Coumadin diet

Hey guys
Sorry for the long post.
I am a 35 yo male with a severe mitral regurgitation with a prospect of surgical mitral valve repair in the next 1-2 years or (I think more likely mitral valve replacement), condition is genetic.
During the last cardiology checkup, my cardiologist was not there as she was ill but there was an internist with whom I discussed the blood results and she mentioned that I might be taking statins after the surgery but of course and that my lipid panel is not ideal, but the decision will be upon my cardiologists.
For the last 5 years, I have been taking ACE-inhibitors (perindopril 2 mg first 2 years, then 4mg last 3 years) + Beta-blockers last 3 years (first year 25 mg metoprolol, then 37.5 mg metoprolol daily). On top of that, I take corticoid sprays for allergy and antihistamines.
My current height is 175 cm (5' 9"), current weight is 77 kg (170 lbs), evolution of my weight: Jan 2020 - 66kg (145 lbs), Jan 2021 - 68 kg (150 lbs), Jan 2022 - 70 kg (154 lbs), Jan 2023 - 75 kg (165 lbs), Jan 2024 - 77 kg (170 lbs). Blood pressure: Till 2022 around 110/70 mm Hg, Last 2 years - around 130/75 mm Hg
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My blood test results through the years:
https://preview.redd.it/0x63d98sgzlc1.png?width=2499&format=png&auto=webp&s=d9fc356eb800e9b340fccbb316b0f0b06d1e1b3b
To be honest, I'm not really happy about potential "threat" of taking of statins for the rest of my life. I'm afraid that it will solve one problem but will add others (like worsening alergy that is common with statins or nasopharynx inflammation which I fought for years and finally it was solved by tolsils removal in 2018 and special immunology medication every autumn (porc transfer factor) or damaging my liver long term). If possible, I'd like to live to at least 65 years if possible but who knows... My paternal grandma died at the age of 40 (myocard infarction), paternal grandpa of 52 years of lung cancer, my father at the age of 55 (myocardial infarction), my maternal grandpa died at the age of 69 (lung cancer) and maternal grandma of 83 yo of high age.
My biggest problem as of recent years is fatigue due to heart medication to the point that sometimes I've got problems to be functioning well in my daily life. I'm afraid statins will make my fatigue worse and it would be difficult to get out of the loop. And to be honest, if I am to be like a zombie for the rest of my life, I would rather live full life and die sooner. My father was taking them last year before death and it played with his glucose levels somewhat. Plus, I will be taking warfarin (coumadin) for the rest of my life after surgery in case of valve replacement.
My plan is to revert going downhill with LDL by:

1. Getting more physical active - I used to go to the gym regularly, cycle regularly, but since coronavirus period I got more lazy and for the last 1-2 years I have less and less movement and I was at the gym last time maybe half a year ago and last year, I was cycling somewhat less than before. Also, I have been remote at work for the last 2 years and sometimes my only movement most days is from the couch to the bed :-( I also plan to go to the office at least 3x / week on foot (40 min walk: 3.5 km (2.2 miles)
2. Changing the diet: I have been skinny/slim all my life up until 34 yo and then I put on weight quickly so I never restrained my diet. I don't eat neither too unhealthy, neither too healthy - I eat lot of meat, but normally it's chicken, sometimes pork or beef although I do crave fatty things like salami or cheeses or chips :-(. I would try to substitute meats by legumes which I like and more vegetables. Also, I eat relatively a lot of sugar like chocolate bars, 500 ml of soft drinks around 5 times per week etc.

Question: Should I push back to my doctor when it comes to statins and try to change lifestyle and diet first, or just surrender and take potentially life long journey of statins? Is there something else I can try what was not mentioned?
Also, any opinion to anything I wrote welcome
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My father just had several teeth extracted and needs to go on a liquid diet, I was going to give him a bag of Soylent to try to see if he likes it to supplement his nutrition. However, I was reading the back and it says “consult a healthcare practitioner prior to use if you are taking blood thinners (e.g. Coumadin)”
My dad is in his mid 60s and taking a baby aspirin since he had an eye stroke a few years ago. Would it be safe to let him try a bag? I’m not sure if aspirin counts as a blood thinner, or why this disclaimer is there.

My father (58Y) will undergo surgery this week for the third time, the doctors will replace is biological valve (because of a endocarditis) and now the question is: biological or mechanical? The doctors are asking him to decide which kind of valve does he wants.
The mechanical valve (St. Jude type) have one big advantage: it could be his last open hearth surgery (a fourth open heart surgery would be very risky) because this type of valve could last his whole life.
The main problem here is that with the mechanical valve he will have to take anticoagulants (and not any anticoagulant but warfarin, here it is distributed by the brand Coumadin) each day for the rest of his life and he will have to adapt heavily his lifestyle (the diet can affect the anticoagulant effect and a for example some sports can be risky if you take anticoagulants).
He worked his whole life, he is so close to retire and he will like to be able to travel the world as free as possible when he does.
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The question is: is there someone here that is young (less than 60 years old) and has experience living with a mechanical valve and anticoagulants? Is it true that the diet for example affects so heavily the anticoagulant effects? How can you adapt when you are travelling? Are you able to travel abroad as much as you like or there are big limitations that came with the anticoagulant therapy? We would really appreciate your feedback!

