BuddyLeesWife

I knew I had read about this before. This iexcerpt s from the Vanderbilt University Pharmacology of the Autonomic Nervous System http://www.mc.vanderbilt.edu/gcrc/ad_cente...tonomicsPDF.pdf It is under the heading IV. Norepinephrine, Epinephrine, and Dopamine which starts on page 11. The article is very detailed and I find it difficult to read BUT it does discuss the various off-label use of medications that are frequently prescribed for different dysautonomias. E. Alpha2-Antagonists While phentolamine and phenoxybenzamine block a2-receptors, their major clinical action is to block a1-receptors. The only widely available, relatively specific a2- antagonist is yohimbine. By blocking a2-adrenoreceptors in the medulla, it increases sympathetic outflow. By blocking presynaptic a2-adrenoreceptors in the periphery, it enhances norepinephrine release. Yohimbine has long been reputed to be an aphrodisiac, for which purpose the plant from which it is derived it has been sold throughout the world. Studies during the last several years seem to confirm that a2- agonists reduce and a2-antagonists increase copulatory behavior in rats.

Please do a search on recent topics - I posted links to several articles that link apnea and autonomic function. Unfortunately I think I scattered the links across several related posts. My husband is going through an amazing transformation right now and we can only hope that it is permanent and not just a temporary reprieve: his fatigue is normal, his brain fog is gone, his aches & pains are gone, his sweating and heat are gone, dizziness is gone, depression is gone. I just took his temperature a couple of day ago and for many years it has been about a point lower than the standard 98.6 (anywhere from 97.3 to 97.6) - it was 98.6. Since 1998 his NCS symptoms have been constant, mostly controlled with medication with periodic flare-ups causing ER visits and extended time off of work. The last few months he has "felt better than he has in at least 10 years" (his quote). We can only assume it is the result of the improved sleep he now gets using the CPAP.

My husband is not overweight (well, not more than several pounds worth) and while he did snore it was only if he laid on his back and as long as I was there I would just elbow him over onto his side and the snoring would stop. They did diagnose him with moderate sleep apnea but more importantly, he had 165 muscle twitches during the sleep test which kept him from ever getting to the deep resorative type of sleep. These twitches were not noticeable to me. Occasionally he would have a few severe jerks when first falling asleep or during a dream but I had no idea his body was so active during the night - and I am a light sleeper. He was prescribed a CPAP back in July and he has used it faithfully ever since. We aren't sure what is going on but all of his NCS and depression symptoms have improved dramatically, to the point where most of his medications have been discontinued. While he hasn't had another sleep test with the CPAP to see whether the muscle twitches have stopped, we can only assume that improved sleep is the cause and hope that this is more than a temporary relief of symptoms.

Sunfish, I found this article relating sleep apnea to depression. I really hope this is what is happening to my husband. This study started in 1988 with 1408 participants with 3202 sleep studies (scheduled every 4 years. http://www.medscape.com/viewarticle/544731 Sleep Apnea Strongly Linked to Depression NEW YORK (Reuters Health) Sept 18 - Sleep-related breathing disorder (SRBD) has a robust association with depression, according to results of a longitudinal study funded by the National Institutes of Health and published in the Archives of Internal Medicine for September 18. Based on their findings, the investigators advise that, for patients with SRBD, "Medical treatment (eg, continuous positive airway pressure therapy) or behavioral modification of SRBD (eg, weight loss) may help mitigate or prevent depressive symptoms

I know I am harping on the Sleep Apnea topic but here is another interesting research article from Mayo. http://www.medscape.com/viewarticle/545231 Mayo Researchers Describe New Type of Sleep Apnea Susan Jeffrey Medscape Medical News 2006. ? 2006 Medscape September 28, 2006 ? Researchers at the Mayo Clinic have further characterized what they're calling complex sleep apnea syndrome (CompSAS), a condition that appears distinct from both obstructive sleep apnea (OSA) and central sleep apnea (CSA). Complex sleep apnea has clinical symptoms similar to obstructive sleep apnea, with snoring and daytime sleepiness, some sleep interruptions, and probably the same cardiovascular risks, lead author Timothy I. Morgenthaler, MD, assistant professor and consultant in pulmonary, critical care, and sleep medicine at Mayo Clinic College of Medicine, told Medscape. "However, it is different from OSA in that it is not easily treated with CPAP [continuous positive airway pressure]," the standard treatment for sleep apnea. And further in the abstract: "Our future studies will be to see what forms of treatment work best in these patients," Dr. Morgenthaler said. Their findings also shed some light on the nature of OSA, the most common sleep apnea, he told Medscape. "For a long time, physicians have been considering OSA as a primarily anatomic disease," stemming from a narrow upper airway, he said. "However, this study adds to a growing and more elegant body of knowledge that the brain's control of respiration is abnormal in OSA, not just the anatomy. I think that as we understand the underlying causes of OSA better, we will be able to devise better treatments, ones that go beyond just improving the openness of the airway."

