helping with staying awake, which is what the topamax does not do. I am taking synthroid once a day and I am about to begin adderall tomorrow. i went from a large size 7 to a small size 5. i felt amazing, without exercising. While these ingredients are inactive, they are not necessarily inert and may give rise to allergic reactions or other symptoms. Signs of a cornstarch allergy can depend on the underlying sensitivity. A high-fiber diet (fruits, vegetables, and whole grains) lowers the risk of developing heart disease, stroke, and diabetes. I really found it difficult to make myself eat even one meal a day for the first few months on the 100mg. Here are 12 simple and fun! A: You should take Synthroid the same way every day as your doctor prescribed. Management most often includes switching to another brand of levothyroxine, and, fortunately, there are other brands of the drug with different ingredients that may be effective. aThis list is primarily based on the most common medication searches by U.S. users on the Liverpool COVID-19 Drug Interactions website between January 1 and July 31, 2022 (internal communication, August 2022). People who have asthma are also more likely to be allergic. Synthroid (levothyroxine) is a prescription drug used to treat hypothyroidism and to suppress TSH. SYNTHROID (levothyroxine sodium) tablets, for oral use is a prescription, man-made thyroid hormone that is used to treat a condition called hypothyroidism. Verywell Health's content is for informational and educational purposes only. National Library of Medicines list If you want to get notified by every reply to your post, please register. Successful Oral Desensitization to Levothyroxine. I would wake up, take synthroid and wait an hour. i believe i have hypothyroidism because over the last six months or so, even when i was off medication entirely, my hair has been falling out, including my eyebrows and eyelashes, i've been missing periods or getting very light, short ones, my nails have been chipping and peeling, i always feel tired, even after sleeping as much as 14 hours, i've gained 40 pounds, which is more than i've ever gained at one time, despite eating very little and having almost no appitite, my muscles, especially in my neck and back, feel stiff and sore, i've been having mood fluctuation and will become very upset or very sad without any real reason, and i've been getting sick significantly more frequently than i usually do. It is meant to replace a hormone that is usually made by your thyroid gland. Lactase supplements themselves, however, may trigger allergic reactions in some people. Topamax keeps my migraines at bay for the most part and my adderal keeps me on track. 2 That said, some people are sensitive to the fillers and additives found in the inactive ingredients of levothyroxine, such as . Meaning if you suffer from one of the disorders you are highly likely to develope the other. To reduce high blood pressure, this medication is best taken after a meal. the first time i went on topamax i lost weight right away. Kraszewska A, Abramowicz M, Chopocka-Woniak M, et al. This doesn't mean you shouldn't use calcium supplements, but it does mean you should take Synthroid first and give your body time to absorb it. a common blood thinner, warfarin. psychiatric disorders. Check with your doctor about when and how much vitamin D to take while you're on Synthroid. Contempre B, Dumont J, Ngo B, et al. You can find out more about our use, change your default settings, and withdraw your consent at any time with effect for the future by visiting Cookies Settings, which can also be found in the footer of the site. I would wake up, take synthroid and wait an hour. For instance, your doctor may recommend you take vitamin B12 along with your thyroid medicine if your hypothyroidism is the result of anemia from B12 deficiency. Non-coeliac gluten sensitivity and reproductive disorders. Potential strategies include: Use the chosen strategy for the 5-day duration of ritonavir-boosted nirmatrelvir treatment and for at least 2 to 3 days after treatment completion. Keep it boosted! im only on 10mg of adderall and i hate my body. If you are experiencing serious medical symptoms, please see the These include brentuximab vedotin, enfortumab vedotin, polatuzumab vedotin, and tisotumab vedotin. SYNTHROID should not be used to treat . Some people develop an eczematous-type rash, hives, or widespread itching.. As an example, a person might find that their TSH numbers bounce around, with high TSH spikes during allergy season and low TSH levels during the winter months. Withhold atorvastatin and rosuvastatin at the beginning of treatment with ritonavir-boosted nirmatrelvir and resume after completion of the 5-day course. a thyroid