INSOMNIACS place to talk in the wee hours

Anonymous

oh, post from Spookiesmom reminds me: 

Sassy, owls were way messed up this morning on iPad - jumbo size, now they're normal.

Spookiesmom avatar shows up correctly on Mac, sideways on iPad. 

Very strange

Alyson

Yep owls are behaving, gee they have a mind of their own those ones.

Not from here but from home. Then nowhere to go so had better stay.

PS It's my home anyway!!!!

Spookiesmom

Spookie shows sideways on my iPhone too, have been told it's ok on regular 'putters. Must be an apple glitch. 

Anonymous

Spookiesmom, selective Apple glitch.  Looked great on the Mac. It was nice to see Spookie without having to turn my head

Anonymous

quiet night.... Everyone watching the closing ceremony of the Olympics? Thought I'd just check to see if anyone else is awake.

badger

hi Maddy!  I've been up for a little while.  Got the recycling & trash ready to put out, did a couple loads of laundry, and got my lunch packed.  :-)

Chevyboy

OH!  First thing I read is miss smartypants telling us it is WHAT?   75 degrees?  I think she is bragging.... Tain't possible.  show off....

Yes GG.... my little brother!  He just always makes me laugh!  I told you what he said when I told him I broke my Femur...  "I thought that was a small furry animal!"   Little shit!

Sass!  WTH???  WHAT?  I mean I'm trying to pretend I know what you are talking about...  Cammi!  Do YOU get it?  What's this about paint-ball stuff?   And ain't gonna do no good for you to 'splain it any further, cause I STILL won't get it....  I'm hopeless....

Ah little Bluebird..., your Daughter will learn to not pay any attention to her little ears...  If that was the only birth-defect I had, all my other ones would feel lonesome.  Like my toes, for instance...  Or my face...

Ha! 

So that full of shit person ziggypoptart woke up?  You guys, SHE is trouble!  I can just feel it!  Actually though, if I HAD a pole, back in the day, I WOULD have danced on it... So HAH! 

Yes.... nothing like riding down the highway on the back of a big ol' Harley,  and that THUNDER of that engine vibrating through your butt, to make a gal feel, well, happy....  And then going to that bar, and dancing 1/2 the night, and drinking and just having a blast! 

I just made all that up.

WAIT!  I have to find all my carrot recipe's.... You say Sass loves Carrots?  And she loves Spam?  Who knew?

Morning Maddy, Teka & Badger!  Did any of you watch the Daytona finish last night?  OMG it was sooooooooooo good!  Junior WON!  I almost yelled out loud!  

Love your Owl Aly.... and hi to you spookiegirl!  xoxoxo

Chevyboy

camillegal

Good Morning---I slept most of yesterday and all nite---

Chevy I'm with u on this one--I read Sas's posts and think if I read them again will I understand anything?  Guess

I love those shoes and I did think that would be a great weapon and legally no problem, just keep one in u'r purse. U guys said it before, even these models can't walk in them, some fall and some take them off immediately when done, and when I watched Julia Roberts walk on one of the award shows alone, both Joey and I said she can't walk on those shoes--so they are not really very practical for anyone, but they are pretty.

Well I have to get my work station (shut up Chevy) all set up for my ease--so I'll be bok

Teka

Good Morning, Owlettes!

camillegal

Teka like that cup/

FierceBluebird

Now we know how Chevy really got hurt. She vibrated herself off a motorcycle! 

Teka, I swear could smell that roasted coffee!

sas-schatzi

Tamoxifen(active  metabolite endoxifen), ALl AI's go through the 3a4 enzyme path. Anyone with an abnormality of the path or on a drug that majorly affected the path would have an effect of how the drug works.

