Hashimoto’s Thyroiditis and Dr. K’s Book

[hopefulmama]

Hi everyone,

I hope this beautiful Sunday finds you doing really well.

I had mentioned in my last post that I would write more about the book by Dr. K “Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal?”. The author has an office not far from where we live in California and has trained many local practitioners.

I have to say that after 2 years trying to figure out a good path for me to follow toward wellness, this book has provided me with a real ray of light and hope. The author’s premise is that Hashimoto’s is a disease/imbalance of the immune system rather than a thyroid problem and that in order to resolve it you must modulate the immune system rather than relying upon replacement hormones to make up for what the imbalanced body is not doing. He explains how genes for autoimmune disease can be activated and that once the gene has been turned on, it can’t be turned off. Instead you ‘turn down the volume on the immune response’ by restoring balance.

He then goes on to describe the two sides of the immune system: the TH-1 side (responsible for deploying Natural Killer cells and cytotoxic T-cells) and the TH-2 side that deploys B-cell antibodies. If Hashimoto’s patients are TH-1 dominant, there is a protocol for supporting the TH-2 side to achieve balance. If they are TH-2 dominant, there is a protocol for supporting the TH-1 side to achieve balance. According to Dr. K 90% of his patients with Hashimoto’s are TH-1 dominant. Studies show this type of dominance with Type I diabetes, Multiple Sclerosis and chronic viral infections.

On the other hand, Dr. K states that patients with lupus, dermatitis, asthma and multiple chemical sensitivity (and also cancer!) are often TH-2 dominant.

(Dr. K is clear about the fact that NOT all autoimmune disease can be traced to a TH-1 or TH-2 imbalance… other causes can include immune defects and deficiencies. He also recognizes and states the role of bacteria, virus, yeast,parasites, fungi and environmental toxins in creating immune disease states… and the importance of addressing these things (along with healing a leaky gut) to restore balance.)

He goes on to describe a panel of blood tests including TH-1 and TH-2 cytokines and CD4/CD8 (T-suppressor cell/T-helper cell) ratio which will show exactly where each individual is in terms of immune balance… and explains how these tests can be used to monitor overall progress on a protocol.

Dr. K also gives a list of supplements and vitamins that are known to support the TH-1 and another list that are known to support the TH-2, and explains that many immune boosting compounds are faulty because they mix together stimulants for both sides of the immune system rather than targeting the side that needs support.

I have found this to be incredibly eye opening for me, and recently ordered the serum kit to test my cytokine profiles. I am really looking forward to finding out what they say – but I have my suspicions. It certainly explains why I have done so poorly on certain supplements prescribed for me by my very-well intentioned and kind doctors.

Despite the fact that 90% of patients with Thyroiditis are TH-1 dominant, I believe given my own history that I am actually TH-2 dominant. (We’ll see if the blood tests agree!) Given my history of cervical pre-cancer, eczema, multiple chemical sensitivity, allergies, asthmatic reactions to certain supplements and recent awareness of my 3 different markers for lupus, I believe that I am TH-2 dominant… but possibly flared up by certain TH-1 stimulants as well.

I am going to begin working with a new doctor, Dr. C, here in my city this week. He is a student of Dr. K (whose prices I cannot afford) and very familiar with his protocols. I am really excited and optimistic. I should get the blood results back within a few weeks.

All of this would explain why I have grown worse on the protocol given to me over the past 2 years… and it would also explain why I improved so significantly on a protocol given to me by my first naturopath in 2007 for Hashimoto’s. That naturopath, Dr. H, had me go gluten free, and take Vitamin D3, folate, EPA-DHA, magnesium and Moducare (plant sterols and sterolins) and within the course of 6 months my antibodies dropped from 880 to 34 and finally rested at 15 (in normal range) for over two years until my third pregnancy. I felt amazing during that time, and looked my best in years.

I will let you know how I progress over the next year, and if this new path holds any merit.

I think of all of you like my family and care very much about your improved health and well being. If Dr. K’s protocol works for me I will be singing it from the rooftops with the hope that it can in some way help each and every one of you too. My fingers are crossed! If it doesn’t work, I’ll be honest about that too to spare others the expense and time involved in pursuing it.

I plan to bring a copy of Dr. K’s book to Dr. F when I see him in March.

