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Posted
Posted

I ment to point out that I sent this message to my PCP for input and to keep her

informed, I must have overwritten the into!

>

>

>

> I see Dr. Bolton (FEA) On Monday and I believe she is planning on titrating

down/off Phsyco. Meds. I am wondering if Cymbalta is serving two purposes and

blocking neuropathic pain in my feet also. Could it be the reason that while I

have tingling I don't have pain? Don't want to go thru another " act of

congress " to get back on if I stop and then need to get back on! Also, there

may be other meds more appropiate! Thought I'd give you a heads up so you could

think about it if necessary! Here is what I base the question on:

Thanks... - 8395.

>

> In animal models of neuropathic pain it has been found that compounds which

only block serotonin reuptake do not improve neuropathic

pain.[1][2][3][4][5][6][7][8] Similarly, compounds that only block

norepinephrine reuptake also do not improve neuropathic pain. Compounds such as

duloxetine, venlafaxine, and milnacipran that block both serotonin reuptake and

norepinephrine reuptake do improve neuropathic pain. Antidepressants usually

reduce neuropathic pain more quickly and with smaller doses than they relieve

depression. Antidepressants therefore seem to work differently on neuropathic

pain than on depression, perhaps by activating descending norepinephrinergic and

serotonergic pathways in the spinal cord that block pain signals from ascending

to the brain.

>

> - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank

& testicle pain. I have decided against an adrenalectomy at this time since

Meds. are working so well. Current BP(last week ave): 122/73

> Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD.

> Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG,

81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

>

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Posted
Posted

Tell us more about the tingling. CE Grim MD I see Dr. Bolton (FEA) On Monday and I believe she is planning on titrating down/off Phsyco. Meds. I am wondering if Cymbalta is serving two purposes and blocking neuropathic pain in my feet also. Could it be the reason that while I have tingling I don't have pain? Don't want to go thru another "act of congress" to get back on if I stop and then need to get back on! Also, there may be other meds more appropiate! Thought I'd give you a heads up so you could think about it if necessary! Here is what I base the question on: Thanks... - 8395. In animal models of neuropathic pain it has been found that compounds which only block serotonin reuptake do not improve neuropathic pain.[1][2][3][4][5][6][7][8] Similarly, compounds that only block norepinephrine reuptake also do not improve neuropathic pain. Compounds such as duloxetine, venlafaxine, and milnacipran that block both serotonin reuptake and norepinephrine reuptake do improve neuropathic pain. Antidepressants usually reduce neuropathic pain more quickly and with smaller doses than they relieve depression. Antidepressants therefore seem to work differently on neuropathic pain than on depression, perhaps by activating descending norepinephrinergic and serotonergic pathways in the spinal cord that block pain signals from ascending to the brain. - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank & testicle pain. I have decided against an adrenalectomy at this time since Meds. are working so well. Current BP(last week ave): 122/73 Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD. Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

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Posted
Posted

Neuropathic pain is a tricky one to clearly DX. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

I ment to point out that I sent this message to my PCP for input and to keep her informed, I must have overwritten the into!

>

>

>

> I see Dr. Bolton (FEA) On Monday and I believe she is planning on titrating down/off Phsyco. Meds. I am wondering if Cymbalta is serving two purposes and blocking neuropathic pain in my feet also. Could it be the reason that while I have tingling I don't have pain? Don't want to go thru another "act of congress" to get back on if I stop and then need to get back on! Also, there may be other meds more appropiate! Thought I'd give you a heads up so you could think about it if necessary! Here is what I base the question on: Thanks... - 8395.

>

> In animal models of neuropathic pain it has been found that compounds which only block serotonin reuptake do not improve neuropathic pain.[1][2][3][4][5][6][7][8] Similarly, compounds that only block norepinephrine reuptake also do not improve neuropathic pain. Compounds such as duloxetine, venlafaxine, and milnacipran that block both serotonin reuptake and norepinephrine reuptake do improve neuropathic pain. Antidepressants usually reduce neuropathic pain more quickly and with smaller doses than they relieve depression. Antidepressants therefore seem to work differently on neuropathic pain than on depression, perhaps by activating descending norepinephrinergic and serotonergic pathways in the spinal cord that block pain signals from ascending to the brain.

>

> - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank & testicle pain. I have decided against an adrenalectomy at this time since Meds. are working so well. Current BP(last week ave): 122/73

> Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD.

> Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

>

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Posted
Posted

Tell us more about the tingling. CE Grim MD I see Dr. Bolton (FEA) On Monday and I believe she is planning on titrating down/off Phsyco. Meds. I am wondering if Cymbalta is serving two purposes and blocking neuropathic pain in my feet also. Could it be the reason that while I have tingling I don't have pain? Don't want to go thru another "act of congress" to get back on if I stop and then need to get back on! Also, there may be other meds more appropiate! Thought I'd give you a heads up so you could think about it if necessary! Here is what I base the question on: Thanks... - 8395. In animal models of neuropathic pain it has been found that compounds which only block serotonin reuptake do not improve neuropathic pain.[1][2][3][4][5][6][7][8] Similarly, compounds that only block norepinephrine reuptake also do not improve neuropathic pain. Compounds such as duloxetine, venlafaxine, and milnacipran that block both serotonin reuptake and norepinephrine reuptake do improve neuropathic pain. Antidepressants usually reduce neuropathic pain more quickly and with smaller doses than they relieve depression. Antidepressants therefore seem to work differently on neuropathic pain than on depression, perhaps by activating descending norepinephrinergic and serotonergic pathways in the spinal cord that block pain signals from ascending to the brain. - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank & testicle pain. I have decided against an adrenalectomy at this time since Meds. are working so well. Current BP(last week ave): 122/73 Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD. Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

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Posted
Posted

Remember when you had your arm around your sweetheart for too long and it " went

to sleep " . As the feeling started to return you had what I call a " tingling

feeling " . That is the feeling I get in my toes but it doesn't go away.

- 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank &

testicle pain. I have decided against an adrenalectomy at this time since

Meds. are working so well. Current BP(last week ave): 122/73

Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD.

Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG,

81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

>

> >

> >

> > I see Dr. Bolton (FEA) On Monday and I believe she is planning on

> > titrating down/off Phsyco. Meds. I am wondering if Cymbalta is

> > serving two purposes and blocking neuropathic pain in my feet also.

> > Could it be the reason that while I have tingling I don't have pain?

> > Don't want to go thru another " act of congress " to get back on if I

> > stop and then need to get back on! Also, there may be other meds

> > more appropiate! Thought I'd give you a heads up so you could think

> > about it if necessary! Here is what I base the question on:

> > Thanks... - 8395.

> >

> > In animal models of neuropathic pain it has been found that

> > compounds which only block serotonin reuptake do not improve

> > neuropathic pain.[1][2][3][4][5][6][7][8] Similarly, compounds that

> > only block norepinephrine reuptake also do not improve neuropathic

> > pain. Compounds such as duloxetine, venlafaxine, and milnacipran

> > that block both serotonin reuptake and norepinephrine reuptake do

> > improve neuropathic pain. Antidepressants usually reduce neuropathic

> > pain more quickly and with smaller doses than they relieve

> > depression. Antidepressants therefore seem to work differently on

> > neuropathic pain than on depression, perhaps by activating

> > descending norepinephrinergic and serotonergic pathways in the

> > spinal cord that block pain signals from ascending to the brain.

> >

> > - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous

> > rt. flank & testicle pain. I have decided against an adrenalectomy

> > at this time since Meds. are working so well. Current BP(last week

> > ave): 122/73

> > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and

> > PTSD.

> > Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate

> > 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

> >

> >

>

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Posted
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That's exactly the feeling I would get either in my left toes or my left fingers

before my low K was corrected. Used to terrify me because even though I don't

test as diabetic, T2 diabetes runs in my family and family members have had

amputations due to complications of neuropathy. Long story short, once my K

comes up to 3.8 or higher it goes away.

, are you absolutely certain your potassium is normal?

> >

> > >

> > >

> > > I see Dr. Bolton (FEA) On Monday and I believe she is planning on

> > > titrating down/off Phsyco. Meds. I am wondering if Cymbalta is

> > > serving two purposes and blocking neuropathic pain in my feet also.

> > > Could it be the reason that while I have tingling I don't have pain?

> > > Don't want to go thru another " act of congress " to get back on if I

> > > stop and then need to get back on! Also, there may be other meds

> > > more appropiate! Thought I'd give you a heads up so you could think

> > > about it if necessary! Here is what I base the question on:

> > > Thanks... - 8395.

