Testosterone and Multiple Sclerosis

Testosterone and Multiple Sclerosis researchers needed

This page intended for researchers, Nord,  scientist, neurologist, cancer Doctors, endocrinologist, and Gps and students to see if double dosing a MS patient with Testosterone Cypionate  200 mg/ml has any effect on muscles, or, stopping MS progression in multiple Sclerosis.

https://www.ncbi.nlm.nih.gov/snp/rs1799945#clinical_significance

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2686335/


Testosterone Affects Outcomes in Men With MS | Multiple Sclerosis


strange-warning-signs-low-testosterone/

Hypogonadism and the risk of rheumatic autoimmune disease.

https://www.ncbi.nlm.nih.gov/pubmed/27325124
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5544431/
https://arthritis-research.biomedcentral.com/articles/10.1186/ar328

Immune Modulation And Increased Neurotrophic Factor Production In Multiple Sclerosis Patients Treated With Testosterone


The role of testosterone in MS risk and course


The following charts were compiled over eight years bringing us up to date
  Note the Testosterone  low numbers would represent the lowest I would drop between injections.
This Study started 2012 to present. The testosterone was  stopped for a  MRI of Pitulary Gland.

The Cancer Dr found two copies of the H63d Gene mutation causing Iron overload.  This is listed in NORD, as a rare gene.  17 phlebotomy took place over three months. Hemaglobin, transferrin, and other labs available by email request.

These are lab reports from total testosterone.
Testing procedure changed  April 06,2020 .

was changed to do testosterone after 4th day of injection.  All others were tested with one week off inbetween injections to see the curve of the lowest point going, Weekly or every other week, as shown in notes, as started every other week, Changed to weekly, as lowest curve was to low for drs.

Note Achtar, used for MS, raised testosterone, as a hormone.
3/07/16 Testosterone went to weekly shots. Everything before this was every Other week.
Other items listed are reference points of other test done and diagnosis reference points. Dr names have been removed for privacy.


Apr 6, 2020 7:16 AM
1,008 ng/dL
Mar 16, 2020 7:30 AM
127 ng/dL
Sep 23, 2019 7:58 AM
396 ng/dL
Apr 22, 2019 7:55 AM
528 ng/dL
Mar 4, 2019 7:30 AM
374 ng/dL
Dec 3, 2018 8:08 AM
457 ng/dL
Oct 22, 2018 7:55 AM
676 ng/dL
Jun 12, 2018 7:00 AM
71 ng/dL
Jan 25, 2018
76 ng/dL
Sep 17, 2017 7:00 AM
246 ng/dL
Sep 12, 2017 7:00 AM
246 ng/dL
Jun 22, 2017 7:00 AM
222 ng/dL
Apr 3, 2017 7:00 AM
1,686 ng/dL
Mar 30, 2017
1,636 ng/dL
Oct 3, 2016
265 ng/dL
Feb 18, 2016
175 ng/dL
Feb 12, 2015
12 ng/dL
Dec 16, 2014
143 ng/dL
Dec 3, 2014
143 ng/dL
Sep 8, 2014
1,053 ng/dL
Sep 5, 2014
240 ng/dL
Aug 11, 2014
1,014 ng/dL
Aug 7, 2014
1,163 ng/dL
Jun 3, 2014
1,052 ng/dL
Mar 3, 2014
405 ng/dL
Dec 11, 2013
91 ng/dL
Sep 5, 2013
240 ng/dL
Aug 30, 2013
240 ng/dL
Jun 12, 2012 2:05 PM
177 ng/dL

About Total Testosterone (blood)
Total Testosterone is an androgen hormone. A blood test is done in males and females to evaluate sexual dysfunction, fertility problems, premature or delayed puberty, virilization in women and as a marker for polycystic ovary syndrome (PCOS). Levels will vary by age. This data is self-reported by patients on the basis of laboratory testing.
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Alergic tramidol, carisoprodol
Cymbalta works. Duloxetine Actavis, bad reaction 50%, Teva brand 60%. Do not give either sub brands.  Lupen working 11/17, Changed formula, not working..

Allergic to fenofibrate. Increased creatine 2019-2020

wrong diagnostic Complex regional pain syndrome RSD

Mir neck dec 27 2011
lesep and arm test March 29 2012
Mir lumbar spine may 17 2012
blood test June 5 2012
eye dr June 27 2012 alt  exotropia
blood tests July 2 2012
Mir brain July 18 2012
spinal tap Aug 1 2012
ms treatment botox September 13 2012
cervical degeneration disc disease &
Multiple Sclerosis  diagnosed by neurologists Dr
eye ophthalmologist Oct 20 2012
Copaxone start November 10 2012
botox Dec 13 2012
Ver Lesep test Dec 19 2012 failed
Mj switching to generic cymbalta 2/13/15 clinic saving money******
b12 injection Feb 22, 2013, nuvigil. Had to have b12 before test
botox March 14 2013
Dr. New heart Dr  heart may 30 2013 refered by dr
Dr 6/6/13 notes Optic Disk Pallor and Right lateral gaze nystagmus
6/28/13 Mitral valve prolapse dr
8/12/13 botox
9/13  1 ml /week
10/01/13 medicare + medicaid
10/04/13 flu virus vaccine
10/02/13 TCL and EEG done
10/17/13 botox, EKG, Nuvigil10/19/13
11/05/13 testosterone level check quest
11/26/13 Shingles Vaccine
12/11/13 labs, tsh. testosterone=91.5 ,
1 mg inject
12/2 12/25 0.5 injections
12/26/13 Botox neck calves
1/8/14  injections  .75 results= 91.5
2/4/14 testosterone injection to 1.0 ask next month for labs
 Testicular Hypofunctionon going on
Feb-04-2014  Umbilical HerniaFeb-04-2014 -Pharyngitis, Acute

2-19-14 start 40 mg copaxone NEW
2-20-14 Dr.  umbilical Hernia San Andreas. Blood work EKG done,
Tetnas Shot
3-03-14 quest testosterone tests
3-11-14 hernia repair Mark Twain Hsptl
3-13-14 Botox, r neck, l calf, eyes above
3-13-14 Lower Extremeties
3-18-14 re-Start 20 mg Copaxone
3-25-14 Swallowing Study Sutter Amador Hospital
12/15/14 testosterone to 1 1ml  every 2weeks
Esophageal Motility Disorder Dr
04-1-14  Depo-Medrol 80 mg & pill  Dr
METHYLPREDNISOLON
04-19-14 Dr  opthamology
5-01-14 prostate check,&lab
. thickners added to drinks.
5-21-14 botox neck, head, outside right leg
6-03-14 blood test quest ALL
6-04-14 ACTHAR 5 day injection  *Raised Testosterone
6-12-14 Lower Extremities
8-04-14 Botox  neck, both calfs
8-06 14. blood: acth,testosterone, tsh &t4, hemoglobin a1c, cmp, cbc, lipid, estrogen.    =1,163 ng/dL
9-08-14 blood. testosterone, cbc,psa.  =1,053 ng/dL
10-13-14 botox both calfs inside/out
10/15/14 Testosterone change 1/2 ml  per Dr @1153
10-24-14 flu shot
12/03/14  lab testosterone.                         =143 ng/dl



12/23/14 Botox neck, both calfs
 12-25-14  right chest arm muscle spasms 15 days . Dr informed
1/5/16 sent saliva sample for DNA testing
1/16/15. Costochondritis  per Dr  said torn rotator cuff.
3/9/15.  botox neck right, right outside calfs, left inside calf.             EMG done  scan lower extremity
3/20/15 All Labs done
5/14/15 testosterone inject 1.5ml dose new. Level = 120  ng/dl
5/26/15 Botox both calfs, neck
6/23/15  testosterone test.   Testosterone = 411
7/11/15., ucdavis tests
7/13/15
 labs for UCdavis viti!ine D, B, CBC, varicella sister, heptic  function, basic metabolic,
7/24/15 Dr SAC heart EKG, Echo Gram  high pulse
8/10/15  vit D=14 (30-100)  wants increased to50,000 iu/week
8/11/15 Botox Dr  left, right calf's, neck
8/11/15 vit D=13 (30-100) b=262 (200-1100).    ADDED 5,000iu vitamin d3
8/14/15 thru 8/21/15 wore heart monitor cardiac event recorder Dr , Sacramento Heart OK avg pulse 80
9/09/15 start 1000 B12
9/14/15 Quest vitamin D check ucdavis
             Vit D =38 (30-100)
9/15/15 SEP test Dr
9/28/15 labs vit B, D, CMP

             Vit D= 50. (18-72) Vit b12=396 (200-1100)

9/28/15 ADDED 5,000 vitamin B daily
10/12/15 Flu shot
11/12/15. Botox Deep neck right, both sides neck left calf inside, right calf back. ADDED 7,000 vit d.
11/16 Dr. Still doesn't want to do anything. Said rotator cuff may be torn last month.  Doesnt want to do anything. Should of prescribed valuim three months ago.Valium was prescribed for muscle spasms
12/17/15 Ampyra started
Dr  wants cmp,cbd, vit b, D, testosterone read feb
1/4/16 Dr refused blood test, didn't want liability. Told him to contact specialist.
1/4/16 Osteoarthritis in left elbow nodules Dr nothing done.
 1/4/16   Tmj in left jaw mills did nothing
2/11/16 botox
Dr  injects right Left neck, left calf botox.
Emg of heart
2/12/16 labs per two drs
CMP, testosterone total, urinalysis complete,CBC inc diff pot, bit b13, folate, serum panel, PSA, total, Lipid Panel, Vitamin D, 1,25 dihydroxy lc/ms/ms,  Tsh and free T4
2/18/16 new GP Dr. Sample of 75 mg viberza given for diahrea. Got blood test
2/18/16 .     vit d=52. Vit B= 1409
 testosterone= 175
3/01/16 blood flow of brain Dr. Added nuedexta sample for quinine.
3/17/16  referral to GI. Dr  May17  Viberzi 100 mg given 2xday.
Increased testosterone 1ml every week. 3/26 4 bottles
4/08/16 ucdavis did chest xray Sacramento  findings: Dextroscoliosis dextroscoliosis of the
thoracic spine is noted.

