Medical Forum / General / Cardiology / May 2007
PCOS/hyper-insulinemia/metabolic syndrome x
|
|
Thread rating:  |
PetShopQueen007 - 28 May 2007 05:13 GMT since its been proven that i have this condition, and probably have since i was born (hence why i was having the same symptoms and hair growth and other things even before i ever started having a period), and how 90% of my problems are probably caused by this... i had a few questions.
they say that those with PCOS have the free-circulating insulin that can cause a fatty buildup and arterial problems, etc. i have a high insulin, but not sure for how long. all i know is from the time i was diagnosed with it (1996)... and have never once had high (bad) cholesterol or any of that. my good cholesterol is also perfect and has always been perfect.
now, being 25 and active and a fairly healthy diet for all my life and everything.. *could* it be possible that this has accumulated in my arteries and even in my heart and this is whats causing my heart strain?
on my EKG's its consistently shown non-specific st-t waves... but echo always showed no signs of ischemia. could this be a blockage in my heart arteries? could such a blockage be causing the tachycardia and right heart strain (specifically), though?
i spoke to my doctor on the phone the other day and he says that all of this should just be addressed with the endocrinologist and that this is most likely all just hormonal. okay, yeah i know that, but hormones causing this by themselves, without a blockage? everyone keeps saying, that st-t waves can be very common in a perfectly normal, healthy heart and might not mean anything at all. but... it just doesnt seem right. could they be being caused by the tachycardia and strain?
how can they be so sure there isnt a blockage causing this based on the echo? i dont get it.
supposedly, though.. i had two EKG's show a significant decrease in the st-t waves or to the point of really not even being there. it made no sense what the doctor was referring to. he couldnt seem to make up his mind if they were there or not. what the hell?! again, im just gonna switch to another cardiologist in the same practice.
im wondering if that fall i had just knocked some sh.t out of wack that was in my arteries anyway (fat or insulin-causing blockages), and not particularly a clot/PE.
either way, underliningly, its all gotta do with this PCOS sh.t.
if say, there is a blockage in my heart... at this stage, couldnt they do something about it?
Andrew B. Chung, MD/PhD - 28 May 2007 08:26 GMT > since its been proven that i have this condition, and probably have > since i was born (hence why i was having the same symptoms and hair [quoted text clipped - 13 lines] > arteries and even in my heart and this is whats causing my heart > strain?
>From your clinical history, occlusive coronary disease is not suspected.
> on my EKG's its consistently shown non-specific st-t waves... but echo > always showed no signs of ischemia. could this be a blockage in my > heart arteries? could such a blockage be causing the tachycardia and > right heart strain (specifically), though? Your clinical picture is more consistent with recurrent subacute PEs.
> i spoke to my doctor on the phone the other day and he says that all > of this should just be addressed with the endocrinologist and that > this is most likely all just hormonal. okay, yeah i know that, but > hormones causing this by themselves, without a blockage? With recurrent subacute PEs.
> everyone keeps saying, that st-t waves can be very common in a > perfectly normal, healthy heart and might not mean anything at all. > but... it just doesnt seem right. > could they be being caused by the tachycardia and strain? By recurrent subacute PEs.
> how can they be so sure there isnt a blockage causing this based on > the echo? i dont get it. Your clinical history goes against the idea of occlusive coronary disease.
> supposedly, though.. i had two EKG's show a significant decrease in > the st-t waves or to the point of really not even being there. it made [quoted text clipped - 11 lines] > if say, there is a blockage in my heart... at this stage, couldnt they > do something about it? You would not have passed the stress tests if you had occlusive coronary disease.
Meanwhile, you would be wise to have your doctor(s) supervise your eating less down to the right amount thereby becoming hungrier to lose all the visceral adipose tissue (VAT) that is causing your metabolic syndrome (MetS):
http://HeartMDPhD.com/HolySpirit/overweight.asp
May GOD bless you in HIS mighty way making you hungrier than ever.
