Effects of aging Part 2

[aja8888]

The other thread was too old to continue.

I'm about to turn 75 in a month and still very active and medically, from a bloodwork standpoint, fine with none of the common issues like diabetes, high cholesterol, etc. Up until now, I have been taking Tamsulosin for an enlarged prostate, and a beta blocker, Metoprolol for historical high blood pressure. Those daily meds are accompanied with a baby aspirin. There have been times when the BP med was not necessary and was taken off the list.

My trips to the doctor have been an annual physical paid for by Medicare and that's about it. I have had physical injuries though: tore both meniscuses in my right knee a year ago and that required scoping. I also wore out my left hip and had a total replacement 10 years ago (thank you long distance running years ago).

Each week, I meet two close friends of mine on Wednesday evening for a two mile walk followed by a visit to a local sports bar for beer/water/food. The water is for me as I don't do alcohol well.

Three weeks ago, while on our Wednesday evening walk, I felt faint and almost passed out about 3/4 the way through the walk. It was hot here and I blamed it on the heat. The same thing happened the next week and it was worse as I damn near fainted at the bar twice and was in a cold sweat the rest of the night.

That scared me enough to see a doctor. So I went to a local cardiologist and had a visit. After a quick exam, he suggested stopping taking the BP med, of which I did for all last week. I also recorded my BP at various times during the week. Last night, I resumed my Wednesday walk and a repeat performance occurred. When I got home that night (two hours after the walk), I checked my blood pressure and it was 90/48 with a heart rate of 170. I checked it three times with no real change.

I called the doc today and they had me come in and examined me again. They are putting me on a heart monitor on 10/1 and told me to stop the Wednesday night walks. They want me to continue to stay off the beta blocker but not the Tamsulosin.

It's early in this, but I am somewhat hopeful that this will be figured out. It's crazy how things can change so quickly when getting older. Also, there is no history of heart problems or strokes in my family.

A-fib was a possibility mentioned to me, but they need more data......thoughts?

 

[ivinsfan]

I dont know how much beta blockers you were on but a system of abrupt stopping is an elevated heart rate. Betablockers are generally tapered and not stopped abruptly. The light headedness could have been low blood pressure and the fast heartbeat might be a withdrawal issue. My DH is on betablockers.

 

[aja8888]

I dont know how much beta blockers you were on but a system of abrupt stopping is an elevated heart rate. Betablockers are generally tapered and not stopped abruptly. The light headedness could have been low blood pressure and the fast heartbeat might be a withdrawal issue. My DH is on betablockers.

Thanks for the information.

I am under the care of a top cardiologist in our area.

The cardiologist said the Tamsulosin also lowers BP and he felt it was safe to stop taking the 20 mg beta blocker. I'll have to go with his recommendation at this time. MY BP readings since off them for a week have been on the low side ~ 110/60 with a resting pulse rate of ~ 60. I know that is not a lot of time to verify the effects. My biggest worry is the increased heartbeat as I have experienced that over the years, but not nearly as bad as it is now.

 

[MRG]

I've recently reduced my metoprolol from 100 mg to 50mg. Oh what fun it's been. Resting heart rate over 100 for a couple months, later a low heart rate in the morning and high in the evening. I hate beta blockers!

The Flowmax is an alpha blocker and will reduce your BP as well. The removal of the beta blocker is probably what is causing the higher heart rate. That and I believe there's an inverse relationship between BP and heart rate(i.e. when my BP is low, my heartrate is higher).

Take care.

 

[Telly]

....Three weeks ago, while on our Wednesday evening walk, I felt faint and almost passed out about 3/4 the way through the walk. It was hot here and I blamed it on the heat. The same thing happened the next week and it was worse as I damn near fainted at the bar twice and was in a cold sweat the rest of the night....

That to me sure sounds like too-low of blood pressure.

I also recorded my BP at various times during the week. Last night, I resumed my Wednesday walk and a repeat performance occurred. When I got home that night (two hours after the walk), I checked my blood pressure and it was 90/48 with a heart rate of 170. I checked it three times with no real change.

