On 9 October I went to New York city to meet with Dr. Eric Braverman
owing to total loss of libido for 7 straight years, plus lack of
short term memory, poor concentration or focus. After many testing
procedures namely : BEAM (brain electrical activity mapping, Millon,
Myers Briggs, GAMA, Wechsler memory scale) plus of course the
conventional physical upon my arrival at the clinic, he diagnosed me
with dysthymia and ADHD.

[If that is what Braverman told you then all that he was doing was feeding you
two fancy names for the symptoms which you clearly have. Dysthymia means "morbid
anxiety and depression accompanied by obsession" which you definitely appear to
have about your problems (although perhaps with some reason behind it). And
standard ADHD is rarely something which first appears at your age (or 7 years
earlier). So if you did not have it when you were younger, then the appearance
of its symptoms now is the result of some other cause. Thus, neither dysthmia or
ADHD can be correctly classified as a "diagnosis". --Paul]

[The fact that Attention Deficit Hyperactive Disorder (ADHD) is included in the
DSM-IV (Diagnostic and statistical Manual of psychiatric disorders) does not
mean that it is logically a diagnosis by the standard meaning of the word (the
art or act of identifying a disease from its signs and symptoms). It has been
conveniently included so that doctors can refer to a collection of symptoms and
signs by a number on patient's insurance forms since treatment is now paid for
by many voluntary plans and government agencies. Some people even want to have
such a label ("diagnosis") - one wonders if it is so that they can have some
sort of "excuse", can have their insurance pay for supposed treatment or can
collect disability/welfare. http://web4health.info/en/answers/adhd-diagn-dsm.htm
**Kitty]


It should be noted that dysthymia, ADHD and
the likes do not differ that much in their treatment, as I was told
by two local doctors. Thus it's doesn't seem that important to know
what % of each one has, at least to some extent. Of course some
accuracy is important as in every diagnosis.

[It is evem more important to understand the difference between a list of
symptoms and a diagnosis (which apparently too few doctors understand these
days). --Paul]


Below are the results
of my blood workup as taken on 10 October (I wasn't given the labs
ref. range for those) :

[You should write and demand a full transcript of the results from the Lab that
actually did the analysis, including reference ranges and units of all values
(something you have not provided here). Without this you have not received a
complete or even useful set of information. --Paul]

[In addition, I suggest that you also include a request for a copy of
results/findings for *all* other tests performed at the Braverman clinic.
**Kitty]


Hematology

WBC 6.9
RBC 5.7
HGB 16.6
HCT 48.9

[Your red blood cell count (RBC), hemoglobin and hematocrit are both on the high
side even for a man of your reasonably young age, which does not suggest that
there is any problem with growth hormones and other cellular growth factors.
These values could suggest that your iron level is too high, but without test
results for those, no conclusion and no suggestion for change can be given.
--Paul]


PLT 253

[There are about a dozen other related parameters which you were not given and
may have great relevance to your health. Look at my and Kitty's test results to
see all the additional hematology parameters listed there. --Paul]


Chemistry
NA 137
K 3.8
CI 98
CO2 23
BUN 14
Cr 0.9
Glucose 85

[Where is magnesium, calcium, phosphorus, uric acid, liver enzymes, iron,
ferritin, albumin, globulin, total protein, alk phosphatase, GGTP, LDH, SGOT,
SGPT? Again you are missing critical results that are normally included in any
decent blood chemistry test.

Both your potassium and chloride are on the low side. I suggest that you get
some potassium chloride (sold in bulk for water softening) and start taking 3
grams daily. See directions for usage at:
http://morelife.org/personal/health/his-regimen.html Since your sodium is also
not high, using a little sodium chloride or eating/drinking more salty foods
daily would also likely be beneficial. --Paul]


Endocrinology

TSH 2.880

[Although your low TSH shows that your thyroid output is likely adequate, I am
surprised that you did not get a complete thyroid panel at least including T3
and T4. --Paul]


LH 0.7
FSH 2.2

[By themselves these low values are not particularly negative, although they do
impinge on sperm output and viability if you are concerned about that. --Paul]


