Experimenting With Drugs

I’ve been experimenting with drugs for a few years now having been prescribed statins to control my cholesterol level since 2012. I’ve also had to stop or take breaks for several weeks because I experienced muscle pains when I take the medications. There are more and more reports of this happening to other people too.

 The first statin prescribed to me was Atorvastatin (Lipitor) 40 mg. daily. It worked very well because my total cholesterol level went from 229 to 139 in a couple of months.  I took it for a few more months then started to get thigh injuries when I went running. I thought it was because my thigh muscles were compensating for my ankle tendon injuries, but apparently I was mistaken. I reported this to my doctor who stopped the medications, but in a few months, my cholesterol level started to climb back up. Without notifying my doctor, I started splitting the pill in half (20 mg.) and took them every other day. This was enough to keep my cholesterol level in check but the muscle pain resumed. I further reduced the dose to 10 mg. three times a week which still controlled my cholesterol at about 179 and at the same time kept the muscle pains to a minimum as long as I didn’t push the pace when I was running. By this time, I already told my doctor what I was doing.

After changing jobs and medical insurance companies, I told my new doctor about the muscle pains, so she switched me to Pravastatin (Pravachol) 20 mg. daily. The pain intensified again so the doctor discontinued it. She prescribed fish oil instead: Omega 3-6-9 complex, 1 capsule twice a day. I took it for a year and when my cholesterol level was checked, it had risen to its highest level ever to 255. So the fish oil didn’t work and in addition, I was eating a lot of cheese and German sausages at that time.

The doctor then prescribed Rosuvastatin (Crestor) 20 mg. daily and my cholesterol level did a correction and went down to 179 after only 3 months. However, the muscle pains started again so the doctor discontinued the Crestor and said I can never take statins again because of the side effects.

I took a six week break from the Crestor and without notifying my doctor, I started splitting the 20 mg. pill and took 10 mg. three times a week. This seemed to keep the muscle pain under control so I kept on taking them. I still have a bunch of pills that are going to last me at least a year.

After my recent job loss, I had to buy my own insurance through Obamacare and found a new doctor. I told him what I did and he hasn’t changed anything so far. After having blood tests done, my cholesterol level has gone down to 156. Of course, not eating German sausages and drastic cut down on cheese helped. As long as the muscle pain stays at a minimum or non-existent, I think I shall continue with my self-prescribed treatment plan. I’ve also switched to brisk walking instead of running.

I know I’m only mentioning total cholesterol, but my HDL/LDL ratio has always been good regardless of what my total cholesterol is and my triglycerides has never been an issue.

Statin Myopathy, Cholesterol Level, Diet, AREC, and Running

          

Photo courtesy of David K. - AREC President

          Normally, I'm overly excited about rejoining AREC's Long Beach Marathon training, but due to my most recent muscle problems, this time, I'm just elated at making it there at all.

          Backtracking a little bit to give you some history: I had to start taking Lipitor again three months ago because my cholesterol level went up when I stopped taking the medication due to muscle pains as a side effect. How bad have the pains been? Well, if I do the same type of workout two days in a row, let's say for example- using the recumbent bike, my leg muscles are more likely to hurt. Giving myself a few months break while taking Coenzyme Q-10 supplements relieved the pain and enabled my muscles recover somewhat. Even though I only took half the dose of the Lipitor (20 mg.) and only 3-4 times a week this time around, I began experiencing the muscle pains again after just 3 months, mainly on both thighs. So I requested a cholesterol level test from my doctor before visiting him and later found out that even the lower dose of medication taken roughly every other day decreased my cholesterol level from 220 to 178. More importantly, my LDL also dropped and my LDL/HDL ration remained good. So the good doctor recommended that I further reduce the dose of the Lipitor to 10 mg. three times a week in hopes that my muscle pains would disappear. By the way, I walked from home to the lab and back for my blood draw and that made for a six mile workout :-) We shall see if the doctor's recommendation is effective in a few weeks.

