SlappyMc

As someone mentioned, how much salt is in your diet? Since your body will try balance the salt with more water, so higher/larger blood volume, which means higher BP. I am 62. Had a left ACA stroke in June 2020. Put on lisinopril and atorvastatin. When finally home after rehab did more online research and two changes in meds. First, if one reviews the statin literature most humans experiencing mental issues are on something like atorvastatin, which is fat (lipid) loving statin and so has an easier time making it into one's brain. So asked for and switched to rosuvastatin (a water loving statin)(not an easy call, since the three doctors who offered their opinion said that the clot originated inside my brain and so if rosuvastatin has a harder time making it there...)(that risk versus possible mental issues from a fat (lipid) loving statin). The first change was my BP med. Some have mentioned everything but indapamide. Since you are not in the US, should be able to obtain the time-release version (no time-release in the US). For a big reason for my insistence: https://www.eshonline.org/esh-content/uploads/2019/07/4.-Redefining-diuretics-use-in-hypertension-why-select-a-thiazide-like-diuretic.pdf Solves the salt leading to high BP problem by removing the salt, which you pee out, so a diuretic. Taken first thing in the morning. In the US, they want a systolic of 130 or lower. These fellows here say that they are modeling the data wrong: https://www.math.ucla.edu/~scp/publications/mortality.PDF So, according to them not log linear but instead horizontal splines. May just be me but I'm going with the math/stat heads. They wrote a subsequent paper on diastolic and 90 is the correct number, though perhaps med intervention not warranted until 94. See: https://www.math.ucla.edu/~scp/publications/dbp Now on to the surrogate marker that is BP, maybe it is not, repeat not the BP. As there are these things called pleiotropic effects, which for indapamide means (from the eshonline piece above): Lastly, indapamide appears to reduce oxidative stress, whereas chlorthalidone and HCTZ do not [107–109]. As the endothelium mediates direct vasodilation at least in part by responding to nitric oxide, beneficial cardiovascular effects of indapamide may also be related to improvements in endothelial function, which, in turn, improves vasomotor tone, arterial stiffness and remodeling, inflammation, and target organ damage. As well: Not only the antihypertensive efficacy of indapamide and HCTZ has been compared. In a small study that specifically compared the metabolic and endothelial effects of indapamide retard with those of HCTZ, patients with hypertension received either indapamide retard (1.5 mg/day) or HCTZ (25 mg/day) for 12 weeks. At the end of the study, both drugs reduced BP levels to a similar extent. However, whereas indapamide retard was metabolically neutral, the patients who received HCTZ showed a significant increase in triglycerides (+15.3%, P<0.05) and glucose levels (+12.2%, P<0.05). Moreover, there was a tendency for endothelium-dependent vasodilation to improve with indapamide and become worse with HCTZ. See: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4142573/ Now back to the other important part of the eshonline piece: Both treatments had significant effects on stroke and on the composite endpoint (stroke and coronary heart disease). Similar results were obtained by the United Kingdom National Clinical Guideline meta-analysis for stroke (significant versus placebo for both treatments) and all-cause mortality (only significant versus placebo for indapamide)[2]. Coronary heart disease, however, was significantly reduced with indapamide, but not chlorthalidone [2]. First, read the paper, since a split when it comes to heart disease (I omitted part). Now note the all cause mortality, since one can die from anything. From another paper: In relatively diverse patient populations, long-term indapamide treatment provided a 15% risk reduction in all-cause mortality, a 21% reduction in cardiovascular death and a 37% reduction in fatal stroke. See: https://journals.lww.com/jhypertension/Abstract/2019/07001/BENEFIT_OF_INDAPAMIDE_BASED_TREATMENT_ON.143.aspx Will remain forever convinced that has zero to do with BP and everything to do with helping endothelial cells, etc., aka those pleiotropic effects. For the same reason I am not taking a statin merely to lower my LDL. Instead, plaque usually comes with a lipid core, which means it's prone to rupture. Statins calcify the lipid core and so less likely to rupture. Again, pleiotropic effect and all that. But did not give up lisinopril, instead halved the dose, which I take about two hours before bed. As for why: Shortly after the study [PROGRESS] was published, an editorial (in line with a small number of earlier critical letters and commentaries2-4) in the American Journal of Hypertension stated explicitly the two major problems with PROGRESS. Firstly, it is illogical and misleading to combine two treatment arms that have significantly heterogeneous results—if the findings from two trial arms differ substantially “then the findings need to be presented separately and interpreted separately”; secondly, “the major limitation of the PROGRESS trial was the failure to include a group randomized to indapamide alone.”5 These editorialists speculated that indapamide alone may have reduced stroke by as much as 38% (43% for the combined therapy minus 5% for perindopril alone), which would be consistent with the 34% risk reduction seen with low dose diuretics in the primary prevention setting6 and the 29% risk reduction seen with indapamide alone in the post-stroke antihypertensive treatment study (PATS).7 However, from the design of PROGRESS, one cannot know whether the benefit seen with combination therapy is due to indapamide alone or to an additive or synergistic effect of indapamide with perindopril. What is clear is that the benefit is not attributable to perindopril alone [that 5% was not clinically significant aka no better than placebo]. The same editorial also argues that the blood pressure differences between the two arms (5/3 mm Hg for perindopril alone v 12/5 mm Hg for the combined therapy) are unlikely to explain the large difference in stroke reduction.5 For example, the blood pressure reduction with indapamide alone in the PATS trial was only 5/2 mm Hg, less than the reduction seen with perindopril alone in PROGRESS. Yet indapamide alone in PATS was associated with significant stroke reduction, while perindopril alone in PROGRESS was not. That last is the part where surrogate marker comes in, since perindopril alone reduces BP more than indapamide alone yet perindopril alone does near nothing to prevent recurrent stroke (that was the PROGRESS trial)(PATS was the Chinese version for recurrent stroke). For how f'd the whole thing, why was there no indapamide alone arm in PROGRESS? Because the makers of perindopril knew that indapamide does the heavy lifting? So take the combo pill, now that the patent for perindopril has expired. Why the article references the false/misleading claims. So half the dose of lisinopril since maybe there is that synergistic effect. Thank Deity it's cheap. Oh, and not that this helps you, but here in the US, the not time-release indapamide can be bought, a 90 day supply, for 10 dollars at Walmart. Lastly, some say, but I don't/didn't feel excited. Which may mean nothing. Since one can still be excited. Even with rest (white coat effect). Sorry, for one more, know near zero about heart attack, since never had one, but once you've had a stroke, if you have any symptom that can mean stroke, cue both CT and MRI. Which I had in mid-October 2022. No further stroke damage. Indapamide, the miracle pill. And to put that in context, from October 2022, note the left ACA stroke damage, and all the other stroke damage from before that: No evidence of acute infarct or acute intracranial hemorrhage. Multiple old infarcts involving bilateral cerebellum with some old petechial hemorrhages. Old cortical infarcts involving the bilateral posterior frontal, parietal [left frontal and parietal are left ACA] and right occipital lobes with encephalomalacia and old petechial hemorrhage. Old infarct with encephalomalacia of the anterior corpus callosum. Patchy white matter lesions are seen in bilateral cerebral hemispheres likely representing moderate to severe chronic small vessel ischemic changes [cue greater risk of dementia]. No significant mass effect or midline shift. The ventricles and extra axial spaces are within normal. Fluid in the left maxillary sinus. The mastoid air cells are clear. Visualized orbits are within normal. Visualized vessels demonstrate normal flow-voids. By the time I'd my left ACA I'd had all of that other stroke damage. Seems that the right frontal/parietal was damage to a non-functional area since my left leg is the same as it ever was. Re my right occipital lobe, had an M.D. eye test in connection with DL renewal and my vision is 20/20 and I can at least discern green, red and yellow. Re that fluid, the provisional diagnosis of peripheral vertigo became the discharge diagnosis once both the CT and MRI came back negative for stroke. Anyway, watch the salt and see the monks re meditation.

