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A hopeful new article proposing that adding T3 to thyroid treatment is the way to go!

Screen Shot 2014-03-19 at 5.48.52 PM(This post was updated in 2015. Enjoy!)

In a recent article by thyroid patient Mary Shomon, there was mention of an interesting article by Dr. Wilmar Wiersinga that came out this year in the journal Nature Reviews Endocrinology titled “Paradigm shifts in thyroid hormone replacement therapies for hypothyroidism.” And I find this article fascinating.

I’m going to break it down a bit and add more important observations that I’ve not seen expressed elsewhere and which are important, because the truth stands out about T4-only and decades of patient experiences.

In the abstract summary of his article, he states:

Evidence is mounting that levothyroxine monotherapy cannot assure a euthyroid state in all tissues simultaneously, and that normal serum TSH levels in patients receiving levothyroxine reflect pituitary euthyroidism alone.

Informed thyroid patients can only shout Hallelujah!!

But actually, the evidence has been there all along…and the medical profession has not been listening!

For over 50 years since T4-only was pushed upon thyroid patients in the early 1960’s (not the 1970’s mentioned in the actual article), we haven’t done well on levothyroxine. But when we came into our doctors offices and complained of those pesky symptoms of continued hypothyroidism while on levothyroxine, the replies from our doctors have ranged from “You need to exercise more and eat less”, to “it’s just your age”, to “It’s part of being a busy mother” to  “Here’s a prescription for an anti-depressant/statin/BP med”….on and on.

My own mother was the classic example. She as put on Synthroid in the early 1960s in her forties. And from that time on until she died in her early eighties still on Synthroid, she paid continual and growing problems: chronic depression, rising cholesterol, heart problems, weight gain, body stiffness, inability to stand for long periods, poor stamina, dry hair and skin, and problems with her cognitive abilities. And today, informed patients know that all those symptoms are classic symptoms of continued hypothyroidism—all common in far too many patients on T4-only in their own degree and kind…sooner or later.

Stop the Thyroid Madness is the direct result of thyroid patients gathering in groups on the internet by the turn of the 21st century and proclaiming T4-only has only served to make them sicker!

Dr. Wiersinga also states in his abstract:

Levothyroxine plus liothyronine combination therapy is gaining in popularity; although the evidence suggests it is generally not superior to levothyroxine monotherapy, in some of the 14 published trials this combination was definitely preferred by patients and associated with improved metabolic profiles. Disappointing results with combination therapy could be related to use of inappropriate levothyroxine and liothyronine doses, resulting in abnormal serum free T4:free T3 ratios. 

That is a bit confusing to say “evidence suggests it is generally not superior to levothyroxine monotherapy”. What about the clinical presentation of patients shown every day in the offices of doctors over the past 50+ years?  Why have so many thyroid patients on levothyroxine for example, been put on anti-depressants, statins, BP meds, pain meds and more?

The Medical Dictionary defines “clinical presentation” this way: The constellation of physical signs or symptoms associated with a particular morbid process, the interpretation of which leads to a specific diagnosis.

Why has there been such a gap between what a doctor learns in medical school /continuing education vs. the clear clinical presentation by millions that underscores how poorly T4-only really has been?

As far as those “disappointing results” which Dr. Wiersinga mentions, informed thyroid patients have the answer: low iron and cortisol issues–both issues which all-too-many levothyroxine patients acquire due to being a poor treatment, and which either T3 or natural desiccated thyroid will reveal. Or, the patient is held hostage to the TSH lab test, leaving them underdosed, and again, many acquire either low iron and/or a cortisol problem.

Dr. Wiersinga concludes in his abstract:

However, in selected patients, new guidelines suggest that experimental combination therapy might be considered.

We agree and bravo!!

But Informed thyroid patients have a strong reply: why limit a better treatment to only “selected patients”?? Why continue to put each and every thyroid patient on one of five thyroid hormones, which more than 50 years have revealed has been an abject failure in too many, sooner or later?

Why not put the majority of your thyroid patients, not a “selected few”, on a medication which gives back the exact same hormones that one’s thyroid would be making in the first place, aka Natural Desiccated Thyroid Hormones? “Selected patients” should only refer to those who may need T3-only since they could have a conversion problem. 

