April 30, 2016

My Pills: Part Five -- My Farewell to 5-HTP and Blood Pressure Meds

I've been reporting on the controversy I triggered when I decided to stop taking blood pressure (bp) pills but continued taking the OTC serotonin-boosting supplement 5-HTP (which has the side effect of elevating bp).

My Emergency Room Visit on March 5
On Friday night, March 4, I had an enjoyable visit with a treasured friend from out of town. I was feeling fine when I went to bed. But I had trouble falling asleep, so I went downstairs and stretched out on the living room couch.

This change of scene usually works, but not this time.

So I decided to go back upstairs to the bedroom. As I slid off the couch and attempted to stand, I collapsed onto the floor. My leg muscles were completely useless.

It took a long time to pull my body along using just my arms to get to the phone on the table by the couch to call 911. (OK, I know. "You should be using a wearable medical alert device." For the past six months, I've been gathering lots of information on these systems… the sort of thing I do well and therefore to excess. What I have trouble doing is making a decision.)

I spent several hours in the emergency room at nearby Sibley Hospital. I was given all sorts of tests, which I passed with flying colors. The doctors finally decided to release me and let my housemate drive me home, even though my legs still weren't functioning.

I suspected a cause. I’d experienced several similar incidents -- though not so disabling -- earlier in the week. I was already wondering after these incidents if they were related to my recent experiments with an OTC sleep aid I found at Trader Joe's. Those pills combined small amounts of 5-HTP, melatonin, and L-theanine. 

(Another aside: I know, you’re probably asking "Why the hell are you taking more sleeping aids when – as you claim – the 5-HTP has been taking care of your insomnia?" The answer is the same one that explains many odd decisions I’ve made in my life. "Anything worth doing is worth overdoing.")

I finally figured out that adding the Trader Joe’s sleeping aid to my regular 5-HTP regimen resulted in my OD-ing on serotonin boosters. (Yes, I often get around to recognizing my insanities. Of course, sometimes it takes 35 years… like it did with alcohol.)

I really shouldn’t joke about my addictive tendencies. They’re weaknesses that have threatened my life on more than one occasion. Worse, they’ve jeopardized the lives of others when I was driving drunk.

My Decision to Stop Taking 5-HTP
In fact, I’d already been thinking about ditching the 5-HTP. My aging brain was tiring of the incessant blood pressure monitoring, and it was annoying – maybe crazy – splitting those pills into halves and quarters, trying to get the doses JUST right. The regimen was wearing me out.

April 28, 2016

My Pills: Part Four – – My Blood Pressure Pills

This is the fourth installment in a five-part discussion of the controversy over my decision to continue taking the OTC serotonin-booster 5-HTP… and at the same time to discontinue taking blood pressure (bp) pills.

In the last post, I discussed my history with 5-HTP. Now, here's the background on--

Blood Pressure Pills and Carbidopa/Levodopa and Me
I had the same internist for 25 or 30 years and enjoyed working with him. But for a variety of reasons, I decided not to stick with him when he switched to a concierge practice several years ago.

During those many years, the most troubling challenge was finding a blood pressure med that controlled my hypertension without causing serious side effects.

He eventually suggested I consult a nephrologist he described as the region’s top expert on blood pressure medications. Let's call him Dr. BP.

I liked working with him and still see him occasionally.

My roller-coaster ride with bp and bp meds kicked into high gear with my Parkinson's disease (PD) diagnosis in 2009. In my recent discussion of 5-HTP, I described how my use of carbidopa/levodopa -- the gold-standard med for PD -- raised a new issue: dealing with the bp spikes I began experiencing during "off periods," when the last pill was wearing off and the new one hadn't yet kicked in.

I'll get back to that issue shortly, but first:

New Thinking on BP Meds and Seniors
For years, you were considered a candidate for bp meds if your numbers exceeded 140/90. But in 2013, a new report made several recommendations: maintain that 140/90 threshold for people 30-59, but raise it to 150/90 for adults 60 and older. Some medical authorities, like the American Heart Association, disagreed and argued for sticking with earlier ranges.

April 27, 2016

My Pills: Part Three -- 5-HTP

I had planned to write a single post – a LONG post – about my experience with two pills:
  • the serotonin-boosting OTC supplement 5-HTP,
  • and prescription blood pressure medication.

 Then reason set in, and I decided to divide the subject into three posts:
  1. my background with 5-HTP,
  2. my background with blood pressure (bp) meds,
  3. the final resolution concerning both.
 So, here’s topic #1 for today.

