How to improve your health when your blood sugars are out of control.

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  • Healthy people are proactive about our health
  • Healthy people seek out more information
  • Healthy people consult professionals before implementing significant changes in our medications or lifestyle choices
  • Healthy people are patient and persistent in overcoming health or lifestyle challenges.
  • Healthy people accept total accountability for our own health, without taking on blame for things beyond our control.

What can you do to improve your AIC when you’re feeling terrible from a variety of symptoms and conditions, many of which are either a direct result of your diabetes, or at least are indirectly impacted by persistent high blood sugars.

There are any number of things you need to deal with in order to make real change. The most important of these things is probably NOT your diabetes. At least not directly.

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I’ve been a type two diabetic for many years. Diabetes probably started with me in my twenties although my first symptoms didn’t start to show up until I was nearly forty. I’m now in my sixties and I’ve been on insulin for more than fifteen years. That means I’ve been pricking my finger at least once a day since I was fifty years old, and injecting myself with insulin ever since.

The one thing I can say about my diabetes is that it has progressed in a predictable way, gradually causing negative effects to my body. All the way along the road various doctors have given me a lot of prescription medications, as well as a lot of advice. I’ve been to diabetic clinics where nurses and dieticians have attempted to teach me how to control my blood sugars through diet and exercise.

Why Me?

When I was first diagnosed with diabetes I even received counselling, to try to make sense of Why Me? I think everyone feels victimized by negative health conditions, whether it’s COPD, Heart Disease or Cancer. The answers to Why Me? are both existential and practical.

There are two parts to the answer. First, there is the part of Why Me? over which you have no control, never did, never will have and makes no difference anyway. Whether it’s fate, God, a cruel universe, DNA or the conditions of your life (including a bad diet, smoking, poor or no exercise, etc.) leading up to becoming diabetic none of them actually matter in coming to terms with the emotional fallout of Why Me?

Truthfully, there are many things I could have done differently in the past that might have made a huge difference in my experience of diabetes now and in the future. But for whatever reasons I had, or gave myself, I did what I thought was within my capacity to change in my habits and behaviors.

You can check your blood sugars regularly with you meter tests, get your AIC blood work done in the lab and consult with your doctor as often as she thinks is useful or necessary. You may make changes in your diet and exercise program, and do your best to lose weight and keep it within certain boundaries. And if you do all these things from the beginning, your diabetes will be stable and you will reduce the consequences of this disease.

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For most of us, however, no matter how much we say we care about our health, we’re not really willing to do whatever is necessary to fundamentally change our outcomes. We do some of it, maybe ever some of it every day with serious intentions.

This is the Second Part to Why Me?

This is the part of Why Me? you can control if you choose to do so. So how do you change what you do and how you act, to have a real impact on your own health? This goes back to me saying that it’s not actually about diabetes, or even about your physical health.

It’s really about becoming conscious about who and what you want to be in your own life. We’ve all been beat-up by life along the way. Parents, friends, lovers, partners and even strangers have both positive and negative impacts on our self esteem. Why is that? Why do we let anyone else impact how we feel about ourselves, and how we make positive or negative choices about our lives, including those choices about dealing with negative health outcomes resulting from poor choices.

I hate to say this but “Who cares?” It doesn’t matter what happened in the past, or how you allowed yourself to be negatively influenced regarding healthy living. It really doesn’t matter, but only if there is some way you can turn your life around and ultimately take control of those things that you can control.

How to take control and like it.

The first thing is to understand what it is you need to do to make things better. If you don’t know what you need to do, it’s pretty hard to decide what to do. So find out. See you doctors. Read everything you can find out about current treatment alternatives, and inquire from other people their experiences. Read blogs. Get new referrals to diabetic clinics and resources. Talk over alternatives with your specialist. Make a plan of action with on a few, specific steps, done regularly and persistently.

Don’t try to do everything all at once. Set limited goals with realistic objectives. For example: Don’t try to lose a lot of weight in a week or even a month. Lose weight in amounts that can actually be achieved. If you find it too hard to do by yourself, join a club or a weight loss program which comes with monitoring and emotional support. But don’t blame the program if your weight loss isn’t happening. Be totally honest with yourself, and reset your goals. Weight loss is fundamental to improved diabetic outcomes and lowering blood sugar.

Don’t hang around waiting for someone else to improve your health.

If it isn’t happening, then look elsewhere for support, but don’t give up on necessary change. Remember that whatever happened yesterday is no longer relevant unless it results in change today. Guilt is useless unless it is accompanies by a renewed sense of personal accountability.

When I graduated many years ago from UBC my school motto was TU UM EST. What I didn’t realize was how powerful an idea that really is.

TU UM EST!

Frustrated

by bureaucratic delivery of medical devices and services

Two nights ago I went to my local Shoppers Drug Mart in Walnut Grove, Langley to submit my prescription for my new type of FreeStyle Libre sensor and meter, as well as my two new types of insulin. It was a frustrating day yesterday sorting it all out, without yet having received anything… once I come up with the necessary funds. All told about $268.00 out of pocket, with $178.00 eventually refundable from Blue Cross once I send in the receipt showing that I’ve paid it.

