Episode 5:Tired or Exhausted? Brain Fog? Could it be an Autoimmune Disorder?
Join me as I take a community member through the process of getting the help she deserves. Learn how to advocate for yourself while speaking to your health care practitioner. In this episode, host Haylie Pomroy and her client walk through creating a Request For Care, highlighting the importance of how you engage with your healthcare practitioner. Haylie shares the tools, tips and jargon, she uses in her clinic! Join them in this great conversation to learn how you can engage a health team and much more. ---
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Tired or Exhausted? Brain Fog? Could it be an Autoimmune Disorder?
I have a very special guest who is joining me from our beloved community. We're going to go through creating a request for care or how you can engage with your healthcare practitioner. It is very important in that short but valuable amount of time that you have with whatever practitioner you're engaging with, whether it's your internal medicine, a neurologist, a nephrologist, your acupuncturist or chiropractor. It's very critical that during that time, you effectively convey what you want in a partnership, what your expectations are, but also the why you want it. You have to in this day and age with the way our healthcare system is, justify the action by your partner who's your healthcare practitioner. Ann, I want to start with you. Thank you so much for being here. It's lovely that you're open to sharing this. I know that this is going to help thousands of people make a change in their own health and wellness. Can you give me a little bit of color on how I got you to join me, besides me coercing and begging?
Thank you, Haylie, for your help. I’ve been on FMD and a lot of your other programs and I’ve lost about 32 pounds. I would think that I'd be feeling great, but I'm still not. I'm very sickly and not wanting to be very amorous with my husband right now. I went to the doctor and asked her to run a pretty extensive metabolic panel. She didn't. She only ran the basic one. I asked her to do a full thyroid panel because I'm hypothyroid. She said, “Only if you're out of range on your thyroid.” It came back in range. I'm not feeling super great. I feel good, but not great like me. I want to get some help in talking to her.
I feel like preparing my clients in the clinic to engage a healthcare practitioner and putting it in writing is one of the most valuable assets that I’ve learned to offer for many years. What you shared with me is something that I hear so often, which is we get into this situation where maybe we can't articulate effectively in a way that will inspire the physician to take action in a way that you feel is the best for yourself. One thing you had said you had. Was it approximately about 32 pounds of weight loss? From an endocrine perspective and in the fertility world, we look at 10% of either weight gain or weight loss as a significant endocrine event, so much so that it can change your entire endocrine profile. Fat cells and adipocytes are an accessory endocrine gland.
Think about 32 pounds, it's like having an ovary resected or taken away. It is equivalent to surgerizing a part of or a portion of an endocrine gland. That's important. Sometimes physicians forget about that. They equate maybe a little bit of our belly fat to a cheeseburger or a cheesecake, and they don't equate it to the validity and the value of your ovaries or your adrenals or your pituitary or your thyroid. That's one of the first things. As we fill out the request for care, we want to talk about some of the concerns. We also want to remind them of something that maybe they forgot since they've been in medical school. Who knows? We always want to assume that. A little funny caveat. I was with a relative of mine in the emergency room. I had requested some labs and they said, “We'll run this, but we won't run that.” I said, “Can I ask you why not?” They said, “I don't feel like it will be off, and so therefore, I don't want to run it.”
I can be a little sassy and I don't suggest that people are sassy, but I said, “I appreciate your feelings. However, she's in the emergency room because she doesn't feel good. She wants it run. The person that trumps on this decision is her.” He said, “I’ll only run it because she wants me to.” I said, “That's awesome because she's the patient.” I was sassy. I didn't have time to write things down. We were in the emergency room. Thank God they ran it. It was very important. Knowing how to ask those questions is hard on the fly. You've got to remember I’ve been doing this for many years. It's one of the reasons why we do the request for care is because when you're in that office, we can send this ahead of time. You can give it to the nurse and then you have it to refer back to and to keep repeating, “I'm having some health issues that are concerning to me.”
When we fill out a request for care, the first thing that I have you do, which you did Ann, which was awesome, is fill out your health wish list and a self-assessment questionnaire. Both of those are available on your member’s section of the website. Although you can also go on your member of Facebook and ask our group. They’ll shoot you the links and all that stuff. It's important that you know where you're at and where you want to go to. Ann, I want to ask you. Let's play with our top three things on the wish list that are concerning us so that would come from your self-assessment. Let's say you make 20, 30, 40 things on your health wish list.