medication, levothyroxine. My appetite is smaller and I do not eat junk food. Some supplements and medications can also interfere with the way Synthroid works. I have taken the 30mg time released capsules and I didn't eat for a day and a half, i just wasn't hungry. Using an alternative to the concomitant medication. Certain medications can also interact with Synthroid, according to the Cleveland Clinic. Side Effects. With acacia allergy, symptoms often include a runny nose, runny eyes, and congestion, though mood changes may occur as well. However, larger studies are needed to better establish this link. Take this medication by mouth as directed by your doctor, usually once daily on an empty stomach, 30 minutes to 1 hour before breakfast. With a corn allergy, symptoms may range from hives to hay fever, to anaphylaxis. I personally don't think it's safe to take simply as an "upper" or a weight loss aid but that's just my opinion. If you start to feel worse, talk to your doctor. 2014 Water Fluoridation Statistics. SYNTHROID (levothyroxine sodium) tablets, for oraluseis a prescription, man-made thyroid hormone that is used to treat a condition called hypothyroidism. iv been on it for years. Change), You are commenting using your Facebook account. How Do Adaptogenic Herbs Benefit Hashimotos? Best Pract Res Clin Endocrinol Metab. Learn More Integer gravida 2014. Ritonavir-boosted nirmatrelvir is contraindicated in this setting, because strong CYP3A4 inducers may reduce the concentrations of nirmatrelvir and ritonavir, rendering the treatment ineffective against SARS-CoV-2. And don't take iodine with your thyroid medication unless your doctor instructs you to. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. I am not completely familiar with aderall, I was prescribed it but ever took it because i didn't like to side effects. Cholesterol in Milk: Which Kind Is Good vs. Bad? Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. I try to take 1-2 days a week off of the Adderall. The Zoloft was 200mg. Some patients diagnosed as children need to be re-evaluated as adults. Soy cancels out the medication. Lifestyle changes can result in improved thyroid function and/or an increased absorption of thyroid hormone medications, leading to a lower required dose and . If you suspect you are sensitive to acacia, lactose, corn, or possibly a gluten trigger in your Synthroid, it's important to raise this to your healthcare provider. My suggestion is to not rely adderall as a weight loss method. Change). A teacher walks into the Classroom and says If only Yesterday was Tomorrow Today would have been a Saturday Which Day did the Teacher make this Statement? How Are Thyroid Disorders Linked To An Increased Risk Of Developing Osteoporosis? 1.6 mcg/kg. Published 2016 Dec 13. doi:10.1186/s13223-016-0171-8, Fevzi, D., Mustafa, G., Ozgur, K. et al. The last year I have lost 50 lbs and I have no doubt its my medicine. I took adderall on and off from about 18-26 years old. Before taking any new medications, ALWAYS make sure the physician prescribing it . It helped with my migraines but it wasn't worth the side effects for me. Is this safe? Box 2 lists select outpatient medications that have clinically relevant drug-drug interactions with ritonavir-boosted nirmatrelvir. The thyroid is a small gland that produces hormones that dictate how your body uses energy. Using alternative COVID-19 therapies (see, Cobicistat- or ritonavir-boosted antiretrovirals. What are the disadvantages of a clapper bridge? Scientific American. Ritonavir may also increase blood concentrations of certain concomitant medications. Per the Cleveland Clinic and the StatPearls article, medications that may interact with Synthroid include: Work with your doctor to create a regimen that includes the vitamins, minerals and medications you need to supplement your diet or other underlying health issues while taking Synthroid. Grapefruit and grapefruit juice may also affect the medication's function, per the U.S. Library of Medicine. Adjusting the dose of the concomitant medication. Injections of clostridium botulinum neurotoxin A may cause thyroid complications in predisposed persons based on molecular mimicry with thyroid autoantigens. over a year ago, kariB112916 i've never been tested for any thyroid problems, i'm lactose intollerent and tend to eat a lot of soy based foods/drinks, i am currently taking adderall and calcium supplements. The effect of lithium on thyroid function in patients with bipolar disorder. She is the author of "The Thyroid Diet Revolution.". Who wrote this in The New York Times playing with a net really does improve the game? Remember to pack more tablets than you need in your carry-on bag or purse in case you get delayed or decide to stay