Prayerfully in Jesus' awesome love,
Andrew <>< -- Andrew B. Chung, MD/PhD http://EmoryCardiology.com
"Unlike the 2PD-OMER Approach, weight loss diets can't be combined with well-balanced diets." http://HeartMDPhD.com/Love/TheTruth
PetShopQueen007 - 28 May 2007 17:53 GMT hopefully you are right and its something like this, that's 'correctable'.
well, im setting up with a new endocrinologist/gyno (like the other doctor i had who was very knowledged in PCOS, etc and seemed to be very up to date on it all...), and hopefully i can find out where everything stands as far as hormonal levels and all of that go, and work out a good system plan to go along with what im already doing.
another thing... is it normal... for someone's blood pressure (with my physical characteristics) to go from 120/80 to say 105/70 and even 96/70? all within a week, each time at the doctor's, its been either of these. 96 seems a bit low to me, too. even day by day it'll be like this or even within a few hrs time. fluctuates about around those intervals all the time. in fact, i think its always kind of been like that. though, in the past, my doctor's never really mentioned it.. but when they did or i asked....
so, i dont think these fluctuations have much to do with the day or time of day, or what i ate, etc. since it can change within a matter of minutes to an hour, really.
and on my right arm, the BP is usually higher than the left. right would be 120/70 and the left 105/70, or something like that. the doctors never really.. clarify anything for me about this when i asked about it.
Andrew B. Chung, MD/PhD - 28 May 2007 17:58 GMT The endothelial dysfunction associated with metabolic syndrome (MetS) can lead to blood pressure (BP) variability and arterial spasm (left vs right arm BP differences) as you describe.
May GOD bless you in HIS mighty way as you lose your VAT making you hungrier than ever.
Prayerfully in Jesus' awesome love,
Andrew <>< -- Andrew B. Chung, MD/PhD http://EmoryCardiology.com
"Unlike the 2PD-OMER Approach, weight loss diets can't be combined with well-balanced diets." http://HeartMDPhD.com/Love/TheTruth
> hopefully you are right and its something like this, that's > 'correctable'. [quoted text clipped - 22 lines] > doctors never really.. clarify anything for me about this when i asked > about it. PetShopQueen007 - 29 May 2007 12:11 GMT On May 28, 12:58 pm, "Andrew B. Chung, MD/PhD" <heartd...@emorycardiology.com> wrote:
> The endothelial dysfunction associated with metabolic syndrome (MetS) > can lead to blood pressure (BP) variability and arterial spasm (left > vs right arm BP differences) as you describe. can this be corrected/reversed?
like i said.. a year ago, i dont recall ANY of this vascular stuff happening. not even in november. this stuff started exactly the week all this heart stuff started happening, and the fall, period... etc.
as for strange blood pressure fluctuations.. thats been going on for a while (since early 2005) and the feeling of just getting off an elevator.. and SOB since at least later 2004, early 2005.
my mom was saying today she first remembered me complaining about all of this about 2-3 months after stopping the birth control pill completely... and yeah, i remember feeling very strange/different after that.
i dont think this is PH at all now. all this other sh.t is related and obviously is.. i mean it all fits the pattern. but still.. PCOS/mets x causing it all out of the blue like that? at least the vascular? it was my understanding that most of these types of problems develop over a period of time.. usually years.. decades. but so suddenly like this? id think id have had at least 'some' vascular sympyoms prior to this. i swear to god, i cant think of anything prior to december, as far as that goes. i just remember 2 days after that fall and the onset of this other thing.. coming home from work, and it was very cold out..and i wasnt wearing any gloves or anything and driving home. my hands wer elike ice (takes forever the heat to work in that car and besides. its just a 10 minute drive home), but when i got inside the house.. the warming reaction in my hands and fingers was really strange. i cant explain it. id never really had it happen like that before, except many years ago, playing around in the snow as a kid and almost getting frostbite and tossing my hands under really hot water, which wasnt exactly a good idea, LOL> but yeah it felt extreme like that and they felt pretty strange the rest of the night. so much so, i mentioned something to my mom. they looked a normal color and the capillary refill seemed normal. just the feeling.. like the nerves.. or something. but they never responded in this extreme type of way before. of course when the fingers warm up from the cold, you're gonna feel stuff like that, but this was way different. and throghout my life, ive been very known to have some of the best circulation and veins.. but within a matter of a couple weeks.. they even started looking all different. not just little areas here and there.. im talking about widespread vein appearance changes. they dont 'look' as strong and healthy as they did before. for the first time in my life that week, i was feeling like i had all my blood drained and fingers going numb for no reason and toes. even my face. that really scared me. then 3 weeks or so later.. a lot of that subsided and my fingers and everything seemed somewhat back to normal. i wasnt having any problem doing anything, but i still noticed a difference. it was like my body was changing before my eyes, for some unknown reason. and not just seieng i, but you just feel like .. inside everythings just not working right. even feeling like sh.t all the time from my auto-immune problems and the PCOS.. id never felt this way before. this was soemthing o a whole other new category and even despite feeling 'sick' before all that, i still felt 'healthy' and 'together'... and strong.
one thing that came back to me was.. back in high school.. after having a really really bad flu and a bad period.. (may 2000), and id had an odd episode upon waking up, of really ow blood pressure.. definite blue coloring in my face and around my lips. felt like i was gonna pass out. id NEVER felt that way in my life. i felt like id been drugged. i got up that morning to go to school and felt really.. really washed out and strange. not just from the flu. i jump in the shower.. and i start seeing spots and my arms had a blue tint to them. i thought.. oh its just the flu.. (how stupid was that?!?!) and like my heart was trying to over-compromise for the lack of a freekin blood flow, and id currently had been on amoxicillin for the flu, and i dont recall taking any of my cold meds that morning... maybe the night before.. a regular sudafed... but anyways, i felt like sh.t and i couldnt take off from school. so later that morning, im sitting in class.. blow my nose and all of the sudden i feel this hot rush in what feels like my stomach and it progresses and feels like im about to combust from within. started sweating and like my skin was burning... i turned blood red and felt it move all the way to my head, heart racing, skin tingling,.. like some really, really acute.. fever rush. i felt like i needed to get some water, right away but couldnt get up. id had my head down on the desk and refused to even move. after about 5 mins, it subsided and i thought i was gonna vomit, but nothing happened. and the rest of the day, everyone said i looked drunk and totally washed out. i went to the nurse and they refused to even send me home, but... something was NOT right. i felt kinda better after this little 'attack', but still felt like id been thru a war inside my body. needless to say, after that i stopped taking the antibiotic and th sudafed, just in case. tho, id never ever had a reaction like that to either drug before. so, i dont think thats what that was.
there'd been a couple other odd little things from before i was on the pill, but ive mentioned those already. but, those were all tied into around when i had my period.
im wondering.. if, like i was saying before.. that my vascular and nervous system are reacting to some strange chemical or hormonal imbalance.. more of an acute type.
as for my leg.. that things acting up like hell the last day or two. not sure if its from the heat or what. started hurting and 'itching' kind of inside and outside and started looking swollen again (though the pouchy thing never goes away), and i was walking around lastnight and looked down at my leg and see a little knot in the vein next to my leg bone, and it looked like a faint bruise... and i touched it and i could feel it. felt like my moms messed up vein bulges. freaked me out. id never had that before either. its been feeling more odd.. ever since i had my period a week and a half or so ago.. but this knot thing really creeped me out.
i just dont know how the heck to bring allt his up to the doctors.. my current one, i think.. believes im a quack now. i dont even know where to begin with what tests would need to be done, theres just too many to be done.. and the doctors wont bring it up themselves, so i have to, and when i do, they act like there is no need and start this whole fight about it. even despite the physical evidence. god forbid a patient suggests certain things.
Andrew B. Chung, MD/PhD - 29 May 2007 12:21 GMT > Andrew, in the Holy Spirit, boldly wrote: > > The endothelial dysfunction associated with metabolic syndrome (MetS) [quoted text clipped - 115 lines] > need and start this whole fight about it. even despite the physical > evidence. god forbid a patient suggests certain things. It is likely what we see in you is the proverbial "straw that broke the camel's back."
Time to get the straw (VAT) off the camel's back and wait for the healing to occur.
GOD is the Source of all healing.
May HE bless you in HIS mighty way making you hungrier than ever so that you will lose the VAT:
http://HeartMDPhD.com/HolySpirit/overweight.asp
Prayerfully in Jesus' awesome love,
Andrew <>< -- Andrew B. Chung, MD/PhD http://EmoryCardiology.com
"Unlike the 2PD-OMER Approach, weight loss diets can't be combined with well-balanced diets." http://HeartMDPhD.com/Love/TheTruth
PetShopQueen007 - 29 May 2007 23:00 GMT as for VAT fat loss.. ive been working on that. the last few months now, especially.. the foods ive been eating and frequency. i hardly eat that much lately, anyways. lol. i'll have a tuna fish sandwich and soup for lunch and dinner.. something like fish, veggies, rice or pasta.. or a light chicken and veggies meal. as for my mid-section (which seems to be the area for the most VAT fat), ive always kind of been slightly more 'bloated' around that area ever since i was little. same for my mom. within the last few months, thats gone down quite a bit , but that might've been due to water retention or just me losing weight overall. (losing 5 pounds can make a huge difference on me.. im very very small.)
anyways,... what type of doctor would be best for this whole thing? the mets, possible adrenal issues, etc.. an endocrinologist? or an endocrinologist/gyno (which is VERY hard.. to find in this area.. at all)?
also, as far as deep vein thrombosis goes.. the deep veins to be worried about would be the ones in my calf itself.. behind the leg?
the problem area with mine.. is off to the side.. next to the ankle (close to the heel) and above the ankle... and goes slightly to the area right below the calf muscle on the side. not behind on the calf itself. the bulgy vein is right next to the front leg bone midway on the lower leg. about half an inch.
would this sound more like a superficial vein?
Susan - 29 May 2007 23:41 GMT > as for VAT fat loss.. ive been working on that. the last few months > now, especially.. the foods ive been eating and frequency. i hardly [quoted text clipped - 7 lines] > due to water retention or just me losing weight overall. (losing 5 > pounds can make a huge difference on me.. im very very small.) If you have PCOS or Cushing's, you should be eating low carb; ixnay the iceray and astapay. :-)
> anyways,... what type of doctor would be best for this whole thing? > the mets, possible adrenal issues, etc.. an endocrinologist? or an > endocrinologist/gyno (which is VERY hard.. to find in this area.. at > all)? Reproductive endocrinologists are at the forefront, but not all of them. The best intervention is low carb diet, with metformin if diet alone isn't 100% effective.
Susan
Andrew B. Chung, MD/PhD - 30 May 2007 03:50 GMT > as for VAT fat loss.. ive been working on that. the last few months > now, especially.. the foods ive been eating and frequency. i hardly [quoted text clipped - 7 lines] > due to water retention or just me losing weight overall. (losing 5 > pounds can make a huge difference on me.. im very very small.) The key is eating less down to the optimal amount thereby becoming much hungrier.
As for the right diet... avoid foods that cause a reduction in appetite.
As for the right activity... avoid doing things that cause a reduction in appetite.
As for the right people... avoid people that cause a reduction in appetite.
As for the right meds and supplements... avoid things that cause a reduction in appetite.
It is when you are hungry especially when the stomach is growling that your body is dismantling the VAT.
> anyways,... what type of doctor would be best for this whole thing? As for the right doctor in your case... one who listens to you and answers your questions thoughtfully so that you experience an increase in appetite after visiting him/her :-)
> the mets, possible adrenal issues, etc.. an endocrinologist? or an > endocrinologist/gyno (which is VERY hard.. to find in this area.. at [quoted text clipped - 12 lines] > > would this sound more like a superficial vein? Yes. However, where there is a problem with superficial veins, it is likely there is also a problem with the deep veins.
May GOD bless you in HIS mighty way making you hungrier than ever.
Prayerfully in Jesus' awesome love,
Andrew <>< -- Andrew B. Chung, MD/PhD http://EmoryCardiology.com
"Unlike the 2PD-OMER Approach, weight loss diets can't be combined with well-balanced diets." http://HeartMDPhD.com/Love/TheTruth
Susan - 28 May 2007 20:26 GMT > hopefully you are right and its something like this, that's > 'correctable'. [quoted text clipped - 17 lines] > time of day, or what i ate, etc. since it can change within a matter > of minutes to an hour, really. It's normal if the person has PCOS symptoms caused by Cushing's syndrome or disease, a common condition rarely diagnosed. Everyone with PCOS is supposed to be evaluated for Cushing's first.