Best wishes to you all and I hope that 2012 will be a year of tremendous health for all of us!

Warmly,
A

p.s. If you skip down lower in this post to my 3rd comment, you will see the CD4/CD8 results I just got back… so enlightening!

[Parisa]

Thanks for sharing! There are a number of people here struggling with thyroid issues in addition to their other autoimmune conditions and this could be an important piece in their recovery.

[mary77]

Dr. K’s book sounds like a MUST read. I will be looking for future posts from you with the hope that you will be returning to a state of good health…best of luck and keep us informed!
Mary

[vera]

I do hope you will keep us updated very often about this Hashimoto’s issue! I’m struggling with it, too, and some of the hormones I’ve been prescribed made me FAR worse (esp the Armour Thyroid – which totally upset my adrenals).

It was Mary Shomon’s book that helped me understand the delicate adrenal/thyroid balance – and that some people cannot take thyroid (or at least, that it has to be carefully balanced with other things in sensitive individuals like myself).

I’d love to get a copy of the book you’re referring to, and may do that. It’s so true, some supplements send a person into a tail spin!

Please do keep us posted!

Lori

[Krys]

@hopefulmama wrote:

a panel of blood tests including TH-1 and TH-2 cytokines and CD4/CD8 (T-suppressor cell/T-helper cell) ratio which will show exactly where each individual is in terms of immune balance…

I …recently ordered the serum kit to test my cytokine profiles.

That is one fascinating book! And I’m greatly impressed with your investigative skills. Wow.
Andrea, could you share the name of the test and the laboratory that does it?
Krys

[hopefulmama]

Krys,

I ordered the kit online through True Health Labs (and I believe the blood is drawn by Labcorp).
http://www.truehealthlabs.com/th1-th2-balance-balance-test/

As an aside, I noticed that Dr. B.H. (who is the guy behind the lab) keeps a blog and the most recent article relates to Lyme disease, with one on gluten intolerance right before: http://doctorbrady.wordpress.com/

I don’t know enough about the lab yet to recommend it, and I can tell you that Dr. B.H. is a chiropractor and not an MD. He also works with Dr. K in some kind of network, so I can’t guarantee that there isn’t some kind of conflict of interest. Still, I felt confident enough to proceed. I’ll let you know what I find out!

Warmly,
A

[lynnie_sydney]

Andrea – I take my hat off to you for ceaselessly searching and investigating. I truly hope this provides a new path for you and look forward to your results and updates. The body is such a complex system, isnt it? It is so rewarding to have people such as you, Maz, AF, Krys and many others here who keep raising the bar on finding answers.

Be well! Lynnie

Palindromic RA 30 yrs (Chronic Lyme?)
Mino 2003-2008 100mg MWF - can no longer tolerate any tetracyclines
rotating abx protocol now. From Sep 2018 MWF - a.m. Augmentin Duo 440mg + 150mg Biaxsig (roxithromycin). p.m. Cefaclor (375mg) + Klacid 125mg + LDN 3mg + Annual Clindy IV's
Diet: no gluten, dairy, sulphites, low salicylates
Supps: 600mg N-AC BID, 1000mg Vit C, P5P 40mg, zinc picolinate 60mg, Lithium orotate 20mg, Magnesium Oil, Bio-identical hormones (DHEA + Prog + Estrog)

[hopefulmama]

Thank so much for all of your support!

I wanted to chime in with the next installment of this new adventure I’m taking.

Got my results back from CD4/CD8 ratio labs today. Very informative!

In a nutshell, if I’d had this test done two years ago I would never have worried that my autoimmunity was trending toward SD.

My CD4/CD8 ratio is lower than “normal”… .8 with a reference range of .86 to 5.00

A low ratio is often seen in HIV+ patients or those fighting viruses/infections… also in Hashimoto’s and SLE. Doctors often use the CD4/CD8 ratio to determine whether a therapeutic protocol is working… they set your baseline and then they check you periodically to see if your ratio is rising or lowering. In SLE if the CD4/CD8 ratio rises they consider the therapy to be effective.

