Meds are dropping like flies!

[aztecan]

Well, my doctor appointment was today.

You just have to love my doc. He is pretty straight forward.

He started off this visit scowling at my latest lab results, or at least some of them.

"Your results suck," he said.

"Oh, which ones?" I ask.

"All of them," the doc said, adding, "The CD4 and viral load aren't back yet, but the rest look pretty bad."

(((((SIGH)))))

I am not particularly worried about the CD4 and viral load. Unless something untoward has happened, they will be fine.

But, my cholesterol, triglycerides and CPKs were all high and the liver enzymes were a bit off, or at least one of them was.

The doc and I had already talked about my stopping the Advair I use for the COPD issues. Today is the last day (yippee!). I was concerned about the probability of getting thrush from it.

I will have to watch and see how things go. The doc said if I start having breathing problems, I would probably have to start up the Advair again.

I am hoping that doesn't happen.

The liver enzymes weren't that high and may or may not be a result of my taking a statin. But, the elevated CPKs is a definite result of the statin I am taking.

The doc said the increasing muscle cramps and the worsening muscle soreness and stiffness were caused by the elevated CPKs. I had been through this with Vytorin, but was hoping the Pravastatin would not do the same thing. It took longer to show up, but it did.

The CPKs were in the mid-500s, which wasn't as high as when I took Vytorin and they shot up into the 900s within a few weeks, but it apparently is still too high.

Of course, the hyperlipidemia is pretty much a result of my HIV meds, so I may or may not be able to get them lowered.

At least the cholesterol, etc., wasn't astronomical. They were high, but not horribly so. But considering I was taking Pravastatin, Zetia and 6 grams (6,000 milligrams) of fish oil a day, they weren't as good as they should have been,

So, the doc told me to stop taking the Pravastatin and Zetia. I wish I had known, I just had the Pravastatin filled. But, at least I had held off on the Zetia. It had the highest copay of $40 a month, so there is a bright side.

The doc wants me to wait a few weeks after stopping the cholesterol meds and then I will again try Niaspan. Maybe, if I am diligent with my diet and stick to the Niaspan, I can get this under control.

If not, the doc said there are some very old cholesterol meds I can try. We'll see.

So, tonight I will stop taking three meds. That is a first for me.

Wish me luck.

HUGS,

Mark

[Miss Philicia]

Mark, that all sounds horribly confusing.  I'll be thinking of you for sure though.

[AlanBama]

Honey, I'm with Philly here, it all sounds quite confusing....

I do like the sound of "dropping" 3 meds though.....so I'm hoping that you can get all of this worked out.

Sorry your numbers 'suck' right now....it's hell growing old with HIV on board, isn't it?

Love & hugs,

Alan

[rondrond]

I'm wishing you luck Mark,
ronnie

[Robert]

Mark.

Call me confused.    But that's OK.  What's important is that you understand what's going on and what you need to do.  I'm going to tell whose ever in charge to see if they can start changing things for the better.  I  don't want to see my favorite Aztecan getting sick.

robert

[ubotts]

Seems you have enough on your plate or should I say platter. Just hang in there and in time, maybe you wont need the adviar.

I take that as well, but it has never given me thrush..

I will be praying for you, and wishing all the best with your meds.

[aztecan]

Hey Gang,

Thanks for the well wishes and support. I re-read my post and realized I was all over the place. No wonder people are confused.

There are basically two things going on:

1-My doctor and I decided to drop Advair from my regimen. It is an inhaler used as a maintenance medication for people with asthma, bronchitis or some other form of COPD (Chronic Obstructive Pulmonary Disease). My lung issues arise from my years of smoking. I know, kick me in the butt and call me stupid.

2-My doc was concerned, as was I, about worsening pain in my muscles. The pain was something like neuropathy, but it continued to get worse over time. Also, during the past month, I have experienced worsening muscle cramps. They started in the toes and feet, but now are occurring over most of my body. I don't think I have had a full night's sleep in weeks because the cramps waken me several times a night. Jumping out of bed trying to get a muscle cramp to ease made getting proper sleep a problem.

