Help wanted (Score so far related)

[Marcus]

Has your doctor diagnosed you with a hiatal hernia? If so, are they recommending this surgery?

No, Marcus. I'm putting the cart before the horse as I said in the OP. I've got an appointment with my primary on Sep 11th. I am sure I'll be sent for testing following that.

That's what i thought you meant by that but i wanted to clarify. Sometimes we ruminate over anticipated things and the rumination does damage whether the thing materializes or not. It's hard to stop this when it happens because it seems common sense to be prepared, mentally as well as in other ways, for everything, but then sometimes the mental effort takes on a life of its own and is exhausting.

I have no solution other than to offer empathy and compassion, but there is one trick i use that sometimes works-- i put a literal date on an issue and then use my best reasoning mind to determine whether i can actually DO anything about the problem before then. If i have thought it through, and all that is left is no possible action and only rumination (i.e. repeating the same thoughts), i try to convince myself to hold off on the rumination until that date. Sometimes this gives some respite from the internal churning, sometimes not, but it is the only help i can offer at the moment.

Best to you.

[Jersey Girl]

No, Marcus. I'm putting the cart before the horse as I said in the OP. I've got an appointment with my primary on Sep 11th. I am sure I'll be sent for testing following that.

That's what i thought you meant by that but i wanted to clarify. Sometimes we ruminate over anticipated things and the rumination does damage whether the thing materializes or not. It's hard to stop this when it happens because it seems common sense to be prepared, mentally as well as in other ways, for everything, but then sometimes the mental effort takes on a life of its own and is exhausting.

Absolutely agree! I wanted to see if anyone here had in real life experience with that type of surgery because if I can hear what issues they faced, I can figure out how to deal with it. I've read comments elsewhere where post op patients had ongoing nausea. Like I said, I'm putting the cart WAY before the horse here. I was having one of those nights and decided to invite you all into it. Lucky you!

I have no solution other than to offer empathy and compassion, but there is one trick i use that sometimes works-- i put a literal date on an issue and then use my best reasoning mind to determine whether i can actually DO anything about the problem before then. If i have thought it through, and all that is left is no possible action and only rumination (i.e. repeating the same thoughts), i try to convince myself to hold off on the rumination until that date. Sometimes this gives some respite from the internal churning, sometimes not, but it is the only help i can offer at the moment.

Best to you.

Thanks! I know exactly what you mean. The churning. I only have a month to wait until the appointment happens. Most days, I do really well and don't obsess over any of this. Then I have a bad day where I've got that ache under the sternum area or have gone into AFIB and I start thinking about it all again. I'm really tired of that type of cycle replaying itself over and over again in my life. It steals parts of your life from you and it steals parts of yourself if only temporarily, to where you don't feel fully present.

[msnobody]

Jersey, I had no idea you were going through this. From what I understand, Nissan fundoplication is a big surgery, but I’ve never known anyone having problems with it— not much experience with it however. I hope what I say doesn’t add to your anxiety. It probably will, so maybe you shouldn’t read this. OTOH, maybe this will serve as part of an informed decision. Can you get in with a GI doc without having to wait, or going through your PCP?

My experience is with my mother who *never* got the surgery. She had about 65% of her stomach above her diaphragm, resulting in a tortuous esophagus. She went through many an esophageal dilation and several removals of food impaction, even bruising inside her esophagus a time or two. She experienced chest pain a few times, and the gastroenterologist would tell her to take an extra Omeprazloe 40 mg (took omeprazole 40mg twice daily) and if it didn’t relieve the chest pain, then to go to the hospital. We had an understanding with GI that if she got into trouble on the weekend, to go to the ER. If on the weekday, call their office and they’d take her directly into the GI lab. Certain foods were usually the worst like pork, roast beef, turnip and collard greens. She was finally told to eat puréed food, which she didn’t do. She did finally start to avoid troublesome foods.

I often wondered if she had gotten the surgery in her younger days, how much better her quality of life would have been. After she was elderly and frail (late 80’s), it was suggested to her to get a feeding tube which would pull her stomach down and anchor it to the abdominal wall/feeding tube. She wouldn’t have to be fed through it, but would need to flush it with water periodically throughout the day. She declined that as well. This was after aspirating food into her lungs and developing pneumonia.

