Reviewing labs

[Deb]

Dr. Fett,
I just received my most current medical records and am reviewing them. I was looking to see if they did the hsCRP test and don't see anything coded like that. Is total protein the same thing or is it listed as something else?

Also, I noticed my creatine phosphokinase level was 556, which is high. What significance is this? This test was done on 03-05-07, 4 days after my ICD was implanted. I don't have any other records showing this test having been done previously, so I have no reference.

One other thing, my BNP had gone down to 36. Now I see that on 01-15-07 it was 157 and on 03-12-07 it was 131. Should I be concerned with this fluctuation or is this normal?

Oh, last question for now, my coreg dose had been increased to 25 mg twice per day. I began to have dizziness and nausea last week. Sunday, my blood pressure dropped to 102/58, normally I'm around 130 - 140/80 - 90. I called my doctor and they've lowered my am dose to 18.75 and 25 mg at night. My HR is still on the high side. Will my coreg be able to be titrated up at a later time or was my reaction an indication that I can't tolerate the higher dose? If they can't increase to a higher dose, what are my options to help lower my HR?

Thank you for your help.

[JAMESFETT]

I think you are coming along fine, and you are working things out with your cardiologist, that is good.

The "blip" in CPK may well reflect the manipulation that occurred with heart and other muscle tissue with the implantation, since CPK will rise with muscle changes. I don't think that is worrisome.

No CPR is not the same as total protein. If you don't find it in the charges perhaps it was never done? Since CPR is a test that can monitor inflammatory process, and since it is very inexpensive, my attitude about it is, "it's never too late to do if one is not yet recovered."

I do encorage periodic monitoring of BNP; and when observed over time it is helpful to know what is happening with the left ventricle.

I would not be concerned about a blood pressure reading of 102/58, and would look at that as within the range of variability. I do watch for symptoms, such as lightheadedness or dizziness with standing upright from a sitting or lying position. That can be a side-effect of medication reflecting blood pressure lowering effect. One can counter that by a slower increase (smaller amount of upward adjustment at a time) of meds, with the first small increase coming at bedtime; and aiming for the highest dose needed to improve function but still being able to tolerate.

You are doing it right, in working this out with your cardiologist.

JD