Rexie

Some of you have some concerns that marijuana may drop blood pressure. This is both true and not true. Marijuana and delta9-tetrahydrocannabinol (THC) increase heart rate, slightly increase supine blood pressure, and on occasion produce pronounced, short-term orthostatic hypotension related to the most immediate effect occurring within a few minutes after partaking when heart rate increases by 20-50%. Thus, after smoking or vaping a sudden change of posture from lying down to standing up may produce orthostatic hypotension (a feeling of light-headedness and faintness) that is often the earliest indication of intoxication in naive users. So, if you haven’t tried marijuana or used it much, just make sure to sit down before using and wait a few minutes. Tolerance to most of the initial cardiovascular effects appears rapidly. With repeated marijuana use, supine blood pressure decreases slightly, orthostatic hypotension disappears, blood volume increases, heart rate slows, and circulatory responses to exercise and Valsalva maneuver (a breathing technique) are diminished, consistent with centrally mediated, reduced sympathetic, and enhanced parasympathetic nervous system activity. If one wants to skip the initial bump-up of heart rate increase and possible orthostatic hypotension sometimes associated with smoking or vaping, ingestible forms of natural marijuana or synthetic THC might be the way to go although noticeable effects take longer to manifest. Marijuana users have significantly higher levels of dopamine and norepinephrine than non-users. Both neurotransmitters help keep blood pressure up in the normal range for those with chronic low blood pressure. Marijuana is a good help for pain and a nice distraction from pain, including IC pain for some people. It will get most people up and active for long, pleasurable periods of time or help folks unwind, relax muscles, and reduce spasticity & spasms during sedentary pastimes. Those with eating challenges might like its appetite stimulating properties so that food and beverage intake can fuel activities of all kinds. All of marijuana's good effects can be had without becoming totally blitzed or buzzed - just use less.

Pistol! Get well soon! Apparently COVID-19 is a systemic multiorgan viral invasion and symptoms like yours have cropped up after initial COVID infection and is referred to as Acral edema and may include numbness and fluid leakage from small blood vessels in the area due to increased vascular permeability. It usually last 6 days or so. See: Acral edema during the COVID-19 pandemic, Jara Valtueña MD, PhD, Daniel Ruiz-Sánchez MD, PhD, Victor Volo MD, Pilar Manchado-López MD, María Garayar-Cantero MD, International Journal of Dermatology, Vol. 59, pp. 1155–1157; 2020: https://onlinelibrary.wiley.com/doi/epdf/10.1111/ijd.15025 Dermatological manifestations associated with COVID-19: A comprehensive review of the current knowledge, Mohseni Afshar, Z, Babazadeh, A, Hasanpour, A, et al, J Med Virol., Vol. 93, pp. 5756- 5767; 2021: https://onlinelibrary.wiley.com/doi/10.1002/jmv.27187 Be of good cheer...

MTRJ75, I always have to decompress after an outing, especially ones with multiple steps or errands in unfamiliar places, even if they have been all pleasant and not really a big deal. I love getting stuff done, and praise myself lavishly when home, but the cost does seem high sometimes. Overstimulation brought on by simply moving, coupled with bright light, vivid colors, temperature, sounds, any associated stress while driving or shopping or at a lab or vet's, etc. makes for lots of neuromuscular pain, spasms, stiffness, and sometimes chills, low blood pressure, and exhaustion when I get home. Over the years the time to regroup after an adventure has gotten far less, from days to at most an hour, usually now within 20-30 minutes. I take an ashwagandha tab (with maybe a toke or two) and sit still and quiet, often playing a simple phone game or if not too head-spun, I'll read a novel. It helps not to dwell on my state which is why I like a quiet distraction. The ashwagandha puts the brakes on run-away sensations and overstimulation by increasing GABA, our inhibitor neurotransmitter. I remind myself of an electrical system shorting out - the downtime with herbs is a reset. A 5-20 minute nap can also be useful; it helps me reset systems. The day may go on then pretty normally (my norm) or I may drag a little or a lot but be ok in general, and be able to eat and do the things I need to do. I am very glad sometimes I don't have a partner or family now. What I might consider making a heroic effort to get the stuff I need done done, and done well, does not much impress normal folks at all. And frankly, sometimes I come back so badly head-spun and body-sprung. I would not be what I call "present" to anyone anyway. I do recall how much this bothers other folks and how reluctant they could be to allow me some time to myself to achieve homeostasis again. I have learned over the years to set limits to interactions and activities with others or to not be so bothered by their reactions. With my pets, if they have no immediate needs, I'll just announce "Rest! I need rest!" and they get it without hurt feelings. I do like people, perhaps this would work with normal humans... (it never worked with my troubled mom, she could storm for days behind one of my "failures")

Mike, for me, it's great with intestines, the blushable-thing (who doesn't thrill to discover the normal physiological response of wetness?), dry mouth, snivels, breathing; medium with throat soothing; a help with eyes and dry skin - not a fix. As far as I can tell from personal experience and extensive research, it is perfectly safe. It is sometimes recommended that you take it at times you are not taking important meds lest it interfere with their absorption. But, in my chemistry mind, I don't see it complexing with anything to mess with drugs you might take. You can open a cap and put it in water, a smoothie, or what not and it is not thick or gel-like or anything, just adds a wee bit of texture. My ashwagandha and other goodies work just as quick as ever when taken with a cap of slippery elm.

cmep37, I did think of Mike while writing my post. And Yes, Pistol, it does make things feel more slippery. And it's nice to feel 'hydrated' everywhere... Using slippery elm has also helped eliminate Summer-Fall allergy woes (pollen is usually high in my area). And it does have some positive, good effect on dry eyes and skin. Maybe I should take more, which is recommended, but one cap is enough for the small woman that I am. Anyway, it is a great addition that won't kill me.