My partner is on lifelong warfarin after an episode of 25+ PE several yrs ago due thrombophilia (F5 and PGV). Initially, they were followed by hematologist, then the primary care dr took over with monthly INR, monthly call from pcp nurse asking if any doses had been missed, dietary changes, then another call after nurse discussed with pcp advising dosage, etc.
We moved a couple of yrs ago, decided to let our new pcp handle coumadin, inr, etc. Well, the new pcp seems basically hands off. He orders coumadin prescription, but the office never bothers to call my partner about reminders for blood draws, never calls us to give results, or ask questions about diet, etc. We only get blood work when partner remembers, which their memory is good.
My question is in the presence of thrombophilia who handles your coumadin? Hematologist? PCP? Pulmonary? Cardiologist? This pcp office just seems so loosey-goosey

Facts of Case:Age: 60 yo, M, (6'1'', 250 lbs / 1.8M 113 kgs), WhitePrimary Complaint: Black mark on back of neck https://imgur.com/a/1EM8olW ; NeuropathyDuration: >1 yr (Mark first noticed in 2018)Existing Medical Issues: Atrial Fib Diagnosis 2008; Unsuccessful Cardiac Ablation 2009; re-entered atrial fib, did not re-attempt procedure; Obese; Likely Pre-Diabetic / Untreated Diabetes; History of Mental Illness (Depression / Narcissistic Personality Disorder); History of Poor Diet, ExerciseCurrent Medications: Coumadin (10 mg / day); Tylenol (as needed to treat neuropathy)Habits: Drinks, does not smoke, does not use recreational drugsFamily History: Heart attack / Quadruple bypass (Father); Diabetes (Father); Obesity (Father, Mother); History of moles, freckles, growths, and skin tags (Mother); Alcoholism (Mother)Questions:

1. Is the black mark likely melanoma? If it were and the photo was taken in 2018, what is likeliness of positive prognosis if immediately removed within a year?
2. Is melanoma caused by atrial fib or is it that they are coprevalent due to similar risk factors?
3. Is it possible for melanoma to spread to the heart? If this were the case, wouldn't the patient be in stage IV? Isn't cardiac metastasis rare and most often diagnosed post-mortem?
4. Is it more likely that neuropathy is caused from untreated diabetes vs. melanoma?

Edit: This is the medical history of my father. Unfortunately, I also have a spot on my arm that is black, discolored, and given the medical history above, I intend to get it checked out ASAP before it gets bigger. That said, based on the photos, do you think that this melanoma and has the potential to have spread aggressively if it weren't treated in a year? OR, if based on the photo and that the spot in question was removed, is it fair to say the prognosis is likely positive or dire?
Thanks for your insight.

My brother (73) was diagnosed last month. A rather routine urinalysis showing a little blood led to an ultrasound and a CT which found the metastases and the pancreatic tumor. He was told on Monday he probably had 3 to 4 months to live since he's already having some negative signs and symptoms. The worse of his problems are blood clots. He had been on Xarelto for years because he has Afib. When the cancer was found, that accounted for the new clotting and mini-strokes he had early in the summer. Since the PC was found, he's been on Coumadin and/or Lovanox injections(heparin).
Monday he met with the oncologist for the first time and was given the option to start chemo tomorrow or to say "no". Leg swelling that day, led to another test to see if he had blood clots in the leg. -- Yes, he did. Meaning he had to stop the Coumadin and go back on heparin at a higher dose.
The tumor board met again today and reviewed his case again. He had decided against doing chemo which was good, because the board took that off the table due to his continued clotting problems.(Chemo would just exacerbate the problem.) Since the blood thinners are not working, they are stopping them completely immediately. Hospice is being arranged to start tomorrow. (That was to bein very soon anyway.) Now, it's a matter of hours or days before a thrombosis will kill him.
My "other" SIL and I were talking yesterday and both thought the same thing at the same time. -- That the "best" way to go might be a big, big clot. Versus getting sicker and sicker and just waiting for the 3 or 4 months to play out. That's what is really happening now.
I'm not a religious person, but I'm praying he goes quickly and all at once. (Not having a stroke and lingering even hours.)
To look at him, you wouldn't think he was sick at all. He's been feeling mostly "ok" too. A bit nauseous at times and feel full soon after beginning to eat. Some weight loss. (He thought that was a good thing related to adjusting his diet earlier in the summer.) There is nothing "fair" about any cancer or illness. This cancer is definitely one of the worst I've ever seen or heard of.
Now--- it's just a matter of time and keeping my phone close to me, turned on and the volume up. Not sleeping well, I'm sure.

