D3, T3, IAG, LDN Update

I'm still struggling with the side effect of Vitamin D3 overdose (constipation). For awhile I did really well with adding 150mg extra magnesium (for a total of over 1000 mg daily magnesium) to metabolize the vitamin D and adding extra T3 (1/3-1/2 of a 5 mcg pill). Both extra Mg and T3 resolved my regularity problem.

However, after I experienced some hyperthyroid symptoms (palpitations), I decided to cut back on the extra T3. BIG MISTAKE!! The constipation returned with a vengence (bleeding hemorrhoids). So I'm back on extra T3 and extra Mg and have normal regularity. However, I'm still dealing with bleeding hemorrhoids. So I'm using 1-2 daily (10 minute) sitzbath sessions to relieve hemorrhoidal swelling and hopefully heal the bleeding hemorrhoids. Preventing constipation is the best thing I can do to prevent hemorrhoids. Nevertheless, I know from experience that bleeding hemorrhoids heal rather slowly.

At my last appointment my doc expressed some concern about taking IAG (arabinogalactan) longterm (more than 6 months). Because I already took IAG for almost 5 months, I asked my doc what she learned about longterm side effects of arabinogalactans. She told me 'joint pain', but she didn't know the physiology of that side effect (or what specifically caused that reaction). So I did some online research and read that IAG is sometimes used for autoimmune diseases.

I know that many autoimmune diseases are highly correlated with (or even caused by) gluten intolerance (gluten antibody damage). Also joint pain is often a symptom of gluten intolerance. So I need to see studies which show that joint pain is actually the result of IAG, rather than untreated gluten intolerance. In other words, perhaps subjects who experienced joint pain were not on a gluten free diet. So the gluten, rather than the IAG, caused the joint symptom. Nevertheless, I plan use IAG only when I have cold symptoms and taper off slowly over the next month or so.

Meanwhile, I counted my remaining low dose Naltrexone capsules and calculated that I have a months' worth left. I divide the contents of my 3mg capsules into capsules containing 1.75-2mg. So I have enough to continue taking that nightly for over a month. I started LDN in late November. So by the end of March, I will have taken LDN for 4 months. That should be long enough to raise my white blood cell (specifically neutrophil) level to a normal range.

Increased T3 Morning Dose

After I saw my mid January blood tests, I realized my worsening constipation was caused by having too much vitamin D in my body. (My vitamin D level was 93 with a normal range of 30-80.) So for the past 3 weeks I've taken extra magnesium (which vitamin D uses) and sometimes extra vitamin C (because I was fighting yet another cold). I also added a teaspoon of flaxmeal to my cereal. All that worked to improved regularity, but also caused extra gas, bloating and cramping pain. (Bloating often causes cramping pain for me, even without any gastro infections.)

So yesterday morning I tried adding a bit more T3 (liothyronine) to my morning dose. Yesterday I added about 2/3 of a pill, because my pill splitter doesn't evenly divide tablets. I felt a little weird, with very mild palpitations. So I took a little less than a full dose in the afternoon and slept well last night. As I expected, the extra T3 resolved my constipation. So this morning I added less than 1/2 of a T3 tablet to my morning dose for a total of about 7, rather than my usual 5 mcg. I had no cramping pain or bloating, because I didn't take extra Magnesium or vitamin C, but I had normal regularity again this morning.

I hope the vitamin D levels decrease enough within the next few weeks, because I usually don't need more than 10 mcg of T3 daily (total of morning and afternoon dose). In fact I did well (normal regularity) when I only took 7.5 mcg of T3, BEFORE my vitamin D levels got too high after taking 6000IU daily for a few months. Right now I'm abstaining from vitamin D until I notice normal regularity. I plan to just add very small amounts (1/4-1/3 of my 5mcg tablet) to my morning dose for a few days and then return to my prescribed 5mcg 2x daily T3 dose.

For anyone who reads this blog, I don't need suggestions about constipation cures. I follow all the usual anti-constipation suggestions, including lots of fiber, fluid, exercise, magnesium, vitamin C, etc., everything EXCEPT laxatives, which I will NOT use. Most laxatives contain either senna or sorbitol, which both cause painful intestinal cramps for me. Others just contain magnesium, which I already take. I prefer to use natural remedies. However, despite following all those 'regularity' rules, liothyronine (T3 thyroid hormone) is the only thing that gave me consistent normal regularity, because my problem was 'low motility' caused by hypothyroiditis, rather than lack of fiber, fluid, etc. So once my D3 levels return to normal (after a period of abstention), I should only need to take my prescribed amount of T3 (or less) to maintain normal regularity.

