Nov 29, 2011
Low Sulphur Experiment is Successful
Mar 30, 2011
Metoprolol
LAST UPDATED, BOTTOM Nov. 28, 2011
Cardio-version ended my second episode of atrial fibrillation, as described in the January 25, 2011 post here. My cardiologist recommended that I take 50 mg of time release Metoprolol every morning for the remainder of my life. The purpose of the Metoprolol is to suppress the heart rate. By preventing it from beating too fast (for example, under great stress), the Metoprolol helps prevent the sort of instability that might lead to atrial fibrillation.
My doctor expects the atrial fibrillation to return. (He said, "When, not if.") He said the most likely causes of reversion to afib are (1) alcohol (which I do not drink at all) and (2) general anesthesia (which I hope to avoid for many years).
This post summarizes information about Metoprolol that I have gained through the help of an associate. As a layman, I think the information I cite is reliable, but each person must decide for himself.
WHAT IS METOPROLOL? According to drugs.com, Metoprolol is a beta blocker, that is, a drug designed to block heart receptors. The drug blocks chemicals in the blood that stimulate heart beat. Metoprolol thus reduces heart rate and thereby improves efficiency of pumping and reduces blood pressure.
IS METOPROLOL SAFE? Though I prefer taking no drugs at all, I think Metoprolol (also known as Toprol XL) is a safe drug, compared to many others. Coincidence and correlation are not causation. No proof shows that Metoprolol always or generally causes any particular adverse conditions. However, as always, some users report one or more adverse conditions while taking Metoprolol. For most adverse conditions reported, the number of reports is very small compared to the much larger number of individuals taking the drug. Partial exceptions are sleepiness (10% of users), depression (5%), and intestinal upset (diarrhea or nausea, 5% each). I experienced all of those at one time, but the effects faded after a few weeks.
WHEN SHOULD I TAKE IT AND HOW? I should take my Metoprolol tablet ("Extended Release") at the same time every day, in the morning, with breakfast. I need to swallow it whole so that this time-release tablet dissolves slowly during the following 24 hours. (Thus, I am receiving the lowest dose at the very time when I need Metoprolol the least, which is during deep sleep, when the heart is naturally beating most slowly.)
IS 50 MG A LARGE DOSE? I read literature from my pharmacist that said the range available is 50 to 200 mg. (My doctor originally recommended 150 mg.) If that is accurate, then I am taking the smallest dose available as a whole time-release tablet. I am considering cutting each one in half, a procedure which is acceptable as long as I do not crush it and thus destroy its time-release capability.
UPDATE, April 30, 2011: Last week both my eyes became bloodshot. The left eye's right side was becoming dark red. Alarmed, I went to an urgent care clinic on Saturday morning. While giving me a routine preliminary examination, the nurse noticed that my bloodpressure was acceptable (115/65) but my heart rate was disturbingly low (40 BPM). Metoprolol is the most likely cause of both problems -- the bloodshot eyes and the excessively low heart rate. On the next day, and thereafter, I took half a dose, 25 mg, at breakfast. My eyes began clearing within 24 hours. My heart rate is closer to 50 BPM now (at around 10 am). I will continue at the half-dose while I consider ending my use of Metoprolol.
UPDATE, May 21, 2011: I have extended my dosage experiment by reducing the dosage of Metoprolol to 12.5 mg (cutting the tablet twice). So far, my blood pressure (typically 120/65 at 9 am) and my resting heart rate (typically 45-55) have remained low, even with a 75% reduction in dosage. My medication symptoms (somewhat loose stools, drowsiness, slight nausea between meals) are gone. I may dispense with the Metroprolol altogether.
UPDATE, August 26, 2011: A few days after the May 21 update, I increased the daily time-release Metoprolol back up to 25 mg and kept it there until August 25, when I stopped the Metoprolol completely. Now, on my second day, I am seeing a more positive mood, somewhat faster transit of food through my intestine, less drowsiness after breakfast, no more dry eye.
Unfortunately, my blood pressure rose (up by c. 10/10 to c. 130/80, averaged throughout the day) and my heart rate rose (up about 10 bpm, to around 65). (I was alarmed when my BP spiked mid-afternoon at c. 133/96, but then it declined into the evening. I will continue monitoring. If they do not go higher, I will continue avoiding the Metoprolol.
