February 22, 2019
Support Prior to Treating CIRS
The other day I ran across series of presentations by Dr. Andrew Heyman on Chronic Inflammatory Response Syndrome (CIRS). Dr. Heyman has been working with Dr. Shoemaker for some time now (helped with NeuroQuant) and follows Dr. Shoemaker’s protocol. In addition, given his integrative/functional medicine background, Dr. Heyman also brings alternative therapies to the table. This new information along with Dr. Heyman’s very detailed and well laid out presentations drew me in and I ended up spending several days pouring over his CIRS videos. By the time I decided to stop, I had about 25 pages of notes that I hope to build into Biotoxin Journey starting with this article.
Learning about alternative herbs and the like that can be used in place of allopathic medicine (drugs) along with approaches that help to support a person while treating CIRS is so very important. Many with CIRS either can’t get to the help they need, because there simply are so few CIRS doctors, or they can’t afford to pay for a qualified doctor and expensive medicine. Dr. Heyman acknowledges the huge sea of people that are going untreated, that are suffering terribly. His presentations go a long way toward helping those less fortunate help themselves.
So we’re lucky to have Dr. Heyman, whom after watching several of his videos, is clearly “firing on all eight cylinders”, is super dedicated to finding answers that work, and that although he comes from an integrative background, he’s also very science based. Like Dr. Shoemaker, one gets the impression that he only suggests alternative therapies that are supported in the literature along with using labs to confirm efficacy. He seems to do a nice job marrying rigid science with a more holistic approach.
One of the approaches Dr. Heyman uses is to begin treating CIRS patients right away. CIRS folks are being fried on many levels including their brains and nervous system. It can be horrific. It’s one thing to be super tired and in pain. It’s a whole other matter when a person is also riddled with unbearable anxiety, or being totally crushed by depression, or some other array of traumatic psychological symptoms stemming from toxins eating away at the brain and nervous system.
On the topic of stress, Dr. Heyman mentions the work of psychologist Bruce McEwen. In particular, Mr. McEwen describes how the body naturally down-regulates the stress response over time to help protect against the damaging effects of the natural stress response. For example, although high cortisol and DHEA levels can be very beneficial in helping the body deal with stressors in the short term, over time, there are numerous adverse consequences when these hormones remain high related to the gut lining, hippocampus, MSH, among others.
The Impacts of Stress on the Brain and Learning – Bruce McEwen Ph.D.
With prolonged stress like CIRS, the body responds over time by suppressing cortisol and DHEA levels in order to limit the type of damage that high levels of these hormones produce. This is why supplementing with cortisol, or testosterone, or vitamin D does not work well without first treating CIRS; the underlying driver has not been addressed.
Unfortunately, lower cortisol and DHEA levels are not healthy either as this causes the immune system to become both TH-1 dominant and unregulated. A poorly regulated immune system increases the risk of autoimmunity, high IL-6, TNF-alpha, and CRP. It also leads to toxicity in the brain (microglial activation), less serotonin in the brain (happy neurotransmitter), and various symptoms related to inflammation.
So not only does CIRS destroy the person physically but the prolonged stress causes further damage. Dr. Heyman gets this; he knows people need help immediately. As such, he begins treating patients right away with his “foundation” protocol that I’ve outlined below. I only wish these sorts of options were available to me when I was in the depths of hell.
I’m so grateful that not only has Dr. Heyman, like Dr. Shoemaker, made the effort to share the details of his protocol but just as important, acknowledges that folks can go a long way toward helping themselves when they are given the requisite information. I wish there were more doctors like him. Really, the CIRS doctors out there need to step back and look at the current state of affairs. We’re brutally dying here; there is no way a few dozen doctors can treat the estimated 40 million with CIRS. Help us by sharing what you know!
In general, the “foundation” protocol starts one month prior to additional treatment and includes introducing healthy fats so the body can begin healing frayed nerves along with taking anti-inflammatory herbs to counter the over-active innate immune system. In addition, supplements to help clear brain fog along with pharmaceuticals to quell some of the worst psychological symptoms are also prescribed. The idea is to provide the critical relief that the person so desperately deserves along with the support required to allow them to follow the involved CIRS protocol.
Dr. Heyman’s Foundation Protocol
Patients are started immediately on the following while waiting for the results from lab tests and continue with these foundation supplements for the duration of treatment. Not only does this protocol provide longed for relief but also is essential, particularly for those with chronic Lyme, in preventing an exacerbation of symptoms when the CIRS protocol is started.
