PPI Stepdown

I’ve been on PPIs (Nexium, esomeprazole) since my VSG surgery in 2016. My four year anniversary is coming up and I really don’t want to continue on PPIs. They are prescribed liberally and people are on them for YEARS, just like me, but now we’re starting to see some of the longterm problems of taking a PPI (Proton Pump Inhibitor) such as H Pylori, malabsorption of minerals and even kidney damage. This article is a good round up of all that PPIs can damage. You can’t just stop taking a PPI because of rebound GERD that is worse than the original. The proton pumps (digestive acid) go into overdrive without the inhibitor – which is what’s happened the last two times I attempted to get off PPIs.

I’ve been having more and more issues with the PPI in the last year. I started having intense histamine reactions to random foods a few months ago, so I found a histamine blocker (Seeking Health Histamine Block is AWESOME!) that worked. I had to take it daily to keep the reactions from happening. When I researched it, guess what was the culprit? Yep. PPI.

Next, I started having leg cramps. I know that PPIs retard mineral absorption, and after some research, I confirmed that the PPI was likely interfering with potassium as well as calcium and magnesium. So I got a potassium supplement.

THEN, I realised that the list of things I was taking to OFFSET the damn PPI was getting longer and longer. It made no sense to keep adding more and more supplements to offset a drug that has known issues for long term use.

So, I began my step down from 1.5 tablets a day (1 20mg in the morning and a half tab before bed; 30mg/day) about six weeks ago. First I moved the time I took the single pill to evenings so it would peak while I am asleep. Breakthrough GERD is worse at night when you’re laying down. I dropped the second dose entirely. This worked pretty well, there were random bouts of GERD at random times, but it was OK for the most part.

Last week, I changed to half a tab at 9pm ONLY. So far, so good. I still have random bouts of GERD that have no pattern. I can chew a few TUMS to tame them down. I have a bed wedge, which has helped with the occasional night time breakthrough GERD. But it’s the same as the one dose was, so I’m encouraged.

I’ll stick with the half tab for a few more weeks, then I’ll attempt ZERO PPI. It’ll work or it won’t. I’m hopeful that it will work and I can get by with random bouts of GERD that can be handled with TUMS. Or perhaps I can go back to an H2 blocker (Tagamet, etc.) at night if necessary. The H2s have far fewer side effects than the PPIs.

I hope I can be rid of PPIs once and for all. They are TERRIBLE for you.

I will post again with the results of the end of PPIs.

Sweet n Sour Chuck Roast

This is a combo of a couple of recipes I read online plus my leanings towards Asian flavours! I only got one shot of it, sadly. I hope you enjoy!

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Sweet n Sour Roast

This is an easy one pot roast that is loaded with umami! If you like tons of gravy, then you'll want to up the liquids by half. Mine was pretty tight. Also, you might need to adjust the cook time according to the size of your roast. Mine was only 2#. Add 20 mins per pound over that. You may also wish to up the veg with the size of the roast, to ensure you have enough for serving.
Course Main Course
Cuisine American, Asian
Keyword easy roast, roast beef, sweet and sour,
Prep Time 30 minutes
Cook Time 2 hours
Servings 6
Author misangela

Equipment

  • Dutch oven

Ingredients

  • 1 1-2# Chuck Roast Any kind of roast will work, even pork or lamb
  • ½ pound small potatoes halved or 3/4" dice large potato
  • 1 med white onion frenched or med dice
  • 2-3 carrots 3/4" dice
  • 1 leek, sliced white part only optional
  • 1 small pack cremini mushrooms, thickly sliced button shrooms are fine
  • 1 Red or green Bell Pepper optional, but adds nice colour; I used Korean peppers (green)
  • 3/4 cup soy sauce
  • 5-6 cloves garlic, diced
  • 1 Tbl ginger paste or freshly ground ginger
  • 1/2 cup seasoned rice wine vinegar
  • 2 Tbl sesame oil
  • 3 Tbl brown sugar
  • 1 cup sake sub chicken or beef stock
  • S/P

Instructions

  • Clean the roast of any visible silver skin or large pockets of fat.
  • Set oven to 325ºF.
  • Season the roast with S/P and set aside while you prep the veg.
  • Put the dutch oven on med high heat with 2 Tbl oil. When oil is shimmering, brown the roast on all sides. Set aside roast and turn down heat to medium.
  • Add veg to pot and cook gently for about 5 mins.
  • Add roast back into pot in the center, nestled in the veg, still on medium heat.
  • Add brown sugar, ginger paste and sesame oil and rub into roast.
  • Add soy and RW vinegar. Stir everything to get it all coated. Turn off heat.
  • Add about 1/3 of the sake or stock.
  • Put on the lid and into the oven on the center rack. Set timer for 2 hrs for a 1-2# roast and add 20 mins for every pound over that.
  • Check every hour or so to make sure it's not too dry. You may need more liquid than a cup. I suggest alternating stock and sake and finishing with stock so you won't have a raw sake flavour. It's also a good idea to check seasoning about halfway through cooking to see if it's too salty or needs salt. Too salty = add some water; not enough salt, add soy or salt.
  • Roast is done when it falls apart with a fork.

