I was diagnosed with MS last July. I had a bout of vertigo and had recurrent deep vein thrombosis in my arm. I've been on propranolol, pradaxa and tysabri for the past 3 months. I haven't had any attacks since the first one in July. Last night I had the worst dvt attack ever. All night pacing, unable to lie down or sleep.. I had run out of percoset last month and thought I was on the mend and I was going to be one of those cases of having only one attack; CIS?
The only additional sign was nausea and hours of dry heaving much of the night. I haven't read of nausea being a sign associated with MS. The vertigo in July did not include nausea. I've got a call in to my doctor to get the percoset refilled and I'll ask about the nausea.
kaypeeoh
Nausea as a sign of MS?
Re: Nausea as a sign of MS?
ouch not fun. taking anything other than the listed meds?
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Re: Nausea as a sign of MS?
reviewing.
re your earlier post http://www.thisisms.com/forum/post249902.html#p249902
have you had bloodwork to rule out any of the considerations posted here? http://www.thisisms.com/forum/undiagnos ... ml#p229973
also pls consider these baseline magnesium values
Decrease in Ionized and Total Magnesium Blood Concentrations in Endurance Athletes Following an Exercise Bout Restores within Hours-Potential Consequences for Monitoring and Supplementation (2017)
https://www.ncbi.nlm.nih.gov/pubmed/27997264
from the abstract:
"Both, iMg and tMg, returned to baseline, on average, 2.5 hr after exercise. These findings suggest that timing of blood sampling to analyze Mg status is important."
from full text:
Table 1 Participants’ Characteristics
...................................men...............women
Plasma tMg (mmol/L).....0.88 ± 0.03.....0.87 ± 0.08
so, per empirical rule this means at baseline 50% of male athletes studied were below 0.88 mmol/l at baseline before exertion. a sucky low normal place to be.
also per empirical rule, 84% of male runners in the study were below 0.91 mmol/l (still low normal, consistent with ms patients).
typical for magnesium assessment: even at -3 SD (0.79 mmol/l) none of the male athletes were technically deficient according to current poorly defined reference ranges. (eg in this study, "Their total plasma magnesium concentration was > 0.70 mmol/L (lower limit of normal)"
using this definition of the normal range for serum magnesium, outright magnesium deficiency status is only captured in female study participants, and for that matter only in 0.15% of those.
then "After exercise (12:30 p.m.), both total and ionized magnesium concentrations were significantly lower. Ionized magnesium decreased by 0.06 ± 0.03 mmol/L to 0.45 ± 0.03 mmol/L (p < .001). Total magnesium decreased by 0.08 ± 0.04 mmol/L to 0.73 ± 0.06 mmol/L (p < .001)."
sure, levels return to pre-exercise levels within a few hours post exertion. but if most of the group was not in a good place to start with, bears thinking about taking some corrective action.
if you use 0.95 mmol/l as the lower cutoff for serum mag, as has been suggested in literature, in men only the right tail of the bell curve, 0.15% are within the normal range at this study's baseline. some women better off, with 16% above 0.95 mmol/l at baseline.
re thrombois x vertigo x magnesium:
case studies only, also females not males, but still interesting
Pills and thrombosis: platelets, estrogens and magnesium (1970)
https://www.popline.org/node/475109
A 22-year-old woman with 3 episodes of thrombophlebitis in 2 years also had vertigo, headaches, anxiety, spasms and tetany. She had a positive Chvostek sign bilaterally, low red blood cell magnesium of 45.5 and 50 mg per 1, abnormal EKG, electronystagmogram and electromyogram, Platelet hyperaggregability and ADP and adrenalin. Magnesium lactate 3 gm and pyridoxine 750 mg per day normalized all these signs and she has been well for 2 years. The second case was a 44-year-old woman with suicidal depression, obsessed with her severe acne, which was being treated with 250 mcg ethinyl estradiol on Cycle Days 5-25. To rule out platelet hyperaggregability, she was subjected to electromyogram and hematologic workup. She had positive Chvostek sign, tetany, low plasma magnesium of 16.4 mg per 1, low red cell magnesium of 46.7 mg per 1, and platelet hyperaggregability induced by ADP, collagen and adrenalin. With treatment of oral magnesium lactate 3 gm per day the platelet findings became normal.
