Author Topic: St. John's Wort and my story  (Read 36825 times)

asdfdoc

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St. John's Wort and my story
« on: August 29, 2012, 08:28:48 PM »
Hello guys,

I also suffer from POIS since I was 16. However, I don't think if my is immunologic cause.

Let me introduce myself first. I am 27 yo male. I am a healthcare professional (doctorate). I've been doing a lot of research on symptoms specific to me by reading pubmed articles and I worked with psychologists and psychiatrist to come up with differentials. None of them ever heard of my POIS symptoms

First of all, I have ADHD and social anxiety.
I was given 3 differentials for possible for my other symptoms: depression, bipolar type 2 disorder, PTSD

I ruled out immunologic cause. How? I got sterilized needles, syringes and all! I read papers given in this forum. Diluted "that" to 400k:1 did skin test (like TB), no reaction. Repeated it to 1000:1, no reaction. I concluded that my cause is NOT immunologic.

I have following other symptoms in addition to ADHD and social anxiety
1. fatigue (physically and mentally) within 5 minutes lasting up to 2-3 days. Symptoms significantly improve with at least 3 hours of sleep
2. irritability (normally)
3. premature ejaculation
4. slow metabolism (unless I work out)
5. obsession to one topic that I am interested in (currently POIS and all these diagnosis)
6. mild OCD
7. problem weight control

I personally thought all these symptoms including ADHD and social anxiety are connected. They may not be, but this is the way I am approaching my problem. My hypothesis is that all my symptoms come from one genetic defect, a hormonal one. My dad has similar symptoms and problems.

I avoided dealing with all these until 3 months ago till I tried to write a paper but I kept failing because of my ADHD (dopamine problem). I saw a psychiatrist and was put on Modafinil first then Adderall later. Modafinil at high doses (200mg) and adderall at low doses (2.5mg to 5mg) temporarily but completely restored me for 3-4 hours. However, they didn't work if I take medications before orgasm. For example, I take an adderall 2 hours before sex then I would still experience POIS. They only worked if they were taken afterwards. Adderall gave me lots of problems such as stage 2 hypertension and mania. Adderall did not help me with ADHD what so ever. So I stopped taking them completely.

However, on one of the adderall trial days, I was feeling moody so I took a 5-htp (serotonin precursor), then I was able to focus really well for the first time in my life. This was a break through! This got me thinking that I may have problem with serotonin system instead of dopamine system. I did a trial run. After a week long break from sex, I took 12hr time release 100mg 5-htp at 6PM and I noticed slight mood lift, then I had sex around 11PM. Oh boy, I was fatigued for about 30 minutes after sex, but then I came right back to normal! 100mg instant release did not work but time release one worked. I actually was so energized, I went again! then I passed out. I slept fine as well. Next morning I woke up with the muscle fatigue especially abdomen area. I also took 5-htp time release one in the morning. I didn't really experience the mood lift this time and I had a very vivid nightmare and night terror at night (this happened before).

I was ready to go talk to my doctor to get me prescribed for an SSRI. But my doctor did not give it to me. Reason being, her differentials included bipolar 2 disorder, an SSRI to my system will trigger mania and that is not good. My doctor is correct and I support her decision not to prescribe me anything. My doctor suggested therapy and possible mood stabilizer later in the future as another trial. However, I am curious, obsessive and angry. I had to at least test out my hypothesis. Although my symptoms did fit very mild version bipolar 2 description (my gf also said she doesn't think I have bipolar 2), all my symptoms mentioned above pointed to serotonin deficiency. I had to try either continue trying 5-htp twice a day or something else. 5-htp gave me night terrors and I read somewhere that 5-htp can cause heart problems, so that was not my first option. So I looked around for alternative way of testing out this hypothesis.

St. John's wort is herbal treatment that is known to act similar to MAOI except the real mechanism is still unknown. It is readily available at food stores w/o prescription. It is known to work similar to SSRI (serotonin most favorably). But I've also read a research paper that said that SJW causes 160% increase in extracellular dopamine and 140% serotonin. SJW (and all SSRI, SNRI and MAOI) is known to not have any noticeable effect for 4-6 weeks. Despite my doctor's warning, I had to try St. John's wort. I'd figured that this route of solving problem may calm me to find out if serotonin works or not than just anxiously wait for next appointment in 3 weeks.

