Treatment options for chest pain depend on the underlying cause. Here’s an overview of various types of chest pain and their corresponding treatment strategies:

1. Cardiac-Related Chest Pain (e.g., Angina, Heart Attack)

• Medications:
• Nitrates: To relax and widen blood vessels, improving blood flow to the heart.
• Aspirin: To reduce blood clotting.
• Beta-blockers: To lower heart rate and blood pressure, reducing heart workload.
• Statins: To lower cholesterol levels.
• ACE inhibitors or ARBs: To lower blood pressure and protect heart function.
• Procedures:
• Angioplasty and Stent Placement: To open blocked arteries.
• Coronary Artery Bypass Surgery: To create a bypass around blocked arteries.
• Lifestyle Changes:
• Diet, exercise, quitting smoking, and managing stress are crucial for long-term management.

2. Gastroesophageal Reflux Disease (GERD)

• Medications:
• Antacids: For immediate relief.
• H2 Blockers: To reduce acid production (e.g., ranitidine, famotidine).
• Proton Pump Inhibitors (PPIs): To block acid production more effectively (e.g., omeprazole, esomeprazole).
• Lifestyle Changes:
• Avoiding trigger foods (e.g., spicy, fatty foods, caffeine, alcohol).
• Eating smaller meals.
• Not lying down immediately after eating.
• Elevating the head of the bed.
• Procedures:
• Surgery (e.g., Nissen fundoplication): For severe cases not responding to medication.

3. Musculoskeletal Chest Pain (e.g., Costochondritis, Muscle Strain)

• Medications:
• NSAIDs: For pain and inflammation (e.g., ibuprofen, naproxen).
• Acetaminophen: For pain relief.
• Therapies:
• Physical Therapy: To strengthen and stretch the muscles.
• Heat/Cooling Pads: To reduce pain and inflammation.
• Lifestyle Changes:
• Avoiding activities that exacerbate pain.
• Practicing good posture.

4. Pulmonary Conditions (e.g., Pulmonary Embolism, Pleuritis, Pneumonia)

• Pulmonary Embolism:
• Anticoagulants: To prevent further clotting (e.g., heparin, warfarin, DOACs like rivaroxaban).
• Thrombolytics: To dissolve existing clots in severe cases.
• Surgery or Catheter Procedures: In life-threatening situations.
• Pleuritis:
• NSAIDs: To reduce pain and inflammation.
• Antibiotics: If caused by bacterial infection.
• Corticosteroids: In some cases, to reduce inflammation.
• Pneumonia:
• Antibiotics: For bacterial infections.
• Antivirals: For viral infections.
• Oxygen Therapy: In severe cases to aid breathing.

5. Panic Attack or Anxiety-Related Chest Pain

• Medications:
• Anxiolytics: Such as benzodiazepines for immediate relief (e.g., alprazolam, lorazepam).
• SSRIs or SNRIs: For long-term management of anxiety (e.g., sertraline, fluoxetine).
• Therapies:
• Cognitive Behavioral Therapy (CBT): To manage anxiety and panic symptoms.
• Lifestyle Changes:
• Stress management techniques like mindfulness, yoga, and regular exercise.

6. Pericarditis

• Medications:
• NSAIDs: To reduce inflammation and pain.
• Colchicine: To reduce inflammation and prevent recurrences.
• Corticosteroids: In severe or refractory cases.
• Procedures:
• Pericardiocentesis: To remove excess fluid around the heart in cases of pericardial effusion.

7. Aortic Dissection

• Emergency Treatment:
• Immediate Surgery: Often required to repair the tear.
• Blood Pressure Control: Using IV medications to lower blood pressure and reduce stress on the aorta.

8. Other Gastrointestinal Causes (e.g., Peptic Ulcer)

• Medications:
• PPIs or H2 Blockers: To reduce stomach acid.
• Antibiotics: If caused by H. pylori infection.
• Lifestyle Changes:
• Avoiding NSAIDs and other irritants.
• Eating smaller, more frequent meals.

9. Herpes Zoster (Shingles)

• Antiviral Medications: To reduce severity and duration (e.g., acyclovir, valacyclovir).
• Pain Management:
• NSAIDs, acetaminophen, or stronger pain medications.
• Topical creams (e.g., capsaicin) or patches (e.g., lidocaine).

Each type of chest pain requires a specific approach to diagnosis and treatment, and it is crucial to consult with a healthcare professional to determine the exact cause and appropriate treatment plan.

My Dad recently switched from Warfarin to Xarelto and developed a bleed in an ulcer and is currently under medical care in a hospital because it developed a bleed.
That is not my question though. I seem to remember steroids having uncertain effects on folks. Some may experience a greater clotting risk while others may experience a greater bleeding risk.
Is there a similar interaction warning for folks on steroids for inflammation as there are for folks taking NSAIDs?
I remember being prescribed methylprednisone for pleurisy and scratched a mosquito bite and it bled like crazy. I have been on Xarelto for almost 8 years and never experienced this kind of surface bleeding until I was on this particular medication.
The drug interactions aren’t very clear here. Am I misremembering the steroid risk with meds like Xarelto?
Edit: Fixed the grammar errors I found. Ha ha!

Hey guys
Sorry for the long post.
I am a 35 yo male with a severe mitral regurgitation with a prospect of surgical mitral valve repair in the next 1-2 years or (I think more likely mitral valve replacement), condition is genetic.
During the last cardiology checkup, my cardiologist was not there as she was ill but there was an internist with whom I discussed the blood results and she mentioned that I might be taking statins after the surgery but of course and that my lipid panel is not ideal, but the decision will be upon my cardiologists.
For the last 5 years, I have been taking ACE-inhibitors (perindopril 2 mg first 2 years, then 4mg last 3 years) + Beta-blockers last 3 years (first year 25 mg metoprolol, then 37.5 mg metoprolol daily). On top of that, I take corticoid sprays for allergy and antihistamines.
My current height is 175 cm (5' 9"), current weight is 77 kg (170 lbs), evolution of my weight: Jan 2020 - 66kg (145 lbs), Jan 2021 - 68 kg (150 lbs), Jan 2022 - 70 kg (154 lbs), Jan 2023 - 75 kg (165 lbs), Jan 2024 - 77 kg (170 lbs). Blood pressure: Till 2022 around 110/70 mm Hg, Last 2 years - around 130/75 mm Hg
​
My blood test results through the years:
https://preview.redd.it/0x63d98sgzlc1.png?width=2499&format=png&auto=webp&s=d9fc356eb800e9b340fccbb316b0f0b06d1e1b3b
To be honest, I'm not really happy about potential "threat" of taking of statins for the rest of my life. I'm afraid that it will solve one problem but will add others (like worsening alergy that is common with statins or nasopharynx inflammation which I fought for years and finally it was solved by tolsils removal in 2018 and special immunology medication every autumn (porc transfer factor) or damaging my liver long term). If possible, I'd like to live to at least 65 years if possible but who knows... My paternal grandma died at the age of 40 (myocard infarction), paternal grandpa of 52 years of lung cancer, my father at the age of 55 (myocardial infarction), my maternal grandpa died at the age of 69 (lung cancer) and maternal grandma of 83 yo of high age.
My biggest problem as of recent years is fatigue due to heart medication to the point that sometimes I've got problems to be functioning well in my daily life. I'm afraid statins will make my fatigue worse and it would be difficult to get out of the loop. And to be honest, if I am to be like a zombie for the rest of my life, I would rather live full life and die sooner. My father was taking them last year before death and it played with his glucose levels somewhat. Plus, I will be taking warfarin (coumadin) for the rest of my life after surgery in case of valve replacement.
My plan is to revert going downhill with LDL by:

1. Getting more physical active - I used to go to the gym regularly, cycle regularly, but since coronavirus period I got more lazy and for the last 1-2 years I have less and less movement and I was at the gym last time maybe half a year ago and last year, I was cycling somewhat less than before. Also, I have been remote at work for the last 2 years and sometimes my only movement most days is from the couch to the bed :-( I also plan to go to the office at least 3x / week on foot (40 min walk: 3.5 km (2.2 miles)
2. Changing the diet: I have been skinny/slim all my life up until 34 yo and then I put on weight quickly so I never restrained my diet. I don't eat neither too unhealthy, neither too healthy - I eat lot of meat, but normally it's chicken, sometimes pork or beef although I do crave fatty things like salami or cheeses or chips :-(. I would try to substitute meats by legumes which I like and more vegetables. Also, I eat relatively a lot of sugar like chocolate bars, 500 ml of soft drinks around 5 times per week etc.

Question: Should I push back to my doctor when it comes to statins and try to change lifestyle and diet first, or just surrender and take potentially life long journey of statins? Is there something else I can try what was not mentioned?
Also, any opinion to anything I wrote welcome
​
​

Hi All, just joined this subreddit to seek insights and support. Quick summary: post pandemic I started having joint inflammation and swelling in my knees, for two years ortho docs thought it's condromalicia patella (weak quads) and later last year in August (2023) - it was diagnosed(mis) as rheumatoid arthritis. The medication started helping with the swelling. Until this February (2024) after a exerting weekend at a concert i fell ill and started coughing blood with fever - turns out my lung arteries had clotted. Fast forward 2 weeks - doctors diagnosed me with Lupus with Secondary APS.
I think the reality of my situation hasn't dawned on me yet. I have been on Antibiotics, Warfarin (5-6 mg) and Immuno Suppressants for the past 2 weeks and as I read & learn more about this condition I grow more concerned.
I am 24, planning to go abroad for my master's education later this year. I love hiking, concerts, travel, I regularly run 10Ks (ran the last one in Nov), I'm a mma enthusiast and was planning to go to Thailand to train Muay Thai. I have always been kind of reckless when it comes to cuts and bruises. And i have always embraced adventure.
Now I'm at a point in life, I'm not even sure if I'll be able to do any of it without endangering my life & bleeding out. I do feel a lil exhausted mentally with these thoughts. My faith keeps me strong tho. (God can't be that unfair)
Any advice, insights, experiences will be appreciated. Thank you for taking the time, hope you have a great day.🙌🏻

About me: LH since Jan 21, POTS, dizziness/balance problems, tinnitus, covid toes, tingling in fingers, stopped sweating, mild gastroparesis, and reflux.
I would like to make a list of substances that can dissolve (fibrin(ogen) amyloid) microclots and improve vascular health. Please feel free to expand it and share your experiences.

1. Triple therapy: dual antiplatelet therapy (DAPT- Clopidogrel 75mg + Aspirin 75mg) once a day, and a direct oral anticoagulant (DOAC- Apixaban) 5mg twice a day
2. Nattokinase / serrapeptase / lumbrokinase (fibrinolytic enzymes)
3. Aspirin
4. Sulodexide (for endothelium regeneration, but also antiplatelet and anticoagulant)
5. Blood thinning supplements (antiplatelet, antiinflammatory): large dose Omega-3, vitamin E
6. Tadalafil, arginine (vascular health, blood flow)
7. Statins (lowering cholesterol, antiinflammatory)
8. Actovegin / solcoseryl (unfortunately it may cause autoimmune problems)
9. Others?

GPT-4 says that: For therapeutic intervention, especially in conditions where the natural fibrinolytic system is overwhelmed or insufficient, several strategies can be employed:

1. Fibrinolytic (Thrombolytic) Therapy: Drugs like alteplase (recombinant tPA), reteplase, and tenecteplase are used in acute settings to dissolve significant blood clots, such as those found in myocardial infarction, ischemic stroke, and pulmonary embolism. These agents act by enhancing the conversion of plasminogen to plasmin, accelerating clot breakdown.
2. Anticoagulants and Antiplatelet Agents: While not directly dissolving clots, these drugs prevent new clot formation and can be adjunctive in managing conditions where microclot formation is a risk. This approach may indirectly support the body's ability to clear existing clots.
3. Direct Oral Anticoagulants (DOACs) and Warfarin: These medications reduce the formation of fibrin by inhibiting the factors that lead to its production, thereby reducing the risk of clot formation.