Scleroderma patients are known for for having an *increased* CD4/CD8 ratio… it is well documented in the scientific literature. Their CD8 cells experience apoptosis (death) and the CD4 cells dominate:

Increased transendothelial migration of scleroderma lymphocytes
(http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1754998/)
“CD4+ T lymphocytes play an important part in the pathogenesis of scleroderma (systemic sclerosis, SSc) and predominate in perivascular SSc skin lesions. Both soluble and membrane bound adhesion molecules are overexpressed in SSc.”

Increased Frequency and Compromised Function of T Regulatory Cells in Systemic Sclerosis (SSc) Is Related to a Diminished CD69 and TGF? Expression (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2695559/)
“The frequency of CD4+CD25+ and CD25highFoxP3highCD127neg T cells was highly increased in all SSc subgroups… CD4+ T cells are increased in the circulation of SSc patients [20], [21], whereas NKT cells and ?/? T cells are decreased.”

Increased frequency of T regulatory cells in Systemic Sclerosis displaying a markedly altered phenotype and compromised regulatory capacity (http://www.hopkins-arthritis.org/physician-corner/education/acr2008/scleroderma.html)
“In line with previous observations, all 36 SSc patients had higher frequencies of CD4 + cells and CD4/CD8 ratios compared with healthy controls. In contrast with that observed in RA and SLE, further analysis revealed that all SSc patients had significantly higher numbers of CD4+CD25+ cells when compared with that observed in healthy controls.”

* * *

I haven’t done the rest of the cytokine panel yet so don’t know yet which of my immune pathways are elevated/dominating… but if I ever needed 100% confirmation that my body is not actually experiencing SD… this is it. Even after 2 years, I do not have elevated CD4 T lymphocytes.

However, I do have a raging case of Hashimoto’s and apparent trending toward lupus…

Here is one study relating Hashimoto’s to a low CD4/CD8 ratio:

Peripheral blood T-lymphocyte subsets in autoimmune thyroid disease.
(http://www.ncbi.nlm.nih.gov/pubmed/1342892)
“A decrease in the CD4/CD8 ratio in Hashimoto’s thyroiditis hypothyroid patients was observed, in contrast to an increase in the ratio in autoimmune hyperthyroid patients.”

* * *

I wish someone had run this blood test for me two years ago. In all of the hundreds of blood tests run for me by various doctors, nobody ever checked for this. It would have saved me countless sleepless nights.

For those on the board who *do* have SD, having this test done periodically will let you assess how your protocol is going… if your ratio lowers into a normal range, you will know that the protocol you are on is effective. If it remains high, you will know to try something new or different.

Hope this helps someone!

Warmly,
A

[Parisa]

Here’s a link to a QA session with Mary Shomon (thyroid advocate) and Dr. Kharrazian, the author of “Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal?”

http://thyroid.about.com/od/alternativeholisticinfo/a/chiropractors-thyroid-kharrazian.htm

[fastspinW]

Andrea,

The plot thickens! As someone who suffers from Type 1 diabetes, Hasimoto’s thyroiditis, Raynauds, RA, ulcerative colitis, etc. it daily becomes more obvious to me just how interconnected these various illnesses are. More and more it would seem that the various theories surrounding the individual diseases need to be evaluated in a more thorough manner with an eye to common triggers. I always enjoy reading your posts as your willingness to do the research legwork often results in insights that should prove most valuable to us all.

I will mention, by the way, that my own doctor recently put me on low dose Naltrexone which is said to have a positive effect on many of the conditions I suffer from including Hasimotos. You might give it a look if you haven’t already.

All best,
Winston

[Krys]

@hopefulmama wrote:

Krys,

I ordered the kit online through True Health Labs (and I believe the blood is drawn by Labcorp).
http://www.truehealthlabs.com/th1-th2-balance-balance-test/

Thank you very much!
I would like to find out more about the state of my thyroid because accepting my “normal” test results as normal, just insults my intelligence.
I don’t know why TH1 and TH2 were not tested. Everything tested was normal with T3 being low normal. My thyroid always activates and starts crazily pulsating whenever autoimmune reaction to foods start. It then affects the heart and palpitations can last for hours (as long as the thyroid keeps pulsating). So it obviously plays a role in it. All hypo symptoms have been present for some years now, though daily Iodoral and kelp have helped with exhaustion and even diminished ice cold hands, feet and some other symptoms. I would like to be able to do something about it and “normal” results make it easy only for waiting for deterioration.

