Beta Blockers May Reduce BC Recurrence

sas-schatzi

Solfeo, not sure if you started reading the post yet. I just finished revising it. I think it's now complete. Give it another read.

sas-schatzi

Wenchie and Solfeo. I'm being OCD as usual. On the suggestion of "medic alert " bracelet or necklace". I revised it to "SBPusually<100. The usual would be hypotension. You may be told that's the word you need to use. If that be the case, that's what you may have to do. The reason I chose that phrasing is that in a shock state the "Fright and Flight" response. It's an activation of the Sympathetic nervous system. The first thing that happens is an elevated BP(vasoconstriction) and increased heart rate. This is an early response as the body attempts to bring the body back to equilibrium. Other body organs are also activated, but too much for this discussion. As shock progresses the BP is unable to be maintained, and starts too fall. To not make you crazy with details. Low BP of unknown origin is a late sign of cardiovascular failure, that's why the fluids. Hypotension in the presence of a head injury with no other known injuries is usually a pre terminal event. Your BP numbers change the whole perception of what your body is doing.

In an emergency, it can be a huge benefit to caregivers to know your normal. LOL, my OCD always assumes you want details.

luvmygoats

I also don't know Sassy if propanolol was ever made ER. (Yes it is made ER, just looked it up) I can say from experience that even metoprolol ER has a rebound affect from the times I have forgotten morning meds. Now that I'm on omeprazole again - sigh - I take everything a bit later not to mention the once weekly Fosamax which drives them even later.

I have little experience professional with any other BBs. I couldn't even identify another beside metoprolol and propanolol and if I knew Timolol was I forgot (you'd think the "lol" would be a hint to me). I knew glaucoma doc asked me a couple of questions when I got the Timolol/Dorzolamide eyedrops. Before that I was on Brimonidine and that made me seriously loopy/not in a good way (I think this was when I was still on Diovan for BP).

Your post makes sense to me and I admit I have been less than stellar in following this thread. I abhor summer colds and I've had a doozy. 4 days gone and nada accomplished around here.

OCD is good. I had a nursing partner in NS who was a runner/competitive swimmer. Remember her pulse was ridiculously low. Good to know norms.

sas-schatzi

I think I've been censored

solfeo

I don't take anything without fully researching it first, but from what I already know the main issue with licorice is that it can raise blood pressure. In my situation that would be the desired effect as long as it doesn't prevent the BB from doing its thing on the palpitations. I wouldn't take it without the BB regardless but my ND said there are other options that we can consider once I get the results from the heart monitoring back. Just like everything else I do I will go into it fully informed.

I have had medical situations where folks have over-reacted to my low blood pressure. Like in childbirth, where they wouldn't listen to me about it being my normal and kept pumping me full of ephedrine until my heart nearly exploded and my baby was in distress. He ended up in the NICU for 4 days because of it. Perfectly healthy baby until they got their claws into him. I am going to check out those books you recommended, Falls, because I swear I'm lucky that the so called medical professionals in my life haven't killed me yet. I'll save my rant about the 2D6 thing for the other thread.

Yesterday was a trippy day for me coming to terms with the fact that the tamoxifen hasn't been fully metabolizing. I'm going to take the day off today from thinking about any of this stuff, and I'll start delving more into the BBs during the week. Thanks for the info Sassy, I'm sure I'll have questions.

solfeo

Censored? What did I miss?

__asher__

I'm currently on high blood pressure medication. Would it behoove me to request a beta blocker vs. what I'm currently taking (Norvasc)? I'm trying to decipher whether it is beneficial for a beta 1 or beta 2 or either. It looks like Propranolol or Timolol. Does it need to be administered prior to or soon after surgery or can you take afterwards?

Also, is there a particular dosage? I'm on a low dose of the Norvasc.

