Cat Forum / Cat Anecdotes / February 2005
Seems I'm always asking for Purrs...
|
|
Thread rating:  |
jmcquown - 02 Feb 2005 18:46 GMT Sorry, but here we go again. Tomorrow at 12:30 I have an appointment set up by the Social Security Disability folks for a medical exam. They called last week and told me to expect the paperwork in the mail. I got the paperwork and was mildly surprised to find the exam is not for my IBS or depression - it's for arthritis. Now, I never claimed to have clinically diagnosed arthritis. But I mentioned to the local case worker I take aspirin a couple of times a day due to aches in my arms. She apparently noted this in my paperwork before sending it off to the state capitol. I reiterated to the new case worker in Nashville I have NOT been diagnosed with arthritis. But she's sending me off tomorrow to get X-rays to determine whether or not I have arthritis. (I don't know; maybe it's just normal to have your arms ache when you're middle aged.)
I can only surmise (probably a bad idea) they took the medical records my regular doctor sent at face value since they (so far) aren't sending me to anyone to evaluate those claims. Oh, and I got a travel voucher; they calculated the mileage and will reimburse me $11.20 USD after I see the doctor.
Anyway, any spare purrs for my visit tomorrow would be appreciated.
OB Cats: Persia successfully killed another paper bag this morning. It was apparently full of greeblings :)
Jill
 Signature I used to have a handle on life...but it broke off.
Holly - 02 Feb 2005 18:54 GMT Purrs from my crew that everything turns out in your favor. Holly, Pheniox, Sasha and Isabella (who has finally been accepted)
Jo Firey - 02 Feb 2005 19:13 GMT Problems in your neck could very well make your arms hurt. And if you have IBS it might be that you have other autoimmune problems such as some form of Inflammatory arthritis.
This won't necessarily be the only exam they send you for. I had two. One for depression and another for arthritis. Deaf they took my word (or my doctors word) for.
They will sometimes approve disability for a combination of problems where they would not for any one problem by itself. They also look into your occupation, your work history and consider your age.
Jo
> Sorry, but here we go again. Tomorrow at 12:30 I have an appointment set > up [quoted text clipped - 23 lines] > > Jill jmcquown - 02 Feb 2005 19:30 GMT > Problems in your neck could very well make your arms hurt. And if > you have IBS it might be that you have other autoimmune problems such > as some form of Inflammatory arthritis. I've had pains in my left neck & shoulder which I initially attributed to sleeping in a weird position. But I surely can't be sleeping that way all the time? Heat helps with it; those Thermacare patches are nice. I've also (lately) had pressure in my chest. It is my understanding heart related problems in women often manifest themselves in neck & shoulder pain - oh joy.
John is very worried about this; he had bypass surgery last year and is upset to hear about my feeling pressure in my chest and pain in my arms and shoulder. What's a body to do? I'm under a lot of stress; bills due and no income or good job prospects. (sigh)
> This won't necessarily be the only exam they send you for. I had > two. One for depression and another for arthritis. Deaf they took > my word (or my doctors word) for. I'm sure they'll send me for another. But when I filed (back in October) the notification on the web site indicated they would have to make a determination by 3/5. So they are running out of time... or I am.
> They will sometimes approve disability for a combination of problems > where they would not for any one problem by itself. They also look [quoted text clipped - 32 lines] >> -- >> I used to have a handle on life...but it broke off. Monique Y. Mudama - 02 Feb 2005 21:07 GMT >> Problems in your neck could very well make your arms hurt. And if you have >> IBS it might be that you have other autoimmune problems such as some form [quoted text clipped - 6 lines] > problems in women often manifest themselves in neck & shoulder pain - oh > joy. I have posture problems, and my chiro recommended one of those weird memory foam pillows for me. My lower back hurt the first few nights, but since then I'm pretty happy with it. It encourages my neck to curve properly (apparently, I somehow developed the habit of keeping my neck straight, so my spine curves too much to accomodate). Anyway, the reason I mention this is, whether I sleep on my side or my back, the pillow seems to discourage really bizarre sleeping positions. Maybe something like this could help? I hate to suggest it, as it costs money and I have no idea if it would actually help.
 Signature monique, roommate of Oscar the (female) grouch ~~~~~~~~~~~~~~~~~~ Eros was adopted! Eros has a home now! *cheer!*
jmcquown - 02 Feb 2005 22:27 GMT >>> Problems in your neck could very well make your arms hurt. And if >>> you have IBS it might be that you have other autoimmune problems [quoted text clipped - 16 lines] > positions. Maybe something like this could help? I hate to suggest > it, as it costs money and I have no idea if it would actually help. Hey, I'm open to any and all suggestions :) Thank you for your thoughts on the matter. (I use a feather pillow which I tend to bunch around my neck in a sort of U shape for supporting my neck.)
Jill
Howard Berkowitz - 03 Feb 2005 02:32 GMT > I have posture problems, and my chiro recommended one of those weird > memory [quoted text clipped - 11 lines] > suggest it, as it costs money and I have no idea if it would actually > help. To put things on topic, and to give the purrs, I have a certain degree of feline enforcement of sleeping positions. I tend to lie on my side, which is probably best for me. That will get Mr. Clark on my hip or a little above. A 17 pound heating pad does get achy, but if I lie on my back, I will get a massage and bath. If, however, I roll onto my stomach, it is understood that my back belongs to Ding.
Steve Touchstone - 03 Feb 2005 09:29 GMT >I have posture problems, and my chiro recommended one of those weird memory >foam pillows for me. My lower back hurt the first few nights, but since then [quoted text clipped - 4 lines] >bizarre sleeping positions. Maybe something like this could help? I hate to >suggest it, as it costs money and I have no idea if it would actually help. My mom got one of those pillows for my Dad. He initially resisted using it, but now he wouldn't be without it. In fact it's very well travelled, as they've taken it to Europe and on a couple cruises.
Also, adding purrs that things work out with your claim. Sometimes it seems like they have a script they follow to delay claims as long as possible.
 Signature Steve Touchstone, faithful servant of Sammy and Little Bit
stouchst@JUNKsirinet.net [remove Junk for email] Home Page: http://www.sirinet.net/~stouchst/index.html Cat Pix: http://www.sirinet.net/~stouchst/animals.html
Monique Y. Mudama - 03 Feb 2005 17:48 GMT >>I have posture problems, and my chiro recommended one of those weird memory >>foam pillows for me. My lower back hurt the first few nights, but since [quoted text clipped - 12 lines] > Also, adding purrs that things work out with your claim. Sometimes it seems > like they have a script they follow to delay claims as long as possible. Not my claim! CatNipped's! I just have the pillow ...
 Signature monique, roommate of Oscar the (female) grouch ~~~~~~~~~~~~~~~~~~ Eros was adopted! Eros has a home now! *cheer!*
Treeline - 03 Feb 2005 01:27 GMT > I've had pains in my left neck & shoulder which I initially attributed to > sleeping in a weird position. But I surely can't be sleeping that way all > the time? Heat helps with it; those Thermacare patches are nice. I've also > (lately) had pressure in my chest. It is my understanding heart related > problems in women often manifest themselves in neck & shoulder pain - oh > joy. After you get your disability, you can get a prescription or the PT person can give you something that looks like a small bedroll. You put it in the pillow and forms a sort of little log for the neck for those with neck problems. It's paid for by PT or physical therapy and runs around $20. I got one and it works although it sometimes rolls around in my pillow. Keep your neck nice and parallel when sleeping.
There is now a common Fast CT Scan. It's somewhat cheap and covered by insurance. It's a cheap and easy way to find out if your arteries are calcified. It WILL NOT detect soft deposits. It will detect hardening of the arteries by zeroing in on the calcium deposits. It's several hundred dollars but your insurance should cover it when you get insurance, assuming you do not have any for the moment.
The neck and shoulder pain might be the complex called fibromyalgia or chronic fatigue syndrome. This can be diagnosed by a series of tender spots on the shoulder and neck area. It's also associated with depression. The spots are on the upper back and with a light sleep pattern, I'll bet this is something that might be a cause for you. Granted this gets a lot of bad press as an illness.
One common, well should be common treatment, are extremely low dosages of SSRI's, about 1/4 the usual dosage. The point is to get someone undepressed enough so they can get some normal sleep, the deep sleep of delta waves. Often the people are not getting deep sleep and that leads to the aches and pains and even I would guess IBS. This can be diagnosed by sleep EEGs but that's well, well. Anyway, it's a very light dosage, 1/4th the normal dosage for the SSRI's (selective serotonin reuptake inhibitors). Since 1/4th, well tolerated, just enough to smooth you out during sleep and during the day.
Inositol can achieve what SSRI's do and it's available in health food stores. But it's the same price as a prescription for SSRI's (Zoloft Paxil Prozac). A natural product, really derived from the B vitamins. It will perk you up. Couple tablespoons in orange juice. Au naturel. It's in the medical literature. I am not making this up although it's not widely known for some reason. Meroowwrr.
I am not a doctor. Nor do I play one in the streets. But I read the literature and have correctly diagnosed people which is then confirmed by their lazy doctors! Usually in person. Doing this over the internet is a bit silly but I was concerned about your going for disability which can be a super hassle depending on where you live.
Oh, if you get any static, see a lawyer. Going to the formal hearing without a lawyer is probably a big-time no-no from what I hear. I don't know how this works but a lawyer will step in when the administrative person tries to trip you up with tricky questions to make you look bad. And that's very easy to do without a lawyer to say, you don't have to answer that...
Howard Berkowitz - 03 Feb 2005 02:59 GMT > > I've had pains in my left neck & shoulder which I initially attributed > > to [quoted text clipped - 42 lines] > One common, well should be common treatment, are extremely low dosages of > SSRI's, about 1/4 the usual dosage. Ummm...are you sure you are thinking SSRI's? Most "typical" SSRIs do not have any effect on chronic pain. What is often effective for chronic pain, fibromyalgia, and sometime migraine prevention is a low-dose, as you suggest, tricyclic antidepressant [TCA] (e.g., amitriptyline 10-25mg at bedtime, where the starting psychiatric dosage is about 75mg).