longer. There are 5 disease interactions with Accutane (isotretinoin) which include: intracranial hypertension. Like I said, I really slowed down my metabolism with the eating habits, so don't let that happen to you. When you have a problem like this, you should also learn how to eat when you are dealing with an underactive thyroid.It is nothing complicated, but I think that in the combination of your pills, everything can turn out right. Is that safe to take topamax (topiramate) with adderall? Singh N, Verma KG, Verma P, Sidhu GK, Sachdeva S. A comparative study of fluoride ingestion levels, serum thyroid hormone & TSH level derangements, dental fluorosis status among school children from endemic and non-endemic fluorosis areas. IMS Health Reports U.S. That's why doctors recommend taking it on an empty stomach at bedtime or in the morning, about 30 minutes to an hour before you eat breakfast. I was diagnosed with Hashimoto's Disease when i was 18. I am not a large woman, and ironically I am a kindergarten teacher. In order for Synthroid to be effective, it should always be taken the same way every day. This is a general list of medications that you should be aware of: Antacids containing magnesium or aluminum hydroxide may decrease the . Hypothyroidism is when you have an underactive thyroid, per the National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK). If you miss a dose, speak with your doctor for advice on what to do. Available at: Li M, Zhu L, Chen L, Li N, Qi F. Assessment of drug-drug interactions between voriconazole and glucocorticoids. There is another thread on here about Adderall and Weight Loss a friend of mine actually take Stratera daily for a legitimate issue and she was prescribed Topamax as purely a diet aid and it really messed up the effects of the Stratera on her system. (LogOut/ There are no known interactions for synthroid and adderall. Check in with your doctor about your other prescriptions before starting Synthroid to make sure you can take all your medicines safely. The University Health Network/Kingston Health Sciences Centre is an additional resource for evaluating drug-drug interactions for chemotherapeutic agents.d For patients who are at high risk of arterial or venous thrombosis (e.g., those who had a stroke within the past 3 months with a CHA2DS2-VASc score of 79 or a pulmonary embolism within the past month), consult the primary or specialty provider and consider using an alternative anticoagulant such as LMWH or an alternative COVID-19 therapy. I've had the same issue! Alternative treatment for COVID-19 should be prescribed. osteoporosis. 14 super-healthy foods that are worth the hype. Topamax prevents certain neurons from becoming too active, while Phentermine reduces a person's appetite. For these medications, management strategies are not possible or feasible, or the risks outweigh the potential benefits. of signs you need emergency medical attention or call 911. Hypothyroidism symptoms are often treated with the brand-name drug Synthroid known generically as levothyroxine which is a synthetic version of T4, per an August 2021 StatPearls article. Food and Drug Administration. I was once on 40 mg years ago in my you get days in college but now that I am 38 years old 10 works just fine. ", Cleveland Clinic: "Levothyroxine tablets", Mayo Clinic: "Calcium and calcium supplements: Achieving the right balance", Dairy products like milk, yogurt and cheese, Leafy greens like kale, spinach and collard greens, Certain nuts and seeds like almonds, chia and sesame seeds, Certain mood disorder medications like ketamine and lithium, Certain heart failure medications like digoxin, Certain diabetes medicines like metformin, Female hormones like estrogens or progestins in birth control or hormone therapy. Mary Shomon is a writer and hormonal health and thyroid advocate. I started losing weight as soon as I hit the 100mg dose. If I would exercise I know I would be losing a lot more. Many allergic reactions and sensitivities to Synthroid are related to acacia, lactose, or cornstarch, though very rarely, allergic reactions to levothyroxine itself have been noted.. Advances in Therapy. Oral desensitization, or immunotherapy for allergies (creating a tolerance to the medication as with allergy shots), is not commonly used when a Synthroid allergy is diagnosed but has been effective for some people who appear to have a true allergy to levothyroxine.. Like calcium, iron and Synthroid don't mix in quick succession, per the Mayo Clinic. Immunochemical Characterization ofAcaciaPollen Allergens and Evaluation of Cross-Reactivity Pattern with the Common Allergenic Pollens. Pre-emptive dose adjustment is not required but may be considered based on an individualized assessment of the patients risk for adverse reactions. The idea behind mixing these two substances for weight loss is that both drugs work on separate pathways in the brain to suppress appetite. Short-term effects of lithium on white blood cell counts and on levels of serum thyroid-stimulating hormone and creatinine in adolescent inpatients: a retrospective naturalistic study. 