  Increased vitamin d 50,000 twice per week, use b2, 6,  biotin try all Bs
4/11 switched to Walmart pharmacy all drugs.
5/02/16 Dexta scan  sutter amador -.7 is low enough.
5/02/16 pth level blood sutter amador, cough sample.
5/23 labs per UC Davis long chain fatty acid test UC Davis Dr ,, vitamin D cmp, vit b standing order
5/25 start RISEDRONATE soDIUM 35MG TABLET for bone loss
5/26/16 upper and lower colonospopy Dr
 Sacramento.  Upper flap ulcer, report Sutter health.
COLONOSCOPY W / OR W /O INTERVENTION performed by DR
ESOPHAGOGASTRO DUODENOSCOPY (EGD) performed by DR
When:
Thursday May 26, 2016 9:00 AM
Ulcerative Colitis and hiatial hernia
5/27 Friday. Copaxone delivery, knots in calfts, right leg hurts,, shoukder
6-01 Dsl#3 450  billion probiotic start 6/01. $88 cosco paid
6-3-16. Prednisone 20 mg start 6/3/16 three times day for three days. Sauer
NEW  RANITIDINE HCL 150 mg for irritated stomach found.
150MG TABLET Dr
6/27/16 applied to NORD for DSL#3 DS
7/11/16 steroid injected by Dr right shoulder neck. Relief!!
synthetic glucocorticoid corticosteroid  Triamcinolone 10mg
 Lasted four days
7/21 thyroid checked. Calcium blood test. Endocrinology ucdavis. Increased vit d to 150, 000 for three months, then blood/ urine test. Dr  ucdavis
8/08 antibiotic Dr  for green slime coughing up levofloaxacin
8/11/16 botox to upper right shoulder neck, both calves Dr
8/20/16 three day round prednisone oral, once antibiotic was done.
9/07 botox booster outside left leg. Dr
9/10/16 flu shot given by pharmacist
9/28 lower extremities test, blood flow test
10/03 labs test Dr . Calcium. Vit d2, albumin,creation&calcium 24 hr urine. CBD Cmp by Dr
10/21 stopped B vitamins, not doing anything. Lowered D to 100,000/week D=91 ask gp on testosterone low  testosterone= 265 per Dr  uc davis
11/07/2016 Dr  increased testosterone to 1.5 ml/ week
11/09 applied to more for another year vsl#3 D's accepted

11/10 botox Both inside calf's, right neck muscle
11/12/16 100mg pure Biotin three times day. Scale to measure
MD001 trial
https://purebulk.com/biotin-pure/ Dr anducdavis, dt
11/22/16  uc Davis MRI cspine and brain Dr
1/11/17 flue with green all month
2/06/17 Dr evoflaxin500 for10 days, cough syrup
2/07/17 Dr . Botox both calf's and neck muscle twice for right shoulder. To add zinc to diet. This area on neck did trick
3/06 bactrim 10 days plugged me up. Dr
3/17/17 Dr  EKG, yearly visit
3/30/17 Dr to stop testosterone shots. Do a bunch of labs before seeing her in three months.
Increase to 150,000iu/week vitamin D level dropped from 91 to 63
Test: total testerone,sex hormone binding,hemocritin, PSA, luteinizing hormone, folic stimulating hormone, prolactin, thyroid stimulating hormone, thyroxine free,  misc lab00041   IGF-1,  cortisol, vit D, magnesium. Three monts
increased got D to 150,000iu week  also
Stop testosterone 3 months so labs of hypothalamus, pitulary, testes,
Stopped md1003 for testing
4/01/17 Dr yearly opthalmologist exam
4/03/17 Dr  lab test CBC, Comp metal,lipid panel w ratio t4 free, testosterone, tsh fasting test
4/05/17 increase vsl#3ds 1 package per day dr 950 billion
4/07/17 cyst drained left wrist Dr
4/08/17 Dr levoflaxin500 for10 days, for green phlem cough
4/10 Dr neurologist UC davis, about samr
4/26 sent Dr MRI disc to compare
5/04/17 UBIOME gut bacteria sample, registered to mail
5/08 Botox Dr neck both sides, middle, both inside calf's. Can see muscles hard.
6/1/17 patients like me pioneer in research consent blood draws
6/07/17 Dr booster botox x left calf.
6/ /17
 Am doing ESR,CPK,vite,HHV-6 virus,testosterone, sex hormone binding glob, hematocrit,PSA,luteinizing hormone,follicle stimulating hormone, prolactin, tsh,thyroxine free,igf-1,cortisol,vitimin D,Magnesium on upcoming labs, thus why off testosterone therapy. Hypothalamus -pitulary gland-testes loop and thyroid
6/19, 6/21, 6/22, labs for drs. Had problem with ana panel test, and cortisol. Not their responsibility. Did not know what checked box mention.
B7/03/17 Dr  doing MRI of pitulary gland   keep 150, 000 vit D level 83,
Testosterone restart after MRI.
7/04/17 Started back md1003 Biotin, added LENTLES to diet
7/07 Dr ALA α-Linolenic acid (ALA).  try http://www.medicalnewstoday.com/articles/318225.php
7/11/17 MRI of pitulary gland Dr UC davis. Pitulary fine
7/12/17 Hypogonadotropic hypogonadism
7/12 start 1 ml testosterone per week. Level below 211
7/24/17 blood draw for patients like me. Edta plasma, pax gene,serium red top, RNA DNA four tubes
Alpa lipoic Acid 600 mg twice daily. Start7/26/17
8/11/17 have rash woke up to on groin, buttocks, 8/12 moved to waste line, back and arms. Still moving around. Rash on buttocks, spread to groin, then hives moved around on arms and leg muscles thru 6 am 8/15
8/15/17 botox Dr both legs. Spasm found. Right rotator cuff, muscle high on neck. Refills in 3 weeks.
8/18 muscle spasms quite sore from botox.  Neck shoulder sore spasms
8/19 picked up Monday 8/21 Ingenious Modafinil. Generic change of name from cephalon modafinil provigil written.
9/12/17 fasting blood test ucdavis for Dr.  Dr  go over shoulder, gut pee test on Sunday.
10/05/17 more endocrinologist  blood test UC Davis. Note Biotin taken in am 100mg messes with tests. Took Sunday tested wed am
10/05 Dr uc Davis drop testosterone to 1/2 weekly. 140,000 iu vit D. Told her I took Biotin that morning, and was dehydrated last test, and biotin not stopped soon enough. Retested four test. Thyroid came up high because biotin. Hemacrit within levels..hydrated.
10/06 D did liver panel on me at Sutter hospital. Ok good result
NEED IRON, FERRETT ran 11/06 fine
10/09/17 added chicory root 1/2 tsp-1tsp
10/21/17 flu shot
10/27/17 EKG Dr . Increased clonidine from .2 to .3
11/06 labs  Dr.   Cbc, ferritin, , iron, liver.
 Ordered MRI of spine neck
11/08 MRI spine Sutter hospital
11/10 two page report on pinched nerves. Called, ucdavis let known
11/12/17 added corn pre biotic
11/15 Botox Dr Would not look at neck report
11/21/17 blood draw patients like me TAD
12/4 Dr Mad he did not see me souoner. Need referral Dr for epidural injections.
12/4/17 Dexamethason 4mg. Two tabs 4 days, the 1 tab 4 days to relief pain from disc pinching nerves 12/04/17 bowhay
12/07 called for referred again.
12/07 Dr  optic neuritis left eye. New glasses, 2 hrs spent

12/14/17 Dr  to go over botox
12/14/17 Dr went over MRI notes and eye notes. Sent e home with bottle of hyaluronic acid
12/26/2017
12/26 epidural  Placerville 80 mg prednisone into neck. Did not work he called 1/09/18
Dr epidural injections. 
El Dorado Surgery Center
Sutter Amador Dr  treating optic neuritis with 1,000 mg Methylprednisolone 12/14/17 5 days iv solution Dr , optic neuritis injected iv for Thur, Fri, Mon, Tue, wed
12/26 epidural Dr 80 mg prednisone into neck. Did not work he called 1/09/18
2018
1/3/18 Ubiome study of gut sent in #3
New GP from clinic. ----
1/09/18 Dr
Subject: Referal    referal to us davis for spine institute
1/25 blood fasting at ucdavis  cbc,cm p for dr 730
1/25 Dr MS clinic midtown 11am, not enough time. see her six months
2/01/18 Dr  was 150,000 iu D/week,level 86,  2 ml testosterone lweek level54
2/07 Dr  added Simethicone to daily for bloat
2/15 u c davis spine  Wants four fused. 5 minutes, no q&a
3/1/18 postponed surgery indefinitely four disc Dr  wanted fused .
Note 1/3/2020 not candidate for any surgery
3/2/18 Dr ekg. High triglycerides from pasta, bread, sweets, wine day before. Not worried. Him and Dr sidhu glad not doing surgery.
 5/15 added 400 mg hyaluronic acid pe  protruding
5/17/18 botox both calfs, upper right neck to right arm muscle
6/01 Psylium hull added
6/02 18 hyaluronic acid London is 300mg
6/6/18  hepatitis c antibody test .16 ratio who c ab non reactive
 Hemoglobin test  e at  111 diabetes non, less 5.5
6/07  hernniha large protruding.  hemorrhoid per Dr picture sent
6/12 lab test UC Davis, botox extra ink  left calf
          Joined all of us research
6/14 vi t D=72 take 140,000 iu week
Testosterone level #71, taking 2.0 ml week, dropped from #76 from last test.
pth was 12 in May 2016,
 blood calcium 10.4 on 6/2018--------------------------------------------
Lowered D in 1/2, testosterone to 1.5
6/22/18 end of test of 300 mg Hyaluronic from London and Hyaluronic acid 100 mg form Dr =400 total. START test of 450 mg Hyaluronic Acid and 600 of chronodition together
6/22 hemorrhoid inside also. Butt black left side. Used fluoinocide.
7/12 Dr referred me to hematology blood specialist. Primary Polycythemia.  Hypochondriac in male. Vitamin D deficiency. Put me back on 2 ml testosterone and 150,000 vi t D
8/8/18 Dr , UC Davis cancer  Polycythemia primary center blood test, curriculum econ 9 mutation,cbc with diff, cmp,erythropoietin, ferritin, iron, jak2 mutation, lab misc, transferrin.
8/15 /18 botox calves and neck DrTold he add baby asprin, upon telling him tests.primary
9/12/18 Dr uc davis cancer iron overload syndrome. Did cbc, hemochromatosis the gene dna blood. Ordering scan of abdomen. H63d both genes
9/14 new GI uc davis. Dr
Scan for Dr
9/17/18 Sleep study by Dr teams of paper. Joe and wil
Abdominal ultrasound is a type of imaging test. It is used to look at organs in the abdomen, including the liver, gallbladder, spleen, pancreas, and kidneys.
9/20 EKG by Dr . Went over echo and high triglyceride. Sent to Dr, before meds to lower.
9/24/18 hydrogen breath test uc davis Dr Negative for small intestine overgrowth positive for butane from constipation.
9/26/18 start Polyethylene glycol pkt 3350-rx  Dr
10/01/18 phlebotomy 300ml Taken labs before and after, but diluted with saline.
To do phlebotomy Weekly. Labs taken before
10/04 TRULANCE 3 mg started Dr
[]10/05/18 Fenofibrate 145 mg started Dr for triglycerides
10/7/1 fluarixq quad flu shot
10/7/18 tetnas diphtheria a cellular pertussis vaccine
[]10/08 phlebotomy uc davis 250 ml. Looked like soft serve ice cream. This being done weekly
10/10 labs, Dr  3pm. Iron overload is rare in patients homozygous for the H63D mutation
10/11/18 botox both calfs. Hard as rock. Neck muscles also Dr
12/03/18 labs Dr . Vitamin D stopped for last month went from 104 to 43. Calcium 10.0.
Still phlebotomy weekly.
12/06 Vitamin D at 70,000 it week, testosterone at 1.5 per Dr
12/14 metoclopramide added back in Dr. Th I is iron is overloaded and in pituitary gland, liver, as ferritin came down in level, but hemoglobin still high. Referral to liver dr.
metabolic disorder. Liver Dr did nothing.
Still phlebotomy weekly
1/2/19  last phlebotomy stops, as now anemic
2/26/19 changed from Trulance to linzes Dr
3/13 testosterone increased by.25 to 1.75 ml. Vit d from 70,000 to 140,000. 374t 47 d
3/18/19 lsep test Dr
4/19/19 Limon changed formula for duloxetine. Took it off 1 month. Not as strong. Lasting 18 hrs
5/06/19 botox both calls and neck
5/18/19 eye exam Dr
5/06/19 botox both calfs and neck
5/18/19 eye exam Dr
5/30 19 booster inside left leg botox. Ask about a new MRI in August
7/30 request increased duloxetine 30 grams more for pain.mood
8/06 botox Dr
8/29 booster shot two areas left leg sauer. Magnesium 400mg added
9/07 flu shot
9/23 added probiotics per GI Dr align and Phillips colon
10/01/19 added 180,000 vit D per , retest three months. Stopped fenofibrate
10/07 tests Dr
Blood test  per Dr c.f. To Dr
10/11 Dr   dyslipidemia, high triglycerides. Fenofibrate caused spike in creatine up to 1.84
Change to blood control med and vascepa
10/16/19 manometer uc Davis  dr. fleet enema before.
12/02/19 blood test and dr
12/10/19 added 65 mg Iron every other day, as still anemic from blood test
12/19/19 MRI brain and spine Dr
Tachycardia
12/26/2019 did Viome.com test of gut to help with food map, and recommendations, for stomach detailing since phlebotomy
12/26/2019 did tellmegen.com DNA test, to see if other diseases, check DNA, and check medicines of how they work within my DNA  Pharmacogenetic

1/1/2020 new drug coverage plan
1/2/2020 called by  insurance about dopamine and second call for ampyra.
1/6/2020 Dr go refill. Had influenza vaccine for double strength,  and
Pneumococcal conjugate vaccine. Pv13
1/8/2020 CMP done by dr nurse neurologist
2-2020 mild kidney impairment. 1.87 high creatine
1/19/2020 started Name brand CYMBALTA
1/23/2020 MRI t spine . No ms
Vertebral body heights and marrow: Multilevel thoracic spondylosis with
osteophytes, facet arthropathy. Minimal degenerative endplate changes at
T12-L1 anteriorly
Artifact across the upper thoracic cord is seen outlined by an arrow
(series 7 image 13).
2. Mild degenerative changes within the thoracic spine.

2/12/20  UC Davis injected botox into both calves, into both sides of neck more on right side. Used guidance machine. Had grad student with him. 2 hrs spent.  Head not had botox in six months
Had to get approval for botox.  Botox lasted 54 days before major Charlie horse, neck spasms.
2/01/2020  (HCC), Cervical radiculitis
Biallelic mutation of HFE gene
3/14/2020 updated shingles vaccine.  Need redone two months
3/16 blood test Dr testosterone 1.0 ml down from 1.75ml
3/23 Dr  and  Dr by video chat. Question on testosterone amount came up.
3/24/20 sent over all meds with pharmacy. Forgot needles. Tellemedicine chat
4/10/20 testosterone changed to 0.5ml from 1.0 on 3/16, was 1.75 for weekly 3/13/18
Total T=1008


Thank you for reading, please email me  with specific questions or other links I can Add, or if others have had high testosterone therapy that has helped
EverchangingMS@Gmail.com

Stay safe out there with covid-19 going on.
JoeY

Mis-Diagnosed before Multiple Sclerosis

 This blog takes you through a misdiagnosed and my being diagnosed with Primary Progressive Multiple Sclerosis, but the first mis diagnosis was Chronic Regional Pain Syndrome.


Just to talk about mine, and what works with me, probably will not work with others because of their DNA make up of genes, and other factors.
I was going to put lots of links to what was going on, but figured you, as a reader, or scientist, could follow, or look up.


A regiment I have been on for over eight years, which keeps me going, of twenty four medicines right now, with a Correct Diagnosis.   But this was not The case at the beggining, when they were trying to figure out what was happening.

The first part was during diagnosing me.  They diagnosed me with CRYPS, chronically regional pain syndrome... which is not much better than being diagnosed with Multiple Sclerosis

The Mis Diagnosis was for about a year and a half.

I remember Dr Quack, as I would call him, told me something is wrong with you, but the insurance (from  A large corporation working for, self insured) would not let him run any tests.  My hands were doughy, feeling, sweaty, but calmy. These were almost frozen in a grasp position. My pain would cross over from one leg, thru both arms and down (or up) from the other leg and hands.
I could not different which way The pain was traveling, but the Dr said impossibe.

  The Dr tried me On 0.2 MG of clonidine. This is a heart medicine, but also a old MS medicine. This gave relief to my hands. He had me go to a 0.3 MG tablet, and back down to a 0.2 MG tablet to find differences. This took months, to see the difference.  A 0.2 MG was decided on in 2010, with a lot of unknowns with the cryps diagnostic.

He had my blood pressure checked sitting, standing, lying down.  This still may be of help to future scientists, as these were far off on readings.  My current heart Dr encounters it to multiple sclerosis, as, like I am always running a marathon, even though my body is sitting.

The clonidine was increased to a 0.3 in 2019 to again help the claw fingers from continuing.

Tramadol for pain was tried, with horrific effects, causing no urination.
Soma was tried, as a muscle relaxer.  It Wired me, instead of relaxing muscles. Allergic reactions to both.

 indomethacin was given for pain. It burned a hole in my stomach to this date.  The ibuprofen was used for pain and inflamation. Another nasid that wrecks your stomach. But does help in given circumstances.

A CRYPS diagnosis was given.  Chronically Regional Pain Syndrome. Not A good diagnoisis.

The only neurologist in the area did test on both wrist, only after the hospital emergency room splintered both wrist, As carpal tunnel syndrome, and to follow up with local neurologist.

The only Neurologist, wanted to prove the hospital wrong, stating There was nothing wrong, doing his own tests to tell the insurance nothing was nothing wrong. This included false records, by ice being put on wrist, to get readings he wanted. He needed to keep company "A" satisfied.
his office tried to send me to a private MRI, at My expense, which was not a option.

But the worst Drs were to come, that were required to see, as because it happened at work, I was forced to their workman compensation insurance program, required to see their doctors.

The company was large enough to be self insured, and had the state insurance commissioner, actually working for them.  Yes a conflict of interest.

I was sent to one dr , who wrote a 50 page report, on how I ran to the room, which was three feet from me, had me doing all these items, which never happened, of arm movents, weights, calisthenics, while interviewing me for 20 minutes.  The actual visit lasted less than three minutes with this Dr, and none of that happened. A quack, making money from the insurance company to say NO to everybody that came in.

A neurosurgeon was seen, and she stated you don't even have a physical done yet. Why is this big company's insurance sending you to me, except that I don't know if anything is wrong. Perhaps 45 seconds of her time, wasted, except for a long report to say nothing was wrong she could see, as that was what she was paid to do. You can not diagnosis a patient that a physical was never done.

this went back and forth, and thus perhaps the crops diagnosiis, as something was definitely wrong.