Dr. Heyman says that it’s important to aggressively replace lipids (fats/oils) in order to heal cell membranes. Phosphatidylcholines (PC), also known as lecithin, are specialized fat molecules that are used to construct cell membranes. Related to CIRS, PC helps repair the nervous system and mitochondria ATP energy production along with reversing dendritic pruning in the brain by healing the myelin sheath covering damaged (excoriated) nerves in CIRS. In addition, as discussed in Phospholipids, PC is critical for detoxification.
CIRS causes bad lipids to build up around and inside the mitochondria – the energy factory of the cell. These bad fats cause inflammation, poor communication between cells, and consequently inhibit healing. In this context, Dr. Heyman mentions the work of Dr. Patricia Kane – see the PK – Membrane Stabilizing – Protocol for Neurological Disorders.
In his practice, Dr. Heyman uses oral and IV lipids that include phosphatidylcholine (PC). PC helps the outer membrane on mitochondria. In addition, taking phosphatidylinositol and posphatidylethanolamine is important for the inner mitochondria membrane. Since IVs generally only have PC, it’s important to take oral sources that contain all three forms of lipids (fats). Dr. Heyman has seen dramatic results using phosphatidylcholine. However, be advised that it can take close to two years of lipid supplementation to turn over the cell membranes. Correcting lipids corrects abnormal gene expression.
- Phosphotidylcholine (PC)
1.8g of PC twice daily – 9 grams of typical 20% PC lecithin powder. Note: According to my calculations, this equates to 2Tbls of Swanson Sunflower Lecithin Powder twice daily (96 cents/day). I like to put my lecithin in the green smoothies I make for each meal.
- Black Currant Oil or Fish Oil
Dr. Heyman suggests 2-3 grams of Omega 6/3 oil in a 4:1 ratio twice daily. These oils help repair the blood-brain-barrier along with sealing up membranes. Note: Dr. Heyman used to recommend Safflower, Chia, and Flax Seed. However, the oils in these seeds easily go bad and can be damaged by heat. In an interview with health guru Dave Asprey, Dave commented that the omega-3 oil in chia and flax are easily damaged by light and heat along with containing higher amounts of lectins. Dave has not done well with these seeds. In response, Dr. Heyman said it’s important to get quality seeds that are kept refrigerated and lightly ground to prevent heating just before consuming them in a cold drink. Do not use pre-ground products. However, in a more recent version of his foundation protocol, Dr. Heyman now recommends black currant or fish oil. My Note: Alternatively, a person may want to consider krill oil as, according to Dave, it doesn’t spoil easily and a person only needs half as much as fish oil.
Dr. Heyman doesn’t go into any details here other than mentioning that electrolyes are important. I talked about electrolytes in Biotoxin Journey – Blocked Detox – ECM
- Wheat Germ Oil
Wheat Germ oil contains polycosanol. Polycosanol helps with cholesterol but, more importantly, it is a “structural fat”.
Green tea contains L-Theanine that helps calm and focus the brain. Take 50-200mg two to four times daily (28 cents/day).
“Synapsin— is an innovative, patent-pending powder blend of ginsenoside Rg3 and nicotinamide riboside along with ingredients to aid in solubilization and dispersion. It is designed to be used in formulations for the support of neurological health and cognitive support. Synapsin was invented by renowned author, pharmacist and functional medicine speaker Jim LaValle, RPh, CCN, ND, and is commonly used in combination with methylcobalamin or hydroxocobalamin in formulations to support neuronal function and cognition.”
Dr. Heyman recommends down time with Synapsin – 3 months on followed by 2 weeks off. Spray contains 2mg Rg3 and 2mg NR and is taking during the entire treatment process. It takes 2-4 weeks to see benefit.
NR/Rg3 Nasal Spray
Plant Sterolins raise T-regulatory cells to help balance TH1, TH2, and TH17 aspects of the immune system. Rg3 is very helpful sterolin for CIRS patients with neurological issues. The nasal spray, Synapsin, contains Rg3 and Nicotinimide Riboside (NR). Alternatively, NR can be taken as an oral supplement with the typical dose being 250 – 500 mg daily – best taken sublingually. It can also be mixed into a nasal spray. Dave Asprey commented that he did not experience benefit from oral NR under 1,000mg.
