INSOMNIACS place to talk in the wee hours
Comments
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Teka like that cup/
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Now we know how Chevy really got hurt. She vibrated herself off a motorcycle!
Teka, I swear could smell that roasted coffee!
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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.0 -
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.
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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.
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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!!
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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!
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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.
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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?
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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.
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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.
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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.
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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.
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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!!
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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".
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$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.
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Hole-in -one----funny , I the Fearless leader or something like that LOL.
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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 pathwaysA 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
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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.......
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Me and my Harley....
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Sas, it did make sense. Of course all I saw was yet another genetics company getting rich, my private gene information getting out there and my getting dropped by insurance companies. Of course this would never ever happen `cause it's not allowed but we all know how that works. So when you`all are skinny and fit and feeling fine cause you have drugs that actually work, and I am laying here moaning about all my pills that don't do a damn thing for me, you can say I told ya so!
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Damn Chevy, is that the After and Before picture? That rod done straightened out your leg good!
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LOL Chevy--Your DGS will tell you , you had an Austin Moore, Your break was different than you told me. Actually, they had to reem out the femur to put the ball joint in. Interesting on the bruising, usually not much. But that may have been from WALKING around on a broken femur. You are a WONDER WOMAN. Cuz if it was a ball joint, you were walking on weight bearing portion of the hip.
Would you call that docs office and ask them the name of the procedure, and if they put a ball joint in.? Please.
Ziggypoperoni---yup, you got it:)
Everyone here's the link to the intro video
http://www.youscript.com/movie
I'm still learning BBL
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Ladies, I have a question for you: Does your face actually look like your physiognomy has changed? I kept looking at myself in the mirror, thinking that I didn't look like myself, and thought it was an emotional response. But yesterday I was out with several old friends and some photos were taken, which once I saw them, I had to ask my bf if that was what I looked like now. He said yes, that my face looks different now. Not just a weight thing either.
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Okay Sass.... I told GS when I was in the Hospital.... He assists on spinal surgery, with DePuy Spine.... But he knows all about "Open Reduction Internal Fixation surgery.
It did not involve the ball and joint.... just a fracture at the top of the Femur.... I could not walk..... or put any weight at ALL on that foot/leg, until they put that rod in. The PC said today, that if I TRIED it, the bones would have separated, and it would have been much worse.
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This link is how to use the site. Give it a try. IT'S FREE FOR 90 DAYS. LOL What can you lose. You plug in your drugs >>hit save on top of screen. Then hit interactions. If you don't hit save, it'll wipe out all the drugs that you have entered.
Even if you aren't genetically tested. The drug checker will look at drug interactions. If you see a RED icon on the side of the pill name in the interaction checker ---that's a major drug interaction.
Live on the wild side.....give it a go.
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Chevy, note last one--austin moore
http://www.aaos.org/news/bulletin/may07/managing9_...
is this what they put in
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Oh well I do or did too, but what you describe is the placement of a device into the marrow canal. I don't remember doing it any other way then with an austin moore -----okay, I give.
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