This article is an interesting read:
https://www.sciencedirect.com/science/article/pii/S2161831322002952
"The gut microbial influence on tryptophan metabolism emerges as an important driving force in modulating tryptophan metabolism. "
"Tryptophan is an essential amino acid being utilized for protein synthesis and, thereby, affecting the growth and health of both animals and humans. In addition to serving as a nutrient, accumulating evidence has revealed that changes in the gut microbiota composition affect the GBA by modulating the tryptophan metabolism (10., 11., 12.). "
"On the one hand, tryptophan serves as a sole precursor for the biosynthesis of the neuroendocrine transmitter serotonin and, subsequently, a pineal hormone called melatonin (21)"
"The tryptophan availability can be altered in a vitamin B6–dependent manner, as evidenced by an impairment of the tryptophan metabolism after a vitamin B6 deficiency (24)."
One thing it says is that tryptophan is cleared from the body via the liver by it producing an enzyme called IDO. People with inflammatory bowel disease often OVER produce IDO causing more tryptophan to be cleared from the body than it should be.
Another interesting this is the B6 issue. Funny enough, I was diagnosed with high B6 after a blood test, yet I am low in all other B vitamins. So I think that's some hint that this is the right tract.
In short, I think that our gut microbiome was affected and it did mess with the tryptophan pathway, which also affects melatonin and serotonin, which is causing most of the symptoms. But that's just a theory and I can't prove it. I thought I'd share the article though.
"Another interesting this is the B6 issue. Funny enough, I was diagnosed with high B6 after a blood test, yet I am low in all other B vitamins. So I think that's some hint that this is the right tract."
B vitamins are used in combination in metabolic processes so a deficiency in some can result in buildup of others. Sadly, I didn't get a complete blood test while I was having the worst symptoms, but several months later. A regular blood count test didn't show anemia or anything else. Months later, when I got a test that included vitamin B12, B1 but not B6, I had a buildup of folate and homocysteine. Both of these require B12 to be metabolized to other essential amino acids, so their buildup would indicate a long term B12 deficiency that interrupted this process. It's possible B6 was high, but I'll never know that. The neurological symptoms I've had match B12 deficiency as well as B6 toxicity, but also serotonin and dopamine imbalances.
When I mention neurological issues to my gastro, he says he doesn't know anything about them and that for those, I should work with a specialist who does. When I asked him which specialist would that be, he didn't have any suggestions. When I tell the neurologist about the nutrition deficiencies, she tells me that I should discuss that with gastro. It's been discouraging, and I've had to rely on my own research and experimentation for the most part. Gastro neurologists exist, but I haven't been able to find one yet.
I have learned so much about vitamins and digestion in the past two years, sometimes I feel I know a lot more than the specialists I'm talking to. Gastro wants procedures, like colonoscopy, and not complex digestion cases. Neuro has imaging and EMG and if nothing shows there, well, nothing's wrong, and these symptoms must be psychological. I understand to some extent as what we know about our bodies is just the tip of the iceberg at this point in time.
The problem in my case is that I had so much going on during that period of time, so I can't say it's POCD due to anesthesia, or it's metabolism, or some of each. At least I know it's not Parkinsons, MS, or ALS :-). I've gotten a lot better, and if I hadn't gone into this as strong as I was, I think my life would have been over.
I noticed an unusual symptom immediately after the surgery that seems uncommon, and I can't find any reference to it. Normally, when we empty our bowels, we have a feeling of satisfaction, most likely some surge in serotonin or dopamine. It feels good. Well that went completely away. I brought it up with Gastro, and he said it could be due to the bowels not emptying entirely. I am going to hunt this down and see if I can do the pill camera test that measures the function of the entire digestive system, starting with stomach acid, time to empty, bowels motility, etc.
That's where I am today. I am still not losing hope that we can figure it out and that I will get my life back.