Contents
- Requirements
- Changes
- Sugar Intake
- Aging
- Quality of Life Assessment
- Mental Status Exam Assessment
- Notes of Appointment
- Actionable Solution
- Outcome of doctor’s appointment
- Time Line – Notes for Appointment
- Therapeutic Effect
- Therapeutic Affect
- Unbearable Side Effects
- Debilitating Side Effects
- Psychotropic Medication interfering with Neurology
- Risk of Falling and Calling 911
- What to do after a fall
- Unsteadiness side effect
- Pick one to treat mania: Abilify or Lithium
- Lithium Toxicity
Changes (2026)
- Increased Salt
- Drinking more water
- Weight gain
- 3-25-3-25 (154.0 pounds)
- 5-13-26 (168.0 pounds)
- Increase Body Fat
- https://www.nhlbi.nih.gov/calculate-your-bmi
- BMI increase to 25.9 = Overweight
- Acceptance – Do not accept side effects anymore
- Goals – No tremors & no risk of falling
- Increase Sensitivity to Side Effects
- Cyclical to Steady State Nicotine
- Quality of Life decreasing
- High sugar intake
- Aging of internal organs
- Aging Process – Sped Up
- Age related medication kinetics and dynamics
- July – Living Solo
Sugar Intake
A daily sugar intake scale measures the recommended limits for added sugars, typically capped by major health organizations at 25 grams for women, 36 grams for men, and 50 grams under general federal guidelines. One teaspoon equals about 4 grams of sugar.
Recommended Daily Limits
Women:
Maximum 6 teaspoons (25 grams or 100 calories) per day.
Men:
Maximum 9 teaspoons (36 grams or 150 calories) per day.
General Guidelines (FDA/WHO):
Maximum 12 teaspoons (50 grams or 200 calories) per day based on a 2,000-calorie diet.
Food Label Scale (Per 100g)
High (Red): More than 22.5 grams of sugar per 100g.
Medium (Amber): 5.1 to 22.5 grams of sugar per 100g.
Low (Green): 5 grams or less of sugar per 100g.
How many grams of sugar per 100g do two Reece’s Peanut Butter Cups Have?
Reese's Peanut Butter Cups contain 52.4 grams of sugar per 100 grams.
Because nutrition labels report sugar based on the exact weight of a serving rather than a flat 100g metric, the breakdown of a standard package is as follows:
Standard Package Breakdown (2 Cups)
Total Serving Weight:
A classic 2-cup package weighs 42 grams.
Sugar Content Per Serving:
The 2-cup package contains 22 grams of total sugar.
Mathematical Scaler:
Scaling 22 grams of sugar from a 42-gram package up to a 100-gram equivalent yields exactly 52.38 grams.
If you are tracking macros or monitoring sugar intake, you can look up specific product variants directly on the Hersheyland Product Directory.
Would you like to compare these numbers to the Zero Sugar version or calculate the sugar content for a different serving size (like miniatures or king size)?
With respect to medication what changes over time to cause increased side effects
Over time, increased side effects are primarily caused by changes in Pharmacokinetics and the Aging Process, specifically reduced organ clearance, altered body composition, and heightened target sensitivity.
Organ and Metabolic Changes
Decreased kidney function:
Kidneys filter drugs slower, causing medications to linger and accumulate in the blood.
Reduced liver efficiency: The liver breaks down drugs less effectively, prolonging a drug's active time in the body.
Lower blood flow:
Less blood reaches vital organs, slowing down how fast the body processes and discards substances.
Body Composition and Sensitivity
Altered fat and water ratio:
Total body water drops while body fat rises, causing fat-soluble drugs to store up and water-soluble drugs to concentrate at higher levels.
Lower protein binding:
Less blood protein (albumin) is available to hold onto drugs, leaving more "free" active medication circulating to cause adverse reactions.
Receptor sensitivity:
Brain and tissue receptors often become more sensitive to medications, especially drugs affecting the central nervous system.
If you or someone you know is experiencing new side effects, would you like to share:
The name of the medication [Lithium]
How long it has been taken [On and off since 1989]
Whether new over-the-counter drugs or supplements were recently added [No]
Quality Of Life (QOL)
QOL_SEQOL_COTS_23072907_Notes V2026
Result Up Front
QOL1, QOL5, QOL10 - Selected QOL10
[20260726-SU-Link Check Fails]
https://www.researchgate.net/figure/Descriptive-statistics-of-the-QOL10-QOL5-and-QOL1_tbl1_303469199
Transformation – QOL10 - Keith Torkelson, MS, BS Self-score - QOL10 Item Scale
20260726-SU- (*) Context of Side Effects and using walker
Baseline – Mental Status Exam (MSE)
On-going Med Problems and Meds
20260727-M: MSE Modified Scoring. Original Brief Mental Status Exam (MSE) Form 12-Item.
APS Healthcare Version (12 Items massaged into 16-Items) – Modified. For triage. Pertains to Keith “Buster” Torkelson MS on Buster. Dr. does not report our MSE back anymore. HSF = Higher scores are favorable - RT = Real Time. 1.00 = Yes | 0.00 = No | 0.50 = SoSo
20260729-W-Dr. Discontinues Lithium
Patient = Keith E Torkelson: Doctor = Rimal B Bera MD
Study Start Date = January 8 2026 (SU)
Update = For July 29, 2026 (W)
Reasoning – Morning Medications associated with side effects. Need – To eliminate the side effects listed in the table below. Debilitating & Pre-occupying Side Effects associated with morning Meds. Dangerous harm or toxic reactions. Reactions – Discovered how debilitating side effects are while preparing for our upcoming Neurological Consultation. Current important issues. Have faith in doctor in charge. Ruminations.
20260729-W-Dr. Discontinues Lithium
Med Gap Improvement
Morning Medications
Plan A – Pick just one to keep (Abilify)
Plan B– Prepare for Neurology - Eliminate morning medications – Reevaluate after neurology exam(s) [Not done]
Actual – Dr. discontinued Lithium only
Evidence – One Morning Medication Gap associated with diminished side effects
Morning Medications – Underlying Cause(s) – Safety Strategy
Goals – Control side effects before seeing the neurologist and restore QOL
Leave the nighttime medications the same
“Keep nighttime medications the same”
20260727-W-All kept the same
Psychological Ruminations
Psychological rumination is the repetitive, passive, and unproductive focus on negative feelings, past mistakes, or distress without reaching a resolution. It differs from healthy reflection because it traps the mind in a circular loop rather than producing actionable solutions.
Actionable Solution
Practical steps like setting clear goals, fixing workflow bottlenecks, and tracking measurable results.
Side effects of my psychotropic medications are worsening
Contact your prescribing doctor or psychiatrist immediately, avoid stopping the medication abruptly, and seek emergency care if you experience severe symptoms like suicidal thoughts, high fever, or severe muscle stiffness.
20260729-W-Outcome of Appointment
Basically we made progress. Dr. found it difficult to associate side effects with each medication in question. We had trouble explaining our reasoning in the minute or so we were given. We asked to discontinue Lithium and Wellbutrin. Dr. discontinued Lithium. We are making progress. As of today, July 31, 2026 (F) we have been off Lithium for two days. We notice a difference especially with hand tremors. We were able to walk about 1 mile without our walker. Walking and tremors are our primary hurdles.
As you age do you require less psychotropic medication to achieve the same result
Yes, older adults generally require lower doses of psychotropic medications to achieve the same clinical result or to avoid severe toxicity. This is due to age-related changes in how the body processes drugs (pharmacokinetics) and how the brain responds to them (pharmacodynamics).
Why Doses Change with Age
Slower Metabolism:
The liver shrinks and receives less blood flow, meaning it breaks down psychotropic drugs more slowly.
Reduced Clearance:
The kidneys filter waste and clear medications less efficiently, causing drugs to stay in the system longer.
Body Composition Shifts:
Older bodies have more fat and less water. Fat-soluble drugs (like many antipsychotics and benzodiazepines) linger longer, while water-soluble drugs (like lithium) concentrate in smaller volumes of fluid.
Higher Brain Sensitivity:
The brain and central nervous system become more sensitive to chemical effects, meaning standard adult doses can cause excessive sedation, confusion, or falls.
