October 2018 vomiting chapter

[scales]

Someone requested that I post the chapter on vomiting from the SN thread. Please note I use a phone to take screenshots so quality isn't the best. Here it is.

 

[dartanian]

thank you so much for this!

 

[Deutschv2]

Great, thanks. It's weird they suggest 3x10 meto an hour before here when nitschke says 30 minutes before for SN in aug 2018. Doesn't seem to be a big discrepancy though. Good post

 

[Empty RN]

thanks a bunch

 

[Deleted member 1768]

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Someone requested that I post the chapter on vomiting from the SN thread. Please note I use a phone to take screenshots so quality isn't the best. Here it is.

Thanks Scales...smile.

 

[Dead Meat]

Thank you scales for that very informative post this really helps. I truly appreciate it.

 

[Juan]

Thanks

 

[Chinaski]

Correct me if I'm wrong here, but didn't the last Ppeh advise 60mg of meto 30-45 minutes prior? Now he's saying 30mg an hour prior. I also note there is more caution to the language used, where previously they seemed ultra-confident that meto would definitely prevent vomiting, now they seem almost ready to acknowledge that vomiting will still occur.

Am l right to be a trifle concerned by these inconsistencies?

 

[Chinaski]

Hell, he ends that chapter by saying "nitrogen may be more suitable", ffs man

 

[polyswarm]

Thanks a lot for posting this, appreciate it!

 

[WaitingForTheBus]

Fuck mate, If I start smoking pot, I'd probably forget that I wanted to ctb in the first place. I'd just raid the pantry for munchies. Good to know though, makes that part more accessible. Thanks for posting.

 

[polyswarm]

@Chinaski They never seem to acknowledge any changes they've made or the views of other people with knowledge on the subject. It all looks like baseless conjecture since they never seem to mention success stories with the exact dosage that was taken.
I was hoping this chapter would go a lot more in depth.

But on the other hand, I'm probably just overthinking too much. It's not an exact science where one pill more or less will result in drastically different results. And most sources all provide very similar information, it's mostly the dosage that's different each time.

 

[Chinaski]

The May version says "if anti vomiting drugs are taken, the risk of vomiting is very low and problems are rare, except in cases where vomiting is a known specific problem". This has gone completely, to be replaced with "if you vomit even the tiniest amount abandon it as a method completely, try nitrogen instead, where for only 2 million dollars Max Dog Brewing can help".

No explanation as to the change in stat dose of anti emetic either, which is literally reduced by half.

I'm absolutely devastated by this tbh, Nitschke is such a toad.

 

[dartanian]

The May version says "if anti vomiting drugs are taken, the risk of vomiting is very low and problems are rare, except in cases where vomiting is a known specific problem". This has gone completely, to be replaced with "if you vomit even the tiniest amount abandon it as a method completely, try nitrogen instead, where for only 2 million dollars Max Dog Brewing can help".

No explanation as to the change in stat dose of anti emetic either, which is literally reduced by half.

I'm absolutely devastated by this tbh, Nitschke is such a toad.

yeah you are right.
I just checked the August edition. There he suggests taking 60mg 40 minutes ahead.
What the fuak he thinks he is writing, cake recipes are more accurate than this.

 

[Sayo]

Thanks for uploading, scales! I really appreciate you sharing it with the community so we can have a look.

Really starting to get sceptical of Nitschke's recent stuff. It feels like Exit do not put as much effort into their recent writings. This is incredibly poor quality work, and lazy. There are reasons not to employ ondansetron with some of the methods advocated in the PPeH, never mind dramamine. The wording around their meto change is weird too.

And finally, many people would have simply no idea what the side effects column of that table even means.

Cavalier advice through and through - in Australia, where many of Exit's members reside, you will not get metoclopramide because you are concerned about seasickness. In fact, metoclopramide is not very effective for it. Maybe Nitschke does not think the anti-emetic is important before the N for some reason (given that the chapter is primed for N), or that ondansetron will suffice, but it will definitely not for e.g. the inorganic salts. I really have to question what was going on here. Not all of it is wrong, but the correct and useful information was already available.

 

[dartanian]

Does someone here familiar with success stories with N and knows what antiemetics dose and regime they took?
maybe members of the forum you remember ctb with N.
might be worth to check their posts history and see what they said they are going to take.

 

[Chinaski]

"Recent reports have suggested smoking a spliff blah blah"

Fucking seriously? People at end of life have successfully passed with this regimen? Sounds very much as if PN is working the room here, pitching to his audience without offering anything tangible or helpful.

