25-30% of people with lupus experience hypertension (high blood pressure), which is defined as a blood pressure of greater than 140/90 mmHg. In addition, many more lupus patients have blood pressures greater than the normal 120/80 mmHg limit. The most common causes of high blood pressure in people with lupus are kidney disease and long-term steroid use. Other medications, such as cyclosporine (Neoral, Sandimmune, Gengraf) can also cause elevations in blood pressure.

High blood pressure can cause everyday headaches, but more importantly, it can lead to stroke, heart failure, and heart attack. Cardiovascular disease is the number one cause of death in people with lupus, so it is very important that your blood pressure is brought to the healthy 120/80 mmHg level and maintained. It is imperative that you take steps yourself to help achieve and maintain optimum cardiovascular health—remember, you play the most important role in your own well-being.

You can take several steps on your own to ensure that you remain as healthy as possible. Do not smoke, because smoking increases the risk of cardiovascular disease. In addition, it is important that you maintain a healthy diet and regular exercise regimen; these elements are especially significant for people taking steroid medications such as prednisone. A low-fat, low-cholesterol diet is essential for a healthy lifestyle. Focus on eating whole grains, vegetables, and lean sources of protein. Limit your sodium (i.e., salt) intake, since sodium levels are directly linked to blood pressure. In addition, try to exercise at least 30-minutes per day. This goal can be difficult for people with lupus who experience reoccurring joint and muscle pain, fatigue, and other symptoms, but engaging in low-impact daily activities such as walking, biking, yoga, Tai chi, and other forms of stretching may help to alleviate some of this pain while also helping you to maintain a healthy weight and a strong cardiovascular system. These activities also reduce the risk of osteoporosis, and people who exercise daily report that they actually feel better physically and mentally.

However, it is important to remember that while diet and exercise are extremely important for optimal cardiovascular health, these elements alone may be insufficient in controlling your blood pressure. Therefore, your doctor may prescribe a medication to help control your blood pressure. There are several types of medications that work to lower, control, and/or maintain blood pressure, and each works in a different way. Your doctor will work with you to evaluate and prescribe the blood pressure medication that best suits your personal condition. It is important that you remember to take your blood pressure (and other) medications as directed by your physician and notify him/her of any changes to your personal health. Take your blood pressure medications every day, including the days that you see your doctor. Do not stop taking your blood pressure medications without speaking to your doctor, since suddenly stopping your medication could put you in danger of a heart attack, stroke, or, in some cases, kidney failure.

Diuretics 

• Chlorthalidone (Hygroton)
• Chlorothiazide (Diuril)
• Hydrochlorothiazide (Esidrix, Hydrodiuril)
• Indapamide (Lozol)
• Metolazone (Zaroxolyn, Mykrox)
• Bumetanide (Bumex)
• Furosemide (Lasix)
• Torsemide (Demadex)
• Amiloride (Midamor)
• Spironolactone (Aldactone)
• Triamterene and hydrochlorothiazide (Dyazide)

Your kidneys play a very important role in helping to maintain blood pressure. A complex system of tubules in the kidney is responsible for regulating the balance of water and salts in your blood. When excess fluid and sodium build up in your kidneys, your blood pressure goes up. Diuretics (a.k.a., “water tablets,” or “water pills”) help to rid the kidneys of excess fluids and sodium through urination; in doing this, diuretics also help to reduce blood pressure. Diuretics are usually prescribed as the first line of treatment for high blood pressure but may also be given to enhance the effect of other medications.

There are actually four kinds of diuretics— thiazide diuretics, loop diuretics, potassium-sparing diuretics, and combination diuretics. Each class works on a different part of the nephron, the functional unit of the kidney that makes up its vast system of tubules. Thiazide diuretics (chlorthalidone, hydrochlorothiazide, indapamide, and metolazone) are sometimes the first drugs suggested for people with high blood pressure. These medications prevent the reabsorption of sodium and water in a specific part of the nephron called the distal convoluted tubule. In doing so, they also force more water into the urine to be removed from the body. Thiazides relax the muscles in blood vessel walls, allowing blood to flow more easily. Generally, thiazide diuretics are taken once daily. These medications can lower the amount of potassium in your body, so this factor will be monitored by your doctor.

