I've had some issues these past few months, and I now suspect they're mostly side effects of meds I take.. My dilemmas are nothing compared to the problems of others, like people I know who are receiving chemo for cancer. Still, I want to recap what's been going on.
My Prescribed Meds and Supplements
Here's what I was taking at the start of the summer:
- Carbidopa/levodopa, the gold-standard med for Parkinson's disease. I take the minimal 25/100mg pill four times a day at six-hour intervals. It's the one med I regard as essential. If I miss a pill, I'm usually reminded an hour or two later when I'm staggering around like the drunk I used to be.
- Azilect, the second most-prescribed -- and costliest -- med for PD. I was initially prescribed a 1mg dose, but secured my neurologist's OK to cut it in half. I've tried skipping it altogether occasionally, with unclear results.
- Blood pressure meds, which I've taken for decades. These past few years, they've caused unwelcome side effects. At the start of the summer, I was taking half the "minimal" dosage of tribenzor, a combo of three types of bp medications.
- Statins for cholesterol, another decades-long connection. I'd been taking Lipitor (and its eventual generic), but stopped when I thought the med was contributing to lower back and other muscular pains. My cholesterol numbers then increased, and my new internist persuaded me to take 10mg of pravastatin.
- Vitamin D. My last annual physical showed a common-for-seniors vitamin D deficiency, so I now take 1000mg daily.
- 5-HTP, the serotonin-boosting, over-the-counter supplement. With carbidoba-levodopa, it tops my list for enhancing my well-being. It's helped my mood, sleep, and digestive regularity for years. In combination with my morning meditations, it triggers creativity and problem-solving. But higher doses increased bp, so I took a minimal dose (half of a 50mg pill). Several months ago, I began taking the full 50mg, and it didn't boost my blood pressure. I have a theory: since Parkinson's increasingly depletes dopamine, raising serotonin levels helps keep things in balance. I've written often about this supplement; just enter "5-HTP" in the search box for other comments.
- Curcumin is a derivative of the Indian curry spice turmeric. Extensive studies have shown the compound's anti-inflammatory properties, and its potential for treating many conditions and illnesses, including Parkinson's and Alzheimer's. I take BCM 95, which is especially effective in crossing the blood/brain barrier. It's another frequent topic on this blog.
I'd been doing fairly well on this regimen. Then early this summer, I began to experience intense midday fatigue. Sometimes I felt woozy and unsteady, like I'd forgotten my 11am Parkinson's pill. The problem was most intense on days when I was outside a lot, especially at midday. Systolic (upper) bp readings during these spells were often well below 100.
At the start of our five-week European Grand Tour, the midday malaise went away, but seemed to return the further south we went.
I also was experiencing increased incontinence, a problem ever since my 1995 prostatectomy . . . and exacerbated by my Parkinson's.
My Theory: The Diuretic BP Med and DC's Humidity
In recent years, I've complained that the older I get, the harder it is for me to deal with DC's oppressive summer heat and humidity. In addition, my son has questioned my use of a bp med that includes a diuretic. Time to Google. Here's what I found:
- Diuretics and blood pressure meds can suppress sweating, thus causing heat-related problems, especially for older people.
- A recent study by the University of Glasgow/UK found that the hotter and more humid the weather, the further blood pressure can dip.
- Some diuretics can eliminate too much potassium in urine and cause hypokalemia (low potassium levels in the blood). Symptoms include weakness and fatigue -- my very issues.
On Friday, my new internist agreed I shouldn't take a diuretic. She prescribed the bp med my son swears by: Avapro (generic irebesartan), which I started taking two days ago. Yesterday, I had the worst day ever of fatigue throughout the afternoon and evening. Today at noon, I still had a low systolic reading (104). Today, temperatures and humidity finally dropped. My energy level now -- at 10pm -- is good. The forecast for the rest of the week is nice, with highs in the low 80s, and low humidity. I can test my theory.
Another Warning Voice
Coincidentally, today's Washington Post's health section included an article titled "A young geriatrician on the struggles of Alzheimer’s patients — and their caretakers." She wrote:
My typical patient has at least three chronic conditions, such as Alzheimer's, heart failure, and diabetes, plus numerous geriatric syndromes: falls, incontinence, depression and pain, to name a few. These patients come clutching lengthy medication lists or shopping bags full of pill bottles.
The drugs they take can interact badly, and they carry a heightened risk of dangerous side effects for older patients because of physiologic changes that come with aging, such as reduced kidney function. The medications are prescribed by a legion of doctors who often fail to communicate with each other.Bottom Line for Me
Take as few prescribed meds and supplements as possible. When I first started researching health issues years ago, I bought many touted supplements. Then I began noticing the warnings and cut back. Then someone recommended a local nutritionist who gave me a blood test, then recommended numerous supplements . . . which I could buy from him. I fell for it at first, then recovered my good sense. Now the mantra is "less is more."
I've stopped using mail-order med suppliers. Now my CVS -- which also knows what supplements I take -- fills all my prescriptions. I told my internist last week I wanted her -- not my blood pressure specialist -- to manage my bp meds. Again . . . LESS IS MORE.