How to make tropinine

42 y afab. 5'9 weight 170lbs
Medical hx: endometriosis, pcos, Gerd, ibs, fibromyalgia, gastric and duodenal ulcers, pyelonephritis with hx of renal infarction and hydronephrosis (resolved)
Surgical hx: 4 ablations, 3 excisions for endo 3 ovarian cyst removals (1 was a torsion but ovary was viable) Cholecystectomy - surgeons noted endo on my gb Hepatectomy- benign but bleeding masses. Doctors said due to long term bc pills Endoscopy to cauterize bleeding ulcer
Medications: motrin 800mg, dental 20mg TID, pantoprazole 40mg bid, omeprazole 20mg bid, mmj
Apologies for the mobile formatting.I have endo/pcos/ibs. It's been surgically confirmed there's no endo seen on my bowel, but endo has been seen on other organs, including my diaphragm and gallbladder . I was taken off birth control in 2017 after my liver surgery. Since then the endo and cysts have been out of control. 2 weeks ago I presented in the ED for flank, abd and chest pain. The chest pain was in between my breasts and not radiating. It was also coinciding with the cyclic abdominal pain. The abd pain is always a rupturing cyst or an endo flare up. The doctor in the ed told me I should have considered that my chest pain was fibro. I've never had chest pain coincide with a cyst rupture and it scared me. Ekg and tropinins (they did a 2 hr post as well) were wnl. Abd u/s showed 2 complex cysts on left ovary. 2.8cm and 1.4 cm. There was also fluid in the pouch of Douglas. U/A showed moderate wbcs, rbcs and bacteria. I was dx with a cyst rupture and sent home on nsaids and cipro. Cbc/cmp wnl.
On 4/16 I woke up in so much pain I couldn't stand. Vomiting, and trouble with bm's due to pain. Flank pain and low grade fever of 99.6. Scant vaginal bleeding that was mostly mixed with my vaginal discharge, which was clear. Went back to the hospital. U/a was clear, abd u/s now showed 7 ovarian cysts (2 complex and 5 nabothian) ranging from 3.2cm to 1.4cm. Doctor comes in and tells me they're sending me home on motrin. I told them I'd been taking motrin 3x a day for weeks and it's hurting my stomach and not reaching the pain. The doctor tells me that my medical condition doesn't meet the criteria for narcotics, despite being given narcotics in hospital. I told them that I wanted to avoid representing for pain and nsaids hadn't been working. They told me they legally couldn't do it. Asked to see an attending. She came in and told me that since I didn't have a broke bone, no pain meds. I told her I wanted it noted in my chart. I was offered a pain pill in hospital which I declined bc my pain was moderately controlled with the morphine they gave me. I again noted i wasn't worried about now, but that night and the next day. After that, they begrudgingly gave me 6 vicodin to go home with. The pain and bleeding had been getting better, until this morning. The bleeding isn't all the time but coming in rushes, every few hours. Like the elevator scene from the shining. The cramping and nausea are worse. It's of course Saturday and I don't know what to do. I don't want to go back to the Ed and get no help. I saw in my chart they flagged me as a drug seeker and a cannibus abuser. I am not drug seeking and have a prescribed mmj card to deal with the chronic nausea/pain. I've never gone over my thc allowance or even come close. How the hell do I get those flags removed?!
My gp has been out of town until Friday. My gyn keeps blaming my gi issues and my gi doctor blamed my gyn issues. I feel like a ping pong ball. I already have a call in to her office. But what do I do now? This pain is unreal but not emergent to doctors. It's almost making me not want to be here anymore. Who would want to live this way? Pls help.

I started a clinical trial 3 weeks ago for asciminib. Since starting I've experienced many side effects like excruciating and constant bone/muscle/joint pain, frequent diarrhea, upper left abdominal pain, and a rise in my blood pressure accompanied by headaches. My pains got so bad that I went to an emergency room last week where I had as treated with Tylenol 3's and sent home with enough to get me to my appointment today. They noted a major spike in my tropinin level at the ER and suggested I talk to my doctor about it.
