HC and Medrol

[Lethal Lee]

Hi Deb,

How long is too long to be taking Ativan?
Recommendations say use for short time only to minimise risk of addiction. That is is "defined" as 2-4 weeks.

To date have lost 15 lbs
Over how many weeks is this weight loss?
Maybe water retention has eased?
Are you losing inches as well?
Do your clothes feel looser, waist of pants loose or tight?
Any diarreah? Are you eating well & regularly?
Are you currently over or under ideal weight?
Sleeping OK continuously for at least 8 hours?

Thyroid Meds *sublingually
26th Feb - 1/4 grain increase to 1 1/4 grains dosed 30-15-15-15
10th March - 1/4 grain increase to 1 1/2 grains how dosed?
24th March - due to increase 1/4 grain to 1 3/4 grains

Good that you have increased to 1 1/2 grains & it seems to be helping. Are you intending to increase another 1/4 grain in about a week?

BP & HR
High BPs seem to be reducing. In fact now seem too low!!!
BP sitting to standing ...most still falling but only slightly & a couple did rise.
This is an improvement but indicates not yet correct balance of Potassium & Sodium & Florinef dosing.

Temps
Are a bit high at av of 99 - 99.1 this may well be because Sodium/Potassium not right yet. My temps were high like this until I sorted Sodium/Potassium out. How the temps ARE stable so Adrenals seem reasonably happy at least.

Are you feeling hot at all? Getting sweaty a lot? Have any noticable worsening in muscle weakness, trembling especially in legs? No fine hand/arm tremors if hold arms straight out with palms upright?

HC
5 th March - 10-10-7.5-5 = 32.5mg HC total
11th March - 10-10-5 - 5 = 30mg HC total

You have reduced by 2.5 mg daily?
Why is that? Feeling OK?
Hows the Adrenaline rushes now?
Any headaches?

Florinef
20th Feb - 1/4 tab in am
27th Feb - 1/2 tab (1/4 in am + 1/4 in pm)
5th March - 3/4 tab in am
12th March - raise 1/4 tab to 1 tab am.

Stay on 1 tab for at least a week & continue to monitor.
I would really like to see you sort out Florinef, Sodium & Potassium before next period comes around.

Sodium
Salt 1/2-1/2-1/4-1/4 = total 1 1/2 teasp

Suggest you reduce by at least 1/4 teasp to 1 1/4 in total.
Perhaps make the second dose 1/4 teasp & keep a.m. at 1/2 teasp? Maybe even decrease to 1 tesp total (1/4 teasp x 4)?
Reduce Salt same day you add the 1/4 tab Florinef.

Potassium
24th Feb
Sodium......... 137 *far too low
Potassium..... 3.9 *far too low
9th March
Sodium......... 143 *good
Potassium..... 3.7 *far too low

Really need to get the Potassium up!!!

Dosing
24th Feb - 4 x 99mg (dosed 4 x 99mg tabs) = 396mg
10th March - 5 x 99mg (dosed?)= 495mg
11th March - 6 x 99mg (dosed 3 tabs x 2 daily) = 594mg

This is still far too low considering 3.7 result on 9th March.
I repeat I think you need start on the rx Potassium.
You said you have 20meQ (780mg) tabs?
I would take 1 in am & a second later say around 4-6pm.
Thats a total of 1560mg total (966mg increase).
As rx Potassium is slow release & lasts ~ 4 hours you need to take at least twice a day.
It takes a LOT of Potassium to increase blood levels.
Remember it took 1200mg to increase my levels to 4.2.

Ativan & Cigarettes
Hows the Ativan & Smoking going?
Is your Sister still staying with you?
Hows the stress levels at home?

And how long do I wait to get Sodium & Potassium tested again?
I would wait at least a week after increasing to 1 tab Florinef, increasing to 1560mg rx Potassium, and decreasing Salt to 1 to 1 1/4 teasp. Unless you find youself feeling a lot worse & want to check what's happening.

