Welcome to Ellis Toussier-Ades Bigio-Antebi's Anemia, Hemoglobin, Hematocrit, EPO, and Senile Dementia (senility) If lower red blood cell count with age CAUSES SOME FORMS of senility, Can some forms of senility be prevented with EPO? March 25, 2006 Dear Ellis, "I want to express my feeling of deepest gratitude to you for teaching me about the significance of EPO. I learned about EPO first from you. Initially I did not pay much attention to it. What happened to me about two years ago when I was 88, was sudden mysterious anemia (hematocrit 35-38%). My doctor did not worry about my anemia... He said it is mild and stable, there is nothing to worry about... but I felt terribly weak... I felt like I was dying. Reading what you have written about EPO on Rejuvenation, I asked another doctor to write a prescription for EPO. The results are beyond description. A Miracle! Now I feel stronger... much stronger than I was 10 or more years ago. Now I think better than before, and I publish better books and papers than before. I wish to express again my deepest feelings of gratitude towards you. I feel you saved my life and restored my high working and creative capacity. With kindest regards, Sebastian Shaumyan Professor of Linguistics, Yale University March 25, 2006 Dear Ellis, I LUV YA MAN !!!!! This stuff is starting to "kick in".... After years of anemia, I can finally breathe!!! I can't wait to inject the next two boxes and bring my hematocit up into the upper 40's.... I was sooo anemic before... remember, my hematocrit has been as low as 38%... Thank You so much for what you're doing for me... when no one else cared... (name withheld by request) ====================== Ellis, I know just how he feels. You are a lifesaver. Without EPO supplementation my hematocrit gets a s low as 35. You can imagine how I feel. (name withheld by request) ====================== Introduction: The human body can survive three weeks without food, three days without drinking, but only three minutes without oxygen. Sufficient oxygen to each cell in the body is the basis of life itself. Water, nutrients, and oxygen are transported into the mitochondria and burned there to produce energy. If not enough oxygen is available when nutrients are burned, the burn is incomplete. Less energy is produced, and "garbage" remains inside the cell. Eventually this might result in cell death or impairment, perhaps cancer. The amount of oxygen in our blood is directly proportional to the number of red blood cells. Red blood cells carry hemoglobin, which carries oxygen. Iron is also necessary, as the agent that carries oxygen. All body organs, including heart and lungs, the brain and the nervous system, the digestive system, the skin, as well as all muscles and fibers need to receive sufficient oxygen to fullfill their tasks in the body in the best possible way, to keep us healthy and fit. Without sufficient oxygen, the neurons in our brain and nervous system wither and die. When a neuron dies, the muscle fiber served by that neuron also atrophies and withers away, and the space is then occupied by fat. This loss of muscle and subsequent replacement by fat is called "sarcopenia." The single most important measure of oxygen in our blood is called "hematocrit" . Hematocrit is the volume of red blood cells as a percentage of total blood volume. Like a fireplace, our body needs sufficient oxygen to burn food and produce energy efficiently. A lack of oxygen can cause a lack of concentration, exhaustion, migraine headaches, problems with digestion, poor muscle tone, a weak immune system, accelerated aging, and chronic degenerative diseases such as cancer. Anemia is defined as insufficient red blood cells. According to the criteria of the World Health Organization, anemia is the bottom 5% of the normal curve. (In my criteria, "anemia" is anywhere below average HCT, ie, below 45% Hematocrit (HCT) or 15% hemoglobin in men and/or women, because given the importance of red blood cells, you should want to have at least an "average" Red Blood Cell count.) The problem is that hematocrit drops noticeably after age 50. As can be seen in the charts below, the average hematocrit at age 87 would have been defined as anemia at age 50!!! Roughly, this is a drop of .25% per year from age 50 to 60; .50% from age 60 to 75; and about 1% from age 75 to 90. Most doctors don't worry about what is "normal," so in the case of senior citizens they lower their expectations and they are not concerned with a hematocrit of 13%! I can hear them telling my father before he became senile: "Go home, old man... your blood tests are all "normal" for your age!" But I am concerned about a hematocrit of 13% because I THINK it leads to senility, sarcopenia, and/or other degenerative diseases such as cancer and heart disease. Source: The Reykjavik Study by O.J. Bjornsson, et. al Normal Distribution, Hematocrit, range on 2134 healthy men age 34 - 61. Hematocrit % ... Age >>> 34 37 40-44 46-49 50-54 56-58 61 Mean 45.26 44.97 45.26 45.14 45.14 45.75 44.84 Variance 6.37 7.92 6.24 7.38 7.52 6.88 9.13 Stan. Dev. 2.52 2.81 2.49 2.71 2.74 2.62 3.02 5th Percentile 41.61 40.33 41.11 41.01 40.29 40.09 39.58 50th Percentile 45.00 44.83 45.22 45.03 45.13 44.66 44.87 95th Percentile 49.08 49.34 49.43 49.72 49.37 49.03 49.27 (N) No. Measurements 139 146 472 606 482 206 83 Normal Distribution, Hemoglobin, range on 1069 healthy men age 34 - 61. Hemoglobin % ... Age >>> 34 37 40-44 46-49 50-54 56-58 61 Mean 15.24 15.08 15.27 15.15 15.17 15.07 15.43 Variance 0.85 0.94 0.96 0.99 1.46 1.34 1.10 Stan. Dev. 0.92 0.97 0.98 0.99 1.21 1.15 1.05 5th Percentile 13.51 13.40 13.60 13.50 13.01 13.17 13.75 50th Percentile 15.30 15.13 15.39 15.19 15.23 15.18 15.40 95th Percentile 16.70 16.74 16.91 16.78 16.91 16.72 16.85 (N) No. Measurements 70 74 220 299 256 106 44 Source: Herman Nilson-Ehle, Rudolf Jagenburg et. al Hemoglobin declines, 1815 healthy men, age 70 to 88. Hemoglobin % ... Age >>> 70 75 79 81 82 83 85 88 Mean 14.9 14.4 14.4 14.1 14.1 13.9 14.0 13.8 5th Percentile 12.0 11.5 11.5 11.5 11.5 11.4 10.6 10.5 95th Percentile 17.3 16.8 17.4 16.3 15.9 15.6 15.6 15.2 (N) No. Measurements 448 331 269 145 125 106 291 100 Discussion: First, notice that hemoglobin is almost exactly one third of hematocrit. Hemoglobin can be less than one third of hematocrit, but it is normally nearly one third of hematocrit. Hematocrit is defined as the percentage of red blood cells in total blood volume. Since hemoglobin is almost exactly one third of hematocrit, you can multiply hemoglobin by 3 and get a very good approximation of hematocrit, or you can divide hematocrit by 3 and get a very good approximation of hemoglobin. Notice too, how even the levels of hematocrit and hemoglobin are from age 34 to 50. They remain almost constant until age 60. (This is true, in fact, from age 15 to 60.) But within the normal distribution, different individuals have much more, or much less, hematocrit and hemoglobin than others their age. Thus, the top 5% has hematocrit of more than 49% and the bottom 5% has hematocrit of less than 40%. This means roughly 25% or more oxygen carrying red blood cells for the top 5% group than for the bottom 5% group. It is not enough to kill you, but it is enough to make a big difference in athletic performance, probably in intellectual performance, and resistance to diseases. After age 60 hematocrit and hemoglobin drop, but not enough to notice from day to day, or even from year to year. From age 60 to 70 it "only" drops about 1/4 of 1 percent (.0025) per year... but from age 70 to 88 the yearly drop is twice as high, about 1/2 percent (.0050) per year.... I am sure that beyond age 88 it drops even more and faster. One fourth of one percent, or one half of one percent might seem to be very little, but it is cumulative. So the sum of the drop in red blood cells is actually very significant after 30 years! It is not enough to notice from day to day, or year to year, but it is definitely enough to notice from decade to decade! This is further complicated because the volume of blood also decreases with age. It is even further complicated because with advancing age the incidence of diabetes or pre-diabetes also increases greatly, and with it the average level of glucose in the blood increases greatly also. Glucose normally adheres to about 5.5% of hemoglobin in non-diabetic adults, but this increases about 50% or more in pre-diabetic or diabetic adults, to 7%, or 9%, or even higher. (This is revealed through a blood test for "Hb-A1c" where "A1c" is a sub-type of hemoglobin that has glucose attached to it.) Hemoglobin that has been attached to glucose loses much of its ability to deposit oxygen. It is not hemoglobin anymore... It is "ex-hemoglobin" for our discussion. So now we have: less blood volume, less hemoglobin in that blood volume, and less hemoglobin that can effectively deposit oxygen. This creates a condition of hypoxia (very low oxygen, or oxygen starvation) in the brain of senior citizens which might also be complicated by arthritis and hardening of the arteries, which itself might have been caused or complicated by a lack of sufficient oxygen in the blood. What exactly am I saying you "notice" from decade to decade after age 60?? Loss of memory! Loss of cognitive functions! Senile dementia! Everything that is associated with ANEMIA at a younger age will happen to senior citizens as a "normal" process! A brilliant man at age 60 is probably forgetful or completely senile at age 88. This does not happen to everybody, and the top 5% of men age 88 still are acceptably lucid, although probably less than they themselves were at age 60. Anemia is defined as below the lower 5% of the normal range of hematocrit. The World Health Organization defines it as equal to or below hemoglobin 130 per liter (13%). which would be hematocrit of about 39% and below. Now see the tables above and see why I am alarmed: At age 88 the mean (average) hemoglobin 13.80 has descended to nearly the 13.75 of the bottom 5% defined as anemia from age 15 to 60! In senior citizens this is accepted as "normal" ?!!! It is only conjecture on my part that hematocrit is perhaps the principle cause of senile dementia, but it is such a logical assumption that it is worth making a study to find out if there is a relation. At first glance, it seems like a very good guess. The brain and all body organs need oxygen to function well. The use of vaso-dilators result in more oxygen to the brain, and an increase in cognitive powers, but this is temporary. Hyperbaric Oxygen therapy results in a vast improvement in senior citizens, but this is temporary too. Other authors have suggested that a lack of oxygen to body organs might begin the process of degeneration that leads to cancer, Parkinson's, and other diseases. I am suggesting that a lack of oxygen is directly responsible for loss of memory in senior citizens, and that this can be prevented, or perhaps reversed, if we can keep the brain supplied with oxygen by sustaining a respectable level of red blood cells throughout their life. Senior citizens (age 88 and more) that have an acceptably high level of hematocrit, thus of oxygen to the brain are the exception. Only the top 5% have hematocrit well above the level defined as "anemia" at younger ages. These exceptional top 5% probably include senior citizens like Grandma Moses and Pablo Casals and George Burns, who continued to work until nearly age 100, and even more. But almost all senior citizens at age 95 are senile... and I would like to live to at least 100 and not be senile! [Women, by the way, have a significantly lower normal hematocrit range than men, although the top 50% overlaps. This could be an interesting topic for further discussion and/or research. - Ellis] From various sources, including above tables Comparison of Normal Range of Hemoglobin: Male, Female Hemoglobin % . . . Male . . . Age >>> 15 to 60 70 88 5th Percentile 13.4 12.0 10.7 Mean 15.2 14.9 13.8 95th Percentile 16.8 17.3 16.2 . . . . Hemoglobin % . . . Female . . . Age>>> 15 to 60 70 88 5th Percentile 11.7 11.4 10.8 Mean 13.7 13.9 13.5 95th Percentile 15.7 16.0 16.5 I quote briefly from two studies: 1. "Significance of low hematocrit levels in asymptomatic young adults: results of 15 years followup" by Froom P, Benbassat J, et. al. One thousand Israeli airmen aged 18-30 yr. at entry were used as subjects. Hematocrit levels were examined annually. We arbitrarily defined anemia as a hematocrit of 40% or less on two or more tests, and compared the prevalence of diagnosed disorders in subjects with and without anemia. A finding of anemia doubled the likelihood of chronic disease." 