Lisonopril and cardizem together

Hi all. I’m a nurse working with a resident I think is doing a poor job, and I want to make the best of the situation for everyone involved.
I get this brand new patient from ER and I’m working on organizing all of the orders, etc. This resident ordered 30 units of Levemir on a diabetic patient who didn’t take insulin at home, wasn’t on steroids or anything that would raise his b/s. He was 112 accu-check. As I’m investigating whether I should give this before calling him, my patient’s heart rate drops to 44 on the heart monitor and he’s on cardizem drip for rapid A-fib, he had been running 80s-120’s. So, of course I turn it off but I have to notify him that I did this.
As my routine, before calling the doctor, especially residents, I try to get all pertinent data together before calling so I can evaluate whether or not I’m comfy with doctor’s response, and if he he/she has any questions. It turns out this doctor already ordered for the patient in the ER, and the patient received, home dose Metoprolol XL, and two IVP beta blocker. So I’m thinking, ok this guy has had way too much beta blocker and it’s catching up with him.
So, I call and tell him what’s going on and question whether or not he would like me to give insulin and told him about drip. He comes down to see patient and tells me to continue the drip because the cardiologist will be mad if we stop it. I said, “why would he be mad?” He said because the cardiologist told him to order it…..
I’m like, well yeah, but he’s not tolerating it well now. And resident told me if his HR drops to the 40s just to “ wake him up and have him wave his arms around or something to get it above 60.” I’m so confused. What. The. Actual. F.
Anyway I tell him I’m not going to do that because the order says to titrate to keep hr below 100, and that is good enough for me. He was pissed at me ya’ll! He asked if I knew who he was and I said no. And he said, “ Of course not.” Omg.
Anyway, I wrote in the patient’s chart that he told me to give the insulin and continue the drip with heart rate in the 40’s and contacted the attending to verify.
What do you all think?

Developed asthma at 43 - after a mysterious illness my home had in February 2020. They presume we had Covid but with no testing available at that time it is merely an educated guess. Each year it has gotten worse - especially around Spring. I am vaccinated, mask IF i go out, lung function test good last year, some mosaic scarring on CT scan, see a good pulm. Anoro at first but that did not work and moved to Qvar after an awful asthma attack last April- now this April placed on Qvar and one puff Advair HFA - pray it works as oral steroids triggered my Afib last year. Afib and asthma do not work well together and neither do the meds - had to change off Metoprolol to Cardizem. Thought was there that maybe the Metoprolol caused my asthma. Can anyone else relate?

I’m looking for others’ anecdotes and experiences with Topiramate/Topamax, especially if your etiology is similar to my own, but everyone with knowledge is welcome to reply:
I’ve had lifelong congenital, classic migraines since childhood. In my late 20s, Cardizem did little to nothing for them; so, I was put on Propranolol/Inderal for about a decade, which was effective at reducing the frequency of my migraines, but needed supplementation with Amidrine/Midrin/Duradrin and Maxalt/Rizatriptan for breakthrough attacks.
For a variety of reasons, I discontinued the Propranolol for a few years, until I was diagnosed with primary hypertension. We got my blood pressure under control by returning to Propranolol and adding Hydrochlorothyazide to the mix. I also take Atorvastatin, because (although I’m an athletic vegetarian and my cholesterol numbers are all pretty good) I have a family history of strokes and heart disease.
These days, the Propranolol seems to suppress my pain phases fairly well, with relatively few breakthrough pain phases. However, I still get almost daily aura and frequently some associated migraine symptoms, such as what I call cognitive blind-spots/viscosity.
I approached my physician about trying one of the new medications, such as Qulipta or Aimovig, one of the Calcitonin Gene-Related Peptide (CGRP) antagonists, or something else other than Botox/Botulinum-toxin. My doctor referred me to a neurologist due to her lack of knowledge and experience; but, while awaiting an appointment with the specialist, my PCP’s in-house pharmacologist stepped in at my request to look into my current medication regime. My pharmacologist and physician together discovered that my insurance requires a pre-authorization for the CGRP-class medications, and to get that I must fail two prophylactic drugs. They can count Propranolol as one, and are recommending I try Topiramate.
I’m concerned about the potential side effects; such as, cognitive impairment, mental alertness, physical coordination and heat regulation (especially as an athlete who sweats A LOT as it is), visual field defects (‘though I already wear glasses), and kidney stones (despite currently having excellent kidney function, determined by my lab results). My pharmacologist said Topiramate is one of the better medications for preventing aura, and I’m open to her recommendation, as well as staying on medication that’s effective if it proves so. However, I first want to know what others have experienced.
Thanks for reading all this. I hope it helps find people with similar etiologies. 😱/😁

Age 38
Sex m
Height 5’ 10”
Weight 267
Race white
Duration of complaint years
Location USA
Any existing relevant medical issues insomnia, anxiety, depression, obesity, fatty liver, high cholesterol
Current medications: Xanax 0.5, lisonopril, escaprolazam (Lexapro), Lipitor
Ok, so I’ve been self medicating with alcohol and bad eating habits since I was in my late twenties. About five years ago, I decided to quit drinking and change my life around. The key to that success was: lots of exercise, Xanax around 6pm, dinner, Ambien, sleep repeat. It was very much a routine that kept me sober for 6 months, I lost 60 pounds, my cholesterol levels and blood pressure were normal — until I made the stupid decision and convinced myself I could reintroduce drinking socially and slowly everything fell apart.
I know I can get back to that routine, but my doctor doesn’t want to prescribe me Ambien because I’m already prescribed xanax (I wouldn’t take them together, about 7 hours apart.) in fact very few doctors have been willing to prescribe me either, suggest melatonin or benedryl —- but what winds up happening is that I’ll drink late at night to curb the anxiety and get to sleep.
Are there any doctors out there who practice harm reduction rather than wag their finger at my dependence on prescribed substances in lieu of alcohol? Yes I am counseling, I’ve tried the steps. My anxiety and insomnia always win regardless, and I’m feeling at a loss