UPDATE, October 16, 2011: After returning to a 25 mg dose, shortly after Aug. 26, I continued for about a month and then once again took 12.5 mg daily until yesterday. Today is my first day trying again to live without Metoprolol. (I am now taking only a daily probiotic capsule and a twice-weekly Vitamin B12 tablet, 500 micrograms each.) In the days ahead, if my blood pressure and heart rate do not rise alarmingly, I will continue avoiding Metoprolol.
UPDATE, October 30, 2011: My blood pressure did rise alarmingly. Here are readings in the late afternoon two days after stopping: 122/87, 68 bpm at 405 pm; 116/86, 70 bpm at 408 pm; 121/88, 67 bpm at 430 pm; 142/96, 60 bpm at 530 pm. I have returned to taking 25 mg of Metoprolol every morning, probably for the rest of my life, as my cardiologist had suggested. A typical recent reading is: 126/74, 50 bpm at 810 pm.
UPDATE, November 28, 2011. OFF METOPROLOL! At the recommendation of a Physician's Assistant, at a new general practice clinic, I halved my dosage of Metoprolol for a week and then stopped taking it. So far, five days later, the readings are acceptable: E.g., 116/71 at 58 bpm and 128/72 also at 58 bpm. I learned that, at least at the new clinic (which has no cardiologists), cardiologists generally have a reputation for seeking a much lower heart rate than most primary care physicians would seek. I am now free of pharmaceuticals.
Burgess Laughlin
Author, The Power and the Glory: The Key Ideas and Crusading Lives of Eight Debaters of Reason vs. Faith
Mar 17, 2011
BkRev: "Over-Diagnosed" by Dr. H. Gilbert Welch
Jan 25, 2011
My atrial fibrillation adventure
Burgess Laughlin
Author of The Power and the Glory: The Key Ideas and Crusading Lives of Eight Debaters of Reason vs. Faith
Jul 15, 2010
What do I eat now?
Dec 28, 2009
What I learned from 2 days in the hospital
Friday evening about 7 pm, I sneezed and had a stab of chest pain. There was no follow-up pain. At 1 am I woke up with excruciating chest pain, right side. I recognized the symptoms: collapsed lung. (I have had 16 earlier pneumothoraces, through 47 years.) I grabbed my hospital bag and cabbed to the hospital (Good Samaritan, Portland).
I was treated respectfully and competently by every person in their huge staff: physicians, nurses, physician assistants, radiology experts, and all their assistants.
Here is what I learned or confirmed from earlier experiences:
GENERAL
- Always have a hospital bag packed, including a novel or two for the long, boring hours, and a list of contact phone numbers.
- Discuss issues with the medical people, to attain at least general clarity, remaining willing to compromise between their caution (stay longer) and my eagerness to leave (to cut my costs and get back to work).
- At age 65, my lifestyle has paid off: Doctors found no sign of heart disease, cancer, kidney problems, liver problems, or any of the other many problems that their older patients usually have. (In the section of the hospital where I was, all the patients were gray haired; perhaps this was a Medicare wing.)
- When I don't exercise, I need very little sleep. That was good because I was so wired up and tubed up that I could barely roll over; sleep was very difficult.
- The physicians and nurses were surprised to meet a 65-year old patient who uses no pharmaceuticals. (My roommate -- who had acid reflux, heart disease and other problems -- was taking six medications daily before he needed to come to the hospital for his latest emergency [mass sweating, nausea, fainting].)
WEIGHT
- As a result of following my anti-itis diet (fruit, vegs, and starchy roots), with 100% compliance, I have become technically underweight (BMI of 17, the lowest of my adult life). I was shocked at how little I weigh (when I entered the hospital, 124 lbs at 6 ft; 121 lbs when I left.) now compared to the last time I was weighed (about 135 lbs, several years ago).
- Despite being technically underweight, I have been fully functional and the hospital staff found no evidence (from a "full array" of blood tests, as well as CAT scans, x-rays, interviews) of malnutrition or other problem.
- I will need to concentrate on boosting my weight by 10 lbs or so -- perhaps with increased sugar consumption and with avocados, olives, and so forth.
FOOD
- Even from the beginning, during admittance, be very polite, clear, and assertive about dietary requirements: "Give me only fruit (any kind), vegetables (any kind), and potatoes." Simple and clear and easy for them to write down. Do not say "vegan" or "vegetarian" or similar terms, because they are too vague or confusing to most people.
- By explaining to the nurse on duty (12-hour shifts) what I wanted to eat, I received what I wanted. I tried to always make it easy for the people working in the kitchen (who are about three links removed from the patient). Keep it simple. Don't be picky. Always use the word "plain." Order whole foods, though I found I didn't need to use that word (which is confusing to most people).
