A contradiction late last night.

[Khonkaen]

After 16 hours of heart/chest pain and unable to sleep I popped down to my local A& E, paid my Eur14 and first saw a nurse who spoke English (I live in central Portugal). He did a BP test (which was lower than the reading on my LIDL tester and normal) quick blood test and an ECG. Then I went to speak to the doctor who had no English, so the advice was given via the nurse. The advice was this.

The new thinking is that you only take antiacid, Pantoprazol, when you need it, she told me to double the 20mg for a week and then stop, until I feel I need it again. Now both the cardios I have seen have merly prescribed the tablets, the more recent visit I was told to change from Omeprazole to Pantoprazol, which he said was stronger, but more compatible with the Ticagrelor I was taking.

To my way of thinking the doctor I saw last night is wrong, because the Ticagrelor is highly corosive and needs a strong antiacid to netralise that. If I stop I will end up with real stomach problems.

I have to say I am okay now, first thing...but hate saying that, you know, tempting fate.

Anyway, no more tomatoes, or acidic red wine.

[Hidden]

After 16 hours of pain I would have definitely tried a nitrate. It’s not unusual to have angina after a cardiac event.

[Khonkaen in reply to Hidden]

Pleae explain "a nitrate" the pain was not constant maybe every hour for 20 minutes and more annoying and worrying than agonising.

[Hidden in reply to Khonkaen]

Of course, because I have been diagnosed with unstable angina after my heart attack and stent I take isosorbide mononitrate. This is a longer acting nitrate instead of a GTN that lasts 30 minutes or so. You mention in the thread, heart pain, which I interpreted as angina pains. That’s why I mentioned nitrates.

The reason why i mention this is because I was given the runaround after my stent and I was still having pain. Being told it’s muscular, it’s stomach acid etc, and because I wanted it to be true I accepted it. I now accept I have ongoing angina issues, possibly in my smaller arteries and the only thing that works is a longer acting nitrate.

[Khonkaen in reply to Hidden]

There seems to be a lot of working stuff out for ourselves, then there is an issue of responibility on any action we take. This half-year time seems to be the difficult period for me..so far.

I think I need to step up my exercise routine, since I am just walking 2-4km/day and a bit of gardening. I fear as these drugs take there toll I need to build a little muscle, this is where the communial aftercare classes would have been handy.

[benjijen in reply to Hidden]

I sooo agree!! I find the same.

[WardijaWardija in reply to Hidden]

Seems I had the same run-around as yourself, after having had 3 stents, with a remaining blocked 4th artery being left as it was deemed to small and narrow to stent. I then went on to have occasional stable angina, for which I eventually prescribed isosorbide 60mgs daily.

I have only been taking it for a couple of days, but on each of the days, I have been experiencing angina some 2 hours after taking it. This seems rather odd to me as previously when not taking the medication, I only had angina on odd days when I over extended myself, certainly not every day.

Any thoughts on this please? I'm confused.

[Hidden in reply to WardijaWardija]

I’m not 100% sure, so I can only comment on my own experience. But as I recall I do remember having a tight chest and a ‘nitrate headache ‘ for a few days after starting it.

[adrian64]

they recently discovered that long term use of ppi's cause absorption problems and can cause electrolyte imbalances, so that might be why they were reluctant to prescribe them long term.

[Speakeazi]

There is also a “theoretical”issue with omeprazole and Clopidogrel and in the past I have been advised that Pantaprazole does not have this theoretical interaction

[Khonkaen in reply to Speakeazi]

You are going have to explain that...........

[Janma123 in reply to Khonkaen]

Omeprazole is thought to reduce the effectiveness of Clopidogrel and there is advice against them being taken together. My hubby was on both for several years and then the Clopidogrel was replaced by aspirin.

[WardijaWardija in reply to Speakeazi]

Hi. I take both omeprazole 40mgs and clopydogrel 75mgs.

Can you tell me what the theoretical issue is please.

[Janma123 in reply to WardijaWardija]

Omeprazole is thought to reduce the effectiveness of Clopidogrel and there is advice against them being taken together. My hubby was on both for several years and then the Clopidogrel was replaced by aspirin.

[WardijaWardija in reply to Janma123]

Thanks. I have not been advised as to this. I am, and have been on ompeprazole 40mgs for many years in respect of a Hiatus hernia. The Clopidogrel only started in July. I've been on asprin 75mg for 18 months.

[Janma123 in reply to WardijaWardija]

Is your doctor monitoring your vitamin b12, folate and vitamin d3 levels as omeprazole reduces the acid in the stomach and prevents extraction of vitamin b12 from food, which leads to deficiency?

[Khonkaen in reply to Janma123]

I had a blood test done about two months ago, my cholesterol was low T=115mg/dl, HDL38, Trig=84 and so was my folic acid at 2.2ug/L. Funnily enough I had another this morning for those two things, get the results on Wednesday before our flight to Thailand.

When I was do my proper vegan thing I got some B12 tablets and have been taking 2 or 3 a week ever since and the last blood test showed normal.

However, I have read B12 and folic acid are linked, or the same?

[Janma123 in reply to Khonkaen]

Vitamin b12 only occurs naturally in animal based foods - meat and offal, fish, eggs, cheese etc and requires a high level of stomach acid to release it from foods. It is then absorbed by another enzyme action in a short length of the ileum. Folic acid is derived purely from vegetable (mainly green leafy) sources.

They do work together and affect a huge range of functions in the body.