My new insulin prescriptions are 85% covered by Blue Cross unlike my previous prescription for insulin which was covered entirely, once my initial 100 deductible is paid for the year. I don’t know why this is so, but is probably a result of this being newer technology and newer method of managing diabetes in BC and, for the moment, is grudgingly covered by Blue Cross under the agreement with my wife’s employer, and then only to 85% of the cost of the newer medications.

Money required for medications and equipment causes a lot of anxiety as money is particularly tight on my government pension, and I’m counting the days to the next pension check for when I’ll have any money to spend, pretty much on anything.

I’m don’t mean to be grumbling about my current financial situation. First of all its mostly my own fault. Secondly, the only person who can do anything about it is me, so there’s not a lot of point in getting angry about it. Still, coming up with an extra $300 all at once, halfway through the month is going to take some doing.

Assuming that I can figure out how to get the money together, it looks like I’ll be starting my new insulin regime tomorrow or the next day, and will start using my new sensor soon. I am both excited and anxious about it.

New Insulin Monitoring, and new Insulin too!

My endocrinologist has been talking about getting me set up on a whole new system of monitoring my diabetes, in an effort to improve my blood sugar management. It turns out that my Blue Cross administration approved it last fall but nobody told me that they had done so. It was only when I submitted the application again late last month, and it was declined that I found out that it had already been approved, and it was expected that I would start to use, once the approval was provided. Just as a comment, this is a good example of how not to communicate about medical affairs. If I had thought to go to the Blue Cross members page and look, I would have seen that it was approved. However, I seldom, if ever, need to go onto the website and the members area. An email would have helped.

The next step is to return to my General Practitioner for the necessary prescriptions for the machine and the insulin, and whatever ever is required to use the system. Hopefully he will also provide me with instructions on how to do this.

Flash Glucose Monitoring System for Diabetes. … The FreeStyle Libre Pro is a glucose monitoring system intended to replace finger-stick tests; it uses a sensor implanted in the arm that a health care provider scans with a specialized reader for a record of glucose levels, trends, and patterns in people with diabetes.

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I am also hoping that with the new system of monitoring and delivering my insulin during the day, that I will need less of the other medications I have been taking for some time. My pharmacist thinks my doctor should eliminate the pills I take to control the diabetes, and use close management of insulin to control the blood sugars.

The reason for this recommendation is that it seems quite likely that a number of adverse symptoms I am experiencing are possibly related to my other diabetes medicines, and if I can stop taking them these side effects may, in fact, go away.

Any, this is a new start for in trying to better control my health and my diabetes, but only one of a number of steps I plan on taking in the next months and years.

I’m also hopeful that I will be able to use my iPhone 6+ as my monitoring device rather than the one from FreeStyle Libre.

A Critical Medical Self-Analysis

Purpose of this exercise

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There can be no time more suitable than the present to make better choices for my future health and well-being.  New choices mean reviewing and carefully considering alternatives not previously pursued, or if previously pursued, inadequately.  In some respects, this analysis reflects a continuing and necessary re-evaluation based of my current state of health, not as a snapshot, as it were, but rather as a streaming and changing set of conclusions and actions based on them.  However, this analysis is specifically about now and the immediate future, with a clear understanding that nothing is ever completely settled in these issues, and there is new information available on an ongoing basis.

More simply put – This self-analysis is about resetting how I go about living my life with due consideration to what I have learned about the conditions and diseases that currently plague me.  How to do better and improve my health for the future – this is my object.

Much of what will be expressed here rests on certain persisting patterns of behavior which require significant modification.  In other words, I must change if there is to be any real improvement in my health reality. And based on what I know about achieving anything of consequence in my life, it will need to be outlined in a program of specific steps, which depend upon my own actions rather than on others.  My physicians can only provide me with information and treatment within what I’m willing or able to do myself.  My partner, as supportive as she has tried to be over the years, is not responsible for any part of this, despite my tendency to try to lay responsibility at her door particularly for my dietary habits and lack of blood sugar control.

