on the road with a bit of a flurry.\u00a0 Nothing treacherous, this was not a big deal, she\u2019s driven in these conditions hundreds of times before.\u00a0 Laura was a good driver and proud of her driving skills.\u00a0 This time, however, as she pumped her brakes to slow down, her car sped up.\u00a0 \u201cWhat the\u2026\u201d\u00a0 She slammed on the brake pedal, but the car continued to race forward 40 mph, 50 mph, 60 mph.\u00a0 She couldn\u2019t stop the car.\u00a0 \u201cWhat\u2019s happening here?\u201d\u00a0 She reached down with her left hand to pull the floor mat away from the accelerator, but that didn\u2019t help.\u00a0 Her BMW 328ix continued to pick up the pace.\u00a0 Laura was doing everything in her power to control the steering; she couldn\u2019t stop the car, \u201cwhy doesn\u2019t it stop?\u201d Terrified she maneuvers around slower moving vehicles, speeding through stop lights, avoiding pedestrians and frantically looking for a snow bank to plow into.\u00a0 \u201cWhere is a snow bank?\u201d\u00a0 She screams, \u201cI\u2019ve got to stop this car.\u201d Then she wakes up in a sweat, her heart racing. \u00a0She realizes this was a bad dream.<\/p>\n
Now Irv, her husband is really getting concerned. \u201cSame dream?\u201d<\/p>\n
\u201cEvery detail is exactly the same, I don\u2019t know what\u2019s going on and every day it\u2019s happening at around the same time.\u201d\u00a0 She looks at the Bose clock radio on the dresser just off the foot of the bed; it was 4:14 a.m.<\/p>\n
\u201cI\u2019m sure this is nothing,\u201d Irv commented, \u201cit\u2019s just a dream.\u201d<\/p>\n
Yes, it was just a dream, but just another component of a weird series of unexplained occurrences that have been happening to her over the last two years.\u00a0 It all started with a period of brain fog so oppressive that her ability to focus was nearly completely obliterated.\u00a0 Formerly an avid reader, Laura breezed through dozens of pages of her favorite novels only to realize that she hadn\u2019t any recall of anything that she had just read.\u00a0 \u201cI\u2019m not a stupid person,\u201d she mused, \u201cI\u2019m a Cornell graduate with a master\u2019s degree in communications from Princeton University.\u201d\u00a0 A senior editor for Advertising Executive Magazine,<\/em> her job, in New York City, depended on her ability for extreme mental acuity, but now her ability to concentrate became severely compromised.\u00a0 This wasn\u2019t the Laura Marx she has known for nearly four decades!<\/p>\n A mother of three sons, Jason, Jordan and Joshua, she was starting to mix up her children\u2019s names.\u00a0 \u201cJason, hurry, you\u2019re going to be late for school.\u201d<\/p>\n \u201cMom, I\u2019m Jordan and I\u2019ll be ready in two minutes,\u201d her ten-year old quipped.\u00a0 \u201cJoshua, honey, please take out the garbage.\u201d<\/p>\n \u201cMom, you\u2019re looking at me, but I\u2019m Jason,\u201d her precocious ten-year old countered.<\/p>\n She had mentioned to her husband Irv, more than a couple times, \u201cI\u2019m investing in name tags.\u201d<\/p>\n Although at the onset of her symptoms Laura was only 36, she was also starting to feel like a woman in her late 60s.\u00a0 She was more tired when she woke up in the morning than she was before she slipped into bed the night before.\u00a0 Even if she had gotten eight to ten hours of sleep, she found it difficult to crawl out of bed.\u00a0 This, combined with her forgetfulness, her inability to concentrate, her series of bad dreams, she had to admit, something was very wrong. \u201cI think it\u2019s time to visit Dr. David Gold,\u201d Laura had admitted to herself.\u00a0 It had been several years since her last complete physical exam, so Laura realized that she was due.<\/p>\n While mornings were starting to be almost intolerable, she would continue to be compliant with a few supplements including a multiple vitamin\/mineral, a vitamin E and a capsule of fish oil.\u00a0 After gaining several pounds over the last few months, Laura decided to eliminate breakfast, but would down two strong 12 ounce cups of freshly brewed black coffee to consume enough caffeine to muster an adequate amount of energy to get the boys ready for school and get her prepared to get to work.\u00a0 The 360 milligrams of caffeine certainly was able to keep Laura up because it triggered the flight or flight mechanism, but the excessive dose of caffeine made her dehydrated, shaky, and irritable, exacerbated her physical fatigue and drained her emotionally.\u00a0 Additionally, her adrenal glands, which were already exhausted, where working on overdrive.\u00a0 She was literally living on the edge, whereas the slightest exertion could cause a physiologically catastrophic incident.<\/p>\n On the day of her initial appointment with Dr. Gold, nearly two years ago, she and Irv entered the three-story professional building and walked toward the elevator when they noticed a note indicting that the elevator was out of order.\u00a0 There was no other choice, but to climb the three flights of stairs to Dr. Gold\u2019s office.\u00a0 Laura, who had been an accomplished varsity athlete throughout college, as a competitive swimmer at Cornell, should have had no trouble climbing three flights of stairs.\u00a0 This day, however, became a monumental task.\u00a0 By the time they had reached the third floor, Laura collapsed, shaking violently and on the verge of passing out.\u00a0 \u00a0Irv ran to Dr. Gold\u2019s office to get help.\u00a0 The office staff called 911, while, Jonathan, Dr. Gold\u2019s physician assistant, administered CPR.<\/p>\n On her way to Beth Israel Hospital in Passaic she was in a panic.\u00a0 Not totally cognizant of what had transpired, Laura was flailing her arms dislodging the oxygen mask that was administered to her and screaming Irv\u2019s name.\u00a0 \u201cIrv, what is happening to me?\u00a0 Where am I going? Where is Dr. Gold?\u201d\u00a0 Irv and the entire EMT and paramedic staff were trying their best to restrain and console Laura, but she was confused, disoriented, scared and terrified.\u00a0 Nothing like this has ever happened; she never had any significant health problems before.\u00a0 The worst thing she ever suffered was a concussion that was sustained at a swim meet in her junior year of college, when a competitor crossed into her lane during the backstroke segment of a 400 meter medley and slammed the back of her fist onto Laura skull.\u00a0 Amazingly, Laura finished that race amassing one of her fastest times ever for that event.<\/p>\n There was great concern as nobody could have predicted the seemingly serious circumstances that were unfolding. \u00a0The hospital was only about five miles away, but to Irv, it was the longest five-mile ride of his life.\u00a0 The ambulance pulled up to the entrance of the emergency room, Laura was transported into the hospital and was fortunate to have a bed available for her almost immediately.\u00a0 Irv was a wreck, held Laura\u2019s hand for nearly six hours while the nursing staff had performed some preliminary assessments, including blood pressure monitoring, EKG, hook-up an IV and took some blood gas measurements.<\/p>\n The suspense of not knowing what is wrong was emotionally crippling.\u00a0 Laura was suffering from shortness of breath, anxiety, palpitations and hysteria.\u00a0 \u201cWas she having a heart attack?\u201d Irv\u2019s mind was racing, \u201chow can a healthy 36-year-old woman be having a heart attack?\u201d\u00a0 \u201cYes, she was under stress, a full-time demanding executive position, three sons and me.\u00a0 Did I do anything to cause this?\u201d<\/p>\n After six hours the emergency doc walked in and spoke calmly to both Laura and Irv.\u00a0 \u201cMy name is Dr. Omansky.\u00a0 Laura, all of your tests are normal and your heart is fine.\u00a0 We\u2019ll send your results to Dr. Gold and he\u2019ll review these with you.\u00a0 You had an anxiety attack, I\u2019m prescribing a two-week supply of Xanax, it will help you relax.\u201d \u201cBut, Dr. Omansky, I\u2019ve never had anxiety before, why all of a sudden am I experiencing these symptoms?\u201d Laura inquired. Dr. Omansky explained, \u201canxiety can occur unpredictably, often have no obvious cause and can, itself, create fear of further attacks.\u00a0 These attacks may be triggered by a stressful event, but usually come on with no identifiable cause.\u201d<\/p>\n Dr. Omansky suggested that Laura speak to a psychiatrist, \u201csomeone in social services may be able to give you a referral. \u00a0If not, consult your primary care doctor for someone who he may recommend.