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- Oct 16, 2013
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I agree with cmack. Great to see you, MissLeopardIt's good to see you MissLeopard.![]()
I agree with cmack. Great to see you, MissLeopardIt's good to see you MissLeopard.![]()
Concerning moving, i just came back from an emergency trip to Florida. If it weren't for my son living up here, I wouldn't mind moving there.
Ronroush - I'm so sorry to hear about your father. We're all getting to that age now where we have to start worrying about them. :-( We were hot here in Orlando area over the weekend - 89º! No way - bring me my winter!
Izzy - Wisdom tooth! Yikes! Hope the infection clears up quickly! Funny story, when my daughter was about 6 months old I had to have a root canal. She wasn't the easiest baby (to put it mildly). The dentist apologized at one point for the root canal to be taking so long and I told her to take her time! I was sitting in a reclining chair watching TV and no screaming in the background!!! If you ever need to talk about depression, etc, please pm me. We have a lot in common with our depression.
Akgirl - I've been an expert in anxiety and depression for the past 8 years (PTSD)! It's no fun, I know how paralyzing it can be. Congrats on being able to overcome it a bit to get some of your freedom back! That's a huge step! Just remember to breathe!!
Thanks, Danibee. I was in Orlando international Airport last week.
Hope you have a diagnosis soon.Doctor appointment yesterday. Biopsy results from endo and colonscopy, and the small bowel series all were fine. Next up is the pill cam, which will basically be checking off a box. I don't expect to find anything. Once the pill cam comes back clean, then the GI doc will refer me back to the hematologist to look at hematological reasons behind my anemia.
Still leaves issue of stomach pains and nausea. Doc has ordered a HIDA scan in the meantime. He also gave me a supplement called FDgard to see if that helps the pain and nausea.
So, yea. That's where I'm at. Definitely not Crohns or celiac.
Sending you support.I'm starting to think the universe has it out for me. Kicked the wisdoom tooth infection, but today: flu! xD
Woke up with body aches like crazy. There's a snow storm outside, so I'm not missing much. Going to stay bundled up on this couch for the foreseeable future.
Is there a specific issue you wanted addressed that she didn't address? Do you have a diagnosis yet? Is she thinking inflammatory arthritis or a connective tissue disease or lupus?
Plaquenil does take 6 weeks to work. How long have you been on it? If it hasn't been long,I wouldn't expect a decrease in pain just yet.
Also, has she suggested a different NSAID for you? My daughter tried MANY NSAIDs. She was on Naproxen for a while and it caused such bad gastritis that she ended up losing 15 lbs because she would not eat (and this was a thin kid to begin with). It took a lot of trial and error but we found an NSAID that would work for her and didn't cause GI problems.
Celebrex is the one that is the easiest on the gut. I have one daughter on it. Both girls are on NSAIDs with PPIs to protect their stomach. Have been on them for years, including the daughter with IBD. Her rheumatologist and GI decided it was ok since her joints are so much worse than her gut.
An NSAID should be helpful for the joint pain and inflammation and stiffness (if you have any).
You could also try something like Neurontin (Gabapentin), Lyrica or Elavil. Antidepressants and anticonvulsants are used for pain in low doses.
I would definitely ask if there are different nsaid options
Ds tried multiple NSAIDs as well
Ended up tolerating Celebrex very well
Even had a good scope on it
No issues
Hi MissLeopard,
First off, I'm glad the plaquenil is already helping. That is great to hear.
Regarding the discussion you had involving opiates. I had a talk with my GP on day one, I told him that I likely needed certain, (possible substances of abuse) to treat my pain. I gave him my word that I would prove it to him, over time, that I was being responsible. Things worked out well. First you have to get the chance to prove yourself, there is the tough part. I thought I would tell you how I approached it.
Regards,
Chris
Medications: The U.S. Food and Drug Administration has approved three drugs for the treatment of fibromyalgia. They include two drugs that change some of the brain chemicals (serotonin and norepinephrine) that help control pain levels: duloxetine (Cymbalta) and milnacipran (Savella). Older drugs that affect these same brain chemicals also may be used to treat fibromyalgia. These include amitriptyline (Elavil) and cyclobenzaprine (Flexeril). Other antidepressant drugs can be helpful in some patients. Side effects vary by the drug. Ask your doctor about the risks and benefits of your medicine.