Susan
Andrew B. Chung, MD/PhD - 28 May 2007 21:34 GMT > > hopefully you are right and its something like this, that's > > 'correctable'. [quoted text clipped - 20 lines] > It's normal if the person has PCOS symptoms caused by Cushing's syndrome > or disease, a common condition rarely diagnosed. Cushing's syndrome is neither normal nor common.
> Everyone with PCOS is > supposed to be evaluated for Cushing's first. Someone with Cushing's syndrome will likely have physical exam findings suggestive of that diagnosis.
May GOD bless you in HIS mighty way.
Prayerfully in Jesus' awesome love,
Andrew <>< -- Andrew B. Chung, MD/PhD http://EmoryCardiology.com
"Unlike the 2PD-OMER Approach, weight loss diets can't be combined with well-balanced diets." http://HeartMDPhD.com/Love/TheTruth
PetShopQueen007 - 29 May 2007 01:15 GMT > Cushing's syndrome is neither normal nor common. yes, its not normal or common, but i guess abnormally 'normal' with those with PCOS../cushings.
oddly, my dog was diagnosed with cushings a couple years back.
> Someone with Cushing's syndrome will likely have physical exam > findings suggestive of that diagnosis. my endo back in the 90s thought i had it, until the test results.
i argued with him over the result though.. since it was 2 points above the highest normal reading.
as for symptoms of cushings.. everyones different.
like hey, i have PCOS... but am not overweight and can still have a normal period (now), and havent gone into full-blown diabetes..
Andrew B. Chung, MD/PhD - 29 May 2007 02:14 GMT > > Cushing's syndrome is neither normal nor common. > > yes, its not normal or common, but i guess abnormally 'normal' with > those with PCOS../cushings. No such thing as the latter.
> oddly, my dog was diagnosed with cushings a couple years back. > [quoted text clipped - 5 lines] > i argued with him over the result though.. since it was 2 points above > the highest normal reading. Serum cortisol levels are highly variable.
ACTH stimulation is used to improve specificity.
> as for symptoms of cushings.. everyones different. > > like hey, i have PCOS... but am not overweight Many women aren't overweight and yet have enough VAT to cause health problems.
> and can still have a > normal period (now), and havent gone into full-blown diabetes.. Your health problems appear to be more vascular.
May GOD bless you in HIS mighty way.
Prayerfully in Jesus' awesome love,
Andrew <>< -- Andrew B. Chung, MD/PhD http://EmoryCardiology.com
"Unlike the 2PD-OMER Approach, weight loss diets can't be combined with well-balanced diets." http://HeartMDPhD.com/Love/TheTruth
PetShopQueen007 - 29 May 2007 02:16 GMT im going to see if they can do the 24-hour urine cortisol test. never had that.
so, if this is my problem..causing all these symtpoms, .. cardiac and vascular.. can they be reversed/corrected?
Susan - 29 May 2007 02:43 GMT > im going to see if they can do the 24-hour urine cortisol test. never > had that. > > so, if this is my problem..causing all these symtpoms, .. cardiac and > vascular.. can they be reversed/corrected? Yes, though diagnosis and treatment is variable and tricky. A 24 hour UFC can be helpful, but many pathology proven Cushing's patients never have elevated test results. Midnight salivary cortisol can be more helpful, if positive, by showing the disrupted diurnal variation pattern. Cushing's tends to be cyclical, so many folks have to test repeatedly for months or longer to catch a high result.
Here's a great resource:
http://www.cushings-help.com/intro.htm
Susan
Andrew B. Chung, MD/PhD - 29 May 2007 02:46 GMT > im going to see if they can do the 24-hour urine cortisol test. never > had that. > > so, if this is my problem..causing all these symtpoms, .. cardiac and > vascular.. can they be reversed/corrected? It is unlikely that your problems are arising from Cushing's syndrome.
Moreover, without an adrenal tumor, Cushing's syndrome would be without definitive treatment.
In the interim, it would remain wise for you to lose all the visceral adipose tissue (VAT) by eating less down to the right amount.
May GOD bless you in HIS mighty way.
