Brief Answer:
Now your brain fog has become part of your PMS? You poor girl! ;)

Detailed Answer:
I was wondering about how things were going....where did we we leave things last time? Did I have any "homework" for you to do? Who were you going to follow up with next? So, before you were getting the symptoms just at the point when you would eat anything.....so that could literally be 3x/day......now, it's possibly adjusted its schedule to 10-12/month intersecting with your PMS time of the month. It seems that this "brain fog" is adjusting itself almost on a random basis on a month to month basis or something so that it's rather unpredictable but no question that the frequency and perhaps the severity of the symptoms are less than before.

Are you continuing to work out and exercise...I know you're not doing the competitive bodysculpting type of extreme work but I do hope you are staying active because I believe you need to keep your body in shape from a physical point of view otherwise your symptoms could actually become worse not to mention the possibility of your developing diabetes at some point and gain weight.

Are we certain you do not have PCOS (polycystic ovarian syndrome)? I remember your saying that you had an ultrasound or echo of some sort which showed some "cysts" in the ovaries? Was that either discarded as a "false alarm?" Or hasn't been worked up or looked at yet? PCOS does relate to insulin resistance which can cause hyperglycemia and that can certainly be as much a reason for brain fog (HIGH BLOOD SUGAR) as HYPOGLYCEMIA due to not eating properly or on time, etc. The truth of the matter is there is still swirling controversy regarding the exact effects on insulin that the ovarian and luteal cycle have. Some studies have reported and demonstrated insulin resistance while others have reported essentially no effect on insulin to any great extent. We do know that the ovaries have lots of insulin receptors. Kind of makes sense since it's a highly metabolizing organ on a monthly basis.

Now, there is a HYPOTHALAMIC-HYPOPHYSEAL-OVARIAN AXIS and so quite obviously there is a clear connection between the 2nd half of the ovarian cycle (your PMS phase) and insulin secretion. There is a known relationship between low progresterone levels and brain fog types of symptoms. A simple serum check of your progesterone levels would be able to detect this and correlate it to the time of your cycle to determine whether it is normal or not. Oral contraceptives can improve progresterone levels and could potentially improve this symptom.

Of course, you realize that as a neurologist I'm considerably outside my territory of expertise when I start delving into FEMALE HORMONES and your symptoms....though BRAIN FOG certainly is within my bag of tricks to explain....do you have another endocrinologist that you think could help out?

Orrrrrrr.....wanna take a road trip to Cleveland? We got LOTS of endocrinologists! LOL......BTW, I hope this answer is worthy of your HIGHEST START RATING POSSIBLE.....the last set of questions I only came up to a mere 80% level of proficiency (4 Stars)....my apologies for not hitting the highest marks. I hope this one will better hit the top because I always strive for that even if the area under discussion is not exactly in my wheelhouse. At least I have interesting theories!

Let me know your thoughts on things and answers to some of the questions you've posed.

This query required 111 minutes to read, research, and compile an envoy to the patient

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Brief Answer:
How about just simple food allergies?

Detailed Answer:
Hello there. Have you undergone what I believe a lot of advertising is dedicated to these days which is specific food allergies? Frankly, I don't know a whole lot about that topic (remember, I'm now outside the realm of my expertise as a neurologist! LOL) but my understanding is that there are labs that can test you for a whole truckload of allergies to specific foods and food substances...so, in the case of nachos which you believe resulted in 2 hrs. of floating away is it possible that occurred as a result of a food allergy? Also, were those straight away PLAIN NACHOS or was there a whole bunch of STUFF on the nachos such as frijoles, crema, salsa, etc. etc.? O posiblemente fue el nacho sin nada encima o adentro?

I doubt that previous body sculpting training permanently caused some whacky change in chemistry in your body sufficient to cause very severe and significant changes in mental status as you've described. I understand your meal times have been modified to 5x/day and you are weighing a very stable 122 lbs. and she works out 4-5x per week. You were told to "stay away" from HIGH CARB LOADS and to relax when she feels episodes.

I can't capture the difference between protein loading in the morning as opposed to carb loading but that's OK...if they think that will help. Sounds like maybe overall things could be improving. I've always thought that INERTIA could have something to do with your getting better. In order once you find a stable lifestyle to engage in with your workouts, diets, and dietary routines then, I believe you will lock in with your brain even more.

Therefore, I think my best advice is to go ahead and follow recommendations which have been suggested. I think that eating 5-6x/day is what you should get accustomed to doing now and using clean carbs as well as high protein content in all your meals- perhaps to replace some of the carb content in fact since this can still result in energy being produced and transferred to maintain your metabolic rate.

How about posting most recent results of: Vit. B12, Folate, Vitamin D, D2, and D3, serum pre-albumin, TSH, FT4, ESR, & CRP?

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Brief Answer:
Random cortisol is Ok?

Detailed Answer:
It sounds as if they drew what we refer to as a RANDOM cortisol level as opposed to performing something a bit more precise such as a DEXAMETHASONE SUPPRESSION test. Cortisol is a steroid and when secreted it actually causes sugar rises to occur with the amount of cortisol being correlated to the glucose rise. I don't know the cortisol output during the output of a woman's menstrual cycle but it makes sense for it to be higher since this is during the degradation and sloughing off phases which sounds to me to be most coincident with when STRESS HORMONES/STEROIDS should be secreted in greater amounts...which should raise glucose levels. This would then, signal a large or at least a LARGER insulin release by the pancreas, which if sensitized, could result an overshoot of sorts and this may very well result in additional lowering of serum sugar and thus be related to dizzy, woozy, or lightheaded feelings.

You mention "hypotension" but cortisol release into the bloodstream tends to do the opposite which is ELEVATE blood pressure through the concomitant release of catecholamines (i.e. epinephrine) and this would therefore, result in a vasoconstriction type of effect. So blood pressure actually should be a bit elevated during those times when cortisol spurts are higher. However, because of the relationship of fatigue which can follow CHRONIC expression or higher than normal or at least unequal distributions or even OVERPRODUCTION of cortisol such as under stressful circumstances FATIGUE is well known to occur. This is because of the delicate balance of the HYPOTHALAMIC-PITUITARY-AXIS (HPA) which can be disturbed by irregular or more than normally stable amounts of cortisol production.

I do believe this is likely to have happened during your training years with the overall amount of constant stress you placed yourself under...both physically and mentally. Let me insert an actual QUOTE from the Dartmouth Journal of Science that discusses this HPA axis a bit more.

"The bottom line is that both episodes of acute stress and more prolonged stressful circumstances precipitate lower levels of general health, and exposure to such stress should be minimized. In the most extreme cases, Cushing’s Syndrome, characterized by dangerously high cortisol levels, can result. Those afflicted with Cushing’s experience rapid weight gain, hyperhydrosis, and hypercalcemia, along with various psychological and endocrine problems."

Now, please be aware that I'm not suggesting you have Cushing's syndrome which is more directly what they're talking about but I wouldn't be surprised if a part of what your feeling could be related to this HPA axis balance and I do believe you did say that gaining weight is much easier now than ever in the past. And FATIGUE is also a big part of this picture as well.

My feeling is that as time has gone on with you....things have slowly gotten back to a more normal state of affairs...we talked before of INERTIA....so now, your bottom little by little is readjusting to a new SET UP in terms of both activity levels as well as dietary intake and that you are not being as extreme as before with restrictions and ingestions of certain foodstuffs that you needed to watch due to the bodysculpting competitions. I think you'll potentially come back to even a better and more tolerable state of affairs with respect to your symptoms if you stick with a good, "not crazy" routine....remember, you also have diabetes to contend with in your gene pool so that's another factor that has to be taken into consideration. I'm not saying to be scared of it so that you go to any extremes but it can potentially try knocking on your door one day and so checking for that on a regular basis through simple blood and urine samples will help identify if that starts to occur at which point you can nip that in the bud if it happens.

I would be in favor of REDUCING THE OVERALL amount and types of testing and just focus on living well, staying at a comfortable weight according to your body dimensions...though those may be far above what they used to be for competition....you will still have a great looking physique if you allow yourself to live at an elevated set and rest point...which you've already done....and as I've said that should result in a better feeling of general health and well being with respect to eating and other abilities such as improving or overcoming fatigue.

Prove what I just said to me by sending a pic with you feeling your best....maybe 3-7 days before mid-cycle....which is when you likely are at your overall peak these days from what you've told me. You can either do a workout/gym picture or one where you're in a dressier pose. I guarantee you will have very proportionally satisfying body measurements though your fat percentage will be elevated over competition levels. What is your current fat percentage level at mid cycle and how about at either initiation or right at the end of your cycle? Does it fluctuate a lot? It shouldn't. I'm now thinking out loud and wondering about something called CGRP levels which in you will be at low normal amounts....and in my opinion that's a good thing. CGRP stands for Calcitonin Gene Related peptide and in humans it is known to occur in greater amounts when fat stores increase...in other words, it seems to be depoted in adipose tissue. It's primary role that we know of is a pain blocker and is currently used in medications marketed for control of migraine headaches. I don't recall you telling me anything about headache problems but another role for CGRP, which is automatically and normally produced in your DORSAL ROOT GANGLION cells as well as a few other select places in the body, is to mediate VASODILATION...so in a way this could be useful against the hypertensive effects of excess cortisol in the system which could occur under stress conditions as we talked about.

Anyways, there's something else that could possibly play into what we're talking about here in a positive way if we wanted to take a look at it or something down the road. But beware this is a relatively newer entity and I'm not sure that we should be getting too involved in this in your case....it was just a side thought given its relationship to fat stores (which is greater when body fat percentage goes up and less when it goes down) and how that could mediate other things by stabilizing or DEstabilizing those numbers.