TCAs are sometimes called "first generation" and SSRIs "second generation", but that's misleading. There are other classes of the same vintage as TCAs (monoamine oxidase inhibitors, or MAOI). [1 for some explanation]
>The point is to get someone > undepressed > enough so they can get some normal sleep, the deep sleep of delta waves. Usually, the improvement in sleep, chronic pain, and fibromyalgia with TCAs is attributed to other than an antidepressant activity -- but it's even less understood than the antidepressant effect. One of the key things about the use of TCAs in these conditions is that if they work, they tend to work within a few days, where it typically takes 3 weeks or so for them to affect depression. The working hypothesis is that in the first usage, the TCAs make more neurotransmitters (principally serotonin) available in the tissues outside the brain, where the continued dosage is necessary to reset a brain chemical level in depression. Other suggestive evidence is that cyclobenzaprine (Flexeril) is the first-line drug for fibromyalgia. While it's chemically related to the TCAs, it has no antidepressant activity -- but it is known to increase serotonin levels in muscle tissue. TCAs are "nonselective" in comparison to SSRIs, as they increase both serotonin and norepinephrine levels.
Without getting into the biochemistry (although I will comment on that below), the original idea of SSRIs -- blocking the reuptake of neurotransmitters from the sending neuron, so they can act longer on the receiving neuron -- has generalized. There are reuptake inbibitors that increase both serotonin and norepinephrine, serotonin only, or norepinephrine only. A new dual reuptake inhibitor, duloxetine (Cymbalta) is the first reuptake inhibitor approved for pain syndromes, specifically for diabetic neuropathy.
> Often > the people are not getting deep sleep and that leads to the aches and [quoted text clipped - 16 lines] > I am not making this up although it's not widely known for some reason. > Meroowwrr. I'm just not familiar with it.
> I am not a doctor. Nor do I play one in the streets. But I read the > literature > and have correctly diagnosed people which is then confirmed by their lazy > doctors! Fair enough. I just simulate them in software. :-)
>Usually in person. Doing this over the internet is a bit silly > but I > was concerned about your going for disability which can be a super hassle > depending on where you live. [1] Quickie course in the biochemistry of most antidepressants.
Depression appears to be related to low effective levels, in the brain, of one or both of two neurotransmitters, serotonin and norepinephrine. Most of you probably know that nerve-to-nerve transmission is more chemical than electrical, although it's more electrical with respect to when one cell "fires".
Picture a hollow gap between the sending neuron and the receiving neuron. This gap is called the synapse. The sending neuron doesn't just send a quick burst -- the chemical transmitters stay in the gap for a period of time. The longer they are present, the more they are absorbed by the receiving cell. The receiving cell will eventually convert them to waste products, but the longer they act on the receiving cell, the greater the effect.
TCAs inhibit one enzyme, COMT [2], in the receiving cell, which breaks down both serotonin and norepinephrine. COMT isn't the only enzyme involved; MAO [4] is another enzyme in the breakdown chain. MAO inhibitors slow postsynaptic (receiving) breakdown in a different way than TCAs. MAO inhibitors, while clinically effective, aren't used much because they can interact with a wide (and weird) range of foods and drugs (including TCAs) to cause fatally high blood pressure.
Back to the sending/presynaptic cell. This cell keeps track of how much neurotransmitter it pumps into the synapse, and, when it decides it's sent enough, it sucks it back up (reuptake). Reuptake inhibitors slow this process and keep the transmitter in the synapse longer.
So, the different classes of antidepressants all raise the effective duration of neurotransmitters in the receiving neuron. TCAs and MAOIs do it in the receiver, while reuptake inhibitors do it to the sender.
[2] Do you really, really want to know what COMT stands for? I warned you... [3]
[3] Catechol-O-methyl transferase.
[4] MAO is monoamine oxidase. MAO inhibitors interact with foods rich in a chemical called tyramine. The most important of these foods, clearly, is chocolate [5]. Aged cheeses, smoked fish, and Chianti (but not so much other red wines) also have a lot.
[5] Chocolate also contains phenylethylalanine, which has been thought to be a mood elevator, sexual stimulant, or both -- in women.
Treeline - 03 Feb 2005 03:30 GMT > > > I've had pains in my left neck & shoulder which I initially attributed > > > to [quoted text clipped - 48 lines] > you suggest, tricyclic antidepressant [TCA] (e.g., amitriptyline 10-25mg > at bedtime, where the starting psychiatric dosage is about 75mg). Thanks for your input. It's been a few years since I heard this discussed by a Hahvad doc specializing in this on an interview on NPR. Sounds as though you know more about this than I do. I can't find my notes now. I block out the antidepressant you mentioned since when combined with an MAO can cause strokes, but that's ancient history now. But it's in the literature now what type of anti-depressant to take. Thanks again for your correction.
> TCAs are sometimes called "first generation" and SSRIs "second > generation", but that's misleading. There are other classes of the same [quoted text clipped - 111 lines] > thought to be a mood elevator, sexual stimulant, or both -- > in women. Howard Berkowitz - 03 Feb 2005 04:33 GMT > Thanks for your input. It's been a few years since I heard this discussed > by a [quoted text clipped - 3 lines] > the > antidepressant Pretty much ANY antidepressant, including chocolate.
>you mentioned since when combined with an MAO can cause > strokes, > but that's ancient history now. But it's in the literature now what type > of > anti-depressant to take. Thanks again for your correction. This is probably far too much information, but I'll paste the information from Medscape's database. This class of drug, which still has applications although never the first choice, has one of the widest range of bad interactions of ANY class of medication. You need to have about a two-week period between the last dose of any other antidepressant I can think of, and the first dose of MAOI:
Concomitant use of MAO inhibitors and certain food or prescription or nonprescription (over-the-counter, OTC) drugs can result in interactions that have the potential to cause hypertensive crisis due to the release and potentiation of catecholamines similar to that experienced in pheochromocytoma. The severity and consequences of such interactions vary among individuals. If only minor increases in blood pressure occur, patients may be unaware of the interactions. However, if substantial and rapid increases in blood pressure (an increase of 30 mm Hg or more in systolic blood pressure within 20 minutes) occur, patients may experience symptoms associated with subarachnoid hemorrhage or cardiac failure (sudden severe occipital headache, palpitations) if the cerebral vasculature or cardiac musculature are already weakened. (See Hypertensive Crisis under Cautions: Cardiovascular Effects.)
Food
Hypertensive crises have occurred following ingestion of foods containing large amounts of tyramine or tryptophan in some patients receiving MAO inhibitors. In general, patients should avoid protein foods that have undergone protein breakdown by aging, fermentation, pickling, smoking, or bacterial contamination; protein extracts and liquid or powdered dietary supplements also should be avoided. Patients should be specifically instructed not to eat foods such as cheese, particularly strong or aged varieties (e.g., cheddar, Camembert, Stilton) and processed cheese; sour cream; wine, especially chianti, champagne, and alcohol-free or reduced-alcohol wine products; beer, including alcohol-free and reduced-alcohol beers; pickled herring; anchovies; caviar; shrimp paste; liver, especially chicken liver; dry sausage (e.g., Genoa salami, hard salami, pepperoni, Lebanon bologna); figs, particularly if overripe, or canned figs; raisins; bananas or avocados, particularly if overripe; chocolate; soy sauce; bean curd; yeast extracts (including brewer?s yeast in large quantities); yogurt; papaya products, including certain meat tenderizers; and pods of broad beans (e.g., fava beans). Excessive amounts of caffeine may also reportedly precipitate hypertensive crisis. Specialized references on food constituents or a dietician should be consulted for more specific information on the tyramine content of foods and beverages.
Sympathomimetic Agents and Catecholamine-releasing Agents
Because some patients appear to be particularly sensitive to the hypertensive effects of sympathomimetic agents during MAO inhibitor therapy, centrally acting sympathomimetic agents (e.g., amphetamines) or peripherally acting sympathomimetic agents, including prescription or nonprescription cold, hay fever, or weight-reducing preparations that contain pressor agents (e.g., ephedrine, phenylpropanolamine), should not be administered concomitantly with an MAO inhibitor.
Parenteral or oral administration of reserpine or guanethidine in patients receiving MAO inhibitors may cause a severe pressor response as a result of a sudden release of accumulated catecholamines. Therefore, the manufacturers of MAO inhibitors do not recommend concomitant use of guanethidine in patients receiving an MAO inhibitor and also recommend that reserpine be administered cautiously in patients receiving MAO inhibitors.
Levodopa and other Catecholamines
Hypertension, headache, hyperexcitability, and related symptoms reportedly have occurred in patients receiving MAO inhibitors concurrently with methyldopa, dopamine, or levodopa. It has been suggested that use of a decarboxylase inhibitor (e.g., carbidopa) with levodopa may prevent hypertensive reactions during concomitant therapy with an MAO inhibitor.
?Drugs Associated with Serotonin Syndrome
Serotonin syndrome may occur in patients receiving MAO inhibitors in combination with other serotonergic drugs. Although the syndrome appears to be relatively uncommon and usually mild in severity, serious complications, including seizures, disseminated intravascular coagulation, respiratory failure, severe hyperthermia, and death occasionally have been reported. The precise mechanism of the syndrome is not fully understood; however, it appears to result from excessive serotonergic activity in the CNS, probably mediated by activation of serotonin 5-HT1A receptors. The possible involvement of dopamine and 5-HT2-receptors also has been suggested, although their roles remain unclear.