I haven't heard about those fibrinolytic drugs that seem most effective - from what I read they're more hardcore, given in the case of heart attack, etc.
My experience:

1. Currently I'm taking sulodexide, large dose omega-3, vitamin E (from time to time), tadalafil and arginine. No improvement so far (2 months)
2. I tried taking serrapeptase - after 2 days I felt horrible and had a week-long reactivation of covid toes (painful vascular inflammation in toes)
3. I tried taking nattokinase for 3 months. It immediately worsened all my symptoms - especially dysautonomia - POTS and balance problems. I tried to push but I gave up after 3 months. 3 days after stopping it I got back to my previous state. It was a year ago.
4. I'm considering triple therapy. It seems that I'm missing a Direct Oral Anticoagulant like apixaban in my regimen. My strong reaction to serra and natto made me think that something is up with those microclots. I'm also considering lumbrokinase as I haven't tried it yet. Maybe I should try serra or natto once again (last I took it was a year ago). Btw. it was definitely NOT a histamine reaction (I react totally different to histamine)

Please expand the list and share your experiences! : )
​

My partner is a 62yo male of Mayan/Mexican/Sicilian ancestry. He is HIV+ (undetectable for years), diabetic and on blood thinners due to congestive heart failure. His gall bladder was removed about 15 years ago. He is underweight (5'2" 100lbs), and historically has been very fit and muscular, exercising/lifting daily.
In 2019 he had his first diagnosis of AP and over the course of the last 5 years has been hospitalized multiple times for it. In 2023 he was hospitalized 9 times, usually only for a day or two.
He does not drink at all. He follows a pretty strict diet trying to balance his blood sugar levels while getting enough calories to maintain weight. He takes Pancreaze with every meal, which has helped greatly day-to-day but hasn't prevented the AP attacks which seem to come on every 4-6 weeks.
It seems that every trip to the hospital is different. Sometimes his lipase levels are sky high, sometimes they are not. Sometimes his triglycerides are high, sometimes not. Chemistry panels are almost always normal otherwise. CT scans, in addition to usually showing some inflammation in the pancreas (although not every time), have shown various other issues including pancolitis and bladder distention.
I am pretty convinced that something else is going on which is causing the AP, or mimicking it, other than dietary sensitivity. They have run multiple tests on him, colonoscopy (normal), cancer screens, etc. but I think the doctors are missing something.
Any thoughts or suggestions? The repeated hospitalizations have taken a toll on him and greatly diminished his quality of life. I would love nothing more than to be able to help him at least make them less frequent!
He takes the following medication daily:Lisinopril, Cymbalta, famotidine, Triumeq, gemfibrozil, warfarin, digoxin, carvidelol, humulin

Hi all,
First. Best (health) wishes for you and loved ones, this New year.
A while ago i got severe pain in my left groin, again. Where i had clot, twice. Symptoms alike. Heart palpitations, out of breath, dizziness.
A couple of weeks after hospital stay and possible lingering gallbladder inflammation. I had an INR of 1.6 and due too, feeling very sick.
I am feeling awfully sick for over 2 months now, not able to work, do anything in household. So became more immobile. Ever since i also experience stabbing pain left, towards lungs.
My GP, who has dismissed me with DVT's before, had told me it was impossible to get another thrombosis on INR of 1.6. I had trouble believing. He refused to check it out. Though i had expressed my concerns and wasn't able to visit his practice, due to living alone and extreme sickness.
Eventually groin pain subsided, but it was very scary.
Still very sick and for about 3 weeks now, i noticed my ankles were almost impossible to move after getting out of bed,, while walking of stairs. They are all red and my right DVT leg, got even a dark purple and swollen, from my ankle.. Again excruciating pain, rising to my groin, with same heavy feeling since yesterday night ( i experienced with former clotting events). I can't sleep ever since ankle became purple as the pain, and a heavy itch are unbareable. I can't go upstairs to go to bed, so i sleep on the couch.
I tried to find doctor closer by, multiple times and even contacted insurance, but we have a patient stop around here. And many are overworked.
Recently my mom died of complications of a missed heart attack, which 4 doctors claimed to be stomich acid. And missed necrosis. Years before, she was dismissed with 2nd thrombosis as well.
Unfortunately i've been struggling with health since my 1st DVT. Which ironically got 1 year after an accident. Leg pain went away, untill 2nd time though. Doctor told me cause of leg pain, was unknown, but it's never been investigated. Nor, does he think much about family's clotting history.
He said, i need to take OTC, NSAIDS but i'm also on warfarin.
I'm struggling for breath at the moment and at wits end. It hurts so much. Sorry, for venting.
Love from Holland.

Highly bioavailable curcumin can benefit mitochondrial dysfunction, inflammation, cell signaling, and endothelial function in a few key ways:

1. Mitochondria - As a potent antioxidant and anti-inflammatory agent, curcumin protects mitochondria from oxidative damage, reduces inflammation-induced mitochondrial dysfunction, improves mitochondrial biogenesis, and supports mitochondrial energy production.
2. Inflammation -Inhibition of inflammatory enzymes like COX-2: Curcumin blocks the activity of cyclooxygenase-2 (COX-2), lipoxygenase, and inducible nitric oxide synthase (iNOS), which play major roles in inflammation.Reduction of inflammatory cytokines: Curcumin lowers the production and release of pro-inflammatory cytokines like TNF-alpha, interleukin-1, -2, -6, -8 and -12. This helps reduce inflammation signaling between cells.Curcumin was reported to have antiallergic properties with inhibitory effect on histamine release from mast cells.Curcumin can inhibit NLRP3 inflammasome activation and downstream inflammatory cytokines. (which is seen in Long Covid caused mito dysfunction)
3. Cell signaling - Curcumin has been shown to beneficially modulate cell signaling pathways related to inflammation (NF-kB, TNF-α), antioxidant response (Nrf2), apoptosis (p53), and cell adaptation/survival (mTOR).Suppression of NF-kB activation: NF-kB is a key inflammation-regulating transcription factor. Curcumin inhibits its activation and translocation to the cell nucleus, thereby reducing downstream inflammatory gene expression.
4. Endothelial function - Curcumin boosts endothelial nitric oxide production which relaxes blood vessels, increases vasodilation and blood flow, and reduces endothelial inflammation for better cardiovascular function.

Absorption
Curcumin has a bad bioavailability of 1%. With peperine this increases to 2%. So if you want to use it for therapeutic uses, you need to use a custom high bioavailable solution, like the following:

• https://www.amazon.com/Terry-Naturally-Powerful-Turmeric-Softgels/dp/B00EEEGEGM?th=1
• https://www.amazon.nl/gp/product/B08NFBXDGC/ref=ox_sc_act_title_4
• https://www.amazon.nl/Vitals-Curcumine-Particles-biologische-beschikbaarheid/dp/B07XYVQX73/

Omega 3 fatty acids (EPA/DHA)
Studies have shown that taking curcumin along with omega-3 fatty acids, especially DHA and EPA, can significantly increase plasma levels of curcumin by up 4-7 fold compared to curcumin alone.
Not only that, Omega 3 EPA/DHA are also highly potent in reducing inflammation on it's own.
Omega-3s from fish oil can inhibit substance P binding to NK-1 receptors. They also reduce production of inflammatory prostaglandins, thromboxanes and leukotrienes. It lowers levels of key inflammatory cytokines like TNF-alpha, IL-1beta, IL-6, etc.
https://pharmd.substack.com/p/high-dose-epa-for-long-covid-and?sd=pf
When considering, please DO read the above article.
Medicine interactions
Here are some of the major known interactions of curcumin with medications and other supplements:
• Blood thinners - Curcumin may increase the risk of bleeding when taken with anticoagulant and antiplatelet drugs like warfarin, aspirin, clopidogrel due to having additive blood thinning effects.
• Diabetes medications - Curcumin may enhance the glucose lowering effects of diabetes drugs like metformin and glyburide, increasing the risk of hypoglycemia.
• Non-steroidal anti-inflammatories (NSAIDs) - Curcumin also has anti-inflammatory effects, so concurrent use with NSAIDs like ibuprofen may amplify effects.
• CYP3A4 substrates - Curcumin may inhibit the CYP3A4 liver enzyme used to metabolize many drugs, leading to higher medication levels and more side effects. CYP3A4 metabolizes/breaks down over 50% of drugs that the body processes. This includes things like statins, calcium channel blockers, immunosuppressants, antihistamines, etc. It's part of the detox pathway.
• Antidepressants - Curcumin may boost levels of serotonin and dopamine, so it may further increase neurotransmitter levels if combined with SSRI antidepressants.
• Immune suppressants - Due to effects on immune cell signaling, curcumin may potentially reduce efficacy of immunosuppressant drugs like cyclosporine.
More research is still needed on many potential interactions. Those on multiple medications should exercise caution with curcumin supplements and inform their healthcare provider of use. Starting slow at lower doses can help assess tolerance.
Supplements / Herb Interactions
There are also some supplement interactions.
Avoid using together with other herbal/health supplements that can also affect blood-clotting. This includes angelica (dong quai), capsicum, clove, dandelion, danshen, evening primrose, garlic, ginger, ginkgo, horse chestnut, Panax ginseng, poplar, red clover, saw palmetto, and willow.
Avoid using together with other herbal/health supplements that can lower blood sugar, such as alpha-lipoic acid, chromium, damiana, devil's claw, fenugreek, garlic, guar gum, horse chestnut, Panax ginseng, psyllium, Siberian ginseng, and others.
Boron
Boron has some good effects for people dealing with Long Covid. There are some encouraging results in the following research on covid: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8837486/
However boron also increases the antiviral capabilities of curcumin, as seen here: https://www.researchgate.net/publication/350680757_Letter_to_the_Editor_Boron_enhances_the_antiviral_activity_of_the_curcumin_against_SARS-CoV-2
Do any of you have any experience with high bioavailable curcumin and did it do anything for you? It seems as a real potent substance with the issues Long Covid deals with.
A lot on the following mitochondria dysfunction, curcumin can deal with: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10179190/

We love being around plants for their ability to refresh the air and calm our minds. We also grow herbs in our kitchens to garnish our cuisines and prove our cookery skills to friends and family.
But did you know that there are plants that have medicinal value and work wonders in healing your body?
Well, medicinal plants have been used for centuries as a remedy to various ailments. The good news is that you can grow your medical herbs at home to enhance your family’s health all year round. Additionally, due to their growing demand in the beauty and medical industries, you can grow them in large quantities as a business.
Here are 11 medical herbs that can be a great addition to your garden.

1. Medical cannabis

Cannabis contains about 40% of cannabinoids (CBD), a compound thought to have anti-inflammatory effects on the brain. For this reason, medical cannabis is prescribed as a remedy for various ailments. For starters, cannabis has been used in pain management for conditions such as arthritis, endometriosis and reducing the side effects of cancer treatment. It also helps reduce inflammation in conditions such as rheumatoid arthritis and Crohn’s disease, among others. Additionally, this medical plant works well in sleep management as well as in neurological and mental disorders.
However, cannabis has been considered illegal for the longest time. It is essential to ensure that growing it is legal in your area. You are better off working with a cannabis consulting firm to get advice on anything you would like to know about growing cannabis.
​

2. Aloe Vera

Aloe vera can be grown inside for aesthetic appeal, but it is the clear gel found in its leaves that makes it a medical herb. This gel has soothing, cooling, and moisturizing effects that make it suitable for healing burns, treating acne, and promoting healing in anal fissures. It also has properties for improving oral hygiene and fighting plaque, making it a common ingredient in oral hygiene products. Another great medicinal value for this plant is in improving digestive health. Adding a few drops in food and fruit juices can help heal stomach ailments such as irritable bowel syndrome.
Aloe vera thrives in bright light; give it a south-facing window when growing it indoors. However, be careful to over-water it as it retains moisture.