Loop diuretics (bumetanide, furosemide, and torsemide) work on a part of the nephron called the “Loop of Henle” and prevent sodium from re-entering the blood. However, loop diuretics also interfere with the reabsorption of other salts, such as calcium, magnesium, and potassium. Proper monitoring may be necessary to prevent complications, such as low potassium. Your physican may recommend that you take a potassium supplement while taking these medications. Loop diuretics are generally less effective than thiazides for controlling blood pressure because they work for a shorter period of time and may result in a loss of blood pressure control at certain times in the day. These medications are generally taken once or twice daily.

Potassium-sparing diuretics (amiloride, spironolactone, and triamterene) are weaker than thiazides and loop diuretics but do not yield the potassium-depleting effects that loop diuretics do. These medications are sometimes used in combination with other diuretics, namely hydrochlorothazide (“HCTZ”). One example of a combination therapy is Dyazide (HCTZ/triamterene). Potassium-sparing diuretics are typically taken once daily.

Certain medications can interact with diuretics, so be sure to tell your doctor about any medications (both prescription and over-the-counter), vitamins, and supplements that you may be taking. Be especially wary of interactions with the following drugs: digitalis and digoxin (especially if your potassium level is low), certain antidepressants (especially when taking thiazide or loop-acting diuretics, other medications for high blood pressure, lithium, and cyclosporine (especially when taking a potassium-sparing diuretic).

Diuretics can cause certain side effects. Common side effects include weakness, muscle cramps, skin rash, increased sensitivity to sunlight (with thiazide diuretics), vomiting, diarrhea, cramps, lightheadedness, or joint pain. Less common side effects include impotence and irregular heartbeat. Many of these side effects can mimic lupus symptoms, so speak with your doctor if you feel that you are experiencing any new symptoms that may be caused by a new medication. However, it is important that you do not stop taking your medication unless both you and your doctor decide that this is the correct course of action. In addition to keeping your blood pressure under control, many anti-hypertensive medications also affect the function of your kidneys, so stopping your medication without appropriate approval could have serious consequences.

Angiotensin-Converting Enzyme (ACE) Inhibitors

• Benazepril (Lotensin)
• Captopril (Capoten)
• Enalapril (Vasotec)
• Fosinopril (Monopril)
• Lisinopril (Prinivil, Zestril)
• Moexipril (Univasc)
• Perindopril (Aceon)
• Quinapril (Accupril)
• Ramipril (Altace)
• Trandolapril (Mavik)

Angiotensin-converting enzyme (ACE) inhibitors are used to control blood pressure, treat heart failure, lower protein in the urine, and prevent kidney damage. These medications make your heart’s work much more efficient by expanding blood vessels and decreasing resistance to blood flow. ACE is a chemical in your body that converts a hormone called angiotensin-I to angiotensin-II. Angiotensin-II is involved in several actions, one of which causes the muscles surrounding the blood vessels to contract. The narrowing of your blood vessels caused by this contraction causes your blood pressure to rise. As their name suggests, ACE inhibitors work to inhibit ACE, and in doing so, they also inhibit the production of Angiotensin-II. Because of this inhibition, the blood vessels dilate (enlarge), thereby reducing blood pressure and making it easier for your heart to pump blood. ACE inhibitors have a two-fold benefit for many lupus patients, because in addition to controlling blood pressure, they also decrease protein in the urine (proteinuria), and thus help to prevent kidney scarring in lupus patients with kidney involvement. ACE inhibitors should be used carefully, however, in people with renal artery stenosis (narrowing of the artery that supplies blood to the kidney).

