What the Label Really Means, or Rough Weather Ahead

[dr_pretentious]

"If condition persists, consult your doctor." Straightforward, right? No, not so much. Apparently, if you follow the dosing instructions on a bottle of Extra Strength Tylenol for any prolonged period of time--like, say, three months--you can tox out your liver. Apparently, the doctors who told me that tylenol would do just fine, now that I can't take ibuprofen or any of its NSAID cousins, never considered the possibility that I'd try the extra-strength tylenol. Considering that most people with the chronic pain diagnosis I have take opiates as daily maintenance drugs, I don't know why it didn't occur to them that I'd choose the stronger over-the-counter version over the weaker one. As far as I knew, I had consulted my doctor.

So now, until the bloodwork says my liver is happy, no more painkillers for little me. At all.

Maybe the lab will have something nice to say about my blood, and I'll be in the clear.

Just in case, though, I figured I'd give y'all a heads-up. I may be less useful than usual for a little while. As I discovered back in November, asking for help isn't the end of the world. (Who knew?) It's possible I might have to do that again.

Comments

[calene.livejournal.com]

Ugh! Sorry to hear that. The same thing happened to my mom last year, and it wasn't fun. Sending good vibes your way. Hope this clears up soon so you can have some help with your pain again.

And I'm not sure there's much I can do to help from here, but I'm here if you need it. Even if it's just someone to gripe to who offers virtual hugs in return. :)

[dr-pretentious.livejournal.com]

Thanks!

Dan just pointed me to the wikipedia entry on tylenol. The toxicity section is pretty scary. I'm really lucky that my doctor put two and two together before anything bad happened. It looks like no fun at all.

[reynaud.livejournal.com]

I'm sorry to hear that. May your liver be nice and detox quickly, so you cen be relatively pain free.

And in a desperate search for some sort of silver lining (or even brass, at this point), at least now you can have some sympathy for any characters you write about who have a chronic pain!

[dr-pretentious.livejournal.com]

Yeah, I've been looking for the good in the situation, too. Chronic pain's old news for me, but it does have a couple of weird little benefits. When the fibromyalgia flares up, all my senses get keener. The photosensitivity's a real inconvenience, and it's not so much fun when loud noises map over as pain in my skin, but then, good food becomes Euphorically Good Food, and I have a sense of smell fit for blending perfumes with. I figure, I can sit in a nice dark place and mix up some anointing oils while I wait this out. Synesthesia's not such a bad deal, then. Feeling the scent of sandalwood in my skin is almost worth the price of admission.

I have to be really vigilant about the chronic pain worming its way into characters who don't have it. Anytime a character is weary, or spends an entire scene flat on his or her back with any sort of debilitating condition, I have to ask myself, am I writing this because it's one of the things I know, or is it actually good for the story? "Weary" is one of the words I run searches on when I'm revising, to make sure that not once instance of weariness occurs unnecessarily. That word is almost as pernicious a tic as "pretty much."

Smells

[tracyandrook.livejournal.com]

So I have all of this soap stuff and I am fishing for some smells to put in soap. Just a suggestion. Want some soap?

Re: Smells

[dr-pretentious.livejournal.com]

How do you feel about candlemaking? Dan won so much spiffy handmade soap in the Yule gift exchange/extreme musical chairs game, we're pretty well stocked over. [Insert joke about self-cleaning coven here.] But, believe it or not, I am actually running out of tapers.

Tapers, not tapirs. Anytime I need tapirs, I just look here (http://community.livejournal.com/tapir_time/).

Tapers

[tracyandrook.livejournal.com]

...I recall that the last group of tapers I made, much less wax actually burned than ended up all over the table. I shall have to troubleshoot this batch of wax. I think stearic acid should harden it up a bit. This cannot be done soon. And folks tend not to like smelly tapers so much.

It's the old problem of clashing smells. How dare they discontinue unscented deodorant! You can smell like anything you want as long as it goes with "Powder Fresh". Bleah.

Jar candles are just fine though. I already have the jars.

Justin and I went to the Bronx Zoo and he must have spent twenty minutes communing with the tapir in the jungle house. I think it was trying to get Justin to relax.

Re: Tapers

[dr-pretentious.livejournal.com]

I think every organism Justin ever met has tried to get him to relax. Dear Justin. I wonder what he's up to these days.

[reynaud.livejournal.com]

Your condition gives you synesthesia? Wow. Of all the conditions I've heard about, that one is the one I'd probably most like to have. Although I've heard there are some really awful versions of it, like tasting sounds, where most of the tastes are pretty nasty. But I'd love to be able to see sounds.

Admittedly, it sounds like in general you'd trade that in for a day without pain.

Was this just from the messed up ankle?

[dr-pretentious.livejournal.com]

Nope, I've always had it, though it wasn't diagnosed until I was a couple of years into grad school. Before that, my doctors told me it was all in my head, and that everybody else was in just as much pain as I was, and I believed them. I really thought the synaesthesia was normal.

Most of the time, I can keep the fibromyalgia in remission with low doses of unexciting medications, with a bit of Tai Chi and yoga on the side. Most years I have a week or two of crash-and burn when something knocks me off my equilibrium, but I have a repertoire of skills now that allow me to pull out of flares in fairly short order. Getting by with no analgesics will mean more Tai Chi, more yoga, more massage, and more care to avoid little injuries and catching colds. It's the disruption between one stretch of equilibrium and the next that's always a bitch.

[jeneralist.livejournal.com]

I draw the group's attention to one of my favorite singing groups, "The Bobs," and their song "Synesthesia":

As a baby in my mother's arms
She would croon and I'd see pink
And when she'd bathe me in the sink
The radio would play red or green or lavender
When the Beatles sing it's a yellow thing
Yeah, the Stones are always purple
Every melody that I hear
Fills my mind with colors bright and beautiful

SYNAESTHESIA
If everyone could see the things that I hear
SYNAESTHESIA
A giant box of Crayolas in my ear

(the rest of the lyrics are at http://www.bobs.com/Lyrics.cgi?Synaesthesia or listen to the song by following the link at the bottom of the page at http://home.comcast.net/~sean.day/index.html )

[citabria]

Well, foo! Here's hoping your liver enzymes are fine!

[shellyinseattle.livejournal.com]

Ouch! Sorry to hear about this. I hope the pain remains bearable.

[jasminewind.livejournal.com]

Is there any manner of homeo- or naturopathic treatment that could help you keep your liver healthy or get it healthier faster?

[dr-pretentious.livejournal.com]

I have to wait for the lab results to come in before I sort out alternatives. Fortunately, my doctor's German, trained in Germany, so she has actual training in herbal medicine and can read the Commission E monographs untranslated.

[vgnwtch.livejournal.com]

At least there's no liver damage. Big plus. I'm sending lots of love your way.

!!!!Mostly, herbs to NOT take

[tracyandrook.livejournal.com]

Oh my goodness gracious. I'm sorry. !!!BE CAREFUL ABOUT HERBS!!!

In an emergency there is an antidote for Tylenol: N-acetylcysteine (Mucomyst) but it needs to be given soon after an OD.
The course of acetaminophen toxicity is at its maximum 4 days past OD and lessens after that. JEN PLEASE VERIFY
Here's some herbs to avoid, with their citation sources.

http://home.caregroup.org/clinical/altmed/interactions/Herb_Groups/Hepatotoxic.htm
Pyrrolizidine alkaloids (PA's) are found in over 240 species, mostly amongst the Asteraceae (Daisy) and Boraginaceae (Borage) families. The toxicity of PA's has been known since the nineteenth century; Senecio "hepatitis" in cattle was described in 1884. The mechanisms of toxicity are well documented have been reviewed recently. (See, for example, Denham A.1996). Hepatotoxicity among PA's varies with minor differences in chemical structure
Pyrrolizidine alkaloid-containing herbs:
• Alkanna tinctoria (Alkanet, Anchusa)
• Borago officinalis (Borage)
• Cynoglossum officinale (Hound'stongue)
• Eupatorium purpureum (Queen of the Meadow)
• Lithospermum officinale (Stoneseed)
• Petasites spp. (Butterburr)
• Senecio spp. (Liferoot)
• Symphytum asperum (Prickly Comfrey)
• Symphytum caucasicum (Comfrey)
• Symphytum officinale (Comfrey)
• Symphytum tuberosum (Comfrey)
• Symphytum x uplandicum (Russian Comfrey)
• Tussilago spp. (Coltsfoot)

Abstract: Hepatotoxicity associated with supplements containing Chinese green tea.
Herbert L Bonkovsky. Annals of Internal Medicine. Philadelphia: Jan 3, 2006.Vol.144, Iss. 1; pg. 68, 4 pgs
Recent reports have identified an association between hepatotoxicity and health supplements containing green tea extract (Camellia sinensis). In our patient, the temporal pattern of C. sinensis administration and liver enzyme abnormalities (with a positive rechallenge and exclusion of other possible causes) strongly suggested that the supplement was the inciting agent for both episodes of severe, symptomatic drug-induced liver injury. Extract of C. sinensis is the most probable cause of hepatotoxicity in this patient because 1 this extract is the major ingredient of the supplement by weight (383.3 mg per 3 capsules); 2 there are now several recent reports of similar symptomatic hepatoroxiciry in patients using C, sinensis extracts; and 3 other ingredients of the supplement have not been reported to be hepatotoxic at levels found in 3 capsules (calcium, 167 mg; chromium, 67 µg; magnolia extract, 100 mg; aqueous epimedium extract, 100 mg; β-sitosterol, 40 mg; banaba leaf extract, 11 mg; and vanadium, 10 µg).