\u201d<\/p>\n Greeting them at the hospital was Laura\u2019s sister, Rona, who escorted them back to retrieve their car left at Dr. Gold\u2019s office.\u00a0 \u201cI don\u2019t understand what\u2019s going on here,\u201d Laura had noted.\u00a0 \u201cI\u2019ve always been healthy. I\u2019m worried.\u00a0 Something serious is going on and I\u2019m scared.\u00a0 I\u2019m only 36 years old and feel like an old lady.\u00a0 Will a two-week round of Zanax turn everything around?\u00a0 Is this some kind of miracle pill that will reverse all of my symptoms?\u201d\u00a0 Laura was rambling, she wanted answers, but knew that Irv and Rona were equally in the dark.\u00a0 Irv was worried.\u00a0 Laura was his entire life. \u00a0He married his best friend and he worshiped and adored Laura and was willing to do whatever is necessary to get her through this.\u00a0 Additionally, Laura and Rona, who were only 18 months apart in age, were as close as two sisters could possibly be with each other. \u00a0While Rona had her own troubles, a nasty divorce and a stillborn pregnancy four years ago, she could empathize with what her sister was going through. \u00a0They were so close, she could literally feel Laura\u2019s frustration, pain and confusion.<\/p>\n Laura was able to reschedule her appointment with Dr. Gold the following week.\u00a0 This time the elevator was working fine.\u00a0 Laura and Irv had a 2:00 p.m. appointment and it wasn\u2019t until 3:45 p.m. that they were escorted into an examination room.\u00a0 Jonathan, the physician assistant, entered the room with his clip board and asked.\u00a0\u00a0 \u201cTell me, how you are feeling?\u201d \u00a0Laura, always had been impeccably prepared, presented a comprehensive list of her symptoms.\u00a0 Her list included the following:<\/p>\n <\/p>\n Over the next 15 minutes, Jonathan recorded notes onto Laura\u2019s chart, performed blood pressure readings, took her temperature, listened intently though a stethoscope while he poked and prodded, then plunged an otoscope in both ears, took some notes and dashed out uttering, \u201cDr. Gold will be in to see you shortly.\u201d\u00a0 Shortly was 20 minutes later!<\/p>\n Dr. Gold walked in with a big smile, \u201cLaura, how are you?\u00a0 We haven\u2019t seen you in a couple of years.\u201d<\/p>\n \u201cMaybe if visiting you wasn\u2019t an all day affair, I\u2019d see you more often,\u201d Laura asserted.<\/p>\n Dr. Gold ignored Laura\u2019s sarcasm and proceeded to address some of her medical complaints.\u00a0 \u201cLaura, this is a request for a comprehensive blood chemistry, take it to the lab, additionally, I\u2019m giving you two prescriptions to help you feel better.\u00a0 Once the results are available we\u2019ll call you to come in to discuss them.\u00a0 In the meantime, get these filled at your pharmacy and take them as directed.\u201d<\/p>\n \u201cDoctor, what am I\u2026\u201d Laura started to ask, but Dr. Gold abruptly turned toward the door and left the examination room.<\/p>\n Frustrated and angry, Irv checked his watch, \u201che was with us for exactly three minutes. Three minutes!\u00a0 We waited for him for over two hours and he gives us three minutes?\u201d<\/p>\n Checking online for information on the prescriptions Dr. Gold has recommended, Laura realized that she was given an anti-depressant called Effexor XR, which according to the company\u2019s (Wyeth) Website www.effexor.com<\/em>, is a prescription antidepressant indicated for major depressive disorder, generalized anxiety disorder, panic disorder, and social anxiety disorder.\u00a0 Common side effects include nausea, dizziness, sleepiness, sexual side effects, sweating, dry mouth, nervousness, insomnia, loss of appetite, weight gain and constipation.\u00a0 \u201cThis is crazy,\u201d Laura screamed to Irv.\u00a0 \u201cThese are the symptoms I already have, this doctor is nuts.\u00a0 Isn\u2019t anyone listening to me?\u00a0 Except for the dry mouth, I already have every one of these symptoms.\u00a0 Now I can take this drug and be more dizzy, more nauseous, sleepier, is that possible? more constipated, less interested in sex and more nervous.\u00a0 And I can be fatter than ever.\u00a0 Wouldn\u2019t you be interested in me if there was more to love?\u00a0 Great, why wouldn\u2019t I want to take this drug?\u201d<\/p>\n \u201cWhat\u2019s the second drug?\u201d Irv blurted, then mockingly \u201cmaybe the second one is intended to reverse all of the side effects of the first drug.\u201d<\/p>\n \u201cThe second drug is something called Strattera.\u00a0 It\u2019s supposed to eliminate my brain fog.\u00a0 It says here on the Strattera Website (www.strattera.com) that Strattera is a non-stimulant medicine approved to treat attention-deficit\/hyperactivity disorder (ADHD). The most common side effects of this one includes constipation, dry mouth, nausea, decreased appetite, dizziness, trouble sleeping, sexual side effects, menstrual cramps, and problems passing urine.\u00a0 Sound familiar? This is lovely! \u00a0These are the same side effects as the first one.\u00a0 Could you imagine, along with the symptoms I already have, if I took both of these.\u00a0 You would really have to send me to the looney bin.\u201d<\/p>\n \u201cIrv, what do you think I should do? Should I wait until we get the results of the blood tests?\u00a0 Should I be seeing someone else?\u201d Laura was desperate for answers, but Irv, an accountant with no knowledge of medicine, didn\u2019t have an answer.<\/p>\n \u201cThis is very frustrating, Laura.\u00a0 I wish I had some information to help guide you, but I haven\u2019t a clue.\u00a0 Maybe we should wait until the results come back and then see if he can give us more time and answer some of our questions and concerns.\u201d<\/p>\n \u201cShould I call him and ask him about these medications?\u201d queried Laura.<\/p>\n \u201cDid Gold look like he was interested in taking any more time with us than he did?\u201d<\/p>\n \u201cThis is frustrating, but I do know that I don\u2019t want to be drugged up, especially with medicines that may make me feel worse.\u00a0 I agree, we should wait until we get the results of the blood test.\u00a0 I\u2019ll make an appointment with the lab and get it drawn tomorrow morning.\u201d<\/p>\n \u201cLaura Marx,\u201d Laura said after answering her office line.<\/p>\n \u201cLaura, this is Betty, I\u2019m one of the nurses at Dr. Gold\u2019s office.\u00a0 He asked me to call you to tell you everything in your labs was fine and to keep taking the medicines he prescribed.\u201d<\/p>\n \u201cI\u2019d like to speak with him about my symptoms and go over the reports,\u201d Laura recounted.<\/p>\n \u201cThere\u2019s not much Dr. Gold can tell you if your lab tests are within the normal range.\u201d<\/p>\n \u201cThere\u2019s got to be something wrong if I\u2019m feeling the way I\u2019m feeling.\u201d<\/p>\n \u201cMaybe you\u2019re just under some stress, take some time off and relax.\u00a0 You\u2019ll be just fine.\u00a0 Everything was perfect, you are in great health,\u201d Betty assured her.<\/p>\n \u201cPlease send me the report; I\u2019m going to have to change doctors if Dr. Gold refuses to speak with me.\u201d Laura protested.<\/p>\n \u201cLaura, you can do whatever you wish, but if your labs are normal, what do you expect Dr. Gold to tell you?\u00a0 The symptoms you\u2019re experiencing are commensurate with life\u2019s stresses; Dr. Gold gave you the correct remedy for your condition.\u00a0 He advised me to tell you that the medications he prescribed are appropriate for what you are experiencing.\u201d<\/p>\n \u201cBetty, I\u2019ll be there tomorrow morning to pick up my labs, please have a copy ready for me when I arrive.\u00a0 There\u2019s got to be more sympathetic doctors who really care about their patients.\u201d<\/p>\n Laura arrived at Dr. Gold\u2019s office first thing in the morning to retrieve her blood reports.\u00a0 Of course, Laura wasn\u2019t exactly sure what she was going to do with them.\u00a0 She didn\u2019t understand how to interpret the results, nor did she have any idea who to ask or which doctor she should switch to that was on her insurance plan.\u00a0 She was still at square one, but it seems as if she\u2019s getting worse every day.\u00a0 Dr. Gold has been her primary care doctor for more than a decade.\u00a0 Although she didn\u2019t see him very often, he was there to prescribe an antibiotic when she got the flu, an anti-inflammatory when she strained her knee from playing soccer and a cortisone shot when she had tennis elbow.