Almost Four Years!

Esomeprazole image courtesy Shutterstock.

It’s been almost four years since my VSG surgery. It feels like a lifetime ago. Lots of crap has happened since then: my car died, so I got a new car, Nick’s job ended, pub project failed, and now we are recovering.

I’ve been taking Nexium (esomeprazole) daily since my VSG surgery in May 2016. After the healing period, I discovered that I had HORRIBLE GERD if I didn’t take some sort of PPI. They had me on Prilosec (omeprazole) after surgery, but it was giving me the absolute worst side effects, so I knew I couldn’t keep taking it. I tried H2 blockers (Tagamet, etc.), but they didn’t work well for me. So I ended up on esomeprazole, twice a day, a full 20mg tablet in the morning and a half tab before bed. I have been doing this for almost four years.

While I have zero GERD while on this PPI, I have a multitude of other issues to deal with. The only physical side effect I’ve had from the get-go is diarrhea. However, PPIs affect absorption of vitamins and minerals, not to mention that they are seeing kidney damage start to crop up with people who have been on it for years. The nature of how a PPI works prohibits the absorption of calcium in particular, but it basically messes up absorption of everything.

I’ve been taking supplements to try to offset the affects of esomeprazole. I’ve been taking these things for four years:
– a good quality multivitamin
– calcium/magnesium supplement
– Vit D + K supplement
– Vit B supplement
– selenium
– CoQ10

Things have been mostly fine until recently. I suddenly started having histamine reactions. They were sparse at first, but have become an almost daily occurrence. So I started taking a histamine blocker (actually a DAO supplement) to get these reactions under control. I also started having leg cramps regularly, so I added potassium to my supplements. These extra supplements helped, but…

THEN I started to realise that ALL THESE THINGS are side effects of the PPI. I did some research and sure enough, the PPI can alter the digestion of histamines, therefore causing these reactions. I already knew about the prevention of minerals being absorbed. So I decided that what needs to happen is getting off these terrible PPIs and therefore not having all these side effects. NOT TO MENTION the other things that are happening to me long term, that I’m not even aware of, such as kidney damage and gods know what. Pubmed abstract on kidney damage. An often reposted paper by Dr Al Aly of the VA St Louis.

So, last week, I began my attempt to get off the PPI. I dropped the night time dose and moved my whole tablet dose to 5pm. By moving the whole tablet dose, the meds peak during the night and wear off in the late afternoon, when I am upright and less susceptible to heartburn. So far, so good. I’ve had some issues with break through heartburn late in the day, but nothing too terrible.

In my attempts to get off the PPI in the past, I think I’ve moved too fast. This time I’m going to stay at this dose for a month, then try knocking it down to a half pill only at night for a month, then off. I think (hope!) the key to getting off a PPI with little rebound GERD is going slowly to wean off. I hope my altered stomach can figure it out and allow me to get back to normal. ::fingers crossed::

The thing about PPIs is that the amount of the dose is irrelevant as far as absorption goes. Taking 20mg or 60mg still blocks absorption of nutrients due to the lack of digestive acids which are needed to break down foods. So I MUST be off them completely. EVERYONE should be off them, really. Doctors do not know or care to tell patients that long term PPI use is VERY bad for them. It’s easier to prescribe a PPI and be done with it. I know, as a PPI user, that yes, they do work to keep GERD at bay, but at what cost?? I really wish Drs would STOP prescribing shit to people to fix a symptom without even a thought about long term issues! Statins are another drug that is prescribed liberally without one whit of concern about the LONG LIST of interactions they have.

I’ll post here again when I step down to a half pill at night. I hope I can get off the PPI for good and I hope these posts can help others get off them, too. PPIs are not a long term solution, despite Drs prescribing them that way. Take control of your health! Research every drug you are prescribed! I guarantee you that your Dr has NOT. I hope I’ll have good news in a couple of months!

VGER

Voyager 2 Probe courtesy NASA JPL

Most of the people who are my acquaintances will know what that means. VGER.

Voyager 2 Probe courtesy NASA JPL
“Now voyager sail thou forth to seek and find.”


Yesterday, February 7, 2020, the Voyager 2 probe that has been inactive for a few weeks, was reactivated. Something happened in January and it shut down and NASA’s JPL (Jet Propulsion Lab) was unsure it would ever reactivate. Fortunately the geniuses at the JPL did get it going and it is sending telemetry once again. Brilliant! Here is the story on Inverse.

I get very emotional when I talk about space exploration. I cried when we got telemetry from Saturn’s rings. I cried today when Voyager 2 was reactivated. It is stunning that in my lifetime space exploration was begun by going to the moon and now we have a probe 11.6B miles from earth sending us info. It’s even more stunning that we can watch live telemetry IN OUR HANDS on a phone. I watched the SpaceX capsule test the other day, LIVE. If you aren’t moved by these things, I don’t know what to tell you. This is mankind’s entry into space. The final frontier.

