Say Ahh Hypothyroidism
Q: What is hypothyroidism?
A: Hypothyroidism is the medical term for when a person does not make enough thyroid hormone. It is a condition that makes you feel tired. The thyroid gland in your neck makes thyroid hormone. This hormone controls how the body uses and stores energy.
Q: What are the symptoms of hypothyroidism?
A: Some people with hypothyroidism have no symptoms. But most people feel tired. That can make the condition hard to diagnose, because a lot of conditions can make you tired.
Other symptoms of hypothyroidism include:
- Lack of energy
- Getting cold easily
- Developing coarse or thin hair
- Getting constipated (having too few bowel movements)
- Menstrual irregularities in women
If it is not treated, hypothyroidism can also weaken and slow your heart. This can make you feel out of breath or tired when you exercise and cause swelling (fluid buildup) in your ankles. Untreated hypothyroidism can also increase your blood pressure and raise your cholesterol—both of which increase the risk of heart trouble.
Q: Is there a test for hypothyroidism?
A: Yes. Your health care provider can test you for hypothyroidism using a simple blood test.
Q: How is hypothyroidism treated?
A: Treatment for hypothyroidism involves taking thyroid hormone pills every day. After you take the pills for about 6 weeks, your blood will be retested to make sure the levels are where they should be. The dosage may need to be adjusted depending on the results. Most people with hypothyroidism need to be on thyroid pills for the rest of their life.
CARNITINE, FATIGUE, AND NERVE FUNCTION
A substance needed for cellular energy production is L- carnitine. This quasi amino acid is normally found in the body, and is easily interconverted from one form to another. Some is obtained from eating red meat and dairy products, and the body can also synthesize it from other dietary amino acids. A few people with specific medical conditions have actual deficiencies which are alleviated by supplementation; for this reason it is sometimes called vitamin B(t). It has been tried as treatment for many other situations. It is sometimes touted as beneficial for body building; unfortunately, there is no evidence that it helps athletes or otherwise healthy people perform better when exercising, nor with weight loss. There is some evidence that some (not all) people with fatigue due to hepatitis, celiac disease, chronic fatigue syndrome, advanced age, multiple sclerosis or cancer can obtain modest relief when taking a supplement. One cause of male infertility may also be improved, as could some persons with certain types of heart disease, and those taking the seizure medication valproic acid. One small study (ie, statistically not very significant) indicated slight benefit in diabetic weight loss when combined with orlistat, an over the counter medication that blocks fat absorption.
Larger studies need to be done to provide more solid evidence of benefit from L-carnitine supplementation. Supplementation has been reported for fatigue in vegans, persons with ADHD, anorexia or Lyme disease; no studies have been performed in persons with these issues except with ADHD due to the fragile X syndrome, in which case it may be helpful.
Consumption can cause nausea, vomiting, abdominal cramps, heartburn, gastritis, diarrhea, and a fishy body odor. L-carnitine should not be consumed as a supplement by persons with thyroid disorders or a history of seizures without consulting their medical provider.
Another form of L-carnitine, acetyl-l-carnitine, is used for several nerve-related conditions. There is some evidence of improved cognition in those with mild age-related (over 65) or chronic alcoholic-related cognitive impairment, and in depression in the elderly. Doses tested ranged from 1500 to 4000 mg daily, divided into 2-3 doses. Pain from diabetic neuropathy may be decreased with the higher doses of this form of carnitine.
Although these two forms of carnitine can be interconverted by the body, because research has been done on one substance or the other, that product should be used. The cost of these products can vary wildly; comparison shopping is recommended. In addition, and as is true with all supplements, the FDA does not regulate these products for purity or to ensure they contain what they claim.
Natural Medicines Comprehensive Database, accessed 9/24/2012
Up-to-Date, accessed 10/9/2012
Gingko is a Chinese herb which has been used for many applications. As is so common, only a few indications stand up to scientific testing, or have been sufficiently tested. In our college population, improving cognitive function is likely to generate the most interest. There are a number of aspects of cognitive function which can be evaluated; the studies and abstracts in my sources report using different names for these functions, and total number of subjects tested is low. However, in healthy, young to middle-aged people, overall memory improvements are likely in the range of 7%. Speed of working memory seems to be the function exhibiting the most improvement.
