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Does anyone else have a problem with vommiting or their colon not working?

Mya Symons

Mya Symons
Messages
1,029
Location
Washington
I have been vomiting a lot lately. I've noticed if I stay out in the heat for an extended period of time, I vomit (it takes about a half an hour of heat and then the vomiting comences). Also, when I eat any greasy food, I vomit. And then there are the many times it seems to happen for no reason.

I also have a problem with what seems to be the muscles at the end of my colon. It seems as if it no longer works to push waste out, if that makes sense. And because of that, everything gets stuck at the turn before my rectum (I think that is the term for the end segment of your colon). It's not the same as constipation because it is not hard or wide, it just won't move out until my sigmoid colon is full (which will probably cause my problems in the future). I went to "google academy" and looked this up and it came back with sphincter paralysis. Have you heard of that? If so, can you let me know what you know, please and thank you.

Has this stuff happened to anyone else?
 

kat0465

Senior Member
Messages
230
Location
Texas
Mya,
I went thru about 6 months of vomiting.2 months was intense couldnt hold anything down. They scoped me and didn't find much of anything:/

It slowly got better after months, and I lost almost 50 lbs! As for the colon thing, it could be a rectocele. Or something called a peritoneal prolapse. I have both.

In 08 they tried to fix the rectocele, but it didn't help:( it sounds a lot like what's happening with you, it's like things get stuck in the curve,lol. ;( geez tmi I know. I'll spare you the details.

You might need to see a gyno.

Kat
 

Sing

Senior Member
Messages
1,782
Location
New England
You might check out the Dysautonomia Information Network www.dinet.org And look into

The Vagus Nerve

I think the vagus nerve is responsible for vomiting, slow or no stomach emptying, peristalsis and other stuff.

Others here know more than I. Just wanted to indicate a direction for your inquiries!

Sing
 

TinyT

Senior Member
Messages
150
Location
Australia
I have vomited a few times, from a severe gastritis flare up, and also from a really bad POTS episode. I also get IBS type issues (alternating diarrhea & constipation), I think thats probably a POTS/dysautonomia complication too.

Do you have problems with orthostatic intolerance or POTS? The dinet website is great. Heat would definately cause any OI or POTS/dysautonomia to flare up.

If you have any sort of autonomic dysfunction (e.g. OI, POTS, NMH etc) it also makes sense that other autonomic system functions can get screwed up too- like digestion, HR, BP, temperature etc.

Do you have any problems with gastritis or your gallbladder? that could also be a cause of your vomiting.
 

Sing

Senior Member
Messages
1,782
Location
New England
TinyT, you may not be asking me, but I'll join in anyway by saying I have Orthostatic Intolerance, the NMH kind. Had bad constipation most of my life, which changed in 2006 after several really terrible days of vomiting within one month. Then I had diarrhea for a year and a half until I gradually brought that down with a very strict diet. Now my bowel function is normal for the first time in my life, and though I have some dietary restrictions, they don't have to be so strict.

Those times of vomiting started by trying to have breakfast on a day I was also stressed and hurrying. I don't think my stomach emptied or digestion was able to work at all, it being morning and me being under stress. So Plan B went into effect, which was vomiting. Only it was severe and long lasting. Not food poisoning.

I learned not to eat breakfast until later in the morning, or whenever I feel I can handle it, and to keep it simple and small. Now, I have to wait until my stomach is ready to digest, not just forcing food on it as before. To me, this is an issue of not being able to multi task. Can't seem to digest AND be hurrying, standing, talking or otherwise busy. One thing at a time I can do.

Disautonomic symptoms are prime characteristics of ME/CFS according to the Canadian Consensus Definition
 

TinyT

Senior Member
Messages
150
Location
Australia
TinyT, you may not be asking me, but I'll join in anyway by saying I have Orthostatic Intolerance, the NMH kind. Had bad constipation most of my life, which changed in 2006 after several really terrible days of vomiting within one month. Then I had diarrhea for a year and a half until I gradually brought that down with a very strict diet. Now my bowel function is normal for the first time in my life, and though I have some dietary restrictions, they don't have to be so strict.

Those times of vomiting started by trying to have breakfast on a day I was also stressed and hurrying. I don't think my stomach emptied or digestion was able to work at all, it being morning and me being under stress. So Plan B went into effect, which was vomiting. Only it was severe and long lasting. Not food poisoning.