\u00a0 Other than those few episodes, there wasn\u2019t much reason to seek his counsel.\u00a0 Now Laura was really sick.\u00a0 Something was very wrong and she needed someone who had a bit more compassion than Dr. Gold!\u00a0 Laura was so angry that she did something that even surprised her.\u00a0 As she was leaving she noticed that the waiting room was packed with patients.\u00a0 She decided to make an announcement, \u201chey everyone, be prepared to wait for at least two hours to see this doctor.\u00a0 He doesn\u2019t care about any of you, you\u2019ll be lucky if he gives you three minutes of his time.\u00a0 Don\u2019t ask him any questions because he won\u2019t answer them anyway.\u00a0 If you really care about your health, you\u2019ll find another doctor that\u2019s more compassionate than him.\u201d Then Laura stormed out of Gold\u2019s office!<\/p>\n Laura was so despondent that she decided to take the day off.\u00a0 She called her office and told her secretary that she was going to work from home.\u00a0 \u201cYou know,\u201d she said to herself, \u201cI want to do some things for myself. \u00a0I\u2019m going to have a day of beauty.\u201d\u00a0 Laura opened her Blackberry and called Mademoiselles\u2019 Spa and Salon in Montclair.\u00a0 \u201cMelissa, this is Laura Marx, do you have any openings today?\u201d<\/p>\n \u201cLaura, great hearing from you,\u201d responded Melissa, what services were you looking for?\u201d<\/p>\n Laura, said, \u201cI need the works, facial, hair, nails and maybe a massage.\u201d<\/p>\n \u201cWe have an opening this morning at 11, can you make it?\u201d<\/p>\n \u201cI\u2019ll be there,\u201d Laura confirmed ecstatically.<\/p>\n During her facial, Laura was spilling her sorrows to Melissa.\u00a0 \u201cI just don\u2019t know why all of this is happening to me.\u201d<\/p>\n \u201cYou know, Laura, my sister Victoria had the same exact symptoms that you\u2019re telling me.\u00a0\u00a0 She had a thyroid problem.\u00a0 She felt awful for a long time and her doctors kept on telling her that there was nothing wrong with her.\u00a0 Just like you, she was prescribed antidepressants and tranquilizers. \u00a0She started taking them and became as big as a house, plus they made her symptoms worse. There was never anything wrong with her head, it was her thyroid!\u00a0 Vicki\u2019s symptoms were identical to what you\u2019re experiencing, now she\u2019s on a thyroid medication and she\u2019s 150% better, not perfect, but she\u2019s doing real well.\u201d<\/p>\n \u201cI don\u2019t know if they checked my thyroid,\u201d Laura mentioned.\u00a0 \u201cI have the blood report, picked it up this morning, but I have no idea how to interpret the results.\u00a0 I need to find a new doctor.\u00a0 I am now persona non grata in that office.\u201d Laura confessed her recent malfeasance when she left Dr. Gold\u2019s office.<\/p>\n Leaving Mademoiselles\u2019 four hours later, Laura felt great.\u00a0 She purged her frustrations to Melissa and her husband Eugene while getting pampered with a facial, a great massage, a new set of nails and a make-over.\u00a0 She felt and looked like a new woman.\u00a0 Her day of beauty set her back $785 with all of the tips, but worth every penny.\u00a0 Hopefully, the best news was that she left with the name and phone number of Vicki\u2019s doctor.\u00a0 She first had to see if this new doc was a participant in her healthcare plan.<\/p>\n By the time Laura got home, she discovered that Dr. Leonardo Franco, an endocrinologist in Hasbrouck Heights, was a provider covered in her plan, but after calling she discovered that he was booked solid for the next three months and wasn\u2019t accepting any new patients at this time.\u00a0 \u201cI can\u2019t believe this,\u201d Laura said to herself, \u201cthere\u2019s got to be a way for me to get to see him.\u201d\u00a0 By this time in Laura\u2019s desperation, she was resorting to covert tactics.<\/p>\n Laura pressed redial on her Blackberry, \u201cDr. Franco\u2019s office, this is Marybeth.\u201d<\/p>\n \u201cHi Marybeth, how are you? This is Betty at Dr. David Gold\u2019s office,\u201d Laura tried her best to disguise her voice.\u00a0 \u201cWe have a patient that we\u2019d like to refer to Dr. Franco.\u00a0 Dr. Gold feels it\u2019s important that she be seen by an endocrinologist as soon as possible. \u00a0Her name is Laura Marx.\u00a0 If she calls within the next few minutes, is it possible for Dr. Franco to squeeze her in to his schedule?\u201d<\/p>\n \u201cWe\u2019ll do our best Betty, have her call and ask for me.\u201d<\/p>\n After the usual office introduction, \u201chello Marybeth, my name is Laura Marx; I believe you are expecting my call?\u201d\u00a0 \u201cYes, dear, you are looking to schedule an appointment with Dr. Franco?\u201d<\/p>\n \u201cYes, it\u2019s important that I see him as soon as possible. \u00a0Does he have anything for this week?\u201d<\/p>\n \u201cCan you be here tomorrow at three?\u201d<\/p>\n \u201cOf course, I\u2019ll be there a little early to fill out any required forms.\u201d Laura gave her all of her requested information including her insurance carrier, phone number, address and reason for her visit. \u201cI have my recent labs reports with me so you needn\u2019t call Dr. Gold\u2019s office for anything,\u201d a stealthy move by Laura to avert any potentially embarrassing call to Dr. Gold\u2019s office.<\/p>\n That evening she confessed to Irv about what had transpired during this eventful day, starting with playing hooky from work.<\/p>\n \u201cWhat have you turned into?\u201d exclaimed Irv in astonishment.<\/p>\n \u201cI\u2019m feeling desperate,\u201d replied Laura, \u201csomeone\u2019s has got to know how to help me, there has to be some physiological imbalance that is causing the symptoms that I\u2019m experiencing,\u201d as she continued to relay the events of the day to Irv.\u00a0 \u201cI need to perform some research before I see Dr. Franco tomorrow, based on what Melissa was telling me at the salon about her sister, it sounded like she was describing my symptoms to a \u201cT,\u201d and this doctor that I\u2019m seeing tomorrow was the one who helped Vicky.\u00a0 She had a thyroid problem and now she is much better.\u00a0 I\u2019m wondering if I\u2019ve got the same problem.\u00a0 I\u2019m going to perform an Internet search for thyroid symptoms and see what comes up.\u201d<\/p>\n Two hours later, an ecstatic Laura stormed into the bedroom where Irv was watching Thursday night football, a heated rivalry between the Minnesota Vikings and the Chicago Bears.\u00a0 \u201cIrv, check this out,\u201d Irv paused the live action, thanks to the DVR technology, \u201cI Googled thyroid, check out all of the symptoms associated with underactive thyroid.\u201d\u00a0 Laura presented a list of 36 different complaints, \u201cI\u2019ve got at least half of these, the only thing missing on this page is my photograph!\u201d quipped Laura.\u00a0 \u201cDo you believe that Dr. Gold didn\u2019t identify these obvious thyroid symptoms?\u00a0 Maybe he didn\u2019t even pay attention to any of the symptoms I described.\u00a0 How is it possible that I perform a two-hour search on the Internet and discover all of this information and a doctor like Gold, who attends four years of medical school and has been in practice for at least 30 years, doesn\u2019t acknowledge them?\u00a0 Does this make any sense? Or is it because he just doesn\u2019t care anymore?\u00a0 Is this typical of most doctors today or is it just him?\u201d\u00a0 Laura heighted her intensity with each rhetorical question she raised.\u00a0 \u201cI just hope this new guy that I\u2019m seeing tomorrow can find something and come up with a solution\u201d<\/p>\n Armed with an arsenal of information and lots of questions, Laura embarked toward Dr. Franco\u2019s office.\u00a0 She arrived at 2:35 p.m. for her three o\u2019clock appointment and signed the office logbook.\u00a0 She was given a couple of forms to complete, one confirming her insurance information and the other entered a collection of basic contact information.\u00a0\u00a0 Since Laura had expected that there was going to be a considerable wait before Dr. Franco got around to seeing her, Laura brought her new Kindle, an electronic reader.\u00a0 She had about a dozen novels stored, but last night she purchased a book titled, Thyroid Power<\/em> written by Dr. Richard Shames and his wife, Karilee.\u00a0 The book was favorably reviewed on the Amazon Website so she figured that while she was waiting she would acquire some knowledge so she wouldn\u2019t be completely in the dark when Dr. Franco entered the examination room to consult with her.