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Medical Forum / General / Cardiology / March 2006Advice please
I have had numerous admissions to Accident and Emergency with severe chest pain/shortness of breath and when this occurs my B.P. increases substantially, right sided systolic exceeds left sided systolic by up to 20..Prior to these episodes I develope severe headaches and sometimes numbness in my lower left leg. ECG's show no gross abnormalities. Cardiac catheterization in the Cardiologist's description was perfect. I am 53 years of age with diabetes treated with metformin 500mg twice daily. I suffer from PTSD and depression from service in South Vietnam with the Australian Army but still work. I am not overweight. Walk regularly. Sometimes I have arrythmias. Of interest in my blood tests, when these chest pain attacks occur the following abnormalities are consistently shown: lower than normal range potassium higher than normal anion gap. I have also been diagnosed with minor gout (untreated) This is all very frustrating. No doctors or specialists can determine what is causing this all to happen. Appreciate any opinions/advice Many thanks. Ron >I have had numerous admissions to Accident and Emergency with severe chest >pain/shortness of breath and when this occurs my B.P. increases [quoted text clipped - 21 lines] > > Ron What are you typically doing when/before these events happen? Do they seem to come at random? Bill - not a Dr. > I have had numerous admissions to Accident and Emergency with severe chest > pain/shortness of breath and when this occurs my B.P. increases [quoted text clipped - 10 lines] > lower than normal range potassium > higher than normal anion gap. I am not sure by what you mean by lower than normal or higher than normal or to what degree and whether these are constant findings or only during the episodes you describe. The anion gap is used only for evaluation of metabolic acidosis and or quality control of testing systems. Metabolic acidosis is divided into anion and non-anion gap acidosis (hyperchloremic). Metformin is known to cause lactic acidosis in which the lactate as an anion would contribute to the anion gap and thus cause an anion gap metabolic acidosis. One would do a lactic acid level if really interested in that. The potassium is usually increased in metabolic acidosis as the acid enters the cells and the potassium leaves the cells and enters the extracellular fluid. If you have a low potassium then would be actually favor a metabolic alkalosis. I would be interested in the CO2 to check for respiratory compensation or origins. Without a pH known then the CO2 would be low in respiratory alkalosis hyperventilation or in metabolic acidosis. > I have also been diagnosed with minor gout (untreated) > [quoted text clipped - 6 lines] > > Ron > I have had numerous admissions to Accident and Emergency with severe chest > pain/shortness of breath and when this occurs my B.P. increases > substantially, right sided systolic exceeds left sided systolic by up to > 20.. This would suggest "spasm" involving the left subclavian artery. > Prior to these episodes I develope severe headaches and sometimes > numbness in my lower left leg. This would suggest that there is widespread endothelial dysfunction resulting in multiple foci of arterial "spasm." > ECG's show no gross abnormalities. Cardiac > catheterization in the Cardiologist's description was perfect. I am 53 years > of age with diabetes treated with metformin 500mg twice daily. I suffer from > PTSD and depression from service in South Vietnam with the Australian Army > but still work. I am not overweight. Type 2 diabetics typically are not "lean and trim." > Walk regularly. Sometimes I have > arrythmias. Of interest in my blood tests, when these chest pain attacks > occur the following abnormalities are consistently shown: > > lower than normal range potassium > higher than normal anion gap. Uh-oh. Could be an AE to the metformin. > I have also been diagnosed with minor gout (untreated) > > This is all very frustrating. No doctors or specialists can determine what > is causing this all to happen. > > Appreciate any opinions/advice Would suggest you ask your doctor(s) about switching you off of the metformin and to supervise your use of the diabetic 2PD-OMER Approach to become "lean and trim." > Many thanks. You are welcome, Ron :-) All thanks and praises belong to the LORD Whom I love with all my heart, soul, mind, and strength. Will be available to "glow" and chat about this and other things like cardiology, diabetes, Bird Flu, the 2006 global earthquake advisory, cooking and nutrition that interest those following this thread here during the next on-line chat (03/16/06) from 6 to 7 pm EST: http://tinyurl.com/8w7uq For those who are put off by the signature, my advance apologies for how the LORD has reshaped me: http://tinyurl.com/7mcuo Prayerfully in Christ's love, Andrew http://tinyurl.com/rgsp8 >> I have had numerous admissions to Accident and Emergency with severe >> chest [quoted text clipped - 20 lines] > > Type 2 diabetics typically are not "lean and trim." He must be a lying f.cker then eh Chump?  