Need your advice

[Guest guest]

Ann, I only had severe swelling and redness when I was at the height

of a major flare. Fortunately, I saw a dermatologist at that time who

was able to confirm to the rheumy that she saw it - otherwise I feel

the rheumy would not have been willing to give the PA diagnosis. As

soon as I started taking Naproxen and aspirin, the redness and

swelling subsided - or maybe it was just going to " remit " on its own,

who knows? I still had terrible pain though, even without the

swelling and redness.

The only joint that has any swelling or heat now is my right knee. It

comes and goes every few days or so. Even with MTX and continuing

NSAIDS and aspirin. The swelling is very slight, there is NO redness,

but my hubby has measured a skin temp difference (with 4 different

scientific temp instruments) of 4-5 degrees - compared to the other

knee - consistently whenever the pain is really bad. The pain can get

VERY bad even without swelling or redness!

The first time I had a major flare of this illness, I had no skin or

nail involvement at all! That was 10 years ago. They only look for

pitting or lifting, but I think that inflamed nail margins and/or

cuticles that won't push back are clearly also signs of nail

involvement for me at least. People who see it tend to think I've

messed with a hangnail, but that's not it. It's spontaneous. Do you

ever have that?

best regards,

sherry z

>

> I feel like from reading the previous post that there are plenty of

> people out there who have joint pain w/o swelling or pitting of nails

> that carry the diagnosis of PA. So am I really that unusual? Does

> anybody have a good handle on how many people are like that?

[Guest guest]

Hello Ann,

First off, this disease hits everyone differently. My nails don't have the

normal pits either. They have more ridges now than when I was first diagnosed.

My only Ps was a little on my scalp for a few years. My rheumy always told me

I had a good range of motion in all my joints. If the MTX helps to take some of

the pain away,

PA would seem to be the right dx, but there is nothing says you can't get a

second opinion from another rheumy. Especially if it would make you feel more

confident

in their diagosis. Just hang in there until you are satisfied. God Bless.

Janet in Ca

-------------- Original message --------------

From: " annmlucas " <annmlucas@...>

> Hello everyone,

> I have enjoyed reading everyone's emails over the past year since I

> have joined. Its good to hear that there are others out there with

> similar things going on. I just got back from a visit with my rheumy

> and wanted to get your advice.

>

> First a little background. I have had psoriasis since I was about 12.

> It was usually very mild on my scalp. I had prescriptions for it

> when I was younger but really hasn't bothered me too much as an adult.

> I am currently 39, normal weight, eat a good diet and used to be an

> avid runner. I was diagnosed with PA about a year ago after I had

> continual pain in my foot, hands and back and all my labs were

> negative for everything (complete workup to exclude the normal things

> like RA, lupus, etc. I do have fatigue and in fact anemia on one of my

> labs (the only thing that has shown up) and I have had general " flu

> like " feeling when I have the pain and fatigue.

>

> My rheumatologist says that " this is not the way PA usually presents "

> since I don't have swelling, pitting of nails, etc. But he feels this

> is my most likely diagnosis since I do have P and joint pain, fatigue.

> On xrays, and MRI's of my feet, I have some things that show up but

> nothing on xrays on my hands. Upper back has been xrayed but that was

> normal. No other xrays have been done.

>

> He did put me on methotrexate and mobic after I had tried several

> NSAIDs that just didn't touch the pain. I had been happily trodding

> along for the past 6 months doing fairly well. Even able to start

> going back to the gym for pilates, lifting weights and swimming and

> biking. I had some bad days but overall things I could deal with. Of

> course, in general I am doing a lot less than I used to but I am

> dealing with that. The last weekend in August I had a an episode of

> pain that lasted longer than usual and the pain was just unbearable so

> he put me on tramadol. That seems to take the edge off the pain but I

> don't like taking another medicine plus it makes me feel even

> " foggier " than normal.

