Serum sodium .... 144..... ref range 137-145
potassium serum..... 4.2.... ref range 3.5-5.1
chloride ... 106...ref R 98-107
CO2... 24.. ref range 22-30
Anion Gap 14.0... ref range <18
Glucose *HIgh* 119.. ref range 70-99
BUN... 13.. ref range 7-17
creatinine... 0.57 *LOW* ref range 0.60-1.00
Bun/creatinine ratio HIGH...23... ref range 12-20
Albumin...4.7... ref range 3.5-5.0
Calcium 10.0.. ref range... 8.4-10.2
phosporus... 3.9.. ref range ... 2.5-4.5
Magnesium....1.9 ref range 1.6-2.3

Homocysteine...6.0-...ref range 3.36-20.44

Here are my thyroid results.. I have hashimoto.. can anyone please comment on this for me :) I have not taken any thyroid meds in MONTHS, at least 6 or so months. My saliva test said I had a Free T3 of a 6.00.. which is such a lab error, I know this now from the serum testing..

Free T3... 2.99 ref range 1.7-3.7
TSH 2.82 ref range... 0.50-5.00
Free T4 ... 0.69.. ref range 0.50-1.50

24 hr urine 5-HIAA ... 2.5 ref ranges < or = 6.0
total volume 2100
collection duration 24

here is the renin ( ok they were looking for renal vascular hypertension )..

Plasma Ren Activity....... I am 5.8

ref range for NON hypertensive adults..
Upright/sitting o.65-5.0

CLINICAL cutoffs for Hypertensive individuals..

low-renin sodium /volume mediated Hypetension likely < 0.65

Primary aldosteronism possible <0.65

renin medited hypertension likely >= 0.65

renal vascular hypertension possible >1.5

renal vascular hypertension is more likely >10.0

do these test results look like Addison disease in anyway, or is there other testing that is not here too complete the bigger picture..

They did not send me the Plasma Aldosterone, Free Plasam Metanephrine, or the proteinuria..I have called the hospital 4 times for these copies and they have not called me back..so this is what I have so far..going too have too call them again...

So, can I get some thought please :)

Thank you :)

TSH range

Your TSH is getting in the high end of the new range for TSH...if you were given Armour? I can see why you felt badly on it. Your FT4 is lower in the range than your FT3 which when given Armour could have caused you problems. Armour has much more T3 than T4 and if your T3 was already in good shape it would elevate it too much...you might feel much better on T4 alone. Now, remember I am just giving an opinion. :) May be way off base. Am I remembering correctly that you took Armour?

BUN:creatinine

yeah I often wondered if my thyroid med was the issue...This would answer why I never could tolerate it. see that is the prob with lab values and doctors, they do not recognize these new ranges, so one if kind of in a bind there where Endo's and prper dosing of meds go..when I go see the endo I am going too ask him about swtiching this med..thank you Jo for taking the time too look this stuff over :)

Here's something I found...

Plasma renin activity Adult, ages 20–39 (upright position, normal-sodium diet): 0.1–4.3 nanograms per milliliter per hour (ng/mL/hr)

Adult, age over 40 (upright position, normal-sodium diet) 0.1–3.0 ng/mL/hr

Adult, ages 20–39 (upright position, low-sodium diet) 2.9–24.0 ng/mL/hr

Adult, age over 40 (upright position, low-sodium diet) 2.9–10.8 ng/mL/hr

High values
A high renin value can mean kidney disease, blockage of an artery leading to a kidney, Addison's disease, cirrhosis, excessive bleeding (hemorrhage), or malignant high blood pressure is present.

Renin Assay

It looks like to me that according to this, if you were NOT on a low sodium diet your renin is high and as is says one of the reasons could be addison's.


High values
A high BUN value can mean kidney injury or disease is present. Kidney damage can be caused by diabetes or high blood pressure that directly affect the kidneys. High BUN levels can also be caused by blockage of the urinary tract (by a kidney stone or tumor) or low blood flow to the kidneys caused by dehydration or heart failure.
Many medicines may cause a high BUN. Be sure to tell your doctor about all the nonprescription and prescription medicines you take.
A high BUN value may be caused by a high-protein diet, Addison's disease, tissue damage (such as from severe burns), or from bleeding in the gastrointestinal tract.
High BUN-to-creatinine ratios occur with sudden (acute) kidney failure, which may be caused by shock or severe dehydration. A blockage in the urinary tract (such as a kidney stone) can cause a high BUN-to-creatinine ratio. A very high BUN-to-creatinine ratio may be caused by bleeding in the digestive tract or respiratory tract.