3. Calendula

Calendula has bright orange flowers that can make a great addition to any home. But don’t let the sunshine flowers fool you. They are bursting with medicinal wonders inside. For centuries, this plant has been used to heal rashes, wounds, and burns. The edible ray florets have antioxidant compounds that reduce the risk of heart disease and some types of cancer. Additionally, this herb has been used in lifting the spirits and enhancing the immune system.
Calendula loves soil that doesn’t dry out quickly or stay wet for a long time. It also blossoms in bright sunlight. The good thing is that it can also tolerate some shade. If you live in a place where winters are a bit warm, Calendula will do just fine in that season. If you want to create your big healing garden and start a business with plant cultivation, Calendula is the first choice you should start with. If you have trouble with managing your premises, then call for help from a property management company.
​

4. Ginger

Ginger is great in tea, especially in the monsoon season. Besides keeping you warm, ginger has a ton of other medical benefits to your body. It has properties that make it an excellent antioxidant, antibacterial and antiviral herb. It also has anti-inflammatory properties, best for healing joint pains, and juice that enhances the digestive process. If you get used to consuming ginger, you will be reducing the risk of contracting diseases such as diabetes, cancer, and asthma.
Being a tropical plant, ginger loves warm weather, filtered sunlight, and rich, moist soil, but not soggy or waterlogged. It also loves humidity; you might need to mist it regularly.
​

5. Lavender

Lavender is ubiquitous in cosmetic products such as soaps, oils, and perfumes for its soothing fragrance. Besides this, the beautiful smell works as an antidepressant to treat diseases such as insomnia, anxiety, and stress. It also treats headaches and can ease itchiness on the scalp, and make the skin glow. This plant is also known for its antiviral and antibacterial properties.
Growing lavender indoors is a natural way to add a beautiful scent to your indoors. Just be sure to pot it in quick-draining soil. Additionally, place it in a south-facing window as it loves adequate sunlight. You can also use led grow lights to help you develop all these plants indoors since you can customize the necessary color and shade.
​

6. Chamomile

Chamomile is considered to be one of the cure-all herbs. It is commonly used in America for the treatment of anxiety and depression. This herb is also used in Europe for wound healing and for decreasing swelling and inflammation. Some of the studies have looked into the benefits of Chamomile for all conditions. It is also used as a tea and can be applied as a compress. The FDA regards the herb as safe.
The plant might raise drowsiness that is caused by other herbs, medicines, or supplements. This herb can be utilized topically or for your skin to treat skin irritation and even during radiation therapies for cancer. It is available in capsule format as well that is used for controlling vomiting at the time of chemo.
​

7. Echinacea

Echinacea leaf is typically used for treating flu, cold, wound healing, and other infections. Several studies considered how well the Echinacea worked for prevention or shortening the spell of cold, although none of the results were conclusive. However, many other studies do show the advantages of using this herb for treating upper respiratory infections. You are advised to use this herb medicinally for shorter terms because some researchers have indicated that long-term use may affect your body’s immune system. It is a good idea to consider the opinion of your healthcare provider regarding any medicine you are consuming. Some people that are allergic to plants from daisy families are likely to have allergic reactions to the Echinacea. Some of these daisy families include marigolds, ragweed, and daisies.
​

8. Garlic

Garlic is a root and it is utilized all across the world for cooking and its several medicinal properties. Some of the compounds developed from garlic have been established to have cardioprotective, antimicrobial, anti-inflammatory, and anticancer properties. These properties possessed by garlic might have played a significant role in developing the widespread belief that garlic helps blood pressure and lower cholesterol. However, the clinical evidence obtained as a result of the research is conflicting. FDA regards the use of garlic as entirely safe, although it may raise the possibility of bleeding. It should never be used together with blood thinners and warfarin. Due to the same reason, a large amount of garlic should not be consumed before surgeries and dental procedures.
​

9. Feverfew

Feverfew is a leaf that was conventionally used in the treatment of fever. Nowadays, it is commonly utilized for preventing migraines and treating arthritis. However, some researches have indicated that specific feverfew blends can stop migraines. However, some side effects, such as mouth ulcers and digestive irritations, when these leaves are chewed.
Some people that suddenly stopped the use of feverfew they were using for treating migraines found out that their headaches returned. Feverfew cannot be utilized together with anti-inflammatory non-steroidal medicine as these medicines can affect the way feverfew works. The leaf should not be used together with warfarin either and not with anticoagulant medicine.
​

10. Gingko

The Gingko leaf extracts have been used to treat a range of conditions such as bronchitis, asthma, tinnitus, and fatigue. The leaf is also utilized for improving your memory and prevents dementia apart from several other brain disorders. Several studies have come forward supporting the slight effectiveness of Gingko.
However, exactly how the herb works is still not clearly understood. Just the extracts from Gingko leaves have to be used for the treatment. Remember, the seeds contain Ginkgo toxin that may cause seizures and lead to death in several cases. As some of the available info suggests that Gingko may raise the risks involved in bleeding, you are better off not using the herb together with anti-inflammatory or non-steroidal medicine. It is a good idea to avoid it with anticonvulsant medication, anticoagulants, or tricyclic antidepressants.
​

11. Saw palmetto

Saw palmetto is utilized for treating urine-related symptoms developed due to benign prostatic hypertrophy or BPH. However, more recent research has not substantiated the effectiveness of saw palmetto for this condition. The side effects involved are a mild headache and digestive upsets.
​

Summing-up

There are plenty of herbs that you can grow at home for their medical properties. The above listed give you an excellent place to start if you are yet to include herbs in your garden. However, it is good to do your research on the plants you plan to grow to ensure that you are equipped with all the necessary information for healthy growth.
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Source

ECA Stack - Dopamine Enhancing Routine/Cycle
ECA, which stands for Ephedrine, Caffeine, and Aspirin, is a combination of these three compounds commonly used for its potential synergistic effects on fat loss and neural stimulation. Avoid the use of Ephedrine if at all possible, if you do decide to use it, please do additional research and talk to a professional before you make the decision. Caffeine alone should suffice, and with the techniques outlined below the natural dopamine production will be much more beneficial, maintainable and with far fewer risks or side effects.
ECA Stack – Dopamine / Energy Level Boosting Effects
The ECA stack is a combination of ephedrine, caffeine, and aspirin that is often used as a dietary supplement or performance-enhancing aid. It is named after the initials of its components. The stack is believed to promote weight loss, enhance energy levels, and improve athletic performance. Let's take a closer look at each component and their effects, particularly in relation to dopamine.
Ephedrine, a sympathomimetic amine, acts as a stimulant and bronchodilator. It affects various neurotransmitters in the brain, including dopamine. Ephedrine increases dopamine release by acting as a substrate for the dopamine transporter (DAT) protein. It competes with dopamine for uptake by the DAT, resulting in increased dopamine levels in the synapse and prolonging its effects. Additionally, ephedrine can stimulate dopamine release by activating adrenergic receptors and promoting the release of dopamine from the presynaptic neuron. The increased dopamine levels can lead to increased alertness, enhanced mood, and potential euphoria.
Caffeine, a naturally occurring stimulant, is known for its effects on alertness and wakefulness. It primarily works by blocking adenosine receptors in the brain, which inhibits the sleep-promoting effects of adenosine. This blockade indirectly affects dopamine levels by reducing the inhibitory effect of adenosine on dopamine release. Consequently, caffeine increases dopamine release in certain brain regions, leading to heightened arousal, improved mood, and enhanced cognitive function. However, it's important to note that caffeine's effects on dopamine are relatively mild compared to drugs that directly target dopamine receptors and transporters.
Aspirin, a nonsteroidal anti-inflammatory drug (NSAID), primarily acts on the prostaglandin pathway and has analgesic and anti-inflammatory properties. While aspirin does not directly interact with dopamine receptors or transporters, it can indirectly influence dopamine levels through its effects on other neurotransmitter systems. For instance, by inhibiting prostaglandin production and reducing inflammation, aspirin may indirectly impact dopamine signaling. Additionally, the relief of pain achieved through aspirin's analgesic properties can affect dopamine release and potentially influence mood and motivation.
The ECA stack, as a combination of ephedrine, caffeine, and aspirin, is believed to work synergistically to enhance its effects. Ephedrine and caffeine can both increase dopamine levels, resulting in increased alertness, improved mood, and heightened energy. Aspirin, while not directly affecting dopamine, can indirectly support dopamine function by reducing inflammation and promoting comfort.
Interactions with other Medication

1. Blood Pressure Medications: Ephedrine and caffeine can both increase blood pressure and heart rate. If you are taking medications for high blood pressure, such as beta-blockers or calcium channel blockers, combining them with the ECA stack may interfere with the effectiveness of these medications or lead to excessive cardiovascular stimulation.
2. Stimulant Medications: The combination of ephedrine and caffeine in the ECA stack can have stimulant effects on the central nervous system. If you are taking other stimulant medications, such as amphetamines or methylphenidate, combining them with the ECA stack may increase the risk of side effects, such as increased heart rate, elevated blood pressure, and nervousness.
3. Antidepressants: Some antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs), can affect the metabolism and clearance of ephedrine and caffeine. Combining these medications with the ECA stack may increase the risk of adverse effects, including serotonin syndrome, high blood pressure, and rapid heart rate.
4. Anticoagulants/Antiplatelet Medications: Aspirin, one component of the ECA stack, is an antiplatelet medication that can thin the blood and increase the risk of bleeding. Combining aspirin with other anticoagulant or antiplatelet medications, such as warfarin or clopidogrel, may potentiate the blood-thinning effects and increase the risk of bleeding complications.
5. Thyroid Medications: Ephedrine, a sympathomimetic amine, can potentially interact with thyroid medications, such as levothyroxine. Ephedrine may increase the release of thyroid hormones or interfere with their metabolism, leading to altered thyroid function and potential side effects.

Suggested Routine to naturally boost dopamine levels
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1. Morning:

• Start the day with 30 minutes of moderate-intensity exercise, such as a brisk walk or a workout routine. This can help increase dopamine levels and promote overall well-being.
• Consume a balanced breakfast that includes foods rich in tyrosine, such as eggs, lean meats, or legumes. Include fruits or vegetables for added antioxidants.

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1. Daytime:

• Throughout the day, practice stress management techniques whenever needed. Take short breaks to engage in deep breathing exercises, meditation, or mindfulness to reduce stress levels and support dopamine balance.
• Stay hydrated and consider replacing caffeinated beverages with herbal tea or water.

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1. Afternoon:

• Take a break for creative activities or hobbies that bring you joy. This can include listening to music, painting, writing, or engaging in any other creative pursuits that stimulate dopamine release.

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1. Evening:

• Allocate time for socializing with friends or loved ones. Plan activities like going for a walk together, having a meal, or engaging in meaningful conversations that promote positive social interactions and support dopamine levels.

1. Night:

• Before bedtime, create a calm and conducive environment for quality sleep. Establish a regular sleep schedule and aim for 7-9 hours of uninterrupted sleep. Avoid the use of caffeine or ephedrine in the evening, as they may interfere with sleep quality and dopamine regulation.

