New test for medication metabolism done by endocrinologist

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Retired Mom
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   Posted 3/8/2013 5:53 AM (GMT -7)   
Hi guys,

I had an appointment with my endo a couple of days ago and was very surprised that he decided to do a new test on me. He said he does not feel I metabolize my medication correctly and wanted to find out what is going on. They did a series of four mouth swabs (& drew blood for another test), but the swabs are sent out, along with a list of the medications you take to see how your body metabolizes the different chemicals.

He's not much of a talker, but is one of the best doctors I have ever seen. I am thinking he is simply concerned about tbe number of medications I take each day. He was happy that I went ahead with the SCS implant, but not surprised that I still have cp.

Apparently you only have to have this done once. It works on all types of pain medications and whatever else you are taking. They say I can give a copy to any doctor and to the pharmacist and they will know which drugs my body can metabolize and the proper dose to give. I seriously don't get how all of it works, but I do know it is DNA/genetic testing and that it will tell a great deal about me.

I have had one test kind of like this before, but the dr who ordered it could not read it...lol. That one was only dealing with heart disease, cholesterol, and triglycerides. It just told them which type of med would work best for me, but she never did anything with the results. I guess I should pull that back out and send it over to the endocrinologist, since he is so good.

I'll let you guys know what we find out. I do know that my urine drug screens show I haven't taken my Xanax xr for 3-5 days when I actually take it every day without fail.

If anybody has already had this done, please tell me more about it.

Thanks!

rocckyd
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Date Joined May 2012
Total Posts : 530
   Posted 3/8/2013 6:19 AM (GMT -7)   
I've heard of that test before. Let us know how it goes.
Single mom to my little man (9yrs old)
36yrs old. JRA since a kid. Chronic Uveitis, pleurisy, pericarditis, intersticial lung disease, sjorgrens syndrome, Cushing's Syndrome, gastroparisis
Bilateral TMJ replacements due to bone fusion, port-a-cath, NJ tube

sjkly
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Date Joined Dec 2007
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   Posted 3/8/2013 6:23 AM (GMT -7)   
I don't know specifically what test you had but I do know a little about genetics and drug metabolism
 
Take codiene for an example.
In a normal body codiene is metabolized into morphine at a particular rate (kind of a small percentage of metabolism)
Some genotypes don't process codiene into morphine at all and the codiene doesn't work well.
Some genotypes process more of the codiene into morphine and the codiene works really well.
Then Morphine is suppossed to be metabolized and eliminated at a certain rate.
Some genotypes don't do that.
 
So, I take a small amount of codiene (half a teaspoon of cough syrup), metabolize a larger than normal percentage of that to morphine, then don't metabolize the morphine.
I stay very dopy for 12-16 hours.
 
Also, I have cholenestrase deficiency-so certain anesthesias and paralytics last much longer than they are supposed to.
 
Most likely what your doc is testing is your ability to process codiene into morphine.
 
Mos
 
 

Post Edited (sjkly) : 3/8/2013 3:25:45 PM (GMT-7)


straydog
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Date Joined Feb 2003
Total Posts : 11532
   Posted 3/8/2013 9:23 AM (GMT -7)   
RM, I think this is awesome, its about time the medical community move forward in doing a test such as this. I think this could be a crucial bit of info that could help a person, especially ones with multiple problems that are on more than a couple of meds. Back a few years ago, I remember reading an article on a fella that had severe crohns disease. The medication the dr wanted to put him on had some side effects the dr was concerned about. The test was done and come to find out the man was not metabolizing the medicine normal at all. Once the dr got the report he started increasing this mans medication & got him in remission for the first time in years without getting his liver messed up.

Please let us know your results...Susie
Moderator, Chronic Pain Forum & Psoriasis Forum

opnwhl4
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Date Joined Dec 2008
Total Posts : 4869
   Posted 3/8/2013 9:45 AM (GMT -7)   
sjkly

A friend of mine has the same issue you have. Codiene makes him loopy for a long time. But for some reason hydrocodone doesn't work very well at all.

I had anesthesia problems like you described when I was in the hospital for a torn esophagus. Actually it happened twice there during twilight sedation for an EGD also. I ended up in ICU both times and it took over 24 hours before I remember anything.

Take care.
Bill
opnwhl4
Moderator: GERD/Heartburn
Nissen 6/06 and 5/09
#3 on 8/24/11

Alcie
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Date Joined Oct 2009
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   Posted 3/8/2013 10:25 AM (GMT -7)   
Great posts! Does anyone have more information or links? Is there testing for any other pain meds?

Morphine doesn't do anything at all for me, had it twice, IV and spinal block that didn't work. Codeine just makes me violently ill. I used to get pain relief with Dilaudid (hydromorphone), but last couple of times I needed something after surgery it hardly worked and lasted only an hour.

