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3 Months Off- Update


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#1 CatLover

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Posted 02 December 2016 - 09:02 PM

Hi!

I wanted to update on what I have had happen during my 3 moths off C. Sorry its long...

My thyroid levels were tested and came back severe! I was put on medication immediately, it was affecting me so badly that I was barely moving. I have had my thyroid tested 3 times on C and it was always normal. One month off C and it was critically high. Doing better on the medication but we are still trying to regulate it. 

 

My intestinal system went into a shock of sorts. After 10 years of C keeping things in a certain way my system had no clue what it was supposed to do. So I was having horrible attacks of abdominal and intestinal cramping. My system couldn't seem to regulate my movements and decided it should all happen at once randomly for no reason. Lots of testing later I had all the major stuff ruled out. Turns out I had some swollen glands in my stomach. But since the scopes I haven't been able to kick heartburn. Despite having my hiatal hernia in place and taking meds. 

 

Does anyone else get heartburn from their anxiety and stress?

My doctors tried to put me on Prozac but my body rejected it on dose two. We got some of my GI system back on track with a week and a half treatment of prednisone, some prescription strength probiotics, L-Glutamine, and Dipan (a pancreatic enzyme for people without gallbladders). 

Monday (11/28) I saw my psych doctor and we decided to put me on Buspar. I am staring at 5 mg 2x day for a week then go up to 10mg. We will be slowly going up to around 20-30mg. It takes 2 weeks to fully kick in but so far I am noticing slightly less stress. Not enough to curb the heartburn though. 

 

Other than that I still get weird chills and have some body temperature abnormalities. I took a shower the other day and the water was hot everywhere but the back of my legs and my head. Weird. Also feel this nagging pull to find my spare beads (I had a family member hide them) and take them. 

 

Hope everyone is doing well!


#2 fishinghat

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Posted 03 December 2016 - 09:04 AM

Wow!! What a story. Certainly not typical post-withdrawal. I can understand the digestive issues being worse but that is too much. I am a little concerned about the hot water not feeling hot on the back of your legs and neck. That would sound like a neurological issue may be involved. In any case I appreciate the update and certainly look forward to your next post. Hopefully things will be better.


#3 CatLover

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Posted 09 February 2017 - 03:32 PM

So I am now taking 20 mg of Buspar 3x a day. It works about 85%. I have days where I have to take a valium (2-6mg) just to hold it together. Once I am established at the 3x a day we are going to increase the Buspar dose. 

 

My thyroid levels are now perfect but my liver enzymes are continuing to rise. I now have to go get an ultrasound of my liver. Could the fatty liver be a result of the Cymbalta? I am sure the hypoT is, as I didn't have it at all until I weaned off Cymbalta. 

 

Any information you have on a connection between Cym and fatty liver would be very helpful to show my Dr. She wants me to exercise 30-60 min a day, start taking Vit E, and change to a low carb/low sugar diet. The diet is going to be next to impossible. I am allergic to a lot and with my spectrum disorder I don't like a lot of foods. I also have to eat for my gut (so things stay happy). 

 

My appetite is way down as well. I have increased the amount of avocado since my last blood check on my liver and my levels increased. Avocado is supposed to help lower it. So not sure about that. 

 

I will update again after my ultrasound. 


#4 fishinghat

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Posted 09 February 2017 - 06:04 PM

Cat Lover, I have a bunch of info on this subject but if you don't mind I will be posting it in the morning when I have more time to dig it out and put it together. Sorry.


#5 fishinghat

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Posted 10 February 2017 - 09:33 AM

OK Catlover, back with you and sorry for the delay. I will be back in a little bit with some info. Thanks for your patience.


#6 fishinghat

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Posted 10 February 2017 - 10:27 AM

My comments are in bold. You may share any or all of my comments with your dr. I am not a physician but I don't think she would have an issue with my opinions.

 

 

"So I am now taking 20 mg of Buspar 3x a day. It works about 85%. I have days where I have to take a valium (2-6mg) just to hold it together. Once I am established at the 3x a day we are going to increase the Buspar dose."

All of those doses seem fine except the buspar dose. The 20 mg at 3 times per day is the maximum recommended dose and should not be raised above that.

"My thyroid levels are now perfect but my liver enzymes are continuing to rise. I now have to go get an ultrasound of my liver. Could the fatty liver be a result of the Cymbalta? I am sure the hypoT is, as I didn't have it at all until I weaned off Cymbalta. "

First of all I am glad the thyroid levels have returned to normal and this is typical after getting the Cymbalta out of your system.