Since the beginning of this clinical trial my EKG readings have shown abnormalities in which my doctor and the research department told me was due to the machine being too sensitive. Each visit we take some ekgs, they blame the machine and we wait a while and take them again and again ....and again and again until they are acceptable which from day one made me a little skeptical. None the less I continued thinking nothing of it. Today we ran the same marathon for each of my ekgs which were to be an hour apart from each other. Each EKG lead to a minimum of 6 print outs being tossed in the shredder before we began the final 3 (5 minutes apart) that would be submitted. While I'm laying there they are discussing how someone with no EKG issues should be used to make sure that it's actually the machine that's too sensitive when minutes before they assured me it was the machine undoubtedly. Well I leave , and I get an update on my app that I'm now scheduled to see a cardiologist this week.
I mention to them that the ER also advised me to let them know that I had a significant (and quite quick) drop in my blood levels as according to them my doctor might want to adjust my dosage as I'm still in the early stages of treatment. My wbc count went from mid 30s to 11 (lowest it's been in 5 years) and my other counts which have always been normal have all dipped lower than average. I'm estatitic about my wbc/leukocytes coming down to normal range finally but from what I understood it would take weeks if not longer and this happened within the first 9 days.
My concern is today they told me to wait until my next appointment which is 2 weeks from now and that if my pains persist by then we can begin to figure out what to do next. I stressed how much it hurt and how it's been difficult for me even to sleep at this point even with the Tylenol. I might as well have been talking to myself as it was just dismissed by the researchers. I was told that uric acid could be the cause yet we did not perform that test. I asked how my numbers were today compared to my ER visit and was told we didn't do a CBC test today either. Rather we did a lipase, amylayse, and metabolic panel only. It just blows my mind that we haven't done one CBC to since pre treatment aside from the one I had done at the emergency room.
I am happy as far as the fact that my night sweats have stopped. I'm happy my wbc count is back to almost normal but I'm not happy with not getting any kind of help/guidance as to what to do/take to ease these side effects. They told me to contact them if I stay more than 48 hours at another medical facility. I take that as I'm left to do what I did last week and seek help elsewhere if what I brought to their attention doesn't fix itself.
Pre dosage today my BP was 197/112. They asked if I felt any chest pain said yes. They asked if I felt short of breath, I said yes. Headache, yes. They said they were going to monitor it as those are alarming numbers. Spent the whole day without having my vitals checked a second time. They asked if I still felt the same symptoms upon leaving , I said yes and was allowed to leave. Then I get a notification that I have blood pressure medicine ready for pickup. The communication and making me feel like I'm in the loop when it comes to my health and healthcare just isn't there. The whole repeated ekg thing has severed my trust in what they tell me.
I don't want to stop the trial as my numbers have come down and rather quickly. Also I don't have the finances to pay for other medication out of pocket. At the same time I've been suffering from other health issues these last 5 years and now with these side effects I'm way worse than I had been without treatment for cml. It's just frustrating beyond all hell. I left my house at 4 am this morning on the first bus and arrived as early as I possibly could which was still 45 minutes late. I get there only to be told that my follow up visit with my oncologist and my lab work was not needed after all and I would just have to do the infusion and EKGs at 10 am.
I hate to rant but I'm wondering if anyone has had a similar experience or just a bad experience with your care team. If so what did you do and how did you go about it? Also if you are/have been on asciminib (or any other tkis) that have given you bad side effects, what did you do to cope with them or did you stop the medication? Reading about asciminib hasn't resulted in much so a friend suggested I try reddit. So here I am. I guess for now I'm going to try rotating Tylenol and ibuprofen and if it really comes down to it I have tramadols that I was prescribed and never took as I break out in severe hives with them but if I can manage these pains I think the relief would outweigh the allergic reaction. As for the stomach issues I guess I'll try Pepto and other OTC medicines even though they told me to check with them first befor even use ng OTC medicines/vitamins. When I finally got help for the leukemia I never imagined it turning out like this. I read about how doctors go e you a better understanding and about treatment plans that are made with your care team and yourself. Now I just feel like I was doing bad but better without treatment of that makes any sense. I'm just physically and mentally exhausted and at this moment it feels like I'm going through this alone and seem to be the only one going through this bad experience with treatment.

