Difference between verapamil and lisinopril

Post SVT ablation, I guess I am in a bit of a twilight zone here until I get the Afib meds sorted.
I had no afib incidences yesterday, but just in case, I took my verapamil dose (early) pre-exercise as that has been a good preventer for me in the past.
Something a bit unusual happened last night when I exercised.
Immediately after starting even just my warm up I noticed the tattle-tale shortness of breath. I knew I was going to have Afib. I dialed it so far back I was like coasting. I know this means my meds are not right (going to see the GP today) but something quite different happened this time.
During my exercise, I could feel the Afib heart beat, then there was a pause, almost like the heart was having trouble finding it's rhythm again, then there was some chest pain. The pain was like a muscle soreness. Maybe angina, I don't know.
Then the heart picked up it's normal rhythm again.
I kept dialing it back, resting. Taking it easy. The same thing happened about 5 times.
Usually during past afib, I just have the somersault heart feeling, then everthing continues uninterrupted.
Anyone have this sort of thing happen to them? Where there is a long pause until restart and soreness between?

Reposting since my previous post got deleted.
I am a 56 y/o female, 5'4", 215 lbs. I have a history of anaphylactic allergies, asthma, eczema, diabetes, cluster migraines. I'm currently taking Mounjaro (7.5), Lisinopril, and Tresiba.
I was on vacation in OBX, NC the last week in April. On our last day there I woke up with what I thought were two bug or spider bites. One on my left forearm and the in between my knuckles on my right hand. The areas were really swollen and itchy but I figured that was normal for insect bites.
I was super tired when I returned home, but it was a 4 hour drive. Over the next few days I was still really fatigued. I would come home from work and go to bed. Wake up after a couple hours and go back to sleep.
Along with the fatigue, I noticed the bites didn't go down right away. They stayed swollen and super itchy for almost two weeks, and I still have marks where the bites were. Just as I thought maybe I should get them looked at, the swelling went down. I'm not sure what could have bitten me. Perhaps midges?
In the meantime, I started getting bad headaches. As I said, I have a history of migraines and clusters. I just thought it was another cluster cycle. The extreme fatigue continued. My neck (not throat) was sore. This past Thursday, I broke out in huge welts on my right arm.I hadn't eaten anything, and hadn't spent time outside. This Saturday, I woke up with pink eye. I thought maybe it was an allergic reaction, but the doctor told me it was bacterial. Yesterday was the worst--I had a headache, was super nauseated and super tired. I slept the whole day and when I ate, it made me sick.
I came home early from work today, and just woke up from a two hour nap.
I test my blood sugars, and they are in normal range not more than 120, and usually below 100. My bp which usually is high is normal. I got a COVID test today because I found out i was in a training last week where several people had COVID. I tested negative for COVID and the flu.
Are these just random symptoms or could it be that my body is just having some crazy reaction to these bites? Or is everything just coincidental? I didn't bring it up to the doctors at urgent care because I figured they'd just dismiss me. The doctor today said I just have a virus and it should be out of my system in the next day.
I do have a primary doctor, but I have so many different things going on I feel like a hypochondriac.
Sorry this is so long.