TLDR: New AGACNP grad in a new speciality, difficulty with time management, keeping all my patients straight in my head, and responding quickly to urgent situations. Need advice from others who have been in similar situations.
Wanted to reach out to you all because as a brand new (6 weeks in) Neurocritical Care NP, I am struggling with time management. To start, I have 12 years nursing experience, most of it in high acuity med surg (3-4:1 ratio) and ED, though I did most of my clinicals in the Medical, Surgical, and CV ICUs. I got hired for this job by some awesome attendings who apparently saw my potential despite having no nursing ICU or Neuro experience. We are also expanding our service and adding about 6 APPs to the 3 that were already there over about 4 months. I came in 2nd.
That said, I am really struggling with time management. Or maybe I’m not, as everyone seems to think I’m doing fine and I’m just frustrated with myself maybe. Anyway, I normally carry 3-5 patients depending on complexity and my familiarity with them but I feel like I have consistently have trouble being ready for rounds. We get there at 6:30, have a half an hour for sign out, and then round at 8:30. I typically go see all my patients and review charts, but struggle with putting together a comprehensive plan in time to present. The goal is the ability to see up to 8 patients a day and I just don’t see how that will ever happen in an hour and a half! There’s also the expectation to have a basic understanding of everyone on my service, up to 15 patients, so I can respond to critical events.
The other thing that I’m really struggling with that I haven’t in years is keeping everyone straight in terms of diagnosis and major complications. Even my own patients, I struggle to keep their diagnosis in my head...I end up thinking uh, something is wrong with their brain...and focusing on things I know more about like their kidneys (worked on an ESRD unit).
The nurses get (understandably) frustrated with me when I don’t act fast enough when, for example, a patient becomes randomly tachycardic, looked like SVT, and I need a minute to take off my ED hat and put on my Neuro hat. I almost asked someone to valsalva the other day (first line of defense in the ED, very bad for Neuro patients). Stopped myself though! Wanted to push cardizem, we use metoprolol. Even adenosine to see underlying rhythm as pt had history of a flutter. Doubted myself on the EKG because I want one before and after and it’s not like I can just get one at the bedside, because we have to call a tech.
Add all this to the fact that I’m having some major life changes at the moment (family health issues that required a move, mainly), and don’t have as much time to study on my days off as I would like.
This post turned into way more of a rambling word vomit of all my issues so if you’ve read this far, thank you!
Any tips from someone that jumped straight into a new speciality and may have had some of the same issues?

Hi, hope this is allowed.... I'm new here & probably about to make a long, weird & annoying post but I need some information from direct, experienced sources not the overwhelming confusion that is google lol. Here goes: I've had Orthostatic Hypotension (with occasional syncope) since I was a teen. In my 20s I started having severe arrhythmias SVT, AFIB/atrial flutter & overall "Inappropriate Sinus Tachycardia Syndrome''. I had a cardiac ablation & seemed to benefit for a short time (less than a year) then reverted to having the arrhythmias again. My BPM will just randomly sky rocket sometimes over 200, I take several daily cardiac meds that don't seem to help & rarely respond well to IV adenosine or cardizem. When I have these "spells" I shake uncontrollably & sometimes hyperventilate. It wasn't until my Electrophysiologist saw one of the episodes live in action at a random appointment (I live very rural & usually end up in ER or ambulance when they occur, he is located 90 minutes from me) that he decided to do some more tests which lead to an additional diagnosis of Dysautonomia & an explanation that I am not responding to traditional cardiac approaches because my cardiac issues are just a symptom of this other disease? I was told I'd be referred to The Mayo Clinic for further management (who I am still waiting to hear from). Soooooo... what I'm wondering is does anyone have a similar story? Does anyone suffer from chronic hypokalemia or low magnesium? Hand tremors? Recurrent unexplained miscarriages? (I have had 11 & been to 3 Specialists who cant find an issue) Exhaustion & random pains? Extremely easy bruising? Constipation? Heat intolerance? ( being out during summer literally makes me feel ill, I always thought it was just because I'm a chubby ginger) And speaking of chubby, is it extra hard to lose weight with this? I'm really curious how many of my random symptoms & oddities will be tied together by this new diagnosis so I really appreciate the input from all you helpful folks.
Sorry to anyone I annoyed with this novel & thank you in advance to anyone willing/able to settle my mind a bit!