She did develop a fib in her mid to late 80’s. I didn’t know it could be related to hiatal hernia. Her a fib was controlled with medicine until while in the hospital for cellulitis in her leg, she choke on some food and her a fib went crazy. They had a hard time getting her heart rate down, and it never was controlled again. She was 89 when this happened. She was diagnosed with a stiff left ventricle heart muscle; diastolic heart failure.

Honestly, I kind of wished she had gotten the surgery while she was still a candidate for it. I had to respect her wishes though.

Try not to be anxious, Jersey. Your mind may be imagining something you will not have to face. I wish I knew how to turn my brain off some nights when I’m anxious about something. As my friend says, if God allows it, He will be right there with you.

Much love to you, Sister.

[Jersey Girl]

Jersey, I had no idea you were going through this. From what I understand, Nissan fundoplication is a big surgery, but I’ve never known anyone having problems with it— not much experience with it however. I hope what I say doesn’t add to your anxiety. It probably will, so maybe you shouldn’t read this. OTOH, maybe this will serve as part of an informed decision. Can you get in with a GI doc without having to wait, or going through your PCP?

I didn't tell you about this because we were discussing other things between ourselves. Anyway, I didn't mind reading about your mother at all except it makes me feel so sad for her journey. I don't see myself in that description. The thing about the GI doc is that I know that one of my starting places is scoping procedures. I want to see if my primary can get me admitted for the preparation and procedure because I don't think the clinics have the ability to treat AFIB if I happen to go into it which is a real possibility. I've read up on this of course but my sense so far is that the clinics aren't equipped with a cardiologist on site and I think I really need it. I know they probably can treat cardiac arrest but I don't know about AFIB. Does that make sense? If I have to settle for the clinic, I'll tough it out as best I can. My primary is awesome. She's so smart, she listens, we collaborate on decision making, and it doesn't hurt that she is a Christian girl either. She is a good fit for me.

My experience is with my mother who *never* got the surgery. She had about 65% of her stomach above her diaphragm, resulting in a tortuous esophagus. She went through many an esophageal dilation and several removals of food impaction, even bruising inside her esophagus a time or two. She experienced chest pain a few times, and the gastroenterologist would tell her to take an extra Omeprazloe 40 mg (took omeprazole 40mg twice daily) and if it didn’t relieve the chest pain, then to go to the hospital. We had an understanding with GI that if she got into trouble on the weekend, to go to the ER. If on the weekday, call their office and they’d take her directly into the GI lab. Certain foods were usually the worst like pork, roast beef, turnip and collard greens. She was finally told to eat puréed food, which she didn’t do. She did finally start to avoid troublesome foods.

I often wondered if she had gotten the surgery in her younger days, how much better her quality of life would have been. After she was elderly and frail (late 80’s), it was suggested to her to get a feeding tube which would pull her stomach down and anchor it to the abdominal wall/feeding tube. She wouldn’t have to be fed through it, but would need to flush it with water periodically throughout the day. She declined that as well. This was after aspirating food into her lungs and developing pneumonia.

She did develop a fib in her mid to late 80’s. I didn’t know it could be related to hiatal hernia. Her a fib was controlled with medicine until while in the hospital for cellulitis in her leg, she choke on some food and her a fib went crazy. They had a hard time getting her heart rate down, and it never was controlled again. She was 89 when this happened. She was diagnosed with a stiff left ventricle heart muscle; diastolic heart failure.

Honestly, I kind of wished she had gotten the surgery while she was still a candidate for it. I had to respect her wishes though.

It makes me so sad to hear about this. And I thought I had misery! I've changed my dietary intake completely over a period of 10 years which I feel kind of proud of. I eat clean and I think the closest thing I eat to a processed food is Ranch dressing. I'll tell you what I ate today. Keep in mind that I stayed up until the wee hours so didn't wake up until after lunch after a really good sleep.

Shredded Wheat (2 biscuits) with 2% milk. (I usually eat oatmeal, blueberries, pure maple syrup)
2 packs of Orchard Valley Harvest Dark Chocolate Almonds (These are a staple, I love them!)
Salad- Cubed grilled chicken breast, tomatoes, iceberg and spring mix lettuce with a little Ranch dressing.*
RX Bar (protein bar from the package--3 egg whites, 7 almonds, 2 Dates, no BS) Love these and usually eat them for snack in between meals.

