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Laurence Badgley, M.D. Profile picture
@BadgleyLaurence
Aug 21, 2019 • 9 tweets • 2 min read • Read on X
Hydromorphone (dilaudid) not interact with CYP-450 enzyme system, but rather metabolized by another pathway. Many patients w. EDS have defective CYP-450 metabolism, a genetic trait, so the active metabolites of other opiates are underproduced, resulting in ineffective analgesia. t.co/Hr0vn5P7GT
Dr. Tenant demonstrated many of the more widely promoted (by doctors) analgesics like hydrocodone (Norco) are metabolized by CYP-450 enzymes & in many people there are genetic defects (CYP-2D6, CYP-2C9, CYP-2C19) that ineffectively generate the active metabolite, w. ill results.
Doctors are mostly ignorant of these enzyme dynamics. When patients complain of ineffective analgesia, doctors assume the patient is “drug seeking”. Once branded, the patient commonly finds resistance vs. opiates from other doctors who review the medical record.
A problem in patients with pain generated in soft tissues is that blood tests & imaging studies do not reveal the pain generators, which are often inflamed entheses, loci where soft tissues (ligaments & tendons) attach to bone.
IMO, etiology of inflamed entheses is chronic biomechanical stress on soft tissues attempting to hold the body together & upright within the ambient gravitational field. Lose joints (injuries & inheritance) affect this ability. Weak muscles from sedentary inactivity are complicit
Cortisone & local injectable anesthetics can provide a few days or weeks of respite, but in #HSD patients there are frequently too many (myriad) inflamed loci to treat. This is where opiates become useful to allay pain so patients can rehabilitate.
Rehabilitation requires physical therapies to reduce (massage) muscle spasms, correct (exercise) crossed muscle syndromes, tonify (aqua therapy & walking) muscles of upright posture, and correct joint subluxations (Prolotherapy).
The general rehabilitation concept is to strengthen & stabilize the body tower. Efforts also need to be made to reduce body tower mass with a Paleolithic style ketogenic diet that is low carbohydrate high fat (LCHF).
CONCLUSIONS: Meat is good. Analgesics help rehabilitation efforts.

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More from @BadgleyLaurence

Laurence Badgley, M.D. Profile picture
Apr 16
LOOSE JOINTS, HYPERMOBITY? Gravity is at play in these women with tissue variations. When joint are unstable the obvious compensation is “gorilla” muscles to take over lax ligament efforts. A wise Physical Therapist is key. Lots of dedicated exercise also.
LOOSE JOINTS INHERITED (-15% women) is normal. These woman’s have easier births & indigo-smart children. These women are often quite attractive and smart.
ABORIGINAL SOCIETIES
CHERISHED HYPERMOBILE
WOMEN BECAUSE THEY WERE SMART & PROLIFIC BIRTHERS. INTELLIGENCE GENES LIKELY GROUP WITH HYPERMOBILITY GENES & GENES FOR BEAUTY. MEN WANTED FECUND ATTRACTIVE WOMEN SO THEY SELECTED THEM OUT.
Read 6 tweets
Laurence Badgley, M.D. Profile picture
Apr 14
HYPOPERFUSION? Yes, maybe sympathetic nervous system dominance + decreased pituitary vasopressin causing excess free water elimination in urine ⏩️ decreased blood circulation of hyperosmolar blood.
COVID-CAUSED decreased blood volume of blood that is too thick might explain orthodtstic hypotension, POTS. Might also explain the wormy blood clots.
COVID-CAUSED diminished total blood volume might evoke sympathetic nervous system activation to prevent hypotension and prevent syncope. Diminished blood volume would be expected to deliver less oxygen to tissues ⏩️ fatigue & exercise intolerance.
Read 5 tweets
Laurence Badgley, M.D. Profile picture
Apr 9
TO BE GAY ON NOT, THE QUESTION? In ancient days of the mid last century, the proper medical terminology was “homosexual”. Homo is a Greek prefix for “man” such as used in our species name, homosapiens, I think. Along the way a new adjective/noun, a euphemism, was created, “gay”.
“GAYNESS” might be adverb. I don’t know, grammar not my long suit. In any case, Anthropologist of last century seemed to be of consensus that a fixed ~15% of the population was homosexual as a transcultural genetic characteristic of homosapiens. Indeed, genes direct hormones.
TO BE GAY OR NOT: THE “GREAT H & E DEBATE” (heredity vs. environment) is a dynamic that has ever lent unending entertainment and fascination to the study of the human condition & especially to the world of medical studies.
Read 7 tweets
Laurence Badgley, M.D. Profile picture
Apr 6
MCAS & COVID:
MCAS IN LONG COVID: is possibly etiologic via biomechanisms known about MCAS, HYPERMOBILITY (HS) & FIBROMYALGIA (FM). Persons with HS & FM commonly suffer MCAS. Reason has been theorized that mast cells reside proximate connective tissue.
MCAS, HS, & FM: hyperflexible connective tissue evokes mast cell degranulation. Reactive substances provoke proximate neural tissues. Some experimental data for this dynamic. It might be that those with long COVID & MCAS expression might have hypermobility (about 15% women).
Read 11 tweets
Laurence Badgley, M.D. Profile picture
Mar 12
IC CAUSE DISCOVERED: for years clinicians have been mystified by etiology of IC. Genes, microbes, toxins, & biochemistry have failed to provide insights. IC oft occurs in women who have Hypermobility Syndrome and/or IBS. These circumstances suggest that IC is a dysautonomia.
IC A DYSAUTONOMIA? parasympathetic part of autonomic system stimulates smooth tissues of bladder & bowel to contract/evacuate those organs. Over activity of this neural network is unmeasurable, as yet, in current medical sciences. Absence of evidence is not evidence of absence.
IC CLINICAL DATA: hypermobile women are potentiated for developing pelvic girdle instability from loose sacroiliac joint (SIJ) ligaments & are prone to Mast Cell Activation Syndrome (MCAS). Dr. Afrin’s book explains MCAS. I published case studies of IC remission via SIJ fusion.
Read 9 tweets
Laurence Badgley, M.D. Profile picture
Mar 12
IRRITABLE BOWEL SYNDROME: doctors will tell you the cause is “unknown”. This is not true. IBS is commonly found in women either Hypermobility Syndrome. Reason is that these women are prone to pelvic girdle injuries and ligament laxity of one of the sacroiliac joints.
IBS & HYPERMOBILITY SYNDROME: This association well known in medical circles. Some of these women have regular daily frequent loose stools. Some have intermittent episodes of several days of constipation. Another set of these women have alternating constipation and loose stools.
IBS EXPLAINED: reason cause is “unknown” is that anatomical, tissue, and biochemical explanations are unknown and wanting. However, the dysfunction of the bowel suggests the cause is dysfunction of the autonomic nervous system, the parasympathetic and sympathetic.
Read 14 tweets

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