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Do statins really reduce your risk of heart disease?
Well, you sort of said it there - 17 meds, their interactions, etc can create a chemical soup, but they can also leave you better than you were, so you can't be sure - you are taking the right steps by losing weight, exercising and quitting smoking - cut out meats if you can, especially red meats (chicken should be okay) for a while and maybe even consider a macrobiotic diet or alternate fasting and you'll go even farther.

As to how to best take all those meds, one way is to take it all to a good pharmacist and go over what you can or even should take with what, and what are the best times of day for each for the maximum effect and minimum interaction and you will do a bit better still and lessen possible side effects. Some doctors also offer such counselling, but pharmacists are trained for this. Old school doctors tend to be better at prescribing in a sensible way and making sure your timing is right on all of it, but if you are getting meds form a bunch of different specialists, you need one quarterback to oversee the whole list and make sure it all works in your favour.
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Yup - my PCP is my 'quarterback', all blood work is ordered by him, goes to him, then to my other various doctors. One PCP, one pharmacy (med list carried in wallet), and Rosemary (lead Pharmacist) has and will in the future go over the meds with me. Biggest issue is my night pills and the 'Miralax' that I can't seem to remember to take but at night (was told 60 minutes either side of any meds-ugh).

Heart Doc wants the 20mg of Bystolic to stay 'rest of my life', but PCP is unhappy with my low pulse when sleeping, and is pointing at the Bystolic and the fact that with all the riding, my heart health has improved (proven by the lower/better pulse numbers), and does not want me to drop below 40 PERIOD. Heart Doc states the Bystolic is forever regardless as it (does something??) that I will need forever...

I know when my BP was like 70/54 I felt like ka-ka til I was taken off the ace-inhibitor - so, how low of a resting pulse is "too low"??
*I* am not a DOCTOR or any type of Health Care Professional.  My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
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Dunno, it can go as low as 40 easily, depending on age and fitness, but there are other factors at work here. Bradycardia in your case may well be because of your increased fitness and not something to worry about. In the elderly it can be an indication of heart disease. In the middle aged, it can indicate heart healthiness. So it depends on a myriad of factors, including age, general fitness, drugs, sleep oxygenation, waking oxygenation and dozens of other factors. Do you have a recording pulse oxymeter? If so, take a few night's readings and have a look at the average rates over those nights. Do it again a week later and average it again and compare - that should factor out variables such as drugs induction times, etc. My first guess, given what you have told me, is that we are seeing an increase in heart health, but that is just that, a first guess, based on the very little information you gave me and all things being equal - your cardiologist has to be the one to make such a call.

There is no way to make a fast and hard correlation between bp and pulse rate. A person can have a normal resting heart rate and still have high blood pressure. And someone whose heart rate is abnormal can have normal blood pressure. So giving me the bp doesn't help here, but, yes, that sort of bp may make you feel like death warmed over. You want to shoot for a decent rate and remember that it will go up and down like a yo-yo anyway. That's normal. The real thing is to see that readings on either arm are within, say, 10% or so of each other - if they swing wildly out from that, and consistently, then there may be an indication of a circulatory problem and suspect heart problems.

Nebivolol (Bystolic) is to treat your high blood pressure and should never be stopped cold turkey. Some people who have suddenly stopped taking drugs in this family have had chest pain, heart attack, and irregular heartbeat - if you WERE to stop it, you would need to do so gradually on a schedule worked out by your doctors, and to cease all exercise for the tail off period of around 2 - 3 weeks in order to protect heart from strain. Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. This isn't something prescribed lightly by your cardiologist, and he would have a good reason to keep you on it even if your general health has improved. Serious side effects, the type you NEED to report to your doc immediately, are: symptoms of asthma (for example, feelings of tightness in the chest, shortness of breath, cough, wheezing), blue fingers/toes, fainting, very very slow heartbeat, new or worsening symptoms of heart failure (such as swelling ankles/feet, severe tiredness, shortness of breath, unexplained/sudden weight gain), mental/mood changes (such as confusion, mood swings, depression). So that is your watch list, but then again, with 17 meds, any of these can show up for a dozen reasons.