It’s so fascinating that not only have you figured out your problems, found all the answers, but you clearly understand all of it, too!!! I’m getting lost in this vastly interconnected puzzle.
@fastspinW wrote:

As someone who suffers from Type 1 diabetes, Hasimoto’s thyroiditis, Raynauds, RA, ulcerative colitis, etc. it daily becomes more obvious to me just how interconnected these various illnesses are.
…..low dose Naltrexone …

Winston, you’ve summed it up very well!
LDN does so much! There were many threads devoted to it about 1,5 years ago. It made me feel so morose that I could not stand it. Nobody described this type of reaction, so you should be fine. Good luck!
Warm wishes, Krys

[Krys]

I must have pressed the “submit” button, as the previous post “posted itself” before I was ready to do so.
Everything you are describing is new to me, I don’t have any knowledge of anything you are writing about, yet it is so clear: YOUR POST IS PRICELESS!!! I HOPE EVERYBODY CAN SEE IT AND BOOKMARK IT FOR FUTURE REFERENCE!!!

“hopefulmama”:

Dr. K “Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal?”.
…Hashimoto’s is a disease/imbalance of the immune system rather than a thyroid problem and that in order to resolve it you must modulate the immune system rather than relying upon replacement hormones to make up for what the imbalanced body is not doing. He explains how genes for autoimmune disease can be activated and that once the gene has been turned on, it can’t be turned off. Instead you ‘turn down the volume on the immune response’ by restoring balance.
….90% of his patients with Hashimoto’s are TH-1 dominant. Studies show this type of dominance with Type I diabetes, Multiple Sclerosis and chronic viral infections.
….. patients with lupus, dermatitis, asthma and multiple chemical sensitivity (and also cancer!) are often TH-2 dominant.

… other causes can include immune defects and deficiencies. ….bacteria, virus, yeast,parasites, fungi and environmental toxins….

I think all of us would greatly benefit from doing this test and employing the strategies delineated in his program. I want to read this book and finally get some understanding about the thyroid complexity.
It will be fascinating to see how fast you progress, Andrea!

…..many immune boosting compounds are faulty because they mix together stimulants for both sides of the immune system rather than targeting the side that needs support.

I’ve discovered that myself and was mystified how the herbs, especially some medicinal mushrooms that were supposed to modulate the immune system, seemed to aggravate it instead. Thank you for sharing such great find!

I improved so significantly on a protocol given to me by my first naturopath in 2007 for Hashimoto’s. That naturopath, Dr. H, had me go gluten free, and take Vitamin D3, folate, EPA-DHA, magnesium and Moducare (plant sterols and sterolins) and within the course of 6 months my antibodies dropped from 880 to 34 and finally rested at 15 (in normal range) for over two years until my third pregnancy. I felt amazing during that time, and looked my best in years.

You are still so fortunate to have such a great experience to compare to! 2 years is a long time to waste, but your amazing investigative skills have made sure it is not 10 or 20. And you are helping so many others not to waste the time. How precious!

Got my results back from CD4/CD8 ratio labs today. Very informative!
…if I’d had this test done two years ago I would never have worried that my autoimmunity was trending toward SD.

My CD4/CD8 ratio is lower than “normal”… .8 with a reference range of .86 to 5.00

A low ratio is often seen in HIV+ patients or those fighting viruses/infections… also in Hashimoto’s and SLE.

Scleroderma patients are known for for having an *increased* CD4/CD8 ratio…

THIS IS PRICELESS INFO FOR SO MANY PEOPLE!!! WOW! I hope all SD-ers and many others see your post and bookmark it for reference. What a great gift your post is!!!

I wish someone had run this blood test for me two years ago. …It would have saved me countless sleepless nights…

For those on the board who *do* have SD, having this test done periodically will let you assess how your protocol is going… if your ratio lowers into a normal range, you will know that the protocol you are on is effective. If it remains high, you will know to try something new or different.

Andrea, you rock girl!!!
I’m keeping my fingers crossed that the program works for you fabulously and will look forward to any future progress reports.
Warm wishes, Krys

[hopefulmama]

Wow, I am overwhelmed by and so grateful for your kind comments and encouragement. This board is the exact opposite of a dark and sad space. I always leave reading each dialogue thread feeling basically uplifted and hopeful, not to mention warmed by the generosity of spirit shown here. Thank you so much! Krys, Winston, Parisa, Lynnie, Lori and Mary – your enthusiasm and support went a long way toward making my day today.

