Had a Heart Attack today at age ~30. Be safe guys.

One of the reasons the docs go by the formularies is because when they step outside the box they get hit with lots of paperwork from insurance companies. Pre-authorizations, doc to doc phone calls, it's awful. So they relent and just prescribe what insurance wants them to. When I get these prescriptions I just tell the pharmacist that if the insurance asks for pre-auth just run it through as private pay. No time to mess about with that bullshit. It just happened - I messaged my doc and he sent in a prescription for Vascepa. Pharmacy called and said it needed a pre-auth. I told them don't bother i'll pay out of pocket.
 
My BP rode high, but usually in the 130/80 territory

I was RX'ed 200mg labetalol but I stopped taking it a week ago because of beta agonism reduction on fatloss and my BP was still fine without it

Also take 20mg Cialias daily

I'm a huge advocate for sharing as much info in public places without identifying information, to help others make informed decisions and reduce harm

Thousands of people can potentially read your posts over time from Google searches

So I'm happy to share my meds

The ones newly prescribed ones are the bottom 5, and 200mg Labetalol is being replaced by Metoprolol

View attachment 349543
Were you previously taking an antipsychotic?
 
That’s in my stack. Along with cialis 5 mg daily, pita 4 mg daily, and just added vascepa. Zetia and bemp acid on deck if needed. Luckily my BP is 115/60. But I’ve got low HDL and family history of heart disease so I’m super aggressive. Gear is < 600 mg weekly. No orals. And on Reta 2 mg.
Vascepa any different from lovaza? I’ve been using that for the last 3 years or so.
 
All the GLP-1 will help metabolically but Reta seems to have an impact on lipids as well as liver fat deposits beyond the effect of just weight loss.

Just to add anecdotally, my LDL dropped 39%, from 122 to 75 over the 13 weeks I’ve been using Reta. No other changes other than that along with the weight loss that occurred during that time. Was pretty interesting to see.
 
Just to add anecdotally, my LDL dropped 39%, from 122 to 75 over the 13 weeks I’ve been using Reta. No other changes other than that along with the weight loss that occurred during that time. Was pretty interesting to see.
How much were you using weekly?
 
- If your BP is 130/80 at night or evening, it could be 20+ points higher in the morning. BP spikes in morning for most people by 10-30 points.

- If you've been blasting orals/roids since a teen, you had no idea how much exposure you've had to high LDL. Just because you had ldl 70s on statins in your late 20s/age 30 doesn't mean anything.


On morning BP: 120/80 in the morning drops to about 105/60s or so at night in a healthy person.


TLDR: you could have been waking up with 140+ bp and spent many years at a sky high LDL.
 
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- If your BP is 130/80 at night or evening, it could be 20+ points higher in the morning. BP spikes in morning for most people by 10-30 points.

- If you've been blasting orals/roids since a teen, you had no idea how much exposure you've had to high LDL. Just because you had ldl 70s on statins in your late 20s/age 30 doesn't mean anything.

TLDR: you could have been waking up with 140+ bp and spent many years at a sky high LDL.
As someone with a similar, albeit less intense, history of blasting during my younger and stupider years (with no use of ancillaries, bloodwork, or BP measurement), this is why I risk stratify myself as if I am an obese smoker with uncontrolled diabetes and advanced kidney disease when I look at my cardiac labs, BP, health markers, etc. I've had to continuously impress this upon my PCP and cardiologist and they are starting to come around and honor my requests for tests / meds. Since I offer to pay out of pocket, they know that ordering it won't result in a bunch of bullshit paperwork and hassle for them if insurance doesn't cover it. But it's the area under the curve that matters; the cumulative exposure. Much like pack-years of smoking. I've seen sad cases of people who finally quit cigarettes after decades get diagnosed with lung cancer within a year or so after quitting. I wasn't exactly a picture of health during my 15 year hiatus from PEDs, but the past few years have been different. I'm still fighting an uphill battle so I keep PED doses moderate / low and am insanely aggressive with health maintenance, most notably cardiac stuff. Luckily the BP is quite low, as are the Lp(a) and ApoB. That said I am not blowing smoke up my ass and I know i'm still at elevated risk even though my labs for the last few years look good.
 
Book appointments with 4-5 cardiologists, each few days apart.
Go in, tell them what u want, fire them if they say no.
If you get it, cancel the other appointments.

Pick younger doctors.
Not sure where you are but doesn't really work like that in the States unless maybe you're rich and private pay.
 
Not sure where you are but doesn't really work like that in the States unless maybe you're rich and private pay.
If you have an HMO then that's correct - you will need a referral from your PCP to the cardiologist and they won't make 4-5 at a time. If you have something called a PPO you can make all the specialist appointments you want. Depending on the insurer, I'm not certain if after the 3rd or 4th cardiology consult they may deny payment and stick you with the bill, but it is possible.
 
You can search for cardiologists who specialize in lipids (they call themselves lipidologists)
After Googling "lipidologists", the main care center I go to was the first result.

They have a team of specialists for this and the page specifically mentions PCKS9 inhibitors, lol.

Will try my luck...
 
Not sure where you are but doesn't really work like that in the States unless maybe you're rich and private pay.
The insurance plan my employer provides lets me do this, I'm pretty sure.

I've always been able to pick any specialist and book an appointment without a referral if the office takes my insurance.
Were you previously taking an antipsychotic?
I was not, curious why you ask?

On a side note. You said you were taking 20mg cialis daily. Any ill effects from that high of a dose every day?
No, not as far as I can tell.
What’s your diet like and what changes do you think you’re going to make to your cycle, if any?
I've been eating the same thing every day all year pretty much:

- Cottage Cheese + Pineapple
- Chicken + Green Beans + Black Bean + Greek Yogurt bowl
- Protein shake

1758492900775.webp
 
I saw lamotrigine there. A second or third line bipolar disorder treatment.
Ah, yeah my psych added that in for depression/anxiety. I don't think it does much, and I also don't think the Buspirone is doing much either tbh.

The Ropinarole I was RX'ed because my partner complained about RLS in bed keeping them awake. But I want to discontinue it because apparently dopamine agonists can worsen RLS over the long run, and I also have been waking up at 1-2AM every night automatically. I'm nearly certain it's the Ropinarole.

Though it is nice to have an RX for a Dopamine Agonist on hand for prolactin stuff.
 
The insurance plan my employer provides lets me do this, I'm pretty sure.

I've always been able to pick any specialist and book an appointment without a referral if the office takes my insurance.

Not sure where you are but doesn't really work like that in the States unless maybe you're rich and private pay.

Call a specialist to make an appointment, when the receptionist says you need a referral, ask if someone there can give you one

I've done this a few times and usually get a callback on the same day to schedule an appointment with the specialist

...don't know what's happening behind the scenes; maybe having a referral saves the receptionist some time, but it went through insurance just the same
 

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