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The Prize of My Sacrifices

My life has been an open book, especially after that dreaded meet and greet with Death and his scythe. I have allowed it to be, so people would be aware of their lifestyles; and make them learn from my example on how they are going to live their lives towards health.

Few months after that emergency bypass operation, I was never able to control the main culprit that made me this “known” to my colleagues. I was already in quadruple drug therapy for my lipids (ruosovastatin, ezetimibe, fenofibrate, EPA+DHA). I got back to working out two months after my surgery. I had been watching my food intake, avoiding red meat and only preferring vegetable and white meat. Aside from that, I also have problem with my heart beat rhythm hence I was maintained on amiodarone. Eleven months after the surgery, finally I saw light. Total cholesterol and triglycerides went to normal levels, although LDL (bad cholesterol) was still high for a patient who underwent a bypass operation. I was then advised to have another follow-up visit after the holidays to check the effect of christmas celebrations.

Not only did my laboratory result became abnormal and back to pre-operation level, I gained weight. The light I saw few months ago was just a glimmer. On investigation, my thyroid hormones suggested hypothyroidism leading to hypometabolism, which now explains my weight gain and abnormal lipid levels. These were the result of my anti-arrhythmic amiodarone. We had to drastically revise my medications. I had to take thyroid hormone supplementation, change amiodarone to beta-blocker bisoprolol, increase the dose of ruosovastatin and increased my workout. At first I was still having palpitations and skip beats with bisoprolol and thus dose was increased. I was supposed to undergo holter monitoring in case my arrhythmia would persist.

At 18 months after the surgery, getting depressed with all the elevations of my lipids, weight gain, I decided to make a drastic change in my diet. I dropped meat and went quasi-vegetarian (having chicken or fish once a week). It was a very difficult lifestyle change as I easily get hungry, forcing me to have a lot of snacks, sometimes taking pastries (which I should also be avoiding; not that I have high blood sugar, but then simple sugars have been identified as one culprit in causing chronic inflammation of the blood vessels trapping cholesterols and forming a plaque, even if your cholesterol level is not necessarily high). Being a residency training officer of the department of Pediatrics at SLU-HSH, I decided to quit the post while maintaining the post as head of breastfeeding committee and neonatal services unit of the same hospital.

Then having been a Zumba enthusiast, I went on training and earned my license to be an instructor. Having kept this diet, exercise and religious medication, I had my follow-up on my 20th month after the surgery. Sacrifice and effort finally paid off. My total cholesterol was now down to 156.96mg/dL (from a previous of 423 the first time I found out I had elevated levels to 212 prior to my cardiac arrest). Low density lipoprotein (LDL) was now down to 92 mg/dL, and my triglyceride was still maintained below 200mg/dL at 105.32. My liver enzyme was very slightly elevated and thyroid hormone was within acceptable normal limits, bordering hypothyroid. I lost two kilograms, I can now wear my old pants and I feel a little more confident than the previous months. Because of these, my cardiologist decided to discontinue my thyroid hormone supplementation, decrease my dose of ezetimibe and lower my ruosovastatin from 40 mg to 20 mg.

Whether these changes were due to my more frequent exercise or diet restriction, or lesser stress from work, it doesn’t matter; it also means that I will have to maintain these statuses so as to keep my lipids in check. I thought I could already have the clearance to eat lechon, sigh… Well, better this than have another heart attack soon. The sacrifices paid off.

Next goal: a sculpted body? I dare myself.

 
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Posted by on August 17, 2014 in Personal

 

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And The Battle Continues…

Last November 2013, I thought I had one of the happiest moment of my life when after all the rigid routines I followed – food control; exercise and medication, my total cholesterol finally went down below 200 mg/dL for the very first time, however my bad cholesterol (LDL) was still high at around 140s. According to my doctors and friends who I talked to, for a person who underwent cardiac bypass, the ideal LDL level should be around 90mg/dL or less.  Nevertheless, that was a significant achievement I had so far as far as my blood picture was concerned. At that time, my medications consisted of (1) ruosovastatin at 20mg/day, (2) fenofibrate 160mg daily, (3) ezetimibe 10 mg every MWF, (4) EPA + DHA at 1 softgel daily, (5) clopidogrel 75mg daily, and (6) amiodarone 1/2 tab every M/Th. My cardiologist, Dr. Sophia Black, told me to come back on January as I might be indulging during the Christmas break, which was of course expected, especially among Filipinos who love to party. And when you say party in the Philippines, there’s a barrage of food of all sorts, making me at risk to have a rocket-high resurgence of my cholesterol levels.