>

> Then the past 4 weeks I have had daily pain that is pretty intense,

> fatigue, " flu like " feeling and of course, depression since I am in so

> much pain and am so tired. He had me increase my methotrexate by 2

> pills two weeks ago but that didn't seem to help so he had me come in

> today. Again, he noted " this is not the way PA typically presents

> itself " since there is no swelling. He took urine and blood to look

> for infection (but there is no fever), he is going recheck thyroid,

> sed rate, cbc. He also recommended I talk with my regular doc to see

> if she has any ideas. He is not in the office tomorrow so he is

> having her sent the lab results and suggests I talk with her.

>

> He mentioned adding another med to the methotrexate but is hesitant to

> do this since I don't have any obvious signs of inflammation. I have a

> regularly scheduled appointment with him in 2 weeks that at first, he

> said to keep so we could talk about treatment options and then later,

> he said that if I wanted to change the appointment to 6 week out that

> would be ok. I plan on keeping it but I want something done

> different. I don't want to keep going on like this!

>

> So here are my questions:

> I feel like from reading the previous post that there are plenty of

> people out there who have joint pain w/o swelling or pitting of nails

> that carry the diagnosis of PA. So am I really that unusual? Does

> anybody have a good handle on how many people are like that?

>

> Do you think that joint damage can still be occuring without obvious

> signs of inflammation?

>

> What do you think about going on one of biologics for just joint pain

> without inflammation? Anybody else done that and if so, does it help?

>

> I feel like maybe I should see an expert in PA to see what they think.

> My rheumy has about 20 pts with PA and he is older so he has seen

> quite a few in his practice but I think it might help to get an

> opinion from someone who focuses solely on this. What do people think

> and who is someone who is an expert on PA? I am in NC and am willing

> to travel.

>

> Thank you for your help!

>

> Ann

[Guest guest]

Ann, I had absolutely no redness or swelling of any joints when I was

first diagnosed. My labs were also all completely normal EXCEPT for:

an elevated white blood count (no infection to account for it), an

elevated neutrophil count (again, no infection to account for it), and

an elevated C reactive Protein level (no cardiac problems to account

for that either.) What I did have was sacroiliac back pain and right

hip pain severe enough that I could only walk with the assistance of

two canes.

The rheumatologist did a thorough head to toe exam, including

measuring my costal area on inspiration and expiration. I had mild

psoriasis on my scalp, and nowhere else, and no nail pitting or

ridges. Based on the sacroiliac pain, hip pain, some abnormalities on

the sacroiliac spine Xray (although not the CLASSIC findings of

ankylosing spondylitis), the decreased costal expansion with

respiration (normal is supposed to be when you take a deep breath,

your rib cage should be at LEAST 4 cm greater when it's measured than

when you exhale and it's measured.), and the above-mentioned lab

findings, he informed me that my diagnosis was spondyloarthropathy due

to either ankylosing spondylitis OR psoriatic arthritis, although I

didn't " fit classically into either one but showed features of both. "

He promptly started me on Methotrexate, which worked for about three

years.....then the right hip pain recurred and became more and more

severe, and both feet and both hands began showing erosive athritis

changes....but still no actual redness anywhere, and very MINIMAL

swelling of feet/hands/wrists. We had just moved, and I consulted my

current rheumatologist who performed still more labs and did another

thorough exam....this doctor agreed with the diagnosis of PA, and

diagnosed Sjogrens syndrome as well. He started me on Enbrel 50 mg

weekly. I had to go off the Enbrel and Methotrexate for almost 2

months recently to have my hip replacement done....and while I was off

the meds, I had a horrible psoriasis flare, my first one ever. My back

was covered, two toenails are ridged and discolored STILL from that,

and I developed the inverse/intertriginous psoriasis as well. I was

never so happy in my life as when they told me I could FINALLY restart

the meds postop

Unfortunately, my hands and SI joint have not been the same since, so

we're considering either increasing the Enbrel dose to 50 mg twice

weekly OR changing to either Humira or Remicade.

Best wishes to you!