Dopamine Enhancing Dietary Overview
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1. Proteins: Foods rich in proteins provide the necessary building blocks for dopamine synthesis. Include lean meats, poultry, fish, eggs, tofu, legumes, and dairy products in your diet.
2. Tyrosine-rich foods: Tyrosine is an amino acid involved in dopamine synthesis. Foods such as almonds, avocados, bananas, eggs, chicken, and turkey are good sources of tyrosine.
3. Leafy greens: Dark leafy greens like spinach, kale, and collard greens contain high levels of folate. Folate is important for neurotransmitter synthesis, including dopamine.
4. Fruits and vegetables: Berries, particularly blueberries, are rich in antioxidants and may have neuroprotective effects, promoting brain health. Other fruits and vegetables, such as oranges, tomatoes, and bell peppers, provide essential vitamins and minerals that support dopamine function.
5. Nuts and seeds: Almonds, walnuts, flaxseeds, and chia seeds are rich in nutrients like magnesium, zinc, and omega-3 fatty acids, which are beneficial for brain health and neurotransmitter function.
6. Dark chocolate: Dark chocolate contains compounds like flavonoids and phenylethylamine (PEA), which may help enhance mood and support dopamine release. Choose dark chocolate with a high cocoa content (70% or higher) and consume in moderation.
7. Green tea: Green tea contains an amino acid called L-theanine, which has been shown to have a positive impact on dopamine levels and brain function. It can promote relaxation while enhancing alertness.
8. Turmeric: Turmeric contains curcumin, a compound known for its anti-inflammatory and antioxidant properties. It may help protect dopamine-producing neurons and support overall brain health.
9. Probiotic-rich foods: Emerging research suggests a link between gut health and dopamine production. Including fermented foods like yogurt, sauerkraut, kimchi, and kefir in your diet can support a healthy gut microbiome, which may indirectly influence dopamine levels.
10. Water: Staying hydrated is essential for optimal brain function, including neurotransmitter synthesis and release. Make sure to drink an adequate amount of water throughout the day.

Several vitamins play a role in the synthesis, regulation, and function of dopamine in the brain.
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1. Vitamin B6 (Pyridoxine): Vitamin B6 is involved in the conversion of the amino acid L-tyrosine into dopamine. It is a co-factor for the enzyme aromatic L-amino acid decarboxylase, which helps convert L-tyrosine to L-DOPA, a precursor of dopamine.
2. Vitamin B9 (Folate): Folate is important for the synthesis and metabolism of neurotransmitters, including dopamine. It participates in the conversion of L-DOPA to dopamine through its role in one-carbon metabolism.
3. Vitamin B12 (Cobalamin): Vitamin B12 is involved in the formation of myelin sheaths, which protect nerve cells, including dopaminergic neurons. It also plays a role in the synthesis and maintenance of neurotransmitters, including dopamine.
4. Vitamin D: Vitamin D receptors are found in various brain regions, including those involved in dopamine synthesis and regulation. Vitamin D deficiency has been linked to altered dopamine signaling and neurotransmission.
5. Vitamin C: Vitamin C is an antioxidant that helps protect dopamine neurons from oxidative stress. It is involved in the biosynthesis of dopamine by acting as a cofactor for the enzyme dopamine β-hydroxylase.
6. Vitamin E: Vitamin E is an antioxidant that protects dopamine neurons from oxidative damage. It helps maintain the integrity and function of dopaminergic neurons.

Other Considerations: Enhance and Maintain dopamine levels
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1. Regular exercise: Engaging in aerobic exercises like running, swimming, or cycling can stimulate dopamine release and promote overall brain health. Aim for at least 30 minutes of moderate-intensity exercise most days of the week.
2. Get enough sleep: Quality sleep is essential for proper neurotransmitter function, including dopamine regulation. Aim for 7-9 hours of uninterrupted sleep each night to support optimal brain health.
3. Manage stress: Chronic stress can negatively impact dopamine levels. Explore stress-reducing techniques such as meditation, deep breathing exercises, yoga, or engaging in hobbies and activities you enjoy.
4. Listen to music: Listening to music you love can induce pleasure and increase dopamine release. Choose music that uplifts your mood and makes you feel good.
5. Set and achieve goals: Accomplishing goals, both big and small, can activate the brain's reward pathways and boost dopamine levels. Break larger goals into smaller, achievable tasks to experience a sense of accomplishment along the way.
6. Practice mindfulness: Mindfulness exercises, such as meditation or mindful breathing, can help improve dopamine receptor sensitivity and enhance overall well-being.
7. Spend time in nature: Being in nature has been shown to have a positive impact on mood and overall brain health. Take walks in green spaces, go hiking, or simply spend time outdoors to potentially increase dopamine levels.
8. Socialize and connect: Engaging in meaningful social interactions, spending time with loved ones, and nurturing relationships can stimulate dopamine release and promote feelings of happiness and well-being.
9. Seek pleasurable experiences: Engage in activities that bring you joy and pleasure, whether it's playing a musical instrument, dancing, painting, or engaging in hobbies you are passionate about. Enjoying pleasurable experiences can enhance dopamine release.
10. Limit excessive dopamine-depleting behaviors: Certain behaviors like excessive consumption of alcohol, drug use, and excessive gambling can deplete dopamine levels over time. Moderation and balance are key.

Combating Weight Loss (If Needed)
While there are numerous meal replacement brands available worldwide, here are 10 well-known and popular brands that offer carb-intensive meal replacement options:
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1. Soylent: Soylent offers a range of meal replacement products, including their original formula, which provides a balanced mix of carbohydrates, proteins, and fats.
2. Huel: Huel offers complete meal replacements in powder form, with options that include a significant amount of carbohydrates, sourced from oats and other ingredients.
3. Ample: Ample provides meal replacement shakes made from real food ingredients, including carbohydrates from sources like oats, sweet potato, and tapioca.
4. Garden of Life: Garden of Life offers meal replacement powders and shakes that are rich in carbohydrates, often derived from organic whole food sources like oats, quinoa, and fruits.
5. Orgain: Orgain produces organic meal replacement shakes that contain carbohydrates from ingredients such as brown rice, fruits, and vegetables.
6. Kate Farms: Kate Farms offers plant-based meal replacement shakes that provide a balance of macronutrients, including carbohydrates from organic pea protein and brown rice.
7. Vega: Vega offers a range of plant-based meal replacement shakes and powders that contain carbohydrates from sources like organic sprouted brown rice and organic quinoa.
8. Ensure: Ensure is a well-known brand that offers meal replacement shakes designed for nutrition and energy, with carbohydrate-rich options available.
9. SlimFast: SlimFast offers a variety of meal replacement shakes and bars, including carb-conscious options that provide a controlled amount of carbohydrates for those watching their carb intake.
10. Atkins: While primarily known for their low-carb products, Atkins also offers meal replacement shakes and bars with a focus on controlled carbohydrate intake.

English is my first and only language. It is difficult to type with one hand, so please excuse errors. All names were changed to protect the innocent ,
My neighbor has 3 large dogs - 2F 1M 40-60 pounds. The male is named Rover.
The neighbors are in their approximately mid-30s – Jane and George.
My wife, Linda, is 71 and mobility impaired. She must use a cane and occasionally a mobility scooter.
Our son is Bill age mid 30s.
I am 69. I have had my left knee and both shoulders replaced. I have also had surgery on both hips and right knee. I am on anticoagulants (Warfarin).
We have some smaller dogs 8-10 pounds. Our backyard is completely fenced with chain link and has an active hot wire approximately 6 inches above ground level within the perimeter of the fence.
Past Issues
When George and Jane moved in, the backyard was only fenced on three sides. The back section was unfenced.
1) Linda was in our Driveway. Rover aggressively charged Linda. Rover was restrained by George.
2) George was showing off Rover to Bill. Rover snapped at Bill. No damage, Rover restrained by George,
3) I was in our driveway. All three dogs surrounded me. Two females behind me and Rover in front of me. Rover repeatedly butted into my legs. Fortunately I had a piece of pipe in my hand and was able to repel his attack. Eventually he relented and all three dogs returned to their yard. George and Jane were notified. George stated that I should take any actions required to defend myself.
4) I was in our driveway with a small dog on a leash. Rover charged us. Rover was fended off by my walking staff. George and Jane were notified. George reiterated that I should take any actions required to defend myself.
5) Fence was rebuilt to enclose George and Jane’s entire yard.
6) One of the females pushed through the gate and wandered into my driveway. I told her to go home and she ran down the fence line and out of my sight. She immediately reappeared in the fenced area leading me to believe there are a minimum of two weak areas in the fence. I informed Jane so actions could be taken to protect the animals as we live on a busy street.
DATE
On DATE, I was bringing my garbage can from the curb to my garage via my driveway. Rover pushed through the gate and hit my leg causing me to stumble but not fall. Rover then jumped up, latched onto my right hand, and held on. Yes, it hurt and I am right-handed.
George was in his garage, rushed out, got the dog off me, and secured the dog in his house. I said I required emergency room care. He stated he would take me. He went to his house to get his car keys. I went to my house, wrapped my hand in paper towels, and had my wife retrieve my ID. My wife is mobility challenged so I told her George would transport me to the ER.
When I returned to the driveway, George and Jane were there. Jane wrapped my hand in a bath towel (due to the Warfarin there was a lot of bleeding). I was transported to the University Hospital ER, on Main Street, The ER treated me to the extent of their abilities (this is a free-standing adjunct neighborhood ER). The ER had me transported to the main trauma center via ambulance.
At the hospital, I was further treated and then taken to surgery as I had a displaced fracture in my hand. After surgery, I was admitted to the hospital for approximately 24 hours where I was on a regimen of observation, IV antibiotics, and pain relief. I was discharged with prescriptions for additional antibiotics and pain medications. George and Jane came to the hospital to transport me home and we stopped at Pharmacy to pick up my prescriptions.
Amoxicillin and clavulanate potassium tablets
Oxycodone hydrochloride and acetaminophen tablets
DATE + 6 days
Trip to Pharmacy to pick up ondansetron tablets
DATE + 7 days
Never having heard from My County Animal Control, I drove to their office. I talked to Ron England. Mr. England explained they had no record of the dog bite incident. He also explained that University Hospital is legally obligated to file an animal bite incident report. Mr. England also contacted Ms. Smith at the My County Health Department to verify if a report had been filed. There was no record of the report.
I proceeded to the University Hospital emergency room and requested to speak to a patient advocate. After being informed that the facility had no patient advocate, I spoke to the charge nurse, Edith Jones. Ms. Jones investigated and found that the report was never filed. Ms. Jones interviewed me and assured me the report would be filed.
DATE + 10
Visit to University Hospital Orthopedic Clinic. Examination, X-rays, and bandage change. Due to inflammation around the puncture wounds, another anti-infective was added to my medication regimen. Appointment made to return on DATE + 14 for further evaluation.
Ms. Smith, from the My County Health Department, contacted me about the incident. I told her what occurred. She requested contact info for George and Jane. I gave her Jane’s phone number.
DATE + 11
Trip to Pharmacy to pick up sulfamethoxazole and trimethoprim tablets
Current Situation DATE + 12
I am now at home but my activities are limited as my hand is heavily bandaged and I was instructed not to use my right hand. As I am somewhat of a caregiver for my wife, she is also affected by my limitations. My hand will be immobilized for 6-8 weeks. I will require multiple medical visits during that time and probably weeks of Physical Therapy afterward.
At this point, I do not know what my out-of-pocket expenses will be for insurance deductibles, mileage for medical visits, medications, and who knows what else. I do not know if there is any permanent damage or scarring to my hand.
At the present time, I fear for the safety of my wife and grandchildren in my yard as well as my own trepidation of being attacked again.
I also am experiencing the side effects of the medication.
Should I contact a lawyer? Is this sufficient for legal action against Jane and George?

