Botox : Information

I've received criticism from some regarding my desire to get medical botox and then having actually done it.  People can't understand why I would put "poison" in my body.  I have done my research and now I want to clear a few things up regarding "poisons" and most importantly, Botox.

There is a bacterium called Clostridium Botulinum that is most often found in spoiled food.  By consuming infected food this bacteria it is able to enter your blood stream and systemic systems and can virtually attack any part of your body.  Clostridium Botulinum, or Botulism, produces 7 different neurotoxins.  These 7 toxins attach themselves to the axon terminals of neurons preventing the synthesis and exocytosis of the chemical messenger acetylcholine.  Acetylcholine is used throughout the body, but is especially important in the innervation of muscle tissue.  Without the release of acetylcholine a muscle contraction cannot occur, which means paralysis of that muscle.  This is particularly troublesome if the neurons being attacked are those that innervate the muscles of respiration.  If you can't breathe, you will inevitably die.  This is also a serious problem if the neurons are those that innervate your heart.  

Could the prevention of muscle contraction possibly be a good thing? 

One cause of migraine headaches in some people is neuralgia or nerve pain.  A cause of occipital and trigeminal neuralgia is that a few of those nerves (or their branches) upon leaving the skull have to pass through very narrow passageways in bone, tissue, and between muscles.  If one or even many of the muscles surrounding that nerve contracts it can pinch or irritate that nerve causing nerve pain (neuralgia). 
Again, I ask, could the prevention of a muscle contraction be a good thing?  If those facial, cranial, and neck muscles can't contract, they can't pinch the nerve and will therefore prevent neuralgia (nerve pain).

As I said, the bacterium Clostridium Botulinum produces 7 different neurotoxins.  Those neurotoxins affect many different proteins necessary in the synthesis and release of acetylcholine.  Botulinum Toxin A is only ONE of those SEVEN toxins.  And it only affects ONE protein.  Botulinum Toxin A (Botox) is RELATED to the bacterium Clostridium Botulinum (known as botulism).  But it is not botulism.  It is a purified, sterilized, and diluted protein derived from Clostridium Botulinum. 

Second point - I do not ingest botulism or even Botox.  It is not put "IN" my body.  It is put on my body.  It does not enter the blood stream to then travel to other areas in my body.  It does not affect other systems in the body.  (Like any medicine that you might ingest.) 

The amount of Botox used in medicine and cosmetics is 50 units.  Because this is only one of 7 neurotoxins used by bacterium Clostridium Botulinum, and it has been diluted, purified, and sterilized, in order for Botox to be fatal a person would have to receive an injection of THOUSANDS of units DIRECTLY into the heart.

Curare is a toxin derived from a plant.  It has been used for thousands of years to make the often fatal "poison darts".  Curare is also used to relax muscles during anesthesia.
Purple foxglove is a poison that has been found to be a very effective heart medication.
Willow bark is toxic and causes fatal bleeding.  But it is also used to prevent or minimize the effects of a heart attack as well as to prevent strokes. And has been found to reduce inflammation, relieve pain, and reduce fever.  In fact, millions of people consciously ingest this poison every single day (it is called aspirin). 
The crocus flower is a very poisonous flower, but one of the most expensive spices in the world is derived from this flower.  If you have ever intentionally eaten saffron, you could be said to have consciously ingested a poison.

Let's also not forget that whenever you get a vaccination you are getting a small or inactive amount of a particular virus injected into your body.  You are getting "medicine" that has been derived from a very mean, nasty, and virulent virus.  (Viruses are some of the most potent, fast-evolving, fascinating, and beautiful creatures on this planet.  And they are amazing and efficient little killing machines.)

It would seem that the words "toxin or poison" and "medicine" can be synonymous.  What may be "medicine" to one person may be toxic to another.  And what may be toxic to one may be "medicine" to another.  Or what may be toxic when used in one way is actually medicine when used another.

When I went on Cymbalta no one said to me, "Why would you put that poison in your body?"  But from my personal experience ingesting Cymbalta was much more toxic to my entire body than Botox has been to the few tiny muscles it was applied to.

Also, interesting to note, studies have shown that Botox is safer than aspirin.  But I bet that many of you have taken aspirin and thought nothing of it.

Cymbalta Withdrawals

As a result of the chest pain I have stopped taking Cymbalta.  I know that one side effect is heartburn and I wanted to see if it was the Cymbalta causing it.  (I consulted with my neurologist about this first, I did NOT simply go off it all by myself.)  Friday, May 27 would technically be my second day off the stuff.  All day I just felt an overall "yuckiness".  Just "not well".  Hard to explain, hard to put my finger exactly on what it was.  If I exerted myself the feelings would get much worse and I'd also start to feel lightheaded.  Also a slight headache.  (I've never had the flu, but I imagine this is what it might feel like in its very early stages.)
Saturday, my third day off he stuff.  Much worse!  Nausea, dizziness, lightheadedness, headache, fatigue, and still that overall "yuckiness".  Saturday night the nausea hit it's peak.  I threw up 4 times in about 90 mins.  And I still had chest pains. 
In the middle of the night it occured to me, I know what histimine does to the body, it makes sense that an antihistimine would decrease my feelings of nausea (and also help me sleep!)  I did a little research online via my iPhone and sure enough - benadryl would help with my nausea.  So dug through Jody's medicine cabinet and was fortunate enough to find benadryl.  Now, let me be lucky enough to keep it down.
It worked!
Sunday morning I still felt yucky but remembered that the pharmacist had told me that I could take dramamine whenever I get nauseated from my migraines.  I looked at what dramamine helps with and it said - nausea and dizziness.  YAY!  So I took dramamine to help me get through that day.  It never made anything go away, but made it bearable.
Monday, more of the same.
Tuesday, more of the same.  But at this point I was so frustrated with feeling yucky in addition to the headaches and migraines (and who knows, maybe an additional withdrawal symptom of Cymbalta) depression.
I cried the entire drive to work.  I took several breaks during my work day to go to the bathroom and cry. I cried my entire lunch hour.  It took everything I had not to cry while sitting at my desk greeting clients and interacting with co-workers.
I finally called my neurologist.  She named off the list of known withdrawal symptoms of Cymbalta - check, check, check.  She said that I could go back on it and we could try to take me back off it even more slowly, but at this point I am nearly half way through the withdrawal period.  I elected to tough it out.
My drive home Tuesday afternoon was very scary, I'll be honest with you.  I was starting to experience the strange neurological withdrawals that I had read about.
Wednesday, in the shower I nearly passed out from the dizziness.  So I stopped midshower and went right to bed (with a towel around my head and everything).  Called in sick and slept nearly the whole day.  Felt yucky, yucky, yucky.
Today is Thursday and I am back at work.  Still feeling yucky.  Still very lightheaded and on the verge of passing out. :(  And still crying constantly (or at least fighting off the tears.)  I've never really suffered from depression - a few days this past winter.  And this is crap is ridiculous.  I don't even know why I'm sad and crying half the time. 
I've read that withdrawals can last 2 weeks.  I'm almost to the halfway point.

Falling Apart? Or Bad Week?

It all started with the wonderful, and yet painful, massage on Tuesday.  I was sore for several days after that.  Then the severe chest pains on Wednesday morning that had me thinking I may need to run to the hospital. 
To make matters worse, I had a little fall Thursday morning.  (I lost my balance while sitting on the counter in the bathroom.  Are you finished laughing yet?)  The fall hurt my hip (where I landed), my shoulder (which hit a small cabinet I have in my bathroom), my foot (which hit against the side of the door on my way down), my lower back, (I guess from the jarring landing I made), and my wrist (which I can only assume I tweaked while trying to catch myself and soften the blow). 
I'm off the Cymbalta, which was making me sick and is now REALLY making me sick - I'll discuss that in a minute. 
The Trazodone which is supposed to help me sleep is not really working any longer.  And besides that, the side effects of the trazodone add to my inability to sleep.  The side effects are congestion and dry mouth.  So as soon as I lay down I begin to feel congested so I can't breathe through my nose anymore.  And then it causes dry mouth which is exponentially worsened by the fact that I have to breathe through my mouth.  The final and most exciting side effect is the blurred vision.  So when I can't sleep, I can't do anything else, because I can't really see.
Then to top it all off - I think I sprained my pinky toe Monday night.
So now I hurt everywhere and feel like I am just falling apart!