Delusion? You mean like dark energy and dark matter? How many more ad hoc hypotheses will you need? Oh, it's matter alright, the overwhelming majority, and never mind that it neither emits nor absorbs radiation. Neither does my God. Some of us instead have the no control model: Do you think that these Galileans were worse sinners than all the other Galileans because they suffered in this way? No, I tell you; but unless you repent, you will all likewise perish. Or those eighteen on whom the tower in Siloam fell and killed them, do you think that they were worse offenders than all the others who lived in Jerusalem? No, I tell you; but unless you repent you will all likewise perish. Both those Galileans and the eighteen were dead, no changing that, and not because they were in any way worse humans than some others. Which is not to excuse many of the faithful, since you have heard it said, but for the grace of God there go I, which must mean that those on the receiving end of calamity/disaster did not enjoy the grace of God, right? Some well and truly do not understand what they say. For more of that, did you know that the US was all sweetness and light until the Euros came? Is why the one gravestone at Little Big Horn reports that US Indian Scout Sgt. Bobtail Bull died defending the Arikara way of life. As for why my particular faith, recall the West Wing: This guy's walking down the street when he falls in a hole. The walls are so steep he can't get out. A doctor passes by and the guy shouts up, Hey, you, can you help me out? The doctor writes a prescription and throws it down the hole and moves on. Then a priest comes along and the guy shouts up, Father, I'm down in this hole, can you help me out? The priest writes out a prayer, throws it down in the hole and moves on. Then a friend walks by, Hey, Joe, it's me, can you help me out? And the friend jumps in the hole. Our guy says, Are you stupid, now we're both down here? The friend says, Yeah, but I've been down here before and I know the way out. Now on to that other Paul, Christ died once for all. And so, since some complain about death, as in killing, do you think there'd be much of that if whenever one was in the presence of some other human, one recalled, Christ died once for all? We might want to go with telfillin, as in: And it shall be a sign for you upon your hand, and for a memorial between your eyes, that the law of YH-H may be in your mouth; for with a strong hand did YH-H bring you out of Egypt. What is Egypt? That iron furnace aka sin, that house of bondage aka captivity in that sin? Here I thought that Christ means born again. In other words, I too was in Egypt once. So gonna need telfillin. So I don't ever forget that Christ died for you. By the way, I am admittedly an arch-heretic. Not a pride thing, simply how it turned out. Life would be so much easier if I was not that. The problem is otherwise not limited to religion but much else as well. As if it was Sunday school, taught by authority, and thereafter humans spend their entire lives never checking to see if what they were taught is true. Recall all of the continued racism after the US Civil War. Was no one listening to Howell Cobb? If blacks will make good soldiers our whole theory of slavery is wrong. Sadly, some never learn their lesson. For the bonus freebie, did you know that the trifecta of disadvantage owns God? Read Genesis 1, God called to the dry land, earth, etc. As in, the act of naming implies ownership. I am 'el-Shaddai, walk before me and be blameless. God naming God. Yet this certain human, a female, from Egypt, not free, aka the trifecta of disadvantaged, owns God...you are 'el-Roi, the God who sees me. Genesis does not report that God has any problem with Hagar staking her claim to ownership. There's a lesson there...