re vertigo, nausea and magnesium:
Restoring electrolyte balance: magnesium (1996)
http://bit.ly/2nkg30t
Magnesium deficiency or hypomagnesemia is due to increased renal excretion caused by the use of loop diuretics or aminoglycosides. Symptoms include arrhythmias, ataxia and vertigo, while treatments include the intake of magnesium-rich foods and oral magnesium supplements. On the other hand, high magnesium levels or hypermagnesia is due to excessive intakes of magnesium-containing antacids and cathartics. Symptoms include weakness, nausea and vomiting, while treatment includes intravenously hydrating patients with magnesium-free fluids.
mag status might be worth looking into! thinking the nausea may be secondary to the vertigo, less likely a consequence of mag excess.
this kind of statement drives me nuts:
http://bit.ly/2i954ll
"Despite testimonials to magnesium therapy for vertigo on the Internet, there is no solid medical evidence linking BPPV with magnesium deficiency or supporting magnesium therapy. Alternatively, there is growing evidence linking BPPV with bone loss and with low levels of vitamin D."
ummmmmmm but what about the association between mag and low d3? case study example of the available evidence linking low mag and low d3, albeit thin:
http://www.thisisms.com/forum/natural-a ... ml#p249333
"Table 1. Electrolyte balance and other biochemical data at admittance, during and after magnesium supplements and esomeprazole
................................Normal value..........Day 1........6 months
Serum magnesium.....0.65-1.05 mmol/l.....0.18..........0.67
Serum vitamin D3.........30-130 nmol/l......39.............58"
might be time to address that lil vertigo/mag/d3 research gap, yea? could help a few ppl out. at least science is starting to get around to the mag/d3 connection! eg:
D3 might be screwing with magnesium status
Essential Nutrient Interactions: Does Low or Suboptimal Magnesium Status Interact with Vitamin D and/or Calcium Status? (2016)
http://www.thisisms.com/forum/natural-a ... ml#p245963
"Magnesium is a cofactor for vitamin D biosynthesis, transport, and activation; and vitamin D and magnesium studies both showed associations with several of the same chronic diseases. Research on possible magnesium and vitamin D interactions in these human diseases is currently rare. Interactions of low magnesium status with calcium and vitamin D, especially during supplementation, require further study."
yes. time to get on that.
and,
Magnesium Supplementation in Vitamin D Deficiency (2017)
https://www.ncbi.nlm.nih.gov/pubmed/28471760
"Screening for chronic magnesium deficiency is difficult because a normal serum level may still be associated with moderate to severe deficiency." (you don't say!!)
"Adequate magnesium supplementation should be considered as an important aspect of vitamin D therapy"
re your earlier post http://www.thisisms.com/forum/post249902.html#p249902
have you had bloodwork to rule out any of the considerations posted here? http://www.thisisms.com/forum/undiagnos ... ml#p229973
also pls consider these baseline magnesium values
Decrease in Ionized and Total Magnesium Blood Concentrations in Endurance Athletes Following an Exercise Bout Restores within Hours-Potential Consequences for Monitoring and Supplementation (2017)
https://www.ncbi.nlm.nih.gov/pubmed/27997264
from the abstract:
"Both, iMg and tMg, returned to baseline, on average, 2.5 hr after exercise. These findings suggest that timing of blood sampling to analyze Mg status is important."
from full text:
Table 1 Participants’ Characteristics
...................................men...............women
Plasma tMg (mmol/L).....0.88 ± 0.03.....0.87 ± 0.08
so, per empirical rule this means at baseline 50% of male athletes studied were below 0.88 mmol/l at baseline before exertion. a sucky low normal place to be.
also per empirical rule, 84% of male runners in the study were below 0.91 mmol/l (still low normal, consistent with ms patients).
typical for magnesium assessment: even at -3 SD (0.79 mmol/l) none of the male athletes were technically deficient according to current poorly defined reference ranges. (eg in this study, "Their total plasma magnesium concentration was > 0.70 mmol/L (lower limit of normal)"
using this definition of the normal range for serum magnesium, outright magnesium deficiency status is only captured in female study participants, and for that matter only in 0.15% of those.
then "After exercise (12:30 p.m.), both total and ionized magnesium concentrations were significantly lower. Ionized magnesium decreased by 0.06 ± 0.03 mmol/L to 0.45 ± 0.03 mmol/L (p < .001). Total magnesium decreased by 0.08 ± 0.04 mmol/L to 0.73 ± 0.06 mmol/L (p < .001)."
sure, levels return to pre-exercise levels within a few hours post exertion. but if most of the group was not in a good place to start with, bears thinking about taking some corrective action.