Since the onset of my Afib in May of 2021 I’ve done a ton of research on every aspect of it. I’ve been on Diltiazem which had no effect, Sotalol which also had no effect and the side effects were debilitating. One dose of Eliquis thinned my blood so much I bled for an hour after they took my IV out on my first ER visit. I literally bled all over my clothes and my car driving home. Within 12 hours I had 2 inch dark red patches on both arms. They put me on Warfarin instead. Now I’m on 100 mg of Flecainide twice a day and in AFib every other day. Aside from my weight AFib is my only health issue.
In the meantime medical providers have billed me and my insurance over $50,000 for treatment that hasn’t worked while their level of compassion and empathy is nonexistent. No ablations, no cardioversions, just 2 ER visits. I’ve read just about everything I can get my hands on regarding ablation and that’s not looking good either. Too many people have to have multiple ablations, too many side effects and poor outcomes for my comfort, and studies show that the older you are the less effective they are. I won’t put myself through that. I‘ve had every test available on my heart and there’s absolutely nothing wrong with it. My heart rate never goes over 110. My CHADS2 score is 1 so I have a 3% chance of having a stroke.
My Afib was most likely caused by obesity as I am an emotional eater and 65 pounds overweight. I eat a lot of nutritious foods now and walk every day but the weight is coming off very slowly because I am insulin resistant, but not diabetic. I bought my own blood tests to confirm that because no doctor would order that or C Reactive Protein so I could determine the level of inflammation in my body. It’s pretty high. All this medication, doctor visits, constant INR checks and billing have had no effect whatsoever so what am I doing here? I have to seriously consider next steps. Thank you for coming to my Ted talk.
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Hi. I’m posting this to multiple subreddits because I’m desperate for any advice or help.
Just some background info: I’m a 23 year old female diagnosed with SLE/Lupus and Antiphospholipid syndrome. The latter I got diagnosed with in 2021 after I had a small pulmonary embolism in August of 2020, and the former I got diagnosed with fairly recently in October of 2022, about a year ago, where I got admitted to the hospital with peritonitis and pleurisy. I’ve also had open heart surgery in November of 2022 to remove a blood clot in my heart.
A lot already, I know.
In regards to medication they started me on Warfarin, which I calculate the dose by measuring INR once a week. I also started 20 mg of prednisolone for the inflammation (and a PPI to pair, replaced with a different antiacid), which now has been tapered down to 5mgs. Additionally I started taking Hydroxychloroquine/Plaquenil in late November.
I wanna state that I have never been the kind of person to be “prone to” nausea. I’ve never had any issues with nausea before this all started, but I do have emetophobia.
Anyways, to the actual issue
I’m gonna try to explain this in a way that makes sense, but there’s a lot of factors to bring in, so if anything doesn’t make sense, please let me clarify.
In January/February of 2023 I started getting what at first was a sort of chronic constant nausea. It seemed like it was triggered by some kind of stomach bug, possibly norovirus, or something similar. I got sick on January 11th with diarrhea and vomiting, which both stopped after about 12 hours. The nausea went away for a day or two but returned soon after. I was stuck with this nausea for about a week, until I called my doctor and got prescribed metoclopramide for it. She claimed it must’ve just been leftover symptoms from the stomach virus I had previously.
I was nausea free for about 4 weeks, when it made its return in mid-February. I tried just waiting it out again but it really didn’t wanna leave. Up to this point the nausea had been pretty consistently bad and could usually be removed with the metoclopramide. But now it could act almost like “bouts” or “waves” of nausea which sometimes ended up with me dry heaving and gagging, but not actually throwing up. This is also sometimes accompanied with gut problems like “loose stool” and mild stomach cramps, though not always. It ended it switching between the “consistent constant” nausea and the “waves” for a few weeks. I also started having issues with becoming nauseous in my sleep, and I’d wake up, usually early in the morning (between 6-8 am) nauseous. This still happens some nights.
In early April it got so bad, and I got desperate enough to contact my rheumatologist and ask to stop taking the Plaquenil/HCQ, because I’d read that for some people it causes extreme nausea and other stomach and gut issues. She agreed. I stopped taking it in the first week of April.
Over the summer I’ve gotten slowly “better”. But it feels like I’m stuck in this horrible cycle of “feeling better with only manageable nausea for two or three weeks then feeling terrible again for a week or two”. For example, I got a horrible setback in the beginning of August where I was stuck in my room feeling horrible for a week. And then another setback in mid-September. I don’t know if it could be related, but I’ve noticed that it tends to get worse right before, and during my period. Though I don’t think my period is in any way the cause of the nausea. I have noticed, like I said, that it tends to make the symptoms worse though.
I’ve been in and out of the doctor's office more times than I can count. I’ve had multiple sets of bloodwork done. Everything has looked fine. We even tested for food allergies and such. I’ve also done stool tests. In June I had a gastroscopy done (camera down my throat to look at my stomach and esophagus), which also looked fine. I’m now waiting to get tested for gastroparesis, though I have a feeling this test will also come back normal.
This nausea is very unpredictable, and can come on suddenly, hitting me like a truck. As to what triggers the nausea? Sometimes it can be eating, sometimes not eating, sometimes exercise, sometimes anxiety, sometimes nothing. Anything and nothing at all.
Because of this I’ve basically been unable to live my life for the last 8-9 months. Even longer if you count my surgery and lupus flare up. I’ve missed so much, even my own nephew’s christening. I’ve been prescribed numerous antiemetics. These are metoclopramide, Zofran, Phenergan and Prochlorperazine. Sometimes they work, sometimes they don’t. So, I can’t really rely on them to “save me” if I’m out in public. I’ve also tried ginger tea, ginger candies, raw ginger, etc. without much success. Because of all this it’s almost like I've developed some kind of anxiety and Agoraphobia (in addition to already having emetophobia), where I’m scared of entering situations that I can’t easily escape in case of triggering an episode of nausea. This could be going in public, visiting friends, attending events, going to work, etc.
I’m extremely depressed. It feels like my life is over. I have no idea what to do. I cry a lot, and I feel trapped in my own body.
Does anyone have any idea what the cause of this could be? I’d appriciate any advice.

Hi. I’m posting this to multiple subreddits because I’m desperate for any advice or help.
Just some background info: I’m a 23 year old female diagnosed with SLE/Lupus and Antiphospholipid syndrome. The latter I got diagnosed with in 2021 after I had a small pulmonary embolism in August of 2020, and the former I got diagnosed with fairly recently in October of 2022, about a year ago, where I got admitted to the hospital with peritonitis and pleurisy. I’ve also had open heart surgery in November of 2022 to remove a blood clot in my heart.
A lot already, I know.
In regards to medication they started me on Warfarin, which I calculate the dose by measuring INR once a week. I also started 20 mg of prednisolone for the inflammation (and a PPI to pair, replaced with a different antiacid), which now has been tapered down to 5mgs. Additionally I started taking Hydroxychloroquine/Plaquenil in late November.
I wanna state that I have never been the kind of person to be “prone to” nausea. I’ve never had any issues with nausea before this all started, but I do have emetophobia.
Anyways, to the actual issue
I’m gonna try to explain this in a way that makes sense, but there’s a lot of factors to bring in, so if anything doesn’t make sense, please let me clarify.
In January/February of 2023 I started getting what at first was a sort of chronic constant nausea. It seemed like it was triggered by some kind of stomach bug, possibly norovirus, or something similar. I got sick on January 11th with diarrhea and vomiting, which both stopped after about 12 hours. The nausea went away for a day or two but returned soon after. I was stuck with this nausea for about a week, until I called my doctor and got prescribed metoclopramide for it. She claimed it must’ve just been leftover symptoms from the stomach virus I had previously.
I was nausea free for about 4 weeks, when it made its return in mid-February. I tried just waiting it out again but it really didn’t wanna leave. Up to this point the nausea had been pretty consistently bad and could usually be removed with the metoclopramide. But now it could act almost like “bouts” or “waves” of nausea which sometimes ended up with me dry heaving and gagging, but not actually throwing up. This is also sometimes accompanied with gut problems like “loose stool” and mild stomach cramps, though not always. It ended it switching between the “consistent constant” nausea and the “waves” for a few weeks. I also started having issues with becoming nauseous in my sleep, and I’d wake up, usually early in the morning (between 6-8 am) nauseous. This still happens some nights.
In early April it got so bad, and I got desperate enough to contact my rheumatologist and ask to stop taking the Plaquenil/HCQ, because I’d read that for some people it causes extreme nausea and other stomach and gut issues. She agreed. I stopped taking it in the first week of April.
Over the summer I’ve gotten slowly “better”. But it feels like I’m stuck in this horrible cycle of “feeling better with only manageable nausea for two or three weeks then feeling terrible again for a week or two”. For example, I got a horrible setback in the beginning of August where I was stuck in my room feeling horrible for a week. And then another setback in mid-September. I don’t know if it could be related, but I’ve noticed that it tends to get worse right before, and during my period. Though I don’t think my period is in any way the cause of the nausea. I have noticed, like I said, that it tends to make the symptoms worse though.
I’ve been in and out of the doctor's office more times than I can count. I’ve had multiple sets of bloodwork done. Everything has looked fine. We even tested for food allergies and such. I’ve also done stool tests. In June I had a gastroscopy done (camera down my throat to look at my stomach and esophagus), which also looked fine. I’m now waiting to get tested for gastroparesis, though I have a feeling this test will also come back normal.
This nausea is very unpredictable, and can come on suddenly, hitting me like a truck. As to what triggers the nausea? Sometimes it can be eating, sometimes not eating, sometimes exercise, sometimes anxiety, sometimes nothing. Anything and nothing at all.
Because of this I’ve basically been unable to live my life for the last 8-9 months. Even longer if you count my surgery and lupus flare up. I’ve missed so much, even my own nephew’s christening. I’ve been prescribed numerous antiemetics. These are metoclopramide, Zofran, Phenergan and Prochlorperazine. Sometimes they work, sometimes they don’t. So, I can’t really rely on them to “save me” if I’m out in public. I’ve also tried ginger tea, ginger candies, raw ginger, etc. without much success. Because of all this it’s almost like I've developed some kind of anxiety and Agoraphobia (in addition to already having emetophobia), where I’m scared of entering situations that I can’t easily escape in case of triggering an episode of nausea. This could be going in public, visiting friends, attending events, going to work, etc.
I’m extremely depressed. It feels like my life is over. I have no idea what to do. I cry a lot, and I feel trapped in my own body.
Does anyone have any idea what the cause of this could be? I’d appriciate any advice.

