Led

Content note: pain, bad mental health, health issues.

Six months later, we’re back. It’s sad — we were acclimating well, met our neighbours, started riding all over the country, and then I started to be in pain.

Any kind of pain is bad, but the body part(s) affected really define the flavour of the impact it has, I guess, and this has been the first time I’ve had really significant leg pain. That’s sort of underselling it; it’s sometimes in my knees, usually ankles, feet, and though it seems like it shouldn’t be related, also in my elbows, fingertips, and even the sides of my neck, and it all feels very much related.

Still, for the most part it’s in my lower legs, and it. is. constant. I went back on nifedipine, since a Raynaud’s “diagnosis” last year had me try that and it sort of helped during winter. My hands and feet are always really cold, and they were worse than usual, so I was hopeful it’d help. Estonia only had the “medium acting” variant, and it felt a lot bumpier than the modified-release ones in Australia.

After that didn’t help at all, it was time to see the doctor. And see the doctor I did. And again, and again. And a physiotherapist. And an orthopaedist. Two X-rays, two different kinds of strong anti-inflammatory, three weeks of gabapentin, a month and a half of physio, and three months later in total and not even the slightest improvement. Exercising didn’t help, resting didn’t help. Ruled out referred back pain, inflammation, neuropathy, muscular.

Meanwhile, the time between appointments started to stretch out, I guess as folks returned from summer holidays, and I was just miserable. I hadn’t been able to do much of anything in a long time, and the healthcare system in Estonia was really making it hard. The pain on some days made me want to beat whichever leg was hurting into a pulp, because that somehow was more tractable and bearable.

So we’re back. I’ve had some relief since, in being able to switch back to the modified-release nifedipine, as well as get back on an antidepressant — duloxetine, both for the general sense of despair I’ve been accumulating this last quarter of a year (!), and for its help with ?fibromyalgia. The pain is a little bit more distant, but it’s still there and still getting worse.

Finally getting some blood tests confirmed it’s not something easy (anaemia, B12 deficiency) or obvious (cancer, RF+ RA). My money is on COVID-related vasculopathy, but I guess it’s not so easy to confirm, deny, or help. With some amazing luck, I managed to score an early rheumatologist appointment (someone had just cancelled), which then got bumped forward another week, so that’s now tomorrow.

I can’t particularly have my hopes up — we’re up to 4 months now since this started to intrude on my life. Last time I had a new chronic illness, it took more than a year for it to start subsiding regularly enough that I could start to believe it might abate entirely. (It came back for months at a time, years later.)

And unlike that time, this one isn’t only in my head: my legs and feet are increasingly randomly surfacing bruises that don’t clear up for months at a time. A few days ago while out to therapy, there was a particularly sharp ache across the top of my left foot, and when I got home, I took my shoe off and found that a vein had just turned completely black in a spot right there. There’s a blue patch on the back of my right leg (the one that hurts less on average!) that hasn’t gone away in the whole four months. And as my doctor here said, it’s entirely possible that at the end of all our investigations, I’ll still have this pain to manage, maybe indefinitely.

Which, y’know? That kind of thing just happens in life.

RSS autodiscovery

It’s come to my attention that some folks don’t know my blog has an RSS feed! This is kind of astonishing to me as it suggests people actually manually check blogs for new posts sometimes?!

At any rate, it does, it’s just not linked anywhere explicitly — but it is supported via RSS autodiscovery, which I just kind of .. assumed everyone used, relied on, knew about? But apparently not!

I guess I’ll add a link, just in case. :)

Tüüpiautomaat: automated testing of a compiler and target against each other

I’m currently working on a bit of a long-winded project to recapture QuickBASIC, the environment I learned to program in, in a bit of a novel way, while remaining highly faithful to the original. (I actually started a related project 9 years ago (!), and I’ll be able to reuse some of what I did back then!)

The new project involves compiling the BASIC down into a bytecode suitable for a stack machine, and an implementation of such a stack machine. Importantly, there’ll soon be a second implementation which runs on a different architecture entirely: namely, it’ll be an implementation of this architecture on an FPGA. So the machine needs to be reasonably easy to implement in hardware — if it simplifies the gateware design, I’ll happily take tradeoffs that involve making the compiler more complicated, or the ISA more verbose.