Doctor Appointment and Birthday

I saw my doc the day before my birthday. We discussed my latest WBC differential results. Because my most recent WBC result increased (from 3.0 to 3.4) and my Hashimoto's antibodies decreased, I decided to continue the LDN at 1.5-1.75mg, which still helps immunity w/o disturbing my sleep. I'll try to take my T3 before 4:30 so that I get tired earlier in the evening. Since the T4 only gives me palpitations and overheating, which disturb my sleep, but doesn't help regularity, we decided to discontinue T4 (Levoxyl) and continue T3 (liothyronine) at my current dose of 5mcg 2x daily. Also I'll continue to abstain from vitamin D (and take more magnesium) until my vitamin D blood levels return to normal symptoms. Unfortunately that could take weeks or even months. SIGH

My doc called in a 3 month supply of my T3 supplement so that I don't have to pick up cold germs when I visit my HMO clinic pharmacy. My doc also recommended I continue taking B12 (1000 mcg daily) and begin taking 1000 mcg of folate daily, because my low WBC could also be related to low levels of those two vitamins. So I'll continue T3, arabinogalactin, B12 and LDN, but add folate for the next 2+ months and then retest after I've taken LDN for 3+ months (or finished my prescription).

The next day I celebrated my birthday by seeing "Black Swan" (for which Natalie Portman won the Golden Globe Best Actress award). That was a dark, disturbing movie, but Portman's acting was outstanding and well worth the award. After the movie I went to get a 'grow out' haircut. I'm growing my hair from a pixie to a short bob. So my stylist had to shorten the back and the bangs (which were in my eyes) and barely skim everything else. I like the overall look of my 'growout' cut, but I don't plan to get another cut for about 3 months. My stylist promised free bang trims when I couldn't stand the length of my bangs. So I can let the rest of my hair grow. After my haircut we visited my local HMO clinic pharmacy to pick up my 3 months' supply of T3 and then went home. I enjoyed my "Tacos Guymos" (favorite Mexican restaurant) leftovers for dinner.

For my birthday, my husband bought me 5 pound weights. I'd been using 3.5 pound weights for years and noticed those were not helping anymore. The 5 pound weights were difficult at first, but I quickly noticed the difference in my arm muscle tone. He also bought me a package of new socks after my feet got wet on my birthday and some facial moisturizer (Clinique). So all in all I enjoyed my birthday.

We planned to continue birthday celebrations with another movie ('No Strings Attached'), clothes shopping and dinner at PF Chang's. However, on the way to the movie, I realized I left my afternoon T3 dose at home. So we decided to just see the movie and go home. Since I was struggling with yet another cold (and feeling really tired), I was happy to go home early and miss the evening rainstorm.

WBC Differential Results

My WBC Differential blood test showed an overall increase, from 3.0 over two weeks ago to 3.4 three days ago. I suspect that WBC score varies from day to day. However, any increase tells me the Low Dose Naltrexone helped improve my immunity. Because I doubted whether LDN was helping, I abstained from taking that for one night. I STILL slept poorly. Since LDN does not have a lasting effect, abstaining for one night prevents any LDN side affects. So I realized that my afternoon T3 dose (and possibly my longer lasting T4 dose) were affecting my sleep, not the LDN.

My neutrophils were the only form of white blood cells which were below the normal range. My neutrophils (absolute) were 1.93, whereas the standard range is 2.00 to 7.30. That's considered mild neutropenia. My monocytes were in the mid normal range. All the other white blood cell differential scores were in the low normal. That included lymphocytes (1.06 vs. a 1.0-3.4 normal range), eosinophils (0.03 vs. a 0.0-0.5 normal range), basophils (0.01 vs. a 0.0-0.2 range).

I researched causes of neutropenia and found that taking antibiotics frequently lowered white blood cells and especially neutrophils. One website listed antibiotics which usually caused neutropenia. Vancomycin (which I took for 6 months during 2009) was near the top of the list. Metrodiazonale (Flagyl), which I took for 17 days before I started Vancomycin, is lower on that same list.

Letter to My Doctor

Here's what I wrote to my doctor, after receiving her request for more blood tests (WBC differential), just before our scheduled appointment to discuss my previous blood tests. I do not want to pay for another appointment to discuss the new test, because I understand exactly what caused the abnormal results on the previous tests. So I explained to her what happened which influenced those abnormal results in the following email:

Today I received your Lab Order Request for WBC differential and will have that done at my local Group Health Clinic tomorrow. I'll ask GHC when you (and I) should receive those results. Then I'll reschedule our appointment to discuss those results as well as my other January test results. However, I may need new prescriptions for both the T3 and T4 before our next appointment. I'll run out of the T4 in 4 days. I'll run out of the T3 in 10 days.

I received the results of all my recent blood tests over a week ago. I was disappointed to see that my white blood cell count remained low after taking LDN for over 6 weeks. The other abnormal test results (low T4, increased TSH, high Vitamin D and possibly low MCHC) reflect what I did during the past 2 months (1) to avoid the side effects of LDN. which interacted with my thyroid hormones to cause hyperthyroid symptoms, and (2) to fight chronic cold symptoms (with vitamin D).

As I previously mentioned, I experienced hyperthyroid symptoms (overheating and palpitations which prevented and/or disrupted sleep) soon after beginning the LDN. So I initially reduced my thyroid supplements so I could continue the prescribed dose of LDN without hyper symptoms. Then I got severe constipation, an impacted stool and bleeding hemorrhoids, all hypothyroid symptoms. So I increased the T3, which had previously improved regularity, and abstained from T4, which did nothing for regularity, while I decreased the LDN dose to 1.5-2.0 mg. However, even the lower doses of LDN continued to disrupt my sleep.

I took the arabinogalactin and 6000IU of Vitamin D daily for 2 months, because I experienced cold symptoms (sinus pain, sore throats, runny nose) between arabinogalactin doses (4-6 hours after taking IAG). I usually get colds when I don't get enough sleep. So I suspect insufficient sleep caused by the LDN negatively affected my immunity. Although I had normal regularity while I took just T3 supplements, I again developed increasingly severe constipation (about a month after the impacted stool incident) before I saw the high vitamin D results and decreased my vitamin D supplments. I'm now slowly returning to normal regularity, but still have bleeding hemorrhoids.

Despite continuing to eat high iron content foods, my MCHC decreased. I wonder whether daily bleeding hemorrhoids could have affected that number.

I hope the WBC differential tests will give you more information my low leukocyte results. I think the LDN caused more problems than it resolved. I believe abstaining from the LDN and getting a few weeks of solid sleep while taking my thyroid hormones and arabinogalactin could improve my imunity.

January Blood Test Results

My recent blood test results contained both good and bad news. Although I understand exactly how my other results changed, I don't know why my white blood cell count didn't increase after taking LDN for 6 weeks. Here are the latest results with my comments about differences current and previous test results:

CBCs: Everything was normal except Leukocyte count and MCHC, which were both low again.

Leukocyte (white blood cell) level remained at 3 (normal is 4.0-10.7). That did not increase despite taking Low Dose Naltrexone and arabinogalactin to fight viral infections for over 6 weeks. I don't know why the LDN didn't improve my immunity and raise my white blood cells. However, I haven't slept well very often since I started taking LDN. As mentioned, LDN interacted with my thyroid supplements so that I awoke overheated with heart palpitations. Those symptoms decreased when I abstained from thyroid, but then I got severely constipated (a hypothyroid symptom). So I decreased the LDN to minimum 1.5 mg dose and slept well for a few nights. When I took a higher LDN dose (1.75-2mg), I slept poorly.

MCHC decreased to 32 from a previous 33 (33-37 is normal) in November and 32 in September. I suspect the MCHC levels decreased again, because I've had bleeding hemorrhoids almost daily for the past 6 weeks. That began after an impacted stool episode which occurred after I decreased my thyroid supplements to prevent hyperthyroid symptoms caused by interaction between LDN and thyroid supplements.

THYROID HORMONE TESTS:

TSH increased from 0.797 in November to 1.72 in January (normal range is .3-3.0). Both those results are normal, but I suspect my doctor prefers a lower TSH score. Decreasing my T3 and T4 supplements to prevent hyperthyroid symptoms caused by interaction with LDN affected my TSH.

Free T3 increased from a previous 2.0 in November to 2.7 in January (normal range is 2.4-4.4). Because T3 decreased my hypothyroid symptoms (constipation, low energy, low body temp) more effectively than T4, I continued taking T3 while I eliminated T4 to avoid hyper symptoms. Despite having no improvement in hypo symptoms while taking only T4, I can more easily overdose on T4. So I cut T4 and continued T3.

Free T4 decreased from a previous 1.19 in November to 0.67 in January. Not taking T4 while continuing to take T3 could have caused that decrease. So I recently resumed taking 25 mcg (1/2 prescribed dose) daily.

Anti-TPO (Thyroid Peroxidase AB) decreased from 53 in November to 47 in January (normal range is 0.0-60). That decrease may have been the one positive effect of taking LDN.

Thyroglobulin Antibodies remained less than 0.9, as they were in November (normal range is 0.0-4.0).

