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22 minutes ago · Motiger76 I have a history of a myocardial infarction and afib in Heart & Blood Health

Hi, Tiger (@motiger). Glad to get your message just now. Glad also that you’re taking Coumadin/Warfarin and don’t mind the inconvenience. I think it’s the best of the anti-coagulants (despite TV ads in dispute). One reason for my choice was the death of a friend who was on Coumadin and fell off a step ladder and struck his head. I was the first to find him, called the EMT, and sent him off to the emergency room. Sadly, the ER had no Warfarin antidote — CAN YOU BELIEVE THAT? So they called in a helicopter to ferry him to a more competent hospital — but the half-hour wait was too much, and he died shortly after he arrived at the other hospital. Sounds perverse, doesn’t it — he died from lack of treatment for an anti-coagulant. Not perverse, however. For Warfarin there is the Vitamin K solution that can stop the effects of the anti-coagulant in 15-20 minutes, while the other anti-coagulant drugs still do not have antidotes available, although drug companies are working to develop them.

My other point is whether you might be too concerned about your 150bpm heart rate. After a brisk mile walk, that doesn’t seem threatening, but you — and your cardiologist — would know better than I. I caution you about hankering to change to Carvedilol, which might work for you, but also might cause some uncomfortable side effects. Like with politics, it looks like the two (or three or four) sides of the issue need to get together and agree on a compromise that meets your personal preferences as the patient (the PPP).

For my heart rate, I rely on my BP meter at home, which reports heart rate along with blood pressure. Like you, I sometimes worry about a rate measured during a brief time, then multiplied to its per-minute equivalent. So I just take my heart rate the old fashioned way, counting the beats per minute and using that as a check on the meter. Bottom line, though, I rarely have any syncope symptoms (feelings of fainting) from accelerated heart rate during or after exercise, although it sometimes shows up when I stand up fast from lying or sitting positions.

1 day ago · Confused About Stage 3 CKD Diet in Kidney & Bladder

We’re ships passing in the night, @wietop, so if my comments appear to be ignoring yours, it’s a matter of timing. We’re on the same wave-length here, though, and that’s encouraging. Keep us posted on your evolving relationship with your PCP! Martin

1 day ago · Confused About Stage 3 CKD Diet in Kidney & Bladder

Thanks for the additional information, @wietop. In my case, too, CKD is a result of hypertension. My HMO has a basic policy of referring cases like yours and mine to a nephrologist, because kidneys are so deeply involved in hypertension. In addition, my primary care physician (PCP) is such a busy-body (and I love it, because she’s not satisfied with patients being stable, even over many months). She’s always trying to cure — or mitigate the symptoms of — a condition, and I’ve adopted that approach as well.

Since diet is your main quandary, perhaps you can ask your PCP for help in getting nutrition counseling, which Medicare usually will pay for. Martin

1 day ago · Confused About Stage 3 CKD Diet in Kidney & Bladder

Just to add my voice, @wietop, I like what @rosemarya says here and the questions she raised. In addition, I have no reason to avoid bread that is made from whole grains, although I minimize my bread intake for reasons other than CKD. If bread is your choice, whole grain is the way to go (in order to avoid the glucose loads that come from processed white grain flour or the arsenic loads that may come from rice). Preference for a low-sodium bread is a good choice, whether that is in the brand name, the advertising slogans, or the ingredient list. My HMO offered nutrition counseling for free after my CKD diagnosis. I hope you’ll have a similar service opportunity. Finally, set a goal of developing a trusting relationship with your medical team; that will involve face-to-face conversations, perhaps more often than is customary or even comfortable, but you’ll like it! Martin

1 day ago · Motiger76 I have a history of a myocardial infarction and afib in Heart & Blood Health

Hi, @motiger. Glad you could join us here on Mayo Connect, and I hope you’ll enjoy and benefit from conversations with the members that @kanaazpereira has poked for you. I wrote a fairly long comment in response to your opening message, then lost it when my computer window closed without warning. It was too wordy anyway, so I’ll reconstruct from memory only the main points that I’d have bothered you with.