Fatty liver disease means you have extra fat in your liver. You might hear your doctor call it hepatic steatosis.
Heavy drinking makes you more likely to get it. Over time, too much alcohol leads to a buildup of fat inside your liver cells. This makes it harder for your liver to work.
But you can get fatty liver disease even if you don’t drink a lot of alcohol.
What is Fatty Liver Disease? and How to Get Rid of It?
In the U.S., it’s estimated that fatty liver disease affects 20 to 40 percent of the population. The scary and surprising fact is that this type of liver disease often doesn’t cause any obvious fatty liver disease symptoms. Many people don’t even realize their livers are fatty until they have testing (such as a CT scan or ultrasound) for another health concern or they experience an obvious alert such as pain in the abdomen.
There are two main types of this disease: nonalcoholic fatty liver disease (NAFLD) and alcoholic fatty liver disease. Having a fatty liver can leave you feeling tired or cause mild abdominal discomfort (fatty liver pain), but otherwise you may not have any symptoms. Signs of fatty liver can also include a feeling of fullness in the middle or upper right side of the abdomen, nausea, weight loss and a decrease in appetite. These are just some of the possible symptoms of fatty liver.
Is a fatty liver dangerous? It can be! The more severe type of NAFLD is NASH, which stands for non-alcoholic steatohepatitis. NASH causes the liver to swell and become damaged. According to the American Liver Foundation, NASH is one of the top causes of cirrhosis in adults in the United States and up to 25 percent of adults with NASH may already have cirrhosis. NAFLD is also linked to an increased risk of liver cancer.
Before you jump to the conclusion that a fatty liver may be a likely part of your future or a diagnosis you can’t do anything about, the good news is that the liver is highly regenerative — in fact, it’s the only organ that can regenerate itself.
That’s why it’s not that surprising that with the right fatty liver disease diet and some powerful yet easy-to-do fatty liver home remedies, you may be able to improve the state of your liver starting today!

What Is Fatty Liver Disease?

The human body’s largest organ is the liver. This vital organ stores energy, helps to digest food and removes toxins and poisons.
What is fatty liver disease? Fatty liver disease is a common health problem that results from a buildup of extra fat in the liver. It’s totally normal for the liver to contain a small amount of fat, but when fat storage reaches 5 to 15 percent of the liver’s total weight, then a person is said to have fatty liver disease.
The severity of a fatty liver (also called steatosis) can be a grade 1, grade 2 or grade 3 fatty liver. A fatty liver grade 2 is more serious and more likely to cause symptoms as compared to fatty liver grade 1. The more fat in the liver, the higher the grade and the more likely for the fatty liver to cause problems. There are also different kinds of fatty liver disease.

Nonalcoholic Fatty Liver Disease vs. Alcoholic Fatty Liver Disease

There are two main forms of fatty liver disease: non-alcoholic fatty liver disease (NAFLD) and alcoholic fatty liver disease. What causes fatty liver? In NAFLD, people have a buildup of fat in the liver that is not caused by alcohol use.
However, the build up of fat and damage to the liver is similar to what occurs in a case of alcoholic fatty liver disease, which is directly linked to consuming large quantities of alcohol. A “large amount” of alcohol is typically usually said to be more than one drink per day on average for women and more than two drinks per day on average for men.

Fatty Liver Symptoms

Now that you know what is fatty liver, it’s time to take a look at some of the ways you can identify this disease by knowing the common nonalcoholic fatty liver disease symptoms. First, it’s important to note that it is possible to have non-alcoholic fatty liver disease and exhibit no symptoms. This is actually quite common. When symptoms do occur, there are several possibilities.
Signs of a fatty liver (due to alcohol or other causes) can include:

• Fatigue
• Weakness
• Loss of appetite
• Nausea
• Abdominal pain especially in the upper right abdomen
• Swelling in the upper abdomen
• Spider-like blood vessels
• Itching
• Jaundice (yellowing of the skin and eyes)
• A build up of fluid and swelling of the legs (edema) and abdomen (ascites)
• Mental confusion

Fatty Liver Causes

What causes a fatty liver? An excessive accumulation of fat leads to a fatty liver. In a diagnosis of alcoholic fatty liver disease, the main cause of fat accumulation is consuming large amounts of alcohol.
Suspected causes of nonalcoholic fatty liver disease (NAFLD) as well as non-alcoholic steatohepatitis (NASH) include:

• Being overweight or obese
• Insulin resistance
• High blood sugar (hyperglycemia), indicating prediabetes or actual type 2 diabetes
• High levels of fats, specifically triglycerides, in the blood

All of these possible causes seem to encourage excess deposits of fat within the liver with obesity likely being the most prevalent cause.
According to American College of Gastroenterology,

NAFLD is a very common disorder affecting and may affect as many as one in three to one in five adults and around one in ten children in the United States. Obesity is thought to be the most common cause of fatty infiltration of the liver. Some experts estimate that about two thirds of obese adults and half of obese children may have fatty liver.

Fatty Liver Risk Factors

What are the risk factors for fatty liver disease? Nonalcoholic fatty liver (NAFLD) is more common in people who exhibit any of these health problems or features:

• Obesity
• Type 2 diabetes
• Prediabetes
• Metabolic syndrome or another metabolic disorder
• Hispanic
• Rapid weight loss
• High blood pressure
• Middle aged or older (NAFLD is most prevalent in people who are middle-aged or older, but younger people including children can also have NAFLD)
• Certain infections like hepatitis C
• Take certain drugs including corticosteroids and certain cancer drugs
• Exposure to some toxins

According to the Cleveland Clinic, “Some genetic metabolic conditions or prescription medications, including amiodarone (Cordarone®), diltiazem (Cardizem®), steroids, and tamoxifen (Nolvadex®) also may increase the risk of non-alcoholic fatty liver disease. If you are taking one of these medications and are diagnosed with fatty liver, your doctor might substitute another drug.”
Is having a fatty liver life threatening? If left untreated and it progresses, a fatty liver can definitely be life threatening. Let’s take a look at possible fatty liver health complications.