I started taking SJW yesterday. Instruction says you have to take 3 pills per day spread out. I took 1 pill at 6PM, I noticed immediate mood lift w/o any hypertension. 9PM, I took another one and I had sex at 11PM. POIS symptom is no longer there. Slept fine, I actually woke up with a very mild abdomen cramp. Today, I took 1 pill at 7AM, 2nd pill at 12PM, then I had sex at 12:30PM, no POIS symptoms. I still had focus problem but everyone around me said that is actually normal after sex. And I was able to focus fine 3 hours after! I took my 3rd pill at 5:30PM and I am still POIS symptoms free. My mood was excellent and I was not irritable the whole day. I don't know if my anxiety issue is still present. I still have to experiment more. The most amazing this is that I actually felt an immediate effect from SJW instead of waiting 4-6 weeks! I tried googling this around, but I was only find a handful of people who felt an immediate effect from SJW and there wasn't much information from them. I know this is not a placebo effect because there is no way I am awake and focused enough to type this on this forum. I plan to take SJW for about 3-4 more weeks and I hope all my other issues go away. If I do experience a manic or a full-blown bipolar event, my hypothesis is rejected and I am back to square one.

Just in case you guys are interested in what other supplements I take, I take: 500mg calcium, fish oil, multivitamin, 300mg chelated magnesium

I hope this helps someone!

kurtosis

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Re: St. John's Wort and my story
« Reply #1 on: August 30, 2012, 03:39:03 AM »
Very cool. SSRI's had minimal benefit for me. I did notice that they lowered my libido and that does control POIS somewhat, but not in a good way :)
I found SNRI's to work better and NaSSa's to put me to sleep. If the goal of a treatment is to help you stop worrying about POIS then NaSSa's were great. I don't remember a thing that happened the first week I took them and spent more than half of it in bed asleep. I concluded that unless the psychiatrist was going to pay my salary and I could spend the next few years dosing then I'd have to try something else!

Other posters have reported benefits from St John's Wort in the past. I think there's material on the Naked Scientists Forum about it. Demografx will probably remember.
There's gotu kola in the ginkgo supplement I'm taking and it's plausible that's increasing amine levels.  There seems to be some synergy in how these herbs work together but I've noticed if I take 240mg the day before and the day of an O, I don't feel the "POIS effect' of complete inability to focus within minutes of an O. Now my O's are sort of pleasant and lack of focus is short or non-existent. To give an example, I had an O, took some more ginkgo, ate a yoghurt as I felt "protein hungry" and went back to working on an engineering paper with no obvious problems. Indeed, I even had a few good ideas.

I've also tried modafinil and noticed only a short lived improvement. The first 6 hours were fun and I wondered what it would be like to spend the rest of my life taking it :D

Must be interesting to be a healthcare professional with POIS. Have you any idea what the genetic hormonal problem might be?
Would you be interested in getting the genotypical DNA analysis at 23andme?
I'm wondering whether POIS sufferers would have anything noticeable but I'd rather do it if others are doing it to so I have results to compare it with.

I've noticed that my grandfather had and father have a fondness for dopamine boosting foods (chocolate, high tyrosine protein like cheese & yoghurt) and things like periwinkles which contain vinpocetine. I believe they're were/are self medicating a milder form of POIS.

asdfdoc

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Re: St. John's Wort and my story
« Reply #2 on: August 30, 2012, 08:31:50 AM »
23andme $299. Sold me. I am curious. oh god.

Woke up today w/ a very mild abdomen cramp again, but much better than yesterday. I am on SJW now and I feel great. No signs of POIS.

As far as dopamine boosting foods, I cannot eat any dairy because of lactose intolerance since age of 20. I have taken tyrosine supplements or egg whites. No help. Tyrosine just makes me super hyper, especially with my multivitamin (b-25 complex w/ all other vitamins).

There are other ways to test out my hypothesis. legal or illegal way. If I take a capsule of MDMA after sex, then my symptoms disappear completely or I become manic, that will give me a definite answer. Interesting, but it's a possibility. I do not plan on doing this. I am curious, but I am now against all drug use. And plus, SJW (MAOI) or SSRI with MDMA use is extremely dangerous.