* I make these on the little George Foreman! No marinade, no seasoning. I usually make the salad with sunflower seeds, a bit of shredded "Fiesta Blend" cheese, and Ranch. Today I made it super light on account of having a bad night last night. I don't have the ache today that I did yesterday just below the sternum. My diet usually contains protein, fruits, veggies, some dairy, whole grains, olive oil. As I said, I went super light today.

On a normal day (whatever that is) I would have eaten the salad as noted (*) for lunch and dinner if I didn't have something else made for dinner. I often substitute drained/washed kidney beans for the chicken.

Try not to be anxious, Jersey. Your mind may be imagining something you will not have to face. I wish I knew how to turn my brain off some nights when I’m anxious about something. As my friend says, if God allows it, He will be right there with you.

Much love to you, Sister.

I don't think your last sentence is a mistake. Maymay covered that exact topic on her Sunday devotion. I consider your reminder to be a reinforcement. You know I love you, my friend of so many years!

You said you didn't know that hiatal hernia can be associated with Afib. I've known it for years. But as I said, it's not studied in the US...where the UK is all over it. Gastriocardiac syndrome. If you click this link it'll go to a paper about it. Notice the researcher they mention who identified this in the early 50's. I've known about him for years and followed the trail until I got to the EP/Cardio guy educated in the UK who correctly diagnosed me after years of suffering. In the paper you'll notice they used beta blockers. Those are contraindicated for this type of Afib and I have documentation on that. It's just recently that it's getting attention in the US. Notice the date of this paper is Dec 2020. I have another one that cautions against using beta blockers. UK docs know all about this. The US hardly at all.

I have to wonder how many patients in the US have what I have and are being treated for "electrical" issues and put on beta blockers from the first event like I was. Then they go on to have multiple ablations that don't work and finally, get pacemakers. If only this country weren't so far behind. Imagine the relief it would bring to so many who are feeling tortured by beta blockers, etc. That cardiologist I had to begin with, after I threw a fit when the events increased dramatically and with the event I had just prior to throwing the fit included shaking uncontrollably (!!!), wanted to put me on HIGHER DOSES of Metoprolol. She asked me if I wanted to talk to an EP about ablation and I said yes. HE is the one who figured it in 5 minutes of me recounting my journey. He had me titrate off the med wearing a holter monitor the whole time. Those 8 weeks of withdrawals (daily panic attacks!) were well worth it!

Here you go nurse nobody! If you want the one on beta blockers, I can come up with it for you.

https://www.ncbi.nlm.nih.gov/pmc/articl ... l%20hernia.

[Doctor CamNC4Me]

I don’t have experience with that, but I’m posting in solidarity. I won’t post platitudes because I dunno, they seem cheap. I’m curious, though. Are you seeing a specialist, and if so, what is their diagnosis?

- Doc

Thank you. You don't know how much it means to me that you didn't post platitudes because, quite frankly, they are useless words though I know people mean well. Not seeing a specialist yet. Starting with my primary in an upcoming appointment on Sept 11th. She is incredibly smart, I love her, and have full confidence that she'll point me in the right direction. Testing first, I am sure. All this time I've tried to cope as best I can, doing things I know that are helpful to me.

But as I indicated in the OP...I feel like I'm stuck in a cycle, losing ground, and completely fed up with my circumstances and that is the attitude always leads me to launch into pursuit with a vengeance.

I want out of this mess.

I’d recommend taking a look at Gabpentin as an anxiety mitigation tool. When I was recently going through a serious medical issue, I was prescribed Gabapentin for pain along with Ibuprofen- I refuse to take any sort of opiate unless it’s used for surgery. Anyway, I found Gabapentin to be very effective at chilling me out without any sense of being on anything/high.

2 cents, for what it's worth

- Doc

[Gunnar]

You are my longest standing and most revered friend I have on this forum, and I'm saddened to hear that you are going through this. Though I have nothing in my experience that I can offer that might benefit you in this matter, I am impressed by and grateful for the advice that others here have been able to offer, but even more impressed by your own ability and diligence to research and find information on your own relating to your condition. I hope you find a lasting and satisfactory solution to your problem.

I had no idea that hiatal hernias or hernias of any kind could be related to or cause AFIB. My younger brother has had some problems apparently related to hiatal hernia, which sometimes cause him to have coughing fits (which he hates because, like me, he loves to sing). So far, though, (as far as I know) he has not experienced AFIB. He has cut back significantly on how much he eats, both to lose weight (he was a bit overweight) and help with the hiatal hernia.