Fatty Liver Complications

Non-alcoholic fatty liver disease (NAFLD) is the most frequent cause of liver disease in the Western world. Having fatty liver disease means that you have fat deposits within your liver and these undesirable deposits can prevent the liver from doing its important job (and what’s so crucial to optimal health) — to remove toxins from your blood. This puts someone with this liver disease at serious risk for toxic buildup and all kinds of unpleasant symptoms of a poorly functioning liver including jaundice, edema, chronic fatigue, nausea and more.
When non-alcoholic fatty liver disease progresses and becomes severe, it is then non-alcoholic steatohepatitis (NASH). According to the National Institutes of Health (NIH), between 7 and 30 percent of people with NAFLD will develop NASH and at least one-third of people with NASH eventually develop cirrhosis.
The late-stage scarring of the liver known as cirrhosis is the main complication of NAFLD and NASH. When cirrhosis occurs, liver cells are progressively replaced by scar tissue and liver function deteriorates more and more.
According to Mayo Clinic, approximately 20 percent of people with NASH will progress to cirrhosis, which can lead to:

• Abdominal fluid buildup
• Swelling of veins in your esophagus, which can rupture and bleed
• Confusion, drowsiness and slurred speech
• Liver cancer
• End-stage liver failure (the liver has stopped functioning)
• The need for a liver transplant

People with NAFLD, NASH and cirrhosis are all believed to be at an increased risk of developing liver cancer.

Conventional Treatment of Fatty Liver

To diagnose a fatty liver, your doctor will likely perform blood and imaging tests. A liver biopsy may also be necessary.
Common conventional treatment recommendations for fatty liver disease involve eliminating or controlling the cause(s). For example, according to the National Institute of Diabetes and Digestive and Kidney Diseases, conventional fatty liver treatment may includes a doctor’s recommendation to lose weight loss since which helps to decrease fat in the liver as well as inflammation and fibrosis.
Rapid weight loss, however, is not a good idea since this can only make things worse. Gradually losing weight is the smart way to go. Some doctors may advise aiming to lose around 7 percent of body weight over a one year time frame.
Other recommendations may include:

• Stop taking any drug that may be causing fatty liver
• Better control diabetes
• Lower triglyceride levels
• Stop consuming alcohol

There are currently no approved medications to specifically treat NAFLD and NASH. Some doctors give their fatty liver patients vitamin E and thiazolidinediones (a class of drugs, including rosiglitazone and pioglitazone, commonly taken for diabetes) when alcohol is not the cause. However, these drugs can cause adverse effects and some say they don’t make enough of a difference long-term.
When NASH leads to cirrhosis, conventional treatment typically includes certain medications and possibly operations or procedures. When cirrhosis leads to liver failure, a liver transplant can be required.

Fatty Liver Diet and Supplementation

Are you wondering, how can I reduce my fatty liver? Some of the main natural tactics include following a healthy fatty liver disease diet loaded with whole foods. There are also a number of supplements that can be helpful as well.

1. Foods to Boost Liver Function

What foods to eat if you have a fatty liver? In general, you will want to incorporate more plant-based diet foods and choose helpful fatty liver foods including vegetables, fruits and healthy fats.
The following helpful foods are known to decrease inflammation while also aiding the body in its use of insulin, which is often a problem for people with a fatty liver:

• Foods high in monounsaturated fats like olives, olive oil, avocados and nuts.
• Foods rich in omega 3 fatty acids including wild-caught fish like salmon and sardines, chia seeds, flaxseeds and walnuts.
• High antioxidant foods that can help to protect the liver cells from damage, especially items rich in vitamin E, which some research shows can improve the state of a fatty liver. Some healthy foods high in vitamin E include sunflower seeds and almonds.
• Liver boosting vegetables including artichokes and bitter, leafy greens like mustard greens, chicory, arugul, and dandelion.
• Green tea, which is rich in catechins, has been shown to help decrease body fat and discourage obesity.

2. A Mediterranean and Ketogenic Diet

You may want to consider following a Mediterranean diet, which some some studies have suggested can decrease fat in the liver. This diet emphasizes vegetables, fruits, whole grains, legumes, beneficial fat sources like extra virgin olive oil, and healthy proteins like sardines and other omega-3 fatty acid rich fish.
You can take it one step further and follow a Mediterranean ketogenic diet. A pilot study published in 2011 in the Journal of Medicinal Food finds that this type of combined diet plan which focuses on whole foods (especially healthy fats, proteins, and vegetables) can help people overcome metabolic syndrome, which is closely associated with nonalcoholic fatty liver disease.
So for people struggling with a fatty liver linked to metabolic syndrome, this study shows that the potential therapeutic properties of a Mediterranean ketogenic diet can improve metabolic syndrome along with NAFLD.