Wanda

[Guest guest]

Thank you for your response. I have always had hangnails and terrible cuticles

but didn't relate it to psoriasis. That is an interesting thought!

ann

" S. Zorzi " <szorzi_1999@...> wrote: Ann,

I only had severe swelling and redness when I was at the height

of a major flare. Fortunately, I saw a dermatologist at that time who

was able to confirm to the rheumy that she saw it - otherwise I feel

the rheumy would not have been willing to give the PA diagnosis. As

soon as I started taking Naproxen and aspirin, the redness and

swelling subsided - or maybe it was just going to " remit " on its own,

who knows? I still had terrible pain though, even without the

swelling and redness.

The only joint that has any swelling or heat now is my right knee. It

comes and goes every few days or so. Even with MTX and continuing

NSAIDS and aspirin. The swelling is very slight, there is NO redness,

but my hubby has measured a skin temp difference (with 4 different

scientific temp instruments) of 4-5 degrees - compared to the other

knee - consistently whenever the pain is really bad. The pain can get

VERY bad even without swelling or redness!

The first time I had a major flare of this illness, I had no skin or

nail involvement at all! That was 10 years ago. They only look for

pitting or lifting, but I think that inflamed nail margins and/or

cuticles that won't push back are clearly also signs of nail

involvement for me at least. People who see it tend to think I've

messed with a hangnail, but that's not it. It's spontaneous. Do you

ever have that?

best regards,

sherry z

[Guest guest]

Thank you for your response! I guess it really bothers me when my doctor keeps

saying I'm not the " classic " presentation like maybe this isn't really pa,

something else. If its something else, I want to them to figure it out but I

mainly want the pain to go away! And I wonder if it will always be this way.

That is so depressing to think that I will have to live like this.

Best wishes to you,

Ann

dreimutter1957 <dreimutter1957@...> wrote:

Ann, I had absolutely no redness or swelling of any joints when I was

first diagnosed. My labs were also all completely normal EXCEPT for:

an elevated white blood count (no infection to account for it), an

elevated neutrophil count (again, no infection to account for it), and

an elevated C reactive Protein level (no cardiac problems to account

for that either.) What I did have was sacroiliac back pain and right

hip pain severe enough that I could only walk with the assistance of

two canes.

The rheumatologist did a thorough head to toe exam, including

measuring my costal area on inspiration and expiration. I had mild

psoriasis on my scalp, and nowhere else, and no nail pitting or

ridges. Based on the sacroiliac pain, hip pain, some abnormalities on

the sacroiliac spine Xray (although not the CLASSIC findings of

ankylosing spondylitis), the decreased costal expansion with

respiration (normal is supposed to be when you take a deep breath,

your rib cage should be at LEAST 4 cm greater when it's measured than

when you exhale and it's measured.), and the above-mentioned lab

findings, he informed me that my diagnosis was spondyloarthropathy due

to either ankylosing spondylitis OR psoriatic arthritis, although I

didn't " fit classically into either one but showed features of both. "

He promptly started me on Methotrexate, which worked for about three

years.....then the right hip pain recurred and became more and more

severe, and both feet and both hands began showing erosive athritis

changes....but still no actual redness anywhere, and very MINIMAL

swelling of feet/hands/wrists. We had just moved, and I consulted my

current rheumatologist who performed still more labs and did another

thorough exam....this doctor agreed with the diagnosis of PA, and

diagnosed Sjogrens syndrome as well. He started me on Enbrel 50 mg

weekly. I had to go off the Enbrel and Methotrexate for almost 2

months recently to have my hip replacement done....and while I was off

the meds, I had a horrible psoriasis flare, my first one ever. My back

was covered, two toenails are ridged and discolored STILL from that,

and I developed the inverse/intertriginous psoriasis as well. I was

never so happy in my life as when they told me I could FINALLY restart

the meds postop

Unfortunately, my hands and SI joint have not been the same since, so

we're considering either increasing the Enbrel dose to 50 mg twice

weekly OR changing to either Humira or Remicade.

Best wishes to you!

Wanda

[Guest guest]

IO had a doctor who was similarily relunctant to diagnose my PsA. I

have no sed rate and x-rays look normal. I did have swelling and nail

pits. The test that finally diagnosed me was a bone scan. This

helps daignose joint damage before you can see it on an x-ray. Most of

major joints in my body showed some sign of slight damage. You may

want to try this if you have no swelling just to be on the safe side.