Most people tolerate ACE inhibitors well, but these medications do have some potential side effects. The most common side effects are a cough which may last up to a month, elevated blood potassium levels, low blood pressure, constipation, dizziness, headache, drowsiness, weakness, metallic or salty taste, and rash. Rare, but serious, side effects include kidney failure, allergic reactions, a decrease in white blood cell count, and a swelling of the tissue just below the skin (angioedema). In addition, women who are pregnant or may become pregnant should not take ACE inhibitors because they are known to cause birth defects.

Be sure to tell your doctor about any other medications, vitamins, or supplements you may be taking, since certain medications can interact with ACE inhibitors. Be especially cautious with potassium supplements, salt substitutes (which can contain potassium), and other drugs that can affect the amount of potassium in your blood, since ACE inhibitors may increase your potassium levels. ACE inhibitors may also increase the concentration of lithium (Eskalith) in the blood of people taking this medication, which can cause an increase in side effects.

Angiotensin-II Receptor Antagonists / Angiotensin Receptor Blockers (ARBs)

• Candesartan (Atacand)
• Eprosartan (Teveten)
• Irbesartan (Avapro)
• Losartan (Cozaar)
• Telmisartan (Micardis)
• Valsartan (Diovan)

Angiotensin-II receptor blockers (ARBs) are used to control high blood pressure, treat heart failure, lower protein in the urine, and prevent kidney failure. They are similar to ACE inhibitors, but their mechanism of action is slightly different. In your body, there are many substances that send messages to different cells and tissues to enact certain changes. However, in order for the signals to go through, there are often molecules that receive these substances to help transmit messages. Whereas ACE inhibitors block the formation of angiotensin-II, angiotensin-II receptor blockers block the molecules in your body that receive angiotensin-II so that the substance cannot transmit the signal for your blood vessels to contract. Therefore, your blood vessels remain enlarged, which keeps your blood pressure from rising and makes it easier for your heart to pump blood. Like ACE inhibitors, angiotensin receptor blockers also reduce proteinuria (excess protein in the urine) in people with lupus nephritis, which helps to keep the kidneys safe and healthy. The benefit of angiotensin-II receptor blockers is that they produce less cough as a side effect; if you experienced a cough from ACE inhibitors, you will most likely be switched to an ARB.

Like ACE inhibitors, ARBs are tolerated well by most people, but they do have some side effects. The most common side effects are elevated blood potassium levels, low blood pressure, dizziness, headache, drowsiness, weakness, metallic or salty taste, and rash. Cough can occur, but this happens less often with ARBs than with ACE inhibitors. The most serious (but rare) side effects include kidney failure, liver failure, allergic reactions, a decrease in white blood cells, and swelling of the tissue  just bellow the skin (angioedema). In addition, women who are pregnant or may become pregnant should not take ARBs because they are known to cause birth defects.

Be sure to tell your doctor about any other medications, vitamins, or supplements you may be taking, since certain medications can interact with ARBs. Be especially cautious with potassium supplements, salt subsitutes (which can contain potassium), and other drugs that can affect the amount of potassium in your blood, since ARBs may increase your potassium levels. ARBs may also increase the concentration of lithium (Eskalith) in the blood of people taking this medication, which can cause an increase in side effects.

Beta Blockers

• Acebutolol (Sectral)
• Atenolol (Tenormin)
• Betaxolol (Kerlone)
• Bisoprolol/hydrochlorothiazide (Ziac)
• Bisoprolol (Zebeta)
• Carteolol (Cartrol)
• Carvedilol (Coreg)
• Metoprolol (Lopressor, Toprol XL)
• Nadolol (Corgard)
• Propranolol (Inderal)
• Sotalol (Betapace)
• Timolol (Blocadren)
• Nebivolol (Bystolic)

Beta blockers are used to lower blood pressure, treat abnormal heart rhythms and angina (chest pain and discomfort that occurs when your heart muscle does not get enough blood), and improve survival in people who have had a heart attack. Beta blockers are so-named because they block the action of adrenaline (a.k.a., epinephrine) and other substances in the body on “beta” receptors, which in turn slows the nerve impulses that travel to the heart. In doing this, beta blockers relieve stress on your heart, slow your heart beat, and lessen the force with which your heart muscle contracts. These medications also reduce the strength with which the muscles surrounding the blood vessels contract throughout the body, reducing pressure in your blood vessels and increasing blood flow. By allowing your blood to flow more easily and relieving some of the stress on your heart, beta blockers decrease heart rate, cardiac output, and ultimately blood pressure.