Maxine - did you also have any muscle twitches? In addition to the apneas, my huspand had 165 muscle twitches during his test which also disrupt your sleep pattern. I was aware that he moved during the night but neither of us would have guessed anything near that number of occurrences. I don't notice him twitching now so maybe even the ones that were undetectable to me have stopped too.

Maybe some good will come of this: First, if they are able to prevent the tragic loss from SIDS and secondly, if it is autonomic related, maybe we will benefit from more research. Another Article from WebMD http://www.webmd.com/content/article/129/1...CFSA6SQodGQKenw Clue to Sudden Infant Death Syndrome Brain Stem Abnormality Seen in SIDS Babies, Study Shows "Normal babies wake up when the air they breathe contains too much carbon dioxide and not enough oxygen, but the thinking is that babies susceptible to SIDS lack this arousal reflex." And Still Another: http://www.medscape.com/viewarticle/545200 Preterm Infants and Sleeping Position William T. Basco, Jr, MD, FAAP Effect of Prone and Supine Position on Sleep, Apneas, and Arousal in Preterm Infants According to Bhat and colleagues, previous research has demonstrated that, in preterm infants, prone sleeping position is associated with a marked increase in rates of sudden infant death syndrome (SIDS).[1] This study sought to examine a larger number of preterm infants than that included in other studies in order to determine how sleep position might be associated with apneas or sleep quality.

My husband has NCS and used to faint. Prior to his diagnosis, he was treated for depression with an SSRI and his fainting improved. When he received his NCS diagnosis, we learned that anti-depressants are a common form of treatment so it made sense that his syncope improved. He was initially on Zoloft, then Effexor and most recently Wellbutrin BUT the Drs. think that the anti-depressant is now pushing him into periods of hypomania (a less severe form of mania) so he was directed to stop taking it about a week and a half ago. So far he is doing great - really great and says he feels better than he has in 10 years. We have been fortunate that his symptoms have been mostly controllable with constant tweaking of medications and lifestyle. We are really hoping that this lasts and that the syncope doesn't start again but we know that it might. The changes in his response to the anti-depressants have taken place over the past several months and the only thing we can pinpoint is his improved quality of sleep because of the CPAP usage for sleep apnea that he began in the summer. Has anyone else noticed a dramatic improvement in their symptoms with better sleep?

Exerpts from the CNN report on SIDS. The study was published in Wednesday's Journal of the American Medical Association. CHICAGO, Illinois (AP) -- In a small study with big implications, researchers found some of the strongest evidence yet that sudden infant death syndrome -- a medical and sometimes legal mystery once known as crib death -- may be caused by brain stem abnormalities The brain stem abnormalities involve an imbalance in the way the brain uses the neurotransmitter serotonin. The brain chemical plays a role in regulating mood and is the target for many depression-fighting drugs. But it also influences breathing, body temperature and arousal from sleep. http://www.cnn.com/2006/HEALTH/10/31/sids....h.ap/index.html

Great idea walking on the treadmill and keeping your abs strong prior to surgery - if you can incline it at all that is even better for your abs. Walking was also the best activity for my recovery. I was directed to take a stool softener for several days following surgery as things can really firm up when your system tries to start back up following the anesthesia and pre-surgery prep. Plan on living for about a week in flannel PJ pants or sweats as your abdomen will be swollen - fortunately the PJ bottoms are in style now! In response to one of your earlier questions on post surgery bleeding - I only had some diluted bleeding for the first week, my system figured out pretty fast that the uterus was gone. Very occasionally, maybe 2-3 times a year, I will have a very slight trace of blood but neither my gyn or pcp are concerned. I hope you get a great lift in energy soon.

The CPAP has been great for my husband's fatigue. He has used it since July and notices a huge difference. I hope you experience the same.

My husband came off Effexor - they gave him 2 of the "start up packs" and had him take them in reverse (instead of tapering up on the medicine, he tapered down but over 4 weeks instead of 2 weeks). The first one he took in the pack was 1/2 of the dose he was currently on and then it stepped down by 1/2 again before ending all together. He had some dizziness/fog on the first step down, that was actually the most difficult for him but the other two were ok.

I don't have autonomic issues but I had the surgery you are considering in 2001 and it has been great for me. I still get some PMS type symptoms once a month which is how I know my ovaries are still functioning but without the extreme bleeding it is just bothersome. I do think my hormones may be starting to taper off now so I started taking an herbal supplement about a year ago (on the advise of my doctor) and it seems to help (I am 47). I know I have mentioned before how much the severe blood loss drained my energy and how awful I felt for many years. After having the surgery, my energy level came back and I was amazed that I had adjusted to functioning at such a reduced level. I hope that you experience the same improvement.