[Guest guest]

ann, i had 3 doctors tell me within a 2 month stretch that they thought i had

pa. though i also hurt really bad, i didnt show alot of damage. so on the visit

to another rheumy i went 3 days prior to appt without any medicine. needless to

say by the time i got to the specialist i WAS showing swelling and soooo much

pain. he was afraid to touch me it hurt so much. thats when i got the proper

diagnosis. LOL but i wouldnt recommend to everyone. it was a long 3 days. casey

Ann Lucas <annmlucas@...> wrote: Thank you for your response! I

guess it really bothers me when my doctor keeps saying I'm not the " classic "

presentation like maybe this isn't really pa, something else. If its something

else, I want to them to figure it out but I mainly want the pain to go away! And

I wonder if it will always be this way. That is so depressing to think that I

will have to live like this.

Best wishes to you,

Ann

[Guest guest]

Ok....so here's my question. If there is a test (ie the bone scan) that

will show the signs of damage more easily than an MRI then why don't

more doctors order this test? Is there a reason they are hesitant to

order this test? Just wondering if anyone has any thoughts on this.-Betz

[Editor's Note: Betz, much of the early PA damage is to the muscles and tendons

around joints rather than to the bones themselves. Ergo, our damage will not

necessarily show up on a bone scan any more than on an MRI. Bone scans are

fabulous tools where bone damage is suspected and they are therefore great for

people with osteoporosis or advanced PA, but they are not effective for the

earlier stages of PA where the joints have not yet suffered appreciable damage.

This is one of the reasons why it is so necessary to get on medication to help

stem the progression of the disease. In the early stages, a lot of damage can

be prevented. For people like me where damage has already been done to the

joints over a period of 40+ years since being diagnosed with arthritis, it

cannot be reversed by medication. However, I take biologics to try to prevent

further bone damage. I also have osteoporosis in my right hip and take a weekly

pill for that. Bone scans and bone density tests are useful tools for osteo.

Kathy F.]

>

> IO had a doctor who was similarily relunctant to diagnose my PsA. I

> have no sed rate and x-rays look normal. I did have swelling and

nail

> pits. The test that finally diagnosed me was a bone scan. This

> helps daignose joint damage before you can see it on an x-ray. Most

of

> major joints in my body showed some sign of slight damage. You may

> want to try this if you have no swelling just to be on the safe

side.

>

>

[Guest guest]

I have had bone scans of my feet (this was because an x-ray showed bipartite

sesamoid -which is a little bone in the ball of you foot). Both feet " lit " up

in the same area even though at that time only had pain in one foot. MRI was

done after this and it showed other little things going on in my feet but not

the typical signs in feet so rheumy again said this isn't the classica area it

affects (it was mainly toes and sesamoid region). Most likely I was born with

these little bones bipartite (some people apparently are) and possibly have

arthritis in that area now. I have wondered about having MRI's of other areas

(or bone scans) but my rheumy indicated that since its so expensive it may not

really be worth it. But now I am beginning to wonder if maybe I should push for

this just to see what we can find out. Maybe it would help them be more

definite about what is going on.

Ann

<mtymry@...> wrote: IO had a doctor

who was similarily relunctant to diagnose my PsA. I

have no sed rate and x-rays look normal. I did have swelling and nail

pits. The test that finally diagnosed me was a bone scan. This

helps daignose joint damage before you can see it on an x-ray. Most of

major joints in my body showed some sign of slight damage. You may

want to try this if you have no swelling just to be on the safe side.

[Guest guest]

In a message dated 10/20/2006 4:39:43 P.M. Pacific Daylight Time,

itsbetsy@... writes:

.....so here's my question. If there is a test (ie the bone scan) that

will show the signs of damage more easily than an MRI then why don't

more doctors order this test? Is there a reason they are hesitant to

order this test? Just wondering if anyone has any thoughts on this.-Betz

Hey Betz...the rheumy who diagnosed me believed in a combination

approach...xrays for extremities, xrays + MRI for spine and bone density scan.

