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    Old 05-24-2007, 09:10 AM   #16
    accessn12
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    Re: Beta Blockers and Edema

    Yeah, I don't dare not take the beta. Very rarely now do I exceed 90 bpm, whereas before, I never went under 100 until I started them.

    I like your bedside manner. Direct, confident and caring. I imagine you don't hold and rub your face in your hands very often? That always seems so undoctorlike. lol

    I weigh in at a whopping 99 lbs (lost 12 lbs over the last year) without the water. Think 40mgs is appropriate at that weight? I do find that about 4 days running on the 10mgs seems to make most of it go away but it only takes 2 days off to come back. I kinda stopped peeing very much back in february. For a while there, output was less than 400ml. They kept screwing up the metanephrine test jugs and I had to redo it 3 times over the course of a month. Oh yeah, another one of the endos' brill ideas. Test for pheochromocytoma 16 years into beta blocker treatment. Squeezing out a little more on my own now but it still ain't my normal flow. I'll try buffering the lasix a little more. I been taking em with one of those high calorie shake drinks and a bowel of cheerios. I just hate walking around green. Everyone seems to notice.

    Have no idea what my ejection fraction is. What is an ejection fraction? I've had 2 ecg's in my life. One in 1983 which shows some kind of weird flat top spikes that come in between some more normal looking spikes with a "1/2" hand written under one of em. I don't know how to read em. And then the er did one in 1991 that says right atrial enlargment but none of those weird flattened thingys. That's it. No other cardiac evaluations. I do have a copy of every single piece of my medical records going back to 1981. Even though I have had documented tachycardia, high cholesterol and am hyperthyroid, with a very strong family history of heart disease, no one has ever seemed to be concerned with my cardiovascular system. I guess that's cause I don't have high bp?????

    >>"Probably to ascertain thyroid size and look for any nodules."<<

    Guess again. They did a raiu and scan 3 days before that. They had a very pretty picture of my hot diffuse goiter with measurements and everything. They don't normally mri thyroids. The mri says "incidental note of diffuse goiter" and goes on to describe the spine. My guess is someone screwed up.

    I do have an appointment with my pcp on the 31st. I made the appointment end of last month. He's not an easy man to get an appointment with. I can get an appointment with the fnp pretty easy but every time I've seen her, she huffs out of the room saying if I don't do rai, I'm going to end up with a pacemaker. She's got an absolutely wonderful bedside manner. I'd really like to punch her out.

    You know what my most recent diagnosis is? "You aren't peeing enough." Give me strength.............

     
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    Old 06-07-2007, 07:11 PM   #17
    Hypergirl48
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    Re: Beta Blockers and Edema

    Was reading this thread tonight and hope you don't mind if I jump in here! I'm on metoprolol succ (Toprol-XL generic). Started taking it last summer when I starting having racing heart, etc., with hyperthyroid. I was diagnosed with Graves' and had the RAI, but I'm still on the beta blocker. I have HBP and had PVC's before the hyperthyroid and the beta blocker helps both. Can't take ACE anymore because of the cough I get with that! Now I'm having edema in my ankles and pitting edema on my legs! Today my PCP prescribed a diuretic and wants me to have a cardiolite stress test because of some funny feelings in my chest and the edema.

    So, I've found a lot of interesting dialog here! One thing, I just developed a cough a few days ago and noticed someone here ask about coughing. Why? What significance does the cough have with the beta blocker?

    Thanks!

     
    Old 06-08-2007, 04:46 PM   #18
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    Re: Beta Blockers and Edema

    access,

    How's this scenario: Have the RAI and cut down on the size and functioning ability of your thyroid. Then you will be in the position that a lot of HYPOthyroids are in, lots of TSH floating around with nothing much to do? Taken to it's extreme, you could slow your thyroid to near nothing and even if your pituritary goes ATOMIC, there can't be a concomitant increase in thyroid hormones?

    Hypergirl,

    Beta-blockers cause pulmonary vasoconstriction and can cause an asthma-like cough or actual asthma. It's becasue adrenaline is blocked and adrenaline opens the airways and increases bloodflow.

    The effect is worse for non-selective beta blockers like propranolol and nadolol and less with selective beta-blockers like metoprolol and atenolol which are more "cardio selective" to the heart.

    But even the selective blockers aren't completely selective and thus metoprolol can cause a dry cough.