The other drug approved for fibromyalgia is pregabalin (Lyrica). Pregabalin and another drug, gabapentin (Neurontin), work by blocking the over activity of nerve cells involved in pain transmission. These medicines may cause dizziness, sleepiness, swelling and weight gain.
It is strongly recommended to avoid opioid narcotic medications for treating fibromyalgia. The reason for this is that research evidence shows these drugs are not of helpful to most people with fibromyalgia, and will cause greater pain sensitivity or make pain persist. Tramadol (Ultram) may be used to treat fibromyalgia pain if short-term use of an opioid narcotic is needed. Over-the-counter medicines such as acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (commonly called NSAIDs) like ibuprofen (Advil, Motrin) or naproxen (Aleve, Anaprox) are not effective for fibromyalgia pain. Yet, these drugs may be useful to treat the pain triggers of fibromyalgia. Thus, they are most useful in people who have other causes for pain such as arthritis in addition to fibromyalgia.
For sleep problems, some of the medicines that treat pain also improve sleep. These include cyclobenzaprine (Flexeril), amitriptyline (Elavil), gabapentin (Neurontin) or pregabalin (Lyrica). It is not recommended that patients with fibromyalgia take sleeping medicines like zolpidem (Ambien) or benzodiazepine medications.
You need to look for studies on PubMed.
But a few caveats about Tramadol -
Has the same risk of serotonin syndrome - so it would not be prescribed if you are on two anti-depressants. My daughter was only on one anti-depressant and her pain management doctor and rheumatologist were hesitant to put her on Tramadol. They did, and she was fine, but the two anti-depressants might be why your doc hasn't mentioned it.
It has side effects - if Flexeril caused side effects at 2.5 mg (which is a BABY dose), so will Tramadol, I would guess. Expect nausea, sleepiness, feeling "fuzzy." I remember you having slow gastric emptying - Tramadol can worsen that.
The good news is over time you get used to them but the bad news is over time you get tolerant to opioids and need higher and higher doses. That is why doctors are now not using them for chronic conditions as much as possible.
I think another reason might be the opioid epidemic - doctors are now VERY hesitant to prescribe opioids, even mild ones like Tramadol. They want you to try everything else first.
Things you could try:
Switching anti-depressants - some anti-depressants work well for pain, including Fibromyalgia pain. Cymbalta is one.
Trying an anti-convulsant (might be allowed even with antidepressants - my daughter takes Gabapentin with an anti-depressant).
Trying injections into the joints that hurt - steroid injections. So for example, if you are having lower back pain, they may do facet joint or SI joint injections.
Trying another NSAID - I would also about the more gut friendly NSAIDs. Advil is NOT one of them. My daughter (who has a very sensitive stomach!) can tolerate 3 - Mobic, Celebrex and Relafen. She does need a PPI with them, but they work very well for rheumatic conditions.
I'm not anti-Tramadol at all, in fact I am pro-Tramadol for occasional use! I think it works well and for MOST it has few side effects. My older daughter takes it occasionally. I just think, unfortunately, with the opioid epidemic, you may have a hard time getting someone to prescribe it.
It is very frustrating to us too that patients who are responsible and really need pain relief are now suffering because it is getting harder and harder to get opioids. I have a daughter with very severe AS and significant joint damage and her quality of life would be a lot worse without them.
My younger daughter's rheumatologist told us at the first appt. that she NEVER prescribes opioids and you have to go to pain management for that. Often rheumatologists only take care of the disease - and they consider the pain that comes with it a pain management doctor's problem if it is not controlled by NSAIDs, DMARDs and biologics.
Another reason might be that you do not have a proper diagnosis yet, right? Currently they are just calling it a connective tissue disease which is vague. Your rheumatologist doesn't know what you have and until she does, she may be more hesitant to prescribe certain drugs. That is probably why she put you on Plaquenil - it works for some patients but it's a pretty mild drug. Probably the mildest DMARD she could have put you on.
The best treatment for fibromyalgia is actually exercise. There are plenty of studies that support that. I would try to get 30 minutes of aerobic exercise a day - it can make a huge difference. It doesn't have to be intense exercise - even walking counts.
Good luck!!