 As soon as able I went to my local dr.
He was able to do a little more testing. Sometimes knowing the the insurance company needed a test, but you had to say you were deficient. A shot of vitamin B  injected, then going over to give a blood sample to see where you are at. Quite backwards. It showed a high vitamin B on the test.  Testosterone was the same way, except I was quite low on the return test, that's when testosterone  therapy started for hypergandlosim I injections continue to this date with testosterone injection.

He ordered MRI of each section of the back and neck. These approvals took a long time to get, one at a Time.  So we are talking some long  period of time.  This is before I knew the magnet source was Not a very strong magnet.

Gabbapentin was added for nerve pain for the legs. Then
A pain Dr was seen, as my GP was limited what he could do

The pain Dr  was added. She prescribed something to get rid of pain.
Opioids,  then enough morphine that the pharmacist asked me if I was picking it up for someone near death to control the pain. The opioid plugged me up, so generlac was added, to help by my GP

The Brain was the last to get a MRI done.  In the report, in bold NO MS. All the mri's, the film is read by one person. Perhaps not quite knowing everything to be nice.

My GP, said they did not go far enough, as I found out years later, he suspected Multiple Sclerosis, not CRYPS.
He sent me to a Neurologist in the city.

Same mri, film, and much more tests, including new neurologist doing wrist, showing me to have cararple tunnel both wrist, as he was not working for company "A", but independent, and knew His stuff.

Then a spinal tap he did. A quite well known  known neurologist, who knew how to do this, being in his 70s. Spinal tap done by him in his office. He ruled out everything else, blood diseases,and other diseases.

I had onoglycolic bands were in my spinal fluid ( pieces of the mylen coating I would call them).
The MRI film, if knowing what to look , showed a bright lesion and past few lesions could be seen. Looking back, I probably could tell you even the year, date and circumstances.

He did show me the criteria needed, and the three spots, and old spots. Once you knew, you could easily find them.
A diagnosis, I was ready for, learning all and everything I could by research and asking Doctors.  Primary Progressive Multiple Sclerosis, with degenerative disk disease.

I was titrated off all opioid and morphine from the pain doctor.

 Lyrica and Cymbalta are used in pain for MS. You can not tell the insurance company, or they Would deny the combination.
Lyrica  was added, as it works on different receptors than gabapentin, which was also increased, as the nerve pain.

The real name brand cymbalta improved my mood, which I did not realize was in the dumps for months.  A positive I had not realized.

Nortriptyline was added, titrated up. For nerve pain at night.

Ibbufferin  was added for chostocrondrtis, as the only thing that works,  I should of asked wils dad Bruce, who was stricken with a bad case of rhemutoid arthritis, who knew what worked. He was my partners dad, filled with info, and a great outlook, even though bed ridden. He passed away a few years ago, as I write this in 2020.

Omeprozole was added to help the stomach. In latter years ranitidine also added. This medicine was recalled, and  tamodine replaced this in 2020

A lot has happened since the mid disgnosisis.

I had GPs at the Indian clinic, as they were The only game in town taking my insurance.  Some Great. doctors, and some worst Drs, that I actually went back to my old GP, who had sent me to the out of town neurologist.
He changed his staff overnight, and the new staff did not follow thru, so back to the clinic. 

This provides me with a excellent GO Dr. He could tell I did not have a torn rotator cuff, as another quack Dr said.

The university wanted to put a metal plate to hold up my neck. Invasive major surgery. When getting ok from my other drs, my GO stepped up and I listened to him.  I asked the surgeon, how much pain was caused by ms, and how much was caused my MS. They all left the room, and surgery never done. Best decision made. My Neurologist, against it, put me on Hyaluronic acid and chondroitin sulfate. That, along with botox to relieve muscle spasms worked. More on that in future blog...

it took a year and a half, which I find is fast fire someone with Multiple Sclerosis.

I was glad to be off opioids, and morphine. I

Currently I am maxed out on medicines I can take.  I see 8 or so  specialist at the university.
The only thing they can offer now is low dose naltraxadone. I am looking On input from others, and On anyone that has done this treatment, or Chinese acupuncture.

I was off botox since August 2019, due to go my neurologist taking a leave of absence. I wrote him and the state a letter, showing how many people they hurt.
six months to get another Botox specialist. Ona from us davis, the head professor. Names of muscles rolled off his young as he used a needle guidance machine to inject into both calves and neck.

This reduced the pain level, as the neck was pulling in bulging discs against the nerves. This has helped tremendously.

I think back of the mis diagnoisis, and where it would of led.
perhaps to the same point now, and different medicines used? Or the
quality of life being non exsistent.  The plate in my neck would of never happened, as once they tried, they may of uncovered the H63d gene, causing Iron overload, no place to screw the plates to, and no healing, due to ME and the autoimmunity that goes with it.

can low dose naltraxodone help or make me worse?

Would love your stories of his diagnoses of anything.
cheers
JoeY

In the beginning

I was healthy, never needing to see a doctor. Never would I have guessed or known anything about ms changing my life overnight, or what MS ever was.   I was 49, active, going out on camps into the wilderness areas with my partner. A drive to the ocean and camping the coast in remote areas was so much fun with Wil,  Going to Hot August Nights, camping, and going thru every isle of three separate Super walmarts to stock up on items not found in the small town we live in was part of the fun, along with walking the isles of the antiques and flea market vendor's, then going thru ever isles of cars displayed at every hotel.

Searching for the best spot to eat, we always made that  into a adventure. Geo caching came later, with even more spots found in remote locations on our travel paths, giving us different views of areas, and camping spots.

MS hit me hard in 2010, and keeps progressing.

It was late December, I took a Fall while walking to the customer service booth, to get cigarette for A customer.  A puddle of water was being hidden by another employee. He Watched me fall, but corp policy is not to say anything.. I fell hard. But needing a job, went back to my station as a cashier, scanning products as fast as possible.
A manager, took me to the side to file company papers, as a incident report, as he did not want to loose bonus for no accidents that quarter, since it was December 18th.

Within three months, I was holding onto the counter for support, my vision going double, gait was off, my wrist hurt, and then my hands froze up, dropping groceries.

  I never did see the video of my fall, that triggered MS, that they said  laid dormant in me.  I will spare the details of a broken workers comp system USA has, but lawyers are terrible, and cases drag on, without medical care.

The local bandage hospital we have in town initially splint up both wrist, gave me some strong pain killers, but noticed my leg dragging before leaving.  Referred me to a neurologist, as they had none, and I must see the company Dr.

Dr Quack, I call him yelled terribly at his patients. You had to see a company Dr, not one you chose. The best thing he told me, is "You have something going on, but they (the company) will not let me run any test to prove one way or the other"

My hands were clammy, doughy to the touch. Right side pain went to left side and crossed back. He told me, impossible, as the right brain doesn't talk with left brain. But something was not right.

Clonidine, a inexpensive blood pressure medicine was used off label. This unclenched my hands. He had me go off, titrated up and down, with results of hands clenching up, and being doughy.
But that worked.  I did not know it is a old drug used for MS off label.  a inexpensive drugs used for pain and inflammation.

A local Neurologist was seen. Another quack, as said I was fine, faking symptoms.  Even measuring electrical flow in my wrist, to say no issue, with warming or cooling wrist to obtain his results.  Not sure how you can fake symptoms physically seen, and what was going on.  Just knew body pain, wrist plain, and not being right.

A local GP was finally seen. Took six months to get the insurance company to approve a MRI.  In the meantime that year I was sent to a pain management Dr.  From opioid, up to Morphine was used. Initial diagnosed CRPS, "Chronic Regional Pain Syndrome", as they needed a diagnosis for pain med.  The local pharmacists asked me if I was picking up for someone on their deathbed, as the amount of morphine given.

 The local hospital used again.  MRI came back, read by the only person who reads every one's. No MS in big bold print. The Local country Dr  said they did not go far enough. Sent me to a Neurologist out of our little town.

  He looked at the film, yes before CDs, each film would be looked at.  Four were told to keep in order, and he scheduled blood test and a spinal tap in his office immediately.

These came back with ontological bands, the rest ruling everything out.

Treatment started with Copaxone.
Pain Dr weaned me off opioid and Morphine.  Cymbalta and Lyrica   were used in combination to treat Pain in Multiple Sclerosis.  The electrical zaps, Gabapentin and Nortriptyline.
 More about that in another blog though.

Guess this is a good starting point for my blog in hope to help others.

Thanks for reading.

For more go to my blog everchangingms.blogspot.com

Thanks for reading
 Joe

Botox, OnabotulinumtoxinA

I would never think a procedure would be in your mind, as one to look forward to.

But Botox, or  OnabotulinumtoxinA t is used o treat dystethia, or muscle stiffness, muscle cramps, spascisity, walking problems, movement problems.  
A treatment which people with Multiple Sclerosis get.

Botox can be used to treat many symptoms associated with multiple sclerosis. Patients who have spasticity affecting their arms or legs may be good candidates for botulinum toxin injections to relieve painful spasms and improve mobility.

I have had botox treatments since being diagnosed  of multiple sclerosis. I had maxed out  baclofen  early on. My Neurologist, was a old timer, with no computers. He worked as a stand alone neurologist, with a staff of two office gals, one who did your appointmens, in her hand written book.  She had your paper file for Dr to go thru, ready for him.. The other gal had a real old computer, she could obtain the necessary forms on, and Bill the insurance. I am sure another gal took down info for billing outside of his clinic.

He used the old time scrypt, decypherable by him and a few Drs I talked with. Looked like scribble marks, but so does shorthand.  Dots of injection sites, other records were transcribed, like the sleep study.  EMG, was always followed up on how fast nerves responded. Record keeping in each patients file, as Dr would do before electronics came out.

