old stuff from my other blog
Aug. 13th, 2005 12:27 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
bunrabAnother bunch of old entries from my other blog, which I am slowly trying to incorporate into the archives here. If you are not interested in CHF, feel free to ignore these.
Friday, August 01, 2003
Ugh, it's been several days. Since I have started taking the spironolactone, I've been sleeping 12 to 16 hours a day, which starts leaving me with too little time to do things. (I've even been sleeping through meals!) So I put a call in to the doc, see if I can go off it again - whatever benefit it's supposed to incur, I think being asleep through most of the day outweighs that benefit.
Anyway, back to beta blockers. Let's see if I can redo my long post.
Adrenaline isn't just one thing, it's actually several. And the receptors for it around the body aren't just one kind, there are several. There are alpha-adrenergic receptors, and several kinds of beta-adrenergic receptors. Different areas of the body have different balances of these. When adrenaline hits the heart, it stimulates it to beat faster and harder - the famed fight-or-flight response. For a person with heart failure and a tendency toward tachycardia and/or arrhythmia, this is not good. So the class of drugs generally called beta-blockers, works to prevent the adrenaline from being received by the heart, so the heart won't be overstimulated.
OK. Beta blockers generally block one or more of the beta-adrenergic hormones. Beta blockers can be recognized by their generic names, which all end in lol. As in, acebutelol, bisoprolol, labetalol, etc. There are also drugs that are solely alpha-adrenergic blockers, but they don't end in lol. Terazosin, for example, is an alpha blocker used for hypertension and benign prostate hyperplasia. Most of the beta blockers are used as anti-hypertensives, anti-angina, and as anti-arrhythmics. And most of them aren't prescribed for CHF; in fact, most of them carry warnings that people taking them for other heart problems may develop CHF! Some are used for specific other purposes - timolol, for example, is used to treat glaucoma - it reduced the pressure of fluid in the eye. It's used on animals as well as humans - I know several dogs and rabbits who have had their eyes treated with timolol. That's one of the ones that carries CHF as a possible risk. Propanolol is one of the oldest of the beta-blocker class, and has been prescribed for angina and hypertension for nearly 40 years (brand name Inderal). It's also one that carries CHF as a possible risk.
On the other hand, carvedilol (brand name Coreg) is both an alpha and beta blocker, blocking more than one type of beta receptor. This was the first beta blocker approved for treating CHF, only a few years ago. Another one, metoprolol XL form, has been approved since then. Several studies have shown that carvedilol gives significant survival benefits to patients with advanced or severe heart failure; one study showed that it reduced death rates by 35%. This is probably the single most significant improvement in mortality rates and in hospitalization rates of any of the drugs prescribed for CHF. Despite the possible disadvantages, it's definitely worth taking.
Now the downsides of carvedilol. There's an extremely long titration period. Titration is the fifty-cent word for ramp-up, that is, building up to the therapeutic dose. Starting out on a full dose right away is guaranteed to make you feel a lot worse, and so many people wouldn't comply with continuing to take it. The ramp-up allows you to get used to the side effects more gradually. It takes about 10 weeks, starting at 3.125 mg and doubling every couple of weeks, to get to 25 mg twice a day. Even at the low dose, fatigue, tiredness, lethargy and slow heart rate are expected side effects. They gradually wear off - then come back for a few days each time the dose is doubled. So it's about three months before you really begin to feel better. One should be taking one's blood pressure and pulse every morning, and if your pulse rate falls below 60, let the doctor know. Also, since the purpose of this drug is, in part, to slow the heart rate, one should not be doing exercises that call for a high target heart rate. No aerobics. Doctors recommend walking, yoga, and swimming (as long as you're not trying to do them competitively, high-powered and high-pressured) as exercises that keep you moving and flexible, without pushing your heart into fighting with the beta-blockers. One should also have one's digoxin levels measured regularly while taking beta-blockers.
There's your bunch of trivia for the day. Wasn't that exciting?
Bad, bad BunRab! I had a baked potato with butter on it at lunch, and Chinese food for supper which undoubtedly had some salt in the sauce. I didn't eat all the rice, soaked in all the sauce, however, as I used to do; I took each prawn and each snowpea and each walnut and sorta wiped the sauce off against my rice, before eating each piece. I spent part of the morning helping to empty folders of old music; I play in the volunteer municipal band, and we start rehearsals again in only 3 and a half weeks or so, so it's time to get last year's music back in the envelopes and new folders full of new music, all shiny and unwrinkled, made up. We have about 90 people in the band, and since many of us are over 40 and wearing bifocals, that means separate folders for just about everyone, since few of us can see well enough to share a stand. I'll be happy to start up this season feeling MUCH better than I did last year at this time, when I hadn't been diagnosed, and was coughing all the time and gasping for breath a lot, which is not conducive to playing the tenor saxophone. Now if only I knew my teaching schedule for next semester yet (which starts at about the same time), I'd be all set!