- These are my own NR research notes
- Form of vitamin B3 (niacin) from cow’s milk
- Speeds neurogenesis and prevents neuronal damage
- NR increases NAD+ levels resulting in improved nucleus and mitochondrial health
- Niagen is sold and packaged by numerous companies – get pure Niagen
- Truniagen – $35/bottle/month
- Chronic Nicotinamide Riboside Supplementation is Well-Tolerated and Elevates NAD+ in Healthy Middle-Aged And Older Adults
- Supplementing with nicotinomide riboside (NR) daily mimicked a caloric restricted diet resulting in the increased production of the healthful anti-oxidant Nicotinamide Adenine Dinucleotide (NAD+).
- NAD+ levels rise proportionally to the dose.
- 1 gm daily of NR raised NAD+ by 60 percent.
- NR lowered blood pressure in stage 1 hypertension by about 10 points.
- NR is typically given as an oral supplement at doses of 250 – 500 mg daily
- Hidden Vitamin in Milk Yields Remarkable Health Benefits
“…researchers found that mice on a high-fat diet supplemented with NR gained significantly less weight (60 percent) than mice fed the same diet without NR, even though the mice supplemented with NR ate the same amount of food as mice on the high fat diet not treated with NR. They had improved energy. They were in better shape than the untreated mice, with significantly better endurance and stronger muscles. Additionally, none of the treated mice developed diabetes, as seen in the untreated mice on the high fat diet. And when fed a normal diet, NR treated mice had improved sensitivity to insulin. The NR treated mice also showed lower cholesterol levels. All of these benefits came without toxicity.”
- The NAD+ Precursor Nicotinamide Riboside Decreases Exercise Performance in Rats
This was the only negative study I could find on NR and is in contradiction to other studies including there being no known adverse side effects in human studies.
- Novel NAD+ Metabolomic Technologies and their Applications to Nicotinamide Riboside Interventions
I provide the first evidence of effective NAD+ supplementation from NR in a healthy, 52 year old human male, suggesting the metabolic promoting qualities of NR uncovered in rodent studies are translatable to humans. During my investigation of NR supplementation, my work establishes an unexpected robust, dramatic increase in deamino–NAD+…
- Charles Brenner, PhD Discusses Nicotinamide Riboside
- NAD levels peak about 8 hours after taking NR. However, you do not need to dose NR throughout the day. Since NAD levels naturally peak once during the day and once during the night, at most, you could take NAD in the morning and then again before bed – particularly if you’re taking higher doses.
- NR can be taken with our without food.
- Taking high amounts of NR may reduce folate levels.
- In animal studies, NR boasts metabolism.
- NR helps with metabolic stressors like insulin resistance, weight loss, prevention of diabetic neuropathy, and protection against noise induced hearing loss.
- NAD is central to cellular bioenergenics, DNA repair, resistance to Reactive Oxygen damage, steroid synthesis, and so on.
- Additional NR Benefits
- Boosts ATP and mitochondrial health
- Reduces inflammation and oxidative stress
- Anti-tumor and enhances DNA synthesis
- Reprograms dysfunctional cells
- Increase cognition and reduces Alzheimer’s
- How To Boost NAD, The Coenzyme of Life: Charles Brenner #491
- A 250mg dose will increase resiliency but typically won’t be felt
- 500mg in the morning and 500mg in the evening are more therapeutic
- Dave Asprey didn’t feel any improvement until 1 gram where it turned up his brain to 100%
- Normally takes 2-3 weeks to notice improvement
- Hair and fingernails grow faster
- Recovery after workouts and air travel is quicker
- Taking NR in the evening may help with sleep
- Unlike B3 in the form of niacin, NR does not cause flushing
- NR reduces hypertension (high blood pressure)
- These are my own Rg3 research notes
- Rg3 is a triterpene, a large family of bioactive ginsenoside compounds, found in Panax Ginseng.
- Panax Ginseng is also known as True Ginseng, Mountain Ginseng, and Wild Ginseng and is not the same as Siberian Ginseng, American Ginseng, Chinese Ginseng, or Pseudoginseng.
- Rg3 protects the brain from oxidative damage and stimulates neurogenesis. Decreased brain excitotoxic and oxidative stress results in better memory effects and less “brain fog”
- Rg3 reduces microglial activated inflammation and neuronal cell apoptosis in neurodegenerative conditions
- According to Dr. Heyman, stress initially causes the hippocampus to swell but prolonged exposure to adrenalin causes it to shrink. When this happens, the brain reduces cortisol levels to protect itself. Lower cortisol levels, due to prolonged stress, is common. The hippocampus converts short-term memory into long-term memory, and gives emotional “weight” to stored memories.