Cymbalta Side Effect?

Sometimes I worry about reading the potential side effects of a medication because then I may experience them simply because I expect them.   Like a placebo - sort of.
But I looked up the side effects of Cymbalta anyway and I saw insomnia.  Well, as you know, my faithful blog reader(s), I am suffering from insomnia.
I have never had heartburn in my life until about a year ago.  And then ONLY when I took a peppermint pill for my tummy.  But for the last two months I've had heartburn quite often.  I tried to identify what it was - was it caffeine, was it chocolate, was it spicy foods?  It almost didn't seem to matter.  I'd get it on an empty stomach.  Everything but water gave me heartburn.
I learned in physiology the difference between all the heartburn medications and which was the weakest and which was the strongest.  So I went to the pharmacy and picked up the strongest heartburn medication available.  It was even a time release one so that it would work all day.  It didn't help.
When I had I looked up side effects of Cymbalta, there it was - heartburn. 

I've been having a most interesting issue with my stomach and esophogus and chest the past month or so.  Whenever I eat (it doesn't matter what, it doesn't matter how much) I get that feeling like something is stuck at the bottom of my esophogus and top of my stomach.  Each swallow - stuck.  I knew that it wasn't, but it was that sort of feeling.  Only this was painful and would radiate up my esophogus giving me pain in my chest.  It would only last a few seconds, but it was very irritating.  Then when I finished eating I'd have this pain that would start at what I imagine to be my esophogeal sphincter and would radiate up my esophogus.  It came in waves and could be quite painful.  It would last 10 or 15 mins after I finished eating.
This weekend I experienced it a few times and my chest hurt so bad I thought for a second - what if this is a heart attack?

This morning, after I ate breakfast, that pain was back - and with a vengeance!  I doubled over, I saw stars, it was hard to breathe, I was in tears and swearing like a sailor!  Each wave just a minute or two apart was excrutiating!  I thought I was going to have to go to the emergency room.  And it lasted nearly two hours!  It slowly subsided after about an hour and fifteen minutes - enough so that I was no longer constantly thinking about where the nearest hospital was. 
I decided that since Cymbalta is quite possibly giving me heartburn, I'd look up the other side effects.  I saw "abdominal (stomach) pain" listed.  Well, that's not exactly informative.  What KIND of stomach pain?  What did it feel like?
I continued my search - this time turning to websites that were not drug specific - and I found a blog that's meant to be a support to those suffering from depression.  It had postings about antidepressant medications and the side effects people had suffered.  One woman posted "Ever since starting Cymbalta several weeks ago I have had horrible heartburn.... There are times when the pain in my chest is just a huge pain in the center of my chest. It gets so bad that I take the Extra Strength Vicodin that is prescribed for my disk degeneration". 
YIKES!
So I called my neurologists PA and told her about my experience and that I wonder if maybe it's from the Cymbalta.  Well, I'm going off Cymbalta immediately to see if this stomach/esophogus problem goes away.

