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Mind and Body: Head Games and Hypoparathyroidism

By Ken Anderson

Daylight, alright.
I don’t know, I don’t know if it’s real.
Been a long night and something ain’t right.
(Song lyrics from “Head Games” by Foreigner, 1979)

Even after 20 years of being hypoparathyroid, at times I still feel as if a foreigner to my own body, to my own mind. Or maybe to what I used to be or could have been; I guess it doesn’t really matter much since this is who I am now. In the search for understanding and a moment’s peace, different resources can be explored to explain that “something ain’t right.”

But first I need to grasp myself (o-o-oh, that doesn’t sound right) the general physiology of human anatomy. The body naturally seeks to maintain its internal environment in a relatively constant balance (the condition of homeostasis), for without this stability, cells will not function effectively. This process is an ongoing dance between the eleven major systems, two of which are the Endocrine (parathyroid gland) and Nervous (brain) Systems. As hypoparathyroid adventurers, we can all demonstrate the relationship between low parathyroid activity, the Nervous System, and muscles, with the contractions of tetany. However, often we can only describe the intuitively felt connection between low parathyroid activity and psychological disorders such as depression, anxiety, and cognitive disorders. And, as many of you know, this seemingly obvious (and you would expect heavily researched) relationship of physical and mental or emotional concerns is somehow not as apparent when explaining symptoms to doctors, family, or friends.

The first step toward enlightenment would logically be my endocrinologist. Having been together as patient and doctor for about 12 years, I think he comprehends the level-tracking aspect of hypoparathyroidism and the interweaving of various factors in a complicated blending that can obscure cause from effect or even any relationship at all. I am not sure, though, that he will confidently and firmly link a presenting emotional or mental issue with known physical complications such as kidney disease or carpal tunnel syndrome.

A clearer distinction between mental and physical often seems to be readily concluded by my doctors, as if what occurs in the mind and emotions is somehow separate from the physical state of hypoparathyroidism. However, the mental health professionals I’ve consulted have consistently suggested a stronger connection between a hypoparathyroid cause and mental and emotional effects, both in cognitive ability and mood shifts. Bringing the physical side of my health care together with the mental side has been unsuccessful. The former disputes much of the contentions of the latter, and the latter cannot go any further in advancing my well-being without greater support from the former. Consequently, I become confused, discouraged, and lost in the middle.

And we are here as on a darkling plain
Swept with confused alarms of struggle and flight.
Where ignorant armies clash by night.
(from “Dover Beach” by Matthew Arnold; do I need to explain who I consider to be the ignorant armies?)

OK. Well, then, I need to do my own research to garner evidence in support of what I feel to be true, that my mental and emotional state is directly impacted by lower calcium levels. The internet, library, and appropriate message boards / support groups are the easiest resources to check, and given more time and energy, I could contact a local medical school or the health science departments of nearby colleges for assistance.

As extremely interesting as the parathyroid glands are, the brain is even more incredible. As stated in Chapter 2 of “Mental Health: A Report of the Surgeon General”

“As befits the organ of the mind, the human brain is the most complex structure ever investigated by our science. The brain contains approximately 100 billion nerve cells, or neurons, and many more supporting cells, or ganglia.”

And I thought starting our old lawn mower was becoming too complicated.

How well the brain functions depends upon the ability of these neurons to communicate effectively with each other. In simple terminology, this communication process involves a connection via a synapse, the functional junction linking one neuron to another, usually through electrical signals, although it could also be chemical.

To again quote from “Mental Health: A Report of the Surgeon General:”

“In aggregate, there may be between 100 trillion and a quadrillion synapses in the brain. These synapses are far from random. Within each region of the brain, there is an exquisite architecture consisting of layers and other anatomic substructures in which synaptic connections are formed. Ultimately, the pattern of synaptic connections gives rise to what are called circuits in the brain. At the integrative level, large- and small-scale circuits are the substrates of behavior and of mental life. One of the most awe-inspiring mysteries of brain science is how neuronal activity within circuits gives rise to behavior and, even, consciousness.”

So, within my brain, these billions of neurons are forming circuits, with a specific purpose and logic behind each guiding the synaptic connections. Could my hypoparathyroidism be, in effect, a mental circuit breaker?

