No Go for Diovan

If you remember back in July, my heart doctor put me on Diovan once a day. He said a small dose of 40 mg would not cause any trouble for my yo-yo BP. Well, I tried it, as I mentioned before, and when my BP was normal (which is most of the time), it would bring it even more down, and I would feel lethargic, light headed and in a fog for a couple of hours.

As you also may remember, I called the PA and she was not sure what to try, but gave me a whole spectrum of choices: take ½ instead of a full one; take it at night, when the BP is higher, take it ONLY when I measure the blood pressure and I know for sure that it’s high… etc. After reading more online, and considering her “recommendations” as very volatile – I decided to stop taking it unless my BP is so high that it scares me.

That is – in case I measure it and I know it’s high. I measure it several times a week, but not every day. And occasionally, it’ll be high, like in the 150’s (for the systolic value), and I’d take ½ of a pill – usually at night. I have only one account of when I took ½ a pill and I measured the blood pressure after several hours, and it had come down to 110 over 60 from 150 over 95, I believe. So, it works! But how are you supposed to keep measuring it twice a day, every day, and walk around with your pressure meter and your pills, and your notepad, and have a life on top of that?!

Sure, I don’t recommend anything to anyone. But for me, I decided I’m not going to be paranoid about it. I’ll take ½ of a pill only if it’s high. It still makes me uncomfortable to take BP meds randomly, but I’d rather do that than take them all the time, add more chemicals to my cocktail, and feel like crap, when my blood pressure is too low!

My blood pressure has been better, because I have been more active than I normally am in the winter, and also because I have tried to keep the wine consumption low at night, when the BP was rising. So far, so good on the numbers.

Other than the (very!) occasional Diovan (maybe 2-3 times a month), the only thing added was the 50,000 IU Vitamin D which apparently did the trick for my D levels. No side effects that I can see there. I have stopped, however, the calcium I was taking as in many reports online you are advised against taking it while on high dosages of D, especially when you have a history of hardened arteries and plaque deposits. The doctor never recommended for or against the calcium – this is, again, my own decision, if you will.

But after all, it is our own life, isn’t it?!

Study: Stents for the Brain

Because there is virtually no history of heart attacks in my FH family, but there are tons of examples of stroke, of all sorts of severity levels, I found this article interesting:

http://www.nytimes.com/2011/09/08/health/research/08stent.html?_r=1&emc=tnt&tntemail1=y

News

In the news this week is this research/ study/ rumor of a new drug. I have come across it thanks to the FH Facebook group I follow. Good read, and interesting findings: http://www.reuters.com/article/2011/08/26/us-cholesterol-idUSTRE77P53O20110826 .

Also, of some interest is this chart attached to the story - pretty amazing for far ahead in Lipitor in drug sales, compared to the rest of the statin pack. No wonder a generic is not in sight yet - it's a goldmine!

Happy reading!

Because You Just Gotta Live Some, Too

One of the member of the Facebook FH group said the other week that she discovered recently she has FH and sometimes “she is just being a brat about it, complaining about the many tests she has to take” and all that jazz … I honestly cannot and would not blame her!

Some days I so wanna be a brat about it! I so wanna ask somebody, anybody, “why me” and “why this”?? But, at the same time, I feel so fortunate compared to other people who have afflictions so much worse than this!

As my sister says, “at least you won’t starve with this disease!”. Well, they want you to, but … I say: at least, you can move, and talk, and walk, and hold a job, and … Trust you me: it could be worse! Not that our lives are easier in this disease, but we’re, in a way, more lucky than others, I think.

So, when I wanna “feel like a brat about it”, I eat. I eat what I am not supposed to be eating. Usually “illegal” stuff, full of cholesterol! It doesn’t happen often or frequently, but it happens.

One morning, I woke up with a sick craving for eggs and bacon! And so, I made one scrambled egg, with turkey bacon and toast, and I tell you this – it was the most savored breakfast by anyone on record, minus all the small children in Somalia who would relish any kind of meal right about now, unfortunately.

My "decadent" breakfast

And it’s summertime! How can one possibly live without funnel cake?? What’s a State fair or any kind of outdoor fair without funnel cake?! I usually hate sweets, but I love funnel cake. And once a year, I allow myself to indulge! And, well, yeah … be a brat!