During the holidays, I tried not to disappoint my doctor by trying to avoid parties as much as possible. And if ever I cannot resist the invitation, I would only opt for white meat at the most. I had lesser exercises too however, which I regretted immensely. To my memory, there were only 2 parties I went to, that of the Dept of Pediatrics at SLU, and Christmas celebration at home. January came, I started to feel tired when I climbed 4 flight of stairs that I routinely used to do with ease where I live. My doctor also noted that I started to gain weight, I was in denial though I noticed my clothes getting tight already. The laboratory results showed that my cholesterol increased all over again, and what was remarkable was I became hypothyroid, which is a possible adverse effect of my amiodarone. Hypothyroidism brings about decreased metabolism (explaining my weight gain), and a surge in cholesterol level (which should never happen anymore). We decided to discontinue amiodarone and shift my anti-arrhythmic into bisoprolol 2.5mcg/tab, 1/2 tab daily. Levo-thyroxine 25mcg/tab, 1/2 tab daily was added. Ezetimibe was increased back to daily and the rest was maintained. I will have to come back after 2 weeks. I resumed my usual exercise schedule as before. (Please note that I only took the levothyroxine UNDER prescription).

During my follow-up, 2weeks after starting with bisoprolol, my doctor noted that I had skip beats, which I barely noticed. She increased my bisoprolol now to 1/2 tab twice daily. If after 2 weeks and my skip beats will still persist, I will have to undergo holter monitoring. She then advised me to come back again after 2 weeks. On my follow-up, it was good news that no skip beats were no longer appreciated, thus the holter monitoring was no longer pursued. I had my repeat blood test, my thyroid hormones were already getting back to normal values but still I was fat (at 68 kgs from a previous of 63 last november). So I still had to continue my levo-thyroxine. I still felt this tightness/fullness in my chest after I jog for about 5 seconds. And I had this allergic rhinitis and postnasal drip cough bugging me at the same time. I was on levocetirizine and montelukast. I took antibiotics to no avail. Montelukast really knocks me off when I take them thus I can no longer stay up for a longer time to do my paper works.

I had monthly follow-up afterwards. On the month of May, we repeated all my lab works. Thyroid hormones were still on the above normal values. Cholesterol was still high. So my doctor decided to maximize my dose of ruosovastatin from 20 to 40 mg daily, with an advise to have a liver function test one month after to check on the effect of the statin to my liver. I also saw my pulmonologist, Dr. Kareem Eustaquio, who also gave me fluticasone nasal spray on top of my anti-colds medications. Still not completely ruling out GERD, I took pantoprazole as it is the only potassium-pump-inhibitor that will not interact with my other lifetime medications (again, UNDER prescription). They say that statins usually makes muscles sore when taking it. When I had it at 10, 20 mg daily, I never felt such even after intense workout. What I noted though is that after taking it at 40 mg daily (even if my workout is just plain cardio), I would feel very tired and doze off easily, even if I haven’t taken yet my montelukast. And of course I have still to take my montelukast for my rhinitis. With that effects of statin and montelukast combined, they knock me off immediately, impeding my planned paper works to accomplish before I call it a night. From this time on as well, I have decided to have my food devoid of meat – both white and red, as much as I can. But there were occasions where I could not completely avoid eating meat (chicken and fish) and that happened less than 5 meals in a month.

One month after, at the first week of June, I did my liver function test. It was a good news after all, my liver was not adversely affected by my high dose of statin. I mentioned to my doctor the chest tightness I feel initially when I do my exercises, and she told me that it could be an effect of my bisoprolol. So since my blood pressure is still maintained (last check up it was 90/70), and I don’t have irregularities of my heart beat, she reduced my bisoprolol to 1/2 tab daily already. All the other medications were maintained… I now weighed 67 kgs. (Just 1 kg shed off, it’s too slow!)

This made me realize how hard it must be for patients with hypothyroidism to lose weight. Mine was an acquired type, and yet it is taking me a difficult time to shed weight. I thought that since we already discontinued the culprit and I was on thyroxine supplementation, I would be able to lose weight fast. It is not that easy. So you can’t blame those overweight people with the same problems, especially if it is congenital, or if the factor causing it remains, to remain obese no matter how hard they try to lose weight. It’s not that simple.

Meanwhile, I am still strictly watching my intake. I still do my exercises, at least 4x a week, where I would spend about 1-2 hours in the gym dancing zumba with spinning, or some resistance training… My next visit will be 2 months after (August), with repeat lab works. So, here’s to wishing myself a normal cholesterol, after depriving myself of all the food I wished to have eaten.

To the enlightenment of everyone, if I avoid going to scientific fora or a party where food is involved,  it’s not because I dislike the company that sponsored it, it is because I don’t want to insult the host by not eating the food offered; I only have a few food I can take. That is also the only time I could go to the gym and workout. And, take note that exercise is my lifetime prescription. I can’t go with the excuse of “minsan lang naman…” No. That missed one chance to exercise may be detrimental to me, which may not be applicable to your scenario. I am not the same as you all are. Remember that I am not diabetic nor hypertensive, I was watching my food, I exercised, I took medications and yet I had my cardiac arrest, compared to you have none of these that I have…

 
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Posted by on June 12, 2014 in Personal

 

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