The syndrome most commonly occurs when 2 or more serotonergic agents with different mechanisms of action are administered either concurrently or in close succession. Serotonergic agents include those that increase serotonin synthesis (e.g., the serotonin precursor tryptophan), stimulate synaptic serotonin release (e.g., some amphetamines, dexfenfluramine [no longer commercially available in the US], fenfluramine [no longer commercially available in the US]), inhibit the reuptake of serotonin after release (e.g., selective serotonin-reuptake inhibitors [SSRIs], tricyclic antidepressants, trazodone, dextromethorphan, meperidine, tramadol), decrease the metabolism of serotonin (e.g., MAO inhibitors), have direct serotonin postsynaptic receptor activity (e.g., buspirone), or nonspecifically induce increases in serotonergic neuronal activity (e.g., lithium salts).
The combination of MAO inhibitors and SSRI antidepressants (e.g., fluoxetine) appears to be responsible for most of the recent case reports of serotonin syndrome. The syndrome also has been reported when MAO inhibitors have been combined with tricyclic antidepressants, tryptophan, meperidine, or dextromethorphan. In rare cases, serotonin syndrome reportedly has occurred with the recommended dosage of a single serotonergic agent (e.g., clomipramine) or during accidental overdosage (e.g., sertraline intoxication in a child). Some other drugs that have been implicated in certain circumstances include buspirone, bromocriptine, dextropropoxyphene, methylenedioxymethamphetamine (MDMA; ??ecstasy??), and selegiline (a selective MAO-B inhibitor). Other drugs that have been associated with the syndrome but for which less convincing data are available include carbamazepine, fentanyl, and pentazocine.
Clinicians should be aware of the potential for serious, possibly fatal reactions associated with serotonin syndrome in patients receiving 2 or more drugs that increase the availability of serotonin in the CNS, even if no such interactions with the specific drugs have been reported to date in the medical literature. Pending further data, all drugs with serotonergic activity should be used cautiously in combination and such combinations avoided whenever clinically possible. Some clinicians state that patients who have experienced serotonin syndrome may be at higher risk for recurrence of the syndrome upon reinitiation of serotonergic drugs. Pending further experience in such cases, some clinicians recommend that therapy with serotonergic agents be limited following recovery. In cases in which the potential benefit of the drug is thought to outweigh the risk of serotonin syndrome, lower potency agents and reduced dosages should be used, combination serotonergic therapy should be avoided, and patients should be monitored carefully for symptoms of serotonin syndrome. For further information on serotonin syndrome, including manifestations and treatment, see Serotonin Syndrome under Drug Interactions: Drugs Associated with Serotonin Syndrome, in Fluoxetine Hydrochloride 28:16.04.20.
Selective Serotonin-reuptake Inhibitors
Concurrent use of selective serotonin-reuptake inhibitors (SSRIs) and MAO inhibitors potentially is hazardous and may result in serotonin syndrome. Probably because of its extensive clinical use and the prolonged elimination half-life of both fluoxetine and norfluoxetine, fluoxetine has been the SSRI most commonly implicated in serotonin syndrome when combined with MAO inhibitor therapy. In at least 2 cases, serotonin syndrome has developed when MAO inhibitor therapy has been initiated after the discontinuance of fluoxetine therapy. Shivering, diplopia, nausea, confusion, and anxiety reportedly occurred in one patient 6 days after discontinuance of fluoxetine therapy and 4 days after initiation of tranylcypromine therapy; signs and symptoms resolved without apparent sequelae within 24 hours following discontinuance of the MAO inhibitor in this patient. In another case, the initiation of tranylcypromine therapy more than 5 weeks after discontinuance of fluoxetine reportedly resulted in serotonin syndrome. The manufacturer of fluoxetine, the manufacturers of MAO inhibitors, and some clinicians state that concurrent administration of fluoxetine and MAO inhibitors is contraindicated. Because both fluoxetine and its principal metabolite have relatively long half-lives, the manufacturer of fluoxetine, the manufacturers of MAO inhibitors, and some clinicians recommend that at least 5 weeks elapse between discontinuance of fluoxetine therapy and initiation of MAO inhibitor therapy, since administration of an MAO inhibitor prior to elapse of this time may increase the risk of serious adverse effects. Although the manufacturers of some MAO inhibitors (i.e., phenelzine) recommend that at least 10 days elapse following discontinuance of MAO inhibitor therapy prior to initiation of fluoxetine therapy, based on clinical experience with concurrent administration of tricyclic antidepressants and MAO inhibitors, the manufacturers of fluoxetine and the manufacturers of some MAO inhibitors (e.g., selegiline, tranylcypromine) recommend that at least 2 weeks elapse following discontinuance of an MAO inhibitor prior to initiation of fluoxetine therapy.
Other SSRI antidepressants, including sertraline and citalopram, also have been associated with serotonin syndrome when given in combination with MAO inhibitors. Because of the potential risk of serotonin syndrome when SSRIs are combined with MAO inhibitor therapy, the manufacturers of fluvoxamine, paroxetine, and sertraline currently recommend that a drug-free interval of at least 2 weeks elapse when switching from an MAO inhibitor to these agents or when switching from these agents to an MAO inhibitor.
Moclobemide, a selective and reversible MAO-A inhibitor (not commercially available in the US), also has been associated with serotonin syndrome and such reactions have been fatal in several cases in which the drug was given in combination with citalopram or with clomipramine. Pending further experience with such combinations, some clinicians recommend that concurrent therapy with moclobemide and SSRIs be used only with extreme caution and that the SSRI should have been discontinued for some time (depending on the elimination half-lives of the drug and its active metabolites) before initiating moclobemide therapy.
Tryptophan
Although tryptophan sometimes has been used to enhance the antidepressant activity of MAO inhibitors, serotonin syndrome, which was fatal in at least one case, has been reported in a limited number of patients receiving these drugs in combination either with or without concurrent lithium therapy. While the mechanism for this interaction has not been fully elucidated, it has been suggested that these adverse effects resemble serotonin syndrome and therefore may result from a marked increase in serotonin availability in the CNS when these agents are administered concurrently. Behavioral and neurologic syndromes, including disorientation, confusion, amnesia, delirium, agitation, hypomanic signs, ataxia, myoclonus, hyperreflexia, shivering, ocular oscillations, and Babinski signs, also have been reported in patients receiving MAO inhibitors and tryptophan concomitantly. Pending further evaluation of this potential interaction, clinicians should be aware that toxic reactions may occur when MAO inhibitors and tryptophan are administered concomitantly.
Buspirone
Elevations in blood pressure have been observed in several patients receiving an MAO inhibitor and buspirone concomitantly; no adverse sequelae were associated with these elevations. Buspirone may have been partially responsible for a case of serotonin syndrome that resulted in the death of a patient receiving buspirone, an MAO inhibitor (tranylcypromine), and fluoxetine concomitantly. Pending accumulation of additional data, it is recommended that MAO inhibitors not be used concomitantly with buspirone. Some manufacturers recommend that at least 10 days elapse between discontinuance of MAO inhibitor therapy and administration of buspirone.
?Tricyclic Antidepressants
Concomitant administration of MAO inhibitors and tricyclic antidepressants is contraindicated, and it generally is recommended that at least 2 weeks should elapse between discontinuance of tricyclic antidepressant therapy or MAO inhibitor therapy and initiation of therapy with the other class of drugs. Serious, sometimes fatal, reactions including hyperpyrexia, confusion, diaphoresis, myoclonus, rigidity, seizures, cardiovascular disturbances, and coma have occurred in patients who received an MAO inhibitor and a tricyclic antidepressant concomitantly. Patients receiving therapeutic dosages of an oral MAO inhibitor and an oral tricyclic antidepressant concomitantly generally have experienced nonfatal hyperpyrexia, hypertension, tachycardia, confusion, and seizures; most reported cases of hyperpyretic crises, severe seizures, or death occurred following overdosage or parenteral administration of one or both drugs. Although the mechanism has not been clearly established, these reactions resemble serotonin syndrome and may be caused by excessive serotonergic activity in CNS. (See Drug Interactions: Drugs Associated with Serotonin Syndrome.)
?CNS Depressants
Several manufacturers caution that MAO inhibitors may be additive with, or may potentiate the action of, CNS depressants such as opiates or other analgesics, barbiturates or other sedatives, anesthetics, or alcohol. CNS depressants should be administered cautiously to patients receiving MAO inhibitors in order to avoid excessive sedation and acute hypotension; a reduction in dosage of the CNS depressant agent(s) may be necessary. One manufacturer recommends that, if emergency surgery is necessary in a patient receiving an MAO inhibitor, the dose of opiate, sedative, analgesic, and other premedication be reduced to one-fourth to one-fifth the usual dose.
Meperidine
Meperidine should not be used in patients receiving MAO inhibitors since severe, generally immediate reactions, including excitation, sweating, rigidity, and hypertension, suggestive of serotonin syndrome, have occurred. Circulatory collapse and death have also occurred following administration of a single dose of meperidine in some patients receiving an MAO inhibitor.
Dextromethorphan
Concomitant use of MAO inhibitors and dextromethorphan (ingested as a lozenge) has been reported to cause brief episodes of psychosis or bizarre behavior. Cases of apparent serotonin syndrome, including at least 2 fatalities, have been reported in patients receiving concurrent MAO inhibitor and dextromethorphan therapy. Dextromethorphan preparations should not be used in patients receiving an MAO inhibitor.
?Bupropion
Studies in animals using phenelzine have shown that the acute toxicity of bupropion is enhanced by the MAO inhibitor. Concomitant use of an MAO inhibitor and bupropion is contraindicated, and it is suggested that at least 14 days elapse between discontinuance of MAO inhibitor therapy and initiation of bupropion therapy.
