Transcription
Okay, we're going to start. So, take each year your seats. Uh, a big session this time because there's a lot of info and things like that. Hello, hi. Hello, everybody. Um, okay, hi, hi. Um, [Applause] hello, hi. So, um, we're going to start maybe, um, with the first case. I, I wanted to start with questions first, but it might be difficult. Um, maybe the case of, um, here, uh, the pharmacist Samya Elardi. Here's a question concerning their daughter of 20 months. She has pheno phenylketonuria. It has another name now, it's the Guthrie test that you do. So, she has too much phenylalanine in the urine and she was also diagnosed of having, um, hearing problems at three months and she received therefore an implant, a cochlear implant. But phenylketonuria gives a lot of central nervous system neurological disorders. And the question is that she must continue, um, lifelong to take L-carnitine. And she takes a dose of 600 milligrams per day. That's two times one half milliliter of a solution. And the question is, does L-carnitine, as a precursor of, uh, the TMO, and the TMO that is a 3-methylamine oxide, is there a danger?
Um, so normally in adults, you can already have side effects of L-carnitine at a dose of, um, how much is it exactly? Uh, three milli, three grams. I take personally about six grams, have no problems with it. And if your doctor has a problem of nausea, vomiting, abnormal cramps, or diarrhea, then it's too much for her. Otherwise, it's, it's, it's safe. It can also give a fishy body odor. You understand the English? Yes. Okay.
Um, so if, if she has seizures, then she can have more seizures. Or if she has kidney insufficiency, which there is not, probably this muscle weakness. But normally, it's with any amino acid you take in too high amounts. It is, um, abdominal pain, some nausea and vomiting that you can have. The abdominal pain gives abdominal cramps and you can have some diarrhea. In this fishy body odor, I don't think I, I have a fishy odor with six grams. So I think, so if she doesn't have that, I think it's okay.
Now, there's another a problem that can come. And I deal with to do an amino acid test. Is that when you give too much of one amino acid, you can have a deficiency in others because, um, amino acids are absorbed through a protein in the intestines and there's a competition for the absorption. So you might have to do an amino acid test in the, the urines of 24 hours or in the blood. In Belgium, they can do it in the blood, but urines is better. I think they can do it now in the LIMS test we have here in Belgium. So that, that for the questions.
And then, um, there would be, um, I will answer other questions, but maybe we'll keep some of the questions for later because I'll answer, uh, two patients. And first, I will see with Odette. She sent her case, um, because I prepared it actually. Um, well, so, Odette, um, and I would ask, Dr. Catherine Vuolla, can you send again the anamnesis? Because I tried to open, it doesn't open. Best is always to send Word files, if possible. Uh, so, um, to send a Word file. And that is, send it to me. Um, so here is the case of Odette. And so I put it, I'm going to see if I can put here. Um, I don't think you see it. So I need to share my screen. Share my screen. Share. Do you see it? Yes, yes, yes, we see it.
So, Odette is 55 years and as main complaint, there's a fatigue in the morning. That must make you think that there's low thyroid because that's typical for the thyroid. It's a swinging mood, so ups and downs of the mood. That must make you think there is, um, can be yeast infection because yeast eats the sugar in your blood. With ups and downs, it can also mean, uh, that there's glutamine deficiency because the mood is much more liable. Dry hair must make you think there's low thyroid, but it can be other problems behind it. If it's thick and rough, it's low thyroid. Tingling in the scalp. Um, Odette, can you maybe, um, give more information about this tingling in the scalp?
Yeah, yes, doctor. So I feel like tingling and numbness and I have to scratch, okay, over the scalp for, let's say, five, ten minutes, and then I will feel relieved. Well, that's normally yeast infection. Do you have some dandruff? Some little skins? No dandruff. No, surprisingly. I don't have dandruff, but it does either. It could also be that you might put some hair color or whatever, but I don't think you put hair color, or do you? No, no. I used to color years and years, but since last two years, I stopped completely. That's why my hair is completely, you know, it's almost 80% white. Okay.
Well, then I still think you should treat it as a yeast infection. Uh, um, and do it in four to six weeks, two times a week, ten minutes. You put an anti-yeast product like Nizoral shampoo or a selenium solution shampoo. Is, is, and that really works. But if it comes from yeast, you have other symptoms. And the ups and downs of energy or mood can be also a sign there's yeast. Can I see your tongue? Can you show your tongue? Yeah. Okay. Well, maybe a little yeast, but not, not really much. We'll go further because there are probably questions on it.
And so you're taking already the BHRT treatment with estrogen, progesterone, and testosterone. The doses you take are very little. Uh, testosterone, okay. But the progesterone, 30 milligrams, that looks really too little. And the bi-estrogen, that's probably 40, or 60 estradiol, that can be enough, but it's on to the lower side. Um, DHEA looks okay. Growth hormone looks a good dose, actually. Vitamin D, vitamin E are good doses. Nexium, you take an antacid. Don't. So when you take an antacid, you generally always have a bloating upper belly. You have a, because your stomach accumulates everything, cannot digest things, so they accumulate. There's not enough gastric acid. So Nexium is good for three weeks, but certainly not for three years or something. So, uh, copper looks a good dose. Zinc, good dose. Probiotics, very good dose. L-carnitine, two grams twice a day, very good dose. Prednisolone, five milligrams is also an acceptable dose. Um, birch oil, omega-3, you are taking actually good doses. Sometimes birch oil can be too little because the dry skin or dry hair may also come from a lack of omega-6 fatty acids. Do you have a flaky skin on the legs, on the lower legs, dry skin? No, no. It's a dry, but there is no flakes. Okay.
But we'll see maybe at the end. Maybe a second check would be vitamin A, 25,000 international is not high, it's rather low. Magnesium citrate, magnesium only the 400 milligrams. Is that the elemental magnesium or the whole magnesium citrate molecule? The whole magnesium. So, yeah, then it's probably little. You probably have something like 150 milligrams of elemental magnesium. That's probably too little. Okay.
And then in the antecedents, if we look here, you had migraine since the age of 30 years. That must make you think there's low thyroid, but you're not taking thyroid hormones. And the first one before, are you, sorry, doctor? Yeah, this I forgot to add it. I'm taking levothyroxine 50 microgram daily since almost one and a half years. Okay. That's a little dose. And it's L-thyroxine, which is much less efficient. Yeah, probably need to increase that. Go to Euthyroid or Armour Thyroid and or Nature-Throid and increase the dose. I think you need to get rid of the migraines. 75 to 90 milligrams, but you have to slowly increase.
And then in the personal, there's been, um, they've taken part of the fat in the belly away, probably because you had growth hormone deficiency and, and maybe the diet was not good. Lower esophageal fundoplication. Yeah, because of the reflux. I did this procedure and then I ended with complications. That's why they did, they have to open my abdomen. And because I had the reflux with hiatal hernia, so they fixed the reflux and they put mesh in the diaphragm. And also I ended with the intestinal adhesions. I had a lot of complications in my abdomen. Yeah, that's typical for, um, people who are at the moment of the operation and after too low in cortisol. And then they inflame all over. And maybe your diet was also an inflammatory diet. So you have to really go to fresh vegetables and and fruits and avoid grains and sugar and things like that. Donald Sugarman is okay. Incision repair or mesh, that's all the whole thing. Alex Felix might be, uh, also a family. There's easier Alex Valgus. Yeah, yeah. But it's a little possibly that the shoes are too small with, um, growth hormone deficiency. So growth can counter that a bit. And then in your family, antecedence, or variances, bear cysts in your mother, probably progesterone deficiency and iodine deficiency. [Music] DNS repair. What is that? DNS? Uh, it's a deviation in the nasal septum. Deviation in the nasal septum. Okay, okay. I know fissures are very repairable with putting testosterone locally. That's really a treatment. Safer. Uh, you would have it or your sister has again, maybe prescribed testosterone locally. Yet, the dose is good for women. They no need to behind.
So you answer the questionnaire and you see that there's some digestive disorders. You have some reflux, stomach acidity, etc. Reflux often in people at night because they eat in the evening proteins. Like proteins in the evening. I used to, but since I started our course with you, you know, I stopped it. And helped you as much with flu or less? No, it's less, but still it's there from time to time. Because often what I propose to my patients if they have that is to sleep in a recline oblique position. So it's not the only, the head that has to have a pillow, but you have a sort of, it has to be oblique wise that you, you go in the bed and you have, um, uh, the chest is higher than the stomach, I would say. The upper chest and the head is also higher than the, the neck and etc. So you really have to recline position. That really helps to do it positionally. And then of course, to avoid any foods that is irritating because you could also have more reflux with other allergenic foods. So you did, you do an allergy test or not? Uh, no, actually I did not. It might be interesting because it might be foods that I say you take it because it's good, but it's not good for you because you're, it irritates your intestines. And then you see there's coffee and tea that is very bad for the reflux and for the stomach. It promotes gastritis, especially it was the caffeine, but even without the caffeine, I wouldn't. I would just really take water or soup or things like that. But I would be careful with the caffeine. Also, we're probably not able to to well tone the, the thyroid hormones and the thyroids take the migraine away. So if you take the coffee, won't be able to give the thyroid that are more efficient against, um, headaches. And so while you're eating well, grilling, barbecue, also irritating for the intestine. I would avoid that. And, um, you also take cheese and yogurt, also a lot of more with reflux or more acidity, at least in the, um, the chest and then the esophagus. So milk products give more acidity. So you really have to be careful with not eating them. And maybe once a week, but certainly not three days a week. Unsoaked nuts, that's also everything gives a bloating belly. Because if you knew what you know now, you probably wouldn't have had needed an abdominoplasty. So nuts, um, that's good. Um, sugar, sweets, that's also irritating. Now, you may do exceptions. The problem is you take it every day. Then it's not a good, uh, good thing. No, not every day. Not every day. Twice a week? Not more. Yeah, maybe, maybe three times, four times. Okay. Try to go to maximum two or one time. And then if you have no reflux or acidity, then it's okay.
And you see here that the intestines, there's more gases, there's not a good digestion, more, there's in constipation. That's the low thyroid. Exactly. Stools that have not enough pancreas enzymes. But when the belly is bloated because you're not choosing your food 100% correctly enough, uh, then there's no, the pancreas doesn't work well. So the pancreas will work better, uh, by improving further the food to the paleo diet and not any much in the evening. And otherwise, you have to take supplements of pancreas enzymes. And the best are those that come from pork because those that come from plants are not so specific. So when you look at you, you see here, tongue here is a little coated. So there's probably yeast infection in your intestines. So you will improve that by stopping the milk products and and the sugar and sweets. Because I don't think you eat bread or, yeah, pasta, rice, they're not really much. Yeah, not really. Yeah, white bread, you do eat. So white bread, not so good. What gives yeast in the intestines is every food that when you let it a long time in the intestines becomes humid in a warm temperature, and they are yeast forming. You can do that also in a plastic bag. You put bread in it with water at 37 degrees Celsius, no air, water, and the temperature makes that there's more yeast. So avoid these foods.
Um, now the nutrients. When we see, you feel that your neck is tense, shoulders tense, lower back, hands, upper arms. Is the skin is a little rough? So that's that's typical for vitamin A deficiency. The rough skin. And here, magnesium can be deficient here, although you do not have afternoon fatigue. So maybe there's other causes for it. And the other causes could be growth hormone deficiency. And when we look at the blood test, for example, we see the white blood cells are good, red blood cells are more or less good. But you have thalassemia, I think here, because you have a very thin volume. And I think iron is good. So, basically, that's more typical for calcium. And then you can have a lot of red blood cells without too much problems because it's not so, so voluminous in the blood. A quick overview of the, don't look apparently good. I don't see any, uh, problem here in the white blood cells. And then you see the liver test looks good, but it's not very high. It's a little low. That's low thyroid. Generally should be like 20, 25, but should not be 40. And calcium is okay. Magnesium is the only serum magnesium that doesn't give us such a good idea. It's better to have a whole blood magnesium or red blood cell magnesium. Then you know what's in the cells and there's where the magnesium is work. So here I cannot say if you have too much or not. It, there's no severe abnormality, but, but it could be more evident in another type of blood test for magnesium where the cell magnesium is included. You have a very high level of C-reactive protein with, um, not exaggerated elevation of the white blood cells. So C-reactive protein can be increased when you have a viral infection, but I didn't see any activation of the lymphocytes. So you, you, you're taking Prednisolone. Is that for rheumatoid arthritis? Yes, yes. So maybe there's still some rheumatoid arthritis, but I think it's also triggered by the food. The milk triggered that. The white bread triggers that. The sugar and sweets trigger that. So I think it would be interesting of decreasing it. And then the iron is not really okay. These are values of women who are before the menopause. And actually, it should be at least 70, if possible 100. Don't need 300, but you need 100. And here's just 35. So that should give you normally an evening fatigue. I think you didn't complain from falling, but that is typical for iron. The fist that's too low.
Doctor, if I can't take any oral iron supplements, so what about injection? You can take injections, but if you, you cannot take because you have digestive problems. It's not that you have an allergic reaction, because otherwise injections, you have to be careful. Huh? Yes. Now, the injections have to be given in such a way that you, um, you inject like, uh, how do you call it? A hook, like for fishing. You have to, otherwise you will have a black spot that is two or three years on the superficial skin. So you, when you inject, you inject inside and then you do a sort of hook, like a fish hook, and then you inject behind the muscle or below the muscle, and then you won't have too much problems of having a black spot. Because that's important with the intramuscular injections in the buttocks, that you inject deep enough. Okay, okay.
Um, the vitamin D is very good, actually. I like that. It's above 80. Okay, that's a good value. And when we look here at hypothyroidism, there are indeed symptoms of hypothyroidism. Um, I have to, I have changed a bit of figures here. Okay. So, um, you see here, there's morning fatigue, there is morning stiffness. That's typical. It's stiffness due to the myxedema, the, the accumulation of waste protein between the cells that gives the stiffness in the morning. And it tends to disappear during the day. Um, then also, uh, headaches are typical for low thyroid because everything's compressed in the head, that and the skull that does not expand. Slowness in the morning. So that would be good. There's also some constipation and, and problems of not digesting well. The stomach is also very lazy, you know. Hypothyroidism and poor thirst can be signs of that. And I don't know if it's dry here on your elbows. Is it dry on your elbows or not? No, no, it's not too dry. You can see it. Okay. It looks, it doesn't look dry, but no, no, it's not 100% sure. And then you see their flat feet. That's for a [Music] low thyroid function in childhood. And when we look here, um, [Music] what we see here is, uh, you see the tonus of the, the foot is not optimal. That's typical for, um, low growth and IGF-1. And it looks like it's slightly yellow here, for example. They're a little yellow, probably here, a little bit yellow. And they're a bit yellow. Yeah. So that's typical for accumulation of beta-carotene that should be high, probably in blood above the upper limit, and low vitamin A. But we don't have vitamin A. Looks okay. The T3 is within reference range. Ideal would be to have four and a half. It's a little bit lower here. And the thyroxine is low, just above the, uh, low range. So you have two diagonals that are a bit low. You need to have more optimal values. And that corresponds now. Ideal, what I do is I do a 24-hour urine test. Um, and with that, uh, I know the production of thyroid hormones during a whole day and then whole night. So, so I have a better evaluation. They will be probably very, very low in you. And, um, but they are studies that show that at these values of T2 and T4, you have more risk of pathology. Lower thyroid hormones, I would say here. Adrenal hormones, as you see here, you have some sweet cravings, you have gastritis, can be a sign, and joint pains in the feet. And the fact that you need Prednisolone, also, it could be that still not optimal. But personally, I think that it's because your diet is not optimal enough and that counters the action of cortisol. Give an example. My wife, for example, during three months, she, she, she developed some, some pain and cortisol deficiency while she was taking cortisol. And the only thing that she did wrong was, um, she ate one slice of bread without gluten in the morning with jam without sugar. And that neutralized completely the cortisol. When she stopped, the next day she was perfect. She was full of energy, good mood, and and stayed so afterwards. So it was really that little slice of bread that was, uh, detrimental to her. Then when we look here at other things, aldosterone, maybe slightly low. Low blood pressure. How low is your blood pressure? It's between 100, 110, this is the systolic over 70. So maybe it's sometimes low. And you probably need some fludrocortisone if you're checking 25 units aldosterone or in the morning in blood. After, probably the aldosterone is lying. Then you need some fludrocortisone. It would be about 100 micrograms, so 0.1 milligram per day. That can help. But check your blood pressure, that doesn't get too high. Um, DHEA deficiency. Yeah, but it could be also due to male hormone deficiency here that you have these signs. So we'll look here further.
