Blog changes

Thanks to everyone who followed Training Because I Can! over the last nine years. This blog started with Addison's Disease, hypothyroidism and a crazy idea of doing an Ironman distance triathlon. My life has changed and so has this blog. I am using this blog strictly for Addison's Support topics from here on out. I hope to continue providing people with hints for living life well with adrenal insufficiency.

Thursday, March 6, 2008

Calling all cars! I need help!

  • I need the name and phone number for an endocrinologist in Northern New Jersey or New York City who TREATS ADRENAL/PITUITARY PROBLEMS. Email me at as soon as possible please.
  • Is there anyone out there who has been put into adrenal/pituitary suppression from exogenous steroids, particularly Kennelog injections? What did you do to taper? Call me or email me using this FREE way to call.

Here's the situation in a nutshell. I have a friend who was diagnosed with wheat allergies, psoriatic arthritis, and migraines. She's got weakness in her fingers and quad muscles, muscle and joint pain (yes, both!) and tremendous pain in her neck and spine. Over the course of 5 weeks she was given shots of Kennelog with an epidural to the spine in the amounts of 80 mg, 80 mg, 100 mg, 80 mg and 100 mg. She became Cushingoid with low potassium, tachycardia and high blood pressure that was treated with Potassium supplements and blood pressure medication. 2 weeks ago she became ill with the flu. She became weak, with very low blood pressure. On Friday, February 29th she was given an ACTH stimulation test where her cortisol was .5 initially and she stimulated to 4.6 at 60 minutes. She was in adrenal crisis. She was told to take some prednisone over the weekend, taper through this week and she'd be fine in 3-6 months.


Wednesday, March 5, 2008

Addison's: Anxiety, Gut problems and Women's Testosterone

[Hormones in depressive illness. The role of cortisol and sexual steroids (author's transl)]

Ann Biol Clin (Paris). 1979; 37(1):49-57 (ISSN: 0003-3898)

de Lignières B; Mauvais-Jarvis P
It is actually highly probable than depression is linked to a decrease in noradrenergic activity in brain, at least in some areas including hypothalamus. The complexity of relations between dopaminergic and serotoninergic systems lead to multiple possibilities in hypothetical etiologic factors and in therapeutic interventions. A plasmatic drop in testosterone in men and estradiol in women is one of the situation able to induce a decrease in noradrenergic activity. It seems to be of primordial influence on depression at least in patients with predominant clinical hypogonadic symptoms. We still don't know the frequency on hypogonadism in peoples with predominant depressive symptoms. However this incidence may be fairly high because it is now demonstrated than environmental stress could impaired testicular and ovarian function by the means of anxiety hormones, catecholamines and cortisol, and also by a direct effect on hypothalamus. In no case this hormonal reactions are adaptative by means of anti-anxiety or anti-depressive effects. In contrary, they contribute to maintain the psycho-endocrine syndrome.

Dyslipidemia and high waist-hip ratio in women with self-reported social anxiety.

Psychoneuroendocrinology. 2004; 29(8):1037-46 (ISSN: 0306-4530)

Landén M; Baghaei F; Rosmond R; Holm G; Björntorp P; Eriksson E
Department of Psychiatry, Institute of Clinical Neuroscience, Sahlgrenska University Hospital, Göteborg University, SE 431 80 Mölndal, Sweden.
Previous research has indicated that phobic anxiety is associated with coronary heart disease. In this study, the possible association between social anxiety and various anthropometric, metabolic, and endocrine measurements known to be associated with cardiovascular disease were studied in a population-based cohort of 216 women 41-42 years old. Each participant was assessed by means of a DSM-IV based self-report questionnaire regarding social anxiety and related psychiatric diagnoses. Waist-to-hip ratio (WHR), body mass index (BMI), and serum levels of lipids and hormones were assessed. The prevalence of social anxiety was 14% (n=31). The social anxiety group displayed higher serum levels of triglycerides (1.3+/-0.9 vs. 1.0+/-0.5, P=0.003) and low-density lipoprotein (LDL) (3.3+/-0.8 vs. 3.0+/-0.7, P=0.03), but lower high-density lipoprotein (HDL) (1.4+/-0.3 vs. 1.6+/-0.4, P=0.04) and HDL/LDL ratio (0.46+/-0.15 vs. 0.57+/-0.22, P=0.008) than the other women. Serum levels of total testosterone (1.6+/-0.8 vs. 2.2+/-1.1, P=0.013) and free thyroxin (14+/-2 vs. 16+/-4, P=0.04) were lower in subjects confirming social anxiety. While WHR was significantly higher in the social anxiety group (0.83+/-0.06 vs. 0.80+/-0.07, P=0.016), BMI did not differ between the groups. Our data suggest that self-reported social anxiety is associated with two established risk factors for cardiovascular disease: dyslipidemia and increased WHR.