Yes and no. Yes, Manila overall re med care but that does not mean that there are not locales with at least decent (by US standards) care. Re Cebu, one will be fine at Chong Hua Hospital. Re Iloilo, perhaps, if needed, The Medical City, St. Paul's Hospital, or Qualimed Women's And Children's Hospital. Next, they aren't working overseas for health care but instead for jobs (and jobs that pay better than in the PI). Lastly, for the OP, not that anyone sane wants to live in Manila, but if your health well and truly matters then somewhere near either St. Luke's in Quezon City or BGC, or close enough to about a handful of facilities in Makati. Also, depends on what exactly is wrong with you. Since some facilities overall are not all that but may do one, a couple, or a few things rather well. Now to end where I began, sorry, but St. Luke's and a handful in Makati are as good as just about anywhere else in the world. Why some of us here in the US write our US elected reps asking that the law be changed to allow use of Medicare overseas at approved facilities. I mean, it's not like there's not something reasonably close: https://tricare.mil/selectoverseas

Cue the Ramones..DDT did a job on me...

Hopefully they get this sorted by 2030. And perhaps a 30 day extension. Since would mean, 90 days Da Nang, 90 days Jomtien, 90 days Nha Trang, 90 days Cha-am/Hua Hin. Wash, rinse, repeat. Almost, since owing to only the 2x visa exempt per year, when the calendar mandates such, then a month in either Phnom Penh or Vientiane.