The ISA started out with opcodes like:

pub const Opcode = enum(u8) {
    PUSH_IMM_INTEGER = 0x01,
    PUSH_IMM_LONG = 0x02,
    PUSH_IMM_SINGLE = 0x03,
    PUSH_IMM_DOUBLE = 0x04,
    PUSH_IMM_STRING = 0x05,
    PUSH_VARIABLE = 0x0a,
    // [...]
    OPERATOR_ADD = 0xd0,
    OPERATOR_MULTIPLY = 0xd1,
    OPERATOR_NEGATE = 0xd2,
    // [...]
};

For the binary operations, the stack machine would pop off two elements, and then look at the types of those elements to determine how to add them. This is easy to do in Zig, but this is giving our core a lot of work to do — especially when we consider how extensive the rules involved are:

Ideally, the executing machine doesn’t ever need to check the type of a value on the stack before doing something with it — the bytecode itself can describe whatever needs to happen instead.

In other words, when compiling this¹:

a% = 42       ' This is an INTEGER (-32768..32767).
b& = 32800    ' This is a LONG (-2147483648..2147483647).
c% = b& - a%  ' This should result in c% = 32758.  A smaller a% would result in overflow.

… instead of having an op stream like this:

PUSH_IMM_INTEGER(42)
LET(0)
PUSH_IMM_LONG(32800)
LET(1)
PUSH_VARIABLE(1)
PUSH_VARIABLE(0)
OPERATOR_SUBTRACT     // runtime determines it must promote RHS and do LONG subtraction
CAST_INTEGER          // runtime determines it has a LONG to demote
LET(2)

— and so leaving the runtime environment to decide when to promote, or demote, or coerce, and when to worry about under/overflow — we instead have this:

PUSH_IMM_INTEGER(42)
LET(0)
PUSH_IMM_LONG(32800)
LET(1)
PUSH_VARIABLE(1)
PUSH_VARIABLE(0)
PROMOTE_INTEGER_LONG     // compiler knows we're about to do LONG subtraction
OPERATOR_SUBTRACT_LONG
COERCE_LONG_INTEGER      // compiler knows we're assigning to an INTEGER
LET(2)

A proliferation of opcodes results, but crucially it means most operations execute unconditionally, resulting in a far simpler design when it comes to putting this on a chip.

The upshot of this design, however, is that the compiler needs a far greater degree of awareness and ability:

• It needs to be aware of what types the arguments to the binary operation are.

  In the example above, we have a LONG and an INTEGER. This appears trivial, but we need to keep in mind that the arguments can be arbitrary expressions.

  We need this in order to determine the opcode that gets emitted for the operation, and to know if any operand reconciliation is necessary.

• It needs to be able to reconcile different types of operands, where necessary.

  BASIC’s rules here are simple: we coerce the lesser-precision value to the greater precision. In effect the rule is INTEGER < LONG < SINGLE < DOUBLE.

  STRING is not compatible with any other type — there’s no "x" * 3 = "xxx" here.

• It needs to be aware of what type a binary operation’s result will be in.

  I started out with the simple rule that the result will be of the same type of the (reconciled) operands. This worked fine when I just had addition, subtraction and multiplication; above, we add a LONG and an INTEGER, the INTEGER gets promoted to a LONG, and the result is a LONG.

  Division broke this assumption, and resulted in the motivation for this write-up.

• It needs to be able to pass that information up the compilation stack.

  Having calculated the result is a LONG, we need to return that information to the procedure that compiled this expression, as it may make decisions based on what’s left on the stack after evaluating it — such as in the first dot-point here, or when assigning to a variable (which may be of any type, and so require a specific coercion).

This all kind of Just Worked, right up until I implemented division. I discovered QuickBASIC actually has floating and integer division! Young me was not aware of the backslash “\” operator (or any need for it, I suppose). Floating division always returns a floating-point number, even when the inputs are integral. Integer division always returns an integral, even when the inputs are floating. The precision of the types returned in turn depends on that of the input types.

This presented a problem for the existing compiler, which assumed the result would be the same type of the operands: having divided two INTEGERs, for example, the bytecode emitted assumed there would be an INTEGER left on the stack, and so further emitted code would carry that assumption.

Upon realising how division was supposed to work, the first place I made the change was in the actual stack machine: correct the behaviour by performing floating division when floating division was asked for, regardless of the operand type. Thus dividing two INTEGERs pushed a SINGLE. The (Zig) machine then promptly asserted upon hitting any operation on that value at all, expecting an INTEGER there instead. (The future gateware implementation would probably not assert, and instead produce confusing garbage.)