WenchLori

Sassy, I don't like that kind of paintball game. I know my Dr's are all way behind on everything and giving me the same advice you just gave me. Thank you, I appreciate everything you do for all of us here. You are truly a blessing 🙏

sas-schatzi

Hugs Wenchie, Your life is so complicated right now. preparing for surgery, Mom, family, and sx. Reading the 2D6 thread would be too much. As far as thanking me, Hugs. What goes around, comes around. I'm a polio kid. I know what it means to be ahead of change when change is occurring. AND what it means to be on the wrong side of the change. Salk vaccinated his kids in June of 1952 b/c he was so sure he was right. My brother, twin, and I had polio in September 1952. The vaccine wasn't approved by the FDA until 1954. Polio impacts my life till this day. Wrong side of the change.

My parents changed our outcome by getting us into a Sister Kenny clinic. We were stolen away from the hospital. I have memories of it and I was only 2 years and 3 months. Sounds bizarre, but I do. The shushing and secrecy, I can describe it all. Sister Kenny was an Australian nurse who developed a management of post polio that was unaccepted by orthodox medicine. She got results that was far superior to orthodox medicine. Their was an old movie made with Rosiland Russell. If you can Netflix it's worth a view. In Australia nurses were called "Sister" rather than nurse.

Between Nurse Kenney treatment of post polio's and the post WW2 management of veterans, the advent of physical therapy was developed. Flipped out to google to check spelling of her name. But once again I have confused my computer with too much activity. Hugs sweetie.

luvmygoats

Nope you are correct in the spelling. Sister Elizabeth Kenny.

https://en.wikipedia.org/wiki/Elizabeth_Kenny

http://www.oandp.com/articles/2008-11_09.asp

http://www.mnopedia.org/thing/sister-kenny-institu...

luvmygoats

Hugs Lori.

__asher__

Interestingly, I found this journal article about Nifedipine promoting and proliferating cancer cells. While I'm not on Nifedipine, I am on a calcium channel blocker (although Verapamil was not found to have the same effects) and this seems like a good reason to switch to a beta blocker.

Nifedipine and Proliferating and Migrating BC Cells

WenchLori

Thank you Sassy and luvmygoats! Right back atcha!

solfeo

My skin biopsy results were good. No abnormality was found. Dr. Doom is calling it "post inflammatory changes," presumably because that is a fancy way to say he doesn't know what the heck it is, but it was never irritated or inflamed. He told me to follow up annually or if it gets worse. I don't think I'll be going back there though.

WenchLori

Solfeo, it would have been nice to get a more definitive answer. I bet someone here may know what he was referring to? My brain is so frazzled by all of this BC crap that I don't remember my name half the time let alone an answer one of my surgeons gave me. I love my PS! after he tells me something I ask "Exactly what does that mean?" He's gotten to the point that after he tells me something he follows it up with "Now that means..."

sas-schatzi

Solfeo, Chit , follow your initial gut reaction. You saw that it wasn't taken from the heart of the changed area, but from the periphery. You questioned that any inflamed or tissue changed area was caught in the bx. Either get a second opinion or ask for a re-bx to the central area

OH Wenchi. another study on slow channel calcium blockers.................wearing down............Also, on one . I have a vested interest.............Weary about the chase

WenchLori

Sassy, I can only imagine how weary you are getting. You have so many things going on right now! (((((Sassy)))))

sas-schatzi

Wenchi, Sorry, You sweetie have much more worries than me. I just get pissed when folks don't do the right thing. The "Trust but Verify". We can trust our docs , but we have to verify everything. They are only human.

I know that too many have been lost because they trusted...........We have to keep working, not just here , but all over

WenchLori

Sassy, Amen to that 🙏😍

solfeo

The problem with my shoulder sidelined me, and I postponed the follow up with the cardiologist to get the results of the Holter monitoring. It was just too much to handle at the same time. I see the cardio tomorrow afternoon. I really don't want to deal with this now either but I guess I have to get it taken care of.