Testosterone deficiency in women.

J Reprod Med. 2001; 46(3 Suppl):291-6 (ISSN: 0024-7758)

Davis S
Jean Hailes Foundation, 173 Carinish Road, Clayton, Victoria, 3168, Australia.
Testosterone (T) is an important component of female sexuality, enhancing interest in initiating sexual activity and response to sexual stimulation. Testosterone is also associated with greater well-being and with reduced anxiety and depression. Clinical and biochemical definitions of T deficiency have not been established; hence, the prevalence of this condition is not known. However, surgically menopausal women are among the populations most likely to experience T deficiency, a syndrome characterized by blunted or diminished motivation; persistent fatigue; decreased sense of personal well-being; sufficient plasma estrogen levels; and low circulating bioavailable T (either a low total T/sex hormone binding globulin (SHBG) ratio or free T in the lower one-third of the female reproductive range); and low libido. Exogenous estrogen, particularly when administered orally, increases SHBG, which, in turn, reduces free T and estradiol (E2). After oophorectomy, levels of T and its precursor, androstenedione, decline by approximately 50%. T replacement continues to be evaluated as an adjunct to estrogen replacement therapy, particularly for women with androgen deficiency symptoms, surgically menopausal women and women with premature ovarian failure. In the United States, oral methyltestosterone is the common product currently approved for androgen replacement in women. The best product specifically designed for women has yet to be determined, as standardized, long-term, randomized, control clinical studies are lacking and product refinement continues.

Do male sex hormones protect from irritable bowel syndrome?

Am J Gastroenterol. 2000; 95(9):2296-300 (ISSN: 0002-9270)

Houghton LA; Jackson NA; Whorwell PJ; Morris J
Department of Medicine, University Hospital of South Manchester, West Didsbury, United Kingdom.
OBJECTIVE: Irritable bowel syndrome (IBS) is more common in women and it is frequently assumed that being female may predispose to the development of this disorder. Alternatively, being male could offer some degree of protection and if so, this might be mediated by testosterone. The aim of this study was to assess whether male patients with IBS have lower levels of testosterone and related gonadotrophins than their unaffected counterparts and if this relates to rectal sensitivity. METHODS: Fifty secondary care, male outpatients with IBS (aged 19-71 yr) were compared with 25 controls (aged 22-67 yr). Each subject had serum testosterone, free testosterone, sex hormone-binding globulin, follicle stimulating hormone, and luteinizing hormone (LH) measured, together with rectal sensitivity to balloon distension. Anxiety and depression were also assessed. RESULTS: The only difference in the hormone levels between patients and controls that reached statistical significance was the lower value for LH in the IBS patients (p = 0.014). Although patients were more anxious and depressed than the controls (p < p =" 0.10]." p =" 0.001)">). Finally, there was a tendency for IBS symptomatology to be inversely related to testosterone levels (p = 0.15). CONCLUSIONS: These results support the need for further exploration of the role of male sex hormones in the pathophysiology of IBS.

[Hormone therapy of ageing: myths and realities]

Rev Med Brux. 2004; 25(4):A371-5 (ISSN: 0035-3639)

Cogan E
Service de Médecine Interne, Hôpital Erasme, ULB, Bruxelles.
Is well being in the elderly be improved by hormone replacement therapy which compensate deficits accounting for generalized weakness, poor endurance, loss of muscle strength, impaired mobility and balance and decreased cognitive functions? Hormone replacement therapy of menopause has favorable effects on bone loss and decreased cognitive functions but also on several unpleasant symptoms--vasomotor instability, skin atrophy, mucosal dryness, anxiety and fatigue--but at the prize of increased incidence of cancer and cardiovascular morbidity. Decreased testosterone levels in elderly men are associated with increased fatigability, decreased muscle strength and bone mass and increased risks of accelerated atheromatosis. Testosterone substitution seems to be helpful but with side effects, particularly development of prostate cancer. Aging also affects adrenal function. The consequences of decreased DHEA production are still matter of debate. DHEA administration in elderly women seems to be associated with favorable effects on physical and psychological well being. Somatopause is characterized by a progressive decrease of growth hormone production starting as soon as the third decade. Growth hormone therapy has favorable effects on lean body mass, skin atrophy as well on body fat reduction. However, numerous side effects and the theoretical increased risk of cancer limit the use of growth hormone therapy in the elderly.