Current Symptoms

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  • Frequent urination – especially at night, interrupting my sleep.
  • Poor sleep – several things wake me up at night, variously including frequent urination, frequent cramps in my feet and calves, pain my shoulders and hips, dry mouth and nasal congestion, sleep apnea, hay fever, and difficulties breathing.
  • Chronic pain during waking hours – moderate to severe pain in my feet, neuropathic pain as well as mechanical distress, including pain caused by walking on supersensitive soles of my feet, as well as my toes.  Also… periodic moderate pain in my back and shoulders, and more serious pain in my lower back and hips when walking more that 1,000 to 2,000 steps.
  • Periodic breathing problems – mild to severe asthma on a continuing basis, almost always somewhat symptomatic but much worse when exercising or physically stressed.  Sometimes exacerbated by emotional stress or conflict.
  • Chronic physical exhaustion and fatigue – comes and goes during the day but is worse during periods of relative inactivity (sense of exhaustion) and during periods of exercise (weakness and muscle fatigue)
  • Dizziness upon standing – it is sometimes acute and sometimes minor
  • Mental fatigue and a sense of a loss of acuity and sharpness – I am finding it difficult to concentrate on mental tasks which require the application of my intellectual skills and professional skills.  I still feel capable of creative work for relatively brief periods, but fatigue quickly overtakes me, and I must put things aside, while I attempt to recover my energies and focus.
  • Forgetfulness and feelings of anxiety regarding memory
  • Visual deficiencies – lately I can only read or work on the computer for a certain period before my eyes begin to become less effective, making it necessary for me to interrupt my work or reading, and brake completely from work that require visual acuity.  Eye fatigue contributes to my overall sense of fatigue and exhaustion.  Note: I probably need new glasses, something I will discuss with my ophthalmologist on Friday when I next visit her.
Rain coast blogger
Rain Coast Review Blog author

  Conditions and/or diseases

  • Diabetes
  • Slightly elevated cholesterol
  • Sleep apnea
  • Asthma and bronchitis (borderline COPD)
  • Diabetic Neuropathy
  • Evidence of diabetic damage to my eyes
  • Fatty liver
  • Obese
  • Arthritis in hips, hands, shoulders, lower back
  • Tendonitis in hands and wrists
  • Eczema
  • High and low blood pressure
  • Allergies to a broad band of common allergens including pollens, animal dander, dust and others.  Anaphylactic reaction to Cipro and Penicillin
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Discussion

I have had recent visits with my family doctor, my Endocrinologist and my Respirologist (Pulmonologist), plus an upcoming CT Scan in early June at Burnaby General, and an eye exam this Friday.  I’m clearly a heavy draw on the medical system with all these frequent appointments to deal with various ailments.  Clearly I’d like to see less of them, and they would like to see less of me.  All we have to do to accomplish this feat is to improve my health sufficiently so that they wouldn’t need to see me so often.

Diabetes blood sugar and neuropathy management

Endocrinologist

My most recent visit with my Endocrinologist, as usual, thorough, with a significant discussion about changing my medications, in particularly, moving to two different types of insulin every day, with a long acting insulin injected in the morning with design purpose of bringing my premeal and fasting insulin down to ideally 7.0mml or below and then having me take fast acting insulin with each meal, dividing up the insulin between the meals, more or less based on the prorated amount of food being ingesting at each meal.

In order to manage this much more intensive insulin regime, it will be necessary for me to check my Blood sugar levels first thing each morning, as well as 2 hours after each meal.  The goal of the fast-acting insulin is to return my blood sugars to 10mml or below within the two hours.  

In order to maintain such a frequent reading of my blood sugar levels, I need to have a new form of monitor with a patch blood reader that sends the information to a monitoring device, either my iPhone or one that comes with the patch.  I submitted the request to Blue Cross two weeks ago and am currently awaiting approval. Note: I should follow up with them before Friday to make sure they are working on this.

The Endocrinologist wrote me prescriptions for the insulin and the device, as well as had his assistant prepare the forms for Blue Cross.  Once I have approval, I will need to deliver these forms to the Pharmacy for processing.

The Endocrinologist and I had a fairly long conversation regarding various aspects of my diabetes including the need for me to have my eyes re-examined, thus an appointment this Friday with Chui Luca, my Ophthalmologist.  We also discussed my weight gain since being diagnosed with diabetes with him expressing some thought that while weight loss would be desirable many type two diabetics in my circumstances find it very difficult to lose weight while taking insulin.  Not only does insulin contribute to weight gains, but so do Jentadueto and Invokana my other diabetes treatment medications.

In addition, gabapentin, which has been prescribed for my neuropathy due to diabetes, also leads to weight gain along with other symptoms I am experiencing.

The more common side effects of gabapentin include:

  • abnormal eye movements that are continuous, uncontrolled, back-and-forth, or rolling
  • clumsiness or unsteadiness
  • constipation
  • diarrhea
  • difficulty speaking
  • drowsiness or tiredness
  • dry mouth
  • nausea
  • vomiting

Talk with your doctor about precautions you can take for side effects from gabapentin:

  • Ask your doctor for advice on diet and exercise to help manage your weight if you are concerned about possible weight gain from gabapentin.
  • Don’t drive or operate heavy machinery until you know you can function normally while taking gabapentin.
  • Talk to your pharmacist about over-the-counter medications that can help relieve some of the more common digestive system side effects.

Gabapentin side effects may make you want to stop taking the drug. However, don’t stop taking it without first talking to your doctor.

Stopping gabapentin suddenly can cause serious problems, such as withdrawal symptoms or the return of seizures. Your doctor will help you stop taking the drug safely.

