Re: Actos and Heart Failure

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 hidden]> wrote in message
news:[email hidden]...

Quoted message said:

John said:

[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 said:

John said:

[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

Bob Cardone cardone1!@!mindspring.com said:

Dr Chaos said:

John said:

[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 said:

John said:

[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.

Quoted message said:

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 said:

Bob Cardone cardone1!@!mindspring.com said:

Dr Chaos said:

On Thu, 02 Oct 2003 03:28:14 GMT, John <[email hidden]> 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 hidden]> wrote in message
news:[email hidden]...

Quoted message said:

Dr Chaos said:

On Thu, 02 Oct 2003 03:28:14 GMT, John <[email hidden]>

Quoted message said:

Quoted message said:

Quoted message said:

[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.

Quoted message said:

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 said:

Bob Cardone cardone1!@!mindspring.com said:

Dr Chaos said:

On Thu, 02 Oct 2003 03:28:14 GMT, John <[email hidden]> 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

Quoted message said:

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

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 hidden]> wrote in message
news:[email hidden]...

Quoted message said:

Quoted message said:

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

Quoted message said:

Quoted message said:

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:

Quoted message said:

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 hidden]> wrote in message
news:[email hidden]...

Quoted message said:

Thank you for that link. It did not, however, address the issue of

increased

Quoted message said:

incidence of heart failure and other cardiovascular adverse events when
Piaglitazone (Actos) is used in combination with insulin. A quote,

"Patients

Quoted message said:

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 hidden]> wrote in message
news:[email hidden]...

Quoted message said:

Quoted message said:

Dr. Chung: I read that it's probably not a good idea to treat a

diabetic

Quoted message said:

Quoted message said:

Quoted message said:

with Actos in combination with insulin. Can you comment on this? I have

for

Quoted message said:

Quoted message said:

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:

Quoted message said:

http://www.intelihealth.com/IH/ihtIH/WSIHW000/21054/8476/360118.html

Hope this helps.....Virginia in MI

John said:

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.

Quoted message said:

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 hidden]> wrote in message
news:[email hidden]...

Quoted message said:

John said:

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

Quoted message said:

subsequently go down. Greater care should be taken to avoid hypoglycemia

in

Quoted message said:

this setting. Closer glucose monitoring may be warranted initially.

Quoted message said:

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 said:

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 hidden]> wrote in message news:<[email hidden]>...

Quoted message said:

John said:

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 said:

"Dr. Andrew B. Chung, MD/PhD" <[email hidden]> wrote in message news:<[email hidden]>...

Quoted message said:

John said:

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).

Quoted message said:

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 hidden]> wrote in message
news:[email hidden]...

Quoted message said:

John Sanders said:

"Dr. Andrew B. Chung, MD/PhD" <[email hidden]> wrote in message

news:<[email hidden]>...

Quoted message said:

Quoted message said:

Quoted message said:

John wrote:

> OK, so I kept my appointment with my primary physician this

afternoon. He is

Quoted message said:

Quoted message said:

Quoted message said:

> a cardiologist. He gave me the findings of the cardiolite stress

test that

Quoted message said:

Quoted message said:

Quoted message said:

> 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

Quoted message said:

Quoted message said:

Quoted message said:

> symptoms it could be a false positive. We have three choices, he

said.

Quoted message said:

Quoted message said:

Quoted message said:

> 1. Assume it is a false positive, which would be imprudent; or 2.

Have an

Quoted message said:

Quoted message said:

Quoted message said:

> angiogram done, or 3. Have a non-invasive CT scan done. If the CT

scan

Quoted message said:

Quoted message said:

Quoted message said:

> confirms the moderate apical and lateral ischemia, then do the

angiogram. I

Quoted message said:

Quoted message said:

Quoted message said:

> chose to try the CT scan first and expect to get it done within the

next

Quoted message said:

Quoted message said:

Quoted message said:

> week.

A CT scan has no utility for detecting ischemia. It can detect

calcified

Quoted message said:

Quoted message said:

Quoted message said:

plaques as a calcium score but this correlates poorly with degree of

occlusion

Quoted message said:

Quoted message said:

Quoted message said:

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).

Quoted message said:

Quoted message said:

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 said:

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