?Anesthetics
The hypotensive and CNS depressant effects of general anesthetics may be exaggerated in patients receiving MAO inhibitors. Since inhibition of monoamine oxidase may persist for several days following discontinuance of therapy, some manufacturers suggest that MAO inhibitors be discontinued for at least 7?14 days prior to elective surgery to allow time for recovery of enzymatic activity before general anesthetics are used. If emergency surgery is necessary in a patient receiving an MAO inhibitor, the dose of the general anesthetic should be carefully adjusted.
Patients receiving MAO inhibitors should not be given cocaine or local anesthetics that contain sympathomimetic vasoconstrictors, since hypertension may result.
Because MAO inhibitors may potentiate the hypotensive effect of local anesthetics used in spinal anesthesia, these agents should be used with caution in patients receiving MAO inhibitors.
?Disulfiram
MAO inhibitors should probably be used with caution in patients receiving disulfiram. In one study in animals receiving large intraperitoneal doses of disulfiram and the d- or l-isomer of tranylcypromine, severe toxicity, including seizures and death, occurred. However, in other studies in animals receiving large oral doses of disulfiram and racemic tranylcypromine, no adverse interaction was reported.
?Metrizamide
Animal studies suggest an increased risk of seizures when metrizamide (no longer commercially available in the US) is administered concurrently with drugs that lower the seizure threshold; however, the clinical importance of such an interaction has not been clearly established. The manufacturer of metrizamide has stated that MAO inhibitors should not be used concomitantly in patients receiving the contrast medium. The manufacturer of metrizamide also stated that MAO inhibitors should be discontinued, if possible, at least 48 hours before and for at least 24?48 hours after administration of metrizamide.
?Diuretics and Hypotensive Agents
In general, MAO inhibitor antidepressants should not be administered concomitantly with diuretics or hypotensive agents since a marked hypotensive effect may occur.
?Drugs with Anticholinergic Activity
Some manufacturers state that anticholinergic antiparkinsonian drugs should be used with caution in patients receiving MAO inhibitors, since severe reactions have reportedly occurred when these drugs were used concurrently; however, additional information is needed to determine the clinical importance of this potential interaction. It also should be considered that MAO inhibitors may prolong and intensify some anticholinergic effects (e.g., dryness) of antihistamines.
Treeline - 03 Feb 2005 06:05 GMT > This is probably far too much information, but I'll paste the > information from Medscape's database. This class of drug, which still > has applications although never the first choice, has one of the widest > range of bad interactions of ANY class of medication. You need to have > about a two-week period between the last dose of any other > antidepressant I can think of, and the first dose of MAOI: Not bad. Depressing that I actually understood all of it. One of the sneakiest side effect I have heard about is the antibiotic, common erythromycin and viagra!!!!!! watch out on that one. i won't tell you what happens because it can be tragic or comic depending...
But for fibromyalgia or CFS, Elavil, as you suggested is fine for the low dose antidepressant, just a 1/4 fraction of the usual dose. Just now I was talking to my ex-gf and she says in her book it also mentions Ambien probably for a sound deep sleep and something for the muscle relaxant.
Ambien for sleep, 10 mg of Elavil amitrypilene, Zelustril for muscle relaxant or did she mean Zestril which would be a muscle relaxant but for the heart, hmmm. Anyway, Elavil is the antidepressant. My ex was the one when we went to her internist and I was waiting for her, I read the literature on the table and diagnosed the CFS according to the silly pamphlet. Her doc, a university doc, said yes, I was right but that's all I got. But why could he not do his job? it was his field too. duh.
and now back to our regularly scheduled meow
CatNipped - 03 Feb 2005 16:08 GMT >> This is probably far too much information, but I'll paste the >> information from Medscape's database. This class of drug, which still [quoted text clipped - 33 lines] > > and now back to our regularly scheduled meow My doctor was giving me Neurontin and Effexor (along with Wellbutrin, Ambien, and Zanaflex) for my fibromyalgia, but I found it didn't really help - especially after my body got enured to the effects. And, it was pure h*ll to get over the withdrawals when I stopped taking it.
(Howard and I have discussed this before - my doctor would not give me a regimen for discontinuing the medication since he wanted me to remain on it even though I was losing my insurance and couldn't afford it, so I quit all my meds cold-turkey - stupid and potentially life-threatening, but I did manage to get through it.)
Since that experience I'm determined not to get on any other long-term medications, but I can't get by without the Ambien and Zanaflex - I can't sleep without them, and when I don't sleep the pain is unbearable.
I can pretty much suck up the pain and still function just using the Ambien and Zanaflex - the doctor mentioned just last Monday that they were having success with another anti-depressant in fibromyalgia patients, but I didn't really listen to even the name of the drug since I'm so determined to stay away from any other maintenance medications.
Hugs,
CatNipped
Howard Berkowitz - 03 Feb 2005 17:11 GMT > >> This is probably far too much information, but I'll paste the > >> information from Medscape's database. This class of drug, which still [quoted text clipped - 59 lines] > medications, but I can't get by without the Ambien and Zanaflex - I can't > sleep without them, and when I don't sleep the pain is unbearable. There have been some recent studies that confirm Ambien is safe and effective for much longer periods of therapy than previously thought. Still, there are some potential problems. I've started using low-dose Seroquel, which is officially an atypical antipsychotic, but is finding a number of off-label uses. I find it more gentle and yet probably giving more refreshing sleep than Ambien. Roughly comparable cost.
> I can pretty much suck up the pain and still function just using the > Ambien [quoted text clipped - 9 lines] > > CatNipped CatNipped - 04 Feb 2005 01:11 GMT > There have been some recent studies that confirm Ambien is safe and > effective for much longer periods of therapy than previously thought. > Still, there are some potential problems. I've started using low-dose > Seroquel, which is officially an atypical antipsychotic, but is finding > a number of off-label uses. I find it more gentle and yet probably > giving more refreshing sleep than Ambien. Roughly comparable cost. Hmmmm. I use the Ambien because it *WILL* put me to sleep in under 20 minutes - guaranteed. The only problem is that Ambien is made to wear off in 4 hours. The purpose of this is that, normally, once a person gets to sleep they'll stay asleep and wake up 8 hours later without feeling drugged - but it doesn't work that way for people with fibromyalgia. I have a problem with the *type* of sleep I get. I don't ever go into deep, "delta" sleep. I stay in "alpha" stage sleep in which the brain waves almost mimic being awake. This means I sleep, well, like a cat. I wake up very easily, so after the Ambien wears off in 4 hours I usually wake up every few minutes after that.
I think the theory behind fibromyalgia is that "delta" sleep is when the body washes out all the lactate in your muscles, refreshing them, and repairs all the micro-damage that happens to the muscles all day long. By not going into "delta" sleep, this doesn't happen so you wake up feeling even worse than when you went to sleep. [OK, Howard, feel free to correct me - I know I probably screwed this up completely, but it's just what I seem to remember from the doctor's explanation years ago.]
Anyway, all this to ask, Howard, does the Seroquel work for longer than 4 hours?
Hugs,
CatNipped
CatNipped - 04 Feb 2005 01:30 GMT > > There have been some recent studies that confirm Ambien is safe and > > effective for much longer periods of therapy than previously thought. [quoted text clipped - 16 lines] > I think the theory behind fibromyalgia is that "delta" sleep is when the > body washes out all the lactate <-------------- LOL, my Freudian slip is showing!
Hugs,
CatNipped
in your muscles, refreshing them, and
> repairs all the micro-damage that happens to the muscles all day long. By > not going into "delta" sleep, this doesn't happen so you wake up feeling [quoted text clipped - 8 lines] > > CatNipped Howard Berkowitz - 04 Feb 2005 02:19 GMT > > There have been some recent studies that confirm Ambien is safe and > > effective for much longer periods of therapy than previously thought. [quoted text clipped - 16 lines] > very easily, so after the Ambien wears off in 4 hours I usually wake up > every few minutes after that.
> I think the theory behind fibromyalgia is that "delta" sleep is when the > body washes out all the lactate in your muscles, refreshing them, and [quoted text clipped - 6 lines] > seem > to remember from the doctor's explanation years ago.] I'm not sure there's any real data on the association with sleep EEG levels and fibromyalgia. While the EEG is still probably useful in the evaluation of convulsive disorders and possibly some organic brain disease, it's a less important tool now that we have things like PET and functional MRI scanning. They reveal much more of what's going on in the brain. Where EEGs give data on the outside, these techniques image the inner structures, and -- critically -- chemical activity in them.
One interesting and recent finding, still seeking more data, is that the parts of the brain that trigger violent emotion develop faster in adolescent males than the parts that appear to moderate it.
> Anyway, all this to ask, Howard, does the Seroquel work for longer than 4 > hours? Let's put it this way -- I often need 9 or 10 hours to be rully refreshed, but if I sleep for 8 or so on it, I usually wake up rested and don't wake up during the night -- major bed cat activity excepted. We don't have bedmice, it's just that Mr. Clark weighs about 17 pounds and sometimes sleeps on parts of my body not quite stressed for it.
Treeline - 04 Feb 2005 17:09 GMT > I'm not sure there's any real data on the association with sleep EEG > levels and fibromyalgia. While the EEG is still probably useful in the [quoted text clipped - 3 lines] > brain. Where EEGs give data on the outside, these techniques image the > inner structures, and -- critically -- chemical activity in them. You might want to rethink this a bit. About 9 years ago I read about delta waves and CFS or fibromylagia. What is extremely handy about EEGs is that you can fairly easily collect 8 hours or days of data. Try that with an fMRI!!!
Now while the EEGs are taken on the outside of the skull, if you are looking for delta waves, that's really all you need. If you want to see what the hippocampus or the amygdala is doing at the tip of the hippocampus, then you need imaging equipment that can go there. But it's not necessary here for establishing the lack of delta waves.
But if you want to see what the brain is producing and producing over 8 or 10 or 24 hours, EEGs are fabulous for that. And relatively cheap to do for anyone. You can walk around with ambulatory EEGs monitoring. Never seen an ambulatory MRI or PET, have you?