Years ago when I was young (I am still pretty young), I tried most of drugs once each just for the experience so I have no regret in the future. SJW effect felt like an extremely mild version of phenethylamine (ie, 2ce, 2ci), LSD or shroom come down to me. Not sure if you guys are familiar with these, hallucinations occur due to serotonin stimulation, and these are all serotonin agonists. However, my friends describe the comedown of these psychedelic drugs as a very mild version of what they feel after sex. Obviously, I wouldn't know because I don't have a baseline. Normal people (my friends) describe post-orgasmic feeling as tired yet energized and relaxed, lacks focus for about an hour, but come right back to normal state. Again, they said that post orgasmic feeling is comparable to a weak version of psychedelic drug come down. And that's just what I am feeling with SJW.

Another interesting thing that I noticed when I experimented with hallucinogens long time ago was that I needed more dosage than regular people to even feel anything. I would need 3x LSD dose to even see lines becoming waves and I did not even trip at the end. I took 5g of shroom and I only saw waves of lines. However, it looked like my serotonin system in other parts of my body like my gut is totally working; this meaning I get nausea and all the bad side effects similar at the same dose to what others feel. All side effects are there but hallucinations were minimal and weak. Oh god, I remember I spent like 3 hours in the bathroom because of diarrhea on shroom trip. All jokes aside, I think I know there's something wrong with my serotonin system.

I am guessing my serotonine gets flushed out with an orgasm. Possibly my reuptake of serotonin is impaired, or simply there are too many serotonin receptors? Who knows? I gotta keep experimenting. BTW, I do not advocate any illegal drug use!
« Last Edit: August 30, 2012, 12:19:03 PM by asdfdoc »

kurtosis

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Re: St. John's Wort and my story
« Reply #3 on: August 30, 2012, 02:17:27 PM »
23andme $299. Sold me. I am curious. oh god.

Woke up today w/ a very mild abdomen cramp again, but much better than yesterday. I am on SJW now and I feel great. No signs of POIS.

As far as dopamine boosting foods, I cannot eat any dairy because of lactose intolerance since age of 20. I have taken tyrosine supplements or egg whites. No help. Tyrosine just makes me super hyper, especially with my multivitamin (b-25 complex w/ all other vitamins).

There are other ways to test out my hypothesis. legal or illegal way. If I take a capsule of MDMA after sex, then my symptoms disappear completely or I become manic, that will give me a definite answer. Interesting, but it's a possibility. I do not plan on doing this. I am curious, but I am now against all drug use. And plus, SJW (MAOI) or SSRI with MDMA use is extremely dangerous.

Years ago when I was young (I am still pretty young), I tried most of drugs once each just for the experience so I have no regret in the future. SJW effect felt like an extremely mild version of phenethylamine (ie, 2ce, 2ci), LSD or shroom come down to me. Not sure if you guys are familiar with these, hallucinations occur due to serotonin stimulation, and these are all serotonin agonists. However, my friends describe the comedown of these psychedelic drugs as a very mild version of what they feel after sex. Obviously, I wouldn't know because I don't have a baseline. Normal people (my friends) describe post-orgasmic feeling as tired yet energized and relaxed, lacks focus for about an hour, but come right back to normal state. Again, they said that post orgasmic feeling is comparable to a weak version of psychedelic drug come down. And that's just what I am feeling with SJW.

Another interesting thing that I noticed when I experimented with hallucinogens long time ago was that I needed more dosage than regular people to even feel anything. I would need 3x LSD dose to even see lines becoming waves and I did not even trip at the end. I took 5g of shroom and I only saw waves of lines. However, it looked like my serotonin system in other parts of my body like my gut is totally working; this meaning I get nausea and all the bad side effects similar at the same dose to what others feel. All side effects are there but hallucinations were minimal and weak. Oh god, I remember I spent like 3 hours in the bathroom because of diarrhea on shroom trip. All jokes aside, I think I know there's something wrong with my serotonin system.

I am guessing my serotonine gets flushed out with an orgasm. Possibly my reuptake of serotonin is impaired, or simply there are too many serotonin receptors? Who knows? I gotta keep experimenting. BTW, I do not advocate any illegal drug use!