Addison's:Getting diagnosed with something

One has a greater sense of intellectual degradation after an interview with a doctor than from any human experience.
- Alice James
"We have two options in life both medically and emotionally, give up or
fight like hell." -Lance Armstrong

How to get diagnosed
· Get a 3 ring binder and dividers.
o Section 1 – Family health history & copies – write a complete family health history, talk to relatives, get all of your facts straight and complete. Find out why your relatives have died
o Section 2 – Personal health history & copies- Write YOUR health history with as much information as you can, talk to relatives. Include things like: surgeries, menses, libido, courses of medicines, concussions, allergies, food sensitivities, migraine headaches, all pregnancies, be specific and include dates with as much accuracy as you can.
o Section 3 – Symptom list & copies - Write a list of your symptoms. Keep them objective so they can’t argue with them. Avoid anything that might sound like depression. Skin? Eyes? Finger nails/toe nails? Digestion? Etc.
o Section 4 – Labs/divide by year (label them “Master” with a highlighter and NEVER allow them to be removed from the binder unless they are given back to you immediately. Get copies of all labs as far back as you can. You CAN NOT be refused these documents! If you are, immediately contact the American Medical Association.
o Section 5 – Research (this is where you put journal abstracts and explanations of each test you look up – you may need to subdivide this section). Use only reputable sources that cite scientific journals like PubMed and MedScape.
· Once you get copies of labs, this is where it gets tricky!
o Study your labs and if you find values that are outside of the norm, research, research, research.
o Go to bulletin boards on the internet and ask for help with lab values, similar experiences and guidance. Never believe anything you are told on a BB, use it as a spring board for research.
o When you have an idea of what might be wrong with you, copy pages out of the Merck Manual.
o Ask on a BB for what the standard diagnosis tests are.
o Consult the online organization for the disease you might think you have. Print off as much information from that site as you can. Ask what the standard diagnosis tests are for the disease you might have.
o Go to and get lab protocols for each of the labs you are requesting so that you look informed. Very often, the lab workers won’t let you know that you need to fast or come in first thing in the morning and the doctors certainly don’t know the protocol for blood work. Make sure the test is done right when you get it done! This is vital!
o I prefer to make my first appointment with a General Practitioner because they don’t look at you as one body system, they look at you as more of a whole organism.
o Prior to the appointment fax (or drop off the following):
§ Your specific concerns (see below)
§ Your personal health history
§ Your specific symptoms
§ Family history
§ List of requested tests & lab protocols
o Bring copies for yourself and your doctor of the above (specific concerns, personal and family health history, list of requested tests) to your appointment (they will often claim that they didn’t get the fax!), bring your notebook with your labs and bring your specific concerns. Remember a pen so you can take notes.
o If you are refused any of your requests, have the doctor sign a paper that he/she is refusing to test you for that specific item.

Here's an example of what I take to the doctor's office EVERY TIME I GO. I take two copies, one for me and one that I request to be put in my file. Interestingly, I've never been denied a request for blood work or testing.
August 18, 2006
Goals of today’s meeting:
1. Have this appointment cost as little as possible by providing background and documentation
  1. Get electrolytes tested today and tomorrow after my long run
  2. Figure out the reason why a well trained athlete would be impeded by dehydration and then, more importantly, fix the problem
Current medications:
  1. 25 mg/ day of hydrocortisone taken the following way
    1. 10 mg at 6:00 am
    2. 5 mg at 9:00 am
    3. 5 mg at 11:00 am
    4. 5 mg at 2:00 pm
  2. Hydrocortisone dose increased 7/1/06 from 20 mg/day to 25 mg/day because I had an ER admit, got a cold and had constant, debilitating nausea and malaise
  3. Hydrocortisone is only increased during running/exercise after 12 miles or 3 hours
    1. 5 mg extra/1 hour of exercise after 2 hours of consistent, strenuous exercise
    • Diagnosed with Addison’s Disease 11/02 (See Appendix A or Endocrinology text book for explanation of Addison’s Disease)
    • ER admit for dehydration due to vomiting 5/30/06
    • Currently training for a marathon 09/03/06. I’ve been training consistently since December 15, 2005 and I was in shape before starting marathon training.
    • When I run 17 – 20 miles, especially in the heat I get
i. Stomach cramps
ii. Nausea
iii. Diaphragm cramping
iv. Severe hypotension
v. Lack of urination despite drinking water constantly
vi. When I do finally urinate after drinking and ceasing exercise, it’s infrequent, orange
  • Electrolytes tested today
  • Electrolytes tested Saturday following 12 mile run
  • Potential standing order for electrolytes (believe me, I won’t abuse it. I want to be charged to have my blood taken less than you’ll want to do this for me)
  • Renin & aldosterone tested today (needs to be done in conjunction with electrolytes to provide an accurate picture for the potential need of Florinef supplementation (See Appendices B & C for explanations of Renin and Aldosterone testing)
  • Suggestions for salt supplementation to prevent dehydration
  • See Appendix D for abstract “The effects of stress on salt and water balance”
  • See Appendix E for Q&A from the National Adrenal Diseases Foundation about adjusting medication for exercise