The full article also describes three paradigm shifts, plus a proposed fourth one:

1)   1891, when the real gland (sheep at the time) was first used to treat hypothyroidism. bottle1

2)   1960 — 1988, when desiccated thyroid use declined and levothyroxine use increased

3)   the 1990s, when it was reported that T3 was needed after thyroid removal (but wasn’t pursued)

(See Chapters 1 and 2  in the revised STTM book for more excellent information)

And the 4th paradigm shift might occur, he explains, when those of us with poorly functioning thyroids could see regeneration from embryonic stem cells, as outlined in a 2012 study. Pretty exciting!

But I think a 4th paradigm shift has already occurred! A growing body of doctors have changed the way they treat hypothyroidism, and it’s by prescribing natural desiccated thyroid. As a southerner would say “Bless their little souls!!”

Until the possibility of stem cell treatment of our hypothyroidism becomes a reality, which may not be soon enough, we all hope to see better understanding by our physicians about what treatment really hasn’t worked well, and what treatment really does.

i.e. doctors need to return to the observation of “clinical presentation” 

Adding T3 to our treatment, and especially with natural desiccated thyroid, has changed lives. And we can at least shout “Bravo” to  Dr. Wiersinga for positively proposing that Endocrinologists consider the fact that perhaps, T4-only is NOT the way to go and adding T3 just might be for very good reasons. And by the way, thyroid patients also know that the TSH lab test is as much a failure as T4-only.  

Seize the Wisdom!

Yours truly,

Janie A. Bowthorpe

Post Script: The full article can’t be found in most places yet, but here is one place where the charge is less than others if you want to see it: http://www.readcube.com/articles/10.1038%2Fnrendo.2013.258

 

 

 

 

An hypothesis about RT3 – did you know you might have a hidden pool of it?

arrowPlease note this is a HYPOTHESIS, based on limited information, from 2014, and not to be taken as gospel.

Everyone makes Reverse T3 (RT3)–an inactive thyroid hormone. It’s a way to clear out excess T4 when your body isn’t needing that extra storage hormone. i.e. instead of the T4 converting to the active T3, your body (and specifically your liver), will convert it to RT3. If someone without a thyroid problem gets the flu, up goes the RT3 to conserve energy. If someone has a bodily injury, up goes the RT3 to conserve energy.

And thyroid patients seem to see their RT3 go up in the presence of low iron or a cortisol issue.

But if you think about it, why doesn’t it go down faster when we decrease our T4? T4 has a half life of one week, yet it can take 8 – 14 weeks for RT3 to go down. Hmmmmmm…

Thyroid patient Sebastian from Germany sent me this information about Reverse RT3 that I find fascinating. What do you think?

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I’m studying biology and chemistry and have Hashimoto’s Thyroiditis with high RT3. I just wanted to inform you about an interesting idea/hypothesis I have found.

There seems to be a “hidden pool” of RT3 in the human body. This RT3 pool can increase in size while enough T4 is available, and then secrete RT3 in times where the body needs it but hasn’t got enough T4 to produce it via deodination (the removal of an iodine molecule).

“It is concluded that a hidden pool of RT3 production exists in vivo in man.”
“It would appear that hypertrophy of this hidden pool of rT3 production occurs in high T4 states […]”

Source: LoPresti et al., “Does a hidden pool of reverse triiodothyronine (rT3) production contribute to total thyroxine (T4) disposal in high T4 states in man.”, J Clin Endocrinol Metab. 1990 May;70(5):1479-84. http://www.ncbi.nlm.nih.gov/pubmed/2335581

I have made observations regarding  my own thyroid blood tests and the blood tests of other patients that seem to support this hypothesis. I have been on T3-only for 6 weeks now, started with an RT3 of 330 pg/mL at approx. day 0, and now have measured a RT3 of 685 pg/mL (twice as much!), even though my TSH is low, FT4 has fallen rapidly to 0.5 ng/dL, and no T4 medication has been taken for full 6 weeks.
Another patient I know has also made interesting correlations between FT4 and RT3. He isn’t on T3-only, but observed a time-delayed (!) correlation between both values – which could be interpreted as an indicator for the presence of an RT3 storage pool in the body, that grows when enough T4 is available, and sets RT3 free in times when there is less T4 available.

