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.

April 12, 2016

Health Update: Incontinence (Good News) and Shingles (Little Pain, but BIG Fatigue)

Finally, some good news on the health front. Ever since my March 5 emergency room visit, I've had nothing but setbacks. Now, however, some welcome news.

"Urgent PC" for Incontinence
I’ve dealt with incontinence for a long time. The problem began in January, 1995, after my prostate was removed. The issue has only gotten worse with the advent of my Parkinson’s… and my advancing age.

Some cancer cells remained in my body after the prostatectomy, so I see my urologist every six months. During my last visit several weeks ago, I mentioned that the incontinence was getting worse.

He put it nicely: "Incontinence is not a medical problem, it's a social problem." He mentioned two medicines for incontinence, but wouldn’t recommend either. Why? One of them tended to elevate blood pressure; the other often led to constipation. I wasn’t prepared to deal with either of those unpleasant side effects.

But he suggested I might want to consider a relatively new treatment for incontinence: "Urgent PC." This video describes the procedure:

For 12 weeks, I get weekly treatments – about 30 minutes each time – in my urologist's office. After that, I’ll receive treatments every month.

So far, I’m three sessions into the initial 12-week regimen, and I’m already experiencing significant improvements.

And Then, Shingles
Three weeks ago, a large rash suddenly appeared on the left side of my midriff. I got an appointment with the nurse practitioner in my GP's office for the next day.

April 5, 2016

Time to Accept That I Am a Sick Old Man Who Is Only Going to Get Sicker and Older

I'm making a major shift in my approach to dealing with Parkinson's (PD) and aging.

I was diagnosed with PD in the fall of 2009, the year I turned 80. Until recently, I've fought to maintain as much of my pre-diagnosis quality of life as possible.

Now I'm switching my focus. I have a serious progressive disease, and I'll be 87 in a few months. I must re-examine virtually everything about my old "normal" life, make appropriate changes for the very different man I am now, and prepare for my final exit.

Guidance from President Obama
President Obama told Vanity Fair recently:
You'll see I wear only gray or blue suits.I'm trying to pare down decisions. I don't want to make decisions about what I’m eating or wearing. Because I have too many other decisions to make.
Well, I don't have that many big decisions to make. I just want to conserve my increasingly limited energy.

For example, yesterday I decided I'd just put blueberries on my morning cereal and forget about the blackberries and raspberries. Blueberries are one of our healthiest foods, and a favorite of mine. Why waste the time and energy buying, storing, and eating the blackberries and raspberries? This change may save me only a few minutes a day... but that's over 12 hours a year.

Many of the changes I'm making will conserve much more of my time and energy. Several examples:
  • I've canceled the daily delivery of the Washington Post and now get only the Sunday paper. I don't think I'm missing much by not reading yet another story about Metro breakdowns. 
  • I'm throwing away about 90 percent of the books I've got stashed all over the house, and most of the miscellaneous clutter I've accumulated over the years. 
  • My recycle bin is overflowing with the papers I'm discarding from my files. Many are clippings and printouts of information I can now easily find on the internet. 
Most of all, my recent decision to stop researching and writing blog posts about general health topics will free up loads of time and energy.

April 2, 2016

Sarcasm: Are Expressers Well-Adjusted and Recipients Fortunate?

This was a draft I sent Stanley, my editor, for Friday's post:
In yesterday's post, I talked about a major Harvard University study has been going on for 70 years and has involved intense work tracking the lives of two groups of men just a few years older than me. A recent Ted talk summarized the important, interesting findings about the importance of close friendships as we age.

Today's topic concerns another Harvard study, a joint effort with Columbia University. It deals with the subject of much more limited scope and interest. I wouldn't be reporting on it, except that it gives me a great response to the frequent criticism I get, particularly from one of my nearest and dearest, about my addiction to put-down humor. 
I immediately decided to prepare this post on the study when the report  I was reading cited these findings:
  • People who use sarcasm are more creative and psychologically well-adjusted than others. 
  • Sarcastic humor is employed by people with high intellects. 
  • Liberal use of sarcastic comments can help lift the IQs of the less intellectually well-endowed recipients of the sarcasm. (Of course I particularly loved that last finding!)
Stanley replied, asking if I really wanted to run this study recap without commenting on the downside of sarcasm and put-down humor.

Since I also had some misgivings about this, I decided to do some further checking. When I went to Google, I found several links to stories in the popular press. All of them basically used the same pitch on the findings of this study that I featured above. Here's the concluding comment from one of them:
But what does all this mean for everyday communication? If you enjoy a bit of snark then the findings are truly liberating. Instead of having to hold back those razor sharp quips and withering barbs out of fear of hurting your loved ones’ feelings, you are now free to let rip, safe in the knowledge that you are helping them to become smarter and more creative!
I tried to find the text of the official report but it was available only at a steep price. Fortunately, I found a summary of the report written by the authors. Here is what it concludes: