Re: complex case

[Guest guest]

Hi

do you know her TSH and free T4 levels. 25 mcg is a very low dose especially if she is still experiencing symptoms many of which sound like hypothyroidism. things like the adrenalin rushes are common in hashimotos and are due to the thyroid antibodies destroying more bits of thyroid - this can be controlled by upping the thyroxine as it does seem to calm the antibodies down.

also what dose of D3 is she on and has she had her levels checked - presumably the private doctor would have done that?- as with any auto immune disorder quite hefty doses can be needed at first. presumably the paleo diet excludes gluten but also cutting out dairy may help.

B12 levels are also often low in hashimotos which could contribute to muscle pain, and sore eyes ( may be sjorgens going on ?)

you didnt mention withania which Im sure you know can support a failing thyroid .

best wishes ,annette

complex case

Dear All,

I am struggling to make any progress with a particular patient and would appreciate your insights:

54 year old female who developed ME like symptoms following a foot operation 6 years ago (the operation was a disaster and she is in constant pain), on top of that she was diagnosed with Hashimoto's 2 years ago and is on 25mg thyroxine (which seems to be very low? anyway, it has made no difference to her symptoms). Her symptoms are: extreme anxiety, which does not respond to the usual herbals, "heat in the head", sore, dry eyes with extreme floaters and some distortion of vision, muscle weakness, and what the patient calls "adrenalin rushes" but could be hot flushes (periods stopped 3 years ago), generally feeling depressed and despairing, nausea in the morning, poor sleep. She is worse on any exercise. Her blood tests are unremarkable except for low eosinophils; cortisol test showed high cortisol in the morning (chronic pain?). She is on paleo diet, takes vit D3.

I have tried so far (in various combinations):

Glycyrhiza, Leonorus, Hypericum, Eleuthro, Lavandula, Ribes nigrum, Filipendula, Uncaria, Borago, Valeriana, Passiflora, Salvia, Dioscorea, Tarax rad, Tabebuia, Artemisia annua, Rehmania.

She says she is not better and her anxiety is getting worse but wants to keep on trying as she responded well to herbs in the past.

It has been suggested to her by a doctor (whom she saw privately and who is a specialist in ME) that she should increase her thyroxine to 75mg/day and take supplement of DHEA of 10mg/day - however, she is not keen to do either.

I would be grateful for your collective wisdom.

Best wishes

No virus found in this message.Checked by AVG - www.avg.comVersion: 2012.0.2177 / Virus Database: 2437/5092 - Release Date: 06/25/12

[Guest guest]

Hi Annette,thanks for your reply, yes, I tried Withania, too, forgot to list it. Her latest results are from Oct 2011: T4 was 1.1 miu/L, free T4 14.2 pmol/L, B12 normal (but it says that if intrinsic factor is high, the results can be false normal). I am pretty sure she is dairy free, she has mainly fish and vegetables. Good suggestion re Sjorgen. Thanks To: ukherbal-list Sent: Monday, 25 June 2012, 18:55 Subject: Re: complex case

Hi

do you know her TSH and free T4 levels. 25 mcg is a very low dose especially if she is still experiencing symptoms many of which sound like hypothyroidism. things like the adrenalin rushes are common in hashimotos and are due to the thyroid antibodies destroying more bits of thyroid - this can be controlled by upping the thyroxine as it does seem to calm the antibodies down.

also what dose of D3 is she on and has she had her levels checked - presumably the private doctor would have done that?- as with any auto immune disorder quite hefty doses can be needed at first. presumably the paleo diet excludes gluten but also cutting out dairy may help.

B12 levels are also often low in hashimotos which could contribute to muscle pain, and sore eyes ( may be sjorgens going on ?)

you didnt mention withania which Im sure you know can support a failing thyroid .

best wishes ,annette

complex case

Dear All,

I am struggling to make any progress with a particular patient and would appreciate your insights:

54 year old female who developed ME like symptoms following a foot operation 6 years ago (the operation was a disaster and she is in constant pain), on top of that she was diagnosed with Hashimoto's 2 years ago and is on 25mg thyroxine (which seems to be very low? anyway, it has made no difference to her symptoms). Her symptoms are: extreme anxiety, which does not respond to the usual herbals, "heat in the head", sore, dry eyes with extreme floaters and some distortion of vision, muscle weakness, and what the patient calls "adrenalin rushes" but could be hot flushes (periods stopped 3 years ago), generally feeling depressed and despairing, nausea in the morning, poor sleep. She is worse on any exercise. Her blood tests are unremarkable except for low eosinophils; cortisol test showed high cortisol in the morning (chronic pain?). She is on paleo diet, takes vit D3.

I have tried so far (in various combinations):

Glycyrhiza, Leonorus, Hypericum, Eleuthro, Lavandula, Ribes nigrum, Filipendula, Uncaria, Borago, Valeriana, Passiflora, Salvia, Dioscorea, Tarax rad, Tabebuia, Artemisia annua, Rehmania.

She says she is not better and her anxiety is getting worse but wants to keep on trying as she responded well to herbs in the past.

It has been suggested to her by a doctor (whom she saw privately and who is a specialist in ME) that she should increase her thyroxine to 75mg/day and take supplement of DHEA of 10mg/day - however, she is not keen to do either.

I would be grateful for your collective wisdom.

Best wishes

No virus found in this message.Checked by AVG - www.avg.comVersion: 2012.0.2177 / Virus Database: 2437/5092 - Release Date: 06/25/12

[Guest guest]

The thyroid picture seems the most obvious thing to pursue ( you didn't mention fucus?) - but the detail you mentioned in her history about her symptoms seeming to follow a foot operation put me in mind of a conference I went to a couple of years ago on the adverse psychiatric side effects of anaesthetics --see link below. One of the anaesthetists said she had tried and failed to find research money to understand and catalogue women's different (adverse) responses to aesthetic according to where they were in their cycle -following this logic all sorts of different biochemical states ( e.g. raised cortisol levels) might impact.. - not sure how, if you considered that it might be a trigger, what that would change ( if anything) in your approach...She seems to be doing all the right things..

http://www.april.org.uk/main/index.php?uid=269 & rand=0.87494000%201267802994

melissa

son BSc(hons) MNIMH@...www.herbalbarge.co.ukwww.herbalsnuff.co.uk07736966197

complex case

Dear All,

I am struggling to make any progress with a particular patient and would appreciate your insights:

54 year old female who developed ME like symptoms following a foot operation 6 years ago (the operation was a disaster and she is in constant pain), on top of that she was diagnosed with Hashimoto's 2 years ago and is on 25mg thyroxine (which seems to be very low? anyway, it has made no difference to her symptoms). Her symptoms are: extreme anxiety, which does not respond to the usual herbals, "heat in the head", sore, dry eyes with extreme floaters and some distortion of vision, muscle weakness, and what the patient calls "adrenalin rushes" but could be hot flushes (periods stopped 3 years ago), generally feeling depressed and despairing, nausea in the morning, poor sleep. She is worse on any exercise. Her blood tests are unremarkable except for low eosinophils; cortisol test showed high cortisol in the morning (chronic pain?). She is on paleo diet, takes vit D3.

I have tried so far (in various combinations):

Glycyrhiza, Leonorus, Hypericum, Eleuthro, Lavandula, Ribes nigrum, Filipendula, Uncaria, Borago, Valeriana, Passiflora, Salvia, Dioscorea, Tarax rad, Tabebuia, Artemisia annua, Rehmania.

She says she is not better and her anxiety is getting worse but wants to keep on trying as she responded well to herbs in the past.

It has been suggested to her by a doctor (whom she saw privately and who is a specialist in ME) that she should increase her thyroxine to 75mg/day and take supplement of DHEA of 10mg/day - however, she is not keen to do either.

I would be grateful for your collective wisdom.

Best wishes

[Guest guest]

Hi Free T4 is normal so hard to see the rationale for suggesting tripling the dosage to 75 mcg. A side effect of thyroxine supplementation - particularly when not needed is..... anxiety. Of course, DHEA will lead to adrenal suppression which may be the last thing she needs. In such cases, it may be that the thyroxine is a bit of a red herring.Such endocrine supplementation (suppression?) is common in some medics who work with so-called environmental medicine and see patients with conditions with ME, chronic fatigue, Lyme's and similar which are ill understood or poorly treated by more conventional medics.Such anxiety and heat symptoms as your patient describes can be due to a lingering pathogen (as it is described in Chinese medicine) or on-going inflammation. Think about heat in the liver with those head or eye symptoms or perhaps heat in the stomach. This can then have a knock on effect in heating the mind causing anxiety.RegardsDr GascoigneMedical doctor, acupuncturist, herbalistClinics in Bath & Tetbury, UKTel: +44 (0) 79 88 05 92 01Also, Bandon, Co. Cork, IrelandTel: +353 (0) 87 9266234Website: www.drgascoigne.comOn 25 Jun 2012, at 19:45, anna.newton@... wrote:

Hi Annette,thanks for your reply, yes, I tried Withania, too, forgot to list it. Her latest results are from Oct 2011: T4 was 1.1 miu/L, free T4 14.2 pmol/L, B12 normal (but it says that if intrinsic factor is high, the results can be false normal). I am pretty sure she is dairy free, she has mainly fish and vegetables. Good suggestion re Sjorgen. Thanks To: ukherbal-list Sent: Monday, 25 June 2012, 18:55 Subject: Re: complex case

Hi

do you know her TSH and free T4 levels. 25 mcg is a very low dose especially if she is still experiencing symptoms many of which sound like hypothyroidism. things like the adrenalin rushes are common in hashimotos and are due to the thyroid antibodies destroying more bits of thyroid - this can be controlled by upping the thyroxine as it does seem to calm the antibodies down.

also what dose of D3 is she on and has she had her levels checked - presumably the private doctor would have done that?- as with any auto immune disorder quite hefty doses can be needed at first. presumably the paleo diet excludes gluten but also cutting out dairy may help.

B12 levels are also often low in hashimotos which could contribute to muscle pain, and sore eyes ( may be sjorgens going on ?)

you didnt mention withania which Im sure you know can support a failing thyroid .

best wishes ,annette

complex case

Dear All,

I am struggling to make any progress with a particular patient and would appreciate your insights:

54 year old female who developed ME like symptoms following a foot operation 6 years ago (the operation was a disaster and she is in constant pain), on top of that she was diagnosed with Hashimoto's 2 years ago and is on 25mg thyroxine (which seems to be very low? anyway, it has made no difference to her symptoms). Her symptoms are: extreme anxiety, which does not respond to the usual herbals, "heat in the head", sore, dry eyes with extreme floaters and some distortion of vision, muscle weakness, and what the patient calls "adrenalin rushes" but could be hot flushes (periods stopped 3 years ago), generally feeling depressed and despairing, nausea in the morning, poor sleep. She is worse on any exercise. Her blood tests are unremarkable except for low eosinophils; cortisol test showed high cortisol in the morning (chronic pain?). She is on paleo diet, takes vit D3.

I have tried so far (in various combinations):

Glycyrhiza, Leonorus, Hypericum, Eleuthro, Lavandula, Ribes nigrum, Filipendula, Uncaria, Borago, Valeriana, Passiflora, Salvia, Dioscorea, Tarax rad, Tabebuia, Artemisia annua, Rehmania.

She says she is not better and her anxiety is getting worse but wants to keep on trying as she responded well to herbs in the past.

It has been suggested to her by a doctor (whom she saw privately and who is a specialist in ME) that she should increase her thyroxine to 75mg/day and take supplement of DHEA of 10mg/day - however, she is not keen to do either.

I would be grateful for your collective wisdom.

Best wishes

No virus found in this message.Checked by AVG - www.avg.comVersion: 2012.0.2177 / Virus Database: 2437/5092 - Release Date: 06/25/12

[Guest guest]

Thank you , that is very useful. I think that a more TCM like approach is asked for. It did occur to me that excess thyroxine can be the reason for anxiety, and I agree that the environmental medicine offers very little that is useful. The patient is happy to take things slowly and even try different herbs one by one. I did wonder about a lingering pathogen but would expect her WBC to be higher, also her ESR and CRP are normal (which does not exclude a low grade chronic inflammation I guess). I appreciate your pointers very much. To: "ukherbal-list " <ukherbal-list > Sent: Tuesday, 26 June 2012, 7:34 Subject: Re: complex case

Hi Free T4 is normal so hard to see the rationale for suggesting tripling the dosage to 75 mcg. A side effect of thyroxine supplementation - particularly when not needed is..... anxiety. Of course, DHEA will lead to adrenal suppression which may be the last thing she needs. In such cases, it may be that the thyroxine is a bit of a red herring.Such endocrine supplementation (suppression?) is common in some medics who work with so-called environmental medicine and see patients with conditions with ME, chronic fatigue, Lyme's and similar which are ill understood or poorly treated by more conventional medics.Such anxiety and heat symptoms as your patient describes can be due to a lingering pathogen (as it is described in Chinese medicine) or on-going inflammation. Think about heat in the liver with those head or eye symptoms or perhaps heat in the stomach.

This can then have a knock on effect in heating the mind causing anxiety.RegardsDr GascoigneMedical doctor, acupuncturist, herbalistClinics in Bath & Tetbury, UKTel: +44 (0) 79 88 05 92 01Also, Bandon, Co. Cork, IrelandTel: +353 (0) 87 9266234Website: www.drgascoigne.comOn 25 Jun 2012, at 19:45, anna.newton@... wrote:

Hi Annette,thanks for your reply, yes, I tried Withania, too, forgot to list it. Her latest results are from Oct 2011: T4 was 1.1 miu/L, free T4 14.2 pmol/L, B12 normal (but it says that if intrinsic factor is high, the results can be false normal). I am pretty sure she is dairy free, she has mainly fish and vegetables. Good suggestion re Sjorgen. Thanks To: ukherbal-list Sent: Monday, 25 June 2012, 18:55 Subject: Re: complex case

Hi

do you know her TSH and free T4 levels. 25 mcg is a very low dose especially if she is still experiencing symptoms many of which sound like hypothyroidism. things like the adrenalin rushes are common in hashimotos and are due to the thyroid antibodies destroying more bits of thyroid - this can be controlled by upping the thyroxine as it does seem to calm the antibodies down.

also what dose of D3 is she on and has she had her levels checked - presumably the private doctor would have done that?- as with any auto immune disorder quite hefty doses can be needed at first. presumably the paleo diet excludes gluten but also cutting out dairy may help.

B12 levels are also often low in hashimotos which could contribute to muscle pain, and sore eyes ( may be sjorgens going on ?)

you didnt mention withania which Im sure you know can support a failing thyroid .

best wishes ,annette

complex case

Dear All,

I am struggling to make any progress with a particular patient and would appreciate your insights:

54 year old female who developed ME like symptoms following a foot operation 6 years ago (the operation was a disaster and she is in constant pain), on top of that she was diagnosed with Hashimoto's 2 years ago and is on 25mg thyroxine (which seems to be very low? anyway, it has made no difference to her symptoms). Her symptoms are: extreme anxiety, which does not respond to the usual herbals, "heat in the head", sore, dry eyes with extreme floaters and some distortion of vision, muscle weakness, and what the patient calls "adrenalin rushes" but could be hot flushes (periods stopped 3 years ago), generally feeling depressed and despairing, nausea in the morning, poor sleep. She is worse on any exercise. Her blood tests are unremarkable except for low eosinophils; cortisol test showed high cortisol in the morning (chronic pain?). She is on paleo diet, takes vit D3.

I have tried so far (in various combinations):

Glycyrhiza, Leonorus, Hypericum, Eleuthro, Lavandula, Ribes nigrum, Filipendula, Uncaria, Borago, Valeriana, Passiflora, Salvia, Dioscorea, Tarax rad, Tabebuia, Artemisia annua, Rehmania.

She says she is not better and her anxiety is getting worse but wants to keep on trying as she responded well to herbs in the past.

It has been suggested to her by a doctor (whom she saw privately and who is a specialist in ME) that she should increase her thyroxine to 75mg/day and take supplement of DHEA of 10mg/day - however, she is not keen to do either.

I would be grateful for your collective wisdom.

Best wishes

No virus found in this message.Checked by AVG - www.avg.comVersion: 2012.0.2177 / Virus Database: 2437/5092 - Release Date: 06/25/12

[Guest guest]

Hi , I did not mention Focus because the patient was supplementing with kelp herself (has stopped now as it was making no difference), I do wonder if thyroxine is a a red herring here as suggests. Thanks for the link - isn't it interesting?Best wishes To: ukherbal-list Sent:

Monday, 25 June 2012, 23:45 Subject: Re: complex case

The thyroid picture seems the most obvious thing to pursue ( you didn't mention fucus?) - but the detail you mentioned in her history about her symptoms seeming to follow a foot operation put me in mind of a conference I went to a couple of years ago on the adverse psychiatric side effects of anaesthetics --see link below. One of the anaesthetists said she had tried and failed to find research money to understand and catalogue women's different (adverse) responses to aesthetic according to where they were in their cycle -following this logic all sorts of different biochemical states ( e.g. raised cortisol levels) might impact.. - not sure how, if you considered that it might be a trigger, what that would change ( if anything) in your approach...She seems to be doing all the right things..

http://www.april.org.uk/main/index.php?uid=269 & rand=0.87494000%201267802994

melissa

son BSc(hons) MNIMH@...www.herbalbarge.co.ukwww.herbalsnuff.co.uk07736966197

complex case

Dear All,

I am struggling to make any progress with a particular patient and would appreciate your insights:

54 year old female who developed ME like symptoms following a foot operation 6 years ago (the operation was a disaster and she is in constant pain), on top of that she was diagnosed with Hashimoto's 2 years ago and is on 25mg thyroxine (which seems to be very low? anyway, it has made no difference to her symptoms). Her symptoms are: extreme anxiety, which does not respond to the usual herbals, "heat in the head", sore, dry eyes with extreme floaters and some distortion of vision, muscle weakness, and what the patient calls "adrenalin rushes" but could be hot flushes (periods stopped 3 years ago), generally feeling depressed and despairing, nausea in the morning, poor sleep. She is worse on any exercise. Her blood tests are unremarkable except for low eosinophils; cortisol test showed high cortisol in the morning (chronic pain?). She is on paleo diet, takes vit D3.

I have tried so far (in various combinations):

Glycyrhiza, Leonorus, Hypericum, Eleuthro, Lavandula, Ribes nigrum, Filipendula, Uncaria, Borago, Valeriana, Passiflora, Salvia, Dioscorea, Tarax rad, Tabebuia, Artemisia annua, Rehmania.

She says she is not better and her anxiety is getting worse but wants to keep on trying as she responded well to herbs in the past.

It has been suggested to her by a doctor (whom she saw privately and who is a specialist in ME) that she should increase her thyroxine to 75mg/day and take supplement of DHEA of 10mg/day - however, she is not keen to do either.

I would be grateful for your collective wisdom.

Best wishes

[Guest guest]

Hello ,I would also be tempted to look at what was going on before she got the ME symptoms and try and address those. ME, like most things, does not come out of nowhere and if you can look at her health picture before the onset of those symptoms sometimes there are clues to systems, organs, tissues, energies, emotions etc that can be helped with herbs and other things in your tool kit. best wishes,Guy Dear All,I am struggling to make any progress with a particular patient and would appreciate your insights:54 year old female who developed ME like symptoms following a foot operation 6 years ago (the operation was a disaster and she is in constant pain), on top of that she was diagnosed with Hashimoto's 2 years ago and is on 25mg thyroxine (which seems to be very low? anyway, it has made no difference to her symptoms). Her symptoms are: extreme anxiety, which does not respond to the usual herbals, "heat in the head", sore, dry eyes with extreme floaters and some distortion of vision, muscle weakness, and what the patient calls "adrenalin rushes" but could be hot flushes (periods stopped 3 years ago), generally feeling depressed and despairing, nausea in the morning, poor sleep. She is worse on any exercise. Her blood tests are unremarkable except for low eosinophils; cortisol test showed high cortisol in the morning (chronic pain?). She is on paleo diet, takes vit D3.I have tried so far (in various combinations):Glycyrhiza, Leonorus, Hypericum, Eleuthro, Lavandula, Ribes nigrum, Filipendula, Uncaria, Borago, Valeriana, Passiflora, Salvia, Dioscorea, Tarax rad, Tabebuia, Artemisia annua, Rehmania. She says she is not better and her anxiety is getting worse but wants to keep on trying as she responded well to herbs in the past. It has been suggested to her by a doctor (whom she saw privately and who is a specialist in ME) that she should increase her thyroxine to 75mg/day and take supplement of DHEA of 10mg/day - however, she is not keen to do either.I would be grateful for your collective wisdom.Best wishes

[Guest guest]

Hi Yes, a lingering pathogen may be an issue. I also agree with Guy's point about what was happening prior to her symptoms and also what may have triggered them. A normal WBC does not exclude a lingering pathogen, in my experience. You may well see heat in the form of redness on the tongue.RegardsDr GascoigneMedical doctor, acupuncturist, herbalistClinics in Bath & Tetbury, UKTel: +44 (0) 79 88 05 92 01Also, Bandon, Co. Cork, IrelandTel: +353 (0) 87 9266234Website: www.drgascoigne.comOn 26 Jun 2012, at 19:17, anna.newton@... wrote:

Thank you , that is very useful. I think that a more TCM like approach is asked for. It did occur to me that excess thyroxine can be the reason for anxiety, and I agree that the environmental medicine offers very little that is useful. The patient is happy to take things slowly and even try different herbs one by one. I did wonder about a lingering pathogen but would expect her WBC to be higher, also her ESR and CRP are normal (which does not exclude a low grade chronic inflammation I guess). I appreciate your pointers very much. To: "ukherbal-list " <ukherbal-list > Sent: Tuesday, 26 June 2012, 7:34 Subject: Re: complex case