If we were talking about a mechanical reciprocating pump, operated by a controller, I'd have some thoughts... Where measured, pump output pressure is too low, while pump stroke rate is too high. Possible causes: Restriction in piping from pump, leaky valves in pump (operating inefficiently), or, for a totally different possibility, for some reason the controller is running the pump way too fast, in a region where the pump's mechanical ability to transfer fluid stroke-by-stroke is compromised, like valve float in a early 1960s V8.

I'm not a doctor, and it's been a long time since I stayed in a Holiday Inn

 

[W2R]

Wow, I am glad that you didn't fall and get hurt!

My thoughts are that you are paying one of the top cardiologists around, to give you his expert advice. I'd follow his advice very closely, and report to him if your symptoms continue.

I'm on Metoprolol too, but only 25 mg/day, and I measure my blood pressure every morning, first thing, before coffee. It is usually a little low (around 105/60 or so). The lowest I have seen recently was on August 11th when it was 88/58, with a HR of 87. I didn't feel faint. But that's me and there are big individual differences between people.

Getting old is the pits. I have had two loved ones die this summer and both were younger than me.

 

[eytonxav]

Here are some possibilities:https://www.belmarrahealth.com/causes-low-blood-pressure-high-heart-rate/

One of things I would check first, are you getting sufficient hydration in these hot temperatures?

 

[O2Bfree]

I had similar symptoms pop up in middle-age, a fast heart rate and fainting, and it turned out to be SVT, supraventricular tachycardia caused by an accessory pathway, which is an extra electrical circuit in the heart. The circuit caused a feedback loop that made my heart race, usually at a rate of around 220 bpm. The trigger was usually exercise, and sometimes an adrenaline rush or way too much coffee. I did not think to take my blood pressure during an episode. Apparently, I was born with the extra circuit, but it didn't cause symptoms until I was older.

My cardiologist spotted the problem on the ECGs captured by a Holter monitor. The cure was simple enough: a cardiac ablation. Haven't had any episodes since an electrophysiologist zapped the extra connection.

 

[RAE]

How long have you been taking both of the meds? What dosage of metaprolol are you taking? I take 12.5 mg of metaprolol daily, and have had no issues.

I am not a doctor, but my suspicion is that your recent problems are being caused by the Tamsulosin, and not the metaprolol. I say that because I looked up some of the common side effects for Tamsulosin, and here is what it said:

Flomax (tamsulosin hydrochloride) is an alpha-blocker used to treat the symptoms of a prostate gland condition called BPH (benign prostatic hyperplasia). Flomax is available as a generic drug, Common side effects of Flomax include

• dizziness,
• lightheadedness,
• weakness, drowsiness,
• headache,
• nausea,
• diarrhea,
• back pain,
• blurred vision,

Tell your doctor if you experience serious side effects of Flomax including:

severe dizziness, or fainting


If I were you, I would have a discussion with your doc asap about these common side effects with tamsulosin, as it sounds like you've experienced a few of them.


As a side note, I also have an enlarged prostate, but I don't currently take any prescription meds for it. I recall looking into tamsulosin a few years back, but decided not to go there because of what I read about it, including these common side effects.


Again, I am not a doc, so this advice may not be worth much. But I'd look into it, if I were you.

 

[FIREd]

Sorry to hear that aja8888! Hopefully the docs can figure out what's going on. I think that things can go south quickly at any age.

 

[aja8888]

How long have you been taking both of the meds? What dosage of metaprolol are you taking? I take 12.5 mg of metaprolol daily, and have had no issues.

If I were you, I would have a discussion with your doc asap about these common side effects with tamsulosin, as it sounds like you've experienced a few of them.

As a side note, I also have an enlarged prostate, but I don't currently take any prescription meds for it. I recall looking into tamsulosin a few years back, but decided not to go there because of what I read about it, including these common side effects.

Again, I am not a doc, so this advice may not be worth much. But I'd look into it, if I were you.

Thanks for the input and advice + links!