cmep37, I take 400 mg of Slippery Elm (Ulmus rubra) at nighttime and it has made a huge difference in positive, good feelings, both physically and mentally. I was tending to experience too much intestinal sensation in the early morning that would interfere with sleep. Like you, although normal, stools were a little hard. I had endometriosis, too, when a young woman and by the time I had a hysterectomy it had caused bladder, rectum, and uterus to all adhere together. Years later this is still a sensitive area for me sometimes. Slippery Elm causes reflex stimulation of nerve endings in the gastrointestinal tract and at remote locations (respiratory and urinary tracts, mouth, etc.) leading to increased mucus secretion and less internal dryness. It is used in a wide variety of GI conditions and makes for a quiet, happy tummy - no more severe cramps or spasms for me. Additionally, the quercetin in slippery elm is an inflammation-modulating plant flavonoid that helps alleviate my symptoms of interstitial cystitis (IC). Slippery elm may be my favorite find for 2021. It is FDA approved as safe and is classed as a nutritive - it goes with anything else one might be taking.

Rosemary (Rosmarinus officinalis) essential oil, in studies and for me, has demonstrated anti-hypotensive effects (up to an increase of 20 mmHg). I like it because it helps improve my diastolic readings which often lag. I have used sprigs to make a stimulant tea (3-4” plant sprigs in boiling water; steeped 5 minutes), used the oil in dermal application to calves or other areas (feet, thighs, upper abdomen under the sternum), and tried it as an inhalant. Any of the three methods of using rosemary will increase blood pressure, heart rate (4-7 beats), and respiration rate for me (and for others in research studies), leaving me with a more active mood. It helps me get a deep, natural breath. Once in the morning on a really bad day will help me get going; more is counterproductive for me, leaving my muscles too tense and wired by day's end. Rosemary has been shown to decrease the power of alpha1 and alpha2 waves while increasing the power of beta waves in the anterior region of the brain. It is reported to improve cognition, memory, and mood; and has also shown remarkable anxiolytic (anti-anxiety) properties. Some of the flavonoids in rosemary cross the blood-brain barrier and increase the effect of the GABA neurotransmitter. Rosemary activates dopamine. Inhaled rosemary reduces stress and cortisol levels and is commonly used for mental strain and fatigue in folk medicine. Rosemary is also used in folk medicine as an antispasmodic, analgesic, antirheumatic, antiepileptic, and anti-inflammatory agent. Preliminary evidence suggests that rosemary oil may help reduce tissue inflammation that can lead to swelling, pain and stiffness, possibly by stemming the migration of white blood cells to injured tissues to release inflammatory chemicals. Rosemary essential oil exhibits both a psychostimulant effect and it enhances memory through activation of the DAergic system. Rosemary also been shown in studies to have anti-inflammatory and peripheral antinociceptive properties and complements oral pain meds (acetaminophen, codeine, tramadol, etc.). In studies rosemary has caused inhibition of pain due to its interaction with opioid and 5-hydroxytryptamine (5-HT1A) receptors. When used dermally (my favorite method – 100% just splashed on legs and rubbed in) with a dash of inhalation at time of application, rosemary gives me a groovy, tingly, and pleasant "up", imparting a sense of feeling mentally and physically refreshed with no side effects. After 20 minutes I feel significantly more attentive, alert, energetic and cheerful. It smells pleasant; the smell dissipates with absorption. Topical rosemary oil, as tested, has been helpful for circulation problems in many people. Studies have shown that it has a vasodilator and warming effect in people with systemic sclerosis and Raynaud's phenomenon. For me, rosemary does help relieve calve muscle cramps and stiffness and seems to jazz up circulation. Exercising calves is very good for increasing circulation and is easy to do anytime you're up - just stand on your toes a few times, a few times a day while using support. As a bonus, a dilution of 12.5% rosemary oil repels mosquitoes for 90 minutes or so. For that dried-out-internally feeling, I love slippery elm herb (400 mg at bedtime). Works wonders for me to relieve that dehydrated feeling with no down side at all.

Well after autonomic symptoms appeared I got a TDaP, Boostrix, vaccine which contains immunization against tetanus, diphtheria, and pertussis in 2016 after I fainted and had to have stitches for a gash over my eye. I asked for a "plain" tetanus shot and the hospital pharmacist did try to find one but the only thing available anywhere then was the 3-in-1 vaccine. I didn’t have any problems with this vaccine. I get gashed frequently working with cats, in the garden, and around the house and enjoy not worrying about tetanus.

