The high reverse t3 levels (rt3) are a result of a restricted diet with over training. To verify there was no issue the reader will note in the results a lab draw on 10/12 that measured Iodine. The link discusses the relationship between Iodine and the thyroid gland.

Very low cholesterol has been tied to issues with memory loss and dementia, as well as other health issues. While many TRT specialists aim for a total cholesterol of 180 mg/dL I believe the body can function with lower levels. The thinking goes something like this. See the hormone tree below:

Note the cleaving enzyme that cleaves cholesterol into pregnenolone and then on down the steroid pathway. Without enough cholesterol there is not enough fuel for the remaining hormonal system, right? True – to a point.

The reality is everyone is different and that 180 mg/dL is not some magic number or target. For some, 120 may work fine, or even lower. The worry is that patients will remain non-compliant with cholesterol lowering medications without doctor supervision in an effort to “jump-start” their own testosterone or maximize hormone fuel by boosting cholesterol. The warning here is…be careful.

I lowered my dose to 5mg of cholesterol and purchased a cholesterol meter that measures Total Cholesterol, Triglycerides (TG), and HDL. This allows LDL to be calculated using the formula LDL Cholesterol = Total Cholesterol – HDL – (TG / 5). I ensure I am always above 120 and I am doing just fine. If I hit 180, I don’t panic. I get by without any problems with frequent exercise and some sanity in my diet.

Not shown in this lab that did show up on previous labs I appear to have lost was an increase in hematocrit and RBC leading to polycythemia – an increase in red blood cell count per unit blood volume. This increases the risk of clot formation. If you have heart disease, watch out for this side effect. More often seen on shot therapy for TRT, it can happen even with gels. More discussion can be found here. Treatment usually involves blood letting, a procedure that can be ordered by your doctor. Also, it helps to cease TRT treatment every 12-18 months for a short period of time.

As far as the testosterone levels go, I was on 1.5 tubes of Testim for this test, applied in the morning, and the blood work done 2 hours after application. Note the high total testosterone level. This level is a false reading as a future lab would indicate.

WARNING: Never apply Testim or any gel to the area where the blood draw will occur. This can taint the results. This is what happened for this particular test. I had to ignore the results.

10-6-10.pdf

Note the really important lesson here is twofold. First, the “sweep spot” theory is just that – a theory, and a bunk one at that. While it may be true in some men, and at the time of this test I thought I found the cause of my own libido issues, later when my levels were steady at a number greater than 82pg/mL functioning and sexual appetite were more than just fine. My sweet spot seems to be a range that is not too high (what that number is I do not know) or too low. Second, the real metric of interest is a stable level that is not bouncing around all over the place.

Armidex is one of those drugs that causes E2 to bounce around, especially for those on weekly Testosterone shots. Your T levels peak, then fall. One protocol has the user add in HCG the last two days prior to the day of your next shot to “bump” your T levels back up. I prefer the protocol which has the user inject every other day. Take your weekly dose and divide by 3.5. With such small doses, it is now possible to inject with an insulin needle, and there is strong evidence that these injections can be given subcutaneously as opposed to intramuscular.

For gel users, dosing twice a day can help, although gels are less likely to convert to the estrogens than shots. With stable T values, E2 control is easier and one avoids the roller-coaster ride. One must be cautious that E2 does not drop too low. Low E2 for some patients, especially those with adrenal or thyroid issues, can lead to a host of problems, including severe and long-lasting – sometimes permanent – joint pain and damage. If someone tells you to drop your E2 to the floor, ignore them. Gel use does not always mean that E2 will remain in the normal range. I am an example of that as future labs will indicate. If you are insulin resistant then any exogenous T will convert to the estrogens.

The real reason estrogens should be in range for men is the tie in with increased cancer risk for males with raised estrogens. The solution to this problem is not an AI (aromatase inhibitor) but rather a good diet and exercise program to address the weight issue. There may be some men who still have estrogen issues where an AI is called for. However, keep in mind there are ways to assist estrogen problems that are natural and if these fail, then an AI can be used, with the understanding that AIs like Arimidex only reduce E2 and not the other two estrogens. In the labs below, the user will see all three estrogens are measured. This is not necessary and only Estrone and Estradiol need be tested.

Note the name of the estradiol test – ultrasensitive estradiol. For Quest diagnostics this test is still probably too sensitive for men and there is another test. Look at expert KSMan’s post on the subject over at Anabolic Minds.

I now use Labcorp and the name of the test is the Sensitive Estradiol test. Always ensure you are using the right test. Failure to do so results in wasting time and money.

Here is my Estradiol lab:

9-2-10.pdf

It was at this time, years ago after a collapse following treatment with a combination thiazide diuretic and ACE inhibitor for blood pressure, that I first started testosterone replacement therapy (TRT). After the PCT fail, I restarted TRT and began working with my family physician. The initial results that indicated low testosterone follow. However, it should be noted that a body mass index done a couple of months later indicated large adipose fat deposits, and previous labs pointed to insulin resistance. At the time, I did not understand the significance of this finding. My body fat from the hydrostatic chamber test hovered around 27%. With insulin resistance, SHBG tends to be low. Recall the formula: Free T = Total T – SHBG bound T – Albumin bound T. As testosterone is easily ripped off of Albumin, Bioavailable T is basically Free T + Albumin bound T.

If SHBG is low, this will drive Free T (and Bioavailable T) high. The body will attempt to dump excess high Free T in numerous ways, one of which, for those of us with larger deposits of adipose fat (fat surrounding internal organs) is conversion to estrogen via the aromatization process. This occurs in various areas of the body, including adipose fat and the liver, as well as other locations. One can have normal to high normal or even high Free T and low Total T. That is why a total T measurement by itself is not the best of tools to diagnose what is really happening. Subjective reports are also important. Although in this case my Free-T was normal, my %Free-T was high. Subjectively I had low libido, low energy, and poor erection quality. I also found it difficult to think. In this case, Total T was probably a good measurement when coupled with my subjective report to diagnose hypogonadism. However, an SHBG measurement when coupled with an A1C would have indicated insulin resistance.

Treatment of insulin resistance may have been the best approach in my case. The result would be increased SHBG bound T. This would have, over time, caused my Total T to raise. The bodies attempt to dump free-T, including conversion to estrogens, which would lower total-T, is mitigated with less adipose fat. By reducing adipose fat, one way to control or reverse insulin resistance, this conversion would not have taken place and a balance would have been struck with normal Free T and normal total T, with much less estrogens. Instead, after the results below came back I started on Testosterone Cypionate 100mg/week intramuscular injection (IM). Levels after five weeks were around 500 Total T. A bump up to 125mg brought my levels higher (see the other set of labs from my new doctor (8-31-10).

The issue with the shots? At first the dopergenic effect created a raging libido and strong erections. Strength skyrocketed and I started building muscle. However, after a short period of time – about 4-6 weeks, the libido and erection effects wore off profoundly. My doctor did not know what to do and recommended I seek out a specialist. As I had a wedding anniversary cruise in two weeks I needed help fast. I knew that many who used T shots also used an aromatase inhibitor (Arimidex is popular) to bring down the strongest of the estrogens (E2 or Estradiol). I also knew the shots would do little to increase DHT (a testosterone byproduct responsible for all things male) and that gels converted on the skin via the 5-AR enzyme into DHT in the body. DHT increase libido and erections. My thought was to start Testim immediately 5g/day, with .25mg Arimidex every three days, and HCG 250IU every three days. More on those last two medications in a later post, but needless to say in a very short period of time I came raging back just in time for the cruise. Dr. Dan Freeland worked with me and we would continue to work together. It would be later that Shawn Bean would enter into my treatment program in consultation with the doctor. The ride was just beginning, but at least for now I was good to go.