    I've taken three different beta blockers and never coughed...but I coughed my HEAD off with my only ACE inhibitor.

    Last edited by Lenin; 06-08-2007 at 05:50 PM.

     
    Old 06-08-2007, 06:53 PM   #19
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    Re: Beta Blockers and Edema

    Thank you, Lenin!

     
    Old 06-09-2007, 04:57 AM   #20
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    Re: Beta Blockers and Edema

    Hi lenin,

    Both surgery and RAI are contraindicated when the pituitary is what's causing the problem. With surgery, the thyroid grows back and will keep growing back no matter how many times they remove it and if they don't get the whole thing with rai, it'll grow back too. If they go for total ablation with rai, not only does the pituitary go ballistic and often starts to grow but it ends up causing a whole bunch of other problems in other organ systems. It's a really complicated issue involving mutant receptors throughout every organ system and one of the reasons I'm considered so "atypical". I'm a mix of hyper, hypo and euthyroid with the hyper predominating. The only accepted treatment protocol is beta blockers and if you'll believe it, the addition of thyroid hormones or thyroid hormone analogs to supress the pituitary and lower the natural hormone production. My pcp has finally said to hell with the endos and is doing the research himself to see what we can do. I wish I had found this guy years ago. First doc I've ever run into who wants to take the time to help.

    It's been a busy week and a half. I've seen my pcp twice. I have stage 2 kidney disease. I've had an abdominal ct and now have to go in for a scope and biopsy to see what is causing the thickened gastric wall. Perhaps why the lasix has been tearing up my tummy? Running into an insurance glitch on the scope so I don't know how long it's going to take to come up with the funds for that but somehow, I will have it done. I had an echo on wednesday and am now awaiting results on that. I hate techs that keep their mouths shut. "The cardiologist will read it and send the results to your pcp."

    The edema is somewhat better. Since I am no longer "dehydrated" I am no longer being told to force fluids so the lasix is now able to pull a lot of it off. Idiot nurse. She had ordered the wrong test on the kidneys, not the one that the pcp had put in the chart. Of course everything looked good cause the calculations hadn't been done. She ordered the test in individual pieces and then called to say everything was fine. It was one of those tests that size and a couple other things come very much into play and they hadn't been entered into the equation because the calculations were not ordered.

    I'll let you know how the echo turned out. I'm keeping my fingers crossed on that one.

    Hypergirl - The last endo I saw switched me to topral from inderal when I complained about the edema. Funny. When I looked it up, it is one of the betas that is most likely to cause edema. Even more so than inderal. I'm now back on atenolol.

     
    Old 06-09-2007, 06:26 AM   #21
    Lenin
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    Re: Beta Blockers and Edema

    I think we are still allowed to link to GOVERNMENT sites, so if you haven't stumbeld upon this give a read:

    [url]http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1492817[/url]

     
    Old 06-11-2007, 04:31 AM   #22
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    Re: Beta Blockers and Edema

    Interesting read. I hadn't run across it cause I haven't looked too far into the option of surgery. My grandmother very likely had the same condition. She had her thyroid removed at 17. It grew back and she died of a cardiac embolism at the age of 23 back in the 1930's. My mother also probably has the same problem but hers doesn't manifest itself quite as much. She's always had bad hypertension and has been taking betas along with a whole slew of other meds to control that for years. If you're interested in what we are most likely dealing with try [url]http://www.hotthyroidology.com/editorial_79.html[/url] (sites other than .gov can be posted too if they are preapproved). The articles a few years old and there are currently a lot more reported cases and it is now known to be much more common than orginally thought even just a couple years ago.

    One of the things that the article you posted caught my eye on was the fact that inderal controls the tremor better than the metropolol or the other non-selective betas. It fails to mention that it's not just the tremor but some of the other weird stuff too. I saw you mention in another thread about the adrenaline rush. Being hyper is kinda like that, and most of the time it's to a lesser degree, only it lasts 24/7. Throw in a couple flutters or missed beats or a little too much stress and you can really be off and running.

    I've always felt the inderal controls the symptoms better than the others. I don't like some of the side effects at the higher doses and if I go above 160mg, it starts to affect the conversion of t4 to t3. I also hate the way it makes me feel numb. The atenolol allows me to feel alive but doesn't control the annoying symptoms as well. The inderal actually does a good job controlling symptoms at a pretty low dose. It just doesn't keep the heart rate down low enough until you really crank it up. Have you ever run into anything in your research that says a selective beta cannot be combined with a non-selective to lessen the side effects and still achieve the desired results?