I'm afraid now that if, when actually, I need more surgery that I will again not be given adequate pain treatment. I'd like to ask for testing.

sjkly
Veteran Member


Date Joined Dec 2007
Total Posts : 2113
   Posted 3/8/2013 4:24 PM (GMT -7)   
Tramadol works great for me. It is metabolized differently then codiene, it relieves my pain makes me a bit drowsy but not to the point I can't function.

Matt-man&little-boy
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Date Joined Jul 2012
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   Posted 3/8/2013 5:52 PM (GMT -7)   
I can't help but think that this is the kind of information that could be harmful if the wrong doctor got their hands on it... My thinking is, if you have a doctor that sees one medication that will work phenominally, and one medication that doesn't work as well (specifically pain medication) the doc will use what works the best, and build the body's tolerance to that medication... and it seems to me, the best working stuff, in reference to pain, should be reserved for post surgery, and the like. That's just a thought that popped into my head. I can definately see though, how for some of our members who havent had any luck on pain medications, that this kind of test would be very beneficial.
Matt
360-fusion L3-4 September 2012 XLIF and ILIF procedures. disc bulg with small tear T12-L1. Rouxen-Y gastric bypass 2003, bleeding ulcer 2005, sm bowel obstuction 2011- surgicaly repaired. Left shoulder problems possible AVN not confirmed, humeral head collapsed in approximately 9mm. Dx with CRPS November 2012, both legs from mid-calf down.

skeye
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Date Joined Mar 2008
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   Posted 3/8/2013 5:55 PM (GMT -7)   
RM,

I had something similar done several years ago. It was a blood only test, but it sounds like the same thing. They did genotyping of genes that encode for the 3 major cytochrome P450 pathways in the liver. CYP450 is a very important enzyme involved in many metabolic processes, including drug metabolism. There are MANY more than 3 CYP450 pathways, but these 3 pathways (CYP2D6, CYP2C9, and CYP2C19) are responsible for metabolizing the majority of drugs that are broken down in the liver -- including most anti-depressants and pain medications.

One of my docs had me tested after years of not responding to pretty much any medication. We were especially concerned about my lack of response to essentially any and all all anti-depressants, but also my lack of response to pain medications (both opioid and non opioid meds).

It turns that I have some genetic mutations that makes 2 of these three pathways highly abnormal in me. One of them (which is considered "THE major pathway") is barely functional, if at all, and another one (which is considered "the second major pathway") does not work at all. Unfortunately, these 2 pathways together metabolize the vast majority of all pain medications, and antidepressants, as well as NSAIDs -- which explains my lack of response to everything. The head of the genetics lab actually called my doctor personally, because my results were so unusual.

The test was definitely helpful in explaining why I don't respond to anything, but unfortunately it didn't provide me with much in the way of medication options, as the list of (pertinent) medications metabolized by the one functioning pathway is very small. My doctors and I now have to look carefully at each and every medication that they want to put me on before it is prescribed, and there are many medications that I absolutely cannot take (including essentially all OTC pain relievers, with the exception of tylenol), as certain medications could cause liver damage, toxicity, or other serious side effects due to my body's inability to metabolize the medication. It also means having to adjust doses of medication that may only be partially metabolized & being careful to start new medications slowly, so we can pick up on any problems early on (I did have one serious reaction to one such medication a couple years ago).

My doctor also has to write a letter to the hospital & surgeon any time that I have surgery. As they need to know that they have to be careful with what & how much anesthesia they use, and also that I cannot metabolize certain pain medications, or that they need to use different dosages.

Anyways, I hope the testing provides you and your doc with some useful information that they can use to adjust your treatments, if necessary, & come up with the best treatment plan for you!

Oh, I'll also mention that there have been some studies done that correlate the presence of these genetic abnormalities with an increased risk/incidence of depression, which I find interesting, since depression has always been a big issue for me.

Skeye

Post Edited (skeye) : 3/8/2013 9:54:51 PM (GMT-7)


skeye
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Date Joined Mar 2008
Total Posts : 2856
   Posted 3/8/2013 10:47 PM (GMT -7)   
For those interested in more information:

This is the test that I am referring to:
www.genomas.net/lph/cyp.php
a bit more detailed description:
www.genomas.net/lph/CYP_HILOMET_Trifold_Nov06.pdf

and this is a pretty extensive list of the drugs metabolized by some of the various CYP450 pathways, as well as drugs that are inhibitors or inducers of each pathway:
medicine.iupui.edu/clinpharm/ddis/p450_Table_Oct_11_2009.pdf


Skeye

Post Edited (skeye) : 3/8/2013 9:51:52 PM (GMT-7)


kwitbugin
Regular Member


Date Joined Mar 2013
Total Posts : 94
   Posted 3/9/2013 6:20 AM (GMT -7)   
RetiredMom, Would you mind sharing what lead you to the endocrinologist? Just trying to formulate some thoughts....

