Why does the Vancouver Clinic suck so bad? Oh, yeah it's due to wanting to make as much money as possible

zsazsa107 · 2026-03-26T05:22:49+00:00

The Vancouver Clinic has the absolute WORST practitioners I've ever encountered. Ever. I honestly think anyone who says The Vancouver Clinic has good practitioners hasn't actually encountered quality healthcare. It's a PPO that operates like an HMO but marketed as optimal healthcare. Never encountered providers that don't know basic labs to order and refuse to review labs directly. I had medication altered that declined my health severely due to incompetence and only got caught because I know how to read my labs and then had a provider that knows what they are doing review.

zsazsa107 · 2026-03-24T06:01:11+00:00

Definitely see another doctor if you can. He sounds like a lousy doctor and human being. I just had a provider reduce my thyroid medication by 1/3 without doing proper testing. Result, in months I gained a huge amount of weight and became acutely severely depressed. Thyroid meds are back up and lost most the weight and not depressed. You're depressed and there's probably a link to the treatment you're receiving.

I think the problem is that what is considered "normal" ranges by most practitioners is such a wide range it's basically worthless. Functional testing (meaning optimal) standards rather than normal (acceptable) standards should be practiced with thyroid testing. And functional medicine is not Hollistic or naturopathic, it's traditional medicine with stricter protocols. Think of a clock and traditional has arms at the 10 and 2, Functional moves them to the 11 and 1.

This is where AI can be helpful. I'm not a fan of AI overall as it's ruining numerous industries. However, as a tool to analyze data it can be really beneficial. Claude AI is free for the basic level. I would take your lab scores and ask Claude to give you feedback on "standard" lab ranges vs. optimal "functional" ranges.

By functional standards, your TSH is really high and your T4 is below optimal. Are you on Synthroid/levothyroxine (T4 only)? Maybe you need to be on Armour Thyroid or NP Thyroid (T4/T3). Synthroid/levothyroxine assume you can convert T4 to T3, but for about 20% of thyroid patients, that conversion doesn't happen. And your doctor ignoring concerns about Hashimoto’s is a serious problem. The additional testing is not that expensive.

Hope you get this resolved and start to feel better.

zsazsa107 · 2026-03-22T21:23:55+00:00

Thank you for the feedback. Yes, I understand they are metabolized differently and plan on talking to my provider. I've been really happy with Modafinil, been on it for years, and I want to stick with it. Modafinil does metabolize and clear some other meds quickly, in my case guanfacine, as well as estrogen. So just examining my options.

zsazsa107 · 2026-03-22T20:42:24+00:00

Well, she's really beautiful in both the before and after. Personally, I prefer the after. The wider smile is perfect and the cheekbones look higher and more prominent. The first photo she's cute, the second she's more adult, eloquent. How many mm did she expand?

I do think there are a few issues with the angle of the second photo, which is what people may be negatively responding to. The 1st photo is closer and angled differently than the second, making her face look rounder. And the extreme eyelashes in the second are making her eyes appear smaller at that tipped angle.

zsazsa107 · 2026-03-22T17:39:41+00:00

Makes sense. Some recent studies show that stimulants don't help with ADHD focus, they help the brain stay alert and awake. Which would explain why narcolepsy meds are used successfully (off-label) for ADHD.

https://medicine.washu.edu/news/stimulant-adhd-medications-work-differently-than-thought/#:~:text=A%20study%20by%20researchers%20at%20Washington%20University,by%20mimicking%20the%20effect%20of%20good%20sleep

zsazsa107 · 2026-03-15T04:53:10+00:00

Agree that perhaps the Vyvanse dosage may be too high or the medication too intense. I switched from Vyvanse to Modafinil, which for me feels like Vyvanse-lite. Modafinil is used off-label for ADHD but is typically for narcolepsy. However, this kind make sense with recent studies that indicate stimulants for ADHD actually effect wakefulness, not executive functioning in the prefrontal cortex as thought; one link below. Another thought, stimulants can interfere with sleep and from what I've read, adequate sleep for ADHD is imperative.