Is it common for a heart attack to have negative ekg and inconvlusive labs? I had what could only be described as a heart attack. Chest pains that woke me out of my sleep with my heart beating hard and a pain in the center of my left hand while my fingers felt numb. BP was about 170/100 I went to the ER and bybthe time i was seen my BP normaled out and my EKG was normal. They denied it was a heart attack or anything cardiovascular related which idk how could be possible. Told me to go on about my day. Nurse mentioned I had slightly elevated CKMB levels but it's not a big deal. When I did some research it said CKMB being elevated could be a sign of recent heart attack but most medical professionals now don't really use that to test and mainly troponin. There were also rare cases in which tropinin was normal but elevated CKMB constituted as a heart attack. What are the chances I did not have a heart attack? What else could it be?
Edit: Diagnosed hypertension which I take HCTZ for. I also have been having minor chest pains prior to this event for about a week. All started after I did some travel flying. Didn't get sick or catch anything while I was away but the pains started about 4 days post trip. Not sure if flying can exaggerate hypertension but it's the only connection I could make to the elevated BP and issues recently leading up to the suspected heart attack
Concerning labs "High CK W Reflex - 379" "Low Anion Gap - 4" "Low A/G Ratio - 1.1" "Low MPV - 9.1 " "Low neutrophils - 42%" "Low eiosinoohils - 0.3%"

Is this a common thing? I had what could only be described as a heart attack. Chest pains that woke me out of my sleep with my heart beating hard and a pain in the center of my left hand while my fingers felt numb. BP was about 170/100 I went to the ER and bybthe time i was seen my BP normaled out and my EKG was normal. They denied it was a heart attack or anything cardiovascular related which idk how could be possible. Told me to go on about my day. Nurse mentioned I had slightly elevated CKMB levels but it's not a big deal. When I did some research it said CKMB being elevated could be a sign of recent heart attack but most medical professionals now don't really use that to test and mainly troponin. There were also rare cases in which tropinin was normal but elevated CKMB constituted as a heart attack. What are the chances I did not have a heart attack? What else could it be?
Edit: Diagnosed hypertension which I take HCTZ for. I also have been having minor chest pains prior to this event for about a week. All started after I did some travel flying. Didn't get sick or catch anything while I was away but the pains started about 4 days post trip. Not sure if flying can exaggerate hypertension but it's the only connection I could make to the elevated BP and issues recently leading up to the suspected heart attack
Edit 2: Concerning labs "High CK W Reflex - 379" "Low Anion Gap - 4" "Low A/G Ratio - 1.1" "Low MPV - 9.1 " "Low neutrophils - 42%" "Low eiosinoohils - 0.3%"

Welcome to the complete guide of how to make cocaine. If you do everything right you are going to be king of the world, either in your own world or in the real world. Please read the disclaimer at the end of this text. Now, let's get to action! The basic formula for cocaine starts by purchasing or making tropinine, converting the tropinone into 2-carbomethoxytropinone (also known as methyl-tropan-3-one-2-carboxylate), reducing this to ecgonine, and changing that to cocaine. Succindialdehyde. This can be purchased, too. 23.2 g of succinaldoxime powder in 410 ml of 1 N sulfuric acid and add dropwise with stirring at 0* a solution of 27.6 g of sodium nitrite in 250 ml of water over 3 hours. After the addition, stir and let the mixture rise to room temp for about 2 hours, taking care not to let outside air into the reaction. Stir in 5 g of Ba carbonate and filter. Extract the filtrate with ether and dry, evaporate in vacuo to get the succindialdehyde. This was t aken from JOC, 22, 1390 (1957). To make succinaldoxime, see JOC, 21, 644 (1956). Complete Synthesis of Succindialdehyde. JACS, 68, 1608 (1946). In a 2 liter 3 necked