She also

said to make sure MRIs were done/read by the same place/doctor as they would

be better able to draw conclusions from one MRI to the next. She also said

(since I was diagnosed pretty early on) that she didn't expect to see any

damage in the first few years (and we didn't) but that the purpose was to track

subtle changes that would indicate damage.

My dad is suffering from brain cancer and his doctors have also insisted on

MRIs taken in the same facility and read by the same doctor.

Hope you are feeling better and the BP is improving:-)

[Guest guest]

My son has had a bone scan, and the doctor just ordered another MRI

and may order another bone scan afterward. It's hard to find a

pediatric facility for a bone scan, the test is more time consuming,

and it has to be more expensive than an MRI. My guess is that the

availability of testing facilities and cost are the main 2 reasons.

My son's bone scan was a 7 hour affair because of how many joints

were being scanned. An MRI is much faster.

> >

> > IO had a doctor who was similarily relunctant to diagnose my

PsA. I

> > have no sed rate and x-rays look normal. I did have swelling and

> nail

> > pits. The test that finally diagnosed me was a bone scan. This

> > helps daignose joint damage before you can see it on an x-ray.

Most

> of

> > major joints in my body showed some sign of slight damage. You

may

> > want to try this if you have no swelling just to be on the safe

> side.

> >

> >

>

[Guest guest]

Dang it Gael...I was hoping you lived closer to a

pedatric hospital so that your son would have access to the right care.

We had to wait four months for to see a pediatric gastro doc.

There seems to be a huge need for pediatric specialists in the country.

Where do you live Gael? Not even sure that you are in the US. -Betz

[Guest guest]

We're in ville, FL. We are lucky to have a pediatric

rheumatologist in Gainesville, FL (1.5-2 hrs. away). There's one

hospital in town that does pediatric nuclear medicine. My son was

seeing a local rheumatologist, but she referred him on to peds and

promptly divorced us saying she doesn't see kids. Cameron was her

only peds patient, but she's big into her staff seeing the patients

and just following up on them rather than having to come into the

room herself. Every one of our appointments she had to come in, and

she said that.

Dang it Gael...I was hoping you lived closer to a

> pedatric hospital so that your son would have access to the right

care.

> We had to wait four months for to see a pediatric gastro

doc.

> There seems to be a huge need for pediatric specialists in the

country.

> Where do you live Gael? Not even sure that you are in the US. -Betz

>

[Guest guest]

GET OUT. I lived on Amelia Island before moving up here to the

Hudson Valley region of New York state 10 years ago this Feb. My X

was the golf pro at a club at exit 1 on I95. Osprey Cove. I thought

there was a childrens hospital in J-ville. almost had tubes

put in here ears and I could have sworn it was at a children's

hospital. Am I wrong? Wonder if there's anything up the coast in

Georgia like in Savannah? I think that's anywhere between an hour

and an hour and a half from you. Is your husband Navy Nuke out of

Kingston Ga? What's in J-ville?...Naval or Air Force? I remember all

of the big ships that you could see from the beaches at southern end

of Amelia Island. I loved that area. I still have hundreds of black

fossilized sharks teeth that used to wash up on the beach there

because of the dredging the navy would do. You guys should try to

get over to the Shrimp Festival in May in Fernandina on the island.

It's full of local color. Your son might like it. You really get a

feel for the shrimping industry there. The theme is pirates of

course and they stage a big pirate fight on a shrimp boat docked

there in town. It's a site. -Betz

>

> We're in ville, FL. We are lucky to have a pediatric

> rheumatologist in Gainesville, FL (1.5-2 hrs. away). There's one

> hospital in town that does pediatric nuclear medicine. My son was

> seeing a local rheumatologist, but she referred him on to peds and

> promptly divorced us saying she doesn't see kids. Cameron was her

> only peds patient, but she's big into her staff seeing the

patients

> and just following up on them rather than having to come into the

> room herself. Every one of our appointments she had to come in,

and

> she said that.

>

[Guest guest]

Well you GET OUT, because Cameron was born in Poughkeepsie, NY!