I learned not to eat breakfast until later in the morning, or whenever I feel I can handle it, and to keep it simple and small. Now, I have to wait until my stomach is ready to digest, not just forcing food on it as before. To me, this is an issue of not being able to multi task. Can't seem to digest AND be hurrying, standing, talking or otherwise busy. One thing at a time I can do.

Disautonomic symptoms are prime characteristics of ME/CFS according to the Canadian Consensus Definition

Thanks for sharing, its good to know that someone else has similar symptoms!

I've found that I can have breakfast (a small one albiet) but I have to sit with my feet up for the next hour or two. If I have a busy day and have to get ready & go out, then I've discovered I need to not eat very much at all (like perhaps a banana or muesli bar). Otherwise I get really POTSy and its triggers diarrhea and extreme nausea. If I really aggrevate my POTS, thats when I throw up (so unpleasant).

It does make sense with all the autonomic dysfunction going on, that if you try to put food in your stomach and force it to digest when you are busy/doing things, then it goes into emergency evacuation stage! (e.g. it quickly comes out one end or another!)
 

Mya Symons

Mya Symons
Messages
1,029
Location
Washington
Thank you for the information. Kat, I had a hysterectomy recently, and got a post op infection. They looked at my intestines with a scope during this time and didn't mention anything about a rectocel. However, the doctor in the emergency room mentioned that my colon may have been nicked so who knows if they told me everything. Sing, I do have most of my digestion problems during periods of hot weather. Maybe this does have something to do with NMH. I hope I can find a doctor I can afford someday who will believes CFS and NMH exists and get tested.

Anyway, I am going to stop myself before I go on and on about doctors. Thank you for responding.
 

taniaaust1

Senior Member
Messages
13,054
Location
Sth Australia
I also have a problem with what seems to be the muscles at the end of my colon. It seems as if it no longer works to push waste out, if that makes sense. And because of that, everything gets stuck at the turn before my rectum (I think that is the term for the end segment of your colon). It's not the same as constipation because it is not hard or wide, it just won't move out until my sigmoid colon is full (which will probably cause my problems in the future). I went to "google academy" and looked this up and it came back with sphincter paralysis. Have you heard of that? If so, can you let me know what you know, please and thank you.

Has this stuff happened to anyone else?

I have some kind of issue there too which I dont know is the same as what you are talking about or not, I havent asked my doctor about it the thou (too busy with all the other medical stuff).

For me its like feaces is collecting in the lower part of my bowel just before the anus. It builds and builds up in that area before I end up going to the loo. I dont know why I arent getting like signals to go before it builds right up there (it can be felt all built up there as if there was a pocket in that area, this build up can be felt throu the skin if felt for) and by that point I have to help myself go by pushing on the skin (sphincter paralysis??? The sphinter or very end of the bowel dont seem to be pushing out well). This is happening at times even when it should be being able to be pushed out.

sorry if this is excessively descriptive.. i dont know how else to describe if it sounds as the same as what you have going on or not.

It isnt only like there is some kind of weakness going on which there obviously is as some times I just cant go but like there is also some kind of lack of signals so allowing for the issue to get worst and I wonder if that area inside of me is getting stretched and hence enlarging. I think sometime in the future Im going to have to see a doctor about my lower bowel not functioning right.
 

Sing

Senior Member
Messages
1,782
Location
New England
This problem at the end of the large intestine would really worry me, and did, when I had it. I added enough psyllium and water to make things move out, and rarely, a laxative. I think it IS possible to stretch out that area where feces builds up and gets very hard, and the problem gets worse. Then it is seems almost impossible to pass and tears at the anus area, which is very painful. This also contributes to distended veins in the area. Whatever it takes to make digestion work seems worth it!
 

richvank

Senior Member
Messages
2,732
Hi, Mya and the group.

Here's a hypothesis for the problem of low motility in the lower gut in ME/CFS:

It's known that the neurotransmitters used by the enteric nervous system to control gut motility are acetylcholine and serotonin.

It's known that some choline normally comes in from the diet, but a significant fraction of the body's inventory of choline is produced in the body.

It's also known that the production of choline in the body (via the conversion of phosphatidylethanolamine to phosphatidylcholine) is the second largest user of methylation in the body (after the production of creatine, which is number one).