Like you, I have A-fib, but neither diabetes nor infarction. My main medication is Carvedilol, a newer version of the drug class that includes Metoprolol. My dosage matches yours — 25mg AM and PM. But my dosage is that large as much for its effect on my blood pressure as on regulation of my heart rate. Does your diagnosis also involve hypertension?

Because A-fib sometimes results in small blood clots being formed in the heart and sprayed around in the arteries, I’m also on an anti-coagulant — Coumadin. That has meant regular blood tests to be sure of a safe coagulant index and avoiding a lot of leafy vegetables which contain Vitamin K, a Coumadin antidote. Have you taken an anti-coagulant?

Are you pushing too hard with your exercise regimen? Not that I can see, and if your cardiologist is OK with your daily walk of a mile — with a heart rate of 150 at the end — you should keep right on trucking. My heart rate used to be 50bpm (from running, biking, and hiking); A-fib pushed it up above 90, but it’s now regularly 75-85 as a result of the Carvedilol.

Incidentally, a number of patients on Carvedilol have troublesome side-effects, often because they (or their doctor) abruptly cut their dosage in half or less. It should always be phased down with the doctor’s close oversight.

Let us know how you’re doing . . . what you’re thinking . . . as a result of these discussions. Oh, forgot to mention that I’m originally from Iowa, so I’m assuming that “motiger” reflects a relationship with the University of Missouri Tigers. Right? Martin

Mon, Nov 27 11:22am · Dizziness with ckd in Kidney & Bladder

Glad you mentioned “orthostatic BP,” @cehunt57. When my CKD was diagnosed a few years ago, my nephrologist told me to change how I was taking my BP, citing the possibility that dizziness might be the result of orthostatic hypotension. That occurs when a person’s blood pressure falls after suddenly standing up from a lying or sitting position. It is defined as a fall in systolic blood pressure of at least 20 mm Hg or of diastolic blood pressure of at least 10 mm Hg when a person assumes a standing position. He asked me to report my BP in three ways — while sitting (as normal), while lying down, and immediately after standing up. After a few weeks, I automatically adjusted my posture to compensate from or overcome the dizziness, and I quit thinking about it. Now, on rare occasions, when dizziness recurs, I remember to check for “ortho-hypo.”

Thu, Nov 2 7:12pm · stopping Carvedilol (Coreg): When will the effects wear off? in Heart & Blood Health

@shirleyperkins, did you phase down your dosage under doctor’s orders? If you stopped taking Carvedilol abruptly, I hope you’ll call your doctor for advice on how to adjust your current dosage and symptoms to avoid the discomfort and possible injury. Martin

Mon, Oct 30 9:30am · stopping Carvedilol (Coreg): When will the effects wear off? in Heart & Blood Health

Good morning @eileena. I think Teresa @hopeful33250 is on point with her recommendations a couple of hours ago. In the meantime, let me add that, as a Coreg user for a couple of years, I rely on this medication to both stabilize my heart rate and reduce my high blood pressure (I also take a diuretic and Lisinopril for my hypertension).

Your blood pressure levels are interesting in two respects: First, they are at the low levels that I’d prize; I rarely find my BP to be less than 140/88. Second, the variations you report (127-134 systolic and 66-70 diastolic) don’t strike me as worrisome or particularly significant; BP often varies that much from hour to hour, from sitting to standing, from resting to walking, from before a meal to after one, from during an a-fib incident to after one. I’m also impressed with the minimum daily dosage of Coreg (6.25mg per day) you have been taking, since mine is 50mg.

As Teresa has advised, your experience with Coreg as you describe it is a basis for a good conversation with your cardiologist about the interaction of your BP, your heart rate, and the medication. Martin