Table
2a:
Medicines
That
All
Patients
Received |
For
Sleep:
|
|
A |
Melatonin
3/10
mg
P.O.
QHS28
and |
B |
Valerian
180
mg/Melissa
90
mg
combination
(Valerian
Rest
by
To
Your
Health),
1-2
tablets
P.O.
QHS29
|
Plus
the
below
treatments
as
needed
to
result
in
7-8
hours
of
solid
sleep
without
waking
or
next-day
sedation.
Mixing
of a
low
dose
of
several
medications
was
used
instead
of a
high
dose
of a
single
agent
in
order
to
decrease
next-day
sedation. |
A |
Zolpidem
(Ambien)
10
mg,
½-1
½
P.O.
QHS
and/or |
B |
Trazodone
(Desyrel)
25-200
mg
P.O.
QHS
and/or |
C |
Cyclobenzaprine
(Flexeril)
10
mg,
½-2
P.O.
QHS30,31
and/or |
D |
Carisprodol
(Soma)
350
mg,
½-1
P.O.
QHS
and/or |
E |
Amitriptyline
(Elavil)
10
mg,
½-5
P.O.
QHS31,32
and/or |
F |
Clonazepam
(Klonopin)
½
mg,
½-8
tablets
P.O.
QHS |
For
nutritional
support
(these
two
supplements
are
used
long-term):
|
|
A |
Daily
One
Cap
Multivitamin
(Twinlab),
1
tablet
P.O.
QAM |
B |
Magnesium
with
malic
acid
(Fibrocare
by
To
Your
Health),
2
tablets
p.o.
Tid |
Table
2b:
Treatments
That
Were
Individualized
Based
on
Test
Results
or
Clinical
History
|
Treatment: |
If: |
Ferrous
Fumarate
(Chromagen)
1
P.O.
QD
between
2
and
6 PM
on
an
empty
stomach. |
Ferritin
£ 40
ng/mL
(ug/L)
or
iron
%
saturation
£
22%.
|
B12
1,000
mcg/cc,
1cc
I.M.
1-3x
a
week
for
12
doses
then
PRN
or
B12
1,000
mcg
SL
QD
(if
patient
was
unable
to
obtain
injections). |
B12
level
<
540
pg/mL
(398
pmoL/L).18,19,33 |
Levothyroxine
(Synthroid)
25
mcg,
1-4
QAM
or
dessicated
thyroid
(Armour)
30
mg
½-3
tablets
QAM
(adjust
to a
clinically
optimal
dose
based
on
relief
of
symptoms
while
keeping
the
free
T4
within
normal
range). |
If
TSH
>
2.5
or <
.9
U/mL
and/or
total
T3
is <
95
ng/dL
(1.5
nmoL/L)
and/or
free
T4
is <
1.0
ng/dL
(13
pmoL/L)
and
patient
has
3 of
the
following
symptoms:
weight
gain,
oral
temp
<
98.3°,
dry
skin,
thin
hair,
constipation,
achiness,
and/or
cold
intolerance. |
Cortisol
(Cortef)
5
mg,
1-3
tabs
QAM,
½-1
½
tabs
at
noon
and
½
tab
at 4
PM,
using
lowest
clinically
optimal
dose
(usual
dose
5-12
½
mg/day—up
to
20-25
mg/d).34,35
|
Cortrosyn
stimulation
test
with
cortisol
baseline
£ 12
ug/dL,
(33
1nmoL/L)
and/or
½
hour
increases
< 7
ug/dL
(193
nmoL/L),
or 1
hour
increase
< 11
ug/dL
(303
nmoL/L)
with
a 1
hour
cortisol
level
< 28
ug/dL
(773
nmoL/L)
or
HgbA1C
<
5.1%
and/or
patient
has
3 of
the
following:
sugar
craving,
shakiness
relieved
by
eating,
dizziness,
moodiness,
recurrent
infections
that
persist
longer
than
expected,
high
stress
at
illness
onset
or
low
B/P.