There are others too - Effexor is one. Fetzima is similar to Savella which is actually approved for Fibromyalgia. Fetzima is an antidepressant.
Savella isn't an anti-depressant so it might be one to try. I don't know if it interacts with your other meds though.
Generally, the SNRIs are used for pain as well as depression. SSRIs did not do as well in trials for chronic pain.
I don't necessarily think other options are "milder" just that in this current climate, getting even Tramadol might be difficult. It is a mild opioid - it's given to kids with arthritis.
All muscle relaxants are meant to be used for a short time. However, my girls have been on Flexeril for years and it still works for them. One is on 5 mg and the other on 10 mg. They haven't had any issues stopping it - no withdrawal symptoms that you would get with opioids. They just stop.
The other issue with opioids is that they can actually cause more pain if used for a long time. This is called opioid induced hyperalgesia. They actually change your brain and nervous system and make you more sensitive to pain. They are not recommended for people with fibromyalgia for that reason - people with fibromyalagia have nerves that are more sensitive to pain anyway.
But if you use them only occasionally, then that should not be an issue. It's really long-term use that is the big problem.
The other things that could help - Voltaren gel, Lidocaine patches, a TENS unit, acupuncture and massage. My daughter has tried all of the above. Acupuncture did not help her, but everything else did, especially massage.
A second opinion is a good idea. You also could consider seeing a pain management doctor. Both my girls see one. If you do see one, remember to ask about serotonin syndrome because of your antidepressants. It can be very serious and is often forgotten by doctors.
Lidocaine patches might help you them. A physician has to prescribe them (even your PCP could - it doesn't have to be your rheumatologist). My girls use them on joints that hurt. Voltaren gel is another option - it's an NSAID but since it's topical, it won't upset your gut.
I have heard Lamictal being used for pain, but anti-convulsants do tend to come with a lot of side effects. My daughter tried Trileptal, which is similar.
My kiddo uses Gabapentin for both sleep and pain. It definitely helps her sleep. Not sure on the pain part though. She takes it at night so it actually helps that it makes her sleepy.
It may be worth trying physical therapy since exercise is the number 1 recommendation for fibromyalgia and according to studies, works better than any medication. A physical therapist can recommend a TENS unit and get you a good one. He or she can also work on massage.
Often with chronic illnesses, we tend to do less when we're in pain. Then you get deconditioned, which causes more pain. That is why regular exercise is crucial as well as staying active as possible. A PT can help with that - help get you started.
My daughter even did an intensive pain rehab program which had 4-5 hours of PT/exercise a day! It REALLY helped her - more than any of the pain meds have. And she has tried a LOT of them.
Lamoctil is not without its issues and many side-effects,
Some are serious
My daughter takes lamoctil for epilepsy, side effects being abdominal pain (some has been severe) back pain, insomnia, tremor, changes in appetite (hungry all the time). Mood swings (amuses me as it’s used for mood disorder)
Acne, rashes (some can be life threatening) these are the effects she has had.
Here is Cochrane review for lamoctil in pain management
http://www.cochrane.org/CD006044/SY...drug-chronic-neuropathic-pain-or-fibromyalgia
As for tramadol... it’s very addictive. The more you use, the less effective it becomes
I’ve lived with chronic pain (arthritis) for 24 years, and you do learn to live with it, I’ve never used any hardcore pain relief because I don’t like the side effects and I’ve always been aware of the issue with drug tolerance developing so it becomes useless
I do think pain management courses and clinic would be really helpful
I hope you find some relief soon
My intention was not to use Lamictal for pain control - I have a mental health condition and my psychiatrist and I have discussed the usage of mood stabilizers if my current treatment is not working. Unfortunately, I think it might be necessary because I'm still showing symptoms. I do not wish to discuss what I have, but I know Lamictal is often used for treating it as are other mood stabilizers. The condition is pretty difficult to treat, though, so mood stabilizers may not work or have limited results. Lamictal can help with pain control, but it's not often prescribed for that usage. Gabapentin is much more common, from what I've heard.
I've never been to a pain management specialist so I don't know if I need a referral for my insurance to approve it. I'll have to check my benefits book.
I forgot about your insurance with your job.
I understand you don’t want to discuss your condition, but I think I’ve got a pretty good idea.