I stated earlier (post #3)the dose of metoprolol has been 20 mg/day. I'm a little perturbed at my fairly new primary care doc as she was the one who got me on tamsulosin two years ago and never mentioned the fact that it also lowers BP. I've been off the metoprolol for well over a week now and feel better with an average BP (resting) of 110/60. We also calibrated my BP monitor at Thursday's appointment.

As I am under the care of one of the top cardiologists in Houston (and we specialize in growing them here), I am sure he will sort this all out over the next 45 days.

 

[aja8888]

Sorry to hear that aja8888! Hopefully the docs can figure out what's going on. I think that things can go south quickly at any age.

You are not kidding there! With the monitor to be issued to me on 10/1, we should get a load of data that the cardiologist can work with. Other than that, its a guessing game at this point in time.

 

[aja8888]

I had similar symptoms pop up in middle-age, a fast heart rate and fainting, and it turned out to be SVT, supraventricular tachycardia caused by an accessory pathway, which is an extra electrical circuit in the heart. The circuit caused a feedback loop that made my heart race, usually at a rate of around 220 bpm. The trigger was usually exercise, and sometimes an adrenaline rush or way too much coffee. I did not think to take my blood pressure during an episode. Apparently, I was born with the extra circuit, but it didn't cause symptoms until I was older.

My cardiologist spotted the problem on the ECGs captured by a Holter monitor. The cure was simple enough: a cardiac ablation. Haven't had any episodes since an electrophysiologist zapped the extra connection.

Thanks, I'll mention SVT with the DR at the next visit. The highest rate I have recorded so far was at 180 BPM. Scared me though.

 

[Alan]

You are not kidding there! With the monitor to be issued to me on 10/1, we should get a load of data that the cardiologist can work with. Other than that, its a guessing game at this point in time.

Sorry to hear this aj. I have been on the 48 hr monitor twice now, 2015 and 2017, and in neither case did it register the paroxysmal Aib I suffer from. In January 2018 I purchased my own monitoring device from
https://www.alivecor.com/. It costs about $100 and has been invaluable in recording and tracking my irregular heart episodes in the form of ecg traces, including AFib. It is recognized by the cardiologists over here in England and has been invaluable to my logging many episodes of AFib. Whenever I feel light headed I do an ecg trace and in my case it is AFib, that lasts for an hour or much longer but so far never longer than a few hours. (I should be having cryogenic AF ablation in October and have just started on blood thinners in readiness for the op)

For Apple Watch users you can also get an Alivecor band to wear under the watch and receive alerts whenever an irregular heart rate is detected.

https://store.alivecor.com/products/kardiaband

Hopefully the monitor you wear on 10/1 will provide all the data the cardiologist needs. When I lived in The Woodlands I used to be under a cardiologist at the N Houston Heart Centre there and was very happy with him.

 

[bmcgonig]

Sorry to hear this aj. I have been on the 48 hr monitor twice now, 2015 and 2017, and in neither case did it register the paroxysmal Aib I suffer from. In January 2018 I purchased my own monitoring device from
https://www.alivecor.com/. It costs about $100 and has been invaluable in recording and tracking my irregular heart episodes in the form of ecg traces, including AFib. It is recognized by the cardiologists over here in England and has been invaluable to my logging many episodes of AFib. Whenever I feel light headed I do an ecg trace and in my case it is AFib, that lasts for an hour or much longer but so far never longer than a few hours. (I should be having cryogenic AF ablation in October and have just started on blood thinners in readiness for the op)

For Apple Watch users you can also get an Alivecor band to wear under the watch and receive alerts whenever an irregular heart rate is detected.

https://store.alivecor.com/products/kardiaband

Hopefully the monitor you wear on 10/1 will provide all the data the cardiologist needs. When I lived in The Woodlands I used to be under a cardiologist at the N Houston Heart Centre there and was very happy with him.

+1 on the Kardia from Alivecor. Your cardiologist will probably thank you as well especially if you can bring in some proof of Arrythmias..or none.

 

[MRG]

Thanks for the input and advice + links!