Here are the two labs referenced above:

• 5-27-10.pdf
• 8-31-10.pdf

I immediately began to treat the depression, and began an exercise program that consisted of 100 deep-knee bends, as many push-ups as I could handle, and walking for short distances. After the depression resolved itself, additional tests which indicated high cortisol and I barely passed a dexamethasone supression test. Failure of this test is indicative of adrenal issues. Measured testosterone was very low at 185 ng/dL. I decided to treat the testosterone only and attempted both Androgel and Testim, finally deciding on the Testim. I saw many specialists including a neurologist, a lung specialist, a neurosurgeon, and a cardiologist. After over fifty thousand dollars worth of tests they found….nothing wrong. MRIs, stress tests, multiple visits to my general practitioner and nothing, nada, zilch. I first suspected rhabdomyolysis, which testing quickly ruled out. MRIs of the pituitary, hypothalamus, and adrenals were negative. The only conclusion offered by one doctor – I suffered from a variant of Guillain-Barre syndrome, an ascending paralysis that in the worse cases becomes complete, with the patient on a ventilator. The disease usually resolves itself after a period of months, weeks, and sometimes years.

Six months later, with no improvements at all, I awoke one day to find all the symptoms gone. It was like a light suddenly switched on. To this date the only consensus is that I should stay away from ACE inhibitors – a type of blood pressure medication that blocks Angiotensin II, a very potent chemical that causes the muscles surrounding blood vessels to contract increasing the pressure within the vessels thereby causing high blood pressure. With the recovery complete, I decided to stay on TRT. It would be many years before I attempted my first restart protocol. After the protocol failed, I found myself back on TRT and looking for an answer. With the recovery of my the rest of my endocrine system – including the complete reversal of diabetes – it makes sense that my Hypothalamus-Pituitary-Testicular Axis (HPTA), involved in testosterone regulation and production, would recover as well. As long as I had left it alone. With years of HPTA suppression the chance of a spontaneous recovery was slim to none. Hence the attempt to restart. When this failed, I visited my general practitioner whose heart was in the right place but whose knowledge of TRT left much to be desired. With a simple total testosterone test, the conclusion to start me on Testosterone Cypionate at 100mg/week began. This is where my recent experience and education start. As the details below note, this latest adventure lead me to Dr. Daniel Freeland and Shawn Bean. This is my story to date. Future posts will begin to detail labs related to the information below, which is merely a synopsis of my experience with the various methods of TRT for the past 8 months and is not exhaustive of my personal experience during this time.

Test Cypionate. Wow. What a month I had. Libido – through the roof. Erections? Top notch. Muscle gains – out of this world. Weight loss, lean body mass, mood improvement – fantastic. Six weeks in – everything remained the same except for two items – libido and erection quality. Both dropped off not just a little but completely. The reason is related to the bodies response to initial TRT. There is a strong dopergenic affect that lead to the brain desensitizing to the effects of dopamine over a short period of time. While sensitivity is regained, the proper balance of dopamine is directly related to many other systems. Something else was also going on in my body. Only two weeks away from an anniversary cruise I panicked. The GP, flummoxed, called an endocrinologist who recommended an increase in my dose. As my hemaocrit levels were already high I refused. I was just beginning to push myself into polycythaemia, a condition no heart patient wants to find themselves in – especially one with 25 stents. Also, there was very little liklihood the increase would have worked. Why? Even though I had never had SHBG, E2, or DHT measured I already guessed the answer. My bet was my E2 was screaming high and DHT was low. Gels increase DHT far more than shots through the 5-AR enzyme, present in the body, but also found on the skin . The more surface area covered by a gel, the higher the DHT. E2 can also increase, but I needed something and I needed it fast. I decided to test out my theory by visiting Dr. Freeland.

I switched to Testim immediately with 250IU HCG every three days. By the time my cruise date arrived, I was able to once again perform and my mood was markedly improved. As Androgel’s efficacy left much to be desired for me in the past, I decided on the Testim. One problem. My insurance does not cover Testim. Even with Auxilium’s coupon of $75 and Costo’s lower cost of $300 compared to most pharmacies charging over $375, I was looking at paying $225/month. It would get worse. Soon I would find that I required more than just the 5 gram tube of Testim and that 10 grams, spread across two applications, provided optimum results. The coupon worked for just one box of 5g tubes. Therefore, the total cost to me now was $525/month. Still, I tried it for about three months, loathe to attempt the compounded creams or Androgel. During this time I played around with Arimidex (which I will never do again), and varied my HCG dosing as multiple labs were drawn. It was then I decided, after prodding by Dr. Dan Freeland, to give Androgel another go, this time using more of the gel than my prior attempt all those years ago.

Starting with 6g 2x per day and 250IU of HCG I noted very high levels of testosterone – over 1200 ng/dL. Also, the levels were constant enough dropping to around 900 ng/dL the following morning. Dosing twice per day is important for me. I am insulin resistant, driving my SHBG low. A single application under these conditions drives my Free-T so high my body dumps testosterone into estrogens as fast as possible and excretes the rest. Measurements the following morning would be at hypogonadal levels. Dosing at twice a day mitigates this effect. However, at 1200 and 900ng/dL (two hours after application on day one, and before application on day two) I experienced a breakout of bad back acne. The above protocol with Androgel included times where HCG was used and also not used. The usual protocol recommended by Shawn is to use gel only first, get the levels where you want them, then add in HCG for additional subjective and physiological benefits, retest, and adjust the HCG.

Lowering the dose to 5g 2x/day seemed to help, but for reasons unknown to me at this time, my E2 levels on Androgel, unlike Testim, were low normal and low respectively for the two measurements. I added HCG back in at 100IU every three days and did note a drop in testosterone, high free-T, high DHT, high normal E2, and high E1.

Since this last lab, HCG dosing changed to 50IUs every three days. My next labs due to be drawn in a few weeks will indicate my state under this new protocol with Androgel and HCG. Low ferritin levels were also noted at this time with suspected thyroid issues being the possible culprit. However, so much blood was drawn over a two week period that I suspect one of two things – too many blood draws or gastrointestinal bleeding – a complication of Plavix use for some patients. Being on Plavix for over 5 years now, this later case cannot be ruled out.

It was also during this time that a complete Nutra-Eval from Genova Diagnostics was reviewed by both Dr. Freeland and Shawn Bean (who specializes in interpreting these tests). Multiple supplements were recommended and follow up labs in two weeks will recheck ferritin levels as well as look at the thyroid in detail.

Shawn’s ultimate goal is to get my body the proper building blocks and resolve any outstanding health issues to give the next restart protocol the best chance at success. The adventure continues.

Transdermal testosterone includes patches (which will not be covered due to their low absorption rates) and gels such as Testim and Androgel, which are both 1% concentrations, and creams from a compounding pharmacy which range from concentrations of 1% to 10% with higher concentration rates equating to lower skin surface area for application. A study indicated Testim absorption to be better than Androgel, however my personal experience is that both are good absorbers. The smell of Testim turns most men off to its use, but I found that women particularly like the odor. However, my insurance does not cover Testim. Androgel efficacy is improved in my case by rubbing it on the flanks as well as the arms. Remember, the more surface area the higher the DHT, which can lead to unwanted side effects such as acne, accelerated hair loss in those prone to male pattern baldness, and hair growth in unwanted areas. However, the boost in libido and improvement in erections is noticeable for me. Shots, mentioned next, worked fine in my case for about 1 month. Two months into the treatment I had profound lack of libido and total erectile dysfunction unresponsive to PDE5 inhibitors such as Viagra and Levitra.

The second type of TRT is the shots including Testosterone Cypionate and Testosterone Enanthate. This is usually the first type of TRT attempted by many doctors, and is also the TRT many return to who are poor absorbers of the gels – often due to hypothyroidism and the concomitant increase in skin thickness which reduces the gels efficacy. Shots are given typically once per week at a starting dose of 100mg. A few words of caution are in order – many doctors will start their patients on very high doses once per month. This is stone age TRT and should be avoided at all costs. Injections once per week are better, twice per week even better, and for those on Plavix concerned about scar tissue, taking your weekly dose and diving it by 3.5 offers two benefits. One, instead of intra-muscular injections – which can be done at home if your doctor is a human being – lower doses offer the ability to administer shots via an insulin needle subcutaneously. Also, dosing this frequently offers the user more consistent levels of Estradiol, which if shown to be too high are more easily controlled via an aromatase inhibitor such as Arimidex. This protocol is described here, although I would not start with as high a dose of Arimidex as this protocol calls for. Instead, start low at about .25 mg/week or even lower and increase from there. You don’t want to tank your E2 due to the horrible side affects that can be associated with low levels of Estradiol (E2), especially in the presence of thyroid or adrenal issues.