> > >

> > > In animal models of neuropathic pain it has been found that

> > > compounds which only block serotonin reuptake do not improve

> > > neuropathic pain.[1][2][3][4][5][6][7][8] Similarly, compounds that

> > > only block norepinephrine reuptake also do not improve neuropathic

> > > pain. Compounds such as duloxetine, venlafaxine, and milnacipran

> > > that block both serotonin reuptake and norepinephrine reuptake do

> > > improve neuropathic pain. Antidepressants usually reduce neuropathic

> > > pain more quickly and with smaller doses than they relieve

> > > depression. Antidepressants therefore seem to work differently on

> > > neuropathic pain than on depression, perhaps by activating

> > > descending norepinephrinergic and serotonergic pathways in the

> > > spinal cord that block pain signals from ascending to the brain.

> > >

> > > - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous

> > > rt. flank & testicle pain. I have decided against an adrenalectomy

> > > at this time since Meds. are working so well. Current BP(last week

> > > ave): 122/73

> > > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and

> > > PTSD.

> > > Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate

> > > 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

> > >

> > >

> >

>

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Posted

Thanks for your good wishes but I seldom resort to luck, too many times the

outcome isn't what I desired! If the phlebotomist is Don I'm quite certain the

draw is done real close if not on the money! My only question is the needle

size since I believe the one they use is a green 21g (Winged needles are

usually a 21g green label, a 23g blue label, and a 25g orange label (however

this needle is only used in pediatrics or extreme cases as it is so small that

it can often result in hemolyzing the blood sample, thereby invalidating the

test). Don gently rocks the sample to mix, I'll have to count how many times.

I have the Medical Laboratory Observer article and Dr. Grim's summary in my

folder if I need to reference!

My glass is always half full and as such I believe a lab that draws as much as

they do with as many doctors as they serve there would be a pattern of errors if

it was being done incorrectly. Someone would notice that K was always high (or

low) on a certain day. I usually rely on professionals being professional and

doing their job right until I notice an anomaly . Then I'm on it " like stink on

shit " ! I'm more concerned about the way they take your BP! (I wonder what my

real BP would have been if I had ment Dr. G. 6-years earlier!

- 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank &

testicle pain. I have decided against an adrenalectomy at this time since

Meds. are working so well. Current BP(last week ave): 122/73

Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD.

Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG,

81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

> > > > >

> > > > > >

> > > > > >

> > > > > > I see Dr. Bolton (FEA) On Monday and I believe she is planning on

> > > > > > titrating down/off Phsyco. Meds. I am wondering if Cymbalta is

> > > > > > serving two purposes and blocking neuropathic pain in my feet also.

> > > > > > Could it be the reason that while I have tingling I don't have pain?

> > > > > > Don't want to go thru another " act of congress " to get back on if I

> > > > > > stop and then need to get back on! Also, there may be other meds

> > > > > > more appropiate! Thought I'd give you a heads up so you could think

> > > > > > about it if necessary! Here is what I base the question on:

> > > > > > Thanks... - 8395.

> > > > > >

> > > > > > In animal models of neuropathic pain it has been found that

> > > > > > compounds which only block serotonin reuptake do not improve

> > > > > > neuropathic pain.[1][2][3][4][5][6][7][8] Similarly, compounds that

> > > > > > only block norepinephrine reuptake also do not improve neuropathic

> > > > > > pain. Compounds such as duloxetine, venlafaxine, and milnacipran

> > > > > > that block both serotonin reuptake and norepinephrine reuptake do

> > > > > > improve neuropathic pain. Antidepressants usually reduce neuropathic

> > > > > > pain more quickly and with smaller doses than they relieve

> > > > > > depression. Antidepressants therefore seem to work differently on

> > > > > > neuropathic pain than on depression, perhaps by activating

> > > > > > descending norepinephrinergic and serotonergic pathways in the

> > > > > > spinal cord that block pain signals from ascending to the brain.

> > > > > >

> > > > > > - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous

> > > > > > rt. flank & testicle pain. I have decided against an adrenalectomy

> > > > > > at this time since Meds. are working so well. Current BP(last week

> > > > > > ave): 122/73

> > > > > > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and

> > > > > > PTSD.

> > > > > > Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate

> > > > > > 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

> > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

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Posted
Posted

Tingling of the extremities is a common complaint in my Lyme group. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Remember when you had your arm around your sweetheart for too long and it " went to sleep " . As the feeling started to return you had what I call a " tingling feeling " . That is the feeling I get in my toes but it doesn't go away.

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But if the faulty blood draw gives a normal K in a person with a real low K how would they know? They will not. Shaking the blood too hard will also raise K falsely. They should gently rock it up and down. Many labs have a machine to do this right. But for K they may or may not do this. Ask if they are doing A serum or plasma K. Plasma has fewer problems. iPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Thanks for your good wishes but I seldom resort to luck, too many times the outcome isn't what I desired! If the phlebotomist is Don I'm quite certain the draw is done real close if not on the money! My only question is the needle size since I believe the one they use is a green 21g (Winged needles are usually a 21g green label, a 23g blue label, and a 25g orange label (however this needle is only used in pediatrics or extreme cases as it is so small that it can often result in hemolyzing the blood sample, thereby invalidating the test). Don gently rocks the sample to mix, I'll have to count how many times. I have the Medical Laboratory Observer article and Dr. Grim's summary in my folder if I need to reference!

My glass is always half full and as such I believe a lab that draws as much as they do with as many doctors as they serve there would be a pattern of errors if it was being done incorrectly. Someone would notice that K was always high (or low) on a certain day. I usually rely on professionals being professional and doing their job right until I notice an anomaly . Then I'm on it "like stink on shit"! I'm more concerned about the way they take your BP! (I wonder what my real BP would have been if I had ment Dr. G. 6-years earlier!

- 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank & testicle pain. I have decided against an adrenalectomy at this time since Meds. are working so well. Current BP(last week ave): 122/73

Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD.

Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

> > > > >

> > > > > >

> > > > > >

> > > > > > I see Dr. Bolton (FEA) On Monday and I believe she is planning on

> > > > > > titrating down/off Phsyco. Meds. I am wondering if Cymbalta is

> > > > > > serving two purposes and blocking neuropathic pain in my feet also.

> > > > > > Could it be the reason that while I have tingling I don't have pain?

> > > > > > Don't want to go thru another "act of congress" to get back on if I

> > > > > > stop and then need to get back on! Also, there may be other meds

> > > > > > more appropiate! Thought I'd give you a heads up so you could think

> > > > > > about it if necessary! Here is what I base the question on:

> > > > > > Thanks... - 8395.

> > > > > >

> > > > > > In animal models of neuropathic pain it has been found that

> > > > > > compounds which only block serotonin reuptake do not improve

> > > > > > neuropathic pain.[1][2][3][4][5][6][7][8] Similarly, compounds that

> > > > > > only block norepinephrine reuptake also do not improve neuropathic

> > > > > > pain. Compounds such as duloxetine, venlafaxine, and milnacipran

> > > > > > that block both serotonin reuptake and norepinephrine reuptake do

> > > > > > improve neuropathic pain. Antidepressants usually reduce neuropathic

> > > > > > pain more quickly and with smaller doses than they relieve

> > > > > > depression. Antidepressants therefore seem to work differently on

> > > > > > neuropathic pain than on depression, perhaps by activating

> > > > > > descending norepinephrinergic and serotonergic pathways in the

> > > > > > spinal cord that block pain signals from ascending to the brain.

> > > > > >

> > > > > > - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous

> > > > > > rt. flank & testicle pain. I have decided against an adrenalectomy

> > > > > > at this time since Meds. are working so well. Current BP(last week

> > > > > > ave): 122/73

> > > > > > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and

> > > > > > PTSD.

> > > > > > Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate

> > > > > > 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

> > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

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Posted
Posted

Since I see the lab report online within an hour or so and it is reported in the

section labled Plasma I think that question is answered.

Reversing your question, if extremily high K gives a normal reading how would

they tell? (Oh yea, I forgot, they would have a CADAVER!

- 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank &

testicle pain. I have decided against an adrenalectomy at this time since

Meds. are working so well. Current BP(last week ave): 122/73

Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD.

Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG,

81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

> > > > > > >

> > > > > > > >

> > > > > > > >

> > > > > > > > I see Dr. Bolton (FEA) On Monday and I believe she is planning

on

> > > > > > > > titrating down/off Phsyco. Meds. I am wondering if Cymbalta is

> > > > > > > > serving two purposes and blocking neuropathic pain in my feet

also.