My 5-HTP Saga
Years ago, I occasionally used 5-HTP to combat jet-lag insomnia. In the process, I discovered it helped treat constipation, too.

When I was diagnosed with Parkinson's disease (PD) in 2009, I dug into the research about my new condition. I soon learned that PD often carried with it three particularly common non-motor symptoms:
  1. insomnia,
  2. constipation, and
  3. depression.
I figured my new information explained why I’d been having difficulty with insomnia and constipation during the many months before that official diagnosis.

So, with the approval of my neurologist at that time, I started taking the minimum 50mg dose of 5-HTP every day. It worked well on the constipation and sleeplessness, and even seemed to give my mood a lift, even though I hadn’t felt like depression was really an issue. 

I wanted to share my “miracle” experience about 5-HTP with the world, so I began this blog, which I originally titled "Parkinson's and 5-HTP." Surely hundreds of people with PD – perhaps thousands – would find the same benefits I did… or so I thought.

Within months of beating the 5-HTP drum, I learned that my very positive experience just wasn’t happening for others with PD. It was a big disappointment that I couldn’t help more people “see the light,” so I broadened the blog’s focus to include more general issues about PD in particular and aging in general, and renamed it “Aging, Parkinson’s, and Me.”

That “Me” in the new title provided yours truly carte blanche to ramble on about any topic of interest to me.

So, getting back to 5-HTP, I began indulging my unfortunate tendency to assume that anything worth doing is worth overdoing. Not only was it protecting me from insomnia and constipation, it typically raised my normal depression- free good moods into euphoric states filled with what I considered brilliant, creative ideas.

 If I felt really good on small doses of 5-HTP, wouldn’t I feel that much better on higher doses? One new, very troubling problem arose: as the 5-HTP doses went up, so did my blood pressure.

April 15, 2016

My Pills: Part Two -- Pills I've Tried and Abandoned that May Well Be in Your Medicine Cabinet

Here are some popular pills I no longer take:

Multivitamins: I'd taken multivitamins for years. But in April, 2013, I summarized my research in this post:
The consensus recommendation is this: when possible, get your nutrients from food and not pills. While multivitamins are generally assumed to be safe, some contain excessive doses of nutrients, 19 or more times the recommended daily intakes.  
For instance, some supply high doses of vitamin A, which may weaken bones. Heavy doses of copper can interfere with the absorption of zinc, and vice versa. 
But some groups may not be able to obtain all the vitamins and nutrients they need from diet. For example, some of us old folks have a diminished capacity to absorb vitamin B-12 from food. Especially in cold northern winters, it can be difficult to get adequate vitamin D from sunlight and diet. Most multivitamins, however, don't supply as much vitamin D as experts recommend. 
Strict vegetarians may not get enough B-12, zinc, iron, or calcium. Women of child-bearing age and pregnant women may have special needs not met through diet.  
If you have any of these concerns, it might be best to talk with your doctor about specific supplements you may need, rather than relying on all-purpose multivitamins. The blood results from my annual physical last year showed that I was low on vitamin D, so I now take a vitamin D-3 pill with breakfast every morning. 
I'd much rather go this route than try to figure out which among the staggering array of multivitamins might provide enough vitamin D without overloading my system with other vitamins or minerals.  

​And these days, I find it almost impossible to read the small print on the pill bottle labels.

Daily aspirin therapy

April 14, 2016

My Pills: Part One – the Four I Take Regularly

"Less is more" is my mantra for almost everything, and it's particularly relevant to the prescribed medications and supplements I take. I discussed this subject last year in a post that began with this cartoon:


While the following list may actually seem short to many, here’s what I take now.

My Prescribed Medications
Carbidopa-levodopa: This is the medication most often prescribed for those of us with Parkinson's disease (PD). Sinemet is the brand name, approved by the FDA in 1988.

The body converts the active ingredient levodopa into dopamine, the neurotransmitter that PD depletes. Carbidopa helps the levodopa pass the blood-brain barrier, enhancing the medication’s effectiveness.

After 40 years of clinical experience, levodopa remains the gold-standard treatment for Parkinson's. But this miracle drug isn't perfect. It brings unwelcome side effects, some of them serious. Patients typically find that the drug wears off toward the end of each regular dosing cycle. 

As the PD progresses, doctors usually prescribe increased dosages. I started with two pills three times a day. Now, nearly seven years into my own experience with PD, I take two pills seven or eight times a day. My neurologist told me he will not increase this daily dosage.
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