Status Upates

It certainly has been awhile. It is good to be back.

A lot has been happening and I know some of you are interested in my current status. As far as my latest testosterone measurements, taken 1 month after stopping the oral medications Clomid and Nolvadex, was 550 ng/dL. Not trusting this number and knowing that increases in my testosterone levels have been accompanied by increased liver enzymes in the past, I asked to be re-tested. However, a severe cold held off the latest blood test until yesterday. This time I am checking my testosterone, liver enzymes, kidney function, C-Reactive Protein, lipid profile, thyroid, vitamin-D, and a few other tests. I should have the results back in two weeks.

Meanwhile, next week on Friday I have a cardiac nuclear stress test. If I pass it, it will be 8 months since the placement of my last set of stents. My cardiologist is taking an 18 month sabattical and assisting a poor area in El Paso, TX to build a cardiology community.

For me, that meant going on a search for a new cardiologist. My previous cardiologist suggested one of his partners. This is my first option. My own research lead me to two well respected cardiologists in the Austin area. No surprisingly, they were unhappy with my number of stents, saying that most of them were probably not medically necessary. However, they both agreed that some cardiologists are more agressive than others with the use of stents.

Read the rest of this entry

Testosterone Renormalization Protocol Day 45

The results are in – my total testosterone is 265ng/dl. This is lower than I would have liked. I get tested again in 1 month. Two weeks of the orals clomiphene citrate and tamoxifen are left and then I take a two week break.

Depending on my next test results, I have a few options according to the Houston doctor who specializes in treating hypogonadism. I could just accept the new number, take another month of clomiphene and tamoxifen once per day as opposed to two and then re-measure after being off the orals for two weeks, or go back on Testim gel for 12-18 months and then repeat the protocol of HCG, clomiphene, and tamoxifen.

What my Houston doctor found amazing is that, when he did this, many of his patients with numbers similar to mine bounced back to 500ng/dl, which is exactly where I would like to be. I think I will be taking this approach if my results are not satisfactory in one month.

The protocol has certainly not been a failure. My original total testosterone was 185ng/dl and now I am sitting at 265ng/dl. I now understand the possible cause of my maximum heart rate drop. My maximum heart rate while on Testim gel (total testosterone around 700ng/dl) was around 182. When my testosterone bottomed out after the Testim cessation it was around 162. Now it is around 166. I believe testosterone to be the main cause of this result. The most testosterone receptor cells can be found in the brain and the heart, so it just makes sense to me. The real test will be if I go back on the Testim and my maximum heart rate increases to 182 bpm.

Mended Hearts

Most of you have never heard of Mended Hearts. Hope is their charter. From their website:

Hope for recovery. Hope for a rich, full life. For more than 50 years, Mended Hearts has been offering the gift of hope and encouragement to heart patients, their families and caregivers.

Patients, spouses, family members, friends, medical professionals, Mended Hearts brings together all of us who are faced with the realities of heart disease to form a network of caring individuals.

Take some time to browse through our Web site and learn who we are and what we do. If you or someone you know is a heart patient who would like to visit with one of our accredited visitors online, by telephone or in your community, e-mail us now or call 1-888-HEART99 (1-888-432-7899).

Membership is not free, but the amount is very reasonable. My intention is to join the community of Mended Hearts and become a patient visitor. If someone about to undergo any operation, intervention, or other treatment for heart disease wishes to find someone who will listen to their fears and provide comfort, then I would be called to visit that person and provide support to them.

I was very excited to attend my first monthly meeting, but alas the weather caused a cancellation. Still, there is next month. Look for a local chapter in your area and get involved.

Troubles, Troubles, and more Troubles

My first paycheck with the 10% cut will start next month. After updating my budget to include this new reality, my wife and I are in the red. Still, we don’t pass the means test for Chapter 7 and the Chapter 13 monthly draw to pay back my credit cards would be almost where it is now. The reason for this is the passage of the Bankruptcy Reform Act of 2005. The allowances for clothing, food, and medications are sparse compared to average expenditures. Even with excellent health care I pay over $270/month in co-pays for my medications.

We have six months left on our current home lease. After much discussion, my wife and I decided moving to a two bedroom apartment mitigates some of the pain. We will be saving almost $600.00/month. I won’t say how much I make, but the pay cut amounts to $500.00 less per month, so this looks like a good plan.

Even with all of this happening, I am still optimistic about the future. I know there a large number of families and individuals out there who are suffering greatly and I pray for them as often as possible. Getting a 10% pay-cut, while painful, is better than losing my job. Many folks have lost their jobs, homes, and retirement accounts. Some are forced to start from scratch. Some have committed suicide, some have killed their families, and some have done both. I can’t imagine the amount of stress it would take to cause some to crack in this manner. I consider myself lucky that my faith, my wife, and my friends are all there for me.

