New Here & Needing Taper Advice!
#61
Posted 12 April 2020 - 08:46 AM
"Since my last post: Being off Metoprolol now for this period of time, my B/P has stabilized except during a PAT attack, especially if severe & prolonged. When my bpm are 120-130+, my B/P drops very, very low. This is happening 1-2X’s a day. Once under control, B/P goes back to normal. PAT attacks vary from quick, mild attacks that are more a nuisance than anything, to periods that are severe, painful & prolonged. I’ve been trying all my natural control techniques, nothing’s helping."
I have had PAT for over 55 years now. I use to take Atenolol (beta blocker) to treat it which helped but around 40 years ago I found a dr that taught me a simple breathing technique to control it. When a event occurs lay down right where you are at, take a deep breath and let it out slowly, and repeat as necessary. My worst episode was at 190 bpm for 45 minutes before I learned that technique. Now it is unusual to exceed 2 minutes in length. When I went through my various withdrawals over the years my PAT would flair up as well. Often times at the rate of 2 or 3 episodes a day. Normally it runs about 2 or 3 a month.
The low sodium levels due to Cymbalta is well documented in the medical journals and does continue into the withdrawal period even after being off of it completely. It often takes a month or two to see improvements in it after your last dose. There is details on that in the ebook.
These symptoms, including the liver issues, are not uncommon with Cymbalta. I understand your drs being concerned but these items should pass as you come off the Cymbalta for a month or so. Going cold turkey will probably increase the intensity of these issues but worrying about them causes more stress and increases them as well. Flip a coin.
May I ask what your last Alt and Ast were and how long ago that was. (Liver function test)? Also what was your last serum sodium level and how long ago was that?
There is no clear cut answer here. Going cold turkey may shorten the time of the off spec labs but may also make the labs worse in the short run. If sodium levels get to low it is common to develop seizures until they resolve. Once I know your blood results I would have a clearer picture of just how bad these things are and how vulnerable it would be for you to increase your withdrawal rate.
At what rate are you currently dropping?
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#62
Posted 13 April 2020 - 12:06 AM
Hi Hat. Thank you so much for your response. And thank you so, so much for the breathing technique tip. Earlier, just as I finished reading your post, a nasty episode hit. I immediately got down & followed your instructions. Because of the dizziness & pains being so intense, I didn’t stop at my cuff so I don’t know the bpm & they were beyond being able to count manually. It helped, it had to of, for being as bad as this one was, instead of the (at least) 50 to 60 minutes or much longer, it only lasted 35 minutes before easing. This will definitely be my “go to” technique when the bad ones hit.
All I know about my liver function tests is I don’t know much at all. Just that I was told, after 3/2nd labs, that they’d been slowly going up, then were elevated in January & more so the first of March. She was more concerned about my sodium levels, they’d been below normal for 18 months & hadn’t been addressed by previous doctor. I know I wrote down both my liver (Alt & Ast) & sodium results when I checked on MyChart last month but I can’t find that paper. I see I gave you the sodium but not the liver results, I know I had intended to. Now, with everything going on with the Coronavirus, I’m unable to get the information. Friday was the last day the clinic I go to was open, even for calls, all patients are now being routed to the main clinic in the city & appoints are for emergency only. I no longer have access to MyChart on-line, there was a security breach & we’re all locked out while it’s being investigated. So, my last labs were 3/2nd, all I know is my sodium level, it was 22. When I talked to that (new to me) dr on the phone Friday (4/10th), he was just “thinking” my sodium level was probably better. He based that on some of my symptoms (by far, not all) being somewhat better, after increasing salt/decreasing fluids & believing I was no longer on Cymbalta.
This past month, I’m sort of following a schedule with tapering. On March 16th, I was at 24 beads, now I’m at 18 beads. So, I’ve dropped 6 beads in 26 days…averaging 1 bead drop, approx every 4-6 days. If I stay at, say every 5 days, that’s another 3 months. So when I finally do have my labs checked again, that’s 3 months of being on Cymbalta, that the dr(s) will think I haven’t been, so that won’t be taken into account when they review my results. Much like the dr last Friday, thinking the PAT would of been at least minimally improved, if Cymbalta was the cause, because he thought I’d been off for a month. I didn’t tell him different because he laughed when he seen tapering by bead counting in my chart. I ignored this because, like it or not, at the time he simply was my only option to speak to a dr. I have no idea how long it’ll be before I’ll have medical guidance (such as it is) with any of this again or labs.