Can you imagine the cost of an fMRI for 8 hours of continuous moderating? And someone is going to have to sleep inside the tube too? That would be around $25,000 easily, don't you think?
About PET, I do not know that much about them. What would be the ease and cost? With EEGs, a person can sleep in a bed as normal, with a showercap that has the attached EEGs. So they can toss and turn and be observed. Can't observe someone inside an MRI.
But in any case, the lack of delta waves is easy, super easy to do with EEGs and was done a long time ago. Why do you say there is "no real data?" Did you look? I found it back in 1995, so I'm perplexed since you are usually so good at this stuff. Are you really sure that is not any data with delta waves and CFS or fibro?
> One interesting and recent finding, still seeking more data, is that the > parts of the brain that trigger violent emotion develop faster in > adolescent males than the parts that appear to moderate it. No, say it ain't so. Really? Never would have thunk it. [testosterone is great for this - betcha it does not happen before puberty - it's all hormones without even looking up the studies, i betcha]
Treeline - 04 Feb 2005 17:31 GMT > > One interesting and recent finding, still seeking more data, is that the > > parts of the brain that trigger violent emotion develop faster in > > adolescent males than the parts that appear to moderate it. Okay, let me get serious this time. The sympathetic nervous system is super fast, all the time, regardless of age. The parasympathetic nervous system, the relaxing one or meditating or moderating one, is too slow and often not trained well in most humans in the western hemisphere. More interest in the eastern hemisphere, talking globally not brainwise or brain hemispheres :)
It's an interesting finding but expected. Now what part of the brain is supposed to moderate it? I am perplexed because the parasympathetic nervous system has its main nexus around the lower tummy area, below the belly button, the fabled t'an tien in Chinese medicine or mythology, and the upper back between the shoulder blades, yes? So if you can remember what part they were referring to, heck, what parts for both nervous systems, that would help. For the sympathetic nervous system, it's the hippocampus? the fight or flight system? sound right?
But what part in the brain itself moderates anger? The thinking part in the prefrontal lobes, the top/front part of the head where thinking and judgment is supposed to occur. You got me thinking now about this. I have to start going to the brain gym ;)
Okay, I remember now, the hypogastrium for the parasympathetic complex is the medical name for what the t'an tien or tan dien for giqong taiji and all those centering oriental arts. Basically 1 inch below the belly button and 1 inch inwards. Well the hypogastrium might be simply the name of the area and not the name of the nexus for the parasympathetic nervous system which mediates violent responses or really slows down the human being.
Howard Berkowitz - 04 Feb 2005 17:57 GMT > > I'm not sure there's any real data on the association with sleep EEG > > levels and fibromyalgia. While the EEG is still probably useful in the [quoted text clipped - 20 lines] > need imaging equipment that can go there. But it's not necessary here for > establishing the lack of delta waves. The problem is that we really don't have a decent theoretical understanding of the different waveforms. We have some clinical correlations that can be useful in dealing with specific disease entities. I'm concerned that too much is being extrapolated from brain waves.
> But if you want to see what the brain is producing and producing over 8 > or 10 > or 24 hours, EEGs are fabulous for that. And relatively cheap to do for > anyone. Ambulatory EEGs are extremely useful in the clinical evaluation of seizure disorders. I have not seen evidence that they give meaningful data on other brain activity.
> You can walk around with ambulatory EEGs monitoring. Never seen an > ambulatory > MRI or PET, have you? Not really relevant, if I can get a short meaningful sample from imaging, but continuous data from EEG recording which isn't too specific.
> Can you imagine the cost of an fMRI for 8 hours of continuous moderating? > And > someone is going to have to sleep inside the tube too? That would be > around > $25,000 easily, don't you think? I'm still unclear on the need for that period of continuous monitoring.
> About PET, I do not know that much about them. What would be the ease and > cost? [quoted text clipped - 3 lines] > someone > inside an MRI. Why not? Indeed, there have been published studies of internal organ positioning during sexual intercourse, with external video to correlate. There's no problem putting optical fiber inside the magnetic field of the MRI.
> But in any case, the lack of delta waves is easy, super easy to do with > EEGs [quoted text clipped - 5 lines] > and > CFS or fibro? I'd want to see it. Most neurologists I know are using EEG less and less.
Nerve conduction studies and electromyography are giving interesting data in fibromyalgia, as are tissue biopsies. I'm unclear if you are referring to research or routine treatment.
> > One interesting and recent finding, still seeking more data, is that > > the [quoted text clipped - 6 lines] > without > even looking up the studies, i betcha] Not directly the hormones, as, for example, the state of the amygdala.
Treeline - 04 Feb 2005 23:27 GMT > > Now while the EEGs are taken on the outside of the skull, if you are > > looking [quoted text clipped - 9 lines] > entities. I'm concerned that too much is being extrapolated from brain > waves. Who doesn't? Delta waves are associated with deep sleep. It's not a theory. It's simply an observation. What are you saying here? Delta waves are not necessary? Look, humans need 2 legs for locomotion. It's possible to get by with one or no legs but 2 legs are better. Same with delta waves. Most normal or average or healthy people have delta waves in deep sleep. There is not much here in the way of extrapolation. It's mostly observation. Where do you see theory or extrapolation? I don't follow your usual excellent line of reasoning.
> > But if you want to see what the brain is producing and producing over 8 > > or 10 [quoted text clipped - 4 lines] > seizure disorders. I have not seen evidence that they give meaningful > data on other brain activity. This is because most of medicine only use EEGs for epilepsy. Most neurologists do not even understand the difference of bipolar versus referential recordings for research. It's sad that you have not seen much evidence because it's due to the stupidity and lack of real scientific knowledge of most docs. They memorize textbooks and learn how to wear white coats. Most of them could not do any real science even if you threw them into a lab. EEGs should have been used in science but even though they are simple pieces of equipment they still require a knowledge of physics and electricity that is simply beyond the ken of most doctors. I'm not saying that doctors are stupid per se. They have high IQs. I am saying they are stupid when it comes to real science.
> Not really relevant, if I can get a short meaningful sample from > imaging, but continuous data from EEG recording which isn't too specific. Only talking about delta waves which are sporadic in sleep, like what, 2 sessions of 45 minutes. Are you familiar with deep sleep and the propagation of delta waves at all? Without going to the internet, I say that deep sleep is synonymous with delta waves. No delta waves, no deep sleep. But delta is not a continuous thing, hence the monitoring to make sure that someone goes into deep sleep.
That is the whole point to this discussion. CFS people do not have delta in their sleep. Not real delta.
> I'm still unclear on the need for that period of continuous monitoring. See above.
> Why not? Indeed, there have been published studies of internal organ > positioning during sexual intercourse, with external video to correlate. > There's no problem putting optical fiber inside the magnetic field of > the MRI. Enlighten me how two people screw inside an MRI. Please! I am amazed at your in depth knowledge here.
So how come the rest of us have to remain still during an MRI and these people get to move around during an MRI?
I just don't see how this can be down with high resolution MRIs. Or even low resolution. How do you do MRIs of moving people?
> I'd want to see it. Most neurologists I know are using EEG less and less. Most neurologists I knew could only use EEGs for epilepsy because it's at the idiot level. Frederic Gibbs, the father of EEGs in the USA, once lamented to me how ignorant most neurologists were in using their EEGs. Truly not understand the basic physics. They make mistakes. In fact, their ignorance prevents them from using EEGs because their positioning of the electrodes for bipolar montages actually destroys the usefulness of EEGs for most research purposes, other than the very narrow of epileptiform signatures of the wave forms. Bipolar allows easy viewing of the spike wave form for finding epilepsy which is what most neurologists can do. Any moron could do it also. It's a very easy thing to discern.
I cannot recall a single neurologist who understood how differential amplifiers are how EEGs work and what is the difference between monopolar/referential and bipolar recordings. It's not difficult. Really first or second year undergraduate physics or engineering.
> Nerve conduction studies and electromyography are giving interesting > data in fibromyalgia, as are tissue biopsies. I'm unclear if you are > referring to research or routine treatment. 10 years ago I read the CFS did not produce or go into deep sleep which is characterized by delta waves. This is like saying someone's temp does not go to 97 F. It's not theory. It's observation. Now if you are saying that it's irrelevant, then that's another issue.
> Not directly the hormones, as, for example, the state of the amygdala. Amygdala is flight or fight. Now what mediates the opposite? That would be the pre-frontal lobes??? if in the brain and that's probably the last to develope in human beings, and probably not developed fully until the 20's for most human beings. This is what may mediate the parasympathetic nervous system. Unlike the amygdala which is for the sympathetic nervous system. We are born to flight or fight, for obvious reasons. And testosterone just exacerbates this. As it does with spatial and mathematical reasoning. But that's another gender issue. Testosterone goes together with maleness and violence. Unless a woman has very high levels, then there are there more spatial abilities. Whether there is also more violence, I do not remember. It's kind of rare for women, but I believe that very high levels of testosterone in women also come with high levels of aggression. I guess if you look into eunuchs you can see if early castration solves the problem of violence, but might interfere with the math scores on the SATs :) For the record, Denmark chemically castrated rapists (think of cyproteron acetate and such) and it worked. They used male hormone drugs.
thanks for your replies. let's see how far this goes. i don't understand why you are dinging on delta waves since that, for me, is not theory but an observation. deep sleep entails delta waves. you say this is theory or not so? enlighten me. i'll try not to be too biased against your reasoning.
CatNipped - 05 Feb 2005 02:07 GMT > Who doesn't? Delta waves are associated with deep sleep. It's not a theory. > It's simply an observation. What are you saying here? Delta waves are not [quoted text clipped - 3 lines] > here in the way of extrapolation. It's mostly observation. Where do you see > theory or extrapolation? I don't follow your usual excellent line of reasoning. I have only experiential evidence, and only my own experience, but having gone through a sleep study I know that I don't produce delta waves when I sleep, I stay in alpha stage sleep. I know from experience that I wake at the slightest stimuli (tap your fingernail lightly on your desk and that would wake me). And it takes me *HOURS* to go to sleep without Ambien - and only if the room is totally dard and totally silent, and only if I'm lucky.