I stated earlier (post #3)the dose of metoprolol has been 20 mg/day. I'm a little perturbed at my fairly new primary care doc as she was the one who got me on tamsulosin two years ago and never mentioned the fact that it also lowers BP. I've been off the metoprolol for well over a week now and feel better with an average BP (resting) of 110/60. We also calibrated my BP monitor at Thursday's appointment.

As I am under the care of one of the top cardiologists in Houston (and we specialize in growing them here), I am sure he will sort this all out over the next 45 days.

AJA I saw my shiny new PCP twice about dizzy issues while on metoprolol and flowmax(she put me on it), she totally dismissed it. As soon as I saw a urologist, I mentioned dizziness and he immediately took me off of it.

I'm on finasteride for BPH now and the worst dizziness is behind me.

My point is most PCP'S don't have a clue about BPH or the meds to treat it. Before my insurance would pay for Flowmax they insisted on step therapy. I was given doxazosin, haha that crap had me crawling on the floor cause if I stood up I'd pass out! My idiot doctor never told me it was a super powerful BP med. My BP was 60/40!

 

[imoldernu]

Beyond the prostate issues... A few personal observations, and not medical advice..

The Afib... Best to look up Afib in WebMD, for a good explanation. Basically, AFib worries concern blood flow and the threat of a clot. I have Afib, but rather than the irregular kind, mine is permanent and alway irregular. Instead of bump-de-bump-de-bump-de-bump-de-bump... it goes bump-de-bump-diddy-bump-de- bump. It's always like that. A stethoscope records it that way, all the time. For me, It's asymptomatic so I don't notice it and so far no problems.

The recommended protection is Xarelto, but that comes at a ridiculous price. Against Dr. recommendations, I just use a baby aspirin, as even with a Plan D supplement, it still comes to over $1,000/yr.

So... as for diagnosis... First, the Dr. uses a stethoscope... if the irregularities are indeed irregular, then the common check on this us the use of a Holter Harness, worn for a given period, and then used to plot out the irregular beat.

In my case, the follow up was first an EKG. After that, I was prescribed and had an echocardiogram... followed later by a Cat scan... to determine if the major heart arteries were occluded. All of this under the care of the Heart specialist.

The Echocardiogram provides a graph of how the heart actually beats. Should you get one, ask for the CD that shows the beat... this is used to determine what kind of irregularity is going on, and interesting to playback. Reading the chart is a science in itself.

You probably won't have any of these tests and scans, but it's worthwhile to understand what for most people is a mystery.

While my Afib is permanent and very regular, those with intermittent irregularities often have them "shocked" back to normal... a common event for some people.

Again... not medical advice, but a first person understanding of what is going on.
..................................................................................................

Off topic for this, but a bit about what happened when jeanie had a TIA many years ago. What happened was a blood clot, that was in the carotid artery... blocking blood to the brain. The blood stopped on the artery of the neck, from the ear to the throat. The clot is like what happens when you have a small cut... the blood congeals and dries. Often, as in DW's case, that clot gets stuck on the way to the brain, on the wall of the artery. In her case, lucky... Florida's #1 surgeon was there on a visit. A five inch incision in the neck and then cutting into the artery itself to take out the offending clot... and stitching the artery after the removal. Very delicate.

I think this is kind of the way that heart attacks happen. The CT scan looks for damage that might have occured in (typically) the descending artery,according to the doctor. a potential location for a clot.

............................................................................................

For medications... We enter all of our meds into this WebMD drug interaction check, and pay very close attention to what shows up... A double check on the doctor's recommendations...

https://www.webmd.com/interaction-checker/default.htm

Sorry for rambling on, but frankly, until some of these things happened to us, I really didn't have a clue. So... observations from an amateur.

