Ft3 4.0 2.0-4.4 pg/ml
Rt3 10.0 9.2-24.1 ng/dL
Ft4 .80 .78-2.19 ng/dL low
TSH. .02 .465 - 4.68 uIU/ml
tot. iron 55 30-170 ug/dL
TIBC 284 265-497 ug/dL
% sat 19 20-50% low
Ferritin 51.4 (no range given)
Vitamin D 32.3 30-100
April labs: Taken 14 hours after last Armour dose
Ft3 5.1 2.0-4.4 pg/ml high
Rt3 33.1 9.2-24.1 ng/dL high
Ft4 1.53 .78-2.19 ng/dL
no TSH on this lab
tot. iron 52 30-170 ug/dL
TIBC 288 265-497 ug/dL
% sat. 18 20-50% low
Ferritin 87.0 (no range given)
Vitamin B12 1000.00 239-931 pg/mL high
Vitamin D2 <1.0 ng/mL
Vitamin D3 106 32-100 ng/mL high
Endomysial antibody Iga negative
t-transglutaminase tTg IgG 9 positive
t-Transglutimanase IgA 10 positive
Due to the high Ft3 and suppressed TSH from Feb., my doctor asked me to reduce my Armour by a 1/4 grain before we had RT3 results. He told me there was really no specific way to treat it, but I know from STTM there are. He said if my cortisol saliva test shows a problem we can treat that. I take the saliva test next week and will have results two weeks later.
Ferritin and Vitamin D increases are from supplementing: 2 TBS Black-strap molasses and 10,000 IU Vitamin D3 daily for two months. I reduced Vitamin D to 3000 five days ago.
Please advise from what you see here. I'm not sure what to do next. Should I call my Dr? My next appointment is in November.
I see no problem with your RT3. FT3 to RT3 ratio is 15.4, well within the the 10-20 reference range. With your FT3 over range, we'd expect your RT3 to be also. Don't forget also that desiccated contains RT3. I think what you're doing still stands.
Really? The jump from 10 RT3 to 33 scared me. I used a ratio calculator but thought it had to be 20 or higher. I must have read that on the STTM site.
So I may not need to do anything right now?
I decided to try the 3 and 1/2 grain dose for a week and see if my temps stay low. If they do, I will have to raise again. I tried to get a TSH from the current blood draw to see if that had changed but wasn't able to get it called in on time.
It used to be that FT3:RT3 ratio of 10-20 was "normal". Now, some sites are pushing for "over 20". If the ratio were under 10, I might be concerned. However, your FT3 is so high that RT3 will be as well. I think I'd do what you're doing...rein in the FT3 a little by cutting back on your desiccated, and you'll probably see the RT3 go down as well.
Have you talked to your doctor yet about your saliva test? I don't know enough about the ranges on them and how tightly they're interpreted. Obviously, your 11:15 and 4:00 are high, and the other two are top of range. DHEA is very high. I've never had an adrenal problem (that I knew of, anyway), so I really don't know much about it. Some bridges are best left uncrossed!
You might try starting a new thread with this adrenal information. I'm sure you'll find someone who can help you.
I'm glad to hear you're still feeling pretty well.
I think I started perimenopause too so I'm excited! This is a part of my life I have looked forward to for a long time. Hot flashes? Not yet! But when I get them in a store, as so many women seem to get them in stores, I will probably announce to the world that I'm getting my first hot flash! I have to have a sense of humor about what's to come!
Yes, I think I will start a new thread about the adrenal issues. Great idea!
Any suggestions? The numbers look good but I have not treated high cortisol from a few weeks back. Going off wheat seemed to help me more than anything. back to working out too. Thanks for any thoughts
Your labs are looking really good! Your FT3 came down a little (not to worry...it's still over range), but your FT3:RT3 ratio looks excellent...it's now 21.5. FT4 suffered a little.
The only thing I can really suggest is perhaps adding just a very little synthetic T4 to your meds to bring up your FT4 level a little. It's only at 23% of range, which isn't unusual when you're on desiccated, but there's also not much there for conversion. Of course, that could backfire and raise your RT3 again.
