Jun 27, 2014
1. From age 18 to 25, 1962-1969, I smoked heavily, then stopped and never smoked again.
2. Around 2004 I discovered through a CAT scan that I have emphysema (mild in right, medium in left).
3. Around June 1, 2014, I had spring allergy symptoms: sniffling, sneezing, a little coughing. (Adopting my subset of the McDougall Program diet got rid of earlier terrible spring-time allergies: http://anti-itisdiet.blogspot.com/2010/07/what-do-i-eat.html)
4. A sore throat developed. The coughing worsened. At one point, I coughed very deeply and felt a stabbing pain in my left lung, low.
5. A few days later, I began coughing up a little blood (clotted), as well as a lot of mucus.
6. On last Saturday, I coughed up about two cups of blood. A kind neighbor took me to the local hospital, where I received blood tests (yes, I am thin; no, I am not anemic) and chest x-rays. I coughed up some more blood. The ER doctor prescribed an antibiotic (Augmentin, which wrecked my gut and I needed to discontinue after only two days)
The most likely explanation of events is that the coughing ruptured an artery in my lung most weakened by emphysema, the blood accumulated in the lung, and over several days the body coughed it up—all a perfectly natural sequence of events.
RESOLUTION. The coughing of blood stopped (classic bell curve) within two days. Now, almost a week after the hospital event, I am very slowly recovering. Everyday I can walk a little further. I can work a little longer. I need less cough syrup to suppress the cough. The cough interfered with eating; my BMI dropped to 15.6, in spite of adding fat sources: walnuts, avocados, and olives.
My primary care physician recommended another antibiotic, doxycycline, and I am taking it for 10 days—without intestinal distress.
A CASE OF OVERDIAGNOSIS. My PCP told me that the radiologist at the hospital suspected that I have lung cancer. His "reasoning" was this: He couldn't see all parts of my lungs because I have a lot of scar tissue from 17 pneumothoraces in the last 52 years. The radiologist recommended a thorough investigation (in the radiology department) to either find the lung cancer or decide there is zero chance that I have lung cancer. Among other things he recommended a CAT scan (45 times more radiation than a normal chest x-ray!).
I refused any more investigation.
The radiologist's argument amounts to this: There is a dark space under my bed. Monsters can lurk in dark spaces. Therefore there probably is a monster there.
AGREEMENT. My PCP and I have agreed once again that "less is often better than more." We also agreed that my approach to medical care is the "Shelton Way" not the "Bellevue Way." I live in a small timber town, Shelton, but it is the county seat. It has a county hospital that networks with formerly independent, specialized clinics. My clinic is now part of that network. I am unsure, but I assume that my doctor's reference to "Bellevue" apparently points to an advanced research hospital. I am unsure whether he was referring to Bellevue, Washington or to the Bellevue Hospital in New York.
The Shelton Way means: Not expecting answers to every medical questions; accepting ambiguity; being guided by symptoms not by what "might be there." The Bellevue Way means leaving no questions unanswered; resolving all ambiguity by conducting all possible tests, no matter how expensive; and worrying about what might be wrong, even if no symptoms or other evidence point in that direction.
I have told my doctor that if I cannot locally receive the medical care I supposedly need, then I will do without that medical care. I refuse to chase the latest testing and treatment. I am ready to die if locally available medical care is insufficient.
CONCLUSION. This episode has been very unpleasant, but I have learned and I have increased my respect for my PCP.
Author of The Power and the Glory: The Key Ideas and Crusading Lives of Eight Debaters of Reason vs. Faith, described here: http://www.reasonversusmysticism.com/
Oct 4, 2013
What I eat is a subset of the McDougall Program way of eating. That Program is the best therapeutic way of eating for some individuals who are ill—for example, with obesity:
Nutritionist Jeff Novick lists diet programs similar in their overall pattern: http://www.jeffnovick.com/RD/Articles/Entries/2013/12/5_The_Specturm_Of_Health__The_Evidence_For_A_Whole_Food_Plant_Base_Diet_-_Pt_1.html
Occasionally friends ask what diet I recommend for maintaining or enhancing health for a lifetime. The way of eating that I generally recommend is not what I eat. The diet I recommend is the one I learned forty years ago, at the age of 30, from the book, Live Longer Now: The First One Hundred Years of Your Life, by Nathan Pritikin and others. A few used, inexpensive paperback copies of the book are available: http://www.amazon.com/Live-Longer-Now-Prit/dp/0425086917
At age 30, I had clogged arteries around my heart, chest pains (especially when I was under physical or mental stress), pain on the inside of my left arm (under stress), and high blood pressure. I had been eating the Standard American Diet—high fat, high protein, and Calorie Rich and Processed foods (C.R.A.P.). By adopting the Pritikin diet, described below, I lost 75 pounds in 15 months and got rid of all my symptoms.