BUN/High Values


In this it says that one reason high BUN to creatinine ratios occur is because of dehydration which also is a sign of addison's.
The docs didn't test me for addisons' for a long time because like you I had normal ranges of sodium/potassium BUT I was eating salt like crazy. They were puzzled by the high sodium in my urine...well duh!!! My body wasn't retaining it! Like you my renin was high and I had BUN/creatitine out of whack too. I also have and still do have problems with my CO2 being out of range which can factor into complicated chemical reactions not happening because of acidity problems because of sodium/potasium imbalances. (A lot of research went into figuring that one out I tell ya)
Anyway you can see you have some tell tale signs of dehydration and further investigation needs to be done. Now did you have an ACTH stim test (sorry memory?) What did that say?
I agree with Jo and that your T3 is creeping up there. Most people feel better when they are a little less than you are at right now. You are right at the top of range but that doesn't always mean you FEEL ok at the top of range. IMHO.

I'll do some more looking and if I find something I'll post more...but your renin does seem high, your kidneys are working extra hard.

(grh)

Adult Normal Salt Intake
(ng/mL/h)
Upright 1.31-3.95 [/color]
Supine 0.15-2.33
Salt Excretion
(Na mEq/24 h)
Na = 0.30 8.82-23.86
Na = 30-75 4.09-7.73
Na = 75-150 1.44-2.80
Na = >150 0.39-1.31

Renin Activity/Adult Salt Intake

Normal Results Return to top

Normal values range from 1.9 to 3.7 ng/mlL/hour.

Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

What Abnormal Results Mean Return to top

Higher-than-normal levels may indicate:

Addison's disease
Cirrhosis
Essential hypertension
Hemorrhage (bleeding)
Hypokalemia
Malignant hypertension
Renin-producing renal tumors
Renovascular hypertension

Renin Tests/ Test Results

Here are some more and they are all saying the same thing.....

Hope this helps

(grh)

during the testing I was taking in sea salt about 1 1/2 tsp daily..I guess I will know what all this means when I go see the Kidney doc on the 6th.. Not too far away. hoping too get answers too this guessing game.
I know there is no blockage in my arterys from the renal duplex scan, and the kidneys look good.

My ACTH stim I did have done...Obvioulsy had this done PRIOR too HC...

My base cortisol at 7am was 10
1 hr after the cortrosyn injection it went too 27. something. So yes I had that done.

Say I do have Addison's, why do I not feel well on the HC..Actually ok.. I feel pretty good.. No more fatigue, mild muscle weakness at times, but the HEAD ISSUE..why do I have this and why would it start 3 months after taking HC? I mean HOW HIGH does one have too go on HC before the head issue clears up? I am not so sure if this sound dumb on my part, but I refuse too go any higher then 20mgs of HC, unless it is too stress dose, and at one point I did get as high as 20mgs of HC and the head issue was still there..

Now I am starting too wonder if HC is not the real cause of the head issue, but yet again like we talked about before.. GLUTEN intolerance causing me this issue..I guess the only way too know this is too crack DOWN BIG TIME ON THE GLUTEN..or hormones..

I have talked too ALOT of ppl who are on HC for either Adrenal Insuff, or Hypo PIT, and no one deals with the head issue, unless it is low aldosterone related..can you tell I am seriously obsessed with trying too figure out this head issue, so I can FIX IT.. it very debilitating at times..

I just hope Doc Sparrow will have some answers for me..Thank you Jo and Shelley :)

Missy,
If you were taking that much salt and you STILL tested high on the renin than I think you really need to be on florinef, not more HC. With that good of a stim your adrenals were functioning at the time of the test but there really is something up with the renal/aldosterone problem. I think it's VERY important to go on a gluten free diet to see if that helps. Whenever you are doing something that makes your immune system work too hard it's really hard for any system in your body to work properly at all. Make a commitment to go gluten free for 6 weeks and see what happens.
Like I said before it is even rarer than addisons to have your aldosterone malfunction but your cortisol still work so your doc may not be looking at that.... but that is a possiblility with you being on high salt and still having a high renin. If you are chronically dehydrated than it makes sense that you have the "head" issue when your hormones are in flux....it's like treading water and your nose is just above the surface...you are breathing and doing ok but if something upsets the water and you get a small wave then your nose is covered and you are in trouble. Know what I mean?
If I were you I'd go gluten free, as that won't hurt you at all, and I'd have a serious talk to the doc about getting florinef even as a trial. With your blood sugars high it would be good to go low carb too.
i hope I'm not being too pushy.... I just know that when I don't feel well it's really hard for me to make decisions and really get a good plan going, so it helps for me to have an advocate that will speak up and help me form an attack plan.