Thanks, Mike. Glad to meet another Camaro lover! Been a long time since I frequented speed shops and the like (fond memories remain), but I still love a smooth, sleek, powerful ride. Just remember while you're out there - a genuine great smile or grin always charms the ladies. I got up early and speed-read my way through eighty or so journal articles. Good news, we can perhaps each do a few things to beat that cold feeling as it turns out, according to our own cases and what we each take, eat, drink, and do. The experience of persisting coldness is related to low vasopressin levels. Vasopressin, also known as antidiuretic hormone (ADH) or arginine vasopressin, AVP, is a peptide hormone formed in the hypothalamus, then transported via axons to the posterior pituitary, which releases it into the systemic circulation in response to extracellular hyperosmolality. Vasopressin has two principle sites of action - the kidneys and blood vessels. It has several physiological effects, including conservation of water by concentrating urine (through its effect on the kidneys) and promoting vasoconstriction in high concentrations. Besides regulating the balance of fluid and salt in the body, vasopressin helps coordinate thermoregulation, helps regulate vagal nerve tone, and promotes energy balance and healthy metabolism by exerting direct actions on glucose and lipid metabolism. It impacts our circadian rhythm and may also have a role in facilitating learning and memory. Release of vasopressin is generally controlled by osmoreceptors (cells sensitive to plasma osmolality) in the hypothalamus. Osmoreceptors respond to changes of extracellular fluid osmolality. A decrease in plasma volume also causes release of vasopressin. Vasopressin is also released directly into the central nervous system by somato-dendritic release (some neurons secrete neurotransmitters from their cell bodies and dendrites in contrast to classical neurosecretion at synapses). Vasopressin is anatomically and functionally linked with catecholaminergic systems and the mesolimbic dopamine system. Several neurotransmitters have effects on vasopressin levels. Acetylcholine and angiotensin II stimulate release of vasopressin. Norepinephrine, gamma-aminobutyric acid (GABA), and atrial natriuretic peptide (a cardiac hormone) are inhibitory. Alcohol prevents vasopressin release and may cause low levels, as will certain drugs such as lithium and phenytoin. Too little vasopressin in blood may also be caused by compulsive water drinking. Certain foods and environmental endocrine disrupting chemicals may alter the pathways and behaviors coordinated by vasopressin, e.g. the soy phytoestrogen genistein; the plastics component bisphenol A (BPA), and various flame retardants. Vasopressin production is reduced by aging. Low night-time levels of vasopressin are believed by some to contribute to nocturnal polyuria in the elderly. So what did a hot shower and hot car do for me yesterday? They increased my hypothalamic temperature, stimulating vasopressin release and reduced my general sensation of feeling cold that in itself can prevent vasopressin release. Until I can get my dental abscess cleared up in two weeks which has my system a bit unbalanced, I can reduce my GABA enhancers and put up with more pain and muscle stiffness, and also reduce my norepinephrine enhancers (coffee, nicotine, and others) that help keep blood pressure up, while relying more on hydrocortisone (for adrenal insufficiency) to help regulate my blood pressure and other functions (recommended anyway during times of illness). I use to get a few of these cold spells once in a while beginning some 40 years ago (and even as a child), long before autonomic dysfunction. Continuing a high salt intake will help keep not only blood pressure up, but also help increase vasopressin levels. Exercise is good, too, and will be easier for me as our summer heat comes down. Tomorrow I start not smoking, tapering nicotine with patches. One study from 1999 demonstrated that the experience of persisting coldness can respond dramatically to brief treatment with intranasal vasopressin (1-d-amino-8-D-arginine-vasopressin; DDAVP; desmopressin acetate) twice daily for 1 month. Relief can be seen as soon as one week after beginning treatment and response can persist even long after discontinuation of treatment, the theory being that the hypothalamic thermostatic mechanism has been reset. Intranasal administration of vasopressin may act in two ways to reset the hypothalamic thermostatic mechanism. Vasopressin may decrease local brain temperature, enabling the hypothalamus to adjust to an appropriate set point. In addition, a brief exposure to vasopressin may reset the hypothalamic feedback mechanisms where vasopressin release has been inhibited by the sensation of coldness. The use of administered vasopressin does have some cautions regarding water intoxication and hyponatremia, and should not be used in those with moderate to severe renal impairment, and with great caution in those taking pressor drugs (antihypotensive agents and certain cardiac drugs). It would be considered an off-label use today for treating persistent coldness. Arginine vasopressin: Direct and indirect action on metabolism, Mitsuhiro Yoshimura, Becky Conway-Campbell, Yoichi Ueta, Peptides, Vol. 142; 2021 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8270887/ Somato-Dendritic Secretion of Neuropeptides, Colin H. Brown, Mike Ludwig, Javier E. Stern, pp 59-80 in Neurosecretion: Secretory Mechanisms, Lemos J., Dayanithi G. (eds), Masterclass in Neuroendocrinology, Vol 8, Springer, 2020 https://link.springer.com/chapter/10.1007/978-3-030-22989-4_4 Vasopressin Treats the Persistent Feeling of Coldness After Brain Injury, Jonathan M. Silver, M.D., and Karen Anderson, M.D, J. Neuropsychiatry, Vol. 11, Issue 2, pp. 248-252; 1999 https://neuro.psychiatryonline.org/doi/full/10.1176/jnp.11.2.248 Dietary sodium intake increases vasopressin secretion in man, S E Kjeldsen et al, J. Clin. Hypertens., Vol. 1(2), pp. 123-131; 1985 https://pubmed.ncbi.nlm.nih.gov/3915319/ Endocrine Disruption of Vasopressin Systems and Related Behaviors, Heather B. Patisaul, Front. Endocrinol., Vol. 8; 2017 https://www.frontiersin.org/articles/10.3389/fendo.2017.00134/full

Mike, if you had a conversation about this with a practitioner of medicine, you've managed something I never could get rolling. I can see their numerous faces now as they pause a second, look at me like I've committed a major paux pas for bring this concern up, and then move right along to end our session. I am miraculously warm for a spell after showering in hot-hot water forever, jumping in my wonderfully overheated Camaro and leaving the AC off to run errands and pick up dinner which I was actually able to eat after hitting the hydrocortisone a little to get heat-trashed blood pressure up into a range conducive to life. Folks don't realize how crippling feeling cold-to-the-core can be and what a head-spin it is. It is definitely not conducive to anything but wanting more drugs or herbs or both. Now to turn up the tunes and get some work done - life can be lived in spurts of correct functioning, fashion be ******. You all have a good one!

merkat30 wrote: "I really feel stupid in woolly jumper everyone else is in shorts!!" Yeah, I say a lot of dirty words and laugh wearing my warm and comfortable flannel shirts in the Texas heat. But, whatever, I'm still walking and talking. In a panic, I do try to throw that shirt off for package deliveries or unexpected company - it does look stupid and embarrassing, even my light-gray and off-white 'summer' flannels. Couple those shirts with my loose pants (I'm very touch sensitive) and I'm a fashion disaster. I just slap a smile on and keep going. You don't have an infection in the wisdom tooth area, do you? I have a major abscess in a failed root canal and crown now from a jaw smacking event many years ago and I feel much worse and more prone to being cold. It all gets fixed end of month - getting an implant; they told me I could carry it to my grave (very reassuring, don't ya know). Sometimes I feel deprived not having tasty, summer ice cream floats, milk shakes, and ice cream, but there's no joy there if I'm freezing. Such is life.