\u00a0 The only negative comments were that it was elementary, but since Laura knew nothing, elementary was a good thing.<\/p>\n By the time Laura got about ten percent into the book (digital books do not have page numbers), there was a symptom questionnaire.\u00a0 She took out a pen and a pad of paper from her purse and started to check those questions that corresponded to her.\u00a0 She was suddenly taken aback by the question relating to past exposures to chlorine, fluoride and bromine.\u00a0 Laura hadn\u2019t a clue what bromine was, but all of her life she used a fluoridated toothpaste and, most importantly, she was a competitive swimmer.\u00a0 Every pool was heavily chlorinated.\u00a0 Using the search feature, she entered chlorine and was directed to a page that was headed, \u201cOther Water Hazards: Chlorine in the Swimming Pool.\u201d\u00a0 According to Shames, it has been suggested, though not yet scientifically proven, that one way that chlorine inhibits the utilization of, a comparatively weaker, iodine compromising the production of thyroid hormone.1<\/sup> As an example, one of their patients started a swim program at a local high school pool and, after just a couple of weeks, starting developing significant decline in her cognitive abilities.ibid<\/sup><\/p>\n \u201cSwimming,\u201d she thought to herself, \u201cwas supposed to be a healthy exercise; what could be healthier than swimming an hour or two a day?\u201d She would never fathom that there was an association between her many years of swimming and the debilitating symptoms she\u2019s now experiencing.\u00a0 \u201cCould that be possible?\u201d she muttered under her breath. \u00a0She realized that she was thinking out loud, but kept her head down as she suddenly became a bit embarrassed that someone would think she is mentally disturbed.<\/p>\n A thought came to mind, \u201cremember when we saw someone standing on a street corner having a conversation and nobody was near them and we thought they were crazy?\u00a0 Now you could bet that they are on their cell phone.\u201d\u00a0 Laura started to laugh, but put her hand in front of her face as to not be as obvious, but several of the patients nearby looked at her and smiled, thinking that she was merely reading a funny passage in her electronic book.<\/p>\n At 4:30 p.m. Laura heard her name called.\u00a0 \u201cHello Laura, my name is Jeanne, I\u2019m Dr. Franco\u2019s physician assistant and I\u2019m going to get some information from you before Dr. Franco comes in to see you.\u201d\u00a0 In examination room, Laura handed her recent blood chemistry to Jeanne and her list of symptoms.\u00a0 Jeanne proceeded to get blood pressure readings, check her pulse and looked into Laura\u2019s eyes.\u00a0 She then briefly glanced at Laura\u2019s blood chemistry.\u00a0 \u201cIt says here that you were referred to Dr. Franco because you suspect that you have a thyroid disorder, but your level TSH level is very good.\u00a0 See here the reference range is .5 to 4.5; your level is a safe 3.65.\u00a0 Whatever symptoms you seem to be experiencing don\u2019t seem to be thyroid-related,\u201d exclaimed Jeanne, \u201cbut I\u2019ll have Dr. Franco speak to you.\u00a0 He should be in to see you in just a couple of\u2026\u201d<\/p>\n Laura interrupted Jeanne and bellowed, there\u2019s only a TSH on this report.\u00a0 From my research TSH isn\u2019t even a thyroid hormone,\u201d Laura felt confident after her research from last night, \u201cthere was no test for total T4, T3 or a free T3.\u00a0 How could you be sure that it isn\u2019t a thyroid problem unless you are looking the entire panel?\u201d<\/p>\n Jeanne responded as if she had been asked this question a thousand times before, \u201cAccording to the American Association of Clinical Endocrinologists (AACE) guidelines:\u00a0 The most valuable test is the sensitive measure of the TSH level, the TSH assay should always be used as a primary test to establish the diagnosis of primary hypothyroidism and the only other recommended test is the free T4. Total T4 and free T3 are not listed as acceptable routine tests.2<\/sup> I\u2019m not sure Dr. Franco would authorize those tests for you.\u00a0 Generally when we order Free T3 and Free T4 tests they are only for patients with hyperthyroidism or overactive thyroid. \u00a0It would be unwise to use those tests for someone with hypothyroidism. <\/strong>He should be in to see you in a minute; ask him.\u201d<\/p>\n Within a minute, an expressionless Dr. Franco entered the room.\u00a0 Without introducing himself, he asked Laura why she thought she had a thyroid problem.\u00a0 As she did with Jeanne his PA, Laura presented her list of symptoms.\u00a0 \u201cThese symptoms that you are experiencing are nebulous and could be related to any woman nearing her 40th<\/sup> year.\u00a0 Have you had a complete gynecological exam with an assessment of your hormones?\u00a0 There doesn\u2019t seem to be anything wrong with your thyroid; it is well within the normal range.\u201d\u00a0 \u201cHow about running the other elements of the thyroid panel,\u201d Laura blurted.\u00a0 <\/strong><\/p>\n \u201cWe don\u2019t authorize that unless we have strong suspicions of thyroid disorder, especially if we suspect overactive thyroid and I don\u2019t believe that there is anything wrong with your thyroid.\u201d <\/strong><\/p>\n \u201cHow about this reference to chlorine and the inhibition of iodine metabolism, I was a swimmer.\u201d\u00a0 <\/strong><\/p>\n \u201cLaura, with all due respect, you will find all types of hogwash on the internet.\u00a0 I recommend that you stop looking on the computer, listening to quacks and manufacturing diseases.\u201d<\/strong><\/p>\n Laura left Dr. Franco\u2019s office more frustrated, anxious and scared than ever before.\u00a0 All of the research she had conducted indicated that a TSH wasn\u2019t a sufficient indicator of thyroid dysfunction and this doctor, an endocrinologist, was not acknowledging any of her symptoms.\u00a0 She was not, however, going to give up this fight, she was more determine than ever to find out what was wrong.<\/p>\n It was now 5:15 p.m. and knew that Irv was on his way home.\u00a0 She called him on his cell phone to air her anguish and disappointment, but assured him that her fight for answers is just beginning.\u00a0 \u201cI\u2019m going to find someone who will listen to me and make the connection.\u00a0 I\u2019m more confident than ever that my problems are thyroid related, I just need to find someone experienced and compassionate enough to listen to what I\u2019m saying.\u201d<\/p>\n Over the next couple of years, Laura had visited a myriad of primary care doctors and specialists that were participants in her insurance plan.\u00a0 She honestly couldn\u2019t believe some of the ridiculous comments that these \u201cso-called\u201d medical professionals were saying:<\/p>\n \u201cI\u2019ve seen people with a TSH of 10, 20, and even one patient with 60, so 3.65, which is in the normal range, really isn\u2019t bad, and couldn\u2019t account for all of the symptoms you are feeling\u201d<\/p>\n \u201cYou probably had some emotional trauma during childhood. Your symptoms are caused by depression. You need Zoloft or Effexor.\u201d<\/p>\n \u201cYou must have bad genes. Some people just have less energy than others; you\u2019ve got to learn to live with it.\u201d<\/p>\n When she asked about adrenal insufficiency, one doctor inquired, \u201cdo you feel that you have Addison\u2019s disease?\u201d<\/p>\n At last Laura found Dr. Michael Osterman who agreed to order a complete thyroid panel including a total T4, a total T3, a free T3, a thyroid peroxidase (TPO) and a thyroglobulin.\u00a0 All of the values did come back within the reference ranges with the exception of the free T3 and an elevation is her LDL cholesterol.\u00a0\u00a0 Laura was given prescriptions for both synthroid and simvastatin, a cholesterol lowering drug.<\/p>\n At this point Laura developed a respectable body of knowledge relating to thyroid imbalances.\u00a0 She questioned this doctor on his rationale of prescribing a T4, when it was her conversion from T4 to T3 that seemed to have been the problem.\u00a0 His response was, \u201care you the doctor or am I the doctor?\u201d\u00a0 When she inquired about taking natural desiccated thyroid, his response was, \u201cdo you realize that it\u2019s PIG THYROID, that\u2019s disgusting!\u201d \u00a0<\/strong><\/p>\n The fact that this doctor was wearing a <\/strong>yarmulke, a skullcap worn by Jewish orthodox males, Laura realized that he didn\u2019t touch pork so Laura then asked, \u201cdo you have a problem prescribing pee from pregnant horses?