One of the tests done by the doc checks the levels of CPK in the blood.  Here is a definition and a link.

http://www.nlm.nih.gov/medlineplus/ency/article/003503.htm

Why the Test is Performed
When the total CPK level is very high, it usually means there has been injury or stress to the heart, the brain, or muscle tissue. For example, when a muscle is damaged, CPK leaks into the bloodstream. Determining which specific form of CPK is high helps doctor's determine which exact tissue has been damaged.
This test may be used to:
   •   Diagnose heart attack
   •   Evaluate cause of chest pain
   •   Determine how badly a muscle is damaged
   •   Detect early dermatomyositis and polymyositis
   •   Tell the difference between malignant hyperthermia and postoperative infection
   •   Reveal who carries muscular dystrophy (Duchenne)
The pattern and timing of a rise or fall in CPK levels can be diagnostically significant, particularly if a heart attack is suspected.

My test results indicated there was something going on because my CPKs were elevated.

This is why there is a warning about taking cholesterol meds with some of the HIV meds. The combination can cause elevated CPKs and muscle/heart issues.

A couple of cholesterol meds, Pravachol and Crestor, are supposed to less likely to cause this reaction when taken with  protease inhibitor or other HIV meds. As I mentioned, I had taken Vytorin, but that didn't last long because the reactions were both rapid and pronounced.

Pravachol, or Pravastatin as the generic is called, lasted quite a while, but it seems the effects showed up eventually.

So, I will try Niaspan, which is a time-released high-dosage form of Niacin. It causes flushing, but aside from that, should be safe when combined with my other meds.

I am really going to have to monitor my diet though.

Anyway, I hope this is less confusing. Yesterday I was somewhat discombobulated.

HUGS,

Mark

[Dachshund]

Good luck to you Mark. I'm old school when it comes to medicine (not aidsmeds) that less is more. Hope a change in diet can find you a happy medium. Speaking of eating how's your massive garden growing?

luvs,
hal

[aztecan]

Good luck to you Mark. I'm old school when it comes to medicine (not aidsmeds) that less is more. Hope a change in diet can find you a happy medium. Speaking of eating how's your massive garden growing?

luvs,
hal

So far, so good for the garden. I have been picking peas this week and everything else seems to be growing well. I have my doubts about the brussel sprouts and kohlrabi, though. They don't seem to be thriving. I think it is too hot.

Ready to come help me weed?

HUGS,

Mark

[Dachshund]

So far, so good for the garden. I have been picking peas this week and everything else seems to be growing well. I have my doubts about the brussel sprouts and kohlrabi, though. They don't seem to be thriving. I think it is too hot.

Ready to come help me weed?

HUGS,

Mark

I'm pretty sure brussel sprouts like cool, like Northern Cali cool, and did you say help or smoke?

AD

[BT65]

Mother Mark,

Thanks for expanding on that.  I was a bit confused myself when I read your first post.  I'm on Lipitor for cholesterol, and so far, no bad side effects. 

Good luck with the diet thing.  That would be a hard one for me.  I'll be thinking about you.
  Luv,
Betty

[heartforyou]

Hey Mark,

Keep us updated on this.
I hope your doc can sort this out asap...

love you

hermie

[OneTampa]

Here is wishing you the best Mark.

[joemutt]

Mark, I wish everything will be sorted out and well soon.
(I am on a similar meds regimen as you and my dr wants me to
re start cholesterol meds so thanks for the timely info)

[Peter Staley]

Mark -- sounds like a lot to figure out right now.  Please take the possibility of statin induced myopathy (muscle disease) seriously -- it's very rare, but can be pretty serious when it happens.  I'm not sure it's happening to you -- only a doctor can tell you that.

Sounds like you're working hard on all this, which is great.

Here's hoping everything settles down soon.

[aztecan]

Thanks all. There always seems to be something to keep us on our toes, figuratively speaking, that is. 

Hey Peter,

I am keeping an eye on the muscle pain and cramps. My doctor said things should start to improve in a week or so. If they don't I will be back visiting him again.

I already have a lab slip for a follow up on the CPKs, et al, which my doctor wants me to do in about two weeks. He wants to make sure the levels are dropping like we both hope they will.

I am embarking on a low fat diet again. I was a bit lax before, but I will work on it. Let's see, I think I have a cook book around here somewhere titled "101 Ways to Cook Fish."

Oh, the rest of my labs showed up. The viral load was less than 48, so its undetectable. The CD4s have dropped though. They are down to 953. Not worrisome, but I hope to get them back up to a robust 1,300 or so at some point.

Onward and upward.

HUGS,

Mark

[bear60]

Good luck Mark.  I dont know how you do it!  It seems like an incredible balancing act.  But you are on top of everything.

[BT65]

Congrats on your CD4 & viral load.