(grh)

Renin Assay

Renin Tests

Plasma Renin Activity

Renin Assay/MedlinePlus

Renin Activity/Plasma

That is a lot of salt...I seem to need a lot of salt and when I wasn't on enough florinef I was taking 5 salt tablets a day! Florinef could really make a difference to how you feel...and as Shelley said, hypoaldosteronism is unusual and your doctors may not be thinking in that direction.

The renin is a very variable tests that a lot of drs don't store much faith in, the blood needs to be centrifuged immediately and placed on ice, then with the hourly factor included the results range is very lab dependent. Simply being stressed or having rushed to the appt is enough to put it over the normal range. 5.8 is fine and normal, Joshua's lowest was 59 and his highest was 438 so to me that is great.

Your glucose levels is indicative of diabetes, if you are not already dx'd then you will need further testing, you will also need to start watching your diet and exercising to lower your glucose levels and keep them stable. Could be why you aren't feeling well.

Your thyroid is out of whack with new standards as well...I think it was Jo that made some great suggestions there.

Low creatinine is not usually a cause for concern the creatinine/BUN ratio could indicate the following that I have pasted from labsonline.
Labs Online/BUN

Increased BUN levels suggest impaired kidney function. This may be due to acute or chronic kidney disease, damage, or failure. It may also be due to a condition that results in decreased blood flow to the kidneys, such as congestive heart failure, shock, stress, recent heart attack, or severe burns, to conditions that cause obstruction of urine flow, or to dehydration.
BUN concentrations may be elevated when there is excessive protein catabolism (breakdown), significantly increased protein in the diet, or gastrointestinal bleeding (because of the proteins present in the blood).

So to me the priorities would be the glucose and the thyroid needs to be further assessed. If they are under control then the creatinine/BUN ratio may right itself anyway. JMO but hope it helps.

Also did you have a normal stim test or the low dose stim test? The low dose one picks up more borderline cases that the normal one misses.

Question......how long have you had hashimoto's....? Do you have anti thyroid antibodies? That is hashimoto's.....
I am not very swift this week...but if those results are w/ no thyroid meds on board..then....they are normal, no????

Having undiagnosed addisons makes our thyroid levels off......before diagnosis I had my thryoid meds raised a ton of times....kept going too low. Then after starting hc....I had to titer it back down again....event. ended up back on my original dose......
Is it possible that your thyroid is functioning fine for now and it was a result of undiagnosed addisons?

Did they do a serum acth level...don't see it....and also I assume this was a morning fasting blood draw? (thinking of the glucose)

Will read everyone's responses more in depth later...but.....I am wondering why some think she needs florinef w/ a salt level like that??
Diane

I really appreciate all the input from each of you but I need to make one request: Please put the link to the material not the copy and paste method. A lot of these sites are copyrighted. :)

Also, it lets the reader read the whole article and hopefully they will and they are helped that much more! :)

Missy said she'd been taking 1 1/2 tsp. of sea salt daily at this time...that would bring her salt levels up probably...and Shelley was saying with that much salt in her and still a high renin it might be that she needed florinef instead of more HC. We're not doctors but just floating aound ideas...her doctors will have the final say.

And she has not the best thyroid numbers...the TSH is high end ( new values) and her FT4 is low end and her FT3 is at a much higher place in the range. And since she was put on Armour with it's higher ratio of T3 she'd have naturally not felt well! She would probably fair better with T4 alone for now...

My ACTH before the stim test was 13.. I forget the amount of the cortrosym injection.. I know I posted it here in a thread, but darn it I cannot find my thread.. was going too take a minute too look for it today.

Ya know there were more then a handful of ppl who were telling me the SAME THING...It may be forinef I need and not HC. I'm just wondering how I approach my doc about this.

Yes I tested + for thyroid antibodies. this is how I was DX'd for Hashimoto, I was DX in 2004 with this.

and for the Insulin, no it was not a morning fast, I ate at 9am that morning, and the test was done around 1:30 pm... so it really was not fasting, but I can tell you this from past Blood Glucose draws even after i ate, were NEVER ever that high my highest was a 108..