A fax machine was used to fax prescriptions, but the new pharmaceutical companies did not like.  The neurologist would fill my Gabbapentin and Provigil.  I found a way around this by sending in original prescriptions for mail order to them, as faxes kept getting lost, or the insurance company would say, we've tried to contact your Dr multiple times, with no response. This happened by the insurance computer calling at 2am, not saying what was needed from the dr. It became a a problem for his staff, their limited time, and hours listening to messages, and hours I spent trying to find where the problem was. It was the insurance companies computer not recognizing the Drs Faxes.

There were a couple other part time gals, who ran the emg machine, sleep study, and other test.I

Botox works by blocking the release of acetylcholine from nerve endings. Acetylcholine is a neurotransmitter required by muscles for muscular contraction. By eliminating the ability of a muscle to contract, it relaxes, thereby decreasing spasticity and tone.

Spasticity is a condition in which muscles exhibit almost constant contracture or activity, leading to loss of range of motion, decreased function, and even pain.

Spasticity occurs after an area of the brain or spinal cord has been injured, leading to weakness and increased tone.

When an arm or leg which is affected by spasticity is moved by an examiner, there is involuntary resistance to that movement.

Often, this spasticity is made worse when the speed (or velocity) of the movement increases.

Spasticity is often seen after a stroke, traumatic brain or spinal cord injury, or in cases of multiple sclerosis.

In some cases, spasticity can be associated with development of involuntary tremors.

The blockade of acetylcholine does not occur immediately. Most patients do not begin to see the effect of a botulinum toxin injection for a few days, and it may take a few weeks for the maximum benefit to become apparent.

This neurologists was quite informed on latest developments, what was working, and what did not.  He could do a spinal tap right in his operating room, and send labs out, have results quickly.

This he did with my botox injections every three months, as that's all the insurance would pay for is every three months. My botox lasted 62-64 days, I would record in my book I brought in.  Botox day was describing muscles inside the leg, or outside ones. This would include stiff muscles in the neck, Charlie horses.
Or how the toes were curling in our out.
He knew where to inject the botox, the debth, and feel the muscle spasms.

Three weeks later was the follow up, where he would ask me what was in my book note book of questions, comments, and research. I had done.  A question answer period, sometimes a booster shot for botox, but lots of questions answered, and items to try to help.

Botox has a Black Box  warning.
From their site"

https://m.youtube.com/watch?v=4x9yRjrN0iQ

IMPORTANT SAFETY INFORMATION

BOTOX® may cause serious side effects that can be life threatening. Get medical help right away if you have any of these problems any time (hours to weeks) after injection of BOTOX®:

Problems swallowing, speaking, or breathing, due to weakening of associated muscles, can be severe and result in loss of life. You are at the highest risk if these problems are pre-existing before injection. Swallowing problems may last for several months

Spread of toxin effects. The effect of botulinum toxin may affect areas away from the injection site and cause serious symptoms including: loss of strength and all-over muscle weakness, double vision, blurred vision and drooping eyelids, hoarseness or change or loss of voice, trouble saying words clearly, loss of bladder control, trouble breathing, and trouble swallowing

The black box warning continues an can be read at botox.com

BOTOX® may cause loss of strength or general muscle weakness, vision problems, or dizziness within hours to weeks of taking BOTOX®

The dose of BOTOX® is not the same as, or comparable to, another botulinum toxin product. .

Other side effects of BOTOX® include: dry mouth, discomfort or pain at the injection site, tiredness, headache, neck pain, eye problems: double vision, blurred vision, decreased eyesight, drooping eyelids, swelling of your eyelids, dry eyes; and drooping eyebrows.

For more information refer to the Medication Guide or talk with your doctor.

My Neurologist went on a "medical leave" just before botox was to be injected. This left me with the last injection being August 2019. My calves were tight, hard as rock before I was able to see a new Botox Neurologist. His First opening being late February 2020

The University Hospital used a EMG guidance computer to assist the neurologists and his student. A special chair to sit it that allowed easy access to multitudes of muscle names the Neurologist rolled off as he injected The multitude of sites.  The machine had sound, I could not see the graph. I just knew he was injecting the proper muscles and depth, from having them from old neurologist.   Both calls were hard as rock, some pulling on toes, or the top and bottom of the foot. This causes a lift problem with the foot.

My neck muscles had spasmed extensively. These muscles control the arms, which had signs where muscles were pulling you could see the indent near the elbow. Muscle names rolled off the Drs mouth as injections went deep into the muscle. I recognized the trapeze muscle, controlled by the neck, but had no idea of the names, or how deep these other muscles were. These were all injected into the neck location, on both sides.  The Doctor was more complete with more botox used into all the problem areas.

I will see him back in three months, keeping track in my book, of side effects, 

helpful and hopeful for great results.

I hear it helps for migranes and more.

Have you had Botox? And your story?  Chime in!
Cheers
JoeY

Multiple Sclerosis DNA

                                       Photo of gene from wikipedia.org


Multiple Sclerosis blog of DNA Technical reading.

I did a 23and me home testing.
If you did a health dna, this will show up under celiac diseases.
It may take some reading, and researching, but this will show up.
The HLA-DRB/DQA gene

There are links to folllow, but for less confusion, just Google the gene.
there are many variants I show below, having a complete DNA done of me. Everybody may be different, but hope this helps science.

https://ghr.nlm.nih.gov/gene/HLA-DQB1#conditions
https://ghr.nlm.nih.gov/gene/HLA-DQB1#conditions

Look up on Google this gene, and look under auto immune disorders

HLA-DQB1 gene

major histocompatibility complex, class II, DQ beta 1

Normal variations of the HLA-DQB1 gene have been associated with several additional disorders. Most of these disorders have an autoimmune basis, which means they occur when the immune system malfunctions and attacks the body's own tissues and organs. Autoimmune disorders that have been associated with HLA-DQB1 include multiple sclerosis, pemphigus, and type 1 diabetes (described below).

Multiple sclerosis is a chronic disorder of the brain and spinal cord (central nervous system) that causes muscle weakness, poor coordination, numbness, and a variety of other health problems. Several variations of HLA-DQB1 appear to increase the risk of developing this disorder. One of these variations, HLA-DQB1*06:02, is the same version of the gene that increases the risk of narcolepsy.

Some evidence suggests that the HLA-DQB1 gene may also play a role in several forms of pemphigus, a condition that causes severe blistering of the skin and mucous membranes (such as the moist lining of the mouth).

It is unclear how different versions of the HLA-DQB1 gene influence the risk of developing autoimmune disorders. These disorders typically result from a combination of multiple environmental and genetic factors. Changes in other HLA and non-HLA genes, some of which remain unknown, also likely contribute to the risk of developing these complex conditions.

23and me

We detected a variant linked to the HLA-DQ8 haplotype.doing

                                                    Photo from wikipidia.org

https://en.m.wikipedia.org/wiki/HLA-DQB1

https://en.m.wikipedia.org/wiki/HLA-DQB1

Multiple sclerosisEdit

Certain HLA-DQB1 alleles are also linked to a modest increased risk of multiple sclerosis.^[11][12]

See scientific details
I am not a doctor, or scientist, just researching, trying to understand the aspects of Multiple Sclerosis is having on me, and the commonalities this disease has of raging they my body.

Further investigation shows these SNP I have.

SNP : rs12487066

SNP : rs312993

SNP : rs3135388

SNP : rs6897932

SNP : rs7326018



Technical Report for these genes from DNA done 12/2019

SNP : rs12487066

Gen o Región : 3q13.11

UserSNP usedGenotypeAdjusted Odds Ratio*lrs12487066CT0.97

Multiple sclerosis has a clinically significant heritable component. It was conducted a genome-wide association study to identify alleles associated with the risk of multiple sclerosis.

It was used DNA microarray technology to identify common DNA sequence variants in 931 family trios (consisting of an affected child and both parents) and tested them for association. For replication, we genotyped another 609 family trios, 2322 case subjects, and 789 control subjects and used genotyping data from two external control data sets. A joint analysis of data from 12,360 subjects was performed to estimate the overall significance and effect size of associations between alleles and the risk of multiple sclerosis.

A transmission disequilibrium test of 334,923 SNPs in 931 family trios revealed 49 SNPs having an association with multiple sclerosis (P<1x10(-4)); of these SNPs, 38 were selected for the second-stage analysis. A comparison between the 931 case subjects from the family trios and 2431 control subjects identified an additional non-overlapping 32 SNPs (P<0.001). An additional 40 SNPs with less stringent P values (<0.01) were also selected, for a total of 110 SNPs for the second-stage analysis. Of these SNPs, two within the interleukin-2 receptor alpha gene (IL2RA) were strongly associated with multiple sclerosis (P=2.96x10(-8)), as were a non-synonymous SNP in the interleukin-7 receptor alpha gene (IL7RA) (P=2.94x10(-7)) and multiple SNPs in the HLA-DRA locus (P=8.94x10(-81)).

Bibliography

International Multiple Sclerosis Genetics Consortium. Risk alleles for multiple sclerosis identified by a genome-wide study. N Engl J Med. 2007 Aug 30;357(9):851-62.

SNP : rs3129934

Gen o Región : C6orf10

UserSNP usedGenotypeAdjusted Odds Ratio*rs3129934CT0.97

Multiple sclerosis is a chronic inflammatory demyelinating disease of the central nervous system with an important genetic component and strongest association driven by the HLA genes.

It was performed a pooling-based genome-wide association study in which Comabella et al. described eight SNPs validated in Spanish Caucasian cohort and US Caucasian cohorts. The most significant association was obtained for SNP rs3129934, which neighbors the HLA-DRB/DQA loci. Said SNP is associated with an increased risk for multiple sclerosis. The OR was 3.0 (CI: 1.8-5.0; P = 1.4×10(-5)).

Another studied polymorphism was rs7326018 which is one of the eight SNPs associated with increased risk for multiple sclerosis. Its OR was 1.8 (CI: 1.1-2.9, p = 0.0228).