If you feel worse on wheat, then by all means, avoid it. Did you reintroduce it slowly and carefully? You can have a much different response to starting with a cracker a day than scarfing down a whole pizza by yourself! LOL Once off any food group for a while, you do develop a temporary intolerance to it.
Another alternative, now that your numbers look so good, would be to give it a little time and see if your symptoms continue to alleviate. It takes time to heal after being hypo, and symptom improvement often lags lab improvement.
If you are in perimenopause, you may also need progesterone, as that drops dramatically during that time and can cause all kinds of problems and symptoms. I have been using progesterone cream and it has made quite the difference and possibly what brought down my own high RT3. I am on the same dose of NDT as always and at last testing, my RT3 had come down considerably.
Thanks! I am still symptomatic of hypo. I think my hair is thinning again and I know I have slightly lower energy and focus than I did a couple months ago.
I hope HOPE these will improve again at this dose. Maybe the relief of symptoms is lagging behind the drug. I was feeling better than I have in a long time, at the higher dose.
I started eating wheat hamburger buns and s'mores while camping a couple weeks back and now I feel like I have a full blown wheat addiction. It definitely messes with my energy level and possibly with mental clarity. I'm having a tough time quitting it again. Really tough time.
Thanks, Jackie. Not sure if I'm in menopause as I had hoped. Everything is working like clockwork.
Can I buy a decent progesterone cream over the counter?
I'd like to try a small amount to see if it helps. Still too daunting to try self medicating for the high cortisol. Have to let that rest for a while.
I started working out again because I have lost so much muscular strength and endurance the past year. I need to start building muscle to lose all the fat. Feeling really down about my body right now.
Things are still like clockwork for me too...not in menopause yet, but the progesterone has gone a long way to making me feel "right". I felt noticeable improvement pretty quickly but have heard of some women that don't feel great on it until it evens out the estrogen/progesterone. I also use less than it states, but I get Progest by Emerita as it is one of the few that actually have ENOUGH progesterone in them and contains no estrogen as some brands do--it's good stuff, has a calming effect and not the horrid side effects of synthetic progesterone they would have all of us on.
I believe I had high cortisol a couple of years ago when I went off the pill and started perimenopause. My cortisol is now too low and I'm not taking anything for it myself. If you are having any symptoms of peri, progesterone is your friend. Good luck!!
My drs assistant called me to say that he wants me to reduce to 3 grains from the last lab results. To make a long story short, I told her I will not reduce to 3 grains. I was totally symptomatic at that dose! I told her I will compromise and drop another 1/4 grain and she said she will ask him if that is acceptable.
I asked her if we are trying to reach a lab number or trying to make me feel better? I also told her that several Armour patients told me my numbers are ideal for Armour.
My only hope is that with my vitamin D and iron improved, maybe a smaller Armour dose will work where it did not before. However, I am seeing a definite return of memory issues and hair loss, where both had been improving. Also lower energy and sleep disruption. She said the dr thinks stress is causing those and I am still on too much Armour. Any thoughts? I'm frustrated to tears right now. And I have had added stress the past couple weeks.
Improving your iron and vitamin D might make all the difference. Low iron/ferritin levels cause more T4 to be converted to RT3. Even though I don't see your FT3:RT3 ratio as a problem, the more T3 you get from your meds, the better you're going to feel (at a lower dose). Of course, you do have to get your vitamin/mineral levels up a bit before that benefit is going to kick in.
Stress doesn't help anything. So stop it! LOL I don't know what you can do about it in many cases as stressing about stress is more stressful than the original stress. Anything you can do to tone that down?
I have some ongoing stress that won't really go away. Normally I handle it ok, but I think it has an effect on my body regardless. I'll try dropping by a 1/4 grain but I feel like I'm in chains to the lab ranges. That scares me and THAT is added stress. I will give it a little more time though.
My temp is running at 97.8 and 97.5 for the start of my period. I was just hitting 98.2 when I was at 3 and 3/4 grains, for the first time in months and maybe in years.
A little more time and we will know if this working. Thanks for reading.
I hope you aren't sick of hearing from me! I'm upset because
my hair is obviously thinning again and my skin is getting rougher and super dry. A couple months ago my hair was growing back. I had all kinds of new growth. Now It's coming out again.