All this brings me to my reason for this post, which is: VGER. I am a huge Star Trek nerd. I have Vulcan tattoos on my forearms. I was angry about the idiotic Klingons in Discovery and their mangling of the Klingon language. I can talk to you about ship design. I believe that we are not the only sentient beings. There is simply too many galaxies out there for this to be true. Even if EACH galaxy only has one habitable planet, that is still myriad possible species.

I was not a Trek nerd until my 20s. However, around 1980 or 81, I saw Star Trek: The Motion Picture late at night on Home Box Office, as it was called when it was new. (My family are luddites, but by the gods, they’ve always been cutting edge when it comes to TV. The cable company had to run a line to the house when they wanted to get cable!)

This movie was my entré into sci-fi. Yeah, it’s not a great movie, but that didn’t matter. It caught my imagination. It made me think: WHAT IF? What IF the Voyager probe gained sentience? I was fascinated with this and I’ve watched that movie so many times over the years, still pondering the WHAT IF? I saw a few of the Trek films in the theatre during the 80s/90s, but I didn’t fully realise my nerdom until I was introduced to TNG (ST The Next Generation series). I never cared for TOS (original series Trek), but I liked the movies. THEN I found TNG and fell in love all over again. I’m currently entranced with the movie Passengers and the notion of long term space travel that takes 100 years. I think this will be how it’s done before we figure out how to bend space time and/or create warp drive. (YES I think this is possible.)

Over the years, I have become a huge Trek and space exploration nerd. Which brings me back to the emotions I have for SpaceX, the Voyager probes and all the NASA/JPL projects. I hate that the United States has fallen so far into disarray that we can’t even run a proper space program any more, but I’m grateful that Elon Musk has taken the task himself. He realised that the US simply did not have the will to bother with space any longer (because building a racist wall is FAR more important!), and he has the money to finance himself. Boom! There we go: space exploration once again. Thank you Mr Musk, humanity owes you a lot.

I believe that space IS the final frontier. And I believe we’ll get out there one day. And I believe we’ll meet our distant neighbors. I just hope we are not assholes to them. LOL

Space: the final frontier. These are the voyages of the starship Enterprise. Its continuing mission: to explore strange new worlds, to seek out new life and new civilizations, to boldly go where no one has gone before

I’m sad that I won’t live to see all this, but I can dream, I can watch Trek and I can follow what little space news there is to follow. I hope future generations will get their heads out their asses and go forth into the universe. Live long and prosper.

Italian White Bean and Shrimp Soup

Italian White Bean and Shrimp Soup
Italian White Bean and Shrimp Soup
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Italian White Bean and Shrimp Soup

This is a delightful white bean soup. It's light and very flavorful, not to mention full of greens and fiber rich white beans. It's also really easy! I do recommend using shrimp stock if you can; directions on how to make it in the notes.
Course Soup
Cuisine Italian
Keyword cannelini, shrimp, white bean
Prep Time 15 minutes
Cook Time 15 minutes
Servings 8
Author misangela

Ingredients

  • 1 pound Shrimp Med to Large, peeled & deveined, cut in half crosswise if large
  • 1 med White onion small dice
  • 3 cloves Garlic minced
  • 1 tsp red pepper flakes
  • 1 tsp Dried marjoram optional, or use dry basil
  • 2 cans Cannelini, Navy or Great Northern white beans 14 oz, mostly drained
  • 1 can Fire Roasted Diced Tomatoes 14 oz, plain is fine, mostly drained
  • 1-2 Quarts Shrimp Stock use +/- to get the thickness you want
  • 2 Cups Lightly packed baby arugula rough chopped
  • 8-10 leaves Fresh Basil chiffonade, then cross chopped
  • 12 leaves Fresh Oregano chopped (optional)
  • 1 med Lemon zest and juice
  • Extra Virgin Olive Oil

Instructions

  • Start the shrimp stock first, if you're making your own. I highly recommend this!
  • In a large pot, add in about 1 Tbl olive oil and put over med heat.
  • Add in onion, garlic red pepper and dried herb. Cook until translucent, do not brown, about 5 minutes.
  • Add beans, tomatoes and lemon zest. Allow to cook for 2-3 minutes.
  • Add shrimp stock and bring to a simmer. Adjust seasoning. Simmer for 2-3 minutes, then turn off heat.
  • Add shrimp, arugula, basil, oregano and lemon juice. Let stand about 5 minutes before serving.
  • Serve with a turn of extra virgin olive oil on top and toasted baguette.

Notes

Make your own shrimp stock!  Just save the shells from shrimp and simmer for about an hour with some salt in a 2 quart stock pot. SO GOOD! Really makes a difference in this soup. 
As you use shrimp, put the shells in a freezer bag and when you have a bagful, make stock by adding 1 qt of water for every quart bag of shells. Simply simmer for about an hour and add some salt. I make stock and store in the freezer, but if you don't have space, just keep the shells and use for stock as you need it.