What is your HDL? Recommendations I would have as a pharmacist:
1. Either stop niacin or increase the dose. 500 mg is a subtherapeutic dose. I am not convinced niacin has a major impact on coronary heart disease
2. Ask you physician about the beta-blocker. Newer evidence shows that beta-blockers have minimal benefit on asymptomatic heart disease without a history of heart attack. This implies that if you have chest pain, left-ventricular dysfunction, or a history of MI, you should be on a beta-blocker. If not, you probably would not benefit.
3. I might leave the Crestor on the same dose. It may be that the primary benefit of statins is anti-inflammatory action(pleotropic mechanism) rather than their action on LDL.
4. I would recommend you wean yourself off of Zoloft over months rather than weeks. The effects of withdrawal can be dramatic. Consider reducing the dose 25 mg every 2 weeks! I know that many patients can withdrawal over a few months, however I have known patients that need a year to get off the drug.
5. Consider reducing your carbs to get your triglycerides down. Fish oil is really controversial regarding their benefit with heart disease. Vascepa, the newest prescription fish oil, is the only product that has shown benefit. I am a little skeptical of the study, however.
6. You can probably do without your vitamin D. I do not have strong feelings about this.
7. Have you ever been on an ACE-inhibitor? I prefer them over ARB's (losartan).
8. What was your potassium? It should not be high. ARB's can decrease potassium from being eliminated but not generally in patients with good kidney function.
Paul, wow good stuff, thank you,
1. My niacin dosage is 1000 mg a day, (500mg morning and evening). But I think I’m going to stop it. PDA - to answer your q, it was my idea although in the past my doc has had me on niaspan, a prescript
ion strength version
2. Re the beta blocker, yes I thought if that, and that’s good info, I plan to discuss with the Dr. do you have any links to the newer studies? I was put on the BB for palpitations, which I don’t have any more.
3. Agree on the Crestor, I’ve read that the anti inflammatory effect is key
4. Re Zoloft, thanks, noted, as others have said. And as I’ve seen on the forum that Roblee provided a link to.
5. I’ve reduced carbs to under 100grms net carbs a day (I try for 50 mg, but that’s hard.) re the fish oil, I’m conflicted. Maybe I talk to him about
viscera, or Lovaza.
6. My Vit D was VERY low, before I started supplementing, right now it’s in the middle of the normal range, so I think if it ain’t broke, don’t fix it
7. I was on Accupril some years ago, too much coughing
8. Funny you should mention Pottasium... in this recent round if blood tests, it was high at 5.5 (top of ref range is 5.3) not sure what it means, I saw on the portal the Dr made a note to “retest Potassium STAT” but he never called me. And I’m not anxious to call him (which I know is wrong) . My kidney function (I think creatinine?) was normal, and so was my liver panel< but ferritin was, and has been for a while, high.
Thanks for your feedback.
I am not a doctor, just another guy without a prostate
Dx Age 64 Nov 2014, PSA 4.3
BX 3 of 12 cores positive original pathology G6
RALP with Dr Ash Tewari Jan 6, 2015
Post surgical pathology G7 (3+4), - ECE, - Margins, -LN, -SV (+ frozen section apex converted to negative)
PSA @ 6 weeks 2/15, .<02, remained <0.02 until January 2017, .02, repeat Feb 2017, still .02. May 2017-.033, August 2017- .033 November .046, March 2018 .060. June 2018 .068, July 2018 - .082, August 2018, .078, August 2018 - .08 Start ADT. Sept 2018 Start SRT
Sept 2018 thru November 2018 – T = 4, PSA = <.05
Decipher test, low risk, .37 score
My story.... tinyurl.com/qgyu3xq