Sunday, August 03, 2003
Today's link: Cholesterol drugs improve strange heart problem.
A quote from the article:
Drugs that are commonly used to lower cholesterol levels appear to improve a mysterious type of heart disease with an unknown cause.
The disease, known as idiopathic dilated cardiomyopathy (IDC), results in an enlarged heart that doesn't pump properly. Unlike the most common type of heart disease, IDC is not due to a blockage of the coronary arteries that feed the heart. Although less common than other heart problems, it is the number one reason people get a heart transplant.
Statins, which include Pravachol and Lipitor, are frequently given to patients with high cholesterol levels. In addition, they have been shown to be useful for patients with heart disease involving the coronary arteries. However, it was unclear if statins were beneficial for IDC.
IDC is how my heart failure occurred, and probably the same for many of you - your heart is enlarged, no one knows why. Although they refer to it as "strange" it's strange in the sense of unknown cause, not in the sense of rare - because it's pretty common!
Monday, September 01, 2003
Wow, here I haven't been for nearly a week. Sorry about that. I spent the weekend at a Mensa Regional Gathering, which stands for "let's invade an unsuspecting hotel, hold chocolate tastings, and stay in the hot tub till way after hours." Mostly, I was eating junk food from the hospitality suite, but the guy running hospitality did make some macaroni salad with no salt in it, so I had some of that. And the Bananas Foster (ever seen flaming bananas made in a crock pot?) was good.
I was presenting a workshop at the RG (crafts, nothing y'all would be interested in) and someone took pictures. It was amazing to see myself in the photos- I had not realized just how much difference 30 pound weight loss would mean. I look way different. And people who hadn't seen me since last Labor Day weekend noticed the difference - that was nice. (Austin holds a regional gathering Labor Day weekend, Dallas does theirs Thanksgiving weekend, Houston does theirs Memorial Day. About 80% of the people who go to each are the same people - and if you want to travel, you could attend a Mensa RG every weekend of the year somewhere in the country. All of which would feature chocolate and hot tubs, and pretty much none of which would feature any evidence of high intelligence. I don't go to any RGs but our own; I'm not that much of a party animal.)
'Scuse me, my hearing aid battery is beeping "I'm dying" at me - gotta go.
Tuesday, September 09, 2003
Tuesday nights are Band rehearsals. I play in the volunteer municipal band, an organization for people who never outgrew marching band. We've rehearsed every Tuesday evening except 6 weeks each summer for 21 years now. The band is getting greyer - there are some new members every year, but the core of people who started out 20+ years ago are all, well, 20+ years older. The guy who sits next to me had a heart attack a couple years ago. He has not lost weight since then, though - I worry about him. I've lost over 30 pounds since getting diagnosed with heart failure. I hope it will do me some good. One thing I noticed when rehearsals started up a couple weeks ago was the difference between my energy levels this year and last year at the same time. In August 2002, when rehearsals started, I hadn't been diagnosed yet, and we were still struggling to find out why I was always so short of breath. The corridor leading from the outside to the band hall is an uphill one; last year, in the length of a corridor that's only a hundred feet or so, I had to stop and rest 3 or 4 times along the way as I headed to the band hall. This year, while I still wouldn't want to sprint, especially while carrying 30 pounds of tenor saxophone, case, music, accessories, etc., I can walk quite steadily up the corridor without stopping. That's a vast improvement, due almost entirely to the diuretics clearing out my lungs.
The same sort of thing occurred at the Mensa RG in the previous post. The hotel where Lonestar holds its RGs has a set of stairs leading to the meeting rooms; the stairs wind around, 4 stairs, then a landing and a turn and 4 stairs in a different direction, then another landing and turn, and so on. Last year, I had to stop on every one of those landings and rest. This year, although I still wouldn't try and bound up the stairs 2 at a time, I could walk steadily up the stairs without stopping.
I still don't have as much energy as I'd like to, especially when the weather is really, really hot. I still need a nap every afternoon, and tend to sleep 10 or more hours a day rather than 7 or 8. But being able to breathe normally is a vast improvement in quality of life.