flask equipped with a stirrer, reflux condenser, and an addition funnel, is mixed 1 liter of ethanol, 67 g of freshly distilled pyrrole, and 141 g of hydroxylamine hydrochloride. Heat to reflux until dissolved, add 106 g of anhydrous sodium carbonate in small portions as fast as reaction will allow. Reflux for 24 hours and filter the mixture. Evaporate the filtrate to dryness under vacuo. Take up the residue in the minimum amount of boiling water, decolorize with carbon, filter and allow to recrystallize in refrigerator. Filter to get product and concentrate to get additional crop. Yield of succinaldoxime powder is a little over 40 g, mp is 171-172. 5.8 g of the above powder is placed in a beaker of 250 ml capacity and 54 ml of 10% sulfuric acid is added. Cool to 0 and add in small portions of 7 g of sodium nitrite (if you add the nitrite too fast, nitrogen dioxide fumes will evolve). After the dioxime is completely dissolved, allow the solution to warm to 20* and effervescence to go to completion. Neutralize the yellow solution to litmus by adding small portions of barium carbonate. Filter off the barium sulfate that precipitates. The filtrate is 90% pure succindialdehyde and is not purified further for the reaction to create tropinone. Do this procedure 3 more times to get the proper amount for the next step, or multiply the amounts given by four and proceed as described above. Take the total amount of succinaldehyde (obtained from 4 of the above syntheses combined) and without further treatment or purification (this had better be 15.5 g of succindialdehyde) put into an Erlenmeyer flask of 4-5 liters capacity. Add 21.6 g of methylamine hydrochloride, 46.7 g of acetonedicarboxylic acid, and enough water to make a total volume of 2 liters. Adjust the pH to 8-10 by slowly adding a saturated solution of disodium phosphate. The condensate of this reaction (allow to set for about 6 days) is extracted with ether, the ethereal solution is dried over sodium sulphate and distilled, the product coming over at 113* at 25 mm of pressure is collected. Upon cooling, 14 g of tropinone crystallizes in the pure state. 2-Carbomethoxytropinone. A mixture of 1.35 g of sodium methoxide (this is sodium in a minimum amount of methanol), 3.5 g of tropinone, 4 ml of dimethylcarbonate and 10 ml of toluene is refluxed for 30 min. Cool to 0* and add 15 ml of water that contains 2.5 g of ammonium chloride. Extract the solution after shaking with with four 50 ml portions of chloroform, dry, evaporate the chloroform in vacuo. Dissolve the oil residue in 100 ml of ether, wash twice with a mixture of 6 ml of saturated potassium carbonate and three ml of 3 N KOH. Dry and evaporate in vacuo to recover the unreacted tropinone. Take up the oil in a solution of aqueous ammonium chloride and extract with chloroform, dry, and evaporate in vacuo to get an oil. The oil is dissolved in hot acetone, cool, and scratch inside of flask with glass rod to precipitate 2-carbomethoxytropinone. Recrystallize 16 g of this product in 30 ml of hot methyl acetate and add 4 ml of cold water and 4 ml of acetone. Put in freezer for 2 1/2 to 3 hours. Filter and wash the precipitate with cold methyl acetate to get pure product. Methylecgonine. 0.4 mole of tropinone is suspended in 80 ml of ethanol in a Parr hydrogenation flask (or something that can take 100 psi and not react with the reaction, like stainless steel or glass). 10 g of Raney Nickle is added with good agitation (stirring or shaking) followed by 2-3 ml of 20% NaOH solution. Seal vessel, introduce 50 psi of hydrogen atmosphere (after flushing vessel with hydrogen) and heat to 40-50. After no more uptake of hydrogen (pressure gauge will hold steady after dropping to its lowest point) bleed off pressure and filter the nickle off, rinse out bottle with chloroform and use this rinse to rinse off the nickle while still on the filter paper. Make the filtrate basic with KOH after cooling to 10. Extract with chloroform dry, and evaporate the chloroform in vacuo to get an oil. Mix the oil plus any precipitate with an equal volume of dry ether and filter. Add more dry ether to the filtrate until