EDIT: lol ---I READ THE COMMENTS, ALL YOU NEED TO READ IS THE BOLDED STUFF. THE OTHER STUFF IS THE GENETIC EXPLANATION. YOU DON'T NEED TO KNOW THAT ---BUT YOUR DOC SURE AS HELL SHOULD.       IS THAT BETTER?????????

tamoxifen through the 3A4 path ----

Effects

This medication is metabolized by CYP3A4. CYP3A4 metabolism may be reduced in CYP3A4 intermediate metabolizers (*1/*22 or *22/*22).
The liver enzymes CYP3A4 and CYP3A5 are the most common drug-processing enzymes in the body and about half of most common drugs are metabolized by them, including medications used to treat heart disease, pain, cancer and infectious disease.
Until recently the clinical actionability of known CYP3A4 variants was questionable. However, in 2011 a new variant, *22, was discovered. This variation has been shown to have a correlation with the exposure of many common medications.

Tamoxifen through the 2d6 path----

Effects
This medication is metabolized by CYP2D6 which is highly polymorphic. DNA testing identifies common variants that result in dramatic differences in patient exposures. More than 50% of the population carries these variations that may lead to adverse reactions or lack of efficacy at normal therapeutic doses. 

Arimedex, Femara, Aromasin. " I failed all three". The info was available in 2011. I went on Aromasin as a last try in 2011. Had this testing been done. The dose would have been changed or gone to every other day dose.

Effects

This medication is metabolized by CYP3A4. CYP3A4 metabolism may be reduced in CYP3A4 intermediate metabolizers (*1/*22 or *22/*22).
The liver enzymes CYP3A4 and CYP3A5 are the most common drug-processing enzymes in the body and about half of most common drugs are metabolized by them, including medications used to treat heart disease, pain, cancer and infectious disease.
Until recently the clinical actionability of known CYP3A4 variants was questionable. However, in 2011 a new variant, *22, was discovered. This variation has been shown to have a correlation with the exposure of many common medications.

sas-schatzi

I know this all sounds very technical. But there are only seven major players--2d6, 2c9, 2c19, 3a4, 3a5, VKORC1

Polymorphic means there are variations----in this case of these genetics, it means the path can be absent, intermediate, normal, rapid, ultra rapid. 

All the two's ----2d6, 2c9, 2c19----have a greater numbers in the population with  abnormalities. That's why Genelex offered them in a package b/c abnormalities are that common.

Then when the test for coumadin/ warfarin became available they packaged it with the "2's". It made the package panel very attractive. The gene is VKORC1(subset of 2c9)  1of 15 hospital admission in the USA are due to complications caused by coumadin/warfarin. We are talking likely millions and millions of dollars. That's why insurance companies are now VERY likely to cover this test b/c it's cheaper than one day in the hospital. Medicare covers the cost, but must be pre-approved. Plus, adverse drug interactions have become to be recognized as a major source of complications for patients resulting in added medical problems and costs.

The complete conversation with Daugherty was "only 5% of the population has variations in 3a4 &3a5, statistically that is very small, they felt that it was taking money for a test that was likely for most normal" I've told you the pitch I made.

25% of all drugs take a first pass through 2d6

50% of all drugs go through 3a4 and 3a5

The way the Genelex system is set up: the genetics are entered into the system & patients drug list. The computer does an interaction check and uses the genetics to show whether the drugs are interfering with each other at a PARTICULAR path. If there is a conflict the computer offers a suggestion of alternate drugs. As in cases where a path is abnormal a similar thing occurs. There is a pharmacist on duty to answer questions and help.

Story time: Gary my counselor after I told him about the above, had a patient that was on Prozac. Trying to get her on a maintenance dose was impossible b/c she continued with mood fluctuation. In frustration, he decided to have her tested. Prozac is 100% metabolized by 2D6. Her pathway was absent. He had spent  time trying to regulate her on a drug that had no chance of working.

When he told me this story, he initiated it with a Thank You. Once he got her genetic tests back, the Genelex pharmacist worked with him to figure out the best alternative. They got her regulated on a med. He from that time forward will not recommend any drugs without genetic testing. The case was actually publishable, but couldn't talk him into it.