I don’t know the success of lamoctil for the other conditions it treats other than epilepsy, but I do hope you find a medication that helps. Also when you’re in a job you really like and feel valued that may also make a world of difference for you.
Yeah gabapentin is often used here for pain.
Good wishes all around, MissLeopardI was able to continue with COBRA for at least a month because I have some very important doctors' appointments that I need to keep. It's very expensive, though, but worth it because I've already met my OOP maximum so everything is no-cost.
Thanks for the well wishes on the job search. It can be intimidating, but I know I'll find something worthwhile. I'm also preparing to return to school in the summer.
Lidocaine patches are actually available OTC in the USA now. Aspercreme and Icy Hot both have them and I think Salonpas even makes a version now.
Thanks for the tip!! It seems like the OTC ones are 4% and also contain menthol. Ours are 5% and are just Lidocaine. So they are pretty similar.
The nice part is that insurance pays if you have a script. My older daughter uses them daily on her back and my younger daughter is starting to use them more often for her ankles, so it helps that they are covered by insurance. But good to know that they are also OTC in case we ever run out.
Good luck with Lamictal - it is prescribed for pain but mostly after you have failed the common meds - Gabapentin, Lyrica, Elavil, Nortriptyline, Cymbalta, Savella etc. My daughter tried Trileptal but it made her too "fuzzy" and VERY confused so she had to stop it. It did help her with sleep though.
MissLeopard - since you’ve already reached your OOP max, you might as well get as many appointments as you can right now! I’d definitely get a second opinion. I can tell when a doctor has started to give up on me or doesn’t really care anymore. So that’s when I usually start looking for a new one. It’s frustrating that your doctor didn’t really give you many options; it sounds like she mostly just told you what she won’t give you. Now might also be a good time to try acupuncture and massage, if your insurance will cover it. This is a little more unconventional, but have you tried CBD oil? I’ve heard it works well for pain. And it’s something that you should be able to get even if marijuana isn’t legal in your state (it’s legal in mine now). I actually bought some CBD oil from a specialty pet store, which sounds totally weird hahaha. It didn’t end up really helping me, but pain is not my issue. Plus, they say it has no side effects (I didn’t have any, and I react to everything). I don’t know too much about fibromyalgia, so I’m sorry I can’t be of much help. I hope you can get a second opinion soon! I swear you could go to 10 doctors and get 10 completely different treatment plans. So you never know who might be the one to help you.
I had the same "fuzzy" feeling with Topamax that my neurologist prescribed for suspected vestibular migraines. Turns out, I don't have them anyway - I have cervical vertigo instead. I hate that fuzzy feeling so I hope it doesn't happen with Lamictal or any other medication I try. I already struggle thru brain fog thanks to fibromyalgia.
Congratulations on the dryness improving and on getting a condo. Take real good care of yourself. Hope you are better soon.Hi everyone!
Just skimmed through the discussion on pain management and oh boy, it's a tricky one isn't it? The ones that work usually give you side effects and sometimes NOTHING works and you don't know what to do with yourself... Hope you figure something out.
Me, I'm home with the flu. Coughing hard and with a recently operated-on diaphragm that is... ouch.
Have a decent amount of good news for a change though; dryness has improved (could be because I'm full of flu mucous, who knows, but it's nice for now) AND I'm signing the contract for my BRAND NEW CONDO on Monday!So darn excited. Hopefully I'll be able to move in mid-April.
Hi everyone! Just checking in. I've been hanging out with my mom the last few days and I'm feeling much better - health-wise. I realized that one of my meds that had been increased in the last month was making me feel sedated and tired all the time so I talked to my doctor and she lowered the dose again (the higher dose wasn't helping, anyway; I felt no difference). Now, my energy is doing much better. My mom and I went to the zoo on Thursday and I wore my FitBit and did almost 8k steps! I was so proud of myself. I slept really good that night, too, from all the exercise and being out in the cool, fresh air.
Yesterday (Friday), we went shopping at TJ Maxx and had some fun. My legs and back were bothering me a little, though, because I stupidly wore my Minnetonka moccasins (which I love but they don't have enough support for walking over an hour). Still, we had fun together which made me feel good.
