Hypersensitivity and Kindling

[Freeby60]

On 9/1/2022 at 8:52 AM, Shep said:

ADMIN NOTE See prior discussion here Post-withdrawal nervous system hypersensitivity, hyper-reactivity and kindling

 

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Hypersensitivity and Kindling   

 

What causes hypersensitivity? 

Some people may experience minor difficulty in stopping a psychiatric drug one time, but the next time they start, startup symptoms are much worse,  and the next time they stop, the withdrawal symptoms are worse. The nervous system can become destablilzed or sensitized from repeated adverse drug effects and withdrawal events.

 

If someone goes on and off multiple psychiatric drugs, they may be in a state of overlapping withdrawal reactions and often a persistent hypersensitivity.

 

 In One Theory of Antidepressant Withdrawal, Altostrata writes:

 

 

What is kindling? 

Kindling is a neurological reaction where repeated withdrawal or adverse drug reactions cause hypersensitivity, then hyper-reaction when the same drug or a different drug is introduced. The kindling response is an exaggerated adverse reaction to exposure to a drug. 

 

You may be vulnerable to kindling if you have a history of repeated rapid taper or cold turkey withdrawal and / or a history of heavy or chronic alcohol use, especially binge drinking -- in effect, going on and off the drug, with hyper-reaction when the drug is taken again.  

 

Generally, kindling is an activation reaction -- a sense of overstimulation, which may be an inner electrical feeling, anxiety, nervousness, panic, or at the extreme, akathisia, which includes an urge to move to relieve intense inner agitation.

 

Here is an excellent explanation on the Benzodiazepine International Coalition website: Benzo Kindling. 

 

 

While the exact mechanism of kindling is unknown, some of the details on kindling have been written about in papers on alcohol withdrawal, which like benzodiazepines, affects GABA (here is one such paper - Kindling in Alcohol Withdrawal).

 

 

While this phenomenon has been documented in the scientific literature for benzodiazepines for a long time, any drug that effects the nervous system and causes dependency can have a traumatic impact on the nervous system when changes are made often and abruptly. Research is now also pointing to kindling in antidepressant use. In the article Expertise from outside the Academy: tapering off antidepressants, Dr. Mark Horowitz cites a study by Dr. Giovanni Fava:

 

 

Example: Hypersensitivity when tapering a benzodiazepine

A benzo works by increasing GABA. Long-term exposure to benzos causes GABA receptor down-regulation and glutamate receptor up-regulation. For a more thorough description of GABA and glutamate during benzo withdrawal, see What is happening in your brain?

 

A slow and careful taper makes it easier for the receptors to gradually return to their pre-benzo state. But when there's a history of prior withdrawal, hypersensitivity may result in increased neuro-excitability, creating worsening withdrawal symptoms upon even very small dosage reduction.

 

The risk of this is much higher with a rapid or cold turkey benzo withdrawal.

 

When tapering a benzo, this withdrawal reaction can even include seizures due to a lowered seizure threshold. Stimulants and some antidepressants (such as Wellbutrin) also lower the seizure threshold. 

 

If someone is dealing with antidepressant withdrawal in addition to benzo withdrawal, neurological hyper-reactivity may be even more intense. And with serotonin needed to release GABA and glutamate (see Serotonin as a Modulator of Glutamate- and GABA-Mediated Neurotransmission), the interplay of all of this neurotransmitter dysregulation can make hypersensitivity more likely. 

 

Example: Kindling in benzodiazepine use

Some short half-life benzos (such as Halcion) and z-drugs used for sleep may cause kindling because much of the drug is eliminated in between nightly doses, a mini-withdrawal effect. Over time, this can sensitize the nervous system with repeated exposure and withdrawal in between doses. When a dose is introduced again or increased, it may paradoxically cause kindling -- an activation instead of sedating effect.

 

Repeated instances of going on and off drugs, adverse reactions, cold turkey, etc. seem to build neurological hypersensivity to drug and dosage changes, resulting in worsening adverse reactions, usually some form of activation.

 

The same may be true of the short half-life antidepressants. After a gap in dosing, a new dose, even if tolerated before, can cause a hyper-reaction. Skipping doses to taper may have the same effect, every re-introduction of the drug causing progressively worse withdrawal symptoms. (See How about taking my medication every other day to reduce my dosage? and NEVER SKIP DOSES TO TAPER).