A starting point is found in a statement on page xxi in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, American Psychiatric Association, Washington, DC, 1994:

“…the term mental disorder unfortunately implies a distinction between “mental” disorders and “physical” disorders that is a reductionistic anachronism of mind/body dualism. A compelling literature documents that there is much “physical” in “mental” disorders and much “mental” in “physical” disorders. The problem raised by the term “mental” disorders has been much clearer than its solution…”

This foothold provides encouragement for seeking further details and in-depth analysis concurring with the broad premise that hypoparathyroidism can directly affect mental and emotional states.

I check the Yahoo HPTH message board and find numerous postings mentioning foggy brain syndrome, mental lethargy, and depression, indicating from this small sampling at least a very possible connection between body and mind. Well, at least I am not alone.

Extracts from an article in the Chronicle of Neurology and Psychiatry (2003, volume 8, pages 13-14) titled

“A Review of Neurological and Psychiatric Problems in Hyperparathyroidism and Hypoparathyroidism” (authored by Colin R. Paterson, DM, FRCP, Department of Medicine, Ninewells Hospital and Medical School, Dundee, Scotland) provide additional insight and more terms to look up:

“Apart from tetany, the main neurological disorders associated with hypoparathyroidism are epilepsy, Parkinsonism, and chorea. … Intracranial calcification, particularly calcification of the basal ganglia, has long been recognized as a feature of idiopathic (auto-immune) hypoparathyroidism and pseudohypoparathyroidism. A minority of patients affected also develop Parkinsonism with tremor, athetosis, rigidity, ataxia, and oculogyric crises. … As with other patients with hypocalcemia, hypoparathyroidism may cause mental changes such as anxiety and depression. A small number of patients have been described with dementia … Psychotic symptoms including delusions and auditory hallucinations have been described in hypoparathyroidism. … Both disorders (hypo- and hyperparathyroidism) may cause non-specific psychiatric problems including, rarely psychosis. It is important that these are recognized since the neurological and psychiatric problems are readily and often completely relieved by normalization of the plasma calcium.”

Whoa. I need a medical dictionary for every other word. Referring to the “Principles of Anatomy and Physiology” eighth edition, written by Gerard J. Tortora and Sandra Reynolds Grabowski (Addison Wesley Longman, Inc., New York???, 1996), the following terms are defined:

  • Ataxia: a lack of muscular coordination, lack of precision, usually due to cerebellar damage.
  • Basal ganglia: paired clusters of cell bodies that make up the central gray matter in each cerebral hemisphere.
  • Chorea: quick, purposeless, jerky contractions of the limbs and involuntary facial twitches.
  • Dementia: an organic mental disorder that results in permanent or progressive general loss of intellectual abilities such as impairment of memory, judgment, and abstract thinking and changes in personality.
  • Epilepsy: neurological disorder characterized by short, periodic attacks of motor, sensory, or psychological malfunction.
  • Neurological: pertaining to the branch of science that deals with the normal functioning and disorders of the nervous system.
  • Parkinsonism: pertaining to the progressive degeneration of the basal ganglia and substantia nigra of the cerebrum resulting in decreased production of dopamine that leads to tremor, slowing of voluntary movements, and muscle weakness.
  • Rigidity: hypertonia characterized by increased muscle tone, but reflexes are not affected.
  • Tetany: hyperexcitability of neurons and muscle fibers caused by hypocalcemia and characterized by intermittent or continuous tonic muscular contractions.

And by searching the Merriam-Webster Medical Dictionary, Medline Plus Health Information site (www2.merriam-webster.com), I can define the remaining terms:


  • Auditory hallucination: a perception of a sound with no external cause usually arising from a disorder of the nervous system.
  • Athetosis: a nervous disorder that is marked by continual slow movements especially of the extremities and is usually due to a brain lesion.
  • Delusion: a false belief regarding the self or persons or objects outside the self that persists despite the facts and occurs in some psychotic states.
  • Intracranial calcification: abnormal deposits of calcium in the bony part of the skull that houses and protects the brain within the cranium.
  • Oculogyric: relating to or involving circular movements of the eyeballs.
  • Psychosis: a serious mental disorder characterized by defective or lost contact with reality often with hallucinations or delusions.

From all this, I am learning how things are supposed to work and some of the problems that may accompany hypoparathyroidism. The words were a bit scary even before I understood their definitions, but to not comprehend much of anything and leave the learning about my illness to others (including professionals) is way more frightening. Further internet research and reading locate additional statements supporting the mind and body connection:

 The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), American Psychiatric Association, Washington, DC, 1994, gives a broad statement that anxiety or mood symptoms may be caused by a variety of general medical conditions, including endocrine conditions such as hypoparathyroidism.

An article titled “Hypoparathyroidism” by John Halpern, DO, FACEP, Clinical Assistant Professor, Department of Family Medicine, Nova Southeastern University College of Osteopathic Medicine, Medical Director, Department of Emergency Medicine, Coral Springs Medical Center, and N Ewen Wang, MD, Consulting Staff, Department of Surgery, Division of Emergency Medicine, Stanford University Hospital (on eMedicine.com), identifies the neurologic effects of hypoparathyroidism: an altered mental status, psychosis, or altered level of consciousness in adults; hyper-irritability, muscle rigidity with normal mental status, or seizures in infants.

In an article titled “Mental Disorders Secondary to General Medical Conditions” by Linda Chuang, MD, and Nancy Forman, MD, (also found on eMedicine.com), the authors reassert that “imbalances of calcium and magnesium can cause psychiatric symptoms” and state that “Patients most commonly experience delirium but may also experience psychosis, depression, or anxiety.”

In the February 2002 issue of the European Journal of Endocrinology (146, Number 2: 215-222, an article titled “Well-being, mood and calcium homeostasis in patients with hypoparathyroidism receiving standard treatment with calcium and vitamin D” by Wiebke Arlt (Department of Medicine, Endocrine and Diabetes Unit, University of Wuerzburg, Germany) et al, discussed findings that hypoparathyroid patients had higher levels of “anxiety, phobic anxiety, and their physical equivalents.” Of perhaps greater consequence, the study concluded that the current method of treating hypoparathyroid patients fails to restore well-being and mood.

From the Complementary Medicine: The Best of Conventional and Alternative Treatments web site online library (www.ivillagehealth.com), the article “Hypoparathyroidism” echoed the assertion that “hypoparathyroidism is often accompanied by anxiety.” Additionally, the article mentioned that “mental deficiency often appears in children with hypoparathyroidism” and, a very crucial point, that “hypoparathyroidism has a fair to good prognosis, especially when a diagnosis is made early.”

In “Hypoparathyroidism and Pseudohypoparathyroidism” by David E. C. Cole and Geoffrey N. Hendy (Chapter 9 of Diseases of Bone and Calcium Metabolism; www.endotext.org), the “wide variation in the severity of the symptoms” of hypoparathyroidism is acknowledged in both the physical and emotional presentations, and that “other less specific manifestations include fatigue, irritability, and personality disturbance.”

From Psychiacomp (www.psychiacomp.com), an article titled “Medical Disorders Due to a General Medical Condition” also supports the contention that hypoparathyroidism is one of the common medical disorders associated with psychosis or mood disorders. The article recognizes a common-sense notion that “Chronic medical disorders themselves predispose an individual to developing a true major depression.”

From the book "Organic Psychiatry" by W. A. Lishman, Third Edition, 1998, Blackwell Science, Inc., the author (a primary catalyst of neuropsychiatry in the United Kingdom) wrote: “A wide variety and a high incidence of psychiatric disturbances have emerged in hypoparathyroidism. Denko and Kaelbling (1962) estimate that at least half the cases attributable to surgery have psychiatric symptoms, and that the frequency is probably higher still in idiopathic hypoparathyroidism.... Such patients [both types] may show sustained difficulty with concentration, emotional lability [mood swings and easily upset]... Children show temper tantrums and night terrors, and adults become depressed, nervous and irritable with frequent crying spells and marked social withdrawal... More rarely, psychotic illness of manic-depressive or schizophrenic type may be seen, particularly in cases due to surgery...”