> > > > > > > > Could it be the reason that while I have tingling I don't have

pain?

> > > > > > > > Don't want to go thru another " act of congress " to get back on

if I

> > > > > > > > stop and then need to get back on! Also, there may be other meds

> > > > > > > > more appropiate! Thought I'd give you a heads up so you could

think

> > > > > > > > about it if necessary! Here is what I base the question on:

> > > > > > > > Thanks... - 8395.

> > > > > > > >

> > > > > > > > In animal models of neuropathic pain it has been found that

> > > > > > > > compounds which only block serotonin reuptake do not improve

> > > > > > > > neuropathic pain.[1][2][3][4][5][6][7][8] Similarly, compounds

that

> > > > > > > > only block norepinephrine reuptake also do not improve

neuropathic

> > > > > > > > pain. Compounds such as duloxetine, venlafaxine, and milnacipran

> > > > > > > > that block both serotonin reuptake and norepinephrine reuptake

do

> > > > > > > > improve neuropathic pain. Antidepressants usually reduce

neuropathic

> > > > > > > > pain more quickly and with smaller doses than they relieve

> > > > > > > > depression. Antidepressants therefore seem to work differently

on

> > > > > > > > neuropathic pain than on depression, perhaps by activating

> > > > > > > > descending norepinephrinergic and serotonergic pathways in the

> > > > > > > > spinal cord that block pain signals from ascending to the brain.

> > > > > > > >

> > > > > > > > - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with

previous

> > > > > > > > rt. flank & testicle pain. I have decided against an

adrenalectomy

> > > > > > > > at this time since Meds. are working so well. Current BP(last

week

> > > > > > > > ave): 122/73

> > > > > > > > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2.

and

> > > > > > > > PTSD.

> > > > > > > > Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol

Tartrate

> > > > > > > > 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

> > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

> >

>

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Posted
Posted

I have know Don many years used to date one of my nieces. Before he worked at

the VA he worked at DHMC in the morgue.

> > > > > > > >

> > > > > > > > >

> > > > > > > > >

> > > > > > > > > I see Dr. Bolton (FEA) On Monday and I believe she is planning

on

> > > > > > > > > titrating down/off Phsyco. Meds. I am wondering if Cymbalta is

> > > > > > > > > serving two purposes and blocking neuropathic pain in my feet

also.

> > > > > > > > > Could it be the reason that while I have tingling I don't have

pain?

> > > > > > > > > Don't want to go thru another " act of congress " to get back on

if I

> > > > > > > > > stop and then need to get back on! Also, there may be other

meds

> > > > > > > > > more appropiate! Thought I'd give you a heads up so you could

think

> > > > > > > > > about it if necessary! Here is what I base the question on:

> > > > > > > > > Thanks... - 8395.

> > > > > > > > >

> > > > > > > > > In animal models of neuropathic pain it has been found that

> > > > > > > > > compounds which only block serotonin reuptake do not improve

> > > > > > > > > neuropathic pain.[1][2][3][4][5][6][7][8] Similarly, compounds

that

> > > > > > > > > only block norepinephrine reuptake also do not improve

neuropathic

> > > > > > > > > pain. Compounds such as duloxetine, venlafaxine, and

milnacipran

> > > > > > > > > that block both serotonin reuptake and norepinephrine reuptake

do

> > > > > > > > > improve neuropathic pain. Antidepressants usually reduce

neuropathic

> > > > > > > > > pain more quickly and with smaller doses than they relieve

> > > > > > > > > depression. Antidepressants therefore seem to work differently

on

> > > > > > > > > neuropathic pain than on depression, perhaps by activating

> > > > > > > > > descending norepinephrinergic and serotonergic pathways in the

> > > > > > > > > spinal cord that block pain signals from ascending to the

brain.

> > > > > > > > >

> > > > > > > > > - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with

previous

> > > > > > > > > rt. flank & testicle pain. I have decided against an

adrenalectomy

> > > > > > > > > at this time since Meds. are working so well. Current BP(last

week

> > > > > > > > > ave): 122/73

> > > > > > > > > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2.

and

> > > > > > > > > PTSD.

> > > > > > > > > Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol

Tartrate

> > > > > > > > > 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50

MG.

> > > > > > > > >

> > > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> > >

> >

>

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Posted
Posted

Don doesn't use a band on me and I don't make a fist with a needle stuck in the

back of my hand! The last time I got " slapped " I was 15 but that is a story for

another time and place!

As for the order, I'm not familiar with which is which but when I got to this

part of the quote, " * Sixth: glycolytic inhibitor tube (e.g., gray stopper).

(Note: Some facilities alter this order reflecting internal studies that support

a modification. Follow your facility's policy.) " I decided they would be doing

it according to DoD and VA accepted standards so it became a moot point.

The needle size may be an issue but I didn't see a comparison between 21g and

19g.

- 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank &

testicle pain. I have decided against an adrenalectomy at this time since

Meds. are working so well. Current BP(last week ave): 122/73

Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD.

Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG,

81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

> > > > > > >

> > > > > > > >

> > > > > > > >

> > > > > > > > I see Dr. Bolton (FEA) On Monday and I believe she is planning

on

> > > > > > > > titrating down/off Phsyco. Meds. I am wondering if Cymbalta is

> > > > > > > > serving two purposes and blocking neuropathic pain in my feet

also.

> > > > > > > > Could it be the reason that while I have tingling I don't have

pain?

> > > > > > > > Don't want to go thru another " act of congress " to get back on

if I

> > > > > > > > stop and then need to get back on! Also, there may be other meds

> > > > > > > > more appropiate! Thought I'd give you a heads up so you could

think

> > > > > > > > about it if necessary! Here is what I base the question on:

> > > > > > > > Thanks... - 8395.

> > > > > > > >

> > > > > > > > In animal models of neuropathic pain it has been found that

> > > > > > > > compounds which only block serotonin reuptake do not improve

> > > > > > > > neuropathic pain.[1][2][3][4][5][6][7][8] Similarly, compounds

that

> > > > > > > > only block norepinephrine reuptake also do not improve

neuropathic

> > > > > > > > pain. Compounds such as duloxetine, venlafaxine, and milnacipran

> > > > > > > > that block both serotonin reuptake and norepinephrine reuptake

do

> > > > > > > > improve neuropathic pain. Antidepressants usually reduce

neuropathic

> > > > > > > > pain more quickly and with smaller doses than they relieve

> > > > > > > > depression. Antidepressants therefore seem to work differently

on

> > > > > > > > neuropathic pain than on depression, perhaps by activating

> > > > > > > > descending norepinephrinergic and serotonergic pathways in the

> > > > > > > > spinal cord that block pain signals from ascending to the brain.

> > > > > > > >

> > > > > > > > - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with

previous

> > > > > > > > rt. flank & testicle pain. I have decided against an

adrenalectomy

> > > > > > > > at this time since Meds. are working so well. Current BP(last

week

> > > > > > > > ave): 122/73

> > > > > > > > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2.

and

> > > > > > > > PTSD.

> > > > > > > > Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol

Tartrate

> > > > > > > > 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

> > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

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Posted
Posted

So he knows the result of a screwed up K test! ;>()

> > > > > > > > >

> > > > > > > > > >

> > > > > > > > > >

> > > > > > > > > > I see Dr. Bolton (FEA) On Monday and I believe she is

planning on

> > > > > > > > > > titrating down/off Phsyco. Meds. I am wondering if Cymbalta

is

> > > > > > > > > > serving two purposes and blocking neuropathic pain in my

feet also.

> > > > > > > > > > Could it be the reason that while I have tingling I don't

have pain?

> > > > > > > > > > Don't want to go thru another " act of congress " to get back

on if I

> > > > > > > > > > stop and then need to get back on! Also, there may be other

meds

> > > > > > > > > > more appropiate! Thought I'd give you a heads up so you

could think

> > > > > > > > > > about it if necessary! Here is what I base the question on:

> > > > > > > > > > Thanks... - 8395.