So when we look here, you see that there are little dark circles under the eyes. Okay. And, um, you're also, you don't have so much eyebrow. Huh? Yes, yes. I don't have. Actually, this is tattoo. Yeah. So inner eyebrow is a bit scarce. That's low testosterone. Middle eyebrow scars because of low growth, low IGF-1. And almost complete absence of the outer third of the eye due to thyroid deficiency. Okay. Are there any pigmentation spots on the face or not? No. Maybe a little bit irregular pigmentation. It's a little sure. But that could be due also to low cortisol and too much ACTH. Yeah. You see here the spots. Uh, yes, yes, yes. Yeah. So [Music] okay. So that's Addison spots, adrenal deficiency. So the protein is only, I think, is good enough, but it doesn't work enough well because your, um, uh, your food, your diet. You also could see that it's a little sharp here. Does that could be due to aldosterone deficiency or vasopressin deficiency? Just a little sharp fold here. Yeah. And you see also these little lines here, there. That's typical for a vasopressin deficiency. You need 2 times 50 or 2 times 100 micrograms of desmopressin per day. Normally with this, and you don't need buttocks. If the skin will become smoother and flatter. Sex hormones. What we see is that you have, um, not much complaints in the testosterone and estrogen deficiency complex, except the pains, shoulders, lower back, middle back. So if there's not enough good tension in the muscles, you get that easier. And then they become contracted very strangely. Growth hormone can decrease much lower back pain. And you have a straighter back, but the back is much more relaxed. The muscles are much more relaxed. So testosterone deficiency, dry skin, cellulite is typical for testosterone deficiencies. The main com sufficient behind it, and varicose veins. Two main deficiency is testosterone deficiency behind it. And on typical estrogen deficiency complaints is Dupuytren's contracture. So your dose is not enough, but you're taking low doses anyway. So you need more. Um, progesterone complaints. Okay, cysts. That's you have to put iodine on on the breast. Lugol's solution, two, two or three drops per breast where they are cysts. And we have to be careful that there's enough progesterone all time. So you will need 100 milligrams of micronized progesterone at bedtime. In the days you take estrogen at a higher amount. Sorry to interrupt you, doctor, but I'm using 30 milligram progesterone intravaginally. So as per our compounding pharmacy, they said that 100 milligram orally equals to 25 milligram intravaginally. I think it's narrow. I always heard that there's more absorption of 25, better absorption vaginally than orally. Anyway, you will know it because if you increase the estrogens, double dose, for example, because that's possibly what you need, um, um, if you eat correctly, because otherwise not so good, you would double the dose. You will probably need 100 milligrams at that moment. Otherwise, you will have, um, [Music] pain in the breast. And anyway, taking more is not dangerous. Really. You, if you take it at bedtime, you sleep better. And that's all. You really have much too much, um, progesterone in the morning. You get a drowsy head because it blocks aldosterone. So you have a low blood pressure. If you have that, then you have to lower the dose. But I would rather think increase estrogen and decrease, and then increase, uh, progesterone. And so you see the progesterone, nothing is found back 24 hours after. No, eight hours of the last intake, because you take it at bedtime, the progesterone, I suppose? Yes, at bedtime, yes. So the next morning, there was nothing left. Oh, okay. I'm not even sure that what you're taking is a good product. There should be at least something left. Um, one milligram nanograms per milliliter, which is not the case. So, um, very low progesterone levels and low estradiol levels. Testosterone-free looks high, but it's completely incorrect. It's, um, this has to be between two and eight. And that's pretty discussion, which is a less reliable test. Okay. I think you need, um, but you're taking a good dose of testosterone dermal. And so, so it could be enough. But I would rather have the total testosterone, SHBG, and then the bioavailable testosterone calculated by that. You know, because the free testosterone is very liable as a test. Okay. It's high normal testosterone level, not estradiol level. And so understand the L-glutamine is min 50% lower IGF-1 level. This should normally no, I had per milliliter. Okay. So this normally should be two and a half to 250. And it's 136. [Music] Um, so, so it's too low. That means that you may have, um, in the general areas, easier atrophy. So you may go to a higher amount. And that is maybe by taking more testosterone. You take five grams, maybe you need seven milligrams. And you take more estrogens. You're probably safe not to develop any hair growth anyway. Okay, okay.
