Medical Journal: 9/20/18

Dr. Weiss prescribed Entresto, a combination of two drugs neither of which I understand, to try to get my heart back in action. The first I knew of that was when I showed up at CVS to pick up another prescription. So I had no briefing about how to take it, what side effects to expect, etc. I talked with the pharmacist, who told me to go off Losartan, since one of the drugs in Ernesto works through the same mechanism. Indeed, he recommended that I take a three-day break from Losartan before starting Entresto; apparently the interaction risk is hypotension. Read the PPI, which told me Entresto tends to raise potassium levels, and my potassium was already at the top of the normal-limit range. Delighted not to eat avocados, but I’ll miss spinach, bananas, potatoes, and sweet potatoes. This is not the first time Dr. Weiss has prescribed something without telling me about it: not a good practice.

Went home and took my first dose. Within 90 minutes I felt much better. Can take a full slow inhale-exhale. Walked about 1/10th of a mile at full pace; at the end, I was breathing fast, but felt fine. Slept almost 12 hours without any breathing problem.

Weighed myself and I’m five pounds down from yesterday; the radiation oncology team pointed out to me that the swelling in my feet and legs probably meant that I was retaining water throughout the body, and asked me whether I had gained weight. I had: I was up to 250 from a trough of 235. However, the foot and leg swelling is still very marked (to the point where it keeps me from fully rotating the right foot up and down) not obviously improved from yesterday.

Got up this morning and took Entresto (Rx is for twice a day) and isosorbide; didn’t take the hydralazine because it has to be taken with food and I felt slightly queasy. It’s now 2pm and I still haven’t taken it, and my breathing is still fine. On the other hand, I’m feeling a little bit dazy –not too much to work, but clearly not 100% mentally –and there’s a fairly loud ringing in my ears. Hoping these are transitional effects and will subside. Called Dr. Weiss’s office to make an appointment and was offered next Thursday; asked to have him call me.

Despite the daziness, it’s hard to express how much better I feel.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact: