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Re: Thyroid Hormone Urine Test

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Hi Ann

I cannot tell you if your daughter is hypothyroid but I can tell you

what it is like from a child hypothyroid's view.

I was a bit like a robot just did as I was told never argued about

anything just went through the motions. Appeared very quiet, shy,

timid never said boo to a goose. Physically could not do PE or games

although I always tried. Mentally dull although always looked to be

trying hard but when it came to testing always failed. Very young

and small for age, pale, cold, lacking personality.

Chris

>

> Hello All,

> I have just had the result of a urine test that my daughter (14

yrs)

> took recently. T3 and T3T4 ratio levels are well within normal

> range. T4 level is within normal range but on the low side. It

was

> 649, ref. range 550-3160. Does this mean she has a problem? Dr.

P.

> suggests adrenal support. I have always suspected she was 'low'

with

> regards to T4 from being born! When she was 7 days old she was

> called back to the hospital where I had her for a blood test which

I

> was told was to check her thyroid levels. This was unusual

because

> my other two children (boy and girl) definately did not have this

> test. I now think that the reason she was called back was because

> the Guthrie test that all babies have suggested a low level of

> hormone initially. I suspect that she has had a low level of T4

all

> her life. I had her tested when she was about 6 yrs old and the

test

> came back within normal range. I did not know then about asking

for

> the numeric results and the range. If my daughter has been low

since

> birth, could this be the reason that she has learning

difficulties?

> This is a really big issue for me, if she could have been treated

> with a small dose of T4 from birth could her learning difficulties

> have been prevented? I don't understand the ins and outs of low

> levels in children - but I know that low levels of T4 can lead to

> behaviour problems, depression and so on. I almost feel as if my

> daughters life has been blighted for want of a cheap drug. Can

> anyone advise? I feel so sorry for her. I should have done

more!

> The alarm bells where ringing when she was only one week old and I

> have done nothing about it. I have failed her. I feel that

adrenal

> support is too little too late. I have been on adrenal support

(NAX)

> since April this year and, to be honest, have not felt any better

(I

> have been diagnosed as underactive for more than 20 years). Would

my

> daughter benefit from a small dose of T4 just to boost her levels

to

> a level which falls more comfortably within range?

> I am so grateful that I have the support of this forum and I await

> your replies.

> Love to you all

> Ann

>

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>

> Hi Ann

>

> I cannot tell you if your daughter is hypothyroid but I can tell

you

> what it is like from a child hypothyroid's view.

>

> I was a bit like a robot just did as I was told never argued about

> anything just went through the motions. Appeared very quiet, shy,

> timid never said boo to a goose. Physically could not do PE or

games

> although I always tried. Mentally dull although always looked to

be

> trying hard but when it came to testing always failed. Very young

> and small for age, pale, cold, lacking personality.

>

> Chris

Hello

Sounds just like my daughter.

My daughter hates PE - she was told by an Educational Psychologist

when she was about 10yrs that she had autistic tendencies, dyspraxic

tendencies and dyslexic tendencies. When she gets home from school

she is so exhausted by her efforts that she goes straight to sleep

for a couple of hours. She became aware of her shortcomings at

primary school and could not understand why she could only produce a

couple of lines of writing whilst her peers seemed to produce page

upon page of writing with less effort.

Are you on replacement therapy and if so, how long?

Thanks for your comments

Much appreciated

Ann

>

[Edit Abbrev Mod]

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PREVIOUS MESSAGE EDITED TO REDUCE LENGHT- JENNY

Hi Ann

Yes I will be in my 40th year of taking it next year.

Chris

> Hello

> Sounds just like my daughter.

> My daughter hates PE

> Are you on replacement therapy and if so, how long?

> Thanks for your comments

> Much appreciated

> Ann

> >

>

> [Edit Abbrev Mod]

>

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T4 level is within normal range but on the low side. It was

> 649, ref. range 550-3160. Does this mean she has a problem? .....

It may do, however it is necessary to make sure the adrenals are

supported first. Are you monitoring temperatures and plotting them as

per Dr Rind's charts? Then you'll see what effect your treatments are

having:

http://www.drrind.com/tempgraph.asp

> This is a really big issue for me, if she could have been treated

> with a small dose of T4 from birth could her learning difficulties

> have been prevented? ........