Um, here we have the growth hormone. And you see there are a lot of complaints of growth hormone deficiency, but not dramatic. Back pain, it's typical. You, you hold your back better. Nasolabial folds here on the face, retracted gums, and need for more sleep. So it's not major pathology, but it still would be good to take growth hormone. I think you need a dose of 0.2 milligrams growth hormone, but very slowly increased. And and it can decrease your cortisol, your cortisol production. I'm on 0.3 milligram growth hormone. Yes, you're taking. Sorry. It doesn't seem to work sufficiently. Then when we look at the lattice, where was the lab test here? No. Are you, did I have the lab list in your laptop? No, it doesn't look. Yeah, here you see, uh, the lattice is 134. But you did not ask the IGF-PBG. Maybe the lab doesn't do it, but it's better if the IGF-BPG is higher. Then, then it's also not good. It, it keeps the IGF-1 in the blood. But this is normally a too low value. I don't think you're tall, but, but it's still, it's too low for you. I'm, my height is 172 centimeters. So that's a good height, actually. Certainly, it's not enough then. And here we see symptoms. And we're looking for symptoms. The lips are good, but they're getting slightly smaller, but not, not severe atrophy. But maybe those nasolabial folds could be a sign that it could, you're starting to to lose some firmness. And here, this is lower here. That can be off low testosterone, low growth, bone, or low, or low insulin. [Music] And, and here it's not too bad. Uh, here, um, you see that it's a little bit more brownish on these folds. And that's good for a difference disease. Ah, lack of, is it on too much ACTH? And then you see again the fixture we saw with some, some less muscle tone on the feet. Okay. So, so now, can I ask you? I'm going to try to see if I can, um, enlarge. Okay. So we're still sharing the screen. If I can enlarge your picture, because I'm going to ask some, [Music] where are you there? And then here, maybe, uh, no, I don't think I will be able to show non-video parts. But note, put in waiting room. So it's a little bit complicated. I cannot. I will double-click now on somebody. Now, why not? No, okay. Well, we'll try to do it with a small screen. Okay. I will stop sharing the screen. Uh, oh, do you see my screen or not? Yes, yes, I can see your screen. Yeah, it's not good. You should not see the screen. Um, no, well, I don't know. I stopped here. Okay. Well, here it is. Here, you're, you're larger, baby. I can try to get you here. No, okay. Well, I see you better here. Uh, can you now show a bit your, your, your hair? You come near the camera like this. Yes, for example, like this. This is okay. Yes, okay. It's a little thick and dry and rough. That's typical for low thyroid. Can you touch on the back of your hair to see if it's dry? Yes, absolutely dry. Yes. And thick and rougher. So that you can rough it. Mix the metals here. Can you take out your glasses and show your conjunctiva? You, you download, you put the lower line lower. Yes. No, that looks not too bad, but the eye doesn't shine enough. There's not enough estrogen. And I think you, you still look at a little rose now. So that is not a sign. Can you put your two fingers and you put them below your throat, below the thyroid gland, actually, a little bit higher, slightly higher? And you put your, your hand again, your chest, and then you swallow. Can you swallow? Swallow. It's difficult to tell if there's a slight hypothyroid hyperplasia. I don't know, uh, with the picture, it's difficult to tell. I'll do it again. Yeah, do it again. I think it's, it's okay. All right. And then can you, um, okay. Can you now show your hand and the hand tonus? And you push here on the hand tonus. Yeah, yes, but you may not contract the hand. You have to really relax here. Okay. And you should go at the other part, not where the thumb is. Yeah, um, it's a little bit further, a little, go further out, away from the camera. Okay. And then push now. And push a little bit lower. It looks a good tone, but you're taking 0.3, uh, milligrams of growth hormone. So probably it's not so bad. Now you take your hand and you, uh, like here, horizontal on the hand. No, you're vertical. And then you relax. Yeah, relax. Good. Perfect. It goes back easy. So that's good. Now, show your, your nails a little bit. I don't see, uh, can you just push your, your finger like this on the nail to see if it's, is it several layers or just one layer? Sorry, what to do exactly? Sorry. Here, like this, to see if there are several layers on your, your nails. No, I suppose not. Are they, um, do you have lots of lines on your nails? I have a dry skin, a lot of dry skin, you know, in the cuticles. Cuticles are very dry, always. Okay. Maybe low thyroid, but they are also vitamin deficiency. I think vitamin B deficiency that can give that sort of dryness around the nails. Okay. Um, now, can you show here, here, and see if you have a sort of, oh, just a minute. Here, yeah, the triceps. Well, yeah, no, it's not the skin, the muscle. You have to take. Yeah, this is, yeah, this is the muscle. Yeah. So it's a little bit relaxed then. Okay. Yeah, it's a little droppy. Triceps can be low growth, testosterone, low, uh, growth hormone, are low insulin. Good. Is it possible to show your belly on the front? Is it possible to show your belly like this? Here, yes. And, okay. Yeah, just, I will manage. No problems. So, and, uh, okay, a little bit lower. Yeah, of course, you have operations. But can you put, it's a little bit bloated on the upper belly. Can you turn around? So the upper belly is bloated because of the, the antacid that they take. All people with antacids have that. Not if they take it one day, but if they take it for weeks, yes. So you will have a lifelong upper belly bloating because of that. Because you're not eating in the evening proteins. That would be the other cause. And below, it's also a bit bloated. So that's the grains and the milk products, mostly cereals and milk products that give that. So you, by changing your diet, you will already have an improvement. And by stopping the Nexium, and if you have acid, you just put your, your more and oblique wise. But if you stop milk products, you'll have less acid. Okay. So, so that's, uh, good. Now, I would like to see your lower leg to see if the skin is flaky. Okay. So let me, let me try to manage. For example, yes, yes. Uh, okay. It's difficult to tell if there's some flakiness. Do you put some cream on your legs? No, no, no. I don't. Yeah, there's no cream. It's a little bit dry, but there is no flakes. Okay. Good, good.
Um, okay. I think we've seen enough time. You have to, okay. So I, I, I think you've seen, you need to have thyroid hormones. You need to go to 75, 90 milligrams of Euthyroid or Armour Thyroid or Nature-Throid. You need to take Prednisolone, possibly also with fludrocortisone, 100 micrograms per day. DHEA, um, I don't, I don't think you need to change the dose because to check DHEA with treatment, you need to take it in the evening before the blood test, the day after in the morning. And you probably haven't done that. The female hormones have absolutely, you double the estrogens, you take more progesterone like 100 milligrams, and you, um, uh, should take a little more testosterone like seven milligrams. And then also go to, um, putting a nitrile shampoo in it. And, um, we didn't talk about melatonin, but you slept good, I think, in your things. Yeah, I sleep well. I don't have any problem with the sleep, but it does protect you against stroke. So maybe some, some, uh, would be good. And then the growth hormone, um, it looked good on the hands, actually. So I think it's more the testosterone that has to be increased.
Okay. Do you have any questions? Because that we go to then another person. Uh, just one question, but it's not about my case. Usually, if the patient's on growth hormone and she got pregnant, yes, shall we continue during the pregnancy? Growth hormone in the second pregnancy. My wife took growth hormone, that's already 20 years ago, and we will continue with the same dose without any adjustment. I would say the same dose, except if you're giving too much, then of course you have to decrease. But the babies are better, they're bigger, actually, and they are healthier. Based on studies in cows, actually, but there are two studies in humans where it's okay. No problem. One study stopped under growth hormone, the other, I think, continued, but it was safe. It's a natural hormone. So I think it's like, you just have to avoid overdosing or things like that. And it will avoid this woman to have abdominal striae during after the pregnancy. The belly will be normally better if the dose was good. Okay, okay.
