So far, it has confirmed my earlier tests and worked perfectly as a predictor.
Dec 18, 2012
So far, it has confirmed my earlier tests and worked perfectly as a predictor.
Nov 29, 2011
Mar 30, 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.
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.
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.
UPDATE, March 30, 2012. BACK ON METOPROLOL. On March 10, when I woke up, I had a very irregular heart beat and a very fast heart rate. It did not subside, even with deep breathing. I went to the local hospital. Diagnosis: tachycardia (cause unknown, but no thyroid problems), a slight anemia (cause unknown), and dehydration. The arrhythmia corrected itself. I was treated with intravenous water, with no improvement, and then with Ativan (valium), with no improvement. My heart rate was c. 120 bpm and blood pressure c. 140/90. Two days later, on Monday, at my doctor's office, my doctor and I agreed that returning to metoprolol was the safest, most sensible next step. I will take 50 mg, daily (time release), measure the results for 2 weeks, and then take my blood pressure and heart rate log to my doctor. In retrospect, I should not have stopped taking the Metoprolol.
In another visit to my doctor, I found that I am in "atrial flutter." I am waiting now to talk to a cardiologist who visits this small town. We will decide whether to simply continue suppressing the heart rate with Metoprolol or plan for another cardioversion to try to reset the rate and rhythm.
UPDATE, July 6, 2012. BACK TO NORMAL; REDUCED DOSAGE. I talked to the local cardiologist, a moderately aggressive interventionist. I rejected his suggestion to prepare for cardioversion. I chose instead to stay with 50 mg of Metoprolol to suppress the heart rate, and live with it. Around June 15, I noticed that I was no longer aware of my own rapid and irregular heart rate. I measure it daily, at the same time, for two weeks. The average rate was about 48 bpm, with blood pressure of about 120/65. The skips and pauses were gone, judging from what I could feel with my finger tips. I cut my Metoprolol dosage in half, to 25 mg/day, time release. On July 5, an EKG at my doctor's office confirmed those numbers and the proper rhythm as well. I will continue to take 25 mg daily, time release.
What might have caused reversion to a regular, though rather low rate? Possibly one of these changes: (1) I had increased by supplementation with Vitamin B12 to 50 micrograms, 5 days per week and 500 micrograms twice weekly, thus more than doubling the dosage; (2) I had started using salt again, thus reintroducing more iodine; (3) I had started eating one Brazil nut per meal (for selenium); and (4) I had stopped eating avocados (to which I might be allergic). How long will this last? We will see.
Comments are welcome, especially about your own experiences with Metoprolol.
Mar 17, 2011
Jan 25, 2011
2010, Dec. 19-23: CHRONIC AFIB. After a large dinner, I experience a rapid, strong, and irregular heart rate. It continued that way, with some variation, for four days. (I have learned to avoid rushing into medical treatments.) At the end of that period, I called 911 because I was worried about the rate. The emergency technicians said it was spiking at about 170 beats per minute.
2010, Dec. 23-25: ER AND HOSPITALIZATION. I went to a local hospital's emergency room. The doctor in charge administered, through an intravenous tube, a drug designed to regulate the heart rate. It did not work. The medication did improve the beat regularity somewhat and did lower the rate to about 130 BPM. (A safe rate is less than 90 and an ideal rate is about 60 BPM.)
UPDATE, April 24, 2012: In March, 2012, I went back into afib. The cardioversion worked for one year. I do not know what caused recurrence. In a local emergency room, the physician said I was dehydrated and "moderately low" anemic. The hospital found no other possible causes (as in the previous episode). I never noticed being particularly thirsty. Now I am wrestling again with trying to decide what to do: Continue with medication (Metoprolol, 50 mg) to control the rate (about 130 bpm without medication, about 80 with medication) and blood pressure (about 125/80 with, 150/90 without)? Or try cardioversion again, and if that doesn't work, try more invasive procedures? This time, I may choose to take the medication and just live (or die) with it. I will write more after I resolve some of the many issues.