HCG or human chorionic gonadotropin is a glycoprotein hormone produced during pregnancy. This hormone can be cultivated for use as Luteinizing Hormone (LH) analog. The benefits of using HCG in conjunction with TRT is twofold. One, subjective experiences of libido and erectile function improve with the addition of HCG. HCG is typically administered at home with a dose of about 250IU every three days using an insulin needle. The other benefit of HCG is its affect on mitigating testicular atrophy. During TRT, the testicles are no longer needed to produce testosterone. This causes the glands to atrophy, sometimes to the point of pain. The average male testicular size is that of a small egg. With TRT, the testicles can become small lumps of collagen about the size of a raisin. Recall from a previous post that LH acts to stimulate the Leydig cells in the testicles to produce testosterone. HCG, in acting like an LH analog, achieves the same response. As long as your Leydig cells are not damaged (as in primary hypogonadism), HCG should keep testicular size at or near normal.

With one caveat. HCG can cause E2 levels to bounce around like a ping-pong ball. For many, including myself, the 250IU every three days proves to be too much. We are hyper-responders to the administration of this hormone. I get by on 50 IU every three days. The state of my E2 given this lower dose will be reflected in my latest labs to be administered in a couple of weeks. HCG mono-therapy in the absence of any TRT is not recommended. Long-term, high-dose HCG can desensitize or damage the Leydig cells, driving the user into a primary hypogonadal state – permanently. Use HCG with caution and in lower doses. High dose HCG can be used to kick-start the testicles during an attempted restart protocol if the user is known to be neither primary nor secondary. Some protocols use 1500-2000IU every other day. The jury is out and the debate is raging on whether this is truly necessary. Often, a restart protocol will use a Selective Estrogen Receptor Modulator (SERM) to kick-start the hypothalamus or pituitary gland into producing LH. In order for this to be effective, the testicles must be ready to make use of the increased LH. Hence the feeling that high dose HCG is necessary to prepare the testicles. However, many in the field believe that a lower dose can be used or, if HCG is used during TRT, the need for increased HCG prior to the administration of a SERM is unnecessary. The SERM use alone should work. SERMs include drugs such as Clomid or Tamoxifen. Future posts will deal with restart protocols as I intend on attempting one myself (for a second time) after the basic building blocks are present to buttress testosterone production. This is an area where Shawn Bean and Dr. Freeland and working in consultation with each other for my particular case.

Third there is oral testosterone. It is useless so don’t even go there.

Fourth is the of pellets. While this shows some promise, I am not impressed with this approach and have yet to find anyone undergoing this therapy who is. It requires minor surgery to implant the devices which release testosterone evenly over a period of months before needing to be removed and replaced. As release can be too quick for some, optimal levels may be difficult to achieve and control. Maybe in the future as the technology improves, but for now I would steer clear of this therapy.

One last item needs to be mentioned. When starting TRT the body’s own production will naturally shut down. TRT is an exogenous approach (testosterone outside the body and not produced by the body). Endogenous production of testosterone is described as ones own testosterone from the Leydig cells. If you initiatve TRT, endogenous production shuts down. This takes time and varies from patient to patient. This is the only time I would allow 1 month for gel replacement prior to a measurement. Often a patient will find their levels are lower than before starting TRT. A complete check of E2 levels, SHBG, and free-T should indicate if there is a reason why. If all systems check out, then increasing the dose is required – for both gels and shots. Don’t despair because the results did not match your expectations. While TRT is a science, it is also an art. Nobody’s body is the same and your ideal approach, be it shots or gels alone (or together), the use of progesterone to lower SHGB, the use of HCG, or moving to a higher dose compounded gel to control DHT is something you and your physician will figure out as you progress. This is why it is so critical to find a doctor who either knows what they are doing or is willing to work with a health consultant such as Shawn Bean to ensure you reach you goals as quickly as possible.

Side effects of TRT are covered in the links above and will not be repeated here. Side effects not covered in the above links such as affects on E2 and DHT for the various approaches will be covered in the next post.

Good luck out there.

• The hypothalamus produces gonadotropin-releasing hormone (GnRH)
• This hormone triggers the anterior pituitary gland to produce two other hormones
• These two hormones are luteinizing hormone (LH) and follicle-stimulating hormone (FSH)
• LH stimulates the Leydig cells in the testicles to produce testosterone while FSH regulates the development, growth, pubertal maturation, and reproductive processes of the body and acts synergistically with LH in male reproductive health.

Simple enough, but what happens is one or more of these systems is compromised in some manner? Defects in the hypothalamus or pituitary gland that compromise the release of GnRH (and subsequently FSH and LH) or adversely affect the release of FSH or LH from the anterior pituitary lead to what is known as secondary hypogonadism. A defect in the testicles that causes a reduction or cessation of gonadal response to LH is characterized as primary hypogonadism. There are many causes of both primary and secondary hypogonadism. The link lists only some of the causes. Also check out this link. Hypogonadism that is present absent any of these conditions or any other known conditions that affect male testosterone production comes under the heading idiopathic hypogonadism. This later label correctly describes my own condition.

Typically a doctor will order a test that measures the total serum testosterone. This is a simple blood test that provides a number, usually in the units of nanograms per deciliter (ng/dl). Normal values vary by the lab performing the test on the blood sample, but typically values are from around 300ng/dL to 1000ng/dl. However, caution should be used in using this raw value as an stark indicator of hypogonadism. For some men presenting with low normal values or even normal values symptoms of low testosterone are often seen. Therefore the entire clinical picture is needed to ensure treatment is provided even in the face of so-called normal results. Also, an entire workup of the thyroid function as well as adrenal function is necessary. Any issue with either of these glands can often lead to hypogonadism or mimic they symptoms of hypogonadism. Also, an understanding of any issues with these glands will guide the treating physician in the selected treatment. As an example, long-standing hypothyroidism will impair the absorption of transdermal testosterone due to build-up of mucin in the skin of people. Mucin causes the skin to thicken impairing absorption of transdermal testosterone.

The story gets a bit more complicated at this point, but not too much. First, a warning – never allow just a total testosterone test to be run by your physician. Total testosterone is only half the story, or perhaps even less than half. Testosterone binds strongly to Sexual Hormone Binding Globulin (SHBG), which itself is a protein, or more accurately a glycoprotein. This means this testosterone is not readily available for the body to use. Other testosterone is loosely bound to albumin, a protein produced by the liver. Any testosterone not binded to albumin or SHBG is known as free testosterone. As albumin binded testosterone is easily ripped off the protein if needed, there is another metric known as bio-available testosterone which is a measure of free testosterone and the testosterone loosely binded to albumin.

There are still arguments about the efficacy of measuring free testosterone. A widespread belief exists that measurement of free testosterone is historically finicky. The data seems to side with this result, however this does not negate the free testosterone test as a test to qualitatively get a feel of just where you are. If possible, getting the bio-available testosterone is a more accurate approach, but not all doctors will order this test.

So now we can begin to think about a few things. What if your SHBG is high (which happens often in the aging population and for other reasons)? Logic dictates that total testosterone will be low as most of it will be tightly bound to the SHBG protein. What if SHBG is low as is often the case of those with insulin resistance – this mirrors my own case. In this case, free-T or bio-available T will be high, causing the body to begin to dump the excess testosterone through excretion and conversion to estrogens. This will often lead to low total testosterone but high free testosterone. Correcting insulin resistance and raising SHBG naturally by addressing this underlying issue will often lead to a reversal of hypogonadism. Starting treatment with TRT on low SHBG often leads to suboptimal results, however it is not contraindicated. In my case, dosing my transdermal gel twice a day as opposed to once a day, provides higher levels of testosterone, which allows me to gain muscle, burn fat, and reach ideal body weight faster. My personal goal is to reverse insulin resistance to the point where I can attempt to restart my own testosterone production without the need for endogenous testosterone (supplemented testosterone). This is what Dr. Freeland, Shawn Bean, and I am working towards.