Yep, must try 23andme and report back.
Tyrosine makes me feel a bit hyper if I take 1g. At 500mg it's good.  When combined with taurine it's great. Taurine seems to reduce my stress reaction. I've noticed that with tyrosine and taurine on board I can work longer and handle pressure much better. Foods that are high in tyrosine (or just tyrosine itself) work well for me after an O.

asdfdoc

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Re: St. John's Wort and my story
« Reply #4 on: August 30, 2012, 09:05:37 PM »
Kurtosis, what did your report say? may I take a peek? via PM?

kurtosis

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Re: St. John's Wort and my story
« Reply #5 on: August 31, 2012, 03:31:25 AM »
Kurtosis, what did your report say? may I take a peek? via PM?

I'll tell you the lot once it's done :) Will probably be sometime next month. I'll be traveling a bit at the start of the month so I won't be able to send any sample in for a while.

Hoping

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Re: St. John's Wort and my story
« Reply #6 on: August 31, 2012, 11:08:55 AM »
asdfdoc -- That's interesting news. I'm glad you're finding some relief. I know some others have experimented with SJW in the past. Keep posting about your experience, even if you find it to be a dead end! The more collective knowledge we have, the better.
May I ask what brand and dosage you're taking?
Experienced POIS since 2002.
My symptoms include: brain fog, depression, physical and mental fatigue, memory problems, social anxiety, concentration problems, myalgia, inflammation.

Nightingale

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Re: St. John's Wort and my story
« Reply #7 on: August 31, 2012, 04:51:45 PM »
Sorry, not about St. JOhns, but about Modafinil (Provigil).  I took this drug, and 2 nights later I had a MASSIVELY bad reaction to it.  I had a psuedo-seizure, felt like my entire body was being electrocuted.  I say psuedo because that's the closest way for me to describe it.  I never lost consciousness, but I fell to the ground.  I was sweating PROFUSELY and in a panic.  I was on an SSNRI at the same time, and a doctor commented that the norepi upregulation could have lead to a major imbalance when I took modafinil.

5 days later it precipitated my first psychotic episode.  There is no history of that in my family.  Provigil really messed me up.
Turmeric and Rosemary 30-45 minutes before orgasm for anti-inflammatory and immune support has helped me a lot. Faster and easier than niacin approach.

kurtosis

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Re: St. John's Wort and my story
« Reply #8 on: September 01, 2012, 05:46:39 AM »
Sorry, not about St. JOhns, but about Modafinil (Provigil).  I took this drug, and 2 nights later I had a MASSIVELY bad reaction to it.  I had a psuedo-seizure, felt like my entire body was being electrocuted.  I say psuedo because that's the closest way for me to describe it.  I never lost consciousness, but I fell to the ground.  I was sweating PROFUSELY and in a panic.  I was on an SSNRI at the same time, and a doctor commented that the norepi upregulation could have lead to a major imbalance when I took modafinil.

5 days later it precipitated my first psychotic episode.  There is no history of that in my family.  Provigil really messed me up.

Why did the doctor prescribe you both then? It does seem it was very risky.

asdfdoc

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Re: St. John's Wort and my story
« Reply #9 on: September 01, 2012, 11:25:09 AM »
Guys. I have been having sex everyday ever since. Sjw cures about 90%. I take an additional 5htp time release 100mg. Cured 100%. I wonder how it's gonna affect me in 4-6 weeks. I cannot wait!!!

kurtosis

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Re: St. John's Wort and my story
« Reply #10 on: September 01, 2012, 12:57:08 PM »
I've heard that SJW appears to be produced to erratic quality can you let us know what brand you're taking?
Do you believe that its action is attributable to a dual benefit of being a Dopamine & Serotonin reuptake inhibitor and to it's ability to inhibit dopamine hydroxylase (or so I've read - http://www.ncbi.nlm.nih.gov/pubmed/15536462 )
It seems this imbalance could be the POIS effect that we're all familiar with.
It does seem we have multiple threads on poiscenter all convering on catecholamine imbalances.

Also, has anybody on poiscenter talked to Dr. Selwyn Dexter to discuss his hormonal theory of POIS?

asdfdoc

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Re: St. John's Wort and my story
« Reply #11 on: September 01, 2012, 04:38:34 PM »
hey I take Nature's bounty brand at walgreens. 300mg tid.

As far as dopamin agonist property, I don't believe it. I looked it up on pubmed as well. I can differentiate the dopamine high and serotonin high. I've experienced too much with drugs. St. John's wort feels to me like a serotonin high only. There is no increase in BP or pulse like adderall gives me. But I may not be right.