Safe Prescribing Principles
Start Low:
Medical providers typically begin with a fraction of a standard adult dose.
Go Slow:
Doses are increased very gradually over weeks or months while watching for side effects.
Keep It Simple:
Reviewing all current prescriptions helps prevent dangerous drug interactions.
If you or someone you care for is taking a psychotropic medication, would you like to share the name of the medication [Lithium and Wellbutrin] and the approximate age [67] of the person so I can provide more tailored safety information?
Cold Turkey off psychotropic medication
Suddenly stopping psychiatric medications can cause severe physical and psychological reactions, including discontinuation syndrome, symptom rebound, and dangerous medical crises.
Physical Withdrawal Effects
Dizziness and vertigo:
A spinning feeling that makes it hard to stand.
Flu-like sensations:
Nausea, vomiting, muscle aches, and chills.
Neurological jolts:
"Brain zaps" or sudden electric-shock sensations in the head.
Tremors and sweating:
Shaky hands, excessive perspiration, and poor balance.
Psychological and Emotional Risks
Rebound anxiety and depression:
Intense return of original mental health symptoms, often much stronger than before.
Severe mood shifts:
Extreme irritability, sudden rage, or severe insomnia.
Psychosis or mania:
High risk of hallucinations or delusions returning if antipsychotics or mood stabilizers are dropped.
Severe Medical Dangers
Seizures:
High risk when stopping certain medications like benzodiazepines abruptly.
Crisis and safety risks:
Severe panic or suicidal thoughts requiring emergency care.
Lived Experience
We have several experiences were a doctor took us completely off one or more medications all at once (Circa 2004). Poof one day and it is gone. One memorable instance was Dr. DRC took us off Ambien cold turkey. As a result our sleep became impaired which lead to a hospitalization. Dr. DMD was the most dynamic and liberal with our medication management. We were changing things up on a monthly basis to keep us going with school and work.
How to find out which medication is causing side effects?
To find out which medication is causing side effects, you should review your timeline, check official drug labels, and talk to your doctor or pharmacist.
Steps to Identify the Culprit
Check the timeline:
Note when the side effect started and compare it to when you began taking a new drug, changed your dose, or added a supplement. Side effects often appear shortly after a change.
Review drug labels:
Read the paper information sheet that came with your prescription or search the official FDA's Drugs@FDA database to see if your symptom is a known reaction.
Look for interactions:
Sometimes side effects happen when two drugs, or a drug and food, mix poorly.
Consult a professional:
Call your doctor or pharmacist. Never stop taking a prescribed medicine on your own, as they can safely guide you on adjusting doses or switching options.
Therapeutic Effect
A therapeutic effect is the intended, beneficial response produced by a medical treatment, drug, or therapy that helps heal, cure, or improve a health problem.
Key Examples
Pain Relievers:
The intended result is reducing or stopping pain.
Antibiotics:
The intended result is killing bacteria to clear an infection.
Blood Pressure Pills:
The intended result is lowering high blood pressure to safe levels.
How It Works and Compares
Target Outcome:
It is the primary goal of taking a specific medicine or doing a specific treatment.
Versus Side Effects:
While a therapeutic effect is the good and wanted result, a side effect is an extra, unintended change the treatment causes in the body.
Dosing:
Doctors try to find the right amount (dose) of a medicine to get the best therapeutic effect without causing dangerous harm or toxic reactions.
Therapeutic Affect
Therapeutic affect relates to emotional expression and regulation in healing. Key components include emotion regulation, empathetic response, and mood stabilization.
Understanding Affect in Therapy
Definition:
Affect means the observable display of an emotion during a session or treatment.
Regulation:
Learning to control intense feelings like anger, panic, or deep sadness without feeling overwhelmed.
Expression:
Safely naming and talking about internal states instead of hiding or fighting them.
How It Helps Healing
Empathy:
Therapists use a calm, supportive approach so patients see that strong feelings are not dangerous.
Growth:
Processing difficult emotions helps lower anxiety and builds better coping skills for daily life.
