Re: Actos and Heart Failure



D

Dr Chaos

Guest
On Thu, 02 Oct 2003 03:28:14 GMT, John <[email protected]> wrote:
> [diabetic takes "Actos", has swelling in limbs, passes echo,
> abnormal cardiolite stress test]

Now I'm *not a doctor*, but purely from a theoretical point of view I
would have imagined that some form of classic heart failure would have
shown up more clearly on the echocardiogram than the stress test. If
you didn't have symptoms other than the feet, then maybe it really is
only just a drug side effect and not heart failure.

I would guess that perhaps the problem is more likely coronary artery
disease, which is exacerbated by diabetes, in which case the diabetes
meds would be generally helpful in reducing the severity.

i.e. maybe you shouldn't necessarily get yourself in some kind of
self-deprecating remorse: you might still have been doing the
right thing.

but talk to your doctors!
 
Thank you, Dr. Chaos (I shudder to think what Dr. Chaos is all about. At
first I thought you were a doctor of asian origin :)

Simon & Garfunkle wondered where Mrs. Robinson went. I wonder where Drs.
Welby and Kildare have gone. What's the use of seeing physicians on a
regular basis if they can't pick up on subte and not so subte changes in
your condition (with the patient's help, of course)? It sometimes seems like
you get your 7-10 minutes face time with doctors who want to get you in and
out in a hurry. I picked a cardiologist as my primary doctor back when I was
about forty because I felt that it would probably be heart problems that
would do me in some day. I expected that any heart problems that developed
would be spotted early. It doesn't seem to have worked out that way. I can't
help but think that doctors are too busy, see too many patients, have too
many outside interests, and do not have enough time to stay abreast of all
the information that is available about the drugs they prescribe.

"Dr Chaos" <[email protected]> wrote in message
news:[email protected]...
> On Thu, 02 Oct 2003 03:28:14 GMT, John <[email protected]> wrote:
> > [diabetic takes "Actos", has swelling in limbs, passes echo,
> > abnormal cardiolite stress test]
>
> Now I'm *not a doctor*, but purely from a theoretical point of view I
> would have imagined that some form of classic heart failure would have
> shown up more clearly on the echocardiogram than the stress test. If
> you didn't have symptoms other than the feet, then maybe it really is
> only just a drug side effect and not heart failure.
>
> I would guess that perhaps the problem is more likely coronary artery
> disease, which is exacerbated by diabetes, in which case the diabetes
> meds would be generally helpful in reducing the severity.
>
> i.e. maybe you shouldn't necessarily get yourself in some kind of
> self-deprecating remorse: you might still have been doing the
> right thing.
>
> but talk to your doctors!
>
 
Dr Chaos <[email protected]> wrote:

>On Thu, 02 Oct 2003 03:28:14 GMT, John <[email protected]> wrote:
>> [diabetic takes "Actos", has swelling in limbs, passes echo,
>> abnormal cardiolite stress test]
>
>Now I'm *not a doctor*,

So why use a name like Dr Chaos on a Medical Website?

Bob
 
On Thu, 02 Oct 2003 13:05:45 GMT, Bob Cardone <cardone1!@!mindspring.com> wrote:
> Dr Chaos <[email protected]> wrote:
>
>>On Thu, 02 Oct 2003 03:28:14 GMT, John <[email protected]> wrote:
>>> [diabetic takes "Actos", has swelling in limbs, passes echo,
>>> abnormal cardiolite stress test]
>>
>>Now I'm *not a doctor*,
>
> So why use a name like Dr Chaos on a Medical Website?

i'm a physicist the "wrong" kind of doctor
 
Dr Chaos wrote:

> On Thu, 02 Oct 2003 03:28:14 GMT, John <[email protected]> wrote:
> > [diabetic takes "Actos", has swelling in limbs, passes echo,
> > abnormal cardiolite stress test]
>
> Now I'm *not a doctor*, but purely from a theoretical point of view I
> would have imagined that some form of classic heart failure would have
> shown up more clearly on the echocardiogram than the stress test. If
> you didn't have symptoms other than the feet, then maybe it really is
> only just a drug side effect and not heart failure.
>

You are correct, Dr. Chaos.

