Saturday, November 6, 2010

"Treatment" Update

It's been a while since I spoke about what I'm doing treatment-wise. Really, it's because I haven't been focused on these treatments as a way of restoring my fertility, but rather to restore my health. My ultimate goals would be to attain for the remainder of my life: a) more energy, b) regularity (not the menstrual kind, the other kind), c) good levels of all vitamins, especially D, d) no more tail-end brown bleeding (TEBB) at the ends of my periods, and e) no more post-Peak pasty discharge. Many of these issues have been due in one part or another to my chronic stress. I am working on getting that balanced, and getting healthier. If from improved health I also experience improved fertility, well of course that would be wonderful and I'd be lying if I said that wasn't further motivation for me. However, I am following this new "treatment" regimen in a much more laid-back manner than any of the fertility treatments I've tried in the past. Somehow over the past 4.5 years, I've been blessed with something I never, ever had in my lifetime: patience!

So, here is the consult letter from Dr D (NaPro California, recommended to me by Dr B - NaPro Ireland, at this year's AAFCP meeting), which I received back in August. I figured I would share her suggestions for me with my readers, in case you feel this information could benefit you, as well.

Dear TCIE,

It has been a pleasure talking with you and going over your records. I am in agreement with Dr. Check who believes that your failure to get pregnant thus far is due to PCOS, mild endometriosis, and adhesions. I think you may have been overtreated on medications that are not helpful. Although you have a few immunological labs that are slightly abnormal, it is more likely the PCOS, endometriosis, and adhesions are the source of infertility. For the adhesions, I agree with the approach of Dr. Check to normalize your hormones and have a repeat laparoscopy for adhesions if you do not conceive after a few months. Progesterone can work wonders. I would give yourself longer because if you are improving nutrition and taking supplements, it will take more like six months to a year or more to normalize insulin, cortisol and bowel function. If you have another laparoscopy it should be at a world class center for laparoscopic treatment of endometriosis such as the Nezhats in California or Atlanta, the Duke Center for endometriosis, or possibly the physicians Dr. Check recommended. Another laparotomy could cause more adhesions.

Significant factors affecting your fertility are your adrenal fatigue, low body mass index, and poor intestinal function. In improving your general health, your endometriosis will improve, and by improving your diet and nutritional status your ovarian function should improve.

I would like to focus on several areas:

You are a "thin" PCOS person. Even with a lower weight, you can still experience insensitivity to insulin and fluctuations in blood sugar. These have a direct effect on your ovarian function. Looking back, your fasting blood sugar was 94 in 2007 (before Metformin). This is suboptimal for a young woman. By stabilizing your blood sugar, your progesterone will rise. You are on Metformin now, but at some point might not really need it. At a later time it would be good to see how your ovaries function without it. The hallmark of regulating glucose and insulin is diet. We spoke briefly about a low glycemic diet. TCIE, you MUST eat breakfast every day and have protein for all three meals and adequate fiber. You need to carefully monitor carbohydrates. You need to stop sugar. High quality foods are very healing for PCOS and endometriosis. I am sending a formal referral to K.W. of the Lavalle Metabolic Institute for help with a PCOS diet, and also taking into account your food allergies, constipation, and need for more body fat. K. is a pleasure to work with. If you have cravings for sugars and carbs, these can be addressed through diet and supplements and will helpyou follow a better diet. Also daily mild exercise (walking 20 minutes for example) helps glycemic control. Suggestions for supplements will be below.

2) Adrenal Fatigue
When you have stressed out adrenals, you may experience "cortisol steal" so that your body ceases to make adequate sex steriod hormones in order to produce cortisol. You are now being given Cortef for this in maximal doses for a female. I eblieve it is important to address and correct the underlying causes of adrenal fatigue and get your adrenals working on their own. One possible cause is unstable blood sugar/insulin. As you improve blood sugar control the adrenals will work better. A really good bood about the interaction between blood sugar, insulin, and cortisol is The Schwarzhein Principle by Diana Schqarzhein. Other sources of adrenal fatigue could be intestinal inflammation due to food allergy and possibly yeast. Chronic viral infection can be an issue. I have in mind your shingles outbreak. Of course emotional stress can play a part. It is important also to get adequate sleep, at least 7-8 hours a night and even more than 8 whtn your adrenals are recovering. If you have insomnia you need to correct it. Coffee and sugar exacerbate adrenal fatigue, mild not excessive exercise will help also. Supplements are an important part of an adrenal recovery program. They include adequate pantothenic acid, Vitamin C, adrenal glandular extract, and adaptogens (botanicals) that help regulate your adrenals. When you are on an adrenal recovery program and correct the underlying causes, at some point you should be able to wean off cortisol. You should read Dr. James Wilson's book on Adrenal Fatigue.