     
    Old 06-11-2007, 04:58 AM   #23
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    Re: Beta Blockers and Edema

    access,

    I don't think that the RTR syndrome pertains to you at all. From my reading it is a condition where the BODY refuses to react to thyroid hormones and thus appears hypothyroid even in the presence of adequate or high thyroid hormones. Your body seems to react only too well to thyroid.

    Yeah, that casueght my eye too about propranolol crossing the brain barrier where other beta-blockers won't. I have found it one of the "nicer" beta blockers...perhaps that CHS relaxation is the primary reason.

    Quote:
    she huffs out of the room saying if I don't do rai, I'm going to end up with a pacemaker
    If it were for myself, that RAI is the trreatment I would try...if it grows back, it grows back. But I think it stands the best chance of success (I avoid surgery WHEREVER possible...even with a tooth! )

    I must freely admit though, what I DON'T know about the thyroid can fill books.

    Last edited by Lenin; 06-11-2007 at 05:02 AM.

     
    Old 06-11-2007, 06:36 AM   #24
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    Re: Beta Blockers and Edema

    It's where parts of the body do not respond properly to the hormones. It's almost always partial and the majority of people who have it aren't even aware of it. A person can be hypo, hyper or completely euthyroid. That's one of the reasons they divide it into categories. It depends a lot on each individuals distribution of the various hormone receptors and the degree of resistance involved. When someone presents with the hyper side of things, they are hyper where the alpha receptors predominate (heart, brain, kidney, intestine, temperature, fertility and a few others), but they are hypo where the beta receptors predominate, primarly the pituitary, liver (high cholesterol is the norm), immune system and a few other organ systems.

    I've been researching thyroids for 16 years. There is not one test result or clinical symptom or sign that points away from this diagnosis. There's a lot of test results that point away from every other possibility. Biggest problem is the endos I have seen have just glanced at the literature and are under the same assumption that you are. They refuse to look into it further and just label me "atypical" and then drop me like a hot rock. I disrupt their assembly line. My current gp finally is cause he's bothered to do more than just glance at it. I want a correct diagnosis and I want proper treatment. I don't want to end up in the same mess that over 50% of the people with this have ended up in.

    One endo gave me a really good chance to see what rai would be like. He wanted to show me how much better I would feel if they would just go ahead and ablate it. They completely supressed the thyroid function with meds and then gave me thyroid hormones to try and make up for it. It was hell.

    Oh, metropolol crosses the blood brain barrier too. I personally don't like too much cns depression. I like feeling alive!

    But back to my original question. Is there any reason different beta blockers can't be mixed?

     
    Old 06-14-2007, 01:30 PM   #25
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    Re: Beta Blockers and Edema

    Finally got a copy of my echo report. It states that the clinical indication for study is short of breath(???). I thought we were investigating edema and long term hyperthyroid but nothing suprises me any more. There is a note on the report about the procedure/quality: The study is technically difficult but adequate for interpretation.

    Estimated ejection fraction is 60%. It says there is mitral regurgitation and tricuspid regurgitation and "unable to accurately estimate the pulmonary artery systolic". Structurally normal aortic valve and aortic root is normal size. It's also got the chamber measurements for the left atrium and left ventricle which are all within normal values.

    The pcp has written "ok no ef problem" on it which has always meant the matter is closed and put in the chart. In light of the erroneous "ok" on the incomplete kidney test, would I be safe in letting this one drop?

     
    Old 06-15-2007, 02:13 AM   #26
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    Re: Beta Blockers and Edema

    A little note to add - I've been poking around. Found a really good article called Understanding cardiac "echo" reports - Practical guide for referring physicians located at [url]http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1781094[/url]

    The other thing that is really beginning to bother me is I was asked 3 questions. Height and weight, any hypertension, any diabetes? I was not asked if I had any other medical problems or whether I was taking any medications. Little oversights like that, coupled with an erroneous indication for the study often bother me a bit so I did some more poking. The use of atenolol results in a mean increase in EF of 8.6 EF units. The study was interpreted by a cardiologist somewhere way off in the "big city". He doesn't know the first thing about me.

    I'm beginning to feel a little paranoid. Any reason why I shouldn't?

     
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