- The hippocampus can be repaired in as little as 2-4 weeks.
- Rg3 can be taken as an oral supplement or nasal spray.
- Dr. Heyman is doing a study with veterans that take 5 mg twice daily, on an empty stomach.
- Given that I didn’t want to see my doctor to get a script for Synapsin, I set about seeing if I could estimate how much Panax Ginseng to take orally. In Cancer Prevention and Therapeutics: Panax Ginseng has a table that shows the combined percentage of Rg1, Rg2, and Rg3 in younger fresh Panax Ginseng to be around 1%.Additionally, the study states that in recommended doses (1-2 g of the crude drug or 200-600 mg of standardized extracts – calculated to 4-7 percent ginsenosides) that there are no known side effects of P. ginseng. Various studies site used between 110mg/day to 37g/day for a 150lb person.
- On the page, Panax ginseng they say that “Panax Ginseng tends to be taken in doses of 200 to 400mg daily for general ‘preventative’ medicine, although some studies on the inclusion of Panax Ginseng in a multivitamin suggest doses as low as 40mg might be bioactive. The 400mg dose appears to confer most cognitive benefit. These doses refer to standard ‘Ginseng Extract’ which is around 2-3% total Ginsenosides, and is a once daily dosage.Trials using Korean Red Ginseng extract for erectile health and libido enhancement tend to use 3g of total Korean Red Ginseng (fermented panax ginseng) extract daily, in three doses of 1000mg.”
- Cognitive function (e.g., memory, focus, attention, and intelligence) and brain health.
- Antioxidant and Anti-inflammatory
- Allergies and Immunity
- Muscle Gain and Exercise
- Energy and Stimulation
- Men’s Health
- Testosterone Boosting
- Libido and Sexual Health
- Given the above, it seems reasonable to assume that less than 0.5% of Panax Ginseng is Rg3. If I use 0.5%, this equates to 1 gram of Panax Ginseng containing 5mg of Rg3. Given the doses shown above, taking 500mg-1g grams of powder daily seems reasonable.
- RG3 300- Ginsenosides $15/100mg Rg3
- NuSci Panax Ginseng Extract Powder 10% Ginsenosides 1,000 grams for $26
Dr. Heyman said very Long Chain Fatty Acids (VLCFA), Trans Isomer fats, Saturated Odd fats, and Renegade fats build-up in the cell membranes forming “ceramide lipid rafts” that inhibit cell function. Butyrate is a type of fatty acid that clears these unhealthy fats and helps your gut heal. To prevent exacerbation of symptoms with butyrate, start by supplementing with healthy fats and oils first. Dr. Heyman noted that Lyme lives off VLCFAs. Dr. Heyman likes BodyBio PC because it’s imported from Germany ($1.50/day).
Curcumin & Stephania Root
As the name implies, CIRS is all about excess inflammation. Curcumin is anti-inflammatory and crosses the blood-brain-barrier. Take 500-1,000mg daily. When a patient is really inflamed, Dr. Heyman suggests using Stephania root. BulletProof makes Curcumin Max with stephania root.
MetaGenics SPM Active
Specialized Pro-Resolving Mediators, or SPMs, reduce painful inflammation and down-regulation of inflammatory macrophages and microglial cells. MetaGenics has a 10-year patent on MetaGenics SPM Active. SPMs, are derived from fish oil and have a powerful effect on reducing inflammation. SPMs consisting of Protectins, Resolvins, and Maresins do not work to reduce inflammation like curcumin or aspirin. Instead, they are cell-signaling molecules that turn off inflammation Start with a “loading dose” of 6 tablets daily for two weeks followed by 2 tablets daily.
NCBI Study: Resolvins and Protectins: Mediating Solutions to Inflammation
Resolution of inflammation has historically been viewed as a passive process, occurring as a result of the withdrawal of pro-inflammatory signals… Only recently has it been established that inflammation resolution is an active process with a distinct set of chemical mediators. Several clinical and epidemiological studies have identified beneficial effects of polyunsaturated fatty acids (PUFAs) for a variety of inflammatory diseases, yet without mechanistic explanations for these beneficial effects. Resolvins and protectins are recently identified molecules that are generated from ω-3 PUFA precursors and can orchestrate the timely resolution of inflammation in model systems.