3) Low Body Mass Index/? Low Estrogen
Although some women can conceive with a BMI of 20, others need to get their BMI in a range of 21-25. Increased body fat will improve your estrogen status. This may help correct the thin emdometrium in the luteal phase. It is not a quick fix, but after a few months if you have an improved diet and higher weight you could see this type of improvement. You should gain 10 lbs. of fat. In the interim, in some patients I have found a low dose estradiol patch will improve endometrial thickness (Vivelle .025). Sometimes I use this in the luteal phase and some time throughout the entire cycle. It would be helpful to obtain or repeat a day 2-3 FSH, and estradiols in the pre and post-Peak periods (along with progesterone)- off your drugs. You have not hadthis type of workup to check this for a few years, I think.

4) Bowel function
Constipation and bowel movements every three days have multifaceted negative effects. Your liver excretes metabolized hormones and toxins from your own body and from external sources. If you are not have one (or two or three) bowel movements daily these excretory products from the liver are not being removed, but are instead reabsorbed and recirculated. In addition, there is considerable immune lymphoid tissue in the gut. This can malfunction if there is inflammation from yeast, food allergy or other sources. Also, the intensive antibiotic therapy may have produced imbalances that are hard to correct. There is a high probability of yeast and dysbiosis. You stated that several years ago an Ayurvedic practitioner gave you some botanicals that improved liver/excretory function and made your acne go away. We would hope to accomplish the same thing. It is critically important to diagnose and treat yeast as soon as possible.

5) Thyroid
I would suspect yu have have suboptimal thyroid function. Did you say you had low basal body temperatures? Your temperatures at all times should be above 97.8 oral especially in the first three days of the cycle and if they dip below this, it might indicate suboptimal thyroid function. When you have poor adrenal function, you do not convert T4 to T3, and T3 is actually the active thryoid hormone. Your TSH, Free T4 and Reverse T3 appear normal. However, the latest Free T3 off treatment I saw was in 2007. It was 2.8 (2.3-4.2). You want your free T3 to be in the upper 1/3 - above 3.5. If you have low body temperatures, dry skin, constipation, and slow reflexes you may be clinically hypothyroid. I know you have gotten diverse opinions on this and been overtreated at one point. High thyroid does not cause birth defects. If you have a fertility problem, it is better to be a little too high thyroid than too low. You need to start correcting the adrenals before the thyroid. Once you are on adrenal supplements/meds, you can begin supplementing thyroid with a T3 containing product. Armour thyroid is an option, but since you have food allergies and possible mild immune problems sustained release T3 is better. You should get a new set of thyroid labs including TSH, Free T4 and Free T3. If your Free T3 is below 3.5 and you are clinically hypothyroid, get compounded sustained release T3. Get 7.5mcg tabs. Take one 7.5 for 2 weeks, then 2x 7.5 for 2 weeks, then 3 x 7.5. After a month on 22.5 SR T3, get a T3 level in the AM BEFORE taking the T3. Normally you should take the T3 on arising, but not the day of the test. You adjust the dose until it is in the upper thurd of the T3 range. DISREGARD IF YOU DO NOT HAVE HYPOTHYROID SYMPTOMS, YOUR BASAL BODY TEMPERATURE IS NORMAL, AND YOUR FREE T3 IS IN THE UPPER THIRD.