[dseezs]

Hi Lee,
Ativan
I try not to take it but always do. My problems with the adrenaline is usually evenings around 8 PM. This for me is around 4 hrs. after 4:30 dose meds and salt.
Feel adrenaline stomach (butterflies), shoulders and neck tense up, then headache and B/P rises. B/P doesn't rise over 130's/80's these days, but I can still feel the adrenaline all the same.
The weightloss started w/trying to go off the meds and ended up in ER's. Diarreah much improved now. Weightloss has stopped. I'm still overweight 5' 1" 155 lbs. but went from 36 in waist pants (tight) to 34 in. I've been eating alright and trying to eat regularly when I remember. I still don't have an appetite most of the time.
Afternoons are the problem as I feel like something gets stuck in the center of my chest or indigestion after eating or drinking.
I sleep OK. (ativan 8PM)??!!! Don't get up to use bathroom at all in the night. Dreaming off and on. Usually sleep 7-8 hrs. I do sometimes wake early feeling ravenously hungry. I do snack at 10PM with meds and salt on cheese, a bit of P.B., or a hard boiled egg.

Thyroid Meds
Dose 30-30-15-15. Will raise in about a week hopefully. Don't see reason not to at this point I guess!

B/P HR
Wondering if some of those very low were from combo of Ativan and adding Thyroid. B/P seem to have come down with the addition of more thyroid.

Temps
Still steady so far. Don't feel hot. Get sweaty armpits, fingers and toes off and on. Also get cold fingers and toes off and on. When they're not sweaty, they're cold!!!
Some trembling in legs around knees when I was in ER's and felt very cold but temp said otherwise. To the point my whole body was shaking and wouldn't stop. That's when I got the Ativan. That hasn't happened since. Get muscle twitches in thighs, arms, etc different places sometimes. Achey calves. Shakey hands off and on. Usually around the times it's time for meds and salt.

HC
Reduced 2.5 as I couldn't tell the difference. 32.5 or 30. Temps went up.

Florinef
Adding 1/4 tab for 1 full tab today. Adding to 4"30 PM dose. Seem to drink and p more then. Altho still don't get up at nite. Going to try to get labs done again in a week. Hopefully!! They think I'm very strange as they keep telling me they are fine!
Sodium
OOPS! Will have to try to reduce tomorrow already to late for today. Will try 1/2-1/4-1/4-1/4
Potassium RX
Start that tomorrow also. The bottle says 15oomg 20mEqK. Doing 8 (99mg) today. So to clarify:
1/2 of RX tab 8:30 AM and 1/2 of RX tab at 4:30 PM?
Cigarettes
Smoking is TERRIBLE!!!!! Smoking a pack a day! I can't stop!
My sister is gone now, but I still feel very uneasy about what will happen to her. Her cancer scans came back alright for the time being. She's had thyroid, breast and ueterine cancers. The amount of stress she endures in her daily life terrifies me for her and I'm afraid of losing her. Just had a brother pass away last Oct.
My stress here at home is no better. No jobs! Husband still can't find work and now they're trying to take away unemployment.
I feel I made things worse by my visits to the ER's and now Dr. office and blood work. I want so much to contribute but can't. Husband is stressed and not sleeping well.
Just trying to hang on. It's pretty rough ans feeling pretty low sometimes!
I'd be lost without you and everyone. Dr is trying to learn with me here too.
Thanks for everything
Deb

[yippy]

Hiya Deb my dear sister. (for anyone reading this...I am NOT the sister that was moved in at Deb's. I'm the sister that is the MLT(ASCP) as well as having a number of health issues myself.......

I'm concerned. The Klor-Con should never be split,crushed,or chewed. It is supposed to be taken ,intact,as one dose. Breaking or crushing the pill may cause too much of the drug to be released at one time because it can(and most likely will)irritate your mouth or throat. (The same applies to the OTC K+)

Take this medication with food or just after a meal.
As an added bonus....it's quite likely that you have yet one more of our family's medical issues...i.e. GERD. Not only might you be having some reflux problems,(caused by the good old hereditary issues,but also because of the long term cortisone intake)but our family does also have a tendency to have a bit of narrowing of the esophagus. (Isn't heredity just grand?!! Dang! If it's not one thing ,with us,then it's 100 others it seems lol)

P.S

I'll try to get over to see you sometime today after I get done with my I.V. stuff at the hospital.