This is something your PCP and your cardiologist have to hammer out between them and both sides have to make the right arguments to see what is really best. I sure as heck can't tell you a thing - a) you're not my patient, b) it is illegal in my country for me to even attempt to influence you one way or another on an open forum like this and attempt to over ride your licensed physician in your country - I could have my license taken from me and c) it would be foolish of you to listen to me if I did - I can give you general information, as I did above, offer my perspective on things in a very careful way, as I did above, and point you back to your doc to ask the right questions, but here you have a complex case file, a ton of information I don't have in order to make a safe and informed opinion and I would be wrong to tell you other than I just did. Certainly I wouldn't say drop the meds if your cardiologist said otherwise. He has his reasons, and your PCP needs to understand those reasons to advise you best. This doesn't mean that he shouldn't be queried, given the change in your health status and the concern being raised, but this is a complex case and complex prescription file, and has to be handled by people who know your file. Sorry I can't tell you more than that, but if I hope it helps anyway.

If the main concern is the low resting heart rate, monitor to the way I suggested and then you can see how things average.
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No worries - I just like that you are 'chatty' enough that I can understand your thinking Smile Am seeking (if that word must be used) simply general information, not step-by-step guidelines to follow.

I have a long and complex (bad) health history, with many different things going on at the same time. Some issues getting better, some getting worse, and some (while bad) are stable.

I do have a CMS50F recording Oximeter, and have been pulling data (more than I should) and at 6'0" and 317lbs am not fit, or healthy. But yay me, I did quit smoking finally!! Since I have enough issues, no booze, no recreational drug use of any type. And, all the heart related stuff *was* due to high resting heart rate - my BP is always in the 110/70 or the like, it has never been high at all. But the various meds I've been put on has dropped my BP way low at times - which makes me feel pretty bad.

I still have 'fits' (pick a word) of my heart pounding for a 1-15 minute period at a time, very randomly, once in a month maybe? Anyhow, I find your posts very insightful, and I for one thank you for them Smile
*I* am not a DOCTOR or any type of Health Care Professional.  My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
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Gerngesehen (sorry, forgot the Englisch for that).

Yeah, don't worry about the pounding fits, that's actually pretty normal even for really skinny people - your heart will do all sorts of things all the time, so don't sweat that - If you get that a LOT and with regularity after certain activities, then you should talk to the doc about that. Given your weight, of course, any weight loss will be to your benefit. And 140 -odd kilos is a lot for even your frame, unless you are all muscle, and even then that would be a lot of mass for your heart to deal with and oxygenate. Mostly here we have to rely on the EKG (or ECG, depending if you believe that a Brit or Dutchman first invented the device) tracings to see if your slow heart beat is a real issue, but I am guessing again that as you drop the weight it will actually come up, and I now understand why your cardiologist wants you on Nebivolol - you would need to get down to around 240 pounds for a marked change to really kick in, but for every ten pounds lost from where you are, you will encounter an improvement in heart function and general health. So keep at it.

If your bp drops, and the meds will do that, there are easy exercises to get it up a bit, including just blowing your nose, more or less - if you hold your nose closed and scrunch up your shoulders so your chin touches your chest, and blow hard for a minute, you will shoot your bp right up. But do this judiciously, as you can actually do some minor damage if your heart is not happy about this, and there is a small but real stroke risk to shooting your bp up fast. Try it gently a few times not hard enough to turn your face red, and see if it helps. There is a small trigger in your neck when in that position that regulates heart and bp, and all you are doing is more or less pressing on it, but it depends a bit on your individual anatomy. Something I learned from my old doc, who at nearly 80 is still going strong, and is still my best teacher in old school style medicine. When my bp drops, I just get up and walk around in a slow circle for a bit, swinging my arms, and that often is enough to get it up a bit. Mostly any type of exertion will do it. My brother's technique is that he simply thinks about his last divorce, and then I have to do things to get his bp down, not up....
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(11-18-2013, 09:14 AM)DocWils Wrote: My brother's technique is that he simply thinks about his last divorce, and then I have to do things to get his bp down, not up....