We have found that nearly all PWCs who have taken the methylation pathways panel have a partial block in their methylation cycle.

It therefore seems reasonable to suspect that choline is deficient in ME/CFS. (Note that there have been some magnetic resonance spectroscopy experiments on the brain in ME/CFS that have been interpreted as showing that choline is high, but as I've explained before, I believe that this interpretation was incorrect.)

It seems to me that deficient choline could result in insufficient production of acetylcholine, and that that could interfere with gut motility.

Serotonin production also appears to be impacted by a partial block in the methylation cycle. This occurs because of the link between the methylation cycle and the folate metabolism, and the apparent link between the folate metabolism and the biopterin cycle. Tetrahydrobiopterin is needed for the reaction that converts tryptophan to 5-HTP, which in turn is converted to serotonin.

Thus, I think that the partial methylation cycle block can explain problems with gut motility in ME/CFS. If this is true, treating to lift the partial methylation cycle block should relieve these problems. Methylation treatment has been discussed voluminously on these forums.

Best regards,

Rich
 

taniaaust1

Senior Member
Messages
13,054
Location
Sth Australia
This problem at the end of the large intestine would really worry me, and did, when I had it. I added enough psyllium and water to make things move out, and rarely, a laxative. I think it IS possible to stretch out that area where feces builds up and gets very hard, and the problem gets worse. Then it is seems almost impossible to pass and tears at the anus area, which is very painful. This also contributes to distended veins in the area. Whatever it takes to make digestion work seems worth it!

sing.. I dont know about the original poster but in my case bulking it up so its softer isnt always helping.. the bowel is still like frozen. Its like the "paralysis" or whatever the issue is is still there. On occassions Im using suppositories now (not glycerine or oil ones but stronger ones which cause spasming) as they seem to be able to cause the spasms/contractions my bowel is completely lacking at times.

i do sometimes get constipation too so know what that is like (and yeah psyllium helps that if its constipation.. I use psyllium etc).. but this bowel paralyses is something else which in my own case seems to be separate to constipation.. thou constipation does commonly happen in it. (I think maybe the constipation happens due to the slow bowel movement .. rather then things moving slow due to constipation).
 

Mya Symons

Mya Symons
Messages
1,029
Location
Washington
Hi, Mya and the group.

Here's a hypothesis for the problem of low motility in the lower gut in ME/CFS:

It's known that the neurotransmitters used by the enteric nervous system to control gut motility are acetylcholine and serotonin.

It's known that some choline normally comes in from the diet, but a significant fraction of the body's inventory of choline is produced in the body.

It's also known that the production of choline in the body (via the conversion of phosphatidylethanolamine to phosphatidylcholine) is the second largest user of methylation in the body (after the production of creatine, which is number one).

We have found that nearly all PWCs who have taken the methylation pathways panel have a partial block in their methylation cycle.

It therefore seems reasonable to suspect that choline is deficient in ME/CFS. (Note that there have been some magnetic resonance spectroscopy experiments on the brain in ME/CFS that have been interpreted as showing that choline is high, but as I've explained before, I believe that this interpretation was incorrect.)

It seems to me that deficient choline could result in insufficient production of acetylcholine, and that that could interfere with gut motility.

Serotonin production also appears to be impacted by a partial block in the methylation cycle. This occurs because of the link between the methylation cycle and the folate metabolism, and the apparent link between the folate metabolism and the biopterin cycle. Tetrahydrobiopterin is needed for the reaction that converts tryptophan to 5-HTP, which in turn is converted to serotonin.

Thus, I think that the partial methylation cycle block can explain problems with gut motility in ME/CFS. If this is true, treating to lift the partial methylation cycle block should relieve these problems. Methylation treatment has been discussed voluminously on these forums.

Best regards,

Rich

Hi RichVank....etc. I agree that I am probably low on Choline. Before I became ill, I took a diet pill that contained Choline, Pyruvate and all the Vitamin B types. I always felt so much better when I took it. I decided to try it again a few years ago (while I was ill) to see if it made me feel better. I did feel somewhat better. Then I read about CFS and FMS and how Choline could build up in the brain and decided it would be better not to take it. I think you are right, though, and I am actually low on Choline.

I have always been interested in trying your methylation protocol, however, there are certain vitamins I cannot digest. For example, the iron in adult vitamins always makes me vomit about 15 to 20 minutes after I take it. Further, large amounts of potassium and calcium also make me vomit. L-Carnitine is another supplement that makes me sick.

