I have had physical therapy, an epidural steroid injection, numerous prescriptions for pain, muscle relaxers and have done home exercises recommended by my physical therapist. All provided only temporary relief, and my doctor has said I’ve reached my maximum medical improvement. Actually, there has been no improvement.

Despite my best efforts, I have had absences from work in excess of my former employer’s guidelines and, after six years, was terminated. This, of course, has resulted in financial problems.

After five to six weeks of feeling lethargic, experiencing extreme thirst, blurred vision and weight loss, I visited my doctor on Aug. 27, 2010, and was diagnosed with type 2 diabetes. No one in my family has ever had diabetes.

Could the physical distress and mental anguish from my accident have contributed to this condition?

DEAR READER: If I understand you correctly, you were diagnosed with diabetes 466 days after your accident. In the interim, you obviously saw a number of healthcare providers who failed to either order lab work or zero in on the diagnosis.

Glucose is the primary source of energy in our cells that make up muscles and other tissues. As food is digested, sugar is absorbed into the bloodstream. With the aid of insulin, cells are able to absorb the sugar and convert it to energy. When type 2 diabetes occurs, cells become resistant to the insulin and/or the pancreas is unable to produce adequate amounts of insulin. As a result, sugar builds up in the bloodstream.

Long-term complications can include nerve damage, pain, and tingling and numbness that commonly begin in the toes and fingers and gradually spread upward through the body over a period of months or years. The kidneys, bones, joints and other areas of the body can be damaged, as well.

My guess is that your neck pain and headaches were and are the result of the accident. You had major trauma to your head and may have even suffered a concussion. There is evidence that stress can cause sugar levels to elevate in known diabetics. This still leaves a big question unanswered as to whether stress is a trigger in a person with no prior history. Perhaps some light can be shed on the matter if your physician has lab results in your file done prior to and following the accident. Request a review of the results to determine whether there was a gradual increase in readings that might not have been identified prior.

From the copies of the MRI results you sent, I can see that you are 67 years old. Is there a possibility that because of your pain, headaches and lack of employment that you have gained a little weight and become sedentary? Are you exercising as much as possible under the circumstances and eating well-balanced meals? Everything we do affects our bodies in positive or negative ways. Sometimes simple lifestyle changes can make an enormous difference and even allow for previously prescribed diabetic medications to be reduced or eliminated.

Take a positive view. Work daily on a healthier lifestyle, and try to prove your doctor wrong. Perhaps you haven’t reached your maximum medical improvement. I would like to hope you are 67 years young and can overcome your devastating accident.

To provide related information, I am sending you a copy of my Health Report “Diabetes Mellitus.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com. Good luck.

I went to my physician for a regular checkup. Routine lab work indicated I had an elevated TSH (6). My doctor asked about fatigue, weight gain, hair loss, brittle nails, dry skin and more. I explained the circumstances of my former job and because of my age, I was at least perimenopausal. I was still having periods every three weeks instead of four. I felt the symptoms I had indicated hypothyroidism. I expressed my feelings and was prescribed levothyroxine, which was to continue forever. Well, I took it for six months and saw no improvement, except for a lowered TSH level. I gained back the 20 pounds and weaned myself off the medication. I still noticed no change in my health.

My question is: Could adrenal fatigue or exhaustion from the stress and being perimenopausal be factors in the elevated TSH? Could they normalize on their own when the stress is removed? I understand there are cardiac implications with levothyroxine. I don’t suffer any issues, but there is a family history on both sides. At what point does the risk outweigh the benefit? I currently feel fine, my nails are longer than they have been in years, and my hair is OK, as is my skin. My energy level is acceptable, and I wish the 20 pounds stayed off that I gained back.

DEAR READER: I can understand why your physician put you on levothyroxine, because hypothyroidism can cause fatigue, changes in hair texture and thickness, split finger nails, dry skin and irregular menstrual cycles. One striking difference is that weight gain is relatively common. However, the reversal in your case is obviously job-related.