As for exercising, believe me I want too exercise.. I don't do anything for fear of passing out with the darn head issue..

If this renin test is not really all that relied on, then someone polease tell me how one gets proper CARE...

Oh the salt... prior too using sea salt my sodium was a 135...

also one question... what exactly DOES the salt do for someone, I mean what benefit should one feel if taking this?

How do you know of your aldosterone is not good? like I said they never sent that test too me, been trying too get my copy for over a week now...

ACTH stim test

Missy the stim test can also be used to measure the response of aldosterone as well as cortisol. You need to triple your baseline cortisol draw.

The salt will replaces the loss of sodium from lack of aldosterone. Generally AD patients have low sodium ( your 135 was right at the borderline) and higher potassium, but some also have low potassium. In the days before florinef salt was all that an Addisonian had to use.

If you weren't fasting the BS isn't that reliable...now a doctor told me years ago to eat a meal with plenty of carbs and wait about an hour and a half and test and that way you caught insulin resistance early. He said by the time you had a high fasting glucose you were too late. But you are eating an insulin resistance type diet so that is good. I myself have diabetes in my family and so I became worried and I now limit my sugar...my only dessert for the day is dark chocolate which has less sugar...I watch the white foods also...I eat potatoes and white rice when eating out.

Missy what was your baseline cortisol before the ACTH test? You said you stimed to 27 is that right? That is above >20 which is the normal...but the cortisol needs to triple...

here Nancy I found it in the thread when I introd myself :)

here is the ACTH stim info..........

Ok I had a cortrosyn injection @ 9:40am of .25mgs, and my baseline cortisol level was 8.5, after 60 minutes it went too 27.8

so mine tripled what does this mean, it is good yes? Ok going too read the link ..

also my potassium was low borderline too, I belive it was a 3.5... but we talked how my magneium would help too raise this, so I wonder if the 4 cal/mag tabs I take at bed time helped too raise my potassium? which is good I think :) If the cal/mag helped too raise the pot..

also I was told I had Insulin resistance a long time ago,. and at that time the testing was done properly..

I want too run something past you ladies.. During my pregnancy I had Horrible excrucitaing back pain, sort in the middle of my back.. I was ALWYS telling them this.. Now I know back pain is normal, but after being PG 4 times, this was different back pain and it hurt BAD..also.. I had excessive thrist, I drank 5 gallons of water ever 3 days, thats alot of water.. now when I look back on that with all that water you would think I would pee alot, I hardly ever pee'd...which I still find some what odd when I think about this.... The thirst was horrible..I was tested every 3 wks for the fist 24wks of my pregnancy for diabetes, my levels always came back GREAT.. I did not have GD at all. So the thirst went unexplained, and it stopped at 25 wks, almost as aburptly as it started.... I no longer had excessive thirst. I craved salt on and off but it was not as intense during my pregnancy, as it was AFTER the baby.. Alanyway, after coming here and reading I am not wondering if it was my kidneys all along..not so much my adrenals.. does this sounds right?

I do have a couple more questions.. after the baby, before HC I have a aldosterone test here.. It was drawn @ 7am on Cycle day 5. I have been told by other ppl, that the best time too test aldosterone is before Cycle day 7, cause progesterone can raise aldosterone.. So I had this test done this way.. before cycle day 7.. anyway my aldosterone came back at a 9.....HOWEVER I was on 20mg of lisionpril at this time of testing, so how does a B/P med effect aldosterone testing?

ALSO, this ticks me off..... I just found out that my lab did not run the 4 tests that were missing, they charged me for the labs, but never ran them.. so I am waiting for a call back from my hospital too go have these labs redrawn...ALDOSTERONE happens too be one of them.. and U just so happen too be obn cycle day 4

what do you ladies know about proper testing for aldosterone?

If you had nothing to eat or drink for 4.5 hours then you do need to be tested for diabetes. if it was drawn within two hours of a sugar drink or food then the gluc is not an accurate representation. You will need a glucose challenge or tolerance test done.

i know that it is often far easier to say exercise than to do it. I am in the same boat with my back, i need to exerceise more but with pain etc I have a real problem at the moment. It wasn't meant as a criticism, sorry if it upset you as that was not my intent.