UPDATE, September 15, 2012: After taking 50 mg of Metoprolol daily April-July, and after refusing a second cardioversion, my heart has returned to normal sinus rhythm. My physician confirmed that a few days ago, while I was taking 25 mg of Metoprolol. (Because my heart rate has been dropping as low as the 40s, I have begun taking 12.5 mg, half a 25 mg tablet.) I probably will continue the Metoprolol. I am monitoring my heart rate and blood pressure. I have discussed the possibility of substituting digoxin, but my physician and I have not yet made a decision. Possible causes of a return to normal rhythm are: (1) an increased dosage of Vitamin B12 (from c. 250 to 1250 micrograms/week) in the two weeks before; and (2) resumption of using salt (containing iodine). The afib has disappeared as "spontaneously" as it had appeared.
Author of The Power and the Glory: The Key Ideas and Crusading Lives of Eight Debaters of Reason vs. Faith
Jul 15, 2010
1. Starch: 2 large whole Russet potatoes (about 2 cups). The day before, I boiled the potatoes, enough for 3 meals.
2. Vegetables: 1 C already cooked vegetable (bought fresh or frozen). I pour the vegetable into a skillet alongside the potatoes (cold from the refrigerator). I add 1/4 C water (for steaming), add the lid, and set to low heat for 15-20 minutes, until the starches and vegetables are hot.
3. Fruit: 2 C, frozen (e.g., peaches, cherries), fresh (e.g., melons, apples), or dried (plums, dates).
4. Supplements (items added in small quantity for nutritional completeness):
(a) a probiotic capsule or chewable tablet.
(b) B12 (cyanocobalamin) tablet (average 250 micrograms daily, for nerve health), because I have no natural source. Blood tests show this works well for me.
(c) one half of a Brazil nut/meal for selenium.
(d) One "fat pill"/meal, to keep my weight up. (My Body Mass Index once dropped below 17, but should be 18-19.); a "fat pill" is one of these: 6 small black olives; 2 T cocoanut milk; 1 cylinder of heart of palm; 1/3 avocado mashed with chopped onions and lemon juice.
5. Drink: water or mint tea.
The low-sulphur starches that I have tested and now can eat in unlimited quantities are: arrow root (2 mg/100 g serving); winter squash (e.g., acorn [frozen] and pumpkin, 10); sweet potatoes (light-skinned, yellow inside, 15); yams (dark-skinned, dark orange inside, 15); parsnips (15); rutabagas (21), potatoes (browns, reds, golds, purple, 22); and white rice (79). I boil the roots and tubers. (I buy winter, hard-shelled squash in frozen blocks, already removed from the shell, ground, and cooked.) I steam the white rice (simmer 1 C in 1.5 C water, about 20 min.). I do not freeze starches, as their taste and texture usually decline.
I eat in limited quantities, up to one serving/meal of any one of the following starches: water chestnuts (?); bamboo shoots (?); corn, whole kernel (?), 1/4 c.
In limited quantities (no more than one serving of any one of these), I eat: cabbage (25); sauerkraut (?); palm heart (?), 1 cylinder; seaweed (?), 1 3-gram sushi sheet; cauliflower (29); mushrooms (34); collard greens (39); green ("garden") peas (43); broccoli (45); asparagus (47); spinach (86), 1/2 c. I buy some of these frozen or dried, for convenience and storability.
The nuts I eat are: Brazil, 1 nut/day (for selenium); and hazelnut, 1 t crushed/day.
- Foods stored in cans, only because of the remote possibility that some substance in the lining of the can has been aggravating my leaky gut. Exceptions I might make are canned pumpkin, which I cannot find in any other form, and black olives. (I still keep canned foods as an emergency supply.)
- Foods containing more than 50 mg of sulphur per 100 g (half cup) serving, except white rice (79) and spinach (86).
FOODS I WANT TO TEST
- Quinoa (Is it a starchy berry or a grain?).
Dec 28, 2009
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:
- 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].)
- 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.
- 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.