One issue is that my blood pressure is not always low at doctor appointments because of white coat syndrome so I'm guessing there will be some debate about whether I can tolerate a beta blocker or not (if I need one). BP was normal when I saw her the first time but normal is high for me. I did finally get an official diagnosis of hypotension from the shoulder doc a couple of weeks ago - I'm guessing that all the Ativan I was taking to get through that mess mitigated the white coat effect. He's not in the same system as the cardio though so that won't help me. I guess I'll take my home BP monitor with me to show her.

Here's my question: if we do decide to experiment with a beta blocker would any drop in BP be sudden and severe enough to cause harm, or would it be something that would come on gradually and be recognizable before any damage is done? Also does anyone know how much it is likely to drop? If it is a slight drop I can probably handle it. Yes, I will ask the doctor but I like having my own information to compare to what they tell me. Trust but verify? Unfortunately, no I don't really trust them at all. I have caught too many of them screwing up.

pwilmarth

I read about the use of beta blockers to prevent resistance to Herceptin earlier this year (there's a clinical study supporting the effectiveness of this strategy).

Herceptin is associated with heart failure and beta blockers have also been shown to prevent this risk. (Canadian study reported in December 2015).

I was already being treated for hypertension but wasn't on a beta blocker. I mentioned these two studies to my oncologist and in consultation with the oncology pharmacist, they agreed to switch my antihypertensive drug from a calcium channel blocker to a beta blocker. When we made the switch, I had no problems with side effects. My blood pressure control has been better on the beta blocker, and I've had no issues with a sudden drop in my BP. The Pharm D that I spoke to said there is no neat conversion tool for them to use when they switch you from one antihypertensive to another. She just started me on a typical dose for Metoprolol and we did a BP check in two weeks after the switch. I took my BP at home daily for the first two weeks (as well as my pulse, because of the risk of Heart Block with the beta blockers). Generally speaking, it take about 7 days for a beta blocker to reach it's max effect and Pharm Ds recommend waiting two weeks before making changes (increases) in the dose of metoprolol.

When it comes to managing hypertension, beta blockers are often used in combination with other antihypertensive drugs and there's an algorithm that practitioners use to determine how and when to combine antihypertensive drugs from different classes - it breaks on whether you have heart disease or diabetes.

BTW, you can take very low doses of Metoprolol - I've seen doses as low as 6.25mg used. With proper monitoring of your BP at home, you should be able to avoid White Coat Syndrome and find a dose that is safe for you.

If you are currently being treated for hypertension and are not a beta blocker, you should discuss this with your oncologist. I'm guessing that many of us could benefit from a prophylactic dose of Metoprolol.

solfeo

Thanks for the thoughtful reply pwilmarth.

The Holter monitoring didn't show anything alarming, which I kind of knew because I didn't experience the worst type of episode I get on that day (figures!). She wants to put me on a 7 day monitor, but I don't think I can afford it since it goes through a 3rd party company and will be considered out of network. The insurance company has really been jerking me around lately, not paying stuff even with prior authorization and I have a few other unexpected large bills to pay already.

She also wanted me to have an ultrasound. I guess I'll do that and then reconsider the longer monitoring if it shows a problem. But for now I've had a reprieve and don't have to worry about finding the right med.

sas-schatzi

Solfeo and all. Been off awhile and not wanting to think. Metoporol is metabolized by 2D6, so wouldn't be a good choice, if you were to take one. Take a look at Coreg/carvidiol. It's primary route is 3A4 with many other paths. Many. It's one of the drugs I switched out when dear hubby was on chemo. Switched him to metroporol cuz it wasn't fighting with anything else. All the drug switches I made worked. Amazed even me. When I controlled his drugs even insulin, his chemo's went fine. But it was done with tremendous CYP work without much computer help. Genelex was some good help, but the software in 2010 was light years behind what each year after was.

There is one study up earlier about carvidiol, but I've already forgotten what it said. But I know there's one back there. Pretty sure it's a mouse study though.

