Since I presented my concerns and information about NED in my February newsletter, I've received several letters with personal stories of exposures to a variety of harmful substances including carbon monoxide, molds, DDT, pesticides, and radioactive fallout from above-ground nuclear testing in the mid-twentieth century. Some of the stories were about extreme exposures and others were less obvious.

W.S., a man who worked as a lineman for a telephone company in the late 1960's, experienced an obvious exposure to PCB's from the oil in a ruptured telephone transformer. He had such a rapid decline in health that his workman's compensation claim was uncontested. PCB's have since been banned, but exposures continue to occur as the old transformers and electronics devices are dismantled in this country and abroad. While this nature of exposure isn't common, the insidious exposure that happens in small amounts over a longer span of time is common. According to the Agency for Toxic Substances and Disease Registry report issued in 2000, we all have measurable amounts of PCB's in our bodies.

Julia C. replied, "You got me thinking about my health problems, and how would I know if I'm having a problem due to NED? I don't feel as good as I think I should, but my doctor said that my blood tests with my yearly physical looked fine. My TSH level was in the normal range so my doctor said I don't have a thyroid problem. My doctor says that I'm just getting older (I'm 43) and I can't expect to feel as good as I did when I was younger. He said that maybe I have a "touch of fibromyalgia" because I have some vague aches, my sleep isn't great, and I fatigue easily. He prescribed an antidepressant for me because he thought I might be depressed. I didn't take it because I don't think that I am, but I know I'm not OK. Could environmental toxins be causing my problems? I grew up on a potato farm in Wisconsin and my family moved to Houston 15 years ago. The cropdusters sprayed the fields with pesticides and I can see the junk in the air here in Houston. How would I know if I have a high enough level of toxins to hurt my health?

Standard laboratory blood tests can be used to measure levels of PCB's, mercury, and many other chemicals. Hair analysis is well-suited to measure heavy metals like mercury and cadmium since it reflects long-term exposures. PCB's are stored in the liver and adipose tissue (fat) and do get excreted over time by the GI tract. It stands to reason that a slow metabolic rate may contribute to a slower rate of excretion from these tissues. The longer the toxin remains in your body, the more damage it can do.

It's interesting to know whether or not you have measurable levels of these chemicals, and at the same time these levels won't tell us if your metabolism has been impaired by them. If you suspect that you have a problem with this, start with the usual thyroid-related blood tests including a TSH, free T4, free T3 level, and a thyroid antibody group. The next step is to actually measure your resting metabolic rate with a device called an indirect calorimeter. You can read about this in the Services section of my website.

Your resting metabolic rate is an indication of how well thyroid hormone is controlling the function of your tissues. Bioelectric impedance is also used to measure the fat-free percentage of your body since this can also affect your resting metabolic rate. I'll interpret the results of all of these tests and teach you how to use metabolic rehab to get well.

As I'm helping a new patients understand how to work with my metabolic rehab protocol, I like to help them set some personal goals. I ask, "What do you miss doing the most?" "What would you like to learn? "What would make you happy?" What is your vision of optimal health?

In 1996 a fibromyalgia patient was referred to me with the chief complaints of severe widespread pain, muscle stiffness, and frequent migraine headaches. She told me that when she got well she wanted to learn to dance the tango. Not only did she learn it, she now teaches tango and has built a community of other dancers, including other instructors. She travels to Buenos Aries for intensive seminars to refine her technique - and has a lot of fun doing it!!

Metabolic rehab is a process, and I've found that people tend to stay on track with their treatment protocol and monitoring much better when they have a goal that brings joy to their lives. Not all of us want the same things - your goal may be to hone your creative writing skills or play more with your grandchildren. The most important thing is to stay on track with metabolic rehab so you can feel well enough to fulfill your potential.

I'm delighted to introduce Lisa, my future Clinical Medical Assistant. Lisa is an intern from the Clinical Medical Assistant program at Front Range Community College and upon graduation will join the staff at the Center. Lisa is well-educated in all aspects of practice management, from assisting with testing to administrative functions. She is dedicated to serving others.

My dear friend, Catherine, has been invaluable to me by serving as my Practice Administrator during the transitions in the clinic, and she'll soon to be accepting a new position. I'm grateful that she will still be here for a few more weeks to help with Lisa's orientation to the Center's policies and procedures. We'll miss Catherine but offer our sincere congratulations and warmest wishes for her success as she ventures forth in her next adventure.

I don't want it to sound as if I think that any and all health problems are only related to poor thyroid regulation due to NED. There are certainly many, many health problems that are not related to poor thyroid hormone regulation and I would not want anyone to limit his or her search for diagnosis and treatment to this alone.

Another tool you can use to help in your recovery is "Your Guide to Metabolic Health", the book I coauthored. It is the by-the-numbers guide to metabolic rehab. Many people have used the information in this book and, with just a few troubleshooting consultations with me, have gotten well. Some people have asked their local library to order the book so others may use it as well.

My emphasis at the Center for Metabolic Health remains on high-precision metabolic rehabilitation, metabolic evaluations, and telephone consultations. We're available Monday through Thursday from 9:00 am until 5:00 pm and Friday from 9:00 am until 1:00 pm. Please call the clinic at 303-413-9100 for information and to schedule appointments.