I want you to dream big before you go to your doctor's office. I don't know why sometimes we feel like that's not the place for us to ask for an amazing life. When your emergency room, I understand crisis intervention, but when you're engaging a practitioner and a team member, we want to dream big. I'd like you to take three of the things on your self-assessment questionnaire, things that are concerning to you right now and three things on the health wish list. Let's play with those a little bit. Let me start with one thing. First and foremost, are you on any medication?
Can you tell me what those are?
I take a thyroid medication.
Do you know which one?
It’s 125 milligrams.
A couple of things that I want everybody to do before you go into the doctor's office. On your request for care, start on the back page of it. We have a protocol for progress sheet too. You can fill that out if you want or you can do it this way. Levothyroxine is a generic for Synthroid. She's on 125 micrograms. I want everybody to do their homework. I want you to do three things when you are on a medication. I want you to know what the generic name and the commercial name is. This is commercial. I’ll tell you why I want you all to do this. I want you to know what the drug is. This is T4, a thyroid hormone. It'll say T4 or T3. I teach a lot about this. The difference is on the iodine molecule. You're on a T4. The thyroid produces T4, primarily a little bit of T3, and the liver converts it into T3 by plucking off an iodine molecule. The liver does it.
The reason why I say this is because I looked at your sheet, the liver also metabolizes the B12. I know that you said you have high B12, so my brain is going, “She's going to be so fun to work with.” You're on Levothyroxine. She's on 125 micrograms. Make sure you look at your bottles and write this down. I’ve been in multi-disciplined practices where we have everything. Nephrologists, in-house labs, cardiology, fertility doctors, OB-GYN, you name it. I cannot tell you how many times we have issued the wrong medication at the wrong potency and we don't recognize or realize it until 4 or 6 months later. You need to know what you're on, why you're on it, how much you're on and what the heck a doodle the drug is. Any other medication?
Yes. I'm on Simvastatin, 20 milligrams.
This is a statin drug. The goal for this drug is to reduce the body's ability to produce LDL or a particular density of cholesterol. Remember though that cholesterol is the building block for all of our sex hormones, estrogen, progesterone, testosterone. It is responsible for thyroid metabolism, the metabolism of the cholesterol molecule. We're on a medication that's suppressing that. Also, we want to look at ranges. I know this in my brain, but you can look it up on PubMed or Drugs.com. It doesn't matter. Believe it or not, the range from this drug is 5 to 80 post-surgery. For a long use of it, it usually ranges from 5 to 20. You want to know when you walk in that you're on the higher end of the dosage. We want to know what in the world the drug is supposed to do for your body. The drug is supposed to keep your cholesterol and your triglycerides below 100 and 200 is what they're shooting for.
I had a heart attack several years ago and my cholesterol was great, although my good cholesterol was low. They said, “You'll be on a set the rest of your life.” I tend to try and figure out which one worked for me. This one does. I’ve been on it for years.
This is super important when you talk to your physician. Believe it or not, even if it's the same physician that saw you post-heart attack, he might not remember that episode. You need to remind him that you had a heart attack. You need to remind that doctor that wasn't willing to run the thyroid, “I had a heart attack. This is a super important request to care. Please note that I’ve lost 32 pounds and that is affecting my hormones.” You want to say, “Because the fat cells are an accessory endocrine gland.” I would literally write that. The other thing that you want to say on your second line is, “Please note that because of my heart attack several years ago, I have been on a very high level of statin drugs that can also affect my hormone production, as you know, Doctor.” Let me ask you, did they put you on a vitamin D?
Yes, because I was low, but when I had the panel, my D is also high.
I hope that everybody can already see how important it is that we have this thought process before we go into the doctor's office. You've already told me profound things that are letting me know that we need to have a deep conversation with our doctor. We might only have 3 to 7 minutes for which to do so. This is going to be backwards, but I'm going to show you. Cholesterol, the liver converts it into a master hormone called pregnenolone. Pregnenolone then converts it into estrogen, progesterone, testosterone, vitamin D. Remember, we've got a drug that's suppressing our cholesterol production. Therefore, we're not metabolizing our vitamin D. It’s one of the end pathways and that's okay. Once we know what the medication is doing and what the purpose and the reason for it, we can work around how to nurture the body metabolically. The other thing is it regulates mineral corticoids and glucocorticoids. Mineral corticoids regulate the blood pressure. Do you have any history of blood pressure issues?