I also found studies which found that RT3 has a 1000 times less feedback on the TSH than T3 has, and 100 times less than T4. This could explain any differences between TSH and symptoms, as the “RT3-system” seems to be almost completely isolated from the thyrotropic regulation system (the latter is that which directly influences the secretory activity of the thyroid gland).  RT3 can obviously rise and fall without having (almost) any effect on the TSH.

Source: Cettour-Rose et al.: “Inhibition of pituitary type 2 deiodinase by reverse triiodothyronine does not alter thyroxine-induced inhibition of thyrotropin secretion in hypothyroid rats”, European Journal of Endocrinology (2005) 153 429?434.

In combination, this could explain why the clearing process of RT3 takes approx. 8-14 weeks, although T4 has a plasma half-time of only 8 days, and rT3 only 4.5 hours!

The intracellular T3 receptors aren’t “clogged”, and then suddenly become free after that period of time has elapsed. Instead, RT3 is a competitive inhibitor of T3, meaning it constantly goes in and out of the T3 receptor. You probably know that already.

Patients report feeling well with T3 only dosages of approx. 80-120 µg T3 per day. According to Celi et al., 2010, this would be equal to 240-360 µg of T4. I always wondered why they don’t end up feeling hyper.

This all makes sense now under the assumption that a hidden RT3 storage pool exists somewhere in the body. Although there is no new T4 being produced or taken in, and although the remaining T4 and RT3 have both decayed rapidly after one starts with the T3 only method, there is still alot of RT3 being set free by the storage pool all the time. This storage pool might be big enough to last for several weeks to months. Since RT3 is the competitive inhibitor of T3, this might be why patients are able to tolerate (and even need) so very large amounts of T3.

Then, after the storage pool has been emptied, the remaining RT3 rapidly decays because of its short half-time and no new RT3 can be produced because no T4 is available in the body. Therefore, RT3 concentrations within blood and cells drop. Thus, the competitive inhibition gets a lot weaker at that point, and patients start feeling hyper because the same amount of thyroid hormones (T3) is now significantly increased in its effect, since it can stay much longer in the T3 receptors without being competitively inhibited (kicked out of the receptors) by RT3.

This process of totally emptying the RT3 storage might occur very quickly, therefore the drop in RT3 concentrations is very suddenly, all of which might happen within several days. And this is why patients then get hyper and have to reduce their dosage to half or less of what they’ve taken previously over the 8-14 weeks.

“Clogged receptors” don’t make sense because RT3 is a competitive inhibitor, capable of traveling in and out of the T3 receptor all the time.

“Clearance” occurring after 8-14 weeks, although both educt (T4) and product (RT3) have significantly (!) shorter lifetimes, doesn’t make sense either.  Neither does a totally defective TSH lab test, because in principle, it worked fine for all the patient’s lifetime before they got their thyroid disease; and because significant correlations between TSH and FT3 and FT4 can be observed.

This all makes sense to me now, based on two assumptions:

1. While T3 and T4 have a strong negative feedback effect on TSH secretion, RT3’s effect on the TSH secretion is minimal, being about a thousand times smaller in effect than that of T3, and about a hundred times smaller in effect than that of T4….as described in the study of Cettour-Rose et al., 2005, mentioned above.

2. The body has a large, previously unknown storage for RT3. This storage can grow while enough T4 is available, and the storage’s content can be set free when needed. As described in the study of LoPresti et al., 1990, mentioned above.

I hope you can use this information for further research. Thanks for reading.

******

* Think Natural Desiccated Thyroid makes you worse? See correctible reasons.

* Are you correcting everything you should be? See what your ducks in a row should be.

* STTM has an active Facebook page! Come on over for tips and information!

* The STTM book comes in English, Spanish, German and Swedish…so far. 🙂

* Did you know you can order your OWN labwork?? Yup.

Jennifer Livingston: this goes even deeper than bullying. You are on the wrong thyroid medication!