Secondly, Cymbalta does not cause fatty liver. The most common cause of fatty liver is excessive alcohol consumption or elevated levels of cholesterol and/or triglycerides. The most likely senerio is that Cymbalta is fat soluble and would collect to higher concentrations in a fatty liver thereby increasing the risk of Cymbalta related damage to the liver. See research and warnings below on the dangers of Cymbalta to the liver.

https://www.ncbi.nlm...les/PMC4607169/

"Our findings, while not statistically significant, may suggest a higher incidence of hepatic injury other than hepatic-related death or liver failure among duloxetine initiators compared to venlafaxine and possibly SSRIs, but not untreated patients. These differences remain consistent with chance, and an elevated risk cannot be ruled in or out."

Translation - Cymbalta can effect the liver but no indication of it causing death or liver failure. This would be a typical result for many meds.

https://www.ncbi.nlm...les/PMC3773985/

"Duloxetine hepatotoxicity developed within 2 months of drug intake and led to clinically significant liver injury. A spectrum of laboratory, histological, and extra-hepatic features were noted at presentation."

Note a more serious finding compared to the above research.

http://www.fda.gov/S...n/ucm319241.htm

Note 2012 warning from FDA...
"Hepatotoxicity
⦁ Patients should be informed that severe liver problems, sometimes fatal, have been reported in patients treated with Cymbalta… "

Cymbalta is fat soluble...

From:
http://www.drugs.com/pro/cymbalta.html
"Duloxetine hydrochloride is a white to slightly brownish white solid, which is slightly soluble in water."
Note - From the structure we can see that the compound is primarily non-polar and therefore should be fat soluble.

From:
http://www.drugbank.ca/drugs/DB00476
Water Solubility = 0.00296 mg/mL (Vertually insoluble)
Note - If it is not water suluble (polar (has a negative or positive charge)) then it is non-polar (not charged) and would be lipid soluble.

From:
http://www.selleckch...l-cymbalta.html
Chemical Information

Solubility (25°C) * In vitro DMSO 67 mg/mL (200.67 mM)
Water <1 mg/mL (<1 mM)
Ethanol <1 mg/mL (<1 mM)

Note - Dissolves well in DMSO a relatively nonpolar solvent.

From:
http://toxwiki.wikis....com/Duloxetine
Soluble in dimethylformamide (nonpolar) and water.

From:
https://www.ncbi.nlm...les/PMC3299448/
Table I
Amount of Solid Lipid (fat) Required to Solubilize 20 mg of DLX and Percent Partitioning of DLX in Lipid vs Water
Solid lipid Amount (mg) % Partitioning
Glyceryl monostearates 400 92
Glyceryl behenate 700 33
Glyceryl palmitostearate 650 60
Geleol 450 60
Gelucire 44/14 800 –

From 33% to 92% lipid (fat) soluble.

Note - have you been diagnosed with fatty liver and if so to what extent? What is the results from your last lipid panel (cholesterol/triglycerides)? If you have fatty liver it is important you know these values.

"Any information you have on a connection between Cym and fatty liver would be very helpful to show my Dr. She wants me to exercise 30-60 min a day, start taking Vit E, and change to a low carb/low sugar diet. The diet is going to be next to impossible. I am allergic to a lot and with my spectrum disorder I don't like a lot of foods. I also have to eat for my gut (so things stay happy). "

Your dr suspects either cholesterol or triglyceride problems as these are typical responses to those conditions. There are various medications (with their own set of medical issues) for treating these issues. I have suffered my whole life from triglyceride levels of 1000 to 2000 (suppose to be below 200). I have lived of the low carb/low sugar high exercise diet since I was 13 and still had those numbers. In 2015 it was determined that my pancreas was 95% fat infiltrated and I had to get drastic or risk pancreatitis. I further tightened up my diet and now run 200 to 300 on triglycerides. I have considerable info on diets for this purpose. These diets for me are very difficult also as I am vegetable intolerant to many things. I have a summary of what I have been through and will post it later to give you some dietary ideas. First we need to establish you do have fatty liver and what your lipid profile is.

"My appetite is way down as well. I have increased the amount of avocado since my last blood check on my liver and my levels increased. Avocado is supposed to help lower it. So not sure about that."

"I will update again after my ultrasound."

Avacado. No medical research done on avacados on fatty liver however the monounsaturated fat in them has been shown to reduce cholesterol/triglycerides. Olive oil and safflower oil have the highest level of these good oils and are more effective at lowering cholesterol/triglycerides than the oil in avacados. Please be sure and remember that the skin and seeds of an avacado are poisonous.


#7 fishinghat

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Posted 10 February 2017 - 10:37 AM

I am a 65 year old white male who has high triglycerides.