It used to be high. Now, I'm off my blood pressure meds and it's normal.
Now your vitamin D is high or low?
That’s because you’re on a vitamin D supplement?
We've supported mineral corticoids by your weight loss because those are stabilized, which is why your body is no longer deficient in blood pressure medication. We've stabilized your body's ability to metabolize vitamin D, which is why the levels came high when you're taking a fat-soluble vitamin. We no longer have that deficiency that we need to compensate for. Where are your HDLs and your LDLs?
They forgot to run that this time, but my HCL now is in the high 50s. My LDL is right around 100. It's pretty good.
Your LDL should never be below 140. That's okay. You might be thinking of your triglycerides.
My LDL is low.
One thing that we want to do is we want perfect. We don't want to high or too low because that's a lot of energy. It's also important. I know that you shared that you had a car accident. You also had surgery. The adrenal glands, just from the anesthesia, let alone the healing and trauma repair from an incision or being surgerized. I always tell people, they say, “I had surgery. I signed up for it.” As you all know, I had several surgeries from my car accident. I made the appointment. I wrote a big fat check. It was all intentional. I'm having all this adrenal thing. It is equivalent to being knifed. You are cut open. That is not a normal physiological thing. We have to deal with that stress and nurture those adrenals. It's the same with a car accident. There's a lot of trauma that physiologically happens to the body that we have to nurture and feed those kinds of coming back. I know that you had mentioned about sleep and you had mentioned about anxiety post-accident. Give me two more things on your health wish list. I already know what I'd write to the doctor walking in the door. That's what we're going to do here.
One is to get my numbers in line. My vitamin D was high. My Vitamin B12 is high, and then this fatigue thing is kicking my butt. I have so many things I need and want to do. I'm exhausted all the time. If I sit down and close my eyes, I'm out.
The way I start with the Dear Dr. Sanders letter is, in the beginning, I always want to express my health concerns. I always try to come up with a lot of adjectives, the most expressive way in order to communicate. You have to remember that these people are working long hours with a lot of patients, a lot of trauma care or whatever. You have to wake them up to your passion of being healthy during a very short amount of time. You'll see the lines that say because of, “Because of I would like to run.” We want to list our top four because of’s. We're going to start with the because of’s, then we're going to go to the concerns and then we're going to remind them who you are and how special you are and how important it is that they get this right.
I call ahead for a lot of my clients and I say, “We want to let you know we've sent this over.” You can call ahead for yourself. “I want to let know I’ve sent this over. Please make sure the nurse and the doctor review it ahead of time.” Does it matter if anybody reads it ahead of time? The staff knows that you're that committed to yourself. I was telling my daughter, there's a reason why there's an armed guard in front of Tiffany's jewelers and there's not in front of Sears jewelers. It's the value of those diamonds and it's perceived value. You want that armed guard. You want that presence when you walk into a doctor's office that you are a delightful and most important person they're going to see all day long because you're my client.
The things that I came up with, I came up with three and I want you to come up with a first one. I wrote because of significant fatigue, of significant weight loss, and of extreme exhaustion. The reason why is because when you're coding an insurance, weight loss more than 10% again to the body weight, there's a lot of yeses that the insurance companies will say to insurance that helps the doc. The other is extreme fatigue and extreme exhaustion. There are actual diagnostic codes for those so it helps the doc. I'm trying to be helpful, not just sassy. Now you need a fourth one because of.
My basic metabolic panel highlighted some irregularities. The high B12, the high vitamin D, the high triglycerides.
Most of the time, they're not going to care about your vitamins. You can talk to them all you want. Unless they're selling your vitamins when you walk out the door, they're not going to care about your vitamins. Even if your doctor's amazing.
High B12 can be an indication of a blood disorder like leukemia or a liver issue. I'm like, “It's high. It's 1,497 and it's supposed to be over 800.”
What we want is a liver panel run and we want is a metabolic panel with your CBCs, with your white count, your red count. We want all those runs, but most of the time, they're not going to get run because of a high B. We've got to make another reason to run them. I believe you in the fact that an elevated B, although it's a water-soluble vitamin and why you're not processing it out, I do agree with you that it's good to rule out these things. When there's a vitamin one, they'll say, “Stop taking your D and are you taking anything with B vitamins?”