Hi Free T4 is normal so hard to see the rationale for suggesting tripling the dosage to 75 mcg. A side effect of thyroxine supplementation - particularly when not needed is..... anxiety. Of course, DHEA will lead to adrenal suppression which may be the last thing she needs. In such cases, it may be that the thyroxine is a bit of a red herring.Such endocrine supplementation (suppression?) is common in some medics who work with so-called environmental medicine and see patients with conditions with ME, chronic fatigue, Lyme's and similar which are ill understood or poorly treated by more conventional medics.Such anxiety and heat symptoms as your patient describes can be due to a lingering pathogen (as it is described in Chinese medicine) or on-going inflammation. Think about heat in the liver with those head or eye symptoms or perhaps heat in the stomach.

This can then have a knock on effect in heating the mind causing anxiety.RegardsDr GascoigneMedical doctor, acupuncturist, herbalistClinics in Bath & Tetbury, UKTel: +44 (0) 79 88 05 92 01Also, Bandon, Co. Cork, IrelandTel: +353 (0) 87 9266234Website: www.drgascoigne.comOn 25 Jun 2012, at 19:45, anna.newton@... wrote:

Hi Annette,thanks for your reply, yes, I tried Withania, too, forgot to list it. Her latest results are from Oct 2011: T4 was 1.1 miu/L, free T4 14.2 pmol/L, B12 normal (but it says that if intrinsic factor is high, the results can be false normal). I am pretty sure she is dairy free, she has mainly fish and vegetables. Good suggestion re Sjorgen. Thanks To: ukherbal-list Sent: Monday, 25 June 2012, 18:55 Subject: Re: complex case

Hi

do you know her TSH and free T4 levels. 25 mcg is a very low dose especially if she is still experiencing symptoms many of which sound like hypothyroidism. things like the adrenalin rushes are common in hashimotos and are due to the thyroid antibodies destroying more bits of thyroid - this can be controlled by upping the thyroxine as it does seem to calm the antibodies down.

also what dose of D3 is she on and has she had her levels checked - presumably the private doctor would have done that?- as with any auto immune disorder quite hefty doses can be needed at first. presumably the paleo diet excludes gluten but also cutting out dairy may help.

B12 levels are also often low in hashimotos which could contribute to muscle pain, and sore eyes ( may be sjorgens going on ?)

you didnt mention withania which Im sure you know can support a failing thyroid .

best wishes ,annette

complex case

Dear All,

I am struggling to make any progress with a particular patient and would appreciate your insights:

54 year old female who developed ME like symptoms following a foot operation 6 years ago (the operation was a disaster and she is in constant pain), on top of that she was diagnosed with Hashimoto's 2 years ago and is on 25mg thyroxine (which seems to be very low? anyway, it has made no difference to her symptoms). Her symptoms are: extreme anxiety, which does not respond to the usual herbals, "heat in the head", sore, dry eyes with extreme floaters and some distortion of vision, muscle weakness, and what the patient calls "adrenalin rushes" but could be hot flushes (periods stopped 3 years ago), generally feeling depressed and despairing, nausea in the morning, poor sleep. She is worse on any exercise. Her blood tests are unremarkable except for low eosinophils; cortisol test showed high cortisol in the morning (chronic pain?). She is on paleo diet, takes vit D3.

I have tried so far (in various combinations):

Glycyrhiza, Leonorus, Hypericum, Eleuthro, Lavandula, Ribes nigrum, Filipendula, Uncaria, Borago, Valeriana, Passiflora, Salvia, Dioscorea, Tarax rad, Tabebuia, Artemisia annua, Rehmania.

She says she is not better and her anxiety is getting worse but wants to keep on trying as she responded well to herbs in the past.

It has been suggested to her by a doctor (whom she saw privately and who is a specialist in ME) that she should increase her thyroxine to 75mg/day and take supplement of DHEA of 10mg/day - however, she is not keen to do either.

I would be grateful for your collective wisdom.