Headache Log: Insomnia

A year ago, I'd fall asleep as soon as my head hit the pillow.  And I'd sleep through most of the night (only getting up once to potty) I'd wake 2 or 3 minutes before my alarm was set to wake me.  I may have a day here or there where I felt a bit tired during the day, but I rarely felt so exhausted I was actually unhappy and depressed.
Now, it takes me 30 minutes to an hour to fall asleep.  (This is what happens on a good night.)  Then I'll wake up every hour to an hour and half.  I'll wake to potty 2 or 3 times (or perhaps its just because I'm already awake that I notice that my bladder feels a little on the full side.)  It will take me several minutes to an hour to fall back to sleep once I'm awake.  When my alarm goes off in the morning I hit snooze for 30-50 minutes before I can finally drag my ass out of bed.  Consequently, and rightly so, I'm exhausted all day long.  Exhausted to the point that I feel depression knocking on my door.
But I want to repeat, this is on a good night. On a bad night, I can't seem to turn my brain off.  The tiniest thing could upset or excite me and I won't sleep.  Sometimes I can't sleep because my head hurts too bad.  And of course the lack of sleep only exacerbates the condition of  my head.  When I finally do fall asleep around 5 AM in the morning, I wake about 2 hours later.  So not even sheer exhaustion can make me sleep longer than 2 hours at a time. 
But caffeine, you are my savior.  Which may be unhealthy and may lead to some of the waking in the middle of the night to potty.

Everyone at work tells me I should try Ambien.  They tell me how wonderful it is and how much it has helped them.  They tell me it allows them to shut off their brain so that they can finally sleep.  They tell me that you never have that drugged and groggy feeling in the morning.  I was also told that it doesn't require 8 hours of sleep - that you can get by on just 7 and still feel wonderful in the morning.

How do I get my hands on such a wonderful product?

Remember my recent story about the doctor who asked me what I wanted  him to get me?  No, he didn't prescribe me Ambien - or any sleeping pill at all.  (Although I kick myself that I didn't try to get some out of him!)
Well, I was relating the story to a friend of mine who's father is a doctor.  And I joked with her and asked her what she could hook me up with. 
"What do you want?"
"Ambien"
And that was it.  Her father called in a prescription for Ambien for me.

WOW!
Now I REALLY feel a bit like a junkie!  But I am sleeping (on the nights that I've dared to take it, anyway).  Still waiting to feel less exhausted during the days.  Maybe that will take weeks. 

P.S. Cymbalta, which I've been on for nearly 2 months now - side effect is insomnia.

Headache Log : Drug Cocktail

Had my follow-up with the neurologist this week.  No hole in my heart, nothing on the MRI of my neck, nothing on the MRI of my brain (except that little pesky white spot).  So where do we go from here? 
Oh, and the good week was a fluke.  Bad weekend following that good week and a headache every single day since then. 
I could happily report that I am now able to focus and concentrate on homework.  (Unless I have a migraine.  But at least we know the Topomax is no longer affecting me.)  And my mood seemed to have improved.  Those were the only happy reports I could give. 
I was sort of hoping for a sleeping pill.  What I got was another anti-depressant that they said would also help me sleep.   And they asked that I start taking my Cymbalta at bedtime instead - perhaps that would help.  Because the headaches are still not gone and in fact, seem to be worse (at least lately) I was also prescribed an additional migraine preventative.  I have to start taking folate and also baby aspirin every morning.
So in an attempt to get rid of my headaches & migraines I now take 5 different pills a day.  Then I have my pill for my tummy. 
Oh, and the only thing that has been giving me any time of relief (excedrin - if the headache is very light) I am not allowed to take any more.  Or rather, I can't take it more than 10 times a month. :(

Lastly, the neurologist has ordered an occipital nerve block.  Not entirely sure what this does, but my understanding is that it will be similar to the Botox shots.  The doctor wants to try and break my body of this headache/migraine cycle.
I'll be getting those shots later in May. 