|
DHEA
5-50
mg
P.O
QD
(decrease
the
dose
if
acne
or
darkening
of
facial
hair
in
females)
occurs.
|
DHEA-Sulphate
(mcg/dl)
(x.02714=umoL/L) |
|
In
Males |
In
Females |
|
DHEA-Sulphate |
RX (
mg/d) |
DHEA-Sulphate |
RX (
mg/d) |
umoL/L |
mcg/DL |
umoL/L |
mcg/DL |
0-2.7 |
0-100 |
50 |
0-0.8 |
0-30 |
25 |
2.8-5.4 |
101-200 |
40 |
0.9-2.2 |
31-80 |
20 |
5.5-7.6 |
201-280 |
25 |
2.3-3.0 |
81-110 |
10 |
7.7-8.7 |
281-320 |
10 |
3.1-3.8 |
111-114 |
5 |
Testosterone
Enanthate
(Delatestryl)
100
mg
I.M.
QWK
(in
males)
or
natural
Testosterone
2 mg
P.O.
QD
or
BID
in
females. |
Free
testosterone
in
lowest
quintile
for
age. |
Estrogen
replacement
(in
females)
offered
to
patient:26
if <
40
Y.O.-Ovcon
35,
if >
40
Y.O.
or
side
effects
on
Ovcon,
Estradiol
½-2
mg
QD
or
Triestrogen
(10%
Estradiol,
10%
Estrone,
80%
Estriol)
1¼-5
mg/d
P.O.
on
day
1-25
of
cycle
and
(if
uterus
present)
natural
progesterone
100
mg
P.O.
qhs
or
200
mg
P.O.
qhs
day
16-25
of
cycle. |
Estradiol
<
75pg/mL
(275pmoL/L)
and/or
FSH
& LH
> 10
mI.U./mL
(I.U./L)
and/or
irregular
periods,
hot
flashes,
inadequate
vaginal
lubrication,
low
libido,
flaring
of
FMS
symptoms
before
periods
or
S/P
TAH
or
tubal
ligation. |
Oxytocin
10
units
P.O.
QD |
Severe
cold
hands
/feet
and
pallor. |
Fludrocortisone
(Florinef)
.1
mg/d
(and
increase
dietary
salt,
water
&
potassium)
beginning
at ¼
tab/day
&
increasing
by ¼
a
tab
Q
3-7
days
|
B/P
<
100/60,
or
orthostatic
dizziness
or
FMS
symptoms
worsened
by
standing
against
wall
for
10
minutes.
|
Sertraline
(Zoloft)
50
mg,
½-2
QHS
OR
Paroxetine
(Paxil)
20
mg,
½-2
QAM
OR
Fluoxetine
(Prozac)
20
mg,
1-2
QAM
OR
Nefazodone
(Serzone)
100
mg
B.I.D. |
If
NMH
symptoms
above,
depression
or
persistent
severe
pain. |
Nystatin
500,000
units
2
P.O.
T.I.D.
x
3-5
months
plus,
in
more
severe
cases,
Itraconazole
(Sporanox)
100
mg 2
P.O.
QD
with
food
x
6-12
weeks
(begin
4
weeks
after
Nystatin
begun).
Do
not
take
Seldane,
Hismanal,
Propulsid
or
antacids
with
Itraconazole. |
If
stool
microscopic
exam
showed
higher
than
normal
fungal
levels
or
symptoms
suggesting
fungal
overgrowth
(e.g.,
thrush,
recurrent
yeast
vaginitis
or
antibiotic
use,
onchomycosis)—by
questionnaire.25
|
Metronidazole
(Flagyl)
250
mg
P.O.
QID
x 10
days.
or
750
mg
P.O.
TID
x 10
days
followed
by
iodoquinol
(Yodoxin)
650
mg
P.O.
TID. |
If
stool
was
positive
for
Clostridium
difficile.
or
If
other
Metronidazole
(Flagyl)
sensitive
parasites
were
present. |
Doxycycline
100
mg
P.O.
B.I.D.
x 6
weeks. |
Recurrent
body
temperatures
>98.6
°F. |