> > > > > > > > > >

> > > > > > > > > > In animal models of neuropathic pain it has been found that

> > > > > > > > > > compounds which only block serotonin reuptake do not improve

> > > > > > > > > > neuropathic pain.[1][2][3][4][5][6][7][8] Similarly,

compounds that

> > > > > > > > > > only block norepinephrine reuptake also do not improve

neuropathic

> > > > > > > > > > pain. Compounds such as duloxetine, venlafaxine, and

milnacipran

> > > > > > > > > > that block both serotonin reuptake and norepinephrine

reuptake do

> > > > > > > > > > improve neuropathic pain. Antidepressants usually reduce

neuropathic

> > > > > > > > > > pain more quickly and with smaller doses than they relieve

> > > > > > > > > > depression. Antidepressants therefore seem to work

differently on

> > > > > > > > > > neuropathic pain than on depression, perhaps by activating

> > > > > > > > > > descending norepinephrinergic and serotonergic pathways in

the

> > > > > > > > > > spinal cord that block pain signals from ascending to the

brain.

> > > > > > > > > >

> > > > > > > > > > - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with

previous

> > > > > > > > > > rt. flank & testicle pain. I have decided against an

adrenalectomy

> > > > > > > > > > at this time since Meds. are working so well. Current

BP(last week

> > > > > > > > > > ave): 122/73

> > > > > > > > > > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19,

DM2. and

> > > > > > > > > > PTSD.

> > > > > > > > > > Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol

Tartrate

> > > > > > > > > > 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50

MG.

> > > > > > > > > >

> > > > > > > > > >

> > > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > > >

> > >

> >

>

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Posted
Posted

Use Note book mostly. Maybe I should add external keyboard. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Sounds like you need an ergonomic check of your workstation - I used to be responsible for that too in my professional career! (Knees and elbows at 90 degrees, feet flat on floor with back supported. Do you have an ergonomic keyboard? (We affectionatly called it the DP Keyboard and everybody thought it was for Data Processing Keyboard but I'll give you a hint, the "D" is for Dolly! I even got an ergonomic mouse and used to use it with my lwft hand when my right started to exhibit signs of CT!

- 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank & testicle pain. I have decided against an adrenalectomy at this time since Meds. are working so well. Current BP(last week ave): 122/73

Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD.

Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

>

> > A feeling of the part being asleep. Pins and needles. Itchiness. says, below, "Remember when you had your arm around your sweetheart for too long and it 'went to sleep'. As the feeling started to return you had what I call a "tingling feeling". That is the feeling I get in my toes but it doesn't go away."

> >

> >

> > Val

> >

> >

> >

> > From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Natalia Kamneva

> >

> >

> > Could you, please, explain to me what exactly tingling means? What kind of sensation is it?

> >

> >

> >

> > Many thanks,

> >

> >

> >

> > Natalia

> >

> >

> >

> >

> >

> >

> > Tingling of the extremities is a common complaint in my Lyme group.

> >

> >

> >

> > Val

> >

> >

> >

> > From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of

> >

> > Remember when you had your arm around your sweetheart for too long and it "went to sleep". As the feeling started to return you had what I call a "tingling feeling". That is the feeling I get in my toes but it doesn't go away.

> > .

> >

> >

> >

> >

> >

>

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Posted
Posted

Great device for productivity but they certainly never consulted with an

ergonomic specialist! Next to impossible to get screen at right eye level or

keyboard correct. Most compromise and screw up both their eyes and hands! We

actually put a " docking station " in the office and had both external keyboard

and screen. Cheaper than paying workman's comp and fighting lawsuits! (That

was 14 yrs ago so I don't know what they do today!)

> > >

> > > > A feeling of the part being asleep. Pins and needles. Itchiness.

says, below, " Remember when you had your arm around your sweetheart for

too long and it 'went to sleep'. As the feeling started to return you had what I

call a " tingling feeling " . That is the feeling I get in my toes but it doesn't

go away. "

> > > >

> > > >

> > > > Val

> > > >

> > > >

> > > >

> > > > From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of Natalia Kamneva

> > > >

> > > >

> > > > Could you, please, explain to me what exactly tingling means? What kind

of sensation is it?

> > > >

> > > >

> > > >

> > > > Many thanks,

> > > >

> > > >

> > > >

> > > > Natalia

> > > >

> > > >

> > > >

> > > > From: Valarie <val@>

> > > >

> > > >

> > > > Tingling of the extremities is a common complaint in my Lyme group.

> > > >

> > > >

> > > >

> > > > Val

> > > >

> > > >

> > > >

> > > > From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of

> > > >

> > > > Remember when you had your arm around your sweetheart for too long and

it " went to sleep " . As the feeling started to return you had what I call a

" tingling feeling " . That is the feeling I get in my toes but it doesn't go away.

> > > > .

> > > >

> > > >

> > > >

> > > >

> > > >

> > >

> >

> >

>

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Share on other sites
Guest guest

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Posted
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shouldn't the K draw be done before the EDTA. As the lavender stopper tube has K

in the tube this can carry over into the the K test tube.

From this site http://orderofdraw.com/history.html The history of how the order

came about. Note because of wronge order of draw one patient had a potassium

level of 25.4.

The order in which tubes should be filled seems to mutate daily into

increasingly creative incarnatios, In fact, it mutated right out of existence

last year when one workshop presenter astonished her attendees by stating,

" There is no order of draw. " Adding to the confusion are Internet phlebotomy

sites, training manuals, certification study guides, and textbooks that

perpetuate many variations.The proper order in which blood-collection tubes

should be filled is designed to prevent the carryover of additives from one tube

to the next. Such carryover alters the composition of the next tube and can lead

to erroneous results--with the potential to mislead physicians and invite

catastrophic errors in patient management. For the record, the order of draw has

been established by NCCLS--the National Committee for Clinical Laboratory

Standards, which develops voluntary standards--through its consensus process

with industry, government, and laboratory professinals and is published by NCCLS

in document H3, Procedure for the collection of Blood Specimens for Diagnostic

Testing by Venipuncture.The order was revised and simplified this past December

to one that works for both glass and plastic tubes, regardless of whether the

specimen is drawn by using a tube holder and needle assembly or syringe. To

understand the necessity for the order of draw and to clarify the widespread

confusionon the matter, let us examine the history on how the order came about

and how it has evolved through the years.Historical perspectiveThe order has its

origins in the literature as early as 1977, when evidence that additive

carryover occurs was first published in the American Society of Clinical

Pathologists; (ASCP's) Summary Report. (1) Authors Nilda Sun and Rita Knauf at

the St. Barnabas Medical Center in Livingston, NJ, reported their observation of

an asymptomatic patient who had a potassium level of 25.4 mEq/L (normal 3.5-5.3

mEq/L) obatained from a nonhemolyzed specimen. Upon Investigation, the authors

discovered that the phlebotomist filled the lavender-stopper tube containing

potassium EDTA immediately prior to filling the tube from which the elevated

potassium was obtained.

The first recommendation on establishing a formal order of draw for blood

collection was published in a letter to the editor of Clinical Chemistry by

Calam, PhD, and Marsha of St. Hospital in Detroit, MI, in 1982.

(2) Although tube manufacturer Becton Dickinson (BD) had been recommending as

early as 1976 that all additive tubes be drawn after non additive tubes, with

citrate tubes being the first additive tube filled, Calam and postulated

that a more detailed order was necessary for additive tubes. They reported five

cases in which they observed spuriously abnormal potassium and calcium levels,

all of which resulted when a lavender-stopper tube containing potassium EDTA was

filled immediately prior to the gel tube intended for chemistry tests. When

specimens were re-collected, potassium and calcium fell within normal limits.

Based on these observations and those of Sun and knoff, Calam and

concluded that not only should additive tubes be drawn after nonadditive tubes,

as BD had been suppesting, but that heparin, EDTA, and

potassium-oxalate/sodium-fluoride tubes (gray stoppers) should have a specific

" order of draw. " The reasoning for their proosed order was based on the fact that

if EDTA could carryover into nonadditive tubes, it could also carryover into

tubes containing other additives. Such proof suggested that the additive of any

tube could also carryover into a subsequent tube, threatening the accuracy of

results. The authors proposed that heparin tubes be drawn before the EDTA tube,

and the EDTA tube should precede the oxalate/fluoride tubes. Since

oxalate/fluoride is disruptive to cell membranes, placing it subsequent to the

EDTA tube prevents problems with cell morphology that might otherwise occur.

Also, with the gray top drawn after the green top, neither potassium oxalate nor

sodium flouride in the gray-top tubes would contaminate sodium or potassium

testing.The order proposed by Calam and for filling additive tubes

(following nonadditive tubes) was adopted by the NCCLS in 1984 in document H3-A2

as:

1.sodium-citrate tube;

2.heparin tube

3.EDTA tube

4.oxalate/fluoride tube

5.Gel separator tubes and clot activators

The introduction of serum gel tubes (1976) and plasma gel tubes (1987) provided

a convenience to specimen-processing personnel who had been required to remove

the stoppers of nongel tubes after centrifugation and physically remove the

serum or plasma for testing or storage. The gel tubes provided a physical

barrier between the serum or plasma following centrifugation, preventing the

changes that occur when serum or plasma is allowed to remain in contact with the

cells for prolonged periods of time prior to testing. Serum separator tubes

contain a clot activator (glass or sillica particles) to facilitate clotting.

