Supplements Working or Placebo Effect?

I seem to have more energy lately. 

I've been able to do more chores around the house like dishes and laundry.  To a normal healthy person, dishes and laundry might not seem like a big deal; however, they are high energy activities that have a history of tiring me out. 

Climbing stairs has also become marginally easier.  I still feel winded at the top of the stairs, but not to the same degree...I think.

I'm feeling cautiously optimistic about this newfound energy.  In the past, big improvements in energy have often preceded illness or a major crash.  I'm making an effort not to overdo things to avoid pushing myself into a crash. 

It has been a couple weeks since starting on my 100 mg CoQ10 and 100 mg B2/Riboflavin three times a day.  I have a history of deficiencies in vitamins B2 and D, iron, and CoQ10 (as well as glutathione), so it makes sense that I might feel a bit better with such high doses of B2 and CoQ10 supplements.

I would like to think the supplements are actually helping me feel better, though I am open to the possibility of a placebo effect.  Whatever the case I'm feeling an improvement, so I'm not going to look a gift horse in the mouth (what does that really mean, anyway?) and enjoy things while they last.  

In case you're interested, here's my latest daily supplement/Rx list:

• Multivitamin, 1x day (I rotate between three brands: Centrum (1 tablet), Holistic Health Neurological Health Forumla (2 tablets), and Brainstrong Prenatal Vitamin (1 tablet + 1 DHA softgel).  No, I'm not pregnant; I take the prenatal vitamin because it has a higher dose of biotin than most vitamins.  I rotate vitamins because each is different in content and amounts.)
• 500 mg Calcium + 800 mg Vitamin D, 2x day (I take Caltrate Gummy Bites -- yum!)
• 100 mg Coenzyme Q10, 3x day
• B-Complex vitamin, 1x day (includes 100 mg B1/Thiamin, 100 mg B2/Riboflavin, 100 mg Niacin, 100 mg Vitamin B6, 400 mcg Folate, 100 mcg B12, 100 mcg Biotin, 100 mg Pantothenic Acid)
• 100 mg Vitamin B2/Riboflavin, 2x day (I only take this pill 2x day because the B-complex vitamin includes 100 mg B2.)
• 65 mg Iron, 1x day
• 25 mg Zoloft
• Yaz birth control pill
• 1,500 mg Metformin

If you are a long-time reader of my blog, you'll notice that this list is quite a bit shorter than previous lists.  The truth is that I got tired of taking so many darn pills all the time, so I decided to cut back for my own sanity.

I realize that I could possibly feel even better if I took additional supplements (NAC, ATP, potassium, fish oil, etc.) or went back on the various protocols I've tried in the past, but I just got so resentful and angry at my exploding pill box.  I had to stop the madness.

My new rule is that everything has to fit in my pill box.  If it doesn't fit, I'm not taking it!

Ugh! Non-Specific Results

The following blog entry was originally posted on 4/6. A note at the bottom was added on 4/9.

This is the story of my life -- non-specific symptoms, inconclusive results. Ugh!

MUSCLE BIOPSY RESULTS

I went to the neurologist this afternoon to get my muscle biopsy results. My results were slightly abnormal, but not abnormal enough to figure anything out. Here's an excerpt from the five page report my doctor gave me:

There are scattered atrophic fibers, most of which are type 2 fibers. This tendency for type 2 fiber atrophy is non-specific and can be seen in chronic deconditioning, steroid use, or myopathy related to underlying endocrine disorders. Specifically there are no ragged red fibers, ragged blue fibers, and all the oxidative enzymatic reactions were normal thus no evidence of mitochondrial abnormalities is present. There is no evidence of denervation, reinnervation, abnormal deposits, inflammation or vasculitis.

Impression: Abnormal muscle biopsy. Tendency for type 2 fiber atrophy.

Basically, there is no obvious evidence of any major neuromuscular disease OR mitochondrial disease, but my results were still abnormal.

I asked the neurologist about the "chronic deconditioning" and she said she typically doesn't see this degree of atrophy in people my age. She said something about 80 year-old's, but I missed half of what she said because I was still processing my results. Maybe she was comparing my level of atrophy to that of an 80 year-old. I know I am not nearly as active as most people my age or as active as I used to be; however, I am not completely inactive because I still work full time and live and work in places with stairs that I have to take.

I asked how my results compared to other people with ME/CFS that she's seen, and I was surprised when she said that she doesn't usually perform muscle biopsies on people with this ME/CFS. She said decided to do the biopsy on me because she felt my particular medical history and symptoms were such that further testing were indicated.

I commented to the doctor that I seem to receive the label "non-specific" quite often and that I keep having things just slightly wrong with me but not wrong enough for them to explain much. For a moment, I expected the doctor to tell me that this was all she could do, and I would just have to live with these non-specific results. I also thought she'd blame my lack of exercise for all my symptoms.

Fortunately, the doctor did not respond in the way I expected. In fact, she surprised me with her support.

She said what we do know is that my results are not normal. Furthermore, my results are abnormal enough that she thinks it's worth pursuing additional testing on my biopsy tissue to check for other mitochondrial diseases. I can't tell you how good it feels to have a doctor take me seriously and be so supportive in my quest for answers!

My neurologist will be in touch with the mitochondrial disease expert I met with a while back to discuss what additional tests to do on my muscle sample.