What's ciprofloxacin ?
Ciprofloxacin is a fluoroquinolone (flor-o-kwin-o-lone) antibiotic, it is used to treat unique kinds of bacterial infections. It's also used to treat humans who have been uncovered to anthrax or certain varieties of plague. Ciprofloxacin extended-launch is most effective accredited to be used in adults.
Fluoroquinolone antibiotics can motive severe or disabling facet consequences that might not be reversible.
Ciprofloxacin ought to be used only for infections that can not be treated with a more secure antibiotic.
Warnings
Ciprofloxacin can cause serious aspect results, which includes tendon troubles, nerve damage, extreme temper or conduct modifications, or low blood sugar.
Prevent the use of ciprofloxacin and phone your medical doctor at once if you have: headache, hunger, irritability, numbness, tingling, burning ache, confusion, agitation, paranoia, problems with reminiscence or awareness, thoughts of suicide, or sudden pain or motion problems in any of your joints.
In uncommon instances, ciprofloxacin may additionally reason damage in your aorta, that could cause dangerous bleeding or dying. Get emergency medical help if you have intense and steady pain on your chest, belly, or lower back.
You may no longer be able to use this medicinal drug if you have a muscle ailment. Tell your medical doctor if you have a history of myasthenia gravis.
Earlier than taking this remedy
You must not use ciprofloxacin if you are allergic to it, or if:
You also take tizanidine; or
You are allergic to other fluoroquinolones (levofloxacin, moxifloxacin, norfloxacin, ofloxacin).
Ciprofloxacin may also motive swelling or tearing of a tendon (the fiber that connects bones to muscle tissues within the frame), specially in the achilles' tendon of the heel. This will occur during treatment or several months when you stop taking ciprofloxacin. Tendon problems can be much more likely in youngsters and older adults, or folks that use steroid medicine or have had an organ transplant.
To make sure ciprofloxacin is safe for you, inform your medical doctor when you have ever had:
Arthritis or problems with your tendons, bones or joints (specially in children);
Diabetes, low blood sugar;
Nerve troubles;
An aneurysm or blood flow problems;
Coronary heart problems, or a coronary heart attack;
Muscle weak point, myasthenia gravis;
Liver or kidney disorder;
A seizure, head injury, or brain tumor;
Problem swallowing tablets;
Lengthy qt syndrome (in you or a family member); or
Low stages of potassium in your blood (hypokalemia).
Do not deliver this remedy to a child without clinical recommendation.
It isn't always known whether or not this medicine will harm an unborn child. Inform your health practitioner in case you are pregnant.
You must now not breastfeed even as taking ciprofloxacin and for 2 days after your ultimate dose. Ask your physician approximately breastfeeding if you take this remedy for anthrax exposure.
How should i take ciprofloxacin?
Take ciprofloxacin exactly as prescribed by way of your physician. Follow all instructions on your prescription label and study all medicine publications or coaching sheets.
Take ciprofloxacin on the same time every day, without or with food.
Shake the oral suspension (liquid) for 15 seconds before you measure a dose. Use the dosing syringe furnished, or use a medicinal drug dose-measuring device (not a kitchen spoon). Do not provide ciprofloxacin oral suspension thru a feeding tube.
Swallow the prolonged-launch pill entire and do no longer weigh down, chew, or wreck it.
Drink masses of drinks even as you are taking this medicine.
Use ciprofloxacin for the full prescribed duration of time, even in case your signs and symptoms speedy improve. Skipping doses can growth your threat of infection that is resistant to medication. Ciprofloxacin will not treat a viral infection which includes the flu or a commonplace cold.
Do now not share this remedy with any other person.
Store at room temperature away from moisture and heat. Do now not permit the liquid remedy to freeze. Throw away any unused liquid after 14 days.
What to avoid
Do now not take ciprofloxacin with dairy products which include milk or yogurt, or with calcium-fortified juice. You could consume or drink those merchandise along with your food, however do not use them by myself while taking this medicinal drug.
Antibiotic drugs can reason diarrhea, which can be a sign of a new infection. When you have diarrhea that is watery or bloody, call your health practitioner before the usage of anti-diarrhea medicine.
Ciprofloxacin may want to make you sunburn extra without difficulty. Keep away from sunlight or tanning beds. Put on shielding apparel and use sunscreen (spf 30 or better) while you are exterior. Inform your physician when you have severe burning, redness, itching, rash, or swelling after being inside the solar.
Keep away from using or unsafe interest till you know how ciprofloxacin will have an effect on you. Your reactions may be impaired.
Ciprofloxacin facet outcomes
Get emergency clinical help when you have signs of an hypersensitive reaction to ciprofloxacin (hives, difficult respiratory, swelling to your face or throat) or a excessive skin response (fever, sore throat, burning to your eyes, skin pain, red or crimson pores and skin rash that spreads and reasons blistering and peeling).
Ciprofloxacin can motive severe aspect results, which includes tendon troubles, harm for your nerves (which may be permanent), serious mood or conduct adjustments (after simply one dose), or low blood sugar (that can cause coma).
Stop taking this remedy and make contact with your health practitioner at once if you have:
Low blood sugar - headache, starvation, irritability, dizziness, nausea, rapid heart charge, or feeling shaky;