Vitamin D3 (25 Hydroxy) increased from 33 in September to a higher than normal 93 in January (normal range is 30-80). I suspect taking 6000IU of D3 daily for 2 months increased my blood levels of D3 too much. However, I took the D3 to improve my immunity (ability to fight off viral respiratory infections), while my white blood cells were (are) low. That high Vitamin D level explained why I experienced increaseingly severe constipation (more bleeding hemorrhoids) during the week before I received that test result. Since then I've cut waaaay back on Vitamin D to let my blood levels decrease and restore regularity to let my hemorrhoid heal.

I received the last of those results at least a week ago. Then I made an appointment to see my doc to discuss what to do about those results. Actually I know how to resolve everything except the white blood cell levels. I can take more T4. I can take less vitamin D3 supplement. However, I also need new prescriptions for both my T3 and my T4 supplements. If I weren't taking the LDN I would request a compounded slow release T3 supplement to eliminate taking a second T4 pill one hour after lunch, which sometimes occurs rather late in the afternoon.

I didn't notice any benefit to taking the LDN. That did not increase my white blood cells, but it did disturb my sleep for many nights as well as cause hyper thyroid symptoms. Insufficient sleep can also lower immunity. (I notice I catch more colds when I don't get enough sleep.) Rather than start me at a low dose, my doc prescribed an LDN dose appropriate for my weight. Then I began waking up in the middle of the night feeling overheated and having palpitations. After I recognized those as hyperthyroid symptoms caused by interaction from the LDN, I decreased my thyroid. Then I got severe constipation with an impacted stool which caused bleeding hemorrhoids. So I resumed my thyroid supplements at a lower dose, which restored regularity UNTIL high levels of vitamin D again caused constipation and bleeding hemorrhoids. Decreasing the vitamin D eventually restored regularity, but I still have bleeding hemorrhoids. I suspect eliminating the LDN and increasing my thryoid supplements will help me sleep better and recover from bleeding hemorrhoids.

Our Birds Are BACK!!

Perhaps because Seattle had warmer (and rainier) that usual weather in January, the Redwinged Blackbirds returned to their usual spot on Greenlake. Usually they migrate South (Mexico?) in early winter and don't return until February or March. So we were overjoyed to see (and hear) them when we passed the traditional RWB bush on Greenlake. For many years my husband and I (among many other Greenlake walkers) hand fed the Redwinged Blackbirds, who land on our outstretched hands to eat chopped peanuts or other seeds. (We just bring peanuts.)

In recent years some Blackcapped Chickadees had joined the feeding frenzy at the bush. Actually the BCCs approach us (land on our hands to eat) much sooner than the RWBs. Usually the RWBs watch us warily until the first of their flock bravely lands on our hand to take a peanut. The braver RWBs (or birds who remember us from previous years) will remain on our hands up to five minutes as they gorge on peanuts. Most Chickadees prefer to eat in private. So they take one peanut, fly off to eat and return often for more peanuts. more often bravely approachthan the RWBs.

Sometimes other people, who walk the Greenlake path, see us with birds eating on our outstretched hands and ask: "Is that your bird?" I always answer: "NO, but he thinks I'm his human." After many days of feeding and increased familiarity, a few male RWBs become very possessive of their human feeders. They definitely have a 'pecking order' and can scare lesser RWBs from our hands. Usually males dominate the pecking order. However, a few familiar females will watch and wait for the dominant male to finish feeding. Then the female will take her turn and feed for a long time.

I most enjoy feeding the RWBs when they are raising families. The male and female birds will individually approach me, take one peanut and fly back to their nestlings. Their feet are often wet, because they land on wet water lily pads to catch bugs to take to their nestlings between peanut feedings. One summer my favorite female RBW (whom we named 'Rita') visited me many times as I sat on the grassy shore along the lake. She flew to me, took a peanut and then returned to her nest to feed her babies. Then I would see her fly to the water, return to the nest and feed her babies again. I realized she was feeding insects to her babies, beause she landed on my hand and 'traded' a dead insect for peanuts. Maybe she was trying to take peanuts and insects to her nestling, but realized decided to leave the insect with me and return after feeding her baby a peanut.

Feeding the Redwing Blackbirds and Blackcapped Chickadees (who land on our outstretched hands), American Coots (who come running to me while madly flapping their wings to get peanuts) and Crows (who recognize me no matter what I wear) motivates me (and my husband on weekends) to walk 3 miles around the lake rain or shine from early spring to early winter every day. They are not really 'our' birds, but we are some of the humans who feed them every year and make Greenlake home for migrating RedWinged Blackbirds and Coots. (Crows follow us year round but Chickadees only approach us when they RedWinged Blackbirds return.)