These are my recommendations:

A. More testig.
1. Maybe I didn't see all the tests, but some of yours are out of date. I would consider going off Metformin for 2-4 weeks or longer to get baseline glucose/insulin testing. You have never had a GTT. 25% of women who have PCOS, including thin ones, have an abnormal glucose tolerance. I would get a Hemoglobin A1C off Metformin (althought his takes a long time to reflect being off Metformin). Then do a fasting adn 2 hr 75 gram glucose tolerance and fasting and 2 hr 75 gram insulin at the same time.
2. Repeat day 2-3 FSH, pre-Peak estradiols, and post-Peak estradiol and progesterone on P+5, 7, and 9. We do not have a very good idea of what is going on with your hormones right now. It would help assess your estradiol production.
3. You need a good stool analysis to test for yeast and dysbiosis. It wouldn't hurt to check overall inflammation level, parasites and limited food allergy effect. A good one is the DiagnosTechs complete profile. It is about $200-250. I can order it for you from my office and you can mail the kit back. It includes saliva samples for antibodies.
* I have reached a new low. I will be mailing my POO cross-country. Suddenly the song "I Left My Heart in San Francisco" is playing in my head, with slightly modified lyrics...
4. Consider repeat food allergy testing with Metametrix in the future.
B. Dietary consult with K.W. for PCOS, weight gain, food allergy and constipation. Please fax the latest chemistry labs, CBC, thyroid and your food allergy profile to her at: (provides #). She will send you a questionnaire and then you can make a telephone appointment. We should send her your stool analysis when you do this. Ask her what she thins about the validity of the rice sensitivity elicited by your LEAP (it might not be real).
C. Meds and Supplements:

The meds you have listed are baby aspirin, Lovenox, Metformin, Naltrexone, and Prometrium. I personally do not think there is enough evidence to keep you on Lovenox (or even baby aspirin). With your constipation issue, I would recommend to switching to progesterone vaginal capsules 600 mgs (compouded by Kubat ) P+3-P+12. The Prometrium puts too much burden on your liver, creates metabolites that recirculate and is constipating. I would not be surprised if 600 mgs progesterone vaginal capsules straighten out your bleeding.
*(I would be.)

I think the Naltrexone is good. I recommend going off Metformin temporarily, and see how you do off and on it perhaps for three months at a time. You have said you are going back on Cortef and Biaxin. Why are you going back on Biaxin? I personally would not take any more antibiotics ever unless you have a very clear indication. If the Toth protocol did not clear up brown bleeding, Biaxin is not liekly to. If you go back on Cortef, I would consider lower than a total of 20mgs per day - maybe 7.5 in the AM and 5 at noon. Or consider compounded sustained release cortisol 10 mgs in the AM.

The supplements I have listed for you are Vitamin E, D 4,000, Calcium 1200, Nature's Best probiotic, fish oil, chinese herbs. An oversight of mine is that I did not recognize that you were on Chinese herbs. I am not sure they are compatible with the herbs that I am recommending for you. In addition, I worry about herbs sourced from China or India because they are often contaminated with lead, mercury, and other heavy metals. These can be extremely harmful. I willr ecommend botanicals for you but I am not sure if they are compatible with your chinese herbs. You should not continue both without more expert consultation. I am chagrined you Chinese practitioner is giving you herbs for your "cycle" but has not addressed or fixed your constipation. This to me is a red flag. I would recommend you go off these herbs while you are initiating new ones for your liver and adrenals. If you do not want to do this, get a consultation with one of the doctors at the Lavalle Metabolic Institute who is an expert in hebs. These docs also could help address other problems and be very helpful with supplements, with a greater depth of experience than myself.
* (I ran out of the Chinese herbs over the summer, and haven't taken them since. I only included this part of the letter so that those of you combining acupunture/TCM with other nutritional/holistic/supplemental approaches would be aware that they may not be compatible and could actually work against you.)