Physical Therapy ..... One Month In

So this morning was my 7th PT session.  I can't exactly tell if it's working or not.  But I figure as long as it doesn't hurt me, I'll give it time.  My PT says that it's around week 3 that you start to see a difference.  I've seen a slight difference in the intensity of my headaches (knock on wood).  It seems every time I say things are looking up I get a horrible one.   And I have a moderately bad one right this moment.  But is it the PT or the Cymbalta finally kicking in? 
I had some issues with my neck, shoulders, and upper back.  A lot of tightness and tension there.  And a very painful knot on the right side of my neck, just at the base of my skull.   My shoulders still seem really tight and my neck still hurts on occasion, but the painful knot is gone!  So definitely seeing some improvement!  My PT said that he is noticing increased flexibility with my neck as well. 
It's also fun to talk to my PT because he knows that's what I want to be someday.  He knows I've taken anatomy and am currently taking physiology so he uses the proper terms with me.  I enjoy that.

Headache Log : Rose Clinic

So yesterday I went to the Rose Clinic and met with Dr. Rose.  He's the plastic surgeon who does the Botox injections into the nerves to find out if that's the cause of the migraines and then does surgery to relieve the pressure on those nerves and thus relieve the pain.

http://alifeofpayne.blogspot.com/2011/03/headache-log-plastic-surgery.html

He cleared up a lot of questions and concerns I had.  That's not to say that I don't still have a few questions and concerns.  The stabbing pain I get behind my eyes appears to be the result of one of three branches of the trigeminal nerve.  And, of course, the pain in the back of my head is my occipital nerve.  He explained what surgery is performed with each nerve.  I feel a little better about going under the knife if that is, in fact, the route I take. 
He offered me an injection on the spot, but I declined.  I explained that I want to wait and see what results I get back from the cardiologist and the MRA on my neck first.  Also, even though I don't want to be on preventative medication for the rest of my life (or any medication at all!), I'd like to see if the Cymbalta is EVER going to start working.  Two weeks in and I feel no difference yet.

So I may be following up with Dr. Rose in a month.

Of course, I had not been gone from his office more than 20 minutes when the pain intensified and I was wishing I had just gone ahead and gotten a shot.  Just one little tiny shot.   :(

Headache Log : The Train

I started to think the Cymbalta was working.  I don't really know how long it will take to work, I expect several days. But after a weekend with very light and mild headaches I was beginning to see the light at the end of the tunnel.  Then Monday came around and I discovered that light was a train.  And it hit me hard.

I also realize today is my one month anniversary.  I've had this headache for one month straight now. 
(March 14, 2011)

Headache Log : Dr Reichert

"How's your mood been?" Dr Reichert wants to know.  "Have you been depressed?" 

I've had a constant headache since February 14, my mood has not been good.  Of course I've been depressed at times.  It's pretty hard not to get depressed and discouraged. 

Dr. Reichert is just as thorough as his PA.  He has discussed with Paula everything that she and I spoke about and he wants to take me off of Topomax.  He wants to put me on Cymbalta instead.  Cymbalta is an anti-depressant, an SNRI (I actually know what this is!), that is also used to prevent migraines, to treat sufferers of chronic pain, musculoskeletal pain, fibromyalgia, and some forms of neuropathy.  Well, I see little wrong with that - so long as I can stand the side effects.  Paula explains that there are few complaints about the side effects of Cymbalta. 

He also wants to run some blood work to check my hormomes and to see if I have a vitamin D deficiency.  I explain that I just had blood work run by my GI doctor a month ago and my TSH levels were normal.  Ok, hormone level test out, but vitamin D test is still needed. 

And he wants to have an MRI done.  Unlike the MRI done 10 years ago he wants to look at the blood vessels in my head and check my blood flow.  Then he causually throws out a word like embolism.  Yes, EMBOLISM!!! He wants to see if I have an embolism!  Of course I remain as calm as he does. 

Finally, I ask him if he knows anything about occipital neuralgia.  He says he is aware of it.  He'd like to see how I respond to the medication first.  See what the MRI reveals.  And see if the physical therapy helps. 

I leave his office full of optimism.  Almost optimistic enough to cancel my date with the plastic surgeon and the Botox injections - ALMOST.