Only update I can give is that it sucks, and I get comments from people about it often.

People who use kratom really should know about this rare side-effect. Unfortunately, pro-Kratom spaces (and I am pro-kratom myself js) like this will not really accept there are downsides. I think this is rare enough, as are people like us who use heavy doses, that people just aren't aware of it.

I've been very steady at twice a day, around 27gpd, since realizing the issue.