As regular readers might recall, I’ve binned the beta-blocker Nebivolol, which had wreaked havoc, and reverted to the calcium channel blocker, Diltiazem.
The result was that my heart was mostly fine in the mornings, but misbehaved horribly in the afternoons/evenings, and through the night – it’s like having a demented pigeon thrashing around in my chest.
I eventually – like yesterday – figured that out.
For years now I’ve known that a group of my meds caused potassium deficiency, a problem that’s increased by my diuretic. However, the drugs I’ve taken over the past 18 months, Candesartan and Losartan, carry dire warnings that they can concentrate potassium to potentially dangerous levels (simply put, potassium controls heart function – too much can stop it), and that supplements and salt substitutes, like LoSalt, had to be avoided. I have to say, though, that using sea salt has had not the slightest deleterious effect on my blood pressure
Which caused an unquantifiable problem – how much potassium was being retained compared to how much was being lost, and how much supplementation did it need to balance the books? I took 100mg a day and hoped for the best.
Then along came Nebivolol and screwed everything up. New developments – see Part 45
Anyway, I got rid of that, and, with Diltiazem, continued taking 100mg of potassium with my morning meds, and all was well – at least in the mornings
So, yesterday afternoon, it got so bad I chugged another 100mg of potassium, and within half an hour everything had quietened down.
Prior to developing my current heart problems, I took 200mg of potassium once a day – have done for years, because of the demented pigeon problem (a problem I’ve taken to my doctors more times than I care to remember, and been repeatedly rebuffed), which, at the time, I didn’t have a cause for; I didn’t find out that the potassium deficiency was caused by my meds until about 4 years ago. Of late, as I said, it’s been 100mg.
Right now (midday), my heart rate is 75. In maybe 2-4 hours it’ll be 95 and as erratic as hell, and what I’m trying to pinpoint is the ideal time to take another 100mg for optimum effect. There’s no point, I don’t think, in reverting to my previous 200mg in one dose, nor is there any point in taking a second dose too early, as I need it to get me through the night, too. I need to pay close attention to the point at which my heart rate begins its rise towards tachycardia and arrhythmia.
Clearly, then, I need more potassium in my system to keep my heart running smoothly (equally clearly this sort of thing should be investigated and monitored by a cardiologist, not run on a DIY basis; OK, I know what I’m doing, but that’s really not the point).
Which brings me back to Arrowe Park Hospital.
The previous consultant wanted to do a range of tests, including a 24-hour mobile ECG. I explained that It was quite impossible for me to attend the hospital at 09.30 on two consecutive days. Two tests I dismissed as too dangerous, as the information could be obtained by perfectly safe, if more expensive, means, and others, like the mobile ECG, simply needed rescheduling to suit my timetable.
If the tests were actually necessary in February, they’re still necessary now. However, all I have now is a consultant who is inept enough to prescribe a dangerous drug – Nebivolol – while looking me in the eye and telling me it was safe. None of the literature supports that view, and it’s very much a drug of last resort.
Other than that, he seems content to do nothing beyond see me every 6 months and wait for me to die – no tests, not even the safe ones, are on the table any longer.
This, to me, amounts to almost criminal neglect, and is undoubtedly punishment for having had the temerity to complain about one of their consultants who, let’s not forget, after I’d explained, in detail, why I was unable to keep the appointments he’d arranged because of the unrealistic times, simply disappeared. For 5 months.
My complaint was eminently justified – my current neglect is not, and it seems that the penalty for complaining at Arrowe Park is, effectively, a death sentence. Sounds melodramatic? You should see it from my perspective!
OK, I could, given the failure of Nebivolol, have asked for an earlier appointment at APH – my GP could have done so too, let’s not forget – but what would be the point? The clown has already damaged my health, irretrievably, as far as I can tell, so what would be the point in seeing, again, a consultant who has already fucked up my life? Why give the useless bugger a chance to do even more damage?
I’m pretty sure I’d feel better if I reintroduced Losartan, at a very low dose, and I’ve got plenty, but that just complicates the potassium issue (though with the dose I have in mind – 12.5mg – how much potassium could that actually retain? I also have some Digoxin to try – this was originally prescribed when I was an inpatient at APH last year – but it has a lot of potential adverse interactions with drugs I’m already taking and I’m reluctant. That didn’t bother APH at all, incidentally…. And no, that doesn’t fill me with confidence!
Got to do something, though…
Oh, look, just as I was about to publish this, I got a text from my GP surgery, telling me to book an appointment for my annual COPD review – I wonder what part of “housebound” they’re still having problems with?