There are oodles of new BB on the market since I retired in 2009. For me that's huge b/c when new drugs came to market I studied and studied them. Any new drug not only meets the characteristics of the classification it's in, but usually has one or two unique qualities that causes it to be different than the other drugs in the class. It's those unique characteristics that should cause a newly prescribed drug to be chosen. But..but regretfully some docs are drawn to the drug du jour. That can be trouble. 1.usage 2.cost.

Usage b/c after market(approved for use by FDA and sold on the open market) side effects may show up in the wider population that didn't show up in trials. For example, the aromatase inhibitor Arimidex was the first drug in the class. The musculoskeletal complaints and damage didn't show to be a serious problem during trials. Took a few years before the docs accepted the complaints as being related. I remember hearing a speech by one of the lead researchers saying "We were surprised by these complaints, we will have to take another look and study this more". My thought was no shit Sherlock.

In choosing a drug with your doc ask that strong consideration be given to a drug that has been in the market for an arbitrary 5-10 years. That generally allows for any aftermarket problems to be identified and/or the drug pulled from the market or use narrowed to amore specific group. Generally, you'll see maybe 3-4 years for a marginal problem drug. 1-2 years for a bad drug. I'm sure someone has a stat someplace, but that's ballpark.

Cost, pretty obvious. One time a doc ordered an antibiotic. Script was just under a 100$. I had the pharmacist call and request a cheaper drug in the same class that was considered to be still widely effective. That change cost me only 16$.

Next post will be more specific to your question.

wallycat

Coreg/carvidiol is also one of the few beta blockers that won't predispose you to diabetes; many who are genetically susceptible to diabetes end up with it on beta blockers.

sas-schatzi

Chit solfeo very long involved post and lost internet

sas-schatzi

Solfeo and all, I'll try again, hope the same thoughts get covered. I'll take a different sequence this time.

Blood pressure machines. All are not equal. Consumer Reports has done a comparison of machines for at least 15 years. Omron has been the leader in the field for a couple of decades at least and was rated best. BUT Walmart bought the rights to use the Omron technology. The Walmart brand Reli-On is half the price of the Omron brand with the same internal technology.

No matter the quality of the machine you must learn how to properly take a manual pulse. Rather than write the full description here have a nurse teach you how to do a radial pulse. In your scenario I suggest a 30 second or one minute pulse. Pulse check is NOT just checking rate. Assessing quality is very important. Is it weak, bounding, regular? The newer Omron technology has been designed for years to check for regularity, but the technology isn't perfect. Plus the subtleties can't be noted. Once well established on a cardiac regimen taking a bp a few times or once a week is adequate. Of course, if you notice a symptom change take it.

Take AM BP after you pee. A full am bladder can alter results. All textbooks will say take the am bp before arising. Decades of practice have taught me about the full bladder scenario. You won't find the connection on google b/c it hasn't been studied. If Bladder isn't full take before arising. When adjusting to any new cardiac drug check bp minimum one more time in the day i.e in a relaxed state before preparing dinner. Key is relaxed state in the evening.

Position of cuff on arm and position of the arm. The cuff can be placed on the wrist. Research was done in the 80's that showed that it was just as accurate as the upper arm. Relaxed on your lap or arm chair. Cuff on the upper arm, the arm should be positioned at the side against the side chest. Key is the arm should NOT be raised above heart level. The analogy I use is a garden hose. If you raise the garden hose above the tap/bib level you will see that the end flow decreases i.e pressure decreases. if the arm is above heart level you will see a decrease in particularly the systolic level. In teaching this for decades, I have seen a range change from 0- 65 points, where I did a proper check, then a repeat check in a few minutes with the arm elevated on the bed rail or my hip. This will make you a bit crazy now b/c you will notice how frequently improper bp's are taken. This is critical, truly, if treatment decisions are being made based on the BP. Most/ many cardiologists take there own BP's for this reason.

Cardiac diary. Ideal is to start minimum one week before starting on antihypertensives or diuretics.. Ideal, am and pm measurement. This gives you a great understanding of what your normal is. You mentioned White Coat Syndrome(WCS). I'll add it's description here for others following.