LOL! We lived in Hyde Park while my X went to the CIA (Culinary

Inst. of America). The childrens' hospitals are Wolfsons and

Nemours. Nemours is right across from the Mc House,

and Wolfsons is across the hwy from Nemours. That's downtown, and I

think it's 95.

My husband is stationed on the Boone at Mayport, except now it's the

Boone somewhere in the Med. We live really close to NAS, which is

where he'll work if he gets the Humanitarian Transfer. It's on the

CO's desk.

That shrimp festival sounds really fun. The kids would love the

pirates. May is always busy with 2 kids' b-days, baseball/softball,

piano recital, and the end of school, so I lost touch with reality

outside my 4 walls last year. I'm going to have to look for info on

that, because we're interested in town festivals. It's a slice of

small town America.

Gael

>

> GET OUT. I lived on Amelia Island before moving up here to the

> Hudson Valley region of New York state 10 years ago this Feb. My X

> was the golf pro at a club at exit 1 on I95. Osprey Cove. I thought

> there was a childrens hospital in J-ville. almost had tubes

> put in here ears and I could have sworn it was at a children's

> hospital. Am I wrong? Wonder if there's anything up the coast in

> Georgia like in Savannah? I think that's anywhere between an hour

> and an hour and a half from you. Is your husband Navy Nuke out of

> Kingston Ga? What's in J-ville?...Naval or Air Force? I remember

all

> of the big ships that you could see from the beaches at southern

end

> of Amelia Island. I loved that area. I still have hundreds of black

> fossilized sharks teeth that used to wash up on the beach there

> because of the dredging the navy would do. You guys should try to

> get over to the Shrimp Festival in May in Fernandina on the island.

> It's full of local color. Your son might like it. You really get a

> feel for the shrimping industry there. The theme is pirates of

> course and they stage a big pirate fight on a shrimp boat docked

> there in town. It's a site. -Betz

>

[Guest guest]

In a message dated 19/10/2006 17:04:38 GMT Standard Time, annmlucas@...

writes:

I have enjoyed reading everyone's emails over the past year since I

have joined. Its good to hear that there are others out there with

similar things going on.

Hi Ann,

Its good to hear from you. I hope you managed to get the advice you were

looking for. Most of the problems you mentioned did sound like typical PA

symptoms

to me at least going by this board.

You were a runner? Me too. Maybe we can go for cyber training runs eh? lol

I hope things start to improve for you again soon.

Take care,

[Guest guest]

Hi ,

I guess because I don't have the visible swelling he thinks I'm not typical. (On

the MRI there is some moderate swelling of the soft tissues in my feet but that

is the only area of my body for which I have had an MRI.) He thinks its more

like fibromyalgia (but I don't have the " tender points " for that diagnosis) or

depression. I admit I am somewhat depressed while I am having pain (who

wouldn't be) , but I don't feel depressed during periods where I am feeling

pretty good (ie this summer - not much pain and I felt fine). And as far as I

know depression doesn't give you specific joint pain.

My GP did a cortisol last week and that came back normal so now she would like

me to go for a sleep study so that will be scheduled soon. I also wondering if

perhaps I should see an allergist because maybe the tiredness is caused by

allergies. I take Claritin and Nasonex for allergies but maybe I am having more

problems.

I will keep you posted and at least we can dream of running! One of the funnest

things I have done lately is ride my bike with my dog (chocolate lab) running

beside me. He is so fun to watch! He loves to run and will run 6 miles without

stopping! Amazing! I wish I had him when I was running regularly because he

would have really kept me motivated! Since lately, the pain has been so bad, I

took my rheumy's advice and went swimming. It felt good at the time but

unfortunately, I developed an ear infection. My GP felt like it was both

swimmer's ear and an middle ear infection so now I get to take more meds!

Thank you for your relpy,

Ann

[Guest guest]

Ann...sorry about your ears on top of everything else. Hope that clears

up soon for you. I know that can cause you to be out of commission for

a bit. -Betz

[Guest guest]

Thanks Betz,

You know I've noticed that since I have started taking the antibiotic, I feel

much better all over. So lets hope it will last!