Lastly is the story of estrogens. There are three of them (E1, E2, and E3). The first is estrone, the second estradiol, and the third estriol. Testosterone is converted to estrogen in adipose tissue, which is present in the liver and in very large quantities in the fat surrounding the internal organs. Look sideways in the mirror and let that gut stick out without holding it in! Do you look pregnant? That’s adipose fat. Conversion of T to E via this mechanism will lower testosterone and raise estrogen. Testosterone supplementation in cases of heavy conversion of T to E often leads to gynecomastia or man-boobs. Understanding where you stand with your estrogen levels is an important clinical indicator of how well testosterone therapy will work for you. While there are medications that block the conversion of T to E2 (such as arimidex), great care must be taken that one does not drive E2 into the ground. In the presence of other issues with the thyroid, this can lead to serious issues with joint pain and swelling as well as other health hazards. We will be discussing arimidex and other medications like it in future posts. For now, I would just warn the reader to be cautious when using this drug. The dosage for males is often very small (.25 mg every three days to start). Often it is not required for transdermal testosterone (Testim and Androgel) but many on the shots (e.g. testosterone cypionate) will often find themselves in need of this medication. I will discuss one protocol in the future which makes E2 control using arimidex for those on the shots in a later post.

So what does arimidex do to the other estrogens? Nothing. It does not lower E1 or E3, but targets E2. Why is that important? Because E2 is the strongest estrogen in males and if it is too high – or too low – it can lead to libido issues and ED, negating one of the main reasons for testosterone replacement therapy (TRT). To be more exact, it has been my experience that a constant level of E2 is more important than its level as long as that level is not too high. Many readers may have heard of the E2 sweet spot of between 25-30 pg/ml (picograms per milliliter). Move too far from this and your libido will magically disappear! Erections will become impossible! Doom will befall you! Hogwash. It is the constant changing levels of E2 that is the issue, so E2 control that maintains as constant a value as possible is more important. Keeping E2 within the normal range is, like the other estrogens, important for only one reason – high estrogens increase cancer risk. My E2 levels have been as high as 90 pg/ml but steady at that number and I experience no libido or ED issues. Everyone is different and for the reader, perhaps 25 pg/ml is the right number for you, but don’t waste precious time aiming for some magic number.

Which leaves DHT or dihydrotestosterone. This is the one I am most interested in. If it gets too low then bye bye libido. My own experience with shots was a nightmare. While I never had DHT measured while on the shots, a quick look at how transdermal T converts to DHT via the 5-AR enzyme (which is found on skin, seminal vesicles, prostate and epididymis) gave me an aha moment. As DHT is involved in “all things male” I felt that rubbing gel on my skin would bump up my DHT and give me back my libido and erectile function. As I was only days away from an anniversary cruise I was desperate. A switch to Testim from shots and within only about four days I noticed a stark difference. Adding in a little HCG (a hormone which mimics LH) and I found my libido bouncing back like a ping-pong ball. The day was saved! However, be warned – if you suffer from male pattern baldness an increase in DHT can and will accelerate loss of hair. It can also lead to acne and hair growth on areas you would not normally want to see hair growth – such as the back. Of course, it also thickens the beard rather nicely and since using transdermals I have noted a more manly beard distribution and I am the only male member of my family with chest hair.

Are there any other tests you should think about? An excellent source for all things testosterone is T-Nation. Here is a list of tests you should order. I would also recommend reading the sticky posts at the top of the TRT forum.

In closing, I would like to address the concept of libido. Many men believe that supplementation with T will magically transport them to a time, many years ago, where erections were strong and libido dominated everything. Libido is a complicated process and while many men will benefit from TRT in this area, there are many other processes involved, including neurotransmitters. So complicated is this issue that the worse thing a man can do who does not notice immediate improvement in libido is to give up hope. Patience and a working with a physician who understands these issues can often resolve them to your satisfaction.

Update: The incomparable Shawn Bean of Matrix Health and Wellness noted an important fact about SHBG. You will be hearing a great deal about Shawn in the coming days and weeks. His dedication to my health – and yours – is a passion rarely seen in the field of nutrition.

Higher SHBG may be a sign of potential inflammation and I have seen this occur in a lot of physician’s patients. Measurements of “silent inflammation” include hsCRP (high sensitivity CRP) and homocysteine levels. For those physician’s patients with a risk for cardiovascular disease another good test is Lipoprotein-associated phospholipase A2 or Lp-PLA2. It is best used when a physician determines a patient to possess a moderate to high risk of developing CVD or of having an ischemic stroke or in the presence of a family history of CVD or CHD.

Here is what I found about Lp-PLA2. It is an enzyme that circulates in the blood and attaches to LDL cholesterol particles. These particles then adhere to arterial walls and oxidize. Oxidized LDL is susceptible to enzymatic attack, promoting pro-inflammatory markers capable of triggering the atherogenic process. The end result is the build-up of plaque in the arteries and the production of molecules that attract immune cells to the arterial walls. These molecules bind to the cells called monocytes, which are large white blood cells, and are converted to macrophages, increasing the amount of atherosclerotic build-up. For those with heart disease or at risk for heart disease, if you have high SHBG it would be wise to have all three of these tests done. Given the nature and historical pathology of the inflammation process, even in the absence of high SHGB I would recommend hsCRP and Lp-PLA2 for those at high risk for heart disease or current heart disease sufferers.

Update 2: The good thing about having Shawn checking your work is the reader benefits from his wealth of information. Here is something else he noted:

Pretty much I see elevated SHBG in hidden gut inflammation or liver issues IE NASH (Nonalcoholic steatohepatitis), fatty liver, staravation, malabsorption resulting in low protein, fat, carb, or overall caloric intake, low GH, adrenal output, and several other factors including excessive fiber which is backed by published scientific studies. It is also linked to an inflamed prostrate.

TRT will not magically turn a diminishing libido into a raging storm of sexual passion, nor will it address erectile dysfunction issues in all cases when the only treatment involves measuring testosterone levels, choosing a treatment, and then walking out of the doctor’s office. Too many physicians have very little understanding of TRT, and many have no idea how to handle the tougher cases.

One point in particular is the rather annoying habit of Endocrinologists to place a patient on TRT and tell them to come back in three months. If you are unfortunate enough to be the victim of such a doctor – run, don’t walk – and find a qualified physician in your area who understands the entire process involved in TRT therapy. In my own personal case, I have been through 10+ iterations in the type of therapy and dosing for that therapy, often spending days frustrated with the results. The fact is, except for the very beginning of your therapy, it only takes about 10 days for any of the gels to reach full efficacy and about 1 month for the shots. If I had to wait 3 months between each change, three years would have passed with unnecessary personal suffering. Instead, with the help of Dr. Daniel Freeland of Bee Caves Family Practice in Austin, Texas and the assistance of Shawn Bean of Matrix Health and Wellness, one of the greatest health consultants whose approach to the issue of testosterone therapy utilizes the discipline of PNEI (psycho-neuro-endocrino-immunology) – a unifying approach to the understanding the functioning of the human body as an interdependent system of the psychological, endocrine and immune systems – I am now on track to attempt to attempt to restart my own testosterone production.

While not everyone will be capable of doing this – my type of deficiency is idiopathic, meaning there is nothing wrong with my testicular function, hypothalamus, or pituitary gland – even those who have issues with any of these glands/systems still benefit from an full-on approach that takes into account all the body’s systems and maximizes the treatment efficacy by optimizing the body’s systems. I will have more to say about Shawn Bean and Dr. Freeland as these posts continue. The next post will deal with the types of testosterone deficiency. I will then follow this up with labs for the past number of months and my own experiences with various treatment methods. I will then post results from the Nutra-Eval test from Genova Diagnostics and Shawn’s conclusions concerning my overall health, along with his recommendations to maximize my chances at restarting my body’s own testosterone production.

Along the way the reader will learn about SHBG, insulin resistance, adrenal issues, thyroid issues and their role in TRT.

For me, testosterone replacement therapy has lead to leaner body mass, greater strength, a vast improvement in cardiovascular fitness, and best of all the complete absence of any exercise induced angina. For someone with 25 stents, this is saying something.

As a service to my readers here is my take on the impact of ObamaCare on the future of health care delivery in this country. The following synopsis is based on objective evidence. The impact of cardiology and other chronic illnesses will be profound.