Prog 1.09
Estradiol 21.4
DHEA 18.8
DHEA-S 491
SBG 17.6

[These values are all good. The medium value for estradiol (which is made from
testosterone) combined with the low value for free testosterone shows that you
may be generating too much aromatase. It is possible that an aromatase inhibitor
which you should be able to get on prescription will both lower your estradiol
and raise your free testosterone. The sex hormone binding globulin is fairly low
which is good for leaving your testosterone free, but it also leaves the
estradiol free to have some opposite effects with respect to masculinity,
possiblity including libido. The DHEA values are just where they should be,
which shows that you have adequate adrenal cortex output (unless you are taking
supplemental DHEA?). --Paul]


Cortisol 16.4

[When was this value taken? The norm is for cortisol to be high in the early AM
and then about half the level by the end of the afternoon (9 AM and 4PM are
typical times). --Paul]


IGF-1 126.0
IGF-3 2.6

[The IGF-1 value is a little low, but this could reflect lack of exercise and a
too high fat percentage. I have no idea what the IGF-3 stands for. I do not know
of any IGF-3 although there is a standard test for IGFBP-3 and your value would
be quite low for that test. --Paul]


Total Testosterone: 184
Free Testosterone: 6.3
DHT: 12.3

[These are all less than 30% of what they should be at your age and are most
certainly the cause of your low libido. The only good news is that these low
values should help you keep your hair and prevent any prostate problems. Still
they make you elegible for a prescription for a testosterone patch or gel (and
an aromatase inhibitor as I mentioned above). In addition, it is possible that
the problem behind everything is insufficient output of GH. so you might also
try GH injections as well or instead which you should also be eligible for
prescription with these numbers, perhaps after some more direct GH tests.
--Paul]


Prolactin:1.8

[This is good and it means that you DHEA/prolactin ratio is super good which is
a great benefit for preventing mental deterioration. --Paul]


Nutritional

Chol: 175
trigs 73
LDL 102
HDL 59

[These are all okay. --Paul]


Other

CRP <0.3
ESR 2
Fibrinogen 283

[These are all fine. --Paul]


Homocysteine 12.06

[This is far too high and is a risk factor for both CVD and Alzheimer's so you
better get after lowering it. The best ways are to supplement B2, B6, B12,
Folate, and Betaine (trimethylglycine). For dosages see our regimen. --Paul]


Now since then, I've had two phone consults with him, and during
last one he ordered some test to be done over-- (likely to validate
the first ones), they include : DHEA, Total testosterone, Free
testosterone, SHBG, LH, FSH--I think SHBG wasn't done on 10 October,
at least i don't have anything to believe that it was in my
possession.

[I think (and assumed above) that what you listed above as SBG is actually SHBG.
If it is not, then what is SBG? --Paul]


I should be noted that the list of test above was
analysed by an American lab, and that the 6 in this very paragraph
were analysed in Canada. Out of 6 tests I so far have only received
4 :

Total Testosterone : 14.1 Ref. range (8.4-28.7 nmol/L)
Free testosterone : 6.0 '' '' (2.0-14.0 nmol/L)
LH : 2 Ref. range for men (2-9 U/L)
FSH : 2 Ref. range for men (2-12 U/L)

**The conversion factor to go from nmlo/L to ng/dl is : 0.0347, thus
14.1 divided by 0.0347 = 406 ng/dl. It appears that my Total T went
from 184 ng/dl to 406 ng/dl. Dr. Braverman said that this could be
due to stress/anxiety.

[I agree with that. Taking a long distance trip to get costly tests, is not the
best way to get values that would be the same as when you are at home under
normal circumstances. --Paul]


The following value were sent to me yesterday upon my request :

Your lab results are as follows,
On 10/10:
Albumin 5.6 (elevated)
Total protein 8.5 (elevated)
Total Bilirubin 2.7 (elevated)

On 10/11
Albumin 5.2 (normal)
Total protein 7.9 (normal)
Total Bilirubin 1.9 (elevated)
Direct bilirubin 0.3 (normal)
Indirect bili 1.6 (slight elevation)

Again, I was not given the labs reference range. As can be seen from
the dates next to the blood test results, the first results are from
10 October. On 11 October I was given the results and was told about
the above value being elevated. As a likely explanation I was told
that it could simply be accounted by the way blood was transported
to the lab, so they took more blood on 11 October, which came in at
those above listed value. I don't know what to make of those values
since I do not have the labs reference range.