Recommended Supplements:
1. Optivite: This is the premier PCOS vitamin. You need a high dose vitamin to include enough Bs. You cannot get enough in one vitamin, and need to take 4-6 a day. Six would be better. 4 in the AM and 2 in the PM (4:00PM or dinner). It also has 1500mgs of C which is good for adrenal fatigue and selenium for the thyroid. 180 pills, 6 per day for 30 days is $18.
2. Adrenal Supplements: You did not give me your blood pressure. There are two possible adrenal supplement programs for you:
a. If your BP is < 120/80
(Mine is) and excellent adrenal supplement is Adren-All from Orthomolecular. Take 2 in the AM and one at noon for now. It includes adrenal glandular extract, Panthothenic acid 350 mgs and a good selection of adaptogenic herbs. You can get this on the internet (amazon).
b. If your BP is >120/80 an alternate program is adrenal CORTEX 250 mg (Allergy Research Group) (not whole adrenal) 2 in the AM and one at noon; Phyto ADR (Pure encapsulations). Take 2 in the AM, one at noon or 4 PM. If you continue to have sugar cravings there are other alternatives.
3. Liver Support
You should take milk thistle 150-300mgs two times daily or LIV52 (Himalaya) two times daily for now. Milk thistle is widely available. LIV you can get on the internet.
4. For constipation you should take fiber 35-45 mgs daily. Learn the fiber content of foods. I would recommend ground flax seed, which you can add to shakes. For constipation AND adrenal fatigue, you should also add Magnesium glycinate, citrate, oxide, or other magnesium 150-200mgs 3 times daily. This will not be excessive even in addition to the Magnesium in Optivite. In addition, another 100 mgs of Vitamin C will help constipation. You could actually go up in 100 increments to higher Vitamin C until constipation disappeared.
5. You almost certainly have yeast and dysbiosis. You will need a yeast treatment program. First you should do a stool analysis. Then you should get a strong probiotic such as KlaireLabs TherBiotic Detox support with 50 billion organisms for a couple months, followed by a good but less potent maintenance probiotic.

TCIE, I wish you the best in your attempts to get pregnant. Please email me for further questions.

Sincerely yours,

Dr. D

Our phone consult lasted almost 2 hours. She has been soooo nice and helpful, and I am so thankful that I found her! Another big plus is that my local NaPro Dr is so awesome, and has been helping me to implement all of these suggestions, as well as lining up all the testing for me. I am currently doing the pre and post-Peak OFF MEDS (off Metformin) bloodwork this cycle, and my NaPro Dr also had me do an ultrasound series, which I did on myself ;) I saw a cumulus oopherus, which is great because on other ultrasound series we haven't always seen one. (The cumulus oopherus is the cloud of cells that you can sometimes see on ultrasound in the dominant follicle. It forms around an egg, and ONLY forms around an egg - so if you see one, it is proof that there is an egg in the follicle, but if you don't see one, it may just be too small to see.)
I briefly came off Naltrexone before reading this letter in its entirety, because Naltrexone was really expensive. However, that was the cycle I had the raging week+ long PMS. So I spoke with a client of mind who actually compounded her OWN Naltrexone, and she told me how to do it. So, my kitchen has now become a compounding pharmacy, and I'm paying $10 for a YEAR'S WORTH of LDN (low dose Naltrexone!) because I get 30 tabs of 50mgs, and one 50 mg tab lasts 2 weeks! I used to pay $45 for one month!!

I am in the process of weaning off the Hydocort/Cortef, to start the Adren-All supplement Dr D recommended. I am down to 2 pills per day, and will likely start the Adren-All when the next cycle starts, so as not to throw off the labwork too much in this cycle.

I ordered the Optivite, and I'm surprised I never knew about this vitamin until now, it being the premier PCOS vitamin and all! I am taking 4 of those and 1 of my Neevo (because I do believe the L-methylfolate in Neevo is crucial for my MTHFR... I cannot process regular folic acid, high doses or otherwise, so the Neevo makes it in the already broken-down form).

I've been taking Magnesium since I spoke to Dr D back in August, as well as improving my diet with more protein and fiber. She had also suggested I stop dairy, which she didn't write in the letter. The combination of all of these things has lead to regularity, which has been AWESOME!

I still take my baby aspirin daily, but no more Lovenox for me. If I ever do get pregnant, I will really have to do some thinking about whether or not to go back on the Lovenox... it's a tough one...

I will be doing the stool analysis this cycle, and am interested in starting that detox program for yeast and dysbiosis. Maybe it will help my post-Peak pasty, too?

I've been using Agave Nectar as a sweetener in my tea and in cooking. I don't generally eat too many sweets, but I do enjoy the ocassional gluten-free/dairy-free brownie. Mmmm... brownies...