Like you, I always suspected there was something wrong with my

children's health, but couldn't discover what it was, and it does seem

as though their lives have been blighted. However, there's no point

in blaming yourself, or crying over spilt milk. I expect you did

everything you could in the light of what you knew at the time. How

old is she now? My sons are 25 and 27, but I hope to get them sorted

out before they are much older! :-)

> I feel that adrenal support is too little too late. .......

It is best to start off gently and add more treatments as necessary

(no need to use a sledgehammer to crack a nut). Also it can take time

to build up dosages even when you are certain what you need.

> I have been on adrenal support (NAX) since April this year and, to

be honest, have not felt any better ........

It didn't appear to do anything for me either. I have been taking

cortisol for 11 weeks and so far that hasn't appeared to do much

either. That doesn't mean these things are useless, just that they

are not the whole solution. It can be complicated and you need all

the pieces of the jigsaw puzzle.

Best wishes,

Miriam

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>

> Hello Ann - your daughters T4 is very low - to be normal when not

on any

> treatment, >

> Hi Sheila,

Thank you so much for replying

Urine test gives results for T3, T4 & T3T4 ratio

Amy's results as follows: T3 = 1440 (800-2500)

T4 = 649 (550-3160)

T3T4 ratio = 2.22 (0.5-2.3) is this result O.K. or on the high side?

Do you think I should take her to the G.P. with these results? Does

she need to take thyroxine? Arguably, the T4 result is low but not

UNDER the range. Will this test result have any gravitas? I think

that the G.P. will refuse to treat her on the basis of this test

result and insist on a blood test. Recently (Sept. 08) he refused to

consider a blood test for her as he said that she was too young to be

suffering from an underactive thyroid. Can I insist on her seeing an

endo? If so, can I choose which one she sees? The last one I saw

laughed in my face and said I should see a psychiatrist. I would not

think that I would be able to prove that my daughter's learning

difficulties are due to a thyroid problem. If I had only known then

(when she was born) what I know now I could have done something to

prevent this awful situation. I am so upset about this that I feel I

can't live with myself knowing that I could have made her well and

she would not have gone through her formative years with such

a 'handicap'. I have not slept at all since I got the results. Even

now I keep bursting into tears. That blood test she had done when

she was a week old should have told me to dig deeper, but I was

satisfied when the results came back as 'normal'. Where do I turn?

Ann x

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Hi Ann

Please try not to beat yourself up, no-one can predict

hypothyroidism in children and it is nothing you have done. There

was no family history when I had it, we'd never heard of it.

As your daughter is under 16, your GP, if you express your concerns

may refer her to a Pediatric Endocrinologist which I think they now

have in most hospitals, they certainly do at our local one and I

think pediatric ranges may be different from adults anyway.

Chris

> >

> > Hello Ann - your daughters T4 is very low - to be normal when

not

> on any

> > treatment, >

> > Hi Sheila,

> Thank you so much for replying

> Urine test gives results for T3, T4 & T3T4 ratio

> Amy's results as follows: T3 = 1440 (800-2500)

> T4 = 649 (550-3160)

> T3T4 ratio = 2.22 (0.5-2.3) is this result O.K. or on the high

side?

> Do you think I should take her to the G.P. with these results?

Does

> she need to take thyroxine? Arguably, the T4 result is low but not

> UNDER the range. Will this test result have any gravitas? I

think

> that the G.P. will refuse to treat her on the basis of this test

> result and insist on a blood test. Recently (Sept. 08) he refused

to

> consider a blood test for her as he said that she was too young to

be

> suffering from an underactive thyroid. Can I insist on her seeing

an

> endo? If so, can I choose which one she sees? The last one I saw

> laughed in my face and said I should see a psychiatrist. I would

not

> think that I would be able to prove that my daughter's learning

> difficulties are due to a thyroid problem. If I had only known

then

> (when she was born) what I know now I could have done something to

> prevent this awful situation. I am so upset about this that I

feel I

> can't live with myself knowing that I could have made her well and

> she would not have gone through her formative years with such

> a 'handicap'. I have not slept at all since I got the results.

Even

> now I keep bursting into tears. That blood test she had done when

> she was a week old should have told me to dig deeper, but I was

> satisfied when the results came back as 'normal'. Where do I turn?