2. "Subtle brain abnormalities in children with sickle cell disease: relationship to blood hematocrit." by Steen RG, Xiong x, et. al. "We compared 50 patients with 50 healthy age-similar controls, using magnetic resonance imaging. Brain T1 was significantly lower in patients in every gray matter structure but in none of the white matter structures. Sickle Cell Disease was associated with a 23 fold increase in the risk of mild mental deficiency. Full-scale IQ of Sickle Cell Disease patients was a function of hematocrit, and when hematocrit was used to stratify patients, those with a hematocrit of less than 27% had significantly lower psychometric test scores, and significantly lower gray matter T! than those with a hematocrit of 27 or more. Both cognitive deficits and subtle T1 abnormalities were associated with a low hematocrit." So what can be done about it? At least I intend to monitor my hematocrit and hemoglobin levels to make certain that hematocrit is above 45%, preferably 47% or 48%, and at least 15% for hemoglobin. When I will notice that these two important blood components are dropping (probably after age 60, but it could be before that) then I intend to take EPO to increase my hemoglobin and hematocrit levels UP to these better levels. Erithropoyetin is a hormone produced by the kidney which stimulates the bone marrow to produce more red blood cells. It has been available since 1985 in recombinant form, ie, it is now made in laboratories through genetic engineering, and so we can inject it and put up our hematocrit and hemoglobin. In my opinion, it will prevent senility, or senile dementia. I watched my father become senile when this hormone was already available, and I wish I had known then what I think I know now, to prevent him from becoming senile. But I hope I will be able to prevent senility in myself, and I hope that doctors and others will learn and study more about this hormone and prevent it in their patients, and in themselves, too. However, the use of EPO is not without danger. Too much of it can raise hematocrit too high. This could result in an especially high concentration of RBCs (red blood cells). The danger sets in when this hematocrit level gets too high. At this point, blood could literally 'clog up' an artery leading to a vascular disaster in the form of a heart attack, stroke, cardiac failure, or a condition called pulmonary edema, which is a form of water logging of the lungs because of left ventricular failure. You can most definitely get too much of a good thing. Furthermore, some people might have an allergic reaction to EPO. Their body might create antibodies which could oppose the action of EPO, which could result in very serious complications. (I have not heard of this occurring, but I am speculating that it might occur. So... EPO has to be monitored frequently with blood tests, and should only be taken under medical supervision. On the other hand, EPO is not a dangerous hormone if used judiciously. I have found, in myself, that it takes three injections of a high dose of EPO to raise hematocrit about 1%, so it would be practically impossible to "accidentally" overdose on EPO. A person with hematocrit of 40% would have to exceed 70 injections of a high dose of EPO in about 3 months or less to be in "danger" of the side effects described above. EPO is forbidden for athletes according to the rules of the International Olympic Committee, and other sports bodies, but I think it will be shown to be a great hormone for those senior citizens who need it after their hematocrit drops (perhaps as early as age 50, but definitely worth monitoring after age 70.) EPO is relatively "expensive," but cost has come down considerably in the past year. At present cost, a treatment costs between $500 and $1000 for the first three months. To raise red blood cells about 5%, for example from 39% (anemia) to about an average level (44%) costs about $650. Red blood cells remain viable for 4 months, or more, so after the level has been reached, a maintenance dose of EPO is much less than to get to 44%. EPO costs $650 for 12 vials of 4000 iu. This is enough to raise hematocrit about 4% or 5% for 4 months, after which half as much is needed as a maintenance dose. July, 2003 Dr. Ward Dean (author of "GHB, the Natural Mood Enhancer" and "Smart Drugs and Nutrients" and "The NeuroEndocrine Theory of Aging" and "Biologica Aging Measurement" and many many other IMPORTANT books wrote: "Ellis - You are the one who alerted me to the dangers of anemia, and the benefits of ProCrit (erithropoyetin) as a potential anti-aging substance. Your ideas were recently validated in an article in Archives of Internal Medicine, Vol 163, June 23 2003 (pp. 1400-1404) titled "Anemia, Not Just an Innocent Bystander." ( http://archinte.ama-assn.org/ ) The article concluded that "The evidence leads to an undeniable conclusion: Anemia is not an innocent bystander. Mounting evidence suggest that anemia impacts the length and quality of life of patients with diverse conditions." So congratulations, Ellis, you were ahead of your time. Ward Dean, M.D. For comments about this page, please e-mail me to etoussier@hotmail.com or etoussier@yahoo.com E-Mail Me See the Table of Contents of All of my Pages I buy growth hormone and Erithropoyetin wholesale in Mexico. If you come to Mexico I will help you to get a legal prescription and you can buy EPO, Humatrope, Saizen, Serostim, and Norditropin at excellent prices. If you are not coming to Mexico, write to me and I will help you to buy these or other medicines legally in the United States. See my page, Buying EPO, Growth Hormone and Medicines in Mexico: Buying EPO, Growth Hormone and Medicines in Mexico The following posts are copied and pasted from the Rejuvenation discussion list which I moderate. I post them here (slightly edited by me, for ease of reading and continuity) in the hope that they will be read by more patients and doctors. I hope it will get their attention to other possible medical uses of EPO. The first 2 posts are an introduction to the health problem that was presented, and the interesting and important discussion that followed. 1 From: Bob/Dave Date: Wed Aug 22, 2001 8:03 pm Subject: Good days and Bad days To: Rejuvenation@yahoogroups.com Hi ,Ellis, I'm Bob/Dave.. I am a 66 year old male I have emphysema .. bronchitis... crohns, I am on udos choice.. panthothic acid.. magnesium citrate.. golden seal root, vit C, beta carotene 25000 units, Saw palmetto, B 12 injections 2xmo., rutin 7.5 mg, androgel testosterone daily... also low carb., no sugar, no salt, and low fats diet. I just had my first Hgh injection. My AAMD started me off on 1 unit every other day my IGF-1: 121 low average. He said everything else was low average... He said after 1 mo. and blood test he will adjust protocol according to results of the blood test... I walk 2 miles a day 30 minutes.. 15 minutes 3 miles on stationary bike.. I still work 50 hrs a wk some heavy lifting (self employed fresh fish market in NJ) Question... if you would be so kind about how long should it take to start feeling some results? [I expect in one week you will know you feel better... in about two weeks you will SEE results showing up in the mirror... in about one month you will be crowing to everybody that will listen (and very few will listen) that you are feeling better than you have in years... and that will continue month after month. - Ellis] Right now I have good days and some not very good days. It seems like old age is setting in, and I don't like the feeling. [I wonder what you mean by you have good days and some not very good days. In any case... please tell me your "hemoglobin" and "hematocrit" level, which is probably on a past blood test. If these are also "low average" then the problem is here, and I will tell you what to do next... if they are high, then the problem isn't here. - Ellis] Any ideas or advice would be greatly appreciated... Thank you, Bob/Dave Reading your posts so easily understandable moved me off the aminos. Thanks also to Gordon and Whooo, and a few others challenging the others on the merits of aminos vs. injectable hgh. It seems you guys gave the better arguments with more human feeling and research data.. after all you guys are on the real hgh and the others argue their home made hgh was more effective and safer.. I hope it does work well for them.. Unfortunately I don't have the time to wait ... [We are all here to help each other. The real problem in this world is knowing WHO TO BELIEVE, and I am glad you have chosen to believe Gordon and Whooo and me, and others on Rejuvenation... I have chosen to believe Dr. Cranton and Dr. Hughes and Dr. Dean and a lot of other good doctors. There is SO MUCH STATIC from others, but through the fog I can see very clearly that this is the right path, and I hope you will see it and keep on following us. Read my whole program here. I invite you to do as much of it or adapt it to yourself as you can: Rejuvenation, My Personal Program Thanks for writing, keep on sending your input, and just keep on going. This will change your life for the better. - Ellis] 2 From: dave236@webtv.net Date: Fri Aug 24, 2001 2:06 pm Subject: Re:* * * Hemoglobin 13.5 Hematocrit 40.4 Many many thinks for your gracious reply... MY hemoglobin 13.5 hematocrit 40.4...sorry to get off subject... I complained about having good days and not so good days and you asked for the above...thank you dave/bob PS what do you think of my protocol... I'm all ears on any advice... [Hello