Retired Mom
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Date Joined Feb 2010
Total Posts : 1752
   Posted 3/10/2013 11:10 PM (GMT -7)   
Hi guys. Sorry it took so long to respond. I see him for a pituatory disorder that prevents me from producing human growth hormone.

Skeye, the info you mentioned is virtually the exact same thin tat was referenced on the pamphlet he gave me. He asked me if my stim was helping and I tol him it eas working great, but that I had hoped to be able to go off of many of my meds and had found that I couldn't yet. He asked if I had pain all over and I said yes. He is exceptionally quiet and a great thinker. All he did was tell me he thinks I am not metabolizing some of my medications correctly and he wanted to do this test.

I find it so interesting and am honestly excited to know if there is something really odd going on with me. He is NOT my PM and honestly does not really believe in pain meds in general, but he does believe my pain levels...that I can tell.

I am particularly interested in why mscontin works, but fentynol does virtually nothing for me at all. It's like "can I take this off yet"? I also want to know why Xanax xr shows in my drug tests that I haven't taken it in 3-5 days what intake it daily. Lastly, I want to know why the nurses fuss so much about the amount of pain meds it takes to get my pain under control after any procedure or while in the hospital. Nobody wants to hurt like that. Oh, and I do have some issues waking up from surgery and have serotonin syndrome and severe migraines from ANY SSRI medications.

We shall see......he is the best I have ever seen, so I am looking forward to him coming up with something. He is also checking thyroid again ith some other exceptionally sensitive test because I have many thyroid cysts that have so far been just fluid filled and don't show up on anything except ultrasounds or MRI's. I don't even take thyroid meds.

I'll keep you guys posted and wil pass along the info so any of you can ask your own dr to order it if you feel it is beneficial.
Failed TLIF, Pituatary Disorder, Fibro, Failed Bladder Surgery, Failed Nissen, GERD, Anxiety, TMJ, Migraines, Idiopatic Reactive Hypoglycemia, Bilateral CTS, Tarsal Tunnel Syndrome, Peripheral Neuropathy, Plantar Fascitis, Tibular Tendonitis,a host of other diagnoses, & a REALLY screwed up back from the top to the bottom!!!

Retired Mom
Veteran Member


Date Joined Feb 2010
Total Posts : 1752
   Posted 3/10/2013 11:31 PM (GMT -7)   
Oh, I wanted to mention that even the smallest amount of codeine makes me (& now my daughter) vomit uncontrollably for hours. We NEVER use it for any reason in our house. So, I don't think he is looking for anything on that specifically. The pamphlet info shows the same tests Skeye had done and several more of the breakdowns like she mentioned. There were a ton of the things, including the ones she mentioned specifically. It's all odd to me because he only treats my hgh deficiency, keeps an eye on my blood sugar, and treats some resistant triglycerides. He's not primary care or even PM, but he is amazing as far as dr's go!
Failed TLIF, Pituatary Disorder, Fibro, Failed Bladder Surgery, Failed Nissen, GERD, Anxiety, TMJ, Migraines, Idiopatic Reactive Hypoglycemia, Bilateral CTS, Tarsal Tunnel Syndrome, Peripheral Neuropathy, Plantar Fascitis, Tibular Tendonitis,a host of other diagnoses, & a REALLY screwed up back from the top to the bottom!!!

LivingColor
Regular Member


Date Joined Sep 2012
Total Posts : 467
   Posted 3/11/2013 6:24 PM (GMT -7)   
The great chef Ferran Adria is one of the guys who convinced me of the validity of this kind of thing. He was one of the first chefs (publicly at least) to show in a tangible way that some people tasted specific chemicals that exist in food differently. But he is a chef, not a scientist. I was hoping someone else would pick up that research and try to follow genetic lines for it.

Specifically, a naturally occurring substance present in most vegetables (he did not explain which it was, but I think it was a sulphur compound often found in fertilizers, natural and chemical) that, when isolated from the harvested vegetable, and given to people to taste on it's own, about 60% of people found no taste to it, and the rest found it to be from mildly to extremely bitter. Every chef and foodie had their mind blown. And this was back in 2001. And it was more of a poll than a scientific study, extensive scientific notes were not kept, but Adria got curious when only certain people would complain that something tasted differently than everyone else at the table. His restaurant, El Bulli, served a tasting menu, which meant everyone at every table got served the same thing.

Now that the mapping of the genome is there, and they have had 10 years to delve into it, this type of testing for specific ailments or tendency toward ailments, along with the efficacy of existing drug treatment (my mom had a mouth swab series done the last time she went for her cardiology checkup for certain drugs usefulness for her specifically) may point toward some new types of options. Or create the market for more specific drugs to be developed.