Next cycle my local NaPro Dr and I have plans to begin the high-dose compounded vaginal progesterone capsules post-Peak. I seriously doubt it will take care of the brown bleeding, but we'll see.

I have not started the milk thistle yet, I keep forgetting to buy it when I'm at the store. Does anyone else take this?

So, things are moving along in the nutrition/supplement field, but my chart has not yet shown any improvement. In fact, the past 5 or 6 cycles, I have had the WORST mucus I've ever had, throughout the whole Peak-buildup. Gummy and Gluey, every time. It is sometimes lubricative, sometimes crystal clear, sometimes stretchy (mostly tacky, though)... ALWAYS gummy/gluey. It. Sucks. In fact, the last beautiful, perfect 10KLs I've seen were the cycle of my last surgery in June, when I was in Cancun... without DH. Since then it's been MIA.

But interestingly, one of the things we look for with a NaPro follicle study ultrasound is the cervix, and the width of the cervix (if it has fluid in it, indicating it is open with cervical mucus present). And on ultrasound, during the days when I was only seeing gummy/gluey mucus, my cervix was TO DIE FOR. Seriously, if you had seen it, you would have wanted it. I have the best cervix on the block. No joke. It was WIDE open, not just in one section (which I often see when scanning other women), but ALL the way throughout the cervix, with beautiful mucus galore. Now we were taught in ultrasound school that fluid is anechoic (void of echoes) and therefore shows up black on ultrasound. We were also taught that other tissue types, like fat, skin, muscle, bone, have varying degrees of sound attenuation and therefore differing echogenicities... but one thing we never learned is how does sound behave through gummy/gluey cervical mucus?? Becuase it certainly appeared BLACK and anechoic, indicating it was fluid (liquidy mucus, you know, the GOOD kind)... so what the heck is going on? Did I have great mucus IN the cervix that just didn't want to come out, so it sent its retarded gummy/gluey cousin out onto my toilet paper??

And like Eddie Izzard, I like to end my blog posts with that kind of... Hmmph... feeling, so...


My Heart Exults said...

Wow! I am going to have to read this again and take notes. This response is motivating me to make the changes I need to make. I have been avoiding several things lately, like testing my adrenals and avoiding carbs, but I'm wondering if my IF is something I am actively contributing to??? Thanks for posting this entire letter, I know I received something out of it!

Angela said...

Holy crap! Your Dr. D sounds amazing! I can't believe the length of that letter!!! There is SOOO much info! You are definitely getting your money's worth!!

I'd love to talk more about the best cervix on the block ;) but unfortunately I have to go pretend to want to buy stuff at a Pampered Chef party *sigh* Hmmm...does it make it a sad day when you'd rather talk online about fertility fixes rather than go buy kitchen utensils??? ;)

Anyway, I'm so impressed with your doc!

... said...

Shipping poo cross-country? That IS a new one!

So much information here. I was curious if you were told from the beginning of your pcos diagnosis to reduce sugar, do a low GI/carb diet? If so, has there been any improvements? I had improvements with b/w (still not hot) and constipation. (Gosh, we share so much here). I know you have diet restrictions that compound the problem, but I was curious about this.

Sounds so promising.

barbie said...

Very impressed with your Dr on the thyroid stuff! Very.

Kinda disagree with the adrenal stuff, if you read Jefferies there is no harm to taking 20 mg long term. Be sure you dont' wean off the hc too fast, this can cause a crash later.

Dr Wilsons book is very good, extremely helpful in understanding the causes of adrenal fatigue. This was the first adrenal book I read and found it very helpful.

Love all the natural stuff, like the magnesium for instance, a biggie for those is thyroid issues and a great help for constipation. The herbal supplements for adrenals are great as well.

The mailing poo thing.........hmm what can be said about that :} EEK!

And hey can I borrow the problem of NEEDING TO GAIN weight? I might have to go kick you.

Sew said...

I need a pen a paper to get this together...Because dang, I'm not sure where to begin on the treatment...

This is some good stuff! ;)

I would think that the last 5-6 cycles is your body adjusting...You seem sensitive to food, I could be wrong...