          A couple of days after the doctor's visit, I showed up at AREC marathon training not necessarily to train with them but mainly to pick up the beach towel which is what we get for being a member this year (last year it was a windbreaker). How often do I go to AREC runs? Well I saw a woman with her husband carrying a baby last Saturday. I never even saw that woman pregnant last year! Anyway, the workout for the day was either 4 or 6 miles and I opted for the longer distance, thinking it would take me about an hour and a half to cover it. Of course a few people after seeing me walking asked if I was recovering from an injury and all I can say is that it's just SNAFU (situation normal, all fu.... up). Nevertheless, my pace felt pretty brisk but since I was the only walker who was doing 6 miles, I was in last place. So much so that when I reached the turnaround point where the water station was, I suggested to Tina and Rosie that they could probably start packing up the supplies because I was the last one . About a mile down the road, good old Dave, the club president was still taking pictures and waiting for the last person. Thank you Dave, for being such a caring president :) I wended my way through the streets of Naples (Long Beach) in the last two miles until I reached the finish area at Joe's Crab Shack. When I clicked off my stopwatch, it registered 1:18:32. Hmm, that seemed quite fast for 6 miles but I couldn't calculate pace per mile out of the top of my head. See, I haven't been using my GPS watch lately. I had to wait to get home to plug in the numbers in a pace calculator before finding out that I had walked at an average pace of 13 minutes and 5 seconds per mile for 6 miles! My goodness, I've never walked that fast before, with or without muscle pain! That was pleasantly surprising since if I'm not mistaken, my previous fastest pace was about 13:40 per mile. I haven't exactly done any roadwork lately other than my futile attempts to jog a few weeks ago before my thigh muscles began being affected by the statins again. I guess those treadmill hill walks must be helping. And I should probably also thank AREC and it's members for the motivation they provided. And to think that I even forgot to bring coughdrops which I suck on during workouts to keep my mouth moist. Maybe not carrying 2 to 3 pieces of candy lessened my load which enabled me to walk faster :) Now if I can only learn proper racewalking technique...

Always appreciating Dave's photos :)

          Going back to my battle with cholesterol - taking psyllium and fiber gummies weren't working by themselves. In addition to the lower dose of Lipitor, I also had to do other things like cutting the cheese from my diet, bringing my own turkey sandwiches to work instead of eating the ham and cheese they give out for snacks, substituting fat free sherbet for ice cream, and using imitation crab meat or tofu instead of meat for my barley and vegetables concoction. Other things I've cut out are hamburgers, hotdogs, fried chicken, and peanut butter and jelly sandwiches except for an occasional jelly sandwich. One thing I can't let go completely though are the sweets, which is my guilty pleasure, and some of you may have already seen my dessert photos on Facebook.

          So two things to be happy about: being able to walk faster and lowering my cholesterol to healthy levels. To end this post, I decided to just focus on the things that I can do (like walking at a good pace) and be thankful for them rather than lament what I cannot do (like running).

Always try to look good when you see a photographer :)

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SYTYCR - So You Think You Can Run

Apologies to the TV show So You Think You Can Dance (SYTYCD).
          I have been taking CoEnzyme Q-10 supplements for several months to counteract the myopathy caused by taking Atorvastatin for high cholesterol and thought that my thigh muscles had recovered enough to try running again. After a few weeks of dabbling on this running or plodding workout, I have come to either an assumption or conclusion. It's not a new one because I've been arriving at the same result for at least the past two years. I've already been content with my exercise routine in recent months without running, but for some reason I keep getting drawn back to give it one more try, not in the hopes of returning to previous capabilities, but just as another workout option. It worked for about three weeks, then not surprisingly, my muscle imbalances and statin related myopathy came back to spank my butt. As if it wasn't hard enough trying to run again.
          How did it happen this time? Was the cause due to restarting the Lipitor three months ago and the effect the return of myopathy even with the coenzyme Q-10 supplements? Or was the cause due to restarting running and doing 2 minute pickups too soon with the effect as being too much too soon? More likely, it is the combination of both. My muscles were already achy from just three weeks of running 2 to 3 times a week and the pickups just took it over the top. It didn't take very much - just 3 pickups in the last 10 minutes of a 40 minute run, but that's all it took to trigger the pain on both hips. I have already chopped my stride to lessen the impact but with the pickups I unintentionally extended the stride which I think started the pain. My hips don't lie when they say they're hurting. How do I know if it's really a bad injury? When I descend down stairs, it hurts like the dickens (I really don't know what that means). I have to hold on to the rails to keep my balance and so I don't fall. It's not the kind of pain that can be relieved by analgesics either. Believe me, that's based on experience and research. Would you believe the feeling of utter depression actually overcame me the day after and it lasted for several hours? Being debilitated made me feel that way. Fortunately I got over that funk the next day.
          So it's back to no running (or plodding). Is it safe to assume that I should stop making these comeback attempts? When something that give you most pleasure also gives you the most pain, then is it definitely time to stop forever? The problem with running is that it's like heroin which from what I hear, the detox and cravings are intense. Nevertheless, getting high on running even just for three weeks was worth it. SYTYCR? I cannot, or rather , should not. Until the pain dissipates and/or the cravings start again...
          How I wish someone had developed a training plan for people with myopathy, perhaps something similar to a beginner's guide to running. As far as Do I Think I Can Dance? HA! Let's just say that Elaine on Seinfeld dances much better!