I am still working on getting my first post in my philosophy section completed. I want it to be perfect and communicate my ideas succinctly, so keep checking back on this site and follow the link on the main page to the philosophy section.

Good luck to all of you out there.

Best Regards,

Gerald Merits

Sorry about the light posting.

Hectic has been the name of the game for the last three weeks. First of all, one of our two dogs – Harvey, pulled a disk. Thankfully, he has made a full recovery rather quickly. The surgical cost of handling a slipped disk would have cost over $8000.00.

Next came the news last week that I am going to get a 10% pay cut – across the company I work for. Being over $50,000.00 in credit card debt, this was not welcomed news. I have been paying off about $1200.00/month, but I won’t be able to keep that up now. I may not even be able to make the minimum payments. My father, who lost his job as a consultant geophysicist is in danger of possibly losing his house.

I am also worried about the love of my life. My wife has a odd shaped mole that is on her back. We have a dermatologist appointment this Thurday to get it checked out. It is probably nothing, but it is hard to keep positive and upbeat about this particular situation.

On the heart front, my workouts are becoming more intense and my maximum heart rate is increasing. It is now around 172 beats a minute, while four months ago is was around 180 beats per minute, so I can’t complain.

The testosterone recovery appears to be going very well. It is now day 30 and I am noticing improvements in testicular size almost daily. I get another measurement of total testosterone and luteinizing hormone (LH) this Thursday. Hopefully, the results are positive. There is no guarantee, but it sure would be nice to get off the Testim gel permanently. Fingers crossed.

Which brings me to my final point – stress. For those with heart disease it can be a major enemy – especially chronic stress that seldom lets up. Using meditation in the past has helped and I am now beginning to utilzie this technique again. However, nothing beats a good workout – either cardio or weight lifting. As my Houston doctor says – get your mind focused on something. Good advice all around.

If you feel you may suffer from an axiety or panic disorder, see a psychiatrist as soon as possible. There are a number of good medications to assist you. As always, make sure your pyschiatrist and cardiologist are aware of any medication changes.

Gerald Merits

Testosterone Normalization Day 24

It is now day 24 of my testosterone normalization protocol. The HCG injections stopped at day 19. My total testosterone measured on January 2nd just prior to stopping the HCG injections was measured at 327 ng/dL. The range is about 250-850 ng/dL, so definately an improvement from my pre-protocol result of 187ng/dL. During this time I was also taking the orals clomiphene (50 mg twice a day) and tamoxifen (10 mg twice a day).

Im still on the orals and will get my total testosterone remeasured on January 22nd. My second month or orals has been ordered. The amount taken and dosage will not change. I am not sure what will be done after this.

If my total testosterone is not around 500mg/dL 1 month after stopping the orals, restarting the entire protocol is one option to push my values higher.

During my treatment I expereinced one day of high anxiety and one day of a mild depression. Testicular size, which shrunk after the HCG was stopped, has rebounded on the oral medications to a range of 5-7 cubic centimeters. The average male testicular size is 12 cubic centimeters. When I started the treatment, testicular size was less than 3 cubic centimeters.

I feel great, my confidence levels are boosted, and morning erections have returned. There is also a slow reversal of my erectile dysfunction issues.

I am lucky to have such a good doctor in Houston and here in Austin and a very understanding and supportive wife. I believe I am really making a good comeback. Of course, days will exist when things don’t look so rosy, but for now I am happy at this latest turn of events.

Keep on truking,

Gerald Merits

A study done by the Cleveland Clinic repots that beta blockers can slow or even reverse arterial plaque. The story can be found here.

From Medical News Today:

Researchers aimed to identify whether beta-blockers have any effect on progression of coronary disease in a group of more than 1,500 patients with this disease. They began by measuring the amount of fatty plaque found in the arteries of these patients, using high-resolution intravascular ultrasound. This required the insertion of tiny ultrasonic transducers in the coronary arteries to provide a baseline examination.

Subsequently, the ultrasound examination was repeated after 18 to 24 months and the progression rate of coronary disease was compared in patients who were treated with beta-blockers and those who were not treated with these agents. The researchers found that patients treated with beta-blockers had a significant reduction in the amount of fatty plaque at the follow-up examination, whereas those not on a beta-blocker experienced no change in the amount of plaque.