I'm not doing as well as I was a couple months ago. Can I still expect to improve on this lower dose, when I am not doing as well as I was at a higher dose? I feel like a whiner and I hate whining.
A relative said I should get on antidepressants but I am only depressed because I am hypothyroid! It's the only thing that has ever caused me to feel depressed no matter what has been going on in my life! I am already feeling numb and low energy! I do not need a drug that will keep me like that.
Thank you for reading this post. My husband is sick of hearing about my thyroid. Knowing this is read by someone who gets it is comforting.
Thanks for your patience and your reply.
I has high cortisol and high DHEA on a saliva cortisol test.
My dr never called me or had anyone call me from his office after he received that lab. Having appointments six months apart isn't helping. I did another post about it and I should have just kept it in this one. I haven't treated the high cortisol myself yet, though PS (Phosphatidyl Serine) has been recommended and also regular exercise, which is my normal. Lately though, I'm too tired to hop on the bike. When I do, I feel exhausted. I have lost endurance. I used to bike a 100 or more miles a week in the summer but now I do three or four miles and it's a struggle.
I think I'm tired. I will try to be patient until the next labs and if they look "normal" but I feel like this, with my hair coming out, super down and exhausted, I will insist we either treat my cortisol or we raise the Armour. He may refuse to treat me.
There was a reason I was at 3 and 3/4 grains! I was starting to feel normal at that dose and others were noticing that I was doing better.
Thank you for reading and for writing back to me. :-)
Can you see your doctor sooner? Although I've never had adrenal problems myself, I've heard that it's almost impossible to get thyroid hormones adjusted properly until adrenals are normalized somewhat. If you don't address that, you might be waging a losing battle.
If I were you, I wouldn't put up with those symptoms any longer than absolutely necessary. Give your doctor a call...
Thanks! Yes, I did cut back a half grain. Today, almost two weeks into my period, my basal temp took a dive from 97.7 (ave) to 97.2. Its not a huge drop, i guess. I'll go through the rest of the cycle and keep track.
I think I'll send the dr a note first to update him, then see how it looks in a couple weeks.
Well, your TSH is technically more than "slightly lower" than 0.3. It can only go to zero, and you are very close to zero and 0.28 below 0.3. Not that I find that relevant! LOL
Both your FT3 and FT4 have dropped significantly. The drop in FT3 from 4.7 to 3.7 represents a 42% of range drop. That's huge. You were at 12% above range, and now you're at 71% of range. FT4 went down 13%...not as dramatic, but still significant. Your FT3 is now barely in the upper third of range, which is, as you know, the target area for FT3.
If your doctor wants to lower your meds again, then he's obviously looking at your TSH and ignoring the rest (including your symptoms).
If he does want to lower, I'd try making the following points to him, and if they don't make an impression, unload him:
1. Your symptoms have increased.
2. Your FT3 dropped 42%...close to half of range...that's okay???? Furthermore, it's okay even though you still had symptoms at the higher level???
3. You're on desiccated, so you're by and large functioning on that FT3 that just tumbled.
4. Any further drop in meds will probably cause FT4 to go below range.
5. With a 42% drop in FT3, TSH doesn't move, and we're supposed to believe it's an "ultra sensitive" indicator of thyroid status. What more do you have to say than TSH simply is NOT responding to changes in FT3 and FT4 levels.
6. If he still isn't listening, slug him! LOL As a less violent alternative, chain him to the exam table and swallow the key.
I'm serious too! I wouldn't know where to start figuring all the math, so this is very helpful.Thank you for your post! I have not heard from his office yet but I will stand on all four of these if he asks me to lower. I'll let them know that I'm off wheat to see if that helps and then I will see them in Nov. I am not dropping again.
The hair loss is really stressing me. I have lost a lot where normally I have a lot. I wish I could post pics so you could see the difference. I have a letter I sent to my Dr a couple weeks ago that includes four pictures. It was growing in so well a few months back that I felt confident to have about seven inches cut off, and now what I have is limp, frizzy and thin. I get out of the shower and it's all over my back, all over the floor every day. I got my toe caught in a strand the other day walking in my bedroom. Seriously. Plus, my skin is super dry. My arms and thighs are bumpy; they are worse than they were a few months ago. I wake some nights because my upper arms are so itchy I have to put lotion on them to go back to sleep. I KNOW HYPOTHYROID skin when I'm scratching it! The sound of me scratching annoys the heck out of my family.