And so opened up a new kind of bug to look out for: a mismatch between (a) the assumptions made by the compiler about the effects on the stack of the operations it was emitting, and (b) the actual effects on the stack produced by those operations running on the stack machine.

Rather than just some isolated tests (though short of creating some whole contract interface between compiler and machine — maybe later), why not be thorough while using the best witness for behaviour there is? Namely, the compiler and stack machine themselves:

test "compiler and stack machine agree on binop expression types" {
    for (std.meta.tags(Expr.Op)) |op| {
        for (std.meta.tags(ty.Type)) |tyLhs| {
            for (std.meta.tags(ty.Type)) |tyRhs| {
                var c = try Compiler.init(testing.allocator, null);
                defer c.deinit();

                const compilerTy = c.compileExpr(.{ .binop = .{
                    .lhs = &Expr.init(Expr.Payload.oneImm(tyLhs), .{}),
                    .op = loc.WithRange(Expr.Op).init(op, .{}),
                    .rhs = &Expr.init(Expr.Payload.oneImm(tyRhs), .{}),
                } }) catch |err| switch (err) {
                    Error.TypeMismatch => continue, // keelatud eine
                    else => return err,
                };

                var m = stack.Machine(stack.TestEffects).init(
                    testing.allocator,
                    try stack.TestEffects.init(),
                    null,
                );
                defer m.deinit();

                const code = try c.buf.toOwnedSlice(testing.allocator);
                defer testing.allocator.free(code);

                try m.run(code);

                try testing.expectEqual(1, m.stack.items.len);
                try testing.expectEqual(m.stack.items[0].type(), compilerTy);
            }
        }
    }
}

We go as follows:

• For all binary operations, enumerate all permutations of left- and right-hand side types.

• For each such triple, try compiling the binary operation with the “one”-value² of each type as its operands. (For integrals, it’s literally the number one.)

  • If we get a type error from this attempt, skip it — we don’t care that we can’t divide a DOUBLE by a STRING, or whatever.

  • If not, the compileExpr method returns to us the type of what it believes the result to be. This is the same information used elsewhere in the compiler to guide opcode and coercion decisions.

• Create a stack machine, and run the compiled code.

  • Seeing as we didn’t actually compile a full statement, we expect the result of the operation to be left sitting on the stack. (Normally a statement would ultimately consume what’s been pushed.)

• Assert that the type of the runtime value left on the stack is the same as what the compiler expects!

I love how much this solution takes care of itself. While it lacks the self-descriptive power of a more coupled approach to designing the compiler and runtime, it lets the implementations remain quite clear and straightforward to read. It also lets them stand alone, which is handy when a second implementation of the runtime part is forthcoming, and is (by necessity) in a completely different language environment.

There was greater value than just from floats, of course: relational operators like equal “=”, not equal “<>”, etc. all return INTEGERs 0 or -1, but can operate with any combination of numeric types, or with pairs of STRINGs. Bitwise operators like AND, OR, XOR, IMP (!), etc. can operate with any combination of numeric types, but coerce any floats to integrals before doing so. I bet there’ll be more to uncover, too.

Hope this was fun to read!

Kalakarp

Feeling very seen by fish today.

Ravimid

Reviewing all the medications I’ve ever been on. This will be intensely specific to my experiences; YMMV! Content note: mentions of mental illness, suicidal feelings, assault, sex.

mental health(-ish)

• escitalopram
  • A day or two after starting it I felt like the world had colour in it again for the first time.
  • Not very effective for anything other than “light depression” (?) imo.
  • Prescribed initially for depression/I’m 23 And Life Is Generally Hard, was on it for two years.
  • Later prescribed in an attempt to counter chronic idiopathic nausea, to no effect.
• quetiapine
  • Wow! I didn’t know what “suicidal compulsion” actually felt like until I took my first dose. That was also my last dose.
• desvenlafaxine
  • Going up from 100mg to 200mg, I’d just stop knowing how to form sentences halfway through them.
  • Effective on moderate GAD-type symptoms.
  • Coming off it was, contrary to all expectations, pretty uneventful. Except that for about three weeks, all I could smell was blood, with no apparent source.
• brexpiprazole
  • If you close your eyes, you will fall asleep. At any time.
  • Definitely calm.
  • Much too sleepy to continue, but it definitely brought me down after increasingly intensifying distress post-sexual assault.
  • As with any antipsychotic/dopamine antagonist, not particularly inclined to remain on one for any longer period of time.