Dave. You asked for it, so I will give you my advice... Your hematocrit is extremely low, and your hemoglobin is extremely low. It is not "low average" it is "low sick". This means you have a lot less red blood cells than average, and red blood cells carry hemoglobin, which carries OXYGEN. To give you an idea how low, you are in the bottom 5% of the population, ie, of 100 people, 4 persons have less hemoglobin than you do, you are number 5, and 95 have more hemoglobin than you do. Those 4 who have less than you are defined as "anemic". You are being told your level is "low-normal" but you are in fact "low-sick" and you have to cure this illness because it is extremely serious. I am in the top 5% or 10% of the population, with more than 16, and you have 13.5 That means that I have 20% or 25% more oxygen reaching my brain than you do. I assure you that if I was locked up in a car and they sucked out 20% of the oxygen in the car, and if I were to spend 10 years like that, it would affect my brain. So the low hematocrit or hemoglobin is affecting your brain. While you still know what is happening, you have to reverse the damage. I am not sure how much damage has already happened, if any, but it surely will happen if you don't do something about this right away. Also, I think much of the damage can be reversed, if it has occurred. This is the reason why you have days where you feel very tired, dizzy, or you forget many things, or you feel numb, and buzzing on your hands and feet. (I am guessing, because you didn't say it, but I know that this is happening.) There are several solutions to your problem... good, better, and best. Right away, start with the good one... go and get piracetam or hydergine or vinpocetin, or all three. These will dilate the blood vessels, and this will increase the oxygen to your brain, and also to other vital organs of your body. This is analogous to making the freeways wider so traffic moves faster. The second thing which you can do, even better than dilating blood vessels, is hyperbaric oxygen (HBO) therapy. This will force oxygen into your blood plasma. It is similar to a CocaCola that they force carbon dioxide to mix into the water with pressure. This has great therapeutic effects on your brain and your nervous system. For more information about this, see Ocean HBO See the videos, which you can link to from the left hand column, and the SPECT scans here: SPECT Scan of a dizzy senior citizen. HBO therapy is analogous to forcing more cars to go through the freeways. This is a very good solution, but the benefits don't last very long, and you have to continue to take HBO frequently, and it is quite expensive. You wrote that you are just starting on 1 i.u. of growth hormone per day. This is very good. It might also help to increase your hematocrit and hemoglobin... I am not sure of this, but it might. But it will also help you in other ways, so keep on going. I hope you will let us know your IGF-1 blood test results when you re-test in 30 days. But the absolute best thing you need, urgently, is EPO, ErithroPOyetin. Erithropoyetin is a hormone produced by the kidneys which stimulates the bone marrow to produce more red blood cells. EPO will increase the number of red blood cells in your blood, and it will also increase the hemoglobin, and therefore it will increase the oxygen being carried everywhere in your body. This is analogous to putting more cars in the freeway so they can deliver their cargo. This is absolutely the best treatment you need, and you need it urgently. Unfortunately, EPO is very expensive. It is much less expensive in Mexico than in the U.S. so if you decide to take it, write to me and I will help you to buy it in Mexico (I am in Mexico). I can deliver it to you anywhere in Mexico, or I can send it to you legally, with a prescription, to the U.S. I am not saying this to sell to you, I am saying it in the hope that I can help you to get better at less cost. I cannot tell you what dose you need without more information, so I cannot tell you how much it will cost for the dose you need, but a quick guess is that it will cost about $500 to $1000 in the United States, per month to start, and then less in the future, and about 40% less in Mexico. I advise that you should get your hemoglobin up at least to 15%, which is about 10% more than your present level, and if you raise it to 16%, that would be even better. I could write much more about EPO, and I will. It is exactly what you need. I don't doubt your doctor may be excellent and hasn't told you that you need it, so tell him I told you to tell him, and tell him why I said you need it, and try to get it. If he will not prescribe it, I will help you to get a prescription with other doctors subscribed to Rejuvenation. I really hope this helps you, because you need it. Three stars for this post, for Bob/Dave for telling us his hematocrit and hemoglobin levels, which is going to be very interesting to others. - Ellis] 3 From: jgarciamd@aol.com Date: Mon Aug 27, 2001 12:21 am Subject: Re: * * * Doctor comment, please: Hemoglobin 13.5 Hematocrit 40.4 EPO can help build up your H/H after any surgery. Yes, with significant portions of your bowel removed, that shortens the time nutrients can be absorbed. Older people with less stomach acid will have trouble absorbing Vitamin B-12 for example. HGH will help build the patient up in general terms, but testosterone is more effective in terms of the hematocrit than HGH. EPO is made in the bone marrow and stimulates the formation of new red blood cells, but good nutrition is also needed to make sure the blood cells are healthy. Unfortunately iron will be the most difficult to absorb. I would try ferrous gluconate first, then the EPO. EPO works whether the blood count is low or normal, that is why cycling athletes and runners use it to dope their blood before competitions, to increase their ability to carry oxygen. In the old days, the only way to do that was to train at high altitudes. There have been recent studies showing good results in stabilizing Crohn's with HGH, with or without surgery. Julio L. Garcia, MD FACS plastic surgery and antiaging medicine 3017 W. Charleston, suite 80 Las Vegas,NV,89102 888-FACES89 www.lvcosmeticsurgery.com www.agelessforever.net The above is for informational purposes only and does not constitute a second medical opinion. There has been no establishment of a doctor-patient relationship. If one would like to become an active patient please feel free to contact me. 4 From: Dr. Allyn Brizell BrizX@doctor.com Date: Tue Aug 28, 2001 Subject:* * * Doctor comment, please: Hemoglobin 13.5 Hematocrit 40.4 A hematocrit of 40 means that 40% of the volume of blood is composed of red blood cells which is about normal. Most reference ranges for Hct are between 35-47. [I refer to "The Reykjavik Study: Distribution of Haematological Serum and Urine Values in a General Population of Middle-Aged Men": "2955 males aged 34-61 years were invited for examination during a six month period...(snip) The response was 75% (2203) (snip)... The approximate 5% and 95% centiles were as follows: Hematocrit: 41% - 49% (age group 35 to 49), 40% - 49% (age group 50 - 59); Hemoglobin:13.4% - 16.9% (age group 35 to 49), 13.4%-16.8% (age group 50-59)" By this study, which is the one I used to answer, Bob/Dave's 40.4 is in the bottom 5% percentile. That is anemia, or "pre-anemia". I have put up the tables for you to see them here: http://www.rajeun.net/hb.html - Ellis] What is more important then just looking at a normal range hematocrit is the MCV, TIBC and Ferritin level. [What do "MCV" and "TIBC" stand for? - Ellis] Recombinant Erithropoyetin (r-HU-EPO) EPO is an injectable protein hormone that acts on bone marrow to stimulate red blood cell production. The recommended criteria for initiating the prescribed erithropoyetin therapy for adult patients is a hematocrit level below 35% or hemoglobin level below 10. [I understand that I am recommending that he should use EPO long before "the recommended criteria for initiating the prescribed EPO therapy for adult patients," which is horrendously low. I am hoping to avoid the damage to his brain that he will surely suffer for lack of oxygen if he waits until he reaches this extreme. - Ellis] When an athlete injects EPO (or anyone with a normal h/h), their hematocrit can rise as much as 40%. This results in an especially high concentration of RBCs (red blood cells). The danger sets in when this hematocrit level gets too high. At this point, blood could literally 'clog up' an artery leading to a vascular disaster in the form of a heart attack stroke, cardiac failure, or a condition called pulmonary edema; this is a form of water logging of the lungs because of left ventricular failure. You can most definitely get to much of a good thing. [This is analogous to getting acromegalia with growth hormone. Of course I was not suggesting he should overdose. Hematocrit rises slowly enough with EPO, and can be easily monitored so that he would not overdose. I am recommending he has to use the right amount of a good thing. You can also get too little of a good thing. - Ellis] The use of EPO in generally is for chronically ill patients for the most part. [He is chronically ill. He is not defined as chronically ill, but his condition is going to get worse and worse, unless it is stopped and reversed right now... - Ellis] When evaluating anemia the first thing that needs to be done is find the underlying cause. In most cases that is loss through the GI tract and this can be checked by a simple stool test for blood. Which if positive a colonscopy should be done unless cause is obvious. Treatment options depends on cause of anemia eg.b12 or folic acid def.,viral induced, drug induced, RBC destruction Iron deficiency anemia: 1) adequate nutrition 2) ferrous gluconate in combination with ascorbate acid (which aids in absorption of iron) but be aware that overloading the body with too much iron dramatically increases risks of cancer, heart disease, and neurological degeneration. So do not routinely takes supplements with iron. Also, the use of testosterone replacement can greatly increase RBC volume this can be used to the advantage of an anemic individual or cause "polycythemia" too much blood and necessitate the need for a therapeutic phlebotomy (donating blood) every few months. [His testosterone levels are also "low-average," meaning low. I would think he should also try testosterone replacement therapy, in conjunction with EPO. - Ellis] As for the treament of Crohn's disease with rHGH a landmark study was published in the N Engl J Med. 2000 Jun 1;342(22):1664-6 A preliminary study of growth hormone therapy for Crohn's disease. 