Jennifer Livingston, a mother of three adorable daughters, is a morning anchor at WKBT-TV in La Cross, Wisconsin and a very pretty one at that. And she received an email from a male viewer which stated that her excess weight was not a good role model for young girls. Jennifer’s supportive husband Mike Thompson, who is an evening anchor on the same station and strongly supports his wife, posted the critical email on his Facebook page:

“It’s unusual that I see your morning show, but I did so for a very short time today. I was surprised indeed to witness that your physical condition hasn’t improved for many years. Surely you don’t consider yourself a suitable example for this community’s young people, girls in particular. Obesity is one of the worst choices a person can make and one of the most dangerous habits to maintain. I leave you this note hoping that you’ll reconsider your responsibility as a local public personality to present and promote a healthy lifestyle.”

Livingston followed this up with a bold four-minute rebuttal to the personal attack, emphasizing the cruelty of judging someone based on their exterior, especially considering she is very aware of her weight problem, and has worked hard to deal with it for years. She also referred to the bullying nature of the note. With October being National Anti-Bullying Month, this incidence hit a chord.

Jennifer’s famous brother, actor Ron Livingston, also expressed support for his sister.

BUT JENNIFER, YOUR STORY GOES EVEN FARTHER AND DEEPER THAN YOU KNOW, AND YOU COULD CHANGE MANY LIVES OF YOUR LISTENERS AND BEYOND. YOU MAY BE A VICTIM OF A 50-YEAR THYROID TREATMENT SCANDAL!

You mentioned being on a thyroid medication, and you may be a victim of the same 50+ year thyroid treatment scandal that millions of overweight women have been part of : 1) the use of the TSH lab test, which can be “normal” for years even though the patient has clear hypothyroidism, or 2) the use of Synthroid or any other T4-only medication to treat the hypothyroid condition, which leaves patients with their own degree and kind of continuing hypothyroidism.  And weight gain, plus difficulty losing it, is a common symptom of continued hypothyroidism for all too many  

Neither the TSH lab test or T4-only meds like Synthroid work well, exclaim frustrated, or sick, or overweight, or angry patients all over the world!

Additionally, the longer patients stay on this lousy medication, the higher the risk of having low levels of Vitamin D, Iron, B12 and other important nutrients. More than 50% of T4-only treated patients fall into adrenal fatigue, aka low cortisol, due to the failure to get enough T3, the active thyroid hormone, into the cells of their adrenals. i.e. T4 is a storage hormone meant to convert to T3, but the body is not meant to live for conversion alone!  T4 is only one of FIVE hormones secreted by the thyroid.

And it gets worse….

Many folks replied to the WKTB article about this incident. And one person stated in their post:  “…..GIVE UP A FEW BURGERS AND CUT THE CHEESE. START MOVING JENNIFER!”

Jennifer, do you know how MANY thyroid patients with a weight problem have heard this well-meaning but terrible refrain from friends, loved ones, strangers and even some clueless doctors?? Oh sure, we know that eating healthy is important. Many already eat healthy! But continued hypothyroidism keeps our bodies like that of a snail. It affects our body temperatures (it stays much lower), how our muscles work and our blood circulates (true fatigue here), how we digest food (food tends to stay in our stomach longer), and how we eliminate waste (we tend to be constipated or slow eliminators). When we try to exercise, we end up in bed from the excess fatigue of continued hypothyroidism.

 It’s not a pretty picture, Jennifer….and it’s just as bad as bullying for millions!

Learn from other thyroid patients: //www.stopthethyroidmadness.com/things-we-have-learned

Here’s my story:  //www.stopthethyroidmadness.com/my-story

Here are others stories: //www.stopthethyroidmadness.com/stories-of-others

Here are the crazy things we have to listen to from our doctors: //www.stopthethyroidmadness.com/give-me-a-break

Here’s why Synthroid doesn’t work for all too many: //www.stopthethyroidmadness.com/t4-only-meds-dont-work

Here’s why the TSH lab test sucks: //www.stopthethyroidmadness.com/tsh-why-its-useless

Here are symptoms which went away with Natural Desiccated Thyroid: //www.stopthethyroidmadness.com/long-and-pathetic

Here are many good thyroid patient groups: //www.stopthethyroidmadness.com/talk-to-others

HELP US STOP THE THYROID MADNESS, JENNIFER, OF WHICH YOU MAY BE ONE MORE VICTIM! 

Touching message from a near-91 year old New Zealand resident who feels his government is keeping him sick…

Screen Shot 2015-08-10 at 10.38.26 AM(Though this post was originally written in 2012, it is still appropriate even today! Enjoy!)