Medically reviewed by Lindsay Slowiczek, PharmD on December 20, 2016 — Written by University of Illinois-Chicago, Drug Information Group

Other diabetes Medications

In addition to the two new forms of insulin, and the gabapentin for treatment of the diabetic Neuropathy I also take two other diabetes medicines.

Jentadueto

2.5/1,000 MGs – taken twice daily prior to morning and evenings meals.

Medical Editor: John P. Cunha, DO, FACOEP

Last reviewed on RxList 08/28/2017

Jentadueto (linagliptin and metformin hydrochloride) is a combination of two 2 oral antihyperglycemic drugs indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus when treatment with both linagliptin and metformin is appropriate. Common side effects of Jentadueto are:

  • cough,
  • sore throat,
  • sinus pain,
  • stuffy nose,
  • upset stomach,
  • weight gain,
  • pancreatitis,
  • diarrhea, and
  • low blood sugar (hypoglycemia).

Get medical help immediately if you have severe side effects of lactic acidosis (symptoms include muscle pain or weakness, numb or cold feeling in your arms and legs, trouble breathing, dizziness, lightheadedness, tiredness, weakness, stomach pain, nausea with vomiting, or slow or uneven heart rate.

Jenadueto is available in the following strengths: tablets containing 2.5 mg linagliptin and 500 mg metformin hydrochloride or 850 mg metformin hydrochloride or 1000 mg metformin hydrochloride. The maximum recommended dose is 2.5 mg linagliptin/1000 mg metformin twice daily. Jenadueto should be taken daily with meals, with gradual dose escalation to reduce the gastrointestinal side effects due to metformin.

Invokana

300 MG – taken once daily prior to the morning meal.

Medical Editor: John P. Cunha, DO, FACOEP

Last reviewed on RxList 11/12/2018

Invokana (canagliflozin) is a sodium-glucose co-transporter 2 (SGLT2) inhibitor used to control blood sugar in people with type 2 diabetes mellitus, in addition to diet and exercise. Common side effects of Invokana include:

  • urinary tract infections,
  • increased urination,
  • yeast infections,
  • vaginal itching,
  • thirst,
  • constipation,
  • nausea,
  • fatigue,
  • weakness,
  • skin sensitivity to sunlight,
  • hypersensitivity reactions (including skin redness, rash, itching, hives, and swelling),
  • bone fractures, and
  • kidney problems.

The recommended starting dose of Invokana is 100 mg once daily, taken before the first meal of the day. Doses may be increased to 300 mg in patients who are able to tolerate Invokana at 100 mg doses. Invokana may interact with rifampin or digoxin. Tell your doctor all medications you use.

Asthma and Bronchitis Medications and treatments

After spending 10 days in the hospital in 2016 with severe pneumonia, when I was discharged my Respirologist at Centrio Medical Centre diagnosed me with COPD and prescribed three different inhalers to treat the disease.

Spiriva 2.5 mg

Spiriva 2.5 mg – two puffs with morning medications

Medical Editor: John P. Cunha, DO, FACOEP

Last reviewed on RxList 2/12/2018

Spiriva HandiHaler (tiotropium bromide) Inhalation Powder is an anticholinergic drug used to prevent bronchospasm (narrowing of the airways in the lungs) in people with bronchitis, emphysema, or COPD (chronic obstructive pulmonary disease). Common side effects of Spiriva HandiHaler include:

  • dry mouth,
  • constipation,
  • upset stomach,
  • vomiting,
  • cold symptoms (stuffy nose, sneezing, sore throat),
  • nosebleed, or
  • muscle pain.

Tell your doctor if you have any serious side effects of Spiriva HandiHaler including:

  • difficult or painful urination, or
  • fast heartbeat.

The recommended dose of Spiriva HandiHaler is two inhalations of the powder contents of one Spiriva capsule, ONCE DAILY, with the HandiHaler device. Spiriva may interact with atropine, belladonna, cimetidine, clidinium, dicyclomine, glycopyrrolate, hyoscyamine, mepenzolate, methantheline, methscopolamine, propantheline, or scopolamine. Tell your doctor all medications you use. During pregnancy, Spiriva should be used only when prescribed.

Symbicort

Symbicort 200 mg – two puffs with morning medications and two puffs with dinner medications

Medical Editor: John P. Cunha, DO, FACOEP

Last reviewed on RxList 1/22/2018

Symbicort (budesonide and formoterol fumarate dihydrate) is a combination of a steroid and a long-acting bronchodilator used to prevent bronchospasm in people with asthma or chronic obstructive pulmonary disease (COPD). Common side effects of Symbicort include:

  • headache,
  • throat irritation,
  • nausea,
  • vomiting,
  • stomach upset,
  • diarrhea,
  • back pain,
  • stuffy nose,
  • muscle or joint pain, or
  • changes in your voice.

Tell your doctor if you experience unlikely but serious side effects of Symbicort including:

  • white patches on tongue or in mouth,
  • signs of infection (such as fever, persistent sore throat),
  • mental/mood changes (such as nervousness),
  • trouble sleeping,
  • vision problems (such as blurred vision),
  • increased thirst or urination,
  • muscle cramps, or
  • shaking (tremors).