>
> I would guess that perhaps the problem is more likely coronary artery
> disease, which is exacerbated by diabetes, in which case the diabetes
> meds would be generally helpful in reducing the severity.
>
> i.e. maybe you shouldn't necessarily get yourself in some kind of
> self-deprecating remorse: you might still have been doing the
> right thing.
>
> but talk to your doctors!
>

Definitely.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/
 
Dr Chaos wrote:

> On Thu, 02 Oct 2003 13:05:45 GMT, Bob Cardone <cardone1!@!mindspring.com> wrote:
> > Dr Chaos <[email protected]> wrote:
> >
> >>On Thu, 02 Oct 2003 03:28:14 GMT, John <[email protected]> wrote:
> >>> [diabetic takes "Actos", has swelling in limbs, passes echo,
> >>> abnormal cardiolite stress test]
> >>
> >>Now I'm *not a doctor*,
> >
> > So why use a name like Dr Chaos on a Medical Website?
>
> i'm a physicist the "wrong" kind of doctor
>

Nothing wrong with being a PhD kind of doctor :)

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/
 
Thank you all for your responses. I was venting a bit.

Dr. Chung: I read that it's probably not a good idea to treat a diabetic
with Actos in combination with insulin. Can you comment on this? I have for
several years been injecting 46 units daily of Humulin U.

Thanks so much.

"Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote in message
news:[email protected]...
> Dr Chaos wrote:
>
> > On Thu, 02 Oct 2003 03:28:14 GMT, John <[email protected]>
wrote:
> > > [diabetic takes "Actos", has swelling in limbs, passes echo,
> > > abnormal cardiolite stress test]
> >
> > Now I'm *not a doctor*, but purely from a theoretical point of view I
> > would have imagined that some form of classic heart failure would have
> > shown up more clearly on the echocardiogram than the stress test. If
> > you didn't have symptoms other than the feet, then maybe it really is
> > only just a drug side effect and not heart failure.
> >
>
> You are correct, Dr. Chaos.
>
> >
> > I would guess that perhaps the problem is more likely coronary artery
> > disease, which is exacerbated by diabetes, in which case the diabetes
> > meds would be generally helpful in reducing the severity.
> >
> > i.e. maybe you shouldn't necessarily get yourself in some kind of
> > self-deprecating remorse: you might still have been doing the
> > right thing.
> >
> > but talk to your doctors!
> >
>
> Definitely.
>
> --
> Dr. Andrew B. Chung, MD/PhD
> Board-Certified Cardiologist
> http://www.heartmdphd.com/
>
>
 
Dr Chaos <[email protected]> wrote:

>On Thu, 02 Oct 2003 13:05:45 GMT, Bob Cardone <cardone1!@!mindspring.com> wrote:
>> Dr Chaos <[email protected]> wrote:
>>
>>>On Thu, 02 Oct 2003 03:28:14 GMT, John <[email protected]> wrote:
>>>> [diabetic takes "Actos", has swelling in limbs, passes echo,
>>>> abnormal cardiolite stress test]
>>>
>>>Now I'm *not a doctor*,
>>
>> So why use a name like Dr Chaos on a Medical Website?
>
>i'm a physicist the "wrong" kind of doctor
>

So you hold a Doctorate, but not in Medicine. That's reasonable. I
was just curious about your "handle" .

Bob
 
Thank you for that link. It did not, however, address the issue of increased
incidence of heart failure and other cardiovascular adverse events when
Piaglitazone (Actos) is used in combination with insulin. A quote, "Patients
with ongoing edema (me) are more likely to have adverse events associated
with edema if started on combination therapy with insulin and
thiazolidinediones (of which I believe Actos is one)."

Now maybe that relates to cases where the patient had preexisting edema
before the Actos was used in combo with insulin.

Thanks again.

"Elva4" <[email protected]> wrote in message
news:[email protected]...
> >Dr. Chung: I read that it's probably not a good idea to treat a diabetic
> >with Actos in combination with insulin. Can you comment on this? I have
for
> >several years been injecting 46 units daily of Humulin U.
>
> Not Dr. Chung, but here is an answer from an expert from MA General
Hospital:
>
> http://www.intelihealth.com/IH/ihtIH/WSIHW000/21054/8476/360118.html
>
> Hope this helps.....Virginia in MI
 
Oops! I forgot to provide a link to the quote I mentioned in my last
message. Here it is
http://www.hc-sc.gc.ca/hpfb-dgpsa/tpd-dpt/actos_e.pdf