Idiopathic hypoparathyroidism is also addressed in another article, “Idiopathic Hypoparathyroidism with Intracranial Calcifications and Dominant Skin Manifestations” (Med Sci Monit, 2000; 6(1): 145-150) by Zbigniew Stelmasiak (Department and Clinic of Neurology, Medical University, Lublin, Poland), et al. This article reiterates the importance of early and correct diagnosis and treatment (“Early diagnosis and treatment of patients with hypoparathyroidism may prevent the development of many serious complications or at least result in marked improvement of neurological manifestations.”) Other significant points made by the authors are quoted below:

  • “Hypoparathyroidsm usually starts insidiously, with slowly increasing episodic symptoms dominated by increased neuromuscular irritability. Paresthesias in the fingers, toes and perioral region are a common finding. Muscle cramps may occur in the lower back or legs. Syncopal episodes and/or seizures, mental lassitude, impaired memory or psychoneurotic behaviour are common central nervous system manifestations of hypocalcemia.”
  • “Additionally, some organic brain syndromes, psychosis, and psychoneurosis have been associated with chronic hypoparathyroidism. These include mental changes, emotional lability, irritability, depression, memory impairment, subnormal intelligence, retardation, and functional psychoses. Since all are attributed to hypocalcemia, treatment may improve intelligence and personality but symptom improvement is not guaranteed in all patients. However, there exist many cases of hypoparathyroidism demonstrating oligophenia without intracerebral calcifications.”
  • “Fukunaga noted that patients with more prolonged hypocalcemia demonstrated a higher incidence toward basal ganglia calcifications. Polverosi et al estimated that the caudate nucleus was always affected (100%).”
  • “The pathophysioloy of most neurological syndromes accompanying hypoparathyroidism is accounted for by hypocalcemia. Tetany, muscle cramps and seizures respond quickly following calcium replacement. Movement disorders, which usually appear late during the course, also respond towards calcium therapy, while dementia is the least likely to respond. Parkinsonism and choreoathetosis, rare movement disorders during hypoparathyroidism are extrapiramidal in nature and their relationship with intracranial basal ganglia calcifications is rather obscure. These two extrapiramidal syndromes are caused by completely different neuropharmacological mechanisms. The former by dopamine deficiency and the latter by a ‘dopamine excess’ state. Thus, movement disorders are caused by structural rather than by hormonal or electrolyte factors. These symptoms are caused by circulatory insufficiency due to calcification or abnormal excitation of basal ganglion cells due to hypocalcemia.”

The following abstracts are from the PubMed National Library of Medicine (www.ncbi.nlm.nih.gov):