For patients 12 years of age and older, the dosage of Symbicort is 2 inhalations twice daily (morning and evening, approximately 12 hours apart). Symbicort may interact with antibiotics, antifungal medication, MAO inhibitor, antidepressants, beta-blockers, or diuretics (water pills). Tell your doctor all medications you are taking. During pregnancy, Symbicort should be used only when prescribed. Budesonide passes into breast milk. It is unknown if formoterol passes into breast milk. Consult your doctor before breastfeeding.

Salbutamol

Salbutamol 100ug – two puffs as required

Medical Editor: John P. Cunha, DO, FACOEP

Last reviewed on RxList 2/7/2019

Ventolin HFA (albuterol sulfate inhalation aerosol) is a bronchodilator used to treat or prevent bronchospasm in people with reversible obstructive airway disease. Ventolin HFA is also used to prevent exercise-induced bronchospasm. Ventolin HFA is available in generic form. Common side effects of Ventolin HFA include:

  • nervousness,
  • shaking (tremor),
  • palpitations,
  • headache,
  • mouth/throat dryness or irritation,
  • cough,
  • hoarseness,
  • sore throat,
  • runny or stuffy nose,
  • nausea,
  • vomiting,
  • dizziness,
  • sleep problems (insomnia),
  • muscle pain,
  • changes in taste, or
  • diarrhea.

Seek medical help immediately if you have rare but serious side effects of Ventolin HFA, including:

  • chest pain or
  • irregular heartbeat.

The dose of Ventolin HFA for adults and children for treatment of acute episodes of bronchospasm or prevention of symptoms associated with bronchospasm is 2 inhalations repeated every 4 to 6 hours. More frequent administration or a larger number of inhalations is not recommended. For exercise-induced bronchospasm, the dose is 2 inhalations 15 to 30 minutes before exercise. Ventolin HFA may adversely interact with diuretics (water pills), digoxin, beta-blockers, antidepressants, MAO inhibitors, or other bronchodilators. Tell your doctor all medications you are taking. During pregnancy, Ventolin HFA should be used only when clearly needed. Discuss the risks and benefits with your doctor. It is unknown if this medication passes into breast milk. Consult your doctor before breastfeeding.

Other Medications Prescribed or recommended

Tecta 40 MG

Medical Editor: John P. Cunha, DO, FACOEP

Last reviewed on RxList 10/24/2018

Protonix Delayed-Release Oral Suspension and Delayed-Release Tablets (pantoprazole sodium) is a proton pump inhibitor (PPI) used for short-term treatment (less than 10 days) of gastroesophageal reflux disease (GERD) and a history of erosive esophagitis in adult patients.

Common side effects of Protonix include

  • injection site reactions (redness, pain, swelling),
  • headache,
  • nausea,
  • vomiting,
  • abdominal or stomach pain,
  • diarrhea,
  • gas,
  • dizziness,
  • joint pain,
  • weight changes,
  • drowsiness,
  • tired feeling, or
  • sleep problems (insomnia).

The recommended adult dose of Protonix is 40 mg once daily. Protonix may interact with atazanavir, nelfinavir, ampicillin, blood thinners, digoxin, diuretics (water pills), ketoconazole, iron, or methotrexate. Tell your doctor all medications and supplements you use. Protonix is not expected to be harmful to a fetus. Tell your doctor if you are pregnant or plan to become pregnant during treatment with Protonix. Protonix passes into breast milk and may harm a nursing baby. Consult your doctor before breastfeeding.

APO-atorvastatin 40 mg

Medical Editor: John P. Cunha, DO, FACOEP

Last reviewed on RxList 4/23/2019

Lipitor (atorvastatin) is a statin used for the treatment of elevated total cholesterol, LDL, triglycerides, and to elevate HDL cholesterol. Side effects of Lipitor include:

  • constipation,
  • diarrhea,
  • nausea,
  • fatigue,
  • gas,
  • heartburn,
  • headache, and
  • mild muscle pain.

Contact your doctor if you experience serious side effects of Lipitor including:

  • muscle wasting and muscle breakdown (rhabdomyolysis),
  • confusion or memory problems,
  • fever,
  • dark urine,
  • increased thirst or hunger,
  • drowsiness,
  • loss of appetite, or
  • yellowing of the skin or eyes (jaundice).

The recommended dose of Lipitor is 10-80 mg daily. Erythromycin (E-Mycin), ketoconazole (Nizoral), itraconazole (Sporanox), cyclosporine (Sandimmune), indinavir (Crixivan) and ritonavir (Norvir) decrease elimination of Lipitor. Lipitor increases the effect of warfarin (Coumadin) and cholestyramine (Questran) decreases the absorption of Lipitor. Lipitor should not be taken during pregnancy because the developing fetus requires cholesterol for development, and Lipitor reduces the production of cholesterol. Lipitor passes into breast milk and could harm a nursing baby. Breastfeeding while taking Lipitor is not recommended.