I'm having issues, however, with my insurance thru COBRA. The third-party administrator had an error on the website so my first payment didn't go thru and it showed me as "TERMINATED." As a result, my health insurance was made inactive and is taking forever to fix! I spent a long time on the phone yesterday trying to get answers about when it would be reactivated now that it shows "PAID" and didn't get much in the way of answers. I have a doctor's appointment next week that I've been waiting 3 months for (long waiting list) and I'm worried I may have to cancel it. I really need this appointment because I'm going back to school and I need to have documentation from a specialist for disability services since my old paperwork is over 4 years old. I'm hoping they will allow me to receive the testing and then bill my insurance when it is finally fixed, but I plan to call them Monday to hash out the details. Any prayers for a quick fix would be appreciated. My anxiety has been kicking my butt lately and I'm tired of worrying (so exhausting!).
Hope everyone is doing well!
Hi everyone! Checking in, hope everyone's okay. Not jealous of those of you dealing with disability and insurance - it can be so tricky.
My physical state rapidly declined again after I had the flu and all my dryness symptoms came back with a vengeance. Very frustrated and upset. My GP is chalking it all up to stress when really the only thing stressing me out in life right now is that no one will help me out with my physical symptoms... He's not a good doctor and I'm going to try to find a new one.
Tomorrow I'm having my post-surgery EGD, under anaesthesia. After a number of failed scopes with sedation only they've opted to just put me under right away this time to not waste my time or their resources on things that don't work 75% of the time anyway. A little nervous to be put under again, it's never fun, but it's necessary so I'm just pushing through. Might be having a BRAVO pH study if they do see reflux damage at all tomorrow, if they do they will place the capsule to see how bad the remaining reflux is. I'm hoping not, I'm not keen on any more discomfort than I'm already dealing with.
The dryness is so intensely uncomfortable and disturbing and I don't really have any doctor helping me with it at all right now. I am seeing an optician on Tuesday since the dry eyes have started impacting my vision. Hopefully I will get some "proof" there that something is indeed wrong. A week from tomorrow I have an appointment with an ENT to check my salivary gland function. A week from that an eye specialist who commonly deals with patients who have Sjogren's - so he'll be able to refer me to a rheumatologist if he thinks my symptoms are consistent with that. So a lot is happening within a few weeks of now but I am very frustrated with the slow pace and also honestly sometimes with the quality of the care I am receiving (or not receiving as the case has often been...)
Have started considering seeking a second opinion at one of the major medical centers in the US. From the research I've done I'd be able to get all necessary testing done at some places there within a few weeks' time whereas where I am now I'm waiting approximately 3 months between doctor's appointments that are usually 5 minutes long and where the doctors are dismissive, rude, and ineffective.
I feel I am too young to waste months (years, really) of my life on dealing with ineffectual health care when it's possible that the problem could be treated or even completely resolved if someone with real skill took the time to really investigate what is going on...
Hey Izzie,
I'm glad you are switching doctors and going to a better facility. Life is too short, we need to make moves, or nobody else will! Good for you, I know what it's like dealing with the wrong medical team... not cool! I really hope this is what is meant to happen and you will soon be enjoying life more, you deserve better.
Cheers,
Chris
Update: Optician saw severe dryness and already visible damage to my eyes. The white part had scar tissue, and there was some mild corneal damage in one eye as well. She said I am at a risk for vision loss and this is NOT normal and she believes I must have an illness for this to become so severe in such a short period of time.
I'm very upset by this but also feel validated. She printed out her evaluation for me to bring to my GP as "proof" that this is not stress and I'm not making anything up.
I can't imagine losing my vision... She did give me ointments and drops and everything to try to help halt the damage. But if you don't get at the cause, it's not going to end well.
Good grief, Izzie. It’s a sad day when you have to offer proof you are sick to your own doctor, GP or specialist alike. I am so sorry your eyes have already been damaged by this severe dryness. Will your GP be willing to prescribe for Sjogren’s just to see if an immunosuppressant will help? I believe Plaquenil and methotrexate are used for Sjogren’s. You clearly need treatment to help prevent the dryness, not just ease the symptoms. Do you have an appointment to see your GP, or an endocrinologist, or an immunologist? I hope your eyes at least begin to feel better. I have double vision and at times vision issues stemming from chronic migraines, but no real physical damage. What you have is very distressing. Please try to take it easy.
Izzie, I would ask for a rheumatology referral right away.
Do you have any joint symptoms - pain, swelling, stiffness?