His office says I am hyper and that's why I'm losing my hair. He would probably say that's the reason my muscles are weak, and I know hyperthyroid can cause that, but I have lost endurance and muscle tone from being too tired to bike.
One good thing: I did notice that my basal temps were running a little more level for the past month. Not as huge drops and rises, though still low. I think that's a good sign, if they will just move up to 98.2 or so.
That Dr is going to keep you sick. I would HIGHLY recommend you find another Dr. It is plainly evident that they don't have a clue as to what is going on with you and are looking ONLY at TSH.
My thought would be to add a small dose of T4 medication and leave your Dessicated thyroid dosage alone. This should help raise your FT4 level and the additional T4 should convert some more T3 so you should see the FT3 levels come up a bit.
You can ask to prove this as a "clinical trial". If you feel better with the additional T4 you are right and your Dr is wrong. If you feel worse because you are Hyper then Your Dr is right.
Since you reduced your meds and you feel worse, I have a lot of faith that you are right and your Dr is wrong.
Of course I'd recommend you get tested for Reverse T3 so that you can monitor if by adding this synthetic T4 would result in the RT3 conversion issue that was the title of the original post in this thread.
I believe that some people really need a particular balance with BOTH the FT4 and FT3 levels. With Natural thyroid alone, sometimes it is not possible to obtain this balance. And in some people it makes no difference with the balance. It appears you may be one of those people who need that balance. Or you at the very least need a higher level FT3 than most due to the RT3 problem. But either way the fact that you felt worse by reducing dosage is absolutely telling.
Thanks so much, flyingfool! I agree that a tiny bit of T4 might be worth trying. I'm open to adjusting here and there until it works perfectly.
We would need to check for Rt3 in Nov, but I'll need labs then anyway. Would he even consider it is the question.
When we dropped initially, I felt uneasy. I was starting to see improvement. But we lowered to try to reduce the Rt3 and it worked: my ratio went up to 21.5.
I have a few months left on my prescription. I know Armour is right for me. Both on Synthroid and off I never saw improvement of memory but I started to last Spring on Armour. After all the years with memory issues, I didn't think that could improve but it did. I want it back!
My Dr's office called to tell me my labs are "improving" so I can stay at this dose. I guess improving means my Ft3 is no longer above range. I asked, given the extreme drop in Ft3, if they would consider a trial of a very small supplement of T4 to see if we can raise both T4 and T3 within the optimum range, and we could check Rt3 in Nov. She said she would ask him, but she seemed thrown off that I asked. Who knows, he may "fire me" after today.
It's an issue for prayer for me. I thanked her, and reiterated that I am asking him to consider it; that's all. She said they do not have an order for iron labs for Nov, but I asked if we could get a full panel before that appointment.
My iron levels should be higher now since I supplemented for weeks. I never had stomach issues while taking it. I cut back to just two supplements a week because I was worried about overdoing it.
I have some anxiety after talking to her. Going to a local art fair to relax and enjoy the sunshine today.
Thanks for your input and support. I don't think we ever stop learning about this.
My Drs office called me back regarding a trial of a small addition of T4. He said no because T4 will make me more "hyper."
So I called several Drs and found one who is on a thyroid good doc list who takes my insurance and now have to wait until they call me back. I hope I can get in before the end of the year. I'm calling it a second opinion.
Good for you...best not to burn your bridges until you see if the new doctor is better than the old.
You can preinterview him over the phone (probably through a nurse). A few key questions can weed out the worst of the worst. You can ask which tests he customarily orders for his hypo patients...make sure FT3 is included. You can also ask which meds he's open to using. Some doctors just won't prescribe desiccated, so it's best to find that out before you waste an appointment. You can also ask if he treates clinically to eliminate symptoms or if he treats "by the numbers".
If the phone is answered by a rabid receptionist bent on protecting everyone in the office from ever answering the phone, just ask her the questions. It probably won't take long before she knows she's out of her league and will refer you to a nurse.