[Albumin is simply the major part of total protein, and a blood protein on the
higher side is not unhealthy at all. In fact, the protein/globulin ratio being
high is an indication of good health and potential longevity. Your high side
value for bilirubin is likely because of your high RBC and hemogoblin and is
likely caused by high iron which you really need to get tested. --Paul]


Yesterday I bumped into a 52 year-old doctor whom I've known for
some time, and I brought up those liver enzymes values.

[Actually, you only had kidney values tested. You have not listed any liver
enzymes at all above. --Paul]

[For your understanding of liver function tests, try this site:
http://www.liverfoundation.org/db/articles/1077 **Kitty]


He grabbed
hold of the document which includes many pages, and went :*Can I
satisfy my curiosity ?* I said : *Sure go right ahead*. After
scrutinizing the document for minutes, he told me he was outraged to
see that 90% of the testing procedures were useless. He said that a
33 year-ol doesn't need an ECG or brain mapping (BEAM).

[I agree with that last, at least not until other things have been look into and
found to be okay. --Paul]


He said to
me :*This paper means nothing to me*. Of course it's hard on one's
pride to be told just that, after spending 6000 Cad (I told Kitty it
was 5000 Cad, but the actual amount is 6000 Cad). That same doctor
told me that he wouldn't have needed to run all of those tests to
find out that I was anxious--he said to me that it was overkill, and
that he simply doesn't trust that doctor at all. He then went on to
say that he find it abusing patient's willingness to comply with
what the doc orders. I have to be honest and say that I've improved
since I started his protocol for dysthymia and ADHD. The improvement
is not dramatic, but totally noticeable.

Now his treatment protocol includes these :

*Magnesium 470 Mg/day--morning and dinner
*Zinc 40 Mg/day-morning and dinner
*Brain energy :
DL-Phenylalanine - 300 mg, L-Tyrosine - 200 mg, Rhodiola Rosea - 75
mg, L-Methionine - 60 mg, Octacosanol - 2 mg--2 caps in the morning.

*Brain mood: Thiamine - 15mg, Niacinamide - 25mg, Folic Acid -
300mcg, Vitamin B12 - 250mcg, Pantothenic Acid - 25mg, 5-
Hydroxytryptophan - 100mg, St. John's Wort Extract - 300mg--1
caps.to be taken at dinner.

[Except for the hydroxytryptophan (which can just as well be gained from getting
less expensive tryptophan - from a vet source, or drinking more milk products or
eating turkey breast) and the St John Wort, these are all minimal amounts which
you should have been taking years ago. Our regimen includes far larger doses of
these. --Paul]

[Marc sent me a follow-up email and asked that I include the information that
this doctor who is a friend of his mother "is quite fat and 4 years ago suffered
a stroke--I mean something is wrong here, don't you think ? He says that
prevention the way Braverman or any doctor practices is totally usuless. I
question the validity of what his statement, as his approach doesn't seem to be
fruitful at all." **Kitty]


*Cernilton 120 mg/morning
*Prostate formula
B-6 - 5mg, Zinc (as Zinc Gluconate) - 15mg, Saw Palmetto Berry
Extract (Serenoa Repens) - 80mg, Pumpkin Seed oil - 500mg--2
caps/day--one at breakfast and one at dinner.