> Ann x

>

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--- I have been taking

> cortisol for 11 weeks > Best wishes,

Hello Miriam

Thank you for your reply. My daughter is 14. I have just had the

most awful couple of weeks whilst she has been sitting exams. We

have both cried and cried in frustration at her lack of

understanding. I am a primary school teacher and even my experience

and support has not seemed to help things sink in. She has a very

poor memory. She is also unusually quiet and will not talk to anyone

apart from family. My other two children (girl 12, boy 16) do not

have any problems.

Dr P. suggested that I take Cortef to support my adrenals but I am so

frightened of the side effects I don't know if I dare even try them.

I also don't want to use my credit card over the internet to pay for

it - my husband says that it's not safe and we'll get ripped off! I

asked my GP for some HC but he refused point blank. Like you, I

probably wouldn't notice any improvement. But, when I went on T3 I

noticed some small improvements initially which then wore off! The

uphill struggle goes on ...

Warmest regards

Ann X

>

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I too took NAX for a while and it didnt appear to make any difference to me either, I now take HC and have done since the end of August and that too doesnt appear to do much but maybe it is and I just dont notice, it has stabalised my average daily temps though and they were all over the place when I started graphing. HC will not work alone, you have to be on the right dose of thyroid replacement for everything to start working and I am not yet

T4 level is within normal range but on the low side. It was > 649, ref. range 550-3160. Does this mean she has a problem? .....It may do, however it is necessary to make sure the adrenals aresupported first. Are you monitoring temperatures and plotting them asper Dr Rind's charts? Best wishes,Miriam

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Hi Ann

How does Amy look facially?

Is she having normal puberty or has she not going through it yet or

has she already gone through it?

Is she of average height and weight compared with her peers?

What is her shoe size?

She hates games at school, but is she capable of doing it?

Does she have to wear more layers than the other kids, are her hands

and feet always colder than the others?

What is her blood pressure?

Chris

>

> --- I have been taking

> > cortisol for 11 weeks > Best wishes,

> Hello Miriam

> Thank you for your reply. My daughter is 14. I have just had the

> most awful couple of weeks whilst she has been sitting exams. We

> have both cried and cried in frustration at her lack of

> understanding. I am a primary school teacher and even my

experience

> and support has not seemed to help things sink in. She has a very

> poor memory. She is also unusually quiet and will not talk to

anyone

> apart from family. My other two children (girl 12, boy 16) do not

> have any problems.

> Ann X

> >

>

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Hi ann

Have you had an adrenal profile done? I would advice you do that before you start HC. That way you will know what state your adrenals are in.

I have took HC since the end of August, I take 25mg a day and can honestly say I have had no side effect from it, I too was scared of taking it, but thats because of the bad press that sort of thing gets. I keep telling myself I am replacing what my body doesnt make and am taking a safe physicolical (sp?) does, although a lot of docs will disagree. I see it as resting my adrenals while I sort my thyroid out and it doesnt mean we will be on it for life, read what Dr P has to say on this in the files and other doctors too. I know its hard when people mention the word steroid, it scares many, but in the past people were given massive doses of the stuff and of course they had nasty side effects that docs are wary of it now, we are not talking about big doses here, far from it, ordering off the net is safe and you wont get ripped off if you order from a good site! Tell your husband!

--- I have been taking> cortisol for 11 weeks > Best wishes,Hello MiriamThank you for your reply. My daughter is 14. I have just had the most awful couple of weeks whilst she has been sitting exams. We have both cried and cried in frustration at her lack of understanding. Warmest regardsAnn X>

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--- > Hello

> How does Amy look facially?

She has a large, round, pale-white face. She has been

called 'Moonface' at school.

>

> Is she having normal puberty or has she not going through it yet or

> has she already gone through it?

She started her periods at 11 (very heavy) and is now suffering from

bad acne. G.P. recently prescribed long term antibiotic as she has

some scarring.

>

> Is she of average height and weight compared with her peers?

Average height and overweight. (5'4 " - 11 stone)

>

> What is her shoe size?

Size four. She has long big toe and four tiny, tiny toes.

>

> She hates games at school, but is she capable of doing it?

She has a very clumsy gait when trying to run.

>

> Does she have to wear more layers than the other kids, are her

hands

> and feet always colder than the others?

Yes to that one.

>

> What is her blood pressure?

Dr P measured this when we saw him. Normal - but drops when standing

up.