I asked his receptionist (or nurse, not sure) some questions and gave her some information about why I'm frustrated. She told me he will "work with it" until he gets it right and he is not caught up on the TSH. She said he looks at all the hormones and the whole person to determine health, and would look for underlying issues as well.
She said I can call back if i have other questions, and she will call me when they are ready to set up an appointment.
This is from his website:
The body, mind, and spirit all affect our health. There are often many valid approaches to any particular health problem. The Center offers the following alternatives:
Osteopathic Manual Medicine
Vitamins and Herbs
Talked to his receptionist today. She called me back with a couple answers to earlier questions. She said specifically that he always does Ft3 and Ft4 labs and he uses the new TSH range. And he often prescribes natural hormone therapies. I asked about Armour and she said absolutely. My first appointment is set for the first week of October!
Saw my new doc and wanted to tell you all about it. It went well. I told him my troubles and he gave me the rundown of why the TSH test has hurt many patients since it came out. He said he works toward eliminating symptoms. He also told me it's hard for drs to go against their training because that is all they know. I said, "But you went beyond your training. You found alternatives." And he said, "Yes."
He asked me what I was taking when saw relief from symptoms and I explained that I saw some improvement at 3.75 grains but still had other symptoms. He asked if i had ever tried 4 grains. I said no, so he said we will start where I was feeling better, at 3.75 grains and then work from there.
I asked him about the Rt3 because it was higher at that dose and he said he generally goes by how the patient's doing, more than by that number because stress can cause it to go up but I might be doing just fine.
He was professional and somewhat reserved, and his philosophy for treatment matches my own, so I am happy! He told me giving up wheat would probably help me a lot and I told him I keep trying but every couple weeks I eat it again. He said to keep trying or get to a point where I don't eat it. He also recommended einchorn wheat, the old strain. He said having no wheat would be better, but if I'm going to eat it now and then einchorn would be a better choice. I may have to send away for some.
He's testing my iron but isn't doing the % sat. He said it didn't matter if it was low, that ferritin would be a better inficator. I didnt push it, but I wish I had insisted for tracking purposes, if for nothing else. However, I walked out with a prescription for 3.75 grains Armour and a suggestion to try progesterone cream to see if it helps. "You won't know until you try it." I was going to buy it right in his office and forgot.
So I see him in six weeks and really hope raising works. I cant see it not helping,because it did before. I feel hopeful that we can turn this around.
It sounds like you hit paydirt! If he's not into TSH, you're at least halfway there.
Wow, it really sounds like he knows what he's talking about. I'm so happy for you. I think he'll do what it takes to make you feel well.
I'm good, thanks. Despite crappy labs for over a year now, I just got back from vacation at 6,000-7,000 feet, and it didn't kill me! LOL It becomes more obvious all the time that there's more to this than the current tests indicate. Luckily, as long as I feel good, my doctor doesn't push it...
I'm so jealous and so happy for you. Wish I could hear a doctor say those things to me! I am commenting because of your mention of progesterone cream. Like I stated earlier in this thread, it has made all the difference in some of the problems I was having in addition to my thyroid problems. It has helped dramatically actually. You need to be sure you're getting the right cream though, as many don't really have what we need in them and many made with wild yams etc, give you estrogen too. PM me if you haven;t gotten any yet and I'll tell you what I use. Also, you want to use the smallest amount possible and go up from there.
Very happy for you, that doctor is the needle in the haystack!!!
Hi! Sorry, I haven't been on the forum for a couple weeks! I didn't realize there were posts!
I've been at the higher dose for a few weeks but not seeing improvement yet. Going to be patient. It took months to see some improvement before so I'm giving it time. I do feel blessed to have found this Dr. I want to give it time to see how things are going and also if things are not working, what he recommends. i was shocked and delighted he asked about four grains. That told me he was open to doing whatever works.
I've been depressed and low energy for months and had little endurance this whole summer. Now I have less muscle tone and more fat than ever in my life. I really feel the past months were a huge setback. Scares me but there is hope.
The thing that surprised me was that he asked if I was familiar with a Dr... agh! can't recall his name!... and how he has been comparing the TSH to actual thyroid health for years. I had not heard of the Dr he mentioned but I asked him if he had heard of Dr Derry in Canada and he said no, so I plan to send him this article:
Just saw my Dr again. He wants me to stay on 3.75 grains Armour for now and start progesterone on my next cycle. I've been looking forward to trying it and bought Progest from his office. He said the puffiness, fatigue, abdominal fat and other issues may be related to this.