[Since you had no tests that showed any prostate problems and your low
testosterone and DHT works against such problems this therapy would seem to be
unnecessary at this time in your life. --Paul]


*Tryptophan 1000 mg at bedtime

[If Braverman really wanted to help, he would prescribe GHB for you (it is now
available as the "orphan" drug Xyrem), since it would both help you sleep
soundly and promote GH release at the same time. --Paul]


*Citrinate/Citrin & chromium :
Chromium Picolinate - 100mcg, Garcinia Cambogia Extract - 500mg--one
at each meal.
*Vitamine E 800 IU/day--breakfast & dinner

[This is bad (unless what you call Vitamin E is already mixed forms). You need
to cut the alpha-tocopherol at least in half and replace with gamma tocopherol
and mixed tocotrienols. --Paul]


*Brain calm
Inositol - 500 mg, GABA - 100 mg, Glycine - 50 mg, Passion Flower
Extract - 100 mg--4 caps/day--2 at breakfast and 2 before bed.

[These are really small dosages. You need a lot more than 500 mg of inositol and
100 mg of GABA to accomplish much. And 50 mg of glycine is virtually useless.
Again look at what I and Kitty take in our night-time potion. --Paul]


Vitamin D3--5000 IU/day--breakfast and dinner.

[This is probably the most valuable dosage so far. Although I am not sure how it
directly relates to any of your symptoms and test results. --Paul]


CLA 1000 Mg at breakfast and 1000 mg at dinner.

[This is likely for weight/fat loss purposes. --Paul]


Pro DHA :
2 Softgels Provide: Vitamin E (as d-alpha tocopherol) - 3IU, Marine
Lipid Triglycerides - 1,000mg, yielding: DHA (Docosahexaenoic Acid) -
450mg, EPA (Eicosapentaenoic Acid) - 150mg-- 1 caps at breakfast
and one at dinner.

[This is certainly good for you, but you can get the same or better by eating
salmon, sardines and mackarel 2-3 times per week. I and Kitty do both - eat the
fish *and* take the fish oil caps. --Paul]


CES TENS device : 1 hour prior to bedtime
DHEA 50 Mg/day in the morning

He also wants me on rHGH, which no doctor will ever prescribe to me
in Canada--also It should be noted that I DO NOT want to go on rHGH-
-it should also be noted that my IGF-1 is on the low side--is it
stress that's behind this low value--I don't know but I know stress
sure can wreck havoc on lots of parameters.

[If you don't want to start GH right away (as I too suggested) then start with
testosterone, as I also suggested above. The DHEA that you are supplementing
will increase your IGF-1 value similarly to GH. --Paul]


I find it's a lot of supplements to be tried at once--I mean how do
I know what does what? So what I did was I tried one at a time to
assess their individual benefit. Of course, I'd in mind to try them
all at once, but wanted to experiment with them one by one at first.

[This is wrong. Your purpose is to get better, not to attempt to do any
scientific experiments. If you want to find out which ones you don't need then
take them all to start with and then *after* you are better wean yourself from
them one at a time. However, even that must be done with knowledge because many
of them are needed together with others. --Paul]


My personal conclusion is that the protocol though not bad, is
perhaps way too expensive.

[I am sure it is, and you could certainly stop the prostate portion immediately.
--Paul]


Further, he also advised me to start on 20 Mg Paxil in the morning +
0.5 Mg Klonopin before bedtime. Paxil is not the best of all
antidepressants to for those with loos of sex drive, as in itself it
causes sexual dysfunctions ie. delayed ejaculation, erectile
dysfunctions, loss of libido.


Marc

[If you do some investigation on the cost of the tests that were performed (and
those that should have been) you should be able to calculate a reasonable charge
for testing and then add what you think is reasonable for Dr. Braverman's
consultation time. See how that compares to what you were actually charged.

Consider writing up your own assessment of your visit and follow-ups w/
Braverman and associates including what you were charged vs. the value you
actually received. You could then politely include this in a letter to Dr.
Braverman with your expressed level of disappointment (you need to determine how
great that is). Do this *after* you have requested and received *all* the
results of all testing performed at his clinic. It is possible that you will be
ignored, but if Dr Braverman wants good will of former patients, who are really
his best advertisement, then he will attempt to reach some satisfaction with
you, hopefully by refunding some of the charges. **Kitty]

[And if you do not get any satisfactory response from this effort, then send a
followup letter that you are going to make this all public on the Internet and
do so. However, do not threaten such action initially. --Paul]