[Marcus]

I wouldn't worry about being sent to a clinic without a cardiologist given the risks associated with your afib diagnosis--no doctor is going to be that negligent!

And with all the stress you're feeling, could you try getting an earlier appointment? Or even an ER visit, and request a consult with a hernia specialist?

[msnobody]

Jersey, I had no idea you were going through this. From what I understand, Nissan fundoplication is a big surgery, but I’ve never known anyone having problems with it— not much experience with it however. I hope what I say doesn’t add to your anxiety. It probably will, so maybe you shouldn’t read this. OTOH, maybe this will serve as part of an informed decision. Can you get in with a GI doc without having to wait, or going through your PCP?

I didn't tell you about this because we were discussing other things between ourselves. Anyway, I didn't mind reading about your mother at all except it makes me feel so sad for her journey. I don't see myself in that description. The thing about the GI doc is that I know that one of my starting places is scoping procedures. I want to see if my primary can get me admitted for the preparation and procedure because I don't think the clinics have the ability to treat AFIB if I happen to go into it which is a real possibility. I've read up on this of course but my sense so far is that the clinics aren't equipped with a cardiologist on site and I think I really need it. I know they probably can treat cardiac arrest but I don't know about AFIB. Does that make sense? If I have to settle for the clinic, I'll tough it out as best I can. My primary is awesome. She's so smart, she listens, we collaborate on decision making, and it doesn't hurt that she is a Christian girl either. She is a good fit for me.

My experience is with my mother who *never* got the surgery. She had about 65% of her stomach above her diaphragm, resulting in a tortuous esophagus. She went through many an esophageal dilation and several removals of food impaction, even bruising inside her esophagus a time or two. She experienced chest pain a few times, and the gastroenterologist would tell her to take an extra Omeprazloe 40 mg (took omeprazole 40mg twice daily) and if it didn’t relieve the chest pain, then to go to the hospital. We had an understanding with GI that if she got into trouble on the weekend, to go to the ER. If on the weekday, call their office and they’d take her directly into the GI lab. Certain foods were usually the worst like pork, roast beef, turnip and collard greens. She was finally told to eat puréed food, which she didn’t do. She did finally start to avoid troublesome foods.

I often wondered if she had gotten the surgery in her younger days, how much better her quality of life would have been. After she was elderly and frail (late 80’s), it was suggested to her to get a feeding tube which would pull her stomach down and anchor it to the abdominal wall/feeding tube. She wouldn’t have to be fed through it, but would need to flush it with water periodically throughout the day. She declined that as well. This was after aspirating food into her lungs and developing pneumonia.

She did develop a fib in her mid to late 80’s. I didn’t know it could be related to hiatal hernia. Her a fib was controlled with medicine until while in the hospital for cellulitis in her leg, she choke on some food and her a fib went crazy. They had a hard time getting her heart rate down, and it never was controlled again. She was 89 when this happened. She was diagnosed with a stiff left ventricle heart muscle; diastolic heart failure.

Honestly, I kind of wished she had gotten the surgery while she was still a candidate for it. I had to respect her wishes though.

It makes me so sad to hear about this. And I thought I had misery! I've changed my dietary intake completely over a period of 10 years which I feel kind of proud of. I eat clean and I think the closest thing I eat to a processed food is Ranch dressing. I'll tell you what I ate today. Keep in mind that I stayed up until the wee hours so didn't wake up until after lunch after a really good sleep.

Shredded Wheat (2 biscuits) with 2% milk. (I usually eat oatmeal, blueberries, pure maple syrup)
2 packs of Orchard Valley Harvest Dark Chocolate Almonds (These are a staple, I love them!)
Salad- Cubed grilled chicken breast, tomatoes, iceberg and spring mix lettuce with a little Ranch dressing.*
RX Bar (protein bar from the package--3 egg whites, 7 almonds, 2 Dates, no BS) Love these and usually eat them for snack in between meals.

* I make these on the little George Foreman! No marinade, no seasoning. I usually make the salad with sunflower seeds, a bit of shredded "Fiesta Blend" cheese, and Ranch. Today I made it super light on account of having a bad night last night. I don't have the ache today that I did yesterday just below the sternum. My diet usually contains protein, fruits, veggies, some dairy, whole grains, olive oil. As I said, I went super light today.