I am impressed if ANYONE over 70 years old is active on their computers, especially because they didn’t grow up with one, nor did their own children. So when I get a message via Facebook from a near 91-year-old man in New Zealand who clearly knows his stuff, I am doubly impressed.

But this story is poignant, aggravating, and the very reason Stop the Thyroid Madness exists–to educate YOU in the face of medical and government leaders who are completely clueless! Do we have to wait for our current crop of government officials to be forced or voted out of office  before we see this thyroid diagnosis and treatment travesty stop???

Dear Janie, I am 90 years and 10 months old, and have a TSH of 3.5 . My doctor, using the range of 0.4 to 4, declared me OK and not hypothyroid. This margin is used by the New Zealand Governments Ministry of Health (M.O.H). My letters to the M.O.H. of New Zealand to read the article written by the AACE in America of  January 2003 (to bring down the margin to 0.3 to 3.04) were not taken into consideration.

I am a permanent resident in New Zealand. Because of my repeated requests, they even blocked my letters to them, and in the meantime, leaving me suffering. Have been suffering about 3 years with “Chronic Fatigue Syndrome”.  Found your articles on the Internet and bought your book Stop The Thyroid Madness.

My doctor gave me Synthroid and when it didn’t work, wanted to raise the dosage. Fortunately I was in possession of the book Overcoming Thyroid Disorders by David Brownstein M.D. and refused. Indeed, I share all the “Common Experiences We All Share” as written in your book . My doctor has even referred me to a Psychiatrist—unbelievable! Of course I told the Psychiatrist who works for the N.Z. Public Health Department straight away that I will have nothing to do with him. Just to do something, he wrote me a prescription for a drug used for people who are lunatic. Gave the prescription to the doctor to throw it in his rubbish bin!

Am now looking for a knowledgeable N.D. but have not succeeded yet . They are either not knowledgeable enough about thyroid disorders or too expensive for my pensioner income. Have obtained dessicated thyroid from a compounding pharmacist, but don’t dare to take it without guidance. In the meantime, I have to eat frequent small meals just to prevent awful anxiety attacks or to feel reasonably well ..and the doctor calls me euthyroid?

Well Janie, that is my story. Am so glad that you have written your book, thanks, and that I just today received it by mail order on the Internet. With my best regards – ****

P.S. Of course you can publicise my letter to you. Hope that it will help a bit in our struggle to get proper treatment and that people all over the world will know how indifferent governments can be.

THINK THIS PROBLEM IS ONLY WITH NEW ZEALAND? PATIENTS AROUND THE WORLD SHARE THE SAME STRUGGLES!

Sheila Turner, a Thyroid Patient Advocate in the UK and creator of TPA-UK, has worked tirelessly to change the DARK AGE medical treatment protocols that UK thyroid patients have to endure. Here is a letter she wrote July 2012 to the President of the Royal College of Physicians in one of many attempts to change the inane poor practices: http://www.tpa-uk.org.uk/Report_RCP_et_al.pdf

DR. JOHN C. LOWE’S WEBSITE “THYROID SCIENCE” BACK UP!

http://www.thyroidscience.com/

JanieSignature SEIZE THE WISDOM

New to this?

* Read why the TSH lab test can be a huge failure. 
* See why Synthroid or any other T4-only med can be a problem, sooner or later.
* To read what happens when your brain doesn’t get enough of the thyroid hormone T3, go here.

* To have the Stop the Thyroid Madness revised book in reach for reference, go here.

* To get more tips, inspiration and information, Like the STTM Facebook page.

Has Armour gone back to its pre-reformulation? And 5-HTP is pretty remarkable…

Though this page was originally written in 2012 about Armour and 5-htp, it’s been updated to the present day and time. 

It’s only a handful of comments here or there in patient groups, and I’ve gotten two emails as well. But there are reports that recent bottles of Armour desiccated thyroid have pills which are performing just like they did before the unappreciated reformulation of 2009. i.e. they are softer again and can be done sublingually, and may be back to more dextrose and less cellulose.