My funnel cake "fiesta"

But aside from these extravaganzas, I have been doing pretty well with my diet. Still on the same meds (Lipitor+zetia), same dosages, but I have been enjoying fresh produce from my own yard – who would have thought you can have a veggie garden in the desert, right?! But I have one!

So, I have been eating fresh tomatoes all summer, and squash and herbs, and pretty soon there will be the peppers … This is along with other healthy meals, with store bought ingredients, as well: like potato salads, and cucumbers, and cherries, and wheat pasta and oatmeal granola bars, and such ... Summer soups are yummy, with all veggies and some white meat chicken. So, overall, I still stay on track, but ... a once in a while slip won't kill me. I hope.

And just yesterday, I got my new numbers – which look good, I’d say:

- Total cholesterol: 274, from 285
- LDL: 227, from 230
- Triglycerides: 68 from 98 (yay!)
- But the ratio still looks bad: 8.1 (normal up to 3.1) - :-(

I am happy, however – no apheresis, after all! Trying to work on the high BP, as well - with more exercise and less wine and less caffeine, too! We're still very much working on that one!

But I cannot promise anyone that I am not going to be a brat about food some more. After all, we have to at least have the illusion that we still can enjoy life! At least every once in a while …

Drug Interactions

One of the hardest things to handle in dealing with the medical world is to the relativity of treatments and the un-sureness, evasiveness, almost wishy-washy-ness of medical professionals. Studies evolve all the time, and change the recommendations for some treatments sometimes drastically, overnight – so you never quite know what you need to be on and for how long and how will affect you, really. And no one knows. It’s a risky business.

I have decided a long time ago to have no regrets! I will do what the doctors tell me to do today, with the information they have at the time. And if the information they have now will prove incorrect after studies and many years of practice, well, then, we’ll stop what we’re doing and move on with whatever health we have left. I mean, what would be the alternative, and what would be the point of regrets?!

The alternative is to do nothing, of course. Take nothing. Use our judgment when we choose our lifestyle and hope for the best. I used to take nothing for years – and I felt not so good. Sure, there is no day in my life free of pain or discomfort now, too, but overall, I feel better, more functional, I can do more and that’s why I’ll take whatever drugs they have available for now.

Long intro, I know. My point in this piece was going to be about how un-sure and relative doctors and their helpers are when they are prescribing meds. So, my heart doctor just added a blood pressure medication to my treatment, because some days (key word is “some”, here), my blood pressure is high. OK! I knew this day is coming. With my heart problems and with everyone in my family (even the non-FH folks) with high blood pressure, it was almost a no brainer. Well, I am not sure what it is, but this new medication (Diovan) makes me dizzy, out of focus, and hot in my brain (for lack of a better medical word) right after I take it. I am not sure whether it’s the medication itself (those are some of the side effects), or the fact that I take a beta blocker (Atenolol) on top of it? Or because I take Atenolol+aspirin+Diovan at the same time? Or because I take aspirin, too, with all that? I have no clue.

A google search on the drug interactions of Diovan reveals (on drugs.com) that it interacts with both aspirin and Atenolol. As for the latter – the combo of Diovan+Beta blocker+ ACE inhibitor drug is fatal, and “the mechanism is unknown”. I am not on an ACE inhibitor drug, but made me wonder.

So, I call my doctor to ask: should I be taking all these 3 together? Should I be taking the whole 40 mg pill of Diovan on top of the 100 mg of Atenolol? Should I be taking an aspirin with everything? Should I take Diovan only in the second part of the day, since my BP usually goes up at night only?

I get a call form the doctor’s PA and she is full of “if”-s and “not sure”-s. She usually is, but this is somewhat important, I am thinking – playing with my heart (literally), not to mention my liver and what goes through it!

They prescribe this triple combo to people ALL the time and they have no issues, she says. They have never seen Diovan react with ANY drug (go to drugs.com or any other site that provides this and see the list of interactions). I should take it at noon, since the BP is high at night, OR I should take half of it in the morning and half at night OR I should take it ONLY when I take my BP and it’s high – and that also means “not every day”, if my BP is not high every day. Again: which is it?!

I mention to her that it says on the bottle and in the drug’s description online that I can’t skip dosages and I have to take it daily almost at the same exact time every day – and not on and off. She concludes: “Umm… no – that’s not true”.