When it comes to iron, I can only take slow-fe or certain children's chewable vitamins and as long as the calcium and potassium are regular doses, I don't vomit. L-Carnitine is probably something I will have to avoid completely unless there is a slow release version.

Does your methylation protocol include these vitamins and supplements in adult strength doses or high doses? If so, could you recommend a substitution.?


Regarding the end of my colon not working (rectum/sphincter?): I have tried Psyllium and digestive aids like Align (I can't remember the names of the others, but there have been many). These don't work for me. I think it is because it is not a constipation or digestion problem in this case. I am having the problems because the muscles are just not working. The doctor has told me that at times my sigmoid colon has been significantly swollen. He has no idea why (either does the gastroenterologist). I have had a colonoscopy with a biopsy and they can't find anything wrong. I think it is swollen because there is so much back up. The doctor said if it keeps up I might have to have my sigmoid colon removed. I don't understand why he would say that if he can't figure out what is wrong in the first place. It doesn't make much sense.

Anyway, I am fed up with this problem and am just not sure what to do.

Tania, all I can say is exactly. The only thing that works for me and only sometimes is strong enema. The muscles are not moving. At times I can't even feel I have to go the bathroom and I think it is only gravity pushing things out. It's getting to be very upsetting.
 

richvank

Senior Member
Messages
2,732
Hi RichVank....etc. I agree that I am probably low on Choline. Before I became ill, I took a diet pill that contained Choline, Pyruvate and all the Vitamin B types. I always felt so much better when I took it. I decided to try it again a few years ago (while I was ill) to see if it made me feel better. I did feel somewhat better. Then I read about CFS and FMS and how Choline could build up in the brain and decided it would be better not to take it. I think you are right, though, and I am actually low on Choline.

I have always been interested in trying your methylation protocol, however, there are certain vitamins I cannot digest. For example, the iron in adult vitamins always makes me vomit about 15 to 20 minutes after I take it. Further, large amounts of potassium and calcium also make me vomit. L-Carnitine is another supplement that makes me sick.

When it comes to iron, I can only take slow-fe or certain children's chewable vitamins and as long as the calcium and potassium are regular doses, I don't vomit. L-Carnitine is probably something I will have to avoid completely unless there is a slow release version.

Does your methylation protocol include these vitamins and supplements in adult strength doses or high doses? If so, could you recommend a substitution.?


Regarding the end of my colon not working (rectum/sphincter?): I have tried Psyllium and digestive aids like Align (I can't remember the names of the others, but there have been many). These don't work for me. I think it is because it is not a constipation or digestion problem in this case. I am having the problems because the muscles are just not working. The doctor has told me that at times my sigmoid colon has been significantly swollen. He has no idea why (either does the gastroenterologist). I have had a colonoscopy with a biopsy and they can't find anything wrong. I think it is swollen because there is so much back up. The doctor said if it keeps up I might have to have my sigmoid colon removed. I don't understand why he would say that if he can't figure out what is wrong in the first place. It doesn't make much sense.

Anyway, I am fed up with this problem and am just not sure what to do.

Tania, all I can say is exactly. The only thing that works for me and only sometimes is strong enema. The muscles are not moving. At times I can't even feel I have to go the bathroom and I think it is only gravity pushing things out. It's getting to be very upsetting.

Hi, Mya.

Here's the content of the multi that is part of the simplified protocol.

There is some calcium and potassium, but the dosages are pretty small. There is no iron. There is some L-carnitine (100 mg divided by three, equals 33 mg.)

There may be other multis that have the essentials, but not the things that bother you, but I don't know specifically of one to suggest. Perhaps others have suggestions.