Eating a light snack and/or taking a short 10-20 minute nap all covered up helps me end feeling like I am freezing even when it is warm. I don't get teeth chattering but have involuntary jaw snapping which has broken and cracked molars.

Water and blood pressure - also interesting... (care givers recommend lots of water but don't tell you how to drink it) Rapid water drinking (16 ounces/480 mL) increases sympathetic activity through pressor response mechanisms and profoundly raises blood pressure in people with autonomic failure (33-44 mm Hg) and substantially in older normal people (11-13 mm Hg). Rapid water drinking raises plasma norepinephrine as much as classic sympathetic stimuli such as caffeine (16 ounces coffee) and nicotine (2-4 cigarettes). The effect of rapid water drinking can be exploited to improve symptoms due to orthostatic hypotension. The pressor response is evident within 5 minutes after water drinking starts, reaching a maximum after about 30 to 35 minutes; it’s sustained for longer than 60 minutes. The pressor response after drinking either cold or warm water is almost identical. Drinking 16 ounces/480 mL water causes a greater pressor response than drinking 8 ounces/240 mL water. There is a concomitant decrease in heart rate of about 5-7 bpm below baseline 20 minutes after drinking water. Norepinephrine (plasma measurement) increases thirty minutes after water drinking. The increase in plasma norepinephrine concentrations is thought to be due to sympathetic activation causing increased spillover of norepinephrine from adrenergic synapses into the systemic circulation or to a decrease in norepinephrine clearance. Even water drinking comes with some warnings. In some people with autonomic dysfunction, water drinking increases systolic blood pressure by more than 100 mm Hg, which can result in dangerously high blood pressure in the supine positions. In these people, water drinking should probably be avoided for about an hour and a half before going to bed. I’ve been trying out quick water drinking for correction of low blood pressure dips which don’t resolve without some help. Yesterday I was flying around cleaning before a porch visit from clients to visit their kitten. I was just about to shower when they showed up way early. This was stressful for me, as was the outside temperature of 90F (32C), causing my standing blood pressure to be a little unpleasantly low after the visit (82/54, heart rate 100). Since it was well after lunch and before dinner and a good time for testing, I decided to try quickly drinking 12 ounces of cool water. After 15-20 minutes standing bp was 107/83 with heart rate of 86. Another 20 minutes playing phone games passed and I went for a walk outside (88F/31C ambient). After the walk bp was 92/58 with heart rate 88 – pretty good for me considering exertion and heat. Blood pressure stayed that way all evening. What goes in must come out. Pressor effects (and increased blood pressure) are triggered by a full bladder. Athletic quadriplegics who rely on catheterization to empty their bladders have been known to not empty their bladders before sports competitions to increase their blood pressure (and power and strength), a practice called “boosting” that has been banned due to negative health consequences. If I want to take my blood pressure and suddenly have the urge to pee, blood pressure will always jump higher, putting me into a temporary normal range of 120/80. After voiding, bp will then be its usual pitifully too low (below 90/60). The Pressor Response to Water Drinking in Humans - A Sympathetic Reflex?, Jens Jordan et al, Circulation, Vol. 101, Issue 5; pp. 504–509; 2000 https://www.ahajournals.org/doi/epub/10.1161/01.CIR.101.5.504

Mike, people who use atomoxetine in certain autonomic disorders take it twice a day. Doesn't interest me at all now for my case, but interesting anyway...

cmep37 asked Sushi: "Do you have ADHD symptoms or is the Strattera being used off-label? When I googled it it seemed to be contra-indicated for POTS but I'm assuming that is for people whose sympathetic system is overactive. When I was bedbound I took Modafinil and I did get some benefit from that but after a few years I stopped taking it as the effects had worn off. My GP would probably let me trial it if I could show her some evidence it might help me (my cardiologist won't prescribe anything that isn't a cardiac drug as he won't prescribe anything if he doesn't understand how it works eg neurological drugs). " Not to highjack Sushi's possible response, but because it interests me as being potentially useful for my low blood pressure and orthostatic hypotension, here's some info on and references for Strattera which is a brand name for atomoxetine, and also a little info on how atomoxetine compares to Midodrine. I haven't tried either atomoxetine or Midodrine. Since atomoxetine is a selective norepinephrine (noradrenaline) transport blocker (reuptake inhibitor/selective inhibitor of the presynaptic neuronal uptake of noradrenaline), it causes increased blood pressure by increasing noradrenaline concentrations in peripheral sympathetic neurons, an effect sometimes masked in healthy, normal people by central sympatholytic mechanisms. Atomoxetine has been shown to increase norepinephrine levels as well as dopamine levels because norepinephrine receptors are also sensitive to dopamine and it can be useful in ADHD, as an antidepressant, and in cases of narcolepsy. It is suggested that patients be screened for heart defects before taking atomoxetine. Atomoxetine can increase depression and suicidal ideation in some cases. Side effects include dry mouth, loss of appetite, nausea. vomiting, abdominal pain, constipation, headache, dizziness, irritability, dyspepsia, somnolence, fatigue, palpitation, racing heart, hypertension, postural hypotension, urinary retention, and sexual dysfunction. There may also be a risk of dyskinesia (involuntary movements, facial tics, tremors, fidgeting, writhing, speech disturbance, etc.) when atomoxetine is combined with dopaminergic, noradrenergic, or serotonergic medications. For people with autonomic dysfunction, there have been many studies of the use of atomoxetine over the years. It has been found that atomoxetine acutely increases sitting and standing systolic blood pressure in patients with central autonomic impairment by 54 and 45 mmHg respectively, compared with placebos. However, in those with peripheral autonomic impairment, atomoxetine has no pressor effect. This possibly suggests that a functional central sympatholytic pathway is essential to avoid hypertension in patients taking atomoxetine. Health care practitioners suggest caution when atomoxetine is used in patients with autonomic impairment. A pressor reflex is a nerve reflex that constricts arterioles (small blood vessels) and thereby increases the blood pressure. A pressor substance is any substance that elevates arterial blood pressure. The autonomic nervous system is responsible for maintaining blood pressure in the upright position. The sympathetic nervous system is maximally activated in the upright position. Midodrine, an α-1 adrenergic agonist, is a direct vasoconstrictor, improving upright blood pressure and orthostatic hypotension-related symptoms. Midodrine has become a popular treatment in patients with autonomic failure and neurogenic OH. Atomoxetine is judged to be superior to midodrine for the treatment of orthostatic hypotension in autonomic failure. Atomoxetine produces a greater pressor response in upright systolic blood and upright diastolic blood pressure compared with midodrine. Furthermore, atomoxetine, but not midodrine, improved orthostatic hypotension-related symptoms as compared with placebo. Atomoxetine is metabolized in the liver; it has a half-life of 6 hours in most individuals (extensive metabolizers) but 19 hours in poor metabolizers. Efficacy of Atomoxetine Versus Midodrine for the Treatment of Orthostatic Hypotension in Autonomic Failure, Claudia E. Ramirez, et al, Hypertension, Vol. 64(6), pp. 1235–1240; 2014: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4231172/ “Atomoxetine” in Meyler's Side Effects of Drugs (Sixteenth Edition), The International Encyclopedia of Adverse Drug Reactions and Interactions, pp. 738-740; 2016 “Atomoxetine” in Ch. 23: Pharmacological cognitive enhancers, MacKenzie R. Peltier, Mehmet Sofuoglu, in Cognition and Addiction, 2020 “Atomoxetine” in Current Trends in the Pharmacological Treatment of Autism Spectrum Disorders, Alexander Kolevzon, in The Neuroscience of Autism Spectrum Disorders, 2013 “Atomoxetine” in Ch. 22: Depression, attention deficit hyperactivity disorder and narcolepsy, Derek G. Waller et al, in Medical Pharmacology and Therapeutics (Fifth Edition), pp. 297-310; 2018