In the meantime, my neurologist is starting me on a mitochondrial disease "treatment" to see how I do. She has prescribed 100 mg of Co-enzyme Q10 three times a day and 100 mg of riboflavin (vitamin B2) three times a day (these supplements are available over the counter). Coincidentally, I had micronutrient testing done several years ago and was found to be deficient in both CoQ10 and riboflavin. For some reason I stopped taking CoQ10 (I don't really even remember why), and I switched from B2 supplements to a general B-complex vitamin that contained B2.

I guess I'm going back on the CoQ10 and B2, but this time the doses will be higher than I took before. Here is an interesting link to some treatments and therapies often used for mitochondrial disease.

SLEEP STUDY RESULTS

I mentioned a few posts ago that I had a sleep study done. My sleep study was followed by a Mutiple Sleep Latency Test (MSLT), which took up most of the day.

Several years ago my ME/CFS doctor suggested I get a sleep study because I was complaining of insomnia. To my surprise I was diagnosed with obstructive sleep apnea and prescribed a continuous positive airway pressure (CPAP) machine. I quickly stopped using the CPAP because it was noisy and kept me from sleeping rather then helping me sleep.

Because I am on a mission to look for ways to reduce my constant fatigue, I decided to get another sleep study so that I could get a new CPAP. I had my old results sent to my doctor. To my surprise, the sleep doctor I met with said that my old sleep study results seemed strange.

In fact, the five-year old document gives me the diagnosis of sleep apnea but also states that I had zero apnea incidences! What made the old sleep study results even more fishy was that they said my main complaint was excessive snoring and waking up gasping for breath. I have NEVER complained of this. What?! Had I been given a false diagnosis of sleep apnea just so they could sell me a CPAP?

The good sleep doctor suggested that I go ahead and have another sleep study done and also suggested I do an MSLT to check my daytime sleepiness. I should probably mention that I was open with my CFS/ME diagnosis from the start, but he still thought the sleep study and MSLT were options worth pursuing. I've been really lucky lately because the doctors I've seen have been aware of my CFS/ME diagnosis but still treated me with respect and didn't blow me off.

Here are the important notes from the two page sleep study report:

When I got these results from the sleep study, I felt so mad at the old sleep study company. I will refrain from jumping on my soapbox about medical ethics for now.

The MSLT was unlike anything I'd ever done before. Basically, I spent the day at the sleep study facility and was given opportunities to take 15 minute naps every two hours. The mean part is that every time after I fell asleep, they'd wake me up. It was awful! When I nap, I usually sleep for hours...not minutes.

I had inconclusive results. Surprise, surprise! My results were abnormal, but not abnormal enough to mean much. Here are the important notes from the MSLT report:

The results indicate some level daytime sleepiness but are not consistent with a diagnosis of narcolepsy.

My doctor labeled me with idiopathic hypersomnia -- meaning sleeping too much for unknown reasons.

At least my MSLT confirmed what I had always thought but never actually had any data to back up -- that I am often tired AND sleepy. "Tired" is more of a worn out feeling, while "sleepy" is the sensation of wanting to sleep.

The doctor asked if I wanted to try the medication Provigil (generic: modafinil), which is used to treat daytime sleepiness. After doing some reading, I've found that modafinil is often prescribed to patients with MS to help their fatigue. There are also some patients with ME/CFS who use the medication. Here's a 2009 article by the CFIDS Association of America on Provigil. Note: Provigil's generic equivalent is now available in the US.

I have decided to try generic modafinil (which costs me just $10 for a month's supply, thanks to my insurance company) to see if it helps me feel any better. I have some reservations about taking the drug. It is not an amphetamine, but it does have stimulant properties. I will try my first dose this weekend. I'll be sure to report on how things go!

Time for bed.

---------------
Note Added 4/9/12

I've decided to postpone taking the modafinil for a little while. I have a history of experiencing the rare and unusual side effects of medications (including anaphylaxis), so I'm waiting until my immune system calms down a little.

My immune system is currently in an allergic state because I was recently (though unintentionally) exposed to dairy/casein, so I'm dealing with itchy rashes at the moment. Some of the prepared foods I've eaten in the past few days must have had hidden dairy.

I try to ask about ingredients before I eat something if I haven't prepared it myself, but sometime either I forget to ask OR the person answering doesn't really understand food allergies and says the food is safe when it really isn't. Whatever the case may be, I am itchy.

I think these recent developments are actually good because I'll be able to see if the CoQ10 and B2 make me feel better without the use of modafinil. I'll keep you updated!

Waiting Anxiety

I'm supposed to get my biopsy results THIS afternoon.  I think I must be suffering from "waiting anxiety" because I am finding myself very distracted from everything going on around me.  I have all sorts of thoughts and feelings and "what if's" floating around in my head.

I can't decide if I want the results to be completely normal or if I actually want something to be wrong.  I guess I don't want anything too serious to be wrong, but I want something to be wrong enough  (but easily treatable!) to explain my health issues.  Am I crazy for thinking this way? 

In other news, I have to say that I really like ScarAway.  I'm not allergic to it, and it protects the biopsy site from clothing irritation.  The scar itself has not improved much in the short time I've been using the product, but I'm not concerned because I was really looking for protection rather than aesthetics. 

Quick Note: Biopsy Results Tomorrow

After more than SIX WEEKS, I am finally going to get my muscle biopsy results...tomorrow.  I just made the appointment on Tuesday, and these last few days seem longer than the six weeks I've been waiting!

I'll post my results tomorrow night. 

P.S.  To my regular readers/subscribers: I'm sorry about the recent spam!  I've deleted it from my blog; however, if it gets worse, I'll have to add a moderator approval step for comments -- which I've tried to avoid.