if you use 0.95 mmol/l as the lower cutoff for serum mag, as has been suggested in literature, in men only the right tail of the bell curve, 0.15% are within the normal range at this study's baseline. some women better off, with 16% above 0.95 mmol/l at baseline.
re thrombois x vertigo x magnesium:
case studies only, also females not males, but still interesting
Pills and thrombosis: platelets, estrogens and magnesium (1970)
https://www.popline.org/node/475109
A 22-year-old woman with 3 episodes of thrombophlebitis in 2 years also had vertigo, headaches, anxiety, spasms and tetany. She had a positive Chvostek sign bilaterally, low red blood cell magnesium of 45.5 and 50 mg per 1, abnormal EKG, electronystagmogram and electromyogram, Platelet hyperaggregability and ADP and adrenalin. Magnesium lactate 3 gm and pyridoxine 750 mg per day normalized all these signs and she has been well for 2 years. The second case was a 44-year-old woman with suicidal depression, obsessed with her severe acne, which was being treated with 250 mcg ethinyl estradiol on Cycle Days 5-25. To rule out platelet hyperaggregability, she was subjected to electromyogram and hematologic workup. She had positive Chvostek sign, tetany, low plasma magnesium of 16.4 mg per 1, low red cell magnesium of 46.7 mg per 1, and platelet hyperaggregability induced by ADP, collagen and adrenalin. With treatment of oral magnesium lactate 3 gm per day the platelet findings became normal.
re vertigo, nausea and magnesium:
Restoring electrolyte balance: magnesium (1996)
http://bit.ly/2nkg30t
Magnesium deficiency or hypomagnesemia is due to increased renal excretion caused by the use of loop diuretics or aminoglycosides. Symptoms include arrhythmias, ataxia and vertigo, while treatments include the intake of magnesium-rich foods and oral magnesium supplements. On the other hand, high magnesium levels or hypermagnesia is due to excessive intakes of magnesium-containing antacids and cathartics. Symptoms include weakness, nausea and vomiting, while treatment includes intravenously hydrating patients with magnesium-free fluids.
mag status might be worth looking into! thinking the nausea may be secondary to the vertigo, less likely a consequence of mag excess.
this kind of statement drives me nuts:
http://bit.ly/2i954ll
"Despite testimonials to magnesium therapy for vertigo on the Internet, there is no solid medical evidence linking BPPV with magnesium deficiency or supporting magnesium therapy. Alternatively, there is growing evidence linking BPPV with bone loss and with low levels of vitamin D."
ummmmmmm but what about the association between mag and low d3? case study example of the available evidence linking low mag and low d3, albeit thin:
http://www.thisisms.com/forum/natural-a ... ml#p249333
"Table 1. Electrolyte balance and other biochemical data at admittance, during and after magnesium supplements and esomeprazole
................................Normal value..........Day 1........6 months
Serum magnesium.....0.65-1.05 mmol/l.....0.18..........0.67
Serum vitamin D3.........30-130 nmol/l......39.............58"
might be time to address that lil vertigo/mag/d3 research gap, yea? could help a few ppl out. at least science is starting to get around to the mag/d3 connection! eg:
D3 might be screwing with magnesium status
Essential Nutrient Interactions: Does Low or Suboptimal Magnesium Status Interact with Vitamin D and/or Calcium Status? (2016)
http://www.thisisms.com/forum/natural-a ... ml#p245963
"Magnesium is a cofactor for vitamin D biosynthesis, transport, and activation; and vitamin D and magnesium studies both showed associations with several of the same chronic diseases. Research on possible magnesium and vitamin D interactions in these human diseases is currently rare. Interactions of low magnesium status with calcium and vitamin D, especially during supplementation, require further study."
yes. time to get on that.
and,
Magnesium Supplementation in Vitamin D Deficiency (2017)
https://www.ncbi.nlm.nih.gov/pubmed/28471760
"Screening for chronic magnesium deficiency is difficult because a normal serum level may still be associated with moderate to severe deficiency." (you don't say!!)
"Adequate magnesium supplementation should be considered as an important aspect of vitamin D therapy"
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use the report button to flag problematic post content to volunteer moderators' attention.
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Re: Nausea as a sign of MS?
Hi,
This article may help - http://multiple-sclerosis-research.blog ... onary.html
In 2014, I was started on Tecfedira whilst I was still on a beta blocker. I was off blood thinners at that stage. The reason was different to your DVT. My heart simply couldn't beat properly due to a bad MS attack and the blood was pooling in my heart muscle as it just trickled through creating the risk of blood clots. All good now.