Edit: (5-8-24 4:55) Sorry I haven't been super on top of updating you all. I have a doctors appointment with my primary care provider to have some tests run. Just to cover my bases, just in case it is something from our environment and not done super rare metabolic disorder manifesting in my husband now as an adult. He's gotten a few more tests, and they also did a liver biopsy. I will post them now. We haven't gotten the results back from the liver biopsy yet.
IR liver biopsy
Collected on May 8, 2024 3:35 PM
COMPREHENSIVE METABOLIC PANEL Collected on May 8, 2024 2:33 AM Results
Sodium View trends Normal range: 137 - 145 mmol/L Your value is 141 mmol/LNormal range 137 - 145 mmol/L Potassium View trends Normal range: 3.5 - 5.1 mmol/L Your value is 4.1 mmol/LNormal range 3.5 - 5.1 mmol/L Chloride View trends Normal range: 98 - 107 mmol/L Your value is 114 mmol/LThis value is HighNormal range 98 - 107 mmol/L CO2 View trends Normal range: 22 - 30 mmol/L Your value is 20 mmol/LThis value is LowNormal range 22 - 30 mmol/L Glucose View trends Normal range: 65 - 99 mg/dL Your value is 117 mg/dLThis value is HighNormal range 65 - 99 mg/dL Glucose View trends Normal range: 65 - 99 mg/dL Value
If result of random glucose > or = 200 or if result of fasting glucose is > 125 confirm Diabetes Mellitus diagnosis with second glucose on a different day. High Your value is If result of random glucose > or = 200 or if result of fasting glucose is > 125 confirm Diabetes Mellitus diagnosis with second glucose on a different day. mg/dLThis value is HighNormal range 65 - 99 mg/dL BUN View trends Normal range: 9 - 20 mg/dL Your value is 23 mg/dLThis value is HighNormal range 9 - 20 mg/dL Creatinine View trends Normal range: 0.66 - 1.25 mg/dL Your value is 0.96 mg/dLNormal range 0.66 - 1.25 mg/dL eGFR View trends Normal value: >60 mL/min/1.73 M2 Value 106 Your value is 106 mL/min/1.73 M2Normal value >60 mL/min/1.73 M2 EGFR Comment View trends Normal value: >60 mL/min/1.73 M2 Value Either of the following must be present for >=3 months to be Chronic Kidney Disease: -GFR less than 60 for >=3 months -Albumin to Creatinine Ratio >=30 mg/g or other markers of kidney damage
An estimated GFR chronically in the range of >/= 90 is categorized as normal or high, which corresponds to Stage G1 CKD.
CKD-EPI equation (2021) used to estimate GFR Your value is Either of the following must be present for >=3 months to be Chronic Kidney Disease: -GFR less than 60 for >=3 months -Albumin to Creatinine Ratio >=30 mg/g or other markers of kidney damage An estimated GFR chronically in the range of >/= 90 is categorized as normal or high, which corresponds to Stage G1 CKD. CKD-EPI equation (2021) used to estimate GFR mL/min/1.73 M2Normal value >60 mL/min/1.73 M2 BUN/Creatinine Ratio View trends Normal range: 6 - 22 RATIO Your value is 24 RATIOThis value is HighNormal range 6 - 22 RATIO ALT View trends Normal value: <50 U/L Value 23 Your value is 23 U/LNormal value <50 U/L AST View trends Normal range: 17 - 59 U/L Your value is 18 U/LNormal range 17 - 59 U/L Alkaline Phosphatase View trends Normal range: 38 - 126 U/L Your value is 100 U/LNormal range 38 - 126 U/L Bilirubin, Total View trends Normal range: 0.2 - 1.3 mg/dL Your value is 0.3 mg/dLNormal range 0.2 - 1.3 mg/dL Protein, Total View trends Normal range: 6.3 - 8.2 g/dL Your value is 6.9 g/dLNormal range 6.3 - 8.2 g/dL Albumin Blood View trends Normal range: 3.5 - 5.0 g/dL Your value is 3.8 g/dLNormal range 3.5 - 5.0 g/dL Calcium View trends Normal range: 8.4 - 10.2 mg/dL Your value is 8.6 mg/dLNormal range 8.4 - 10.2 mg/dL Globulin, Total View trends Normal range: 1.9 - 3.7 g/dL Your value is 3.1 g/dLNormal range 1.9 - 3.7 g/dL Albumin/Globulin Ratio View trends Normal range: 1.0 - 2.5 RATIO Your value is 1.2 RATIONormal range 1.0 - 2.5 RATIO Anion Gap View trends Normal range: 7 - 17 mmol/L Your value is 7 mmol/LNormal range 7 - 17 mmol/L Want more information about CAMMONIA Collected on May 8, 2024 2:33 AM Results
Ammonia View trends Normal range: 9 - 30 umol/L Your value is 120 umol/LThis value is HighNormal range 9 - 30 umol/L
THESE ARE ADDITIONAL TESTS I POSTED IN A COMMENT YESTERDAY. I WILL ADD THEM HERE FOR SIMPLICITY.
We've gotten back a few more tests, just in case anyone is interested.
CT liver multiphase w/iv contrast Collected on May 7, 2024 1:55 PM Results EXAM: CT THREE PHASE LIVER
INDICATION: evaluate liver function
Tech Comments: No additional history
TECHNIQUE: Low dose, multi-channel computerized tomography of the abdomen was performed with IV contrast according to the triple phase liver protocol. Multiplanar reformats were reviewed.
COMPARISON: CT chest abdomen and pelvis, 05/05/2024
FINDINGS: LOWER CHEST: Lung bases are clear. No acute findings.
LIVER: Normal morphology. No suspicious hepatic lesion.
BILIARY: No CT evidence of gallbladder abnormality. No bile duct dilatation.
PANCREAS: No evidence of mass or inflammation.
SPLEEN: Unremarkable.
ADRENALS AND KIDNEYS: Adrenal glands are normal. No suspicious renal masses. Normal enhancement bilaterally. Severe bilateral hydroureteronephrosis, similar to prior with significant thinning of the renal cortex.
GASTROINTESTINAL: Visualized bowel shows no abnormal wall thickening or obstruction.
VASCULAR: Abdominal aorta is normal in caliber. The portal venous system is patent.
LYMPH NODES: No pathologically enlarged lymph nodes.
PERITONEUM: No free air or ascites.
BODY WALL AND SOFT TISSUES: Unremarkable.
BONES: No acute or suspicious abnormality.
IMPRESSION: 1. Normal morphology of the liver. 2. Redemonstration of severe hydronephrosis bilaterally with renal cortical thinning.
Collected on May 7, 2024 2:43 PM Results
Prothrombin Time View trends Normal range: 8.8 - 11.7 s Your value is 10.9 sNormal range 8.8 - 11.7 s INR View trends Normal value: <1.14 RATIO Value 1.02 Your value is 1.02 RATIONormal value <1.14 RATIO INR View trends Normal value: <1.14 RATIO
BLOOD GAS VENOUS Collected on May 7, 2024 2:43 PM Results
pH, Ven View trends Normal range: 7.32 - 7.41 Your value is 7.43 This value is HighNormal range 7.32 - 7.41 pCO2, Ven View trends Normal range: 41 - 54 mm Hg Your value is 33 mm HgThis value is LowNormal range 41 - 54 mm Hg pO2, Ven View trends Normal range: 25 - 43 mm Hg Your value is 62 mm HgThis value is HighNormal range 25 - 43 mm Hg Bicarbonate View trends Normal range: 21 - 28 mmol/L Your value is 21 mmol/LNormal range 21 - 28 mmol/L Base Deficit (-) View trends Normal range: 0 - 3 Your value is 3 Normal range 0 - 3 O2 Saturation,Venous View trends Normal range: 60 - 85 % Your value is 92 %This value is HighNormal range 60 - 85 % O2 Intake View trends Value ROOM AIR Your value is ROOM AIR
Patient is 34, male. History of polycystic kidney disease, takes lisinopril 20mg daily for high blood pressure related to the pkd. Lactulose 40mg 3x day. Just began taking this 2 days ago. No other meds or drugs. 6'0, 200 lbs. He's a little over weight, but otherwise active and healthy.
My husband came home late Friday and was acting strange. I would ask him a question and he would just stare at me blankly instead of answering. As the night wore on I noticed his symptoms becoming more and more apparent. He was very tired, when spoken to he would either stare at you blankly, answer in one word answers or reply something totally unrelated to the question asked. He was very lethargic and dazed. His eyes were glassy and blood shot. I took him to the emergency room where he continued to get worse. He began to stare blankly all the time, he couldn't tell you what he did yesterday, he couldn't tell you where he was. From my uneducated view, he seemed to be exhibiting stroke like symptoms. The first hospital did a bunch of tests, everything came back fine. They sent us home. I wasn't satisfied so I took him to another hospital. The er did more tests, all came back within normal limits from my memory. They advised that he was having a psychological meltdown and to contact a shrink. The next morning he was almost absolutely comatose, so I took him to the er again. This time we had a PA who was willing to dig. They ended up finding that his ammonia levels were 203, when normal limits are between 9 and 30. We've been two and a half days. Poison control was contacted, they ran their own tests and couldn't find the culprit as his liver is functioning normally, and his kidneys aren't great, but they wouldn't be the cause either. I will post all the tests and there results below. I'll also post all the meds he's been given.
The whole staff at this hospital is stumped, they're all of the opinion that this might something he came into contact with, and not a product of his own body. As in they believe he has been compromised by something in our environment, but they're unable to find the culprit of the symptoms. They've had him on 40mg lactulose 3x a day and at their last test of his ammonia levels he is down to 120. At that level he is alert and conscious, but still pretty slow. As if he hasn't slept well in days and had a few beers on top.
Also, I have an obsessive stalker. I am not trying to fear monger by bringing that up, but that fact and then his sudden and intense onset of symptoms has me concerned. I have informed the hospital police about the situation. I believe our city police were also contacted when they contacted poison control. It might not be relevant, but it's better to mention it.
Here's a few short videos I took of his behavior.
https://imgur.com/gallery/WEjW3D9
His labs:
May 4th
Alcohol Bld Medical View trends Normal value: <10 mg/dL Value <10
COMPREHENSIVE METABOLIC PANEL Sodium: 147 Potassium 4.0 Chloride 115 C02 20 Glucose 111 BUN 29 Creatinine 1.04 eGFR 97 BUN/Creatinine ratio 28 ALT 44 AST 32 Alkaline Phosphatase 123 Bilirubin 0.5 Protein total 8.0 Albumin blood 4.6 Calcium 9.5 Globulin total 3.4 Albumin/Globulin ratio 1.4 Anion gap 12
CBC WITH DIFFERENTIAL
WBC 6.5 RBC 5.27 Hemoglobin 14.6 Hematocrit 43.5 MCV 82.5 MCH 27.7 MCHC 33.6 RDW 14.6 Platelets 311 MPV 9.0 Diff Method Electronic wbc differential cont Segs relative 58 Lymphocytes 30 Monocyte 9 Eosinophils 2 Basophils 1 Absolute Lymphocytes 1.95 Absolute Eosinophils 0.14 Absolute Basophils 0.03
MRI BRAIN WITH AND WITHOUT CONTRAST
INDICATION: ams, evaluate for stroke, intracranial infection
Tech Comments: AMS
TECHNIQUE: Multiplanar multisequence magnetic resonance imaging of the brain was performed with and without IV contrast.
COMPARISON: 05/03/2024.
FINDINGS: VENTRICLES AND CISTERNAL SPACES: The ventricular system and subarachnoid spaces are within acceptable limits for the patient's age.
CEREBRAL AND CEREBELLAR PARENCHYMA: There is no extra-axial fluid collection or hemorrhage. There is no mass effect or midline shift. No abnormal parenchymal gradient susceptibility signal. No diffusion restriction to suggest acute ischemia/infarct. There is no abnormal signal intensity or enhancement. The brainstem is normal in size and configuration. No abnormal signal alterations are present. The cerebellar hemispheres, vermis and tonsils are normal in size and configuration.
PITUITARY GLAND: The pituitary appears grossly unremarkable. Infundibulum is midline.
ARTERIAL FLOW VOIDS: The flow voids in the vertebrobasilar and internal carotid arterial systems are grossly normal.
DURAL VENOUS SINUSES: The dural venous sinuses appear patent.
CALVARIUM, SKULL BASE: The calvarium and skull base appear within normal limits.
PARANASAL SINUSES AND MASTOIDS: No fluid signal is identified within the paranasal sinuses or mastoids.
MISCELLANEOUS FINDINGS: None.
PROTIME-INR
Prothrombin Time View trends Normal range: 8.8 - 11.7 s Your value is 11.4 sNormal range 8.8 - 11.7 s INR View trends Normal value: <1.14 RATIO Value 1.07 Your value is 1.07 RATIONormal value <1.14 RATIO INR View trends Normal value: <1.14 RATIO
HEPATIC FUNCTION PANEL
AST View trends Normal range: 17 - 59 U/L Your value is 26 U/LNormal range 17 - 59 U/L ALT View trends Normal value: <50 U/L Value 45 Your value is 45 U/LNormal value <50 U/L Alkaline Phosphatase View trends Normal range: 38 - 126 U/L Your value is 132 U/LThis value is HighNormal range 38 - 126 U/L Bilirubin, Total View trends Normal range: 0.2 - 1.3 mg/dL Your value is 0.7 mg/dLNormal range 0.2 - 1.3 mg/dL Bilirubin, Direct View trends Normal range: 0.1 - 0.5 mg/dL Your value is 0.2 mg/dLNormal range 0.1 - 0.5 mg/dL Albumin Blood View trends Normal range: 3.5 - 5.0 g/dL Your value is 4.5 g/dLNormal range 3.5 - 5.0 g/dL Protein, Total View trends Normal range: 6.3 - 8.2 g/dL
C-REACTIVE PROTEIN CRP 0.7
SEDIMENTATION RATE, AUTOMATED
SED RATE 19
(Second Metabolic Panal) BASIC METABOLIC PANEL Collected on May 4, 2024 8:10 PM Sodium View trends Normal range: 137 - 145 mmol/L Your value is 145 mmol/LNormal range 137 - 145 mmol/L Potassium View trends Normal range: 3.5 - 5.1 mmol/L Your value is 3.7 mmol/LNormal range 3.5 - 5.1 mmol/L Chloride View trends Normal range: 98 - 107 mmol/L Your value is 111 mmol/LThis value is HighNormal range 98 - 107 mmol/L CO2 View trends Normal range: 22 - 30 mmol/L Your value is 21 mmol/LThis value is LowNormal range 22 - 30 mmol/L Glucose View trends Normal range: 65 - 99 mg/dL Your value is 108 mg/dLThis value is HighNormal range 65 - 99 mg/dL Glucose View trends Normal range: 65 - 99 mg/dL Value
If result of random glucose > or = 200 or if result of fasting glucose is > 125 confirm Diabetes Mellitus diagnosis with second glucose on a different day. High Your value is If result of random glucose > or = 200 or if result of fasting glucose is > 125 confirm Diabetes Mellitus diagnosis with second glucose on a different day. mg/dLThis value is HighNormal range 65 - 99 mg/dL BUN View trends Normal range: 9 - 20 mg/dL Your value is 32 mg/dLThis value is HighNormal range 9 - 20 mg/dL Creatinine View trends Normal range: 0.66 - 1.25 mg/dL Your value is 1.17 mg/dLNormal range 0.66 - 1.25 mg/dL eGFR View trends Normal value: >60 mL/min/1.73 M2 Value 84 Your value is 84 mL/min/1.73 M2Normal value >60 mL/min/1.73 M2 EGFR Comment View trends Normal value: >60 mL/min/1.73 M2 Value Either of the following must be present for >=3 months to be Chronic Kidney Disease: -GFR less than 60 for >=3 months -Albumin to Creatinine Ratio >=30 mg/g or other markers of kidney damage
An estimated GFR chronically in the range of 60-89 is categorized as mildly decreased, which corresponds to Stage G2 CKD.
CKD-EPI equation (2021) used to estimate GFR Your value is Either of the following must be present for >=3 months to be Chronic Kidney Disease: -GFR less than 60 for >=3 months -Albumin to Creatinine Ratio >=30 mg/g or other markers of kidney damage An estimated GFR chronically in the range of 60-89 is categorized as mildly decreased, which corresponds to Stage G2 CKD. CKD-EPI equation (2021) used to estimate GFR mL/min/1.73 M2Normal value >60 mL/min/1.73 M2 Calcium View trends Normal range: 8.4 - 10.2 mg/dL Your value is 9.6 mg/dLNormal range 8.4 - 10.2 mg/dL Anion Gap View trends Normal range: 7 - 17 mmol/L
(Second cbc)
CBC WITH DIFFERENTIAL May 4, 2024 8:10 PM
E County Line Rd Indpls, IN 46227Testing by Quest Diagnostics 1402 E County Line Rd Indpls, IN 46227 WBC View trends Normal range: 3.3 - 10.5 K/CUMM Your value is 11.3 K/CUMMThis value is HighNormal range 3.3 - 10.5 K/CUMM WBC Result Comment View trends Normal range: 3.3 - 10.5 K/CUMM Value
Difference from previous result noted. Specimen appearance and label verified. High Your value is Difference from previous result noted. Specimen appearance and label verified. K/CUMMThis value is HighNormal range 3.3 - 10.5 K/CUMM RBC View trends Normal range: 4.15 - 5.75 M/CUMM Your value is 5.51 M/CUMMNormal range 4.15 - 5.75 M/CUMM Hemoglobin View trends Normal range: 12.8 - 16.9 g/dL Your value is 15.3 g/dLNormal range 12.8 - 16.9 g/dL Hematocrit View trends Normal range: 38.8 - 50.2 % Your value is 45.4 %Normal range 38.8 - 50.2 % MCV View trends Normal range: 80.0 - 100.0 fL Your value is 82.4 fLNormal range 80.0 - 100.0 fL MCH View trends Normal range: 27.0 - 34.0 pg Your value is 27.8 pgNormal range 27.0 - 34.0 pg MCHC View trends Normal range: 30.5 - 34.5 g/dL Your value is 33.7 g/dLNormal range 30.5 - 34.5 g/dL RDW View trends Normal range: 11.5 - 15.0 % Your value is 14.6 %Normal range 11.5 - 15.0 % Platelets View trends Normal range: 150 - 450 K/CUMM Your value is 326 K/CUMMNormal range 150 - 450 K/CUMM MPV View trends Normal range: 7.7 - 12.2 fL Your value is 9.5 fLNormal range 7.7 - 12.2 fL Diff Method View trends Value Electronic WBC differential count Your value is Electronic WBC differential count Segs Relative View trends % Value 73 Your value is 73 % Lymphocytes View trends % Value 17 Your value is 17 % Monocyte View trends % Value 9 Your value is 9 % Eosinophils View trends % Value 1 Your value is 1 % Basophils View trends % Value 0 Your value is 0 % Absolute Neutrophils View trends Normal range: 1.30 - 6.00 K/CUMM Your value is 8.20 K/CUMMThis value is HighNormal range 1.30 - 6.00 K/CUMM ABSOLUTE LYMPHOCYTES View trends Normal range: 1.00 - 3.50 K/CUMM Your value is 1.92 K/CUMMNormal range 1.00 - 3.50 K/CUMM Absolute Monocytes View trends Normal range: 0.00 - 1.00 K/CUMM Your value is 0.99 K/CUMMNormal range 0.00 - 1.00 K/CUMM ABSOLUTE EOSINOPHILS View trends Normal range: 0.00 - 0.70 K/CUMM Your value is 0.14 K/CUMMNormal range 0.00 - 0.70 K/CUMM ABSOLUTE BASOPHILS View trends Normal range: 0.00 - 0.10 K/CUMM Your value is 0.05 K/CUMMNormal range 0.00 - 0.10 K/CUMM
AMMONIA 203 May 4, 2024 9:40 PM
Lactic Acid 0.8 May 4, 2024 9:40 PM
RESPIRATORY PANEL PCR Collected on May 4, 2024 9:42 PM Misc Source View trends Value NASOPHARYNX Your value is NASOPHARYNX Adenovirus DNA View trends Normal value: NOT DETECTED Value NOT DETECTED Your value is NOT DETECTED Normal value NOT DETECTED Coronavirus 229E View trends Normal value: NOT DETECTED Value NOT DETECTED Your value is NOT DETECTED Normal value NOT DETECTED Coronavirus HKU1 View trends Normal value: NOT DETECTED Value NOT DETECTED Your value is NOT DETECTED Normal value NOT DETECTED Coronavirus NL63 View trends Normal value: NOT DETECTED Value NOT DETECTED Your value is NOT DETECTED Normal value NOT DETECTED Coronavirus OC43 View trends Normal value: NOT DETECTED Value NOT DETECTED Your value is NOT DETECTED Normal value NOT DETECTED SARS COVID 2 View trends Normal value: NOT DETECTED Value NOT DETECTED Your value is NOT DETECTED Normal value NOT DETECTED METAPNEUMOVIRUS View trends Normal value: NOT DETECTED Value NOT DETECTED Your value is NOT DETECTED Normal value NOT DETECTED Human Rhinovirus / Entovirus View trends Normal value: NOT DETECTED Value NOT DETECTED Your value is NOT DETECTED Normal value NOT DETECTED INFLUENZA A View trends Normal value: NOT DETECTED Value NOT DETECTED Your value is NOT DETECTED Normal value NOT DETECTED Influenza A H1 View trends Normal value: NOT DETECTED Value NOT DETECTED Your value is NOT DETECTED Normal value NOT DETECTED Influenza A H3 View trends Normal value: NOT DETECTED Value NOT DETECTED Your value is NOT DETECTED Normal value NOT DETECTED Influenza A,H1N1 '09 View trends Normal value: NOT DETECTED Value NOT DETECTED Your value is NOT DETECTED Normal value NOT DETECTED INFLUENZA B View trends Normal value: NOT DETECTED Value NOT DETECTED Your value is NOT DETECTED Normal value NOT DETECTED PARAINFLUENZA 1 View trends Normal value: NOT DETECTED Value NOT DETECTED Your value is NOT DETECTED Normal value NOT DETECTED PARAINFLUENZA 2 View trends Normal value: NOT DETECTED Value NOT DETECTED Your value is NOT DETECTED Normal value NOT DETECTED PARAINFLUENZA 3 View trends Normal value: NOT DETECTED Value NOT DETECTED Your value is NOT DETECTED Normal value NOT DETECTED Parainfluenza Virus 4 View trends Normal value: NOT DETECTED Value NOT DETECTED Your value is NOT DETECTED Normal value NOT DETECTED RSV RNA, QUALITATIVE PCR View trends Normal value: NOT DETECTED Value NOT DETECTED Your value is NOT DETECTED Normal value NOT DETECTED Bordetella Parapertussis View trends Normal value: NOT DETECTED Value NOT DETECTED Your value is NOT DETECTED Normal value NOT DETECTED Bordetella Pertussis View trends Normal value: NOT DETECTED Value NOT DETECTED Your value is NOT DETECTED Normal value NOT DETECTED Chlamydophilia Pneuminae View trends Normal value: NOT DETECTED Value NOT DETECTED Your value is NOT DETECTED Normal value NOT DETECTED Mycoplasma Pneumoniae View trends Normal value: NOT DETECTED Value NOT DETECTED Your value is NOT DETECTED Normal value NOT DETECTED Mycoplasma Pneumoniae Comment View trends Normal value: NOT DETECTED Value
IP CARBOCYHEMOGLOBIN Collected on May 4, 2024 10:10 PM Carboxyhemoglobin View trends Normal range: 0.0 - 1.5 % Value <1.5 Your value is <1.5 %Normal range 0.0 - 1.5 %
IP TSH WITH FT4 REFLEX Collected on May 4, 2024 10:10 PM TSH W/REFLEX TO FT4 View trends Normal range: 0.40 - 4.50 mIU/L Your value is 1.00 mIU/LNormal range 0.40 - 4.50 mIU/L TSH W/REFLEX TO FT4 View trends Normal range: 0.40 - 4.50 mIU/L
IP CPK Collected on May 4, 2024 10:46 PM CPK 52
SALICYLATE LEVEL Collected on May 4, 2024 10:46 PM
Salicylate Lvl View trends Normal value: <20.0 mg/dL Value <1.0
DICTATED DATE: 05/05/2024 12:22pm TRANSCRIBED DATE: 05/05/2024 01:06pm/modl SOUTH
PATIENT NAME: HEALTH RECORD NUMBER: BILLING NUMBER: DATE OF BIRTH:
DATE OF PROCEDURE: 05/05/2024
CLINICAL SUMMARY: Altered mental status of uncertain etiology in the setting of serum ammonia elevation. Please assess for possible epileptic activity.
TECHNICAL SUMMARY: International 10/20 electrode placement was performed in this portable digital EEG. The background activity shows a poorly regulated intermixture of predominantly delta range activity. This activity is triphasic in nature without localizing or focal features. No significant stay changes were seen. Amplitude did vary at times.
Photic stimulation resulted in no change.
Sleep was not recorded.
Hyperventilation is contraindicated.
IMPRESSION: This EEG is abnormal with evidence of nearly continuous triphasic waves. These are highly compatible with a hepatic encephalopathy. There is no evidence of seizure activity and there is no asymmetry to suggest a structural process
PROCALCITONIN. May 5, 2024 1:25 AM
Procalcitonin View trends Normal value: <0.08 ng/mL Value 0.07
IP ACUTE HEPATITIS PANEL Collected on May 5, 2024 1:25 AM Results
Hep A IgM View trends Normal value: NON REACTIVE Value NON REACTIVE Your value is NON REACTIVE Normal value NON REACTIVE Hep A IgM View trends Normal value: NON REACTIVE Value NON REACTIVE
Hepatitis B Surface Ag View trends Normal value: NON REACTIVE Value NON REACTIVE Your value is NON REACTIVE Normal value NON REACTIVE Hepatitis B Surface Ag Comment View trends Normal value: NON REACTIVE Value NON REACTIVE
Anti-HCV View trends Normal value: NON REACTIVE Value NON REACTIVE Your value is NON REACTIVE Normal value NON REACTIVE Anti-HCV View trends Normal value: NON REACTIVE Value (NOTE)
HCV antibody was non-reactive. There is no laboratory evidence of HCV infection. Normal value NON REACTIVE Hep B core Ab, IgM View trends Normal value: NON REACTIVE Value NON REACTIVE Your value is NON REACTIVE Normal value NON REACTIVE Hep B core Ab, IgM View trends Normal value: NON REACTIVE
URINALYSIS, CULTURE IF INDICATED Collected on May 5, 2024 1:37 AM
Glucose Urine View trends Normal value: NEGATIVE mg/dL Value NEGATIVE Your value is NEGATIVE mg/dLNormal value NEGATIVE mg/dL Ketones, UA View trends Normal value: NEGATIVE mg/dL Value NEGATIVE Your value is NEGATIVE mg/dLNormal value NEGATIVE mg/dL Specific Gravity Ur View trends Normal range: 1.003 - 1.030 Your value is 1.009 Normal range 1.003 - 1.030 Occult Blood Urine View trends Normal value: NEGATIVE Value MODERATEAbnormal Your value is MODERATE This value is AbnormalNormal value NEGATIVE pH, UA View trends Normal range: 4.5 - 8.0 Your value is 8.0 Normal range 4.5 - 8.0 Protein, UA View trends Normal value: NEGATIVE mg/dL Value 30Abnormal Your value is 30 mg/dLThis value is AbnormalNormal value NEGATIVE mg/dL U Nitrites View trends Normal value: NEGATIVE Value NEGATIVE Your value is NEGATIVE Normal value NEGATIVE Leukocytes, UA View trends Normal value: NEGATIVE Value TRACEAbnormal Your value is TRACE This value is AbnormalNormal value NEGATIVE Color Urine View trends Normal value: YELLOW Value YELLOW Your value is YELLOW Normal value YELLOW APPEARANCE URINE View trends Normal value: CLEAR Value CLEAR Your value is CLEAR Normal value CLEAR WBC, UA View trends Normal range: 0 - 5 /HPF Value 11-20Abnormal Your value is 11-20 /HPFThis value is AbnormalNormal range 0 - 5 /HPF Epi Cell-Ur View trends Normal range: 0 - 5 /HPF Value 0-5 Your value is 0-5 /HPFNormal range 0 - 5 /HPF RBC, UA View trends Normal range: 0 - 3 /HPF Value 4-10Abnormal Your value is 4-10 /HPFThis value is AbnormalNormal range 0 - 3 /HPF Urine Comment Micro View trends
No Collected on May 5, 2024 1:37 AM
(note: not sure why it says no)
Cannabinoids View trends Normal value: NEGATIVE _ Value NEGATIVE Your value is NEGATIVE _Normal value NEGATIVE _ Phencyclidine View trends Normal value: NEGATIVE _ Value NEGATIVE Your value is NEGATIVE _Normal value NEGATIVE _ Cocaine Random View trends Normal value: NEGATIVE Value NEGATIVE Your value is NEGATIVE Normal value NEGATIVE Methamphetamines View trends Normal value: NEGATIVE _ Value NEGATIVE Your value is NEGATIVE _Normal value NEGATIVE _ Opiates View trends Normal value: NEGATIVE _ Value NEGATIVE Your value is NEGATIVE _Normal value NEGATIVE _ Amphetamines, Urine View trends Normal value: NEGATIVE _ Value NEGATIVE Your value is NEGATIVE _Normal value NEGATIVE _ Benzodiazepines View trends Normal value: NEGATIVE _ Value NEGATIVE Your value is NEGATIVE _Normal value NEGATIVE _ Trycyclic Antidepressants View trends Normal value: NEGATIVE _ Value NEGATIVE Your value is NEGATIVE _Normal value NEGATIVE _ Methadone Metab View trends Normal value: NEGATIVE _ Value NEGATIVE Your value is NEGATIVE _Normal value NEGATIVE _ Barbiturates, Urine View trends Normal value: NEGATIVE _ Value NEGATIVE Your value is NEGATIVE _Normal value NEGATIVE _ Oxycodone, Urine View trends Normal value: NEGATIVE Value NEGATIVE Your value is NEGATIVE Normal value NEGATIVE Buprenorphine, Urine View trends Normal value: NEGATIVE Value NEGATIVE Your value is NEGATIVE Normal value NEGATIVE Result Comment View trends Normal value: NEGATIVE
AMMONIA Collected on May 5, 2024 4:56 AM
Ammonia 134
Normal range: 9 - 30 umol/L
ETHYLENE GLYCOL Collected on May 5, 2024 12:42 PM Lab tests - Blood
Ethylene Glycol Lvl View trends mg/dL Value <10
Reference range: Negative [<10 mg/dL]
VOLATILE COMPOUNDS Collected on May 5, 2024 12:42 PM Lab tests - Blood
Methanol Lvl View trends mg/dL Value <10 Ref Range:Negative (<10 mg/dL)
VALPROIC ACID Collected on May 5, 2024 12:42 PM Results
Valproic Acid, Total View trends Normal range: 50 - 120 ug/mL Value <10Low
CT chest abdomen pelvis w IV contrast Collected on May 5, 2024 9:21 PM Results New EXAM: CT CHEST ABDOMEN AND PELVIS WITH CONTRAST
INDICATION: altered mental status, possible infection
Tech Comments: No additional history.
TECHNIQUE: Low dose, multi-channel computerized tomography of the chest, abdomen and pelvis was performed with IV contrast. Multiplanar reformats were reviewed.
COMPARISON: 12/05/2018
FINDINGS: CHEST: LUNGS: No focal consolidation. No mass. Major airways are patent.No pleural effusion or pneumothorax.
HEART AND VESSELS: Unremarkable.
MEDIASTINUM AND HILA: Unremarkable.
CHEST WALL AND SOFT TISSUES: Unremarkable.
ABDOMEN AND PELVIS: LIVER: Normal morphology. No suspicious hepatic lesion. No hepatic cysts are identified.
BILIARY: Unremarkable.
PANCREAS: No evidence of mass or inflammation. No pancreatic cysts.
SPLEEN: Unremarkable.
ADRENALS AND KIDNEYS: Adrenal glands are normal. Massively dilated renal collecting systems and ureters compatible with severe hydronephrosis is similar to although slightly progressive from 12/05/2018. Thin rind of renal parenchyma is present and enhances symmetrically. Bilateral hydroureter extends to the pelvis. There is some layering hyperdensity within the left distal ureter which may represent debris.
GASTROINTESTINAL: No evidence of abnormal bowel wall thickening or obstruction.
VASCULAR: Abdominal aorta is normal in caliber.
LYMPH NODES: No pathologically enlarged lymph nodes.
PERITONEUM: No free air or ascites.
PELVIC ORGANS AND BLADDER: Urinary bladder is distended.
BODY WALL AND SOFT TISSUES: Unremarkable.
BONES: No acute or suspicious abnormality.
IMPRESSION: 1. No acute findings. 2. Severe chronic hydroureteronephrosis is similar to although slightly increased from 12/05/2018. Urinary bladder is distended although is otherwise unremarkable. Although the morphology of the kidney is severely abnormal and mimics parenchymal cyst formation, there are no renal parenchymal or hepatic cysts to suggest autosomal dominant polycystic kidney disease. Etiology of severe hydronephrosis is uncertain possibly related to chronic reflux. 3. Thin rind of peripheral renal enhancement without focal abnormality. Small amount of nonspecific hyperdensity within the left distal ureter may represent nonspecific debris.
SODIUM, RANDOM URINE Collected on May 5, 2024 5:03 PM Results New
Sodium Urine Random View trends mmol/L Value 55 No reference range established.
OSMOLALITY,URINE Collected on May 5, 2024 5:03 PM Results New
Osmolality, Ur View trends Normal range: 50 - 1,200 mOsm/kg Your value is 304 mOsm/kgNormal range 50 - 1,200 mOsm/kg
CBC Collected on May 6, 2024 3:56 AM Results
WBC View trends Normal range: 3.3 - 10.5 K/CUMM Your value is 9.9 K/CUMMNormal range 3.3 - 10.5 K/CUMM RBC View trends Normal range: 4.15 - 5.75 M/CUMM Your value is 5.66 M/CUMMNormal range 4.15 - 5.75 M/CUMM Hemoglobin View trends Normal range: 12.8 - 16.9 g/dL Your value is 15.7 g/dLNormal range 12.8 - 16.9 g/dL Hematocrit View trends Normal range: 38.8 - 50.2 % Your value is 46.8 %Normal range 38.8 - 50.2 % MCV View trends Normal range: 80.0 - 100.0 fL Your value is 82.7 fLNormal range 80.0 - 100.0 fL MCH View trends Normal range: 27.0 - 34.0 pg Your value is 27.7 pgNormal range 27.0 - 34.0 pg MCHC View trends Normal range: 30.5 - 34.5 g/dL Your value is 33.5 g/dLNormal range 30.5 - 34.5 g/dL RDW View trends Normal range: 11.5 - 15.0 % Your value is 14.6 %Normal range 11.5 - 15.0 % Platelets View trends Normal range: 150 - 450 K/CUMM Your value is 321 K/CUMMNormal range 150 - 450 K/CUMM MPV View trends Normal range: 7.7 - 12.2 fL Your value is 9.3 fLNormal range 7.7 - 12.2 fL
COMPREHENSIVE METABOLIC PANEL Collected on May 6, 2024 3:56 AM Results New
Sodium View trends Normal range: 137 - 145 mmol/L Your value is 146 mmol/LThis value is HighNormal range 137 - 145 mmol/L Potassium View trends Normal range: 3.5 - 5.1 mmol/L Your value is 3.8 mmol/LNormal range 3.5 - 5.1 mmol/L Chloride View trends Normal range: 98 - 107 mmol/L Your value is 111 mmol/LThis value is HighNormal range 98 - 107 mmol/L CO2 View trends Normal range: 22 - 30 mmol/L Your value is 23 mmol/LNormal range 22 - 30 mmol/L Glucose View trends Normal range: 65 - 99 mg/dL Your value is 124 mg/dLThis value is HighNormal range 65 - 99 mg/dL Glucose View trends Normal range: 65 - 99 mg/dL Value
If result of random glucose > or = 200 or if result of fasting glucose is > 125 confirm Diabetes Mellitus diagnosis with second glucose on a different day. High Your value is If result of random glucose > or = 200 or if result of fasting glucose is > 125 confirm Diabetes Mellitus diagnosis with second glucose on a different day. mg/dLThis value is HighNormal range 65 - 99 mg/dL BUN View trends Normal range: 9 - 20 mg/dL Your value is 34 mg/dLThis value is HighNormal range 9 - 20 mg/dL Creatinine View trends Normal range: 0.66 - 1.25 mg/dL Your value is 1.23 mg/dLNormal range 0.66 - 1.25 mg/dL eGFR View trends Normal value: >60 mL/min/1.73 M2 Value 79 Your value is 79 mL/min/1.73 M2Normal value >60 mL/min/1.73 M2 EGFR Comment View trends Normal value: >60 mL/min/1.73 M2 Value Either of the following must be present for >=3 months to be Chronic Kidney Disease: -GFR less than 60 for >=3 months -Albumin to Creatinine Ratio >=30 mg/g or other markers of kidney damage
An estimated GFR chronically in the range of 60-89 is categorized as mildly decreased, which corresponds to Stage G2 CKD.
CKD-EPI equation (2021) used to estimate GFR Your value is Either of the following must be present for >=3 months to be Chronic Kidney Disease: -GFR less than 60 for >=3 months -Albumin to Creatinine Ratio >=30 mg/g or other markers of kidney damage An estimated GFR chronically in the range of 60-89 is categorized as mildly decreased, which corresponds to Stage G2 CKD. CKD-EPI equation (2021) used to estimate GFR mL/min/1.73 M2Normal value >60 mL/min/1.73 M2 BUN/Creatinine Ratio View trends Normal range: 6 - 22 RATIO Your value is 28 RATIOThis value is HighNormal range 6 - 22 RATIO ALT View trends Normal value: <50 U/L Value 34 Your value is 34 U/LNormal value <50 U/L AST View trends Normal range: 17 - 59 U/L Your value is 19 U/LNormal range 17 - 59 U/L Alkaline Phosphatase View trends Normal range: 38 - 126 U/L Your value is 138 U/LThis value is HighNormal range 38 - 126 U/L Bilirubin, Total View trends Normal range: 0.2 - 1.3 mg/dL Your value is 0.9 mg/dLNormal range 0.2 - 1.3 mg/dL Protein, Total View trends Normal range: 6.3 - 8.2 g/dL Your value is 8.2 g/dLNormal range 6.3 - 8.2 g/dL Albumin Blood View trends Normal range: 3.5 - 5.0 g/dL Your value is 4.6 g/dLNormal range 3.5 - 5.0 g/dL Calcium View trends Normal range: 8.4 - 10.2 mg/dL Your value is 9.7 mg/dLNormal range 8.4 - 10.2 mg/dL Globulin, Total View trends Normal range: 1.9 - 3.7 g/dL Your value is 3.6 g/dLNormal range 1.9 - 3.7 g/dL Albumin/Globulin Ratio View trends Normal range: 1.0 - 2.5 RATIO Your value is 1.3 RATIONormal range 1.0 - 2.5 RATIO Anion Gap View trends Normal range: 7 - 17 mmol/L Your value is 12 mmol/LNormal range 7 - 17 mmol/L
AMMONIA Collected on May 6, 2024 3:56 AM Results New
Ammonia. 124 View trends Normal range: 9 - 30 umol/L
I'm sorry you had to endure all of that, but thank you for doing so.