Ramapril 10 MG

Ramipril side effects

Ramipril oral capsule doesn’t cause drowsiness. However, it can cause other side effects.

More common side effects

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist. The more common side effects that occur with ramipril include:

  • dizziness or faintness due to low blood pressure
  • cough
  • dizziness
  • chest pain
  • nausea
  • vomiting
  • diarrhea
  • weakness or tiredness
  • Serious side effects

Call your doctor right away if you have any of these serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • low blood pressure. This is more common when you’re starting the drug or increasing doses. Symptoms include:
  • dizziness
  • lightheadedness
  • allergic or hypersensitivity reaction (angioedema). Symptoms include:
  • swelling of your face, lips, tongue, or throat
  • trouble breathing
  • stomach pain with or without nausea and vomiting
  • liver problems (jaundice). Symptoms include:
  • yellowing of your skin or the whites of your eyes
  • stomach pain
  • fatigue
  • swelling (edema). Symptoms include:
  • swelling of your feet, legs, or hands
  • low white blood cell count. Symptoms include:
  • sore throat
  • fever
  • purple spot on your skin caused by internal bleeding (purpura)
  • fast or abnormal heart rate or palpitations. Symptoms include:
  • feeling like your heart is fluttering
  • high potassium levels. Symptoms include:
  • weakness
  • arrhythmia (irregular heart rate)
  • worse kidney function. Symptoms include:
  • nausea and vomiting
  • decreased urine output when urinating
  • fatigue
  • loss of appetite

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Senior dosage (ages 65 years and older)

As you age, your kidneys may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of this drug may stay in your body for a longer time. This increases your risk of side effects. Your doctor may start you on a lowered dose or a different schedule. This can help keep levels of this drug from building up too much in your body.

Special considerations

Kidney problems: 1.25 mg once per day. Your doctor may increase your dose to 5 mg taken once per day if needed for blood pressure control.

Renal artery stenosis or dehydration: The starting dose is 1.25 mg taken by mouth once per day. Your doctor may change your dose as needed.

Dosage to reduce the risk of heart attack, stroke, or death

Adult dosage (ages 18–64 years)

2.5 mg taken by mouth once per day for 1 week. Then 5 mg taken once per day for 3 weeks. Your doctor will increase your dose as tolerated to 10 mg taken once per day.

A New Leaf

This a revision to some of the issues I have addressed in my last several posts.

  • Marriage isn’t simple, and it sure isn’t heaven or hell.
  • COPD – it turns out that I don’t have it after all. What I do have is a great unknown, but whatever it is seems to be better than COPD, because it is treatable and can be controlled, unlike COPD.
  • I have prematurely given up Hope for a better life. Just because everything went to hell in a handbasket doesn’t mean that I have to accept my fate as given. I can still change everything.
Donald Wilson, from ten years ago.

Katherine and I are still living together, maybe not so much as husband and wife, but still struggling to find a way to cohabitate without driving each other crazy. Our issues have been enumerated and clarified, but not resolved or resolvable. Where do we go from here. I don’t know.

It turns out that I don’t have COPD. What I know is that I still struggle to breathe, which my respirologists says is a result of bronchial inflammation and asthma. She seems to believe that increasing my inhaler should reduce the impact of both, and improve my breathing. My recent experience of declining vigor and serious lung impairment needs to be put into a different context, one that has the possibility of significant improvement through new decisions and activities.

New hope is an odd thing. I hadn’t realized how deeply I had been affected by all the stuff in my life over the past five years. What is true also, is that I have been willing all along to believe that my life was more or less over, and old age was merely a bad post script to that.

I know it is time to turn over a new leaf and figure out just exactly I want for the next period of my life. I don’t have to accept decrepitude even if I do have to accept that advancing age and declining health options are real. I can fight this. Set some goals, Commit to specific changes.

Things I already know but haven’t been doing lately.

Marriage can be heaven, or hell!

If only I was not me.

I should have learned to stay away from women outside of my marriages.  It’s not that I run around on my wife, but rather that while I am not sexually faithful to only one person she and I agreed to live together as husband and wife, with a specific agreement to provide her with some comfort that I would be sensitive to her feelings and not cause her to be confronted with my relationships.  We agreed that I would be discrete, stay away from anyone in our circle of friends, and not inflict disease or another child with a lover on our marriage. I was also to keep the details of my “affairs” to myself. She didn’t want to hear about them. 

It might sound unusual, and maybe it is, but it was a natural outcome of our situation, and how we became a couple in the first place.  She had been one of my lovers during my first marriage, who had become pregnant with our son.  The pregnancy had led to an ongoing relationship as friends and parents, as well as sometime lovers,  which meant that when my previous marriage ended, we were still involved with each other even if mostly as the parents of a small child. 

During my first marriage, my former wife and I had an explicitly open marriage.  It’s not very good training to being a successful husband. 