Please stay away from alcohol. Yes, alcohol is a painkiller too.
Please keep in mind that many OTC drugs contain tylenol as part of the mixture (I guess they probably would have told you)

!!!did your doctor go over ALL your prescriptions to determine hepatotoxicity?!!! Be very concerned if they did not. Liver insult is cumulative e.g like being smacked, the second adds to the first even if by a different hand (etoh, herbs, other drugs). More in a second

Re: !!!!Mostly, herbs to NOT take

[dr-pretentious.livejournal.com]

Thank you! When I hear back about the lab results, I'll be going over some of this with my doc.


It's especially fortuitous that you posted the caution about borage. I've been using a flaxseed/borage oil blend in salad dressings occasionally (omega-3 and omega-6, and all that). Now I know to lay off it for a while.

milk thistle

[tracyandrook.livejournal.com]

Here's a traditional remedy for toxic hepatitis. Again, I don't want to steer you wrong, jeneralist has an herbal desk reference. Maybe give her a call.


Francine Rainone. American Family Physician. Kansas City: Oct 1, 2005.Vol.72, Iss. 7; pg. 1285, 4 pgs

Headnote]
Milk thistle has been used as a cytoprotectant for the treatment of liver disease, for the treatment and prevention of cancer, and as a supportive treatment of Amanita phalloides poisoning. Clinical studies are largely heterogeneous and contradictory. Aside from mild gastrointestinal distress and allergic reactions, side effects are rare, and serious toxicity rarely has been reported. In an oral form standardized to contain 70 to 80 percent silymarin, milk thistle appears to be safe for up to 41 months of use. Significant drug reactions have not been reported. Clinical studies in oncology and infectious disease that are under way will help determine the efficacy and effectiveness of milk thistle. (Am Fam Physician 2005;72:1285-8. Copyright © 2005 American Academy of Family Physicians.)


Milk thistle (Silybum marianum) was used in classical Greece to treat liver and gallbladder diseases and to protect the liver against toxins. It recently has been investigated for use as a cytoprotectant, an anticarcinogen, and a supportive treatment for liver damage from Amanita phalloides poisoning. Its active ingredient is silymarin, found primarily in the seeds. Silymarin undergoes enterohepatic recirculation, which results in higher concentrations in liver cells than in serum.1 It is made up of components called flavonolignans, the most common being silybin.2

This article was a literature review. It has recommendations for physicians but this is a pdf picture that I cannot attach. I will try to stick it in the Yahoo group files as with other things I can find.

[elphaba-of-oz.livejournal.com]

Have you tried accupuncture?

[dr-pretentious.livejournal.com]

I tried it a few years ago. It went Badly, but the only reason I chose that practitioner was that my insurance would cover her. A local friend has recommended another acupuncturist. I may look into it.

[jeneralist.livejournal.com]

Hey, friend.

Thanks for the heads-up. Now listen: you are allowed to take care of yourself. You are encouraged to rest when you need to, to sit when you want to, to nap if a warm bed presents itself.

And as for the "less useful than usual" stuff: c'mon, when you think of why you're friends with someone, is utility high on the list?

NB: This was jeneralist-the-friend. If you want medical information from jeneralist-the-doctor, I'll change mental hats and LJ icons. Just let me know.

[reynaud.livejournal.com]

Does jeneralist-the-doctor's icon wear a different hat, too?

[jeneralist.livejournal.com]

Only in the OR.

[dr-pretentious.livejournal.com]

No, utility's not high on the list. But we're a community, too. We look out for each other, undertake projects together, etc. I figure, Cat needs to know the FSG main ritual liturgy got temporarily knocked down my list of priorities by a couple of slots. That kind of thing.

As you might guess from the fact that I'm back online, making the case for my codependency, I'm feeling a lot better than I was when Dan called you. Thank you! The tea did the trick.

[kistha.livejournal.com]

I'm a not so big fan of Tylenol.

May you get well soon. The smell thing does sound kind of nice though, nothing like an interesting side effect.

Many good wishes!

Loves

[rednikki.livejournal.com]

Please take care of yourself, sweetie. You deserve to be taken care of.

[dr-pretentious.livejournal.com]

Dan's been looking after me. So far, so good.

[oaktavia.livejournal.com]

okay... now since I can't add much to all of that (gee can you tell I'm behind in my LJ reading? *wry grin*) and since you've already recovered (or at least the labs ar back negative...)
I can give "laughter the best medicine"...
rememember Scott's statement about tylenol overuse?
"I don't take tylenol, I only take acetometaphen!"
aaah the good ol days...

[dr-pretentious.livejournal.com]

Actually, I'd never heard of tylenol overuse until the past few months. What else is in this Scott story? Sounds like a good one.