>

Ann X

>

>

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> Hello Sheila,

> Did you get any responses to the long letter you wrote to those

various

> people?

> No. Fobbed off just like you said.

Been passed on to other departments from PM and the Queen. Still

waiting to hear. PALS said they can't help because they are not

medically qualified! MP said he will respond later. PCT want some

more information from me (that they probably know I don't have). Brick

wall - banging head. I'm not the type to cause a fuss - but when it

comes to Amy - I want some answers and treatment. I will see what

happens when I take her to GP next week. God why is everything so hard?

Ann

X

> >

>

>

> >

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--- > Hello ,

Had adrenal tests. The results were so low they barely registered.

Have most symptoms of adrenal insufficiency. Biggest one being that I

totally overreact to situations - even minor ones. I try to tell

myself not to react to potential events but even when I can stop myself

from reacting vocally (shouting, screaming etc.) my physical (bodily)

reaction often is extreme (shaking, rash on neck, vomitting). Lying

awake for up to five hours during the night is also frustrating. I

must get around to getting hold of some Cortef (as advised by Dr P.).

Where do you get yours from?

Ann

X

>

>

>

>

>

>

> >

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Ann

Your symptoms as described below are very like mine before I started

taking HC just a month ago. I have a very difficult family situation

at the moment and exposure to it causes me to totally crash. Shaking,

nausea, feeling close to collapse... its horrible.

Haivng read all the info from DrP and others, I started self treating

with HC. If you read up on all the side effects of too much HC, then

you can watch out for those when you start taking it. That way you

know what to expect and have the peace of mind that you are in control.

Since starting HC, I'm less liable to let the family thing overwhelm

me. Lord knows there's nothing I can do to change it! Its still

stressful, but I'm more able to cope with it. Dont get me wrong, I'm

not fixed by any stretch of the imagination, but I feel that I'm on

the right road.

You have on-going stress with your worries about your daughter, and in

order to deal with that, you really need to give your adrenals the

treatment they require.

If you are to stand any chance of helping yourself and your daughter

back to health, you should give Dr Ps recommendation a go.

BTW, as regards credit cards and internet trading. Firstly, the

chances of it happening are very slim. Cortef is available here;

http://www.internationalpharmacy.com/en/products/search/cortef/1

And secondly, in the UK, if your card is used fraudulently, as long as

you still have the card in your possession and you have been careful

not to leave it lying around etc, you are not liable for any

fraudulent trading. As far as I'm aware thats the law in the UK, but

please check that out if you want further confirmation. Certainly

its true for our credit card.

My heart goes out to you and I hope you get the help you need. I cant

help thinking you have taken that first important step.

Marie xx

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Hi Ann

I have written what I was like at the same age as Amy underneath your answers for your comparison.

>> --- > Hello > > > How does Amy look facially? > She has a large, round, pale-white face. She has been > called 'Moonface' at school.

Pale, totally expressionless face.

> > > > Is she having normal puberty or has she not going through it yet or > > has she already gone through it? > She started her periods at 11 (very heavy) and is now suffering from > bad acne. G.P. recently prescribed long term antibiotic as she has > some scarring.

From what I have read most girls with hypothyroidism have very early puberty as young as 8, I didnt of course, my treatment seemed to have been pushed to encourage breast buds, periods started at 16, excruciating pain, put on pill to stop pain and regulate. Probably because of being pre-pubertal acne never arose. Boys tend to get delayed puberty.> > > > Is she of average height and weight compared with her peers?> Average height and overweight. (5'4" - 11 stone)

4'4" - 4 1/2 stone - puffy - knicknamed half pint at school

> > What is her shoe size?> Size four. She has long big toe and four tiny, tiny toes.

Child size 13

> > > > She hates games at school, but is she capable of doing it?> She has a very clumsy gait when trying to run.

Used to spend all my time dodging the hockey sticks for fear of being clobbered. Ann has Amy been tested for diabetes?

> > > > Does she have to wear more layers than the other kids, are her > hands > > and feet always colder than the others?> Yes to that one.

Me too.

> > > > What is her blood pressure?> Dr P measured this when we saw him. Normal - but drops when standing > up.

Very low, pulse rose to 44 after treatment started.