 
I don’t know for sure, but I think that a lot of marriages become virtually sexless after a long period of time together. Whether that’s true or not it may or may not reflect an underlying problem in the relationship. My marriage has been sexless for more than a decade and was pretty much very low sex from almost the beginning. My marriage is not typical, I’m sure, but the reasons for not having sex with your partner can be highly unique to the two of you.

The only real problem is not the lack of sex, it’s more likely the lack of real communication and trust between you, on this subject, if not on any other number of subjects, including this one.

My partner and I still live together in the same home, but the marriage (as a sexual relationship, that is) is largely over, although we live together.  We have five kids between us and more than 40 years of being involved with each other.
 
My previous marriage was already in trouble when I met and became involved with my wife. In the beginning, things were okay with us, and after my first marriage broke up we moved in together and ended up married after another child was born.
 
We both came into the marriage with unrealistic expectations. After explicitly agreeing to an “open” arrangement with me, she actually thought that I would change completely and become a different person and not have intimate relationships outside of our marriage. I thought that she would be as good as her word, and be willing to be open as long as I didn’t cause her to be embarrassed, or bring home any diseases.
 
We were both living a fantasy, with serious long-term consequences. I went along my merry way, living pretty much as I did during my previous “open” marriage, and she went on living in a belief that I had changed my behavior, despite our agreements to the contrary. Part of the deal we made at the beginning when we got married, was that would keep my external relationships to myself, and not expose her to the embarrassment of having to deal with them on an ongoing basis.

Well, that didn’t work out so well. She ended up feeling completely betrayed sexually and emotionally, which she more or less kept to herself for more than 30 years. She also withdrew emotionally more and more over the years, until it got to the point where sex would have been totally pointless since we no longer even shared emotional intimacy.

She, on the other hand, assumed that I was lying all along. In other words not telling her that I was faithful, when in fact I was not. I assumed that she was well aware of my other friends when she actually hoped that they didn’t exist, but she was always angry that they probably did.

She, however, wouldn’t now feel as though she has been living a lie for all this time, and so angry that it’s impossible for her to get over it.

The weird thing is that I really can’t imagine my life without her in it, and don’t want to.  But it’s far too late in my life to change who and what I am, or what I have always believed.  Same is true for her.  What can we do?

It has occurred to me many times that it would have been a lot better off if I were not me.  Or at least, made a life with someone who shared my desire for multiple partners rather than someone who really feels that I ruined her life.

I am who I am, and that sucks for us both.

affection close up elegant flower

My wife of thirty-four years and I are on the verge of divorce.  In hindsight, it was always pretty inevitable since we always wanted completely different things from life, and what we wanted depended on our partner being someone completely different than who they are, especially in term of the fundamentals of marriage itself.

It took a very special kind of blindness to last this long, a willingness to overlook a fundamental flaw by pretending that it wasn’t there, but a flaw so deep that once exposed it can never be overlooked again, covered over, repaired or forgiven.

This huge rift between us goes right back to our earliest days, the days when I was married to someone else and she became the mother of my son, born as a result of a brief but torrid relationship which had resulted in his birth, less than 10 months after we first met.

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Nobody would have have thought that such a start propitious.  Having a child out of wedlock wasn’t something that either of us had imagined when we engaged in the obviously dangerous tryst.  But for me it turned out to be less of a moral challenge than it is to her, to this day.  She has never forgiven us for committing seriously immoral conduct, or herself, for that matter, for having slept with a married man.

It makes no difference to her that I was upfront from the beginning.  There was no hidden marriage, or implied statements to the effect that I was single, or almost single.  When she and I met, I had no intention of splitting up with my first wife, nor she with me.

We had an open marriage by mutual choice, arrived at by long discourse and mutual interest in exploring beyond the boundaries of marriage.  My former wife was well aware that I had a number of outside female companions, several of whom we even shared.  The fact is that we did split up within five years, but our open marriage was not the primary source of our going our separate ways.  There were other, far more serious fault lines between us, not the least of which is that we both carried within us the net effects of physical, sexual and psychological abuse as children, most of which we skillfully concealed from each other, but which were the real cause of our breakup.

2016-05-15 13.27.40Our lovers had nothing to do with it.  Well, maybe they did, and maybe my current wife had something to do with it.  Having a baby with another woman put unbelievable pressure on my first marriage, even though I had concealed the existence of the child from my ex.   Maybe this supposedly idyllic and idealistic “open” marriage had more than a little wrong with it.  If everything was so open and above board I would not have hidden such an important thing as having fathered a child with another woman from my ex wife.

We’d actually discussed what we would do if this happened, although we’d both committed to using protection.  We’d mutually agreed that we’d handle it together, and make room in our lives for any such child, and the mother as well.  We’d extend our marriage to include them, for the sake of the child as much as for our own sake, as well.

The truth is that we had both failed to disclose important things from each other along the way, and the baby was simply the last and most significant of those lies between us.