Hi, 41 year-old male here. I just want to get my blood pressure under control, but nothing is working. NOTHING. It honestly freaks me the heck out. Over the past 12 years or so, I've always gotten readings that hovered around 150/90, more or less.
At my worst, about 2 years ago, my BP was at 167/110! Made me sick to my stomach. Just seeing those numbers made me queasy. I vowed right then and there to get this taken care of.
I made an appointment with my doctor at the time, explained everything, and they gave me a prescription: Hydrochlorothiazide (small daily dose). Took that for a few months. No change. Fast forward another year, changed doctors, and they put me on Lisinopril. On a sidenote, the whole thing was tormenting me because I didn't like the idea of taking medication for the rest of my life, but I told myself it was better than living with the uncertainty of this monster. After a few months of that, I mustered up the courage to finally take my reading on my own. No change! I began to get very discouraged and teetered between obsessing over this to completely ignoring the issue, since it was frankly just overwhelming. Some medical professionals mentioned that I may have "white coat" syndrome, and that the act of taking my reading was enough to spike my blood pressure since it made me so anxious at that particular moment. Part of me believed it, since I DID notice I would get anxious during the reading, but could you blame me? The other part of me didn't believe it because, although I did believe that the anticipation of taking my blood pressure did stress me out, I didn't see how it could raise my blood pressure THAT much. So, fast forward another year, and I finally find a third doctor which I honestly liked a lot. Explained my issues and they put me on Amlodipine, 5 mg.
This is where things get a little interesting: They told me to start taking it daily, come back in 2 weeks, and they would monitor my progress to see how it was working. At this point, I highly doubted there would be any difference but I went through the process anyway. On my return, they took my reading (I was anxious and pessimistic), and was euphorically surprised to see the exact numbers 120/80! I was so happy that I had finally gotten this under control! I resigned myself to the fact that I was just going to have to be on this medication forever, but came to terms with it. So the months pass, I'm taking 5mg Amlodipine daily, started exercising, eating better, stopped drinking, and even lost 15 pounds. I was ridin' high! Fast forward about 6 months of maintaining this new healthy lifestyle, I go in for another physical. I'm happy and relaxed, and honestly kind of excited for them to take my blood pressure reading. I finally felt normal and healthy. They took my reading, and it was at freaking 150/90. I felt the room close in on me and was just speechless. Defeated. Hopeless. All they did was up the dosage to 10 mg instead of 5. Blegh.
So this is where I am now. They recommended that I get my own at-home blood pressure machine, which I did, so that I could "get used" to the process since it seemed like the anticipation of getting checked was possibly affecting my readings. But honestly, I'm so distraught, exhausted and traumatized by everything I've been through. There are times when I see a blood pressure machine and I just want to throw up. Makes me want to curl up into a corner and not move. Despite taking daily medication, cutting alcohol, exercising, losing weight, going through 3 different doctors, and being on that stupid medication for 6 months, there is no change. I really am perplexed, scared and pretty much have accepted that I will just spontaneously drop dead one of these days from my heart exploding or something like that. Can anyone give me some advice? This is awful.

Hi guys

• 35 year old.
• Male.
• 6 feet, 2 inch tall
• Weighing 194lbs
• Born with coarctatio of aorta. Corrected at 9 year old. Everything is stable now.
• Meds: 10mg bisoprolol, 80mg asaflow, 10mg amlodipine, 20/12,5mg co-lisinopril, 100mg sertraline.
• Being checked every 6 month in UZ Leuven, Belgium

For the last 8 months I have this weird mysterious feeling between my shoulder blades/upper-back/middle of back. This weird feeling is always moving to different places on my back. I can describe this as a nagging, burning feeling, or a pins-and-needles sensation.
If the feeling on my back isn't present, I have a trembling feeling in my left chest or I have the feeling that someone is choking me (feeling there is an obstruction in my throat or windpipe). Basicallly, one of these feelings is always present (back, chest or throat/windpipe).
I went to several cardiologists. I had an MRI of my heart and aorta. I had a CT scan of my thorax. My lungs were checked by an pulmonologist. I went to a chiropractor. My blood was tested a thousand times. I had hundred of ECG's and echocardiograms. Everything was fine!
I also did breathing exercises (heart coherence and Wim Hoff method) and tried ashwaganda, magnesium, vitamines,... Nothing but nothing worked.
Can anyone advise me properly what else I could do to solve this unpleasant feeling, because its also ruining my mental health. I'm always worried about this and even doubting the many doctors that I've seen.