\u201d \u00a0She then left his office refusing to pay the insurance co-pay and left the two prescriptions on the receptionist desk.<\/strong><\/p>\n Finally, she went to another doctor and <\/strong>when she asked him about Armour thyroid, he kept saying he doesn\u2019t recommend the \u201cArmour All.\u201d \u00a0He stated, \u201cmost doctors wouldn\u2019t put anyone on \u201cArmour All.\u201d<\/p>\n \u201cExcuse me Doc, Armor All\u00ae<\/sup> is the protectant product that I use on my car dashboard, I\u2019m referring to Armour thyroid or natural desiccated thyroid.\u201d \u00a0She then added, \u201cyou should check your Physician\u2019s Desk Reference for the correct name,\u201d not caring about whether she was being insulting or not.\u00a0 Laura was a bright woman; she knew it and was not going to be treated like an idiot by these \u201cso-called\u201d professionals.<\/p>\n Several weeks later, after discussing her situation with Heather Scott, one of the personal fitness trainers at her health club, Heather inquired, \u201chave you ever consulted with a naturopathic doctor?\u201d<\/p>\n \u201cI never heard of a naturopathic doctor,\u201d Laura said.<\/p>\n Heather explained that a naturopathic doctor is a trained health practitioner who doesn\u2019t treat disease; they deal with the imbalances that may precipitate a disease state.\u00a0 They are like detectives, looking for imbalances, deficiencies and predispositions that lead to physiological disturbances.\u00a0 \u201cI know a very good naturopathic doctor who, I believe deals with a lot of thyroid issues.\u00a0 He helped a client of mine who was seriously ill and now she\u2019s doing extremely well.\u201d\u00a0 If you\u2019re interested, I will get you his name and phone number and can call you later tonight before I leave the gym.<\/p>\n That evening Heather called Laura with the name of the naturopathic doctor who was located in her hometown.\u00a0 \u201cHis name was Dr. Bruce Oreg,\u201d she furnished Laura with Dr. Oreg\u2019s phone number, address and Website information.\u00a0 She also mentioned that her client Deirdre had offered her phone number if Laura wanted to get more information.\u00a0 Laura was extremely grateful and did express an interest in speaking with Deirdre and thanked Heather for all of her help.\u00a0 Laura promised keep Heather apprised of whatever decision she would make, as well as her experience with this practitioner.<\/p>\n Deirdre was fabulous; she and Laura spent nearly an hour on the phone together.\u00a0 Afterward, Laura was convinced that this was a logical path to take.\u00a0 Deirdre was about four years older than Laura and had many of the same symptoms when she first visited Dr. Oreg.\u00a0 Deirdre also recalled many of the same experiences with medical doctors, being extremely dismayed by conventional medicine\u2019s approach to sub-clinical thyroid imbalances, which denotes that although the blood chemistry values were within the established reference range, the thyroid isn\u2019t functioning optimally, creating innumerable symptoms.<\/p>\n Laura needed a physiological detective!\u00a0 After researching Dr. Oreg\u2019s credentials and passing his office a couple of times, she decided to make a call even though she still wasn\u2019t absolutely sure what a naturopathic doctor was.<\/p>\n \u201cHello, my name is Laura Marx and I think I\u2019d like to make an appointment with Dr. Oreg, but I would love to speak with him first, is that possible?\u201d<\/p>\n \u201cCurrently he\u2019s with a patient,\u201d Kathleen, Dr. Oreg\u2019s office manager, told Laura, then asked, \u201ccan I have him call you back?\u00a0 He\u2019ll be available at 4:00 this afternoon, does that work for you?\u201d<\/p>\n \u201cI\u2019ll be expecting his call, Kathleen, thank you.\u201d<\/p>\n \u201cI don\u2019t really understand much about naturopathy,\u201d confessed Laura, \u201cbut, I\u2019ve heard some good things about you.\u00a0 Could you tell me something about your approach in assessing and managing hypothyroidism and what I might expect as a patient?\u201d<\/p>\n Dr. Oreg responded, \u201cTypically, naturopaths spend a considerable amount of time with each patient, investigating, fact-finding, analyzing and testing various components to determine physiological areas of imbalance, food intolerances, levels of toxicity, habitual emotional or behavioral patterns and structural deviances, all which may present themselves as disturbances, potentially affecting any organ or organ system in the body.<\/p>\n \u201cWhat type of tests do you perform?\u201d queried Laura.<\/p>\n Realizing that he was speaking with an intelligent individual, Dr. Oreg responded, \u201cwe have a 16-page intake form which is intended to gather information on your symptoms, lifestyle and dietary preferences.\u00a0 I spend a considerable amount of time analyzing blood chemistry from a functional perspective, looking at the relationships of values, rather than focusing on any one value in isolation.\u00a0 I also take hair samples to assess incongruities in mineral balance; I may also analyze urine and saliva samples and can also order, if necessary, various functional laboratory tests such as a food sensitivity test.\u00a0 Additionally, since you suspect a thyroid issue, I will also perform a couple of in-office adrenal function tests to determine an adrenal\/thyroid connection. Naturopathic medicine is about correlating patterns and continuity of findings utilizing several different clinical assessments to confirm suspected imbalances.\u201d<\/p>\n \u201cOnce I\u2019ve gathered all of the pertinent information,\u201d Dr. Oreg continued, \u201cI\u2019ll prepare a comprehensive, personalized report which will feature my interpretation of your assessments, information on your specific conditions and concerns, my clinical recommendations and references to support those recommendations. \u00a0\u00a0My suggestions may include restriction of certain foods or categories of food, specific dietary modifications, vitamin, mineral or herbal supplementation, physical exercise and\/or mind-body behavioral therapies.\u201d<\/p>\n After confirming her intention, Dr. Oreg instructed Laura to record her morning basal metabolic temperature each morning until the day of her visit according to the guidelines presented in the 1976 book, Hypothyroidism: the Unsuspected Illness<\/em>, by Broda Barnes, M.D.\u00a0 The test calls for a morning underarm temperature sampling for ten days in a row, (menstruating women should start on the third day of their cycle, according to Barnes).3<\/sup><\/p>\n Dr. Oreg realized that temperature testing is not infallible, and like any other test, should not be relied on in isolation. \u00a0It, however, is a valuable piece of the pie if used expeditiously.\u00a0 Basal metabolic testing also facilitates the monitoring of a thyroid protocol to assess desired outcomes.<\/p>\n Adjunctive to the determination of optimal thyroid performance administering daily temperature test may be an important indicator of adrenal function.\u00a0 On his Website, <\/strong>Dr. Bruce Rind, M.D., describes his system of taking thrice temperature measurements and noting variations.\u00a0 If the average temperatures fluctuate from day-to-day by more than .2 to .3\u00b0F, adrenal support is necessary.<\/p>\n Once Laura felt assured that a visit to Dr. Oreg was warranted, she confirmed her intention.\u00a0 The call was transferred to Kathleen and an appointment was scheduled for next Thursday at 10:00 in the morning. \u00a0Kathleen proceeded to remind Laura which forms to download and complete and to have her most recent blood chemistry faxed to Dr. Oreg prior to her visit.<\/p>\n In preparation, Dr. Oreg studied the blood chemistry that Laura had faxed prior to her appointment.