SignatureBeav OMF#19 VN 750 Zed Thou mail is beavis dot original at ntlworld dot com (with the obvious changes) > >> I have had numerous admissions to Accident and Emergency with severe > >> chest [quoted text clipped - 22 lines] > > He must be a lying f.cker then eh Chump? No. Someone who is not "lean and trim" may also not meet criteria for the definition of "overweight. Will be available to "glow" and chat about this and other things like cardiology, diabetes, Bird Flu, the 2006 global earthquake advisory, cooking and nutrition that interest those following this thread here during the next on-line chat (03/16/06) from 6 to 7 pm EST: http://tinyurl.com/8w7uq For those who are put off by the signature, my advance apologies for how the LORD has reshaped me: http://tinyurl.com/7mcuo Prayerfully in Christ's love, Andrew http://tinyurl.com/rgsp8 (...) > Type 2 diabetics typically are not "lean and trim." Yet there are people who are lean and trim who have type II diabetes, despite the fact that most people with diabetes have it because they are overweight. Jeff > (...) > [quoted text clipped - 3 lines] > despite the fact that most people with diabetes have it because they are > overweight. The former remains rare so that when this occurs beta islet cell failure should be excluded. Will be available to "glow" and chat about this and other things like cardiology, diabetes, Bird Flu, the 2006 global earthquake advisory, cooking and nutrition that interest those following this thread here during the next on-line chat (03/16/06) from 6 to 7 pm EST: http://tinyurl.com/8w7uq For those who are put off by the signature, my advance apologies for how the LORD has reshaped me: http://tinyurl.com/7mcuo Prayerfully in Christ's love, Andrew http://tinyurl.com/rgsp8 > (...) > [quoted text clipped - 5 lines] > > Jeff Yes, I have a friend who has had T2 for several years, and he definitely is the "lean and trim" (in fact, "skinny and very active") type. I have known him for about 30 years, and he has *always* followed a very strict diet. He will eat fish, eggs, and some poultry -- but that's it as far as meat is concerned. His meals consist almost entirely of veggies with a limited amount of fruit. Nothing deep fried and no sugar added. It's true that "lean and trim" is not a common characteristic of T2, but we do not all fit within the same guidelines. (Unfortunately, I *do* fit the general characteristics of T2!) MaryL > Yes, I have a friend who has had T2 for several years, and he definitely is > the "lean and trim" (in fact, "skinny and very active") type. I have known [quoted text clipped - 8 lines] > > MaryL I was very lean when my insulin resistance got out of hand and got my attention. I was on a very low fat, high carb diet at the time. Susan > x-no-archive: yes > [quoted text clipped - 15 lines] > > Susan I suspect that would describe my friend (in the past), as well. It has been a good number of years since he was diagnosed, but I remember that he would avoid as many sources of fat as possible, but he did eat bread, muffins, etc. He has now been low-carbing for several years but still has difficulty controlling his BG. MaryL Thank you all for your input. Several things I omitted. Prior to these attacks I also get frequency of urination and the other consistent blood abnormality detected is lower than normal limit bicarbonate. Meds taken: 1 baby aspirin in the morning 1 losec daily 500mg metformin twice daily 1 fish oil capsule 1 CoQ10 capsule daily 20mg lipitor 50mg metoprolol twice daily My frustration is that no doctor here in Oz has attempted to explain any of this to me. It has been suggested to me by a colleague (Consulting Psychiatrist, I am a registered psychiatric nurse) that PTSD (from war service in South Vietnam) is sometimes associated with coronary artery/vessel spasms. May The Lord Jesus bless you