Hi guys

• 35 year old.
• Male.
• 6 feet, 2 inch tall
• Weighing 194lbs
• Born with coarctatio of aorta. Corrected at 9 year old. Everything is stable now.
• Meds: 10mg bisoprolol, 80mg asaflow, 10mg amlodipine, 20/12,5mg co-lisinopril, 100mg sertraline.
• Being checked every 6 month in UZ Leuven, Belgium

For the last 8 months I have this weird mysterious feeling between my shoulder blades/upper-back. This weird feeling is always moving to different places on my back. I can describe this as a nagging, burning feeling, or a pins-and-needles sensation.
If the feeling on my back isn't present, I have a trembling feeling in my left chest or I have a feeling of someone is choking me (feeling there is an obstruction in my throat or windpipe). Basicallly, one of these feelings is always present (back, chest or throat/windpipe).
I went to several cardiologists. I had an MRI of my heart and aorta. I had a CT scan of my thorax. My lungs were checked by an pulmonologist. I went to a chiropractor. My blood was tested a thousand times. I had hundred of ECG's and echocardiograms. Everything was fine!
I also did breathing exercises (heart coherence and Wim Hoff method) and tried ashwaganda, magnesium, vitamines,... Nothing but nothing worked.
Can anyone advise me properly what else I could do to solve this unpleasant feeling, because its also ruining my mental health. I'm always worried about this and even doubting the many doctors that I've seen.

Age: 35 Sex: Female Height: 5'3 Weight: 200lbs (working on this with diet and exercise) Race: Hispanic/White Smoke: No Drink: Socially; Rare occasions Medical Diagnoses: High BP, Generalized Anxiety Disorder, Obesity Medical History: Kidney stones - lithotripsy 2x; 3 Pregnancies resulting in 1 miscarriage (September 2018), 2 live births via C-Section (1st in June 2020, 2nd in February 2022); Tubal Ligation in February 2022 Current Medications: Lisinopril 20 mg 1x a day; Villazodone 20 mg 1x a day; Blisovi Fe 1-20 1x a day Current Supplements: Daily multi vitamin, Probiotics, Turmeric, Ashgawanda, CBD
Initial primary complaint: Debilitating pain around menstrual cycle post-partum
I went to see my GP back in November 2023 for my annual physical and let her know that since my menstrual cycle had returned post breastfeeding (April 2023) that I was having immense amounts of pain and discomfort the week before my period, the week during, and for a few days after, so for about 2.5 weeks each month, I feel like death. This was VERY different than what I experienced prior to having children which was very "normal" PMS and period symptoms.
The primary symptoms included: fatigue, joint pain, diarrhea, up and down appetite, insomnia, irritability, abdominal cramps, backaches, headaches and my favorite, random debilitating pain throughout my entire core. This pain would feel like I was being scraped with shards of glass from the inside out and would be absolutely debilitating. The pain was primarily located in my abdomen, back, and hips but shifted throughout and did not stay stagnant in one location only. The only solution so far has been applying heat and to alternate between taking ibuprofen and acetaminophen. Even then, the pain would be so intense at times that I would have to take off from work to stay home and manage symptoms.
She stated that all my labs were normal and that this was normal to have changes in your cycle after having kids and that my hormones were still regulating post-partum.
In December, I noticed that I have these little knots throughout my body that are extremely painful and cause lingering dull and achy pain. When they are pressed, I literally scream out in pain. My monthly massages have become torture as they say my body is covered in these tight knots. They are primarily in my ribs, back, shoulders, neck and thighs.
In February, I requested from my GP to be put on birth control despite my tubal ligation, in hopes of curbing the painful symptoms and scheduled an appointment with my OBGYN.
In March, I had breakthrough bleeding that resulted in off and on horrible period like symptoms for 23 days straight. Once the bleeding stopped, I began experiencing stomach discomfort and regular abdominal pain that seems like what I assume IBS-M is like. I am having a lot of reflux, flatulence and both episodes of diarrhea and constipation that result in pain throughout my abdomen and back. This pain has literally woken me up in the middle of the night from being so intense, similar to when I had kidney stones.
This month, I finally had my appointment to see my OBGYN and had a pelvic ultrasound that came back all clear. She advised to stay with the birth control to control the symptoms.
Since beginning the BC, I have also been experiencing insane mood swings where one day I feel totally like myself and the next day I feel depressed and like the biggest negative Nancy that ever existed. I restarted therapy to see if this will help, but it doesn't seem connected to anything other than my health issues that I have no answers for.
I can tell something is NOT working right with my body, but seem to be getting no where with answers as to what is going on as my lab work and scans are returning normal results.
I am looking for hope, answers, recommendations, advice on what to do next. I have scheduled another appointment with my GP and want to go in prepared to advocate for myself. Thank you all for reading my novel in advance!

Hey y’all!
I’ve been on Verapamil 180mg for a while now, but the pill has changed a bit. It started off an ER capsule, then it was an SR capsule, and now it’s an ER tablet. It seemed to work better for me when it as an SR capsule, but it’s hard to say.
Luckily, my cluster headaches are usually “mild,” especially now that I’ve got the oxygen. Whenever I get an attack, I start the verapamil that day, and when I was on the SR, it seemed to clear up my cluster period that day. When I’m on the ER capsules, it seems to take a day or two, and then a week later another attack, with again two days of attacks.
I’ve sort of been in a cluster period since January, but I also got Covid in February, so that throws a wrench into things.
In any case, has anybody else noticed a difference between Verapamil ER vs SR?

Has anyone had significantly different BP measurements between being manually measured vs with a machine? When I first discovered I had high BP it was at a centracare I was measuring 160/115 on the machine, but 140/90 manually.
I went to see a PCP and I measured 175/118 on the machine and manually was 145/100. Both cases, the doctor seemed to think nothing of it and I’m monitoring my BP on the machine at home.
I’m measuring 111-120/82’s on my machine. week 4 lisinopril and it continues to keep lowering slowly each week. As of last Friday I’ve been lightheaded with muscle fatigue and wondering if my BP is actually too low, but my machine is measuring high? Is that truely a thing? Yesterday was a bad day I felt so loopy.
But was feeling decent when I was measuring 125-130/89’s on the machine
Anyone else deal with machine/manual reading issues and talked to their doctor about it?