On nights when we have rehearsals, we tend to eat out before rehearsals. A pizza place called Frank & Angie's has a 2-for-1 special on individual pepperoni pizzas, the 10" kind. Now, pizza is basically a large lump of sodium and fat - cheese, pepperoni; the crust has salt in it, and tomato sauce is LOADED with salt. But these pizzas have relatively small amounts of tomato sauce, and I pick off half the pepperoni. And all I eat during the day before that is fruit and nuts - no sodium whatsoever during the day. So I have my entire 2000 mg allowance available to blow on the pizza. It's worth it to me. Especially during the summer, when plums and peaches and nectarines and pluots are 99 cents a pound, I have no trouble at all sticking to fresh fruit. I buy unsalted nuts in bulk, usually hazelnuts (filberts). So 3 pieces of fruit and a dozen nuts or so (a handful is anywhere from 8-15 nuts, depending on the type of nut and the angle I reach into the container) is lunch. There are lots worse ways to meet one's daily servings according to the food pyramid!
Wednesday, September 17, 2003
I was really bad this evening- we ate Mexican, and I went ahead and had chips and queso. I am sooo tired of being good. I know most people break their diets far more often than I do. Mostly I'm happy with the fruit-and-nuts deal; I really like fruit, and summer is a great time for it. But all of a sudden I had this craving for queso. It was blocking all other thought out of my mind. I just HAD to give in. I suspect I'll have a rough night tonight; luckily, I don't have to be at school tomorrow until 2 p.m. This is the first time that I've had chips and queso since last December. Curra's, one of my favorite Mexican restaurants, serves their queso with lots of pico de gallo, guacamole, and ground beef in it. Mmmmmmmm.
I spent about three days' worth of spare time building a new cage for Chili the chinchilla. Turns out that Gizmo, our largest rabbit, could hop right up on top of Chili's old cage, sorta dangerous for Gizmo not to mention alarming to Chili. New cage is 3.5 feet tall, I think it will stop Gizmo in his tracks. It gives Chili more room to bounce, too, and I made it with an area tall enough for a 14" running wheel, something most commercial cages don't have room for. Chili will get more exercise than I do. He is 11 years old now, quite middle aged for a chinchilla, so he needs exercise at least as much as I do. (Average lifespan of chinchillas, depending on who you read, is anywhere from 12 to 18 years.) I still don't exercise much; it's BORING. Now, chasing down the chinchilla when he's having floor time, to get him back in his cage for the night, that's exercise I don't mind. It's amazing how nimble a 2-pound rodent can be!
Friday, August 01, 2003
Ugh, it's been several days. Since I have started taking the spironolactone, I've been sleeping 12 to 16 hours a day, which starts leaving me with too little time to do things. (I've even been sleeping through meals!) So I put a call in to the doc, see if I can go off it again - whatever benefit it's supposed to incur, I think being asleep through most of the day outweighs that benefit.
Anyway, back to beta blockers. Let's see if I can redo my long post.
Adrenaline isn't just one thing, it's actually several. And the receptors for it around the body aren't just one kind, there are several. There are alpha-adrenergic receptors, and several kinds of beta-adrenergic receptors. Different areas of the body have different balances of these. When adrenaline hits the heart, it stimulates it to beat faster and harder - the famed fight-or-flight response. For a person with heart failure and a tendency toward tachycardia and/or arrhythmia, this is not good. So the class of drugs generally called beta-blockers, works to prevent the adrenaline from being received by the heart, so the heart won't be overstimulated.
OK. Beta blockers generally block one or more of the beta-adrenergic hormones. Beta blockers can be recognized by their generic names, which all end in lol. As in, acebutelol, bisoprolol, labetalol, etc. There are also drugs that are solely alpha-adrenergic blockers, but they don't end in lol. Terazosin, for example, is an alpha blocker used for hypertension and benign prostate hyperplasia. Most of the beta blockers are used as anti-hypertensives, anti-angina, and as anti-arrhythmics. And most of them aren't prescribed for CHF; in fact, most of them carry warnings that people taking them for other heart problems may develop CHF! Some are used for specific other purposes - timolol, for example, is used to treat glaucoma - it reduced the pressure of fluid in the eye. It's used on animals as well as humans - I know several dogs and rabbits who have had their eyes treated with timolol. That's one of the ones that carries CHF as a possible risk. Propanolol is one of the oldest of the beta-blocker class, and has been prescribed for angina and hypertension for nearly 40 years (brand name Inderal). It's also one that carries CHF as a possible risk.