It was studied and published around 1998, but had been known about for many many decades. WCS is an elevated bp when seeing a doc proverbially in the white coat. But it's larger than that, any anxiety producing situation can elevate the bp. This can be a false indicator to the doc and NOT allow for proper evaluation of your true normal BP. THAT's where the importance of the cardiac diary comes in, take the cardiac diary with you to all cardiologist visits. The doc can then evaluate your routine picture and how you present during the visit. Big safety plan

How to do a cardiac diary: lined paper and make vertical columns. I didn't put in activity. If BP is taken after exercise just note that when documenting position. You can't believe how long it took to do those next two lines to do to get them to line up. LOL.

date/time. Cuff wrist or arm, .bp......pulse..position(laying(L) , sitting(S), standing(ST).... syptoms

8/4 ............ wrist ............... 120/80 .. 80 regular, ................... s....................................... none

8/5 ............. wrist................100/60 ....50 irreg...........................s.....................................faint

If you look at the two examples, you can see something changed. By keeping a cardiac diary you know what the problem is versus saying cheez I feel strange. Enough of an explanation?

Lastly I think. Wallycats post about metoporol and other drugs leading to diabetes is a great point, but believe it or not not all docs are aware of other conditions that a drug may cause. Talk with your Pharmacist about drugs in any class before you buy the prescription. Hydrochlorothiazide HCTZ is one of the most prescribed diuretics in the world. It was the first line drug in BP management for years. When it was prescribed for my DH in early 2000 and I did my serious in depth research on it. It showed that it could lead to diabetes type 2. I was pissed. It had been used for decades and that was not well known. He was already diabetic.

The key is one drug for one purpose may lead to a long term consequence to another body system.

sas-schatzi

Solfeo and all I'm spending all this time on the basics b/c if you are going to take a vasoactive drug, these particulars are necessary to know.

Now to the guts of the discussion with the doc about which drug to use.

1. In discussion with your doc ask for an older well established drug that has a long standing safety record, that won't lead to another disease condition. Plus that is cheap.

2.. Start at the lowest dose . Solfeo start at the pediatric dose. Anyone having a known sensitivity to many drugs start at the pediatric dose or 1/4 to 1/2 the usual starting dose.

3. Ideal is to start cardiac diary for minimum one week before. Take am & pm Bp's for minimum two weeks after starting drug. Then daily for a while untill well established. Once well established you can change to a few times a week or once a week, or whatever you and your doc agree upon.

4. If you have a change of symptoms try and take BP while symptoms are occurring.

5. Study your drug well to know all the expected side effects.

6. Ask Pharmacist to always run a drug checker for interactions if any new drug is added to your regimen

7. Take cardiac diary with you to doc visits

8. If you ever feel weak or faint (this works for anytime weak or faint)---GET FLAT. If the symptoms are related to the vascular system it will allow the system to equalize. Once symptoms pass, rise to a sitting position slowly. Symptoms return get flat again and raise legs to a 45-60 degrees. Then repeat getting up slowly. Getting flat not only allows the body to equalize, but if your Bp or heart rate have become so changed that staying upright would cause a faint, you have avoided the injuries related to the fall from fainting. Google Orthostatic Hypotension for more info.

sas-schatzi

Yooohoooo Solfeo............I'm done now. I think it's pretty complete. I see a few typos' , but otherwise I think it's done. I decided to do the whole indepth thingy when I got started b/c many may make the decision to try BB's This is what should be taught and mostly isn't.

Wallycat thanks for your addition on the diabetes thingy. So many drugs lead to something else it was a great reminder for this subject.

Pwilmarth thanks for you info too

solfeo

Thanks so much for the info! Even if I end up not needing it I'm sure it will be useful for many others.

sas-schatzi

SOL, leFeo................thanks, had to be done..........transferred to my storage thread too. works in many directions'