 

I was first diagnosed when I was 32. My triglycerides that year ran from 800 to 2000. I was a long distance runner, 14 mile runs, and had not an ounce of fat on me. 6' 4" and weighted 165 lbs.

First dr put me on a typical high triglyceride diet that I assume you are familiar with.

Skin free chicken or turkey.
No more than 4 oz of red meat twice a week.
Minimize carbs.
Lots of fiber.
No more than 4 ounces of fruit twice a week.
Skim milk only and a low fat diet in general (olive oil or safflower oil only)
Low carb cereal with skim milk.
Fat free cheese
No more than 4 oz. of root vegetables twice a week.
No more than 4 oz of seed vegetables a week.
No sugar.
Only water to drink.
No more than twice a week omega 3 fish (tuna, salmon, sardines, etc.)
Most vegetables OK.

Well I am vegetable intolerant. Tomatos, cabbage, broccoli, okra, cauliflower, turnips lettuse, and many others cause tremendous gas, nasea and vomiting with a 48 hour recovery time. This means that my vegetable intake was primarily root and seed vegetables with the exception of squash, spinach and peppers.

Well I was on that diet for 1 year and my triglycerides were... wait for it...800 to 2000.

Whoopi!!!

Next the drs tried niaspan (prescription strenght niacin), did not affect my triglycerides. Then moved to fibrates (including finofibrate and gemfibrozil). These resulted in rhabdomyolysis within a few days of starting each. Very painful and very dangerous if left untreated. Obviously I came of the drugs.

Then we moved on to the statins where I tried 3 with the same results. Rhabdomyolysis. No gain there. At the end of that time (I was 45) my triglycerides were ...800 to 2000.

We moved on to Omega 3 fatty acids. Tried them twice with terrible gas, belching, stomach cramps. stomach aches. Toughed it out for 3 months both times but finally had to stop it. Later my dr put me on Lovaza (presription strength Omega 3) thinking that impurities in the OTC omega 3 may have been causing my stomach issues. NO. Had to stop it too.

We moved on to garlic supplements, curcumin, tumeric, vitamin E, Vitamin B12 and flax oil with no effect. By this time I am in my mid-50s. The dr gave up on any further treatments.

During an abdominal cat scan when I was 60 I was informed I had a 95% fat infiltrated pancreas. I had not ate out in decades and I new that the diet was going to have to be reworked.

I took each item in my diet and worked on it.

So here is what I did...

Skin free chicken or turkey.
Before- skinless chicken breast with fat trimmed, boiled and ate.
Now - On investigation I found my chicken was soaked in chiclen broth, which the manufacturer readily admitted contained a lot of fat. I dug around and found some local butchered chicken that was not soaked in anything. I then boil it three time, skimming the fat off each time.

Before -No more than 4 oz of red meat twice a week.
Now - No red meat.

These two changes brought my triglycerides down to 400 to 1000.

Minimize carbs.
Before - whole wheat bread and whole wheat cereal. Use whites of eggs when baking.
Now - Found lowest carb cereal (shredded wheat) and a low carb low oil bread.
Carbs is defined by me as total carbs minus fiber divided by total serving size.
My bread is 36% carbs. My wife makes a special bread for me that is 31% carbs and has 1/3 of the oil that the recipe calls for. In addition, I will allow myself anything under 30% carbs as a bread substitute. This includes pinto beans, butter beans and lima beans.

Lots of fiber. Same


Before - No more than 4 ounces of fruit twice a week.
Now - No fruit.

These last few changes got my TG down to 400 to 600.

Skim milk only and a low fat diet in general (olive oil or safflower oil only). Same
Now - same except use water only on my cereal.

Low carb cereal with skim milk.
Now - same except use water only on my cereal.

Fat free cheese Same

Before - No more than 4 oz. of root vegetables twice a week.
Now - No root vegetables.

Before - No more than 4 oz of seed vegetables a week.
Now - No seed vegetables (except 3 kinds of beans mentioned earlier).

No sugar. Same

Only water to drink. Same

Before - No more than twice a week omega 3 fish (tuna, salmon, sardines, etc.)
Now - 3 times a week.

Most vegetables OK.
Eat some squash, spinach, green beans and red bell peppers. Low carbs.

For the last two years my Tg have stayed between 275 and 330.

I continue to look for ways to improve the diet. I know this is extreme and may not be for everyone but it certainly has not only helped my TG but I feel better as well. In case anyone is curious, I have run 3 miles 4 times a week since I was 13 and also lift weights 3 times a week. In addition my Cholesteral has always been between 120 and 160 my entire life.

Any questions or suggestions are welcome.





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