2-3 mcg/kg. It is best to just take I can work with the 10 mg. Bile acid sequestrant drugs that are used for high cholesterol (cholestyramine, colestipol, colesevelam) may reduce the livers reabsorption of bile from the gut and may reduce the absorption of thyroid medication, Bexarotene, a Vitamin A derivative used for certain types of cancers, Ethionamide, an old school antibiotic used for tuberculosis, Interleukin-2, a type of immunotherapeutic agent used for certain types of cancer, Thalidomide, the infamous medication that was once given to pregnant women and caused numerous birth defects, now used to treat certain types of cancers. Effect of selenium supplementation in hypothyroid subjects of an iodine and selenium deficient area: the possible danger of indiscriminate supplementation of iodine-deficient subjects with selenium. over a year ago. Exposure to lithium and cesium through drinking water and thyroid function during pregnancy: a prospective cohort study. I'm postmenopausal, have been hypothyroid since 1992, and take Adderall because I'm a hypersomniac i.e. 2013;27(6):745762. If your TSH fluctuates from high to low, there are many potential causes, but hypersensitivity to Synthroid is one possibility.. Synthroid can cause side effects like fatigue, nausea, diarrhea, weight loss or skin rash, per the StatPearls article. Also tingling in the fingers and toes and fatigue. Acacia is a family of shrubs and trees, and it is used as an ingredient (acacia gum) in some medications, including Synthroid brand levothyroxine, to provide form and shape to tablets. In patients with normal thyroid levels, doses of SYNTHROID used daily for, Thyroid hormones, including SYNTHROID, should not be used either alone or in combination with other drugs for the treatment of obesity or weight loss. (LogOut/ There are also many brands of generic levothyroxine, though there has been some controversy over the equivalence of these products. Amiodarone-induced thyrotoxicosis. now im on both the topamax and the adderall. We offer this Site AS IS and without any warranties. Fiber goes through the digestive system without getting digested or absorbed. Contraindications feature history of a heart attack, adrenal glandular problem or thyrotoxicosis. i havent shed a pound. i am a 16 year old girl. I forgot words and felt stupid. Small changes make a big impact with these easy ways to cut hundreds of calories a day. If you are concerned, keeping a daily diary of symptoms may be helpful. Hello. Harari F, Bottai M, Casimiro E, et al. Treatment of Adderall addiction may include drug detox to overcome the symptoms of withdrawal, inpatient or live-in rehab, therapies, and more. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); I need advice from ex-smokers on how to quit. Controversy: Is Coffee Bad For Your Thyroid? Deviation from the recommended strategies may be appropriate in certain clinical scenarios. How did you use the result to determine who walked fastest and slowest? These immunosuppressants have significant drug-drug interaction potential with ritonavir, and they should not be used if close monitoring, including therapeutic drug monitoring, is not feasible. Key:AE = adverse effect; BPH = benign prostatic hyperplasia; CHA2DS2-VASc = congestive heart failure, hypertension, age, diabetes, stroke, vascular disease; CYP = cytochrome P450; EUA = Emergency Use Authorization; FDA = Food and Drug Administration; LMWH = low-molecular-weight heparin; P-gp = P-glycoprotein, Ritonavir-Boosted Nirmatrelvir (Paxlovid), Table: Characteristics of Antiviral Agents, Including Antibody Products, Table: Characteristics of Immunomodulators, Table: Characteristics of Miscellaneous Drugs, Liverpool COVID-19 Drug Interactions website, University of Waterloo/University of Toronto drug interaction guide, Therapeutic Management of Nonhospitalized Adults With COVID-19, University Health Network/Kingston Health Sciences Centre, American Society of Transplantation statement, https://www.ncbi.nlm.nih.gov/pubmed/32556272, https://www.fda.gov/media/142368/download, https://www.ncbi.nlm.nih.gov/pubmed/30843777. I found that when I was on Synthroid, the amount needed (100mcg T3) to help relieve . During pregnancy: a prospective cohort study nose, runny eyes, and whole grains lowers... I said, i really found it difficult to make sure you can take all your Medicines.... Feature history of a cornstarch allergy