 

[polyswarm]

@Chinaski Yea I can remember you mentioning in another thread how you prefer that stat-dose over the dosing method, which I agree on. Really frustrating how they're going about this!

I'd be fine with some ambiguity in the book about the best dose but this jumping back and forth is just ridiculous.
It's probably best to take Nietschke's advice with a grain of (inorganic)salts.

 

[polyswarm]

Haha, yea just smoke a doobie and it will be fine.

In the next update of the pph he'll tell you to rub some peanut butter on your stomach and say a hail mary.

 

[Chinaski]

@polyswarm

Derek Humphrey recommends an hourly anti emetic the day before. This isn't just a mild inconsistency. The lack of confidence in anti emetics compared to previous editions is also very, very alarming. I need the peaceful exit these people promised in earlier editions, l can't afford to screw up on the bad advice of a snake oil merchant.

 

[Chinaski]

Haha, yea just smoke a doobie and it will be fine.

In the next update of the pph he'll tell you to rub some peanut butter on your stomach and say a hail mary.

"Recent reports to Exit suggest that listening to Pink Floyd whilst staring at a lava lamp can significantly reduce vomiting to zero and hasten a peaceful passage"

 

[Battered_Seoul]

Cheers, Scales

Exit do seem to be phoning it in. The chapter on Chloroquine makes no mention of either anti-emetics or sedatives, in direct contradiction to both Docker and Chabot, who are helpful enough to suggest that experiencing shock and myocardical toxicity without sedatives could be unpleasant.

On a related point, would having the powdered medication in gel capsules significantly reduce the risk of vomiting?

 

[Lra888]

Thank you for sharing this.

 

[Lra888]

Thank you for sharing this.

 

[Sayo]

@polyswarm

Derek Humphrey recommends an hourly anti emetic the day before. This isn't just a mild inconsistency. The lack of confidence in anti emetics compared to previous editions is also very, very alarming. I need the peaceful exit these people promised in earlier editions, l can't afford to screw up on the bad advice of a snake oil merchant.

I honestly think this is carelessness (don't get me wrong, negligence). He is checked out, and/or let someone else write this. I think if he had actually any new perspective on anti-emetics, he would not be writing about it as 'the usual' and treating it as normal advice. He is just getting worse and worse, unfortunately.

I think previous advice about the dose has been historically sound, especially since we haven't had a rash of failures all citing Exit. However, it's worth noting that Nitschke's dose has always been a bit higher than others' (probably to be on the safe side, since the PPeH is DIY) - dosing is very individual. Dignitas go with closer to 30mg, and it works for them (although they have staff on hand). You could average out all the advice from end-of-life authors and it would be closer to 30 than 60. What really concerns me about it is that he's forgotten his own published opinion.

 

[Chinaski]

There is an obvious shift in language regarding his confidence in preventing vomiting which l find most deeply concerning. He's airbrushed out any comment on its likelihood and replaced it with a greater degree of cautionary advice on what to do if you vomit. This is very concerning, given how for most of us this is the obvious issue.

 

[Sayo]

Ah, I just noticed that on the last page - I read it through emotionally the first time, got to the advice about 'why not just take otc anti emetics or smoke weed', and had not fully processed it. You are right, Chinaski.

I'm not sure what to make of it. I would have no confidence in preventing vomiting if I were telling people to take dramamine or smoke weed before overdosing. On the other hand, he hasn't given out serious anti-vomiting advice like that beyond 'have ipecac on hand' before that I know of. I don't know if this is due to anything he has witnessed (probably not, as he primarily deals with high-profile Dignitas cases these days and legal things and his Sarco dreams and such?) - I suspect it is due to the fact he knows he is giving poor quality advice with no guidance, and that many of the people who follow it will end up vomiting. He should NOT be recommending things that don't work because people can't access the things that do. I don't think it is an indictment of meto simply because of the prior confidence in meto and its prioritisation by other doctors, but I understand that it's impossible to tell from this weird, off-the-cuff writing.

Of course you have every right to be concerned, this is outrageously irresponsible, uncertainty-inducing, the type of potential harm that anti-lifers have levied at him and other doctors before. I'm not trying to diminish that, apologies if it comes off like downplaying it.

 

[Chinaski]

If one were really cynical, it could be observed that this latest effort upscaling the risks of N compared to the positive aspects of Max Dog Nitrogen neatly coincides with A taking time off from his work.

 

[Dogsbody]

I wonder what evidence he works off of...

 

[Chinaski]

I wonder what evidence he works off of...

We need much better resources than this crap, frankly.