Nerve damage signs and symptoms - numbness, tingling, burning pain on your fingers, hands, legs, or ft:
Extreme temper or conduct adjustments - anxiousness, confusion, agitation, paranoia, hallucinations, reminiscence troubles, problem concentrating, thoughts of suicide; or
Symptoms of tendon rupture - surprising ache, swelling, bruising, tenderness, stiffness, movement problems, or a snapping or popping sound in any of your joints (rest the joint until you receive hospital therapy or commands).
In uncommon instances, ciprofloxacin may additionally purpose damage for your aorta, the main blood artery of the frame. This will result in dangerous bleeding or demise. Get emergency scientific help if you have excessive and constant pain on your chest, belly, or returned.
Additionally, prevent using this medication and speak to your health practitioner immediately when you have:
Severe belly ache, diarrhea this is watery or bloody;
Rapid or pounding heartbeats, fluttering for your chest, shortness of breath, and unexpected dizziness (like you would possibly pass out);
Any skin rash, regardless of how mild;
Muscle weak spot, respiration issues;
Little or no urination;
Jaundice (yellowing of the pores and skin or eyes); or
Multiplied pressure within the skull - extreme complications, ringing on your ears, dizziness, nausea, imaginative and prescient troubles, ache at the back of your eyes.
Commonplace ciprofloxacin facet consequences may include:
Nausea, vomiting, diarrhea, stomach ache;
Headache; or
Extraordinary liver characteristic tests.
Remedies
Bladder infection
Ciprofloxacin
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Ciprofloxacin
Widely wide-spread name: ciprofloxacin (oral) [ SIP-roe-FLOX-a-sin ]
Brand names: cipro, proquin xr
Drug elegance: quinolones
Medically reviewed through kaci durbin, md. Closing updated on sep 30, 2021.
Makes use of
Warnings
Earlier than taking
Aspect consequences
Interactions
Dosage
Faq
What's ciprofloxacin?
Ciprofloxacin is a fluoroquinolone (flor-o-kwin-o-lone) antibiotic, it's far used to deal with one-of-a-kind varieties of bacterial infections. It's also used to treat humans who've been exposed to anthrax or positive varieties of plague. Ciprofloxacin prolonged-launch is simplest permitted to be used in adults.
Fluoroquinolone antibiotics can reason critical or disabling side outcomes that might not be reversible.
Ciprofloxacin ought to be used only for infections that can not be dealt with with a more secure antibiotic.
Warnings
Ciprofloxacin can purpose critical facet consequences, which includes tendon issues, nerve damage, serious temper or behavior changes, or low blood sugar.
Stop the usage of ciprofloxacin and get in touch with your physician at once if you have: headache, starvation, irritability, numbness, tingling, burning pain, confusion, agitation, paranoia, troubles with memory or attention, thoughts of suicide, or surprising pain or motion troubles in any of your joints.
In uncommon instances, ciprofloxacin may additionally reason damage on your aorta, that may result in dangerous bleeding or loss of life. Get emergency medical help when you have severe and steady pain on your chest, stomach, or again.
You can now not be able to use this remedy when you have a muscle disorder. Inform your doctor when you have a history of myasthenia gravis.
Earlier than taking this medication
You have to no longer use ciprofloxacin in case you are allergic to it, or if:
You furthermore mght take tizanidine; or
You're allergic to different fluoroquinolones (levofloxacin, moxifloxacin, norfloxacin, ofloxacin).
Ciprofloxacin may also reason swelling or tearing of a tendon (the fiber that connects bones to muscle tissues inside the frame), particularly within the achilles' tendon of the heel. This will manifest in the course of remedy or numerous months after you prevent taking ciprofloxacin. Tendon problems can be more likely in youngsters and older adults, or people who use steroid medicine or have had an organ transplant.
To make sure ciprofloxacin is safe for you, tell your health practitioner if you have ever had:
Arthritis or problems with your tendons, bones or joints (specifically in youngsters);
Diabetes, low blood sugar;
Nerve troubles;
An aneurysm or blood circulate problems;
Heart troubles, or a heart assault;
Muscle weak point, myasthenia gravis;
Liver or kidney ailment;
A seizure, head harm, or brain tumor;
Problem swallowing capsules;
Lengthy qt syndrome (in you or a member of the family); or
Low ranges of potassium in your blood (hypokalemia).
Do now not deliver this remedy to a baby with out medical advice.
It is not regarded whether this medicinal drug will harm an unborn baby. Tell your medical doctor in case you are pregnant.
You have to not breastfeed at the same time as taking ciprofloxacin and for 2 days after your final dose. Ask your physician approximately breastfeeding if you take this medicinal drug for anthrax publicity.
How need to i take ciprofloxacin?
Take ciprofloxacin precisely as prescribed through your health practitioner. Comply with all guidelines for your prescription label and examine all medicinal drug courses or education sheets.
Take ciprofloxacin at the equal time every day, without or with meals.
Shake the oral suspension (liquid) for 15 seconds before you measure a dose. Use the dosing syringe furnished, or use a medication dose-measuring device (no longer a kitchen spoon). Do not deliver ciprofloxacin oral suspension through a feeding tube.
Swallow the prolonged-release pill entire and do no longer crush, chunk, or break it.
Drink plenty of beverages while you're taking this medication.