So when my wife and I moved in together, after my ex-wife and I split up, there was a lot of things we should have discussed before getting pregnant with our second child together.   By the time it came around to deciding to get married it was already too late to work out how we were to deal with our mutual expectations of marriage, and what it means exactly to get married.

Front Door

There’s no place like home?

Instead we got married with a simple agreement that since it was unlikely that I would ever be sexually monogamous we would leave the “faithful” out of the marriage vows, but leave in the marriage vows, promises to stay the course, be loyal to each other’s best interests, to look out for the other person’s growth and do anything we could do to be the best partner possible, but not including fidelity.

She believes that I took advantage of her naivete, or alternatively, she really didn’t understand what it mean to live with an unrepentant polygamous man, within vows that didn’t even suggest sexual fidelity or exclusivity.

She says that she didn’t really believe me when I said that I was always likely to have friends and lovers outside of marriage, but that I wouldn’t let those relationships interfere with my relationship with her, or with my responsibilities to my kids.

In hindsight,  I should never have moved in with her after the end of my first marriage, and most certainly shouldn’t have fathered two more children with her.

If she exercised willful blindness about my nature, and my apparent incapacity to live within a conventional marriage, then I also was willfully blind.  I never really understood her feelings on the subject, which she never articulated in so many words, but has demonstrated without a doubt at times over the last thirty four years.

She didn’t ask, mostly, and I didn’t say.  On the few occasions when she did ask about outside activities or relationships, I repeated what we had agreed to at the beginning of our marriage.  We had agreed that we wouldn’t talk about it, I’d keep it away from my home, and I wouldn’t ever be intimate with a friend or close acquaintance of hers.   She said that she didn’t really want to know, and I took her at her word.

I knew that our agreement was tenuous, at best, because over the years I came to understand that the only way she could deal with it was to pretend that it did’t exist, as if I really didn’t have any outside relationships, nor would I want to have any.   She told herself that my refusal to promise to be faithful, or to discuss any variation on the original stance, was a cover-up,  but not for my being unfaithful, but as a face saving device so that I wouldn’t have to acknowledge that I was a changed man.

She knew that my self-image always contained my sense of being independent and free to engage with anyone as a free human being.  She knew that I believed that I could be faithful my promises to her, without having to accept a value system in which I simply don’t believe.

There were moments over the years when this fault line caused difficulties in our relationship,  when she was sure that I was involved with someone.  But since we had no dialogue about it that actually illuminated anything, she stuffed her feelings down and held back from expressing her sense of shame and outrage at my values and my inherent sensuality.

One result was the effective end of our intimate sexual relationship more than a decade ago. Although it was never raised by either of us, my unwillingness to commit to sexual fidelity seemingly made it impossible for her to fully participate in sexual congress.  She submitted to sex rather than made love, a fact that made it less and less attractive to me over the years, and also made it less and less possible, due to my declining sexual performance generally. 

Finally, a year or so ago, it all came out into the light.  Somewhere along the way I had been exposed to a STD, discovered in a routine battery of blood work, which required me to inform any sexual partners so that they could be tested to protect themselves.

The first person I told was my wife, who went immediately into a slow burn which quickly turned into an inferno.

She said that she wanted a divorce.  And sooner rather than later.  Some days I think that she’s changed her mind because we get along so well, and do so many activities together.  And generally we do get along really well, and cooperate in our lives together.  But when I start to think that things maybe will heal over, it explodes out all over again.

From her perspective the only reason we’re not separated right now is that my health and economic situation is so bad that I wouldn’t be able to function on my own.  Up until now it has been true, and without something changing it might be true for years.

My income is from CPP and OAP, for a total of $1380 a month, which when combined with her income, allows us to live a reasonable life.  On my own it would be pretty much impossible, and the situation wouldn’t be much better on her own either.

But things aren’t actually getting better between us, and whatever store of goodwill and affection sustained us for so many years, despite the underlying fault line, is getting pretty thin.

I remember saying a long time ago to a friend that “when one person in a relationship has contempt for the other, the marriage is over, completely over, and no amount of effort can bring back the respect and trust once it is gone.”  This has never been so true, and when I hear the scorn and disrespect in my wife’s voice, I’m scorned right to the core.

I know.  I should have known better.  Even then, I should have done better.  Although, for the life of me, I have no idea how I could have done better, except by changing myself and my values fundamentally to suit her.  Or alternative, persuaded her to adopt my views on life.

01-Ways-to-Help-a-Friend-Dealing-With-Divorce-Nicole-fornabaio-rd.com_-760x506However, it is now far too late, and in her heart she really can’t forgive me for “sleeping around” on her for all those years.  Even if I were to change and be willing to promise to change now, it would not make any difference to her.

She is convinced that I have betrayed her and that I continue to betray her, not for my acts of betrayal, but because I am unrepentant and refuse to apologize for being exactly who I have always said I am, and done exactly as I always said I would.

It is irrelevant to her feelings today that she knew exactly who I was, and what I believed from the first night we met.  I am who I am, and to her, that’s disgusting.

Not much of a foundation for mutual respect.

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Rain Coast