I always attributed this to my ADHD. My kids also have ADHD and they would only sleep 3 or 4 hours a night (so maybe it was a blessing in disguise that I could keep up with them), but as they got older they were able to sleep longer and longer until now they can get 8 hours a night. I still only get 4 hours *IF* I take my Ambien. So I think the sleep issue is the cause/result of my fibromyalgia.
I once related here a weird experience I once had where I only got about 4 hours sleep over the course of 5 days - I ended up in the emergency room on the 6th day.
> Only talking about delta waves which are sporadic in sleep, like what, 2 > sessions of 45 minutes. Are you familiar with deep sleep and the propagation of > delta waves at all? Without going to the internet, I say that deep sleep is > synonymous with delta waves. No delta waves, no deep sleep. But delta is not a > continuous thing, hence the monitoring to make sure that someone goes into deep > sleep. And I've heard that it's only when you're in delta sleep that your body washes out the fatigue toxins from your muscles and repairs the micro-damage that is the result of normal daily activity. I don't go into delta sleep, so my muscles don't ever get repaird, so I live in constant pain (to get an idea of what it feels like, imagine having lived a sedentary life for about 10 years and then one day swimming for over 5 miles, then imagine how every muscle in your body would feel about a day or two after that).
> That is the whole point to this discussion. CFS people do not have delta in > their sleep. Not real delta. And people with fibromyalgia. The difference, AFAIK, is the CFS people feel chronically tired, but the fibro people are in agony pretty much all of the time. Did you know that 3 of Dr. Kevorkian's (sp?) "patients" had nothing wrong with them *except* for fibromyalgia (and who knows how many people commited suicide without help because of it). I think that the depression that comes from knowing you're going to spend every second of your life in terrible pain is another reason they started treating fibro with anti-depressions, not just to experiment with pain relief (only my guess).
> 10 years ago I read the CFS did not produce or go into deep sleep which is > characterized by delta waves. This is like saying someone's temp does not go to > 97 F. It's not theory. It's observation. Now if you are saying that it's > irrelevant, then that's another issue. Going by how it was explained to me (see above), it does make sense that lack of delta sleep could cause CFS and fibro, if that's how it really works. I just don't know if it has been documented that muscle repair happens *only* in delta sleep.
Hugs,
CatNipped
Howard Berkowitz - 05 Feb 2005 04:11 GMT > > > Now while the EEGs are taken on the outside of the skull, if you are > > > looking [quoted text clipped - 16 lines] > theory. > It's simply an observation. What are you saying here? That we don't have a theoretical basis for the waveform, and, AFAIK, if they are essential for deep sleep. Does deep sleep cause delta waves to generate, or do delta waves induce deep sleep?
I have much more experience in cardiac electrophysiology than brain, and an intermediate level in nerve conduction. My problem with depending too much on EEGs, in their present form, is the lack of theoretical understanding, and the lack of mapping of waveforms to a three-dimensional model.
> > > But if you want to see what the brain is producing and producing over > > > 8 [quoted text clipped - 14 lines] > due to > the stupidity and lack of real scientific knowledge of most docs. This is beginning to sound like a rant. Again, my experience is more in the clinical application of EEGs than in the theoretical work. Maybe someone is doing serious work in mapping them into a three-dimensional model, and correlating them with metabolic activity. I simply see the neurologists I know getting more and more benefit from advances in imaging, while brain electrophysiology seems to stay static.
> > Not really relevant, if I can get a short meaningful sample from > > imaging, but continuous data from EEG recording which isn't too [quoted text clipped - 4 lines] > propagation of > delta waves at all? I need a little more definition of deep sleep, and what you mean by propagation. To me, propagation means how the signal moves through various structures, as, for example, the SA nodal signal in the heart propagates through the AV node, the bundle of His, and the ventricular conduction system.
>Without going to the internet, I say that deep sleep > is [quoted text clipped - 20 lines] > your in > depth knowledge here. Trying to remember the journal - it was a reputable one. I subscribe to JAMA and NEJM, so would tend to think it was there.
> So how come the rest of us have to remain still during an MRI and these > people > get to move around during an MRI? Why are some people rich and handsome? :-) I think they were told, periodically, to "hold it."
> I just don't see how this can be down with high resolution MRIs. Or even > low [quoted text clipped - 12 lines] > purposes, > other than the very narrow of epileptiform signatures of the wave forms. Again, I'm unclear where you are going, other than being upset about this. I've always felt that EEG placement needed the precision of stereotactic frames, and correlation with internal anatomy, before it could tell much of anything.
> Bipolar allows easy viewing of the spike wave form for finding epilepsy > which [quoted text clipped - 8 lines] > bipolar recordings. It's not difficult. Really first or second year > undergraduate physics or engineering. Agreed that is basic electrical engineering. That simply hasn't come up in most discussions, but at least some are quite aware of the design.
> > Nerve conduction studies and electromyography are giving interesting > > data in fibromyalgia, as are tissue biopsies. I'm unclear if you are [quoted text clipped - 6 lines] > 97 F. It's not theory. It's observation. Now if you are saying that it's > irrelevant, then that's another issue. Treeline - 05 Feb 2005 06:39 GMT > > > The problem is that we really don't have a decent theoretical > > > understanding of the different waveforms. We have some clinical > > > correlations that can be useful in dealing with specific disease > > > entities. I'm concerned that too much is being extrapolated from brain > > > waves. Sometimes you just have to make do. As far as I know, no one knows how the waves are formed. But thanks to FFTs originally, we know what waves are being forms. Has there been any research recently that spells out how the brain makes AC waves? Yes the cells fire and all, but do they know? I have not followed this for years and the last brain researcher I talked with said, he really did not know. But he was an old brain researcher at that point.
> That we don't have a theoretical basis for the waveform, and, AFAIK, if > they are essential for deep sleep. Does deep sleep cause delta waves to > generate, or do delta waves induce deep sleep? It's possible we don't know anything about what causes the electricity. I would think by now we do but I have not checked the literature in years. That's not quite true. I have looked at various brain researchers. Heck, we still do not know where the engram is.
I do not see your logic here for the clinical point of view. Delta waves are just slow waves, by definition, in the USA, around 1 to 4 Hz or cycles per second. They are a bit tricky to detect because artifacts are also around that range, heart beat is around 1 Hz and eye blinks and what not.
However, and I could be wrong, when people go into what is known as deep sleep, which is about 45 minutes to what, 1.5 hours for a cycle, it's there that delta waves are observed.
Let's be more precise. The brain produces a spectrum of waves at all times. When we say we talk of delta waves, we are really saying the power or the amplitude of the delta waves have become far more pronounced. When this occurs, the phyisological signals slow down quite a bit, like heart and other things.
But it's just a way of speaking. Delta waves just mean that the brain is producing a lot of power in its somewhat lowest AC waves.
At this level, your argument reminds me of the chicken or the egg came first. It's nice to parcel out the causality but it's not necessary for the clinical application if it's too complicated. Well, I actually do not see your point of view at all. For me, delta waves are deep sleep. For the time being, I will say no delta, no deep sleep. If you wish to split hairs, please do but I am having trouble seeing the relevancy at this point if no delta means no deep sleep.
> I have much more experience in cardiac electrophysiology than brain, and > an intermediate level in nerve conduction. My problem with depending too > much on EEGs, in their present form, is the lack of theoretical > understanding, and the lack of mapping of waveforms to a > three-dimensional model. Eindhoven anyone? I just purchased an EKG or ECG for fun, well, not really. I am using my own modified Lead II to look for p waves. I am amazed how simple EKG's are compared to my own building of EEGs. I can build a usable EKG with about $10 worth of parts. Now for the automatic interpretation, that is expensive. Really, for the simple leads, not the AV ones, it's just a differential amplifier.
Now how good are you? I have been having a running battle with cardiologists and the machines for about 10 years now. They say the machines are mis-interpreting the data. A big-time professor and researcher agreed with me that the cardiologists were wrong and the machines were right.
If you are really, really good, how about I send you an EKG and you tell me if it shows a past heart attack, to use the layman's term, or not?
By the way, when you talk of nodes and so forth, is that not somewhat 2-D? I could ask you to 3-D the heart. That's really simple compared to the brain. If you look at the brain as a covering, okay, you want to know the innards. Too many layers and different type of structures compared to the heart.
Heck, with the heart you can radio ablate and change the abnormal conductions. Can't do that with the brain easily unless you are cruel and what to do lobotomies. Well, drugs can do it. Psychosurgery which is cruel can do it. Way too complicated what you are asking.
The heart is a big muscle and simple to work with. The brain is like hundreds of muscles and you can't work with it. The skull gets in the way...
> > This is because most of medicine only use EEGs for epilepsy. Most > > neurologists [quoted text clipped - 10 lines] > neurologists I know getting more and more benefit from advances in > imaging, while brain electrophysiology seems to stay static. You bet your booty it's a rant. GRRRRRRRRRRR. What can you do when for decades the neurologists have been destroying the use of EEGs? And their ignorance was passed on to the psychologists who are even less intelligent, as a rule, IQ wise, and yes, a rant is putting it mildly. I actually co-authored an article about this but it was done in scientific speak, so very softy did we call these people morons.
> I need a little more definition of deep sleep, and what you mean by > propagation. To me, propagation means how the signal moves through > various structures, as, for example, the SA nodal signal in the heart > propagates through the AV node, the bundle of His, and the ventricular > conduction system. The heart is so simple compared to the brain and waves. Propagation for me is really what I see on the oscilloscope when the electrodes are attached to the skull. If you want a full theoretical model, we need to get off the cat newsgroup dude. How about a series of MRIs in a prospective longitudinal study to start work on this problem? Even basic stuff like schizophrenia is just starting to be done with models. I find most of the MRI and PET stuff to be fine but crude. You're asking for something that's way down the line.