Use ciprofloxacin for the whole prescribed length of time, even in case your signs and symptoms speedy improve. Skipping doses can boom your chance of contamination this is immune to medicine. Ciprofloxacin will not deal with a viral infection together with the flu or a commonplace cold.
Do not percentage this remedy with some other individual.
Store at room temperature far from moisture and heat. Do now not permit the liquid medicinal drug to freeze. Throw away any unused liquid after 14 days.
Exact ciprofloxacin dosage records
What happens if i leave out a dose?
If you take regular drugs or oral suspension: take the drugs as soon as you could, however bypass the ignored dose if your subsequent dose is due in less than 6 hours.
If you take extended-launch capsules: take the medication as quickly as you can, but skip the missed dose in case your next dose is due in much less than 8 hours.
Do no longer take doses at one time.
What occurs if i overdose?
Are looking for emergency medical interest or name the poison assist line at 1-800-222-1222.
What to keep away from
Do now not take ciprofloxacin with dairy merchandise inclusive of milk or yogurt, or with calcium-fortified juice. You can devour or drink these products together with your meals, however do no longer use them by myself when taking this medicine.
Antibiotic drugs can cause diarrhea, which may be a sign of a new contamination. When you have diarrhea that is watery or bloody, call your physician earlier than the usage of anti-diarrhea medicinal drug.
Ciprofloxacin could make you sunburn greater easily. Keep away from daylight or tanning beds. Put on protective apparel and use sunscreen (spf 30 or better) while you are outside. Inform your health practitioner when you have excessive burning, redness, itching, rash, or swelling after being in the solar.
Keep away from using or hazardous interest until you understand how ciprofloxacin will affect you. Your reactions could be impaired.
Ciprofloxacin aspect effects
Get emergency medical help when you have symptoms of an hypersensitive reaction to ciprofloxacin (hives, tough respiration, swelling for your face or throat) or a extreme skin response (fever, sore throat, burning on your eyes, pores and skin ache, pink or crimson pores and skin rash that spreads and causes blistering and peeling).
Ciprofloxacin can cause serious facet outcomes, inclusive of tendon troubles, damage for your nerves (which can be everlasting), severe mood or conduct adjustments (after just one dose), or low blood sugar (that may result in coma).
Stop taking this medication and call your physician immediately if you have:
Low blood sugar - headache, starvation, irritability, dizziness, nausea, speedy heart charge, or feeling shaky;
Nerve damage signs and symptoms - numbness, tingling, burning pain to your arms, palms, legs, or ft:
Serious temper or behavior modifications - anxiousness, confusion, agitation, paranoia, hallucinations, memory issues, problem concentrating, mind of suicide; or
Signs of tendon rupture - surprising pain, swelling, bruising, tenderness, stiffness, movement problems, or a snapping or popping sound in any of your joints (relaxation the joint till you receive medical care or instructions).
In rare instances, ciprofloxacin may additionally purpose harm on your aorta, the principle blood artery of the body. This will lead to risky bleeding or death. Get emergency clinical help if you have severe and constant ache to your chest, belly, or returned.
Additionally, prevent the usage of this medicine and get in touch with your physician right away when you have:
Intense stomach ache, diarrhea this is watery or bloody;
Speedy or pounding heartbeats, fluttering to your chest, shortness of breath, and sudden dizziness (like you would possibly skip out);
Any pores and skin rash, regardless of how moderate;
Muscle weak point, respiratory troubles;
Little or no urination;
Jaundice (yellowing of the pores and skin or eyes); or
Expanded stress in the cranium - extreme headaches, ringing to your ears, dizziness, nausea, imaginative and prescient troubles, ache behind your eyes.
Not unusual ciprofloxacin facet effects may additionally include:
Nausea, vomiting, diarrhea, belly pain;
Headache; or
Strange liver function checks.
This isn't a entire list of side outcomes and others may additionally occur. Name your doctor for medical advice about aspect outcomes. You could document side outcomes to fda at 1-800-fda-1088.
Ciprofloxacin side outcomes (more detail)
What other tablets will affect ciprofloxacin?
A few drug treatments can make ciprofloxacin a lot much less effective when taken at the identical time. If you take any of the subsequent medicines, take your ciprofloxacin dose 2 hours earlier than or 6 hours after you take the opposite medicinal drug.
The ulcer medicine sucralfate, or antacids that contain calcium, magnesium, or aluminum (along with maalox, milk of magnesia, mylanta, pepcid entire, rolaids, tums, and others);
Didanosine (videx) powder or chewable tablets;
Diet or mineral supplements that incorporate calcium, iron, magnesium, or zinc.
Tell your health practitioner about all your different drugs, particularly:
Clozapine, cyclosporine, methotrexate, phenytoin, probenecid, ropinirole, sildenafil, or theophylline;
A blood thinner (warfarin, coumadin, jantoven);
Heart remedy or a diuretic or "water pill";
Oral diabetes medicinal drug;
Merchandise that comprise caffeine;
Remedy to treat melancholy or mental infection;
Steroid remedy (such as prednisone); o
Nsaids (nonsteroidal anti inflammatory tablets) - aspirin, ibuprofen (advil, motrin), naproxen (aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others;
https://www.arshinepharma.com/info/uses-side-effects-and-precautions-for-taking-71254389.html