Hopefully, more research will be published in the future regarding kindling in antidepressants, antipsychotics, drugs used as mood stabilizers, and drugs for pain. Kindling in antidepressants, for example, may involve the damage caused to the serotonin receptors by repeated on and off use of one or more of these types of drugs and the effect this has on the overall nervous system. 

 

A note on dopamine receptor supersensitivity

If you've been exposed to neuroleptics (antipsychotics), you can become hypersensitive to endogenous dopamine (the dopamine your body makes naturally) when the drug's dopamine blockage is removed. As opposed to benzo and antidepressant withdrawal caused by down-regulation of receptors, dopamine receptor supersensitivity is caused by up-regulation. However, dopamine receptor supersensitivity is not kindling - the symptoms of dopamine supersensitivity can occur without additional introduction or reinstatement of a drug or substance. You may experience dopamine receptor supersensitivity after coming off only one neuroleptic but not experience kindling. For more on dopamine receptor supersensitivity, see:

 

Chouinard, 2017 Antipsychotic-Induced Dopamine Supersensitivity Psychosis: Pharmacology, Criteria, and Therapy

 

While dopamine supersensitivity psychosis is specifically a neuroleptic withdrawal symptom, switching neuroleptics or making abrupt dose changes to the same neuroleptic can also lead to kindling. So it's important for people tapering neuroleptics to taper slowly to decrease the chances of both dopamine receptor supersensitivity and kindling. 

 

A note on limbic or psychological kindling

In this article on limbic (or psychological) kindling, the concept of being "hard-wired" for hypersensitivities is explored. If in addition to psychiatric drugs, you are also dealing with trauma, exposure to other drugs, pollutants, or chemicals, etc., you may already be in a state of chronic stress or what is also called the "flight or fight" state.  Whether this directly translates to kindling is not clear - it may be related to learned responses, especially for those who have a history of trauma. Either way, learning how to self-soothe and calm the limbic system can be very helpful. See Non-drug techniques to cope with emotional symptoms.

 

Steps to reduce the damage and mitigate hypersensitivity and kindling:

 

• Come off stimulating drugs first.
   Taking multiple psych drugs? Which drug to taper first?
   
• Consider a slow and mindful symptoms-based micro-taper.
   Micro-taper instead of 10% or 5% decrease
  The Brassmonkey Slide Method of Micro-tapering
  The slowness of slow tapers
   
• Allow withdrawal symptoms or adverse reactions to settle down before attempting another drug change.
   
• If you reinstate a drug or introduce a new drug, start at a very low dose.
  About reinstating and stabilizing to reduce withdrawal symptoms 
  The Windows and Waves Pattern of Stabilization 
  The rule of 3KIS: Keep it simple. Keep it slow. Keep it stable.

Is it possible for kindling/ hypersensitivity to cause a delayed withdrawal response. For example, after trying to CT (or a fast taper) several times I tapered off Wellbutrin within a few months with little to no wd effects. Appx 4-6 months later I was involved in a situation that triggered an acute protracted withdrawal. While my doctor has some cockamamie reasoning about the meds spinning in my brain after I stopped until it left my brain and symptoms recurred, I wonder if this occurred due to being in a hypersensitive state. It is possible? Is there a term

for it? Why would this happen?

[Ariel]

@Freeby60

 

1 hour ago, Freeby60 said:

Is it possible for kindling/ hypersensitivity to cause a delayed withdrawal response. For example, after trying to CT (or a fast taper) several times I tapered off Wellbutrin within a few months with little to no wd effects. Appx 4-6 months later I was involved in a situation that triggered an acute protracted withdrawal. While my doctor has some cockamamie reasoning about the meds spinning in my brain after I stopped until it left my brain and symptoms recurred, I wonder if this occurred due to being in a hypersensitive state. It is possible? Is there a term

for it? Why would this happen?

 

I'm not totally sure I follow your description, but maybe the help topic below could be relevant for you?

 

Delayed onset withdrawal symptoms/syndrome are an actual thing. I experienced this phenomenon myself when I came off lexapro/escitalopram, which, as evidenced by your signature, is a drug we have in common. Escitalopram seems to be notorious for delayed onset withdrawal effect. 

 

I don't know whether there's any connection between hypersensitivity, kindling, and delayed onset WD.  