\u00a0 Some of the important relevant values and corresponding reference range and functional ranges were the following:<\/p>\n Actual<\/u>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ref. Range<\/u>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Func. Range<\/u><\/p>\n Fasting glucose: \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 103\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 65-115\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 78-96<\/p>\n RBC:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 3.9\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 3.8-5.1\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 4.0-4.5<\/p>\n Hemoglobin:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 12.4\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 11.5-15.0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 13.5-14.5<\/p>\n Hematocrit:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 35\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 34-44\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 37-44<\/p>\n MCHC:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 35.5\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 32-36\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 32-35<\/p>\n Potassium:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 3.7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 3.5-5.3\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 4.0-4.5<\/p>\n Sodium:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 146\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 135-147\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 135-142<\/p>\n Total Cholesterol:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 202\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 130-200\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 150-220<\/p>\n HDL:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 42\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 40-90\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 >55<\/p>\n TC\/HDL Ratio:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 4.80\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <4\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 >3.5<\/p>\n Triglycerides:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 132\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 30-150\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 70-110<\/p>\n TSH:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 3.65\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 .35-5.0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 .8-2.4<\/p>\n Total T4:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 9.8\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 4.8-13.2\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 6-12<\/p>\n Free T3:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 74\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 80-230\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 100-230<\/p>\n 25 Hydroxy vitamin D:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 24\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 20-80\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 50-100<\/p>\n Laura arrived at Dr. Oreg\u2019s office Thursday morning at 9:38 a.m.\u00a0 She greeted Kathleen, they exchanged light conversation then handed Kathleen her completed forms and the results of the morning temperature readings Dr. Oreg had requested.\u00a0 While Dr. Oreg was reviewing her lifestyle and initial symptom questionnaires, Laura removed a notepad and her Kindle from her briefcase. \u00a0She scribbled a few additional reminders to herself, than began to read.\u00a0 Unlike a typical medical doctor\u2019s office, however, Laura barely had time to turn on her reading device before Dr. Oreg promptly introduced himself and asked Laura to enter his office.<\/p>\n Dr. Oreg\u2019s office was neatly appointed with hoards of diplomas, certificates, awards and confirmations of his continuing education adorning his walls.\u00a0 She quickly glanced around noticing his bookcases, which were filled with some very impressive medical textbooks including: Medical Physiology<\/em> by Guyton and Hall, Harrison\u2019s Principles of Internal Medicine<\/em>, Endocrine Physiology<\/em>, Functional Medicine, the Physician\u2019s Desk Reference<\/em> and countless books on botanical medicine, clinical nutrition, biochemistry and exercise physiology.<\/p>\n \u201cI really don\u2019t know what you\u2019re going to be able to do for me,\u201d Laura proceeded to confess her frustrations with all of the doctors she had seen prior to this visit.\u00a0 \u201cI\u2019m just hoping that you have the magic bullet that\u2019s going to bring me back to life.\u00a0 Quite frankly, I\u2019m burned out, I\u2019m constantly tired, my concentration is cloudy, I often feel disoriented, I\u2019m extremely tired when I wake up in the morning, even when I think I\u2019ve gotten a good night\u2019s sleep.\u00a0 I still feel anxious, a bit depressed and I\u2019m constantly bloated.\u00a0 I\u2019ve also gained 30 pounds in the last three years.\u00a0 Am I the most demanding case you\u2019ve ever had?<\/p>\n \u201cUnfortunately, Laura, you are typical of many patients that I\u2019ve seen.\u00a0 However, from a conventional perspective you don\u2019t fit the physical profile and most of your labs are well within the reference ranges.\u00a0 Medical docs are trained to look for specific signs and if you don\u2019t fall with those parameters you are healthy.\u00a0 Naturopaths, on the other hand, I\u2019m looking at your temperature readings.\u00a0 Thanks for doing this for me, it is extremely helpful.\u201d\u00a0 Over the last five days, Laura\u2019s results were as follows:<\/p>\n \u201cLaura, optimally, we like to see temperatures between 97.8 and 98.6. Significant decreases are generally indications of an underactive thyroid.3<\/sup>\u00a0 Additionally, your blood chemistry reveals a thyroid imbalance.\u201d\u00a0 Dr. Oreg proceeded to point out the deviations and their significations.<\/p>\n \u201cBoth your fasting glucose and your triglycerides are elevated indicating some blood sugar dysregulation.\u00a0 Taking into account your high LDL cholesterol and low HDL cholesterol, it is suspected that you have a condition called insulin resistance or metabolic syndrome. These signs may also be a consequence of underactive thyroid\u201d<\/p>\n \u201cYou are also borderline anemic with low RBCs, low hemoglobin and low hematocrit.\u00a0 The MCHC we use as a barometer to indicate whether your anemia is as a result of low iron or some of the B vitamins.\u00a0 Being on the high side of the MCHC, you are either B-12 or folic acid deficient or both.\u201d<\/p>\n \u201cLaura, even though your vitamin D is technically within the reference range, it is, in essence extremely low at 24.\u00a0 The designated laboratory ranges are still archaic, as the optimal range is 50-100, with 60 and above as the most desirable.\u201d\u00a0 Deficiencies in vitamin D can be a risk factor for thyroid dysfunction.\u201d5<\/sup><\/p>\n \u201cNow, while your T4 is in a perfect range, T4 is the inactive storage thyroid hormone.\u00a0 It must be converted appropriately to T3.\u00a0 As you can see, your T3 is low so there is some inhibition in the conversion.\u00a0 Most endocrinologists only recognize T4 and surmise that overdosing you with T4 will solve the T3 issue.\u00a0 From my experience, this doesn\u2019t always work, otherwise those patients on T4 medications such as Synthroid and Levoxyl wouldn\u2019t continue to suffer from the typical low thyroid symptoms. In your case, you were smart in refusing the T4 prescription.\u00a0 Additionally, Laura your TSH is within the conventional laboratory range, it is well outside the functional range of .8 to 2.4. From a naturopathic perspective, we would suspect an underactive thyroid, especially when factoring in all of the symptoms that you\u2019re experiencing.\u201d<\/p>\n This was the perfect moment to ask Dr. Oreg one of the puzzling questions she had listed on her notepad. \u201cIf T3 is the active hormone and T4 is considered a prohormone, why doesn\u2019t the thyroid release T3 instead of T4?\u201d<\/p>\n \u201cGreat question, Laura.\u00a0 The answer is for the same reasons that Campbell\u2019s puts its soup in cans instead of steaming soup bowls.\u00a0 It travels better and it is available when its needed.\u201d\u00a0 Laura laughed at the answer, but nodded in acknowledgement.<\/p>\n \u201cFinally, there is a discrepancy between the values of your sodium and potassium.\u00a0 As you can see here your sodium is high in the range while the potassium is low in the range.\u00a0 This is a possible signal of adrenal hyperfunction, which is an over production of cortisol or hypercortisolemia. \u00a0We could also perform a couple of additional tests to confirm this possibility.\u00a0 Chronic hypercortisolemia results in a decrease in T3 and increase the level of the inactive thyroid hormone reverse T3 (rT3). This over production of cortisol down-regulates the production the enzyme which is responsible for the conversion of T4 to T3 (5-deiodinase), which is apt to sustain your symptoms even when the rest of your thyroid panel is within the desired ranges.