E said...

This dr. sounds totally amazing.

I can send you 10 lbs of fat from PA. :)

I am going to look into the optivite.

Thanks for typing this all out!

Amy @ This Cross I Embrace said...

Oh, don't worry, I gained the 10 lbs almost immediately after the consult... I got RIGHT on that... for health reasons, of course...

I agree, Barbie, that there's no harm in being on cortef long-term. To me personally, though, I'd rather not. For two main reasons. A) I don't want to be taking meds by the clock 4 xs day for the rest of my reproductive years... almost like an alarm going off 4 xs a day yelling, "You're childless, and will be forever!" Call it self-preservation. And B) since my grandmother had Addison's Disease, I see how this med is NEEDED for some people, and want to prevent getting to that point myself. We believe my grandmother had an adrenal crisis after the death of my grandfather (when he was only 63). She wasn't diagnosed for quite some time, and they (her kids) thought they were going to have to bury two parents at the time, she was SOOOO sick. I know I have chronic stress, which I want to try to correct before I get to the point of needing Cortef the rest of my life. My labs were never that bad, it was mostly my symptoms (fatigue, etc), which seem to be improving.

Thanks for the comments, everyone.

God Alone Suffices said...

Wow this is SO fascinating! Thank you for posting it!

I have a BMI of 18, so I DEFINITELY need to be gaining. I'm trying, but I have such a hard time gaining weight by eating healthily. I also know I'm supposed to be exercising, but I'm afraid to lose weight so I don't. Do you have any advice there? I also would love to talk to you sometime about my crazy fertility issues!

Amy @ This Cross I Embrace said...

GAS, (hahahaaha, you have a funny blog title acronym!!! and yes, I'm 5),

Yes, my secret is... I don't exercise. No matter how many times I've been told I have to... I can't seem to motivate myself.
It was easy, therefore, to gain the weight once I started forcing myself to eat more frequently throughout the day (for my blood sugars). I had been eating just a small quick lunch and one big dinner. Now I have lots of small meals and snacks all day long.

I suspect when (yes, WHEN) I start exercising, this won't change too much, because a lot of the fat I've gained will turn to muscle, and muscle weighs more than fat. And I'm only talking moderate/mild exercise, not "working out" by any means.

God Alone Suffices said...

lol TCIE, I know I have a funny acronym. Unfortunately, I didn't realize for awhile. :)

I eat a small breakfast, a small lunch, and a big breakfast with snacks every once and awhile. I'll have to start taking your advice! And does walking count as exercise? Because that's about all I'll be motivated to do. :D

Awaiting a Child of God:) said...

Ummm this is definitely going to be printed out by me. Tomorrow. I need to reread and highlight some things...esp bc I now know I have endo and pcos. Thank u so much for posting this. I'm so happy that u found this Dr. I can already hear a bit a few more steps in ur stride:) I'm not done....u will be hearing from me again about all this....hope I don't bother!!

barbie said...

TICE, I get that! If you can manage with out it, more power to ya! I think you'll like Wilsons book for sure, he goes into stressers and how to help those things and in my opinion, his supplements are the best otc adrenal supplements out there.

A Martha trying to be Mary said...

As others I will print this.

Thank you for being so generous and sharing all of this newfound knowledge. You are amazing TCIE!

All sounds amazing!!

Optivite is the main vitamin promoted in the book: Fertility, cycles and nutrition. People swear by it to relieve PMS and have a healthier cycle. Some friends of mine use it with a lot of success. I finished what I was taking a while back and have not been able to buy more, yet my CM improved a lot on it. I think due to the B6.

Milk thistle. I took it for a while after I had taken a lot of antibiotics. Its a very famous liver cleanser. Since I was doing other things to detox I am not sure which of the them worked but I felt a lot better afterwards. Will continue to pray for you TCIE!!!

Meg @ True, Good and Beautiful said...

I am impressed you typed this all out for us. It is very interesting! This doc seems awesome. :)

Good luck!

(and the part about mailing your poo cracked me up!)

doctorgianna said...

Great information. It's nice to see what other doctors deem important. Sometimes if things aren't working, you have to take it from another angle and get fresh ideas.