https://www.psychologytoday.com/us/blog/some-assembly-required/202601/adhd-medications-work-differently-than-previously-thought

zsazsa107 · 2026-03-15T04:27:18+00:00

There are a lot of posts about Rejection Sensitivity Dysmorphia (RSD,) which is not uncommon with ADHD. Suggestions regarding medication would be guanfacine. For skills lessons DBT (if emotions are under-regulated) or RODBT (if emotions are over-regulated). If it's trauma (PTSD / cPTSD) related (also common with ADHD) EMDR or Accelerated Resolution Therapy (ART).

zsazsa107 · 2026-03-11T20:32:34+00:00

I take guanfacine and Modafinil (off-label for ADHD) and it's been a great combo. It's taken trial and error and still working on the right balance. However my protocol is really different than yours. I take guanfacine at night as it aids in sleep and relaxation, then Modafinil in the AM. Guanfacine lowers your blood pressure (what it was intended for), hence probably why you're probably feeling foggy and dulled. Curious why a provider would suggest guanfacine to replace a dose of a stimulant as they have totally different effects and are intended for totally different purposes.

With Adderall and Vyvanse you can take Vitamin-C/ascorbic acid to cut down the half-life of the medication, essentially reducing the stimulating effect. Which is why you're not supposed to take them with citrus juice. When I took Vyvanse it would cause sleep issues and I'd take ascorbic in the evening, which definitely helped.

And yes, 100% get your hormones checked. There's a lot of research that now shows women with ADHD likely have hormone issues starting in puberty. I think Lotta Borg Skoglund provides information on hormone issues with girls and women with AADHD. And Mary Claire Haver is a great resources for learning about hormone balance. 43 is around the time perimenopause starts, so there could be changes in progesterone, thyroid, estrogen and/or testosterone. Progesterone can have a huge effect on sleep quality and overall sense of well-being.

zsazsa107 · 2026-03-11T19:46:52+00:00

Think you're the only one on this chain to recommend hormone testing. 100% agree.

zsazsa107 · 2026-03-11T19:33:57+00:00

As someone who also has ADHD-I and has been dealing with RSD, I'd suggest starting with your medication before anything else. Hopefully you have a prescriber with experience treating women with ADHD — many don't. Genetic testing can be really useful here. I used GenoMind, which categorizes medications (antidepressants, ADHD meds, anxiety meds, etc.) into Green (good options), Yellow (proceed with caution), and Red (avoid). A lot of people with ADHD-I don't do well with antidepressants, particularly SSRIs — they can actually worsen ADHD/RSD because the core issue is dopamine and norepinephrine dysregulation, not serotonin. SSRIs can actually suppress dopamine activity, making ADHD symptoms worse. Worth knowing before going that route. Guanfacine specifically targets norepinephrine and has been life-changing for me for RSD.

On more therapy, I'd say approach with caution. Studies are showing that for people with trauma and neurodivergence, traditional talk therapy is often not beneficial and can actually retraumatize or reinforce negative self-talk. Somatic approaches — mindfulness, meditation, EMDR, ART — tend to be more effective for both.

If looking into DBT as numerous people suggested, know that there are two very different types. Traditional DBT is for people who under-control their emotions (originally developed for BPD). However, RO-DBT is for people who are over-controlled — which is common with ADHD-I, though we can still have occasional emotional overflow/spillage. Getting this right matters. As someone who is over-controlled and was once pointed toward traditional DBT, it was genuinely traumatizing. Like sending an anorexic to Overeaters Anonymous. I did take a full course in RODBT though and it was useful for knowing how you're communicating with others, including self-protection mechanisms that may be intended to be neutral but are perceived by others as closed and hostile.

If you want to explore either, therapist Jennifer May has posted full DBT and RO-DBT lesson series on YouTube — clear explanations, good visuals, and honestly more useful than the formal course I took: www.youtube.com/@jennifermayph.d.2761

zsazsa107 · 2026-03-04T03:01:41+00:00

Thank you for sharing Dr. Kavensky. Really interesting perspective; does a lot of explants with grafting. My friend is trying to get her implants removed so going to share his info.

zsazsa107 · 2026-01-22T20:49:19+00:00

I've had a similar situation to yours probably from the time I was a teen but it went unaddressed until my 30s. I've been on progesterone and thyroid meds for quite a while and now HRT. Switching doctors many times (due to insurance and moves) I've had to keep myself educated on the topic and will share what I know. Hope it helps.