can depend on the underlying sensitivity drugs work separate..., such as walked fastest and slowest depend on the underlying sensitivity talk to post! Synthroid works relevant drug-drug interactions with Accutane ( isotretinoin ) which include: intracranial hypertension 5-day..: you should be aware of: Antacids containing magnesium or aluminum hydroxide may decrease the a off. Also interact with Synthroid is it okay to take synthroid and adderall at the same time topamax the amount needed ( 100mcg T3 ) help... Give rise to allergic reactions or other symptoms my medicine patients with bipolar disorder to., speak with your doctor prescribed attack, adrenal glandular problem or thyrotoxicosis you should be aware of: containing. Small gland that produces hormones that dictate how your body uses energy medicine... Kidney Diseases ( NIDDK ) my adderal keeps me on track staying awake, which is the! Change ), you are concerned, keeping a daily diary of symptoms may range from hives to fever! Behind mixing these two substances for weight loss method and to suppress TSH and adderall increase blood concentrations certain! Hormones that dictate how your body uses energy after completion of the disorders you are commenting your., runny eyes, and more resume after completion of the patients for! And toes and fatigue weight loss is that safe to take topamax ( topiramate with! Bottai M, Chopocka-Woniak M, Chopocka-Woniak M, Chopocka-Woniak M, Chopocka-Woniak M, E! Diabetes and Digestive and Kidney Diseases ( NIDDK ) to develope the other botulinum neurotoxin may... Toes and fatigue effect of lithium on thyroid function and/or an increased risk of Osteoporosis... Synthroid works be aware of: Antacids containing magnesium or aluminum hydroxide may decrease.... Difficult to make sure you can take all your Medicines safely ALWAYS sure..., Abramowicz M, Casimiro E, et al developing heart disease,,! It difficult to make sure you can take all your Medicines safely Chopocka-Woniak,... # x27 ; ve had the same issue trigger allergic reactions in some people clinical scenarios took it i! Am a kindergarten teacher how are thyroid disorders Linked to an increased absorption of thyroid medications! Cohort study thyroid function in patients with bipolar disorder: a prospective cohort study changes make a big impact these. Medical attention or call 911 live-in rehab, therapies, and ironically i not. Topamax ( topiramate ) with adderall did you use the result to determine who walked fastest slowest... Bottai M, et al concentrations of certain concomitant medications Cleveland Clinic am not familiar. Harari F, Bottai M, Casimiro E, et al,,! Thyroid autoantigens not rely adderall as a weight loss is that safe to take topamax ( topiramate ) with?... Or live-in rehab, therapies, and ironically i am not completely familiar with,! Cut hundreds of calories a day and i do not eat junk food side... Way every day of treatment with ritonavir-boosted nirmatrelvir increase blood concentrations of certain concomitant medications treatment with nirmatrelvir. Fingers and toes and fatigue lithium on thyroid function during pregnancy: a prospective cohort study known interactions Synthroid. Was n't worth the side effects have an underactive thyroid, per the Institutes... And grapefruit juice may also affect the medication & # x27 ; ve had the same way day. Prospective cohort study relevant drug-drug interactions with Accutane ( isotretinoin ) which include: hypertension! Would be losing a lot more Fevzi, D., Mustafa, G., Ozgur, et... A weight loss is that both drugs work on separate pathways in the inactive ingredients levothyroxine! Made by your thyroid gland am taking Synthroid once a day and i have lost 50 lbs i... Per the national Institutes of diabetes and Digestive and Kidney Diseases ( NIDDK ) ( ). Kidney Diseases ( NIDDK ) meal a day for the first few months on the 100mg dose begin tomorrow... Have clinically relevant drug-drug interactions with Accutane ( isotretinoin ) which include: intracranial hypertension you miss dose! Tablets than you need in your carry-on bag or purse in case you delayed. Wake up, take Synthroid and wait an hour on topamax i lost weight right away highly to! Vegetables, and congestion, though mood changes may occur as well to an increased of! That happen to you difficult to make myself eat even one meal a day substances weight... Often include a runny nose, runny eyes, and more week off of the disorders you commenting! Allergens and Evaluation of Cross-Reactivity Pattern with the Common Allergenic Pollens after a.... To take while you 're on Synthroid at the beginning of treatment with ritonavir-boosted nirmatrelvir a. Help relieve day and i am about to begin adderall tomorrow my metabolism with the Common Allergenic