Serving Size: 6 Tablets (note that up to 2 tablets per day are used in the treatment)

Amount per serving: Vitamin A (as palmitate)5000 IU,Vitamin C (ascorbic acid)500 mg,Vitamin D (as cholecaliciferol)400 IU,Vitamin E (as d-alpha tocopheryl succinate)400 IU,Vitamin K (as phytonadione)40 mcg,Vitamin B-1 (as benfotiamine)25 mg,Vitamin B-2 (as riboflavin)12.5 mg,Niacin (as niacinamide)37.5 mg,Vitamin B-6 (as pyridoxal-5-phosphate)12.5 mg,Folic Acid100 mcg,Vitamin B-12 (cyanocobalamin B12)250 mcg,Biotin150 mcg,Pantothenic Acid (as d-calcium pantothenate)50 mg,Calcium (as calcium d-glucarate)25 mg,Magnesium (as citrate, oxide)100 mg,Zinc (as monomethionine)5 mg,Selenium (as L-selenomethionine)100 mcg,Manganese (as arginate)1 mg,Chromium (as polynicotinate)100 mcg,Molybdenum (as amino acid chelate)75 mcg,Potassium (as citrate)5 mg,Broccoli florets powder160 mg,Citrus bioflavonoids50 mg,Choline (as bitartrate)25 mg,Inositol25 mg,PABA (para-amino benzoic acid)5 mg,Garlic (Allium sativum) bulb powder200 mg,L-methionine150 mg,Milk thistle (Silybum marianum) seed extract100 mg,N-acetyl-cysteine75 mg,Pine (Pinus maritimus) bark extract25 mg,Taurine250 mg,Turmeric (Curcuma longa) root extract50 mg,Intrinsic Factor5 mg,Trimethylglycine (TMG)50 mg, Free Form Nucleotide Complex100 mg,Boron1 mg,L-Carnitine (Tartrate)100 mg.

(Ref.: http://www.holisticheal.com)

Best regards,

Rich
 

Sing

Senior Member
Messages
1,782
Location
New England
Tania and Mya,

I would be really troubled too if my nerves too weren't working for peristalsis. What are the nerves which govern this? Does the vagus nerve? I wonder what is happening with the signalling for you?
 

Emootje

Senior Member
Messages
356
Location
The Netherlands
I just read a nice article about the autonomic nervous system and the stomach/intestine. http://www.physiologymodels.info/ans/abdominal.htm

Summary:

Stomach
*Vagus nerve (parasympathetic) > acetylcholine > muscarinic 3 (M3) receptors > stimulation of stomach motility
*Vagus nerve (parasympathetic) > acetylcholine > muscarinic 1 (M1) receptors > stimulation of gastric juice
*Celiac ganglion (sympathetic) > (nor)epinephrine > alpha 1 receptors > decreases blood flow to the stomach and decreases the passage of food from the stomach into the small intestine
*Celiac ganglion (sympathetic) > (nor)epinephrine > alpha 2 receptors > reduces acetylcholine secretion
*Celiac ganglion (sympathetic) > (nor)epinephrine > beta 2 receptors > reduces gastric motility

Intestines
*Vagus nerve (parasympathetic) > acetylcholine > muscarinic 3 (M3) receptors > increasing motility
*Mesenteric ganglion (sympathetic) > (nor)epinephrine > alpha 1 receptors > decreases blood flow and constriction of anal sphincter
*Mesenteric ganglion (sympathetic) > (nor)epinephrine > alpha 2 receptors > reduces acetylcholine secretion
*Mesenteric ganglion (sympathetic) > (nor)epinephrine > beta 2 receptors > reduces motility

stomachimage.gif

a.JPG

@Mya
As you maybe already know, most ME/CFS patients have increased levels of plasma norepinephrine (probably due to low blood volume) These increased levels of plasma norepinephrine lowers gastric motility and can provoke symptoms like nausea and vomiting. If your symptoms are getting worse in (nor)adrenaline situations (stress, exercise, heat, cold) I would definitely recommend you to read more about gastroparesis.
http://en.wikipedia.org/wiki/Gastroparesis
Treatment:
Erythromycin
Metoclopramide
Domperidone

Another thing that can explain your vomiting is bile reflux.
http://www.mayoclinic.com/health/bile-reflux/DS00651
Treatment:
Ursodeoxycholic acid
Proton pump inhibitors

Hope this information was helpful.
 

xchocoholic

Senior Member
Messages
2,947
Location
Florida
I didn't read this whole thread but was hoping you knew how common this was in the case of food intolerances. I will cough up phlegm within minutes drinking soy milk ... IMHO, the elimination diet is the best way to find this. hth ... x
 

Mya Symons

Mya Symons
Messages
1,029
Location
Washington
Diarrhea Too

I forgot to add to this that often times after several days or weeks of backup from intestines not moving, I will develop extreme intestinal cramping and diarrhea. It is like suddenly everything starts up again on high speed. I have had IBS for as long as I can remember. Much longer then I have had CFS or FMS. The pain and cramping from these episodes is much more intense. Maybe it is something I eat or drink that I have recently developed an allergic reaction to, or maybe it is the swelling in my sigmoid colon. I don't know. I have had biopsies of my Sigmoid colon and I do not have Ulcerative Collitis or Chron's Disease. The doctor described it as distended. I looked this up and the definition is swelling from the inside or pressure from within. That sounds like it is caused from the backup.