  • At the time I was put on it, the only article in the literature about it had the (actually!) reassuring title: “Brexpiprazole: so far so good”.

• lamotrigine
  • Unclear whether I felt much of anything on this, even after three years at 200mg.
  • Coming off it: ANGER. Wow. (Remember to titrate; SJS can be triggered both on increase and decrease, apparently.)
  • After coming off it: oh my goodness I suddenly feel like being creative again.
• mirtazapine
  • eeeeeeeepy and hunnnnggggy.
  • Extremely and rapidly effective with chronic idiopathic nausea. Nothing else worked.
  • Weight gain pretty woof. That said, the weight I gained on it, I managed to drop while still on it.
  • I don’t remember if I maxed out at 30mg or 45mg — at higher doses the dissociation made memory very wonky.
  • Discontinuation meant a lot of rebound nausea and anxiety. It took me about 4 attempts, over several years, with various titration schedules; the successful attempt was just dropping from a sustained 15mg to 0. Trying to step it down at 7.5mg only prolonged the unpleasantness and resulted in aborting the attempt — subtherapeutic but side-effects remain.
• duloxetine
  • Really pleasant and noticeable, even at 30mg. Everything feels a bit lighter, and mild neuropathy totally neutralised.
  • Night sweats :( Became intolerable not long after increasing to 60mg, and didn’t subside after reducing again.
  • Discontinuation was reasonably uneventful; (manageably) shorterer temper and very mild nausea.
• gabapentin
  • I just started this! Early effects for neuropathy are promising. Slightly dissociative/floaty.
  • Was always curious about gabapentin/pregabalin since I first started having noticeable anxiety, so I’m glad I’ve gotten to try it. Definitely somewhat calming.
• diazepam
  • It is what it is.
  • Avoid taking on an empty stomach if you’re having issues with nausea — it can get so much worse.
  • I treat it with extreme caution. I’ve read so many personal horror stories about benzodiazepine dependence and it takes a really bad time for me to consider taking even 2.5mg. I’ll go up to 5mg if need be, but in general would refuse to take it if I’ve had any separate dose within the last week.
  • For the above reason, despite having been in some very bad places (where doctors were prescribing it in larger quantities at a time), I’ve maybe taken 100mg total over the last decade. Just not worth the risk.
  • Even less inclined to if I’ve taken stimulants on the same day, but I’ve only ever once (namely, in a life-threatening situation) had to even consider diazepam since getting medicated for ADHD 2 years ago. Funny how that works!
• temazepam
  • Not a fan; taken a handful of times ever, mostly at music festivals.
  • I have chronic insomnia and this is just not any part of an answer to it.