I had a hypertensive crisis with 10mg adderall tid one time. But like I mentioned in the first post, 5-HTP co-administration with adderall somehow cured my ADHD. I am trying that combo again today. I took 2 SJW doses today at 7am and 12am, and 100mg 5-HTP timed release at 7AM. I just administered myself 2.5mg adderall about 45 minutes ago (right now 2:30PM). It's kicking in now. It's definitely killing the serotonin effect. I am gonna wait until 2:45 and if I don't feel much I am gonna administer 2.5mg adderall more to see if I can get "focused". I do know that MAOI and Adderall are a very dangerous combo. But I am continuously monitoring my BP and have benzos ready next to me just as a backup plan.

One thing I noticed is that I am hypersalivating. With SJW, my salivary flow has doubled (3ml/min to 7ml/min). It's a common symptom of increased serotonin in system. My girlfriend told me that she doesn't wanna kiss me anymore :(. hahahaha!

Will report back later tonight!
« Last Edit: September 01, 2012, 04:40:54 PM by asdfdoc »

Daveman

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Re: St. John's Wort and my story
« Reply #12 on: September 01, 2012, 07:08:52 PM »
Just be careful Please.

WITHOUT RESEARCH THERE WILL BE NO CURE!
Sessions 5 to 9 days, mostly Flu-like, joints, digestion problems, light cognitive.
Niacin has changed my lif though, now 1 day MAX.
Somewhere in this interaction with Niacin is the answer!

asdfdoc

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Re: St. John's Wort and my story
« Reply #13 on: September 01, 2012, 09:05:37 PM »
update, adderall didn't work on me. took 5mg total, no effect what so ever. vitals are within normal limits. I may repeat this again in a couple of more weeks.

Never mind. adderall worked on me, I became super talkative but still unable to concentrate. I talked to my pharmacist friend and he thinks I may have "too much dopamine" to begin with. That can also cause ADHD. Too much dopamine and too little serotonin? http://phys.org/news197040238.html



« Last Edit: September 01, 2012, 10:39:15 PM by asdfdoc »

Stef

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Re: St. John's Wort and my story
« Reply #14 on: September 04, 2012, 02:25:08 PM »
hey I take Nature's bounty brand at walgreens. 300mg tid.

As far as dopamin agonist property, I don't believe it. I looked it up on pubmed as well. I can differentiate the dopamine high and serotonin high. I've experienced too much with drugs. St. John's wort feels to me like a serotonin high only. There is no increase in BP or pulse like adderall gives me. But I may not be right.

I had a hypertensive crisis with 10mg adderall tid one time. But like I mentioned in the first post, 5-HTP co-administration with adderall somehow cured my ADHD. I am trying that combo again today. I took 2 SJW doses today at 7am and 12am, and 100mg 5-HTP timed release at 7AM. I just administered myself 2.5mg adderall about 45 minutes ago (right now 2:30PM). It's kicking in now. It's definitely killing the serotonin effect. I am gonna wait until 2:45 and if I don't feel much I am gonna administer 2.5mg adderall more to see if I can get "focused". I do know that MAOI and Adderall are a very dangerous combo. But I am continuously monitoring my BP and have benzos ready next to me just as a backup plan.

One thing I noticed is that I am hypersalivating. With SJW, my salivary flow has doubled (3ml/min to 7ml/min). It's a common symptom of increased serotonin in system. My girlfriend told me that she doesn't wanna kiss me anymore :(. hahahaha!

Will report back later tonight!


Hello Asdfdoc and Everyone!

Asdfdoc -- I'm going to be very direct here.

Your self-prescribing/taking St. John's wort -- when your psychiatrist specifically advised you NOT do so, as it could possibly precipitate a manic phase based on her evaluation of you, is alarming.

Then adding and determining your own dosage and schedule of Adderall, while having benzopdiazipines ready just in case your blood pressure shoots up ("benzos' -- i.e. Xanax, Valium, or other sedatives) is so dangerous that I'm having trouble finding the words to really describe the risks you're taking. 

NO ONE - regardless of his/her condtion -- should do what you are doing -- it's very dangerous! You may be headed for full-blown mania and/or a hypertensive stroke.
You'll think that your judgement is sound -- but it won't be.

Asdfdoc, I truly don't mean to be sound hurtful, so please know that.   You and your forum members need to understand the potential severe (if not fatal) side-effects of all of these very strong medications that you're taking in combination, and at your own discretion.