Welcome back from Covid world - so glad you all are OK! Stay on upward wing!

I’m just going to plunge into a few things that you or others might find useful. Catecholamines function as neurotransmitters (chemical messengers that transmits signals across nerve endings in the body) and they also have significant hormonal functions, working to ready the fight-or-flight response. Catecholamines play a crucial role in regulating vascular smooth muscle, airway smooth muscle, and cardiac muscle function and tone. The body produces catecholamines in the intestines, brain, nerve tissues, and adrenal glands. The main types of catecholamine are dopamine, epinephrine (adrenaline), and norepinephrine (noradrenaline). Once made, approximately 97% of the dopamine in blood plasma is normally immediately inactivated by SULT enzymes leaving it in the inactive sulfonated form. Unsulfonated, or free dopamine is the precursor to the other catecholamines norepinephrine and epinephrine. These also circulate primarily in inactive sulfonated forms (norepinephrine ca. 73% sulfonated, epinephrine ca. 84% sulfonated). There are lots of catecholamine-containing food products out there to eat - fruits (bananas, pineapples, etc), fruit drinks, vegetables (potatoes, tomatoes, peppers, etc), nuts, and beans. These will all affect the level of free and bound (inactive sulfonated form) neurotransmitters in your body. So, while catecholamines are good and necessary, often used medicinally, too many are harmful and increased concentrations of circulating free catecholamines are shown to have significant health impacts on metabolic functions including potent regulation of steroids, thyroid and peptide hormones, oxysterols, pheromones, selectins, and neurotransmitters with clinical focus primarily on three common symptoms: blood pressure, headaches (specifically migraine headaches), and palpitations (specifically atrial fibrillation). Excess catecholamines have been implicated in some of the rarer cancers. Sulfotransferases (SULTs) enzymes catalyze the sulfonation of catecholamines and protect humans from excess catecholamines. Five sulfotransferase (SULT) enzyme families and their corresponding genes are known in humans, each targeting different substrates for sulfonation. Within the very important SULT 1 category, SULT1A focuses on phenolics and catecholamines; SULT1B focuses on thyroid hormones; SULT1C handles xenobiotics (chemical substances that are foreign to us, e.g. plant constituents, drugs, pesticides, food additives, industrial chemicals and environmental pollutants); SULT1E deals with estrogenic steroids. SULT2 enzymes sulfonate neutral steroids and sterols, while SULT3 catalyzes the formation of sulfamates. SULT4 and SULT5 are not fully characterized. Faulty or defective SULT genes can impact the corresponding SULT enzymes' abilities to protect against excess catecholamines. There is a genetic test for SULT1A1, I’m not sure about the other SULTs. Natural substances in many foods have been found to inhibit these SULT enzymes, too, and any SULT1A inhibition could have serious consequences for some people. Ingestion of SULT1A inhibitors can lead to catecholamine increases, blood pressure changes, migraine headaches, atrial fibrillation, and undesirable changes in other bodily systems. SULT1A inhibition prevents normal catecholamine deactivation; it does not create catecholamines. It is believed that susceptible people probably have lower-activity SULT1A alleles. A person’s response to SULT1A inhibitors will depend both on the inhibitors ingested and the person’s version of the SULT1A genes. There is a handy table of SULT1A and SULT1A3 inhibitors here: Toxicological effects of red wine, orange juice, and other dietary SULT1A inhibitors via excess catecholamines, Ken Eagle, Food and Chemical Toxicology, Vol. 50, Issue 6, pp. 2243-2249; 2012 https://www.sciencedirect.com/science/article/pii/S0278691512001871 Some of the known inhibitors of SULT1A enzymes by food constituents and additives include Annatto (yellow to deep orange-red food coloring from made from the seeds of the achiote tree), Blackcurrant, Blueberry, Brandy, Cauliflower, Cherries, Chicory, Chocolate, Cinnamon, Cocoa, Coffee, Coffee beans, Cranberries, Dates, Fennel, Gin, Grapes, Grapefruit, Lemon, Lime, Lingonberry, Muscadine wines, Mustard, Olives, Onion, Orange, Pecans, Peppermint, Plum, Red food coloring (Synthetic colorant E122), Red wine, Sherry, Sunflower seeds, Tea, Turmeric, Vanilla, Yellow food coloring (FD&C Yellow 5), Vinegar, Vodka, Walnuts, Whiskey, and White wine. I do best if I avoid many of these foods, spices, and beverages on the list that do trigger migraines for me such as chocolate and vanilla (I use to be a chocoholic and love vanilla). For people with serious heart issues or other conditions believed to be caused by SULT inhibitors, elimination of these foods and things from the diet seems effective. Both your cardiologist and neurologist should be aware of SULT inhibitors. I know you love chocolate and vanilla but maybe going without them and other things on the inhibitor list for a month or so might be a good test you could try yourself. Here is a case report of successful treatment through diet changes: Food-Related Atrial Fibrillation? The Potential Role of