It is my hope the following post serve as a resource that outlines the issues with the new law, the problems Canada and Britain are facing with their current systems, and why ObamaCare should be repealed in its entirety. If you want to jump straight to the socialized health care horror stories, feel free to do so. It is highly recommended reading. But first I would like to start with one from right here in the US, just so the reader is fully aware it not only can happen here, it has happened here (emphasis mine):

The powerful story of Barbara Wagner demonstrates why this discussion is of utmost importance. When Barbara’s lung cancer reappeared during the spring of 2008 her oncologist recommended aggressive treatment with Tarceva, a new chemotherapy. However, Oregon’s state run health plan denied the potentially life altering drug because they did not feel it was “cost-effective.” Instead, the State plan offered to pay for either hospice care or physician-assisted suicide.

In stunned disbelief you may ask, “How can this be? This happens in Europe. I’ve heard stories of Britain’s National Health Service delaying intervention until the patient dies or reports of physician-assisted suicide in the Netherlands. But in America?”

The answer is simple. Oregon state officials controlled the process of healthcare decision-making—not Barbara and her physician. Chemotherapy would cost the state $4,000 every month she remained alive; the drugs for physician-assisted suicide held a one-time expense of less than $100. Barbara’s treatment plan boiled down to accounting. To cover chemotherapy state policy demanded a five percent patient survival rate at five years. As a new drug, Tarceva did not meet this dispassionate criterion. To Oregon, Barbara was no longer a patient; she had become a “negative economic unit.”

In 1994 Barbara’s state established the Oregon Health Plan to give its working poor access to basic healthcare while limiting costs by “prioritizing care.” In 1997 Oregon legalized physician-assisted suicide to offer “death with dignity” to patients who chose to die without further medical treatment. In the end, the State secured the power to ration healthcare in order to control its financial risk, even if that meant replacing a patient’s chance to live with the choice of how to die.

As Canada looks to change its system to allow more privatization due to the sheer cost of universal health coverage or single-payer as it is often called, American is moving in another direction, a direction more closely linked to the British system of public and private insurance that is dubbed the “60 year failure” by many of its victims.

I was born in Canada, and my wife in Great Britain. We see past the airbrushing to the underlying reality because we know relatives exposed to both systems. Some members of her extended family live in Canada. During their last visit to Texas my wife and I learned that the wrong prescription was given to the wife on one occasion, the husband almost died during routine gall bladder surgery when an artery was nicked, and his sister died during an operation because the surgeon refused to continue a treatment for a liver disorder because it was not his specialty – and all of this from a single family.

This is just the tip of the hellish iceberg.

Ronald Regan once said of socialism that it was required in only two places: Heaven, where they don’t need it, and hell where they already have it. Be prepared to be introduced to hell.

Let’s start with what we know of ObamaCare so far, now that we, as Nancy Pelosi put it, passed the bill so we would all have a chance to learn what is in it. Under ObamaCare:

• Emergency Room Volume to Go Up, not Down: …In an article in The Hill, Dallam, a partner at a firm that designs healthcare facilities, notes: “We don’t have the primary care infrastructure in place in America to cover the need. Our clients are looking at and preparing for more emergency department volume, not less.”
• Small Business’s are Hurt, not Helped: One of the great promises of Obamacare was that it would give folks working in small businesses better access to affordable care. Unfortunately, the Obamacare small-business tax credit just doesn’t get the job done, according to the National Federation of Independent Business, the nation’s largest small-business advocacy group. NFIB reports that provisions aimed at expanding small-business-sponsored coverage will have little real impact—though their cost will be all too real.
• Jobs Cut, not Expanded: One of the great promises of Obamacare was that it would give folks working in small businesses better access to affordable care. Unfortunately, the Obamacare small-business tax credit just doesn’t get the job done, according to the National Federation of Independent Business, the nation’s largest small-business advocacy group. NFIB reports that provisions aimed at expanding small-business-sponsored coverage will have little real impact—though their cost will be all too real.
• Harder, not easier, for young people to afford insurance: This week, the White House issued rules for health insurers to extend dependent coverage to “children” up to 26 years old. Beyond keeping the “Big Kids” dependent on Mommy and Daddy, it also directly undercuts the President’s famous campaign promise that American families would see a $2,500 reduction in their annual premiums. Now, we learn that family premiums will rise about 1% in 2012 just from this one provision of the new law. It will cost $3,380 for each dependent in 2011, according to this Associated Press report.
• You can’t keep your insurance if you like it: …CNN reports that AT&T, Verizon, John Deere and others may well drop the health care coverage they now offer their employees. Obamacare makes it much cheaper for these companies to dump their workers into the government-controlled health exchanges and pay a penalty for NOT insuring them….
• Entitlement Crisis worse, not better, as a result of new health care law: …it [ObamaCare] does nothing to reform the overall structure of the Medicare entitlement. While the new law carves out $529 billion in Medicare “savings,” it calls for using those funds—and trillions more—to bankroll even more expansive health care entitlements. According to the National Center for Policy Analysis : “Instead of fixing the health care programs for seniors and those who cannot afford insurance, this law cuts Medicare and adds more people to the failing Medicaid system.” Many seniors enrolled in Medicare Advantage will not be able to keep the plans they like.
• Federal cost will increase, not decease: CMS [Centers for Medicare and Medicaid Services] reports that under new law, overall national health expenditures will increase by $311 billion.
• Expect Longer Waits for Health Care: A recent article from ABC News outlines why Americans can expect longer waits before they see a doctor. One reason is that there just won’t be enough doctors to get the job done. ABC reports that 10 years from now, the United States will short 85,000 primary care and high-demand specialty physicians. Says Dr. Kevin Pho, an internal medicine physician in New Hampshire, “I don’t think we have the primary care capacity to meet the influx of 35 million newly insured.”
• No Promised Coverage for Kids: Major flaws in the gargantuan Obamacare bill started to emerge almost immediately after it was signed into law. One of the most embarrassing: failure to ensure immediate coverage for kids with pre-existing conditions…
• The American people have increased hatred of new law: The repeal message on ObamaCare is picking up steam and the American people have not been convinced by Washington insiders that federally run healthcare is a good idea. Rasmussen reports that the repeal movement is growing. “Support for repeal of the new national health care plan has jumped to its highest level ever. A new Rasmussen Reports national telephone survey finds that 63% of U.S. voters now favor repeal of the plan passed by congressional Democrats and signed into law by President Obama in March.

One can also add to this reduced competition as ObamaCare props up major hospitals while driving physician owned hospitals out of business:

Rob Bluey has a good piece on one of the early casualties of ObamaCare:

Physicians at McBride Orthopedic Hospital had ambitious plans for their Oklahoma City hospital before Obamacare. Two new operating rooms and a four-bed intensive-care unit were part of a multimillion-dollar expansion project that promised to bring competition and more health care choices to the community.

But once President Obama’s signature was dry on the 2,409-page Patient Protection and Affordable Care Act, so, too, was the McBride project. The recently enacted law imposed a series of new federal regulations on physician-owned hospitals, including an immediate ban on expansion.

“We pulled the plug when the law was signed,” McBride Chief Executive MarkGalliart said. “We were ready to break ground. We had everything approved by the state. We had the construction agreement in place. We were going to meet our timeline until the legislation passed.”

The plight of doctor-owned hospitals is one of the areas that was far too neglected during the health care debate. As much as Democrats holler about the skyrocking costs at hospitals, the truth is that for years they have helped to protect the big hospitals from competition from smaller, innovative, hospitals that tend to specialize in one area and can deliver more personalized service.

This one is more personal for me. As many of my readers know I have 25 stents in three major heart arteries, all of them place by Dr. Samuel DeMaio at the Westlake Medical Center in Austin, TX. The service at Westlake is top notch, as are the specialists. When I heard Dr. DeMaio intended on building a new physician owned hospital in Lakeway near Austin, I was quite excited. While the building is still ongoing, major changes to the business model have occurred:

A boutique hospital tucked into the woods of West Lake Hills could be part of a dying breed.

Physician-owned hospitals such as the Hospital at Westlake Medical Center have been targeted by provisions in the wide-ranging health insurance reform legislation that ban new physician-owned hospitals and prohibit existing ones from expanding.

The law is aimed at limiting doctor ownership of hospitals, an arrangement that critics say can lead to conflicts of interest and the siphoning of paying and insured patients, which leaves traditional public and private hospitals to shoulder the burden of indigent care. Safety issues also have been raised over some physician-owned hospitals because of concerns of inadequate emergency room staffing and facilities.

