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3 days ago · Diastolic blood pressure in Heart & Blood Health

Hi, @evittan. I hope you can get a handle on your diastolic BP with the help of a doctor who cares. My experience includes some issues to consider as you look for a second opinion about your situation. My HMO set me up intelligently, sending me first to a nephrologist, (kidney specialist), and that turned out to be a wiser choice than trooping down the list of available cardiologists. In my case, the nephrologist partnered with an endocrinologist to examine whether hormones might be involved in my hypertension.

Of special interest to them was my adrenal glands which produce adrenalin and cortisol — both of which inspire responses in a variety of organs and functions, for example, the heart, arteries, and brain. They focused on cysts on my adrenal glands which might be generating excess hormones that pressed my heart to respond as though I was in anxiety or fear. That turned out not to be the case. But they did come up with a rare condition in my kidneys — the Lyttle Syndrome, a genetic problem that drains potassium from my blood and reclaims none of it, leaving me hypokalemic, with raised blood pressure. A few months later, my cardiologist diagnosed my atrial fibrillation which interferes with the function of my heart, causing another BP problem.

From this experience, you can guess why I am glad to have had a multi-physician medical team — supported by my personal care provider (PCP) and consisting of nephrologist, endocrinologist, cardiologist, and pharmacologist (with incidental support from a neurologist with expertise in the brain's influence on hormones). Costs? Medicare took care of the main costs, and my HMO settled for $130 a month, plus a few hundred dollars a year for medications. Perhaps my adventures will give you some ideas for broadening your medical care and bring other experts to your treatment team.

Tue, Mar 12 7:53am · I'm having multiple odd episodes that are keeping me undiagnosed. Help in Brain & Nervous System

Two quick responses @johnwes5819, then off to town for the morning. First, the collection of doctors doesn't form a team without a communication system and a respected professional who wants to lead and will bring all the others into line. In my case, the team was ready to form within staff of the HMO. Second, your personal expertise — developed with a lot of research of the possibilities — has the potential to track down causes of your symptoms, but it also accompanies you as an encyclopedia when you visit a doctor whose practice is highly focused and comparatively narrow. In this case, consider keeping your questions to those that the doctor is likely to have an answer for; s/he understands what you're talking about and have studied, but needs to reframe her/his approach and undertake a novel or obsolete diagnosis and treatment. One answer to this is, as Teresa @hopeful33250 said, a university medical center with a multidisciplinary approach. Martin

Mon, Mar 11 9:11pm · I'm having multiple odd episodes that are keeping me undiagnosed. Help in Brain & Nervous System

Well @johnwes5819 I'm in deep sympathy for your feelings of uncertainty about where to turn. Your collection of medical personnel is impressive, but may I ask: Who's in charge? That is, does your medical team have a leader and a communication system to share personal information? Were you referred to that variety of specialists by a personal care physician who does that for a living? I hope we can track down a promising medical practice in Indiana that could offer you the kind of universal diagnosis and treatment that you need. Meantime, your focus and intensity in search of causes and treatments are awesome. There must be a medical service in Indiana that could help you manage and direct your care. Martin

Mon, Mar 11 8:25pm · I'm having multiple odd episodes that are keeping me undiagnosed. Help in Brain & Nervous System

Hi @johnwes5819. I am as puzzled as you are about your complex of symptoms. I looked at your other message, and it prompted me to respond right away because what I saw stood out so clearly as a potential problem — 50,000 International Units of Vitamin D3. That's a very high daily dose of Vitamin D3 and might be the source of several of your troublesome symptoms. I suggest that you have a direct conversation in person with a doctor you trust, first thing in the morning, about the Vitamin D3 dose. Second, you made no mention of what kind of doctors are on your medical team. Given the range of your symptoms and their mysterious relationships, would you consider arranging for thorough examination by an endocrinologist; this could reveal something about your body chemistry that is not now known — for example, the catecholamines, hormones made by the adrenal glands (epinephrine (adrenalin), norepinephrine, and dopamine). Third, would it be possible for you to undergo a complete examination by Mayo Clinic at Rochester, Minnesota, or Scottsdale, AZ, or Jacksonville, FL? Mayo or a similarly equipped complex of clinics with a history and reputation of patient-directed, full range, diagnosis and treatment would be a good option to consider. We can help you make arrangements with Mayo. Martin

Fri, Mar 8 9:20pm · Afib: What causes an episode? What if I don't notice? in Heart Rhythm Conditions

Hi @cadillac. Glad that Colleen invited me to join in this discussion so we can get to know you better. I think my a-fib is much like yours. I don't realize my irregular heart beat except in two situations — when my doctor is taking an EKG and when I'm taking my blood pressure. Otherwise, I am not conscious of my heart beat. How about you? Do you feel irregular beats? Would you remain anxious if you didn't know you are in a-fib?

I have had irregular heart beats for 25 years or more, but my a-fib diagnosis came only four years ago when it showed up on my EKG during my annual physical examination. Although I had no sense of the problem, I accepted the diagnosis by my personal care physician and had it confirmed by a cardiologist. We then agreed to two medications — Carvedilol, a beta blocker to smooth out and dial down my heart beat, and Coumadin, an anticoagulant to reduce the chance of blood clots forming in my atrium and getting sent off to sensitive organs like my brain or my kidneys. Would you share with us your current medication? Martin

Mon, Feb 25 2:24pm · very high calcium score. in Heart & Blood Health

Hi @pcspetpro. Glad @kanaazpereira invited me into this discussion again. I share your confusion about whether statins are reliable responses to calcification of arteries or not. I'm particularly interested in "Statins Promote Coronary Calcification? Study Says Yes . . ." It looks to me as though this is a common case of a bad misleading headline.

In the first paragraph of the story under the headline, you'll see that "In the analysis, statins, specifically high-intensity statin therapy, actually promoted coronary calcification despite regressing the volume of coronary atheroma." Notice that the headline gives no attention or credence to "high-intensity statin therapy" as a major factor in calcium contents of debris deposits on the internal lining of an artery. As you suggest, there was some mysterious capability of statins to affect changes in calcium and low-density lipids and doing so in contrasting directions under differing conditions. Unfortunately, the mystery was reported for this study four years ago and might have been solved more recently, but if so, I didn't find that information. Even so, give that report a good read and see if you get a different impression of how calcium deposits in arteries are affected by statins. As Kanaaz says, that's a matter of long-term controversy.

Mon, Feb 25 1:53pm · Lisinopril or atenolol in Heart & Blood Health

Hi @jadillow. I'd like to give you a judgment on whether your resting heart rate in the 50-70bpm rang is OK, but I'm not an expert and haven't examined you face-to-face, so I have to reserve judgment and encourage you to discuss it with your doctor — or if you aren't comfortable with her advice thus far, you could make use of a second opinion. I'll add that my regular resting heart rate 5 years ago was a few beats above or below 50bpm, as it had been for many years. After contracting Atrial fibrillation 4.5 years ago, my heart rate jumped to about 90, then with a beta blocker (Carvedilol 50mg daily) it dropped back to 75-85bpm and stays there steadily. Would you consider giving up the anxiety med if you can become confident of survival with your lower resting heart rate? Martin

Sat, Feb 16 9:18pm · Osteoarthritis and Vitamin D Deficiency in Bones, Joints & Muscles

You're welcome @ssbionicknee. The hormone gland managing calcium is the PARATHYROID, not the thyroid. Just to be clear. I bought a laptop a while ago. It was refurbished. Best I ever had! Martin