Dr. Fett please advise

[melissamph]

Dr. Fett,

I will be seeing my cardiologist for the first time in nearly 2 yrs. Within this two years my GP has taken me off of my ACE and we have lowered my Coreg from 25 mg BID to 6.25 mg bid. This past April my Echo was unremarkable and showed an EF of 60-65%. I am not sure if you are aware but I have lost 100+ pounds post gastric bypass and my BMI is 24.5% now compared to 40%10 mos ago when the Echo was done. My med that I remain on is Coreg. Do you feel I still need it. I am 3 yrs and 4mos out from diagnosis. My doc always has said that he prefer I stay on it indefinitely. My BP and pulse are low and I believe that I won't be able to stay on it much longer. Please advise on how to broach the subject of just dropping the Coreg. Thanks!

[JAMESFETT]

You have been doing very well, and I congratulate you on remarkable progress. Some cardiologists believe in carvedilol (beta-blocker) "for life" in PPCM patients. Our experience with recovered PPCM patients shows us that they continue to do well even after the discontinuation of all heart failure related medications. Out of economic necessity, we do wean off and stop. But I can't quibble with decisions to prolong BB therapy. If you and your doctor should decide to phase out medications, my thought is that:
1)you should first know what April 2006 echo shows, (assuming it will show continued excellent EF)and
2)a phased withdrawal; in your case next step 3.125 b.i.d. for two months, then stop, would be safe to try, followed by annual echo, to be sure recovery sustained.

I am grateful for the healing you have experienced.

James

[melissamph]

Thank you for your wisdom and a plan of action. My cardiologist says, "you have great insurance so why not take Coreg forever since it isn't a financial issue?" I will see what he says. I was sooo hoping I was through with ECHO's for 5 more decades (I am 40)! Hahaha! I have just come down to the 6.25 mg bid and my BP is running a bit higher than it was 110/50 and now it can be 120/64. My heart rate stays at 48-54!! At any rate I need to stay on the 6.25 bid for 2 months and then if my doc OK's it down to 3.125 bid for 2 more months. Thank you for the congrats on my weightloss! It has been a hoot! I feel sooooo good and thankful for all the things that it has allowed me to do since I have lost all of my excess weight! I have no more diabetes (no insulin or pills), No GERD, No Asthma, BP is normal and I can play and jog and roll on the floor with my kids! I am so thankful to the Lord above for providing me the desire to get back into shape. One thing for sure it is a lifestyle change for the rest of my life! As always thank you for your encouragement and wisdom. You are a God Send too!!