Opponents of the ban have scoffed at those characterizations, but they are forced to live with the new law — at least for now. In Austin, owners and administrators of physician-owned hospitals are coping with the new law in various ways, from changing their business structures to considering selling out to wondering whether to continue at all.

Health care as business venture

Visitors to the Hospital at Westlake Medical Center can easily forget that they are at a place that treats the sick and injured.

On a recent sunny day, employees cleaned an outdoor pool that rippled with swimming koi. Music softly hummed from speakers hidden in the live oaks on the carefully maintained grounds. Inside, visitors traversed floors inlaid with glass from Italy and granite from the Middle East to simulate the Colorado River. African mahogany lined patients’ rooms, and all the tubes and needle-disposal bags were hidden in custom-made cabinets.

The hospital was built to attract patients — or “customers,” as CEO Rip Miller likes to call them.

Now, in the wake of the federal legislation, Miller, the only nondoctor with an ownership position in the hospital, is talking about the possibility of selling his creation to one of the area’s large hospital systems.

With Congress removing the ability to expand the hospital, Miller asked, what’s the point of staying in business?

Growth is the reason any entrepreneur gets into a business, said Miller, who has an ownership position in a hotel in South Africa, a construction company and a cattle ranch in North Dakota.

“I don’t think there will be any physician-owned hospitals in 10 years,” Miller said. “I think it’s sad that the country is going to lose the culture of physician-owned hospitals.”

…When the federal law passed, Lakeway Regional Medical Center was — and remains — under construction.

“Things have changed a little bit because of legislation,” said Samuel DeMaio, a physician and chairman of the board at the Lakeway hospital.

What was going to be a physician-owned hospital will now be something different. The would-be physician-owners switched their equity positions to debt positions.

The facility still will be “run and directed” by doctors, DeMaio said — it just won’t be owned by them.

The doctors still will make a reasonable rate of return, but it will be “nowhere near where it would have been in an equity position,” he said.

Lakeway Regional Medical Center is expected to open in April 2012 and have more than 150 patient rooms and at least 24 emergency room beds, DeMaio said…

…Sandvig said the new law could have a negative effect on the availability of care. She warned that if doctors’ hospitals cannot grow, they might quit taking Medicaid and Medicare patients, whose reimbursement rate isn’t as lucrative as charging insurance companies.

“It limits access to the people that need it the most,” Sandvig said, adding that the result will be “antithetical to the purpose of the bill.”

Sandvig said the association is considering a lawsuit that would seek to lift the ban.

In the meantime, Miller said, he won’t let Congress’ action derail him.

He already has come up with a plan to grow his business portfolio. Miller said he is talking with property owners around the hospital about buying their land.

It’s hard to believe the man who saved my life is being forced out of ownership to remove competition. Welcome to the world of socialism, where it is not steal from the rich to give to the poor, but steal from the productive to give to those unable to produce even something as simple as an original thought.

So what exactly are we in for? Here’s the breakdown:

Daniel Hannan is a young Tory European MP who said of Britain’s National Health Service – which he describes as a “60-year failure” that he “wouldn’t wish on anybody” (emphasis mine):

Of course, the service was not genuinely free: nothing of value is. Free, in this context, was just a synonym for a grant from the Exchequer paid out of general taxation. But for Bevan, using the power of the state to tax money away from the men and women who had earned it had a morality that actually earning money in the first place could never possess. The crucial consideration to him was that, once the NHS was in place, the old shame inherent in accepting public handouts would be abolished, because everyone – bared from the hedonistic pleasure inherent in writing a check to the doctor – would now be a client of the state.

But Bevan’s belief that free service at the point of delivery was a matter not so much of bodily health but of moral purity exercised a continuing and malevolent influence. By turning the NHS into something resembling a religion for milk and water Marxists – which is not an unfair description of Bevan’s political sensibilities – and by crushing the old system beneath the iron but faltering wheels of progress, Bevan at once committed Britain to a single payer system and made criticizing it a form of political heresy. All Gordon Brown did was to take advantage of what appeared to be one of the most prosperous periods in modern British history to remedy the deficiency that had vexed Bevan: the system could never get enough money.

As it turned out, it still can’t: even as Brown blew the doors of the Treasury to pump money into the NHS, private spending on health care in Britain – there is some, in spite of the existence of the NHS – has remained steady at 1.4% of GDP. No amount of public spending appears to be sufficient to meet all needs, or to satiate the public’s demand for better health, a lesson that the U.S. might take usefully to heart. The idea that instituting a British-style system in the U.S. will save money relies on the premise that Americans could be restrained from spending their own money on their own health, and would be willing to accept British levels of government-provided care. Any politician who really believes this is welcome to test the validity of their belief at the ballot box.

Indeed, Britain spends less on health than the U.S. precisely because, like any basically single payer system, the NHS ultimately has to ration what it provides to take account of the public’s unwillingness to pay higher taxes, a reality that accounts for many of the NHS’s failures and horror stories. The NHS’s defenders have the difficult job of protecting it from the reality that Britain is no longer dominated by the old cloth-cap class system that made it so appealing in 1948: the NHS is a top-down system trying to get by in a bottom-up age. But that has not prevented British politicians on all sides from promising to try even harder and attacking the littleness of their opponents’ vision. That is why Brown delights in Hannan’s remarks, which give him the opportunity to demand that even meeting with foreign critics of the NHS be ruled out of bounds by all parties, and to play the old ‘Tory spending cuts’ card. This blissfully ignores the reality that his own Treasury has forecast massive spending cuts after he wins the next election – however unlikely that eventuality now appears – which implies that even a future Labour Prime Minister would have to continue the ceaseless struggle to reduce the cost pressures in the NHS.

…But then the left’s demand for the single-payer system in the U.S. is not about health. It is, as it was for Bevan in 1948, about a vision of social morality, which accounts for the eagerness with which its supporters stigmatize their opponents as unpatriotic and evil. That’s a curious basis, even an unhealthy one, on which to build a health care system, which one might suppose should be judged on its results. But it’s an even unhealthier basis for a political system. There is no surer guarantee of fossilization, and eventual irrelevancy, than mistaking particular policies, which need to change, for immutable principles, which need not. If the British people cannot grasp the difference, Dan Hannan will be the least of their troubles.

So what of the horrors referenced above? The details will stun you (emphasis mine):

According to the Associated Press, the national health provider’s newfound shortfall could “force the government to skimp on dentistry, fertility treatments, and cutting-edge drugs.

The NHS administers both health and social services through health-care “trusts.”

A June report from the new U.K. Care Quality Commission found that care is improving, but “only half of trusts say they meet all current standards” and that “there is significant variation between regions.”

Problems with patient care, meanwhile, have been endemic.

- On June 15, a 69-year-old man from Stockton-on-Tees, Cleveland, in North England, fell victim to an NHS ambulance driver wanting to go home at the end of his shift. Stroke victim Ali Ashgar died in the back of an ambulance when the driver realized his shift had ended and took a detour to clock out and get a replacement driver, the (London) Telegraph newspaper reported. Ashgar’s outraged son told the Telegraph: “If you have a patient in an ambulance you don’t worry about your bloody shift finishing.”

- In January, a 43-year old man, Martin Ryan, died of starvation in an NHS hospital, the Telegraph reported. Ryan was left unable to swallow after suffering a stroke, the paper reported, “but a ‘total breakdown in communication’ meant he was never fitted with a feeding tube.” According to an internal investigation, doctors thought that nurses were feeding Ryan through a tube in his nose. By the time they discovered he was starving – 26 days this was not happening, he was too weak for an operation to insert a tube into his stomach.

“Mr. Ryan, who had Down’s syndrome, died in agony five days later,” the newspaper stated.

The Telegraph added: “Disability charity Mencap said the case was one of several where the NHS ‘completely and unacceptably failed’ patients with learning difficulties through a ‘catalogue of disasters.’”

- In 2007, the now-defunct Commission for Patient and Public Involvement in Health released a study suggesting about 6 percent of patients were forced to treat their own dental problems, with one man using a pair of pliers to remove his own teeth, and several respondents using crazy glue to reaffix crowns.

At the time of the study, Londoner Celestine Bridgeman told the Associated Press: “Trying to find good NHS dentists is like trying to hit the lottery because the service is underfunded.”