There is one other issue that bears mention here.  I know that you all may know this already. 5-HTP and other over-the-counter supplements can be purchased in any drug store. Please remember -- SUPPLEMENTS PURCHASED FROM A DRUG STORE OR HEALTH FOOD STORE CAN -- AND HAVE BEEN -- JUST AS DANGEROUS, AND HAVE AS MANY ALARMING SIDE EFFECTS -- AS ANY PRESCRIBED MEDICATION!


There is just no way -- whatsoever -- that one can self-diagnose "too much dopamine" or "to little serotonin," etc. I don't think that physicians can even diagnose this with precision.  In addition, one cannot determine if there is some sort of immune/auto-immune underpinning to one's POIS symptoms.  There's no solid, proven evidence that self-administering diluted semen shots as a test proves anything.  

Everyone here -- please be careful!!  This is playing with fire.

Stef



asdfdoc

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Re: St. John's Wort and my story
« Reply #15 on: September 04, 2012, 04:18:34 PM »
I agree with you, nordnurse. Medications listed here are be very dangerous. I am playing with fire, but I am that curious and desperate to fix my problems.

I am taking precautions such as monitoring my vitals and such to make sure I am alright. I am no way asking other members to mix these medications. It's a very bad idea. I was just experimenting on my own, in my opinion, in a safe way with low dosage. I actually told myself when I started out SJW, I would not mix anything else with it. But I failed, I gave in. My impulsiveness and curiosity took over me. I shouldn't do that. For that, thanks for posting this and reminding me that I am playing with fire. I still plan on taking SJW continuously for next 3 more weeks. Different docs have different opinions. One did say it's dangerous to try SJW, but another told me to give it a try and stop if suspects anything unusual. So here I am. But it is ridiculous that I tried mixing drugs. That's just BAD. Thankfully, I am still alive and well. I felt like I had an adderall hangover the next day. So that was crappy.

As far as diagnosis, I have no idea. This is pure speculation. It's a hypothesis and I cannot prove it. Skin test, my POIS and other symptoms and my other experiments made me conclude that my problem arises from hormonal imbalance. I performed the test that was used in the literature and I repeated it and was negative. That's good enough for me, and my symptoms are gone with SJW.
« Last Edit: September 04, 2012, 04:27:18 PM by asdfdoc »

acronym

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Re: St. John's Wort and my story
« Reply #16 on: September 10, 2012, 08:57:46 PM »
asdfdoc, I am surprised you got immediate results from taking SJW. As you said in an earlier post, it takes time for the benefits to accrue, like a number of other ADs that focus on serotonin. I am currently taking L-Tryptophan each night to help with sleep and alas, it does not seem to have made any significant dint in my pois, beyond the benefit I get from having better quality nights sleep.
I have taken SJW before, but never really noticed a great benefit from it and it made me sensitive to the sun, so I never kept up with it. As someone else said, the qualty of herbs on the market across different brands is not consistent.

asdfdoc

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Re: St. John's Wort and my story
« Reply #17 on: September 13, 2012, 07:58:37 PM »
update: this instant mood lift from st. johns came with insomnia and hypersalivation. I suspect it was hypomanic episode because I had too much energy for some reason. I didn't know how hypomanic status feels like until I felt one this time. With no baseline, it's difficult to differentiate between symptoms. Anyway, by end of week one, I ended up becoming delusional, a symptom of mania, at one point and had to call in sick for work next day. I was not hallucinating but near hallucination status, imagining stuff! I was not on anything else btw, just sjw. This event lasted about an hour. There is a chance that I may be bipolar, I am re-evaluating this case with my pdoc. Interesting development. I will be back here once I find out something.
« Last Edit: September 13, 2012, 08:00:48 PM by asdfdoc »

fsol

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Re: St. John's Wort and my story
« Reply #18 on: September 14, 2012, 05:47:55 PM »
I've been taking 1800mg of st johns wort daily for many years now due to very light depression and it's the only thing I take. I've found no connection whatsoever with my POIS and st johns wort.

demografx

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10 years of significant POIS-reduction, treatment consisting of daily (365 days/year) testosterone patches.

TRT must be checked out carefully with your doctor due to fertility, cardiac and other risks.

40+ years of severe 4-days-POIS, married, raised a family, started/ran a business