Thanks Mark. I'm getting better at making connections between what I put into my body and what happens to it. I'll let my doctor know about how Nortriptyline might be affecting me.

It's a balancing act: do I try to make myself go to the bathroom or risk another headache in the process

Start eating a diet higher in fiber. Get a bowl of chili w/ beans. It works for me. Plus, increase your water intake.

Years ago, I had chronic constipation due to a paralytic ileum and needed a softener/spasmodic combined laxative for about 6 months. It helped things run smoother.

Thanks. I'll take in more water and try to get some chili w/beans. Sounds pretty good right now as another winter storm has come upon us.

I should probably avoid caffeine but I drink coffee which probably doesn't help my situation. Maybe I can switch to decaf for awhile.

About 5 years ago I had an Ileum issue too where they said a part of it expanded kind of like a balloon. They found out because I ended up in the ER needing a - are you ready? - the big E. Talk about panic, but I survived.

About 4 years of IBS (irritable bowel syndrome) followed but things somehow seemed to work themselves out. In the meantime I learned all the relief tricks like home enema kits (on Amazon), suppositories, and related things like Miralax, etc.

I hope to never be in a real jam again (no pun intended).

My paralytic ileum was due to a TOS cervical problem. Once the cervical issues were resolved, the system started working. I probably lost 3 or 4 pounds that first day after my PT got the ileocecal valve to release. I had it so long before treatment that the intestines were distended due to weak muscles and bloating and I needed the spasmotic laxative to exercise the muscles back into shape.

It can be surprising to see how many systems can be messed up by poor nerves exiting the spine.

That really is remarkable. I just looked up TOS (Thoracic Outlet Syndrome).

I'm glad someone finally made the connection between that and your paralytic ileum issue. Similar to PCS I suspect it was no easy road.

I'm impressed that you have a good command of the knowledge behind the ailments you have encountered and the treatments for them. I need to use your example and start to understand the treatments I am getting into and if/how/why they work.

As I approach the beginning of my cervicogenic PT I'll be reading more to understand its principles and effectiveness.

I've come a long way though these past few weeks as just reading a few web pages would have been too much for me. Not sure if its the Occipital Nerve Block a from few weeks ago or the Nortriptyline.

I find it is important to understand what happens to my body because up until 2007, I paid for all of my medical care, in either premiums or co-pays or out of pocket. I did work that could be abusive to my body so I needed to know how to minimize my medical costs and stay working.

Doctors usually struggle to think out of the box so it can help if they are given a nudge. I've had Standford Med School docs who are also professors who were baffled so I found someone who could think outside the box.

I have a number of symptoms that are caused by spine issues, TOS, gastric issues, esophageal reflux, tingling hands and forearms, and more. Treating the cause was a lot better than treating the symptom.

One doc wanted to schedule me for emergency carpal tunnel surgery until I told him how I had does some things that caused a substantial improvement since I first scheduled the appointment 6 weeks prior. He decided it was worth waiting and see if my improvement continued. 25 years later, I have still been able to avoid surgery. I need to be disciplined with how I use my hands but it beats surgery.

I can understand how saving money can be a big incentive in doing research. It reminds me of one of Malcolm Gladwell's books where he says many things come down to incentives. I don't remember the specifics exactly but I'm pretty sure he mentions money as one of them.

"Treating the cause was a lot better than treating the symptom."

I certainly agree with this. Right now my concern is because I think Nortriptyline is working I might prolong my PCS healing time by not recognizing things that aggravate my condition.

It's confusing. Could be ON Block or Nortip - guess I need to be vigilante and do things in moderation.

I'm glad you were able to avoid surgery. This sounds a great example of how someone can improve their own situation by doing their own research.

By the way, quick question: Do you have any advice on how people can determine when and how to come of a med like Nortriptyline? If it's working over time should I give it awhile then slowly reduce the dosage and keep an eye out for symptoms?

It's not going to cause healing but it can reduce some symptoms (insomnia, headaches, depression) so your brain can be under less stress and heal.

I would think that coming off, you would want to step down. A reduced dose for a week or more to see if the reduced dose allows any symptoms to return.

That's interesting. Thanks. Getting my brain under less stress sounds pretty good.

I certainly feel better after so long. I'll keep the Nortrip steady for awhile and at some time reduce the dose. That sounds like a good way to go - just try it for a week and see how I feel.

I appreciate your help. Thanks.