\u201d<\/p>\n Dr. Oreg continued by itemizing some of the contributing factors that may inhibit the conversion of T4 to T3 thyroid production.<\/p>\n \u201cAnother factor that may have contributed to this problem,\u201d Dr. Oreg muttered, \u201cis the fact that during your college years you spent a considerable amount of time in a chlorinated pool.\u00a0 Chlorine is a member of the same family as iodine (halogens:\u00a0 fluoride, bromine, iodine), a major component of thyroid hormone.\u00a0 Chlorine, however, is lighter and more chemically active than iodine.\u00a0 Chlorine has a greater affinity to bind to atoms than iodine, thus interfering with iodine metabolism in the thyroid by replacing a more weakly bound iodide with a more strongly bound chloride ion.\u00a0 While I believe swimming to be one of the healthiest full body exercises, in your case, swimming may have been an additional catalyst distorting optimal thyroid hormone production.\u201d<\/p>\n Tears were starting to stream from Laura\u2019s eyes.\u00a0 She was blown away by Dr. Oreg\u2019s thoroughness, patience and caring.\u00a0 She was virtually speechless as her intensity rose with every aspect of his analysis.\u00a0 No doctor had ever taken the time to educate her on the various manifestations involved in thyroid health.\u00a0 It was obvious that Laura was purging her emotions from years of frustration, anguish and ignorance about her condition.\u00a0 Her thoughts were racing. \u201cHow could someone who had been so vital, energetic and fit plummet into such a funk at a relatively young age?\u00a0 Could Dr. Oreg\u2019s explanations be a key?\u00a0 Will his recommendations finally bring an end to my suffering?\u201d<\/p>\n Dr. Oreg continued, \u201cnow let\u2019s see, what risk factors could you possibly have that would cause you to be hypercortisolemic?\u00a0 You have an executive-level, stressful job, you are super competitive, you commute into New York City every day, you have a husband and three sons, you have a house and you are a woman (Cortisol\/ACTH ratios were significantly higher in females than in males<\/em>8<\/sup>). \u00a0Outside of that, you have a stress-free life!\u201d<\/p>\n Excessive stress,\u201d explained Dr. Oreg, \u201ccould be indicative as to why you are feeling the way you do, plus it can significantly alter normal physiological expression.\u00a0 What we need to discover are the mechanisms that we need to employ to get you feeling the way a 38- year-old woman should feel.<\/p>\n \u201cFirst I\u2019d like to explore any possible role that food sensitivities may play in this entire realm.\u201d<\/p>\n \u201cFood sensitivity?\u201d queried Laura.<\/p>\n \u201cFood sensitivities are delayed reactions, or IGG immune reactions, to particular foods.\u00a0 Contrary to an allergy which may produce an immediate reaction, a sensitivity may take two or three days to manifest.\u00a0 It\u2019s usually a food, food group or food additive which is often abundantly consumed.\u00a0 I\u2019d recommend an IGG food sensitivity test which requires a blood draw.\u00a0 Your blood is sent to a dedicated immunological laboratory that will test the presence of IGG antibodies in the response to an exposure to about 100 food allergens.\u00a0 The premise is that high circulating IGG antibodies are associated with food intolerances which may cause or exacerbate disequilibrium.<\/p>\n Meanwhile, we can do some testing in the office for suspected sensitivities.\u201d \u00a0Dr. Oreg explained the concept of muscle response testing and how each element has a unique vibration.\u00a0 \u201cWhen these elements are in disharmony with our own vibrations, that substance will affect the body\u2019s energetics, causing you to be unable to resist my gentle downward pressure.\u00a0 Those foods that manifest a weak response are those that are considered probable sensitivities.\u201d<\/p>\n After in-office testing, Dr. Oreg advised Laura that it is likely that she may be sensitive to gluten containing foods.\u00a0 This list includes:\u00a0 barley, rye, wheat and, to a lesser extent, oats.\u00a0 Dr. Oreg explained, \u201cthere is actually a great deal\u00a0of research to demonstrate a connection\u00a0between gluten intolerance\u00a0and abnormal thyroid function.9<\/sup>\u00a0This means that individuals with a history of symptoms of poor thyroid function should\u00a0automatically be considered as candidates for gluten elimination.\u201d<\/p>\n How come none of those doctors I\u2019d been to recommended gluten elimination?<\/p>\n \u201cLet me ask you this, have you ever had an electrician do any work in your house.\u201d<\/p>\n \u201cOf course,\u201d Laura responded.<\/p>\n \u201cDid you ever ask him, before you leave could you check my toilet?\u201d<\/p>\n \u201cOf course not,\u201d Laura emphatically replied.<\/p>\n \u201cWhy?\u201d<\/p>\n \u201cHe\u2019s an electrician, not a plumber!\u201d<\/p>\n \u201cThat\u2019s the same reason why you aren\u2019t going to get reliable nutritional information from a medical doctor,\u201d Dr. Oreg affirmed.<\/p>\n \u201cBecause he isn\u2019t a plumber?\u201d Laura sarcastically retorted.<\/p>\n Dr. Oreg asked permission to clip a bit of hair from the nape of her neck for the purpose of ascertaining mineral balance and exposure to toxic metals.\u00a0 Being that hair dye and chemical hair treatments can distort the results, Dr. Oreg asked Laura if her hair was dyed.\u00a0 She responded that she hadn\u2019t dyed her hair since college and her lack of gray hair was a positive genetic trait that she received from her mother, whose gray hair didn\u2019t start sprouting until she was in her late 50s.\u00a0 After carefully snipping and weighing the appropriate amount of Laura\u2019s hair, Dr. Oreg proclaimed, \u201cwe\u2019ll get the results in about two weeks.\u201d<\/p>\n Additionally, an antibody test kit, to determine food sensitivities, was handed to Laura with instructions to visit Dr. Victor Steinberg, a colleague of Dr. Oreg\u2019s.\u00a0 It was arranged that the phlebotomist in Dr. Steinberg\u2019s office was waiting for Laura and would deposit the samples and ship them overnight to a functional laboratory in North Carolina.\u00a0 Dr. Oreg explained, \u201cwhile I suspect gluten is most likely an issue, it is only an educated guess at this point.\u00a0 A blood test is the gold standard and will not only confirm or deny my suspicion, it will also determine any additional foods that may present an immune reaction.\u201d<\/p>\n Before leaving, Dr. Oreg administered two in-office adrenal function tests, which demonstrated a degree of adrenal stress.\u00a0 \u201cWe could suggest a circadian cortisol test, but it would probably just confirm my assumption.\u201d\u00a0 Dr. Oreg recommended a custom herbal adaptogen formula containing ashwagandha, eleuthero, schisandra, holy basil and fresh oat.\u00a0 \u201cAdaptogens,\u201d Dr. Oreg explained, \u201care incredible natural compounds that help the body adapt to stress and support normal metabolic functions.\u00a0 The intention was to modulate her overt reactions and up-regulate her resistance to physical, biological, emotional and environmental stressors.\u201d \u00a0While not an adaptogen, fresh oat, a tonic for the nervous system, had been added to the formula to balance Laura\u2019s mood, calm her shattered nerves and restore a sense of peace and tranquility.10 <\/sup><\/p>\n Laura left with a low glycemic diet plan, gluten-free guidelines, a custom herbal formula, a multi-mineral supplement, an iodine supplement from Standard Process, a container of green superfood, a recommendation to eat two Brazil nuts per day, orders to triple her omega-3 consumption, an appointment card to return in two weeks, a little less hair and high expectations for remediation.\u00a0 By the time of Laura\u2019s follow-up appointment, Dr. Oreg would have the results of the food sensitivity test and her hair mineral analysis.<\/p>\n Laura exuberantly left Dr. Oreg\u2019s office and immediately dialed Irv\u2019s office.\u00a0 \u201cIrv, I\u2019m on my way home and I\u2019m really excited, finally a doctor who listens to me and believes that I can get well.\u201d<\/p>\n \u201cYou just left?\u201d exclaimed Irv.<\/p>\n \u201cHe spent nearly two hours with me and I\u2019m confident that his suggestions are going to catapult me back into feeling the way I expect to feel.\u00a0 I can\u2019t wait for you to get home so I can tell you all about my session with him.\u00a0 By the way, Irv, I hope you\u2019re energized because you and I have to go shopping.