I go to a clinic that specializes in long Covid. These are some tips they've given me to help me through the recovery process. Maybe this'll help someone else who's suffering out there as well. Good luck.
​
NUTRITION RECOMMENDATIONS for COVID Recovery
Daily Multi Vitamin with 1000 mg Vitamin C, 2000 U Vitamin D3, Magnesium 320 mg/day for women and 420 mg/d for men.
-Stay hydrated
-Anti-inflammatory diet/Mediterranean diet
-Anti-inflammatory lifestyle includes: anti-inflammatory diet, not smoking, limiting alcohol intake, exercise/activity, good quality sleep, reducing stress, managing weight
​
DIET
Anti-inflammatory/Mediterranean Diet- Eat a diet high in fruits, vegetables, whole grains, nuts and seeds. Limit processed foods and simple carbohydrates like sugar and white flour. Eat smaller, more frequent meals
-Vegetables and Fruits: Aim for 7-10 servings per day. Eat the rainbow! A variety of colors will ensure you are getting the right micronutrients.
-Whole Grains: Opt for oats, quinoa, brown rice, barley, buckwheat, and whole grain breads/pasta/crackers.
-Healthy fats: olive oil, nuts and seeds, avocados, fatty fish (mackerel, sardines, salmon, herring). Avoid trans-fats often found in processed foods.
-Dairy: low-fat Greek or plain yogurt, cheese, and milk products from animals that were not fed antibiotics (look for words like “grass-fed”, “organic”, or “raised without antibiotics”).
-Eggs: Limit to one per day, or an average of 5-7 per week. Look for words like “pasture-raised” or “free-range”. These eggs have better nutrients than “cage-free” or “caged”.
-Spices: more spices, less salt. Use spices when cooking (turmeric, onions, garlic, ginger, and cinnamon) all have been associated with lowering levels of inflammation, as have lignans
(flaxseed, whole grains, berries), olive oil, fiber, nuts, and magnesium.
-Meat: Avoid red meat if possible, only eat it on special occasions. Substitute with fish, or lean meat. Again, look for key words that indicate it was minimally processed and without antibiotics. Buy local if possible. Limit meat to 3 oz three times per week.
​
Cut down on sugar!
Do not exceed 25-35 grams of sugar per day.
​
Artificial and natural sweeteners do not spike your blood sugar and have zero calories, BUT they have been associated with inflammation. Additionally, the taste of sweeteners is much sweeter than regular sugar and can contribute to addiction to the products. This is why diet soda has been associated with an increased risk of diseases like obesity, high blood pressure, high cholesterol, and diabetes. Choose your sweeteners carefully.
​
Fruits and vegetables with natural sugars do not spike your blood sugar due to the fiber content when you eat them. Which is why it may be better to opt for a smoothie instead of a juice.
​
Water- Drink to thirst! Carry around a water bottle to make it easier. Aim for at least eight 8 oz. glasses of water per day.
-Plain water
-Carbonated water
-Can add lemon juice
-Herbal teas
​
What to avoid
-Foods that are high in unhealthy fats
-Foods that are high in sugar
-Alcohol/other depressants
-Smoking
​
How to get started
-Keep track of what you are eating
-The Daily Dozen app is a great way to track if you are eating the basics every day.
-Smartphone apps: My Fitness Pal, My Plate, Lose It! All can track your daily intake of nutrients.
-Mediterranean Diet cookbooks, online recipes
-Anti-inflammatory Diet: online resources or book The Abascal Way by Kathy Abascal
-Dietician referral if desired
​
"BRAIN" FOODS
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Polyphenols
-Organic compounds mostly found in plants
-Anti-oxidant and anti-inflammatory properties
-Support a healthy brain and cardiovascular system
-Found in berries, grapes, coffee, green tea, curcumin (turmeric), cocoa (at least 70%), nuts
Brain-Derived Neurotrophic Factor