3. What Foods to Avoid

If you’re looking to follow a fatty liver diet menu and lifestyle that can help to improve the state of your liver, there are some things you’ll definitely want to avoid. Of course, excess alcohol is a huge no-no especially if you have alcoholic fatty liver disease.
There are also a number of foods and other items known to have a negative impact on the liver including:

• Too much alcohol or caffeine
• Packaged goods that contain refined vegetable oils, artificial ingredients, sweeteners and colors
• Fruits and vegetables heavily sprayed with chemical pesticides and herbicides (non-organic crops)
• Factory-farm animal products, farm-raised fish or conventional dairy (that has been pasteurized and homogenized)
• Refined sugar as well as too much fructose
• Refined grains
• Uncooked shellfish
• Certain medications (especially acetaminophen)
• Eating poisonous wild mushrooms
• Exposure to harsh chemicals especially endocrine-disrupting chemicals

You can check the LiverTox database provided by the National Institutes of Health to see if any medication, herb or supplement may be linked to liver injury so that you can avoid them as well.

3. Supplements that Boost Liver Health

According to a scientific review published in 2015, there are some supplements that have specifically been shown to help in the treatment of non-alcoholic fatty liver disease including:

• Vitamin E and vitamin C: Since oxidative stress can play a significant role in the development of pathogenesis of NAFLD, antioxidant agents like vitamin E and vitamin C could be beneficial in the treatment of a fatty liver. However, so far study results are unclear. For example, Vitamin E may only be helpful for adults with NASH who do not also have diabetes or cirrhosis.
• Vitamin D: Research has shown that a vitamin D deficiency can result in insulin resistance, metabolic syndrome and NAFLD.
• Resveratrol: Found in red wine as well as foods like red grapes, raw cocoa (dark chocolate), berries and also available in supplement form, resveratrol appears to decrease the severity of NAFLD in animal models.
• Anthocyanin: Animal research points towards anthocyanin‘s ability to decrease fat accumulation in the liver and counteract liver inflammation.
• Green tea extract: Both in vitro and in vivo experiments demonstrate that green tea and EGCG (a type of catechin) may prevent steatosis by decreasing dietary absorption of fats and carbohydrates.
• Garlic: Garlic-derived S-allylmercaptocysteine (SAMC) appears beneficial to nonalcoholic fatty liver disease thanks to its ability to regulate fat storage and glucose metabolism.
• Ginger: May help to prevent NAFLD or slow down its progression to more severe liver diseases.
• Probiotics and prebiotics: As the review points out, “The gut-liver axis is an important pathway in NAFLD development, which is associated with small intestinal bacterial overgrowth and increased intestinal permeability.” So in other words, SIBO and a leaky gut appear to be contributing factors to NAFLD, which is why prebiotics and probiotics can be so beneficial. You can incorporate more prebiotic and probiotic foods into your diet as well as high quality probiotic supplements.
• Cinnamon: May improve insulin resistance and oxidative stress.
• Curcumin: The active component of turmeric, curcumin, may reduce fat deposits in the liver. It may also prevent fatty liver progression with its “potent antioxidant and anti-inflammatory activities.”
• Quercetin: Available as a supplement and also found in foods like apples and onions, quercetin may help to reduce inflammation and may be particularly helpful for people with a fatty liver as well as obesity and/or diabetes.

This review also points out how both epidemiological and animal studies have shown that drinking coffee (opt for organic to eliminate pesticide residues!) on a regular basis can decrease the risk of type 2 diabetes development, which is a known cause/risk factor for fatty liver disease.

4. Detox Your Liver

Check with your doctor first, especially if you have diabetes or struggle with blood sugar issues.

Key Points About Fatty Liver Disease

• What is a fatty liver? A liver which has a fat storage of five to 15 percent of its total weight. This equates to a diagnosis of fatty liver disease.
• A fatty liver can result in no obvious symptoms or it can cause one or more common fatty liver symptoms such as abdominal pain, abdominal swelling, jaundice, nausea, loss of appetite, fatigue, weakness and itching.
• Nonalcoholic fatty liver disease affects people who drink little to no alcohol while alcoholic fatty liver disease is the result of excessive alcohol consumption.
• For people who don’t excessively consume alcohol, other fatty liver causes include being overweight or obese, insulin resistance, high blood sugar and high levels of fats, particularly triglycerides, in the blood.
• A healthy diet for fatty liver should include plenty of whole foods like liver-boosting artichokes and bitter leafy greens, fish rich in omega 3s and olive oil, high vitamin E foods like sunflower seeds and almonds, and green tea.
• Supplements like probiotics, resveratrol, curcumin, vitamin E, vitamin C and vitamin D may help to naturally improve a fatty liver.
• It’s also important to get regular exercise, which can help you to maintain a healthy weight and decrease fat accumulation in the liver.
• Talk with your healthcare provider before changing your diet or trying any new supplements if you have been diagnosed with fatty liver disease.

Everything you need to know about liver cancer
Liver cancer is cancer that begins in the cells of your liver. Your liver is a football-sized organ that sits in the upper right portion of your abdomen, beneath your diaphragm and above your stomach.
Several types of cancer can form in the liver. The most common type of liver cancer is hepatocellular carcinoma, which begins in the main type of liver cell (hepatocyte). Other types of liver cancer, such as intrahepatic cholangiocarcinoma and hepatoblastoma, are much less common.
Not all cancers that affect the liver are considered liver cancer. Cancer that begins in another area of the body — such as the colon, lung or breast — and then spreads to the liver is called metastatic cancer rather than liver cancer. And this type of cancer is named after the organ in which it began — such as metastatic colon cancer to describe cancer that begins in the colon and spreads to the liver. Cancer that spreads to the liver is more common than cancer that begins in the liver cells.