Although clot activators may shorten the time it takes for the specimen to clot,

manufactureres stress that such tubes facilitate complete clotting, not rapid

clotting, yielding serum that is less likely to contain fibrin strands that can

interfere in testing.

Historically, tubes with anticoagulants (e.g., EDTA) or preservatives (e.g.,

sodium fluoride) were referred to as " additive tubes. " In 1998, it was proposed

that separator tubes containing gels and either a clotting activator or an

anticoagulant also be considered as additive tubes. (4) The NCCLS incorporated

these tubes into the order of draw in its 1998 revision (H3-A4). (5) The order

evolved with the gel tubes (serum and plasma separators) following the citrate

tube (blue stopper):

1.Blood-culture tubes

2.nonadditive tube

3.additive tubes (in the following order):

a.sodium-citrate tube

b.gel separator tube

c.heparin tube

d.EDTA tube, ande. oxalate/fluoride tube

Since possible carryover of the clot activator could conceivably alter results,

a gel tube with a clot activator had to be drawn after the blue top. Although

not spelled out, the serum gel tube should be drawn before the plasma gel tube,

as the latter often contains lithium heparin, which could affect the accuracy of

a patient's lithium test in the serum tube.If required, a plastic red-stopper

tube (plastic tubes contain a clot activator) can precede a heparin (green top)

or EDTA (lavender top) tube without concern for carryover. The logic is that any

carryover of the clot activator into tubes other than blue tops is irrlevant,

since carryover should be neutralized by the excess anticoagulant. In contrast,

carryover of a clot activator into a sodium citrate tube (blue top) could

interfere with clotting factors, leading to inaccurate results.Some facilities

maintain the necessity for a different order for syringe transfer because not

all syringe draws go quickly and, therefore, the potential exists for clotting

to occur in the syringe prior to blood transfer to successive tubes. (6,7) To

prevent clotting within the syringe, an order is implemented that fills all

additive tubes first and then the nonadditive tubes. NCCLS consensus concluded,

however, that the potential for carryover from the needle of the syringe had the

potential to be a more significant problem than any clotting that might take

place in the syringe during a properly performed venipuncture. Therefore, the

1998 NCCLS revision also recommended that the same order of draw be followed

when transferring blood specimens from a syringe to multiple blood-collection

tubes.

Plastic tubesMotivated by increasing concern over broken-glass exposures, high

biohazardous waste-disposal costs, and Occupational Safety and health Agency

(OSHA) guidelines mandating substitution, many laboratories began switching from

glass collection tubes to plastic (see " Fairfax of OSHA Talks About the

Bloodborne Pathogens Standard " February 2003 MLO, p.32) This industry-wide

transition from glass to plastic necessitated a modicication to the order of

draw. Plastic serum tubes are now positioned the same as gel separator tubes,

which contain a clot activator. The revised order, " published in December 2003,

is now as follows:

1.Blood-culture tube

2.Sodium-citrate tube (e.g., blue-stopper)

3.Serum tubes with or without clot activator, with or without gelseparator

(e.g., red-, gold, speckled-stopper)

4.Heparin tubes with or without gel (e.g., green-stopper)

5.EDTA tubes (e.g., lavendeer-stopper)

6.Glycolytic inhibitor (e.g., gray-stopper)

(8)In the revised standar, NCCLS recognizes that some facilities may still be

using glass serum tubes without a clot activator to serve as a waste tube before

collecting special coagulation assays. Although the revised order functions well

regardless of the presence of a clot activator in the facility's serum tube, a

provision withitn H3-A5 affords the option of keeping the nonadditive serum tube

before the citrate tube in the following passage: " The order of draw has been

revised to reflect the increased use of plastic blood-collection tubes. Plastic

serum tubes containing a clot activator may cause interference in coagulation

testing. Glass nonadditive serum tubes may be drawn before the coagulation

tube. " The NCCLS order of draw has gone throughseveral revisions dictated by

technology, publication, and common sense. The latest revision should make it

easier for educators and trainers to teach the order of draw and prevent

additive carryover, which can affect patient results. References(1) Sun N, Knauf

R. Cross contamination solved by technique. ASCP Summary Report 1977;14(3):3.(2)

Calam R, M. Recommended " order of draw " for collecting blood specimens

into additive- containing tubes. Clin Chem. 1982;28:1399.(3) National Committee

for Clinical Laboratory Standards. Procedures for the Collection of Diagnostic

Blood Specimns by Venipuncture. Approved Standard, H3-A2, Villanova, PA; 1991(4)

National Committee for Clinical Laboratory Standards. Procedures for the

Collection of Diagnostic Blood Specimens by Venipuncture. Approved Standard,

H3-A5,

> > > > > > > > >

> > > > > > > > > >

> > > > > > > > > >

> > > > > > > > > > I see Dr. Bolton (FEA) On Monday and I believe she is

planning on

> > > > > > > > > > titrating down/off Phsyco. Meds. I am wondering if Cymbalta

is

> > > > > > > > > > serving two purposes and blocking neuropathic pain in my

feet also.

> > > > > > > > > > Could it be the reason that while I have tingling I don't

have pain?

> > > > > > > > > > Don't want to go thru another " act of congress " to get back

on if I

> > > > > > > > > > stop and then need to get back on! Also, there may be other

meds

> > > > > > > > > > more appropiate! Thought I'd give you a heads up so you

could think

> > > > > > > > > > about it if necessary! Here is what I base the question on:

> > > > > > > > > > Thanks... - 8395.

> > > > > > > > > >

> > > > > > > > > > In animal models of neuropathic pain it has been found that

> > > > > > > > > > compounds which only block serotonin reuptake do not improve

> > > > > > > > > > neuropathic pain.[1][2][3][4][5][6][7][8] Similarly,

compounds that

> > > > > > > > > > only block norepinephrine reuptake also do not improve

neuropathic

> > > > > > > > > > pain. Compounds such as duloxetine, venlafaxine, and

milnacipran

> > > > > > > > > > that block both serotonin reuptake and norepinephrine

reuptake do

> > > > > > > > > > improve neuropathic pain. Antidepressants usually reduce

neuropathic

> > > > > > > > > > pain more quickly and with smaller doses than they relieve

> > > > > > > > > > depression. Antidepressants therefore seem to work

differently on

> > > > > > > > > > neuropathic pain than on depression, perhaps by activating

> > > > > > > > > > descending norepinephrinergic and serotonergic pathways in

the

> > > > > > > > > > spinal cord that block pain signals from ascending to the

brain.

> > > > > > > > > >

> > > > > > > > > > - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with

previous

> > > > > > > > > > rt. flank & testicle pain. I have decided against an

adrenalectomy

> > > > > > > > > > at this time since Meds. are working so well. Current

BP(last week

> > > > > > > > > > ave): 122/73

> > > > > > > > > > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19,

DM2. and

> > > > > > > > > > PTSD.

> > > > > > > > > > Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol

Tartrate

> > > > > > > > > > 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50

MG.

> > > > > > > > > >

> > > > > > > > > >

> > > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > > >

> > >

> >

> >

>

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Share on other sites
Guest guest

Guest guest

Posted
Posted

Great history article for the problem. I learned some stuff as well. Please put this in our blood drawing problems folder if you can. BurT is more that most will want to know. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

shouldn't the K draw be done before the EDTA. As the lavender stopper tube has K in the tube this can carry over into the the K test tube.

From this site http://orderofdraw.com/history.html The history of how the order came about. Note because of wronge order of draw one patient had a potassium level of 25.4.

