I had a new patient last week who came in, settled herself into the chair across from me, and offered me a smile with just a little edge of nervousness behind it. “So,” I said, “do you want to tell me about what’s been going on?”
What unfolded was a story I hear frequently, but it never stops mattering.
She’d been feeling unlike herself, but in a way that was hard to pin down, hard to point to and say, ‘this is what’s wrong’. She’d been gaining weight without changing much about how she was eating. Sleep had become unreliable. Energy that used to be there in the mornings just wasn’t. It wasn’t dramatic. There was no single moment she could point to when everything started feeling off. Just a slow drift away from the version of herself she recognized, over the past couple of years.
Getting an appointment with her regular doctor had taken several months.
When she finally got her fifteen minutes, she did her best to explain. She’d been talking with a friend who’d had similar symptoms, and her friend had mentioned getting her thyroid checked. She brought it up, a little tentatively. Her doctor scoffed and told her not to take medical advice from friends. Still, he agreed to run a thyroid test. The rest of the appointment was spent on her blood pressure, which was reading a little high. She didn’t mention that parking had been a nightmare and she’d been afraid she was going to be late. She just nodded and hoped the labs would tell her something.
When she got home, she checked her patient portal and felt a small lift of hope. He’d ordered a TSH, a cholesterol panel, a CBC, and a metabolic panel to look at her liver, kidneys, and electrolytes. Something in there might give her an answer.
The results came back a few days later. A message from the office let her know that her thyroid looked normal, everything was fine, but her cholesterol was higher than they’d like, so she should reduce her fat intake, start a heart-healthy diet, and they’d recheck it in a year.
She told me she’d felt disappointed and dismissed.
She knew, logically, that “everything is fine” was supposed to be good news. But she didn’t feel fine. She felt exactly the same as when she’d walked in, just with less hope that anyone was going to help her figure out why.
By the time she ended up sitting across from me, most of that hope had been wrung out of her. It had been months, really, years, since she’d felt like herself. So I did what I always do first: I listened. She told me about the stressors in her daily life, the losses she’d been carrying, everything that had quietly accumulated on her shoulders.
We talked about her sleep, her energy levels, what she’d been eating and how her digestion had been responding to it. We talked about how she moves her body, or how she used to, before she stopped having the energy for it. She pulled out a bag of supplements she’d collected along the way, some on the advice of friends and family, some grabbed off a shelf on the logic of ‘maybe this will help’. I looked through them without judgment. Sometimes there are gems in those bags.
After all of that, we decided together that we needed a few specific pieces of information before making any real plan. What were her hormones doing? What was her thyroid actually doing? And why, exactly, was she so tired?
I ordered a comprehensive thyroid panel, not just a TSH, but the actual thyroid hormones, because TSH alone tells you very little about how the thyroid is functioning. I added iron and ferritin to check for anemia, which is a surprisingly common and commonly missed cause of fatigue in women. I included an hsCRP to get a sense of what inflammation was doing in her body. And because the cholesterol story felt incomplete, I ordered additional markers to look at LDL particle size, which gives us a much more nuanced picture of cardiovascular risk than a standard panel does.
I also ordered a saliva hormone panel: estrogen, progesterone, testosterone, DHEA-S, and cortisol. Because maybe this was perimenopause. Maybe something was happening with her adrenals. In my experience, it’s often both, and they tend to make each other worse.
We talked about what a truly heart-healthy diet actually looks like (it’s not just low-fat – that guidance is decades out of date), how much fiber she should realistically be aiming for, and some practical strategies for getting there without overhauling her entire life overnight.
She left with a plan. That was new for her.
I’m confident we’ll find a culprit, or more likely, a few of them working together. That’s usually how it goes. It’s a privilege to get to spend an hour with someone like her, to actually hear the full story instead of the abbreviated, anxious version people deliver in fifteen-minute appointments. And I’m grateful that I have a wide range of tools available to go looking for answers.
Getting to feeling better does take some effort and some patience, it might be a few months of targeted supplementation, or reincorporating movement, or adjusting how she’s eating, or some combination of all of it. But most patients do get there. I expect she will too.
If any of this sounds familiar — if you’ve been told your labs are normal but you still don’t feel like yourself — you don’t have to just live with that. Schedule a complimentary 10-minute consultation and let’s start figuring out what’s actually going on.
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Dr. Jennifer Potter, ND
Naturopathic Doctor San Jose
408-356-1364
Dr. Jennifer Potter, ND provides natural healthcare solutions for families and individuals, focusing on perimenopause/menopause, autoimmune conditions, fatigue, and immune support. She is deeply committed to her patient’s well being, prioritizes patient education and combines natural and conventional therapies to deliver personalized care. Outside of her practice, she enjoys time with her two kids, reading fiction, and crocheting.