Prayerfully in Jesus' awesome love,
Andrew <>< -- Andrew B. Chung, MD/PhD http://EmoryCardiology.com
"Unlike the 2PD-OMER Approach, weight loss diets can't be combined with well-balanced diets." http://HeartMDPhD.com/Love/TheTruth
Susan - 29 May 2007 02:46 GMT >>Cushing's syndrome is neither normal nor common. > [quoted text clipped - 15 lines] > like hey, i have PCOS... but am not overweight and can still have a > normal period (now), and havent gone into full-blown diabetes.. I don't know who's arguing with you, clearly someone in my kill file. Cushing's is very common, but even most endocrinologists are completely ignorant of its true characteristics. With 10% of type 2 DMs having it, that's a big group.
I am slim, was very slim when I developed PCOS years ago, don't look at all Cushingoid, yet I consistently run extremely high cortisol, particularly at midnight. When it's lower, I experience symptoms of adrenal insufficiency even while running cortisol in the normal range because my body is used to running on more.
Susan
Andrew B. Chung, MD/PhD - 29 May 2007 03:18 GMT > >>Cushing's syndrome is neither normal nor common. > > [quoted text clipped - 20 lines] > ignorant of its true characteristics. With 10% of type 2 DMs having it, > that's a big group. Someone with hyperglycemia from Cushing's syndrome would neither be diagnosed with nor treated for type-2 diabetes. Instead, the chronically elevated cortisol levels would be addressed.
Excerpt from Merck Manual:
Testing begins with measurement of urinary free cortisol (UFC), the best assay for urinary excretion (normal, 20 to 100 g/24 h [55.2 to 276 nmol/24 h]). UFC is elevated > 120 g/24 h (> 331 nmol/24 h) in all patients with Cushing's syndrome. However, many patients with UFC elevations between 100 and 150 g/24 h (276 and 414 nmol/24 h) have obesity, depression, or polycystic ovaries but not Cushing's syndrome. A patient with suspected Cushing's syndrome with grossly elevated UFC (> 4 times the upper limit of normal) almost certainly has Cushing's syndrome. Two to 3 normal collections virtually exclude the diagnosis. Slightly elevated levels generally necessitate further investigation.
Traditionally, further investigation is accomplished with the test, in which 1, 1.5, or 2 mg of dexamethasone is administered po at 11 to 12 pm and plasma cortisol is measured at 8 to 9 am the next morning. In most normal patients, this drug suppresses morning plasma cortisol to 1.8 g/mL ( 50 nmol/L), whereas patients with Cushing's syndrome virtually always have a higher level. A more specific but equally sensitive test is to give dexamethasone 0.5 mg po q 6 h for 2 days (low dose). In general, a clear failure to suppress levels in response to low-dose dexamethasone establishes the diagnosis.
Source:
http://www.merck.com/mmpe/sec12/ch153/ch153e.html#S12_CH153_T002
May GOD bless you in HIS mighty way.
Prayerfully in Jesus' awesome love,
Andrew <>< -- Andrew B. Chung, MD/PhD http://EmoryCardiology.com
"Unlike the 2PD-OMER Approach, weight loss diets can't be combined with well-balanced diets." http://HeartMDPhD.com/Love/TheTruth
PetShopQueen007 - 29 May 2007 01:12 GMT hey susan,
yeah, they checked me for Cushings back when i was first diagnosed, but they ruled that out (then.) however.. my cortisol was 'normal', however it was about 2 numbers above the highest normal number interval. my doctor then had an ultrasound done on my kidneys and adrenals to make sure there were no tumors or any other abnormalities and everything was supposedly normal. but as for that, i havent had that checked since. ya better bet i'll be mentioning this again to my new endo. because i think something may have been 'overlooked' back then.
> > hopefully you are right and its something like this, that's > > 'correctable'. [quoted text clipped - 23 lines] > > Susan Susan - 29 May 2007 02:48 GMT > hey susan, > [quoted text clipped - 8 lines] > endo. > because i think something may have been 'overlooked' back then. Check the link I provided in another post. One test can't rule it out, Cushing's tends to be very cyclical. Pituitary MRI read by one of a few expert neurosurgeons, plus abdominal C-T scan of the adrenals, along with extensive hormone testing using 24 hour UFCs and salivary cortisols would be more useful.
Susan
|
|
|