ADHD

• dextroamphetamine
  • Current weapon of choice. Calm, alert, focussed.
  • Latent anxiety is reduced a lot, probably because it lets me have some agency in my own head.
  • My doctor gradually increased my dose to 10mg, 4 times a day. This is absolutely fucking nuts. Don’t do that.
  • After 1.5 years I’ve settled on 2.5mg, twice a day at a 4 hour interval, and it’s completely adequate.
  • If I’m having a very long day, a third dose is fine too. 2.5mg doses are very light.
  • For a long while there I was finding myself increasing my dose by 2.5mg or 5mg (per day) every week or so since the tolerance builds so rapidly. You will deplete every last monoamine you have like this. I managed to tolerate 40mg/day (after a buildup) for about two days before I crashed. Do Not.
  • Sometimes 2.5mg doses can feel a little bit too light, but my health right now is such that increasing even just one of the doses leaves me feeling empty the next day. I’m glad to have something that works.
  • Small doses is also good because I’ve yet to see a psychiatrist in Estonia to get a prescription here, so I’m working through my stock from Australia very slowly. As far as I can tell, currently authorised dextroamphetamine products haven’t been imported to Estonia, so it’s unclear how easy it’d be to access it.
  • There’s this one, but it’s only available in 10mg? And searching for it online shows up something with the same name, but it’s atomoxetine instead? Very suss on that.
• lisdexamfetamine
  • Hrrrrrrr. Not a fan.
  • Something about this leaves me feeling depleted at any effective dose. I think I like the little humps I get between dex doses — lisdex is just exhausting, and an absolute pain if you wake up late.
  • 30mg? Not enough to feel anything — too spread out.
  • 40mg? I kinda feel something. It’s a bit eh.
  • 50mg? Yeah, okay, maybe this starts to feel like I’m having an OK dose of dex — I can think, focus, actually listen to people when they talk to me. I feel like I am spread very thin.
  • 60–70mg? Effective — wired — but also I start sleeping longer and longer because of how exhausted it leaves me, making my doses later and later, in turn fucking up my sleep schedule; not to mention the pervasive sense of Bad that starts to accumulate. No ty.
  • My god. I tried combining ~low dose lisdex with a small dex booster in the afternoon. Quick way to know what it feels like to fry your brain. You can do all the stimulant equivalence arithmetic you want, it just doesn’t add up that way.
  • If I was offered lisdex or nothing, it’s not clear to me that I would take it.
  • In general, I’m not sold on long-acting stimulants. I get the abuse angle (it’s what I was put on first, for this reason), and I do read stories of folks who find it legitimately helpful — like most others with ADHD, I regularly forget to take my stimulants — but there was no way to make it work for me. It’s too inflexible, and there’s some (possibly fear-mongering) news out there that suggests long-acting stimulants carry a greater risk of psychosis than short-acting ones?
• methylphenidate
  • Very conflicted on this. (Annoying that it’s so much more readily available, especially in Europe.)

  • Possibly neuroprotective vs. an active COVID infection! I was on MPH when I finally got COVID, and was wondering if I should keep taking stimulants through a moderately bad case of it or not. This article swayed me in favour of maintaining it:

    Remarkably, several drugs acting on receptors to neurotransmitters also appear to decrease hospitalization risk: rizatriptan (OR=0.118, CI 0.003 to 0.750), bupropion (OR=0.399, CI 0.136 to 0.976), and methylphenidate (OR=0.444, CI 0.178 to 0.972).

    I’ll take an OR of 0.444ish. I had to argue with a doctor from the government(!) to avoid hospitalisation, but avoid it I did.

  • I haven’t gotten a sense for how shared this is, but I get noticeable euphoria when starting on 10mg, and it makes one very inclined to up the dose when you stop getting that response after a few days.
  • Dragon-chasing aside, MPH consistently produces a sort of global “bad” sensation that I just cannot with. Even with the initial euphoria, it’s still noticeable — there’s just this unpleasant but persistent background qualia, almost a certain flavour of experience. Unclear if shared or just me.
  • All that notwithstanding, from 10mg it feels 70–80% as effective as dex at ~equivalent dose (5mg dex ≈ 10mg MPH).
  • 5mg didn’t feel like it had any impact at all, but that was a while ago, and I’d revisit it if I had to.
  • If I was offered MPH or nothing, I would probably take it.
  • If I was offered MPH or lisdex, I would probably take MPH.

vascular

• propranolol
  • Very chill. Noticeable sensation in the chest.
  • I once had a kind of shock reaction to a piercing which resulted in a really high heart rate, intense and sudden nausea, cold shivers all over, and me on the floor. (I find lying on a cold hard floor fixes most things.) The next time I went for a piercing I took 10mg propranolol before and it was easy.
  • Initially prescribed to try to combat panic disorder/idiopathic nausea. It at least brought my heart rate down and made it possible to eat again.
  • Later took it for arrythmia on demand. Reasonable at this — would often get painful(!) arrythmia at night which would make sleep impossible, and leave me feeling sore (and exhausted) the whole next day. 10mg propranolol would usually convert it within half an hour.
  • 100–200mg magnesium seems to work for that too.
• nifedipine
  • Certainly feel that one on starting. Not like I didn’t already have some orthostatic hypotension …
  • Take for Raynaud’s in the Australian winter/unspecified (micro?)vascular issues. Recently my legs have been feeling Not OK and so I’ve restarted it. Unfortunately, we don’t seem to have the modified-release ones here, so I have to dose twice a day.
  • Doesn’t impair exercise.
  • Not to be combined with propranolol (or magnesium, possibly).