  • “Subtle psychiatric presentations of endocrine diseases” (Psychiatr Clin North Am. 1998 Dec;21(4):905-16, viii) by Hutto B. of the Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, USA
  • “Endocrine disorders frequently present initially to psychiatrists. This article reviews the differential diagnosis of psychiatric and endocrine disorders. The range of endocrinopathies is presented, with emphasis placed on the common psychiatric symptomatology associated with these conditions. Various signs and symptoms that might stimulate a psychiatrist to pursue a work-up for each endocrine disorder are also emphasized.”
  • “Psychiatric symptoms in endocrine diseases. Keys to identifying the underlying disorder.” (Postgrad Med. 1985 Apr;77(5):233-6, 239) by Peterson LG, O'Shanick GJ.
  • “Several important points should be considered regarding psychiatric symptoms in endocrine disorders. The presence of cognitive deficits in a patient presenting with anxiety, depression, or another apparently "functional" psychiatric complaint should raise the index of suspicion of organic etiology, with endocrine disorders high on the list. Psychiatric symptoms secondary to endocrine disturbance generally reverse, albeit slowly, with treatment of the primary hormonal abnormality. When significant disruption of cognitive functioning is evident, residual deficits may develop. Treatment with psychotropic agents for symptomatic relief of psychiatric complaints should be undertaken with great caution in patients with endocrine disorders.”
  • “Neurologic complications of thyroid and parathyroid disease.” (Med Clin North Am. 1993 Jan;77(1):251-63) by Tonner DR, Schlechte JA, of the Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City.
  • “Common thyroid and parathyroid disorders present with reversible neurologic signs and symptoms affecting the central and peripheral nervous system, musculature, and mental function. Patients with thyrotoxicosis may have myopathy, spasticity, seizures, and multiple psychiatric symptoms. A deficiency of thyroid hormone also causes muscle weakness and may be accompanied by reversible muscle hypertrophy or movement disorders. … Calcium deficiency leads to neuromuscular irritability, paresthesias, and tetany. Psychiatric disorders are also common in this disorder.”
  • “Psychiatric morbidity in endocrine disorders.” (Psychiatr Clin North Am. 1998 Jun;21(2):473-89.) by Geffken GR, Ward HE, Staab JP, Carmichael SL, Evans DL, of the Department of Psychiatry, University of Florida College of Medicine, Gainesville, USA.
  • “Psychiatric disturbances are frequently observed during the course of endocrine disorders. This article discusses the history, current knowledge, assessment, and treatment of psychiatric morbidity in endocrine disorders. The primary focus is on biologic links between psychiatric symptoms and endocrine dysfunction. Psychiatric disorders associated with abnormalities of the pituitary, thyroid, parathyroids, adrenals, and gonads are discussed as well as the chronic illness of diabetes mellitus.”
  • “Seizure disorders presenting with psychiatric symptomatology.” (Psychiatr Clin North Am. 1998 Sep;21(3):625-35, vi) by Tucker GJ, of the Department of Psychiatry and Behavioural Sciences, University of Washington, Seattle, USA
  • “Seizure disorders can be mistaken for psychiatric disorders and, the two have a number of poorly understood interrelations. Disruptions of consciousness, motor activity, hallucinations, and abrupt mood and anxiety changes can all be seizure manifestations caused by cortical neuronal discharges. This article presents the classification and proposed psychopathology of seizure disorders. It then reviews the psychiatric conditions that frequently mimic elements of such seizure disorders, giving hints that will allow the clinician to correctly identify seizures that are creating psychiatric presentations. Finally, this article makes clear the situations in which anticonvulsant medications may be of value when nothing else seems to be working.”
  • “Psychiatric manifestations of systemic illness.” (Emerg Med Clin North Am. 2000 May;18(2):199-209, vii-viii) by Talbot-Stern JK, Green T, Royle TJ, of the Department of Emergency Medicine, Royal Prince Alfred Hospital, Sydney, Australia.
  • “Many behavioral manifestations of systemic disease exist, including delirium, psychosis, mania, catatonia, depression, and anxiety. The features and medical causes of each of those manifestations are described. The indications from history and physical examination that suggest underlying medical illness are reviewed. The psychiatric presentations of several specific conditions are discussed in detail.”
  • “Anxiety and endocrine disease.” (Semin Clin Neuropsychiatry. 1999 Apr;4(2):72-83) by Hall RC, Hall RC, of the University of Florida, Gainesville, FL, USA.
  • “It is our goal in this article to review the literature and define those endocrinological diseases that often include anxiety states as part of their initial presentation or as a characteristic symptom seen during their course. Understanding the mechanism by which anxiety develops as a routine part of these neuroendocrinological disorders may help us understand the organic basis of anxiety disorders. Research using new neurochemical, neuroanatomical, and brain imaging techniques may further define the structural and physiological underpinnings of the anxiety disorders.”
  • “Calcium, magnesium, and psychotic symptoms in a girl with idiopathic hypoparathyroidism.” (Psychosom Med. 1995 May-Jun;57(3):299-302) by Ang AW, Ko SM, Tan CH, of Maudsley Hospital, London, United Kingdom.
  • “In general, psychotic episodes occurred when there was hypocalcemia, hypercalcemia, or hypomagnesemia.”

The final reference regarding the relationship between hypoparathyroidism and mental or emotional issues are excerpts from an article from Dr. Richard C. W. Hall Publications (www.drrichardhall.com/anxiety.htm), titled “Anxiety and Endocrine Disease” (by Richard C. W. Hall, M.D., Courtesy Clinical Professor of Psychiatry, University of Florida, Gainesville, and Ryan C. W. Hall, Research Assistant, Behavioral Genetics Laboratory, Department of Psychiatry, Johns Hopkins Hospital Undergraduate Departments Biology/Psychiatry Johns Hopkins University):

