Terrible symptoms - I need your help! - Acetylcholine overload?

[Abyssos]

Please take your time to read it. I am begging you.

Here is my story and I hope I am getting help as I am losing my mind again.

I was put on benzos by doctors in 2015. My highest dose was 4mg Klonopin a day.
In September 2016 I started tapering and I was done by August 2017. I was also
opioid addicted at the same time, taking 300mg Oxycodone a day. I withdrawed from
the Oxycodone first. I was done with it in April 2017.

During the withdrawal, I experienced pain behind the breastbone when under stress or
after eating. Sometimes even swallowing would cause immense pain in my esophagus.
I had a GI exam and my esophagus was fine. It showed no scaring or anything.
So I guess I had a hypersensitive esophagus.

Now to my real problem:
Due to strong muscular pain in my neck and face due to a TMJ disorder, I took Oxycodone again
in November 2017. However, suddenly when taking Oxycodone, especially sublingual, after just 5 minutes
my body would react with panic. My chest muscles constrict and I can't breathe in properly anymore because
my upper chest literally goes into spasm. My esophagus also spasms and I belch like crazy. The only way to
get it under control is to take high dose Baclofen, Pregabalin or a Benzo. I have tested that. So oxycodone suddenly
causes this reaction. It seems the famous opioid induced muscle rigidity. I also get very strong tachycardia
when this happens. If I take just 20mg oxycodone, I get such heavy breathing I feel like dying. My chest totally spasms.
And this happens to every opioid agonist suddenly. This is no anxiety, it's a real physical reaction.

So because I was in pain but could not take Oxycodone anymore, I started taking 20-40mg Baclofen a day to keep
those almost allergic-like reactions from Oxycodone under control. I took Oxycodone and Baclofen for two months.
Of course I had withdrawal from Oxycodone again, but since it was only 40mg a day, it was over pretty fast and
I slept fine after 2 days. But since then I am suffering horribly.

Since I have used Baclofen and Oxycodone again, I have enormous problems with my gallbladder.
No stones according to the doctors, but I get immense pain in my back, my chest and my right flank
after eating, especially after eating fatty meals or too many carbs. Also, I feel like food is stuck in my
esophagus after swallowing sometimes. I often have to drink a glass of water to make the food go into my stomach.
I also get heart palpations after eating sometimes.

I also have severe bloating when I eat too many carbs. What I noticed is that the pain was the worst when
I was still taking Baclofen. I always noticed that I get immense back pain after taking Baclofen and I thought
it was a muscular problem. But now I am 100% sure it isn't because of the way the symptoms start. The pain
is a very dull ache between my shoulder blades, a bitter taste in my mouth and abdominal gas.

I also noticed that my nose gets completly stuffy, especially when going outside. The moment I breathe in cold air,
it gets completly congested. I have real trouble breathing then. Sometimes I have bronchospasms when exposed to cold air.
I had lung tests aswell, but I am completly healthy according to the doctors.

Now, I think I suffer from too much choline and too little dopamine. This is what I have found out:

1. There is something called biliary dyskinesia. According to the internet, Baclofen can cause dyskinesia.
It seems dopamine hypersensitivity and an imbalance of choline and dopamine is responsible for that.
https://www.ncbi.nlm.../pubmed/8328901

2. A choline and dopamine imbalance also is responsible for opioid induced chest wall rigidity. Too little dopamine
and too much choline in specific areas.
https://www.pharmaco...r-rigidity.html

3. The esophagal hypersensitivity I suffer from also seems to be caused by too much choline.
http://misc.medscape...5-business.html

4. The heart palpations I get after eating could be caused by vagus nerve stimulation through acetylcholine release.

5. And last but not least, the sudden stuffy nose when breathing in cold air is also caused by a choline reaction:
https://www.ncbi.nlm...pubmed/18417052


Now everything looks like my problems come from cholinergic overdrive. I have read that dopamine deficiency leads to
more acetylcholine and I am sure I have wrecked my dopamine levels with months of Oxycodone. The problem is that I cannot take
any anticholinergics as I get terrible dizzyness, depersonalization and tiredness when I take them. Even the day after. I tried
amitryptiline, benadryl, trimipramine. All make me feel ill. So I try to find natural ways to lower choline and upregulate dopamine.