> > > Ann X> >

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You

can download an order form from www.internationalpharmacy.com

and send for your cortisol with a money gram or money order so you don't have

to use your credit card. S0 - that sorry is out of the way Ann. Remember

also that ANY hormone you are not making naturally must be replaced in the same

way as your thyroid hormone. There is nothing that will substitute and the dose

Dr P is recommending is a physiological dose and would cause you no harm - only

good. Until you get your adrenals healthy and producing their own cortisol

again, no amount of thyroid hormone is going to work for you. You need to be

brave on this one, but there are lots of our members who will be able to tell

you the benefits they have had since treating their adrenals properly with HC. When

you are talking about the " side effects " of using HC, you are talking

about the side effects that come from very large doses in the same way as we

talk about the side effects that would come from taking very large doses of

thyroid hormone. You take ONLY the amount of HC your adrenals are not making.

's

response is not a usual response to HC, she has had difficult problems with her

thyroid meds and also taking AD's, and this can prove difficult when things go

out of tune, and yes, there are others also who do not do well on HC as some do

not do well on other medications that do work for others. You are never going

to find out unless you grasp the nettle. You should not decide whether or not

to take up Dr P's recommendations because somebody tells you it doesn't appear

to be working for them.

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Write

and tell me privately what other questions the PCT wants and I will try to help

with that one. Don't let the MP forget - keep reminding him that he promised he

would respond to your particular points and make sure the other departments your

letter was sent (re PM and Queen) also respond to you too. This is a tactic

they use, firmly believing that you will eventually forget and they can then

get on with their other daily chores. We will find some answers regarding Amy.

Do write to your GP as I recommended, and as her appointment is so close, take

the letter with you - tell your GP that you were going to post it, but decided

to bring it with you and you can then go through each of the points I

mentioned. ALWAYS get such things down in writing and again, do tell him to

place your letter in her medical notes.

Luv -

Sheila

> Hello Sheila,

> Did you get any responses to the long letter you wrote to those

various

> people?

> No. Fobbed off just like you said.

Been passed on to other departments from PM and the Queen. Still

waiting to hear. PALS said they can't help because they are not

medically qualified! MP said he will respond later. PCT want some

more information from me (that they probably know I don't have). Brick

wall - banging head. I'm not the type to cause a fuss - but when it

comes to Amy - I want some answers and treatment. I will see what

happens when I take her to GP next week. God why is everything so hard?

Ann

X

> >

>

>

> >

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Marie,

I have now ordered some Cortef.

My stressful life - I don't know how to alter it really. My job is

extremely stressful but I don't want to walk away from it (primary

school teacher). I have had difficult things on top of that to deal

with too (death, miscarriage, bad car crash, and more recently a

hysterectomy (July 08)). Really silly, small things stress me out as

well, I don't know why - not being able to find a parking space,

worrying about what to cook for dinner, what if the alarm clock doesn't

go off ...? Every tiny detail of my life either causes worry or

guilt. Here's a thought. If Cortef helps me to become less of a

worrier and more laid back will I still be the same person? My husband

(of 21 yrs) and I are complete opposites (they say that they attract).

If I become more like him ... Will we clash? Well now - that's another

thing to worry about.

Thanks for your help

Kindest regards

Ann

X

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I am

SO pleased Ann and I know Dr P will be pleased too. I hope it starts

working for you quickly but follow his recommendations on dosing. Your family

should notice a difference and you should be able to cope with everything so

much better. Good luck Ann - I will keep everything crossed for you.

luv -

Sheila

Hello Sheila,

Cortef is now ordered (Int. Pharmacy)

Will take it as suggested by Dr P.

Warmest Wishes - Keep it up - if it wasn't for this site ...

TTFN

Ann

X

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> I have just had the most awful couple of weeks whilst she has been

sitting exams. ............

That reminds me of the various traumas we used to have when my younger

son was at school. Thankfully things are a bit calmer these days.

I am glad to read that you have decided to give the Cortef a go. When

I said I hadn't noticed it doing much yet that wasn't intended as

discouragement. I meant that it might take a lot of patience and

perseverance to find all the keys to good health.

My bank has advised me to use a credit card to order things on the

internet, rather than a debit card, as it offers extra security.