37 adults with moderate-to-severe active Crohn's disease to four months of self-administered injections of growth hormone (loading dose, 5 mg per day subcutaneously for one week, followed by a maintenance dose of 1.5 mg per day) or placebo and eat at least 2 g of protein per kilogram of body weight per day. Patients continued to be treated by their usual physicians and to receive other medications for Crohn's disease. CONCLUSIONS: Our preliminary study suggests that growth hormone may be a beneficial treatment for patients with Crohn's disease. I use rHGH in combination with large dose Glutamine and have found improvement in patients with Inflammatory bowel disease. Healing of intestinal mucosa should reduce amounts of microscopic RBC (Red Blood Cell) loss, thus improve any iron deficiency anemia. Allyn A. Brizel M.D. Center for Clinical Age managemnent [Thank you Dr. Brizel for your post, which generally takes a much more conservative view than I did about EPO, and which is important for Bob/Dave to evaluate. I am not a doctor, and I don't like to go against what doctors say, especially not doctors who I know are good doctors... Except in this case we don't agree that his hematocrit levels of 40.4% are "about normal" because we are obviously using different criteria, ie, different reference ranges for hematocrit. We will probably agree after you see the details of the Reykjavik Study, a summary of which I quoted above, and I have put the hemoglobin and hematocrit tables from this study, and another very extensive study of hemoglobin on senior citizens age 70 to 88, on a page of their own, for everybody to study. These tables document the fact that hemoglobin drops drastically after age 60. This has been known for many years, but it has been accepted as "normal", and it has also been accepted as normal that senior citizens become senile... and we don't know why. Now, maybe, we will know one reason why. I have already sent you (and other doctors on Rejuvenation) the full Reykjavik study and other studies and my report about this by snail-mail, and I have put up a page with the tables of hematocrit and hemoglobin found in that study, and another large study of the hematocrit and hemoglobin of healthy men and women age 70 to 88. The point I want to make is that EPO is NOT BEING PRESCRIBED by doctors for something that I think IT SHOULD BE PRESCRIBED FOR, the lack of which will result in grave brain damage, as is now considered "normal" in senior citizens. Bob/Dave's case is exactly one of those cases where it should be recommended, according to me. Bob/Dave's case (low and falling hematocrit and hemoglobin) is very common after age 60, and becomes more common after that age, as does loss of memory and cognitive functions. As you will see on the tables, the AVERAGE hemoglobin after age 70 drops down to about THE BOTTOM 5% or 10% from age 15 to 60. So in order to see what will happen to senior citizens because their hematocrit and hemoglobin drop, we only have to study the bottom tail end from age 15 to 60 to see what happens to them... and that includes less cognitive functions and twice as much cronic diseases... Anemia is also associated with low intelligence, or mental retardation. I think this shows the reason, or one of the reasons, why senior citizens (me, in a very few years) will lose their cognitive functions! After age 60 hematocrit and hemoglobin drop, but not enough to notice, from day to day, or even from year to year. From age 60 to 70 it drops only about 1/4 of 1 percent (.0025) per year... but from age 70 on it accelerates to approximately 1/2 percent (.0050) per year. I am sure that beyond age 88 it drops even faster. This is still not enough to notice from day to day, or year to year, but it is enough to notice from decade to decade! This is further complicated because the volume of blood also decreases with age. It is even further complicated because with advancing age the incidence of diabetes or pre-diabetes also increases greatly, and with it the average level of glucose in the blood increases greatly also. Glucose normally adheres to about 5.5% of hemoglobin in non-diabetic adults, but this increases about 50% or more in pre-diabetic or diabetic adults, to 7%, or 9%, or even higher. (This is revealed through a blood test for "Hb-A1c" where "A1c" is a sub-type of hemoglobin that has glucose attached to it.) Hemoglobin that has been attached to glucose loses much of its ability to deposit oxygen. It is not hemoglobin anymore, it is ex-hemoglobin, for our discussion. So now we have: less blood volume, less hemoglobin in that blood volume, and less hemoglobin that can deposit oxygen. This creates a condition of hypoxia (very low or oxygen starvation) in the brain of senior citizens, which might also be complicated by arthritis and hardening of the arteries, which itself might have been caused or complicated by a lack of sufficient oxygen in the blood. I point out that Dr. Ronald Klatz did NOT mention EPO as one of the anti-aging hormones, or even as one of the hormones that falls with age, in either of his two books "Grow Young With HGH" or "10 Days to a Younger You". I would be surprised if the use of EPO to prevent brain aging has ever been discussed at any anti-aging conference. A search for "EPO" on www.google.com today showed zero posts related to the use of EPO to prevent brain damage on senior citizens, or the use of EPO to increase hemoglobin on anemic patients, or the use of EPO to increase intelligence, and rec.drugs.smart discussion group focuses on smart drugs, ie, ways to increase cognitive functions now and to prevent brain aging. I could find NO studies on Medline showing the use of EPO on senior citizens to prevent the loss of cognitive functions, to show one way or the other if I am right, or if I am wrong. So, I know that what I am saying is perhaps new, and going against the "common wisdom," but I'm sure I'm right: The cause of senility is due to lack of oxygen to the brain, and the solution to the drop in oxygen to the brain is EPO, erithropoyetin, a hormone that will increase the amount of red blood cells, and thus hemoglobin, and thus oxygen to the brain! I hope this discussion will cause some waves to suggest that the use of EPO HAS TO BE studied on senior citizens to prevent loss of memory, or senility. This is the ultimate smart drug, and for me, the ultimate and most important anti-aging hormone, although I won't need it for a while (but I am taking it already... to learn to use it... my hematocrit is UP from 48% to 50.0% and my hemoglobin is now at 16.8%.) Three (new) stars for this post, by Dr. Brizel whose comments are very valuable. This is an extremely important discussion which I think will affect ALL of us someday, if we live past the age of 60. I hope we all will live to age 100 at least, in a healthy body and with our brains still functioning. See the hemoglobin and hematocrit tables from the Reykjavik Study and another study of hemoglobin on senior citizens, and a discussion, here : (links on this page may not work yet.) http://www.rajeun.net/hb.html - Ellis] 5 On September 2, 2001 Dr. Allyn Bryzel wrote: *** Ellis, very nice rebuttal to my last post.... though your suggestion for the use of EPO for a HCT of 40 would make most Hematologist heads spin 360 degrees. Allyn A. Brizel Center for Clinical Age Management Boca Raton, Florida [Hello Dr. Brizel. I know that. I am saying ALL hematologists aren't using EPO for all the things it should be used for, and that has got to change! So they need a bit of head spinning. I think perhaps they haven't thought of what ELSE this amazing hormone can do for us. I learned about erithropoyetin from an athlete, and I immediately thought to myself, what can this do for anti-aging to reverse any of the signs of aging? I know that VO2Max drops with age, and it is one of the most difficult signs of aging to reverse. Aerobic exercises help a little... probably because they create a temporary condition of hypoxia in the blood, which then signals a healthy kidney to release some EPO... I have a page which explains a little more about VO2Max, but without a mention of EPO, which I just learned about in May of this year... : VO2Max Calculator and discussion I suspected blood levels of red blood cells and hemoglobin would go down with age, but it was very difficult to find tables to show this. After I found the tables (which I had to buy, because they don't appear on the abstracts) I couldn't find any studies at all that were related to the use of Erithropoyetin on senior citizens to prevent the loss of cognitive abilities. When I searched for anemia, I learned that it is very "normal" for senior citizens to be anemic. I also found the relation of anemia with mental retardation, and the relationship of EPO with better intelligence test scores, on very sick patients. But these kidney patients are having their blood hemoglobin levels raised to a bare minimum, about 13.5, which to me is still anemia, or pre-anemia. I am not sure why they choose to raise it to such a low level, but it might be because of the relatively high cost of EPO. But if I was a kidney patient, I would prefer to pay more and to have my brain back than to save money and stay in a state of pre-anemia. The strange thing about lack of oxygen that I have read many times is that nobody complains of lack of oxygen, even while it is ocurring, even while they are sustaining brain damage. It doesn't hurt, and it isn't noticed at all. So it is accepted as if nothing is wrong. But something is terribly wrong, and the only way to avoid brain damage in the long run is to be conscious that it will happen, before it happens, and then to decide that we will not allow it to occur in ourselves, (or a doctor in his patients.) So I decided to take EPO myself, to learn to use it. I can buy it at a pharmacy in Mexico without any problem, and without any prescription. I found brands made in Germany, Switzerland, and the United States, and surprisingly, a brand made in Mexico. I called the National Institute of Cardiology in Mexico, which is a very good hospital where they do a few heart transplants every day, and I asked to speak to the blood bank. I asked them if they know the various brands, and they said yes, they do... Is there any difference between the Mexican brand and the others? No, they are all exactly the same. They are all excellent. So... Viva Mexico! I bought the Mexican brand, and I can confirm it is excellent. I have been taking EPO in various doses to understand how it affects my hematocrit, and now I know this. My hematocrit is now 50%, and my hemoglobin is 16.8. So now I know what Einstein might have felt like, and he felt pretty good. I am going to get my hematocrit up to 52% and keep it there for a while, so I can report to you what it feels like, and what happens. So far, riding bicycle or running on the treadmill is a lot of fun... but I am not an athlete, and I don't care to win any races. I am only doing this to learn, and for good health. So, Dr. Brizel, who cares if we make a few Hematologists and Endocrinologists' and Gerontologist's heads turn? (Or even 10,000 Anti-Aging doctors?) It isn't me that should be teaching them about EPO. They should be teaching me. I hope I will make their heads turn, and then I hope they will think about what we are saying here. I don't have the slightest doubt that what I am saying is right, and I am sure we are going to make the