The order in which tubes should be filled seems to mutate daily into increasingly creative incarnatios, In fact, it mutated right out of existence last year when one workshop presenter astonished her attendees by stating, "There is no order of draw." Adding to the confusion are Internet phlebotomy sites, training manuals, certification study guides, and textbooks that perpetuate many variations.The proper order in which blood-collection tubes should be filled is designed to prevent the carryover of additives from one tube to the next. Such carryover alters the composition of the next tube and can lead to erroneous results--with the potential to mislead physicians and invite catastrophic errors in patient management. For the record, the order of draw has been established by NCCLS--the National Committee for Clinical Laboratory Standards, which develops voluntary standards--through its consensus process with industry, government, and laboratory professinals and is published

by NCCLS in document H3, Procedure for the collection of Blood Specimens for Diagnostic Testing by Venipuncture.The order was revised and simplified this past December to one that works for both glass and plastic tubes, regardless of whether the specimen is drawn by using a tube holder and needle assembly or syringe. To understand the necessity for the order of draw and to clarify the widespread confusionon the matter, let us examine the history on how the order came about and how it has evolved through the years.Historical perspectiveThe order has its origins in the literature as early as 1977, when evidence that additive carryover occurs was first published in the American Society of Clinical Pathologists; (ASCP's) Summary Report. (1) Authors Nilda Sun and Rita Knauf at the St. Barnabas Medical Center in Livingston, NJ, reported their observation of an asymptomatic patient who had a potassium level of 25.4 mEq/L (normal 3.5-5.3 mEq/L) obatained from a nonhemolyzed specimen. Upon

Investigation, the authors discovered that the phlebotomist filled the lavender-stopper tube containing potassium EDTA immediately prior to filling the tube from which the elevated potassium was obtained.

The first recommendation on establishing a formal order of draw for blood collection was published in a letter to the editor of Clinical Chemistry by Calam, PhD, and Marsha of St. Hospital in Detroit, MI, in 1982. (2) Although tube manufacturer Becton Dickinson (BD) had been recommending as early as 1976 that all additive tubes be drawn after non additive tubes, with citrate tubes being the first additive tube filled, Calam and postulated that a more detailed order was necessary for additive tubes. They reported five cases in which they observed spuriously abnormal potassium and calcium levels, all of which resulted when a lavender-stopper tube containing potassium EDTA was filled immediately prior to the gel tube intended for chemistry tests. When specimens were re-collected, potassium and calcium fell within normal limits. Based on these observations and those of Sun and knoff, Calam and concluded that not only should additive tubes be drawn after

nonadditive tubes, as BD had been suppesting, but that heparin, EDTA, and potassium-oxalate/sodium-fluoride tubes (gray stoppers) should have a specific "order of draw."The reasoning for their proosed order was based on the fact that if EDTA could carryover into nonadditive tubes, it could also carryover into tubes containing other additives. Such proof suggested that the additive of any tube could also carryover into a subsequent tube, threatening the accuracy of results. The authors proposed that heparin tubes be drawn before the EDTA tube, and the EDTA tube should precede the oxalate/fluoride tubes. Since oxalate/fluoride is disruptive to cell membranes, placing it subsequent to the EDTA tube prevents problems with cell morphology that might otherwise occur. Also, with the gray top drawn after the green top, neither potassium oxalate nor sodium flouride in the gray-top tubes would contaminate sodium or potassium testing.The order proposed by Calam and for filling

additive tubes (following nonadditive tubes) was adopted by the NCCLS in 1984 in document H3-A2 as:

1.sodium-citrate tube;

2.heparin tube

3.EDTA tube

4.oxalate/fluoride tube

5.Gel separator tubes and clot activators

The introduction of serum gel tubes (1976) and plasma gel tubes (1987) provided a convenience to specimen-processing personnel who had been required to remove the stoppers of nongel tubes after centrifugation and physically remove the serum or plasma for testing or storage. The gel tubes provided a physical barrier between the serum or plasma following centrifugation, preventing the changes that occur when serum or plasma is allowed to remain in contact with the cells for prolonged periods of time prior to testing. Serum separator tubes contain a clot activator (glass or sillica particles) to facilitate clotting. Although clot activators may shorten the time it takes for the specimen to clot, manufactureres stress that such tubes facilitate complete clotting, not rapid clotting, yielding serum that is less likely to contain fibrin strands that can interfere in testing.

Historically, tubes with anticoagulants (e.g., EDTA) or preservatives (e.g., sodium fluoride) were referred to as "additive tubes." In 1998, it was proposed that separator tubes containing gels and either a clotting activator or an anticoagulant also be considered as additive tubes. (4) The NCCLS incorporated these tubes into the order of draw in its 1998 revision (H3-A4). (5) The order evolved with the gel tubes (serum and plasma separators) following the citrate tube (blue stopper):

1.Blood-culture tubes

2.nonadditive tube

3.additive tubes (in the following order):

a.sodium-citrate tube

b.gel separator tube

c.heparin tube

d.EDTA tube, ande. oxalate/fluoride tube

Since possible carryover of the clot activator could conceivably alter results, a gel tube with a clot activator had to be drawn after the blue top. Although not spelled out, the serum gel tube should be drawn before the plasma gel tube, as the latter often contains lithium heparin, which could affect the accuracy of a patient's lithium test in the serum tube.If required, a plastic red-stopper tube (plastic tubes contain a clot activator) can precede a heparin (green top) or EDTA (lavender top) tube without concern for carryover. The logic is that any carryover of the clot activator into tubes other than blue tops is irrlevant, since carryover should be neutralized by the excess anticoagulant. In contrast, carryover of a clot activator into a sodium citrate tube (blue top) could interfere with clotting factors, leading to inaccurate results.Some facilities maintain the necessity for a different order for syringe transfer because not all syringe draws go quickly and, therefore, the

potential exists for clotting to occur in the syringe prior to blood transfer to successive tubes. (6,7) To prevent clotting within the syringe, an order is implemented that fills all additive tubes first and then the nonadditive tubes. NCCLS consensus concluded, however, that the potential for carryover from the needle of the syringe had the potential to be a more significant problem than any clotting that might take place in the syringe during a properly performed venipuncture. Therefore, the 1998 NCCLS revision also recommended that the same order of draw be followed when transferring blood specimens from a syringe to multiple blood-collection tubes.

Plastic tubesMotivated by increasing concern over broken-glass exposures, high biohazardous waste-disposal costs, and Occupational Safety and health Agency (OSHA) guidelines mandating substitution, many laboratories began switching from glass collection tubes to plastic (see " Fairfax of OSHA Talks About the Bloodborne Pathogens Standard" February 2003 MLO, p.32) This industry-wide transition from glass to plastic necessitated a modicication to the order of draw. Plastic serum tubes are now positioned the same as gel separator tubes, which contain a clot activator. The revised order, "published in December 2003, is now as follows:

1.Blood-culture tube

2.Sodium-citrate tube (e.g., blue-stopper)

3.Serum tubes with or without clot activator, with or without gelseparator (e.g., red-, gold, speckled-stopper)

4.Heparin tubes with or without gel (e.g., green-stopper)

5.EDTA tubes (e.g., lavendeer-stopper)

6.Glycolytic inhibitor (e.g., gray-stopper)

(8)In the revised standar, NCCLS recognizes that some facilities may still be using glass serum tubes without a clot activator to serve as a waste tube before collecting special coagulation assays. Although the revised order functions well regardless of the presence of a clot activator in the facility's serum tube, a provision withitn H3-A5 affords the option of keeping the nonadditive serum tube before the citrate tube in the following passage: "The order of draw has been revised to reflect the increased use of plastic blood-collection tubes. Plastic serum tubes containing a clot activator may cause interference in coagulation testing. Glass nonadditive serum tubes may be drawn before the coagulation tube."The NCCLS order of draw has gone throughseveral revisions dictated by technology, publication, and common sense. The latest revision should make it easier for educators and trainers to teach the order of draw and prevent additive carryover, which can affect patient

results. References(1) Sun N, Knauf R. Cross contamination solved by technique. ASCP Summary Report 1977;14(3):3.(2) Calam R, M. Recommended "order of draw" for collecting blood specimens into additive- containing tubes. Clin Chem. 1982;28:1399.(3) National Committee for Clinical Laboratory Standards. Procedures for the Collection of Diagnostic Blood Specimns by Venipuncture. Approved Standard, H3-A2, Villanova, PA; 1991(4) National Committee for Clinical Laboratory Standards. Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture. Approved Standard, H3-A5,

> > > > > > > > >

> > > > > > > > > >

> > > > > > > > > >

> > > > > > > > > > I see Dr. Bolton (FEA) On Monday and I believe she is planning on

> > > > > > > > > > titrating down/off Phsyco. Meds. I am wondering if Cymbalta is

> > > > > > > > > > serving two purposes and blocking neuropathic pain in my feet also.

> > > > > > > > > > Could it be the reason that while I have tingling I don't have pain?