My guess is it's possible to experience one without the other, and it's also possible to experience both; I don't know that there's any causal interplay. 

 

 

[Freeby60]

36 minutes ago, Ariel said:

Delayed onset withdrawal symptoms/syndrome are an actual thing. I experienced this phenomenon myself when I came off lexapro/escitalopram, which, as evidenced by your signature, is a drug we have in common. Escitalopram seems to be notorious for delayed onset withdrawal effect

This makes sense. I also tapered off Lexapro around the same time. I assumed the Wellbutrin would be it because it is a different class of AD and hadn’t experienced it. Thank you! I’ll read over the topic. Ox

[Barry2954]

You may find this article, on delayed crises following benzodiazepine withdrawal, useful. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8724079/ It is basically a very complex explanation of factors which affect the half life of benzodiazepine medications in the body, often extending that half life and delaying onset of withdrawal symptoms.

[margaretLO]

My opinion for the delayed symptoms is that the areas that got injured when you taper or cold turkey try to heal.... As an adverse reaction to the receptors... 

Or for some people the medication is built  up in their blood and tissue and needs time to get off

[Freeby60]

39 minutes ago, Barry2954 said:

You may find this article, on delayed crises following benzodiazepine withdrawal, useful. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8724079/ It is basically a very complex explanation of factors which affect the half life of benzodiazepine medications in the body, often extending that half life and delaying onset of withdrawal symptoms.

Very interesting! Thank you ox

[Freeby60]

38 minutes ago, margaretLO said:

My opinion for the delayed symptoms is that the areas that got injured when you taper or cold turkey try to heal.... As an adverse reaction to the receptors... 

Or for some people the medication is built  up in their blood and tissue and needs time to get off

Interesting. Not that far off from my doc’s idea of medication “spinning” in your brain for period of time.

[Freeby60]

@Ariel I’m curious if you be know what it is about lexapro in particular that causes delayed withdrawal?

[margaretLO]

13 minutes ago, Freeby60 said:

@Ariel I’m curious if you be know what it is about lexapro in particular that causes delayed withdrawal?

I had delay withdraws in all my attempts get off lexapro even in early years that i was very mind

I am cyp2d6 poor metabolizer... Lexapro needs this enzyme, idk if has anything to do with this enzyme.... 

[Freeby60]

I see. Thanks for that. Must’ve been very frustrating!

[Onmyway]

This may be useful to read!

[Freeby60]

20 minutes ago, Onmyway said:

This may be useful to read!

This is fabulous! Thank you 😊 

[Ariel]

On 5/13/2024 at 11:39 PM, Freeby60 said:

@Ariel I’m curious if you be know what it is about lexapro in particular that causes delayed withdrawal?

 

I don't know. I don't think anyone knows. There is so much about these drugs and their mechanisms in the body, and the lasting effects they have on the body, that is poorly understood.

 

In general, we still have so much to learn about our complex brains and bodily systems. I'd venture to say we have only begun to scratch the surface, and out of the little information we do have, we barely know what to do with it or how to apply it in practice. Regardless of how flashy contemporary technology may appear, or how sexy industry marketing will attempt to package various "advances"/"breakthroughs" (i.e. products they're trying to sell), medical science is woefully primitive compared with the vast sophistication of nature. 

 

That being said, I think you said you're working on a memoir? (Good for you, by the way.) If you want to research this topic for your book, I'd suggest you reach out to expert doctors such as Mark Horowitz, Joanna Moncrieff, David Taylor, and their colleagues. They have authored a number of papers and books about psychiatric drugs and psychiatric drug withdrawal, and I imagine they know what there is to know on the subject. 

 

Keep us posted on what you learn along the way!

[Barry2954]

It might be worth taking a look at any other medications which you might have received to see whether a particular type of medication was repeatedly used or also has the symptoms. Trying to help out someone else, who suffered myopathy after an operation, I was able to find out that she was likely to have been given a benzodiazepine anaesthetic for the operation. She had suspected the anaesthetic caused her condition but had no clue how or what to do to try to fix it. Some of the ingredients in our medications are highly toxic and the benzene in benzodiazepine medications is extremely so.

