P'shaw, you guys!

Those of you that are following this are making me blush.  Keep it up!! :-)

I am at home right now enjoying a very rare moment of silence and serenity in my hectic life.  I know I've been a bear today.  We have had computer issues at the office since Friday, and our ability to effectively care for our patients is lacking.  I know that might sound like a cop out - but for those of you whose job is computer based, you understand.  I can't access labs, e-prescribe, access messages, bill, send orders, NOTHING.  It's been straining.  On top of that, we have wrestling, scouts, and this is the week of the all-encompassing 4th grade social studies project.  We were out till 10 last night finishing everything up for that....and Lee's teacher wonders why his agenda book isn't in his backpack.  He's lucky he got out this morning with pants on!

The Elkins wrestling tournament is coming up fast, and we've go so much to do for that it makes my head swim.  I'm also "in training" as a pack master for cub scouts, so that's weighing heavily on me, AND we're having some special sessions on the YMCA board that are meeting this week.  Tres stressful.  So, anyhow, here I sit with a glass of (I know, bad dieter) EXCELLENT Pinot Noir (courtesy of the illustrious and witty Bob Crochelt and Donna Smith), and I write my blog.

The blog has been SO cathartic.  I'm glad that people are reading it and getting something out of it.  Actually, I wouldn't care if anyone read it, because I like writing it, but I'm glad that some do.

I had a great experience in the office today.  Of course, it had to do with bioidentical hormone replacement.  I have a patient who is complaining of low sex drive, fatigue, hair loss, and brain fog.  I had gotten blood work on him in the past, and it showed a low cortisol.   Now, realize that I don't believe in blood work.  I check it more as a CYA (cover your nether regions) to make sure that there is nothing "clinically" wrong with the patient.  He does have some symptoms of Addison's disease, so before we started BHRT, we did that workup.  It was negative, but I was still pretty convinced that he had some adrenal issues given his symptoms. 

We've tried a couple of things, and he's very sensitive to medications, so much of what I've tried has given him side effects.  Armour thyroid has helped him a little, but not with everything.   I had started him on sublingual DHEA for some of his complaints of lack of intitative and low sex drive, but that hasn't done as much as he'd like.  He wanted to increase the dose, but last time I checked his blood work, his DHEA was actually in the high range, so I wasn't comfortable with that.  So, I finally ordered a 24 hour urine hormone profile.

Now, many practitioners will say that this is just another form of voodoo.  My experience is that the 24 hour urines are spot on consistent with symptoms.  When our bodies produce hormones, we use them pretty quickly, so they don't stay in our blood stream long.  When I draw blood, it just gives me a moment in time.  We do this all the time to diagnose pheochromocytoma - a (generally) benign endocrine (hormone) tumor.  We know in medicine that just checking a spot level for this doesn't give us enough information.  So, WHY would it give us enough information when dealing with sex hormones????  Good question, huh?  A 24 hour urine tells me what you have produced and how it has broken down over the last 24 hours.  I can get more information from that and your symptoms than from any test out there. 

Anyhow, I won't get too technical, but when I got this guy's 24 hour urine test back, things just really fell into place.  I could really understand his symptoms better, and I was able to get him on a regimen that I think will help him a lot.  It was also something that I wouldn't have thought of causing his problem, and I learned something about progesterone and 5 alpha reductase today that I didn't know (sorry for those not medical, but I had to include that for my naysayer doctors).  It was exciting on so many levels!  First, I think I may be able to help this person who has looked for help before and was not able to find it in traditional medicine.  Second, I was able to put together the puzzle pieces and make a logical, endocrinological answer to this problem.  It was way cool.

It kind of made up for the computer, the stress, the social studies project, the staff out on sick leave......kind of.

Thanks again to everyone reading my blog.  I hope that if any of you feel like you need help, you'll feel free to contact me.  I'll direct you to the office for an appointment, because I've learned not to do medicine over the Internet (the malpractice carriers don't look kindly on that), but I love this so much, that I'd love to see anyone who is open to it!!!

Have a good night and think of me enjoying a wonderful glass of wine in a quiet house - OMG!!!!!!!  Glee is on tonight!!!!! WOOHOO!!!!!

Dr. Mindy