> > > > > > > > > > Don't want to go thru another "act of congress" to get back on if I

> > > > > > > > > > stop and then need to get back on! Also, there may be other meds

> > > > > > > > > > more appropiate! Thought I'd give you a heads up so you could think

> > > > > > > > > > about it if necessary! Here is what I base the question on:

> > > > > > > > > > Thanks... - 8395.

> > > > > > > > > >

> > > > > > > > > > In animal models of neuropathic pain it has been found that

> > > > > > > > > > compounds which only block serotonin reuptake do not improve

> > > > > > > > > > neuropathic pain.[1][2][3][4][5][6][7][8] Similarly, compounds that

> > > > > > > > > > only block norepinephrine reuptake also do not improve neuropathic

> > > > > > > > > > pain. Compounds such as duloxetine, venlafaxine, and milnacipran

> > > > > > > > > > that block both serotonin reuptake and norepinephrine reuptake do

> > > > > > > > > > improve neuropathic pain. Antidepressants usually reduce neuropathic

> > > > > > > > > > pain more quickly and with smaller doses than they relieve

> > > > > > > > > > depression. Antidepressants therefore seem to work differently on

> > > > > > > > > > neuropathic pain than on depression, perhaps by activating

> > > > > > > > > > descending norepinephrinergic and serotonergic pathways in the

> > > > > > > > > > spinal cord that block pain signals from ascending to the brain.

> > > > > > > > > >

> > > > > > > > > > - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous

> > > > > > > > > > rt. flank & testicle pain. I have decided against an adrenalectomy

> > > > > > > > > > at this time since Meds. are working so well. Current BP(last week

> > > > > > > > > > ave): 122/73

> > > > > > > > > > Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and

> > > > > > > > > > PTSD.

> > > > > > > > > > Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate

> > > > > > > > > > 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

> > > > > > > > > >

> > > > > > > > > >

> > > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > > >

> > >

> >

> >

>

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Posted
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How it's different from numbness? NataliaTo: hyperaldosteronism Sent: Sunday, October 2, 2011 6:43 PMSubject: RE: Re: Communicating with your Team

A feeling of the part being asleep. Pins and needles. Itchiness. says, below, "Remember when you had your arm around your sweetheart for too long and it 'went to sleep'. As the feeling started to return you had what I call a "tingling feeling". That is the feeling I get in my toes but it doesn't go away."Val From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of Natalia Kamneva Could you, please, explain to me what exactly tingling means? What kind of sensation is it? Many thanks, Natalia Tingling of the extremities is a common complaint in my Lyme group. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Remember when you had your arm around your sweetheart for too long and it "went to sleep". As the feeling started to return you had what I call a "tingling feeling". That is the feeling I get in my toes but it doesn't go away..

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Posted
Posted

No like ur arm feels if you sleep on it and wake up and it wakes up with pins and needles sensation Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Is tingling appearing when one is listening a very good music? Is it pretty much the same as goose-flesh? Still cannot get it :-) Sorry.NataliaTo: hyperaldosteronism Sent: Tuesday, October 4, 2011 3:14 PMSubject:

Re: Communicating with your Team

Agree with you. Numb is what you hope your mouth is before dentist starts drilling, tingling is when you feel it when you bite your fat lip after s/he is done!

- 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank & testicle pain. I have decided against an adrenalectomy at this time since Meds. are working so well. Current BP(last week ave): 122/73

Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD.

Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

> >

> > > How it's different from numbness?

> > >

> > > Natalia

> > >

> > > From: Valarie <val@>

> > > To: hyperaldosteronism

> > > Sent: Sunday, October 2, 2011 6:43 PM

> > > Subject: RE: Re: Communicating with your Team

> > >

> > >

> > > A feeling of the part being asleep. Pins and needles. Itchiness. says, below, "Remember when you had your arm around your sweetheart for too long and it 'went to sleep'. As the feeling started to return you had what I call a "tingling feeling". That is the feeling I get in my toes but it doesn't go away."

> > >

> > > Val

> > >

> > > From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Natalia Kamneva

> > >

> > > Could you, please, explain to me what exactly tingling means? What kind of sensation is it?

> > >

> > > Many thanks,

> > >

> > > Natalia

> > >

> > > From: Valarie <val@>

> > >

> > > Tingling of the extremities is a common complaint in my Lyme group.

> > >

> > > Val

> > >

> > > From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of

> > > Remember when you had your arm around your sweetheart for too long and it "went to sleep". As the feeling started to return you had what I call a "tingling feeling". That is the feeling I get in my toes but it doesn't go away.

> > > .

> > >

> > >

> > >

> > >

> >

>

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Posted
Posted

Natalia, The dictionary on my Droid defines tingling as " prickles, stings or

tremors. " When I have tingling, it feels a little like my skin is vibrating or

like I am getting a series of mild electrical shocks over that part of my body.

I have had physical therapy for my back where they use electrical stimulation

that tingles. I hope this helps. ~Lucy

Sent from my Verizon Wireless Phone

Natalia Kamneva wrote:

>Is tingling appearing when one is listening a very good music? Is it pretty

much the same as goose-flesh?  

>

>Still cannot get it :-)  Sorry.

>

>Natalia

>

>

>

>________________________________

>

>To: hyperaldosteronism

>Sent: Tuesday, October 4, 2011 3:14 PM

>Subject: Re: Communicating with your Team

>

>

> 

>Agree with you. Numb is what you hope your mouth is before dentist starts

drilling, tingling is when you feel it when you bite your fat lip after s/he is

done!

>

> - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank

& testicle pain. I have decided against an adrenalectomy at this time since

Meds. are working so well. Current BP(last week ave): 122/73

>Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD.

>Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG,

81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

>

>

>> >

>> > > How it's different from numbness?

>> > >

>> > > Natalia

>> > >

>> > > From: Valarie <val@>

>> > > To: hyperaldosteronism

>> > > Sent: Sunday, October 2, 2011 6:43 PM

>> > > Subject: RE: Re: Communicating with your Team

>> > >

>> > >

>> > > A feeling of the part being asleep. Pins and needles. Itchiness.

says, below, " Remember when you had your arm around your sweetheart for

too long and it 'went to sleep'. As the feeling started to return you had what

I call a " tingling feeling " . That is the feeling I get in my toes but it doesn't

go away. "

>> > >

>> > > Val

>> > >

>> > > From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of Natalia Kamneva

>> > >

>> > > Could you, please, explain to me what exactly tingling means? What kind

of sensation is it?

>> > >

>> > > Many thanks,

>> > >

>> > > Natalia

>> > >

>> > > From: Valarie <val@>

>> > >

>> > > Tingling of the extremities is a common complaint in my Lyme group.

>> > >

>> > > Val

>> > >

>> > > From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of

>> > > Remember when you had your arm around your sweetheart for too long and it

" went to sleep " . As the feeling started to return you had what I call a

" tingling feeling " . That is the feeling I get in my toes but it doesn't go away.

>> > > .

>> > >

>> > >

>> > >

>> > >

>> >

>>

>

>

>

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Posted
Posted

We have to remember that many in this group are from other non speaking English

countries and English was many words that other languages don't have.

> >> >

> >> > > How it's different from numbness?

> >> > >

> >> > > Natalia

> >> > >

> >> > > From: Valarie <val@>

> >> > > To: hyperaldosteronism

> >> > > Sent: Sunday, October 2, 2011 6:43 PM

> >> > > Subject: RE: Re: Communicating with your Team

> >> > >

> >> > >

> >> > > A feeling of the part being asleep. Pins and needles. Itchiness.

says, below, " Remember when you had your arm around your sweetheart

for too long and it 'went to sleep'. As the feeling started to return you had

what I call a " tingling feeling " . That is the feeling I get in my toes but it

doesn't go away. "

> >> > >

> >> > > Val

> >> > >

> >> > > From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of Natalia Kamneva

> >> > >

> >> > > Could you, please, explain to me what exactly tingling means? What kind

of sensation is it?

> >> > >

> >> > > Many thanks,

> >> > >

> >> > > Natalia

> >> > >

> >> > > From: Valarie <val@>

> >> > >

> >> > > Tingling of the extremities is a common complaint in my Lyme group.

> >> > >

> >> > > Val

> >> > >

> >> > > From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of

> >> > > Remember when you had your arm around your sweetheart for too long and

it " went to sleep " . As the feeling started to return you had what I call a

" tingling feeling " . That is the feeling I get in my toes but it doesn't go away.

> >> > > .