> Trying to remember the journal - it was a reputable one. I subscribe to > JAMA and NEJM, so would tend to think it was there. They are reputable and even more so since that editor took a hike who was perhaps, how to gently put it, some questionable practices there at NEJM? New England Journal of Medicine.
> Why are some people rich and handsome? :-) I think they were told, > periodically, to "hold it." You're kidding, right?
> Again, I'm unclear where you are going, other than being upset about > this. I've always felt that EEG placement needed the precision of > stereotactic frames, and correlation with internal anatomy, before it > could tell much of anything. If you destroy the data by not understanding how differential amplifiers work, you basically destroy the opportunity to do research, and that happened for decades. I was being nice when I said the doctors were being dumb. Actually I think they are also corrupt because of the damage they do, at least to me, with their ignorance and greed.
Enlighten me, why do we need sterotactic frames? The system used, A10-20 or whatever, is overkill because it is really a big problem as you suggest. For me, EEGs are like temperature or height, really important information. But to make too big a deal out of it is silly. We do not need to know the height to hundredths of an inch. Same for EEGs.
Some of the most important findings can be expressed as 2-D. For example, schizophrenia is a remodeling of the brain that gets out of control, easy to see 2-D from 3-D modeling. Most of us lose brain cells. The schizophrenics lose too much during adolescence. Fascinating. It's not mental illness at all. But really looks like an infection of the brain. Dumb doctors not to realize this. Took a brain research to nail it down. It's a physical illness with lots of social irritations and outcomes, to put it mildly.
You do not need to know where the delta waves are or why or what or how. You only need to know you do not have any. For helping someone. It's like being four feet tall. Whether someone is 4.01 or 3.99 feet tall is not critical. The fact they are one foot short is all that is necessary.
E. Roy John tried to formalize this with a series of equations, sort of like econometrics for the brain but he called it neurometrics. That's about as good as you can get. Sorry. He published in Science I believe. The first article quantifying schizophrenia using EEGs and a system of equations.
I know, you'll say it's not 3-D and it's mostly tea leaves. Think of economics, and you'll get the picture. A 3-D model is fine. Now whose brain do you suggest we cleave open?
What do you have against tea?
Howard Berkowitz - 05 Feb 2005 15:53 GMT > > That we don't have a theoretical basis for the waveform, and, AFAIK, if > > they are essential for deep sleep. Does deep sleep cause delta waves [quoted text clipped - 16 lines] > that > range, heart beat is around 1 Hz and eye blinks and what not. Let us assume that deep sleep only is accompanied by delta waves. To me, that still begs the question of the interaction between deep sleep and fibromyalgia. There have been posts about such things as "washing out lactate", which would seem to have more to do with the Krebs cycle, glucagonogenesis, and so forth. Before we go looking for causality from the brain, let's understand the muscular biochemistry closer to the proposed problem.
> At this level, your argument reminds me of the chicken or the egg came > first. [quoted text clipped - 8 lines] > trouble seeing the relevancy at this point if no delta means no deep > sleep. As I say, I am completely confused, at this point, how we have gotten into a discussion of delta waves from a discussion of CFS and fibromyalgia.
> > I have much more experience in cardiac electrophysiology than brain, > > and [quoted text clipped - 3 lines] > > understanding, and the lack of mapping of waveforms to a > > three-dimensional model.
> Now how good are you? I have been having a running battle with > cardiologists > and the machines for about 10 years now. They say the machines are > mis-interpreting the data. A big-time professor and researcher agreed > with me > that the cardiologists were wrong and the machines were right. My experience is that machine interpretation is fairly accurate in 95% of cases, but expert cardiologists will differ on those interpretations.
> If you are really, really good, how about I send you an EKG and you tell > me if > it shows a past heart attack, to use the layman's term, or not? No, because it's unwise to diagnose a heart attack -- myocardial infarction -- on the basis of the ECG alone. In my own case, which is clinically much more one of angina, there are silent infarcted areas in my heart -- that show with nuclear medicine and some research techniques along the lines of invasive electrophysiological mapping, with direct stimulation of tissue to determine if the myocardium is merely stunned. These infarcts do not show in my 12-lead EKG. Even during an acute anginal episode, my ST segment stays essentially normal.
In my case, the clinical value of electrocardiographic monitoring has been identifying sick sinus syndrome, and justifying a bradycardia pacemaker.
> By the way, when you talk of nodes and so forth, is that not somewhat > 2-D? I [quoted text clipped - 3 lines] > Too > many layers and different type of structures compared to the heart. 3D heart visualization is constantly improving. My personal feeling is that really useful visualization will require forming the images from multiple modalities, such as ECG correlated with CT.
> > This is beginning to sound like a rant. Again, my experience is more in > > the clinical application of EEGs than in the theoretical work. Maybe [quoted text clipped - 14 lines] > these > people morons. As I have said, brain electrophysiology is not my field. I'm not prepared to argue, without extensive research, if it has or has not been screwed up. All I can observe is significant clinical progress coming from advanced imaging systems, where there seems much less emphasis, among the practicing neurologists I know, on the EEG.
> > I need a little more definition of deep sleep, and what you mean by > > propagation. To me, propagation means how the signal moves through [quoted text clipped - 14 lines] > be > fine but crude. You're asking for something that's way down the line. I'm really not interested in getting into the depths of brain electrophysiology -- there are enough other fields that keep me busy. With respect to the brain, my major interest is pharmacology,
> > Why are some people rich and handsome? :-) I think they were told, > > periodically, to "hold it." > > You're kidding, right? Really, no. The study was European, IIRC Dutch or Danish.
> I know, you'll say it's not 3-D and it's mostly tea leaves. Think of > economics, [quoted text clipped - 3 lines] > > What do you have against tea? My problem is that I don't see a personal professional payoff to going into brain electrophysiology. There are enough other fields that keep me busy trying to stay current with the literature.
Treeline - 05 Feb 2005 20:03 GMT > Let us assume that deep sleep only is accompanied by delta waves. To me, > that still begs the question of the interaction between deep sleep and [quoted text clipped - 3 lines] > the brain, let's understand the muscular biochemistry closer to the > proposed problem. That sounds reasonable. I'm all for detail but my biochemistry is kind of weak.
> As I say, I am completely confused, at this point, how we have gotten > into a discussion of delta waves from a discussion of CFS and > fibromyalgia. Lack of a good night's sleep may be an immediate "cause" - generally any person deprived of deep sleep seem to begin having some symptoms of CFS, if I recall correctly. So the notion was that very low antidepressant dosage, such as the Elavil you suggested to correct my saying SSRIs, could help this. This then led to discussions of Ambien and deep sleep. I guess we segued from immediate symptom and correction to etiology. The etiology is not known. But the lack of deep sleep or Stage IV sleep, usually characterized by delta waves, seems a red flag. You are skeptical of this because it's not fitting into any model. That can be. But the lack of delta waves appears a real phenomenon whether it's meaningful or not, I suggested. For me, it's like having a high fever. Maybe I don't know what caused that fever or which bug it was, if a bug, but I better get that fever down if I am to survive.
> My experience is that machine interpretation is fairly accurate in 95% > of cases, but expert cardiologists will differ on those interpretations. That's what I thought. But expert cardiologists often do not wish to do any more analysis than they can get away with, make money, and not be sued, in my experiences with expert cardiologists. I do not recall a single cardiologist actually analyzing the ECG. They just blew it off saying even if so it's not important. Not important to them. But to me? Knowing I had a heart attack, at any time, is a non-trivial event.
> No, because it's unwise to diagnose a heart attack -- myocardial > infarction -- on the basis of the ECG alone. In my own case, which is [quoted text clipped - 4 lines] > These infarcts do not show in my 12-lead EKG. Even during an acute > anginal episode, my ST segment stays essentially normal. I agree. But if you have nothing else what do you do? Suffer in silence? I am the one who said based on my personal experience, my heart and pain, AND supported by the EKG, a heart attack happened. If one cannot get doctors to go over such basic stuff, they really are almost useless entities, like kings and princes, their times have passed. Reminds me of Dr. Moses Mendelson who pointed out in one of his critical book on doctors that when the doctors in Italy went on strike, the death rate went DOWN, not up, but down. Sounds like Italian doctors are even worse than American doctors.
> In my case, the clinical value of electrocardiographic monitoring has > been identifying sick sinus syndrome, and justifying a bradycardia > pacemaker. It's probably more difficult to speed things up then slow them down. From my experience with brain waves, it's far more difficult to speed them up on purpose than to slow them down. Both are difficult but to train speeding up is, suprisingly, very difficult to do on purpose. Extremely difficult.
> My problem is that I don't see a personal professional payoff to going > into brain electrophysiology. There are enough other fields that keep me > busy trying to stay current with the literature. At this point, that sounds reasonable. Early in the game, I am not so sure. Big professors of cardiology once told me that biofeedback for the heart was not possible or that they knew nothing about it. They were wrong as we know now. You can regulate the heart. And one of the easiest ways is with a heart monitor that just counts the beats, like a sports monitor. One cardiologist found this out, whoppee, and wrote an article about his discovery in 2005, something I noticed in 1995, but I am not a cardiologist so who cares but me? I am not familiar with bradycardia methods, only the opposite, tachycardia.
Howard Berkowitz - 05 Feb 2005 21:22 GMT > > Let us assume that deep sleep only is accompanied by delta waves. To > > me, [quoted text clipped - 50 lines] > attack, at > any time, is a non-trivial event. That hasn't been my personal experience with the cardiolgists I see -- now, maybe this is a special case since I can interpret to a reasonable extent. We often discuss them together.