Severe Anxiety – Poor Sleep – Panic Attacks – Etc.
It’s important to provide the calming relief needed and ensure good sleep. Given that CIRS patients are oftenin severe distress, Dr. Heyman is not adverse to using drugs to accomplish this.
- Lyrica – pain management with long list of side effects including dizziness, constipation, swelling, and suicidal thoughts along with wicked withdrawal symptoms similar to benzodiazepines. Use small doses.
- Lamictal (lamotrigine) – mood stabilizer and anticonvulsant with a long list of side effects including vision, clumsy, rash, anxiety, confusion, depression, diarrhea, chills, and unusual bleeding along with withdrawal symptoms. Lamictal is associated with life threatening skin reaction, Stevens-Johnson syndrome (SJS). Dr. Heyman has never seen an SJS reaction in his patients. Use small doses
- Neurontin (Gabapentin) – when insurance companies deny Lyrica and Lamictal. Gabapentin treats seizures, neuropathic pain, hot flashes, and restless legs syndrome. I’ve used between 50-100mg of this old class of drug in the evening to help when nothing else works without any side effects.
- Seroquel – when sleep is an issue Dr. Heyman may prescribe 25-50mg. Seroquel is often used to treat schizophrenia and bipolar disorder. When seroquel causes fatigue in the morning, use trazodone.
- Neuromedulla Glandular – For poor sleep, take 2 capsules of neuromedulla glandular at night to re-activate the hypothalamus.
Although CIRS is not caused by eating moldy foods, nonetheless, the foods listed below tend to be moldy and consequently can further provoke an already inflamed system.
- Alcohol including beer, wine, and hard liquor
- Wheat, oats, barley, rice, sorghum, and rye
- Peanuts, walnuts, and cashews
- Hard cheeses
- Apple juice, coffee, and chocolate
- Cottonseed oil
- Sugar (from sugar cane or beets)
- Tomato paste
Great article as usual Greg summarizing. Dr. Heyman and his practice are doing tremendous work and they are open minded and flexible for more literate CIRS patients that are also highly sensitive. I’ve recommended a number of people to his practice. One thing is very clear for those of us following Shoemaker and others the last 10-15 years, getting out of a moldy environment has to be the 1st step – albeit a very difficult one.
I totally agree about getting out of a moldy environment being of paramount importance.
Dr. Heyman’s willingness to share details of his protocols with the public blew me away.
I hope other CIRS doctors “follow suit”!
Yes, Dr Heyman is a jewel. I have met him on several occasions at courses I have done. I am a Certified Nurse Practitioner (CNP) interested in this subject. Taking one of the Shoemaker courses at this time. Interested in starting a practice with another practitioner in Santa Fe, New Mexico. If you know anyone interested in starting or working with another provider, I would be interested in meeting that person. Thanks for your great work.
Corey Sutter FNP
coreysutter -at- me.com
Thank you for your commitment to helping others with CIRS. Unfortunately, I don’t interact much with CIRS doctors.
Hope this will give me some relief. How long should I maintain this and what follows? Also, do you know where I can find a doctor that will prescribe the nasal spray? As soon as I mention CIRS or mold, doctors run. Thanks in advance
Tim – VCS is a tool to monitor your clearance of biotoxins. Where do you live?
I hope it helps too. One thing I’ve learned is that a person has to just try various adjunct treatments while sticking to the core of Dr. Shoemaker’s protocol. What helps for one person, may not for another.
Dr. Heyman recommends keeping up with the “pre-treat” protocol for the duration of treatment. Those with CIRS almost always need the extra sleep support along with lowering inflammation and working to rebuild frayed nerves by supplementing with healthy fats.
For years I worked with a sympathetic doctor that didn’t know much about CIRS but was willing to listen and support me (scripts). I know it can be hard to find a CIRS doctor. My only advise is to just make a “boat load” of phone calls. Perhaps calling places that do massage therapy, acupuncture, essential oil therapy, and like might be more fruitful as these sorts of folks tend to be further out there. You can also try calling Hopkinton Drug and ask who is prescribing VIP nasal spray in your area.
In lieu of the Rg3/NR spray, you can get Truniagen and Panax Ginseng as supplements – see my notes above.