Let’s cover a few basic differences between adrenal fatigue and hypothyroidism. Adrenal fatigue carries no specific symptoms of heart palpitations, no fluid retention, orthostatic hypotension, good flexibility of ligaments, thin and brittle nails, thin hair, insomnia, dry skin, cold intolerance and a craving for sweets. Hypothyroidism isn’t generally associated with palpitations and presents with fluid retention, no orthostatic hypotension, poor flexibility of ligaments, normal to thick nails, coarse hair, sleepiness, normal skin, heat intolerance and a craving for fats.

Stress plays an enormous role in health, affecting us in a variety of ways and worsening many medical conditions. Therefore, I cannot rule it out as having a bearing on the symptoms you have. My recommendation is to have your TSH retested to determine what your readings are without the levothyroxine. Discuss the pros and cons with your physician. Maintain a healthful diet, get adequate rest, reduce the stress in your life, and exercise regularly. The body is a truly miraculous thing. Give it some time to recharge, but don’t hesitate to seek medical intervention if appropriate.

To provide related information, I am sending you a copy of my Health Report “Thyroid Disorders.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: I’m glad I could help. I will definitely provide an update as new developments unravel.

To provide related information, I am sending you a copy of my Health Report “Headaches.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 4409-20167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: Most students consider themselves knowledgeable, if not expert, regarding the subject of student pressure. The many theories of this phenomenon do little to solve the problem of what this is and what can be done about it. While the medical director of a local private school for 33 years, I saw the multifaceted consequences of this ubiquitous blight. Neither the problems nor the consequences have changed much over the years and, in fact, they may have exacerbated. All we need do is read the daily newspaper or watch television to see the horror stories unfurl when students and faculty are pressed too hard. There seems to exist two basic classes of student pressure — external and internal.

External pressure, either flamboyant or insidious, is delivered up by the environment. For example, consider pressure from teachers. “I don’t care that you’ve got a two-hour test tomorrow; tonight’s history assignment is STILL 60 pages!” Or from parents: “If I’m going to send you to a fancy private school, you should try harder to get good grades!” Or from peers: “Oh, c’mon. One little puff or a can of beer isn’t going to kill you!”

External pressure can be destructive if it takes the form of unrealistic expectations that students may find difficult or impossible to meet. Such demands can be seen in the teacher who flunks three-quarters of an entire class or in a parent who insists that his child must attend an Ivy League college. Students who accomplish goals solely to please their parents or other adults may become unhappy achievers under a constant blanket of pressure. External pressure is difficult to control because certain people “own” it and use it in an attempt to force other people into developing “maturity and independence.” This approach may be necessary in raising children, but in the adolescent, it can result in uncomfortable feelings. These feelings are often reflected in various escape techniques, such as drugs, feigned illness and dropping out.

On the other hand, internal pressure can be a positive force, as in, for example, the student who achieves because he wants to. Once a person develops a system of internal pressure, he may no longer need to be told what to do. This type of pressure enables people to make valid judgments regarding situations — for instance, “If I wait until the last minute to write my term paper, I’ll be sorry.”

Students who are operating under internal pressure may feel rushed and exasperated, but they seldom feel the need to escape. They tend to take successes and failures in stride. They may have better-developed concepts of what they can and cannot do. They are more fun and less grim. They usually feel good about themselves. By not being a slave to the wishes of other people, they can enjoy the security of attending to the many exciting options around them. They are not afraid of saying: “That’s not for me. I’d rather do this.”

While there are no easy answers to the problem of student pressure, perhaps some students would feel better by developing a certain amount of internal pressure that will enable them to pick appropriate goals and organize suitable methods of achieving them. This approach certainly beats the day-to-day overwork/fatigue/frustration cycle that seems to be such an accepted lifestyle at school.

External pressure is a continuing and constant feature of living in society. It can be dealt with, although not controlled, by putting it in perspective.

Every year of our lives — particularly those spent in the education system — should be filled with fond memories. Some events may not be uproariously funny and might even be rather humbling; that’s what makes us what we are. And I’m not implying that students shouldn’t work hard — quite the contrary. They should give these informative years their all and use each experience as a foundation for the future. I recommend you have a frank talk with your parents and teachers. Be responsive to their concerns and indicate you will attempt to meet their expectations. At the same time, explain the additional pressure creates more of a burden than you can handle. A compromise is in order. If necessary, seek the services of a guidance counselor, the clergy or other trusted adult who can guide you through this difficult period.