I'd like to know 2 do you measure out 4.5mg of a 50mg Naltrexone pill? Do you mix the 4.5mg with any filler? Do you put it in a liquid? My next question do you do a transvaginal scan on yourself that is detailed enough to see a cumulus oophorus?!?!?!

Sew said...

Dr. G. I think you are saying TCIE has mad wanding skills! hahahaha

Amy @ This Cross I Embrace said...

Dr G,

-Yes, I pour out 50mLs of distilled water, then drop a 50 mg tab into it and let it dissolve completely. Then I stir it really well, and using an eye-dropper measurer, measure out 4.5mLs.

-As for the wanding... let me tell you it's a bit tricky. Especially when your "stuff" is anterior ;) Luckily I have long arms... and a long wand.

Christina @ Faith for Fertility said...

I found this interesting: "Your temperatures at all times should be above 97.8 oral especially in the first three days of the cycle and if they dip below this, it might indicate suboptimal thyroid function."

When I was charting my BBT my pre-o temps were always 97.6.

Thank you so much for sharing! Your doctor is amazing! What city is the one in California?

Hebrews 11:1 said...

TCIE you crack me up!!! I always love your posts.

This sounds promising!! I have great hope for you!! I can't wait for more updates. How are things going with the house?

Sew said...

I'm sending you an arangatang TCIE! hahahaha

Dissolve it in water...OH SHOOT ME!

Anonymous said...

Wow, your doctor sounds thorough. That is completely awesome!

I'll say, I've had sub-optimal temps for EVER (not that I've been temping since June) and I've done all the thyroid tests, adrenal tests, iodine load tests, etc. Apparently my thyroid works great (damnit) and I think the current theory is tied to circulation/metabolic/immune function. Gonna have to ask the dr. about that one again, because I can't remember.
Anyway, I love how detailed your doctor is getting and how very understanding she seems to be of your body and your health and I like her plan for you!
Oh, and I used to take milk thistle once upon a time (not consistently though) to improve my liver function I think. Every once in a while I buy the Traditional Medicinals tea also, which is pretty good.

the misfit said...

This is the most amazingly comprehensive analysis of anything medical ever. It makes House's team look like a bunch of fairly lethargic faith-healers. Since I bet Vitamin Shoppe sells it (and because I, too, have Amazon), I am going to get some of that there adrenal support stuff, on the theory that low adrenals impede T4 --> T3 conversion...and I didn't experience any improvement on synthroid, only on natural thyroid...and though I am now much improved, I am still not exactly energetic (or as much as I used to be)...and since the need for natural thyroid indicates low adrenal function, adrenal support will fix me up. My theories always make such perfect sense! In any case, thank you, so so much, for sharing this letter of extreme brilliance so that those of us who are apathetic about seeking treatment can benefit from your amazing enterprising-ness.

Also, prayers and good wishes for amazing improvements to your health (and fertility) as a result of getting to the bottom of all of these things!

[email protected] said...

You know what? Even for me, this was fascinating!!!!!!

Kaitlin @ More Like Mary said...

You amaze me at your ability to keep all this straight!!

Sunshine said...

This is SO helpful!

I never heard about that PCOS supplement- already told a friend!

This is definitely one of the most helpful posts I have ever read.

THANKS TCIE for sharing it with us!

JellyBelly said...

Holy moly that us one thorough doctor you have!!! It took me a few tries to get through all of the info!

I feel the same way about my treatment at this point. Healthy is more important, increased fertility is great, but I want to be able to live in my body!

Stool samples are never fun, I can't imagine having to send it across country! Thanks for that visual! ;)

mrsblondies said...

I'm so glad that Dr. D has a great plan for you. Thanks for sharing the info with us. Good luck!

Little JoAnn said...

Oh my God a doctor that knows EXACTLY what she is talking about. It took me having 50 doctors to come up with this (very very similar treatment)!!!

I agree with 99% of everything...and the liver stuff is huge. She is RIGHT about the fasting glucose level and the insulin stuff TOTALLY smack dab ON!!!

The lovenox will help with implantation and maintaining good blood flow and not having any placenta issues! So, don't rule it out!!!!