Biogenic Amines in “Nutri-Arrhythmias” Genesis, Maria Alessandra Gammone et al, Reports 2019, Vol. 2, Issue 1; MDPI; 2019: https://www.mdpi.com/2571-841X/2/1/1 Sometimes in life it is far easier to get into things than out of of things. While we can live awhile on a bad diet, a better diet is desirable. It takes many months to come back from nutritionally incorrect eating. The same goes for activity. My main focus after HSV-1 encephalitis was to get up or at least sit up as much as possible, gradually increasing walking and other activities. This was challenging for a time because all my sense were crossed which caused me to stop in mid-step fascinated by the sight of a lizard or arrested by floral or grass scents I just wanted to dissolve into, and even a few hallucinations where an ordinary prickly pear bush became one of the most gloriously alive and pulsing things I’d ever seen, or when I'd get totally side-tracked as by a lady in pink I was suppose to be talking to and whose pink outfit caused my whole mind to fill with only pink color making sight and speech impossible. Once able to eat again (and mental filters were restored) another challenging area was diet and eating right which was hampered not only by finances, but by the fact that encephalitis totally wiped-out food from memory (What is it? Do I like it? How do I fix it and store it?). For the first month after acute encephalitis my head hurt so bad and I was so nauseated that all I could manage was Hawaiian Punch & Ginger Ale (clerks, when I was able to stagger to the store, would cheerfully ask “Having a party?” To which I’d smile and think “Only in my mind”). I had Meals on Wheels for awhile some months after acute encephalitis which helped me remember foods as I studied their nicely labeled lunches, often my only meal of the day Monday through Fridays. Later while on SSI for a few years I did have food benefits which helped with food expenses, but shopping was a trip at first and I often wanted to just sink into a store floor looking at aisle upon aisle of foods I didn’t recognize. As all that improved and shopping, fixing and eating became easier, my endocrinologist and other docs made sure I knew the importance of magnesium, Vit D, and other things in my diet. I do feel better eating better and being as active as possible. I don’t like the predatory idea that my diet includes meat, poultry and fish, but for eons this is how humans have fed themselves. I usually remember to thank the chicken, cow, pig, fish or whoever for its sacrifice or offer up a small prayer for them before eating. It’s interesting that I feed my dog and kitties without much of a thought about their high-protein animal-based diets. We all need potassium and it's widely available and hard to not get. Select fruit is nice in small amounts for me, as are a few trusted greens with some good protein; I would never eat an all salad or all fruit meal (I don't think it's the potassium they offer but rather the SULT1A inhibitors some of them contain that bother me). This is a good read on testosterone and the adrenergic system although it is a bit deep. The adrenergic system is greatly influenced by catecholamines, either by their lack or excess. Androgen Effects on the Adrenergic System of the Vascular, Airway, and Cardiac Myocytes and Their Relevance in Pathological Processes, Abril Carbajal-García et al, International Journal of Endocrinology, Vol. 2020, Article ID 8849641, 25 pages, 2020 https://www.hindawi.com/journals/ije/2020/8849641/ One other thing for your consideration - Anti-NMDAR encephalitis, a type of relapsing and remitting autoimmune encephalitis predominantly associated with young women where around 40–60% of the cases are associated with a malignancy, most commonly an ovarian teratoma. Despite systematic screening for neoplasms, no clinically detectable tumor can be found in all cases. There were quite a few Anti-NMDAR people in an encephalitis group I use to belong to and they were all doing very well after diagnosis and treatment. Longitudinal brain morphology in anti-NMDA receptor encephalitis: a case report with controls, Heikki Laurikainen et al, BMC Psychiatry, Vol. 19; 2019 https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-019-2141-4 Investigation of patients with atypical or severe hyperandrogenaemia including androgen-secreting ovarian teratoma, Michael Conall Dennedy et al, Eur J Endocrinol., Vol. 162(2), pp.213-20; 2010 https://pubmed.ncbi.nlm.nih.gov/19906851/ Frankincense is a very nice and healing essential oil (1:20 oil to carrier oil or lotion) for scratches & wounds, itchiness, mosquito bites, Covid shot arm discomfort, etc., and it is good at reducing wrinkles in old-timers. It has anti-bacterial properties and might help acne. It has no nervous system effects on me (and I’m pretty sensitive to dermal inputs) except its smell is rather pleasantly uplifting (I did find one reference that mentioned it might decrease blood pressure, heart rate, and glucocorticoid levels). I know things are more interesting and less frightening when it’s not about us and our own bodies but try not to be alarmed by anything I wrote. Just remember – never give up. There are always answers or work-arounds that make life better. Hope your weekend is as nice as possible!