“Our results have important implications,” said Ilke Sipahi, M.D., F.A.C.C., a Cardiologist at the Cleveland Clinic and the study’s lead author. “Up to now, we thought that beta-blockers were beneficial only to preserve heart muscle function in patients with a previous injury to their heart due to a heart attack. Now we learn that these drugs also have favorable effects on the coronary arteries by reducing clogging of these vessels in a similar fashion to cholesterol-lowering statin drugs. Our results indicate that all patients with coronary disease, such as those with coronary stents, previous bypass surgery and even patients with earlier stages of coronary artery disease can benefit from treatment with beta-blockers.”

I did not have a positive experience with beta blockers, but I believe my dose was higher than needed. My BP was 90/60 with a heart rate of 45 bpm. This caused high anxiety and the start of a clinical depressive episode which resolved itself when I stopped the medication. I may try to go back on a lower dose after reading this study.

New Treatment May Halt Heart Failure

CBS news Healtwatch reports on a new experimental technique that could save thousands of lives for those suffering from Heart Failure.

Usually, the only option available for heart failure patients in the advanced stages of the disease is a heart transplant. However, with limited hearts available for transplants and tens of thousands of patients often the patient dies waiting for a heart. This is what happened to my wife’s father, his heart failure the result of a heart virus.

From the CBS article:

…Delong’s heart was failing and was so enlarged that “you could actually see my shirt moving from my own heart, that’s how bad my heart was,” Delong says.

Doctors told her that a transplant would be necessary, assuming they could find a donor heart. Then, they suggested a different approach.

“Over the past five years, the use of mechanical heart pumps has revolutionized the care of some patients with heart failure,” Dr. Simon Maybaum, of the Montefiore Medical Center, says.

Monique had a mechanical heart pump implanted that took over the work of her left ventricle, letting it rest and heal.

But, like other muscles, resting the heart too much will make it weak.

“One suggestion that we had offered them too much of a good thing – that we had rested the heart too much and that it, indeed, had become lazy,” Maybaum says.

Doctors also gave Delong a drug, Clenbuterol, used to treat asthma in Europe. The drug has the added side effect of stimulating muscle to become bigger and stronger. That, combined with conventional heart failure drugs, led to a remarkable finding in a previous British study.

“Two-thirds of those patients had complete recovery of their heart function, to the degree that their heart pumps could be taken out,” Maybaum says. “When followed for up to a period of four years, [they] had stable heart function and [came] off all medications.”

Delong’s heart recovered so well that, two weeks ago, doctors were able to remove her artificial heart pump.

“I feel great, I feel alive again,” Delong says. “I can walk better, [and] I ran up the stairs for the first time in years.”

Monique is the first patient in a new study to recover enough to have her heart pump removed. The multi-center trial is designed to show that this combination drug-and-pump approach is allowing heart failure patients to get better.

Acorn CorCap Heart Failure Clinical Study

For readers suffering from heart failure, there is a new clinical study from Acorn CorCap looking for participants. The CorCap is a polyester mesh wrapped around the heart to provide support and prevent additional heart enlargement.

There is a section on their website with a survey to identify whether you are a potential candidate.

Testosterone Normalization Day 6

Sorry about the light posting; so much going on right now with holiday shopping, packing to visit relatives, and health related activities.

By the later, I refer to my testosterone normalization protocol. Lucky enough to locate a doctor in Houston and really lucky to find a doctor in Austin willing to work together, by day six I am noticing a difference. Without revealing too much, let’s just say things are a little different in the morning than they were just six days ago. Hopefully, all will go well and I will find myself with normal T-levels and no need for Testim.

Here is the protocol. I take Clomid (50 mg 2x/day), Tamoxifen (10mg 2x/day), and Human Chorionic Gonadatropin (HCG) hormone injections via a small insulin needle into my stomach every other day.

Each injection is around 1cc. Each 10,000IU of HCG powder was mixed by me with 5cc of clean water that comes in its own vial along with the powder in a separate vial. This allows for ten 1cc injections over twenty days. Normally used to aid women with fertility, HCG is similar to luteinizing hormone (LH), a hormone release by the pituatary gland in response to Gonadatropin Releasing Hormone (GnRH) from the hypothalmus. The male testes react to the presence of LH by increasing testosterone. If the testes do not react to LH, this leads to low testosterone levels and primary hypogonadism.

Nolvadex and Clomid act as anti-estogens and stop the negative feedback estrogen has on GnRH release from the hypothalmus. Should failure occur at the pituatary or hypothalmus level and the cause is discernible such as a pitutary growth, the result is secondary hypogandism. Sometimes no reason presents itself for hypogadism, in which case it’s classified as idiopathic.

My only concern is my knowledge of how Nolvadex (Tamoxifen) makes the pituatary gland receptors more sensitive to GnRH, while Clomid desenstizes the pituitary receptors. I just shot off an e-mail to the doctor in Houston asking for a reason behind the dual-therapy. I will keep the reader posted on the response.

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