On the other hand, carvedilol (brand name Coreg) is both an alpha and beta blocker, blocking more than one type of beta receptor. This was the first beta blocker approved for treating CHF, only a few years ago. Another one, metoprolol XL form, has been approved since then. Several studies have shown that carvedilol gives significant survival benefits to patients with advanced or severe heart failure; one study showed that it reduced death rates by 35%. This is probably the single most significant improvement in mortality rates and in hospitalization rates of any of the drugs prescribed for CHF. Despite the possible disadvantages, it's definitely worth taking.
Now the downsides of carvedilol. There's an extremely long titration period. Titration is the fifty-cent word for ramp-up, that is, building up to the therapeutic dose. Starting out on a full dose right away is guaranteed to make you feel a lot worse, and so many people wouldn't comply with continuing to take it. The ramp-up allows you to get used to the side effects more gradually. It takes about 10 weeks, starting at 3.125 mg and doubling every couple of weeks, to get to 25 mg twice a day. Even at the low dose, fatigue, tiredness, lethargy and slow heart rate are expected side effects. They gradually wear off - then come back for a few days each time the dose is doubled. So it's about three months before you really begin to feel better. One should be taking one's blood pressure and pulse every morning, and if your pulse rate falls below 60, let the doctor know. Also, since the purpose of this drug is, in part, to slow the heart rate, one should not be doing exercises that call for a high target heart rate. No aerobics. Doctors recommend walking, yoga, and swimming (as long as you're not trying to do them competitively, high-powered and high-pressured) as exercises that keep you moving and flexible, without pushing your heart into fighting with the beta-blockers. One should also have one's digoxin levels measured regularly while taking beta-blockers.
There's your bunch of trivia for the day. Wasn't that exciting?
Bad, bad BunRab! I had a baked potato with butter on it at lunch, and Chinese food for supper which undoubtedly had some salt in the sauce. I didn't eat all the rice, soaked in all the sauce, however, as I used to do; I took each prawn and each snowpea and each walnut and sorta wiped the sauce off against my rice, before eating each piece. I spent part of the morning helping to empty folders of old music; I play in the volunteer municipal band, and we start rehearsals again in only 3 and a half weeks or so, so it's time to get last year's music back in the envelopes and new folders full of new music, all shiny and unwrinkled, made up. We have about 90 people in the band, and since many of us are over 40 and wearing bifocals, that means separate folders for just about everyone, since few of us can see well enough to share a stand. I'll be happy to start up this season feeling MUCH better than I did last year at this time, when I hadn't been diagnosed, and was coughing all the time and gasping for breath a lot, which is not conducive to playing the tenor saxophone. Now if only I knew my teaching schedule for next semester yet (which starts at about the same time), I'd be all set!
Sunday, August 03, 2003
Today's link: Cholesterol drugs improve strange heart problem.
A quote from the article:
Drugs that are commonly used to lower cholesterol levels appear to improve a mysterious type of heart disease with an unknown cause.
The disease, known as idiopathic dilated cardiomyopathy (IDC), results in an enlarged heart that doesn't pump properly. Unlike the most common type of heart disease, IDC is not due to a blockage of the coronary arteries that feed the heart. Although less common than other heart problems, it is the number one reason people get a heart transplant.
Statins, which include Pravachol and Lipitor, are frequently given to patients with high cholesterol levels. In addition, they have been shown to be useful for patients with heart disease involving the coronary arteries. However, it was unclear if statins were beneficial for IDC.
IDC is how my heart failure occurred, and probably the same for many of you - your heart is enlarged, no one knows why. Although they refer to it as "strange" it's strange in the sense of unknown cause, not in the sense of rare - because it's pretty common!
Monday, September 01, 2003
Wow, here I haven't been for nearly a week. Sorry about that. I spent the weekend at a Mensa Regional Gathering, which stands for "let's invade an unsuspecting hotel, hold chocolate tastings, and stay in the hot tub till way after hours." Mostly, I was eating junk food from the hospitality suite, but the guy running hospitality did make some macaroni salad with no salt in it, so I had some of that. And the Bananas Foster (ever seen flaming bananas made in a crock pot?) was good.
I was presenting a workshop at the RG (crafts, nothing y'all would be interested in) and someone took pictures. It was amazing to see myself in the photos- I had not realized just how much difference 30 pound weight loss would mean. I look way different. And people who hadn't seen me since last Labor Day weekend noticed the difference - that was nice. (Austin holds a regional gathering Labor Day weekend, Dallas does theirs Thanksgiving weekend, Houston does theirs Memorial Day. About 80% of the people who go to each are the same people - and if you want to travel, you could attend a Mensa RG every weekend of the year somewhere in the country. All of which would feature chocolate and hot tubs, and pretty much none of which would feature any evidence of high intelligence. I don't go to any RGs but our own; I'm not that much of a party animal.)