world a better place with this discussion. And, by the way, they say that copying is the best way to flatter, and you will notice that I copied your paragraph of the possible danger of EPO onto my page, "Hematocrit, Hemoglobin, Senility, and EPO" So thanks to you and KB for pointing out that I should mention the possible side effects, which now I do. Since you say it was a nice rebuttal, I hope it means you agree with what I am saying. It will be doctors like you that will put it into practice. - Ellis] 6 From: KB Date: Tue Aug 28, 2001 8:11 pm Subject: Erythropoetin (EPO) Ellis writes [He already is anemic. He needs EPO as a last resort to avoid worse anemia, or what he already has for any longer. There is no other way. I don't think he will develop antibodies to it, but it is not a bad idea to monitor for packed cell volume, or whatever he wants to monitor for. The only bad side effect to EPO, as with other good medicines, is to abuse it... but Dave/Bob is very far away from that point, as that is to raise hematocrit above 55%, probably to 60% or more. ("hematocrit" is the percentage of total blood volume that is made up of red blood cells... the normal range from age 15 to 60 is roughly 40% to 50%, average is about 45%... Below 40% is defined as "anemia" but that is only somebody's opinion... mine is that below 45% is not good, and deserves attention...) Since hematocrit rises very slowly, if he is under any kind of supervision at all, he will never get above maybe 48%, and 50% would still be safe. Please tell us what you know about antibodies as a reaction to EPO. - Ellis] No offense Ellis, but there is a lot more to it than that. If you tell people that they urgently have to take it, you also have to tell them fairly about the risks, like antibodies, resistence, possible stroke if it works too well and so forth. You should have researched it before recommending it, and read the package insert. You have that good reputation of knowing what you are talking about. Developing antibodies can lead to worse anemia, and possibly death. Don't say, "I don't think he will develop antibodies to it" , say "These are the tests you need to watch out for antibody development." You say that "The only bad side effect to EPO, as with other good medicines, is to abuse it... " is it really that simple? What about people who are allergic to a good medicine, like penicillin? Can you define "abuse...."? Anyway, abuse is misuse, and not a side effect, which is an undesirable result of proper use. It may be that it would work very well for Dave/bob. I hope he asks his doctor and maybe gives it a try. If it does help him thats great! But he needs to be aware of the possible complications, including any particular ones that relate directly to chrohns (sp?) disease. Also we all know that doctors are not always up to date on information or willing to try new therapies that sometimes do work. But he should still tell his doc if he takes it in case the doc later gives him something that reacts with or counteracts with it. KB [KB, he has no other good alternative. I know more or less what I am saying because I am taking it myself, with caution, to see how my hematocrit reacts to it. I have read pretty extensively before taking it, including the literature put out by the pharmaceutical companies. I have surely read the package insert, and much more, I know people who have taken it and I know what was their reaction to their dose. It is not a dangerous hormone. And the importance of oxygen to the brain, especially, cannot be overemphasized. EPO is standard treatment for thousands of patients with kidney failure, but it is not standard treatment for millions of senior citizens who we know are getting senile dementia. The "common wisdom" is that we don't know the cause of senile dementia... Nobody has said it might be due to the fall in hematocrit, which translates to a fall in oxygen to the brain, so now I am saying it... Senile dementia MIGHT be caused in part by the drop in oxygen to the brain. I think it is very reasonable to suppose it might be, at least in part, due to the drop in hematocrit. Just look at the results of hyperbaric oxygen therapy on a dizzy senior citizen... I am guessing, but I would place money that says his hematocrit and hemoglobin were too low: SPECT Scan of a Dizzy Senior Citizen In any case, he was greatly benefitted by hyperbaric oxygen, as shown by the SPECT scan. Or read the report (below) about the increase in cognitive functions in kidney patients who are given EPO... in my opinion, EPO is sure to become the ultimate "smart drug." I quote this, from "Cerebral hemodynamic changes following treatment with erythropoietin" by Horina JH, Fazekas F, et.al.: "We investigated the changes in cerebral perfusion, cerebral blood flow velocity, and neuropsychologic performance in 11 patients (mean age 37) receiving EPO... (snip) The score of the Wechsler Adult Intelligence Scale digit symbol test improved significantly (p less than 0.01) after EPO treatment. None of the patients developed cerebrovascular symptoms or side effects. (snip)" You will hear many doctors say that hematocrit does not fall, it remains constant... And they are right, it remains constant from age 15 to about 60... but then it starts to fall slightly... from age 60 to 70 it falls about 1/4 of 1% per year. That is too little to notice from day to day, maybe not even from year to year. After age 70 it falls about 1/2% per year. That is still too little to notice from year to year, but you can notice it from decade to decade. Have you noticed how many senior citizens of age 90 are different than the same senior citizen were at age 80, or at age 50? They have lost their memory. I am saying that occurs partly if not wholly because of the 10 to 15% or more drop in oxygen to the brain. 10 to 15% is the average, but many senior citizens have a greater or faster than average drop. Now you want to be cautious, be cautious, take all the precautions you want to, except Bob/Dave can't wait for the results of a study to see if he is allergic to a hormone, or if he has anti-bodies. He has to decide to take it or not take it. His blood tests show without a doubt that his hemoglobin is extremely low, but not yet to the point where doctors arbitrarily decided they will call it "anemia," and it won't be prescribed to him because he is still not brain dead... EPO would not be prescribed to him until his hemoglobin drops further, which it surely will... His hemoglobin now is 13.5, and I am saying that is alreadytoo low... he needs EPO urgently now. However, as Dr. Brizel pointed out, the criteria to prescribe EPO is that his hemoglobin should be another 25% lower, ie., 10.0% or less.. By that time, I guarantee he will be nearly brain dead. Why should Bob/Dave wait until he is brain dead before he takes action to try to remain well? Or should I ask, why do doctors wait until his hematocrit is 30% lower before they decide they should take an action that they could take now? In other words, his case is still not serious enough yet, but it will probably be serious enough in 4 or 5 years from now after his hematocrit drops another 10 points, from 40% to 30%. He has to wait until he is almost brain dead before he will get a prescription, using the medical criteria that is used today. EPO is not even prescribed for anemia, when it is so obvious to me that it should be, at least for many types of anemia. It is prescribed only for kidney failure, which causes an anemia so extreme because the kidney is not functioning at all, and it is the one that should produce EPO... So I guess some doctor finally figured out that synthetic EPO could substitute for natural EPO, but they never figured out that it can be used for anemia... (I'm not saying doctors are stupid... they just can't know everything unless it is brought to their attention, and EPO has simply been out of the limelight for all these years, probably because it was first approved for kidney failure, and nobody seems to have noticed it way off to the side there somewhere, with the kidney failure patients.) It is a fact that there are several causes for anemia, and maybe some of them are not due to a lack of EPO... it could be bleeding in the intestines, etc., but they all translate to a lower hematocrit, and EPO will reverse that. So what are doctors waiting for to prescribe it? I think what is happening is nobody has ever started a discussion like we're having right now, and now that we're having this discussion some doctors are going to hear about this hormone that they don't even know how to spell EPO and maybe start prescribing it a bit more, and that is what I think is needed. (NOTE: the correct spelling for EPO in Spanish is "eritropoyetina" in Spanish, which is a Latin language with Greek roots... so it should be "erithropoyetin" in English. I see it misspelled "erythropoietin" all the time... even on this page.) Let me ask you, if EPO could be taken in pill form, and if it cost 1 penny per dose, do you think doctors would be so cautious as they are, because it is taken by injection and it costs a hundred dollars (example) per treatment? The same objections you give are also valid for melatonin and DHEA and androstenedione and pregnenolone, etc, but they are sold in health food stores in the U.S. and I haven't read that there is a national health emergency because of the antibodies to them, or even due to their misuse and overdose. So... the house is on fire, and we can't analyze the water to see if it is contaminated and will cause anybody allergies... We have reasonable reason to believe it will put out the fire, so we have to use it and put out the fire. Nobody asks chronic kidney failure patients to ponder the risks of antibodies from EPO, or of pushing hematocrit too high, but I agree it is good form to tell them, and then use it! And yes, you are right, I will be sure to mention the possible side effects to an overdose of EPO, and the possibility of antibodies, next time. Thanks for pointing it out. - Ellis] 7 From: KB Date: Sun Sep 9, 2001 7:28 pm Subject: Liability in case of EPO overdose? Ellis, are you pretty sure that if you sell this man some EPO and he strokes or dies, that you will be invulnerable to prosecution, whether from Mexican or US authorities? Better be sure before you start selling it. You mentioned before that it was worth 500 to 1000 a month, and "Hematocrit rises slowly enough with EPO, and can be easily monitored so that he would not overdose." Since Dr Brizel wrote; "When an athlete injects EPO (or anyone with a normal h/h), their hematocrit can rise as much as 40%. This results in an especially high concentration of RBCs (red blood cells). The danger sets in when this hematocrit level gets too high. At this point, blood could literally 'clog up' an artery leading to a vascular disaster in the form of a heart attack stroke, cardiac failure, or a condition called pulmonary edema; this is a form of water logging of the lungs because of left ventricular failure. You can most definitely get to much of a good thing." And I