[Freeby60]

On 5/13/2024 at 12:49 PM, Freeby60 said:

This makes sense. I also tapered off Lexapro around the same time. I assumed the Wellbutrin would be it because it is a different class of AD and hadn’t experienced it. Thank you! I’ll read over the topic. Ox

Thank you very much, @ariel. Your observations and suggestions are valuable! Yes, I will keep you posted ox

[Freeby60]

7 hours ago, Barry2954 said:

It might be worth taking a look at any other medications which you might have received to see whether a particular type of medication was repeatedly used or also has the symptoms. Trying to help out someone else, who suffered myopathy after an operation, I was able to find out that she was likely to have been given a benzodiazepine anaesthetic for the operation. She had suspected the anaesthetic caused her condition but had no clue how or what to do to try to fix it. Some of the ingredients in our medications are highly toxic and the benzene in benzodiazepine medications is extremely so.

Thank you. Benzodiazepines have been part of my prescribed medications as an on needed basis, although since I was hospitalized in 2019 I am taking .5 mg daily, and certainly during the time I am questioning. I intend to be off all meds before I leave this earth. I pray I have a long and healthy life to enjoy being med free. Ox

[ScaredDad]

To everyone following this thread. I am 100% kindled and hypersensitive. Whether or not I’m having full blown ADRs to my dose is up for debate but I live 24/7 in a highly distressed state with nerve pain and strange ANS symptoms that make caring for myself impossible. It’s a miracle if I shave my face every 4 days. I lay in bed all day trying to read to figure out what to do and stop the SI. I have a wife and daughter and a baby on the way due in 4 weeks. I was totally functional until 1.5 months ago when I jumped off lexapro again not knowing anything. See signature.

 

does anyone have a recommendation on what I do? My goal is to survive tomorrow each day. I’m desperate beyond measure. My gut is telling me remove the drug but I’m scared. For reference I reacted to .4 mg of melatonin. I’m FRIED. I know the recovery will be long but please someone tell me some advice on continuing the lexapro. I cannot live. I lay in bed all day screaming in agony

 

the last 4 days every day I feel like I regress 5 miles. I’m dying 

[Ariel]

PSA from Rosetta:

 

On 9/21/2023 at 3:15 PM, Rosetta said:

Another PSA about the possibility of derailing one’s healing:

 

No amount of alcohol is a safe amount after quitting, a dose reduction, or during any taper of ADs or other psycho-active drugs.  One would think that one glass of wine would be fine.  No, it’s definitely not.  
 

Taking any other AD or psych drug is a very, very bad idea.
 

Sometimes I find it pretty irritating that no one warned me that using ADs would result in so many things being off limits. You may also have negative consequences from the adrenaline based numbing agents at the dentist’s office.  There is a non-adrenaline based agent that can be used, and I recommend that you insist on it based on my unfortunate experience.  I can’t even have a routine colonoscopy because of the sedatives.

 

Steroids, sleeping pills, anti-anxiety drugs, muscle relaxers, various antibiotics (an injury called floxxing can occur from certain antibiotics), and acne medications are also sometimes/often dangerous for people coming off of ADs.  A new trend is to make drugs that serve dual purposes such as a painkiller that includes an AD in the pill.  Prescribing ADs for pain without telling the patient that the pill is an AD is something that has been happening for years, as well.  Of course, MJ and any street drugs are quite dangerous.  
 

Essentially, if you are thinking of taking anything, check to see what other people have experienced by typing survivingantidepressants and then the name of the drug into any search engine.  At least it used to be that that would work better than using the search engine included in the site.

 

 

 

[Farm24]

2 minutes ago, Ariel said:

PSA from Rosetta:

 

 

Is this forever?

[Ariel]

1 minute ago, Farm24 said:

Is this forever?

 

It gets better! 

As long as we practice abstinence and provide best possible conditions for recovery, this will get better. 

There are plenty of success stories in the recovery forum where you can read of people healing and being able to once again enjoy a beer or glass of wine, as well as sugar, caffeine, etc. -- none of which were tolerated during WD. 

 

[Farm24]

1 minute ago, Ariel said:

 

It gets better! 

As long as we practice abstinence and provide best possible conditions for recovery, this will get better. 

There are plenty of success stories in the recovery forum where you can read of people healing and being able to once again enjoy a beer or glass of wine, as well as sugar, caffeine, etc. -- none of which were tolerated during WD. 