If you would like to explore this further, let me know if you want to focus on:
Psychological regulation techniques (like CBT or exposure)
Physiological responses to stress and treatment
Unbearable Side Effects
Severe or intolerable medication side effects require prompt communication with a healthcare provider, and key steps include evaluating symptoms, contacting a professional, and never stopping prescriptions abruptly.
When to Seek Immediate Help
Anaphylaxis:
Sudden rash, throat tightness, or trouble breathing
Severe Reactions:
Chest pain, irregular heartbeat, or severe internal bleeding
Neurological Changes:
Sudden hallucinations, severe confusion, or seizures [Going to see a neurologist]
Steps to Manage Side Effects
Document Symptoms:
Note when the side effect started and how severe it is.
Contact Your Doctor:
Call your prescribing physician before making any changes.
Review Adjustments:
Ask about changing dosages, timing, or switching medications.
Debilitating Side Effects
Debilitating side effects are severe, life-altering reactions to medical treatments like chemotherapy, steroids, or certain prescriptions that disrupt daily functioning, work, or basic self-care. Common examples include extreme fatigue, severe cognitive dysfunction, and uncontrolled gastrointestinal distress.
Common Categories of Severe Reactions
Chemotherapy:
Extreme fatigue, severe nausea, immune suppression, and nerve damage.
Steroids:
Profound mood swings, insomnia, high blood pressure, and bone density loss, and severe weight fluctuations.
Antidepressants & Psychiatric Drugs:
Serotonin syndrome, severe cognitive slowing, emotional blunting, and profound lethargy.
Blood Pressure and Cardiac Drugs:
Debilitating dizziness, orthostatic hypotension, and fainting risks.
When to Seek Emergency Help
Inability to swallow, breathe, or swallow safely.
Sudden confusion, high fever, or signs of severe allergic reaction.
Total inability to perform basic tasks or maintain hydration due to persistent vomiting or diarrhea.
If you or someone you know is experiencing severe reactions, please share:
The name of the medication or treatment causing the issue [Abilify, Lithium and Wellbutrin]
The specific symptoms you are facing [Tremors, Risk of Fall, other]
How long the side effects have lasted [Since 2024, severity has increased]
Psychotropic Medication interfering with Neurology
Psychotropic medications can interfere with neurology by causing movement issues, altering brain chemicals, and changing brain activity. Key issues include extrapyramidal symptoms, serotonin toxicity, and drug-drug conflicts.
Movement and Muscle Effects
Extrapyramidal symptoms:
Antipsychotics block dopamine, leading to muscle stiffness, tremors, spasms, or restlessness.
Tardive dyskinesia:
Long-term use can cause uncontrolled, repetitive facial and body movements.
Neuroleptic malignant syndrome:
A rare, life-threatening reaction causing severe rigidity, high fever, and confusion.
Brain Chemistry and Network Changes
Serotonin toxicity:
Combining certain antidepressants can flood the nervous system with too much serotonin, causing agitation, confusion, and twitching.
Network connectivity:
Sedatives and anxiety medications alter how different brain regions communicate, which reduces overall brain activity and alertness.
Subcortical changes:
Long-term exposure to some mental health drugs may correlate with minor volume differences in regions like the hippocampus.
Drug-Drug Interactions
Neurological overlap:
Many drugs treat both neurology and psychiatry (such as carbamazepine for seizures or mood stabilization), making combined use complex.
Counteracting effects:
Dopamine-blocking psychotropics can cancel out the benefits of neurological drugs used for Parkinson's disease.
Risk of Falling and calling 911
If you fall, stay calm and check for injuries. Call 911 immediately if you feel pain, hit your head, cannot get up, or need a lift assist.
For tips on how to prevent falls and keep your home safe:
Falls are one of the most frequent reasons people call 911. 202607: 6 months ago
Facebook · Tucson Fire Department – Risk Reduction
https://www.facebook.com/watch/?v=1456462979366224
What to Do After a Fall
Pause and breathe:
Stay still for a moment to recover from the shock.
Check for pain:
Move your arms and legs slowly to see if you are hurt.
Call for help:
Use a phone, a medical alert button, or dial 911 if you are hurt or cannot stand up.
When to Call 911
Injuries or head trauma:
Call right away if you hit your head, feel dizzy, bleed, or suspect a broken bone.
