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Thursday, January 9, 2014

First visit with new cardiologist.

I met today with Dr. Curtis Rimmerman of the Cleveland Clinic.  I was referred to Dr. Rimmerman by the highly acclaimed author Dr. Caldwell Esselstyn.   After reviewing my records and seeing the progress that I have made over the past 2 plus years, he acknowledged that a significant part of my improvement can be attributed to the lifestyle changes I have made.

I questioned (or grilled) him on the need for all of the medications I am currently on in hopes that the lifesytle changes I have made and am committed to maintaining would warrant reducing the dosage or perhaps even eliminate some of those meds.

Current Medications:

Metoprolol is a beta blocker.  Beta-blockers are one of the most widely prescribed class of drugs to treat hypertension (high blood pressure) and are a mainstay treatment of congestive heart failure. Beta-blockers slow the heart's rate, thereby decreasing the heart’s demand for oxygen. Long-term use of beta-blockers helps manage chronic heart failure.  

A little over a month ago, I had run out of this drug without realizing it.   My doting wife always laid out my medications every morning but her dad had a serious health issue and was in the hospital.   The doctors would not release him unless he had someone at home to take care of him, so it was off to Florida for her.    While she was gone, I ran out of pills in a bottle that was labeled Levothyroxin.    When I called the doctors office for a refill, I was told that I needed to have bloodwork done and visit the doctor before they would write a refill prescription.   Since I had an appoint schedule two weeks away I would just wait.   What I didn't know is that my wife had put my beta blocker into an old thyroid bottle because of the easy open cap.   What followed was rather significant change in my running workouts.    I found that my heart rate on easy runs which would normally be around 145 were now pushing upwards of 160 and that after 3 or 4 miles I just didn't have the energy to run any further.   When I resumed taking the beta blocker after my visit to the doctor, my runs when the other way.   I would run out of gas after only a mile or so and my heart rate was not even reaching 130.    After being back on the metoprolol for a couple days, my training runs returned to normal.

Levothyroxin, a thyroid hormone, is used to treat hypothyroidism, a condition where the thyroid gland does not produce enough thyroid hormone. Without this hormone, the body cannot function properly, resulting in: poor growth; slow speech; lack of energy; weight gain; hair loss; dry, thick skin; and increased sensitivity to cold. When taken correctly, levothyroxine reverses these symptoms. Levothyroxine is also used to treat congenital hypothyroidism (cretinism) and goiter (enlarged thyroid gland).   Hypothyroidism has a link to coronary artery disease, so we are leaving this one alone until we can get my TSH levels back to normal.

Lipitor or Atorvastatin is used along with diet, exercise, and weight loss to reduce the risk of heart attack and stroke and to decrease the chance that heart surgery will be needed in people who have heart disease or who are at risk of developing heart disease. Atorvastatin is also used to decrease the amount of cholesterol (a fat-like substance) and other fatty substances in the blood. Atorvastatin is in a class of medications called HMG-CoA reductase inhibitors (statins). It works by slowing the production of cholesterol in the body to decrease the amount of cholesterol that may build up on the walls of the arteries and block blood flow to the heart, brain, and other parts of the body.

Since my LDL has been lowered below the target of 70 and I am committed to a plant based diet that have virutally no dietary chloesterol we agreed to cut the dosage in half for three months, then retest my lipid levels again.

Aspirin interferes with your blood's clotting action. When you bleed, your blood's clotting cells, called platelets, build up at the site of your wound. The platelets help form a plug that seals the opening in your blood vessel to stop bleeding.
But this clotting can also happen within the vessels that supply your heart with blood. If your blood vessels are already narrowed from atherosclerosis — the buildup of fatty deposits in your arteries — a fatty deposit in your vessel lining can burst. Then, a blood clot can quickly form and block the artery. This prevents blood flow to the heart and causes a heart attack. Aspirin therapy reduces the clumping action of platelets — possibly preventing a heart attack.

I argued that the plant based diet and exercise program I've been on for the past two years has been successful in opening up the narrowed blood vessels and is no longer needed.    My only proof was the vast inmprovement in my cardiovascular fitness.    I'm able to run much farther and faster with a lower heart rate than when first diagnosed.   The good doctor would rather see clinical proof before taking me off the aspirin so it stays....For now.

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