 

[aja8888]

Sorry to hear this aj. I have been on the 48 hr monitor twice now, 2015 and 2017, and in neither case did it register the paroxysmal Aib I suffer from. In January 2018 I purchased my own monitoring device from
https://www.alivecor.com/. It costs about $100 and has been invaluable in recording and tracking my irregular heart episodes in the form of ecg traces, including AFib. It is recognized by the cardiologists over here in England and has been invaluable to my logging many episodes of AFib. Whenever I feel light headed I do an ecg trace and in my case it is AFib, that lasts for an hour or much longer but so far never longer than a few hours. (I should be having cryogenic AF ablation in October and have just started on blood thinners in readiness for the op)

For Apple Watch users you can also get an Alivecor band to wear under the watch and receive alerts whenever an irregular heart rate is detected.

https://store.alivecor.com/products/kardiaband

Hopefully the monitor you wear on 10/1 will provide all the data the cardiologist needs. When I lived in The Woodlands I used to be under a cardiologist at the N Houston Heart Centre there and was very happy with him.

Thanks Alan. If they don't figure it out with the Medicare monitor, I'll certainly look into buying my own. I'm using a Doc at the Baylor St. Luke's Heart Center in The Woodlands. They are the Doc's that my BIL is using and he is a heart replacement recipient. They are all good up this way.

 

[aja8888]

Beyond the prostate issues... A few personal observations, and not medical advice..

The Afib... Best to look up Afib in WebMD, for a good explanation. Basically, AFib worries concern blood flow and the threat of a clot. I have Afib, but rather than the irregular kind, mine is permanent and alway irregular. Instead of bump-de-bump-de-bump-de-bump-de-bump... it goes bump-de-bump-diddy-bump-de- bump. It's always like that. A stethoscope records it that way, all the time. For me, It's asymptomatic so I don't notice it and so far no problems.

The recommended protection is Xarelto, but that comes at a ridiculous price. Against Dr. recommendations, I just use a baby aspirin, as even with a Plan D supplement, it still comes to over $1,000/yr.

So... as for diagnosis... First, the Dr. uses a stethoscope... if the irregularities are indeed irregular, then the common check on this us the use of a Holter Harness, worn for a given period, and then used to plot out the irregular beat.

In my case, the follow up was first an EKG. After that, I was prescribed and had an echocardiogram... followed later by a Cat scan... to determine if the major heart arteries were occluded. All of this under the care of the Heart specialist.

The Echocardiogram provides a graph of how the heart actually beats. Should you get one, ask for the CD that shows the beat... this is used to determine what kind of irregularity is going on, and interesting to playback. Reading the chart is a science in itself.

You probably won't have any of these tests and scans, but it's worthwhile to understand what for most people is a mystery.

While my Afib is permanent and very regular, those with intermittent irregularities often have them "shocked" back to normal... a common event for some people.

Again... not medical advice, but a first person understanding of what is going on.
..................................................................................................

Off topic for this, but a bit about what happened when jeanie had a TIA many years ago. What happened was a blood clot, that was in the carotid artery... blocking blood to the brain. The blood stopped on the artery of the neck, from the ear to the throat. The clot is like what happens when you have a small cut... the blood congeals and dries. Often, as in DW's case, that clot gets stuck on the way to the brain, on the wall of the artery. In her case, lucky... Florida's #1 surgeon was there on a visit. A five inch incision in the neck and then cutting into the artery itself to take out the offending clot... and stitching the artery after the removal. Very delicate.

I think this is kind of the way that heart attacks happen. The CT scan looks for damage that might have occured in (typically) the descending artery,according to the doctor. a potential location for a clot.

............................................................................................

For medications... We enter all of our meds into this WebMD drug interaction check, and pay very close attention to what shows up... A double check on the doctor's recommendations...

https://www.webmd.com/interaction-checker/default.htm

Sorry for rambling on, but frankly, until some of these things happened to us, I really didn't have a clue. So... observations from an amateur.

Thanks for all the great info! I'm also scheduled for a cartoid artery scan on 10/4 as the Doc heard a slight gurgle (as he said) in one on my left side (neck).

 

[aja8888]

AJA I saw my shiny new PCP twice about dizzy issues while on metoprolol and flowmax(she put me on it), she totally dismissed it. As soon as I saw a urologist, I mentioned dizziness and he immediately took me off of it.

I'm on finasteride for BPH now and the worst dizziness is behind me.