 

Thanks. I just was suspected to have an auto immune disease that requires a colonoscopy.  I am fine now, but I'm thinking years down the line.  Or heck, even getting pld and needing an antibiotic!

[Ariel]

2 minutes ago, Farm24 said:

Thanks. I just was suspected to have an auto immune disease that requires a colonoscopy.  I am fine now, but I'm thinking years down the line.  Or heck, even getting pld and needing an antibiotic!

 

Hi @Farm24

Should you ever find yourself needing an antibiotic, there are topics here discussing members' experiences with a variety of antibiotics. Some kinds seem to be better tolerated than others. People in WD do get antibiotic treatment when necessary and manage, and still go on to heal. 

 

As for colonoscopy, it's possible to do without sedation. Can personally attest to this. 

Another member recently had an endoscopy done without sedation: 

 

On 5/14/2024 at 6:36 PM, Tale said:

Update.

I want to share very good news. I had my endoscopy done without sedation and it went really well. I wasn't nervous and it lasted like 3 minutes. It's kind of weird that they use sedation for a procedure that is so short, but whatever. All doctors and nurses were very surprised by my decision which, I'm not gonna lie, boosted my ego LOL. I felt very proud afterwards. 

 

The most important thing is that you're fine now! 

And whatever happens, you'll cross that bridge when you come to it. 

Our community is diverse and experienced and one can almost always find someone who has successfully lived through something similar, or worse. 

You're okay, and you're healing!

Healing is happening all the time, whether or not we consciously perceive it <3

[Tigz91]

37 minutes ago, Farm24 said:

Thanks. I just was suspected to have an auto immune disease that requires a colonoscopy.  I am fine now, but I'm thinking years down the line.  Or heck, even getting pld and needing an antibiotic!

Hi, great to hear you are fine now. I’m also going through similar in terms of potentially needing a colonoscopy to check for suspected autoimmune diseases. I’m 21 months out and still struggling daily, I am super sensitive to everything even simple foods give me a reaction. 

[Farm24]

5 minutes ago, Tigz91 said:

Hi, great to hear you are fine now. I’m also going through similar in terms of potentially needing a colonoscopy to check for suspected autoimmune diseases. I’m 21 months out and still struggling daily, I am super sensitive to everything even simple foods give me a reaction. 

Oh my withdrawl is awful. Lol.  My auto immune is under control though.  I

Most of my issues left right now are muscle issues.  I cannot even take a supplement either. Heck, going to the chiropractor brought back intense hypnic jerks. 

[Ariel]

@Tigz91

 

Have a look at what Happy2Heal wrote here: 

 

On 9/27/2023 at 12:59 PM, Happy2Heal said:

 

It's hard to find a dr willing to do it, but a sigmoidoscopy has been confirmed to be just as good in finding early colon cancer as the full colonoscopy but is much safer (and cheaper and no sedation is needed) 

you might want to request that if you are concerned about colon cancer.

 

 

I know you mentioned colonoscopy in the context of checking for autoimmune diseases, and H2H is talking about sigmoidoscopy in a colon cancer context, but maybe there is inspiration to be found here for taking the time to do further research and have some conversations with your physician(s). There must be alternatives to choose from. You don't have to go into detail about WD if you don't want to, you can always say you have allergies and have had adverse reactions to XYZ before. 

And if you see my post above, member Tale had an endoscopy done without sedation, no problem. 

[Tigz91]

10 minutes ago, Ariel said:

@Tigz91

 

Have a look at what Happy2Heal wrote here: 

 

 

I know you mentioned colonoscopy in the context of checking for autoimmune diseases, and H2H is talking about sigmoidoscopy in a colon cancer context, but maybe there is inspiration to be found here for taking the time to do further research and have some conversations with your physician(s). There must be alternatives to choose from. You don't have to go into detail about WD if you don't want to, you can always say you have allergies and have had adverse reactions to XYZ before. 

And if you see my post above, member Tale had an endoscopy done without sedation, no problem. 

I was going to request a sigmoidoscopy actually because I had one 12 years ago without sedation. 