My blood pressure was high and I think its because I haven't had any consistent exercise in months. I'm going to start walking indoors. I have always had normal blood pressure but the last one was 140 and this time it was 148. That scares me.
He wrote an order for all my desired labs, and added an iodine loading test. I hope to do that next week.
So for now, I think we're on the right track. It will be interesting to see if symptoms improve with the progesterone.
That's great! Sounds like you got the cream, the right cream too- glad to hear it. Keep in mind to not use too much of it and it does take a little while to see results, maybe a few weeks. Thanks for the update, I think I need to see your doctor...lol.
Happy to let you know how its going! Drs office called me and said Ft3 is high but it's transient. Not sure what that means exactly but the woman who called me didn't seem concerned. They said everything else was normal. I still need to look at the labs myself.
No, I don't take my BP at home. It has never been high at the drs office until the last two times. I said in an earlier post that I have suffered setbacks and this may be part of that. I was biking 70 to 100 miles a week a couple summers ago and almost nothing this past summer because I get too exhausted! The inability to do what I normally do to be fit and to relieve stress is really getting me down. I have to find something active to do this winter!
I could probably run in to the pharmacy near my house to take my blood pressure. Hoping they calibrate the machines regularly.
Agh! I did some yoga this morning after not doing it in awhile and my legs trembled the whole time. I'm hoping this dose, the progesterone and the other vitamins I take will get me turned around. Thanks for checking in!
I have one of those home monitors. They're not horribly expensive, but you want to get one that fits on your upper arm, not one that you put on your wrist. My BP was always higher at the doctor's office...white coat syndrome...your BP goes up the minute you see a cuff coming at you or you think you might have to fight them not to lower your meds. LOL Anyway, my BP is never high at home, in fact, it's quite low at some times of day. Before I have a doctor's appointment, I usually check my BP for several days and bring the results with me. Strangely enough, this has almost cured my white coat syndrome.
Thanks for tip! I may see if I can get one for home. I have heard of using it to check for drops upon rising too.
I have always had healthy blood pressure so two high takes in two months is alarming. I like the idea of checking for a few days before, because I know if I start worrying it really will go up at the drs.
You might not want to stop the iron completely. Don't forget that these labs reflect your supplement. If your diet hasn't changed, you probably still need the iron. I might cut back a little, but maybe not cut out???
Hello! How are you this wonderful holiday season? :-)
I did a 24 hour iodine test a couple weeks ago, but my dr's office didn't give me an excretion percent. I'm not concerned with the high numbers since I took iodine tablets, but how to figure out excretion. He said it's normal but I would like to understand how to he came to that. Do you have any idea how to figure this?
results from the lab:
Iodine, Urine 15317.2 High range is 28.0 - 544.0 ug/L LC
Iodine, 24 HR U 38293.0 High range is 100.0 - 460.0 ug/24 hr LC Limit of quantitation = 20
I don't know a thing about iodine testing, but I did just find this:
"The percentage excretion is calculated by dividing the patient's mg/24-hour iodine results by the oral iodine/iodide dosage (mg) provided on the requisition form by the practitioner, then multiplied by 100."
So, I guess you divide 38293 by the mg of iodine you take and multiply that by 100 to get the percentage.
As I said, I know nothing about these tests, but I would think one would have to infer that you might not need to supplement???
weird. I sent you a reply but it isn't listed here. I agree, I don't think I need a supplement, but I wanted to know for myself how he figured it out. It was 50mgs. so the division/multiplication gives me: 75686. Is that and excretion of 76%? Seriously, you don't want me doing math. :-)
I do the skin patch text now and then but it all disappears in 12 hours. Not sure how reliable that is but I figure the little amount of iodine I get from the patch test can't hurt.
Hope you are well and have no issues with harsh winter!
This site complies with the HONcode standard for trustworthy health information.
The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. Med Help International, Inc. is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. We offer this Site AS IS and without any warranties. By using this Site you agree to the following Terms and Conditions. If you think you may have a medical emergency, call your physician or 911 immediately.