- A June 10 report for the consulting firm Tribal suggested “raising the level of self-care” as a solution to the current budget deficit.

The NHS also comes up short on introducing new cancer drugs, receiving a failing grade from many patients, according to Britain’s major papers.

- Kidney cancer patients were enraged in 2005 when they were refused access to the drug Sutent, which could prolong their lives up to two years, because the National Institute for Health and Clinical Excellence, ironically nicknamed “NICE,” did not deem it cost-efficient.

NICE says it “provides guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.”

James Whale, an irreverent British television and radio personality who survived the disease, lashed out at the NHS when it reported its most recent surplus in May.

“They have been pleading poverty throughout the last year, denying sick and dying kinder cancer patients’ drugs, treatment and support,” Whale said in a statement. “(A)ll the while they actually did have the money to save lives and make a difference.”

Sutent has since been made available on a limited basis after public outcry.

- NICE was forced into a similar position in 2006 when Ann Marie Rodgers, then 53, was suffering from breast cancer and was denied Herceptin, a drug that could aggressively attack her tumor.

“They’ve got no right to decide who can have this life-saving drug,” Rodgers told the (London) Daily Mail at the time. “This is not a poor country, after all. I have worked all my life and paid my taxes.”

The group Women Fighting for Herceptin was formed to raise money to fund the drug and held rallies decrying the fact that NHS and private trusts where the drug was not offered.

“It makes me sick to think a lot of women are in my position,” Rodgers told the Daily Mail. (Rodgers died in June, two years after finally winning a court battle forcing the NHS to make the drug available.)

But wait, there’s more:

Liver Cancer Drug Not Recommended For The NHS

Charities lose appeal to make NHS supply bowel cancer drug

Crisis in elderly care far worse than feared, report warns, which includes a recommendation to the NHS to provide “a minimum level of service” to the elderly. Coming soon to a health care system near you.

Patients denied surgery because of black hole in health budgets

Patients ‘routinely neglected’ at hospital of horrors

NHS trust shamed for cost cutting

Shaming of the NHS: Patients STILL treated in kitchens, abandoned in mop cupboards and left without meals despite Labour’s billions:

Patients are routinely being treated in kitchens, mop cupboards and corridors because hospitals are so overcrowded, a shocking survey reveals.

Third World conditions are commonplace, with hospitals housing patients for days in storage areas, offices, TV rooms and outpatient clinics.

This disturbing treatment of the sick and vulnerable comes despite a tripling of the NHS budget by Labour over the past decade.

The survey of 900 nurses follows a Daily Mail story telling how Doris McKeown, 80, spent 48 hours in a supply cupboard while waiting for surgery at the Norfolk and Norwich University Hospital.

Many nurses also told how extra beds were often crammed into wards to avoid breaching a Whitehall target on A&E waiting times.

This increased the risk of infection and threatened patients’ privacy and dignity, especially on mixed-sex overflow wards.

Examples of appalling care cited by staff included:

• A woman ‘barely coping’ after a miscarriage being sent to a ward with male patients.
• Children left at ‘high security risk’ and a threat of infection when adults were put on their ward.
• One overflow ward being so crammed a nurse could not reach the emergency buzzer when someone had a heart attack. She had to run into the corridor to yell for help.
• One patient being left in a mop cupboard where there was only room for a chair, not a bed. At another hospital, a kitchen was set aside for two beds.
• A hospital discharging elderly patients before they were ready.
• Another using a ward which had been ‘condemned’ for patient use.
• Up to three patients being crammed into a tiny office cluttered with staff belongings.
• Eighteen patients being stuck on trolleys in the corridor of a medical assessment unit.

One nurse said: ‘The only thought is of “stopping breaches” [of targets]: put patients anywhere as long as the box gets ticked.’

The revelations follow a series of NHS scandals, including the deaths of up to 1,200 people at Stafford Hospital, where targets were found to be largely to blame.

The Nursing Times survey also found that beds were ‘faulty’ and ‘condemned’, fire exits were blocked, toilets were ‘inadequate’, and many patients went without showers and baths.

Maintaining single-sex areas was often impossible because of the sheer numbers of extra patients.

Nurses have to take blood samples in corridors and beds are sometimes placed in isolated corners, meaning nurses cannot see if a patient needs help.

Elderly patients are ‘parked’ in day rooms while waiting to be transferred to another hospital, and left ‘soiled and neglected’, and ‘needing fluids’.

Sometimes spare beds run out – and people have to sleep on chairs or mattresses on the floor.

Nearly half the nurses said patients in non-clinical areas did not have proper access to water, oxygen, suction and a call bell.

Four in ten said they did not have the screening to protect their dignity and privacy.

‘If a patient suddenly had a cardiac arrest, we would not be able to get the crash trolley to them,’ said one nurse at a hospital which squeezed extra beds into wards.

Others said cramming patients into wards put them at risk of cross-infection.

One added: ‘Urine bottles are not emptied, meals are missed as staff are not aware of the patient.’

I can hear it now: “Yes, I’m here to visit mum and was wondering what cupboard I could find her. Right next to Mother Hubbard you say? Tah.”

I already shared a few examples from one family in Canada related to me through my wife. Their problems are not unique. A simple Google of the phrase canada health care horror stories and its variants turn up a number of hard to read examples. Canada faces the exact same issues as Britain and our genius government is going to attempt to duplicate these programs here where instead of 30 million people (Canada) or 60 million people (Great Britain), we have 300 hundred million people – AND – we are going to do it for about 1 trillion dollars over a decade if Obama is to be believed. The reality is that ObamaCare will cost U.S. taxpayers over 6 trillion dollars in the first decade alone. Wow, free health care redefined. How’s that deficit working out for us? The Greeks, Italians, Portuguese, and Spaniards are just loving it right now.

Shall we get started?

• To Avoid Year Long Wait, Canadian Patient Flies to India for Hip Resurfacing
• Patient Wait Times Cost Canada $15 Billion a Year
• Fed Up Canadians Choose Surgery Overseas
• Doctor Advises Patient to Fly to Italy for Cancer Treatment
• Canadian’s Access to Drugs Blocked by Goverment Policy
• Excruciating Wait Times
• Government Health Care Only Looks Good on Film
• Why Ontario Keeps Sending Patients to the US

I could go on and on, but I think the reader gets the picture. Unless ObamaCare is repealed either through the legislative process or state level nullification the fact remains that if it is not repealed we are all, to be quite blunt, screwed. At least Canada is starting to get the picture that something is seriously amiss:

American fans of single-payer health care have long held Canada as an example of success in both providing health care and controlling costs. Canadians have more reason to question both, however, especially the latter. The provinces, which bear a significant portion of those costs, may end some services and curtail others as ballooning costs have exposed the cradle-to-grave system as unsustainable:

Pressured by an aging population and the need to rein in budget deficits, Canada’s provinces are taking tough measures to curb healthcare costs, a trend that could erode the principles of the popular state-funded system.

Ontario, Canada’s most populous province, kicked off a fierce battle with drug companies and pharmacies when it said earlier this year it would halve generic drug prices and eliminate “incentive fees” to generic drug manufacturers.

British Columbia is replacing block grants to hospitals with fee-for-procedure payments and Quebec has a new flat health tax and a proposal for payments on each medical visit — an idea that critics say is an illegal user fee.

And a few provinces are also experimenting with private funding for procedures such as hip, knee and cataract surgery.

It’s likely just a start as the provinces, responsible for delivering healthcare, cope with the demands of a retiring baby-boom generation. Official figures show that senior citizens will make up 25 percent of the population by 2036.

Read Canadian Healthcare Continues Its Collapse:

My health-care prejudices crumbled not in the classroom but on the way to one. On a subzero Winnipeg morning in 1997, I cut across the hospital emergency room to shave a few minutes off my frigid commute. Swinging open the door, I stepped into a nightmare: the ER overflowed with elderly people on stretchers, waiting for admission. Some, it turned out, had waited five days. The air stank with sweat and urine. Right then, I began to reconsider everything that I thought I knew about Canadian health care. I soon discovered that the problems went well beyond overcrowded ERs. Patients had to wait for practically any diagnostic test or procedure, such as the man with persistent pain from a hernia operation whom we referred to a pain clinic — with a three-year wait list; or the woman needing a sleep study to diagnose what seemed like sleep apnea, who faced a two-year delay; or the woman with breast cancer who needed to wait four months for radiation therapy, when the standard of care was four weeks.