I had not heard of the pain med screen, but it would make for valuable info. I'll have to look into it. But you're diving into a whole new set of ethics questions there, and leave that for another time.
Short version;
Original DX - Early onset osteoarthritis (dx age 2001), scoliosis, sciatica
Now 2013 - Further testing in progress, poss new diagnosis.
+bipolar disorder, migraines, macular degeneration, TIA's (they think), chronic insomnia, & more
--
God, grant me the serenity to accept the things I cannot change, The courage to change the things I can, And the wisdom to know the difference

Retired Mom
Veteran Member


Date Joined Feb 2010
Total Posts : 1752
   Posted 3/12/2013 4:54 AM (GMT -7)   
Hi guys. I talked to my psych yesterday (since he is the one who gives me the Xanax) and told him about the test. He was thrilled. He knew it immediately when I said the cyp450 thing and all of the other number letter combinations I couldn't remember.

He explained how it works in its most basic form. It is like a highway to say Atlanta (the liver). There may be one large road leading in where all the medications must travel to reach the city. In this case, the meds are metabolized in the liver to be sent on to do their jobs. There can be roadblocks if a specific medicine is not working correctly or if it collides with another one (like a wreck) and nothing behind this medicine will reach its destination. Basically, we will be able to use the test to see which med/meds/combination of meds are blocking the road (pathway) and find other ones that use smaller, less traveled roads (pathways) to still reach their destinations.

It could be something as simple as two meds binding together or greater in that I could not process certain things no matter what. I take a lot of vitamins and otc's with my scripts because of vitamin deficiencies. The blood tests all tell me what to take, but not how they all interact with each other.

I like the analogy of the road because it gives a visual picture of the pathways our meds follow to reach our pain points.

He said he has done the same testing using vials of saliva on occasion, but that he rarely uses it yet. He did say he may start again if he can find the company that does the swabs. I will be giving him the results, of course, so he can contact them from there.

I hope this helps explain the test in a simple and clear way. I know there are obviously others here who understand the more intricate parts, but I wanted to give a basic explanation for the members who never studied this.
Failed TLIF, Pituatary Disorder, Fibro, Failed Bladder Surgery, Failed Nissen, GERD, Anxiety, TMJ, Migraines, Idiopatic Reactive Hypoglycemia, Bilateral CTS, Tarsal Tunnel Syndrome, Peripheral Neuropathy, Plantar Fascitis, Tibular Tendonitis,a host of other diagnoses, & a REALLY screwed up back from the top to the bottom!!!

Retired Mom
Veteran Member


Date Joined Feb 2010
Total Posts : 1752
   Posted 3/12/2013 5:02 AM (GMT -7)   
Living Color,

I absolutely love the info!!!! How cool is that!! It's also really interesting that you mention that some people can taste things others cannot. I find Splenda impossible to swallow in even the smallest amounts. It is a horrible taste to me, but I don't know anyone else who says they can even taste it. I love a diet coke, but I cannot swallow a coke zero. They say they cannot tell the difference.

I love how you were able to put the two types of information together because genetics play a part in almost everything. And, yes, I do see the ethical issues, but I won't get into that one here either...lol
Failed TLIF, Pituatary Disorder, Fibro, Failed Bladder Surgery, Failed Nissen, GERD, Anxiety, TMJ, Migraines, Idiopatic Reactive Hypoglycemia, Bilateral CTS, Tarsal Tunnel Syndrome, Peripheral Neuropathy, Plantar Fascitis, Tibular Tendonitis,a host of other diagnoses, & a REALLY screwed up back from the top to the bottom!!!

kwitbugin
Regular Member


Date Joined Mar 2013
Total Posts : 94
   Posted 3/12/2013 6:57 AM (GMT -7)   
I hope this test sheds some light for you and your doctors. Good Luck!

LivingColor
Regular Member


Date Joined Sep 2012
Total Posts : 467
   Posted 3/13/2013 11:28 AM (GMT -7)   
RM, if you can track down the TV show "Decoding Ferran Adria" with Anthony Bourdain, he kind of demonstrates it in that show. Neither chef could detect it, but the interpreter went running to the cooler for water immediately upon tasting it. That was the lighbulb moment for me.

Imagine that if some people taste food differently, they may interpret colors differently, and anything that can affect one sense could affect others. And it all comes down to nerve endings, and how the brain uses the information.

And about the Diet Coke/Coke Zero thing? I'm the exact opposite. Weird, huh?
Short version;
Original DX - Early onset osteoarthritis (dx age 2001), scoliosis, sciatica
Now 2013 - Further testing in progress, poss new diagnosis.
+bipolar disorder, migraines, macular degeneration, TIA's (they think), chronic insomnia, & more
--
God, grant me the serenity to accept the things I cannot change, The courage to change the things I can, And the wisdom to know the difference
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