have also read posted here that the effects of EPO last 3-4 months, I would like to see your methods of monitering it "easily enough" so that people who are not doctors who are using this at home will not overdose. It really looks to me like you, Ellis, are using scare tactics and emotionally loaded language ("horrendously low", "it sounds like your lung "specialist" would have been content to let you die soon. - Ellis]") in order to encourage sales. Big sales too, this stuff is expensive. You delayed my EPO-cautionary post for 5 days while you wrote up a long, long rebuttal to every point, and have argued with just about every other warning. [I didn't delay your post. In order to answer it, I had to program an entire page (this one), with HTML code for three tables. If you don't consider hemoglobin 10% and hematocrit 30% to be "horrendously low" it is because you don't understand what you are saying, and you are forgiven, but nonetheless you are mistaken. If you remain at the point of "anemia" which is 13% hemoglobin too long you become SENILE, says me... You don't believe me? Then why do senior citizens mysteriously become senile? Why is anemia associated with mental deficiency? - Ellis] But this isn't GH, which is relatively slow-acting and low in serious side effects. This EPO could possibly kill someone after one injection. [No, don't say things you don't know to be true, unless you say you "think" it could possibly kill someone after one injection. It can't. EPO doesn't increase hematocrit so fast... He has hematocrit of 40%.. Anemia is defined by the World Health Organization as hemoglobin of 13% so that means hematocrit of about 39... I said ANEMIA... He is almost anemic by DEFINITION. But he has to have hematocrit of 30% and hemoglobin of 10% before the present protocol for EPO says that they can give him EPO to raise his red blood cells... but by then he might easily be BRAIN DEAD, for years of LACK OF OXYGEN ! That is why he can't wait! Hematocrit increases by about 1% after THREE injections of the largest dose that it is sold (4000 i.u.)... (I KNOW this is true). He would have to be way above 55% hematocrit, which is the upper end of the normal range. So I say that is slow enough so that he won't accidentally increase his hematocrit above 55%, (I didn't even recommend he should raise it to 55%.) - Ellis] What will happen to you if you sell it to them and this happens? [He should get a doctor to approve it and monitor it with him. He can buy it in the U.S. or his insurance company would give it to him for free. I would only help him to buy it in Mexico, if he wants it from here because it is a very expensive medicine and it costs much less here... fact. My advice remains the same, he needs EPO urgently, or he will become senile. Clinical senile dementia roughly doubles every 5 years after the age of 65. about .8 - 1.6% of persons 65 - 74; 7 - 8% of persons 75-84; and 18-32% over the age of 85. He is in his 60's and is already nearly anemic so he may be in the first group of .8 - 1.6% to become senile. I am advising a logical treatment for low hemoglobin: EPO. That is what it does, it increases hemoglobin! It is exactly what he needs! This is not a dangerous hormone, in spite of all that you think it is because it has only been used for patients on kidney dyalisis. That doesn't make it a dangerous hormone. Read Dr. Brizel's statement over again... He says that when an athlete takes it, it can increase hematocrit as much as 40% ... the startoff point of an athlete is not 40% hematocrit, it is closer to 50%... 50% + (40% of 50%) is 70% 70% hematocrit would kill a horse, and I certainly don't recommend 70%... not even 60%... 45% is average, 50% is still normal... He has 40%!!! Look at the tables: http://www.rajeun.net/hb.html Note: Andean natives in high-altitude regions of Peru and Bolivia have adapted to thin air with hematocrits as high as 60% [*]. (* Weihe WH, ed. Physiological Effects of High Altitude. New York: Macmillan, 1964.) Polycythemia patients present hematocrits of 75%-85%, leading to disturbances in blood flow as blood viscosity increases with rising hematocrit. - Ellis] KB PS I am sending this to a few other people simultaneously in order to be sure that it is seen by someone. (I hope that all of you will not mind, and will take an interest.) I expect that you, Ellis, will not want to post it to Rejuvenation at all. [You expect wrong. I am putting it up on a page on the internet for many others to read. I hope you sent it to Dr. Brizel and other doctors, and I hope that Dr. Brizel will comment, because he didn't write to say I am wrong. He wrote to say it was a very good rebuttal to his post. - Ellis] It seems to me that you have been unappreciative of my posts for some time, for reasons which mystify me. Maybe you can explain. It is easy to understand, however, why you would not want others to read *this* post.... however, I write it in the good spirit of not wanting others to get hurt or die by being mislead into abusing a powerful substance usually only given to patients at the transfusion level, and you spend the rest of your life in jail. KB [Thanks for your concern. If I ever sell it, it is completely legal for me to buy it and completely legal for you to receive it, with a prescription. You seem to be obsessed with the fact that it is a dangerous hormone. It is only dangerous if you get your hematocrit too high. You can't get your hematocrit too high "accidentally" so that is out of the question. You monitor hematocrit with a simple, quick, and inexpensive blood test. If a person takes it constantly, he could buy a meter to monitor it at home, and if not, any lab will do it and have the answer in half an hour. I say it is impossible to accidentally overdose, and that is the only possible danger of EPO. In any case, KB, someday you might be in the position that your hematocrit is at 40% and the only direction it will go in the future is DOWN... so at that point you can decide if it is too dangerous, or if it is more dangerous NOT to take it. If you decide to take it, let me know. - Ellis] 8 From: "rsmith" Date: Mon Sep 10, 2001 11:57 am Subject: Re: Liability in case of EPO overdose? KB, I was extremely appreciative of Ellis's research on EPO and his six month personal experience report. I plan to discuss EPO with my M.D. and if appropriate take the drug under his care. Note that Ellis required a prescription to accompany my order. I believe that Ellis acted properly in presenting this information and offering to sell us EPO at a discount. Richard [Thank you, Richard. I also told you that you can perhaps raise hematocrit with B-12 or testosterone, and that you could try vinpocetin, hydergine and piracetam, and hyperbaric oxygen. That is bad salesmanship. If you want EPO after all that, then I offered to help you. I'm not going to break any sales records like that. - Ellis] 9 On Sept. 2, 2001 Dr. Ron Rothenberg wrote: PS Ellis, you are performing an invaluable service to Medicine and to the world community who wish to avoid the programmed destruction of aging. Thanks for all your time and effort. Ron Rothenberg MD www.eHealthSpan.com I copy and paste the following which was posted on Rejuvenation. From: Richard Smith Date: Wed Mar 20, 2002 Subject: * * * Feeling Better with EPO Results Ellis, After a single 4000 Unit EPO SC injection my hematocrit jumped from 39.7 to 41.3%, RBC 4.20 to 4.40, and hemoglobin 13.6 to 14.1. . Note I had also taken 15 hyperbaric oxygen treatments during this test interval, so I can't attribute all of this gain to EPO. However, my brain fog symptom substantially cleared two days after the EPO injection. I should know more clearly if EPO is truly this effective next Monday when I check my hematocrit again. Thank you for encouraging me to take EPO. Regards, Richard [Hyperbaric oxygen wouldn't raise your hematocrit or RBC or hemoglobin... so I think it was the EPO. Excellent! Wow! I'm impressed. I am more impressed by the physical result than by the blood test result, since the blood test can be plus or minus 3% and can even be affected a few percentage points up or down by how much water you drank. But the physical result you mention is a very good sign, and shows you really did have an upward increase. I too am really glad you are taking EPO. Maybe your case will serve as an example for others feeling mental fog when they are anemic, and for doctors to that now you are feeling so much better. Keep on going and let us know how you are feeling. Every bit more helps. - Ellis] ================== Copied from Life Extension Magazine, [I copy and paste the text of the editorial by William Falloon, from the March 2002 issue of Life Extension Magazine. As you might know, I have been saying that senior citizens become senile while erithropoyetin (EPO) could reverse it in the long run, but doctors don't prescribe EPO enough, because the guideline to prescribe EPO is that hemoglobin should be... BELOW 10%... Anemia is defined as hemoglobin BELOW 12%... and normal hemoglobin is 15%... I have argued that the delay in taking EPO results in permanent brain damage and senility. Now William Falloon writes an editorial in which he blames the lack of care for anemia in all patients for "tens of thousands" of deaths. According to the reference cited in his article, 24% to 40% of hospitalized patients over age 65 are anemic. What Mr. Falloon is saying now makes what I have been saying since a year ago come into focus. If patients in a hospital are being denied EPO, senior citizens outside of a hospital are definitely being denied EPO. Anemia is a treatable condition with EPO, and I continue to insist that anemia is at least one cause, and probably the most important, of senile dementia. I hope that now that Life Extension Magazine is also saying that doctors should prescribe EPO more often, perhaps KB and others might change their minds that I will go to jail for putting up this page about EPO. - Ellis] ============ By William Falloon, LEF Magazine, Mar. 2002 ============ http://www.lef.org/magazine/mag2002/mar2002_awsi_01.html I regret having to write this editorial. The reason being that it forces me to discuss elementary medicine instead of cutting-edge science. The problem is that conventional medicine has regressed to a point where I am compelled to alert members about a life-threatening situation that is supposed to be taken care of by doctors.[1] The result of this physician neglect is that tens of thousands of people are needlessly dying because an easy-to-treat disorder is being ignored because doctors accept anemia as a normal state in elderly patients and are failing to treat it. Most people think that modern medicine properly diagnoses and treats anemia. The startling fact is that 24% to 40% of hospitalized patients over age 65 are anemic.