all. Cheers Ron from Australia. >I have had numerous admissions to Accident and Emergency with severe chest >pain/shortness of breath and when this occurs my B.P. increases [quoted text clipped - 22 lines] > > Ron > Thank you all for your input. Several things I omitted. Prior to these > attacks I also get frequency of urination and the other consistent blood > abnormality detected is lower than normal limit bicarbonate. This with the high anion gap remains suggest of lactic acidosis which can occur as an adverse event from taking metformin. > Meds taken: > 1 baby aspirin in the morning [quoted text clipped - 10 lines] > service in South Vietnam) is sometimes associated with coronary > artery/vessel spasms. Arterial spasms in the setting of endothelial dysfunction which does occur more frequently with diabetes can be triggered by any sort of emotional duress. > May The Lord Jesus bless you all. It is my choice to thank the LORD for your kind thoughts. Will be available to "glow" and chat about this and other things like cardiology, diabetes, Bird Flu, the 2006 global earthquake advisory, cooking and nutrition that interest those following this thread here during the next on-line chat (03/16/06) from 6 to 7 pm EST: http://tinyurl.com/8w7uq For those who are put off by the signature, my advance apologies for how the LORD has reshaped me: http://tinyurl.com/7mcuo Prayerfully in Christ's love, Andrew http://tinyurl.com/rgsp8 >> Meds taken: >> 1 baby aspirin in the morning [quoted text clipped - 7 lines] >> My frustration is that no doctor here in Oz has attempted to explain any of >> this to me. It has been suggested to me by a colleague (Consulting metoprolol is a bet blocker, and that is a VERY BAD choice for a diabetic, as they tend to block the early warning signs of hypoglycemia. You are not currently on any medication that 'actively' lower blood sugar levels such as OHA's or Insulin, this is not a serious issue yet, but it likely to become one. The preferred anti-hypertensive drugs in diabetics are the Angiotensin Converting Enzyme inhibitors (ACE inhibitors), in fact Beta Blocker should be avoided like the plague! There is considerable evidence that ACE inhibitors are very effective in delaying the long term kidney damage usually seen in diabetics. >> Psychiatrist, I am a registered psychiatric nurse) that PTSD (from war >> service in South Vietnam) is sometimes associated with coronary [quoted text clipped - 24 lines] >Andrew >http://tinyurl.com/rgsp8 > Thank you all for your input. Several things I omitted. Prior to these > attacks I also get frequency of urination and the other consistent blood [quoted text clipped - 47 lines] > > > > Ron Ron, One of your problems appears to be related to having your electolytes out of balance. The best book that I have found related to this subject is: "The Acid-Alkaline Diet for Optimum Health" by Christopher Vasey (N.D.) The author explains how you can determine (or test) your acid levels and instucts how to interpret the test results. It even provides advice on how to elimimate problems related to having excessive amounts of acid. I am not a doctor. Jason SignatureNEWSGROUP SUBSCRIBERS MOTTO We respect those subscribers that ask for advice or provide advice. We do NOT respect the subscribers that enjoy criticizing people. > > Thank you all for your input. Several things I omitted. Prior to these > > attacks I also get frequency of urination and the other consistent blood [quoted text clipped - 58 lines] > not a doctor. > Jason Ron, This is a follow-up to the above post. I checked for "gout" in the index of several of my medical books. I found out that "gout" is "much more frequent in patients with chronic renal (kidney) failure than in the general population." I suggest that you ask your doctor to conduct a blood test called a "kidney function test" and also a urine dip test. I also suggest that you read this book which is where I found the about quote: "Coping With Kidney Disease" by Mackenzie Walser M.D. (kidney specialist) I should note that I am not a doctor. You may or not have kidney problems--the above tests should help your doctor determine whether you do or do not have kidney problems. The author of the above book explains kidney problems in a way that anyone could understand. Jason SignatureNEWSGROUP SUBSCRIBERS MOTTO We respect those subscribers that ask for advice or provide advice. We do NOT respect the subscribers that enjoy criticizing people. |
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