-Associated with neurogenesis
-Blueberries, fish, turmeric
​
Omega 3 Fatty Acids
-Fish, nuts, flaxseeds
-May have a role in oxidation and inflammation
-May promote cardiovascular health and cognition
​
B vitamins
-Leafy greens, legumes, seafood, poultry, eggs, dairy
-Involved in the production of many neurotransmitters
-May promote nerve and brain health
​
SUPPLEMENTS
We generally encourage people to get their vitamins and healthy fats through food (as studies consistently reflect that people do better with food-based whether it's Calcium or Fish oil).
​
Dietary supplements
-Dietary supplements are NOT regulated by the FDA
-It is up to the manufacturer to ensure safety of the product
-Better to eat a well-balanced diet to obtain vitamins and minerals
-Some supplements may interact with prescription medications
-Talk to your doctor before starting a supplement
Supplements that have shown some promise in reducing severity in new COVID infections and are being further evaluated with studies:
​
Vitamin D3
-Dose: 2000 IU per day in the early phases of COVID illness or until levels are normal, then multivitamin with 600-800 IU/day
​
Vitamin C
-Dose: 1000 mg twice per day in the early phases of COVID illness then multivitamin
Zinc
-Higher doses of intranasal zinc have been used in treating severe COVID with unclear benefit
-Dose: 8 mg/day for women 11 mg/ day for men is the recommended daily allowance (RDA)
-Long-term zinc supplementation can cause copper deficiency with subsequent hematologic and potentially irreversible neurologic problems.
-Oral zinc can decrease the absorption of medications that bind with polyvalent cations.
-Because Zinc can have negative side effects, it is not recommended to take doses above the recommended daily allowance (RDA) listed above
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Magnesium
-May help with headaches, mood, sleep
-Dose: Start with 100-200mg in the evening
Maximum does 320 mg/day for women and 420 mg/d for men
-Monitor for loose stools
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Melatonin
-Can help restore normal sleep/wake cycle, studies ongoing about potential role in prevention and treatment of COVID-19.
-Dose: Start with 3-5mg and increase as needed up to 10 mg
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Supplements that have been used to manage similar symptoms in other medical conditions, but have not been specifically studied for COVID patients:
Probiotics
-Help with gut microbiome
-Many different formulations
-Choose one with several strains of bacteria and adequate colony forming units (CFU)
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B Vitamins
-May help with mood, nerve health, headache prevention
-Vitamin B2 (riboflavin) – 400mg daily (can make urine bright yellow)
-Vitamin B12 (cobalamin) – 1000 mcg daily
-B Complex multi-vitamin likely to cover these doses and have additional B vitamins
Omega 3 Fatty Acids (Fish Oil)
-Anti-inflammatory properties, reduce oxidative stress
-May help with cognition
-DHA (Docosahexaenoic acid) and EPA (Eicosapentaenoic acid)
-Dose: 1-2 g per day
*Please check with your Primary Care Doctor prior to starting this supplement if you are on Warfarin/Coumadin
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Curcumin
-Component of the spice herb turmeric
-Thought to have anti-inflammatory and antioxidant properties.
-Choose a supplement with piperine or bioperine
-Dose: 500 mg 1-2 times per day. Can go up to 500 mg 3 times per day. Do not exceed 2,000 mg per day. Above that dose it could cause blood thinning.
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Co-enzyme Q10
-Antioxidant naturally produced in the body
-Neutralizes free radicals reduces oxidative stress
-Thought to support brain and heart function and reduce muscle aches when taking Statin medications
-Dose: 100 mg twice a day