Hello, I, 28M, have had physical chronic illness for since beginning of 2022. Meds: lithium, caplyta, lorazepam, PrEP, Ketamine troche, prn Zofran, prn rizotriptan, verapamil, adderall, meloxicam, hyoscyamine. Diagnosis: ptsd, bipolar 1, agoraphobia, generalized anxiety disorder, adhd Substances: alcohol (very seldom -maybe one or two beers a month, if any at all)
Head: I have migraines with aura. When I have them they are hard to get rid of and the rizotripan doesn't always do the trick, in which case I go in. I have been getting them for about 5 months, previous to that it was just really bad headaches. I am having a lot of hair loss, I can pull out multiple handfuls each day. I get low grade fevers multiple days of the week, usually between 99 and 100.5. I have been getting those for awhile but they got very frequent about August of 2023. I see a neurologist April 1st
Abdomen: I have always had stomach issues/stomach pains. But in the beginning of 2022 it got really bad. I have really bad stomach cramping that comes on suddenly and is extremely intense. It helps to try going to the bathroom - a lot of the time nothing comes out and it's extremely hard and uncontrollable pushing until the cramping passes. I take the hyoscyamine and it helps. My stool is usually a 6 or 7 on the Bristol scale, sometimes very yellow and a burnt hair smell. My gastroenterologist diagnosed me with ibs without diarrhea, and thinks there is stool stuck in me and water is flowing around it. I have had 2 abdominal x rays in the past 6 months and both look fine. I was told to drink magnesium citrate and then miralax daily - I already use the bathroom about 5 times a day and it's usually with some urgency. I'm not confident in this diagnosis, I may see a different dr. It is not food related, I have tried the food map diet. I also have nausea and vomitting. It kind of seems to come in waves, I'll be really sick and throwing up for about 4-6 weeks and then I'll be fine for a bit. The nausea is pretty consistent.
Bloodwork: my ferritin was 350 a month ago and was 275 today. My triglycerides are elevated and hdl is low. We've tested for a lot of rhumetological stuff and it all came back normal. Tested testosterone - normal. Thyroid- normal.
Joints: I have sever joint pain, I have bursitis in both my hips, tennis elbow in both elbows. The joints in my feet hurt if I walk very much - my hips hurt extremely bad and make walking difficult as well. My finger joints hurt as well. I am stiff and have a lot of joint pain in the morning. It gets better with activity throughout the day but is painful for the first bit I'm awake. I see a rhumetologist and we are doing an mri to look for inflammation, my ra tests came back negative. I take meloxicam for this - I started that about 4 weeks ago, we are switching it to indomethacin as it helped but I was still very sore. I have been on prednisone for the migraines and I don't feel good on them and they didn't help so I opted to try the nsaid route first. The joint pain got bad around August. I was in urgent care for a concussion from a fall on Monday and we did xrays and I have retrolesthesis in my cervical and lumbar vertebrae, and have arthritis in my lumbar vertebrae, I have really bad lower back pain. My rhumetologist doesn't think it is related to the other joint pain going on and said it looks mechanical and wear and tear. My family has a history of bad spines, multiple fusions, rods, and plates in multiple family members. I have a referral to someone for my spine as well as a pt program
With everything together it is very debilitating, I haven't worked since end of 2022 due to these and mental health conditions. I'm not sure really what to do at this point. It feels like everybody I'm seeing is kind of focusing on their own area and I feel like we're treating symptoms and not figuring out what's actually going on - and it's not for lack of trying, my doctors are fantastic but if anybody has an idea that I can bring to them, I would be extremely grateful.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7255896/
Open Peer Review F1000 Faculty Reviews are written by members of the prestigious F1000 Faculty. They are commissioned and are peer reviewed before publication to ensure that the final, published version is comprehensive and accessible. The reviewers who approved the final version are listed with their names and affiliations. Any comments on the article can be found at the end of the article. REVIEW Recent advances in managing Peyronie’s disease [version 1; peer review: 2 approved] Asrit Babu, Oliver Kayes Department of Urology, Leeds Teaching Hospitals, Leeds, UK Abstract
Treating men with Peyronie’s disease remains a challenging problem facing clinicians working across urology and sexual medicine fields. Patients can often be left disappointed by current treatment paradigms, and an overall lack of suitable molecular targets has limited the options for novel, effective medical therapy. Managing men with Peyronie’s disease often involves careful counselling alongside multifaceted and possible combination treatments to help improve symptoms whilst ameliorating potential side effects of therapy. We review the latest medical literature and evidence in the contemporary management of Peyronie’s disease.
​
Background
Peyronie’s disease (PD) is a relatively common progressive fibrotic disorder that affects the tunica albuginea. Traditionally, men will present with a new penile curvature, which may be associated with pain in the acute phase. Prevalence is reported to be in the region of 0.4–20%, with manifestation typically in the fifth decade of life1–3 . PD may also be frequently associated with erectile dysfunction, penile shortening, psychological distress, and a palpable plaque, which is typically found on the dorsal aspect of the penile shaft. In some men, the penile curvature is severe enough to impair penetrative sexual intercourse. The natural history of PD is divided into the active and quiescent (chronic or stable) phases. During the active phase, patients may report penile pain with a changing deformity (1–6 months). In contrast, the stable phase is generally associated with a painless and stable penile deformity (6–18 months).
Observational studies have shown that the majority of patients with PD will eventually have a stable curvature (40–47%), with a similar proportion showing progression (40–48%) and a much smaller group spontaneously improving (12–13%)4,5 . PD affects men principally between the ages of 40 and 60 and is associated with diabetes mellitus, Dupuytren’s contracture, and plantar fascial contracture (Ledderhose disease). There may be a preceding history of trauma. The most common hypothesis regarding aetiology of the disease involves repeated minor microvascular trauma during intercourse resulting in intratunical bleeding and subsequent inflammation and fibrosis. Interestingly, we have seen PD in sexually naïve men who have never had penetrative intercourse. This may not refute the hypothesis but points further to a multifactorial process. Transforming growth factor beta (TGF-β) is thought to exacerbate the erratic healing response. Histologically, there is excessive connective tissue, increased cellularity, and random orientation of collagen fibres within the Peyronie’s plaque. Subsequently, the dysfunctional tunical tissue restricts normal expansion of the underlying corpus cavernosum, creating the observed curvature. There may be flaccidity distal to the lesion with or without a waisting (hourglass) deformity or rotation observed in more severe cases. Surgical correction has historically been the mainstay of treatment but can harbour significant morbidity and in some series is related to poorer patient-reported outcomes.
Patient morbidity from surgery includes haematoma and infection in the early post-operative period, with penile shortening, recurrent/residual curvature, glans hypoesthesia, and delayed erectile dysfunction manifesting later. In the majority of published case series, the main reasons for poor patient-reported outcomes tend to relate to the presence of residual curvature, overt penile shortening, and erectile dysfunction, with dissatisfaction rates ranging from 27–45% in those undergoing plication or plaque excision and grafting6,7 . As a result of this, there has been extensive research into non-surgical interventions that can potentially stabilise or improve penile curvature without the morbidity associated with surgery.
The aim of this review is to summarise the most recent advances in PD treatments, including surgical techniques, non-surgical interventions, and basic science updates. A review of the literature from 2017 onwards (24 months) was conducted by performing a MEDLINE® search of publications using the keyword “Peyronie”.
In the absence of any new data for specific treatments or to consolidate the evidence around newer therapies, we have included older key papers for the readership’s general information. Basic science The most accepted pathophysiological aetiology of PD is that of microtrauma.
This results from repeated injury resulting in an inflammatory response that promotes the formation of fibrous plaques through mediators such as TGF-β. There are very few studies that are able to show a clear correlation between the histological findings of trauma and Peyronie’s plaques in human histological specimens8,9 . El-Sakka et al. verified that TGF-β is strongly expressed in PD histology in a rat model, leading to an inflammatory process and fibrosis10. De Rose et al. conducted a prospective observational study comparing the histological and ultrastructural changes seen in patients undergoing plaque excision for PD (in the absence of trauma) and those undergoing plaque excision for a history of penile fracture.
The results showed the two groups had very similar collagen deposition, cellular composition, and extracellular matrix, in keeping with the proposed aetiology of microtrauma being the underlying cause of PD11.
Stem cell therapy Stem cells are undifferentiated cells that are capable of selfrenewal and differentiation, promoting the repair of tissues via their immunomodulatory and anti-inflammatory action. Adiposederived stem cells (ADSCs) are used most widely owing to their abundant tissue source and ease of isolation. There is currently limited evidence for the clinical use of stem cells in PD, with all studies restricted to rat models. Milenkovic, Albersen, and Castiglione reviewed the current evidence, which was limited to only four pre-clinical studies using ADSCs12. Overall, these data support positive effects through differing proposed mechanisms of action, including reducing collagen and elastin deposition, reducing fibrosis, and increasing myofibroblast apoptosis13–16. Further clinical studies are needed to confirm the efficacy of stem cell therapy for PD in humans.
Pharmacotherapy No oral pharmacotherapy is recommended by the American Urological Association (AUA) or the International Consortium of Sexual Medicine (ICSM) because of the lack of robust evidence. In contrast, the European Association of Urology (EAU) suggest that potassium para-aminobenzoate (Potaba) may result in a significant reduction in curvature, plaque size, and pain17–19. Generally, the EAU, AUA, and ICSM guidelines have similar recommendations but differ on a few key points. These comparative points are highlighted in Table 1. Unfortunately, it is beyond the scope of this review to further delineate any methodological or reporting differences used between these different Page 3 of 14 F1000Research 2020, 9(F1000 Faculty Rev):381 Last updated: 26 MAY 2020 guidelines panels that might generate further discussion regarding monotherapy or combination treatments. Suffice to say, given the relative paucity of high-quality evidence in this area, it is reasonable to concur that current oral monotherapies are universally considered to be of limited clinical use as a medical tool to directly reverse or modify PD outcomes in patients, either for symptom relief or to modify or improve longer-term functional outcomes. Potaba Two placebo-controlled randomised controlled studies (RCTs) have shown evidence that Potaba may reduce progression and pain20,21. Weidner et al. demonstrated that penile plaque size was stabilised in the Potaba group compared to placebo. This subsequently reduced the progression of curvature in the treatment group when compared to placebo; however, it did not reduce any established curvature. This group did not demonstrate any evidence of improvement in pain relief. This is in contrast to the earlier RCT by Shah et al., which demonstrated no evidence of improvement in curvature/plaque; however, it did show there was some improvement with regard to pain. Based on these two RCTs, Potaba currently is the only oral medication that has any recommendation for use within the EAU guidelines. More recently, Potaba monotherapy was compared to combination therapy (tamoxifen, L-carnitine, and tadalafil) by Park et al.22. Perhaps the most striking result was that two-thirds of the patients in the Potaba arm withdrew for various reasons, although treatment side effects were cited as the largest single factor. The study failed to show any statistically significant difference between the two treatment arms owing to the high dropout rate. Overall, the most clinically relevant conclusions from this study showed that the side effect profile of Potaba may lead to very poor compliance and a high discontinuation rate. The potential adverse effects of treatment alongside the limited evidence of efficacy therefore limit the recommendation of Potaba use, which is why it is not recommended by the AUA or ICSM at the time of writing. Vitamin E and antioxidant therapy Vitamin E is a fat-soluble, naturally occurring antioxidant that has previously been shown to improve pain, curvature, and erectile function scores (IIEF) and has been utilised in combination therapy with verapamil injections, non-steroidal antiinflammatories, and herbal antioxidants, as reported in two recent randomised trials23,24. The same authors have performed a further study in combination therapies using vitamin E. This case series was not randomised or controlled. A total of 141 patients were included in the study and assigned to one of five treatment groups that used varying amounts of antioxidant, analgesia, and injectable therapies including vitamin E, silymarin, Gingko biloba, topicals.
Throughout all groups, there was prevention in progression of disease. As the number of treatments increased, there was an improved outcome, particularly in IIEF score, reduced curvature, and improved quality of life/bother scores. The curvature improvement was minimal (4–6°) and likely clinically insignificant. In view of the study design not being randomised or controlled, the results must obviously be taken with caution25.
Phosphodiesterase-5 inhibitors and tamoxifen A recent scientific study has investigated a new model to test potential medical therapies in PD. The team describe an in vitro model that mimics the cellular changes seen in PD. It is well understood that myofibroblasts play a large role in the remodelling of the extracellular matrix and the production of profibrotic mediators and inflammatory cytokines26,27. These cell lines have also been isolated in PD plaques28. The authors were able to create a screening assay to assess the effectiveness of multiple treatments on the transformation of fibroblasts to myofibroblasts. Using this innovative model, they assessed the efficacy of 21 commonly studied oral therapies. The only compounds that proved to be effective on the fibroblast model included phosphodiesterase (PDE)-5 inhibitors and tamoxifen. These medications were then tested further in separate testing systems. The authors noted that each medication has the potential to prevent progression of disease in the active phase but is unlikely to reduce the plaque or curvature. They also identified that there was a synergistic effect with the two medications combined compared to either medication alone29. Pentoxifylline Pentoxifylline is a non-specific PDE inhibitor that also has some effect in reducing TGF-β tissue levels and therefore may have an antifibrotic role and thereby a therapeutic role in PD30. The evidence of its efficacy is limited as a monotherapy; however, there is some evidence to suggest its benefit as a combination treatment. Smith et al. investigated the effect of pentoxifylline monotherapy on plaque calcification and subjective improvement of the clinical condition. They studied 71 men in a cohort study, of whom 62 were treated with pentoxifylline and nine received no treatment. The study showed that 92% of patients treated with pentoxifylline compared to 44% with no treatment had stable or improved plaque calcification. There were no objective outcomes to suggest improvement in curvature; however, there was subjective patient-reported improvement, which makes it somewhat difficult to make any firm conclusions regarding its true clinical benefit31. A further cohort study conducted by Alizadeh et al. compared pentoxifylline with intralesional verapamil and a combination of both therapies. A total of 90 patients were enrolled into three treatment arms (n = 30) with no control group. They reported improvement in curvature, plaque size, pain, and erectile dysfunction in all groups. Outcome measures were not quantitative and therefore no conclusions about degree of curvature change can be made32. Recently, an older double blind RCT conducted by Safarinejad in 2010 using pentoxifylline monotherapy has since been redacted because of statistical incongruities33. A study exploring pentoxifylline as part of a combination therapy has been recently completed by Ibrahim et al.34; a total of 46 patients were included in this retrospective cohort study, which aimed to assess the effect of colchicine or pentoxifylline with penile traction therapy (PTT) (Andropenis® extender) on plaque size, degree of curvature, and penile Doppler parameters. Patients were assigned to oral pentoxifylline (n = 27) and colchicine (n = 18) with all advised to use PTT for 1 hour daily for a total of 6 months. The study reported an improvement in curvature of 14° (55.8° versus 41.4°) and also reported improvement in peak systolic velocity and reduction in plaque size. They found no statistically significant difference in the colchicine or pentoxifylline arm. The study has significant limitations in that there was no control group; therefore, it is possible that the improvement may have been purely spontaneous. It must also be noted that all patients received PTT, which potentially could explain why these parameters improved rather than as a result of any efficacy from the oral therapies.
The efficacy of the Andropenis® extender is discussed further in this paper. Intralesional injection therapy
Collagenase Collagenase clostridium histolyticum (CCH) has been studied for use in PD in the experimental field since 198235. Since 2013, CCH has been approved by the United States Food and Drug Administration as well as the European Medicines Agency. Treatment comes in the form of an injection of two collagenases, which act synergistically to cleave tropocollagen. Its use is recommended by the AUA for PD curvature between 30° and 90°, and the EAU guidelines currently advise a grade B recommendation; however, these guidelines precede the largest published RCT17. IMPRESS I and II were large RCTs comparing CCH and penile modelling against penile modelling and placebo with 417 and 415 patients included in the study, respectively. Exclusion criteria included any patients with an hourglass deformity, significant erectile dysfunction non-responsive to PDE-5 inhibitors, proximal plaques, and curvature outside 30–90°. The treatment protocol involved two injections of CCH (0.58 mg) 24 to 72 hours apart. This cycle regimen was then repeated up to four times, alongside penile modelling by the clinician at the time of injection as well as by the patient three times daily thereafter until review. Curvature improved by 17° and 9° (34% versus 18.2%) in the treatment and placebo arms, respectively. There was also similar improvement in IIEF scores (+1 and +0.4, respectively) as well as penile length (0.4 cm and 0.2 cm, respectively). PD questionnaire (PDQ) bother scores were also improved in the treatment group; however, one-third of the cohort did not complete the questionnaire at one or both measurement points, and the PDQ is still not validated psychometrically18,36. Ralph et al. conducted a randomised study comparing CCH, modelling, and vacuum therapy to CCH and vacuum therapy alone. This small pilot study (n = 30) did not show any statistically significant difference between the two groups in terms of Page 5 of 14 F1000Research 2020, 9(F1000 Faculty Rev):381 Last updated: 26 MAY 2020 curvature improvement or patient-reported outcome measures. There was a clear improvement in curvature of 23.7° in the CCH, modelling, and vacuum therapy group compared to 23.3° in the group without penile modelling. The injection protocol was similar to that in the IMPRESS trial with the addition of vacuum therapy being initiated following the second injection twice daily throughout the remainder of the study.
Verapamil Intralesional verapamil injections are within the recommendations for treatment in the EUA, AUA, and ICSM guidelines. However, their use is supported by overall poor evidence and hence is given a grade C recommendation by all guidelines17–19. Verapamil is a calcium channel blocker that has been shown to interfere with fibroblast proliferation and can decrease collagen deposition by upgrading collagenase activity. There are only two trials comparing verapamil treatment and control subjects. Rehman et al. produced a small randomised control study comparing intralesional verapamil injections against placebo in a group of 14 patients. They used 10–27 mg injections weekly for 6 months. They were able to show a reduction in plaque length, curvature (7.9° in the treatment group compared to 2.2° in the placebo group), and penile pain44. A further RCT by Shirazi et al. compared 10 mg verapamil injections to placebo. A total of 80 patients were enrolled and randomised 1:1 to either the treatment or the placebo arm. In the treatment group, patients were given 10 mg injections twice weekly for a total of 12 weeks. In contradiction to Rehman et al., they were unable to find any significant improvement in curvature, plaque size, or penile pain reduction when compared to placebo45. Favilla et al. recently compared intralesional injections of verapamil against hyaluronic acid (HA) in a double blinded randomised study. A total of 132 patients were included and Page 6 of 14 F1000Research 2020, 9(F1000 Faculty Rev):381 Last updated: 26 MAY 2020 given either weekly 10 mg intralesional verapamil or 16 mg/2 ml injections of HA. Outcomes showed a statistically significant improvement in plaque size (–1.36 mm and –1.8 mm) and IIEF score (1.46 and 1.78) in the verapamil and HA group, respectively. There was no improvement in curvature in the verapamil group in comparison to the HA group, which improved by 4.6°47. There have been a number of further comparative randomised studies of verapamil over the past 10 years that have significant heterogeneity in their treatment regimens and also their comparative treatments. Greenfield et al. compared verapamil with saline in electromotive drug administration (EMDA) for PD. This study failed to show any statistically significant improvement in curvature48. A randomised trial by Mehrsai et al. compared treatment in 60 patients treated with verapamil either via injection or EMDA. The authors found no significant difference in reduction of plaque size; however, they did note an improvement in erectile function (albeit not significant).
The RestoreX® group also showed a greater improvement in length and various subjective assessments (improved penetration, feeling of meaningful improvement, and estimated percentage improvement) when compared to the other two groups. Overall, the study was able to show the largest degree of curvature change in the literature when compared to any other adjunctive treatment with CCH. It must be noted that these outcomes need to be reproduced in a RCT and in a larger cohort using the RestoreX® treatment group.its use is not recommended by AUA, EAU, or ICSM guidelines for the treatment of curvature; however, it may have a use for those with penile pain secondary to PD17–19. A recent meta-analysis by Gao et al. reviewed the most recent RCTs using ESWT for PD. They found no statistically significant difference in curvature; however, they did note a statistically significant improvement in pain scores as well as plaque size in the six studies included comprising 443 patients. The authors, however, did note that pain in PD is usually self-limiting, so the role of ESWT in reducing the pain in these patients is arguable65. Surgery Surgical techniques and outcomes There have been no significant advances in PD surgical management in terms of randomised controlled data. In keeping with historical trends, there have been numerous retrospective reviews of modifications to traditional plication and grafting techniques. Nevertheless, plication remains the standard of care for patients without erectile dysfunction and a curvature of less than 60° provided that the associated loss of length is not problematic. Incision and grafting are indicated in patients falling outside these criteria, although plaque excision without grafting has been reported previously as a simplified technique66.
Inflatable penile prosthesis (IPP) and manual remodelling have been re-assessed in a retrospective review by Chung et al. comparing choice of device manufacturer67. They found high satisfaction (79%) and 5-year mechanical survival (87% or greater) in both AMS CX® and Coloplast Titan® devices as well as comparable revision and complication rates of below 10%.
Further results regarding implant insertion and simultaneous plication demonstrated similar levels of satisfaction. Implant surgery remains the mainstay of treatment for patients with significant curvature and erectile dysfunction. Caution remains regarding a distinct lack of evidence to support universal surgical reconstruction in most men in order to provide safe and significant penile lengthening, as advocated by some surgeons globally.
Graft materials Graft materials in those undergoing excision of the tunica albuginea in severe PD have been much debated and researched over recent years. The perfect graft material should be traction resistant, be easy to manipulate, and adhere to surrounding tissues with low risk of rejection. It should also be resistant to tension to prevent any aneurysmal dilation during normal erectile function. In addition, it should be economically viable and easily available. There has therefore been a large number of different grafting materials proposed and used in recent research for PD surgery including autografts, allografts, xenografts, and synthetics. Garcia-Gomez et al. recently reviewed the current evidence for all graft materials in tunica albuginea excision and grafting procedures. They concluded that the published series has significant heterogeneity in terms of patient selection, outcomes, and follow-up periods, therefore making definitive conclusions difficult. The authors did note that buccal mucosa, pericardium, porcine small intestinal submucosa (SIS), and TachoSil® are being used more extensively than most other materials, but unfortunately there is limited evidence to suggest one material over the other68.
​
There is no doubt that urologists around the world are motivated to help develop and deliver a portfolio of minimally invasive treatments for PD in order to prevent or prolong the time without surgical intervention. Reversing this paradigm will be challenging, but the stepping stones already exist with ‘hotspots’ of high-quality basic scientific and clinical research evidence that will shape future treatments for men with PD. This needs to be matched with an increased general awareness of the problem through public health channels and reflected in a better financial infrastructure to incentivise and reward high-quality research and clinical care. Conclusions Intralesional treatments with modelling are demonstrating notable promise in treating PD non-surgically and at an earlier stage in the disease process. Generally, high treatment costs in non-insurance-based health systems, diverse experience, and the lack of widespread availability impede the current evidence base, particularly in terms of randomised trials. Whilst CCH outcomes and safety are supported by a large body of published evidence, the ideal treatment regime is still not clear, with a large number of studies being produced without control or comparative arms, thereby making the outcomes difficult to assess. IFN α-2B is the only other injectable therapy worthy of mention at this stage. These studies show a small improvement in curvature with a smaller cohort of patients in comparison to IMPRESS I and II, and the results have not been reproduced for over 10 years. Unfortunately, there has been no further robust research in other injectable intralesional therapies, which will likely limit their translational use. Penile traction and mechanical devices in PD are very likely to improve outcomes and may well have a further role in the primary treatment of PD or as an adjunct to injectable therapies. Newer penile traction devices show some promise, but further case-control studies will be needed to evaluate their potential as a non-surgical monotherapy57. Within surgery, there is interest in novel graft materials, and further study into these materials is certainly warranted. In particular, outcomes using TachoSil® when compared to the more commonly used SIS materials have generated interesting data with respect to benefits observed with intraoperative technique and functional outcomes; however, further long-term results and comparative studies are required69,70. Currently, we seek to develop improved tools to assess patient depression, systemic health issues, and markers of poor quality of life. PD remains a difficult condition to successfully treat and should remain the remit of dedicated sexual health specialists and surgeons if we are to improve outcomes for men affected by PD and their partners.