Several studies of healthy elderly report no protection to or improvement of memory, though in those with mild to moderate age-related memory or cognitive impairment there may be modest improvement. Studies of patients with dementias, including Alzheimer’s also indicate improvement, though these studies are of questionable quality.
Those with Raynaud’s syndrome and vertigo may experience fewer or less severe attacks, and women afflicted with breast tenderness and mood aspects of premenstrual syndrome may experience relief when taking ginkgo.
Other conditions likely improving with administration of ginkgo include the eye conditions diabetic retinopathy and glaucoma, and peripheral vascular disease.
Ginkgo may not be effective in reducing altitude sickness, SAD (seasonal affective disorder), sexual dysfunction, or tinnitus (ringing in the ear). A large trial showed that 240 mg daily in the elderly over 6 years does not significantly reduce the risk of hospitalization or death due to cardiovascular disease.
Initial studies with insufficient reliable evidence to rate effectiveness have been done on people with anxiety, ADHD, fibromyalgia, schizophrenia, recovery from stroke, and vitiligo (a skin condition).
The various chemical compounds in ginkgo can have significant adverse effects. Raw seeds, crude extracts, and even leaves, can cause strong allergic reactions, seizures and even death, or cause cancer; these sources are not recommended. Extracts of ginkgo leaves affect the ability of the liver to process various herbs and medications. Persons with seizure disorder and those taking medications that can increase the risk of seizure should not take ginkgo. Insulin and diabetic medications, and substances affecting blood clotting are likely to be affected, as are many other medications and herbs; it is best not to combine any substance (including ibuprofen, acetaminophen, and other over-the-counter medications) which is pharmacologically active without checking with your practitioner. Anyone with allergy to poison ivy, poison oak, poison sumac, mango rind, and cashew shell oil is more likely to have an allergic reaction to ginkgo.
Dosages vary, and likely vary depending on the extract. Because ginkgo irritates the gut, start at a maximum of 120 milligrams (mg) of standardized extract daily, divided into two or three doses, except for improvement of cognitive function when a single dose can be used. If no benefit occurs, and once the gut is normal, total daily dose can be tapered up to a total daily dose of 600 mg. Ginkgo leaf extract is often combined with American ginseng; this combination was used in studies of ADHD but should not be used for PMS. Ginkgo with co-enzyme Q10 was studied as treatment for fibromyalgia.
In a local grocery store natural health section, six products are available containing gingko. Three are combinations with multiple herbs, including gotu kola, an herb containing caffeine. One is one of the most frequently evaluated standardized extracts, and two are standardized extracts plus a modest amount of the dried whole leaf. There is some evidence of increased benefit from the whole leaf; presumably the amount added to these preparations is insufficient to cause side effects in most people.
Natural Medicines comprehensive Database, accessed 2/21/2012
UpToDate, accessed 1/31/2012
NASAL IRRIGATION FOR SINUS CONGESTION
Upper respiratory infections (“colds”) and sinus infections are a common affliction in the dry climate of Fairbanks. Often resolving without use of antibiotics, or even any medications, some of the discomfort can be alleviated by moisturizing the mucosa. Nasal saline, or salt water, in a squeeze bottle, is the easiest to use, and can help with clearing thickened discharge from a common cold. In persons with a history of sinus infection, this treatment begun at the onset of cold symptoms can decrease the risk of progression to a full sinus infection, and relieves pressure and congestion. Others find increased relief from a larger quantity of water as applied with a Neti pot or syringe. This physically removes some of the discharge, and relieves congestion and pressure. It also improves the function of the cilia, small hairs lining the sinuses. The cilia aid the clearance of discharge from the sinuses.
Neti pots were recently in the news after two people in Louisiana got amoebic brain infections from using tap water for irrigation. Updated instructions suggest boiling water prior to use in irrigation to avoid this. However, our drinking water in Fairbanks is too cold for survival of the organism at fault in Louisiana, so use of Fairbanks or UAF tap water should be fine. (However, if one is immune compromised, using boiled or distilled water would be safer.)To prevent reinfection of oneself, however, wash your pot, bottle, or syringe in hot soapy water after each use, sterilize or replace every two to three weeks, and don’t share your equipment with anyone else.