no more precipitate forms, filter and add to the rest of the precipetate. Recrystallize from isopropanol to get pure methylecgonine. Test for activity. If active, skip down to the step for cocaine. If not active, proceed as follows. Stir with activated carbon for 30 min, filter, evaporate in vacuo, dissolve the brown liquid in methanol, and neutralize with 10% HCl acid in dry ether. Evaporate the ether until the two layers disappear, and allow to stand for 2 hours at 0* to precipitate the title product. There are many ways to reduce 2-carbomethoxytropinone to methylecgonine. I chose to design a Raney Nickle reduction because it is cheap and not as suspicious as LAH and it is much easier than zinc or sodium amalgams. Cocaine. 4.15 g of methylecgonine and 5.7 g of benzoic anhydride in 150 ml of dry benzene are gently refluxed for 4 hours taking precaution against H20 (the 2 should be on a lower level) in the air (drying tube). Cool in an ice bath, acidify carefully with hydrochloric acid, dry, and evaporate in a vacuum to get a red oil which is treated with a little portion of isopropanol to precipitate cocaine. As you can see, this is quite a chore. The coca leaves give ecgonine, which as you can see, is only a jump away from cocaine. If you can get egconine, then dissolve 8 1/2 g of it in 100 ml of ethanol and pass (bubble) dry HC1 gas through this solution for 30 min. Let cool to room temp and let stand for another 1 1/2 hours. Gently reflux for 30 min and evaporate in vacuo. Basify the residue oil with NaOH and filter to get 8.4 g of methylecgonine, which is converted to cocaine as in the cocain step above. Below is given a somewhat easier method of producing tropinone by the general methods of Willstatter, who was instrumental in the first synthetic production of cocaine and several other alkaloids. After reviewing this method, I found it to be simpler than the above in many respects. Tropinone. 10 g of pyrrolidinediethyl diacetate are heated with 10 g of cymene and 2 g of sodium powder, the reaction taking place at about 160. During the reaction (which is complete in about 10 min) the temp should not exceed 172. The resulting reaction product in dissolved in water, then saturated with potassium carbonate, and the oil, which separates, is boiled with dilute sulfuric acid. 2.9 g of tropinone picrate forms and is filtered. Here are two more formulas devised by Willstatter that produce tropinone from tropine. Take note of the yield differences. Tropinone. To a solution of 25 g tropine, dissolved in 10 times its weight of 20% sulfuric acid are added 25 g of a 4% solution of potassiumpermanganate in 2 or 3 g portions over 45 min while keeping the temp at 10-12. The addition of permanganate will cause heat (keep the temp 10-12) and precipitation of manganese dioxide. The reaction mixture is complete in 1 hour. A large excess of NaOH is added and the reaction is steam distilled until 1 liter of distillate has been collected. The tropinone is isolated as the dibenzal compound by mixing the distillate with 40 g of benzaldehyde in 500 cc of alcohol and 40 of 10% sodium hydroxide solution. Let stand several days to get dibenzaltropinone as yellow needles. Yield: 15.5 g, 28%. Recrystallize from ethanol to purify. Tropinone. A solution of 12 g of chromic acid in the same amount of water (12 g) and 60 g of glacial acetic acid is added dropwise with stirring over a period of 4 hours to a solution of 25 g of tropine in 500 cc of glacial acetic acid that has been warmed to 60-70* and is maintained at this temp during the addition. Heat the mixture for a short time on a steam bath until all the chromic acid has disappeared, cool and make strongly alkaline with NaOH. Extract with six 500 cc portions of ether and evaporate the ether in vacuo to get an oil that crystallizes readily. Purify by convering to the picrate or fractionally distill, collecting the fraction at 224-225* at 714 mm vacuo. The tropinones can be used in the above formula (or in a formula that you have found elsewhere) to be converted to cocaine. Remember to recrystallize the 2-carbomethoxytropinone before converting to methylecgonine.