As an update for those who are following my new path, I embarked on a “washout” period on Monday… I guess it will be 3 days soon. For newbies, a washout is when you stop all of the medicines or supplements you’ve been taking a while before doing a big blood test so that you can get the most accurate results possible. My TH-1, TH-2 kit was shipped out on Monday from Georgia and when I looked at my calendar for February I realized that I didn’t really want to be going through the dregs of washout later in the month, e.g. around Valentine’s day, etc. The company rep I spoke with for the lab recommended at least a week off of anything that wasn’t vital (they aren’t going to tell you to discontinue any lifesaving meds!) and the guy said:

“The head doctor here always says you should have this panel done when you are feeling at your worst.”

Well… after three days, I can check that box off. Suffice to say, it makes my head spin to see how fast I deteriorate when not taking any of my normal protocol except probiotics. That stuff has been holding me together since I got off the doxycycline. These 3 days have been long and hard. I keep reminding myself that this is the last time I will ever need to do this… just need to establish a credible baseline so I can see if future protocols are working. I’m planning to stay off of everything until Monday and get the serum panel run and shipped off that morning.

Tomorrow I will see Dr. C (a disciple of Dr. K) for the first time and go over my labwork with him. I am hopeful that he will be able to help me begin to find my footing on this new path I am traveling. I’ll keep you all posted.

Winston, I have taken LDN since around October of 2010. My LLMD had it formulated as a cream for me at a compounding pharmacy and I use it nightly in the dosage of .75 to 1.5 depending on how I am feeling. I haven’t noticed it helping much, nor have I noticed it causing problems. Sometimes it keeps me awake a bit. I’m not sure whether it supports TH-1, TH-2 or if it modulates both immune pathways. That will be a good question for Dr. C tomorrow.

Take care everyone. I’ll touch base when I have more concrete info to share!

Thank you again for being such true friends… it means a lot, especially at times when I feel this icky. (Always darkest before the dawn, eh?) 😀

A

[hopefulmama]

Cell-Based Immunotherapy with Suppressor CD8+ T Cells in Rheumatoid Arthritis
http://www.jimmunol.org/content/174/11/7292.full.pdf

Ok so you will need to get your degree in immunology to wade through this study. But it’s all here. Apparently RA also manifests with an increased CD4/CD8 ratio (CD4 being greater than CD8, a “higher” than normal result).

They’ve been working for a while with CD8 T-cells to see if increasing those to balance out the CD4 T-cells would put RA into remission. According to this study, it does… at least in vitro.

Here’s another one:
CD4+,CD28- T cells in rheumatoid arthritis patients combine features of the innate and adaptive immune systems.
http://www.ncbi.nlm.nih.gov/pubmed/11212151
“Patients with RA have an expanded and unusual subset of CD4 T cells that infiltrates the tissue lesions and is characterized by a deficiency of CD28, the expression of CD8-alphaalpha homodimers, and the expression of several types of HLA class I-recognizing NK receptors.”

I don’t know the risks of immunotherapies. I do know though, that the 44 studies they based this paper on lend a lot of credibility to Dr. K’s protocol and his work balancing the immune system by supporting the weak immune pathway to create a balance.

Either way, patients who want to know whether their current protocols are working can use the CD4/CD8 ratio to establish a baseline and then provide concrete answers. This is what the conventional doctors look at to see if their immunosuppresants are doing the job… so we AP folk might as well be able to use it too. Would save a lot of time and heartache, I think. There is a clear normal range for CD4/CD8 cells. If your protocol is working, you will return into that range… or at least head in that direction.

To sum up (from what I understand so far):

Hashimoto’s and hypothyroid – Low CD4/CD8 (below .9)
SLE – Low CD4/CD8 ratio (below .9)
HIV – Low CD4/CD8 ratio (below .9)

RA – High CD4/CD8 ratio (Dr. K quotes 2 and above as being worrisome… normal range is 1 to 3.7)
SD – High CD4/CD8 ratio (Dr. K quotes 2 and above as being worrisome… normal range is 1 to 3.7)
ALS – High CD4/CD8 ratio (Dr. K quotes 2 and above as being worrisome… normal range is 1 to 3.7)
Alzheimer’s – Seems to start with a normal ratio and then progress over time to a CD4+ (high) ratio in severe stages

The interesting thing to me is that many patients with autoimmune disease seem to suffer from Hashimoto’s for years before developing a myriad of often-overlapping autoimmune problems. Lots of folks have Hashimoto’s and then Scleroderma, or Hashi’s and then RA. So my question is, does their CD4 shift from negative to positive? Do these patients swing like a pendulum to the other side?