[Khonkaen in reply to Janma123]

I eat a lot of leavy green veg, more that I used to thanks to Dr Esselstyn's advice I was following, but still my folic acid level was low. There appears to be a connection between Folic acid and B12, do you know what it is?

[Janma123 in reply to Khonkaen]

I am not an expert but I know the body needs both and iron to make 'proper' red blood cells - a lack of either can make oversized red blood cells that are ineffective oxygen and other nutrient carriers. B12 is also vital for nerve health - a lack of it can cause damage to the myelin sheath meaning the brain and the nerve are unable to communicate properly. Pins and needles, tinnitus, brain fog, sight problems, digestive problems balance issues, fatigue and tiredness (the list is endless) are all symptoms of damage caused by b12 deficiency. It can also be implicated in heart disease and strokes. There is much more information on this on the Pernicious Anaemia Society's forum on healthUnlocked. The UK NHS website also has useful information on b12 and folate deficiencies.

If your diet is rich in folate from leafy vegetables it maybe that you have an absorption problem that you would have to check with your go.

Are you taking pantoprazole? Long term use can cause b12 deficiency. Low stomach acid can cause similar symptoms to high stomach acid - particularly 'heartburn ' and reflux.

Best wishes.

[Khonkaen in reply to Janma123]

My B12 was okay, just folic acid low and I have just changed from Omeprozol to Pantoprazol, which I was told was more compatable with Ticagrelor.

I will know on Wednesday if my folic acid has improved and I see my Thai cardio when I get back later this week.

[WardijaWardija in reply to Janma123]

Hi. I doubt it very much - I live in Malta and the health service is a very far cry from the NHS 🙄 . . . But thanks for drawing my attention to this, I will bring it up with my consultant here at my next O/P appointment.

[Khonkaen]

What do you think about taking a double dose of Pantoprazol 20mg. Is anyone taking 40mg?

[Jimmy-45 in reply to Khonkaen]

STEMI to the median RCA beginning of March. Had an elective stent put in to the proximal LAD end of July, so 2 stents thus far. I have diffused CAD with the LAD D2 occluded at 99% and the distal RCA at 80%. Cardiologists here in Aveiro (an hour from you) have thus far refused to perform any further intervention and will only do so when symptoms deteriorate.

In fact, the second stent was done in Porto through a friend who thought his colleagues in Aveiro irresponsible.

The reason I'm mentioning all this is because I've been symptomatic since the MI. However, tests thus far have been inconclusive and they have attributed the symptoms to anxiety and more recently, digestion and/or hormonal.

Therefore, I have been on 40mg of Pantoprazol twice a day (80mg) which they have prescribed for 4 weeks. I stopped after 2 because my potassium and magnesium levels went below the lower limits. Had odd sensations and discomfort during that 2 weeks on it. I'm back on my regular dosage of 20mg once a day.

The efficacy of Pantoprazole in my particular case is dubious, I think. Next would probably be an endoscopic test for H. Pylori and a thyroid test thereafter if the former is ruled out, as advised by the doctors.

Like you, I continue to suffer heartburn, acid reflux like type of pains in my epigastric region together with nausea and dizziness which can be intense on bad days.

It has been a daily struggle. It's real but unless you actually experience it, it's hard for anyone to understand. I hope it gets better for all of us suffering with chronic illnesses. It literally takes the life out of you.

[Khonkaen in reply to Jimmy-45]

That's really tough. I cannot see the logic of going from 20mg to 80mg in one step. but what do I know, especially since as I understand they are used to combat the corrosive effects of the Ticagrelor blood thinners? The guy in Aviero does sound a bit of a dick.

There has been a bit of a brain drain in Portugal to higher paying countries like the UK, the people I saw were in Coimbra, where they seem to know what they are doing. I would try to see someone there if you can, I was told they were one of the best in Pt.

I hope things get straightened for you and you begin making progress, if you call 112 they may send you to Coimbra. It is worth a try.

Do you speak Portuguese?

[Jimmy-45 in reply to Khonkaen]

Hi, Aveiro has no cath lab. In fact, when I turned up at the A and E, I was immediately transferred over to Coimbra for the procedure and sent back to Aveiro. Protocol in Portugal is to resolve the MI and defer to the cardiologists in your area of residence who will decide on any further intervention if necessary.

Yes, I do speak Portuguese but badly.

[Speakeazi]

There is more than an idea that taking the two together will negate the effect of the Clopidogrel. If you Google it, you will find lots of reliable papers on it.

[MountainGoat52]

Reading your account, I wonder something has been lost in translation. Could it be that you were requested to double the Pantoprazole for one week, then stop the doubke dose and revert to your normal dosage? Just a thought.

[Khonkaen in reply to MountainGoat52]

I thought that and kept asking the question and kept getting the same answer, but I think your interpretation is the same as mine, it is the only logical one.

Nyway yesterday I stuck with one and had a resaonable day bodywise but as the day went on the brain got effected, slight crazies, a bit of deep braething helped and as it was soon 8pm got an idea. I was told I could take two of my Lora-ze-pam. These are for sleep and anxiety, slept for 11 hours and feel better this morning.

I know I cant do that too often so need some stress management and keep away from depressing bad news which seems to be everywhere nowadays. I love music, but all my favourites are dead, which I often think about and I watched a documentary of the Travelling Wilburys. 3 out of thiose 5 are gone.

Myabe I will start a happy news thread.

[Trishe]

Hi HiddenI was in hospital in February with unstable angina and had a stent fitted, I was on ticagrelor 80mg, I couldn't get on with it so they changed it to clopidogrel, much better now and pantoprazole, ask your gp if you can change to clopidogrel.

Good luck

Trish