Nonetheless, when I moved up from the starter dose of Tecfedira I ended up in an ambulance with a suspected heart attack. The doctors withdrew the Tecfidira and the beta blocker. Neither the cardiologist nor the neurologist expected the reaction. Ive never needed to go back to either.
I'd be pointing the finger at the Tecfidera and reviewing all the medications with your doctors. There is usually more than one approach they can take.
Take advice but grill them if you have doubts. Don't self medicate in your case. A good book to read is "The great cholesterol myth" by Stephen Sinatra.
Regards,
This article may help - http://multiple-sclerosis-research.blog ... onary.html
In 2014, I was started on Tecfedira whilst I was still on a beta blocker. I was off blood thinners at that stage. The reason was different to your DVT. My heart simply couldn't beat properly due to a bad MS attack and the blood was pooling in my heart muscle as it just trickled through creating the risk of blood clots. All good now.
Nonetheless, when I moved up from the starter dose of Tecfedira I ended up in an ambulance with a suspected heart attack. The doctors withdrew the Tecfidira and the beta blocker. Neither the cardiologist nor the neurologist expected the reaction. Ive never needed to go back to either.
I'd be pointing the finger at the Tecfidera and reviewing all the medications with your doctors. There is usually more than one approach they can take.
Take advice but grill them if you have doubts. Don't self medicate in your case. A good book to read is "The great cholesterol myth" by Stephen Sinatra.
Regards,
Last edited by Scott1 on Sat Dec 02, 2017 2:28 pm, edited 1 time in total.
Re: Nausea as a sign of MS?
interesting tidbits on interactions in the lit
Effect of propranolol on calcium, phosphorus, and magnesium metabolic disorders in Graves' disease.
https://www.ncbi.nlm.nih.gov/pubmed/1588837
"After 40 mg propranolol four times per day (qid) for 28 days, serum triiodothyronine (T3) had decreased (P less than .05), serum reverse triiodothyronine (rT3) increased (P less than .05), serum thyroxine (T4) remained unchanged (P greater than .05), serum Ca and urine Ca and Mg decreased (P less than .05), intestinal Ca absorption increased, Ca balance was corrected, and P and Mg balance was improved (P less than .05). Our results indicate that propranolol can improve the metabolic disorders in addition to the symptomatic manifestations of Graves' disease. The mechanism responsible for the improved mineral balance is unclear, but may be related to beta-adrenergic blockade, increased membrane stability, or a decrease in the thyrotoxic state caused by the therapeutically induced decrease in serum T3."
interesting that propanolol alters the recipient's calcium and magnesium status, especially since the ratio of these is so important. how does your own propanolol regimen compare to that above? do you have any results on file for serum Ca, Mg and P?
re pradaxa:
Drug and dietary interactions of the new and emerging oral anticoagulants.
https://www.ncbi.nlm.nih.gov/pubmed/20584229
"Oral warfarin is associated with extensive food and drug interactions, and there is a need to consider such interactions with the new oral anticoagulants (OACs) dabigatran etexilate, rivaroxaban and apixaban. ... Clinical experience regarding food interactions is currently limited. ... Given the common long-term use of drugs for some chronic disorders, the frequent use of OTC medications and the need for multiple treatments in special populations, such as the elderly people, it is essential that the issue of drug interactions is properly evaluated. New OACs offer significant potential advantages to the field of venous thromboprophylaxis, but we should not fail to appreciate their lack of extensive clinical experience."
wiley is down for maintenance right now, otherwise possibly could have a look at this
Novel oral anticoagulants: the potential relegation of vitamin K antagonists in clinical practice.
https://www.ncbi.nlm.nih.gov/pubmed/20584215
in the meantime
Interactions Not Solved by New Anticoagulants
https://www.medpagetoday.com/cardiology ... tion/20466
"Dabigatran appears to be metabolized primarily in the plasma and liver without mediation by CYP450, but it does act as a substrate for P-glycoprotein, which is involved in the transport of many drugs -- opening up the possibility of significant drug-drug interactions."
Effect of vitamin K intake on the stability of oral anticoagulant treatment: dose-response relationships in healthy subjects
http://www.bloodjournal.org/content/104 ... ecked=true
"Oral anticoagulants exert their effect by blocking the utilization of vitamin K..."