I was diagnosed with this on the 20th. I did 5 days of dilating drops that did not release it. Optometrist says no inflammation and is stable. Recheck in 4 months.
Antiphospholipids antibidies syndrome. Many times scleritis and nodular scleritis, one uveitis. Have not had any of these in a few years.
warfarin, crestor, altace, indapamide. 61F 5’7” 157lbs Canada.
Is this really ok to leave alone? My pressure is ok, no symptoms.
It just feels odd to leave my pupil this big, and it is not completely round either.
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Here is a list of medical herbs and how they help you.
Disclaimer: please make sure what you consume as many things that are very dangerous like hemlock can look like something harmless like carrot flowers. Also if you are suffering from any medical conditions please do consult your doctor to see if whichever one you’re interested in can be combined with any other medication you may be taking. Please be careful as they are herbs some you may find give you an allergic reaction some may not mix with other things. And please be sure if you are consuming the herb you think you are.
-Chamomile, used for anxiety and relaxation, also wound healing and to reduce inflammation or swelling. Few studies have looked at how well it works for any condition. Chamomile is used as a tea or applied as a compress. It is considered safe by the FDA. It may increase drowsiness caused by medicines or other herbs or supplements. Chamomile may interfere with the way the body uses some medicines, causing too high a level of the medicine in some people.
-Echinacea, used to prevent colds, flu, and infections, and for wound healing. Many studies have looked at how well echinacea works to prevent or shorten the course of a cold, but none were conclusive. Some studies do show some benefit of using echinacea for upper respiratory infections.
-Feverfew, used for fevers. It is now commonly used to prevent migraines and treat arthritis. Some research has shown that certain feverfew preparations can prevent migraines. Side effects include mouth ulcers if the leaves are chewed and digestive irritation. People who suddenly stop taking feverfew for migraines may have their headaches return. Feverfew should not be used with nonsteroidal anti-inflammatory medicines because these medicines may change how well feverfew works. It should not be used with warfarin or other anticoagulant medicines.
-Garlic, this has antimicrobial, cardioprotective, anticancer and anti-inflammatory properties. These properties may play a role in the belief that garlic helps lower cholesterol and blood pressure. Unfortunately, the evidence is conflicting. The FDA considers garlic safe. But it can increase the risk of bleeding and should not be used with warfarin, a blood thinner. For the same reason, large amounts should not be taken before dental procedures or surgery.
-Ginger, used to easing nausea and motion sickness. Research suggests that ginger may relieve the nausea caused by pregnancy and chemotherapy. Other areas under investigation in the use of ginger are in surgery and as an anticancer agent. It's wide range of actions may be due in part to its strong anti-inflammatory and antioxidative effects.
-Gingko, used for asthma, bronchitis, fatigue, and tinnitus. It is also used to improve memory and to prevent dementia and other brain disorders. Some studies have supported its slight effectiveness. But exactly how gingko works isn't understood. Only extract from leaves should be used. Seeds contain ginkgo toxin. This toxin can cause seizures and, in large amounts, death. Because some information suggests that ginkgo can increase the risk of bleeding, it should not be used with nonsteroidal anti-inflammatory medicines, anticoagulants, anticonvulsant medicines, or tricyclic antidepressants.
-Ginseng, used as a tonic and aphrodisiac, even as a cure-all. Research is uncertain how well it works, partly because of the difficulty in defining "vitality" and "quality of life." There is a large variation in the quality of ginseng sold. Side effects are high blood pressure and tachycardia. It's considered safe by the FDA. But it shouldn't be used with warfarin, heparin, nonsteroidal anti-inflammatory medicines, estrogens, corticosteroids, or digoxin. People with diabetes should not use ginseng.
-Goldenseal, used to treat diarrhea and eye and skin irritations. It is also used as an antiseptic. It is also an unproven treatment for colds. Goldenseal contains berberine, a plant alkaloid with a long history of medicinal use in both Ayurvedic and Chinese medicine. Studies have shown that goldenseal is effective for diarrhea. But it's not recommended because it can be poisonous in high doses. It can cause skin, mouth, throat, and gastric irritation.
-Milk thistle, used to treat liver conditions and high cholesterol, and to reduce the growth of cancer cells. Milk thistle is a plant that originated in the Mediterranean region. It has been used for many different illnesses over the last several thousand years, especially liver problems. Study results are uncertain about the actual benefits of milk thistle for liver disease.
-Saint John's wort, used as an antidepressant. Studies have shown that it has a small effect on mild to moderate depression over a period of about 12 weeks. But it is not clear if it is effective for severe depression. A side effect is sensitivity to light, but this is only noted in people taking large doses of the herb. St. John's has been shown to cause dangerous and possibly deadly interactions with commonly used medicines. It is very important to always talk with your healthcare provider before using this herb.
-Saw palmetto, used to treat urine symptoms from benign prostatic hypertrophy (BPH). But recent studies have not found it to be effective for this condition. Side effects are digestive upset and headache, both mild.
-Valerian, used to treat sleeplessness and to reduce anxiety. Research suggests that valerian may be a helpful sleep aid, but the evidence is not consistent to confirm it. In the U.S., valerian is used as a flavoring for root beer and other foods. As with any medicinal herb, always talk with your healthcare provider before taking it.
I do not have a medical degree so I copy and pasted it from a website that being here.

Feelings drained, that coffee/energy drink not hitting like it use to? Do you wake up wanting to murder someone until you have your pot of coffee?
I developed a guide to enhance dopamine levels naturally and un-naturally, stop relying on your phone to feel alive, cultivate other methods of dopamine production or just add some synthetic adrenaline (Ephedrine) to spice things up (Be sure to cycle this supplement). This guide can help you lose weight while boosting energy levels and overall mood, if weight is not an issue in your life meal replacement suggestions were added to the end of this post and will compensate as increase in dopamine stimulation will suppress apatite.
​
ECA Stack - Dopamine Enhancing Routine/Cycle
ECA, which stands for Ephedrine, Caffeine, and Aspirin, is a combination of these three compounds commonly used for its potential synergistic effects on fat loss and neural stimulation. Avoid the use of Ephedrine if at all possible, if you do decide to use it, please do additional research and talk to a professional before you make the decision. Caffeine alone should suffice, and with the techniques outlined below the natural dopamine production will be much more beneficial, maintainable and with far fewer risks or side effects.
ECA Stack – Dopamine / Energy Level Boosting Effects
The ECA stack is a combination of ephedrine, caffeine, and aspirin that is often used as a dietary supplement or performance-enhancing aid. It is named after the initials of its components. The stack is believed to promote weight loss, enhance energy levels, and improve athletic performance. Let's take a closer look at each component and their effects, particularly in relation to dopamine.
Ephedrine, a sympathomimetic amine, acts as a stimulant and bronchodilator. It affects various neurotransmitters in the brain, including dopamine. Ephedrine increases dopamine release by acting as a substrate for the dopamine transporter (DAT) protein. It competes with dopamine for uptake by the DAT, resulting in increased dopamine levels in the synapse and prolonging its effects. Additionally, ephedrine can stimulate dopamine release by activating adrenergic receptors and promoting the release of dopamine from the presynaptic neuron. The increased dopamine levels can lead to increased alertness, enhanced mood, and potential euphoria.
Caffeine, a naturally occurring stimulant, is known for its effects on alertness and wakefulness. It primarily works by blocking adenosine receptors in the brain, which inhibits the sleep-promoting effects of adenosine. This blockade indirectly affects dopamine levels by reducing the inhibitory effect of adenosine on dopamine release. Consequently, caffeine increases dopamine release in certain brain regions, leading to heightened arousal, improved mood, and enhanced cognitive function. However, it's important to note that caffeine's effects on dopamine are relatively mild compared to drugs that directly target dopamine receptors and transporters.
Aspirin, a nonsteroidal anti-inflammatory drug (NSAID), primarily acts on the prostaglandin pathway and has analgesic and anti-inflammatory properties. While aspirin does not directly interact with dopamine receptors or transporters, it can indirectly influence dopamine levels through its effects on other neurotransmitter systems. For instance, by inhibiting prostaglandin production and reducing inflammation, aspirin may indirectly impact dopamine signaling. Additionally, the relief of pain achieved through aspirin's analgesic properties can affect dopamine release and potentially influence mood and motivation.
The ECA stack, as a combination of ephedrine, caffeine, and aspirin, is believed to work synergistically to enhance its effects. Ephedrine and caffeine can both increase dopamine levels, resulting in increased alertness, improved mood, and heightened energy. Aspirin, while not directly affecting dopamine, can indirectly support dopamine function by reducing inflammation and promoting comfort.
Interactions with other Medication

1. Blood Pressure Medications: Ephedrine and caffeine can both increase blood pressure and heart rate. If you are taking medications for high blood pressure, such as beta-blockers or calcium channel blockers, combining them with the ECA stack may interfere with the effectiveness of these medications or lead to excessive cardiovascular stimulation.
2. Stimulant Medications: The combination of ephedrine and caffeine in the ECA stack can have stimulant effects on the central nervous system. If you are taking other stimulant medications, such as amphetamines or methylphenidate, combining them with the ECA stack may increase the risk of side effects, such as increased heart rate, elevated blood pressure, and nervousness.
3. Antidepressants: Some antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs), can affect the metabolism and clearance of ephedrine and caffeine. Combining these medications with the ECA stack may increase the risk of adverse effects, including serotonin syndrome, high blood pressure, and rapid heart rate.
4. Anticoagulants/Antiplatelet Medications: Aspirin, one component of the ECA stack, is an antiplatelet medication that can thin the blood and increase the risk of bleeding. Combining aspirin with other anticoagulant or antiplatelet medications, such as warfarin or clopidogrel, may potentiate the blood-thinning effects and increase the risk of bleeding complications.
5. Thyroid Medications: Ephedrine, a sympathomimetic amine, can potentially interact with thyroid medications, such as levothyroxine. Ephedrine may increase the release of thyroid hormones or interfere with their metabolism, leading to altered thyroid function and potential side effects.

Suggested Routine to naturally boost dopamine levels
​

1. Morning:

• Start the day with 30 minutes of moderate-intensity exercise, such as a brisk walk or a workout routine. This can help increase dopamine levels and promote overall well-being.
• Consume a balanced breakfast that includes foods rich in tyrosine, such as eggs, lean meats, or legumes. Include fruits or vegetables for added antioxidants.

​

1. Daytime:

• Throughout the day, practice stress management techniques whenever needed. Take short breaks to engage in deep breathing exercises, meditation, or mindfulness to reduce stress levels and support dopamine balance.
• Stay hydrated and consider replacing caffeinated beverages with herbal tea or water.

​

1. Afternoon:

• Take a break for creative activities or hobbies that bring you joy. This can include listening to music, painting, writing, or engaging in any other creative pursuits that stimulate dopamine release.

​

1. Evening:

• Allocate time for socializing with friends or loved ones. Plan activities like going for a walk together, having a meal, or engaging in meaningful conversations that promote positive social interactions and support dopamine levels.

1. Night:

• Before bedtime, create a calm and conducive environment for quality sleep. Establish a regular sleep schedule and aim for 7-9 hours of uninterrupted sleep. Avoid the use of caffeine or ephedrine in the evening, as they may interfere with sleep quality and dopamine regulation.

Dopamine Enhancing Dietary Overview
​

1. Proteins: Foods rich in proteins provide the necessary building blocks for dopamine synthesis. Include lean meats, poultry, fish, eggs, tofu, legumes, and dairy products in your diet.
2. Tyrosine-rich foods: Tyrosine is an amino acid involved in dopamine synthesis. Foods such as almonds, avocados, bananas, eggs, chicken, and turkey are good sources of tyrosine.
3. Leafy greens: Dark leafy greens like spinach, kale, and collard greens contain high levels of folate. Folate is important for neurotransmitter synthesis, including dopamine.
4. Fruits and vegetables: Berries, particularly blueberries, are rich in antioxidants and may have neuroprotective effects, promoting brain health. Other fruits and vegetables, such as oranges, tomatoes, and bell peppers, provide essential vitamins and minerals that support dopamine function.
5. Nuts and seeds: Almonds, walnuts, flaxseeds, and chia seeds are rich in nutrients like magnesium, zinc, and omega-3 fatty acids, which are beneficial for brain health and neurotransmitter function.
6. Dark chocolate: Dark chocolate contains compounds like flavonoids and phenylethylamine (PEA), which may help enhance mood and support dopamine release. Choose dark chocolate with a high cocoa content (70% or higher) and consume in moderation.
7. Green tea: Green tea contains an amino acid called L-theanine, which has been shown to have a positive impact on dopamine levels and brain function. It can promote relaxation while enhancing alertness.
8. Turmeric: Turmeric contains curcumin, a compound known for its anti-inflammatory and antioxidant properties. It may help protect dopamine-producing neurons and support overall brain health.
9. Probiotic-rich foods: Emerging research suggests a link between gut health and dopamine production. Including fermented foods like yogurt, sauerkraut, kimchi, and kefir in your diet can support a healthy gut microbiome, which may indirectly influence dopamine levels.
10. Water: Staying hydrated is essential for optimal brain function, including neurotransmitter synthesis and release. Make sure to drink an adequate amount of water throughout the day.