Then we have another case. Um, I'm trying to see if I can make it smaller here because I need to to look at the data. And that is, um, [Music] oh, yes, I did not, um, so I couldn't open up the file a second time that I opened for the analysis, but, um, anyway, this patient has a terrible problem of cervical brachial neuralgia. Catherine, and is the patient there? [Music] Yes, she's here with me. Yes. Um, and she understands English? Yes, very well. So it says terrible cervical brachial neuralgia. And that is promoted probably by also maybe an inflammatory diet. I, I don't have enough information about that, or maybe, um, other things. So, um, I had personally a cervical brachial, um, neuralgia, terrible, during two years. I almost couldn't move the, the, the neck during one year and a half. And so I had also very good treatments, but basically I went to experts, nobody could help me except one said, look, you have to be your own osteopath. And here's how you do it to unblock things. She unblocked it. That was the first to unblock me. Anything, but, but she unlocked it slightly. And so I took every day from 20 minutes to two hours per day during four months and a half. I did, I unblocked it by pinching and also by massaging till the pain goes away. And then you stretch, stretch, and here's the thing, you very slowly let it come back. And that way, those wonders because who's the miracle person for your patient, is actually herself. She can do twice a day to the osteopath. And she knows where there's pain. They also devices where you can go on the back of your, um, back. I did it this morning, and I do it four or five days a week where you can go with, it's called Theracane. Theracane, where you can go on the back and you unblock it. But if she doesn't do it, nobody will suffice. Help. That will do operations. We do a lot of manual treatment. And because I'm an osteopath too, and acupuncture treatment. But it seems a lot more inflammatory pain. And each time we work, it really decreases the pain, but after one week approximately, it comes back. That you do it, but then you have to do it twice a day. In her, yeah, okay. She, she's listening to you, to you. So she learns to do it. And you show how to do it. And then you do a professional massage or whatever, every week. But I don't think you will have the time to do it twice a day. And she can't do it even within minutes. And then you have to do also, if it's the neck, an exam, you have to stretch the neck and stretch your neck. And it's really fantastically worked. And it works for any problem you have in the body. If nobody can help it, it's because the capillaries are not open. Because the person itself does not do. But if you do it twice a day, ten to two minutes to an hour, you know, when I couldn't sleep well at night, I did it. I did it really a lot. And and I don't normally have time. I took the time. It's very, very efficient. So you know, there are two exercises if you're an osteopath where you pinch and then you do it. And maybe you have some other exercises, turning around and then stretching and then very slowly coming back. So the magic enhances that. So that's, that's one thing. But then there were, um, I think other things that we can look at. The, the latest is how is the diet? Is it the paleo diet? Or is it a sort of a Mediterranean diet or a westernized diet? A bad diet. We are trying to improve that step by step. So I don't eat very well. You know, I eat very French and lots of meat and pasta and potatoes and, yes. So you could also improve by doing at least five days a week, what's called the paleo diet. That's the diet of our ancestors. It's fruits, vegetables, fresh, not dry. And, um, and no nuts. They have to be soaked in water and put in water all night. And also meat and fish, but cooked at low temperatures. So no grilling, no cooking in oil. Because I have a whole presentation of two hours on how the food affects accurate inflammation and also infection. But basically, inflammation is, is really surprising how much. So any food that is burned with burnt fat will inflame your body. Um, and, and so red meat is bad when it's grilled or barbecued, but it's okay if you boil it or steam it or eat it raw, like the, the steak tartare that they eat in, in France or in Switzerland. So that is extremely important because that will already decrease the inflammation by probably 50% if your food is good. But any grains, any cereals, sugars are not good. And they also decrease hormones. So you have also a sort of hormone deficiency or multiple hormone deficiency because of it. So I think, um, Catherine can well explain you that exactly how to eat correctly. But the, the, the most anti-inflammatory foods are our vegetables and ripe fruits, not of course, the unripe fruits like they eat in hotels. And drinking a lot of water. Water takes inflammation away. And it takes very much. It takes three to four times less pain in your body when you drink a lot of water. Now, for example, you, you look a little bit dehydrated because your eyes are deep into orbits. So maybe you didn't drink enough. And the wrinkles here are sharper. That's normally due to a lack of water. Uh, so, so water is a real protection. I would at least drink two liters of water a day in you. Okay, okay.
And, um, so, so, so that's it. Now, let's look at your other testing. And I did open that normally up, but it doesn't show up. So I hear maybe, and here's the disappeared somewhere here. It, so you're 47 years, and then, there's no argument to have in blood for polio transdermatologists, but you do have a contraction here that can be released by yourself. And you don't eat sugars for the moment. You, you stop the milk products, so that's good. You decrease the slow sugars and you increase the proteins. Okay. And your treatment is DHEA as a hormone. There are many, very good vitamins, but I'm not going to push there. And there's some vasopressin, but it's very small, though, 60 micrograms per day. Normally, you need to take it twice to really be be perfect. So he didn't get in yet because the pharmacy doesn't have it yet. Okay. Doesn't have one, exactly. She didn't begin. Mini, mini? Huh? Oh, she did the desmopressin. Okay. That's surprising. Okay. Now, at age 47, and we will see, there are multiple hormone deficiencies. And thyroid hormones, for example, make you slim and unswell. And now you're a little bit swollen because of low thyroid function. So they're very anti-inflammatory because they stimulate anti-inflammatory hormones. So you will be better. But, but here you still need to do a very local treatment. But on general, your body will be better with thyroid hormones. And, and, uh, if I just look at you, uh, there's also lack of, uh, growth hormone. But growth hormone is dangerous. And Catherine, in her case, because it may lower the cortisol, and then she inflames more. Should, if you have IGF-1, that would be better. Or otherwise, you have to give a small dose of growth hormone. And then of course, the female hormones are probably not optimal there. And you had a nodular thyroid, nodule in 2011. So you have also think he was low in thyroid and low in iodine. So let's look at the lab test here. And what do we see here? Oh, yes. Let me share you my screen. I hope I have the screen on this. Yeah, no, I think it's that. Are you seeing my screen or not? Are you seeing snap test? Yes, yes. Okay. So what we see here is that the FSH is normal. So she's not menopause, but it gets already to be a little higher. So we're already in the perimenopause, above four or five, it depends on what time of the cycle. But it's slightly higher. And, um, the ratio is good. There's no polycystic ovarian syndrome, apparently. Estradiol is high, but it could be the pre-ovulatory peak. At what time of the menstrual cycle was it taken? The 21st day. And you have a 20-day cycle, I suppose? No, yes, yes. So, well, it's high. And the progesterone is high. So you're actually a good producer at that moment. Okay. Of course, we don't have an anamnesis with the symptoms of, uh, low estradiol. And not, so we don't 100%. This is a low value. Normally, this 0.17 should be 0.6. So it's too low. Testosterone, and testosterone is an anti-inflammatory hormone for muscles and ligaments and tendons. SHBG is too low. That means there's low thyroid or low estradiol or both. Cortisol is very low. There's cortisol deficiency. And, uh, DHEA is, uh, it's different. Left is. So this is the value in micrograms. That's too low. It should be two or 2,800. It's 1,437. Sure. It's 50%. So you need DHEA. You need cortisol. Uh, the IGF-1 is very low. And that's a hormone, IGF-1. The lower it is, the more you inflame in your body. So we'll have to do it with a low dose of growth hormone. And when we look here at other testing, oh, here I have testing of the red blood cells. They look good. The platelets are a little high. This may be slight hypercoagulation. White blood cells are a lot of neutrophils. That makes it high, as if there was a slight bacterial infection. The good test for magnesium, the red blood cell magnesium. The zinc is, uh, is good, actually. But it's in micromoles, so I don't know so much about that. And I used another unit. The lead is found there. Aluminum too much. Some heavy metals. Selenium is good. It's good value for selenium because that's anti-inflammatory. Selenium. And the ferritin is very.
Low, so that gives normally an evening tightness. You should normally have a tendency to fall asleep before TV. Do you do that?
Yes, every day.
Every day. What? She had the injectable iron before because now it's low, or she resists afterwards? Yeah, okay. Very good. Find B12 is too low. It should be above 400. Vitamin A is again in another unit, so I don't really know. Vitamin C is very low, but it's difficult to have a good value because of, um, it has to be immediately checked after, uh, take. Vitamin D is too low. It should be actually, uh, um, 200 in that unit, and it's 64. And that gives also more inflammation, so you should add Vitamin D, at least because you have overweight, at least 15,000 to 20,000 a day until you have a correction, because the fat tissue neutralizes a lot of it. Vitamin E is good. Uh, okay. Cholesterol, I won't go. And everything looks a little bit high to cholesterol, so it could be low thyroid.
And then you have enzymes here, and a little bit too much of the gamma, uh, GPD. Do you drink a lot of alcohol or not?
Absolutely not.
And you take antibiotics recently?
No, I took a lot when I was young, but not recently.
Well, the liver is a bit disturbed, so I don't know. Um, this maybe fat, fatty liver, maybe? Yeah, but no. Um, I suspect something happened in between, or you have the Sord Gilbert disease that some people have a little higher of this enzyme. But then you're a little bit yellowish as a color, yellowish-brown. Are you a little bit yellowish-brown? I don't see what's the light.
Catherine says no.
No. Maybe it's the lighting of the room. Yeah, okay.
So, the TSH is, uh, a little bit high. Should be below 1.3. There's more cardiovascular mortality at that level. Uh, doesn't mean that you have an increased risk, but, but you have to be careful. There's more disease above that level. That means low thyroid. The T4 is too low. It has to be high normal, and the D3 should be average. It's average. So there's a higher conversion of T4 because of the low cortisol. Now, no, almost no antibodies against the thyroid, so that's okay. The FSH, we saw this already. And let's look at IGF. You said it has to be around 0.6. I thought 0.30.