My point is most PCP'S don't have a clue about BPH or the meds to treat it. Before my insurance would pay for Flowmax they insisted on step therapy. I was given doxazosin, haha that crap had me crawling on the floor cause if I stood up I'd pass out! My idiot doctor never told me it was a super powerful BP med. My BP was 60/40!

Wow! Hope you are all straightened out now. So much for PCP's (including mine).

 

[W2R]

Did I ever mention that I love this forum? Sorry if this is slightly off topic, but I was fascinated by the feeling of faintness you experienced at those BP's, and wondered why I didn't feel faint with my low BP's. That sounded pretty hokey to me because I am just as susceptible to faintness as the next person, or moreso.

I'm on Metoprolol too, but only 25 mg/day, and I measure my blood pressure every morning, first thing, before coffee. It is usually a little low (around 105/60 or so). The lowest I have seen recently was on August 11th when it was 88/58, with a HR of 87. I didn't feel faint.

So today, I had my routine doctor appointment and got the doctor's assistant to cooperate in a little experiment. My BP is always higher there, which I attributed to white coat syndrome and/or the fact that they pinch my arm so painfully there and have me all flustered by asking me questions and taking my temperature while my BP is being measured. So today I asked to have my BP taken on my forearm (less painful), and asked for her to not talk or take my temperature until it was done.

Results were that the systolic was still 141, whereas the highest I recorded with my daily home measurements in three months was 123, with only 2 days out of 90 being over 120.

Diastolic was 94 at the doctor, and the highest at home in 3 months was 71, only 1 day out of 90 being over 70.

My BP monitor doesn't seem to need calibration but as time passes I wonder if it is just getting too old to be trustworthy. Maybe I need a new BP monitor. I just ordered another online. If I get the same low BP's with it, I'm taking both into the office next time I go to the doctor, to see what's what.

I'm intrigued.

 

[Oz investor]

am currently on 20mg ( daily ) of Bicor ( Bisoprolol ) which hits me like two bottles of scotch a day ( as a former binge drinker this is NOT the problem it is for most folks ) and Entresto ( 24/26mg twice a day ) which has recently been halved . ( and other medications , of course )

my BP is around 90/60 at around 62 bpm ... the problem is the extra dizziness after about 5 steps

( PS the GP is worried about the potential for reduced renal function , after some worrying but inconsistent tests )

am starting to accumulate medical professionals like some collect base-ball cards

i suppose i should consider it my new hobby ( not much else i am permitted to do )

 

[braumeister]

today I asked to have my BP taken on my forearm

Just a thought:
The idea is to have the BP cuff at the same level as your heart. Granted that sometimes it's hard to get the nurse to do that (let alone distract you with talking), I have to ask if you had your forearm at the right height, and was it supported on a table?

These small factors can make a significant difference IMHO.

 

[W2R]

Just a thought:
The idea is to have the BP cuff at the same level as your heart. Granted that sometimes it's hard to get the nurse to do that (let alone distract you with talking), I have to ask if you had your forearm at the right height, and was it supported on a table?

These small factors can make a significant difference IMHO.

Due to remodeling they only had a regular chair for me to sit on, and there wasn't any place to rest my forearm. So, I just kept my elbow bent, and I guess it was approximately the level of my heart. But it wasn't supported on a table. Hmm!! I wonder if that could have caused the higher BP readings.

If it turns out that I don't need the new BP monitor after all, I'll give it to F, who doesn't have one and would probably use it. Makes no difference to me that I'm buying another; I am in a major Blow That Dough mood today.

I forgot to mention that my BP taken at home this morning was 109/69, and 3 hours later at the doctor's office after sitting quietly in the waiting room for a half hour, it was supposedly 141/94. Honestly it's my curiosity just driving me wild. I just want to know.

 

[Oz investor]

i loved the story of my ( now departed ) mum's GP visit where the cuff had a Velcro failure , so the GP held the cuff in place with his armpit ( and arm )

much to his surprise the blood pressure reading was unusually high ( for mum who was on BP medication at the time ).

sometimes it is easy to lose faith in your medical professionals , ( mum decided to swap GPs )