I don’t yet understand how the CD4 number can change drastically over time… since it is considered by doctors and researchers to be quite stable… or if there are different subsets of Hashimoto’s patients, some of whom have a low CD4 and some have a high CD4. This will be one of my questions to Dr. C. I wonder if there are patients out there with say, both lupus and scleroderma. I know there are plenty with MCTD.

I’ve learned from reading on HIV forums over the last few days that you can increase your CD4 numbers through diet and supplements. I’m sure you can decrease them with other foods and other supplements.

Ok, that’s all for now… 12:20am here and so tired! Take care.

[cavalier]

Am resurrecting this post to add to this. Somehow I missed this in Feb. maybe due to my impending trip to Dr S. in Ia. whatever it was – I had never heard of the CD4/CD8 test or the Th1 and Th2 test – which I read about in my digging & felt I should get tested even though no doc ever mentioned these 2 tests to me. I asked my hematologist about this last Tues – he said he would run both tests but didn’t think it would show anything I felt it may give some clues as to how my immune is working.
i called today am waiting for the doc to call me but they faxed over the results already. For some reason the Th1 and Th2 was not run wish it had been 😥 but the CD4 CD8 ratio is high not tons high 4.02 but please keep in mind this is while i am on AP for SD and also on LDN – 4.5 mg’s twice a day for LDN, PLUS melatonin of 15 mg’s not mcg’s all for helping to balance the immune system and lower TH1, specifically Th17 tends to be high in SD.

I don’t have HIV that would be low and this has been tested now 3 times not due to risk but the 1st Immunologist asked and we ran it then this hematologist ran it on my 1st visit and I guess it is pretty standard to run when they do a CD4/CD8 test – just a interesting aside. 🙂
In particular for me i have a High CD4 Positive Lymph.
I have a low thyroid that has been missed in conventional testing for years i suspect one reason for this is i have Hashimoto’s type – I have been discovered in the T3 T4 & free T’s & reverse T’s to be low – am now on armour thyroid – I have 2 bro’s who prob. have low thyroid but never been tested as well as we suspect our mother – I have a sib on synthroid his was discovered in his early 40’s when still in military and a sister now on the same thyroid med – of course years of my thyroid not being treated – one doc argued i needed to be on thyroid yr’s ago with my pcp – i was on it for a bit then stopped as it was felt by my pcp to be too much. i happened to then get the outbreak of raynauds & beginnings of SD symptoms abated when i was on the armour but came back a year after i stopped the armour thyroid – so coincidence dunno but thyroid and adrenals are def. intertwined with rheumatic autoimmune type called diseases or infectious diseases for sure in immune regulation.

I have NO idea how i looked prior to doing all of these things above if my #’s would have been worse the same or what – of course these #’s can flucuate & mine maybe better than some people it’s not super high than high normal – but I will want to monitor this again after I see if i cant add something more to this & then recheck it as a guide but it also tells me there is still to some extent some disease progression going on still as does my SCL-70 # and cardiolipin and PLAC2 test in their still being raised above normal. This is the sum of why I am considering what else i can add. Along with my low folic acid & B12 #’s if i dont supplement they show up as low – also what is a marker for what SSC/SSD can do & a low IgG factor low normal is classic.

For those of you who have run the Th1/Th2 test should
i try to get this rerun again?

Welcome any comments or insights to this info. No Rheum nor any other doc has ever suggested this be looked at but i do feel it is a important part of what the immune is trying to tell us – for me it means the immune is slightly in overdrive which is a reflection of what SD does and that i have more work to do still and to consider upping my game plan if i can. – Again i wish i knew what it looked like before i started in with my current regimen maybe it was the same maybe worse – if the same if so then it could mean what i am doing to not be enough.

Jill SD, lyme etc

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