No, 0.6 for a woman. Yeah. And I have some women I put on a very high level because they are so much cellulite, so much collapsed psychologically, mentally, and no energy. And then I go to, to even very high levels without any problems. I do it always since years. And some women, and, and they have, um, but I do block them. The conversion of testosterone dehydrator is finasteride. The advantage of these women is that you have women that are very collapsed, and then suddenly with those injections once a month, they become the new prime minister, or he could become the new prime minister. So dynamic, and so self-assured, and so determined. So most of my patients actually want to have that, because I have a lot of people who are a bit VIPs, and they need to manage people. And with that, you manage people much easier. Thank you.
So if one is a little, uh, low compared to the IGF-B3, which is on an average level, so that's okay. Uh, anti-diuretic hormone, that's vasopressin. Okay. The insulin is, is low high. It should be, yes, it's already insulin resistance above 10. Insulin resistance. So if you, um, a patient would, I don't know how to call you, your patient, what is your name? Can you give just the first name?
So, Sylvie.
If Sylvie, um, loses weight, the insulin will go down, and she will lose it. I gave her the, the vitamins I gave her are against insulin, insulin resistance: picolinate, the chrome, Vitamin B1, B6, seeds of magnesium, internalization improvement you proposed, but also thyroid hormones, very important. Okay. And, and but then if there's a little high insulin, you might be a little careful with growth when you go very slowly every month with 0.005 milligrams increase to 0.15, for example, or 0. But you'll see the urine, the, in the urine sits very high, the cortisol. And I want your explanations on that. Yeah.
Looking here, first, too low pregnenolone. So, Sylvie, you should normally have a lower memory, and short memory should be a little bit decreased because of this low, uh, pregnenolone. That's the memory of the hormone of short-term memory. So if you go in another room, you might forget what you've been seeking.
All the time.
All the time. Well, then take pregnenolone. It won't, won't be anymore like this, but you do need several months sometimes to really improve it. Um, okay. And then I think I have here urines of 24 hours, and we see that the three NT4 thyroid hormones are too low.
Um, Catherine, what you should ask, if possible, to get also the creatinine. Uh, we have it. It's just above. You have another page of urine tests.
Ah, okay. Yes, here.
Okay, that one. Um, it's, it's low. Did you do a full collection of 24 units? First urine toilet, but all the rest you kept?
Yes, you gave to the lab.
Yes, because here the creatinine is, is, no, it's not so low after. I looked at the wrong. Well, here, here you have to look at 24 hours. Uh, it's, it's a slightly below average. So that means that all the values of the hormones here should be below average slightly. And you see, uh, that diagonals are, are too far below average, so that's not good. The androsterone and yogananda DHCA are low, too low. They're vertical average. So you need male hormones, DHEA also. Uh, with that, metabolites are not so bad in total, but there are many inactive ones there. And you're, you're not taking progesterone. This was the second phase of the cycle, so she was making progesterone. They put the reference values and follicle phase, so you don't have to look at that. And then you see that melatonin is exactly good value for her for 24 hours. And hydroxy spirits are high. That's, that's because you don't sleep so well normally, or you didn't sleep that well. So when you, you don't sleep well, you move too much at night, and you consume the cortisol at night. So it's the wrong, the wrong pitch. You don't have too much. You, you actually are having, um, a sort of depletion at night. So you probably will have to improve the sleep with melatonin and 5-HTP.
Melatonin, I was afraid the melatonin could decrease the cortisol in, in the morning. That's why I didn't dare to give her.
Yeah, but another, keep the sublingual doses, which are very low. And you have, for your health, is even better because without preservatives, your health, 0.2 milligrams, it gives you 0.1 milligrams of lingual. And then if it doesn't sleep well, the last four hours of the sleep, you give 5-HCP, 50 milligrams, for example. Yes, and it will be okay. Now, um, you don't have any other inflammation except your neck assembling.
Oh, it's, it's actually my whole body, but only on the right side. So it's from the top of my head until my toe. So that was my right side hurts.
That responds well to yourself blocking everything during at least four months, uh, two times a day. And you will see there will be a great movement. Now it is true that you have actually, uh, um, low, uh, cortisol. If we, if Catherine maybe next time also ask cortisol that gives the production, the metabolites are metabolically. And I think the production would have been low here of cortisol. That gives you another clue that we're just over consuming cortisol at night, and there's not enough left in the morning when she does the blood test. So, um, I think she needs some cortisol. And, um, I, um, do you have low blood pressure, or high blood pressure, or normal blood pressure?
Uh, usually my blood pressure is 12/8.
So that's good. So I think because of the overweight for the moment, until she loses enough weight, it's better to give Medrol, like because she wants to lose weight, maybe just three milligrams, not four milligrams. But so it's between three and four milligrams. If she has a jet lag or there's a lot of stress, she has to go to four milligrams. But the idea is also to lose weight because that will also benefit the body with thyroid hormones and the female hormones. I, I don't really have enough information, but maybe, um, we can, I'm going to stop sharing my screen and we'll see Sylvie a little bit better. And I think you sent also pictures, or, or did you not send pictures?
Uh, no, there were some I couldn't. Okay, pictures.
So, um, Sylvie, can you just show your hair and go near the camera? Is it dry, or are, Catherine, can you check if the hair is dry on the back?
Yes, yes, a little bit. And rough.
Thicker, sorry. Is it thicker, thin?
Uh, thin. It's getting thinner and thinner. Yeah.
And can you show a bit, come more in the camera because you're just halfway out of the camera. If you can be more in the middle. And, uh, can you show, um, also your eyes and uncover the lower eyelid? Maybe Catherine can do that otherwise for you close to the camera. Yeah, good, good. No, they are not inflamed, but the icing will dry. You see the light is not well reflected in the eyes, and the eyes are a little sunken into orbit. So dehydration. But the dryness of the eyes is like oxygens. And, um, do you find that your hair has lost volume, or like it always has been?
Yes, and that's like talk normally.
Uh, she needs a little estrogen now for the neck. What I always do is I put a very low dose testosterone and Vitamin D because this will help take out the inflammation locally of the nerves and of the muscles. Not the fundamental work. The phenomenal work is still to take out the contractions and, and then the pain. Okay, on the neck. Yeah, 0.25 because you're putting it warm. Do it twice a day, very thin layer. So, so hopefully you cannot see. You can also put some estrogen there, so there won't be any hair growth there. Okay. Then, uh, Vitamin D, it's two grams per hundred gram of Vitamin D3 in a solution, in a fatty solution like jojoba oil, for example, or, uh, cold cream, cold cream solution. Okay. So that will help. But still, um, and, and I would also give probably Omega-3, but you already give Omega-3 that is inflate Vitamin D in very high amounts. And, and but you'll put it also locally and drinking a lot of water for the pain.
Now, let's go and look a little bit closer. Can you show me your tongue near the camera? It's coated, so the food is still not good. And you see that the borders of the tongue are indented. That's a lack of water in the body. Okay. So you need more water. The body craves for water. And one of the reasons could be that the aldosterone is maybe a bit lower, and that she's losing than some of the, the fluid. But I don't have any, uh, good data on that.
No, but we have ADH. Anti-genetic harmony is very low.
Yeah, but it's maybe undetectable because the lab doesn't do well the test. So, so we don't 100%. No, but to know, to be sure, you need to go closer to the camera, and I need to see your skin of the forehead and of the cheeks. Yeah. And can you turn a little bit so I see the cheek? But you're taking desmopressin. I do see brown. I didn't get it yet. The pharmacy hasn't hit, so she didn't get it yet. But okay, she didn't get. Um, I don't see so many, uh, irregular skin or schmutz, but maybe the camera is not so good. Can you look a little closer? Do you find it's like a bit like an orange peel or not?