Types:

Hepatocellular carcinoma

Symptoms:

Most people don’t have signs and symptoms in the early stages of primary liver cancer. When signs and symptoms do appear, they may include:

• Losing weight without trying
• Loss of appetite
• Upper abdominal pain
• Nausea and vomiting
• General weakness and fatigue
• Abdominal swelling
• Yellow discoloration of your skin and the whites of your eyes (jaundice)
• White, chalky stools

When to see a doctor

Make an appointment with your doctor if you experience any signs or symptoms that worry you.

Causes

It’s not clear what causes most cases of liver cancer. But in some cases, the cause is known. For instance, chronic infection with certain hepatitis viruses can cause liver cancer.
Liver cancer occurs when liver cells develop changes (mutations) in their DNA — the material that provides instructions for every chemical process in your body. DNA mutations cause changes in these instructions. One result is that cells may begin to grow out of control and eventually form a tumor — a mass of cancerous cells.

Risk factors

Factors that increase the risk of primary liver cancer include:

• Chronic infection with HBV or HCV. Chronic infection with the hepatitis B virus (HBV) or hepatitis C virus (HCV) increases your risk of liver cancer.
• Cirrhosis. This progressive and irreversible condition causes scar tissue to form in your liver and increases your chances of developing liver cancer.
• Certain inherited liver diseases. Liver diseases that can increase the risk of liver cancer include hemochromatosis and Wilson’s disease.
• Diabetes. People with this blood sugar disorder have a greater risk of liver cancer than those who don’t have diabetes.
• Nonalcoholic fatty liver disease. An accumulation of fat in the liver increases the risk of liver cancer.
• Exposure to aflatoxins. Aflatoxins are poisons produced by molds that grow on crops that are stored poorly. Crops such as corn and peanuts can become contaminated with aflatoxins, which can end up in foods made of these products. In the United States, safety regulations limit aflatoxin contamination. Aflatoxin contamination is more common in certain parts of Africa and Asia.
• Excessive alcohol consumption. Consuming more than a moderate amount of alcohol daily over many years can lead to irreversible liver damage and increase your risk of liver cancer.

Prevention

Reduce your risk of cirrhosis

Cirrhosis is scarring of the liver, and it increases the risk of liver cancer. You can reduce your risk of cirrhosis if you:

• Drink alcohol in moderation, if at all. If you choose to drink alcohol, limit the amount you drink. For women, this means no more than one drink a day. For men, this means no more than two drinks a day.
• Maintain a healthy weight. If your current weight is healthy, work to maintain it by choosing a healthy diet and exercising most days of the week. If you need to lose weight, reduce the number of calories you eat each day and increase the amount of exercise you do. Aim to lose weight slowly — 1 or 2 pounds (0.5 to 1 kilograms) each week.
• Use caution with chemicals. Follow instructions on chemicals you use at home or at work.

Get vaccinated against hepatitis B

You can reduce your risk of hepatitis B by receiving the hepatitis B vaccine, which provides more than 90 percent protection for both adults and children. The vaccine can be given to almost anyone, including infants, older adults and those with compromised immune systems.

Take measures to prevent hepatitis C

No vaccine for hepatitis C exists, but you can reduce your risk of infection.

• Know the health status of any sexual partner. Don’t engage in unprotected sex unless you’re certain your partner isn’t infected with HBV, HCV or any other sexually transmitted infection. If you don’t know the health status of your partner, use a condom every time you have sexual intercourse.
• Don’t use intravenous (IV) drugs, but if you do, use a clean needle. Reduce your risk of HCV by not injecting illegal drugs. But if that isn’t an option for you, make sure any needle you use is sterile, and don’t share it. Contaminated drug paraphernalia is a common cause of hepatitis C infection. Take advantage of needle-exchange programs in your community and consider seeking help for your drug use.
• Seek safe, clean shops when getting a piercing or tattoo. Needles that may not be properly sterilized can spread the hepatitis C virus. Before getting a piercing or tattoo, check out the shops in your area and ask staff members about their safety practices. If employees at a shop refuse to answer your questions or don’t take your questions seriously, take that as a sign that the facility isn’t right for you.

Ask your doctor about liver cancer screening

For the general population, screening for liver cancer hasn’t been proved to reduce the risk of dying of liver cancer, so it isn’t generally recommended. The American Association for the Study of Liver Diseases recommends liver cancer screening for those thought to have a high risk, including people who have:

• Hepatitis B and one or more of the following apply: are Asian or African, have liver cirrhosis, or have a family history of liver cancer
• Hepatitis C infection and liver cirrhosis
• Liver cirrhosis from other causes, such as an autoimmune disease, excessive alcohol use, nonalcoholic fatty liver disease and inherited hemochromatosis
• Primary biliary cirrhosis

Discuss the pros and cons of screening with your doctor. Together you can decide whether screening is right for you based on your risk. Screening typically involves an ultrasound exam every six months.
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Source: http://www.hiwamag.com/health/fatty-liver-disease/