'Scuse me, my hearing aid battery is beeping "I'm dying" at me - gotta go.
Tuesday, September 09, 2003
Tuesday nights are Band rehearsals. I play in the volunteer municipal band, an organization for people who never outgrew marching band. We've rehearsed every Tuesday evening except 6 weeks each summer for 21 years now. The band is getting greyer - there are some new members every year, but the core of people who started out 20+ years ago are all, well, 20+ years older. The guy who sits next to me had a heart attack a couple years ago. He has not lost weight since then, though - I worry about him. I've lost over 30 pounds since getting diagnosed with heart failure. I hope it will do me some good. One thing I noticed when rehearsals started up a couple weeks ago was the difference between my energy levels this year and last year at the same time. In August 2002, when rehearsals started, I hadn't been diagnosed yet, and we were still struggling to find out why I was always so short of breath. The corridor leading from the outside to the band hall is an uphill one; last year, in the length of a corridor that's only a hundred feet or so, I had to stop and rest 3 or 4 times along the way as I headed to the band hall. This year, while I still wouldn't want to sprint, especially while carrying 30 pounds of tenor saxophone, case, music, accessories, etc., I can walk quite steadily up the corridor without stopping. That's a vast improvement, due almost entirely to the diuretics clearing out my lungs.
The same sort of thing occurred at the Mensa RG in the previous post. The hotel where Lonestar holds its RGs has a set of stairs leading to the meeting rooms; the stairs wind around, 4 stairs, then a landing and a turn and 4 stairs in a different direction, then another landing and turn, and so on. Last year, I had to stop on every one of those landings and rest. This year, although I still wouldn't try and bound up the stairs 2 at a time, I could walk steadily up the stairs without stopping.
I still don't have as much energy as I'd like to, especially when the weather is really, really hot. I still need a nap every afternoon, and tend to sleep 10 or more hours a day rather than 7 or 8. But being able to breathe normally is a vast improvement in quality of life.
On nights when we have rehearsals, we tend to eat out before rehearsals. A pizza place called Frank & Angie's has a 2-for-1 special on individual pepperoni pizzas, the 10" kind. Now, pizza is basically a large lump of sodium and fat - cheese, pepperoni; the crust has salt in it, and tomato sauce is LOADED with salt. But these pizzas have relatively small amounts of tomato sauce, and I pick off half the pepperoni. And all I eat during the day before that is fruit and nuts - no sodium whatsoever during the day. So I have my entire 2000 mg allowance available to blow on the pizza. It's worth it to me. Especially during the summer, when plums and peaches and nectarines and pluots are 99 cents a pound, I have no trouble at all sticking to fresh fruit. I buy unsalted nuts in bulk, usually hazelnuts (filberts). So 3 pieces of fruit and a dozen nuts or so (a handful is anywhere from 8-15 nuts, depending on the type of nut and the angle I reach into the container) is lunch. There are lots worse ways to meet one's daily servings according to the food pyramid!
Wednesday, September 17, 2003
I was really bad this evening- we ate Mexican, and I went ahead and had chips and queso. I am sooo tired of being good. I know most people break their diets far more often than I do. Mostly I'm happy with the fruit-and-nuts deal; I really like fruit, and summer is a great time for it. But all of a sudden I had this craving for queso. It was blocking all other thought out of my mind. I just HAD to give in. I suspect I'll have a rough night tonight; luckily, I don't have to be at school tomorrow until 2 p.m. This is the first time that I've had chips and queso since last December. Curra's, one of my favorite Mexican restaurants, serves their queso with lots of pico de gallo, guacamole, and ground beef in it. Mmmmmmmm.
I spent about three days' worth of spare time building a new cage for Chili the chinchilla. Turns out that Gizmo, our largest rabbit, could hop right up on top of Chili's old cage, sorta dangerous for Gizmo not to mention alarming to Chili. New cage is 3.5 feet tall, I think it will stop Gizmo in his tracks. It gives Chili more room to bounce, too, and I made it with an area tall enough for a 14" running wheel, something most commercial cages don't have room for. Chili will get more exercise than I do. He is 11 years old now, quite middle aged for a chinchilla, so he needs exercise at least as much as I do. (Average lifespan of chinchillas, depending on who you read, is anywhere from 12 to 18 years.) I still don't exercise much; it's BORING. Now, chasing down the chinchilla when he's having floor time, to get him back in his cage for the night, that's exercise I don't mind. It's amazing how nimble a 2-pound rodent can be!