Or maybe that's, that's good. Yeah, it's, you see, this is like an orange peel. It's a little irregular. That's typical for low vasopressin, low lack of water supply. But then what you also saw is brown spots. Yes, either. So she needs a little cortisol. And also the eyes are little dark circles on the eyes. When I see it, it's a little dark circle. So, uh, a little bit. Yeah.
Then could you, Catherine, check the thyroid by putting the two fingers below her throat and flat, and see if it's enlarged or not, or on the back? It's also good. And can you swallow now, Sylvie? Swallow. What do you think of the thyroid volume?
It seems to be okay.
Okay, it's okay. Maybe on the left side a little bit bigger, but yeah, slight enlargement. It will become normal with thyroid hormone. The grams that she should take is probably going up between 90 and 120 milligrams. So this, get a thyroid if you can have that, or if it's Novothyral, one tablet and a half, or one tablet and a quarter if she tolerates it, because it's too quick, absolutely absorbed for the T3 there.
Now, Sylvie, um, can we see a bit your belly? Just slightly uncover your belly to see it because that's very important if the belly is inflamed, you know, you have to disinflame it.
Yes.
And can you go on the side? You see that upper belly is bloated. So you eat in the evening, uh, proteins, I think, you know, meat and fish. Yeah, yeah. And so the, the meat of 24 hours ago is still there. And below this, like grains that are eaten, the bread are, um, uh, milk products. But it's mostly that you eat too much protein the evening. It doesn't leave your belly before in you, even 12 hours. In most people, between three and nine hours, the proteins, the meat they eat. So eating meat in the evening is somewhere an aberrancy. It's never good. You always have a bloated upper belly. And then what is the bloated upper belly? It's a zone of inflammation with undigested food and digested by, by, by bacteria that proliferate. So there's too many bad bacteria, not enough good ones. So just eating less. Normally, um, I don't, I even think that we are not made to eat three times a day, maximum one or twice a day. And for the moment, and most of the days, I just eat one time a day. But I lost a lot of kilos, but it was okay because I want to do some marathons. But I think it's next year, in 2022, I will do it. So, okay. But, but, um, so, um, so that, that has information.
Now, um, also such a belly, abdominal business is linked to low growth hormone. So growth hormone will help that also. But you'll probably need 0.3 milligrams of growth hormone to decrease that sufficiently. But start only because growth hormone can decrease cortisol to go to 0.15 milligrams maximum. And then once you lost enough weight, there's much less pain for four months. Normally, should I have no pain, or four months and a half, I think. Um, now, melatonin, I think, was that asked in the test? I don't remember.
Yes, it was low.
Oh, quest low. So melatonin is awesome. No, it was 44.
Yeah, it was 44. This. Yeah.
Okay, so maybe you don't need the melatonin, but I still will give it because you don't sleep well. It will still help. Maybe you need a higher amount. Okay. Um, now if somebody takes melatonin, they often take too much, and then the cortisol goes down, and you have very high levels of the metabolite of melatonin in urines, like 600 in place of 40 or 45. So you should really give sublingual melatonin.
So I think we've covered most of the things. Uh, I, I didn't see a split in the tongue in the middle because that's a sign of, um, Vitamin A deficiency. But maybe we can look at your feet and your lower leg because it could be a lack of omega-6 fatty acids in the leg. Is it possible to see your, your lower leg and then your foot? So, sure.
It looks a little yellowish, uh, what I see here. Uh, so that's an accumulation of beta-carotene that's not enough converted to Vitamin A because of, uh, low thyroid. And you see that the tone also of the foot is not good enough. Uh, it's, it's, it's, it's a little lacking, not much, but it's still lacking. So certainly. And do you see on the heels, uh, fissures, uh, Catherine?
No, no.
So, okay, because that could also happen with low thyroid or low Vitamin E. Now I would like to see the leg. When you see the leg is a little flaky skin on the leg, Catherine, or can we see it ourselves? What do you mean with flaky? I, I don't understand.
This is but a little flaky, at least where the trousers are a little whitish. And that's typical for a lack of omega-6 fatty acids. You find omega-6 fatty acids in a lot of vegetables and plants, but you have to eat them raw. And so I would give some birch oil, five grams a day for three months, and then three grams after. And that will improve. It will also make the hair less dry. Okay. Do you have any, uh, cyst in the breast or not?
No. Uh, oh, here, just a moment. The microphone is off. So, okay. Noticed in the breasts, but there's a high iodine deficiency.
Yeah, but there are no, or there are, so there are no cysts. No, so it's okay. Good. Um, I still, still need to see your hand. If you come with your hand and you put here on the lower part. Yes, I think even the hands are a little yellowish, and the tone is not too bad actually. Yeah, it's not too bad. Can I see the nails? You see that there's a brownish border below the white. That is due to low cortisol. It's the sort of pigmentation that's low quality. Can I see then the fingers? Well, it looks good. I don't know if there's a little bit more brownish color of the joints. I don't think so. Catherine, can you see?
No, not really. Huh? No, not really. But, um, the, the fact that the, the, the tone seems to be correct, it's not linked to the water retention. It doesn't change the thinness. Well, there's not, this is dehydrated, though it could be the mixture. But I, I noticed that people who are dehydrated with the eyes, you know, they often have water retention as if the water wouldn't go in the right place, but would do a stagnation in the tissues. Yeah.
Well, there are two types of water retention. One in the evening, that's due to too much salt or too much aldosterone. And then there's one in the morning, and that's due to too low thyroid. Then you're swollen in your, uh, hands and fingers and, and feet directly. So depending, I don't know, Sylvie, are you swollen in the evening or in the morning?
Um, very often in the morning. Like I have to take my ring out every morning because it hurts really bad.
Okay, that's low thyroid. That will go away when you take thyroid hormones. So you say to me to give her thyroid hormones, but I thought to correct first the iodine deficiency and then check again. You may activate the deficiency by giving iodine. I think you have to do everything enough because, um, is suffering since too long time already. And why would you wait with excess weight because of a low thyroid compression all over the, the body because there's waste products accumulating? So I wouldn't wait with the hormones. Okay. She deserves, uh, to be improved as quick as possible. It's no value. You will not by giving iodine be able to avoid giving the thyroid hormones. Okay. It's not exactly efficient up till the age of 14 years, and then after not. And those who say it's efficient, it's because they don't look at the clinical symptoms of thyroid, the physical signs. And then, then you would know. Um, okay. So, so I think we, we've covered, uh, most of the information. Are there any questions you would have?
Yes, um, I don't understand why the fact that she has bad nights, that she probably moves at night, as the, the cortisol go up in the urines. Yeah.
So it's because you move, uh, you, you are thinking, you are a little moving. The muscle body is not so relaxed. You consume cortisol for that. And that's typical. It's all the time like that. But if you consume it, it should, it should be, ah, okay. So it goes in the urine because it's eliminated during the night. Yeah. Okay. It's all exactly nighttime cortisol overuse. In order to calm that down, you calm it down with giving melatonin, 5-HTP, so she doesn't move, and she will have more of her own cortisol. But it might still not be enough. Okay. Uh, because we saw the values were so low in the morning. It's a little dangerous not to give her because she also has inflammation. So even actually the cortisol takes out the inflammation you have in the shoulders. But hers is more, uh, well, it goes also in the shoulders and goes from the neck to, too late, later. So, so it will help at least part. Works very well for them.