However they didn't try to discourage me from making purchases on the

internet, you can tell your husband! :-)

Best wishes,

Miriam

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.....Pen is a dramatic case - once she started HC the effect was almost

immediate. She may come on to tell you her story

Hi Ann and Sheila

Like you Ann, I worried about trying Cortef, but as I felt so grotty

I didn't see I had anything much to lose. My quality of life was just

so awful. Dr P had told me, months ago, that I would get better, but

if I'm honest I'd started to doubt that would ever be the case. So I

gave in and ordered some.

The improvement on HC has been amazing and I felt the benefit pretty

much straight away. All my symptoms lifted, the tiredness, the

pains, dry eyes, itchy skin etc etc.

That said, I'm going through a challenging patch at the moment (my

own fault)...but I think, ultimately, it's all good!

I've been waiting almost two weeks now for another delivery of Cortef

and because I don't want to suddenly run out and end up with no HC,

I've cut back down to two per day to pace myself (I've also stocked

up on Corlan pellets in case I'm stuck to keep me going). The

difference on being back on two (previously on three and intending to

increase to four) is very noticeable. I am feeling tired again but

NOTHING like I was before.

But on balance, this has taught me some very useful lessons.

The first is to order plenty of HC well in advance (as I said totally

my own fault...last time the order came through really quickly).

The other is that I now have no doubt that it is definitely HC which

has made the big difference, so now I know I'm on the right track and

when my meds do turn up there'll be no stopping me!

Pen x

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Ann, like you I cannot remove the family stress from my life but the

HC is helping me not to overreact when I have to deal with it. It

helps me not to fall apart.

The Cortef isnt going to change your personality; you will still be

the same Ann. You will still be the caring mother to your daughter,

the loving wife to your husband and the mentor to the kids you teach.

But when you're not overreacting to the small stresses in life, you

will be more able to be that person.

Right now your body is struggling to cope with all the demands placed

on it. The fact that you react so badly to any stress is a very good

indication of that. If you dont treat that, you will not be able to

be YOU.

But by giving your body the hormone that your adrenals are unable to

produce, it will help you to get back on track. Assuming that it

works for you, it will help you be more like the person you TRULY are.

My husband and I are like chalk and cheese too. We have very little

in common apart from our love of the great outdoors, but it works. I

know that my being ill is a huge stress on him; it upsets him when I

havent got the energy to get off the couch for weeks at a time (so I

tend not to talk about it much). Nothing would make him happier than

to see me out there living my own life. Come to that, it would make

me pretty ecstatic too !

You two have been together for 21 years, you have a daughter together.

Thats a big commitment you've made to each other. I'm going to guess

that your husband would be very happy to see his wife feeling healthy

and happy. There's no reason that would make you more like him; you

are 2 distinct people.

Try not to worry about it; most of what we worry about never comes to

pass anyway.

Focus on getting your health back. Now that you've seen Dr P, you

have a plan and something to work on so focus on that. I'm seeing him

for the first time at the weekend. I'm not sure whether his approach

will be the one which " fixes " me, but I intend to implement everything

he recommends to give myself the best possible chance at recovery.

He's been doing this for a long time. He's helped a lot of people to

regain their health when they previously had no hope of recovery. I

figure I have a better chance at regaining my health with him than

with anyone I've seen so far. Would this approach help you?

I wish you luck!

Marie xx

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Pen

Have you tried ordering the bigger 10mg tabs and cutting them? I find they last so much longer, I just received another supply and it only took a week. When I first started I only ordered the 5mg ones and found they didnt last very long at all

.....Pen is a dramatic case - once she started HC the effect was almostimmediate. She may come on to tell you her storyHi Ann and SheilaLike you Ann, I worried about trying Cortef, but as I felt so grotty I didn't see I had anything much to lose. My quality of life was just so awful. Dr P had told me, months ago, that I would get better, but if I'm honest I'd started to doubt that would ever be the case. So I gave in and ordered some.The improvement on HC has been amazing and I felt the benefit pretty much straight away. All my symptoms lifted, the tiredness, the pains, dry eyes, itchy skin etc etc.That said, I'm going through a challenging patch at the moment (my own fault)...but I think, ultimately, it's all good! Pen x

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Thanks . Good idea. I'm waiting for two orders of 5mg tabs...like

I said, I won't let myself run out again! But next time I'll do as you

suggest. I waited for pay day before I ordered them and thought they'd

arrive in plenty of time..

Can't understand why they're taking so long though. Maybe the

Christmas post has started to kick in?

Pen x

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