Hi, I do want to give you some hope for your own treatment. My husband is an identical twin and his brother also has NCS. They do share some symptoms but they also each have some that are specific to them and not "enjoyed" by the other. In general, my brother-in-law has much more frequent and severe symptoms while my husband's are mostly under control. Even some of the medications differ between them, although if it works for one of them it is at least worth a try for the other. It is really important that you find a doctor that is familiar with this disorder - good luck to you and your sister.

Sorry I don't know the details included in the article but here is an abstract from the Research section of the DINET site. Maybe your dentist has access to the article. Postural orthostatic tachycardia syndrome: Dental treatment considerations. Brooks JK, Francis LA. Department of Diagnostic Sciences and Pathology, Baltimore College of Dental Surgery, Dental School, University of Maryland, Baltimore, MD 21201, USA. Oralpath5@aol.com BACKGROUND: Postural orthostatic tachycardia syndrome (POTS) is a chronic, relatively common autonomic disorder typically affecting younger females. It is distinguished by a dramatic increase in heart rate on the assumption of an upright posture from the supine position. METHODS: The authors provide an overview of the demographics, clinical assessment, diagnostic features, differential diagnoses, pathogeneses and medical treatment of patients with POTS, with an emphasis on the clinical treatment of the dental patient affected by the syndrome. CONCLUSION: Patients frequently exhibit symptoms of lightheadedness, fatigue, palpitations and syncope. Patients with POTS may have Ehlers-Danlos syndrome, mitral valve prolapse, chronic fatigue syndrome or, rarely, the Brugada syndrome. Despite widespread dissemination of information regarding POTS in the medical literature, scant information on it has appeared in dental publications. PRACTICE IMPLICATIONS: Dentists need to be familiar with the clinical features of POTS and be prepared to treat patients at risk of developing syncope. PMID: 16637478 [PubMed - indexed for MEDLINE]

Neurobiology of sleep.Kalia M. Strategic Planning Initiatives Group, Thomas Jefferson University B-6-A Scott Building, 1020 Walnut St, Philadelphia, PA 19107, USA; Departments of Biochemistry and Molecular Biology and Anesthesiology and Neurosurgery, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA 19107, USA. The central nervous system undergoes several dynamic changes during sleep, which are coordinated by the pons, basal forebrain areas, and other subcortical structures and are mediated by three major neurotransmitters-norepinephrine, serotonin, and acetylcholine. The neuronal populations that produce these neuromodulators constitute the central representation of the sympathetic and parasympathetic subdivisions of the autonomic nervous system. The locus coeruleus (noradrenergic) and the raphe nucleus (serotoninergic) are most active during waking and become progressively less active in the transition from non-rapid eye movement (non-REM) to rapid eye movement (REM) sleep. On the other hand, the cholinergic neurons in the dorsolateral tegmental and pedunculopontine nuclei area are active both during waking and REM sleep. Over the past decade, a number of studies have provided interesting new evidence supporting the role of sleep in sleep-dependent memory processing. These studies have been directed specifically towards the role of sleep in memory encoding, memory consolidation, brain plasticity and memory reconsolidation, and have confirmed the hypothesis that sleep contributes importantly to processes of memory and brain plasticity. It has been shown in humans that sleep triggers overnight learning on a motor-sequence memory task, while equivalent waking periods produce no such improvement. These findings have important implications for acquiring real-life skills and in clinical rehabilitation following brain trauma and sroke. PMID: 16979421 [PubMed - as supplied by publisher] http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_DocSum

I forgot to include that my husband's diagnosis for the bladder problem is "neurogenic bladder".

My husband suffered from this - it was the worst symptom for him. As you stated, sometimes he wouldn't even know that he was wet. He was referred to a urologist by the cardiologist that administered the Tilt Table Test. His exam at the urologist was not that invasive - he had some blood and urine testing but the diagnosis was done in the exam room and I believe mostly based on his NCS diagnosis and also the answers to a urology screening questionaire that was quite detailed. None of his answers were routine for the normal problems of leaking, stopping, starting, retention, etc. When it would happen to him it is as if his entire body flushed whatever was in the system (bladder and bowel). It has been over a year with no accidents using the Detrol LA. The only side-effect he has is dry mouth. He does occasionally still have urges but he also has time to get somewhere - the urologist's goal was to buy him 15 minutes of time. When I was around when it happened, I noticed that he was in a "drunken state" so we are fairly certain that it is related to his NCS. If you do a search on "bladder" you will see my previous posts. I hope this helps or at least gives you a starting point for treatment.