So there you have it, in a nutshell. This foundation of this system must be torn out from the ground and never be allowed to take root in this country. If you think this is a joke or I am scare-mongering, think again. If your not sick, it sure looks good, but if you or a loved one ever gets seriously ill, just look to Canada and Great Britain to see what type of treatment you can expect under ObamaCare. Kill it. Now. Before it kills you or someone you love.

Heart disease and stroke are the most common cardiovascular diseases. They are the first and third leading causes of death for both men and women in the United States, accounting for more than 35% of all deaths. More than 870,000 Americans die of heart disease and stroke every year, which is about 2,400 people dying every day. Although these largely preventable conditions are more common among older adults, more than 148,000 (17%) of Americans who died of cardiovascular diseases in 2004 were younger than age 65 years. Heart disease and stroke also are among the leading causes of disability in the U.S. workforce. Nearly one million people are disabled from strokes alone.

The burden of heart disease and stroke should not only be measured by death and disability. More than 80 million (1 in 3) Americans currently live with one or more types of cardiovascular disease. This figure includes 73 million people with high blood pressure, 5.8 million who have suffered a stroke, 5.3 million with heart failure, 8.1 million who have had a heart attack, and 9.1 million who suffer from regular chest pain (angina pectoris). This year alone, more than 920,000 people will have a heart attack (myocardial infarction) and an additional 780,000 will have a stroke. In total, more than 6 million hospitalizations occur each year because of cardiovascular diseases. Americans also make more than 81 million doctor visits every year because of cardiovascular diseases. The cost of heart disease and stroke in the United States is projected to be more than $448 billion in 2008, including health care expenditures and lost productivity from death and disability. As the population ages, the economic impact of cardiovascular diseases on our nation’s health care system will become even greater.

While often preventable, this is not always the case. However, in my case and in many others I held enough knowledge about heart disease and mitigating the risks. Being aware of high levels of total cholesterol and triglycerides for years, I could have controlled the timing of when the disease manifested itself by following a strict diet, taking my medications, and exercising. Failing to do so resulted in my dealing with this disease at a much younger age.

So what does one do when diagnosed with heart disease? Well, it depends on the disease. I will be talking about my own case, but the methods I used to get a handle on my disease are applicable to all diseases. Research is key, knowledge is power, and we do live in a digital age.

So start with Google. Type in your condition in the Google search box and go from there. In my case, I came across interesting sites that you can see in the sidebar of the Heart Disease Blog under the links section. Included is a link to angioplasty.org for my fellow stent owners. Another link is to a forum where you can ask the experts in cardiovascular disease from the Cleveland Clinic, the number one hospital in the United States for heart disease treatment, and others. Check them out if you like.

In the blog section of this site, I try to keep heart patients abreast of the latest developments, current treatments, and future trends in heart disease. I recommend reading Best Hospitals: Heart and Heart Surgery and Hospital death rates unveiled for first-time comparison, where you can check death rates by state, or compare hospitals in a particular zip code.

Researching you doctor is also important. There are sites that perform this task, but they require a payment, sometimes as high as $50.00. Of course, in an emergency, the patient does not have the time to do this. If you are at risk for heart disease, it is advisable to find the best hospital in your particular location. Also, I would recommend looking for the best cardiologist through research services, asking your primary care doctor, or talking with someone you know who suffers from the heart disease you are at risk for. It could mean the difference between life and death.

Don’t be afraid to ask questions. It is even wise to go through scenarios with your cardiologist. If this happens, what can I expect? Let me give you an example.

In my case, my first visit to my cardiologist happened during a heart attack. Thankfully, a collateral vessel grew to attach to my left anterior descending artery (LAD) at the apex of my heart (the tip), because most of my LAD was 100% blocked. As my cardiologist specialized in stents and percutaneous coronary intervention, the route taken to treat me was with five Cypher drug-eluting stents.

After I recovered, every three months I would undergo a nuclear stress test to check the progression of my disease and whether any of the stents were closing up. It would be a year later when I first failed the stress test. During the intervention, one cardiologist discovered an aneurysm at the tip of my LAD where it came off the left-main artery and in-stent restenosis with new plaque near the apex. When my cardiologist came into the room he asked me a question: Do you want stents or a bypass?

Under heavy medication – including morphine – my clouded mind thought the question a jest. I mumbled stents, smiled, and drifted in and out of consciousness. Later came the news – my LAD was jacketed stem to stern – a full-metal jacket in the jargon of the cardiologist. No bypass for me – ever – unless willing to undergo a riskier procedure where the stent is removed or partially cut away.

Should my cardiologist taken the time to explain to me during our meeting a couple of days before the intervention what the possibilities were? Certainly. However, having saved my life the first time to the point of complete recovery, my anger was transient. He is human. What if I had taken the time the learn enough about my disease to ask the relevant questions? A quick look at some of the sites from a Google search alerted me to the possibility of a full-metal jacket. The decision would empower me at the same time to take an active role in my care. I could ask my cardiologist his belief in the best approach, maybe searched for a second opinion, done more research on the subject. As my disease is diffuse in three arteries, recent research suggests that bypass is a better alternative to stents for patients with diffuse multivessel disease. However, how many people my age were included in that study?

Remember that doctors in the United States are driven hard from the moment they enter medical school, through their entire residency, and finally in their practice. They are not perfect and the culture of hard work and study ethic stamped into their minds from the moment they enter the field of medicine make them vulnerable to overlooking something involved in your current and future care. That is why educating yourself on your condition is so critical to your success. So remember, doctors are human and, even if talented, they can make mistakes.

Some information you should know if you are considering getting a drug-eluting stent:

The possibility exists you will be on Plavix for life. This can create issues if an operation is in your future, and who can predict that? There are protocols for stopping Plavix, but the risk of a heart attack or other cardiovascular event increases.

When drug-eluting stents first entered the scene, they generated much excitement. Coated with an immunosuppresent, conventional wisdom led many to believe that in-stent restenosis due to excessive scar tissue would drop. With bare metal stents, this rate of restenosis is around 30%. With drug-eluting stents, this decreased to 2%-5%, depending on the study. However, it soon became clear that another surprise lay in waiting. The possibility of late stage thrombosis – an often deadly event. While the incidence rate is low, in an attempt to mitigate the possibility of this event in a patient, most cardiologists will keep their patients on dual anti-platelet therapy for life (Plavix and Aspirin).

Make sure you tolerate Plavix well. Should a mild allergic reaction occur, it will often resolve itself with a drug such as Zyrtec (this is what I did).

Make sure you get a TEG test done after being on Plavix for 1 month. This is a new test which indicates the amount of platelet inhibition. My first test suggested only 20% inhibition prompting my cardiologist to increase my dose from 75mg/day to 150mg/day. Subsequent tests showed 80% inhibition rates. It is telling that since increasing my Plavix I have passed two stress tests after failing the previous five (update: the number is now three stress tests).

On label use of drug-eluting stents (DES) is for short lesion blockages in a single artery. Anything else is off-label. This does not preclude the use of these stents for multiple blockages, long lesions, or stenting within a stent. Just make sure your cardiologist doing the intervention is one of the best before taking this route. That is what I did. Even then, I am aware of one other patient with 40 stents – a diabetic – under the care of the same doctor after undergoing bypass surgery, who now faces death as his heart begins to fail. With so many stents, the chance for any additional bypass surgery is impossible. If you have diabetes, stents may not be for you due to the issues diabetics have with healing and accelerated heart disease. Caution is urged for these patients and I strongly encourage you speak at length with your interventionist cardiologist.

Updating has been sparse of late, partially due to other demands on my time. However, I actually do plan to begin paying this blog more attention and although I believe the current information to be quite comprehensive, there is always the latest news and breakthroughs that I would like to begin covering once again.

My last appointment with my cardiologist was last week. It has now been 18 months since my last stent, and 6 months since my last stress test. I am overdue some blood work and I intend on addressing that issue after the holidays when I get a chance to lose some of the weight I know will gather about my waste. Until then, have yourself a wonderful Thanksgiving, merry Christmas, and a happy New Year.