[dseezs]

Yippy,
Thanks for the visit today. I know you weren't feeling the greatest. Good to have someone to chat with for awhile today.

Deb

[dseezs]

Lee,
I have question about my B/P. They are going up some today. Not horriblely high but high enough for me to sit up and take notice again. Low 140's/mid 80's. haven't been this high for awhile.
I took 1 1/2 RX Potass. today. (Won't do 1/2 again. Tummy ache bigtime)! Reduced my salt 1/4 tsp.
Salt 1/2-1/4-1/4 so far. 1 Tab Florinef this AM. Tried 1/4 yesterday afternoon and by last night when I took salt and med felt like my right kidney might explode. Ouch.
What would make my B/P go up like this? Any ideas what to try?
I also should say that these high B/P are after being up moving for a few minutes and don't stay constant, they do go down after sitiing a bit but only to high 120's/low80's.
Any idea what gives?
Thanks
Deb

[Lethal Lee]

Hiya Deb,

Your sister is absolutely right about rx Potassium.
You cannot cut the tabs. That breaches the slow release coating & you get the whole dose in one hit.

You described the Klor-con as "the bottle says 15oomg 20mEqK".
Now as I said before 20mEqK is ~780mg Potassium. Not sure what the 1500mg is about though? Is that the Label put on by the Pharmacist? What are Docs dosing instructions? Did she say take two tabs maybe? That would be 2 x 780mg = 1560mg?

We need to clear this up...can you ring Pharmacist & verify exactly how much mg in EACH tab if you are at all unsure?

As far as Florinef goes you were on 3/4 tab & were increasing to 1 tab (1/4 tab increase). I suggested adding to am dose as I thought from your previous posts that you were taking ALL the 3/4 in the am already?

Then yesterday you wrote
Florinef - Adding 1/4 tab for 1 full tab today. Adding to 4.30 PM dose. Seem to drink and p more then. Altho still don't get up at nite.

Today you posted
Had 1 Tab Florinef this AM. Tried 1/4 yesterday afternoon and by last night when I took salt and med felt like my right kidney might explode. Ouch

So NOW I'm confused!

Please advise
1/ exactly how much & when you took Florinef, Sea Salt & Potassium (and which type) before the adjustments
2/ exactly how much & when you took Florinef, Sea Salt & Potassium (and which type) yesterday?
3/ exactly how much & when you took Florinef, Sea Salt & Potassium (and which type) today?
4/ Also please advise for each day when & how much Ativan you took.
5/ as far as any new or worsening of symptoms, vitals (BP HR) you had could you tell me which symptoms you had when on each day (looking to see if related to Salt, Potassium, Florinef changes)

I do think it very likely that BP changes are related to the adjustments. Dont worry we are still 'fine tuning". If BP or HR become distressingly high take a 1/4 teasp Sea Salt in water see if that helps.

Breaking the RX Potassium may well have given Potassium an immediate boost upsetting the Sodium/Potassium ratio. Wouldnt have helped tummy either I suspect. Although if the tabs ARE ~780mg that would have only been 390mg. But IF they are 1500mg per tab would have been ~750mg!

IF you want to increase Potassium slower take a mix of OTC & Rx tabs rather than cutting a Rx one. By the way ANY tab/med thats slow release CANNOT be cut, crushed in anyway.

So if tab is 780mg Potassium
You were on 6x 99mg OTC = 594mg
I said to take 2 x 780mg RX= 1560mg
You took 1 1/2 x 780mg RX = 1170mg

Did you intend to try taking ~1200mg?
If so try 1 tab rx then take rest in OTC say,
(1 x 780mg rx) + (4 1/4 x 99mg OTC) = 1200mg.

If a tab is NOT a slow release there is usually no problem cutting it & taking 1/2 or 1/4 whatever.

As far as Salt goes as you move higher in Florinef you will need less.
Your Last Sodium was 143 on 3/4 Florinef & 1 1/2 teasp Salt.
So going to 1 tab Florinef a Salt reduction is needed to keep Sodium optimal & not over shoot.

We want to find the right combination of Florinef, Salt & Potssium to optimise blood levels & eliminate symptoms. That means to keep BP & HR at good levels, BP consistently increasing when standing and peeing etc back to normal. That also means as well as right DOSES/AMOUNTS we need to find right TIMING of doses to give you maximum coverage for whole 24 hours.