Surviving The Loss of Running Muscle Memory

Well here I go again trying something I had not done since last December. I would like to say that I have given up running altogether because of my ankle tendon problems and myopathy stricken thighs due to Atorvastatin, but I broke that non-running habit again last Thursday. Any semblance of running nowadays may be worth writing about because of the glaring absence of it in my exercise logs. So this is what happened last Thursday: I jogged to the bank and back home. Not like what I did a couple of weeks before when I jogged 1 minute and walked 1 minute, but one continuous, non-stop jog other than stopping to withdraw money from the ATM and for stop lights. One might call it a slow jog but jogging already implies slow, so perhaps it was more like shuffling my feet forward and backward. Nevertheless I thought it was faster than my fastest walking pace. So how did it feel? Hmm, very, very different. It felt like I had never ran before because the muscle memory that I had  from decades of running had developed Alzheimer’s disease. The unfamiliar strides I took were the shortest I had ever taken, which was probably helpful because I landed less heavily. What was surprising to me was that I was anticipating for the myopathy to act up, but it never did, so I just kept on plugging along.

Another surprise awaited me on the way home. I ran into Katherine with her dog who also happened to be running to and from her bank. The muscle memory might be gone but at least I remember my neighbor Katherine whom I trained with for years. I may have mentioned her before in one or two of my posts and I'd like to lay to claim that I contributed to her marathon PR in L.A. (correctly or otherwise), because of the workouts we did together especially the ones on the track in Long Beach City College. For two people who supposedly don’t run anymore, it was funny to have met on the street while running to and from different banks. We separated ways after exchanging a few pleasantries.

A couple of blocks from home, I had to do a double take in a strip mall because I noticed that the video store I used to rent DVD’s from had closed down, no doubt due to lack of customers who have probably since switched to Netflix, Red Box, or at worst, illegal downloading. I was sad to see it go. I was there so frequently in recent years that the managers knew my membership number by heart. Another thing that tells you is that I haven’t exercised outdoors much so it was the first time I noticed the video store was gone. A few more minutes later, I was back home from the unexpected 42 minute jaunt through the neighborhood with not much or any permanent damage done to both muscles or tendons.

A couple of days later, I logged another run, but this time it was on the treadmill, which lasted 50 minutes. It almost felt like my running muscles were slowly regaining their memory.  I'm so glad the Press Telegram fixed their Android app (there was a problem with it for a couple of weeks) and it made for better reading while running on the machine.  Okay, this can't be right. What's this showing up in my workout log? Two runs for the week? Highly unusual nowadays. My body has learned to live without running but after a couple of these recent experiences, I'm feeling the craving again. It's like a damn drug! Is that normal?

From that running high came the downer two days later – the tragedy of Boston Marathon 2013. WHY???!!!

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Workout Notes - Spring 2013

       