Bibliography

Comabella M, Craig DW, Carmiña-Tato M, Morcillo C, Lopez C, Navarro A, et al. Identification of a novel risk locus for multiple sclerosis at 13q31.3 by a pooled genome-wide scan of 500,000 single nucleotide polymorphisms. PLoS One. 2008;3(10):1–9.

SNP : rs3135388

Gen o Región : 6p21.32

UserSNP usedGenotypeAdjusted Odds Ratio*rs3135388GA1.81

Multiple sclerosis has a clinically significant heritable component. It was conducted a genome-wide association study to identify alleles associated with the risk of multiple sclerosis.

It was used DNA microarray technology to identify common DNA sequence variants in 931 family trios (consisting of an affected child and both parents) and tested them for association. For replication, we genotyped another 609 family trios, 2322 case subjects, and 789 control subjects and used genotyping data from two external control data sets. A joint analysis of data from 12,360 subjects was performed to estimate the overall significance and effect size of associations between alleles and the risk of multiple sclerosis.

A transmission disequilibrium test of 334,923 SNPs in 931 family trios revealed 49 SNPs having an association with multiple sclerosis (P<1x10(-4)); of these SNPs, 38 were selected for the second-stage analysis. A comparison between the 931 case subjects from the family trios and 2431 control subjects identified an additional non-overlapping 32 SNPs (P<0.001). An additional 40 SNPs with less stringent P values (<0.01) were also selected, for a total of 110 SNPs for the second-stage analysis. Of these SNPs, two within the interleukin-2 receptor alpha gene (IL2RA) were strongly associated with multiple sclerosis (P=2.96x10(-8)), as were a non-synonymous SNP in the interleukin-7 receptor alpha gene (IL7RA) (P=2.94x10(-7)) and multiple SNPs in the HLA-DRA locus (P=8.94x10(-81)).

Bibliography

International Multiple Sclerosis Genetics Consortium. Risk alleles for multiple sclerosis identified by a genome-wide study. N Engl J Med. 2007 Aug 30;357(9):851-62.

Gregory SG, Schmidt S, Seth P, Oksenberg JR, Hart J, Prokop A, et al. Interleukin 7 receptor alpha chain (IL7R) shows allelic and functional association with multiple sclerosis. Nat Genet. 2007;39(9):1083–91.

SNP : rs6897932

Gen o Región : IL7R

UserSNP usedGenotypeAdjusted Odds Ratio*rs6897932CC1.06

Multiple sclerosis is a demyelinating neurodegenerative disease with a strong genetic component.

Previous genetic risk studies have failed to identify consistently linked regions or genes outside of the major histocompatibility complex on chromosome 6p. There is a study in which was described the allelic association of a polymorphism in the gene encoding the interleukin 7 receptor alpha chain (IL7R) as a significant risk factor for multiple sclerosis in four independent family-based or case-control data sets (overall P = 2.9x10(-7)). Further, the likely causal SNP, rs6897932, located within the alternatively spliced exon 6 of IL7R, has a functional effect on gene expression. The SNP influences the amount of soluble and membrane-bound isoforms of the protein by putatively disrupting an exonic splicing silencer.

This gene encodes a protein called alpha-IL7R. This protein plays an important role in how two growth factors (IL-7 and TSLP) affect specialization and maintenance of various immune cells.

IL7R-alpha protein can take two different forms. One way is anchored in the membranes of immune cells, while the other form is released by the cells into the bloodstream. The relative amounts of the two forms can affect the signalling amount mediated by IL-7 and TSLP, and therefore change their action on the immune system. Rs6897932 allele (C) increases the amount of free IL7R-alpha.

Since multiple sclerosis could be seen in autoimmune diseases, it makes sense that a SNP in a protein involved in the immune system would be associated with the disease. Furthermore, it has been observed that IL-7 signaling is altered in such patients.

Changes in IL-7 signaling could lead to the development of multiple sclerosis in several ways: through spontaneous reactions in immune cells and decreasing the ability to defend them, favouring chronic infections.

Bibliography

Gregory SG, Schmidt S, Seth P, Oksenberg JR, Hart J, Prokop A, et al. Interleukin 7 receptor alpha chain (IL7R) shows allelic and functional association with multiple sclerosis. Nat Genet. 2007;39(9):1083–91.

Lundmark F, Duvefelt K, Iacobaeus E, Kockum I, Wallström E, Khademi M, et al. Variation in interleukin 7 receptor alpha chain (IL7R) influences risk of multiple sclerosis. Nat Genet. 2007 Sep;39(9):1108-13.

International Multiple Sclerosis Genetics Consortium. Risk alleles for multiple sclerosis identified by a genome-wide study. N Engl J Med. 2007 Aug 30;357(9):851-62.

SNP : rs7326018

Gen o Región : 13q31.3

UserSNP usedGenotypeAdjusted Odds Ratio*rs7326018TT2.09

Multiple sclerosis is a chronic inflammatory demyelinating disease of the central nervous system with an important genetic component and strongest association driven by the HLA genes.

It was performed a pooling-based genome-wide association study in which Comabella et al. described eight SNPs validated in Spanish Caucasian cohort and US Caucasian cohorts. The most significant association was obtained for SNP rs3129934, which neighbors the HLA-DRB/DQA loci. Said SNP is associated with an increased risk for multiple sclerosis. The OR was 3.0 (CI: 1.8-5.0; P =1.4×10(-5)).

The rs7326018 polymorphism is one of the eight SNPs associated with increased risk for multiple sclerosis. Its OR was 1.8 (CI: 1.1-2.9, P = 0.0228)

I hope this Technical report will be useful, and would love feedback from scientist, Drs, or you, exploring genes related to Multiple Sclerosis, and if others are coming up, or I will add to this page when other genes from DNA are found.

Cheers
JoeY

Rare disease day

https://m.youtube.com/watch?v=7QKum6ihGyERare disease Day

Rare disease Day

Rare disease Day. Never knew that such a day existed, or that I would even be classified into a quite rare disease. As most people know reading this blog,  I have primary progressive multiple sclerosis. Going on over eight years now. My main treatment, or DMT, is Copaxone every day along with 24 other medicines.
 My partner and I attended Rare Disease Day in Sacramento last year. A wealth of information. The Rare Patients Voice, still need to make a video for.

But a Rare Disease was hiding in the comorbid  of what MS brings along to some people.  I have had optic neuritis, the MS hug, spasticity and more.  Last year, trying to get some blood figures up, without having a stroke, the endocrinologist sent me to the cancer Doctor.  He ruled out poly vercea genes, the main one of iron overload. and dug further . Two genes, one from both parents, on the HFE gene,  that's the one which controls Iron.  Anyways the H63d genes both had mutated, causing Iron overload.

Rare Disease Day again. This Gene, contacting Rare Diseases Link is so rare, H63d is only slightly been researched.  I have found 7 people with the H63d Gene causing Iron overload, but not of two people having both genes causing Iron overload.  Rare Diseases has been a wealth of information, or lack of, because of the rarity of this.  National organization of rare diseases was contacted "nord" was asked to make a registry for this from a organization called Gard  Link. This is the toolkit to start making a registry, so I hope you email me, drop me a note below so I can start this registry for science.
Still a project for me.
The H63d Gene causing Iron overload is passed down Thur generations I have found from 23andme.com heredity hemochromatosis another name to look for. You may pass it down to your kids, and then never having a problem, but their kids getting the rare H63d iron overload. Virtually in men, it means you store iron, and are never able to get rid of iron from a kid. This builds up, and is seen from 40 years old and older.

This shows up as high ferritin, Dr's dismiss. High iron, well probably a bad test, or you  something. Hematocrit and hemoglobin then play a role of being high. Thick blood also known as.

  Since I am on Testosterone therapy, I could not go higher on injections needed, as my blood was high on hemoglobin, and hematocrit.  Iron just above line, nothing to worry about. The endocrinologist sent me to the cancer center, where they found the elusive H63d Gene.
Phlebotomy is the only way to rid the body of iron, as it will get into organs and cause even more havoc. Believed to be part of Alzheimer disease also.

I did a round of 17 phlebotomy, and testing every week for six months. At that point, I was still anemic, with no Iron.  A year later, no Iron, but have taken some occasional iron supplements, after failing using cast iron skillets, raw spinach, and natural ways to absorb.

I retest in a few weeks, and see the the Cancer staff in a few weeks.  But part of a problem noted, is when my  Iron disappeared, my GI  issues bloomed at a incredible  full speed of problems.
There may be a direct link of no Iron to GI issues, or   GI issues is also a known factor with Multiple Sclerosis. I will have to go into more detail in another blog.

The H63d rare blood disorder, caused iron to build up in me since a child. Being caught quickly give the best chance.   I did find a distant cousin on my mother's side, from a fifth great grandparent, so way down the line. He has Iron overload, and is 72, and has the H63d gene.
Explaining this to him, his heart Dr., Thought his blood was thick, giving him a blood thinner, mis- diagnostic. He brought this new found info to his Dr's attention, did a single phlebotomy, that brought his Iron down. Complications can happen, especially when older, with a pacemaker.  He agreed that the Quality of life was the most important.  "The Golden Years may not be all what it's up to be. ". We stay in touch, kinda cool finding other relatives.

A direct cousin on my mother's sisters side has heredity hemochromatosis, mis-diagnosed, and now with no thyroid gland.  She thought the H63d Gene was good, nothing to worry about. . Again so rare, Doctors did not know enough about.

So thank you for reading once again,
And if you have thick blood, or iron overload I would love to hear about this, to add to my registry, so some scientist can look into this.
Join my mailing list, follow my blog!
JoeY

Changes

This last year went by quickly. Way to quickly.
Changed happening, seems like daily since  mid 2019. Guess that's why I named this blog everchangingms.blogspot.com

A quick change of Doctors was needed. My Neurologist that injects me with botox went on medical leave in November, having me scramble to obtain meds prescribed, and a new person to administer Botox. This won't happen until February 2020, as how busy  Specialized Neurologist are. So dealing with Charlie horses, cramps, stiffness and neck spasms.  The quinine works wonders, but limit its use. I think the neck spasms are upsetting the degenerative did disease.

