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- Fri Oct 23, 2009 9:46 am
Its going to be difficult to keep this short so bear with me.
Before im instantly dismissed, I also need to post a bit of background.
Im a comp sci major+statistician, a huge skeptic, critical thinking nerd and reject "alternative medicine" type of things without hard core double blind studies to support claims.
Thats said.... I have suffered for 10 years with extreme fatigue due to the incompetence of many GP's who would rather send me on my way with the default declaration of "depression" than to spend some time trying to figure out what has actually been wrong with me.
My fatigue has slowly grown over a 10 year period until I finally became completely disabled. Getting out of bed for more than 15 mins at a time was near impossible.
During these years I had my testosterone levels checked. Looking at my spreadsheet of blood test results, I now see they had been slowly dropping every year until I fell off the very bottom of the scale. I was symptomatic of low testosterone when my levels hit 430 (for a 30 year old). I was suspicious of a low testosterone issue because the symptoms matched so well but my doctors kept telling me I was fine because I was "in range".
Then the day came where I finally tested below the bottom of the T scale and was finally put on T replacement. It was like night and day. It has been discovered that my body requires a T level of at least 550 to feel good again. (range 350 - 1200).
Here is the part that angers me so much, and applies to ALL blood tests.
Too many docs use the lab ranges strictly as a black/white mechanism as a decision point to treat or not treat.
Its absolutely ridiculous that one month I could have a T level for 350 and be told im fine, and the very next month a T level of 349, which is below range and get treatment.
We are not binary computers, we are analog machines and each persons optimal level for any given blood test will land on a bell curve somewhere.
I may require a 550 T level to feel good. Or a TSH of 0.7 to feel good, whereas someone else may require a 900 T level to feel good, or may be fine with a TSH of 2.0.
Wheeeeeew... still with me? Now many doctors dismiss "adrenal fatigue" as some kooky myth sold by people who want to sell supplements an don't have real training.
BUT.... keeping the analog human bell curve in mind, it is also absolutely ridiculous to draw a hard line in the sand and claim that if you have cortisol levels below THIS LINE you have addisons and above this line cushings. Its a grey scale. If you are just barely above the line for clinical addisons, there is no way you can tell your patient "oh you are fine". Their cortisol levels are clearly sub-optimal and they could very well be symptomatic even though they pass (barely) all the tests for addisons.
Which brings me to my latest discovery. I have adrenal fatigue, or if you don't like that term because its too often tied to a bunch of hooey, how about "Hypoadrenalism"?
It was hard to detect because my morning cortisol was midlevel, but quickly fell below normal by 11am and for the entire test of the day and night. Which caused my initial thryoid medication to fail and make things worse.
I am also hypothyroid which wasnt discovered until the AACE guidelines were changed a few years ago such that a TSH > 3.0 was considered seriously suspect.
Imagine that, one day I wasnt hypothyroid according to my doc with a TSH of 3.2, and the very next day when the new AACE guidelines were published I was!
So I assert "adrenal fatigue" or ""Hypoadrenalism" or an "non-optimal cortisol" levels, is very real syndrome, it logically has to be. Being 0.01% above the line for addisons, in many cases, cannot be healthy.
So why am I writing this?
IM BEGGING ALL DOCS to stop turning your patients away with a quick hand wave and diagnosis of "depression", then try to put them on anti-depressants when you havent done your homework. I was labeled depressed for 10 years, and it was utter nonsense. Everything in my life was great except for the fact I was so tired I could not live it. I did have secondary depression. How could you not? When you feel that terrible, of course you will be depressed, but depression is not the cause of the symptoms.
TO ALL PATIENTS - never take your docs word as gospel. Being in range for a blood test can *sometimes* mean nothing, especially if you are close to one end of the range. Play close attention to symptoms and get many 2nd opinions.
I would like to hear from the docs if they agree or disagree, but if you disagree please provide a logical explanation why being .01% above the line for addisons is just fine and not likely an issue that currently lacks a label. (like adrenal fatigue, etc)
| Dr.M.Aroon kamath
- Tue Oct 27, 2009 3:00 am
I, at the very outset, declare that my knowledge of statistics at its very nadir!
I will share with you some of what little i understand about the so called "laboratory reference ranges".
Nowadays, it is preferred to call it as 'reference' range rather than 'normal' range
( because a reference population - a 'normal-appearing' population, can be easily defined than a completely 'normal' population).
The usual definition of a reference range is- - the set of values 95 percent of the normal population falls within, or two standard deviations from the mean, although this definition may differ.
The reference range is arrived at by testing a large number of 'healthy' people and observing what appears to be "normal" for them.For obvious reasons, the laboratory reference range may vary from place to place and between institutions!
References range will vary with age, sex, race, diet, use of prescription or other drugs, stress and even the instruments used to measure a given value.
For example if an European citizen happens to fall sick and gets investigated in say africa, his/her blood values may fall out of range(to get the most reliable of results,it would be ideal to be flown back to their home country where the laboratory reference range is likely to be more representative).
Furthermore, reference ranges only denote what are usual values in THAT population, and do not directly correlate with the ranges for optimal health.
I agree with you that at times(unfortunately), a patient may get labelled one way or the other.
But as it stands now, it may be impractical to find out whether a test result is normal for a particular patient if the result may be slightly out of range.It will be time consuming, may involve repeated testing and may not be affordable by some individuals and may not be cost-effective for even governments.
What is recommended by experts in this field however, is that if a test result is out of range, it only indicates that patient should be investigated further - this is different from saying that any value out of range means that patient has a disease.
I empathize with some of your genuine frustrations.
What i can't understand though, is that you say you "reject alternative medicine" type of things without hard- core double blind studies to support claims"--- and yet repeatedlly use the term 'Adrenal Fatigue' which is a terminology still used in some forms of alternative medicine and not by mainstream modern medicine (which prefers the term 'adrenal insufficiency' for the same condition).
Thank you for a statistically significant post.
- Sun Feb 07, 2010 7:52 pm
I have recently been diagnosed with adrenal fatigue via saliva test.
How long does this take to heal? What's the best way to heal? And are OTC allergy medicines like Claritin counterproductive?
- Sun Feb 28, 2010 7:37 pm
I have been suffering from fatigue for around 4 years now, and it's gotten especially worse in the last year. It's so bad that I need to sleep for around 12 hours a day, which is not feasible. If I don't get that much sleep, I'm in a total fog and can get nothing done. I get a burst of energy maybe about once every three or four weeks and it lasts about long enough to do a sink full of dishes. The rest of the time, I drag myself around. I've been tested for anemia, low thyroid, and diabetes and everything's normal. I have also been depressed and have bipolar disorder. I found information on adrenal fatigue syndrome and it gave me hope that maybe I have a problem that can be treated. The thing is, however, I don't feel like I can go to a doctor and announce what I think I have. Please let me know if you can help me with this.