> >> > >

> >> > >

> >> > >

> >> > >

> >> >

> >>

> >

> >

> >

>

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Posted
Posted

Also know as a person with low K and PA. CE Ever get the feeling like you have worms crawling under your skin? I get that in my shoulder blades sometimes. Very annoying feeling. I am a twitchaholic. lol ============================================================================45-Male-Caucasian, 5'9"- 242lbs, PA Diagnosed 2007 Suspected Hyperplasia-No tumors on CT - No AVS.Meds: 50mg Inspra, 40meq Potassium, 1800mg Calcium, 1000mg Magnesium, 100,000UI Vit D (weekly), 20mg OmeprazoleSide effects: Gynecomastia, stomach inflammation (From Spiro)Other Diags: GERD, Hiatal Hernia, Metabolic Syndrome - PreDiabetic, Secondary Hyperparathyroidism caused by Renal calcium leak, Bone Cyct in left Femoral Head and Pelvis. Benign Lung Nodules, Fibromyalgia, Scarring on Right Kidney Lower Pole, Right Flank PainDASH: Started "sort of" DASHing 5/3/2011Status: Last Urine K/Na ratio was 1.1. But total of Na high alsoTo: hyperaldosteronism Sent: Thursday, October 6, 2011 10:51 AMSubject: Re: Communicating with your Team We have to remember that many in this group are from other non speaking English countries and English was many words that other languages don't have. > >> > > >> > > How it's different from numbness? > >> > > > >> > > Natalia > >> > > > >> > > From: Valarie <val@> > >> > > To: hyperaldosteronism > >> > > Sent: Sunday, October 2, 2011 6:43 PM > >> > > Subject: RE: Re: Communicating with your Team > >> > > > >> > > > >> > > A feeling of the part being asleep. Pins and needles. Itchiness. says, below, "Remember when you had your arm around your sweetheart for too long and it 'went to sleep'. As the feeling started to return you had what I call a "tingling feeling". That is the feeling I get in my toes but it doesn't go away." > >> > > > >> > > Val > >> > > > >> > > From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Natalia Kamneva > >> > > > >> > > Could you, please, explain to me what exactly tingling means? What kind of sensation is it? > >> > > > >> > > Many thanks, > >> > > > >> > > Natalia > >> > > > >> > > From: Valarie <val@> > >> > > > >> > > Tingling of the extremities is a common complaint in my Lyme group. > >> > > > >> > > Val > >> > > > >> > > From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of > >> > > Remember when you had your arm around your sweetheart for too long and it "went to sleep". As the feeling started to return you had what I call a "tingling feeling". That is the feeling I get in my toes but it doesn't go away. > >> > > . > >> > > > >> > > > >> > > > >> > > > >> > > >> > > > > > > >

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Many thanks everybody who tried to explain it to me. Now I can imagine the sensation, but cannot remember if I sometimes experienced that. NataliaTo: Natalia Kamneva ; "hyperaldosteronism " <hyperaldosteronism >Sent: Thursday, October 6, 2011 10:29 AMSubject: Re: Re: Communicating with your Team

Natalia, The dictionary on my Droid defines tingling as "prickles, stings or tremors." When I have tingling, it feels a little like my skin is vibrating or like I am getting a series of mild electrical shocks over that part of my body. I have had physical therapy for my back where they use electrical stimulation that tingles. I hope this helps. ~Lucy

Sent from my Verizon Wireless Phone

Natalia Kamneva wrote:

>Is tingling appearing when one is listening a very good music? Is it pretty much the same as goose-flesh?

>

>Still cannot get it :-) Sorry.

>

>Natalia

>

>

>

>________________________________

>

>To: hyperaldosteronism

>Sent: Tuesday, October 4, 2011 3:14 PM

>Subject: Re: Communicating with your Team

>

>

>

>Agree with you. Numb is what you hope your mouth is before dentist starts drilling, tingling is when you feel it when you bite your fat lip after s/he is done!

>

> - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank & testicle pain. I have decided against an adrenalectomy at this time since Meds. are working so well. Current BP(last week ave): 122/73

>Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD.

>Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

>

>

>> >

>> > > How it's different from numbness?

>> > >

>> > > Natalia

>> > >

>> > > From: Valarie <val@>

>> > > To: hyperaldosteronism

>> > > Sent: Sunday, October 2, 2011 6:43 PM

>> > > Subject: RE: Re: Communicating with your Team

>> > >

>> > >

>> > > A feeling of the part being asleep. Pins and needles. Itchiness. says, below, "Remember when you had your arm around your sweetheart for too long and it 'went to sleep'. As the feeling started to return you had what I call a "tingling feeling". That is the feeling I get in my toes but it doesn't go away."

>> > >

>> > > Val

>> > >

>> > > From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Natalia Kamneva

>> > >

>> > > Could you, please, explain to me what exactly tingling means? What kind of sensation is it?

>> > >

>> > > Many thanks,

>> > >

>> > > Natalia

>> > >

>> > > From: Valarie <val@>

>> > >

>> > > Tingling of the extremities is a common complaint in my Lyme group.

>> > >

>> > > Val

>> > >

>> > > From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of

>> > > Remember when you had your arm around your sweetheart for too long and it "went to sleep". As the feeling started to return you had what I call a "tingling feeling". That is the feeling I get in my toes but it doesn't go away.

>> > > .

>> > >

>> > >

>> > >

>> > >

>> >

>>

>

>

>

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Exactly. We don't have the word for this sensation in Russian. Many thanks,NataliaTo: hyperaldosteronism Sent: Thursday, October 6, 2011 10:51 AMSubject: Re: Communicating with your

Team

We have to remember that many in this group are from other non speaking English countries and English was many words that other languages don't have.

> >> >

> >> > > How it's different from numbness?

> >> > >

> >> > > Natalia

> >> > >

> >> > > From: Valarie <val@>

> >> > > To: hyperaldosteronism

> >> > > Sent: Sunday, October 2, 2011 6:43 PM

> >> > > Subject: RE: Re: Communicating with your Team

> >> > >

> >> > >

> >> > > A feeling of the part being asleep. Pins and needles. Itchiness. says, below, "Remember when you had your arm around your sweetheart for too long and it 'went to sleep'. As the feeling started to return you had what I call a "tingling feeling". That is the feeling I get in my toes but it doesn't go away."

> >> > >

> >> > > Val

> >> > >

> >> > > From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Natalia Kamneva

> >> > >

> >> > > Could you, please, explain to me what exactly tingling means? What kind of sensation is it?

> >> > >

> >> > > Many thanks,

> >> > >

> >> > > Natalia

> >> > >

> >> > > From: Valarie <val@>

> >> > >

> >> > > Tingling of the extremities is a common complaint in my Lyme group.

> >> > >

> >> > > Val

> >> > >

> >> > > From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of

> >> > > Remember when you had your arm around your sweetheart for too long and it "went to sleep". As the feeling started to return you had what I call a "tingling feeling". That is the feeling I get in my toes but it doesn't go away.

> >> > > .

> >> > >

> >> > >

> >> > >

> >> > >

> >> >

> >>

> >

> >

> >

>

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Posted
Posted

Can try this when sitting put one leg under you put the leg you sitting on as

far as you can get it. sit this way with out moving for 1/2 hour or a bit

longer. Then try to stand up.

> >> >

> >> > > How it's different from numbness?

> >> > >

> >> > > Natalia

> >> > >

> >> > > From: Valarie <val@>

> >> > > To: hyperaldosteronism

> >> > > Sent: Sunday, October 2, 2011 6:43 PM

> >> > > Subject: RE: Re: Communicating with your Team

> >> > >

> >> > >

> >> > > A feeling of the part being asleep. Pins and needles. Itchiness.

says, below, " Remember when you had your arm around your sweetheart

for too long and it 'went to sleep'. As the feeling started to return you had

what I call a " tingling feeling " . That is the feeling I get in my toes but it

doesn't go away. "

> >> > >

> >> > > Val

> >> > >

> >> > > From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of Natalia Kamneva

> >> > >

> >> > > Could you, please, explain to me what exactly tingling means? What kind

of sensation is it?

> >> > >

> >> > > Many thanks,

> >> > >

> >> > > Natalia

> >> > >

> >> > > From: Valarie <val@>

> >> > >

> >> > > Tingling of the extremities is a common complaint in my Lyme group.

> >> > >

> >> > > Val

> >> > >

> >> > > From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of

> >> > > Remember when you had your arm around your sweetheart for too long and

it " went to sleep " . As the feeling started to return you had what I call a

" tingling feeling " . That is the feeling I get in my toes but it doesn't go away.

> >> > > .

> >> > >

> >> > >

> >> > >

> >> > >

> >> >

> >>

> >

> >

> >

>

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