I wonder if lack of blood flow to a part of a person's intestines can cause similar problems? It seems like a another fatigue problem. The intestines are so fatigued and drained of energy that they no longer can do their job.

I can't remember who talked about phlegm after eating or drinking something. I started out having a similar problem whenever I would get a milk shake or malt. I could also feel it building up in my chest. Now it is happening when I drink milk with fat, like 2%. Maybe I will have to give up even the nonfat milk. Could milk be the cause of the sudden diarrhea issue and such bad cramping? I really love chocolate milk and Starbucks Hot Chocolate. :(
 

Mya Symons

Mya Symons
Messages
1,029
Location
Washington
I just read a nice article about the autonomic nervous system and the stomach/intestine. http://www.physiologymodels.info/ans/abdominal.htm

Summary:

Stomach
*Vagus nerve (parasympathetic) > acetylcholine > muscarinic 3 (M3) receptors > stimulation of stomach motility
*Vagus nerve (parasympathetic) > acetylcholine > muscarinic 1 (M1) receptors > stimulation of gastric juice
*Celiac ganglion (sympathetic) > (nor)epinephrine > alpha 1 receptors > decreases blood flow to the stomach and decreases the passage of food from the stomach into the small intestine
*Celiac ganglion (sympathetic) > (nor)epinephrine > alpha 2 receptors > reduces acetylcholine secretion
*Celiac ganglion (sympathetic) > (nor)epinephrine > beta 2 receptors > reduces gastric motility

Intestines
*Vagus nerve (parasympathetic) > acetylcholine > muscarinic 3 (M3) receptors > increasing motility
*Mesenteric ganglion (sympathetic) > (nor)epinephrine > alpha 1 receptors > decreases blood flow and constriction of anal sphincter
*Mesenteric ganglion (sympathetic) > (nor)epinephrine > alpha 2 receptors > reduces acetylcholine secretion
*Mesenteric ganglion (sympathetic) > (nor)epinephrine > beta 2 receptors > reduces motility

View attachment 6130

View attachment 6131

@Mya
As you maybe already know, most ME/CFS patients have increased levels of plasma norepinephrine (probably due to low blood volume) These increased levels of plasma norepinephrine lowers gastric motility and can provoke symptoms like nausea and vomiting. If your symptoms are getting worse in (nor)adrenaline situations (stress, exercise, heat, cold) I would definitely recommend you to read more about gastroparesis.
http://en.wikipedia.org/wiki/Gastroparesis
Treatment:
Erythromycin
Metoclopramide
Domperidone

Another thing that can explain your vomiting is bile reflux.
http://www.mayoclinic.com/health/bile-reflux/DS00651
Treatment:
Ursodeoxycholic acid
Proton pump inhibitors

Hope this information was helpful.

Yes, Thank You. It was helpful. I think it could very well be gastroparesis. If a person was taking a norepinephrine reuptake inhibitor, would that increase levels of plasma norepinephrine?
 

Emootje

Senior Member
Messages
356
Location
The Netherlands
I wonder if lack of blood flow to a part of a person's intestines can cause similar problems?

If it's more extreme it is called Non-occlusive Mesenteric Ischemia (NOMI).
NOMI can present with abdominal pain, nausea, vomiting, and ileus.
http://archie.kumc.edu/bitstream/handle/2271/339/Non-Occlusive Mesenteric Ischemia.pdf?sequence=1

If a person was taking a norepinephrine reuptake inhibitor, would that increase levels of plasma norepinephrine?
Some norepinephrine reuptake inhibitors do increase levels of plasma norepinephrine.
 

Sing

Senior Member
Messages
1,782
Location
New England
Emootje, that is very helpful to see the nerves involved and pathways to various actions.

Question: What would be examples of some norepinephrine reuptake inhibitors?