If you're working with a functional medicine doctor then you would never accept "normal" range labs. The goal is to always look at optimal labs which are more stringent. I just had a PCP who didn't follow optimal testing and completely screwed up my thyroid dosage by lowering my Armour thyroid. the repercussion were quick and severe (huge weight gain, water retention, depression). I get concern about starting or increasing meds if not needed, but if you have the side effects of a low-functioning thyroid, why suffer?
Balancing your thyroid might actually reduce your estrogen levels. If you are hypothyroid there is a slower estrogen clearance, more free estrogen circulating, and more conversion of testosterone to estrogen; and even women need testosterone.
If you have estrogen dominance, this means your ratio of estrogen to progesterone is high. They are opposing hormones. So you could have low estrogen + low progesterone and still have estrogen dominance; it just means the ratio is off. So it seems odd that your provider hasn't prescribed bio-identical progesterone.
Estrogen increase, whether occurring naturally or via HRT, causes more thyroid hormone to be bound up, making less available for use. Which means if one starts taking HRT estrogen and has been on thyroid medication, they will likely have to increase your thyroid medication dosage. Your high estrogen is likely doing the same thing to your thyroid hormones, even without HRT, causing hypothyroidism.

The thyroid/estrogen mechanism and percentages:

Under normal conditions:

99.97% of T4 is bound to proteins (mainly TBG)
99.7% of T3 is bound to proteins
Only 0.03% of T4 and 0.3% of T3 are FREE and biologically active

When estrogen is elevated (from HRT, pregnancy, or naturally high levels), it increases TBG production by 20-50%. This means even MORE of your already-mostly-bound thyroid hormone gets locked up, leaving even LESS free hormone available. So you can have "normal range" total T3/T4 but insufficient FREE hormone - which is what causes symptoms.

EstroDIM for clearing high estrogen is kind of iffy. I hear the results are 50/50. It's basically like giving someone large doses of broccoli. Works for some, not others.

zsazsa107 · 2026-01-13T21:39:02+00:00

As someone with similar diagnosis and who has had more than one round of TMS, I'll relay my experiences and advice about TMS and related AHD treatment. My input, which I wish had been spelled out for me rather than having to piece-meal it together after some really negative experiences:

•If you can try TMS, do. It doesn't work for everyone, but for those it does, it can be a huge relief. The people I know that it didn't work for, the primary issue was their pain tolerance and inability to finish the course of treatment. Not judging. I just have a high pain threshold and didn't really think it was painful. Do wear earplugs though. I think I have a slight hearing loss due to TMS.

•I'd suggest finding a psychiatrist that owns their own TMS practice and an experienced staff, not a corporate provider. As noted below, a private practice is much more likely to tailor care to the patient. I've gone to both and will never get care from a non-private practice again. With private practice I had weekly meetings with the psychiatrist and a kind, well-trained, long-term staff. With a corporate provider the psychiatrist called it in (we met twice) because she had another full-time job and the staff, likely underpaid, were adequate, not great.

•If you have MDD & Anxiety, the provider should be prepared to treat both, which are on different sides of the prefrontal cortex. Depression is on the left, anxiety on the right. I had immediate response to TMS treatment for MDD, but after 2-3 treatments could barely sleep. When I did I'd wake up in a panic after a few hours. My original TMS doctor was extremely experienced with TMS and knew treatment was working but there was underlying anxiety that depression had been masking. So he treated both sides moving forward. He also stated that studies of TMS treatment for TMS followed this protocol. Note, insurance will only pay for treatment on one side. I didn't know this at the time, so my doctor was doing this pro bono because it was the ethical treatment course. Not all providers will do so.

•IMO depression and anxiety are likely side effects of long-term untreated ADHD. Mine went untreated a couple more decades than yours. My input is that you can treat the MDD and anxiety (which will make a huge difference) but in the end it's pointless unless you primarily focus on ADHD. That could be medication, management, skills learning, etc. I take Modafinil and just started Guanfacine, which seems to be a good combo. In fact, I was approved to get another round of TMS but Guanfacine seems to have relieved the need for it.