Lift assist:
If you are not hurt but cannot stand up on your own, call 911 and clearly tell the dispatcher you need a lift assist.
Preventing Future Falls
Clear pathways:
Remove loose rugs, cords, and clutter from floors.
Improve lighting:
Use night lights in hallways and bathrooms.
Build strength:
Do light exercises to improve your balance.
Unsteadiness side effect
When your equilibrium is off, the main side effects and signs are dizziness, unsteadiness, and a spinning feeling called vertigo. These issues can stem from inner ear problems, low blood pressure, or certain medicines.
Common Physical Signs
Vertigo:
Feeling like the room is moving or spinning.
Unsteadiness:
Staggering or leaning to one side when you try to walk.
Lightheadedness:
Feeling faint, wobbly, or like you might pass out.
Floating:
A strange sensation of floating or moving when standing still.
Associated Symptoms
Nausea:
Feeling sick to your stomach or vomiting, often tied to inner ear trouble.
Vision Changes:
Having blurry vision or trouble focusing your eyes.
Confusion:
Feeling disoriented or less aware of your surroundings.
Anxiety:
Feeling sudden fear, panic, or nervousness because your body feels unsafe.
Steps to get off a walker
Transitioning away from a walker requires a gradual, safe progression: first consult your doctor, move to an intermediate device like a cane, practice close to a stable wall for safety, and build core balance.
Gradual Transition Steps
Talk to your doctor:
Ensure your strength and balance are ready to reduce support.
Switch to a cane:
Move to a single-point cane held in the hand opposite your weaker leg.
Practice near a wall:
Walk alongside a sturdy wall so you can hover your hand nearby as a safety net.
Do balance exercises:
Practice heel-to-toe walking and side-stepping near a secure counter or railing.
Supervised short walks:
Take short, unassisted steps indoors on flat floors with a helper nearby.
Pick one to treat mania: Abilify or Lithium
Choosing between Lithium and Abilify (aripiprazole) for mania depends on individual medical needs, as Lithium is a classic mood stabilizer with strong long-term prevention data, while Abilify is an atypical antipsychotic that works quickly on dopamine and serotonin receptors.
Lithium [7-29-26 (W) Discontinued by doctor]
Best for:
Long-term mood stability and preventing future manic and depressive episodes.
How it works:
Acts as a traditional mood stabilizer, typically taken 2 to 3 times a day.
Monitoring:
Requires regular blood tests to check kidney function and drug levels safely.
Side effects:
Increased thirst, urination, hand tremors, and drowsiness.
Abilify (Aripiprazole)
Best for:
Fast-acting control of acute manic or mixed episodes.
How it works:
Modulates brain chemicals like dopamine and serotonin, usually taken once a day.
Monitoring:
Does not require routine blood level checks like lithium, but tracks blood sugar and movement.
Side effects:
Drowsiness, restlessness, or movement stiffness.
Lithium Toxicity
Lithium toxicity occurs when lithium levels in the blood become too high, often caused by dehydration, kidney problems, or taking too much medicine. Common signs include nausea, vomiting, shaking hands, and confusion. If you suspect a serious or life-threatening overdose, call 911 or contact the Poison Help Hotline at 1-800-222-1222 immediately.
Warning Signs by Severity
Mild toxicity:
Nausea, vomiting, diarrhea, muscle weakness, and fine hand tremors.
Moderate toxicity:
Confusion, slurred speech, extreme drowsiness, poor coordination, and muscle twitching.
Severe toxicity:
Seizures, irregular heartbeat, low blood pressure, coma, and organ failure.
Common Triggers
Dehydration:
Not drinking enough water or losing fluids through illness or heavy sweating.
Low sodium:
Eating less salt or changes in body salts that make the kidneys hold onto lithium.
Medication interactions:
Taking certain painkillers (NSAIDs), blood pressure drugs (ACE inhibitors), or water pills (diuretics).
Kidney changes:
Reduced ability of the kidneys to clear the drug from the body.
Are you experiencing severe neurological symptoms like confusion or seizures?
Did this happen from a sudden extra dose or gradual buildup?