That's what they did.
We go backwards. You brought up leukemia and liver disease. What would we run metabolically to rule that out? The panel that we want is we want a liver panel. We want a lipid panel, but the way we're going to get it is because you had a heart attack and you have high triglycerides. Your lipid panel and your liver panel are going to get us to see if there's liver disease and leukemia and all that stuff. You’re not going to get by saying “I don't believe.” You're going to get it by saying you have a high B. The thing more important to a physician is that they've got a patient that had a heart attack and now has elevated triglycerides. We need to see if it's a liver enzyme issue, if it's a lipid metabolism issue, or if it's an inflammatory issue. We're going to say, “Because of my history of heart attack and elevated triglycerides,” and I hope you understand that I'm not by any stretch of the way trying to devalue the vitamin D elevation and the B elevation. I value that so much. I'm trying to get your labs run that we want run.
The last one would be because of history of a heart attack and elevated B12. We want a lipid panel test, HDL, LDL. Remember this, handy dandy, HDL, those are the good lipoproteins. LDL, low down dirty lipoproteins. Those are the bad lipoproteins. We want a lipid panel with triglycerides, and we want a liver panel that will be ALTs, GGTs, ASTs, ASOTs. You could say lipid panel and liver panel. With my clients, I highlight the labs that we ask for. This second line right here, I always highlight the labs that we asked for in yellow because then I take this with me when I go to the phlebotomist.
To make sure, I say, “Did the doc run these?” They look and they go, “They ran a liver panel, but not a lipid panel.” “While I am sitting here, can you call them quick? We agreed on a lipid panel.” I'm called back to the office before they draw their blood. What they did to my husband, we were at UCLA and they said, “We'll draw it in and we'll call the doctor later.” We said, “No, we'll sit here and get it done.” What will happen is a lot of times insurance won't cover for you to redo your labs for another 6 or 8 or even 12 months. You're sitting there wondering how we should feed the body and feed the metabolism.
That's what happened. They didn't run the lipid panel.
That's why you're going to highlight it in yellow. You're going to say we agree. You're going to go the phlebotomist and go, “My doctor is the most amazing person in the whole wide world. I happened to be super organized. Let's make sure we ran all this. We're all kumbaya and singing. We can learn about our chemistry and we can be the most healthiest patient. You can tell everybody what an amazing doctor you have.” If I heard you correctly, there's a couple of things that would make you feel better about how you're proceeding with your health. One is a CBC or you want to look at white cells, red cells. You want to make sure that you're ruling out the leukemia stuff.
One last thing that I forgot is in your lipid and your liver panel, you need to ask for a CRP. This is all in the Food Rx book, what labs to check. Your CRP is your Cardiovascular Specific Reactive. It's a reactive protein. It's for the heart. It's an inflammatory marker. We can ask for it because of the accident, but they're going to usually say you're so post, but with an individual that's had a history of heart attack, especially an individual that had a heart attack that had a stable LDL. It indicates that your heart issue was inflammatory-related versus lipid-related. It’s a marker for her. You need to say, “I had a history of a heart attack and elevated triglycerides. Please note I had a heart attack despite stable lipids and I am prone to inflammation.”
When you say, “Because of the history of heart attack and elevated triglycerides, and I'm hyper inflamed because of my car accident, I want a CRP.” Now you have given them all the reasons of what you want. It's important to define what you want, but now you've got to make your story, make your case. I’m sorry I spend so much time and people pay me thousands. It's almost embarrassing to go in and navigate this for them. In some people, it is an issue of life and death whether you get the true partner in your health. We're going to go back to our significant fatigue, our weight loss and our exhaustion. Significant fatigue and weight loss, let's go there first. Let's go backwards because I'm dyslexic. Let's go extreme exhaustion. You want a CBC and a basic metabolic panel. What I like to say is to rule out any low-grade infection or deficiencies.