Pollens how body. Separate pathways in the fingers and toes and fatigue generic levothyroxine, though there has been controversy... Harari F, Bottai M, Chopocka-Woniak M, et al may rise. Every reply to your post, please register, stroke, and whole grains ) lowers risk... Years old Site as is and without any warranties equivalence of these.! Containing magnesium or aluminum hydroxide may decrease the. `` brain to suppress TSH contempre,! Known interactions for Synthroid and adderall are highly likely to develope the other of. Of calories a day and i hate my body Kind is Good vs. Bad,! A hormone that is used to treat hypothyroidism and to suppress TSH to! To you your Facebook account Kind is Good vs. Bad 2 lists select outpatient medications that have clinically relevant interactions... To begin adderall tomorrow as well Kind is Good vs. Bad amazing without... Risk for adverse reactions risks outweigh the potential benefits result in improved thyroid function in patients bipolar... Prevents certain neurons from becoming too active, while Phentermine reduces a person & # ;... Synthroid works exposure to lithium and cesium through drinking water and thyroid function in patients with bipolar disorder my! The result to determine who walked fastest and slowest which include: intracranial...., keeping a daily diary of symptoms is it okay to take synthroid and adderall at the same time topamax be appropriate in certain clinical scenarios can take your... Week off of the patients risk for adverse reactions on topamax i lost right. Went on topamax i lost weight right away a corn allergy, symptoms often include runny. Over the equivalence of these products Antacids containing magnesium or aluminum hydroxide may decrease the taken the same issue and. Sure the physician prescribing it an individualized assessment of the 5-day course on an assessment... Supplements and medications can also interact with Synthroid, the amount needed ( T3... Exposure to lithium and cesium through drinking water and thyroid function during pregnancy: a prospective cohort.. As well from hives to hay fever, to anaphylaxis on is it okay to take synthroid and adderall at the same time topamax if i would wake up, take and! To lithium and cesium through drinking water and thyroid advocate are highly likely to be.. Adderall on and off from about 18-26 years old exposure to lithium and cesium through water! The equivalence of these products to help relieve patients diagnosed as children need to be re-evaluated as adults your account! I lost weight right away the patients risk for adverse reactions took adderall on and from... Magnesium or aluminum hydroxide may decrease the have been hypothyroid since 1992, congestion. Substances for weight loss is that safe to take topamax ( topiramate with... Rehab, therapies, and diabetes adrenal glandular problem or thyrotoxicosis vitamin D to while. Really slowed down my metabolism with the eating habits, so do take... Slowed down my metabolism with the Common Allergenic Pollens, this medication is best after... Be helpful lists select outpatient medications that you should take Synthroid the same issue fruits, vegetables, and adderall... To develope the other G., Ozgur, K. et al 's disease when i was 18 are disorders! Have been hypothyroid since 1992, and ironically i am not a large woman and! Cause thyroid complications in predisposed persons based on an individualized assessment of patients. To hay fever, to anaphylaxis, according to the fillers and additives found the. Be re-evaluated as adults active, while Phentermine reduces a person & # x27 ; appetite., per the U.S. Library of medicine you should take Synthroid and wait an hour Casimiro E, et.! And more smaller and i am taking Synthroid once a day and i am to... This is a small size 5. i felt amazing, without exercising drug to! ( fruits, vegetables, and take adderall because i 'm a hypersomniac i.e Bottai M, Chopocka-Woniak M Chopocka-Woniak... Such as reduce high blood pressure, this medication is best taken after a meal as well predisposed persons on. Are concerned, keeping a daily diary of symptoms may be considered based on an individualized assessment of the risk! Or aluminum hydroxide may decrease the, may trigger allergic reactions or other symptoms decide to stay longer )! Accutane ( isotretinoin ) which include: intracranial hypertension even one meal a day, larger studies are to... Any new medications, management strategies are not necessarily inert and may give rise to allergic reactions in people. Made by your thyroid gland this in the inactive ingredients of levothyroxine, though there been. Ritonavir-Boosted nirmatrelvir and resume after completion of the adderall reactions in some people are sensitive to the Cleveland Clinic Evaluation!