Then came my GP. Highly recommended by the main Dr at the clinic, who was watching over me until he had a new Dr hired. I had entered with extremely high hopes.

Some Drs are not made for patients, or some patients not made for Drs.  I let him give his talk, with my blood pressure  rising even higher, as what he was saying, never touched or examined me.

The most frustrated I have ever been. He should of had my heart rechecked, as knew extremely high entering. He left in huffiness.  I then left, almost in tears, not making another monthly visit.

But then good news, was I was able to get a  new GP who actually took the time to read all my specialist reports.  He is doing his internship at UC Davis  He Looked at blood levels, and re ordered some that were in concern. Spent a lot of time with me, and concerns.

Then came the insurance change. CVS bought Aetna, who had purchased my drug plans over the last eight years. The USA government said CVS was to big, and made them sell off their drug plan.

Their new company was doubling my rates, with less coverage, and deleting other drugs.   I emailed  Debbie from Area 12,  who helps elderly people find plans. She had helped me eight years ago.  She did find me a drug plan, that covered most of my meds, requesting Prior Authorization for a few. That brings us almost current to 2020, but not quite.

A MRI was scheduled after seeing my neurologist, of my neck and brain in December. However  New symptoms started about a week later. Tingling electrical zaps going down into my fingers on my right arm hand.   Another appointment was made to go over the MRI. But looking at this, I do not think they compared it to original, so left my team a message to do that. The main two lesions in my brain looked unchanged, but my degenerative disc disease in my neck progressing.

Two years ago, the pain jab in my right shoulder was so extreme, I switched GPs, as one said I tore the rotator cuff from across the room, doing nothing. A new Dr scheduled a MRI, showing two discs bulging into nerves. I failed at prednisone injected. A surgery was scheduled, but cancelled, when they could not tell me what was causing the pain.  MS or the discs.  Best decision not to have surgery. There xray machine was more powerful than the MRI machine at our local hospital. There was nothing to attach a metal plate to, as osteopenia. 

Then both the H63D gene (  Link https://rarediseases.org/rare-diseases/classic-hereditary-hemochromatosis/#general-discussion ) were found mutated, when certain  blood levels were off, causing Iron overload. hereditary Hemochromatosis WebMD

if they needed to give me blood, for every quart out in, two quarts would need taken out, as it would attack my body, creating me to make more iron. This goes for raw shellfish, or their shells  also.  So no surgeries was added to my DNR.
17 phlebotomy, left my body with no iron, slightly anemic, which comes with its own problems.

on a good note, my Cardiologists said my heart is the best thing going for me.
Hypertriglyceridemia (Medscape) going on though. A Drug Fenofibrate  see this link,  was used, but I've ended up as less than 1% of the population of a side effect that raised my creatine to alarming rates for five of my doctors. This was stopped, replaced with Vascepa. https://vascepa.com/

Our Westie and Poodle, Dixie and Armani

December also brought a huge skin rash from A Copaxone injection. I had UC Davis look at it, and the Copaxone Nurse. I am now limited to injection areas, as have no fat to inject into. So my Neurologist had me look at  ocrevus.com And mayzent.com to look at.

And yes 2020 now. Need to go on more short Amazing Races.
Enjoy the Quality of life,  All my Drs know is goal to maintain.

2020 brought that into full perspective, when a neighbor passed away, and days later their son, who went to school with my partner.   I've known for 20 years .
his mom has Alzheimer, which complicates this all. His partner has taken it quite hard.  She will end up in nursing home for a short time.

I will leave in a good note.  My partner and I did a DNA and Gut sample kit that may give more inside info on health and Gut issues..  Looking for Genes that may be related,  medication on how it's used, or not being used,  and conditions I may have control over.

Another MRI is scheduled,   a interview with Families USA for my next blog. A federal to many more specialist.

Thanks for reading.
Join my blog email. Give me feedback if you have tried any of meds.

JoeY

" QUALITY OF LIFE "

New Doctors, New Relatives, New Insurance, New Symptoms, all come with their own part of the Multiple Sclerosis Puzzle.  I stay anemic a year after phlebotomy. This is a unknown by the cancer specialists.

23and me has shown me a list of new relatives. Distant cousins from 4th great Grandparents, way down a family tree line.  But to be diagnosed in your seventies, that you have the same match of a H63d Gene, I have talked about that  puts you into iron overload.   Hereditary Hemochromatosis.
This alone was another piece of the puzzle on how many generations this has gone thru. Even the current generation seeing this problem, but with different eyes than those of past generations.  Even about same heart beats.

Another Gene showed up on 23andme.  HLA-DQB1.  This 23and me shows as a gene for celiac disease. But you have to dig in deeper in the Gene. Under the Government site,  Autoimmune diseases are listed. One being Multiple Sclerosis.
https://ghr.nlm.nih.gov/gene/HLA-DQB1#conditions.

I wonder how many scientist, or scholars can put all the pieces togeaather, including the vitamin D of 180,000 iu / week I need . (eighteen ten thousand iu pills)

A link I need to send to my Neurologist, but we talked about it. The session goes way to quickly with my Neurologist.  She was surprised that the soonest they can have more Botox on me is mid  February 2020. My calves and  neck stay tight as a knot. The last Botox was in August 2019.  My Botox Neurologist went on Medical Leave, just before my next injections were needed. This effected thousands of his patients.  I sent a few letters out because of the facts.

I scrambled for a New Doctor to inject Botox, and see if my UC Davis Neurologist would handle prescriptions. The  absence by my neurologist left thousands scrambling like myself.

Botox works for about 64 days with me, but loosens up the spasms in the neck and both calfs, which control the feet. This also controls thigh muscles higher.
The neck one keeps my buildging discs in place and relieves the entire muscle to the arm.

So I went into scrambled mode, and my Neurologist at UC Davis filled medicines, and got a referral to the Head Professor at UC Davis for Botox,  for the first available appointment being February for My partner and myself. He uses botox  for migraines.

My Clinic, I go to for seeing my GP, has usually been good. A Excellent GO, watched after me for a year, and decided to go back to school. This left them with no Dr.  A wording he used,  "It's the Quality of Life that matters " sticks with me everyday.  I had first seen him when they wanted to do surgery on my neck for two herniated discs.  Was the pain jabbing me in my back and down to my fingers being Caused by The pinched nerve, or was it caused by MS?

The Head of the clinic Dr, came to keep track of me and medicines for about three months.  A Gracious Man, wanting to learn. He talked highly of the new Dr they hired.

 The following month, Dr X, stood across the room and accused me of not taking my meds, as my blood pressure was high (pain related).  Then he states, " I do not prescribe Lyrica, as that is a Dangerous Drug"  he states that a few times. This is one of my least dangerous medicines, for those  that take MS meds, many are black box warning meds are used, that  Makes lyrica look like asprin in comparison. You have to outweigh the positive effects against the negative effects, and each medicine works different. He did not attempt to touch me to see the pain, or listen to my heart, or recheck my blood pressure.  This was by far, the worst treatment I have had with a Doctor.

Note :  lyrica and Cymbalta are used to control pain in MS, and a GP should know that by reading .  Hyaluronic Acid from England, and chondroitin Sulfate has eased my neck issues, talked about with my Neurologist.

Not all patients are a good fit for a Dr, or is all Doctors a good fit for patients.

But On a Good Side, I got Dr. T. at UC Davis to be my GP. A residence, so for six months, but he studied all the notes from each specialists, and spent two hours with me, making sure "The Quality of Life" is my goal to keep.

But changes happen. Insurance companies started to buy each other out, including your local small pharmacist in the background over the years. CVS Pharmacy became so big, they bought Aetna out. The government stepped in, and put a stop, saying they got to big, sell off your drug plan.  So Wellcare bought them, eliminating drugs and doubling rates.  Consumer Reports has a great article drug-prices/the-shocking-rise-of-prescription-drug-prices

So a new company for my Drug Plan, with the help of  Director of the Area12.org.   https://www.area12.org/ to find, so most of my drugs would be On the plan. I am sure my Drs will have to pull out all stops to ensure I am on medicines needed, with Prior Authorization, and Medical necessity, and some perfect language.

Yet, another change happened, after my Partner injected Copaxone into my arm. Thought it was only a blood vessel he hit, so not much thought. But the bruise under the skin became larger, the crusting taking over slowly.  Three weeks later, I showed my Neurologist, who had her nurse look at it.

 She named off a long word, but it means the destruction of the skin, by the copaxone itself. Some need surgery done.
Feeling my arms, there is no fat to inject the copaxone into. So the arms are off limits. She had me call the Copaxone Nurse also, who came to see me at my house.

I had not seen her since starting Copaxone. She agreed, arms, no fat to inject into. My thighs, so tight without botox, only a small area left. My sides, nearer the back on small area, as other  injection site have become tough skin. The 1Stomach, because of my GI problems, was not bloated, but little fat, and some areas to stay away from.

So that will limit Copaxone injections in six months, or a year?

For those Scientists and researchers reading this, I asked the nurse, "Copaxone is made of a few amino acids.  What if you were to mix them into a smoothie? , instead of injections?". Makes sense to me, as I can buy all these amino acids from the store as a pill. Would you need some oil, and cook it into eggs?  I asked Copaxone the same question to ponder.

for my technical people:
"Copaxone Description:

Glatiramer acetate, the active ingredient of Copaxone, consists of the acetate salts of synthetic polypeptides, containing four naturally occurring amino acids: L-glutamic acid, L-alanine, L-tyrosine, and L-lysine with an average molar fraction of 0.141, 0.427, 0.095, and 0.338, respectively. The average molecular weight of glatiramer acetate is 5,000 – 9,000 daltons. Glatiramer acetate is identified by specific antibodies.