Josh continues to pass his stim testing as well and he has had two adrenal crisises, you can pass them - if 95% of the adrenals are destroyed that is when the full dose one is accurate which is why I suggested the lower dose one. It isn't recognised here in Australia so Josh never had it done.

http://www.rcpamanual.edu.au/sections/path....asp?s=33&i=367 is on aldosterone testing and what it means, it also lists the variables so make sure when the blood is drawn that any meds you are on are listed as these will affect the results.

Being pregnant was the only time my blood sugars were normal, I am a reactive hypoglycaemic so that puts me at a higher risk of diabetes so I follow the low GI diet for that reason.

The renin test is not reliable in and of itself but when combined with other testing etc then it becomes more indicative. Our endo always does a renin test on Josh, the fact that his is so high and his kidney function is ok points to the adrenals but it is not diagnositic of itself. These are done at the RCH in Melbourne. Our pedi doesn't do it as it is too variable for his liking and there can be too many errors (so we don't get them done locally)with labs and how the blood is treated. Even leaving the tourniquet on too long raises the levels so there needs to be a lot of trust with the lab taking and analysing the blood for results to be accurate.

Did you have calcium levels done? high calcium can cause thirst etc so might be worth checking....Have you had your HPA tested? With the thyroid, need for salt etc it may not be your adrenals but somewhere else on the HPA that is causing the problems. Kidneys can cause high BP, low pottassium etc and high renin so it is a possibility that if you haven't already had kidney fuction testing then it would be worth while getting it investigated.

The trouble is that so many things can cause the vague symptoms that are endocrine related but can also be related to so many other disorders that it is hard to get dx'd. you need to have a dr that believes in you that you can talk to and knows that it is real and debilitating and continues to search for answers. Sorry you are going through this.

JO, sorry about just posting the name for the copy and paste.....

No, problem, Sue! (grh)

ACE inhibitors effects on Aldosterone/RXMEd


Lisionpril is an ACE inhibitor and does affect aldosterone and potassium. I was taking a Angiotensin II inhibitor for about 5 yrs. and didn't realize it was affecting me so adversely.

Aldosterone Test

Aldosterone

Aldosterone and Renin: The Test

Read these Missy...the last one is good description of testing.


Here is one from our Library:

Angiotensin and Angiotensin II

Also read one of the links I posted earlier about testing the Renin...it discusses the Captopril test and Captopril is an ACE inhibitor...I believe this is one that looks for high blood pressure.
Renin Activity

Awwwwwwww Sue.. sometimes I hate the comnp dear.. NO i was not upset in anyway about the exercising, I was just trying too explain that I would KILL, rob, or mame too do it, but with the head issue going on I get scared that I will fall over and pass out...you did NOTHING or said NOTHING wrong dear..I'm sorry if it cam off as me being snotty..

Nancy I am going too the hosptial too have the aldosterone done in the morning, I am hoping it will be back by Tuesday which is my visit.. I took in no slat today, except for what is in the food naturally. not sure how accurate that will be, but will have it done anyway.

That is fine, I just wasn't sure, and wanted to know that I wasn't meaning to offend in case. I "thought" it was the frustration about the situation rather than what I said but wanted to make sure that I had caused no offence.

It can be hard sometimes with written words to know intent without seeing and hearing expression. Please know that I was in no way offended and just wanted to reassure you that. :)''

I do understand all the frustration, Josh's situation has been ongoing now for over 5 years (half his life) and we still don't have answers but he has great specialists who are aware and vigilant, we know steroids works wonders with him but he is untreated until we can get a dx. He now gets kidney pain and has low protein in his urine which is also being monitored but his kidney function is fine, it is unsure if the pain is caused by his adrenals or not, his heart rate can go high or low for no "known" reason so ALL gets documented and presented at appts.

If you aren't already doing it, start a journal and document meds/times, episodes of lightheadedness, activity level at time, fatigue levels etc in case there starts to be a common thread that points to something. Keep a track too of what your BPs are when the head issues occur, hydration levels, how long it lasts etc as well. It can be in point form for ease and it can be a pain in the butt to do but sometimes it is the key to a dx.

Poor Josh... I do however like the effect that they are testing before jumping too steroids, I truely in my heart hink that is wise. it sounds like Josh is in really GREAT hands Sue..I sort of wish I had waited for that *YES* DXbefore jumping into this, because honestly I feel more problems now then I did prior too the steroid.. Is it the steroid, I really have no idea, I just know I seem too be popping up with issues I never had before.. but right now I take the good with the bad and try too get through. That is really all I can do..Yeah i get down at times, but I am thinkning it is normal.. or hope it is *lol*...