Oh, and I wish - am not all muscle, mostly the other stuff...
*I* am not a DOCTOR or any type of Health Care Professional.  My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
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[Image: 270298-apples.jpg]
Apple-a-day as effective as statins
Eating an apple-a-day is an effective as statins at preventing deaths from strokes and heart attacks, Oxford University scientists has discovered.
An apple a day keeps the doctor away

[Image: images?q=tbn:ANd9GcSjE1_cpZxRqtNOFz8fY43...9kq7G_IxpA][Image: images?q=tbn:ANd9GcS9Sroe3NvU_iplzwyS3Ib...ETHLF8Vccm]
Daily glass of wine boosts the immune system
Drinking a glass of wine each day can boost the immune system, scientists have found

[Image: pills-vitamins_2751654a.jpg]
Vitamins are a waste of money, say scientists
Researchers warned people to stay clear of supplements, which are taken by one in three people in Britain
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Yeah, that is all, well sensationalised and not really true - trust the press to tell only a tiny bit of the story and turn it all into a Lies To Children in the headline. It conveys the gist of what was researched in a way that covers a most general understanding of what was found out and yet is mostly wrong in detail and conclusions. If you are trained to be able to read the detailed study in itself, the press is simply not getting it right, and ignores every other study to headline a sensationalist story.

We are an amazingly interactive beast, and while it is true that a glass of wine a day can have some benefit, it is simply not the whole story, nor is it on vitamin supplements (some of which work very well, BTW), nor is it with an apple a day. If you are on statins, it is not time to throw them away and just eat an apple, but eating an apple every evening does do you a great deal of good. All in all, the real answer is not what you take, but when and how. And nothing is a substitute for a varied and healthy diet and exercise.
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(12-19-2013, 06:17 AM)DocWils Wrote: trust the press to tell only a tiny bit of the story and turn it all into a Lies
I've to admit don,t read the whole article. I only read the headlines and the conclusion
The is the full study published in the British Medical Journal

A statin a day keeps the doctor away: comparative proverb assessment modelling study
Adam D M Briggs, academic clinical fellow, Anja Mizdrak, researcher, Peter Scarborough, senior researcher

The comparison of a medicalised approach to chronic disease prevention with that of a lifestyle one has been previously estimated (polypill versus polymeal), although, in our view, not with any realistic hope of changing population behaviour, despite the suggestion to employ out of work cardiologists as chefs. We offer a simplified version of this: our study suggests that both nutritional and pharmaceutical population approaches to primary prevention of vascular disease have the potential to have a significant effect on population mortality. We find that a 150 year old proverb is able to match modern medicine and is likely to have fewer side effects.

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The nurse practitioner at my cardiologists office told me she doesn't like patients taking krill oil, vitamins or green coffee pill (I think that is the name of it). It made me wonder if the reason is because they want patients to take statins instead. I don't know if that is the case but I am going to continue on my current regimen because it is bringing my cholesterol levels down and that is all I am concerned about. I got the results of my CT angiogram and while I have plaque (I would presume everyone has some) I was told that it isn't all in one place and nothing that I should be concerned about. I still cannot figure out why I couldn't be told this on the phone because when I get a call to come to the office to discuss my test results, it made me think something was wrong. Copays next year will not afford me the luxury of running in the office and pay $40 to be told what my blood work results are. IF something was seriously wrong that would be a different story but not just to give me results that says everything appears to be okay. Anyway, I digressed.
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