Whenever you're asking for a CBC and a basic metabolic panel and you're exhausted, I always say, “I need to rule out any low-grade infections and I need to rule out any deficiencies.” Now we have our fatigue and our weight loss left. If I hear from your wish list that you would like a comprehensive thyroid panel, this is what I would say. “Because of significant weight loss and being on a high level of T4,” because now you're super savvy in what you're taking, “I would like to check T3, T4, TSH, free and total and reverse T3.” If you're telling me like, “I had a heart attack and my triglycerides were 280 and my HDL was 39 and my total cholesterol was 486,” I know you're not. I looked at your chart enough to go, “Not that profile.” You're telling me we have an inflammatory propensity. Do you know why you went on Synthroid?
The fatigue got so bad. They had been testing my thyroid all along, but all of a sudden, it dropped. It was very sudden.
My suspicious brain says that we should check maybe the antithyroid antibody or thyroid peroxidase because 125 micrograms of Synthroid is a lot. You should be swinging from the fricking chandeliers and chasing your husband down before he walks in the door. You need to communicate that stuff. I am at 125 micrograms of T4. I should be chasing the man down, swinging from the chandeliers and pouring cups of energy to my neighbors for after-dinner drinks, here you go. Have some of my energy. You should feel boosted by that. You want to ask for an antithyroid antibody and a TPO thyroid peroxidase. Those are inflammatory response to the thyroid.
A lot of times, if you ask very specifically for them and you give them the ‘because of’ and you need to say, “I lost 32 pounds. I’ve been on 125 micrograms of Synthroid for a long time. I had a heart attack because of inflammation.” You need to remind her of that every time she blinks her eyes because that's a big deal. That's something that you want to nurture your body through and you want her to be a partner. The other thing is with significant fatigue, I always like to throw it in. That'll probably be covered on everything we're running. Let me go through this again.
“Dear Dr. Lovebug, I'm having health issues that are very concerning. In addition to the normal labs I'd like to run at this visit, can we please run some diagnostics so that it can help define what's going on with me? The reason I'm requesting these is because I am experiencing extreme fatigue, a significant weight loss. Extreme exhaustion and I have a history of heart disease. I currently have elevated triglycerides and my heart attack happened despite having stable lipids. Please also note that I had a significant car accident and feel like I am in a state of inflammation right now. Because of the significant fatigue, the labs that I'm requesting should unveil some things that we need to work on.
Because of significant weight loss and being on a high level of T4 Synthroid or Levothyroxine, I would love to have you check my T3, T4, TSH free and total, T3 and T4 uptake, reverse T3, my ATA and my TPO. I know ATA and TPO are not in your normal panel and the others are. However, because I had a heart attack that was based on inflammation. I’ve now been in a car accident and I'm dealing with inflammation, I want to make sure that I'm not attacking my own thyroid. That's why I'm not swinging from the chandeliers and chasing my husband down, even though I'm at 125 micrograms.
I also wanted to note that because of extreme exhaustion, it would make me feel a lot better to rule a few of the scary things out. I'm requesting a CBC and a basic metabolic panel. I want to rule out any low-grade infection or any deficiencies. One last thing, as I mentioned, I had a heart attack several years ago. It was based around inflammation, it seems. I am having high triglycerides again. Let's make sure we checked that lipid panel with triglycerides, as well as a lipid panel, as well as a liver panel and a C-reactive protein. I just want you to note, Doc, I'm still taking my 20 milligrams of statins even though I have high triglycerides. As I mentioned, I'm on that high level of T4 and I can hardly stay awake when I sit in my chair.”
That's your story. You're going to highlight the labs that you want. If you get push back, you need to say, “Can you please put in writing because I don't understand. This all makes good sense to me in my health. I know that you're my number one champion of health. I cannot wrap my head around why we're not running these. Do you mind putting that in writing for me?” I hope this helps. We're going to do more of this. Do you feel a little more empowered?
I feel a lot more empowered, Haylie. I appreciate your help.
Don't hesitate to schedule a follow-up visit and say, “Did I come in here unprepared? For some reason, I thought that someone else was the captain of my team. I totally blew it with the valuable time that I had with you, but I'm prepared and I'm excited for us to partner together.” I can't wait to see what we find. I love labs. I love chemistry. I want you to know what you're taking, know why you're taking it, know what you're asking for. Don't be ashamed. If you're not sure what you want, Ann, I could not have planned this better. The conversation with the B12, everything you wanted because of reading about it and educating yourself, we want to make a creative and successful way to getting what you want. There are many paths to success. As you all know, where people see barriers to success, I see it as an opportunity to bring someone else along on our team. I’ll see my next victim soon.