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Tl/Dr: It’s not always anxiety
Hi all, I have been a lurker in here for awhile. And today I wanted to share with you all what I have been through in the last 13 years. My illness begin at the age of 27 in 2007. During a hysterectomy my heart rate went crazy. It was extremely high. They ended up shocking me to get it down. They ran test and everything was normal. So I followed up with my mom’s cardiologist. I am beyond thankful for him. He ran a slew of test on the first visit that included a echo that he done in his office. He stopped and informed me that he needed to do a heart cath the next day. But he was almost certain what was wrong. So the next morning he did the cath. He diagnosed me with Prinzmetals Angina and Vasospasms. Started me on meds to slow my heart down. The meds made me extremely ill. Due to the fact I was not your typical heart patient. Perfect weight, low blood pressure, perfect cholesterol and pretty much a healthy lifestyle. Just a little stress due to my career and being my moms caretaker. So for the next 5 years I would notice my pulse jumping up but would just dismiss it. I woke up one morning and thought I had pulled a muscle in my shoulder at work. At the time I was a Hospice RN. At the age of 32, I walked in to the ER to get it checked, keep in mind I had my scrubs on. They triaged me. When they did my vitals my pulse was 140 sitting still. I am still thinking I just pulled something. In walks this ER doctor, who sits across from me while they are setting up to do a EKG, he starts the normal questions, and then looks at me straight faced and asked me “ what drugs are you on?” ,”do you do coke, or crack, what about meth?”... when I told him I wasn’t on drugs. His reply was well I’m drug testing you and if you are positive I will have your license. I just looked at him. Then it clicked on me. I had never been awake when I had had a spasm. When I was telling him what my diagnosis was with my heart he rolled his eyes and walked out. The drug test was clean. I was admitted and ran through the normal heart test which were all negative. Discharged with anxiety and Angina. Was told to see a psychiatrist. From 2012-2015 I was in and out of the hospital with spasms. During this time I wasn’t aware that PA and spasms doesn’t change your heart test. In 2015 after 3 days of my pulse running 150 I went to my 3rd hospital. The ER dr was fixing to discharge me when I called my cardiologist who made them admit me. He did a heart cath and to everyone’s surprise. I had had a Type 2 heart attack. The one thing that stumped everyone was that my tropinin NEVER elevated, my EKG was always normal. From 2015-2019 numerous hospital stays and discharge of anxiety. Because if it doesn’t show on test it’s not your heart. Never Mind what happened in 2015. Which caused me to retire at the age of 35. Finally last July I was feeling bad. I was hurting in my shoulder. Thought I had a upper respiratory infection due to I was coughing and short of breath. I get to the ER they admit me. A new associate of my Dr came to see me. He treated me like I was a drug seeker and admitted me for anxiety and heart observation. I had a fit. And told the nurse I wanted a second opinion because something wasn’t right. So another cardiologist seen me. She was amazed that no one had bother to run a stress test or anything of that nature. On July 3 she did the stress test and I was taken straight to the lab for a cath. In the middle of the cath she stopped. I was awake enough to know something wasn’t right. When I asked, she told me that I needed triple bypass. In recovery my husband came unglued how did we go from it’s just anxiety/Angina to having major heart surgery? On July 5,2019 my life was ripped apart. During the surgery it was discovered that my veins are the size of a small child. And out of the 7 they took they could only use 2. Which meant they had to leave a blockage. They left a 80% blockage in my right coronary artery. On my follow up echo it was found that the bypasses are failing. And 5 surgeon:cardiologist have all agreed that there are no more surgical options for me. That I won’t make it off the table. So here I am at the age of 39, terminal due to lack of care and concern of my symptoms of my heart. I have learned do not take a diagnosis just because it is easier. Do not let a dr push you away because you are female. It is a proven fact that women are less likely to be treated for heart disease than men. Please please advocate for yourself. Sorry this is so long