\u00a0 I have a prescription grocery list.\u201d<\/p>\n The results of the hair mineral analysis arrived within two weeks after Laura\u2019s initial appointment.\u00a0 \u201cLaura, this is Kathleen in Dr. Oreg\u2019s office, I want to let you know that we\u2019ve received your test results.\u201d\u00a0 Kathleen set up an appointment for Laura the following Wednesday at 9:30 a.m.<\/p>\n Laura precisely followed Dr. Oreg\u2019s orders and within the first week had a sense of vitality, vigor and enthusiasm that had escaped her for years.\u00a0 She had lost six pounds that first week and four the next.\u00a0 Laura\u2019s noticed a feeling of inner cleanliness.\u00a0 Her breathing was unobstructed, her mind as sharp as when she had attended graduate school at Princeton, her energy had improved significantly and getting out of bed in the morning wasn\u2019t as much of a monumental triumph as it had been over the last couple of years.<\/p>\n The Saturday evening before her appointment with Dr. Oreg, Laura and Irv had dinner plans with there closest friends, Garry and Sheila Betharon who hadn\u2019t seen Laura in a couple months.\u00a0 They were startled at how radiant Laura appeared.\u00a0 \u201cLaura, you look fabulous,\u201d remarked Garry, a respected plastic surgeon.\u00a0 \u201cIf I didn\u2019t know better, I would have sworn that you had some work done.\u201d<\/p>\n Laura smartly replied, \u201cI had actually considered asking you to perform cosmetic surgery on me until I noticed that your office walls were full of portraits by Picasso.\u201d\u00a0 Laura proceeded to explain the horrors she had experienced over the last couple of months culminating with the exciting news about Dr. Oreg. \u00a0\u201cThis is the new and improved Laura Marx,\u201d Laura proudly announced.\u00a0 \u201cI\u2019m on my way back.\u201d<\/p>\n Laura and Sheila had became roommates in their sophomore year at Cornell and have been best friends every since then.\u00a0 Being in regular contact, Sheila was intimately aware of Laura\u2019s health concerns and the frustrations she had experienced with arrogant doctors who shunned her cries for help. \u201cI\u2019m thrilled that you finally found someone who is compassionate and he seems to be very competent.\u201d<\/p>\n On the day of Laura\u2019s follow-up visit, Dr. Oreg had prepared a comprehensive 80-page report which had been personalized for Laura.\u00a0 The report was tabbed with sections on assessment, specific condition information, dietary guidelines, gluten-free recipes, supplement recommendations and references that Laura could perform her own research.<\/p>\n \u201cSo how are you feeling?\u201d inquired Dr. Oreg when Laura entered his office.<\/p>\n \u201cI love you,\u201d remarked Laura.\u00a0 \u201cNot only do I feel phenomenal, but my friends and colleagues at work have noticed a positive change in my demeanor and appearance.\u00a0 My energy has returned, my mind is clearer, my ability to concentrate has returned, I\u2019m less irritable and I haven\u2019t had any anxiety or bad dreams in more than a week.\u00a0 While I\u2019m not 100% yet, the difference is unbelievable.\u00a0 You are a miracle worker. Could it be possible that all this time I\u2019ve been allergic to gluten or is it that custom voodoo herbal formula you created for me?\u201d<\/p>\n Dr. Oreg laughed hysterically at Laura\u2019s wit.\u00a0 \u201cI did caste a spell over the herbs before I gave them to you; that\u2019s my secret weapon.\u00a0 Seriously, however, it\u2019s not you\u2019re allergic to gluten, your diet was so richly laden in wheat, rye and other processed grains that you had developed an over sensitivity to it.\u00a0 For reason that we don\u2019t fully understand, to many people gluten is a source of continued immune system sensitivity.\u00a0 This sensitivity can be relatively mild, whereas subtle \u00a0progressive symptoms may emerge or the sensitivity can be so severe that the symptoms are completely debilitating causing a considerable impairment in the quality of life.\u00a0 Your sensitivity, in my opinion, was somewhere in between.\u00a0 This problem is more widespread than doctors acknowledge.\u00a0 If I did nothing else in my practice than to take patients office gluten, 65 to 70% of my patients would report a significant increase in energy, better concentration, less forgetfulness, better digestion, less congestion and an enhanced mood.\u00a0 You will notice, not only an improvement in your symptoms, but in six more weeks when we check your thyroid labs. \u00a0We\u2019ll detect an improvement in your T4 to T3 conversion.\u201d<\/p>\n \u201cNow, in response to the results of your hair mineral analysis and food sensitivity panel, it is abundantly clear that, in fact, you are gluten sensitive.\u00a0 As you can see from the summary page, the foods are divided into two groups, those foods that were non-reactive and those that were reactive.\u00a0 Those that were reactive are given values from one to four based on the level of reactivity, with four being most reactive.\u00a0 The higher the number, the more antibodies that were generated and we can surmise that they should be limited or avoided completely based on their level.\u00a0 From your test, you can see that wheat, rye and barley are all given a value of three.\u00a0 Additionally, dairy, peanuts, soy and corn are all given a value of two and almonds are given a value of one.\u00a0 I\u2019d recommend complete elimination of all gluten-containing foods for the next six months, limit your dairy to two portions a week and almonds to a small handful every three or four days.\u201d<\/p>\n In reviewing the results of the hair mineral analysis, Dr. Oreg pointed out that Laura was relatively low in magnesium, selenium, potassium, zinc and molybdenum, with slight elevations in copper and cadmium.\u00a0 Additionally, Laura\u2019s level of both calcium and magnesium were significantly higher than her levels of sodium and potassium, substantiating Dr. Oreg\u2019s initial supposition of the adrenals being at least a co-factor.\u00a0 \u201cIn addition to the protocol I\u2019d given you after our first visit, I\u2019m going to add 25 mg of a zinc chelate and 100 mcg of molybdenum.\u00a0 I\u2019m also adding 2,000 iu of vitamin D and a supplement with 1000 mcg of vitamin B-12 and 800 iu of folic acid.<\/p>\n Dr. Oreg explained that copper, an essential mineral supporting iron metabolism may also be problematic when it is out of balance with zinc.\u00a0 This imbalance may be an exacerbating factor in increased anxiety, depression, sleeplessness and joint and muscle pain.\u00a0 Zinc, being an antagonist to copper will, like a see saw, reverse this imbalance.\u00a0 Molybdenum, being an inhibiting factor in copper metabolism, will be an additional adjunct to creating optimum mineral balance.\u00a0 The mineral supplement which has a one-to-one relationship between calcium and magnesium was intended to address the suspected magnesium imbalance, while the adaptogen formula would continue to attenuate her overstressed adrenals, easing her excitation.<\/p>\n Laura was given a comprehensive blood chemistry request by Dr. Oreg.\u00a0 \u201cStay on the prescribed program for the next four months and let\u2019s get another blood chemistry and compare the profiles.\u00a0 Meanwhile, the amelioration of your symptoms is a much better prognosticator of wellness than the laboratory numbers.\u00a0 If you continue to improve, as I suspect you will, your numbers will fall nicely into place.\u201d<\/p>\n Dr. Oreg suggested several biofeedback sessions where he integrates neurolinguistic programming, neurocardiology, heart rate variability and life coaching.\u00a0 The intention is to enable Laura to develop self-efficacy and the ability to transform errant emotional states into a desirable high coherent state.<\/p>\n Laura was elated.\u00a0 For the first time in over two years she was feeling good and had high expectations of progressing to the level she had achieved as an elite athlete.\u00a0 She had a bounce in her step that she had nearly forgotten about.\u00a0 \u201cI feel like screaming that there is hope for those of us with undiagnosed thyroid disorders.\u00a0 Don\u2019t believe your medical doctors when they tell you that nothing\u2019s wrong.\u00a0 There\u2019s an answer and nobody needs to suffer needlessly.\u201d<\/p>\n Laura had her life back and Irv was thrilled that he no longer was going to be jolted from a deep sleep at 4:00 a.m. in the morning.<\/p>\n\n
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