With little relief from many prescribed meds, my answer to prayer 4 or 5 years ago was the herb ashwagandha (Withania somnifera; 660 mg pressed root capsules four times a day), sometimes with added Passion flower (Passiflora species, 350 mg powder capsule). They both help increase GABA levels and serve to balance the nervous system against overstimulation that leads to horrid symptoms like you describe. I try to stay as physically comfortable as possible (appropriate clothing for the weather and not too tight; sunglasses outside; meditation or quiet time as needed, less mental and job stress when possible, etc.). A few weeks ago I added the herb slippery elm (one cap at bedtime, 400 mg powder) which helps quiet and soothe digestion and is a wonderful addition to my herbal program - I am able to eat and eliminate normally again. Using this program has lessened symptoms for me by about 90%; return of symptoms usually occurs when I've over done it physically or had a really busy or stressful day. Then I just stop all movement, sit quietly in low light, and wait for my ashwagandha to kick in (starts working in 5-10 minutes, normalized in 20-60 minutes and I'm "back" and good to go again). If I'm really whacked, I'll drink a cup of Chamomile tea with both the ashwagandha and passion flower. All three herbs have a very safe profile and all my labs and tests are good and/or improved. Some months back my doc did prescribe 25 mg tramadol once in the morning and once in the evening - another big help in pain management. Abe, I hope you find what you need to live more fully without so much misery!

Sasovagal syncope is interesting. I always have to turn away for blood draws for me or if I take kittens for shots. I just always called it a 'needle phobia' that makes me feel like fainting is imminent causing me to reach out for something to lean on; no other symptoms. I always learn something new here.

Hi! Hope you did ok at work and are now resting comfortably at home after a scary, icky start to the day. Many years ago during Lyme disease I had panic attacks which have symptoms similar to those you had going during your blood work adventure. Just knowing that these glitches were just panic attacks was helpful, as was some prescribed rescue alprozolam (Xanax). If I knew I was going for testing or something else that might trigger an attack, I'd take the Xanax ahead of time. Now the ashwagandha I take helps smooth my way and helps prevent panic attacks which I rarely have anymore. It all does really get better with time and help. Loved your Walking Dead reference - people use to walk way around me or give me the evil eye while stopped at a stop light. Whatever. Bet I've outlived many of them. Panic attacks and panic disorder (Mayo Clinic): https://www.mayoclinic.org/diseases-conditions/panic-attacks/symptoms-causes/syc-20376021

Tomato soup usually doesn’t work for me, either. But many soups without MSG and minus those things that trip off IC work for me (both store-bought and homemade). Bouillon (MSG-free chicken bouillon cubes) – I use to enjoy making a cup of hot, salty bouillon (hard to find in stores now but, I just discovered, still available online). IC-wise, I am really liking the addition of slippery elm herb (one cap at night, 400 mg) for its help with bladder soothing – less time up and down at night and quicker back-to-sleep with quieter bladder and tummy (only one time awake now vs 3-4 times a night with trouble falling back to sleep; last night I slept a record 7 hours and it feels good, but is not, unfortunately, the ultimate fix for underlying major total-body pain & stiffness). For serious IC flares I’ll use a little heat therapy pad; warmth in the bladder area really helps end a flare. As to ideas for what ails you, with regard to the catecholamine test results, that’s just a snap shot of what your body was doing at that moment. There are quite a few inherited and acquired syndromes of autonomic dysfunction/failure and autonomic neuropathies, plus a possible pheochromocytoma (tumor of adrenal gland, usually causing high blood pressure) that can affect catecholamine levels. But many things can affect their levels, too. I wouldn’t fret too much over your results. For me, I could never get off the things I take, plus coffee and nicotine, for the suggested week-long period prior to the testing the endocrinologist requested (long-shot test for pheochromocytoma). I made it part of a miserable day off my favorite things and found the odds of a catecholamine test shedding light on what ails me to not be worth the downturn in daily functionality required prior to testing. Even if I had a definitive name for what ails me, I’d still have to deal with my autonomic deficits. I once had a dietician back in my Lyme disease years; she was so enthusiastic about eating well that it was contagious. Unfortunately, I was so far gone she finally just said “Eat anything you can!” (I practically lived a whole year on tasty cream puffs & milk). Anyway, now with self-study nutrition I still remember this gal’s enthusiasm which encourages me today. Part of my recovery plan includes better self-nurturing. Since dysautonomia, I’ve had to work extra hard at tamping out angry feelings that my body has betrayed me – counter-productive. Giving myself better things to eat and drink is one part of rewarding self-nurturing and is interesting, too.

Nitric oxide is important in the body’s natural system for maintaining healthy, flexible blood vessels and it helps support healthy blood pressure. I’m not sure you could reduce nitric oxide levels or even want to do so - a normal amount of nitric oxide is generally considered to be a good antioxidant useful in preventing oxidative stress. If you are worried about having caused POTS by using these supplements that claim to increase nitric oxide production (as for body building, running, or sports activities) any bad effects are not continuous years later but usage may have serious consequences at the time of use. We normally get enough arginine in our diets and can make it, too. See: Adverse effects associated with arginine alpha-ketoglutarate containing supplements, J M Prosser et al, Hum Exp Toxicol, Vol. 28(5), pp. 259-262; 2009 https://pubmed.ncbi.nlm.nih.gov/19755457/