Yep....yep, and she is right about the yeast stuff/inflammation stuff!!!

And, the thyroid and adrenal and EVERYTHING!!!!

And, excersing and VAGINAL progesterone I ABSOLUTElY agree that VAGINAL P is a MUST...

I took 2 kinds Crinone and compounded by a pharmacy.

And, she is totally right about the timeline and the B vitamins and supplements too!

Kerry said...

wow. this is a pretty amazing wealth if information! (enough to self diagnose and prescribe)

and, as I'm trying to sleuth and find out WHO your Dr. D in CA is...
b/c if it's the Dr. D near SF that I saw--- then you are getting way more attention as a distance patient than I got in person.
Praying for your new treatment regimen--and have fun popping the optivite. your pee will be flourecent. Fun!

Anonymous said...

this is super dense, so thanks for sharing. i'm starring it and marking it for later (at least in my head). i used optivite before we were married to help with cramps and it seemed to do the trick. at least psychologically.
my Creighton instructor came back after the last conference talking about a Dr. D and how I should take magnesium, fish oil and D3 so, I am. I wonder if it was the same Dr.?
Oh yes, and I saw your comment on misfits about our sisters commonality and all I could think of to respond was, "Well, isn't that great for our sisters!!" If only it meant something more!

wow, my word verification is "hater". ouch.

The Comeaus said...

THANK YOU for posting this. I actually printed it because I need to apply a lot of this to my own life.

If I may be so bold, I just wanted to say (to you and anybody else who suffers with the problem of being underweight) that I, too, have a BMI of 18 and I know how hard it is to motivate oneself to eat more (even a little more!) and exercise, but exercising made all the difference for me because it gave me an appetite!

Within my first few weeks of eating just a few hundred extra calories a day (it sounds awful, but it just means adding a little more of this and that and having healthy snacks) and mild exercise, I gained 10 pounds and felt and looked great. But then we had to move 1,000 miles away and it devastated me, not to mention destroyed my health regimen, and I can tell you that the lack of even mild exercise really ruined me for a couple of months.

I'm mostly talking about exercises that help you build muscle mass, not aerobic exercises. I do lunges, push-ups (on my knees--I have a bad wrist), sit-ups, jumping jacks and exercises with the little figure-of-eight thingy (haha) that you can get at Walmart for $6. I can't even *believe* the difference that 15 minutes of this every day can make. I run in place for a few minutes, too.

So, I just wanted to encourage you a bit about exercising, because it seems really awful before you do it, but then it just becomes part of the day. It takes an act of the will to get me started, but then I'm so glad I did it. My mood is so, so much better when I exercise.

And the key to not losing weight is to eat a couple hundred calories right after exercising to replenish whatever you have worked off, and focusing on building muscle mass, rather than doing anything heavy.

Sorry, my comments are so wordy. I just really care and I hope this might encourage you a bit! (And I hope you saw my apology in one of the last comments...the post about "nothing much".)


The Comeaus said...

Oh, to clarify...I said the key to not losing weight while exercising is to "eat a couple hundred calories" later. That might sound funny. The thing is, I still nurse our 2-year-old son so I have to eat more calories than normal anyway (which I stopped doing when he started eating solids, unfortunately), but of course it's different for every woman, depending on her circumstances!

Rebecca said...

Just reading this is overwhelming to me, I cannot imagine living it. You have my admiration and my prayers.

polkadot said...

So I am really late with this comment... Dr. D is amazingly thorough. Wow. Sounds like you are in great hands. Your comment about poor quality mucus struck me, and I wondered how long you had been taking all that vitamin C. (obviously there are other things that can affect mucus...) I understand vitamin C is beneficial for adrenal fatigue but you know what high amounts of it can do to mucus. If you calculate how much vitamin C Dr. D is recommending here, it's more than what's in the book II protocol. Just food for thought... I suppose there has to be some kind of balance...or maybe Dr. D will recommend something else to help improve your mucus if the vitamin C is that important? Maybe by the time you read this, you already solved this... (hopefully!!)

I checked out the Schwarzbein book from the library earlier this year. It's a fascinating read! (I even read the older edition, which is still informative, though a bit out of date at times--just minor stuff though.)