The ProExtender, a penile traction therapy device, offers a non-surgical option for those seeking to increase penile length or correct curvature associated with conditions like Peyronie's disease [1]. Employing the principles of mechanotransduction, the ProExtender systematically stretches the penile tissues, which may lead to cell multiplication and subsequent size augmentation, as well as softening of hardened tissue [1][2].
While results can vary and may take several months of consistent use to manifest fully, some users of the ProExtender report noticeable improvements [2]. The silicone strap and adjustable traction rods design allow the device to be worn discreetly under clothing for prolonged periods, making it a practical solution for daily use [1][2].
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What is the ProExtender?
The ProExtender is a medical device designed for men seeking non-surgical penis enlargement or curvature correction. Here's a breakdown of its key features and functions:

• Penile Traction Therapy: Utilizing the principles of penile traction therapy (PTT), the ProExtender aims to promote tissue growth and potentially soften hardened tissue, especially in cases of Peyronie's disease [3][6].
• Mechanism of Action: By applying a steady stretch to the penis, the device leverages the body's natural ability to adapt and develop under physical tension. This results in permanent enlargement as tissue cells divide and multiply [4].
• Device Structure:
• A plastic ring is placed at the base of the flaccid penis, with another ring positioned before the glans penis [6].
• These rings are connected by a traction apparatus that runs along the sides of the penis [6].
• Tension is applied via adjustable springs, allowing the user to stretch the flaccid penis gradually [6].
• Unique Features: The ProExtender's Double-Strap System (DSS) differentiates it from older models by enhancing comfort and ensuring the device can be worn for extended periods without issues [7].
• Adjustability and Size Accommodation: The device is crafted to fit penises up to 7 inches in length when flaccid, ensuring a broad range of users can benefit from its use [5].
• Medical Approval and Recommendations:
• Clinically proven to correct penile curvature and approved for penis enlargement [6].
• Endorsed by medical professionals, including doctors, urologists, and andrologists [6].
• Recognized as a Class 1 medical device by the FDA for penis enlargement and correction of penile curvature [6].
• User Safety and Comfort:
• Designed to provide gentle, non-harmful, and painless traction [6].
• Uses a scientifically proven technique for cell multiplication, facilitating penis enlargement without side effects [6].
• Suitable for all ages, as the process of cell multiplication is effective across different age groups [6].
• Product Specifications:
• Dimensions: 7.6 x 5.94 x 3.19 inches; Weight: 1.12 Pounds [5].
• ASIN: B085DR6DXX [5].
• Customer Reviews: 1.0 out of 5 stars (2 ratings) – it's important to note that user experiences can vary [5].

By providing a detailed overview of the ProExtender, users can better understand how the device works and what to expect. It's crucial to follow the instructions provided with the device to ensure safety and achieve the best results.
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The Science Behind ProExtender

• Treatment of Peyronie's Disease:
• The ProExtender is primarily used to treat Peyronie's disease by applying continuous, gentle traction to the penis, aiming to straighten curvatures [6].
• This method has shown potential benefits such as preserving or increasing penile length and reducing penile curvature [3].
• Mechanism of Tissue Expansion:
• The device causes micro-tears in penile tissue through gentle stretching. These tears then heal, leading to increased cellular growth and tissue expansion [9].
• Regular use, typically for several hours a day over a few months, is necessary to achieve noticeable results [9].
• Clinical Evidence:
• Studies have demonstrated that penile traction therapy (PTT) significantly increases both flaccid and stretched penile lengths and results in a notable improvement in penile curvature [10][11].
• Clinical papers report an average increase of 4.1 cm in penile length and a decrease of 14° in erect penile deviation after PTT treatment [10].
• Enhanced Outcomes with Combined Therapy:
• The effectiveness of PTT can be amplified when used with other treatments such as verapamil or interferon α-2b, offering a more comprehensive approach to managing conditions like Peyronie's disease [10].
• Minimally Invasive Alternative:
• PTT is a tolerable and minimally invasive option, which has also shown promising results for men with dysmorphophobia, suggesting its versatility beyond Peyronie's disease [10].
• Research Directions:
• While PTT presents as a promising treatment, further research is needed to define the optimal duration and patient characteristics for improved outcomes [11].
• Studies to date have been limited by factors such as small sample sizes and lack of randomization, indicating the need for more rigorous clinical trials [3].

Clinical Evidence Supporting ProExtender

• Clinical Study Outcomes:
• In a study from the Journal of Sexual Medicine, participants using ProExtender averaged a 1.1-inch increase in penis length over 6 months [5].
• A separate 1998 study showed an average length increase of 1.1 inches after 1100 hours of use with a 1200g traction force [12].
• Gontero et al. (2009) observed significant improvement in penile curvature for Peyronie's disease patients using a penile extender device [6].
• Length and Girth Gains:
• Research in the British Association of Urological Surgeons' journal found an average stretched penis length increase of 0.67 inches after daily use for six months [8].
• The Journal of Sexual Medicine (2010) reported average length gains of 0.9 inches after 3 months and 1.6 inches after 6 months of use [5].
• The same study detailed average erect length gains of 0.7 inches at 3 months and 1.3 inches at 6 months, with girth increases of 0.3 inches and 0.4 inches respectively [5].
• Safety and Side Effects:
• The 2010 study from the Journal of Sexual Medicine noted no significant side effects during the trial period [5].
• Similarly, the studies by Levine et al. (2008) and Gontero et al. (2009) reported no notable side effects [5].
• However, it's important to recognize that no research studies have confirmed the effects of ProExtender on Peyronie’s disease or penis lengthening in general [3].

How to Use ProExtender
To ensure the proper use of the ProExtender and to achieve the best results, users should adhere to the following steps:

1. Initial Setup:

· Begin by assembling the ProExtender following the manufacturer's instructions to avoid any injury or discomfort [5].
· Attach the protective foam padding onto the penis head before placing the device in its flaccid state [14].
· Adjust the length of the rods equally to apply even tension, which is particularly important for correcting penile curvature [14].

1. Adjustment and Comfort:

· The elongation bars come in different sizes and can be adjusted to increase tension, allowing users to customize the device for a comfortable stretch [13].
· The device is designed with comfort in mind, offering various ways to wear it to maximize comfort during use [13].
· Built with surgical-grade steel and an ergonomic plastic-based frame, the ProExtender is both durable and comfortable for users [15].

1. Usage Guidelines:

· Users should start with shorter durations of wearing the ProExtender and gradually increase the time. A break of at least one day per week is recommended [14].
· For noticeable gains, wear the device for several hours daily, over a period of 4 to 8 weeks or longer, depending on individual goals and progress [2][13].
· It is recommended to wear the ProExtender for a few hours daily and use it consistently for at least three months to observe tangible benefits [15].

1. Cleaning and Maintenance:

· After each use, especially if in contact with bodily fluids, clean the device thoroughly to maintain hygiene and prevent any potential infections [2].
· Regular cleaning also ensures the longevity of the device, keeping it safe and functional for continued use [2].

1. Monitoring Progress:

· Keep a log of daily usage time and any changes in penile length or curvature to monitor progress and adjust usage as needed [13].
· Patience is key, as the ProExtender operates on a medical physiotherapeutic principle, and effectiveness is dependent on regular and correct use [14].
By following these guidelines, users can optimize their experience with the ProExtender, potentially seeing improvements in penile length and curvature while minimizing the risk of side effects. All side effects associated with the ProExtender are temporary and can be avoided by adhering to the operating instructions provided [49][51].
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User Experiences and Results
User experiences with the ProExtender can offer valuable insights into the potential results and effectiveness of the device. Here are some of the outcomes reported by users:

• Individual Results:
• Users should anticipate varied results based on individual factors such as age, genetics, and the specific issue being addressed with the ProExtender [5].
• One user, Austin Hanson, M.D. Urology, shared that after consistent use of the ProExtender for 1½ years, he experienced an increase of more than one inch in penis length and noted improvements in erection quality [12].
• Another user echoed similar benefits, reporting increases in both length and girth of the penis after 1½ years of use, alongside better erection quality [12].
• Reputation and Satisfaction:
• While some users have reported positive outcomes, the ProExtender's reputation is mixed, with an average standing on Trustpilot [3].
• The company behind ProExtender is not BBB accredited and has received an F rating due to numerous unresolved customer service complaints, which potential buyers should consider [3].
• To address concerns about satisfaction, the ProExtender is offered with a 6-month trial period where users can return the device for a full refund if they are not satisfied with the results [3].
• Expectations and Commitment:
• Results are generally modest and require a commitment to time and consistent usage [2].
• The ProExtender has shown effectiveness in increasing penile length and girth, improving erection quality, and correcting curvature, though these results are not guaranteed and can vary from person to person [12][2].
• It is emphasized that achieving noticeable improvements with the ProExtender demands patience and adherence to the usage guidelines provided with the device [2].

These user experiences highlight the importance of setting realistic expectations and the need for a dedicated approach when using the ProExtender. It's crucial for users to consider their unique circumstances and to follow the device's instructions closely to optimize their chances of achieving the desired outcomes.
Potential Risks and Side Effects
While the ProExtender is generally considered safe for use, it's important for users to be aware of potential risks and side effects associated with its use. Here are some of the key points to keep in mind:

• Common Side Effects:
• Initial discomfort or pain may occur, particularly during the first few weeks of use [12].
• Mild and self-limiting side effects have been reported, such as pain, skin redness (erythema), bruising (ecchymoses), itching (pruritus), and swelling near the pubic bone [6].
• Overstretching the penis can lead to discomfort or pain, and users have reported issues such as pinching or chafing from the silicone straps [3].
• Usage Precautions:
• It's crucial to follow the manufacturer's instructions carefully to minimize risks [12].
• Users should monitor for any unexpected changes in their condition and be aware of potential minor injuries, bruising, and allergies [2].
• Consulting with a healthcare professional before using the ProExtender can ensure safety and effectiveness [9].
• Regulatory and Manufacturer Notes:
• The ProExtender is an unregistered medical device and has not been tested by the FDA, nor is it intended to be a medical treatment for any disease, including Peyronie’s [3].
• Innovatech Designs, the manufacturer, states that the device hasn't undergone safety and efficacy testing and is not FDA approved for use in the United States [3].

It is also worth noting that other penile traction devices, such as the PeniMaster PRO, should be used correctly to avoid permanent side effects. Improper application may lead to temporary issues like bluish discoloration, coldness, numbness, or pain [16]. Excessive pulling forces or strong vacuum can cause temporary swelling or discoloration of the glans, and if the foreskin is sucked into the vacuum chamber, it may result in swelling [16].
In comparison, surgical penis enlargement procedures carry their own set of potential side effects, such as infection, bleeding, adverse reactions to anesthesia, uneven texture or shape, numbness, scarring, and changes in the angle of erection [17]. Dr. Rahul Gupta warns that prolonged use of penile pumps, including the ProExtender, could negatively impact sexual function by damaging or distorting the nervous cells and fibers involved in erection [18]. Therefore, users should weigh the potential benefits against the risks and seek professional advice when considering the use of penile traction therapy devices.
Comparison With Other Enlargement Methods
When comparing ProExtender with other enlargement methods, several factors come into play, including safety, cost, and efficacy. Here are some points of comparison between ProExtender and alternative methods:

• Safety and Comfort:
• ProExtender, as a non-invasive device, presents a lower risk profile than surgical enhancement options, with fewer reports of dissatisfaction and side effects [19][21].
• Surgical procedures carry risks like infection, scarring, and penile deformity, whereas penis extenders like ProExtender do not involve these risks [5][21].
• Cost-Effectiveness:
• Penis extenders, including ProExtender, are more affordable than surgery, with prices typically ranging from $100 to $400 [21][24].
• In contrast, penis enlargement surgery is generally more expensive and comes with additional costs related to recovery and potential complications [24].
• Efficacy and Additional Benefits:
• Clinical studies have supported the effectiveness of penis extenders in promoting penile length gains, with ProExtender being a 100% natural method that has shown success over 20 years in more than 20 countries [21][22].
• Exercises and physical manipulation like jelqing lack substantial scientific backing and carry risks of injury and uneven growth [5].

Comparison with Specific Competitor Products:

• Andropenis, Phallosan Forte, PeniMaster Pro, and X4 Labs Penis Extender:
• These devices are recommended alternatives available online, each with unique features such as the combination of vacuum and traction mechanisms in Phallosan Forte or the long warranty period offered by PeniMaster PRO [20][21].
• Quick Extender Pro:
• Offers a Double Strap Support System (DSS) for a more precise and comfortable application, competing directly with ProExtender's unique features [22].
• SizeGenetics and Jes-Extender:
• SizeGenetics provides up to 2800 grams of tension and is clinically tested, while Jes-Extender is a handmade device that promises tangible gains and enhanced sexual satisfaction [22].
• MaleEdge and Hydromax:
• MaleEdge offers a 6-month money-back guarantee, and Hydromax provides a 60-day money-back guarantee along with free shipping [22].
• Non-Extender Methods:
• Penis pumps can cause temporary erections but have potential side effects like bruising and pain [5].
• Pills and lotions generally lack scientific evidence supporting their effectiveness and are considered less reliable than medical-grade devices like ProExtender [5].

In summary, ProExtender stands out as a non-invasive, clinically tested, and FDA-cleared option for penile enlargement, offering a safer and more cost-effective solution compared to surgical procedures and other alternative methods [5][24].
Purchasing Guide
When considering the purchase of a ProExtender, prospective buyers can explore a variety of options to find the package that best suits their needs and budget. Here's a guide to help navigate the purchasing process:

• ProExtender Versions and Pricing:
• Value Edition: Priced at $150, this is the most basic package [2].
• Deluxe Standard Edition: Includes additional comfort features at $225 [2].
• Deluxe Limited Edition: The most comprehensive package, offering the full range of ProExtender accessories for $437 [2].
• Curvature & Peyronie’s Edition: Specifically designed for those dealing with penile curvature, available at $225 [24].
• Starter System: A mid-tier option at $299.95 [24].
• Deluxe System: The top-tier package at $399.95, which includes spare parts and a metal carrying case [24].
• Where to Buy:
• Official ProExtender Website: Purchases can be made directly through the website, often with discounts available via specific links, such as proextender.com/ct/3134?t1=vimeo [13][27].
• Amazon: The ProExtender is also available on Amazon, sold by BZ USA for $179.00 with free shipping [26].
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Hi there, first off, I am not looking for anyone to diagnose me as I know only my physician can do that, BUT I did see a post from someone else who drew a map of their symptoms and explained them to see if they match up with anyones, so I’m hoping that’s allowed still. Sorry in advance for the novel :-)
The photo I have attached is where I feel the pain. The purple is dull or sharp pain, it goes up on my temple and the back of my head a bit, my left ear (can be sharp, throbbing or dull in my ear, really feels like an ear infection but both my PC and my ENT say no sign of infection), as well as pressure, especially on the side of my nostril. The red is where it “burns” or feels “hot”. It feels genuinely hot to the touch and using a thermometer, it is actually warmer than my other cheek. The black is where I’m still swollen, admittedly less than I was in the prior weeks but still swollen. You can only see it if you’re really looking in the mirror, I can mainly feel it when I’m washing my face.
A little background:
In December of 23 I started getting some left side facial pain. Went to the dentist, they did a CBCT, said I looked totally fine and it’s probably sinuses and I should see an ENT. Got the ENT referral but they were booked out for months, and by January I was still in pain and my left side had begin swelling. Went to the ER, they sent me home with round 1 of antibiotics and said to go see a dentist. Went back and saw a different Dr. at my dentist office and he said yea, your wisdom tooth is infected plus a molar a couple teeth away from it. He did a root canal right then and there, and scheduled me for my extraction a few weeks later. During that time, I got another antibiotic due to the pain and swelling. I went to the ER again because my throat/tongue felt weird and tingly and I thought it was from the tooth. They didn’t do any imaging but they suspected blocked salivary glands and told me to suck on sour candy and see an ENT. Finally saw the ENT while waiting for the extraction, and after a quick exam they agreed it was probably due to the infection. Got the tooth pulled, and over a week later I’m still in pain and swelling. I go in to get looked at and my dentist says the site looks good, no sign of infection, but when I come back in the next week for my crown from the root canal if I’m still swelling and in pain I’ll have to take another antibiotic and be referred out to a specialty endodontist (Which is exactly what happened). So, on my last day of antibiotic number 3, I see the endodontist (who did a root canal on me last fall that went perfectly) and he says there is an extra root that was missed from the emergency root canal, but it shouldn’t be causing me this much pain. He left it up to me: Re-treat it and take a steroid, then come back in a month to finish it off, or just hold off. I opted to treat it. A week later, still having pain and swelling. Call my dentist and she sees me the next day. She’s completely at a loss. My whole upper left area is painful/uncomfortable and the intensity changes throughout the day. But, I can’t really pinpoint a specific tooth that’s bothering me. One bothers me for a few hours, stops, then another one will, and so on. I will preface I’ve had a lot of work done in the past year (7ish fillings, 3 crowns, now 2 root canals and an extraction). She does probably the 5th set of x-rays since this has all began and says everything looks fine. Extraction site, RC’d teeth, all of it looks fine- but I’m still a bit swollen. She urges me to see the endodontist again but they’re also throwing their hands up at me, too. I explain my symptoms to her and she brings up Trigeminal Neuralgia. I ask if that could explain the swelling, and she says no, but it’s worth talking to my doctor about. I have an appointment with my PCP tomorrow, my ENT again on Monday, and I put a call in to see my neurologist. I called the endodontist after that appointment and am seeing him Friday; he also sent me another antibiotic which I am taking (number 4).
I have a migraine disorder and I’m supposed to be starting Verapamil for it soon and gabapentin for my fibromyalgia, but they were prescribed close together and during this “infection” ordeal so I was trying to clear up my tooth issues before starting them. It’s becoming clear I will not be clearing up these tooth issues anytime soon. I plan on starting the Verapamil Sunday and the gabapentin 3 weeks after (I have been notoriously intolerant of meds in the past so I don’t want to start them at the same time and have issues and not know which one is causing them). I mention the gabapentin because I saw from looking at other posts it can be used to treat TN.
Other symptoms/information:
I do have tooth pain, but it jumps around. Sometimes it’s the tooth next to the root canal (either of them, if anyone is familiar with teeth numbers in the US it’s 15 and 13), sometimes it’s a previously crowned front tooth (11) or the healed RC (12), and sometimes its one of the bottom left teeth. All of the pain is different. I’ve tried to bite down and see if that triggers any specific one to hurt, I’ve stopped taking NSAID’s so I can ‘feel’ the pain and see if one pops up more than the other, and the pain just keeps jumping around. The only pain that’s constant is my lower left jaw up to my ear, the ear pain/burn, the area on my cheek between the ear and nostril, and my left temple. I am not one to have a fever (though I am checking mine every 20 mins at the moment), and I have a migraine disorder that causes dizziness 24/7, so I’m afraid I’ll miss obvious signs of a bad infection and just let it run rampant. I have 2 teeth I’m personally suspicious about but again, they’re apparently all clear.
My question is, just from what I’ve described symptom wise, does this sound like what anyone else experiences? Can it really cause swelling? How can you tell if you’re having tooth problems then? I’m at a loss for what to do. I’m scared if I finish the antibiotic the pain will be worse because the infection isn’t treated, but apparently it’s an imaginary infection?? Lmao I’m so lost here. Any info, guidance, advice is all appreciated. And thanks to anyone who actually reads all of this!!!!!

So I am a 31/m who has been on bp meds (lisinopril) for the past 3 years. I got put on bp meds in the beginning because I actually felt symptoms. Like dizziness, heaviness in the head, increased bpm, headaches, etc. My bp was going up to like 210/120. Got put on 10mg lisinopril to start. Brought my bp down immediately maybe after one day. Started averaging like 110/70. At this time I had already quit alcohol and cigarettes. So fast forward maybe 2 years later after starting bp meds, I starting smoking cigs again. Bp was still registering fine. Doctor said no need to increase dosage. Then I moved to a different state, found a doctor and this guy bumped me up to 30mg because I was getting readings at the office of 160/100. The dosage brought my bp way too low at home. Met with another doctor and he lowered me to 20mg. Bp started regulating. Now, I quit smoking again, bp is fine at home, but yet when I go to the doctors it measures out anywhere between 150/90-200/100. The ER is tired of me lol I don't know whether to take a beta blocker or take pysciatric meds. I need help!

Hi everyone, I (36M) had been diagnosed with FSGS in June 2023 and since then I had been on Prednisone which brought my protein spill from 9+ grams per day to 1.5g until January.(Please checkout my post history about details at different stage) As i was tapering off of Prednisone, I went for another lab last week and found that my protein spill has gone back to 3g per day. The doctor's office ordered another test for spot check and it confirmed me relapsing.
Currently, I am taking 10mg Prednisone a day and slowly tapering off by reducing every month. Doctor said that he does not want me on Prednisone longer because it has its own side effects and probably we are looking at alternative treatment. I am prescribed Lisinopril 2.5mg to start and up 2.5 every week until I see any side effects. Doctor is worried because my BP is 115/70 so it could bring the BP down further. We also discussed about trials along with Tac and rituximab as other alternatives later.
My eGFR has always been 100+ as after I started Prednisone and it still is. My blood creatinine is 0.73 mg/dL (Range: 0.72 - 1.25) along with all other vitals in range.
It has been a bit overwhelming as i had my hopes pinned on Prednisone working as it was working good so far. During a month period between December and January, I stopped taking statin as per Doctor's advice as my cholesterol was well within control but my cholesterol spiked so had to start again in January.
I don't know what I am looking for in terms of guidance but should I take a second opinion? Does like look at par in terms of experience as others have found so far?
I wanted to have this entry in my profile so that others can benefit from in future as I was in that state where I couldn't find more info about the type of variant I have.
Thank you

For 20-25 years nausea, dizziness and vertigo have plauged me, to the extent that I minimized driving around age 37, and sold SUV & stopped completely by 40. I have talked to many doctors and received IV iron infusions from a hemotologist at a cancer treatment center. A hysterectomy about 8 months ago helped sustain iron balance and improve other qualities of life, but dizziness, nausea and vertigo remained. Prior to the 3 iron infusions, (which began close to a year ago, and I haven't been eligible for more in past 6 months) I was using a cane to get around my own home and at dr appts. Last spring I walked away from a 15-year career, despite WFH since 2020. I was so good at my work, and being outside of the workforce has been harder on me mentally than giving up driving ever was. I hope to work from home again soon, but like many I'm at a loss on how to best convey my skills, and express that said talents can produce excellent and consistent results, capacity variations nonwithstanding.
PCOS, fibroids, anemia, high blood pressure, high cholesterol and obesity have been my "only" chronic health conditions. I did have a "geriatric" pregnancy at 36, but was no more tired or dizzy after baby was born than I was prior to pregnancy. I have had my blood sugars monitored faithfully as my dad was Type 2 diabetic and died in a coma at 48. Since hysterectomy, liver enzymes have been elevated, but never before. I am having a livegallbladder ultrasound in 2 weeks. I have also suffered from frequent loose bowels, multiple times on many days in the past few months.
Quality of life was evading me, and I could scarcely leave bed. The iron infusions and hysterectomy were key stones on a healing path, but I still suffered from debilitating nausea, dizziness and vertigo afterwards. Even car rides required dramamine, etc.
Then I started Wegovy.
I had an Rx for close to 5 months before I was able to obtain the medication through CVS Caremark. I was incredibly concerned about symptoms, and waited another month and a half to start the medicine. I had the support of a nurse friend on tap. I had an Rx of phenegrin, enough for every day of the first month. My husband and I had prepared extensively for me to be down for the count at least a week. The anxiety was real.
But... within 2-3 days of my first dose (0.5) I noticed my body and head were playing different games. I was worried, anxious and keyed up...
But I wasn't dizzy. I wasn't nauseated. No vertigo. Okay... noted. Cautiously, I became slightly more confident with what some would consider standard activity- getting out of bed without sitting on it a minute. Going out on our farm with no building to lean on. Going in the fence with my dogs, not just leaning through to pet them. Standing in the shower instead of using the chair, then standing in the shower without holding a wall. 2 or 3 weeks after starting Wegovy, I drove myself 25 minutes into the city, and went into Costco to shop. I have been using Instacart exclusively for over 5 years (pre-pandemic) due to my physical struggles. And there I went. I DID IT. And I've done it again, and again, a total of 3 or 4 trips into town (I've since switched to Sam's club pickup, but the capacity for partner errands is there). I've pumped gas for the first time in 2+ years, 3 times now. My husband and his cousin, who lives 30 min away, have taken me to every errand, every appointment for years. I had been unable to carry my child or even lift and hold in place since baby was age 3 and 20-some odd pounds. Now baby is 43 pounds, 6 inches taller, and suddenly I can lift, carry, piggyback, toss playfully on the bed, hoist into a bunkbed and so much more. One day I was riding and realized I had been reading an article for over 10 minutes in car, no nausea or carsick symptoms of any kind.
I am on week 3 of the 1.0 dose. Since I started on Dec 9, about 7 weeks ago, I have done more with my body, on my own in the world, with less fear and fatigue, than I have in years. No dizziness, etc. Loose bowels also stopped entirely, and no constipation issues (I wait to take next dose until colon is clear, so sometimes go 8-9 days between shots).
It's like I have a new lease on life. I'm not currently working out, as simply being able to bend down and pick a toy up off the floor is new to me, and I'm building up my stamina for every day tasks. I do still rest a lot.
Details are provided because my question is this- WHY?
WHY do I feel so much more stable, capable and safe to use my body?
I will be seeing my GP and my hemotologist in April. My GP is very nice and quick to send out for any needed tests, but I can tell she has average/vague knowledge on the effects of these medicines. My hemotologist keeps scheduling me in every 3 months despite my iron being stable because they don't like the unresolved dizziness/fatigue, etc.
I would like to be able to provide them with some real-world antecdotes or ideas on what my core issue actually may be, so we can work to better understand that and explore root causes that we can treat, without Wegovy perhaps, in the future.
I am more confident and trusting in my body to function than I have been in 20 years. It would be heartbreaking to have an internal change and have those troubles return. I have been so much more physically engaged with my little one that it would be a genuine tragedy to return to the way I was before.
I will reiterate that I am frequently checked for diabetes and never meet thresholds of even a pill diabetic. I have taken Metformin off and on for 10 years, and consistently the past 2 years, to help manage PCOS, but it never impacted my bloodsugar due to a very low dose.
Current meds: Lisinopril 20mg nightly Wegovy 1x per week, currently at 1.0
Please note that the changes were so immediate, it can't be due to weight loss.
January 2023: 206 lbs Lost 5 pre-hysterectomy, 10 post December 9, 2023: 190.6 lbs January 27, 2024: 179.1 lbs
11.5 lbs lost on Wegovy, no real food item changes. No real goal weight, but anticipating 140lbs or so to be a real "feel good" zone for me.
I really appreciate any insights or feedback I can research and bring to my care team so I can continue to gain strength and stability. I am realizing what a "normal" baseline could feel like, and I am both grateful for it... and selfish to keep it.
And I'm so sorry for all of you struggling with side effects- I sincerely expected weeks of nausea and vomiting, & more when starting out. It's hard to locate any articles or Reddits with people sharing my "less sick than I was" experience.

I am from the US, but I currently away in Central Asia. I got here at the end of December. I'm trying to figure out what do to lower my blood pressure immediately and also bide time until I can get proper diagnosis and treatment. (I can't get home to the US until January 26. Many treatments are available here and in the neighboring countries, if need be, but ducts rates are lower.) An additional complication is that when my blood pressure had been lowered to 140 over 85 up till a few days ago, a had severe vertigo. (I still have it, but less.) My completely uneducated guess is there's blockage in one of my neck arteries, and without the high blood pressure, I'm not getting enough blood to the brain. (This is based on some information below.)
Since finding out my blood pressure 2 hours ago, I have now taken aspirin 500, magnesium 1000, Lisinopril 20.
I'm in my early 40s without heart or brain conditions in the family.
More information -
At the end of August, I start getting this cough. At this point, I'm pretty sure it's from the lungs, because it's happening even when my nose is clear and seems to coincide with my blood pressure. At the time, I thought it was post-nasal drip. It's not been consistent enough, though, for the two GPs and two ENTs I've seen to even detect anything, much less diagnose it. When I get into the doctor, miraculously I have no cough or anything to cough up. Eventually, I go two separate rounds of antibiotics because of a sinus infection, after which the cough clears up for about a week, and then it starts back up.
In November, I started noticing my chest was sore and I could feel my pulse in the right side of my neck towards the front. It was enough that it would move my head even if I were relaxing leaning back on the couch. I wasn't overly concerned because I have a history of inflammation in my sternum cartilage. I get into my GP in December, and my blood pressure is 164 over 94. I get on Lisinopril 20mg on December 22. I fly here on the 25-27th, and I'm starting to get cold sweats and bright yellowish loose stools during the trip. On January 6, I take a nap, and when I wake up, I have severe vertigo.
Everything has been spinning since then. But I've figured out some patterns: if I lie down for a while, it gets significantly better. (With the exception of doctors visits and labs and jerking my child when I can, I've been horizontal since the vertigo started.) I also missed a dose of Lisinopril by accident two days ago, and my vertigo improved. Then the following day, yesterday, the cardiologist I had seen told me to do a half dose (10mg) and to wait until night to take it instead of the morning. After I took it, it was cold sweats and vertigo all night. Things started to improve vertigo-wise in the morning, but then my blood pressure shot up to 160 over 110 this evening.
The loose stool turned into diarrhea, and eventually bright yellow "peeing out my butt". I'm on Imodium and an antibiotic because of this, but they didn't not do much until my lisinopril dose was missed/dropped.
I have seen two GPs, an ENT, and a cardiologist. When I saw the cardiologist yesterday, things were still spinning, but my blood pressure was reduced to 140 over 85. I did a stress EKG, which I failed to complete at 6 minutes because of coughing. I had exercise-induced asthma growing up, but this felt different. I didn't feel like I was being overwhelmed by mucous. And I did a 24-hour EKG (translation?). I get the results for that back tomorrow. Tomorrow, I also do Doppler carotid imaging.
The CAT scans of my head (three since November) have come back clear three times now.
I am sure that my cardiologist would have rushed all these tests had my blood pressure been high when I saw her, but it was lower at 140 over 85 and so there was less urgency. Due to where I am, it's doubtful I can get the imaging done for another 12-14 hours.
Even more information -
I'm 6'2" and obese at 270 lbs.
I am what's called insulemic hypoglycemi--I produce way too much insulin. It's been this way my whole life, even when I was young and fit, and all the men down my father's side of the family have the same thing. Among other things, this means if I eat any carbs (other than veggies or a half piece of fruit), my blood sugar shoots up to 140 and then drops to 40 at about 90 minutes, before going back up. The doctor who prescribed the 4-hour glucose test said they were surprised I hadn't passed out. It also makes keeping cholesterol in check a chore. I haven't been following the right diet.
I have a lot of cranial neuropathy. Back in 2020, a neurologist, a neurologist prescribed me the maximum allowable dose of both Lyrica and Cymbalta simultaneously. The idea was that since one of them wasn't working, he'd get me on the other one, and then wean me off the first. But then he lost his job at the only hospital/medical network in the southern (my) half if the state. Long story short, I was on both medicines at maximum disaster for 8 months. My sense of hunger is totally shot. I always feel between starving and very hungry no matter what I've eaten. I gained 70 pounds. (My ability to remember things, both short-term and long-term, is also shot, and that cooincides with this time.) I try to control my reading, but I suck at it.
As to the cause of cranial neuropathy, I had an accident in late elementary school. I got a hairline fracture in my jaw, dislocated it into my right ear (same side as the current pulse thing) and less so into my left. It caused two cervical discs, one thoracic, and two lumbar discs to become bulging. The neuropathy didn't start till I was in my late 20s, but my doctor's think the accident was the cause.
The only thing that helps with the neuropathy is muscle relaxants. A few doctors have hypothesized that it's is due to my neck muscles pulling (somehow) on my cranial nerves. The many many MRIs I've had did not find bones doing the pinching, but Tizanidine makes the neuralgia manageable. It also makes me fall asleep, and limits my ability to be active.
Oddly, the MRI did find a missing golfball-sized part of my brain where the occipital lobe meets the cerebellum. They said it was probably a long-gone cyst that did it. It also found flattening (translation?) of my pineal gland. None of this guy wise between 2014 and 2018, when I had the last MRI.
I am now completely sedentary due to pain and the muscle relaxants that put me to sleep. It's not an excuse. If I make it through this okay, I'll do whatever I can to changes. As it is, I was getting winded and a teaching heart just going up two flights of stairs.
Medications recap: Bupropion XR 450 Tizanidine between 4 and 20mg a day Lisinopril 20mg Vitamin D3 at 5000ui + K2 at I don't know what. Ciproflaxacin 500mg twice a day (just finished day 2 of 7) Just had aspirin 500.
Thank you for any information or advice you can give.

