QUESTION: This patient is a 40yo F who PTC a little over a month ago requesting IV therapy for leukopenia, as recommended by an ND in CA. She brought labs, salient for WBC 2.7, slightly low hemoglobin and MCHC, TSH 1.7, free T3 2.2, free T4 1.11, progesterone (unsure where in cycle) 0.44, estradiol 77.8, frankly low free testosterone, and low total T (13, RR 6-82). 25OHD was 36. He started her on progesterone 100mg qhs, testosterone cream, and recommended IV therapy. She has transferred her care to me, and I ordered more labs because of symptoms of decreased exercise tolerance, extreme fatigue, heavy menses, SOB, racing heart, slow muscle recovery. Ferritin was 4, AM cortisol was low, lipids WNL. Prior to these labs, she hadn’t had any for a long time so nothing to compare to. I also did a pelvic US to rule out fibroid as cause for menorrhagia and sx of pelvic bloating. Report says possible endometrial polyp and 2 small complex cysts in both ovaries. We will repeat in 3 months. ROS otherwise normal. Has taken many courses of abx. Has 1 BM qd. Bloats easily, but denies any other GI complaints. We have been doing weekly Meyer’s, vitamin A 25,000 IU x 3 months for leukopenia, vitamin D 10,000 IU x 3 months, iron extra (vitanica): 2 capsules BID, adrenal support (vital): 2 caps qam, 1 cap with lunch, B complex 1 qam, probiotic BID. She’s still taking the progesterone 100mg qhs and applying 2mg T cream topically. Her LMP was much more “normal” – the flow was more manageable and wasn’t soaking through ultra super tampons every hour like she was prior, but she did start spotting at day 14. She has had minimal improvement in her energy so far. She’s not constipated from the iron but she says she has stomach discomfort after morning dose only. She’s getting repeat CBC, ferritin, TIBC and fecal occult blood next week. When I listened to your podcast, tons of flashing lights went off that she is likely a non-responder because of mitochondrial/cellular dysfunction secondary to being at rock bottom for so long. My question to you is – what do I do about it? I was thinking about adding CoQ10. Any insights to treatment strategies/mitochondrial support would be greatly appreciated!
ANSWER: These are tough ones. The low ferritin may be at the base of the bleeding as well as the low energy. Of course keep watching any neoplastic signs, but it is less likely with the workup you have. I’d focus on: Methyl support if tolerated (5MTHF and Methyl B12 + B-vits), doing IV Amino Acids, adding a series of IV Iron (which in these cases helps the ‘base’ solidify). I’d add Oral- CO-Q 10, ALA and EFA’s (if not already). The IV’s will help if beefed up but the IV Fe + Methyl Support may be most helpful at the ‘core’.