If it's been a while since getting your Vitamin D, D2, and D3 then, maybe out of everything I mentioned I would ask to get that looked at....you could also throw in a total calcium, ionized serum calcium, and PTH level as well and see where those numbers are at.....everything I mentioned in my other post could be on hold.

Bottom line....I THINK YOU'RE GETTING BETTER....slowly....be patient.....maybe you won't NEED that trip to XXXXXXX ....but we're still in the middle some INCREDIBLE WEATHER up here that I know you'd enjoy if you came! That way we could map out your plan for the upcoming winter months so you stay healthy but well in shape! XXXX!

XXXX XXXX!

This query has thus far required 235 minutes to read, research, and compile an envoy to the patient

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Brief Answer:
Hey XXXX--- XXXX it out.....you are good to go!

Detailed Answer:
Nowadays, the buzz word is DESTRESS....whatever it takes....that can be more important than taking medication, more important than knowing the diagnosis, more important than even eating 3 square meals a day....DESTRESS...whatever it takes...by venting, singing in the shower, having more sex, having LESS sex...since stressing causes wild changes in hormones, glucose, cortisol, changes due dates of periods, babies, and when you should really be eating dinner.

In your case, leaving XXXXXXX for a week...or at least a WEEKEND...and coming by for a good solid medical examination, maybe get a good acupuncture session or 2..or 3. a session with a fantastic Sports Medicine Dietician, and leave with an awesome plan in place that you help design based on what you're looking for but without all the STRESS is just what the doctor ordered!

So in point of fact, I think I've said it before and I'll say it again. In my opinion I believe you're getting better by baby steps....you've recognized that yourself....so no need to really sound any alarms. I think you're on the right track. Remember, I'm JUST neurologist who participates in a bit of an extreme sport of wrestling requiring pretty intense dieting and weight loss myself over a very short period of time. So I'm constantly going through these ups and downs, changing my stress levels, my cortisol levels, my glucose levels, and my hydration levels. In my opinion and from I know from your situation my sense is that you are going in the right direction. I think you can keep working out but you CAN'T keep following that strict of a regimented caloric restriction anymore. Your body won't let you. I don't know if that is directly tied to your family's health history of DIABETES placing you at risk for that metabolic disorder or what...but your body simply won't allow you to do that activity anymore without consequences. So, you avoid it...and you've pretty much done that, right?

Yes, I do think that all the stuff you were doing before was just at the extreme end of the scale and while your reserve metabolic capacity was good enough to handle it back then, further forcing yourself to continue to follow that pace and rhythm is simply going to result in problems. However, the backlash of everything that has accumulated in terms of fat stores, carbohydrate burns, protein deficits you likely had but didn't realize, and even vitamin and mineral stores you may have had lacking is what suddenly tipped the scales in your case. I think stress probably played a huge role making it almost impossible to clearly see what was organic from non-organic.

But again, look at how you're improving day by day. You've got to be patient and settle for baby steps right now.

Pressure in your eyes is a well known complaint in people with headaches of the Stress or Tension type. You need to look at relaxation techniques, maybe some Tai Chi, biofeedback therapy, and Yoga...NOT HOT Yoga....paced breathing exercises, and visual imagery. Plus, great and continuous hydration is your friend.

So, again, probably figuring out exactly what HAPPENED or the few occasions that your body suddenly decides to be weird is less important in my opinion than not being stressed out about it...make sense?

Perhaps, you can get a list of food/beverage items that are associated with "fogging you out" and we can start either eliminating or reducing intakes of these items ONE AT A TIME and seeing how you feel.

So whaddya say?

Bottom line is that I believe things are getting better and you need to recognize that and CONGRATULATE YOURSELF for changing things around for yourself. Let's see if thinking POSITIVE thoughts now given your improvements helps more than being frustrated either at yourself, your doctors, or the fact that you've just got to change your previous routines....that's just the way it is.....you knew that, right?

What about SLEEP as well? Are you getting a good solid 6 or 8 or 10 hours of restful sleep without constantly popping up and down for things....or does stress tend to get in the way?

So how does all that sound? Unfortunately, this is the last question of this thread so you'll have to open a new thread if you want to go a few questions. :(

Or you could save your dollars on these questions and just put it toward a plane ticket and fly in to XXXXXXX for a few days (weather was UN-FRICKIN-BELIEVABLE this week...and still should remain this way, in the 60's....until the weekend....then, they say we are going to pay for such a mild November! HAHA!) and we would be able to put a plan in place and do a rigorous assessment with your cooperation and input.

Please don't forget to give me as HIGH A STAR RATING AS YOUR HEART DESIRES...BUT LAST TIME I APPARENTLY ONLY MADE IT TO 4.....:( Was it all the bad jokes I was telling? HAHA!

Total time on this series of consult- 296 minutes

Let me know how you'd like to go and be patient and XXXX.....XXXX!

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