Directions and recipes are available on the web ( eg from the American Academy of allergy, Asthma and Immunology), or at the Student Health Center for those who have paid the health center fee.
UptoDate, referenced 1/31/12
Alaska Department of Environmental Conservation, verbal communication, 1/31/12
Q: What is Blood Pressure?
A: Blood pressure (BP) is the force created as your heart pumps blood and moves it through your blood vessels. A BP reading measures this as it presses against the inside walls of your arteries. High BP means that your heart is working harder than it should. It’s also a sign that your blood vessels are being damaged. If left untreated, high BP can lead to serious problems such as stroke, blindness, heart attacks, kidney and heart failure. High BP is often referred to as the “Silent Killer” and can even cause death.
Q: What do the numbers mean when I have my BP taken?
A: Two measurements are taken:
- Systolic BP is the top number which measures the force while your heart pumps. A normal healthy systolic BP is below 120.
- Diastolic BP is the bottom number which measures the force between heart beats. A normal healthy diastolic BP is below 80.
Q: But I thought my BP was good if it is below 140/90?
A: With the new guidelines BPs between 120/80 and 139/89 are now considered to be Prehypertension. This new classification is intended to identify those individuals who are able to lower their BP with healthy lifestyle changes hopefully preventing hypertension entirely.
Q: How can I tell if I’m having high blood pressure?
A: Since high BP rarely shows symptoms, the only way to know for sure is to check your BP reading. If you haven’t had it checked within the last year, come to the Center for Health & Counseling and we can check it for you.
Q: How can I bring my blood pressure down?
A: If the following measures prove unsuccessful, your health care provider may recommend antihypertensive medication of which many different types are available.
Initially try to make healthy lifestyle changes:
- Don’t smoke cigarettes or use any tobacco product.
- Lose weight if your’re overweight.
- Exercise regularly.
- Limit how much salt you eat. ( There is a lot of hidden salt in foods such as bread and cheeses)
- Limit how much alcohol you drink.
- Reduce stress with relaxation techniques or biofeedback.
Q: I am a 22 year old guy and was told I should be doing checks for cancer in my testicles. Is this true?
A: Yes. We don’t know exactly why but testicular cancer is the most commonly found type of cancer in men between 15 and 34 years old. If it is detected early it is much easier to treat. It can be detected in a simple and quick monthly testicular self exam (TSE).
Q: How would I know if something was wrong?
A: Do TSE once a month, during or after a warm shower. Gently palpate (feel) each testicle separately between the thumbs and fingers of both hands for:
· Any lump or firm area.
· Change in the size of a testicle.
· Change in the firmness of a testicle.
· Changes in the epididymis. (The raised rim that runs along the top and back of each testicle.) It usually hurts when you press on it.
· Changes in the Vas (the little tube that runs up from the top of each testicle). Normally it feels like a firm piece of cooked spaghetti.
· Check to see if you have any pain, aching, or a feeling of heaviness in the testicles, groin, or scrotum.
Q: What if I find something?
A: If you find something unusual keep in mind that most changes in the testicles are not cancerous. But you should still have it checked out by your health care provider within a few days. Here are some findings that are not cancerous but may need to be further evaluated:
· It’s not unusual to find a mass of ropy veins on the outside of the testicle (varicocele). It requires treatment only if it causes pain or fertility problems.
· It is normal for one testicle to be lower or larger than the other. Only a CHANGE in the size of one testicle should be checked out.
· Sometimes a fluid-filled sac (hydrocele) develops around a testicle. Doesn’t usually require treatment but should be checked out.
· Small bumps on the scrotum can be caused by ingrown hairs, a rash or other skin problems. If they are painful or bothersome you should see your health care provider about them.
Here are some facts about testicular cancer:
· A painless lump is often the only symptom of testicular cancer in its early stages.
· Testicular cancer is almost 100% curable if caught early.
· M en can still be fertile and have kids after treatment for testicular cancer.
· Treatment for testicular cancer doesn’t affect a man’s ability to have sex.
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