As for Calcium, yes this has been checked.. my calcium is a 10.0 which is good...

My Blood pressure has ZERO bearing on my head issue. In fact I have beem taking my B/P per doctors orders. I am too take an am reading, and and a pm reading.. My B/P have been good.. Morning reads are 111-124/76/86... My PM readings are great as well 127-133/76-88..my pulse can get a little high at times like in the low 90's..but other wise it is good. when my head issue acts up.. there are three things I notice B/P is not one of them I take it during the times my head acts up, and it is normal..

the head issues acts up REALLY bad when my period starts, and it also flares up when I take my doses of HC..also I notice when i do take my B/P as the cuff tightens on my arm this too makes my head issue worse..when this happens I think blood flow issue.. but again I have no idea...

There really seems too be a complex of problem and things that set it off.. this is why I cannot pinpoint it..I think the journal is a great place for me too start, and I am going too start this today...I always knew I should do this, but I never seem too be up too it..but now I think it is time too put me first for a while too see if I can figure it out, I al always so busy taking care of my family, that I forget too take care of me...

Missy, there are times with Josh that it frustrates me, esp when he is having a bad run with nausea and is just so vague but I do trust his dr's implicitely, there are very informative and do not write off vague symptoms but add them to the list. Our family dr wanted a second opinion with another reputable pedi in our area and I decided to do it simply for a fresh set of eyes, I have already sent off a synopsis of Joshua's history to him and stated that we are happy with our current pedi but would welcome a second opinion in case he can see something that is being missed by familiarity. I don't think anything has been missed but this is my son and I won't take chances. I would n ot have asked for another referral as I am happy with his drs but when it was offered I thought there is nothing to lose.

you do get to the stage that it gets easier to live with and just have bad days where it gets to you but life needs to be lived despite it all. Recently our pedi had a med student with him and when they heard how low Josh's bp used to be for so long they asked if he was capable of walking or even talking with it so low. They were horrified that I said I was sending him to school at the time. I explained that it was that low for three years with no relief, and yes it affected him in many ways but he had to have some sort of normal life and missing three years of school was not an option so I would only keep him home on the days that he was bad enough that he was vomiting or dizzy when moving. The med student still didn't look impressed but our pedi smiled. Informed them I was a nurse and that I did know my son extremely well, knew when to push and when to ring, explained all the alerts on his hosptial file etc, his endo's working dx and that Josh is highly unusual for a child as he seems to be following an adult path rather than the typical childhood path, showed him the types of documentation I provide for each appt etc to monitor changes both good, bad and unusual. The fact that the fish oil had improved his BP which was interesting as it is now normal since he has been on it etc.

It is the most important thing with chronic problems to have this sort of relationships with dr's, to know that you can say there is vague symptoms and to be heard, even if they can't tell you what to do to change it, if you know that have listened and will look at the whole picture, be open to other possible causes and to keep looking and monitoring is sooo important. If I didn't have his specialists that he has, I doubt that I could ever have coped with it all. We lost our lovely GP that we had and since then we have had 4 different ones as they keep changing at the practice and they are totally clueless, it has really brought home to me again how lucky we are that we have wonderful consistency and such amazing, professionals in his specialist care. they are aware of the GP situation and will now see him for more mundane things if I am concerned so I have peace of mind.

All I can say is that if you are not 100% happy with your dr's, shop around, find the one that is the best fit for you and your situation, that will take the time not just to listen but to explain the where's, how's and why's of any advice or recommendations that they give. You don't have to always agree with them :P but if you can understand where they are coming from then you have more trust and that is soooo important.

In so many ways Josh is good now, he still isn't who he is capable of being but he is much better than he was for so long and for that we are grateful. There are plenty that are worse of than he is and he is basically a happy go lucky kid that takes most things in his stride, he has learnt to pace himself, learnt the difference to 'normal sick" to proper sick etc and knows when he can push through and when he can't. He doesn't give in to peer pressure if he doesn't feel up to something so he has learnt some very good skills at an early age that should help him throughout his life so there is always bonuses. Sometimes you just need to look a little harder to find them. Many of the people here have helped me through some pretty tough times, they are supportive informative and wonderful, caring individuals who will share their experiences, not all suggestions will be relevant for you as we are all different but the breath of experience you gain from their advice is invaluable.