4. No added, isolated fat. This means no butter, margarine, olive oil, bacon grease, and so forth. Learn to boil, bake, and steam foods, not fry them. The fats we need are contained in the foods we eat. We do not need to add isolated fats.
PROPORTIONS. I suggest roughly these proportions:
60% starches—intact or whole. Examples are potatoes, yams, and rice.
25% vegetables—intact or whole. Examples are spinach and bell peppers.
10% fruit—intact or whole. Examples are blueberries and oranges.
5% meats high in B12 and maybe D—in very small quantities, such as 1 tablespoon per meal. Examples are clams, oysters, chicken liver, beef liver, and red salmon.
EXCLUSIONS. Avoid all dairy products (though Pritikin allowed them in small quantities if very low fat). Avoid all C.R.A.P. foods such as candy and ice cream. Exclude alcohol, coffee, and tobacco. You may want to exclude wheat and soy, two foods that cause trouble for some individuals. Last, minimize salt. (Because I have a tendency to high blood pressure, my current, one-year experiment is to eliminate all salt. So far, my blood pressure is lower.)
RESULTS. On the Pritikin Program, all my heart disease symptoms disappeared and I lost about one pound per week, on average, for 75 weeks—without trying to lose weight and without restricting the amount that I ate. Of course, most of the weight loss occurred at the start. I only wanted to be healthy. I succeeded. I am nearing 70.
LOSING TOO MUCH? If you lose too much weight following the four steps above, add processed foods such as whole-grain pancakes and noodles, as well as small amounts of high-fat foods (whole or intact) such as nuts, avocados, olives, and so forth.
P. S. — Nutritionist Jeff Novick, for whom I have a lot of respect, discusses the spectrum of generally healthy diets, including those that include small amounts of animal products. See his December 5, 2013 article on his website: http://www.jeffnovick.com/RD/Articles/Entries/2013/12/5_The_Specturm_Of_Health__The_Evidence_For_A_Whole_Food_Plant_Base_Diet_-_Pt_1.html
Author, The Power and the Glory: The Key Ideas and Crusading Lives of Eight Debaters of Reason vs. Faith, described here.
Oct 3, 2013
(1) March 30, 2011: http://www.anti-itisdiet.blogspot.com/2011/03/metoprolol.html
(2) January 25, 2011: http://www.anti-itisdiet.blogspot.com/2011/01/my-atrial-fibrillationflutter-adventure.html
EPISODE 1. The first episode, in Portland, Oregon occurred around twenty years ago, after Christmas day, about thirty minutes after an extraordinarily large evening meal. I was out walking and bent over to retie my shoe laces. Emergency medical people said my rate was about 175 beats per minute (bpm). In an emergency room of a hospital, a doctor injected a substance (unknown to me now) that stopped the racing and restored my normal rate of about 65 bpm.
EPISODE 5. My fifth episode began on April 29, 2014, after about four months of no tachycardia or irregularity (December 2013 to April 2014). The event started in the evening. The immediate trigger was eating a meal too quickly. I bloated. Then after dinner I bent over to untie my shoe laces. My heart began racing. I could not stop it with deep breathing and back bends. Compression of the heart seems to have been the cause. I began taking 50 mg Metoprolol and 0.25 mg Digoxin. In the following two weeks I went through the familiar stages: (1) At first the medications seem to have little effect; (2) after a few days the heart rate dropped into the 80s; (3) on May 11 (much sooner than in earlier episodes), my heart rate dropped into the 40s-50s. I needed to cut back my walking and walk more slowly too. I reduced my digoxin to 0.125 mg, and then after a few days, deleted it as my heart rate continued to be in the 40s. This episode has shown faster recovery than ever before.
(2) A cumulating effect of the medications. Does the Metoprolol "train" the nerve to fire at a slower rate? I do not know.
(8) Being objective, by which I mean focusing on objects directly in front of and not worrying about real or imaginary events occurring outside of my life. This focusing includes engaging in one task at a time and not multitasking. Often slower is faster.
(9) Chewing my food thoroughly and eating slowly, without stress.
P.S. If you have successfully stopped your own tachycardia episodes, please comment below.
Dec 18, 2012
So far, it has confirmed my earlier tests and worked perfectly as a predictor.
Nov 29, 2011
Mar 30, 2011
(This post is a diary. For a summary and overview of my tachycardia and arrhythmia experiences see the October 13, 2013 post here: http://www.anti-itisdiet.blogspot.com/2013/10/tachycardia-arrhythmia.html)
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.