gastric

• esomeprazole/omeprazole
  • Unremarkable. Not super effective for (probably stress-induced) heartburn/reflux.
  • Was also prescribed it at one point as an attempt to help with idiopathic nausea — no response.
• ondansetron
  • This is meant to be the Big Guns when it comes to nausea, and it did nothing for mine.
  • I was scrambling to find something that would work — it’d slowly subsided on desvenlafaxine in the first instance, and I’d tapered off that after about a year and was all good. A particularly bad anxiety attack provoked it into a full reoccurrence, which was terrifying. I wasn’t inclined to retry stepping up on desvenlafaxine and waiting it out to see if it’d work again — I felt like it might’ve also just been a matter of time, then, as it remitted only after more than a year of (essentially constant) suffering! — so I looked for other things.
  • My research lead me to mirtazapine; there’s a number of different ways in which it’s antiemetic. My GP at the time was happy to prescribe it for me based on my conviction, but wanted to try ondansetron first to see if it’d work as a circuit breaker (and thus avoid necessitating something taken over a longer time). Alas.

cannabidiol

Usual effects of cannabis products apply.

• THC oil
  • First trials found it to be extremely intense and disorienting.
  • Retrying years later (once I was using flower more medicinally and regularly), found it to be a nice way to dose THC in a more controlled manner, without the usual associations that come with vaping bud (i.e. “Time To Relax, And Perhaps Eat Much Šokolaadi.”)
  • Slower onset can be quite pleasant.
• CBD oil
  • First trials found it to make me feel generally unwell!
  • Later trials together with THC oil found it to be a nice way to dampen some aspects of the THC high, if needed.
• cannabis flower
  • Nothing much to report here. Australian medicinal cannabis was decent, actually decent value (per volume), and there was a reasonable variety of strains to choose from, which improved over the years. Doctors were not inclined to gatekeep (perhaps concerningly so) or judge.
  • Driving was a bit nerve-wracking; regular use builds up a level in the blood which can be detected by roadside random breath tests even if you’ve not used any that day, so I was pretty much always on alert/police-avoidance mode. It was a pretty strong deterrent, but I lived in a public transport deadzone so there wasn’t much choice.
  • This may be changing soon in Victoria!

misc

• naproxen
  • Prescribed for leg pain which was suspected referred back pain.
  • Came in a combination form with esomeprazole because COX inhibitors be wild.
  • No effect.
• tadalafil/sildenafil
  • Mildly effective for antiandrogen-related difficulties with penetrative sex.
  • Not a fan of the way these make my heart feel; wouldn’t opt for tadalafil again since it’s just the same but for days instead of hours.
• emtricitabine+tenofovir
  • PrEP. This is important, good stuff!
  • Mild nausea during the first two weeks of starting it, otherwise side-effect-free.
  • Been on and off it a half-dozen times over the last 8 years as my risk factors have increased or decreased. I have nothing but good things to say about PrEP.
  • Caution while travelling; less progressive governments may infer any number of things about you based on the medication you carry.

HRT

• oestradiol valerate
  • Standard first-line transfem primary HRT.
  • In the first few years I seemed to manage decent levels while increasing to 8mg/day, but over time I seemed to stop being able to absorb oral oestrogen and had to switch off.
  • Not particularly sad about that: other forms are less work for my liver.
• oestradiol gel
  • Absorbs well. A little bit annoying to make your skin sticky twice a day but wycd ¯\_(ツ)_/¯
  • Seems to be widely available; the last few years have had many HRT shortages, but I’ve not had issues with this.
• micronised progesterone
  • Preferred over synthetics (e.g. levonorgestrel) due to much reduced blood clotting risk, fewer negative mood side-effects.
  • Helpful for sleep — take at night.
  • First time I started it, within days I was sobbing (+) while watching Frozen. Really unlocks some emotions.
  • 200-300mg is an actual recreational high (N.B.! loss of consciousness/respiratory depression may result at extreme doses).
  • Also an antiandrogen!
• spironolactone
  • At least in Australia, first-line antiandrogen.
  • Diuretic and generally not fun. At the doses required for me, also precipitated pretty intense low mood which abated upon discontinuation.
• cyproterone
  • Antiandrogen. Extremely effective in even tiny doses.
  • My doctor started me on 50mg a day. I don’t have a good analogy for how nuclear this is.
  • May need more initially to get levels down, but (depending on prevailing E levels) you may be fine with 12.5 mg once a week, i.e. 3.6% of the dose I was started on.
  • Some folks report low mood on cypro; it hasn’t been an issue for me.