          About three times a week, I do abdominal workouts usually consisting of sit ups, crunches, twists , or sit ups with a 15 pound weight which I hold against my chest. All of those without anchoring my ankles to anything. Occasionally, I also do leg lifts. With the weighted sit ups, I could normally do 30 to 32 reps. Then I discovered another variation of the weighted sit ups a couple of weeks ago. That time, I held the 15 pound weight against the back of my head then tried to raise my upper body off the mat. I managed half a crunch and a huge grunt, but no sit up. Wow, that was way harder than I thought! I couldn't help but laugh at myself when that happened. I then tried a 10 pound weight with similar results. Down to 5 pounds I went, and was finally able to lift my torso from the ground and managed to do it 16 times. Remember, this was without anchoring my ankles to anything so by the 14th repetition, I couldn't keep my feet on the floor due to the forced reps. I could feel my stomach muscles burning. So that was  surprising sit ups discovery - lesser weight but more resistance and lesser repetitions required. I think I may add that to my routine.
          One Saturday morning, I planned on driving to the bank to get some money from the ATM machine. It was not cold outside so I decided to do a 1 minute jog with 1 minute walk to the bank and back. Just to remind you, I haven't done a run in months because of the myopathy problems I have been having while taking generic Lipitor for my high cholesterol. When I was still running fairly well, that round trip would have taken about 25 to 26 minutes. That Saturday, it took 35. Well, my legs generally felt slightly but pleasantly sore after doing that jog/walk. Delayed Onset Muscle Soreness (DOMS), the pleasant soreness I had is however totally different from statin myopathy which feels more like a cutting pain. This time it affected my right thigh muscle as opposed to the left side a few months ago. To add to that, this run didn't even hit the pleasure areas of my brain and left me dissatisfied. Maybe the reason is because I don't do it as often as I want or can anymore. What was good though was that the afterburn of that brief workout kept my weight down the next day even after eaten a lot of red velvet cookies with white chocolate chunks.
          A couple of weeks after that 1 minute jog/1 minute walk workout, I went to have an oil change for my car and instead of waiting around while the mechanic did it, I walk/jogged around the area. I didn't keep track of how long the jogging and walking parts were but did it by feel. That way, I was jogging more than I was walking and the whole workout lasted 45 minutes.
          I did a rowing machine workout one morning while watching a Japanese documentary film called Jiro Dreams of Sushi. Since the wind resistance machine makes a lot of noise, it helped that the movie had subtitles. You would think that after watching that movie, I would be craving for sushi. Well, I did not.
          And finally, my workouts before and after my colonoscopy. On the day of the procedure, I felt so weak from the clear liquid diet and the trips to the bathroom so I had no choice but take it easy on my 30 minute workout on the recumbent bike. My discharge instructions after the colonoscopy said no vigorous workouts for 24 hours after the procedure. So it was more of the same the next day on the recumbent bike. Two days later, I did a somewhat vigorous uphill walking workout on the treadmill for 45 minutes then a full body weight training workout using rubber tubing. Don't even say I don't follow doctor's orders.
          So there it is folks - dreary descriptions of what it takes to stay in shape: a little bit of this and that which even included some running.

My Walking Workout Variations Because I Cannot Run

          What's up with this blog about life and running when I don't even write about running anymore? Yep, running has been nil in recent months, what with the myopathy caused by statins and the never healing PTTD. No matter, I'm still able to do some walking workouts after all even though those are more boring than running. With these walking workouts I try to simulate the intensity of running. It comes close but never quite the same of course. The closest walking workout I have to the feeling of running is a treadmill hill walk where the incline is set at 10% with the speed at 3.5 mph and no holding on the siderails of the machine. The next one consists of the same incline, slowly increasing the pace from 3.5 to 4.0 mph while holding on the siderails. I do both treadmill workouts for 45 minutes to an hour. Despite the cartoon above, I have not fallen off the treadmill...yet.
          As far as outdoor walking on mostly flat surface, I do a brisk walk of about 14 minutes to 14:30 per mile lasting for an hour and half or more. Such was the case when I had to drop off some papers at my work's Human Resources Department about three weeks ago. That walk lasted for an hour and 50 minutes. For variety, I sometimes carry a backpack loaded with a 15 pound barbell plate. I did that most recently last week when I walked to and from Walmart Pharmacy for an hour and a half to pick up my blood pressure medication. It was warm enough to wear shorts but I discovered that since I haven't been wearing my running shorts lately, the elastic (garter in the Philippines) in the waist had gotten dry and crunchy. The shorts had become loose and if not for the drawstring, they would just have dropped to my feet. The pace is slightly slower when I carry a weighted backpack that of course. I'm looking to increasing the weight next time but in a way that the plates don't bounce around the backpack which hurts my back. Adjustable weight vests would be preferable but those things are darn expensive and there have been instances that the police have been called because they look like bullet proof vests or body armor.

Terribly boring descriptions, aren't they? Well, whatever works to keep my fitness outside of running. Hmmm, now I'm wondering how it would feel to walk with weights uphill on a treadmill...maybe I should start setting up the webcam. (cue background music: Alicia Keys singing "I keep on falling...")