Best wishes

No virus found in this message.Checked by AVG - www.avg.comVersion: 2012.0.2177 / Virus Database: 2437/5092 - Release Date: 06/25/12

[Guest guest]

Hi and Guy,that is a very good point about this lady's past history - in about 2000 she sustained dim mak injury to her arm (from a weird martial art practitioner), which she has never really recovered from and the feeling of heat has been with her roughly since then. I have read about heat removing herbs from the TCM perspective in Alan Tillotson's book, but is there anything in particularly you would recommend? Thanks again.Best wishes To: "ukherbal-list " <ukherbal-list > Sent: Wednesday, 27 June 2012, 0:54 Subject: Re: complex case

Hi Yes, a lingering pathogen may be an issue. I also agree with Guy's point about what was happening prior to her symptoms and also what may have triggered them. A normal WBC does not exclude a lingering pathogen, in my experience. You may well see heat in the form of redness on the tongue.RegardsDr GascoigneMedical doctor, acupuncturist, herbalistClinics in Bath & Tetbury, UKTel: +44 (0) 79 88 05 92 01Also, Bandon, Co. Cork, IrelandTel: +353 (0) 87 9266234Website: www.drgascoigne.comOn 26 Jun 2012, at 19:17, anna.newton@... wrote:

Thank you , that is very useful. I think that a more TCM like approach is asked for. It did occur to me that excess thyroxine can be the reason for anxiety, and I agree that the environmental medicine offers very little that is useful. The patient is happy to take things slowly and even try different herbs one by one. I did wonder about a lingering pathogen but would expect her WBC to be higher, also her ESR and CRP are normal (which does not exclude a low grade chronic inflammation I guess). I appreciate your pointers very much. To: "ukherbal-list " <ukherbal-list > Sent: Tuesday, 26 June 2012, 7:34 Subject: Re: complex case

Hi Free T4 is normal so hard to see the rationale for suggesting tripling the dosage to 75 mcg. A side effect of thyroxine supplementation - particularly when not needed is..... anxiety. Of course, DHEA will lead to adrenal suppression which may be the last thing she needs. In such cases, it may be that the thyroxine is a bit of a red herring.Such endocrine supplementation (suppression?) is common in some medics who work with so-called environmental medicine and see patients with conditions with ME, chronic fatigue, Lyme's and similar which are ill understood or poorly treated by more conventional medics.Such anxiety and heat symptoms as your patient describes can be due to a lingering pathogen (as it is described in Chinese medicine) or on-going inflammation. Think about heat in the liver with those head or eye symptoms or perhaps heat in the stomach.

This can then have a knock on effect in heating the mind causing anxiety.RegardsDr GascoigneMedical doctor, acupuncturist, herbalistClinics in Bath & Tetbury, UKTel: +44 (0) 79 88 05 92 01Also, Bandon, Co. Cork, IrelandTel: +353 (0) 87 9266234Website: www.drgascoigne.comOn 25 Jun 2012, at 19:45, anna.newton@... wrote:

Hi Annette,thanks for your reply, yes, I tried Withania, too, forgot to list it. Her latest results are from Oct 2011: T4 was 1.1 miu/L, free T4 14.2 pmol/L, B12 normal (but it says that if intrinsic factor is high, the results can be false normal). I am pretty sure she is dairy free, she has mainly fish and vegetables. Good suggestion re Sjorgen. Thanks

To: ukherbal-list Sent: Monday, 25 June 2012, 18:55 Subject: Re: complex case

Hi

do you know her TSH and free T4 levels. 25 mcg is a very low dose especially if she is still experiencing symptoms many of which sound like hypothyroidism. things like the adrenalin rushes are common in hashimotos and are due to the thyroid antibodies destroying more bits of thyroid - this can be controlled by upping the thyroxine as it does seem to calm the antibodies down.

also what dose of D3 is she on and has she had her levels checked - presumably the private doctor would have done that?- as with any auto immune disorder quite hefty doses can be needed at first. presumably the paleo diet excludes gluten but also cutting out dairy may help.

B12 levels are also often low in hashimotos which could contribute to muscle pain, and sore eyes ( may be sjorgens going on ?)

you didnt mention withania which Im sure you know can support a failing thyroid .

best wishes ,annette

complex case

Dear All,

I am struggling to make any progress with a particular patient and would appreciate your insights:

54 year old female who developed ME like symptoms following a foot operation 6 years ago (the operation was a disaster and she is in constant pain), on top of that she was diagnosed with Hashimoto's 2 years ago and is on 25mg thyroxine (which seems to be very low? anyway, it has made no difference to her symptoms). Her symptoms are: extreme anxiety, which does not respond to the usual herbals, "heat in the head", sore, dry eyes with extreme floaters and some distortion of vision, muscle weakness, and what the patient calls "adrenalin rushes" but could be hot flushes (periods stopped 3 years ago), generally feeling depressed and despairing, nausea in the morning, poor sleep. She is worse on any exercise. Her blood tests are unremarkable except for low eosinophils; cortisol test showed high cortisol in the morning (chronic pain?). She is on paleo diet, takes vit D3.