"John" <[email protected]> wrote in message
news:[email protected]...
> Thank you for that link. It did not, however, address the issue of
increased
> incidence of heart failure and other cardiovascular adverse events when
> Piaglitazone (Actos) is used in combination with insulin. A quote,
"Patients
> with ongoing edema (me) are more likely to have adverse events associated
> with edema if started on combination therapy with insulin and
> thiazolidinediones (of which I believe Actos is one)."
>
> Now maybe that relates to cases where the patient had preexisting edema
> before the Actos was used in combo with insulin.
>
> Thanks again.
>
> "Elva4" <[email protected]> wrote in message
> news:[email protected]...
> > >Dr. Chung: I read that it's probably not a good idea to treat a
diabetic
> > >with Actos in combination with insulin. Can you comment on this? I have
> for
> > >several years been injecting 46 units daily of Humulin U.
> >
> > Not Dr. Chung, but here is an answer from an expert from MA General
> Hospital:
> >
> > http://www.intelihealth.com/IH/ihtIH/WSIHW000/21054/8476/360118.html
> >
> > Hope this helps.....Virginia in MI
>
>
 
John wrote:

> Thank you all for your responses. I was venting a bit.
>
> Dr. Chung: I read that it's probably not a good idea to treat a diabetic
> with Actos in combination with insulin. Can you comment on this?

Actos addresses insulin resistance by decreasing it. Insulin requirements will
subsequently go down. Greater care should be taken to avoid hypoglycemia in
this setting. Closer glucose monitoring may be warranted initially.

> I have for
> several years been injecting 46 units daily of Humulin U.
>
> Thanks so much.
>

You are welcome.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com
 
OK, so I kept my appointment with my primary physician this afternoon. He is
a cardiologist. He gave me the findings of the cardiolite stress test that
he previously described as abnormal.

Findings: Moderate apical and lateral ischemia.

He said there is a chance that due to my size (6', 330) and absence of
symptoms it could be a false positive. We have three choices, he said.
1. Assume it is a false positive, which would be imprudent; or 2. Have an
angiogram done, or 3. Have a non-invasive CT scan done. If the CT scan
confirms the moderate apical and lateral ischemia, then do the angiogram. I
chose to try the CT scan first and expect to get it done within the next
week.

On the way out he said, "My nickel is on, it's bulls--t." Maybe he was just
trying to make me feel good.




"Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote in message
news:[email protected]...
> John wrote:
>
> > Thank you all for your responses. I was venting a bit.
> >
> > Dr. Chung: I read that it's probably not a good idea to treat a diabetic
> > with Actos in combination with insulin. Can you comment on this?
>
> Actos addresses insulin resistance by decreasing it. Insulin requirements
will
> subsequently go down. Greater care should be taken to avoid hypoglycemia
in
> this setting. Closer glucose monitoring may be warranted initially.
>
> > I have for
> > several years been injecting 46 units daily of Humulin U.
> >
> > Thanks so much.
> >
>
> You are welcome.
>
> --
> Dr. Andrew B. Chung, MD/PhD
> Board-Certified Cardiologist
> http://www.heartmdphd.com
>
>
 
John wrote:

> OK, so I kept my appointment with my primary physician this afternoon. He is
> a cardiologist. He gave me the findings of the cardiolite stress test that
> he previously described as abnormal.
>
> Findings: Moderate apical and lateral ischemia.
>
> He said there is a chance that due to my size (6', 330) and absence of
> symptoms it could be a false positive. We have three choices, he said.
> 1. Assume it is a false positive, which would be imprudent; or 2. Have an
> angiogram done, or 3. Have a non-invasive CT scan done. If the CT scan
> confirms the moderate apical and lateral ischemia, then do the angiogram. I
> chose to try the CT scan first and expect to get it done within the next
> week.

A CT scan has no utility for detecting ischemia. It can detect calcified
plaques as a calcium score but this correlates poorly with degree of occlusion
and/or ischemia.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com
 
"Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote in message news:<[email protected]>...
> John wrote:
>
> > OK, so I kept my appointment with my primary physician this afternoon. He is
> > a cardiologist. He gave me the findings of the cardiolite stress test that
> > he previously described as abnormal.
> >
> > Findings: Moderate apical and lateral ischemia.
> >
> > He said there is a chance that due to my size (6', 330) and absence of
> > symptoms it could be a false positive. We have three choices, he said.
> > 1. Assume it is a false positive, which would be imprudent; or 2. Have an
> > angiogram done, or 3. Have a non-invasive CT scan done. If the CT scan
> > confirms the moderate apical and lateral ischemia, then do the angiogram. I
> > chose to try the CT scan first and expect to get it done within the next
> > week.
>
> A CT scan has no utility for detecting ischemia. It can detect calcified
> plaques as a calcium score but this correlates poorly with degree of occlusion
> and/or ischemia.