- By keeping my requests simple and easy to fill, I got nutritious and delicious food at every meal; Two baked potatoes; two servings of green beans; a "fruit plate" (a mound of diced fresh fruit, such as apples, oranges, melons, grapes); half a cup of olives; and water. The amount of food was large. Even I --and I have a big appetite -- could barely eat it all.
All things considered, my brief hospital stay was positive -- as confirmation of my lifestyle.
Sep 23, 2009
An expanded anti-itis diet?
STATUS REPORT. My skin continues to improve. It is becoming thinner, free of itching, and very slightly oily (not chalky). It remains very sensitive to abrasion. E.g., shaving (with an electric, rotary shaver) still causes inflammation and subsequent peeling if I press too hard or if the razor becomes hot. I continue to be pain-free (no arthritis, tendonitis, or bursitis, except for occasional muscle pains due to posture problems. (My right shoulder still slopes down, but I am working on correcting that.)
EXPANDED DIET. 1. In the meantime, using the standard test, I have reconsidered a few foods that had given me unclear results in earlier tests. I can now regularly eat dried figs and canned tomatoes (diced). I had avoided both because of the prevalence of seeds which I could not conveniently remove.
2. Helena Kloosterman, who is neither a nutritionist nor a physician, has provided a short list of foods, rated for Potential Renal Acid Load (PRAL), a subject I have discussed elsewhere. Her list is based on calculated values, not laboratory results. Consequently, I have been reluctant to even test (one serving per meal, six meals in a row) some of the foods she says are alkaline-producing. The list, accompanied by a formula for the calculation of PRAL, appears on her weblog, Bitter Poison, here:
http://www.bitterpoison.com/archive/calculate-acid-alkaline-with-pral-formula/
Most of the foods rated as alkaline-producing in her list are not surprising: fruits and vegetables. Others were a surprise. For example, from my own tests of corn, oatmeal, rice, and wheat, I had tentatively generalized that all grains (indeed nearly all seeds of all kinds) were acid-producing and therefore to be avoided. (Production of an acid condition, in the kidneys, is not the cause of my inflammatory problems, apparently, but it has been an infallible "confounder" or "co-incident" indicator or "proxy" predictor of inflammation.)
Kloosterman's calculated list shows the grain quinoa (pronounced "KEEN-wah" or "key-NO-ah") to be alkaline-producing. I hesitantly bought a 26 ounce (737 gram) bag of quinoa from a chain grocery store (Fred Meyer, Kroeger) that carries Bob's Red Mill products. I ran the standard test and got no adverse reaction in the skin on my face. I now eat it regularly, about one serving per day, on average, while continuing to eat most of my starch (the core of my meals) from "roots" (potatoes, sweet potatoes, rutabagas). I note however that Wikipedia lists quinoa as technically a fruit, not a grain. Apparently quinoa grows on a bush, not a grass stalk. Perhaps its "fruitness" is why it is not acid-producing. I don't know. I am ignorant about biochemistry.
The fact that at least one grain (if that is what quinoa is) is (slightly) alkaline-producing, and thus okay for me to eat, does confirm one pattern: There are exceptions in almost every category. For example, generally beans, nuts, and grains (all seeds) are acid-producing; however, green beans (string beans), hazelnuts (Filberts), and quinoa are exceptions to their categories.
Kloosterman's list also shows some beans -- such as pinto beans -- as being alkaline-producing, but she states that for the raw form, which no one eats. Does cooking making them acid-producing? I do not know.
FEB. 25, 2010 UPDATE: In the last few weeks I subjected pinto beans and lima beans to the standard reintroduction test (eat one serving per meal, six meals in a row and look for a reaction -- in my skin, in my case). I got no reaction. I then began eating beans (cooked, about 1/2 C per meal) at two meals per day. After about 10 days, my eczema returned in mild form.
I threw out all the beans and I returned to my regular diet of fruit, vegs, and starchy roots. Within 12 hours the eczema began fading! The beans probably were the cause of the problem. Perhaps they have a long-term, cumulative effect that doesn't show up in the standard two-day test.
This result shows that I cannot automatically trust the Kloosterman list, which shows merely calculated, not lab-tested values, especially where the list says "raw" and I don't eat the food in raw form.
Summary: Limiting my diet to fruits, vegs, and starchy roots (and possibly quinoa) works.