[2] Compared to non-anemic people, these blood deficient individuals have high mortality rates from diseases such as heart failure, stroke and cancer. When the oxygen carrying capacity of the blood is impaired (i.e. anemia), people with reduced blood flow to any organ (such as those with coronary artery disease) are at a much greater risk for infirmity and death. Cancer cells thrive in a low oxygen environment and even borderline anemia predicts higher mortality. Anemia can be detected by a standard CBC blood test, yet busy doctors are often accepting anemia as being a normal state in aged people and are failing to treat it. Since drugs used to treat severe anemia (such as Procrit) are very expensive, many insurance companies are not paying for these drugs unless blood oxygen carrying capacity is far below the standard reference range. This means that those most in need of these anti-anemia drugs (such as cancer and congestive heart failure patients) are being denied access. Anemia greatly increases all-cause mortality risk. Health insurance companies are thus saving big dollars by denying Procrit to their sickest policyholders. The neglect of doctors in ignoring tests that reveal anemia, coupled with insurance company refusal to pay for anti-anemia drugs, amounts to widespread euthanasia being inflicted upon the elderly. In this editorial, you will learn about natural and pharmaceutical approaches to reversing anemia. Anemia predicts who will die from acute heart attack In a recent New England Journal of Medicine study,[2] doctors looked at heart attack victims presenting at the hospital. Anemia was a strong predictor of who was most likely to die. One of the tests used in this study was the hematocrit. The hematocrit measures the percentage of whole blood that is made up of red blood cells. Normal hematocrit ranges are between 36% to 50%. Below 36% indicates anemia. What follows are the shocking findings revealed in the New England Journal of Medicine study: Heart Attack Patients Hematocrit Percentage / Odds Of These Patients Dying Within 30 days 5.0 to 24.0% / 78% 24.1 to 27.0% /52% 27.1 to 30.0% / 40% 30.1 to 33.0% / 31% Over 33.1% / (No increased risk) The statistics presented above show that anemia sharply increases the risk that a heart attack victim will die within 30 days. The doctors also found a high prevalence of anemia among these elderly heart attack patients. Blood transfusion reduces mortality The doctors who published the New England Journal of Medicine study then evaluated the effects of a blood transfusion to reverse the anemic state in this large group of heart attack victims. A blood transfusion was associated with a significant reduction in mortality in heart attack patients with low hematocrit (below 33%). In patients with very low hematocrit (below 24%), transfusion was associated with a 64% reduction in mortality. In patients with hematocrit between 24.1 and 27.0, transfusion reduced mortality by 31%. Mortality was reduced by transfusion by 25% in those with a hematocrit between 27.1 and 30. These numbers show that the greater the severity of anemia, the more likely a heart attack patient will benefit from a blood transfusion. Mortality actually increased when transfusions were administered to non-anemic patients, possibly a result of transfusion-related complications. Despite numerous published studies showing the lethal effects of anemia in heart attack patients, only 4.7% of the elderly patients in this study received a blood transfusion. The doctors concluded that "more aggressive use of transfusion in the management of lower hematocrit levels in elderly patients with acute coronary disease may be warranted." Anemia and cancer Anemia is common in cancer patients. Conventional cancer therapies (chemotherapy, radiation, testosterone blockade, etc.) often induce anemia. Elevated levels of cytokines seen in cancer patients (such as tumor necrosis factor-alpha) also suppress red blood cell formation. When we talk to oncologists on behalf of Foundation members, we inquire about the patient's hematological condition. Since cancer cells thrive in a low oxygen environment (hypoxia), we want to make sure the cancer patient's red blood cell count, hematocrit and hemoglobin are in the upper one-third range of normal. The importance of avoiding anemia is well established in the scientific literature. A recent study was conducted to systematically review and obtain an estimate of the effect of anemia on survival in cancer patients.[3] This study found that the increased risk of mortality in cancer patients who were anemic was an astounding 65%! Despite this data, most oncologists fail to adequately treat for anemia. One reason for this is that insurance companies refuse to reimburse for expensive anti-anemia drugs unless the patient is severely anemic (often 25% below the lowest number on the standard reference range). Since anemia predisposes cancer patients to greatly increased mortality, it is in the economic interest of the insurance companies to deny reimbursement for anti-anemic drugs like Procrit [EPO - Ellis]. In fairness, it is important to note that the cost of Procrit is so prohibitively expensive, that if everyone in need were allowed to have these kinds of drugs, many health insurance companies could go bankrupt. So part of this problem gets back to the outrageously high cost of prescription drugs that only exists because of today's FDA-protected monopoly.[4] It should be noted that the sickest cancer patients are often the most anemic, which makes our case even stronger that anti-anemic drug therapy should be used more often. We do not usually recommend blood transfusions for cancer patients because of potential immune- suppressing effects. Cancer patients need to maintain healthy immune function. Anemia predicts mortality Anemia is a strong predictor of early death in the elderly. In a recent study, anemic individuals aged 70 to 79 were 28% more likely to die over a five year time period.[5] Anemic people aged 80 to 89 were 34% more likely to die, while those aged 90 to 99 were 48% more likely to die over a five year period. Cerebrovascular disease (stroke) was the most common disease associated with anemia. If you are over age 65, it is a life or death matter to correct an anemia state. Don't let doctors bleed you to death Two centuries ago, doctors treated sick people by draining their blood (bloodletting). Based on what we now know, those who could afford the bloodletting procedure died much sooner than those who avoided doctors. Medicine has not changed much over the past 200 years. Here we are in the year 2002 and most doctors still do not take anemia seriously. It is shocking to have a member send us their blood results, complain of the symptoms of anemia, and then hear that their doctor said not to worry about their low hematocrit, red blood count, etc. Conventional doctors often tell their elderly patients that anemia is "normal." While it is true that anemia is epidemic in the elderly, this is not an excuse to leave it untreated. I strongly urge all Foundation members to have an annual CBC/ Chemistry blood test that can detect anemia and a host of other correctable life-threatening abnormalities. Those who have health insurance can sometimes have this test done for free at their own doctor's office. Members can order this test directly by calling 1-800-208-3444. The cost at this time is only $26.00. If the blood test reveals that you are anemic, follow the recommendation in the side bar entitled "How To Correct Anemia." Americans are routinely dying from a deficiency of oxygenated blood, yet doctors are failing to recommend supplements, prescribe transfusions and anti-anemia drugs to elderly people most in need. To avoid becoming a victim of this appalling neglect by the medical establishment, have your blood tested annually and if necessary, aggressively pursue the anti-anemia strategies that have been outlined in this article. ======== It is often the aging process itself, however, that causes people to become anemic. Aged men are usually deficient in testosterone and testosterone deficiency can induce anemia.[6] Aged women and men usually secrete low levels of melatonin, and melatonin deficiency has been linked with anemia.[7] Low levels of folic acid, vitamin B12 and other nutrients can induce anemia.[8] Excess levels of the pro- inflammatory cytokines can also induce an anemic state by attacking the blood cell forming proteins (erythropoietin).[9] Supplements that suppress these dangerous cytokines include the DHA fraction of fish oil, vitamin K, DHEA and nettle leaf extract.[10] The prescription drug pentoxifylline is also effective in suppressing the pro-inflammatory cytokines that can reduce red blood production in the body.[11] If supplements such as melatonin, folic acid, B12 and DHA fish oil fail to correct anemia, then testosterone replacement and pentoxifylline drug therapies should be considered. If anemia continues to persist, see if your doctor will prescribe the drug Procrit. [note: EPO - Ellis] The high cost of Procrit will keep most people from being able to afford it unless their health insurance will pay for it. If you are prescribed Procrit, it is especially important that most people take supplemental iron, as Procrit will cause iron to be utilized to help form new red blood cells. Some people fail on Procrit because their doctor forgets to prescribe an iron supplement. It is important to note that when treating life-threatening anemia, the only effective therapy is immediate blood transfusion, as it can take six weeks for Procrit or Epogen to reverse the anemic state. ====================== Three short articles, two by the same investigator, Dr. Donald Silverberg, dated June 1, 2000 and the second one year later, May 31, 2001. ====================== Anemia & Heart Failure June 1, 2000 - Anemia is common in CHF patients and treating their anemia improves heart function and reduces hospitalizations. To test for anemia in CHF patients, Dr. Donald Silverberg and colleagues reviewed the records of 142 such patients and found that 56% were anemic (defined as hemoglobin less than 12 g%). The percentage of anemic patients increased with CHF severity, from 9% in class one CHFers to 79% in class 4 CHFers. Of the CHFers, 26 were still anemic and had severe CHF even after 6 months of maximum CHF therapy. Treatment of these patients with erythropoietin and IV iron raised their average hemoglobin level and EF, even though doses of CHF meds were unchanged except for diuretics. This treatment also reduced hospitalizations by 92%, lowered heart class, decreased doses of oral and intravenous Lasix, and slowed progression of kidney failure. "Treatment of anemia with erythropoietin and intravenous iron may be a useful addition to the attack on CHF," write the researchers. "It would seem from our findings, however, that these useful tools are grossly under used. Clearly, the role of anemia in worsening of CHF requires further controlled trials." Source: J Am Coll Cardiol 2000;35:1737-1744 ======================= Treating Anemia Helpful May 31, 2001 - Heart failure patients who are also anemic that get treatment with erythropoietin and IV iron see improved heart function, according to Israeli researchers. Dr. Donald Silverberg studied 32 patients with class 