I'm from Michigan - about 3 hours away from the city of Kalamazoo. If you can make the time, you might want to schedule a 1 hour car ride west to the shore of Lake Michigan. It is a beautiful site and one of the Great Lakes for which the state is known. It will be cool and windy and depending on the time of your visit you might hit the trees in their full color change. The colors should peak somewhere in Mid-October. I've attached the link to the www.mi.gov website travel section and specifically the "color tour" that is closest to Kalamazoo. Click on the City of St. Joseph to see a view of Lake Michigan from the bluff. http://www.michigan.org/travel/drivingtour...;da=y&m=9;1 I hope you enjoy visiting our state!

My husband is doing great with the CPAP treatment for Obstructive Sleep Apnea. It is really helping with the fatigue and also the brain fog. He is READING again - he loves history but hasn't really been reading for the past few years. He has already completed several books in the past 2 months. I know this is a common topic and I recall the comment that it isn't well studied for autonomic issues. I found a couple of recent articles - one related to MG and another to GERD. The third article I included is a newer overview on recognizing sleep disorders (note the 15 second wake to sleep statement). I use the Medscape advanced search function (www.medscape.com) and if you type in "autonomic and sleep apnea" starting with January of 2006 to the present you get 156 results (I always sort by publish date to get the newest stuff first). You still need to sift through them as many are not relevant. I hope you find these helpful - Obstructive Sleep Apnea Prevalent in Myasthenia Gravis: Study http://www.medscape.com/viewarticle/541366 The estimated prevalence of OSA in the general population is 15% to 20% and the prevalence of OSA syndrome (OSA plus excessive daytime sleepiness) is 3%, note Dr. Michael W. Nicolle from the University of Western Ontario, London, and colleagues in the July 11th issue of Neurology. In their cross-sectional analysis of 100 patients with myasthenia gravis, the prevalence of OSA on polysomnography was 36% and the prevalence of OSA syndrome was 11%. Consequences of Nighttime Heartburn -- Quality of Life and Sleep Disturbances http://www.medscape.com/viewarticle/537219 Obstructive Sleep Apnea GER is a symptom commonly observed in patients with obstructive sleep apnea (OSA), and patients with both GER and OSA have been shown to have significantly poorer quality of life compared with patients with OSA alone.[9] It is clinically well established that OSA is associated with a profound degree of daytime sleepiness, depression, and irritability -- all of which are factors that weigh heavily in diminishing the quality of life. GER exacerbates to an even greater degree the quality of life in this patient population (ie, those with sleep disorders). Basics in Clinical Practice: Recognizing and Treating Sleep Disorders CME/CE Author: Mark T. O'Hollaren, MD http://www.medscape.com/viewprogram/5967 Dr. Dement noted that daytime sleepiness usually indicates that an individual is carrying a large sleep debt, and that a severely sleep-deprived person can go from wide awake to asleep in as little as 15 seconds.

CBT really helped my husband a few years ago. It was prior to his official diagnosis and things were just not improving, he was frustrated and depressed and just kept running in circles trying to figure out what was wrong with him and what might help. He does still take medication but his ability to cope with the symptoms of this illness has improved. He would tell you that it was the first positive step towards managing this disorder. I'm glad it is making you stronger!

My husband has always been a vivid and ACTIVE dreamer - not always nightmares but always very intense with lots of movement. I have noticed that his night movement has decreased significantly since starting the CPAP treatment for sleep apnea in the beginning of July. He does still have some intense dreams and with those he will move around (mostly trying to run from or catch someone in the dream.) but they are much less frequent now.

When my husband had his last bout with a recurring facial rash (urticaria), the drs. considered mast cell activation and they were going to try a "total histamine block" by using 3 meds. I only remember one of the meds - a prescription for Singular and it was something to do with stopping the three sources of histamine. I think one was for the stomach, an OTC med like Zantac maybe and the third was also an OTC med that I recognized but have forgotten. Sorry for the sketchy info but maybe someone else can fill in the blanks. We never did try the regime because at this time his rash is so infrequent and he is doing well symptom wise.

I feel like a brute! I did first try the can & coin thing but it didn't work for my excessive barking dog. I even had one trainer buy one of those little whoopee buzzers, a small thing you wind up and hold in the palm of your hand and when my dog would bark or get out of control I would have to buzz him in the behind. just to startle him and break his chain of concentration. It was a challenge but totally ineffective with my dog. I went to numerous classes, hired numerous trainers, had my dog spend several weeks with another trainer and even hand one come to my house. After a few spritzes with the water he learned what "no bark" meant and we lived happily ever after. I believe the key is finding what works quickly and humanely with your dog. We currently have two dogs -an airedale named Jackson and a welsh terrier named Belle that our neighbors all call mini-me because she looks like a smaller version of the airedale. They are a hoot and their antics are the best medicine for my hubby when he is feeling low. Congratulations on getting your pet!

I know that my brother-in-law has passed out in his sleep - my husband has not.