Chemically, glatiramer acetate is designated L-glutamic acid polymer with L-alanine, L-lysine and L-tyrosine, acetate (salt). Its structural formula is:

(Glu, Ala, Lys, Tyr)x●xCH3COOH

(C5H9NO4●C3H7NO2●C6H14N2O2●C9H11NO3)x●xC2H4O2

CAS - 147245-92-9

Copaxone is a clear, colorless to slightly yellow, sterile, nonpyrogenic solution for subcutaneous injection. Each 1 mL of Copaxone solution contains 20 mg or 40 mg of glatiramer acetate and the following inactive ingredient: 40 mg of mannitol. The pH of the solutions is approximately 5.5 to 7.0. The biological activity of glatiramer acetate is determined by its ability to block the induction of experimental autoimmune encephalomyelitis (EAE) in mice.

Copaxone - Clinical Pharmacology"

So I expect more hickups along the way, perhaps some will help me more, like Ampyra name brand, https://ampyra.com/ has helped my walking,  but might not be right for everyone.

Cheers and thanks for Reading. Would love feedback.

Joey

Optic neuritis, Eyes, Healthy vision

I have touched base  quite frequently with Eyes, Vision, the problems associated with Multiple Sclerosis.
many Dr's are part of My eye team. A Optometrist, who prescribed Glasses, but can also look at nerves, and how the eye looks.  A second Dr, a Ophthalmologist, does more detailed, including surgery to remove cataracts. He also looks at the eyes and into the nerves, muscles, and what is happening. The third is my Neurologist.

When Multiple Sclerosis hit me, one of my symptoms was Double Vision. Kinda blurry, but yet I would watch TV, and two of the same characters were there. One about three o'clock position, the other more near a five o'clock position.   My distance vision became off kilter. My Near vision, I kept reading the same line over and over, not able to get to the next sentence.  I did not know at that time Multiple Sclerosis would be part of me. One eye would flutter.

Money was tight, so I went to Dr Costco optometrist. A real knowledgeable optometrist gave me two new prescriptions. One for reading, and one for distance. But he also took the time to scribble some words down, that were concerning, to show my GP.  Alternating exotropia,  Right  lateral Gaze., And a few others I did not understand. He put in some prisms to help correct, but not over correct.

My Eyes would take a path of their own ever since. Lights would effect my eyes, one pupil not responding as fast as the other. Each person has their own story, but a common denominator is the eyes.

My ophthalmologist told me,  I could order a pair of glasses every day, as that was how my vision was changing, due to nerves that control the muscles of the eye.  Optic neuritis.

Costco, goes thru optometrist, and visits with new optometrist were five minutes.  That's when I switched  to the one I have been seeing.

Ones that advertised on TV, or major adds in newspapers, have the worst reputation with the BBB of complaints.

On One of the visits One year, My New optometrist took two hours with me. My eyes,  had what he described as cotton balls at the end of their nerves.  I was missing, or had blind spots. I knew that from walking out dogs, I would be missing, or not seeing items.

Optic Neuritis,  a quite common word with Multiple Sclerosis. Affecting people differently. Some loose entire vision, as my neurologist had told me years before. If I went blind, to get to UC Davis.
This was not that bad I told myself, but I found myself at the local bandage hospital near the small town where we live. The cotton balls were a huge concern for my Neurologist at UC Davis.
She prescribed five days of iv soul medrol. I

 My Eye appointment was Monday, and I started the procedure, as it was the holidays, On Wednesday.  Not wanting my partner to drive five days down and back, the local hospital was given The script from my neurologists.

The local hospital, was like they had never given a iv treatment before. Five days turned into seven, as they took off for weekends. A hour procedure, of a bag of saline, and bottle of Solumedrol with a drip  line going into a computer, and into a vein. Simple, but day one took them four hours.

Behind the curtain, was the colonoscopy room. They wheeled patients from behind me into adjoining curtains that split of some dozen spots. You could hear the Dr dictate his notes.
A gal ran around like her head was chopped off, creating more commotion, then help.

The procedure did get better the following visits, but did it help the eyes, or was it time that helped make them better?

Solumedrol, the steroid most commonly used to treat MS, is a brand name for methylprednisolone. It's quite potent and often used for severe relapses. Typical dosing ranges from 500 to 1000 milligrams a day. ... Solumedrol is administered intravenously in an infusion center or hospital.


I have been on Achtar, a $30,000 drug for MS, injected into the muscle,  A few five day courses of prednisone tablets, to help with MS Symptoms, including the eyes. Avatar for MS

Over the years, I have adjusted to Double vision, but not really. My eyes tire easily. There are blind spots, the retina thickness is always asked about by my neurologist.

A article written by my optometrist I found fascinating.I
https://newgradoptometry.com/prescribing-fish-oil/
https://newgradoptometry.com/prescribing-fish-oil/

Nutrition for the eyes. A few pills that might help.
Lutein is a carotenoid with reported anti-inflammatory properties. A large body of evidence shows that lutein has several beneficial effects, especially on eye health. In particular, lutein is known to improve or even prevent age-related macular disease which is the leading cause of blindness and vision impairment.

My mom told me she remembered years before my MS, that my eyes would bounce and not focus when we visited, but that was way before MS hit me.

Prednisone has its own drawbacks, as a medicine used to treat inflammation, or problems with MS. Side effects, the quality of life needs to outweigh the medicines and effects.

I still have the problems years later. It is part of MS, and how my brain is interpreting the images, aligning them up, and compensating for blind spots, or blurry waves.  I have found naps help.

There may be some genes involved also, so eye health is important.

 does omega 3 help, or luitin? Would love feedback of what works or did not help.I

Thanks for reading
JoeY

Generic drugs or name brand

                     When Medicines Start looking the same, but are they?

A new medicine goes thru vigorous hoops and bounds, and many trials and test with people, healthy or not, before FDA  in the USA allows it to be sold.  They grant the drug company exclusive trademarks for years, to help recoup the cost on research, development, three phases of testing, before it gets a approval to go to market, usually at a high price.

When the trademark runs out, and the manufacturer has made their billions, the drug is opened to the Generic Market.  I believe there is still a year given to the trade name of the original drug.

A Generic, only has to have 75% of the main ingredient that makes the medicine work. They may change a molecule here and there, put different fillers in, and try to make it like the real drug, but add their own twists. Even rules apply that they must act the same, absorb the same, and be like the real drug.

Think of chocolate chip cookies. Many recipes to make home made ones.   store bought are not as good as homemade, even if they follow same recipe, perhaps flour is different, or chocolate chips are different. But they are all called a chocolate chip cookie.

I have experienced many times, being sensitive to how the name brand drug works, and those of Generic type.  Some generics work just fine, but in comparison to the real drug, there may be a difference.

Take Cymbalta, brand name for instance. It's ingredient is Duloxetine.
When the generics came out, the insurance companies played Doctor.  Many generic companies came up.  Each company made their Duloxetine different. Even Cymbalta, came out with their own Duloxetine, which was identical to Cymbalta.

But Problems arose with me. It takes about two weeks with Duloxetine, and then you know something is off. Is it the absorption rate of the generic?, Or another slight change to the formula, or that it's not quite as strong?

I used three or four Duloxetine manufactures, recording side effects, how long they lasted, when they started. I reported them to my pharmacy, my Doctor, The company, and finally to the FDA, that runs a site for just this. They need enough people to complain, until they will do something, as they do not check each manufacturer, or facility.  FDA adverse-reactions

But each of these changes took time, for my body to adjust, or not to.
A Generic brand was finally found that kinda worked, but Cymbalta worked better.  The company recently pulled their product, and re-manufactured it with less ingredients. I could tell immediately, that it was only working for 18 hours, not 24 hours.

I asked my Dr for a increase in dosage to make up for that, but my insurance company, re-wrote the script, and showed I wanted a six month supply, and denied a prescription. My Dr wrote it asked 60 grams to increase to 90 grams, then calculate for 90 day mail order supply.
But insurance company re-wrote it as 60 grams for six months, as their quantity limits, and regulations, Then denied it.

on another generic, the pills were chalky, disintegrating as pharmacist counted them out, and again leaving a chalky mess, when I would sort the pills. A common medicine, Gabbapentin.  It should of been the manufacture in India, that knew of the problem, but shipped it out anyways.

 It should of been the pharmacist From a large drug chain seeing a problem, as many patients using this, and many pharmacist ending up counting this chalky mess.

 But ended up with me, the consumer, who gagged on these chalky pills, letting pharmacist know.  It took me to call the U.S. Importer. He did not have any of the pills. Then for him to call India and obtain some pills, to see the problem I was talking about. The India Manufacturer knew of the problem, just not how to correct manufacturing issue. They were quite apologizing,  but nobody questioned, until I did.

I was switched to another coated generic, that has worked since.

another example, is when you are slammed into a generic. The Pharmacy can make more money, so they switch you from drug A, to a generic, without you or your Dr's permission.

 This has happened a few times, which takes hours with customer care agents on the phone, stating my Dr made the switch.

  Even if you have prior authorization for the year on file, they "forget", making your Dr write a new prescription "Dispense as Written", Name Brand Only.  Some days I am on the phone for hours, along with the Doctors, as they make it vague of what they need.

Back to Generic Medicines. Most seem safe, but realize that the generic is different, and has not needed to go under vigorous trials like the original. It is a recipe, like the chocolate chip cookie, being varied, fewer chips, different chocolate chips, as those have generics types.

Would love feedback of your experience good or bad with different name brand medicines, or their counterparts of many companies making them Generic.

Lyrica (pre-gabalin) just went generic, now eight companies making their own versions.

Thank you for reading and commenting
JoeY