I'm puzzled then. Why would my cardiologist, with 25 years of
axperience, offer me that option? Maybe I got the name of the scan
wrong. He said the scan is only available in a few places. Actually he
gave me two choices, White Plains NY and Manhattan. Could it be one of
those "full body scan" places that have popped up (but which a Wall
Street Journal article I read recently said are doing poorly for their
owners/backers)?
 
John Sanders wrote:

> "Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote in message news:<[email protected]>...
> > John wrote:
> >
> > > OK, so I kept my appointment with my primary physician this afternoon. He is
> > > a cardiologist. He gave me the findings of the cardiolite stress test that
> > > he previously described as abnormal.
> > >
> > > Findings: Moderate apical and lateral ischemia.
> > >
> > > He said there is a chance that due to my size (6', 330) and absence of
> > > symptoms it could be a false positive. We have three choices, he said.
> > > 1. Assume it is a false positive, which would be imprudent; or 2. Have an
> > > angiogram done, or 3. Have a non-invasive CT scan done. If the CT scan
> > > confirms the moderate apical and lateral ischemia, then do the angiogram. I
> > > chose to try the CT scan first and expect to get it done within the next
> > > week.
> >
> > A CT scan has no utility for detecting ischemia. It can detect calcified
> > plaques as a calcium score but this correlates poorly with degree of occlusion
> > and/or ischemia.
>
> I'm puzzled then. Why would my cardiologist, with 25 years of
> axperience, offer me that option?

Perhaps your cardiologist is referring you for a PET scan (this is different from a CT scan).

> Maybe I got the name of the scan
> wrong. He said the scan is only available in a few places. Actually he
> gave me two choices, White Plains NY and Manhattan. Could it be one of
> those "full body scan" places that have popped up (but which a Wall
> Street Journal article I read recently said are doing poorly for their
> owners/backers)?

You should ask your cardiologist.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/
 
I will at some point, but he is not as available as you are. Thank you.


"Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote in message
news:[email protected]...
> John Sanders wrote:
>
> > "Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote in message
news:<[email protected]>...
> > > John wrote:
> > >
> > > > OK, so I kept my appointment with my primary physician this
afternoon. He is
> > > > a cardiologist. He gave me the findings of the cardiolite stress
test that
> > > > he previously described as abnormal.
> > > >
> > > > Findings: Moderate apical and lateral ischemia.
> > > >
> > > > He said there is a chance that due to my size (6', 330) and absence
of
> > > > symptoms it could be a false positive. We have three choices, he
said.
> > > > 1. Assume it is a false positive, which would be imprudent; or 2.
Have an
> > > > angiogram done, or 3. Have a non-invasive CT scan done. If the CT
scan
> > > > confirms the moderate apical and lateral ischemia, then do the
angiogram. I
> > > > chose to try the CT scan first and expect to get it done within the
next
> > > > week.
> > >
> > > A CT scan has no utility for detecting ischemia. It can detect
calcified
> > > plaques as a calcium score but this correlates poorly with degree of
occlusion
> > > and/or ischemia.
> >
> > I'm puzzled then. Why would my cardiologist, with 25 years of
> > axperience, offer me that option?
>
> Perhaps your cardiologist is referring you for a PET scan (this is
different from a CT scan).
>
> > Maybe I got the name of the scan
> > wrong. He said the scan is only available in a few places. Actually he
> > gave me two choices, White Plains NY and Manhattan. Could it be one of
> > those "full body scan" places that have popped up (but which a Wall
> > Street Journal article I read recently said are doing poorly for their
> > owners/backers)?
>
> You should ask your cardiologist.
>
> --
> Dr. Andrew B. Chung, MD/PhD
> Board-Certified Cardiologist
> http://www.heartmdphd.com/
>
>
 
John wrote:

> I will at some point, but he is not as available as you are. Thank you.

You are welcome :)

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com
 
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