Walking Workouts of an Insomniac Post Myopathy - Part 2

          Two days after my pre-dawn walk to and from Walmart, I unintentionally awoke early again Saturday morning and decided to show up at Signal Hill to walk with the Long Beach Walking Club Meet-up group. I haven't joined them in a couple of months because it was there where I slipped on some gravel and pulled a left thigh muscle. Well, the walk wasn't scheduled till 7 a.m. so I drove to Von's first to buy some tissues which were on sale for 78 cents a box (limit 2), and second, to Food 4 Less to buy some bread. I still arrived 20 minutes early at Signal Hill which was enough time to do a 15 minute warm up. Oh boy, did I need to warm up because it was chillier than it was on Thursday. I had three layers of clothes: a thin base layer, a fleece layer, and a mid-weight jacket, to go with my track pants and gloves. In retrospect, I should have worn a beanie too. When I returned from my warm up, there were two people waiting there and another getting out of her car. It was a very sparse group and probably due to the colder than usual weather. How cold could it really have been? Well, it was so cold that when I talked, I was slurring my words as if I was having a stroke and my hands felt so numb except for my right thumb which was actually painful.
          As we started and headed up the first hill, everyone was ambling along and socializing, which didn't help to get me any warmer, so I took off. This time, I had my radio to keep me company during my alone time. As usual, I backtracked several times so I could stay relatively close to the group while also increasing the duration and distance of my workout. After all those weeks of recovering from the Lipitor induced myopathy, I had lost some aerobic conditioning despite all the indoor cycling workouts. The uphill climbs felt like I was doing all out 400 meter intervals on the track and left me in oxygen debt. In the past, I would carry over the quick leg turnover after I crested the hill, but this time, I had to recover for a couple of hundred feet before I could pick up the pace again.
          The group altered the course slightly on this day so my backtracking enabled me to find out which part to eliminate and to add. They eliminated the dirt path and used the steeper climb of Skyline Drive instead, which made for a tougher workout but slightly shorter than the original route of six miles. That didn't matter much to me because I didn't bring my GPS watch and my plan was to walk at least an hour and a half, not including the 15 minute warm up. With all the backtracking I did plus an extra hill at the end, my total workout time was two hours, which based on previous walks up and down those hills, probably covered slightly more than 8 miles.
          You know what? With my early morning awakenings or at times barely sleeping at all, I would rather have walked on my treadmill because it has been really cold outdoors. But out of respect for my neighbors beside and below my apartment, not wanting to bother them with my noise, it was better to face the elements outdoors. I wish I could say that I ran outdoors instead, but that kind of workout is not in the cards right now. I can tell you though that I've jogged a few times on the treadmill recently, but I don't feel ready to try it on the harder pavement while I continue to recovery from the myopathy caused by Lipitor.

My Experience With Lipitor and the Resultant Myopathy

I went to see the doctor two weeks ago for a follow up on my body’s response to Atorvastatin (generic Lipitor). A few days before that I had my blood drawn for a cholesterol level. At the doctor’s office, I was told that my cholesterol  level went up from 133 to 164 and LDL from 44 to 70, which is understandable because the doctor halved my dose from 40 mg. daily to 20 mg. To add to that, I had been eating almost indiscriminately on Thanksgiving and the days that followed. But that was not what I was concerned about. In the last few weeks, I noticed that whenever I worked out, my muscles seemed to recover more slowly than usual, meaning that the soreness lasted longer, and the left thigh injury I had suffered from running several weeks ago wasn’t healing well. I’ve read about the side effects of Lipitor and myopathy was one of them but I minimized it, thinking that because I try my best to keep physically fit, such a thing could not happen to me. Well, it turns out exercise cannot overcome this side effect because as time went on, my muscles have become more sore. I even feel soreness when I do my usual aerobic workouts nowadays consisting mainly of treadmill hill walks and stationary cycling. Since there are no other factors that could possibly contribute to the soreness, I can only assume that it’s the Lipitor that’s causing it.

During my visit to the doctor, I mentioned the soreness so he decreased the dose to 10 mg. daily. However, that hasn’t seemed to have helped because my muscle pain has become worse since then. It’s so hard to believe the breakdown happened so fast since it’s only been over three months that I’ve been taking Atorvastatin. I’m now seriously considering calling the doctor up to tell him that I’m discontinuing the Lipitor and see if my muscles could recover before permanent damage occurs. I’ll have to start eating healthier again and see if I can maintain the decrease in cholesterol levels I’ve achieved since taking the medication. It would be terrible not to be able to workout due to being debilitated by muscle damage. Heck, I need my daily cardio fix after all, even if it’s not from running.

                Here’s the catch though: drug companies advise that once you take Lipitor or any other statin, you have to take it forever. Of course they have a vested interest in this approach since they make money off it. There is of course an opposing view that in the absence of other risk factors, it’s not worth continuing taking the medication if the side effects affect your quality of life adversely. I’m just stating that here briefly since there is already too much information about this issue on the internet. I’m not getting into coenzyme Q10 and vitamin D and how those might help with the myopathy, or neural pathways of the medication. That’s easy enough for anybody to look up if so interested. Here is a good article on statin myopathy and exercise though : http://www.medscape.com/viewarticle/707898 . The title is: Are Physically Active Individuals Taking Statins At Increased Risk For Myopathy?

                So anyway, I’m planning on stopping generic Lipitor and hope that my LDL doesn’t get out of control. It is at a manageable level now at 70 and not the 138 it was in August. As my high school classmate who is a doctor advised: more psyllium J.

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