I also noticed that I am completly intolerant to nicotine and caffeine. Both cause muscle tension, dizzyness, anxiety. And no matter
how much I control my mind, the physical reactions are too strong. The same problem with Oxycodone.
I cannot enjoy the most normal things in life anymore because my neurochemistry is totally screwed. Of course, some of it is probably
post-acute benzo withdrawal. But I don't think that's the main problem for my problems. Because even in the most acute Klonopin
withdrawal, I didn't have this attacks of chest tightness, stuffy nose and especially the horrible gallbladder pain.

I also noticed that I do not get any euphoria from opioids anymore. It is purely stimulating. Almost like speed. Causing severe physical
anxiety. This could also be due to tyrosine hydroxylase inhibition, which also causes opioid induced chest wall rigidity.
https://www.pharmaco...r-rigidity.html
"Although opioids do not directly affect muscle tone, rigidity rapidly can be reversed by the injection of a competitive or non-competitive muscle relaxant [133]. Although the increased efferent output at the neuromuscular junction is not reduced, muscle relaxants induce their action by inhibiting the binding of acetylcholine at the motor endplate (Figure II-59)."

Anyways. I am wondering what I shall do now. No doctor can help me. I lost 20lbs already because of the gallbladder pain. Every doc says it's
purely mental. It isn't. I am sure it's a strong chemical imbalance of my neurotransmitters.

Has anyone got an idea which supplements I could take to help dampen cholinergic activity that doesn't cause anxiety by another mechanism?

I am really desperate. My girlfriends father died and I cannot take care of her because I feel so sick everyday and I always have to watch
what to eat to prevent my gallbladder or esophagus going crazy.

I hope someone has more knowledge and could give me useful information. I am not that educated in this field.

Thanks alot!

 

[Cotcha Yankinov]

First off, we are not a medical advice board and (most of us) are not medical professionals - listen to your doctors

My personal advice - I would be investigating your neck/jaw issues more thoroughly to help determine the cause of your issues. Is the diagnosis for your face/jaw pain officially TMD or has anybody talked to you about trigeminal neuralgia yet? Trigeminal neuralgia is often mistaken for TMD
http://www.jebdp.com/article/S1532-3382(01)70082-6/abstract

If it were me, I would try approaching this from a musculoskeletal/peripheral nerve irritation/compression perspective. I personally don't think people have much respect for the musculoskeletal system and all the various nerves that run through it.

So many aspects of the peripheral body are under the control of the autonomic nervous system/peripheral nerves. Its possible that whenever you eat something/chew/masticate/swallow you may be essentially irritating nerves like the trigeminal plexus and hence symptoms associated with eating. The jaw/neck muscles and the nerves are kind of a.. clusterfuck. Its surprising that more people don't have issues, really.

Also, I see some tunnel visioning on acetylcholine - I see this sort of thing happen over and over again when people are suffering a lot and not finding any real answers. I assure you that acetylcholine is not going to be fruitful to tunnel vision on.


You may ask why the symptoms associated with drug use? It could be that the drugs affect muscle tone and musculoskeletal use patterns - jaw clenching, breathing with secondary respiratory muscles like the SCM, scalenes et cetera that attach up into the jaw and affect cranial nerves, and neck posture can certainly be altered with use of drugs. A primary trigeminal neuralgia theory is one where an artery compresses a nerve - its possible that the various drugs are having effects on the nerves and arteries in question directly. Remember that baclofen is first and foremost a muscle relaxer.

Anxiety will not help in this sort of situation because it leads to altered musculoskeletal use patterns, especially engagement of "anxiety breathing" muscles like the SCM and scalenes (which once again, affect the jaw). The jaw is also clenched with anxiety. Muscle tension period tends to increase with anxiety.

I would investigate the possibility of trigeminal neuralgia thoroughly with proper neurologists. Many facial pain patients seem to be lumped in the TMD category without a second thought. There are also other conditions like chiari-malformation that may result in similar symptoms.

For now, pay attention to the musculoskeletal aspect of your mastication. Do you tend to avoid symptoms when you just drink liquids? Does heavy chewing (steak for example) cause worse symptoms? Et cetera

One thing I noticed back when I couldn't breathe through my nose is that I had a weird eating thing, I would kind of chew really fast because I couldn't breathe through my nose when eating but I refused to open my mouth and breathe through it for politeness reasons. If you're having trouble breathing through your nose (like on side of your nose closes off at night) that is something to see an ENT doctor about. Fixing your nose is really important if you can't breathe through it, for a myriad of reasons.

CY