It does sound like it could be Sjogrens. I know they definitely use Plaquenil and MTX for it, like Jabee said and when it's severe, Rituxan (which is an infusion).
I am sure you've tried this, but for dry mouth we have a mouthwash called Biotene in the US that is OTC. My daughter has been on medications that cause dry mouth for years and has been using that.
You also need to be followed by a dentist, because you get more cavities with dryness.
The third doctors appointment in as many weeks for me tomorrow. Yay! Well, I guess he's a really nice guy, that's always a plus.
I agree.I know that feeling, cmack! I hope it went well?![]()
Izzie, I would ask for a rheumatology referral right away.
Do you have any joint symptoms - pain, swelling, stiffness?
It does sound like it could be Sjogrens. I know they definitely use Plaquenil and MTX for it, like Jabee said and when it's severe, Rituxan (which is an infusion).
I am sure you've tried this, but for dry mouth we have a mouthwash called Biotene in the US that is OTC. My daughter has been on medications that cause dry mouth for years and has been using that.
You also need to be followed by a dentist, because you get more cavities with dryness.
I saw my psychiatrist on Monday after my insurance was finally reinstated on Friday (she had a cancellation, YAY!). We talked about my worsening mood swings and she agreed to let me try a mood stabilizer as we had discussed in the past. I've agreed to try low dose Seroquel (regular strength, not XR) since Lamictal is contraindicated in people with autoimmune disorders due to risks of agranulocytosis and/or aseptic meningitis. The only thing is that my pharmacy flagged it since there is a potential interaction with the antidepressant I'm on but my doctor and I agree the benefits outweight the risks and I'm waiting for the medication to be pushed thru so I can start it. Hopefully, it will be filled today (Wednesday). My insomnia has been particularly bad lately and she said taking the Seroquel at night will probably help me sleep.
I take Seroquel every evening. I have taken it for years. My current dose is not super high but I still do not sleep well. If I take a larger dose then I get brain fog the next day and wouldn't even drive in the mornings. I don't want to be in a brain fog all the time, I want to be coherent.
You mentioned Lamictal, which I have been taking a long time too. Thank you for sharing your information about it, no one ever said anything to me about Lamictal and autoimmune disorders.
Wishing you well.
Lynda
Hi everyone! Hope you're all well.
Nothing much has happened on my end. Still waiting for a scope, still waiting for some doctor to give a crap. Had a saliva test that was very abnormal, that's about it. Still dry everywhere, comes and goes in a weird way unrelated to anything else. Oh and my reflux is back. "Fun"... It's back full force, like I never even had surgery to begin with. I don't have stabbing chest pain or uncontrollable belching like I used to but other than that I feel exactly the same. Constant, unbearable burning in the chest and throat. Can't tolerate many foods at all.
At least I got the keys to my new place. Doing some painting this week and hopefully I'll be able to move in in another week or so. I love it, it's so sunny and bright! My current place is a depressing bat cave in comparison![]()
Hi everyone! Hope you're all well.
Nothing much has happened on my end. Still waiting for a scope, still waiting for some doctor to give a crap. Had a saliva test that was very abnormal, that's about it. Still dry everywhere, comes and goes in a weird way unrelated to anything else. Oh and my reflux is back. "Fun"... It's back full force, like I never even had surgery to begin with. I don't have stabbing chest pain or uncontrollable belching like I used to but other than that I feel exactly the same. Constant, unbearable burning in the chest and throat. Can't tolerate many foods at all.
At least I got the keys to my new place. Doing some painting this week and hopefully I'll be able to move in in another week or so. I love it, it's so sunny and bright! My current place is a depressing bat cave in comparison![]()
I'm doing okay thanks, I finally had a GJ tube placed on February 27th, it's been a bit rocky with an infection in it so I've had weeks of iodine dressings and antibiotics and I'm still getting puss draining from it which is frustrating. But overall it's so much better than the NJ was!sarahfh, how are you doing? Did they place a GJ or a J tube yet? I have been meaning to message you!
Izzie this might seem a bit left field but have you considered a gastric emptying study to see if your stomach is emptying properly? Just asking as reflux is one of my worst gastroparesis symptoms especially without lansoprazole twice per day. It's literally my body going "well it won't go down so let's send it up". Just a thought![]()