Asking here because I like people’s opinions. Some sway me and some don’t. But you all have different experiences and have seen different people rather than just the bubble of a hospital I am in.
I absolutely love where I work. I’ve told my favorites that I will not transfer to another hospital until they leave (coworkers make or break a hard floor I tell ya). 2 of them are actually leaving as of this month lol. 1 to day shift 1 to ICU. And I have a year left in my contract to kick out my other friend. It’s a great floor because we are the few, actually- only one who has retained pretty much all our staff. People don’t leave bc it’s a shitty unit, they leave bc of their family or night shift doesn’t work with their family life or wanting to learn more. Our charge nurses have been there for 15+ years for example.
I’ve always “wanted” to be a doctor. I’ve never always wanted to be a nurse. Until I became a nurse and realized I actually liked it. It’s not the pay I am after (though I will be after the debt haha) or want and definitely not the schedule. I absolutely love our schedules and want to cry when I think of giving it up lol. But also I’ve had months of working 6 shifts a week, 2 days off and repeat. So when I have to work financially for those days/my family. I do it. I easily go see my family out of state just by scheduling it right and having 5-6 days off without vacation days.
My issue is I want to know/learn more than what’s required of us as nurses. I love knowing the deep patho it takes for cirrhosis to happen or for what afib and cardizem is doing together. I love all that detail. I always have, which is what made studying for nclex hard. I always overstudied things we didn’t have to know. Even pharm I would want to know the complexities of the drug and not just the signs and symptoms. But I had to put what I wanted to learn in a box so that I could actually pass the test. It’s been 3 years and I’m still over here on YouTube watching khan academy videos for med school students lol. Our hospital gives us the option to earn certifications for ICU and what not and that’s more free education I’m interested in. So that’s one way to keep my learning yearning going. Except I don’t want to work in the ICU. I’m not sure what to do because I love everything about nursing except for the fact that I want to know more detail about everything we know.
I’m not worried about the the finances for med school, and no not bc I’m rich but bc I’m completely fine with taking loans if I’m able. When it comes to the schedule, the idea sucks the most. And I’m not scared of studying day in and out for school. Unless I get into a healthy relationship lol. But I’ll be losing the flexibility, the ability to jump from state to state as a traveler, from field to field even with the hospital, the interactions with patients... and what else? I can devils advocate for both being a doctor and being a nurse with the knowledge I have. But based on the info I want to know behind medicine, and how much I like nursing now... is it worth getting into just because I want to learn more?
TLDR; is it worth going to med school after being a nurse solely on the fact that I love knowing what’s required to be a doctor (patho, pathways etc). Other than that I like everything about nursing more than I do for being a doctor (schedule/flexibility/interactions)

175lb 27 yr old male,
Eat Healthy,
Exercise,
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I have been taking nootropics for about a year, adding noots to my stack depending on the circumstance. I’m trying to increase memory, reduce anxiety/stress, immune support, mood, motivation and focus and reduce physical pain from multiple surgeries when my hand was severed at the wrist. I’ve taken lemon balm, curcumin, nalt, alpha gpc, bacopa, sublutiamine, noopept, panac ginseng, Alcar, agmataine, racetams oxir, phenylpi, faso, prami and a couple other racetams, sensoril ND, chammomile, BSO, skullcap, coQ10, phenibut, adrafinil and a few more I cannot remember.
Also use vitamin b complex, egcg, beta carotene, vit E, C, D, folic acid and vitamin k2. I’m sure I missed a few. I was prescribed lisonopril for stage 3 hypertension, but had severe side effects and stopped taking it. I’m trying to repair my GABA receptors and anything else damaged from benzo use. I stopped using noopept, adrafinil, all racetams(even supplementing citicholine/alpha) due to headaches. Concerned about sensoril (SSRI’s prescribed made me feel terrible from the doctors). Stopped phenibut due to potential GABA issues. I am concerned that some products in my stack are contradicting other noots/supplements that I take together. I’ve looked up agonists, antagonists. I do have a medical marijuana card and found cbd added to any stack does help.
Ive started reading into the lions mane, cordyceps, reishi and other products in that line of work.
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Long post, my apologies. Just looking for any recommendations or advice. Thanks!