I have tried so far (in various combinations):

Glycyrhiza, Leonorus, Hypericum, Eleuthro, Lavandula, Ribes nigrum, Filipendula, Uncaria, Borago, Valeriana, Passiflora, Salvia, Dioscorea, Tarax rad, Tabebuia, Artemisia annua, Rehmania.

She says she is not better and her anxiety is getting worse but wants to keep on trying as she responded well to herbs in the past.

It has been suggested to her by a doctor (whom she saw privately and who is a specialist in ME) that she should increase her thyroxine to 75mg/day and take supplement of DHEA of 10mg/day - however, she is not keen to do either.

I would be grateful for your collective wisdom.

Best wishes

No virus found in this message.Checked by AVG - www.avg.comVersion: 2012.0.2177 / Virus Database: 2437/5092 - Release Date: 06/25/12

[Guest guest]

Hi ,

I just wanted to add something to the discussion. I had a patient with a similar

story ,(F55) a nurse, who had a longstanding back issue ( as many of them do

)Had surgery to correct a bulging disc, got MRSA in the wound.

Following this she had sustained ill health dispite working part-time and

needing increasing quantities of pain killers to perform her work.

She had alot of heat symptoms, redtounge , burning stomach (although this was

more likely due to years of pain meds eating away her stomach!)lots of flushing

despite going through the menopause 8 years previously ( i put it down to

adrenal exhaustion).

Main Sx were fatiuge ,pain in all joints, constipation, sleep poor requiring

stillnoct, thyroid normal no RF , no CRP or ESR measurements done by Dr but FBC

fine.

Changed her diet radically , including fresh wheat grass, celery juice every

other day, put on a gluten free diet , and we did a stool test result =

B.hominis !

Treated pt for this, refered her for a couple of colonics and she is now I'm

happy to report like a new woman !

So there can be a pathogen ( I know for some B.Homminis being a pathogen is a

controversial one)...and i think that the presence of one even when not picked

up by regular bloods as said can have a toxic effect on sensitive organ

systemsie. The thyroid ( I have seen this with systemic chronic candida)....

I get my stool tests done with Genova..

Anecdotally I have had numerous female patients who claim they have 'never been

right' since surgical intervention, so that article Mellisa mentioned is

interesting Re ; anesthetics...

Hope thats some help, all the best !

Ciara

[Guest guest]

Hi Ciara,thanks for sharing this - sounds remarkably similar. I will definitely follow a pathogen idea (in fact I have started it already, thinking along the protocol of Kerry Bone for autoimmune disease ie primary lesion), but I think having a stool test done would be a good idea. She does not like the idea of colonics, so we may have to go for more heroic doses of anti-pathogen herbs.And talking about anesthetics, I just had a female patient with a severe rash after a general...Thanks again, best regards To: ukherbal-list Sent: Wednesday, 27 June 2012, 20:05 Subject: Re: complex case

Hi ,

I just wanted to add something to the discussion. I had a patient with a similar story ,(F55) a nurse, who had a longstanding back issue ( as many of them do )Had surgery to correct a bulging disc, got MRSA in the wound.

Following this she had sustained ill health dispite working part-time and needing increasing quantities of pain killers to perform her work.

She had alot of heat symptoms, redtounge , burning stomach (although this was more likely due to years of pain meds eating away her stomach!)lots of flushing despite going through the menopause 8 years previously ( i put it down to adrenal exhaustion).

Main Sx were fatiuge ,pain in all joints, constipation, sleep poor requiring stillnoct, thyroid normal no RF , no CRP or ESR measurements done by Dr but FBC fine.

Changed her diet radically , including fresh wheat grass, celery juice every other day, put on a gluten free diet , and we did a stool test result = B.hominis !

Treated pt for this, refered her for a couple of colonics and she is now I'm happy to report like a new woman !

So there can be a pathogen ( I know for some B.Homminis being a pathogen is a controversial one)...and i think that the presence of one even when not picked up by regular bloods as said can have a toxic effect on sensitive organ systemsie. The thyroid ( I have seen this with systemic chronic candida)....

I get my stool tests done with Genova..

Anecdotally I have had numerous female patients who claim they have 'never been right' since surgical intervention, so that article Mellisa mentioned is interesting Re ; anesthetics...

Hope thats some help, all the best !

Ciara