Wednesday, June 27, 2012

Adrenal fatigue

Stress - anxiety - palpable across the room, emanates from her  pores. Everything is going wrong at the same time. Unfortunately, this is not new. There has been no  response to everything I've thrown at her. The tell-tale Babesia symptoms:  night sweats, flu-like feelings, air hunger, have not budged

I prescribe a dose of Cortef/cortisol.

Adrenal fatigue is not a real diagnosis according to the Mayo Clinic. Look for real diagnoses like fibromyalgia or depression the web page suggests. No science.

There are decades of published, peer-reviewed research showing alterations in adrenal function in depression, chronic fatigue syndrome, fibromyalgia and other related conditions. The results are abnormal, but confusing and difficult to make sense of.

Adrenal function is regulated by a system of feedback loops. One structure in the brain, the hypothalmus, sends a message to another part of the brain, the pituitary, which in turn sends a message to the adrenal glands. The system is called the Hypothalmic-Pituitary-Adrenal axis. Abbreviated HPA axis. The brain is able to sense whether enough adrenal hormones are made and take corrective actions.

The same system works for thyroid and reproductive hormones.

Over-worked adrenals, secreting  "stress" hormones such as cortisol and adrenaline, are unable to keep up with the demands placed on them. The whole HPA system becomes sick in variable ways.

Adrenal fatigue is associated with chronic debilitating illness like chronic Lyme disease.

The adrenal gland is complex in anatomy and function, releasing a wide array of hormones which I will not address here.

Organized medicine likes blacks and whites. There is no gluten sensitivity, only Celiac disease or not. Likewise, only extreme adrenal disorders, Cushings and Addison's disease are accepted. Black and white. No shades of gray.

The adrenal fatigue syndrome is associated with a plethora of symptoms :  Total  exhaustion. Lack of endurance. Anxiety, panic attacks and depression. Dizziness. Dizziness with standing. Aches and pains. Brain fog. Inability to cope with trivial stress. Fatigue more prominent in morning - or -evening. Second wind at night. Insomnia.  Salt and/or sugar cravings. Weight gain. And numerous others.

Testing of saliva, urine and blood may give confusing results.

Cortisol levels peak level at around 8 am. There is a slight spike at 4 am. Otherwise, levels  decline and stay low throughout the day and into the night.

For this reason cortisol should usually be given in the morning.

I have found measuring DHEA, another adrenal hormone, which can be supplemented,  to be helpful.

For the most part, the diagnosis is clinical.

The immune system works better with small doses of cortisol called "physiologic", even though it is a "steroid." High doses of steroids suppress the immune system and must be avoided.

A little cortisol hopefully takes pressure off the overworked, dysfunctional, HPA, system. Hopefully the hormone can be gradually withdrawn as the disease abates. Tapering must be done slowly as the sleepy adrenals wake up.

The above patient needs to reduce stress, get more rest and eat a nutritious diet. She is a tough case.

Monday, June 11, 2012


A generally very happy thirty-four year old female came in for a followup. She feels tired but attributes this to allergy medicines. In fact, Astepro causes drowsiness. She presented for ongoing care for migraine headaches. The headaches seem to originate in her neck and radiate up into her head. These are classic migraines: unilateral,  pounding in nature, associated with nausea and classical visual changes. Migraines run in the family and she has had a longstanding history of migraines. But the headaches have been difficult to control.

By far, the best migraine prevention medicine is Topomax. However, its nick name is "dopomax", because it is frequently associated with brain fog.

She has been off antibiotics for a year and insists her Lyme is "cured."

She presented in 2008 with an illness that went back 12 years.

Previous symptoms have included: memory loss, disorientation, anxiety, depression, nightmares, joint pain, numbness and tingling, night sweats, flu-like symptoms, dyslexia -  problems with writing and reading, brain fog, getting words mixed up and others.

She was previously treated with an aggressive program which included several months of intravenous antibiotics.

When pressed a bit further she admits to some mild muscle and joint pain but all other major symptoms have been  banished.

I would have to agree with her that her Lyme disease is largely in remission.

But headaches frequently persist after Lyme treatment, at times disabling.

Ironically, this patient works in medical research and studies Botox which can be used to treat migraines. (She has given me permission to publish her story).

Some patients are  treated "forever" -  with the thought the headaches are due to Babesia or perhaps another infection. I have found this akin beating a dead horse.

Standard treatments for migraine are usually effective. A new FDA approved treatment which frequently works is Botox which she is reticent to try.

Monday, June 4, 2012

Trouble with ticks

Bumper crop of ticks this year. Our dog came down  with a lame paw and was diagnosed with Lyme disease. Family members have unfortunately had tick bites. (I know).We live in a zero-lot-line community with minimal grass, no deer - but - lots of rabbits. Our dog is always trying to dislocate my shoulders eager to pursue these critters.
The term "deer tick" is misleading. Deer, like us humans are incidental hosts. The animals feed, neck bent, in tick infested brush. Deer heads and necks covered with Ixodes is a testament to just  how dense the population of ticks is. not that deer are a necessary part of the equation. Any warm blooded animal (even us  humans) can severe as the tertiary host for adult female maturation.  In my case, rabbits are generally the final host.

The problem is the primary host: the white footed mouse. Newly hatched larvae take feed on mice having  Borrelia swarming through their bodies (and co-infecting organisms)  then morph into nymph forms which are the primary culprit for human transmission.

The 6 legged larvae become the  8 legged nymphs, well equipped for the job at hand. They can move very quickly and then lie still, perched for action, sniffing out the carbon dioxide and body heat of their next unwitting meal.

When we pull off an adult tick we don't  really know how many others smaller forms may have attacked us unseen. The issue of how long the tick needs to be in place in order to transmit Lyme disease may be a moot point since most tick bites are never seen.

Some have suggested that most of the ticks are not infected and that we need not worry so much. Informal data from Clongen labs indicates the infection rates may range from 30-70 percent depending on the time of year in our area.

Any effective prevention programs must focus on  effective ways to kill the ticks and perhaps the mice if possible. Thinning out deer populations, as some have suggested, will be of no help.

As for my bunnies, their population does thin out - spring to fall - meals for predators like our fox. Unfornuately, the fox become the next host for the stubborn ticks.