On a normal day (whatever that is) I would have eaten the salad as noted (*) for lunch and dinner if I didn't have something else made for dinner. I often substitute drained/washed kidney beans for the chicken.

Try not to be anxious, Jersey. Your mind may be imagining something you will not have to face. I wish I knew how to turn my brain off some nights when I’m anxious about something. As my friend says, if God allows it, He will be right there with you.

Much love to you, Sister.

I don't think your last sentence is a mistake. Maymay covered that exact topic on her Sunday devotion. I consider your reminder to be a reinforcement. You know I love you, my friend of so many years!

You said you didn't know that hiatal hernia can be associated with Afib. I've known it for years. But as I said, it's not studied in the US...where the UK is all over it. Gastriocardiac syndrome. If you click this link it'll go to a paper about it. Notice the researcher they mention who identified this in the early 50's. I've known about him for years and followed the trail until I got to the EP/Cardio guy educated in the UK who correctly diagnosed me after years of suffering. In the paper you'll notice they used beta blockers. Those are contraindicated for this type of Afib and I have documentation on that. It's just recently that it's getting attention in the US. Notice the date of this paper is Dec 2020. I have another one that cautions against using beta blockers. UK docs know all about this. The US hardly at all.

I have to wonder how many patients in the US have what I have and are being treated for "electrical" issues and put on beta blockers from the first event like I was. Then they go on to have multiple ablations that don't work and finally, get pacemakers. If only this country weren't so far behind. Imagine the relief it would bring to so many who are feeling tortured by beta blockers, etc. That cardiologist I had to begin with, after I threw a fit when the events increased dramatically and with the event I had just prior to throwing the fit included shaking uncontrollably (!!!), wanted to put me on HIGHER DOSES of Metoprolol. She asked me if I wanted to talk to an EP about ablation and I said yes. HE is the one who figured it in 5 minutes of me recounting my journey. He had me titrate off the med wearing a holter monitor the whole time. Those 8 weeks of withdrawals (daily panic attacks!) were well worth it!

Here you go nurse nobody! If you want the one on beta blockers, I can come up with it for you.

https://www.ncbi.nlm.nih.gov/pmc/articl ... l%20hernia.

I will read the information from the link you provided.

[Jersey Girl]

I’d recommend taking a look at Gabpentin as an anxiety mitigation tool. When I was recently going through a serious medical issue, I was prescribed Gabapentin for pain along with Ibuprofen- I refuse to take any sort of opiate unless it’s used for surgery. Anyway, I found Gabapentin to be very effective at chilling me out without any sense of being on anything/high.

2 cents, for what it's worth

- Doc

I was prescribed Buspirone as needed. Haven't ever taken it. I have CBD gummies. Never taken any. I don't like the idea of feeling out of control. Gabapentin could be a good idea if only it didn't interact with propofol. But I really don't know that the interaction is. I have full faith in my primary to put me on the right road with whatever specialist she thinks I need.

Cam I don't want to take even one more medication if I don't have to. If I do, I'll give something a go. Gabapentin also has a possible mental health side effect, one being suicidal thoughts and I think you get why I run from even the remote possibility of that happening. My family has been traumatized enough.

[Jersey Girl]

You are my longest standing and most revered friend I have on this forum, and I'm saddened to hear that you are going through this. Though I have nothing in my experience that I can offer that might benefit you in this matter, I am impressed by and grateful for the advice that others here have been able to offer, but even more impressed by your own ability and diligence to research and find information on your own relating to your condition. I hope you find a lasting and satisfactory solution to your problem.

I had no idea that hiatal hernias or hernias of any kind could be related to or cause AFIB. My younger brother has had some problems apparently related to hiatal hernia, which sometimes cause him to have coughing fits (which he hates because, like me, he loves to sing). So far, though, (as far as I know) he has not experienced AFIB. He has cut back significantly on how much he eats, both to lose weight (he was a bit overweight) and help with the hiatal hernia.

Not everyone who has hiatal hernia develops Afib. Your brother likely will never have it. Hiatal hernial is associated with Afib because it irritates the vagus nerve. The typical Afib that is identified in the US is andrenergic. What I have is vagally mediated paroxysmal (happens occasionally) Afib. There is also lone Afib and persistent Afib. Pres. Biden is under treatment for Afib as well as Kareem Abdul-Jabbar.