I do realize, Hat, there’s not a magic or “one size fits all answer” but I do have such a deep respect for you & Iun’s opinions & the guidance y’all have given me. So, here’s me question…based on the situation I’m in & taking into account that compared to so many, I’ve been very fortunate as far as the severity of side-effects (yes, I know, that could change)…could I taper, still 1 bead, but every 2-3 days (holding longer if need be)? I have read about some people tapering by simply removing 1 bead a day, throughout their entire taper. I’ve always wondered how they do it, without problems.
Well, I’ve done it again, another looong message. It seems I have no idea how to communicate without writing a book. Thank you again for your patience, for always understanding & for always being a beacon of light. God Bless.
#63
Posted 13 April 2020 - 09:43 AM
You will get better with time using the breathing technique.
I would continue at the one bead every 5 or 6 days as you have been handling that well. 3 Months isn't that long.
As far as the liver goes, if there is no sign of jaundice, nausea, vomitting or swelling of the legs I would think it is not too serious at this point but of course can not guarantee that. The low sodium can cause irritation but would also cause nausea, vomitting, headaches, cramps and even seizures. Keep a close out look for these symptoms until you can get off the Cymbalta and get new blood labs done. Have you noticed any of the above symptoms?
You hang in there and be patient. Please keep us informed of how you are doing and try not to worry too much. You are not alone.
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#64
Posted 13 April 2020 - 01:04 PM
Regarding those particular symptoms, no I haven’t. What they contributed to low sodium &/or hypotension and the bradycardia, was extreme fatigue, not being able to stay awake, confusion, dizziness etc. Now that I’m off the Metoprolol & B/P is closer to normal (except, of course, during PAT episode) & I’ve increased my salt intake etc, these symptoms are so much better. I don’t think my Ast & Alt were really that much over the “too high” threshold or she would of been equally concerned as with the sodium. I definitely will keep a watch on things though.
I so appreciate your breathing tip. I needed & used it again, during the night & this morning, it makes episodes so much more bearable. And again, shortened the length when compared to before.
You’re so right, 3 months is really not long. Especially when considering the consequences of rushing something like tapering. I really don’t think seeing a dr or having labs done is going to happen anytime soon, so that should be the least of my concerns during this. I’m going to concentrate on what I need to do, to do this as safely as possible. So, I’ll continue tapering 1 bead every 5-6 days, holding longer if need be.
Thank you, Hat, for your guidance & encouragement. And for always patiently listening. Ya’ll have been such a blessing, I definitely could not of done this well, with my CW, without y’all.
Take Care and God Bless...Sharon
- fishinghat likes this
#65
Posted 14 April 2020 - 05:47 PM
Hi Sharon,
Was obviously going to leave this one over to Hat as this is more his area of expertise, but from my perspective, never underestimate the withdrawal effects of a drug when the EFFECTS of the drug aren't even understood themselves.
It is also nice to read that the aforementioned primary didn't take offence to you taking advice from an online forum!
Wishing you well and God Bless
IUN
- Overwhelmed likes this
#67
Posted 16 May 2020 - 12:48 PM
Hi Hat and IUN,
#68
Posted 16 May 2020 - 01:40 PM
https://www.ncbi.nlm...pubmed/15610924
As such it can play havoc with the mind. Gaba is a stabilizing neurotransmitter so with less baclofen in your system the brain will need time to adjust. It could take several weeks to 2 or 3 months.
P.S. - Not brain damage. lol
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#69
Posted 16 May 2020 - 03:45 PM
#70
Posted 16 May 2020 - 04:44 PM
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#71
Posted 17 May 2020 - 11:15 AM
Thank you, Hat.
#72
Posted 17 May 2020 - 11:28 AM
I had a botany teacher whose favorite word was interrelationships. He said you can't do anything to a plant or animal without effecting something else. As we would go through class he would teach us about, say pesticides. after the lesson he would always ask "OK how would that effect …". Like sugar transport, stem length, leaf production, etc. One of the toughest courses I had and one that taught me more about complete consideration of all aspects of something. It seems like that is especially true about meds. Every thing effects every thing else.
#73
Posted 17 May 2020 - 05:00 PM
Almost a Buddhist way of thinking there. Just as someone makes a cup of tea, the tea goes to the water, the water gets consumed, that then become water waste which is then back into the rivers which evaporate, then precipitate back onto the tea plant which makes more leaves grow...
Unfortunately, when meds come along it messes with the beautiful circle of nature and things go wrong.
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