Um, so, so then I give her some estradiol gel. I would intend it to, but I don't have enough information based on here because she has high levels actually. But you have a normal menstrual cycle. It comes every 28 days. Okay. We need another blood test at another time of the cycle. Or, well, it's evident that she has estrogen deficiency because of the age. But maybe she just needs one pump of estrogen from the fifth to 20, 50 of the cycle. And then 100 to 200 milligrams, 100 milligrams Monday, 200 milligrams of the progesterone from the 15 to 20 days. So 5th to 25th, a small dose of estrogen. And, and then 15th, 25th also because of, uh, to, to, to avoid having, uh, overweight problems.
Um, those who are attending, um, the offspring that you would maybe I'll put your picture on because they want to make a little picture of everybody and things like that. So if ever you're okay, open up your, um, all your pictures so we see who you are. It's, uh, interesting for everybody also. And I'm going to answer some of the questions. Catherine, you did ask some questions, but I'll ask them another time because, uh, you give to everybody opportunities.
Doctor Anatoly Tomrock of France, I've always wanted to ask about a problem that, that I encounter when I treat patients with hypothyroidism with natural desiccated thyroid extract. I often measure normal high free T3, low normal VT4, and nearly suppressed TSH. That is normally always the case when you ask a blood test in the morning after the patient takes the thyroid hormones. So there's a peaky level that suppresses during nine hours the TSH. And then there's a level of, um, 3T3 that is much more quicker absorbed than, uh, T4. So you have a high T3, a low T4, and a suppressed TSH. So you have to ask the patient not to take the thyroid hormone before the blood, but after. So you're 24 hour after, and you won't have that sort of, um, uh, testing. So that's typical for, for the thyroid test.
And, uh, now imagine you still have a suppressed TSH in the patients who is on thyroid, and you do the test correctly, and, and the patient looks fine. One third of the patients, following two studies, who are clinically completely okay, so you have to continue the treatment in these patients, have a suppressed TSH or below the lower limit TSH. And a study showed, a very interesting study showed that if you take out the thyroid gland of patients, um, you have, um, thyroidectomy. When you give them thyroxine, you have the parameters of intracellular thyroid activity in, in, in blood like SHBG, alkaline phosphatase, acid phosphatase, and LDL cholesterol are only normal normalized if the TSH is suppressed between 0.3 and 0.03. So below the lower reference rate. So this means that actually, um, this, this validates that you are able to take this, uh, thyroxine treatment even to lower, uh, TSH levels if you do not have hypothyroid symptoms and physical signs. It's okay. And validated by the science actually. In the model on thyroid therapy, you have all the information. It will appear. But, uh, can tell you, you will be, um, if you want to know more about that, absolutely excited about the information that is in it. There's so many ways you can improve thyroid function.
And then Doctor Victoria Kupik in, um, oh, we're already a bit below, so I probably will have one or two more questions only. Um, Doctor Victoria Cooper from USA, I know too high estrogen or too low estrogen can make a difference in weight. How do you really know what is perfect levels? I follow FSH to see if I'm dosing correctly. Is, so how do you know blood tests are a poor reflection of what really happens? If you really want to do the treatment with female hormones correctly, you provide to your patient estrogens and progesterone, and you look at what clinically happens. I mean, what are complaints of too low or too high estrogen, too low or too high progesterone, and same for physical signs. So you check, and actually know the most important sign is painful breasts, for example. Uh, that's to look, uh, swollen painful breast is too low progesterone or too much estrogen. And, um, if the breasts are droopy, you're sure it's too, too low estrogen. So with that, you know. So those, um, I would say typical signs for, um, females, you know it best. Otherwise, menstruation, if the menstruation almost not appearing, and you're treating in the pre-menopause, and menstruates almost not, there's too low estrogen. But if they're too heavy, there's not enough progesterone. So it's, that's the best way to know.
And for weight, um, if you have, uh, you're overweight, you're probably progesterone deficient as a woman, or your patient is. And if you have a bloating of a lower, uh, bloating belly, and, um, that is typical for low progesterone because estrogens give constipation. Progesterone, uh, neutralizes that as a sense. They, they block a bit the transit, and they make you swell because of edema. That's how they block the cancer because of edema. So you have to just to see the patient is not swollen and, and be in the good balance. And then for the wetness, and it's so that, um, when I have to treat a woman of 45 years, I often wait to give the female hormones till they lose enough weight if they are overweight. So because I just gave them progesterone and not estrogen. But it depends on how severe are the signs of female hormone deficiency.
And then let's say a last question. Uh, Dr. Paul, there was another question here from Dr. Victoria Kupik. Is estradiol patch twice a day, 0.05 milligrams, sufficient? And what you need to add estriol to balance and avoid 16-hydroxyestradiol happening? First of all, an estradiol patch is almost never sufficient for a patient. It's, um, it's, um, it's the first day there's too low a dose, especially one of 0.05 milligrams. The second day there's too much. Third day there's not enough. And with the 0.05 milligram patch twice a week, there's never enough. And because it is an imbalance, you, it's difficult. The first day you should get lower progesterone, secondary to progesterone, third day less progesterone. It's very difficult to balance those such a patch. So I prefer having a daily transdermal gel that they put on the arms and the shoulders. That works usually better. Um, okay. And for the estradiol hydroxy estradiol happening, that means that you should avoid having the metabolite 16-hydroxyestradiol. Would estriol provide an improvement? It may, but the major improvement is by giving thyroid hormones and by giving eventually indole-3-carbinol or DIM, which are extracts of cruciferous vegetables that improve metabolism.
And then I'll answer to one question of Dr. um, Paulo Bragassi, Brazil. Can't use testosterone cypionate and nandrolone in, can I use the injections of testosterone are, are neutral, which is an anabolic steroid in benign prostate hypertrophy? I'm already using a formula with progesterone iodine in suppository. So by giving suppository, you decrease the size of the prostate. Nandrolone cannot convert into estradiol, so there's no danger of giving nandrolone. That's 25 milligrams every week or two weeks, and, and or 50 milligrams every two weeks of nandrolone is safe in the benign prostate hypertrophy and is generally well tolerated by the body. Testosterone cypionate, which is more natural, bioidentical hormone, you can give it, but you often have to give an aromatase blocker that blocks the conversion of testosterone to estradiol. Okay. If you have any question, but I don't know if I can see everybody here. No, Raïs raised your hand. Okay. Yes, one small question then.
Yes, I wanted to know with the, the treatment for the eyes, for the myopia, with the growth hormone and the IGF-1, I cannot find a vasodilator. It seems to do that they don't commercialize it anymore. How do you do?
Well, you could double dose of procaine. Procaine, you have, I suppose? Yes, procaine. No problem. It will play the role of a vasodilator. The only problem is that when you put drops in the eyes, is the procaine that hurts. And so that's, you should almost dilute the solution before you put in the eyes by twice in order not to. Otherwise, it will probably be hurting. Even one drop will hurt too much, and it will burn. I can use it for the injection, but for the drop, I don't put it.
Yes, yes, yes. Okay. And because the calcitonin doesn't exist anymore, uh, so I do only with IGF-1, GH, and it doesn't exist. It's everywhere. I cannot have it neither in France, neither in, uh, in Switzerland. You can have it in Belgium. Miacalcic.
Ah, in Belgium still. Okay. I know Miacalcic. Yeah. Okay. Yeah, the names are not always the same. So maybe it could be that there's a name. And I think I have patients from Sweden who buy, bought Miacalcic. Yeah, but no more since a few months.
Okay, well, that's a pity because if it's not there, maybe also in Belgium in a year or two. Okay. Well, other questions, we'll see that next time because I think we have to limit also with the time so that everybody could go back to his practice or family or whatever. I thank you for being there. It's really great. And is it okay for you that we do each time some clinical cases?
Yes.
Okay. Everybody says yes. Okay, perfect. Then see you. Bye-bye. Thank you.