3 to class 4 CHF. The patients had hemoglobin levels between 10 and 11.5 g %. They were randomly assigned to injected erythropoietin and IV iron or to no anemia treatment. In treated patients, hemoglobin levels increased to at least 12.5 g %. During an average follow-up of 8 months, heart class improved 42%. Among untreated patients, heart class worsened by 11%. Blood level of creatinine did not change in patients being treated for anemia but increased by 29% in untreated patients - this indicates worsening kidney function in untreated patients. The number of days spent in the hospital during the trial - compared to the period before entering the study - was 79% less in treated patients and 58% higher in untreated patients. "The correction of anemia is not a substitute for effective CHF therapy, but seems to be an important, if not vital, addition to the therapy," the researchers conclude. Source: J Am Coll Cardiol 2001;37:1775-1780 ====================== CHF and Brain Function March 8, 2000 - Blood flow through the brain is significantly reduced in patients with chronic heart failure. The worse the heart class and EF, the worse the reduction in blood flow. This may explain the cognitive defects (problems with memory, problem solving, etc.) seen in CHF patients. Dr. Dimitrios Georgiadis and colleagues used ultrasound to measure arteries in the brain and their reactivity to carbon dioxide in CHF patients. For comparison, the investigators studied 50 CHF patients, 20 age-matched controls, and 20 young controls, average age 29. The authors report that "brain artery reactivity was significantly reduced in all patients compared to controls, and especially in class 4 as compared to class 2 and class 3 CHF patients." They also saw "a significant relationship between the decline in heart function and the reduction in brain reactivity." Dr. Georgiadis' group concludes that in patients with chronic heart failure, a decline in the brain's blood flow may result in cognitive impairment - reduced ability to reason and remember. In an editorial, Dr. C. Mathias said that although drugs may improve heart output, they may have adverse effects if the brain's blood flow is not corrected, or if blood flow is impaired by a decline in blood pressure. He also notes that measurement of brain blood flow before and after treatments "is likely to provide valuable information that will also be of benefit to patients." Lead study author Dr. Georgiadis said, "We are presently trying to find links between neurological and psychological findings, and brain blood flow. If these are closely related, then cerebrovascular reactivity could be useful in selecting patients for heart transplant." Source: Eur Heart J 2000;21:407-413 I copy and paste the following discussion which was posted on my forum, Rejuvenation, March, 2004. Mike: Regarding the use of EPO and a high hematocrit, there is one big caveat. DVT, or deep vein thrombosis. A hematocrit of ~54 or greater is associated with an increased incidence of DVT, or clots in the deep veins of the leg, because the blood becomes more viscous as hematocrit increases and flows more slowly. DVTs can cause severe pain, redness, and swelling at the area around/below the clot(s), but may cause no symptoms, as was the case w/the last 40 something patients I recently took care of on a heparin drip. Ellis: What is "a heparin drip" and what does it do to help somebody with a high hematocrit? Mike: Heparin is an anti-thrombolyic that the body makes. A heparin drip is a continuous IV infusion that is regulated to achieve the optimal level of anti-coagulation based on the PTT (Partial Thromboplastin Time) level, which is drawn every six hours while the optimal dose is being regulated. Heparin is used to anti-coagulate after open heart surgery, to prevent deep-vein thrombosis, after heart attacks, etc However, the real danger (and it does happen) is when a clot breaks off and floats to/lodges in the lung (or heart, or brain). It is then called a pulmonary embolus. If it's small, you may have no symptoms at all. If it's large, your anti-aging regimen often just came to a hasty halt, as in about 60% of the time. I keep my hematocrit at around 52. - Mike Ellis: That is good advice. I have never been too sure where the edge of the cliff really is, and I don't want to find out, so I try to stay in a good area which I consider is good for my health, and I don't do anything that I consider to be dangerous, or maybe dangerous... However... a hematocrit of 54% is the upper limit of that found in a normal population at sea level, so I don't think 54% is "dangerous" because if I did, I would not even approach 54%... - Ellis Mike: -- 54% is the level I've heard used in the clinical setting as absolutely safe. You're right, the vast majority of people won't have any problems at that level or slightly higher. There is no hard/fast figure that I know of. But there are other factors involved. For instance, if a person eats lots of hydrogenated fat and the intimal lining of the arteries and veins are 'rough', that person is much more likely to develop clots than someone else in this group (assuming we all eat right:). Being sedentary, wearing high heels, family history of varicose veins, multiple pregnancies, obesity, low fiber diet...all add to the risk. So 54 isn't 54... it's different things to different people. Add these risk factors to a person who already has respiratory disease or lives at high altitude and already has a high hematocrit, and the risk rises rapidly. A little wiggle room is a good thing. Clots are like meteors; thousands enter the atmosphere daily, but few hit Earth (lungs/heart/brain) before they burn up (dissolve). Unfortunately it only takes one big one. Ellis: In La Paz, Bolivia, and in the Himalayas, hematocrit in the upper 50's and even 60% are common. I have read that these are natives and their bodies are genetically different, but I don't think this is the case. Not everybody in La Paz is a "native"... and even if they are "natives" they surely also can get "deep vein thrombosis" but they don't, because they are also healthy in other ways... Mike: -- I wouldn't be so sure that they don't. If they eat right, they probably don't have as high an incidence as here in the US (land of gluttony). But many times coronary artery disease or CVA is not attributed to a clot that originated in the legs. Even pulmonary embolism, which kills almost immediately, is often misdiagnosed untill autopsy, if one is done. Patients with emphyzema get to the 70's and of course THAT is surely too high for comfort, and many of them die, especially when it is complicated with diabetes, high blood pressure, etc. Ellis: So... I think we have to look at the whole picture... You and I both keep our hematocrit at around 52% (I have tested mine several times, and it has always been between 52% and 54%, for the past 2 years...) and now, with your warning, (and your example) I will stay right where I am... I feel fine with 52 to 54% and I think the extra oxygen to all my body is good for my health... Mike: -- Just b/c your hct is elevated doesn't mean your body is getting any extra oxygen. To a certain point, that's true (say 45% versus 52%). But there is a point of diminishing returns. Once again, other factors are involved. The body extracts oxygen from the blood at the cellular level based on need. For instance, if you breath from a paper bag, as the O2 (oxygen) content of the inspired air decreases, your body will extract a greater percentage of O2 from the O2-depleted air you are inhaling (ie, O2 affinity increases). Exercise also changes the extraction equation as well as respiratory disease. The Oxyhemoglobin Dissociation Curve comes into play at the cellular/cappillary AND alveolar/cappillary interfaces, and is affected by pH (which, btw, is another consideration when eating a high protein diet which strains the buffer systems. Blood pH will be maintained at all costs, but not intracellular pH, which can become chronically acidic and decrease O2 extraction - that is, shift the oxy-hemaglobin dissociation curve). The oxyhemoglobin dissociation curve determines how readily hemoglobin acquires and releases oxygen molecules from/to its surrounding tissue. Too really get a grip on your O2 use and affinity at the cellular level, you would need to do some pulmonary function tests (VO2 max, etc) as well as exhaled gas analysis to determine your extraction rate. The point being that anything above, say, 52-54% may not be worth the added risk anyway since the body just slows down its extraction rate at some point unless you have a pathology that severely decreases your ability to oxygenate your cells (COPD, emphysema). Ellis: As long as I am not diabetic, and my blood pressure is "low" or "normal" I think I'm safe. If I will ever become a diabetic, I might drop to 49% if I can't control glucose, and I might stay at 52-54% if I can keep glucose under control. I won't increase it to upper 50's UNLESS I would want to climb EVEREST, or go to... La Paz, Bolivia! Ellis: Thanks for writing. Please tell us more about your experience with patients with high hematocrit. Three stars for this very interesting post from Mike. - Ellis ________________________________ I invite you to subscribe to Rejuvenation... Many say it is the best anti-aging forum on the internet. Rejuvenation has more than 2000 anti-aging doctors and patients subscribed. There are more than 10,000 questions referring to the use of authentic injectible growth hormone and other anti-aging therapies in the Archives of Rejuvenation, most of them with answers annotated on the post. For comments about this page, please write to: editor@rajeun.net Ellis Toussier Thanks for your visit Table of Contents | Consult with Ellis Toussier (re: Good Nutrition, Anti-Aging Therapies) | Diabetes Made Simple | The Glucose Theory of Aging | Assess Your Pancreas... | The Anti-Aging Anti-Diabetes Diet... | The Carbohydrate Thermometer | 10 Typical Glucose Tolerance Test Results | Hb-A1c to Mean Plasma Glucose Conversion Table | © 2011 Ellis Toussier, All Rights Reserved. Copyright Notices No part of this site or its content may be reproduced in any form or by electronic or mechanical means, including information storage and retrieval systems, without permission in writing from the copyright holder. PRIVACY POLICY Disclaimer: The information provided on this site is provided for illustration purposes only and does not represent a proposal or specific recommendation. As a word of caution, the information presented cannot possibly substitute for competent medical advice. My treatment of health issues is general and specific to me, and is not intended as a comprehensive discussion of all relevant issues. Your health and mine will vary to some extent, and the applicability of what you decide with your doctor will depend upon your individual circumstances. If you have a particular question about the information presented, you can send me an e-mail and I will try my best to help you.

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