I am looking for help understanding the prognosis of my dad's lung cancer because, in my opinion, the information my dad is giving us from the doctor does not quite line up to what I'm reading in his PET scan reports and I'm concerned that his oncologist is either overly optimistic or my dad is wishing to downplay the severity of his condition.
Age: 79
Weight: 180ish
Activity level: Sedentary
Initial Diagnosis: Late November 2020
Comorbidities:

1. Type-2 diabetes currently controlled with diet and low dosage of medicine. Severe neuropathy in feet as a result of going undetected for too long.
   
2. Low-grade hypertension, also medicated
   
3. A-fib - he is constantly in a-fib but he tells me his doctors describe it as "controlled" by his medicine and his heart rate is in normal range. He's on coumadin for this. He recently had a cardioversion in October that returned him to sinus rhythm for approximately 7-10 days. No further treatment since reverting to a-fib.
   
4. History of Stage 3 laryngeal cancer successfully treated with radiotherapy in 1999. Radiotherapy side effects resulted in 100% blockage of right carotid artery, left carotid artery has had two bypass surgeries. Second one has resulted in 0% blockage since last check-up.
   
5. Possible COPD (undiagnosed, for now). Smoked roughly 1 pack a day from 1960-2004. Quit cold turkey in '04.
   

This whole process started when he was on vacation in the NC mountains in September and had trouble catching his breath, which he had never experienced previously on any of his other yearly vacations to the same area. Doctors initially thought his a-fib, but no. Subsequent CT scan of chest found the initial lung cancer tumor, but they said it was too small and not advanced enough to be causing breathing issues. Further investigation of his heart (echo, stress test, advanced labwork) determined no issues with his heart. He just recently saw the pulmonologist for the first time who ordered additional tests (high res CT, sputum cultures, labwork, and spirometry). In the meantime, he gave my dad Anoro Ellipta samples to last him until the follow up appointment after all the tests. My dad said his resting SpO2 at the pulmonologist office was in the upper 80s and after several deep breaths, stabilized around 93-94. My dad does get mildly winded after showering and if taking anymore than 15-20 steps.
On to the cancer:
After the initial CT scan to investigate his breathing issues, a roughly 2.25cm x 2.25cm spiculated mass was found in his right middle lobe. Initial PET scan found FDG avidity of 14.something. I unfortunately don't have access to that first PET scan report, but I do remember it mentioning two local lymph nodes with FDG avidity in the 2.0-3.0 range that the doctor described as nothing to worry about. A biopsy was done and he was diagnosed as having "Stage I non small cell lung squamous cell carcinoma." The doctor was very optimistic about his prognosis and after meeting with a radiological oncologist and a surgeon, his main oncologist determined the best treatment was radiotherapy. He was assigned 5 treatments and everyone gave us the impression that this would be a wam-bam-thank-you-ma'am type treatment. His oncologist said that it is extremely rare to catch lung cancer so early, that the radiotherapy should take care of everything, and that the literature states similar cases have 5 year survival rates in the 90-99% range. He received his 5 sessions of radiotherapy in December of 2020 and the follow up PET scan was scheduled for beginning of February.
The follow up PET scan showed that the primary tumor had shrunk, somewhat, now to 2.0cmx1.3cm. However, the FDG avidity had gone from 14.x to 3.0. My dad came back from the follow up appointment stating that the doctor considered him "cancer free". However, he cautioned my dad that he would have to do another PET scan in 3 months because the two lymph nodes were still showing with FDG avidity in the 2-3 range and that "they have the potential to become angry, but is not concerning right now." those were the words of dad's oncologist. He told my dad that if the spots did not have any major changes, that no further treatment would be necessary and that there'd be another PET scan 3 months afterwards.
3 months later he had another PET scan. My dad came home and told us that the doctor said everything "generally did not change" but the doctor said he wanted to "get ahead of it" and is recommending a 3 month course of Keytruda. I became a little concerned, because the oncologist gave us the impression that if there was no major change, no further treatment would be needed. With my dad being 79 and not exactly in stellar health otherwise, there is definitely a non-zero chance of him reacting poorly to the immunotherapy and winding up worse off because of it. My mom, dad, and I, however, all agreed to start the immunotherapy treatments.
Here is a link to the most recent PET scan that "generally did not change", but prompted the start of immunotherapy. I also included a photo of the genetic details of the cancer. https://imgur.com/a/k6EdxsW
Today, before his second infusion of Keytruda, I asked him to please ask his doctor the following questions:

1. What staging is my cancer considered at this point?
   
2. If "nothing much had changed" why am I doing the immunotherapy treatment?
   
3. Is the goal of immunotherapy at this point just to extend my life, or is the goal complete treatment?
   
4. What is my prognosis?
   
5. You didn't look at my soft palate during the last appointment, is that any concern? It is mentioned twice on the PET scan report.
   

Today, I got the following answers from my dad

1. "The doctor said It depends on your interpretation, but it is automatically stage IV now."
   
2. "He wanted to do the immunotherapy to try and prevent it from developing any further and to hopefully kill it."
   
3. "Treating it totally."
   
4. "Really good." This is the one I am most concerned about. You hear about stage IV lung cancer and you hear about how it's a terminal illness and how everything starts to go downhill very quickly. My dad said he got the impression from his oncologist that chance of cure is high and he doesn't see much chance of my dad rapidly declining and succumbing to this disease anytime in the next few years. But I am concerned about this due to the now distant FDG avidity (adrenal gland and soft palate?)
   
5. Dad claims the doctor said it was probably an abnormality in the PET scan and not even worth thinking about or investigating.
   

With all this in mind, I really want to get an accurate picture of my dad's prognosis. Do you agree with the cancer being stage IV now? I understand his comorbidities make things pretty complicated, along with his age, and that nothing in medicine is perfectly precise or able to be predicted with 100% accuracy. However, my dad is definitely the type of guy that would downplay the severity of something to save my mom from emotional distress because they've been married over 30 years and she is a highly anxious person who is predisposed to severe worrying and rumination.
If any further information will be needed, I'd be happy to provide it.