Effect of vitamin E supplementation on vitamin K status in adults with normal coagulation status
http://ajcn.nutrition.org/content/80/1/143.short
"high doses of vitamin E may antagonize vitamin K."
interesting stuff, considering the degree to which megadose vit E is involved with the old klenner protocol for ms (not a perfect method but the multi nutrient boost certainly did me a world of good - mind you i was not on any meds with which the various nutrients could interact. other than their nutrient-nutrient interactions with each other!)
at first search, not seeing *any* work done whatsoever so far, on possible drug nutrient interactions for tysabri.
at any rate, getting a handle on serum ca mg p k and e could be interesting, with potentially actionable follow up info as a result.
Effect of propranolol on calcium, phosphorus, and magnesium metabolic disorders in Graves' disease.
https://www.ncbi.nlm.nih.gov/pubmed/1588837
"After 40 mg propranolol four times per day (qid) for 28 days, serum triiodothyronine (T3) had decreased (P less than .05), serum reverse triiodothyronine (rT3) increased (P less than .05), serum thyroxine (T4) remained unchanged (P greater than .05), serum Ca and urine Ca and Mg decreased (P less than .05), intestinal Ca absorption increased, Ca balance was corrected, and P and Mg balance was improved (P less than .05). Our results indicate that propranolol can improve the metabolic disorders in addition to the symptomatic manifestations of Graves' disease. The mechanism responsible for the improved mineral balance is unclear, but may be related to beta-adrenergic blockade, increased membrane stability, or a decrease in the thyrotoxic state caused by the therapeutically induced decrease in serum T3."
interesting that propanolol alters the recipient's calcium and magnesium status, especially since the ratio of these is so important. how does your own propanolol regimen compare to that above? do you have any results on file for serum Ca, Mg and P?
re pradaxa:
Drug and dietary interactions of the new and emerging oral anticoagulants.
https://www.ncbi.nlm.nih.gov/pubmed/20584229
"Oral warfarin is associated with extensive food and drug interactions, and there is a need to consider such interactions with the new oral anticoagulants (OACs) dabigatran etexilate, rivaroxaban and apixaban. ... Clinical experience regarding food interactions is currently limited. ... Given the common long-term use of drugs for some chronic disorders, the frequent use of OTC medications and the need for multiple treatments in special populations, such as the elderly people, it is essential that the issue of drug interactions is properly evaluated. New OACs offer significant potential advantages to the field of venous thromboprophylaxis, but we should not fail to appreciate their lack of extensive clinical experience."
wiley is down for maintenance right now, otherwise possibly could have a look at this
Novel oral anticoagulants: the potential relegation of vitamin K antagonists in clinical practice.
https://www.ncbi.nlm.nih.gov/pubmed/20584215
in the meantime
Interactions Not Solved by New Anticoagulants
https://www.medpagetoday.com/cardiology ... tion/20466
"Dabigatran appears to be metabolized primarily in the plasma and liver without mediation by CYP450, but it does act as a substrate for P-glycoprotein, which is involved in the transport of many drugs -- opening up the possibility of significant drug-drug interactions."
Effect of vitamin K intake on the stability of oral anticoagulant treatment: dose-response relationships in healthy subjects
http://www.bloodjournal.org/content/104 ... ecked=true
"Oral anticoagulants exert their effect by blocking the utilization of vitamin K..."
Effect of vitamin E supplementation on vitamin K status in adults with normal coagulation status
http://ajcn.nutrition.org/content/80/1/143.short
"high doses of vitamin E may antagonize vitamin K."
interesting stuff, considering the degree to which megadose vit E is involved with the old klenner protocol for ms (not a perfect method but the multi nutrient boost certainly did me a world of good - mind you i was not on any meds with which the various nutrients could interact. other than their nutrient-nutrient interactions with each other!)
at first search, not seeing *any* work done whatsoever so far, on possible drug nutrient interactions for tysabri.
at any rate, getting a handle on serum ca mg p k and e could be interesting, with potentially actionable follow up info as a result.
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use the report button to flag problematic post content to volunteer moderators' attention.
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Re: Nausea as a sign of MS?
Thanks for the responses. The doc called back and thinks it was food poisoning. Feeling better today but needed Tylenol-3 earlier.
kaypeeoh
kaypeeoh
Re: Nausea as a sign of MS?
glad the nausea was a passing thing.
side benefit - the research posted above re vertigo makes more sense, without having to account for nausea in the mix!
side benefit - the research posted above re vertigo makes more sense, without having to account for nausea in the mix!
active members shape site content. if there is a problem, speak up!
use the report button to flag problematic post content to volunteer moderators' attention.
use the report button to flag problematic post content to volunteer moderators' attention.
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