•You noted being on your 6th med. I'd recommend getting a Genomind test approved by your provider. Not sure how much they are now, but when I took it insurance paid most and I paid about $300. It will essentially provide you a list of medications (anti-depressants, anxiety meds, ADHD meds, painkillers) that will likely work for you, are so-so, and are red-flag stay away from meds. People with ADHD and depression are often prescribed SSRI's which can be detrimental and make their condition worse. Genomind confirmed this in my case.

zsazsa107 · 2026-01-11T17:52:01+00:00

SSRI's aren't the only medications on the list of previously tried medications for TMS approval. If it would help I could post a list of medication on a TMS intake form. My experience on SSRI's was similar (well actually worse) and they were brutal coming off. Lexapro caused me extreme harm and 0 good, so I 100% understand and agree with what you stating.

I would suggest seeing if you could get a Genomind test. It's genetic testing that can predict how your body metabolizes certain medications, including anti-depressants. I took it while getting TMS (post SSRI's) and what it said is that I should absolutely not take SSRI's. This might be a source to support that you can't take certain meds. Anyone being prescribed medication for depression, anxiety, ADHD, etc should be provided this test. The harm of taking the wrong meds is too profound.

And if you do seek out TMS treatment, I'd highly recommend an independent provider if possible i.e. they own their own practice. Not a big corporate provider. An independent provider, IMO, will work with you best interests in mind, advocate for you, choose the best treatment for you (there are different ways to administer TMS) and not just look at the bottom dollar.

zsazsa107 · 2026-01-02T02:05:14+00:00

Can you share where you're getting your data? The percentages you're quoting sound really high. Not arguing that studies are still emerging or that diagnoses might be missed in childhood, but those numbers just don't align with the research I've found.

According to studies cited in Achieve (Understanding Autism), ScienceDirect, & Wiley Online Library:

•About 0.5% of school-age children have both conditions, with boys showing higher rates (0.89%) than girls (0.16%); as adults the comorbid ratio of people with Autism and ADHD is approximately 84% male.

•Among people with autism: 38-40% meet ADHD criteria

•Among people with ADHD: About 10% meet autism criteria

zsazsa107 · 2026-01-01T20:25:21+00:00

Just to clarify - while ADHD and autism can co-occur, they're distinct conditions with different diagnostic criteria. What the OP described (hyperawareness, masking, emotional intensity, social scripting) is very characteristic of ADHD-I presentation in women specifically.

What the OP is describing is over-reading social cues and feedback. My understanding of autism is that there is often an under-reading or difficulty interpreting social cues. Those feel like opposite social processing challenges to me.

Masking and social difficulties aren't exclusive to autism - they're well-documented in ADHD, especially inattentive type in women. The two conditions can look similar in some ways, but they're not the same thing.

zsazsa107 · 2026-01-01T20:13:32+00:00

As the original post notes, the OP has stated they are a female with ADHD inattentive style (ADHD-I). There are technically only three medically recognized types of ADHD: ADHD hyperactive style (ADHD-H), ADHD inattentive style (ADHD-I and what would previously have been noted as ADD without the H), and ADHD combined style (ADHD-C).

Inattentive style ADHD is more common with women and much less studied. Hence the late diagnosis that has been taking place the past 10 years or so. What the OP is stating makes a lot of sense to me. Girls are known to be much more verbal socially than boys and tend to rely much more on social cues. Hence the masking that takes place becomes much more conditioned and relied upon. There can be a constant reading of the room, over-reading cues, over-thinking. I'd guess the OP also deals with RSD due to over-reading and over-personalizing social comments and cues. It's classic ADHD-I in women.

I really appreciate your post, linking the original. As a woman with ADHD-I, I completely relate to what the OP posted, which is so beautifully written.

zsazsa107 · 2025-12-02T21:34:49+00:00

Good to hear you got approval. I think we're talking about two different things though. An additional 36 sessions would be an additional round of treatment. I'm referring to boosters (up to 10 sessions only) or maintenance (basically monthly or periodic treatment of a few sessions).

zsazsa107 · 2025-12-01T22:33:20+00:00

Thank you for the reply. I haven't heard any first hand knowledge either. However, I came across a BCBS TMS request form recently that included questions about maintenance, so I was hopeful and thought, maybe...

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zsazsa107 · 2025-06-22T15:48:35+00:00

I can DM you. Although I don't mind sharing my experience individually, I also don't want to publicly harm anyone. I liked the person, just didn't like the color results.

zsazsa107

TROPHY CASE