Waiting for my health insurance to kick in, so eventually going to the doctor but can't yet. I have hypertension and have restarted my lisinopril that I stopped taking for a few years. The last few weeks I have noticed heart palpations almost constantly when I am laying down. But paying more attention it almost feels like I have two heart beats, a lower fast heart beat I can feel in my stomach, and my regular heartbeat I can feel in my neck.
I thought palpatations were just fast heart rate so I wanted to know if this sounds like PVCs instead. The other thing I notice is that if I listen to my heatrate, it almost instantly returns to normal. The faster heart rate stops after a few seconds of concentration/relaxing. I also don't believe this is an entirely new symptom, I used to notice a fluttering sensation while laying down but wrote it off as my fan vibrating my bed, it's just way more constant now.
I know I'm dumb for asking for advice but my doctors appointment is on Feb 8th, I am at risk for heart disease, is there a major difference between waiting a month or is there anything a doctor can actually do it I shell out another 140 for minute clinic.

Just found out I have T2D. Started being OCD on reversing it naturally. Think Ive had it for years. Had some preliminary signs of neuropathy starting, found the nerve Drs on youtube and researched all the vitamins etc to protect and rebuild nerves, blood vessels etc. Im a serious google nerd, I do A LOT of research. So I start on those, and start eating better, and start taking my metformin. The Dr wants me to take lisinopril and glimepiride, I dont even like to take aspirin, so I tell the Dr no thanks. Shes not happy but I plan on proving her wrong, since she told me I cant fix this without meds. I did tell her if I do this and dont see results Ill do what she asks, but shes an MD and not keen on me not using meds.
I now take my sugar readings all the time, and I started using a CGM the other day. Im using the Libre 3 for the graph and readings every minute. Ive also started Intermittent fasting. First was at 16/8 for a couple weeks, now Im doing 20/4 and doing longer ones mixed in. Ive done 36, 32, 48, 52s and a couple 72s.
My normal fasting sugar seems to be about 135 to 145 in the morning when Im intermittent fasting. Itll hold this level through the day until I eat. Sugar then goes to 180 or so and comes back to this level again after about 3, 4 or maybe 5 hours. My sugars were much much higher a few months ago when I was eating normal american diet, and probably even worse, I know during the far and few between times I was testing, it was mid 300s or so, into the 400s I know of one time. Now that im all into this I cant even imagine where my sugars been.
Heres the pattern Im seeing right now. Last night I ate dinner about 6pm. I had a BLT on chaffles with avocado slices. As of right now thats 20.5 hrs ago. My sugar was 122 right before eating, at 1130 pm my sugar was still 154 after going up to 180ish. I woke up at 630 am this morning and the CGM said sugar was 122 (didnt do blood test, went back to bed). Got up at 8:15 and cgm said 150, blood said 135. At 9am blood said 165. 1030am is says 160, noon 162, 12:44 151, and literally just now its 138, at almost 20 hrs after eating its not even back down to what it was before eating last night.
I have no other symptoms of high insulin resistance from what I see on the net.
When I do these longer fasts my glucose will go to normal levels. I cut my last one short after 52 hrs because blood said it was 59, and I felt fine. Ive since learned that hypoglycemia from fasting is ALOT different than if it happens from something being wrong with you. Point is, I made an omelette with onions, mushrooms, spinach and cheese. This was 10pm. I admit I was nervous about going to bed with sugar so low, since my best friend for many years died last June after going into a diabetic coma when his sugar dropped overnight. When I went to bed my sugar was 108. When I woke up it was 108, at 1030 am it was 108, ate somewhere around 1230pm 119, at 230pm it was 126. So the point is that when I stop my prolonged fasts, my levels go up a little and come down, but not all the way back down. Then I eat again, and they go up, but again, not back down to premeal level, every time I eat it goes up until Im back at my normal levels of 135-145.
It should start falling about now and if I dont eat I can get it to keep going lower, obviously, but as soon as I start eating again its the same pattern over and over. A little higher sugar levels each time until Im back to 135-145 that goes to 180ish when I eat, and wont go any lower unless I do extended fasts.
I forgot to mention, when I checked my blood test results, from when I first found out about this stuff, my insulin level part of the test says its in the normal range. It wouldnt show as normal if I have IR and is high all the time right?? I mean that makes sense to me. So then what could be going on? Does the rest of this just say IR to you too?
Should I just keep doing IF and eating as little carbs as possible? Sry for the book but Im just trying to figure out what to do next. Thanks for reading so far if you did..

Hi, I am 34 yo and have been getting these headaches for almost 20 years. At first, it started as severe jaw pain radiating to the eye one side. I was diagnosed with Bruxim and given with a mouth split and muscle relaxers.
Years have passed since then and one day i ended up in ER with a burning jaw and face pain. The ER doctor wasn’t able to understand what it was and injected Morphine to alleviate it. Then i was only crying because of the pain and all these burning sensation in left side of my head.
It almost took 3-4 years to be diagnosed with CH. I was given intravenous stereoids and Topamax to help with episode. It did.
2 years ago, i had this terrible cycle began. I was very agitated during and in between the attacks. I used daily Relpax because Sumatriptan injections are not available here in my country. After seeing this different neurologist she’s put me onto Amitrlypine, gave steroid injections, took me off Topamax. I was literally found myself struggling with horrible pain again. Ending up at ER each morning and night you get oxygen and steroide because oral Relpax wasn’t quickly acting. Then i discovered verapamil and asked my neurologist about it and the pain subsided tremendously. Only these weird feelings and sudden throbbing remained.
Now, another cycle began and i ended up with another neurologist. First i tried to convince her that it may not clusters and received stereoid shots and muscle relaxers, thinking it was bruxism. Then after a week, i woke up with the terrible piercing pain on the left temple which radiated to the eye. The pain was there for almost 45 mins i got over it without taking any triptans. After another consultation with the doctor i was given Verapamil 240SR x1 and it helped straight away.
The question is pain there all day with fluctations. Those fluctations were dramatic prior to takin Verapamil. Now i can still feel the pain in and around the left temple and eye. Only around 3/10 intensity levels. General radiating from neck to left upper molar teeth towards the temple and eye. Also in occcipital area. It’s really not comfortable to lay down on place my neck.
Do you think these are the shadow from CH or some other TAC’s? The left side of the neck is very stiff and painful upon turning to especially left. Numbness is there on the cheek and eye. The pain circulates between occipital, temporal and retrorbital area at fluctuating levels. Fortunately, it’s never reaching a point for taking triptans.
Currrently on Verapamil 240 SR

I will try to keep this condensed, but also provide details enough from the process so far. I am looking for a secondary opinion as my Endo, PCP and Cardiologist seem to be stunned. My goal is to actually find the issue so that it can be corrected so that I no longer have to be on TRT AT ALL.
When this first started I was feeling lethargic, low libido, ED, Depression, Panic Attacks and hypertension.
39 YO Male, 5'10", 215 lbs
Two years ago I started to feel horrible. After various test from my PCP, I was placed on 50mg Test C every other week and referred to urology. Urology told me there is nothing they can do and scolded me for allowing my doc to place me on Testosterone. I was referred to Endocrinology who did a years worth of tests before placing me now on 100mg Test C weekly, with lingering issues that have still remained.
Endo initially changed my Test C to 75 mg weekly and within 4 days my libido was through the roof. ED was no more and all issues slowly went away (except for hypertension). After 4 weeks of that dose, the benefits started to wear off. ED, depression, panic attacks and low libido returned (panic attacks and depression aren't as bad as before) . I then contacted my Endo, who upped my dose to 100mg weekly. Since then, my ED is hit or miss. More specifically, during initial TRT my wife and I were able to have intercourse 3-4 times daily, but now it is limited to 1 interaction a day as ED seems to kick in after that. Libido isn't the best, but also not the worst its been. Wife isn't complaining, but agrees the quality of the erections during initial TRT treatment are very different then before/now. At start of TRT they were rock solid and 10 minutes after intercourse would be back at it, just as hard. Now the first erection of the day seems to be at around 90% blood flow and second is 65% maybe. All other symptoms fluctuate throughout the week. Two to three days after my injection I feel better and then slowly start to feel worse again.
Side Note: Between late 2021 and Endo in 2023, there was a 6 month period where I used a private HRT clinic who had me on 200mg Test C (twice weekly 100mg), Anastrozole 0.5 mg twice weekly and Clomiphene 25mg 3x week. I went to the private clinic due to my PCP's 50mg every other week didn't do a thing and I was tired of feeling like garbage. I felt AMAZING at the private clinic and had zero side effects for the first 6 months, until they offered to up my Test C to 300mg Weekly and add Nandrolone Decanoate 300mg weekly w/o Anastrozole/Clomiphene for $99 more/month. Being that I was previously competing as a natural bodybuilder and no longer qualified due to TRT, I gave in and agreed. A week after starting I felt like I could lift a car and my old lifting limitations were expanded greatly, but by end of week 1 I felt sick and by week 2 was in the ER with 201/116 BP. Here I stopped taking EVERYTHING other than BP meds I was now given, went back to feeling like before (Panic attacks, ED, Low Libido, etc). They had me wait 4 months before the Endo performed his blood tests to ensure nothing was in my system still from private clinic.
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Current medications:
Lisinopril 40mg daily
Hydrochlorothiazide 25mg daily
Buspar 20mg / 2x Daily
Testosterone Cypionate 100mg weekly
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Current diagnosis:
PTSD
Major Depressive disorder
General Anxiety Disorder
Secondary Male Hypogonadism
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Blood Work Results: (Only including out of range results, or results more involved in Endocrinology as I understand. More results available upon request. I have done plenty of bloodwork)
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Pre Endocrinology referral/Pre TRT (when I started to feel bad). Oct 2021-
Weight 192lbs
Vitamin D - 16 ng/mL
Testosterone total - 357 ng/dL
Test Total - 55.3 pg/mL
FSH - 1.0 mIU/mL
LH - 1.4 mIU/mL
T4 - 1.3 ng/dL
TSH - 1.99 mIU/L
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Endo tests from Feb 2023 (this is 4 months post canceling private HRT Clinic subscription):
Weight 185lbs
SHBG - 35 nmoI/L
Albumin - 4.4 g/dL
Test Free - 41.4 pg/mL
Test Bio - 83.4 ng/dL
Test Total - 337 ng/dL
Igf 1 - 155 ng/mL
Z Score - 0.2 SD
Aldosterone, LC/MS - 4 ng/dL
Renin, Plasma - 18.32 ng/mL/h
Aldo/Pra Ratio - 0.2 Ratio
LH - 1.9 mIU/mL
FSH - 0.8 mIU/mL
Cortisol - 12.5 mcg/dL
ACTH - 11 pg/mL
Prolactin - 8.7 ng/mL
Metanephrine 28 pg/mL, Normetanephrine 102 pg/mL, total Meta 130 pg/mL
MRI Brain w/and w/o contrast - Normal
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Current blood test when I was on 75 mg test C weekly (right before it was upped to 100mg). Taken at end of weekly injection cycle. October 2023 - 8 months of being on 75mg (from Feb 2023-Oct 2023)
Weight 215 lbs
SHBG - 24
Albumin - 4.6
Test Free - 64.4, Test Bio - 135.3, Test Total - 388 ng/dL
CBC - Hemoglobin - 16.2, Hematocrit - 46%
Additional side note- One blood test is available 6 weeks post being increased to 100mg weekly. Only CBC panel that showed after being increased, my Hemoglobin lowered to 14.6 and Hematocrit also lowered to 43.9%. (Dec 2023)
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Hello!
It's good to be here, let me introduce myself and my story with Ozempic so far.
I learned about GLP1 meds last November but when I tried to make an appointment at the weight loss center they told me they were booked through May and didn't take self-referrals. So I had to find a new PCP since I didn't already have one and I had to wait until February for the appointment.
My PCP diagnosed me with T2D with an A1C of 7.0. She prescribed metformin and Ozempic for that. And because of hypertension and high levels of something in my urine she prescribed lisinopril. She also gave me referrals to a dietician and the weight loss center.
I was shocked that when I started Metfomin and Ozempic there was no change to my appetite and hunger but I started to lose weight immediately! I dropped 3-4 pounds a week for the first 6 weeks and then my progress slowed to 2-3 pounds. I didn't feel any changes to my appetite until I started taking 1mg of Ozempic.
The dietician I worked with was helpful in figuring out my TDEE, BMR, and coming up with a healthy meal plan for calorie intake. We decided on a calorie cycling plan with 1-2 high calorie (1900) days each week and the rest falling in a 1400-1600 range. It's been working well! I already made a lot of big changes to my diet long before I started Ozempic. It was always so frustrating hearing things like "I cut out soda and lost 10 pounds" and "I started IF and lost 20 pounds", etc because nothing I did ever worked. I cycled between 260-265 pounds for years.
My biggest food problem before Ozempic was portion control and managing my hunger. I was always hungry and tried all the tricks I could think of and all the different diets and things like keto, IF, low calorie volume eating etc to achieve satiety and stick to reasonable portions but nothing worked. The things my dietician recommended were small changes and mostly related to the timing of my meals. I stopped seeing her when I started taking 1mg of Ozempic and no longer needed help on how to temper my hunger because Ozempic was suppressing it for me.
I had my first visit with the weight loss center specialist in September. At that time I was 40 pounds down and feeling great! A lot of my pain and stiffness problems were gone. We discussed some options for the future but since everything was working well we decided to just check in 6 months later. A week later I had an appointment with my PCP again and this time she had me do more testing. The urine levels came back excellent and my A1C was 5.3! We decided to stay at 1mg Ozempic but decreased my lisinopril.
I'm now a little over 50 pounds down. SW 263 CW 211. I don't know my GW yet. I've been taking goals in stages: first goal was to get under 250, then 225, and now it's to get under 200. Neither my PCP nor weight loss doctor have given me any real suggestions on a weight range to shoot for but I'm not too worried and just focused on my current goal. I like the way my body is looking these days but I have a ways to go to keep improving my health.
I feel like my weight loss is slowing down and my hunger levels are rising. I'm seeing a few posts that suggest that maybe happens. I'm also wondering if it's the cold weather because even my cat is more hungry than usual LOL. My next appointment with my PCP is in January and the shortage of 2mg pens makes me wonder if it's worth asking for a dose increase or not. My weight loss doctor also mentioned layering Contrave with Ozempic as an option.
Anyway we'll see where things go and I'll keep reading posts here! Nice to meet you all!