Its tricky, time consuming & a matter of trial & error. But well worth it for the stability & reduction of body stress if we can sort this out for you. Hopefully that will mean elimination of need for Ativan & hopefully reduce/eliminate the cigarette consumption too.

I am concerned that you are smoking 1 pack a day. Thats a LOT of strain on Adrenals. Nicotine is supposed to increase Cortisol up to 30%. If your Adrenals are trying to produce extra Cortisol when fatiqued thats asking an awful lot. Plus you could actually be having HIGH Cortisol if Adrenals are capable of producing enough! That will affect T4 ==>T3 as high Cortisol causes RT3 increase.

First thing is to clarify EXACTLY how much mEqK & mg equivalent is in EACH Klor-con tab. Also exactly what was Docs instructions on rx....how many tabs per day? Do you have repeats of the rx if needed?

Then get back to me with answers to my queries.

[yippy]

Hi Lee,

The bottle of Deb's RX K+ is,for some unknown reason,not the typical bottle in which the vast majority of RX meds are dispensed. It's the drug manufacturer's bottle. The Dr. wrote the RX as 20mEq 1 tab p.o. qd. Why the pharmacy gave out the RX in the manufacturer's bottle?...well...who knows.....and just why it is that the manufact. labeled the bottle as 1500mg is beyond me. Gee whiz...converting mg to mEq is very simple math.(providing that the person doing the math would understand that the conversion equation depends upon the ionic properties and atomic weight of the chemical in question)..one would HOPE that the drug manufact. would KNOW how to do that!! Sheesh!

There is a lot more that I could write here,but this post would end up being the length of War and Peace. lol

As for your other questions....I'm sure that Deb will get back to you on that and give you more info.

[dseezs]

Hey Lee,
Sorry to confuse you. I was or am confused too! Unfortunately most of the time LOL!
I learned my lesson w/the cut Potassium. I won't ever do it again! It really hurts the tummy!
The manufacturers label says:
Klor-Con M20
Potassium Chloride
Extended-release
Tablet, USP
Micro-Dispersible Technology
1500mg
20mEqK
30 Tablets
I peeled back the pharmacists label to read: Each extended-release tablet provides 1500mg potassium chloride (equivalent to 20mEq of potassium)
OK. The Dr. instructions say take one tablet by mouth every day. Can refill until 2/10/10.
Mar 10 Tues.
Day 6 99mg. Potassium (5x) 2-1-1-1
Day 6 3/4 Tab Florinef all AM
Day 14 salt 1/2-1/2-1/4-1/4
Ativan 8PM slept ok
Mar.11 Wed
Day 1 99mg Potassium (8x) 2-2-2-2
Day 1 1 Tab Florinef 3/4 8:30 AM 1/4 4:30 PM
Day 15 salt 1/2-1/2-1/4-1/4
No Ativan No sleep til 3 AM
Mar 12 Thurs
Day 1 RX Potassium 1/2 8:30 AM and 1 Tab at 4:30 PM
Day 2 1 Tab Florinef all AM
Day1 salt 1/2-1/4-1/4-1/4
Ativan 7:20 PM slept ok
Mar.13 Fri Today 9:30 AM
Day 1 RX Potassium 1 Tab AM (so far)
Day2 1 Tab Florinef all AM
Day 2 salt 1/2-


I don't know if its a combo of stress, boredom, shakines sometimes, or low thyroid that I feel the need to smoke so much. I'm confused about most things, most days!
I do know that I was smoking 1 1/2 pack a day since beginning of all this way back when. Oct. 07. But at the time I was also drinking alcohol every weekend for months. Now I can't stand the smell of it! I also have a BIG problem with anyone smoking around me when I'm ready to sleep. Same goes for cologne or perfume any time of day. I could swear sometimes people bathe in the stuff. I wear some perfume occasionaly depends on my nose most days. I'M WEIRD!!!!!!
Hope this helps. Some days I couldn't find my butt with both hands if my life depended on it. Then again some days I'm not so bad. Just never know which day I'm gonna have til I'm up for awhile.LOL
Thanks
Deb