I pay under 25.00$ a year to have my own subscription. YouScript.

It's time to shake our Docs up. Technically, my doc did not meet the standard of care. He should have been aware that a test was available. 

ziggypop

I am quite sure that this last post from sassy cleared everything up for you, chevy and cami. I really can't fathom how you didn't get it the first time around. Clear as a bell to me.

And certainly if you didn't get it, that one word 'construction' made it all fall in line.  

4sewwhat

Hey Sas, I got a big problem.   Do you know anything about AFT for radiation patients so they can avoid a flap procedure?  I lost half of my beautiful recon in the damn ice storm and am trying to find a way to salvage it.  I have been in touch with Whippetmom also.  Just thought you might have run across something I could take to my doctor in your travels online.

Hope everyone is well!!

FierceBluebird

Ziggy, I'm with you. I don't know why we bother with such dense women here.   I would like everyone to take note that something- something reduced in CYP3A4 intermediate metabolizers (*1/*22 or *22/*22) could also be reduced  in 1/23 or 23/23 or 1/24 or 24/24 or 1/25 25/25 or really any number for that matter because all numbers get fuzzy to me after awhile.  But whatever sassy said, I'm with her! 

ziggypop

I know, bluebird, like how do you not get that the VKORC1 gene which is, as everybody knows,  a subset of 2c9, is central to the metabolic circadian rhythm necessary for the neuroplasticity of tamoxifen? Lordy, this is gradeschool stuff. I think all the motorcycle vibrations shook chevy's brains around - although how she could ride a motorcycle with those dumboesque things she calls ears is beyond me, you'd think the updraft on them would lift her right off the ground. 

sas-schatzi

LOL you guys are so funny. I put an edit in the first box. The next box is my explanation of how it all works. Seriously, read that box twice. Be honest in the second box did I make it clear. I tried.::)

$$$$$$$$$44444444 hey, what's an AFT. Why/how would an ice storm cause you to loose a flap? More info?

sas-schatzi

Bluebird BTW love the name and I saw a real bluebird only once, in northern Michigan. I spammed your post on a bunch of different threads. Some I'm not regularly on, last time I did that someone reported me. But Mods are patient with me.

Holeinone

gigglegigglegiggle......

I try to follow our leader, but damn its never gonna happen. How in the beejeebees does anyone know what  ~}€*= are? 

I am trying to eat my plant based diet, swallow that little Arimidex pill everyday, and not bite DH head off.

sas-schatzi

Spookie no FOR me my 3A4 is abnormal ---I'm an intermediate metabolizer. My dose of taxotere should have been reduced.

Tell me what your scenario was that almost killed you?

How was Saturday?

I think my chair is history:( very bad b/c I've spent $730.00 on it.

Wren44

Ziggy and Bluebird, Thanks for the big laugh. I needed it.

SAS, Now I'm curious and want to look up all my meds to see what pathway they use. Gonna be another lost day here. And I'm supposed to be cleaning for company.

4sewwhat

Hey Sas!

I had my exchange 12/30.  Turned out beautiful!  Fast forward 6 weeks.  11:30 at night watching a movie arm up in the air doing my stretching and LE drainage massage.  I felt something pop under my incision.  I thought it was just scar tissue like when cording releases or stitches that had not dissolved.  So I go back and push a little.  Bad plan!  pop, pop, pop  looked down and there was a hole in the incision line.  Didn't know how deep it was and if implant was exposed.  First thing I did was go get my antib's.  Called next morning and texted pics.  Atlanta was frozen by now and roads closed.  My doc could not even get out of his neighborhood, not sure I could have either.