Well. To be honest. I've been trying not to think about things too much today.
In my personal achievements column, things have been looking up quite recently. I have been making some changes and doing some really nice stuff in my community and coming out of my box, so to speak.
But then there's this HUGE thing going on with my Grandma. Now, if you know me, this post is going to give me away regardless of the throwaway, but at least it's not linked to my regular account. So onto what's happening. My Grams has COPD, emphazima and has been a chronic (as in: persisting for a long time or constantly recurring....not 420) smoker since she was about 12.
I am her eldest Grandchild and 3 years ago on March 25th, I held my Mother and her eldest daughter in my arms as she took her last breath due to a battle we didn't even know she was fighting until 3 months previous. My Mom had cancer. From the moment of her diagnosis, I spent that 3 months taking care of my Mom Sunday night through Friday night, coming home 1.5hrs to spend the weekend with my own kids and husband. Her's worked during the week and she needed to be taken to appts. Helped up to use the potty and had all of her 'meals' prepped for her. I only bring up my Mom because it was a HUGE hit to my Grams state of mind and has sent her down the nasty hole of depression induced negativeness that makes for a shitty quality of life. My Aunt, who cared for her, took her to appts and stopped by almost everyday or called many times, left her husband and got with the real father of her now 19 year old daughter. Grams still holds resentment that now no one seems to do as much for her. Mainly she's just pissed at my Aunt. Then in December of 2013 my cousin, the eldest of 3 sisters and the daughter of said aunt, took her own life. Another HUGE blow to Grams willingness to try to stay positive. I have her self written eulogy in a drawer in my bedroom. Apparently having done what I did for my Mom and my aunt not wanting to deal with her negativity put me in the drivers seat for bearing the dirty work that she liked to dole out.
She'd been a worker bee her whole life, and the year before losing my Mom she had to stop working. As the Matriarch of our family, she tried to hold the reins and keep everyone together, but we have all started to grow and change and these losses had brought us, just a bit, closer together. But things just haven't been normal.
So Grams starts to get progressively worse. I stepped up to begin helping her. Going to her appts. Getting her meds in a proper order. And I started to realize she would come home after telling her Docs how great shes doing, and then complain about how bad she's doing. She would lie, say she's quit smoking, she wouldn't take her meds right, then get pissed because now she's in the hospital for pneumonia again and she hates the fucking hospital. So, after her last round in hospital care, she pretty much just said FUCK IT! I'm done. I'm tired and I don't want to talk to anyone and I just don't give a shit anymore. So I called in hospice care, but only after speaking to her 3 children. I begin a FB group to keep any and all information about her state of being/mind up to date. We begin scheduling times where people will be home with Grams because she claimed to have fallen a few times while getting to her port-a-potty 2 feet from her bed.
Then the family decides she's getting better. Maybe hospice care isn't the right thing. So we deal with the paperwork and have her taken to the ER. There she is treated, again, for pneumonia and sent home. She falls a few more times and is told to go to ER after the latest fall might require stitches.
She comes home from said visit, and that night starts complaining of pain. After being told by her home nurse and her docs office that she can't have meds until she gets another xray either in office or through ER, she said, can't you just call someone and get me something?? To which the nurse said is a bad idea because of drug interactions. My uncle says to me, I've got some Vicodin after the nurse leaves... I said....uhm no. Her meds (of which there are about 14) and that drug are a huge risk. Look it up - Cardizem and Vicodin (or norco, which is what he managed to get her doc to prescribe!!!)
He proceeds to give her the Vicodin anyways. Without telling anyone. Until 8 hours later. And in the time got the doc who's on call through the after hours service to prescribe norcos.
Now, I have done just about all of her care up until this point. I have her meds in a spreadsheet for everyone to keep track of what she has had, when her next doses are...everything. There were days that I wasn't physically there, but even from home I arranged equipment drop off, nurse calls, scheduling with her PT/OT therapists...all of those things. And now I'm being disrespected and my Grams is being given drugs that could send her COPD ridden self into severe and possibly fatal respiratory depression. And my uncle says that he asked the pharmacist about drug interactions and was told there aren't any...so I called my own pharmacist and was told the truth.... So here I am. Sitting at home. Knowing my Grandmother (who might weigh 100 lbs. soaking wet and who only gets out of bed to pee anymore) is being given these types of drugs (mind you, she's only ever taken Tylenol for her pain in the past, after she couldn't take ibuprofen anymore due to interactions with her meds).
All I want to do right now is walk away. I don't even care to remind people she has a docs appt. Tuesday to have her stitches removed. Or that she has refills coming up soon. Or taking any more of the spreadsheets that have helped keep her meds in check this long (3 weeks). I just want to walk away and let them do whatever the fuck they want to because they pretty much already are...so yeah. There's what I needed to get off my fucking chest today.
TL;DR Fucking shit sucks when your Grandmother gets old and your fucking family thinks it's cool to give her meds that could kill her.

Age: 42 Sex: F Height: 5'3" Weight: 255lbs Race: Caucasian Duration of complaint: Approx. 1 week Location (Geographic and on body): Hands and feet, fingers and heels, Live in OK, USA Any existing relevant medical issues (if any): Fibromyalgia, Hypertension, High Cholesterol, Depression, Anxiety, Bipolar, possible Neuropathy (Haven't seen a Neuro). Current medications: Naproxen, Effexor XR, Lisonopril, Lovastatin, Neurontin (300mg)
The title pretty much sums it up. I was diagnosed with Fibromyalgia back in 1999, but have never been on any med stronger than Naproxen for it due to allergies to meds, insurance not covering meds, or lack of insurance. This past summer, I think it was August, when I FiNALLY got my Dr. to give me something for the numbness and tingling I've been having in my arms and legs for over 2 years. That was the Neurontin. This Dr's office absolutely will not prescribe any pain meds due to its location, so I pretty much have to suck it up when it comes to pain. Anyway, about a week ago, I noticed that I was absently rubbing my fingertips together, pressing on them and I couldn't feel it. When I went to bed that evening, I noticed that when I took my socks off, I brushed against my heels and I could not feel them either. I brushed it off initially, but as I sit here typing this it's really bothering me. I would like to add that 2 weeks ago I had a severe case of sciatica. The pain and weakness were so severe that I couldn't stand for a few hours before slowly making my way to my bed. I did see a Dr. the next day. This is not the first incident of sciatica that I've had like this. Due to my lack of insurance and income, I'm not sure what to do. I'm on a waiting list to get an appointment with a Neurologist, but they said it would be at least an 8 month wait and up to an 18 month wait. My labs come back mostly normal, my cholesterol is coming down nicely and the hypertension is controlled very well with the lisinopril, but my liver enzymes almost always seem to come back slightly elevated, just barely over normal. Very recently had blood sugar and A1C tested and they're ok as well. I try to exercise and eat healthier to try to get to a healthier weight, but I either have a mental breakdown or some sort of physical illness occurs. What do I do in the meantime? I'm not even sure what's going on. Suggestions and/or advice is greatly appreciated!! Thank you.