Almost all vasomotor nerves (those causing or relating to the constriction or dilatation of blood vessels) are adrenergic. Two types of adrenergic receptors (adrenoceptors), alpha and beta, are found in the vasculature. The sympathetic nervous system provides extensive innervation throughout the heart, producing effects opposite those of the parasympathetic system. The beta-adrenoceptors are activated by the catecholamines/neurotransmitter norepinephrine and epinephrine. These beta-adrenoceptors stimulate the rate and force of cardiac contractions. The alpha-adrenoceptors predominate in the innervation of the vascular smooth muscle and also in the lower urinary tract. In both cases, the sympathetic nervous system's adrenergic neurotransmitter, norepinephrine, produces its physiologic effects by binding to these adrenoceptors. Adrenoceptors actively participate in the regulation of the vascular tone, either directly or indirectly (through the release of nitric oxide). A number of sympathetic abnormalities, most notably an increased adrenergic nervous system activity, have been identified as potential causes of high blood pressure. Causes for low blood pressure and orthostatic hypotension have numerous causes. I am so glad you have a sharp cardiologist willing to help you get to the bottom of your issues in a safe and sane manner. This article might help you understand this very complicated area of health: Mechanisms of sympathetic regulation in orthostatic intolerance, Julian M. Stewart, J Appl Physiol (1985), Vol. 13(10), pp. 1659–1668; 2012 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3524660/ As to adding more salt to your diet, I find it’s easy. For autonomic dysfunction it is often suggested to increase sodium intake in your diet to 3-5 grams/day. If no improvement is noticed and blood pressure remains stable, it is often recommended that the patient increase sodium intake to 5-7 grams/day. This will help the body retain fluid in the blood vessels to compensate for low blood pressure or excessive pooling of blood in veins. Please note that 1 teaspoon of salt equals about 5 grams. I can quickly get 2.5 grams salt (non-iodized – less fizzy nerve feelings) in my morning smoothie (a mix of 2% milk, blueberry juice, and a hemp milk drink) by adding ½ teaspoon salt which adds to my taste pleasure. I use drinks and mixes I like that taste good with salt. I also salt the heck out of food. In the evenings I may have another smoothie. I also eat potato chips (my favorite classic thin chips have 170 g sodium/350 g potassium per 15 tasty chips), pretzels, other fun foods most heart-healthy people avoid like the plague (search “high sodium foods” such as http://know-facts.com/top-sodium-rich-foods.html) bearing in mind what effect they might have on my IC. Sometimes I crave salt and will just shake some into my mouth for a hit.

What you’re experiencing is probably a glutamate rush after eating. Glutamate, an amino acid, is found in all protein-containing foods such as cheese, milk, mushrooms, meat, fish, and many vegetables. Glutamate is also produced by the human body and is vital for metabolism and brain function. Glutamate is your main excitatory neurotransmitter; GABA (gamma-aminobutyric acid) is your main inhibitory neurotransmitter. Glutamate can act as both a beneficial neurotransmitter and a dangerous neurotoxin when it overactivates postsynaptic receptors causing glutamate-induced excitotoxic stress. There is a connection between these two neurotransmitters — glutamate is the precursor of GABA. An enzyme called glutamic acid decarboxylase (GAD) triggers the production of calming GABA from exciting glutamate. Conversely, GABA can turn back into glutamate as needed. The predominant precursor for GABA synthesis is glucose, which is metabolized to glutamate by the tricarboxylic acid cycle enzymes, although pyruvate and glutamine can also act as precursors. The enzyme glutamic acid decarboxylase (GAD), which is found almost exclusively in GABAergic neurons, catalyzes the conversion of glutamate to GABA requires a cofactor, pyridoxal phosphate, for activity. Because pyridoxal phosphate is derived from vitamin B6, a B6 deficiency can lead to diminished GABA synthesis. It is possible to develop an autoimmune reaction to the GAD enzyme leading to poor conversion into GABA. Gluten intolerance, celiac disease, Hashimoto’s disease, type 1 diabetes, cerebellar ataxia, refractory epilepsy, limbic and extralimbic encephalitis and other autoimmune diseases are linked to GAD autoimmunity. Since vitamin B6 (pyridoxine) is an essential cofactor in this conversion process, lack of it results in diminished GABA synthesis and a buildup of glutamate. Degenerative diseases of the CNS, such as stiff-person syndrome, progressive cerebellar ataxia, and Rasmussen encephalitis, have been characterized by the presence of these autoantibodies (although lack of GAD autoantibiotics doesn’t rule out some of these diseases). Additionally, drugs and herbs, as well as our other neurotransmitters, can change the balance of glutamate and GABA. For example, activating the GABA receptors in the brain with sedative, anti-anxiety, depressant drugs or anti-seizure meds (tranquilizers, ambien, xanax, depakote, lithium, SSRIs, tricyclic antidepressants, etc.) tends to shift the balance toward GABA, decreasing brain activity and making you relaxed and sleepy. Alcohol also increases GABA activity. Stimulant drugs shift the balance toward glutamate, causing an energized, wakeful state. Caffeine increases glutamate activity and inhibits GABA release. Dysfunctions in GABA-glutamate metabolism are involved in anxiety and depression. GABA is also involved in the regulation of blood pressure and heart rate and plays a role in the perception of pain and anxiety. I try to eat smaller, more frequent, varied nutritional meals (or drink smoothies), and regularly take probiotics that contain Lactobacillus and/or Bifidobacterium to help produce GABA. Once in awhile on bad eating days, I’ll take a balanced B-vitamin tab to ensure I have adequate B6. I also use herbal supplements (ashwagandha, passion flower, chamomile) that increase GABA, and slippery elm to increase overall digestive health. Exercise helps increase GABA and balance your GABA-glutamate system. Yoga is especially good for increasing GABA if you’re into that (I am not). Try taking a walk or do something else of low-to-moderate activity after eating and resting a bit, to remove and let dissipate the fizz of overstimulation and its assorted sensations while letting your body come into balance. And don’t fret. Eating is good and necessary. Bon Appetit!

Echo, those “feelings of impending doom” are mentioned in this review article of POTS: Postural Orthostatic Tachycardia Syndrome Misdiagnosed as Anxiety: A Case Report with a Review of Therapy and Pathophysiology, Hassan Kesserwani, Cureus, Vol. 12(10); 2020 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7652348/ The point of my previous post was meant to reassure you that we can develop mental and personal habits that help us ignore the doom feelings or counteract them with improved feelings. The GABA-increasing herbs I use help me suppress/counter-balance excess sympathetic responses (hyperadrenergic) – kind of like adding brakes to a speeding sports car.