Long story short by the time the ice melted and things were moving again and he was in surgrey all day Friday so he met me in office Saturday and excorted me over for emergency surgery to remove the infected implant.  Since saturday and since infected he pressure washed with antib's and closed it up empty.  Now he says I can't go back with TE to implant because it is the radiated side and chance of failure is very high.  He is very conservative.  I am hoping to push that boundary!!!

AFT stands for autologous fat graft transfer.   They are doing fat grafting into radiated tissue and it is reversing some of the rads damage and making it possible to again do another implant recon.  My doctor is more than capable but has never done it before, for this reason.  He has done fat grafting and we were probably going to do some of it anyway.  I am trying to arm myself with so much good information that he can't turn me down!!  I don't like to doc shop.  I trust him and his work has all turned out great.

I just thought you might have run across something in all your many investigations!  A lot of ladies are out there looking for info about it.  It could really be a great option for those who can't or don't want flaps done.

Thanks!  Good to see all you hooters!!

Teka

I should've been cleaning!

sas-schatzi

Wren know the feeling. When I first did it for my DH, I did it by hand making a chart. Then I found Genelex. At the time, I didn't know I found the only company in the world that does genetic testing and offers the service of how it applies to drugs and interactions. Then I just blundered in to their site, by-passing the START HERE:video. Duh it showed how to use the whole thing. The old adage "if all else fails, read the directions".

sas-schatzi

$4444--HUGE bummer. No haven't researched fat grafting. You said you were in touch with Whippetmom. That's who I would have said go too. She knows so many people throughout the country. 

Try SpecialK, she may have a clue. She is a major researcher and may have come across it.

Are you trying to talk your doc into doing the sx? The words "high failure rate" throws up red flags. Irradiated skin looses the pliability and healing ability of normal tissue. Putting AFT together with irradiated skin may be a double whammy b/c the AFT has to establish a circulation network. 

sas-schatzi

Hole-in -one----funny , I the Fearless leader or something like that LOL.

ziggypop

Ah schazi - can't give you too much of a hard time after the condo nazi incident. I do kind of get what you are saying, I think. 
There are pathways that drugs follow and the drugs are metabolized on these pathways 

A drug, say tamoxifen, follows a certain pathway or pathways in everybody (say pathway X). 

Individuals all have pathway X but the pathway metabolizes the drug more or less well (or faster or slower) in different individuals.

How well (or fast or slow) the drugs are metabolized affects the efficacy of the drug. 

A test is available to test how well the pathways work, but the doctors are not yet using this test to it's full advantage?

Is that the general gist of it? I see that it is FAR more complex, but trying to get the general idea. (so I can explain it to the motorcyclically impaired among us )

Chevyboy

Oh SURE!  Now SHE is going to try and sound intelligent!  Like she knows what Sass even said!  I mean even SASS doesn't know what she said!  How can this little shit try and explain the pathways, and road-blocks, and geneticism imbalances that the typical woman posesses?  I mean seriously? 

I'm always trying, at least 1/2 way, to try and pretend what you smarty-pants gals are saying....  BUT,  sometimes my brain just cannot fathom anything more complex than the rudimentary analysis of a  chocolate coke! 

Cammi, did you hear them?  I think this is a test.  We are supposed to learn and comply.... ain't gonna happen. 

I just got back from my PC.... She took out the staples.... about a million of them!  I didn't know how bruised I was....  all over my butt, and my thigh!   She says that's probably what a lot of the pain is hanging around there for!  And get this!  I'll bet you little shit smarty-pants didn't know the FEMUR was hollow!  Damn!  So the rod was put down the center of that Femur, and screwed into place.... Therefore I am bionic.   It's official.   I, (with all of my knowledge) thought the rod was screwed in alongside my femur bone!  Not jammed down the damn center!  Those people are trying to kill me! 

Sass!  Good information!  I mean really!  I understand everything you posted..... mostly.... I mean maybe soon.... or I'll try.  I hope Cammi don't read this...  she has a job you know.... and her brain will be too overloaded...   it's okay cammi....  I'll watch over you.......