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.

Jacking up the serotonin with new sleeping aids was also increasing my risk of falling -- probably the biggest threat to my health and well-being these days.

So – finally -- I stopped taking 5-HTP.

Within a day or two of stopping 5-HTP, constipation came roaring back big time. I also saw signs that insomnia was about to return.

But then, a much more serious problem took center stage.

My Month-Long Battle with Shingles
The emergency room visit, as I reported, came on March 5.

On March 22, a much happier event occurred at Sibley Hospital. Nivah arrived, the firstborn child of my housemates Bhawana and Nimesh. Click here to read about that happy day.

The next day, when I was getting my weekly massage, my masseuse noticed a rash around my waist on the left side. The following morning I called my new internist about the rash. He was fully booked for the week, but arranged for me to see his nurse practitioner later that same day.

She immediately diagnosed shingles. The doctor came in and confirmed the diagnosis.

A short time after I arrived home from the doctor's office, Bhawana, Nimesh, and Nivah arrived home from the hospital.

Luckily, I had told the nurse and doctor that I would be living in a house with a newborn baby. While shingles afflicts only people who’ve had chickenpox, little Nivah could pick up chickenpox if she came into contact with the virus I was carrying.  

That virus isn’t airborne. But others can be infected by contact with the open sores, clothing, or other items from shingles sufferers.

We were very careful to prevent any transmission from old man to new baby while I remained in an infectious state. Thankfully, that period ended over a week ago.

Some Concluding Thoughts
It's been almost two months since I stopped taking 5-HTP. Although I'm far from happy with the return of constipation and occasional insomnia, it was time to give up on 5-HTP. I’m discovering other ways of dealing with both of those conditions in ways that don’t involve pills.

As for the decision to junk the blood pressure pills, it's become increasingly clear to me that the doctors who insisted I should get back on those meds as soon as possible were wrong.

I still monitor my bp since I occasionally I get systolic (upper number) spikes above 180. When those spikes occur, I can use a small amount of the nifedipine Dr. BP prescribed to quickly bring the numbers back down​.

​But those spikes, I’m happy to say, are increasingly rare.

Here are my readings from yesterday:

7 AM – – 153/97
7:45 AM – – 148/85
10:30 AM – – 130/76
1 PM – – 121/70
1:30 PM – – 140/76
2:30 PM – – 153/91
7 PM – – 135/73

These numbers suggest I was correct when I argued that I did not have underlying hypertension.

When I signed up with my new internist, he gave me a complete physical and found nothing of concern. The same positive results emerged from all the tests at Sibley Hospital early in March. 

I had an echocardiogram a year ago, and my new internist suggested I get another. Neither test showed any problems.

It certainly doesn't look as if my efforts to take a role in my own medical care has been damaging in any way. And the echocardiogram results confirm other evidence in my health history that I do not suffer from heart disease.

With the exception of Dr. BP, everyone else simply looked at the bp numbers and paid little or no attention to the quality of life issues I raised. They rejected my own conclusions based on my extensive bp monitoring at home. I didn’t have underlying hypertension… only the temporary spikes.

I don't think it's just a coincidence that Dr. BP was the outlier. He usually listened to my concerns, discussed them with me, and then worked with me to find solutions.

In this instance, he was the only one who seemed to understand the quality of life benefits I was getting from 5-HTP. He then developed the strategy that permitted me to continue using the supplement and to use nifedipine as needed to bring down unusually high blood pressure spikes.

 I asked Dr. BP about the new suggestion being made that for those of us over age 80 who had no signs of heart disease, discontinuing blood pressure medication would be a viable option., He  suggested I also consider going back on Avapro, the blood pressure medicine that didn't seem to have as many side effects as others I've tried.

We discussed the options for a time and then Dr. BP said: "It's your choice. But if you decide to drop the blood pressure meds I won't lose any sleep over it." So I decided to ditch the blood pressure meds..

That of course provoked more negative comment than my decision to continue taking 5-HTP. Again the opposition was based exclusively on the high BP readings taken in the doctors' offices.

But readings taken in a doctors office are notoriously unreliable. Here, for example, is a report on several papers presented to the American Society of Hypertension:
"Of all the procedures done in a doctor's office, measurement of blood pressure is usually the least well performed but has the most important implications for the care of the patient," said Norman M. Kaplan, MD, clinical professor of internal medicine at the University of Texas Southwestern Medical Center, who moderated one of the sessions.
Experts said the in-office assessment is unreliable because blood pressure can be raised or lowered by the presence of the medical professional taking it. The numbers also can be different from one arm to the other or from one minute to the next.
The American Heart Assn. guidelines -- which call for blood pressure to be measured at least five minutes after a patient arrives in the office while he or she is sitting in a chair with the arm supported -- often are not followed.
Unfortunately this reliance on office blood pressure readings is just one example of the tendency in America to use "one-size-fits-all" medical care. Fortunately, there's a rapidly growing movement toward more personalized medical care, like what I've found with Dr. BP.

I want to talk later about the new Medicare guidelines for next year that will make it easier for doctors to adopt this approach.


Mahala said...

Please be careful!!!

Nancy said...

I think you made the right decision to stop taking the 5HTP.

Contrary to what most people believe about about tryptophan, 5HTP, and melatonin supplements they carry serious risks. A sizable volume of sound research studies demonstrated that increasing serotonin and tryptophan either with drugs or supplements (not food because food's unlikely to significantly raise tryptophan or serotonin in the brain) is linked to brain dysfunction, stress hormone release, cognitive deficits, inflammation, impaired blood circulation in the brain, hypertension, cancer, and other adverse effects - http://www.supplements-and-health.com/tryptophan-side-effects.html