Said one patient who contacted me via email: “It’s interesting what I read in the thyroid group the other day that her pills were back to being soft. But typical condescending Forest Labs who never said a word in 2009 to the most informed group of patients in the world, and haven’t communicated to us directly once again if it really has changed.”

So, if it’s true, there may be a phase of figuring out what you get: the hard ones that patients found HAVE to be chewed up to be the most effective, or the return of the softer ones which could be done sublingually. I’d be curious to know which pharmacies and in which city/state are giving out Armour tablets that are softer.

UPDATE: Forest Labs, the former makers of Armour, was bought out by Activas in 2014, then the price of Armour became the highest priced NDT around. And for many, it wasn’t working like it used to. But some still do well on it, paying the highest price. Learn from this page: http://stopthethyroidmadness.com/options-for-thyroid-treatment

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5-HTP can be miraculous against depression, plus can help troubled sleep patterns

When I went into full menopause, one issue I noticed was out-of-the-blue was afternoon depression, in spite of being optimal on Natural Desiccated Thyroid.  Bottomed-out female hormones can be problematic until I can correct them. And I found something that worked to completely remove the afternoon depression with the FIRST day of use: 5-HTP.  I was shocked.

Turns out that menopause can also mean low levels of serotonin–a brain transmitter that affects your mood positively. Your over-the-counter 5-HTP supplement (which comes from the seeds of the African plant Griffonia simplicifolia) is a precursor of trytophan, the amino acid responsible for making serotonin and melatonin. And lo and behold, what do many prescription anti-depressives, such as Selective serotonin reuptake inhibitors (SSRI) meds, do?? They increase the bioavailability of serotonin! But why put up with the side-effects when 5-HTP is natural and has so few, I decided!!

How much? 100 mg did the trick for me, once a day. But others report needing 200 or 300 mg. I started on too much–had dizziness with starting on 200 mg. Found out the hard way that 100 mg was enough for the time being until I coud better treat my female hormonal issue. I’ve read where some only start on 50 mg.

For better sleep, studies have shown that 5-HTP outright will improve your sleep due to increasing melatonin. Research has reported a lengthening and deepening of their REM period of sleep–the deep sleep–and without increasing the amount of time they sleep. It also seems to smooth any ups and downs with sleeping.  Some research shows it can take several weeks, but I figure that can be individual.

There’s even anecdotal evidence that taking 5-HTP has helped drinkers avoid the bottle. i.e. if someone drinks to self-medicate against depression, 5-HTP could help.

There are definite cautions with 5-HTP! i.e. it’s NOT recommended to take it with anti-depressants or any seratonin-raising drug, as together one could raise their serotonin levels too high. A lot of different experiences with 5-HTP can be found here. As always, talk to your doctor about using it or not. It may be for only short-term use.

NOTE ABOUT DEPRESSION: For hypothyroid patients, especially those still stuck on T4-only like Synthroid, depression is pretty common due to inadequate levels of T3.  Once you get on Natural Desiccated Thyroid, as well as correct any potential low iron or low cortisol issues, you may find that depression is kicked to the wind!

As intellectually stated by Eric Fliers from the Department of Endocrinology in Amsterdam, “triiodothyronine (T3) is also capable of increasing serotonergic neurotransmission by desensitization of inhibitory 5-HT1a autoreceptors in the raphe nucleus, thus disinhibiting cortical and hippocampal serotonin release, and by increasing cortical 5-HT2 receptor sensitivity, further increasing 5-HT neurotransmission.”  

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Two newer pages on STTM as of 2012, and updated to today:

  1. Adaptogens:  read how certain plant and root substances can help you cope better with stress, here.
  2. Graves Disease: never thought I’d have a page on STTM about it, but enough patients have asked that it’s now here. Besides, since many Graves patients become hypothyroid, it’s good for them be included on a site that teaches what patients have learned about far better thyroid treatment, which is NOT T4-only.
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New to this website? Read about:
  1. Desiccated Natural Thyroid as the treatment with the best results
  2. Why T4-only meds like Synthroid aren’t doing the job for all too many
  3. How many thyroid patients fall into sluggish adrenal function aka adrenal fatigue
  4. How you can treat low cortisol without the use of HC
  5. What patients have learned
  6. Mistakes patients make in their treatment
And get the REVISED STTM BOOK for more details and ease of learning about what patients have learned.