Several vitamins play a role in the synthesis, regulation, and function of dopamine in the brain.
​

1. Vitamin B6 (Pyridoxine): Vitamin B6 is involved in the conversion of the amino acid L-tyrosine into dopamine. It is a co-factor for the enzyme aromatic L-amino acid decarboxylase, which helps convert L-tyrosine to L-DOPA, a precursor of dopamine.
2. Vitamin B9 (Folate): Folate is important for the synthesis and metabolism of neurotransmitters, including dopamine. It participates in the conversion of L-DOPA to dopamine through its role in one-carbon metabolism.
3. Vitamin B12 (Cobalamin): Vitamin B12 is involved in the formation of myelin sheaths, which protect nerve cells, including dopaminergic neurons. It also plays a role in the synthesis and maintenance of neurotransmitters, including dopamine.
4. Vitamin D: Vitamin D receptors are found in various brain regions, including those involved in dopamine synthesis and regulation. Vitamin D deficiency has been linked to altered dopamine signaling and neurotransmission.
5. Vitamin C: Vitamin C is an antioxidant that helps protect dopamine neurons from oxidative stress. It is involved in the biosynthesis of dopamine by acting as a cofactor for the enzyme dopamine β-hydroxylase.
6. Vitamin E: Vitamin E is an antioxidant that protects dopamine neurons from oxidative damage. It helps maintain the integrity and function of dopaminergic neurons.

Other Considerations: Enhance and Maintain dopamine levels
​

1. Regular exercise: Engaging in aerobic exercises like running, swimming, or cycling can stimulate dopamine release and promote overall brain health. Aim for at least 30 minutes of moderate-intensity exercise most days of the week.
2. Get enough sleep: Quality sleep is essential for proper neurotransmitter function, including dopamine regulation. Aim for 7-9 hours of uninterrupted sleep each night to support optimal brain health.
3. Manage stress: Chronic stress can negatively impact dopamine levels. Explore stress-reducing techniques such as meditation, deep breathing exercises, yoga, or engaging in hobbies and activities you enjoy.
4. Listen to music: Listening to music you love can induce pleasure and increase dopamine release. Choose music that uplifts your mood and makes you feel good.
5. Set and achieve goals: Accomplishing goals, both big and small, can activate the brain's reward pathways and boost dopamine levels. Break larger goals into smaller, achievable tasks to experience a sense of accomplishment along the way.
6. Practice mindfulness: Mindfulness exercises, such as meditation or mindful breathing, can help improve dopamine receptor sensitivity and enhance overall well-being.
7. Spend time in nature: Being in nature has been shown to have a positive impact on mood and overall brain health. Take walks in green spaces, go hiking, or simply spend time outdoors to potentially increase dopamine levels.
8. Socialize and connect: Engaging in meaningful social interactions, spending time with loved ones, and nurturing relationships can stimulate dopamine release and promote feelings of happiness and well-being.
9. Seek pleasurable experiences: Engage in activities that bring you joy and pleasure, whether it's playing a musical instrument, dancing, painting, or engaging in hobbies you are passionate about. Enjoying pleasurable experiences can enhance dopamine release.
10. Limit excessive dopamine-depleting behaviors: Certain behaviors like excessive consumption of alcohol, drug use, and excessive gambling can deplete dopamine levels over time. Moderation and balance are key.

Combating Weight Loss (If Needed)
While there are numerous meal replacement brands available worldwide, here are 10 well-known and popular brands that offer carb-intensive meal replacement options:
​

1. Soylent: Soylent offers a range of meal replacement products, including their original formula, which provides a balanced mix of carbohydrates, proteins, and fats.
2. Huel: Huel offers complete meal replacements in powder form, with options that include a significant amount of carbohydrates, sourced from oats and other ingredients.
3. Ample: Ample provides meal replacement shakes made from real food ingredients, including carbohydrates from sources like oats, sweet potato, and tapioca.
4. Garden of Life: Garden of Life offers meal replacement powders and shakes that are rich in carbohydrates, often derived from organic whole food sources like oats, quinoa, and fruits.
5. Orgain: Orgain produces organic meal replacement shakes that contain carbohydrates from ingredients such as brown rice, fruits, and vegetables.
6. Kate Farms: Kate Farms offers plant-based meal replacement shakes that provide a balance of macronutrients, including carbohydrates from organic pea protein and brown rice.
7. Vega: Vega offers a range of plant-based meal replacement shakes and powders that contain carbohydrates from sources like organic sprouted brown rice and organic quinoa.
8. Ensure: Ensure is a well-known brand that offers meal replacement shakes designed for nutrition and energy, with carbohydrate-rich options available.
9. SlimFast: SlimFast offers a variety of meal replacement shakes and bars, including carb-conscious options that provide a controlled amount of carbohydrates for those watching their carb intake.
10. Atkins: While primarily known for their low-carb products, Atkins also offers meal replacement shakes and bars with a focus on controlled carbohydrate intake.

Long before conventional medicine, natural nutrients and supplements were used to help with healing for many different conditions. Arthritis affects many people during their lives, and Ayurvedic medicine may offer some remedies that can alleviate some of the painful symptoms that arthritis causes. This includes also are you a product from Lorax Ayurvedic that has very real results for arthritis sufferers.
Fish Oils
Fish oil contains omega 3, and this is known to be anti-inflammatory. It is able to block some of the issues that lead to inflammation and can help reduce joint tenderness and pain. It does tend to be more successful for those with rheumatoid arthritis rather than osteoarthritis, but there are studies to show that it can help with both. Fish oils have DHA and EPA, and to be therapeutically effective, this needs to be at least 30% concentration. It is recommended that you take 500 mg a day.
Turmeric and Curcumin
They are pretty much interchangeable terms because curcumin is an ingredient in Turmeric, and again, it is recommended for people who are suffering from arthritis because it does offer inflammation-relieving properties. It can also dull the pain signals being sent to the brain. The best way to use turmeric or curcumin is in a cream topical application. You cannot take turmeric if you have any blood-thinning medications, such as warfarin or heparin.
Ortho Ayur
Reducing inflammation is a key part of targeting arthritis, and Lorex Ortho Ayur oil, available from Lorax, has been designed to harness the power of three herbs called Gandhpura, Kapur and Nilgiri Oil. Each of these has pain-relieving and anti-inflammatory properties, and the combination of the three creates a powerful massage oil that can be applied topically to help gain some relief from the pain caused by arthritis. The oil can be applied twice a day, both in the morning and at night or straight after having a bath.
Vitamin C
Vitamin C is a water-soluble vitamin, which means it’s very hard to overdose your intake because anything not required for your body is simply eliminated via your urine. Taking vitamin C supplements is good for healthy joints, preventing inflammation and maintaining connective tissues. Various research has been carried out that suggests there are benefits to impeding the progress of cartilage loss and helping stop the degeneration of tissues in the joints.
Calcium
Calcium has a long association with bone health, and if you develop either osteoarthritis or rheumatoid arthritis, you are also at a greater risk for osteoporosis, which is where the bones become fragile and easy to break. Calcium is good for osteoporosis and, therefore, should be consumed if there is any possibility that you have arthritis or any other condition of the bones. Much calcium can be consumed in a standard diet, with both milk and cheese playing a vital role, but you can also supplement calcium tablets which are best taken alongside a vitamin D supplement to increase bone health and better help the calcium become absorbed into the system

ECA Stack - Dopamine Enhancing Routine/Cycle
ECA, which stands for Ephedrine, Caffeine, and Aspirin, is a combination of these three compounds commonly used for its potential synergistic effects on fat loss and neural stimulation. Avoid the use of Ephedrine if at all possible, if you do decide to use it, please do additional research and talk to a professional before you make the decision. Caffeine alone should suffice, and with the techniques outlined below the natural dopamine production will be much more beneficial, maintainable and with far fewer risks or side effects.
ECA Stack – Dopamine / Energy Level Boosting Effects
The ECA stack is a combination of ephedrine, caffeine, and aspirin that is often used as a dietary supplement or performance-enhancing aid. It is named after the initials of its components. The stack is believed to promote weight loss, enhance energy levels, and improve athletic performance. Let's take a closer look at each component and their effects, particularly in relation to dopamine.
Ephedrine, a sympathomimetic amine, acts as a stimulant and bronchodilator. It affects various neurotransmitters in the brain, including dopamine. Ephedrine increases dopamine release by acting as a substrate for the dopamine transporter (DAT) protein. It competes with dopamine for uptake by the DAT, resulting in increased dopamine levels in the synapse and prolonging its effects. Additionally, ephedrine can stimulate dopamine release by activating adrenergic receptors and promoting the release of dopamine from the presynaptic neuron. The increased dopamine levels can lead to increased alertness, enhanced mood, and potential euphoria.
Caffeine, a naturally occurring stimulant, is known for its effects on alertness and wakefulness. It primarily works by blocking adenosine receptors in the brain, which inhibits the sleep-promoting effects of adenosine. This blockade indirectly affects dopamine levels by reducing the inhibitory effect of adenosine on dopamine release. Consequently, caffeine increases dopamine release in certain brain regions, leading to heightened arousal, improved mood, and enhanced cognitive function. However, it's important to note that caffeine's effects on dopamine are relatively mild compared to drugs that directly target dopamine receptors and transporters.
Aspirin, a nonsteroidal anti-inflammatory drug (NSAID), primarily acts on the prostaglandin pathway and has analgesic and anti-inflammatory properties. While aspirin does not directly interact with dopamine receptors or transporters, it can indirectly influence dopamine levels through its effects on other neurotransmitter systems. For instance, by inhibiting prostaglandin production and reducing inflammation, aspirin may indirectly impact dopamine signaling. Additionally, the relief of pain achieved through aspirin's analgesic properties can affect dopamine release and potentially influence mood and motivation.
The ECA stack, as a combination of ephedrine, caffeine, and aspirin, is believed to work synergistically to enhance its effects. Ephedrine and caffeine can both increase dopamine levels, resulting in increased alertness, improved mood, and heightened energy. Aspirin, while not directly affecting dopamine, can indirectly support dopamine function by reducing inflammation and promoting comfort.
Interactions with other Medication

1. Blood Pressure Medications: Ephedrine and caffeine can both increase blood pressure and heart rate. If you are taking medications for high blood pressure, such as beta-blockers or calcium channel blockers, combining them with the ECA stack may interfere with the effectiveness of these medications or lead to excessive cardiovascular stimulation.
   
2. Stimulant Medications: The combination of ephedrine and caffeine in the ECA stack can have stimulant effects on the central nervous system. If you are taking other stimulant medications, such as amphetamines or methylphenidate, combining them with the ECA stack may increase the risk of side effects, such as increased heart rate, elevated blood pressure, and nervousness.
   
3. Antidepressants: Some antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs), can affect the metabolism and clearance of ephedrine and caffeine. Combining these medications with the ECA stack may increase the risk of adverse effects, including serotonin syndrome, high blood pressure, and rapid heart rate.
   
4. Anticoagulants/Antiplatelet Medications: Aspirin, one component of the ECA stack, is an antiplatelet medication that can thin the blood and increase the risk of bleeding. Combining aspirin with other anticoagulant or antiplatelet medications, such as warfarin or clopidogrel, may potentiate the blood-thinning effects and increase the risk of bleeding complications.
   
5. Thyroid Medications: Ephedrine, a sympathomimetic amine, can potentially interact with thyroid medications, such as levothyroxine. Ephedrine may increase the release of thyroid hormones or interfere with their metabolism, leading to altered thyroid function and potential side effects.
   

Suggested Routine to naturally boost dopamine levels
​

1. Morning:

• Start the day with 30 minutes of moderate-intensity exercise, such as a brisk walk or a workout routine. This can help increase dopamine levels and promote overall well-being.
• Consume a balanced breakfast that includes foods rich in tyrosine, such as eggs, lean meats, or legumes. Include fruits or vegetables for added antioxidants.

​

1. Daytime:

• Throughout the day, practice stress management techniques whenever needed. Take short breaks to engage in deep breathing exercises, meditation, or mindfulness to reduce stress levels and support dopamine balance.
• Stay hydrated and consider replacing caffeinated beverages with herbal tea or water.