So, who do you trust? What do you read? Who is the authority here? My mom has a good friend that’s a pharmacist and she told me years ago she argues with doctors all the time about how meds work and react and the doctors just won’t listen. She said it’s all about the chemistry – the chemistry you put in the drugs and the chemistry in your body and how they react with each other. Doctors have a good knowledge of the anatomy of the body but chemistry – not so much, not always, it seems. So, she sees them prescribe random stuff all the time. I am not saying my doctor did, but I surely wish I knew more about why I feel like walking on a cloud half an hour after I take this thing and for about 2 hours after that.

Anyway, I am not convinced at all that this is what I should be taking, if anything for my “randomly high” BP. I am not sure what I’ll do next, but a couple of days’ break from it might clear my head. Literally.

The Yo-yo Blood Pressure and More Drugs

I went to see my cardiologist about a month ago. When they took my routine blood pressure at the office , it was something like 158 over 95. So, he was all alerted. I have had “occasional” high blood pressure before, but nothing consistent.

I can’t remember what I took once, years ago for it, but because the numbers are so inconsistent, whatever they put me on then took my blood pressure way too low on days when it was normal, giving me a feeling of faint-ness, fatigue, dizziness that was bothersome.

As you know, blood pressure medicine is an “all or nothing” deal. You can’t just take them “when you have symptoms”. You take them for the rest of your days. So, they decided, then, years ago, to just increase my Atenolol, which I was already taking, in hope that that will help my BP, too.

And my BP has been mostly normal, but there are some days when … well, it shoots to 158 over 95. So, the current cardiologist asked me to keep a blood pressure diary for a month and come back for a decision… These are some of the numbers I took last month: 134x66, 140x60, 156x72, 120x80, 177x81, 107x54, 131x67. I can’t think of a rhyme or a reason why these up-and-downs are happening, but they do. Usually, as an average, I’d say it’s somewhere between 135-140 over 65-85, thereabouts.

So, the verdict was … more drugs. He added Diovan to Atenolol. It’s “just” a 40 mg dose, for now, which he is pretty sure won’t bring the blood pressure too low on days it’s normal, but it will help with bringing it low enough on the days when it’s high. We shall see. My pharmacy doesn’t have it, so I am waiting for a couple of days to be ordered in. I will report on the progress or happenings as they happen, of course. Surely, the doc said I “should not notice many side effects”, but I know better!

Now, I have to keep yet another BP diary for another month to 6 weeks while getting used to this new drug, and then go back in. I see my doctors more than I see my parents, and that becomes sort of ironic (not to mention WAY too much!) some days.

I have also started taking the 50,000 UI Vitamin D (once a week) yesterday. As I mentioned before, I have already been on 800 UI a day of Vitamin D because I have a deficiency (but who doesn’t, right?!), but now, my D numbers are way lower than half of what’s allowed, so … I am on this horse pill dosage.

Because D increases the amount of Calcium your blood vessels absorb and deposit, I have stopped taking my daily Calcium for now, while on this high dose of the vitamin.

Good/ Bad Cholesterol - An Article Link

I found this article written by Dr. Dean Ornish interesting: http://www.huffingtonpost.com/dr-dean-ornish/cholesterol-the-good-the-_b_870655.html.

My HDL is always going lower, if the drugs I take make a difference in my numbers. That's because if they work, they work on all the fractions of cholesterol, and not only on the "bad" one.

And most doctors tell me that it's not good that my HDL (the "good" cholesterol) is also decreasing ... But I have always wondered - as you can see from the article (and as you probably knew), the role of the HDL is to take more bad cholesterol to the liver where it gets processed and flushed out. But my very problem is ... my liver doesn't know what to do with cholesterol! It can have it there all day long, it doesn't know how to process it! That's why it needs the statin drugs. At least that's what I have been told ... So, the increase of HDL would not help much in my case ...

Anyway - I enjoyed the article, especially the part that says " it’s important to look at arteries, not just risk factors" - that's why I feel sorta good at the end of the day knowing that yes, I have high cholesterol still, and yes I have deposits, and yes, I have blockages all over my body, but they have been pretty stationary for the past ... 6 years, from what one can tell in an ultrasound of any sorts.

Just a small silver lining...