Ann

[Guest guest]

In a message dated 09/11/2006 00:30:37 GMT Standard Time, annmlucas@...

writes:

Since lately, the pain has been so bad, I took my rheumy's advice and went

swimming. It felt good at the time but unfortunately, I developed an ear

infection. My GP felt like it was both swimmer's ear and an middle ear infection

so

now I get to take more meds!

Hi Ann,

I hope it clears up quickly.

Take care,

[Guest guest]

Hi all.

Ive been battleing what i (and doc) seem to think is low Testosterone symptoms

for a few years now.

Im 33 years old and have tested my T levels 5 times so far.

My usuall result is low normal total T and very low bioavailable T.

Estrogen (E2) is usually really low as in bottom of scale aswell.

Ive tried Testogels a few times and they always work for my sexual desire, i get

really big sexdrive within a couple of hours. Yet my energy levels never seem to

improve. I also feel my mind becomes very clouded when im on the gels. I dont

feel sharp.

This time around the doc has asked me to try halv dose (1/2 of 50mg 10%gel dose

bag)for awhile. After applying it i feel my sexdrive increasing, so far so good.

I also feel very sluggish and tired. After 8 hours or so i feel completely

exhausted. Cant focus on anything just want to sleep or maybe have sex cause the

sexdrive is really strong still.

Ive been drugfree for the last 2 years and been doing okay, but with low s-drive

and low energy. I wanted to try gels again cause i can feel something is off,

its just not right to be tired all the time. Ive been having a few good periods

during these years, last time i had one i decided to test myself again and this

is the only time i tested when feeling good. My T- level was 22 (10-30) and

bioavailable t was 13 (8-15). I cant help to think that there is no coinsidence

that my score was high when i feel good :/

Any ideas of what to try now? is halv dose really a good thing to try? (i do

feel like im overdosed even on 1/2 because of the sluggish feel) Im thinking

that the board would suggest i try an even larger dose like 75mg but is that

wise considering how much libido i get even at 25? or is that not indicative of

testosterone levels alone?

I sometimes have morning erections when drugfree. I dont when on gels so far

when ive been on them for a total of maybe a month.

Thanks for advice.

[Guest guest]

Thanks Phil.  What about the way I take the shots. If I follow your advice and

use 1/2 inch do you think that will be ok?

> From: A <danderson4christ@...>

> Subject: Need your advice

>

> Date: Thursday, December 16, 2010, 12:58 PM

> Hoping you guys can help me. I am new

> to this group but am so happy I found you guys.  I have

> been struggling with my T levels for about 6 years now. I'm

> 42 and presently my T level is 159 ng/dL and my free is 6.1

> pg/mL. My estradiol is 19.3 pg/mL. This is my baseline. I

> have used HCG and that brought my levels to 563 ng/dL and

> free to 14.4 pg/mL and estradiol up to 29.8 pg/mL. I didn't

> get up to the level that I think I need to be at to really

> enjoy the benefits you guys are experiencing.  I went

> to a doc in Atlanta who is pretty good. I told him that I

> want to do the T shots and he suggested that I continue with

> a low dose of HCG. I also told him I wanted to continue to

> utilize Arimidex to keep my estrogen down. He wants me to

> take 50mg 1x week.  Take HCG 500iu 3x week. Arimadex

> .25 2x week.  I personally think I should be taking at

> least 100mg per week.  What do you guys think?  I

> also say this protocal online and really would like to

> follow it.  Is anyone following a plan like this one:

>

> - 50mg Testosterone Enanthate/Cypionate every third day.

>

> - 0.25mg Arimidex every third day.

>

> - 500IU HCG every third day.

>

> I tend to think this would keep my levels steady and avoid

> the crash that I read that people experience. Not to

> thrilled about using a long needle every three days. I've

> read that some people use a smaller needle and even subQ the

> shot. I think Phil had mentioned that.

>

> Any advice you guys can give would be greatly

> appreciated.  I'm shooting for the 800-900 range. 

> Thanks.

>

>

>

> ------------------------------------

>

>