Investigative Medical Report

Current Status: You are currently suffering from a "Double Hit" of two different health issues happening at the same time:

• ISSUE 1 (Chronic): Withdrawal from Olanzapine. This is causing your nightly cold sweats and insomnia.
• ISSUE 2 (Acute): Reaction to Pain Medication (Ketorolac). You took this for your kidney stone, but taking it for 8 days hurt your stomach and raised your blood pressure.

Part A: The "Cold Sweats" (The Long-Term Issue)

Is this withdrawal? YES.

Your symptoms of "cold sweats almost every night" are classic signs of stopping Olanzapine. Your brain is trying to reset its internal thermostat.

Warning regarding Cannabis: While Cannabis helps you sleep, withdrawal from it (even between daily doses) can also cause sweating. High-THC products might be making the sweating worse.

Part B: The Stomach Pain (The Recent Issue)

Why did you get sick Dec 15-22?

You took Ketorolac for 8 days. The safety limit is only 5 days.

The "barfing up lunch" and stomach pain were caused by the drug burning your stomach lining (Gastritis). This drug also caused your Blood Pressure to spike.

1. Olanzapine Discontinuation Syndrome (PAWS)

The patient is experiencing cholinergic rebound (diaphoresis, insomnia) due to the cessation of Olanzapine. The previously reported speech difficulty was likely drug-induced dysarthria. Prognosis: Symptoms are self-limiting but may persist for months.

2. Ketorolac Toxicity

Epigastric pain and emesis on Day 7 indicate acute gastropathy/gastritis. The hypertensive urgency (BP 167/95) is attributable to NSAID-induced sodium/water retention.

3. Clinical Recommendation

• Manage PAWS: Consider Magnesium Glycinate (200-400mg) at night.
• Cannabis: Switch from High-THC to CBD or CBN formulations to prevent REM sleep disruption.

1. The "Cold Sweats" Solution

Be Patient: Your body is resetting. This will pass.

Change the Cannabis: Try using a "CBD Oil" instead of strong THC products for a few weeks. Strong pot can sometimes make sweating worse.

2. The "Stomach Pain" Solution

Your stomach is raw. Eat gentle foods for 3 days:

• Toast
• Bananas
• Rice
• Applesauce

Avoid alcohol and spicy food until your stomach stops hurting.

3. Sleep Better

Ask your doctor about taking a Magnesium supplement at night. It helps relax muscles without the side effects of heavy drugs.

Could a Very Small Dose of Olanzapine Help the Sweats?

You asked if restarting Olanzapine at a very small dose and slowly tapering off could help with the persistent cold sweats. For some individuals experiencing severe and long-lasting withdrawal symptoms from certain medications, this can be a valid strategy, but it requires extreme caution and strict medical supervision.

How This Strategy Works (The "Micro-Taper")

If your doctor determines your withdrawal symptoms (like the cold sweats and insomnia) are truly unmanageable and persistent, they *might* consider a "re-tapering" approach:

• Restarting a Tiny Dose: You would start an extremely small dose of Olanzapine – often much smaller than the lowest available pill. For example, a fraction of a 2.5mg tablet (e.g., 0.625mg or 1.25mg) once a day. The goal is *not* to treat a mental health condition, but to gently stabilize the brain's chemistry just enough to ease the intense withdrawal symptoms.
• Stabilizing: You would stay on this very low dose for a period (e.g., several weeks) until the withdrawal symptoms significantly improve or become manageable.
• Extremely Slow Taper: Once stable, the medication is then tapered off *much more slowly* than your original discontinuation. This typically involves reducing the dose by a very small percentage (e.g., 5-10% of your current dose) every 2-4 weeks, or even longer periods. The reductions become smaller as the dose gets lower.

Why a Slow Taper is Important

Your brain and body need time to adapt. A very slow reduction schedule gives them that time, minimizing the shock of removal and reducing the severity of withdrawal symptoms.

Example Micro-Tapering Schedule (for illustration only - consult your doctor!)

Assuming the smallest tablet is 2.5mg, a doctor might suggest a schedule that looks something like this:

1. Week 1-4: Start with 0.625 mg (half of a 2.5mg tablet, broken in half again) once daily. Monitor symptoms closely.
2. Week 5-8: If stable and symptoms are improved, reduce to 0.5 mg daily. (This often requires a liquid formulation or precise compounding).
3. Week 9-12: Reduce to 0.25 mg daily.
4. Continue Reducing: Each reduction would be small and spaced out over several weeks, until the dose is eventually zero. This process can take many months.

The exact dose and schedule will depend entirely on your individual response and your doctor's assessment.

Further Monitoring & Support

• Keep a Detailed Sleep Log: Continue to record when you go to bed, wake up, any awakenings, the severity of cold sweats (e.g., 1-5 scale), and overall sleep quality.
• Consider a Wearable Sleep Tracker: Devices like a smart watch (e.g., Fitbit, Apple Watch, Garmin) can provide valuable data on your sleep patterns, heart rate, and possibly even nighttime sweating, which can be helpful information for your doctor.

Medical Source for Tapering Principles:

For more detailed medical information on tapering psychotropic medications, including antipsychotics, you can refer to:

Horowitz, M. A., et al. A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse. Schizophr Bull. 2021 Jul 8;47(4):1116-1129. doi: 10.1093/schbul/sbab017.