Finally, Robert M is right. You definitely want to make sure you have CIRS before you take on the involved treatment. VCS testing is one inexpensive place to start. Nowadays, you can also order your own testing from Life Extension. If you take a look at my Dr. Heyman notes, you’ll see that it includes several of the markers used to diagnose CIRS by labs and guide treatment.
When 3 out of 6 of the markers are present, the person has CIRS.
1. Fail VCS
2. Susceptible HLA haplotype
4. ACTH/Cortisol imbalance
5. ADH/Osmolality imbalance
6. Low MSH
I know Im suffering from CIRS but I cant find a doctor that my insurance will cover that has even heard of CIRS… I know you must stay positive but it is getting hard, because Im so tired and have no money left. Im losing hope. 🙁
I totally get it. Being able to self-treat CIRS was a strong impetus behind creating Biotoxin Journey. Given the estimated millions suffering from CIRS along with so few doctors that understand, I really wanted to try to get information out there that could help. Until CIRS becomes mainstream, people need tools to try to help themselves.
In case it helps, take a look at my comment to Tim above about finding a doctor.
Thanks so much for amassing the notes and getting this info out, Greg. I too am blown away!
Thanks for sharing. I found one item mentioned to be considered; the use of trazodone (for sleep support) and systemic fungal infections. Its documented to not use trazodone with chronic infections particularly fungal related. It has a high degree of causing dry mouth, which contributes to fungal and bacterial especially in the mouth and sinus areas. This possible affect can then also contribute to jaw cavitations.
That’s interesting about Trazodone causing dry mouth that then can lead to fungal and bacterial issues. I would not have thought of that. Mayo writes, “Trazodone may cause dry mouth. For temporary relief, use sugarless gum or candy, melt bits of ice in your mouth, or use a saliva substitute. However, if your mouth continues to feel dry for more than 2 weeks, check with your medical doctor or dentist. Continuing dryness of the mouth may increase the chance of dental disease, including tooth decay, gum disease, and fungus infections”.
In order to provide a little more context, CIRS is not caused by an internal fungal infection in the body. However, dental issues can make removing the nasty sinus infection (MARCoNS), that many with CIRS have, difficult to treat – an essential step in the CIRS protocol.
For folks following this, Dr. Heyman comments that he prescribes Trazodone when folks can’t tolerate Seroquel. He doesn’t go into details about under what conditions he prescribes Seroquel.
Great article Greg. Any idea on a source for sublingual nicotinamide riboside? I’ve seen at least one powder form that it mixed with water so maybe that would work. Or maybe folks are just emptying out the contents of the pills under their tongues? Having said that, I’m a little concerned about the use of high doses of NR. Chris Masterjohn believes that like all forms of niacin, NR will suck up methyl groups. On the other hand, I’ve seen other opinions that say that this is not the case for NR.
Thanks for the heads up. I did watch Dr. Masterjohn’s video. He’s basically against taking over 35mg of Niacin in any form including Nicotinamide riboside (NR). The concern is with potential negative side effects as additional methyl groups are consumed in the processing of NR. He does say that if a person needs to take larger doses for a specific medical reason, that it’s best to take equal amounts of Jarrow’s TMG and NR. Given his concern, this appears to make sense as TMG is Betaine Anhydrous (Trimethylglycine), a methyl donor.
For another point of reference, this study of 60 individuals found “… that 6 weeks of NR supplementation at this dose (500 mg, 2×/day) is well-tolerated in humans and effectively increases blood cellular NAD+ concentrations”. Also, higher doses of Niacin have been used to treat various ailments for some time now – energy (50-500mg), arthritis (1,000-1,500mg), cholesterol (1,000-3,000mg), and so on.
Thank you and I’m grateful for the information you are providing. Well done.
I too have been recently following Dr. Heyman (found him by Bulletproof’s podcast with Asprey in the past) and my CIRS doc is doing nothing like Heyman’s protocol. I feel like I’m spinning wheels, I’m trying to learn and then explain these “routes” to my doc…so much too do.
I can mention that Synapsin 30ml (Rg3) is ~20 dollars less through Hopkinton ($138) than Town & Country ($156). One thing I know about ALL the compounding pharmacies is that they hammer you on shipping costs, I find it greedy to be honest. $26 to ship a 30ml bottle and it takes over a week to receive. I digress..
P.S. I have no affiliation with either pharms.
Take Care hope to hear more…
Thanks for the info on pricing.
Hope your journey gets easier with time.