The whole ballgame with me at least, is the vagus nerve that pops off the parasympathic nervous system and off I go. There are options for treament that I haven't tried. I use various breathing techniques to cardiovert myself. Sometimes they work and sometimes they don't. It's exhausting to do. Anyway, with digestion if gas builds up or you eat too large a meal, that's what ticks off the vagus nerve and presses on the left ventrical (?) which starts messing with the atria. If you have a hiatal hernia, as I understand it, that can do basically the same thing and especially if some food gets trapped by the hernia. It's complex and I don't think I do very well at articulating it all. The vagus nerve runs from the base of your neck to your tailbone and interacts with several body systems/organs. If it gets ticked off in the area of the heart or stomach, it can set off a chain reaction. I get Afib with Rapid Ventricular Response. It's no picnic, I assure you.

You mentioned my research. Trust me you have no idea how deep a dive I've done over the years! There are only THREE paper on this produced by the NIH, Gunnar. The UK is so far ahead of us, it's a crime of some sort. Look at the dates on these. One paper contradicts the other about the use of beta blockers. Please. I can come up with numerous writings about this from the UK and Europe.

I'll pull out some excerpts but notice the date of the discovery of this condition compared to the date of the published papers. The second paper is the one I brought to my cardio/PA who increased the dosage on beta blocker. When I saw him the next time, he walked in with the paper in hand, thanked me and apologized for the increase in medication. I assured him that no apology was needed since the increase proved my theory that the medication was making everything worse and now I had the personal data to prove it. Gunnar, that was 3 years into this journey. Three years of complete misery though I still have my boughts of misery a couple or three times each year, to the point where now I am just fed up with it all. I guess I failed to reach the acceptance stage.

2012

Beta blockers and digoxin are not only ineffective but are contraindicated, as they tend to precipitate the arrhythmia by shifting the balance toward vagal effects on the atria.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5153084/

6/2020

In animal models, VM-AF was defined as AF caused by stimulation of the vagus nerve with observed atrioventricular block, asystolic periods, sinus bradycardia and an increase in heart rate variability 14,15. In humans, VM-AF was defined as paroxysmal AF that occurs with predominant vagal activation, such as, during sleep, after eating a big meal, or in relationship to other recognized vagal triggers, usually preceded by bradycardia 8,15,16. Patients may have no underlying heart disease or other systemic disorders that could explain the AF 17.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7533140/

12/2020

Rare and unusual presentation of gastrocardiac syndrome

Gastrointestinal pathology can cause cardiac symptoms and disorders. We present a case of a patient who had worsening of her palpitations with food intake. She was found to have a high burden of premature ventricular contractions in the setting of hiatal hernia and gastro-oesophageal reflux disease. After extensive investigations and ruling out cardiac causes, her arrhythmia resolved with the surgical correction of hiatal hernia.

Gastrocardiac, also known as, Roemheld syndrome is a disorder where maladies in the alimentary tract, usually the upper gastrointestinal tract, are found to be related to cardiac symptoms. The causes of the gastrocardiac syndrome include gastro-oesophageal reflux disease (GERD), transverse colon gas, gall bladder dysfunction and hiatal hernia. Atrial fibrillation is the most commonly described arrhythmia in the setting of GERD and hiatal hernia. Multiple case reports and observational studies have reported these findings, but gastrocardiac syndrome remains a neglected and underdiagnosed factor in the workup of arrhythmias.1 Since there is rarely a cause traceable to a cardiac condition, patients often end up getting extensive workup before it can be recognised. Herein, we report a case of Roemheld syndrome in the setting of hiatal hernia and GERD presenting as palpitations secondary to premature ventricular contractions (PVCs).

Ludwig von Roemheld first described the association of cardiac symptomatology with gastric pathology in 1952, which is known as Roemheld gastrocardiac syndrome. He was able to stimulate arrhythmias with an oesophagogastric stimulus.

https://www.ncbi.nlm.nih.gov/pmc/articl ... 20symptoms.

As to my diligence in researching to help myself. Remember what Craig said all those years ago...

Never underestimate the tenacity of a Jersey Girl!

I do the best I can to learn which I am sure isn't enough, but do I try hard with what little brain I have.

Thank you for your reply, Gunnar. I feel exactly the same way about you and I always will. by the way, the 24 year anniversary of my first ever post online (which was to you) is coming up in October. I expect presents!

p.s. I will give you my vagus nerve for a present! You are welcome to it!