  • If a mental disorder is due to a general medical condition and that the disturbance is the direct physiological consequence of that general medical condition (such as hypoparathyroidism), the proper diagnosis code identifies the psychiatric disorder symptom as secondary to the general medical condition. As the author states, “Thus, with anxiety one would not code 300.02, generalized anxiety disorder, but rather 293.89, anxiety disorder due to a general medical condition. The 293.89 code may be used for those specific presentations of anxiety states which include generalized anxiety symptoms, panic attacks, obsessions and/or compulsions. When the 293.89 code is used, it is important that the anxiety symptoms be well defined and prominent and that there is evidence from history, physical examination and laboratory findings that these symptoms are a physiological consequence of the patient's general medical condition. Clinicians should also be sure that the disturbance is not better accounted for by some other mental disorder such as an adjustment disorder with secondary anxiety brought on by the diagnosis of a disease. This diagnosis should not be used if anxiety symptoms occur only during the course of a delirium. Finally, the anxiety symptoms associated with the medical disorder must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. …”
  • The medical condition most frequently misdiagnosed with a primary anxiety disorder was thyroid disorders (including hypoparathyroidism).
  • The authors concluded that “a critical review of the literature shows relationships between medically induced anxiety and hyper-and hypoglycemia, hyper- and hypoparathyroidism, hyper- and hypopituitarism, hyper- and hypoestrogenemia, hyper- and hypoandrogenemia, hyperprolactinemia, hyper- and hypocalcemia, hyper- and hypothyroidism, hyperadrenalism (Cushing's disease), adrenal insufficiency, growth hormone deficiency, pituitary microadenoma and pheochromocytoma.” … “As I hope we have demonstrated, endocrine disorders can and do produce both cognitive and behavioral signs of anxiety, panic disorder, and at times even obsessional symptoms in patients. These changes are generally not specific and cannot be easily compartmentalized diagnostically. They are often variable in their presentation and fluctuate in their severity. To properly evaluate patients for these disorders, one must first entertain in the differential diagnosis the medical disorders that are associated with these conditions. The patient should receive a comprehensive history and physical examination as well as careful laboratory screening. The initial evaluation should carefully define the sequence of symptoms encountered and how they evolved, determine both personal and family histories for these endocrinological disorders, and include a detailed review of systems which is often helpful. Physical examination may define signs and symptoms that distinguish between endocrine disorders and primary anxiety and panic states. Once proper diagnosis and treatment are instituted, symptoms usually clear.”

Enough, enough, I say. If I did not have a hypoparathyroidism-induced mental disorder before, I surely must have now after reading these symptoms. But maybe these research findings and references are sufficient for providing enough fortitude for me to articulately push for the respectful recognition of those symptoms which do annoy me, and to seek for the appropriate, thorough treatment for what I intuitively know to be true.

With Summer coming to a close and with kids returning to school and leaving for college, my mind returns to long-ago days of my youth, of a time when mind and body where healthier, and the end of August would mean a return to school. I find that any reminiscence tends to remind me of music of that time, like the very appropriate 1978 song (for the warm weather and hotter coeds) again by Foreigner titled “Hot Blooded,” which I have revised below to fit what I am like today:


Well, I’m Hypopara, check it and see.
I got a level of only 8.3.
Come on endo, can we do more than that?
I’m hypopara, I’m hypopara.

You don’t have to check the lab, to know I am a bit low.
Doctor, you gotta hear.
You prescribe drugs fine, but this life is all mine.
I need to find a better balance and feel stronger.

Now it’s up to you, we can work together, not apart.
Just me and you, we’ll fix this calcium, almost like new.

That’s why I’m Hypopara, check it and see.
I got a level of only 8.3.
Come on endo, can we do more than that?
I’m hypopara, I’m hypopara.

If I don’t feel right, like my calcium is light,
Can I increase my meds?
But you’ve got to give me a clue, come on doc, what can I do.
Tell me, are you a good doc? My arms are starting to lock.
Are you wise enough? Do you understand all this calcium stuff?
Are these levels best? Higher levels give the brain a rest.

Yeah, I’m hypopara, check it and see.
Check the calcium level inside me.
Come on endo, can we do more than that?
I’m hypopara, I’m hypopara.

Now it’s up to you, we can work together, not apart.
Oh, low calcium, you have made me feel confused and very dumb.

Well, I’m hypopara, check it and see.
I got a level of only 8.3.
Come on endo, can we do more than that?
I’m hypopara, I’m hypopara.

Hypopara, all the time.
Hypopara, messing my life.
Hypopara, you’re driving me crazy.
Hypopara, I’m so tired of you.
Hypopara, I’m a bit too low.
Hypopara, bothering me so.
Hypopara, every day.
Hypopara, just go away.

Not a writer, not a physician;
Not a poet, not a musician.
Little knowledge, less acumen.
More than patient, also human.
(Ken Anderson, Chicago)

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