[Barry2954]

You may find this article useful. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6019704/   It explains that chronic benzodiazepine withdrawal seems to relate to causing increased histone deacetylases for the subset of alpha 1 GABA-A receptors. This means that people with chronic benzodiazepine withdrawal likely have a reduced number of these receptors in our bodies as a consequence of the benzodiazepine treatment. It's possible that there could be other consequences from the treatments as well. Histones are proteins which encase DNA and actions like acetylation of them trigger our genes to activate in various ways. Usually acetylation triggers healthy bodily activities and I have been reading about how reduced acetylation tends to relate to onset of disease, such as is experienced in chronic benzodiazepine withdrawal. The histone deacetylases remove the acetyl groups from the histones so increased levels of them result in reduced expression of the subset of GABA-A receptors. GABA tends to have an inhibiting effect on the central nervous system, so the reduction of GABA signaling leaves us with an overload of cerebral activity and signaling from nerves.

 

 

[Jaffa]

7 hours ago, Ariel said:

And if you see my post above, member Tale had an endoscopy done without sedation, no problem. 

@Ariel lm due for an endoscopy in a couple of weeks and quite anxious. I think maybe I’ll skip the sedative but they still give you something to drink to numb throat so you don’t gag when the tube goes down. So you need this numbing stuff yes ? 

[Ariel]

Hi @Jaffa

 

7 hours ago, Jaffa said:

15 hours ago, Ariel said:

And if you see my post above, member Tale had an endoscopy done without sedation, no problem. 

@Ariel lm due for an endoscopy in a couple of weeks and quite anxious. I think maybe I’ll skip the sedative but they still give you something to drink to numb throat so you don’t gag when the tube goes down. So you need this numbing stuff yes ? 

 

I don't know. 

You might try asking member Tale about their experience. 

In regards to concerns about your specific procedure, I'd suggest communicating with your physician(s) directly as much as possible. You have the right to ask as many questions as you want/need and withhold consent if you don't agree. 

[Jaffa]

@Ariel Thankyou . I’m feeling bolstered by this advice. I certainly will ask all the important questions. 

[ScaredDad]

Can someone please share details of someone tapering while having paradoxical reactions and how they handled it? Did they reduce or go away as they tapered?

 

Even just usernames I can go read about? Please everyone! Thanks 

[ChristopherC]

@Shep Shep - Saw you posted a bit about kindling here, and I read most of it but also tried to avoid reading the scary posts (i.e. super long term, "I never have recovered" posters, etc.) which freaks me out as I am suffering terribly for almost a year. If I was looking for some input on if my situation, i.e. took Fluoxetine for 6-7 years at a pretty low dose, tapered over several years very slowly but got WD symptoms pretty bad/when I reinstated nothing worked or helped + all that I have tried (i.e. other drug, supplements, etc.) have all just made things worse. Would this all be considered kindling and if so what is the best course to resolve it?

[SouthernMan]

Anyone else have new symptoms pop up? Just had a 30 second vertigo symptom where i was off balance and my legs felt akward and was like swaying. Scared me. I had this happen right when i got of the drug, but got better and then just out of no where a bad one. Wasn't light headed or anything, just off balance pretty bad. Sat down and felt like i was leaning and it slowly disappeared. 

[Celeste1990]

On 6/17/2024 at 5:03 PM, SouthernMan said:

Anyone else have new symptoms pop up? Just had a 30 second vertigo symptom where i was off balance and my legs felt akward and was like swaying. Scared me. I had this happen right when i got of the drug, but got better and then just out of no where a bad one. Wasn't light headed or anything, just off balance pretty bad. Sat down and felt like i was leaning and it slowly disappeared. 

Have you gotten this again since? And had you ever gotten that earlier in your recovery or was it brand new?

[SouthernMan]

No it hasn’t happened again. I vaguely remember it like the first week of recovery but not that intense. Pretty sure I have been in a wave since Monday when it happened. Head feels off and swimmy and off balance, elevated heart rate, anxiety, nausea every day and motion sick feeling which I haven’t had in a few months. 

[Celeste1990]

1 minute ago, SouthernMan said:

No it hasn’t happened again. I vaguely remember it like the first week of recovery but not that intense. Pretty sure I have been in a wave since Monday when it happened. Head feels off and swimmy and off balance, elevated heart rate, anxiety, nausea every day and motion sick feeling which I haven’t had in a few months. 

Glad it hasn’t happened again! Hopefully it was just a one off. I get that off balanced feeling all the time. Early in your recovery, did you have constant 24/7 dizziness? That’s my main problem.