​

1. Afternoon:

• Take a break for creative activities or hobbies that bring you joy. This can include listening to music, painting, writing, or engaging in any other creative pursuits that stimulate dopamine release.

​

1. Evening:

• Allocate time for socializing with friends or loved ones. Plan activities like going for a walk together, having a meal, or engaging in meaningful conversations that promote positive social interactions and support dopamine levels.

1. Night:

• Before bedtime, create a calm and conducive environment for quality sleep. Establish a regular sleep schedule and aim for 7-9 hours of uninterrupted sleep. Avoid the use of caffeine or ephedrine in the evening, as they may interfere with sleep quality and dopamine regulation.

Dopamine Enhancing Dietary Overview
​

1. Proteins: Foods rich in proteins provide the necessary building blocks for dopamine synthesis. Include lean meats, poultry, fish, eggs, tofu, legumes, and dairy products in your diet.
   
2. Tyrosine-rich foods: Tyrosine is an amino acid involved in dopamine synthesis. Foods such as almonds, avocados, bananas, eggs, chicken, and turkey are good sources of tyrosine.
   
3. Leafy greens: Dark leafy greens like spinach, kale, and collard greens contain high levels of folate. Folate is important for neurotransmitter synthesis, including dopamine.
   
4. Fruits and vegetables: Berries, particularly blueberries, are rich in antioxidants and may have neuroprotective effects, promoting brain health. Other fruits and vegetables, such as oranges, tomatoes, and bell peppers, provide essential vitamins and minerals that support dopamine function.
   
5. Nuts and seeds: Almonds, walnuts, flaxseeds, and chia seeds are rich in nutrients like magnesium, zinc, and omega-3 fatty acids, which are beneficial for brain health and neurotransmitter function.
   
6. Dark chocolate: Dark chocolate contains compounds like flavonoids and phenylethylamine (PEA), which may help enhance mood and support dopamine release. Choose dark chocolate with a high cocoa content (70% or higher) and consume in moderation.
   
7. Green tea: Green tea contains an amino acid called L-theanine, which has been shown to have a positive impact on dopamine levels and brain function. It can promote relaxation while enhancing alertness.
   
8. Turmeric: Turmeric contains curcumin, a compound known for its anti-inflammatory and antioxidant properties. It may help protect dopamine-producing neurons and support overall brain health.
   
9. Probiotic-rich foods: Emerging research suggests a link between gut health and dopamine production. Including fermented foods like yogurt, sauerkraut, kimchi, and kefir in your diet can support a healthy gut microbiome, which may indirectly influence dopamine levels.
   
10. Water: Staying hydrated is essential for optimal brain function, including neurotransmitter synthesis and release. Make sure to drink an adequate amount of water throughout the day.
    

Several vitamins play a role in the synthesis, regulation, and function of dopamine in the brain.
​

1. Vitamin B6 (Pyridoxine): Vitamin B6 is involved in the conversion of the amino acid L-tyrosine into dopamine. It is a co-factor for the enzyme aromatic L-amino acid decarboxylase, which helps convert L-tyrosine to L-DOPA, a precursor of dopamine.
   
2. Vitamin B9 (Folate): Folate is important for the synthesis and metabolism of neurotransmitters, including dopamine. It participates in the conversion of L-DOPA to dopamine through its role in one-carbon metabolism.
   
3. Vitamin B12 (Cobalamin): Vitamin B12 is involved in the formation of myelin sheaths, which protect nerve cells, including dopaminergic neurons. It also plays a role in the synthesis and maintenance of neurotransmitters, including dopamine.
   
4. Vitamin D: Vitamin D receptors are found in various brain regions, including those involved in dopamine synthesis and regulation. Vitamin D deficiency has been linked to altered dopamine signaling and neurotransmission.
   
5. Vitamin C: Vitamin C is an antioxidant that helps protect dopamine neurons from oxidative stress. It is involved in the biosynthesis of dopamine by acting as a cofactor for the enzyme dopamine β-hydroxylase.
   
6. Vitamin E: Vitamin E is an antioxidant that protects dopamine neurons from oxidative damage. It helps maintain the integrity and function of dopaminergic neurons.
   

Other Considerations: Enhance and Maintain dopamine levels
​

1. Regular exercise: Engaging in aerobic exercises like running, swimming, or cycling can stimulate dopamine release and promote overall brain health. Aim for at least 30 minutes of moderate-intensity exercise most days of the week.
   
2. Get enough sleep: Quality sleep is essential for proper neurotransmitter function, including dopamine regulation. Aim for 7-9 hours of uninterrupted sleep each night to support optimal brain health.
   
3. Manage stress: Chronic stress can negatively impact dopamine levels. Explore stress-reducing techniques such as meditation, deep breathing exercises, yoga, or engaging in hobbies and activities you enjoy.
   
4. Listen to music: Listening to music you love can induce pleasure and increase dopamine release. Choose music that uplifts your mood and makes you feel good.
   
5. Set and achieve goals: Accomplishing goals, both big and small, can activate the brain's reward pathways and boost dopamine levels. Break larger goals into smaller, achievable tasks to experience a sense of accomplishment along the way.
   
6. Practice mindfulness: Mindfulness exercises, such as meditation or mindful breathing, can help improve dopamine receptor sensitivity and enhance overall well-being.
   
7. Spend time in nature: Being in nature has been shown to have a positive impact on mood and overall brain health. Take walks in green spaces, go hiking, or simply spend time outdoors to potentially increase dopamine levels.
   
8. Socialize and connect: Engaging in meaningful social interactions, spending time with loved ones, and nurturing relationships can stimulate dopamine release and promote feelings of happiness and well-being.
   
9. Seek pleasurable experiences: Engage in activities that bring you joy and pleasure, whether it's playing a musical instrument, dancing, painting, or engaging in hobbies you are passionate about. Enjoying pleasurable experiences can enhance dopamine release.
   
10. Limit excessive dopamine-depleting behaviors: Certain behaviors like excessive consumption of alcohol, drug use, and excessive gambling can deplete dopamine levels over time. Moderation and balance are key.
    

Combating Weight Loss (If Needed)
While there are numerous meal replacement brands available worldwide, here are 10 well-known and popular brands that offer carb-intensive meal replacement options:
​

1. Soylent: Soylent offers a range of meal replacement products, including their original formula, which provides a balanced mix of carbohydrates, proteins, and fats.
   
2. Huel: Huel offers complete meal replacements in powder form, with options that include a significant amount of carbohydrates, sourced from oats and other ingredients.
   
3. Ample: Ample provides meal replacement shakes made from real food ingredients, including carbohydrates from sources like oats, sweet potato, and tapioca.
   
4. Garden of Life: Garden of Life offers meal replacement powders and shakes that are rich in carbohydrates, often derived from organic whole food sources like oats, quinoa, and fruits.
   
5. Orgain: Orgain produces organic meal replacement shakes that contain carbohydrates from ingredients such as brown rice, fruits, and vegetables.
   
6. Kate Farms: Kate Farms offers plant-based meal replacement shakes that provide a balance of macronutrients, including carbohydrates from organic pea protein and brown rice.
   
7. Vega: Vega offers a range of plant-based meal replacement shakes and powders that contain carbohydrates from sources like organic sprouted brown rice and organic quinoa.
   
8. Ensure: Ensure is a well-known brand that offers meal replacement shakes designed for nutrition and energy, with carbohydrate-rich options available.
   
9. SlimFast: SlimFast offers a variety of meal replacement shakes and bars, including carb-conscious options that provide a controlled amount of carbohydrates for those watching their carb intake.
   
10. Atkins: While primarily known for their low-carb products, Atkins also offers meal replacement shakes and bars with a focus on controlled carbohydrate intake.
    

What are some newer or latest PO options for managing hypotension? Our attending is out of ideas. Consults aren’t leading anywhere. Hence posting here, hoping for some insights from more knowledgeable peeps.
Note: u/rabiaplus is on same care team.
​Our patient is a 60 year old female with Hx of DVT (on warfarin for 6 years) and RA for over 15 years and has been on several monoclonal antibodies mostly because her joint pain was not relieved. During this time she has b/l knees and hips replaced. All other joints are doing well. She was hospitalized 5 months ago for Acute on chronic renal failure needing HD for the first time. Her kidney biopsy showed amyloidosis likely 2/2 to her RA. Since her initial hospitalization she has been in ICU for the third time. First two admissions were becasue she could not tolerate HD on regular in-patient floor, her MAPs would drop to 30s. Recently she had Cdiff, HI PNA and bacteremia, as well as aspiration PNA requiring antibiotics (vancomycin and zosyn), she is now off Bipap, however, still quite weak. Continues to stay on TF.
ADDED: She has been on consistent dose of 25 mg prednisone for past 3 or 4 months.
​Overall, the main issue holding her in ICU is her hypotension. She has been on CRRT and not been able to come off levophed for over a month. Just like her previous ICU transfers she is not able to tolerate HD. Her MAPs drops in 30’s. Also, her hypotension is constant not just HD related or postural. She has been on midodrine 20 mg TID. Her echo is Normal EF 65%, no VHD or diastolic dysfunction. Very low suspicion that she has cardiac amyloidosis (this has not been confirmed with any biopsy or cardiac MRI considering her current condition)
Just another piece that may not be be relevant to my main question, but sharing to give the whole picture: Her WBC count has been consistently high in 25 to 35s, no fevers, normal procal and inflammatory markers. She has completed her Vanc for C diff , linezolid for VRE UTI and zosyn for HI PNA and bacteremia for sometime. A wbc scan was done to look for any focus of inflammation, but was completely benign.
ADDED: We think patient is over the big hump of fighting infections, and acute management of BP stabilization. We are now planning for a safe transfer to floor. What can we do so that she is not Levo dependent and able to tolerate regular HDs? For example, today we tried HD after being on CRRT for a month. During that period, she was on levo 6 and her MAPs drop to 30s again. We ended up giving her fluid to bring her BP up😞
Big question: what are our options for treating or managing her hypotension? (No longer the big question, kindly scroll down for most recent updates)
May 29 Update: * Family has finally agreed and Palliative is now on board (declined palliative before). * Pt’s MAPS are 55 to 65 now (improved from 30 to 40, two days ago without any change in treatment). * Pt is fully conscious, lively and engaged in the last 24 hrs: solving puzzles, little bit of painting, writing, and holding conversations with family. * Pt is trying her best to work with PT team (exercises in bed), plan is to sit her up in chair soon. * As of now the family/patient both desire full aggressive care. * Pt has been on high dose prednisone and hydrocortisone daily for adrenal insufficiency * Amyloidosis and MM lab work up negative * Pocus/ bedside echo now showing pt is developing diastolic dysfunction/ HFeEF and MS (unfortunately now done during HD) * Formal Echo was normal last week, even MS was not mentioned.
June 06 Update:
Pt seems to be tolerating HD better now, and only occasionally requires a low dose of levo during dialysis. She’s is being given midrodrine and albumin prior to HD to keep the BP up. (Pt has been off CRRT). HD sessions observations:

• May 27 - HD 2 hrs - with levo, BP normal
  
• May 28 - HD 2 hrs - w/o levo, BP dropped slightly
  
• May 29 - HD skipped
  
• May 30 - HD 2 hrs - w/o levo, tolerated 2 litres of fluid removal, bp dropped very slightly
  
• June 1 - HD 2 hrs - blood pressure dropped slightly after 30 min, so levo was administered
  
• June 02 - HD skipped
  
• June 3 - HD 3 hours, 500 mL removed, albumin and midodrine were given prior to session. Levo not needed
  
• June 4 - no HD (legs more physically swollen, right leg more swollen /tighter and left arm more swollen), SOB, crackly lung , fatigue , reported feeling anxious at night
  
• June 5 - HD 3.5 hours, 1000 ml net fluid removed. Midodrine and albumin given prior to session. Levo was not needed.