The reality is that myocardial infarctions or even ischemia cannot always be diagnosed with ECGs alone. In the emergency care situation, you may get a higher confidence level with cardiac enzymes, troponins, or C-reactive protein. In other words, there is a level at which further refinements of the ECG alone may not provide much practical benefit. A few cardiologists I know will occasionally put leads on the back as well as the chest, but that's about the only variant I see even among researchers.
My personal experience was that the first real evidence showed up on thallium exercise SPECT scan, and needed coronary angiography to confirm. On both exercise and physiologic stress, my ST segment stayed isoelectric. Stress echocardiography did reveal reversible myocardial akinesia.
Why did we go to the additional tests? Continuing exercise-induced pain, even with some medical therapy. Within a month of onset of symptoms, I was scheduled for angioplasty. This was good practice -- not ignoring the patient.
Later on, I had another angioplasty, and then bypass. About six months after the bypass, I reoccluded two grafts, and my HMO refused to work them up. Luckily, I was able to find and join an NIH Clinical Center atypical chest pain protocol, and am now on long-term monitoring at NIH. I'm occasionally a volunteer for new cardiac imaging, and typically spend an inpatient week about every five years for extensive testing. The good news is that much of my cardiac pathology has reversed with aggressive medical management.
Apparently, I had bad genetics as far as developing heart disease at an early age. My father died of a MI and complications at age 42, and was a cardiac cripple for several years before that, in the early sixties when cardiologists didn't have much to offer.
In my case, medical and surgical intervention preserved function long enough that my heart has grown new collateral circulation, my output fraction is back to near-conditioned-athlete levels, and the left ventricular hypertrophy is gone. If I lose a good deal of weight, I expect even more benefit, as well as better control of diabetes.
> > No, because it's unwise to diagnose a heart attack -- myocardial > > infarction -- on the basis of the ECG alone. In my own case, which is [quoted text clipped - 14 lines] > kings and > princes, their times have passed. I understand the concern. In general, I can get good cooperation from my physicians, and we share and discuss all results and strategies. When I run into a problem, as with the HMO not approving a workup, I know academic and research medicine well enough to game the system into providing adequate care.
> At this point, that sounds reasonable. Early in the game, I am not so > sure. Big [quoted text clipped - 5 lines] > monitor > that just counts the beats, like a sports monitor. My pacemaker is quite adaptive to changing conditions requiring different rates. IIRC, it senses both motion and oxygen concentration.
?One cardiologist found
> this > out, whoppee, and wrote an article about his discovery in 2005, something > I > noticed in 1995, but I am not a cardiologist so who cares but me? I am > not > familiar with bradycardia methods, only the opposite, tachycardia. There continues to be significant improvement in the broad category of implantable cardiac devices. Where most packemakers are atrial and ventricular on one side, dual atrial pacing appears to be quite helpful in several conditions including cardiomyopathy. Of course, the implantable defibrillators can be lifesaving.
Tanada - 06 Feb 2005 16:00 GMT Man, I hope you two are friends, as I'd really hate to see you two in a p*ss*ng contest.
Pam S. bemused
Treeline - 07 Feb 2005 08:03 GMT > Man, I hope you two are friends, as I'd really hate to see you two in a > p*ss*ng contest. > > Pam S. bemused We have a friend in common, called truth. Try it, you'll like it :)
Treeline - 07 Feb 2005 08:01 GMT > That hasn't been my personal experience with the cardiolgists I see -- > now, maybe this is a special case since I can interpret to a reasonable > extent. We often discuss them together. That's good. Did you hit textbooks on EKGs? They are amazingly expensive although the info is old and old textbooks can be good enough.
> The reality is that myocardial infarctions or even ischemia cannot > always be diagnosed with ECGs alone. In the emergency care situation, [quoted text clipped - 10 lines] > isoelectric. Stress echocardiography did reveal reversible myocardial > akinesia. How did you know it was reversible? Reversible by better echoes or they could tell somehow? Akinesia is what some called hypomotility?
> Later on, I had another angioplasty, and then bypass. About six months > after the bypass, I reoccluded two grafts, and my HMO refused to work [quoted text clipped - 4 lines] > The good news is that much of my cardiac pathology has reversed with > aggressive medical management. That's amazing. New cardiac imaging? Invasive, catheterization or noninvasive such as Fast CT Scans or echoes?
> I understand the concern. In general, I can get good cooperation from my > physicians, and we share and discuss all results and strategies. When I > run into a problem, as with the HMO not approving a workup, I know > academic and research medicine well enough to game the system into > providing adequate care. Good for you. You have a lot of patience. I guess I could do that. But I am not so sure I want another MRI ever, for example.
Howard Berkowitz - 07 Feb 2005 14:19 GMT > > That hasn't been my personal experience with the cardiolgists I see -- > > now, maybe this is a special case since I can interpret to a reasonable > > extent. We often discuss them together. > > That's good. Did you hit textbooks on EKGs? They are amazingly expensive > although the info is old and old textbooks can be good enough. I have several. Also, the major cardiology textbooks like Hurst have extensive chapters.
> > The reality is that myocardial infarctions or even ischemia cannot > > always be diagnosed with ECGs alone. In the emergency care situation, [quoted text clipped - 14 lines] > could > tell somehow? Akinesia is what some called hypomotility? In basic testing, reversibility is defined by having normal perfusion (SPECT) or visible movement (echocardiography) before the stress (by drugs or exercise), and no perfusion/movement afterwards.
> > Later on, I had another angioplasty, and then bypass. About six months > > after the bypass, I reoccluded two grafts, and my HMO refused to work [quoted text clipped - 9 lines] > noninvasive > such as Fast CT Scans or echoes? An assortment. Transthoracic (against the chest) and transesophageal (down the throat) echocardiography, with drug-induced stress, and an assortment of imaging enhancements including several different acoustic contrast media and additional computer processing for three-dimensional visualization. SPECT using different isotope protocols. Radionucleide angiography (also called multiple gated ucquisition (MUGA) or radionucleide ventriculography). MRI before the pacemaker. Catheterization/angiography, including a new technique called Biosense, and an assortment of intracardiac drug stimuli.
Biosense has a couple of elements. First, and most generally, the tip of the catheter has a small attached magnet, and the patient is surrounded by coils, so the catheter tip can be precisely located in three-dimensional space -- you can only estimate the third dimension in convention fluoroscopic angiography. Second, in this protocol, they administered electrical stimulation to various parts of the heart muscle, to differentiate between true scar tissue and "stunned" myocardium that would recover with new blood supply.
During that last procedure, the cardiology fellow, who was English, and I engaged in a bit of dialogue that delighted half the team and utterly confused the rest. When he would find scar tissue after finding stunned myocardiun, I'd respond "'es not dead! 'es merely resting!"
"It only stays there because it's nailed to the rest of the heart! It's gone off and joined the choir eternal! THIS IS EX-MYOCARDIUM!"
It was probably revenge for the chief of invasive cardiology, an Iranian-American, demanding really bad country and western as procedure background music.
> > I understand the concern. In general, I can get good cooperation from > > my [quoted text clipped - 6 lines] > am not > so sure I want another MRI ever, for example. Treeline - 08 Feb 2005 19:31 GMT > I have several. Also, the major cardiology textbooks like Hurst have > extensive chapters. Thanks for the tip. They sure are heavy, around $300 by now?
> In basic testing, reversibility is defined by having normal perfusion > (SPECT) or visible movement (echocardiography) before the stress (by > drugs or exercise), and no perfusion/movement afterwards.
> An assortment. Transthoracic (against the chest) and transesophageal > (down the throat) echocardiography, with drug-induced stress, and an [quoted text clipped - 5 lines] > Catheterization/angiography, including a new technique called Biosense, > and an assortment of intracardiac drug stimuli. That's great. My mitral valve is a big problem here. Everyone says it's a judgment call. You say tomato I say tomatoe. Whether a T-E-E or regular, the leaking cannot be quantified or really known for sure. Great. So I do not know if I have a grade of F for miserable severe Failure or just D for depressing moderately severe because the jet is "eccentric" like me ;) It's great you get good data and somewhat reliable results. Everything for me is mostly judgment calls and when I call the shots, I improve. I sure wish I could trust the doctors as you do so superbly. You must have great social and communication skills. I don't have any - must be another defect with the "connective tissue," this time in the corpus callosum.
> Biosense has a couple of elements. First, and most generally, the tip of > the catheter has a small attached magnet, and the patient is surrounded [quoted text clipped - 4 lines] > muscle, to differentiate between true scar tissue and "stunned" > myocardium that would recover with new blood supply. Thanks for the "tip." I "sense" that. Love puns, sometimes.
> During that last procedure, the cardiology fellow, who was English, and > I engaged in a bit of dialogue that delighted half the team and utterly > confused the rest. When he would find scar tissue after finding stunned > myocardiun, I'd respond "'es not dead! 'es merely resting!" That's really funny.
> "It only stays there because it's nailed to the rest of the heart! It's > gone off and joined the choir eternal! THIS IS EX-MYOCARDIUM!" > > It was probably revenge for the chief of invasive cardiology, an > Iranian-American, demanding really bad country and western as procedure > background music. I never did this, with or without music. Bad decision on my part, very, very bad. Now it does not really matter, too late. Well, I am hoping that researchers in Scotland come up with a nice, bionic valve and I can afford it. I went to the best in the USA, Cleveland Clinic, what a dump, poorest city in the USA in 2004, cannot afford a good infrastructure, bad nursing, bad supporting doctors, regardless of reputation where the "mistakes" are buried in the ground or in the high numbers so it's not obvious they screw up big-time. Can't sue in Ohio unless dead or paralyzed, then it's easy, especially if you are dead. I'll stop before I start ranting.
What is your ejection fraction before I forget? Around 55%?
|
|