Beta blockers may cause certain side effects. Common side effects include drowsiness or fatigue, weakness or dizziness, and dry mouth, eyes, and skin. These medications may also cause cold hands and feet, which can be especially problematic for lupus patients experiencing Raynaud’s phenomenon. Less common side effects include wheezing or shortness of breath, slow heartbeat, trouble sleeping/vivid dreams, and swelling of the hands and feet. Rare side effects include abdominal cramps, vomiting, diarrhea, constipation, back or joint pain, skin rash, sore throat, depression, memory loss/confusion, and impotence. Tell your doctor right away if you experience any of these side effects.

While taking beta blockers, it is important that you do not drink alcohol, since alcohol can decrease the effects of these medications. In addition, avoid caffeine and over-the-counter cough and cold medicines, antihistamines, and antacids that contain aluminum. Be sure to tell your doctor about any medications, vitamins, and supplements that you may be taking, especially other blood pressure medications, anti-depressants, allergy shots, and diabetes and/or asthma medications. If you are pregnant or may become pregnant you should discuss your beta blocker medications with your doctor, since this drug should only be used during pregnancy if it is clearly needed.

Calcium Channel Blockers

• Amlodipine (Norvasc, Lotrel)
• Bepridil (Vascor)
• Diltiazem (Cardizem, Tiazac)
• Felodipine (Plendil)
• Nifedipine (Adalat, Procardia)
• Nimodipine (Nimotop)
• Nisoldipine (Sular)
• Verapamil (Calan, Isoptin, Verelan)

Calcium channel blockers, also known as “calcium antagonists,” are used to decrease blood pressure and treat angina (chest pain) and some arrhythmias (abnormal heart rhythms). They are also used to treat Raynaud’s phenomenon, a cold-induced blue/purple color change in the fingers and toes. Calcium channel blockers work by interrupting the movement of calcium into the heart and blood vessel cells, which in turn decreases the force of contraction of the myocardium (muscle of the heart) and relaxes and widens blood vessels. Many calcium channel blockers also slow down the conduction of electricity in the heart, which lowers heart rate and thus further lowers blood pressure.

Calcium channel blockers may have some side effects, the most common of which are constipation, nausea, headache, rash, edema (swelling of the legs with fluid), low blood pressure, drowsiness, and dizziness.

If you are experiencing heart failure, you should not take diltiazem (Cardizem, Tiazac) or verapamil (Calan, Isoptin, Verelan), since these drugs reduce the ability of your heart to pump blood. In addition, you should tell your doctor about any other medications, vitamins, or supplements that you may be taking, especially other heart or blood pressure medications, anti-seizure medication, and cyclosporine (Neoral, Sandimmune, Gengraf). Diltiazem and verapamil interact most with other medications because these two calcium channel blockers decrease the elimination of certain drugs from the liver, including carbamazepine (Tegretol), simvastatin (Zocor), atorvastatin (Lipitor), and lovastatin (Mevacor). Since your liver cannot eliminate these substances as efficiently, they may accumulate in your blood, an effect which can be toxic to your body.

While taking calcium channel blockers, do not eat grapefruit or drink grapefruit juice, since grapefruit may increase some of the effects of these medications. Also avoid alcohol, since it interferes with the effects of these medications and may increase their side effects. If you are pregnant, talk to your doctor about whether you should continue therapy with calcium channel blockers. No pregnancy problems or birth complications have been found to date in humans, but you should always speak with your doctor about the risks and benefits of any medications you may be taking while pregnant. 

Alpha Blockers

• Doxazosin mesylate (Cardura)
• Prazosin hydrochloride (Minipress)
• Prazosin and polythiazide (Minizide)
• Terazosin hydrochloride (Hytrin)
• Tamsulosin (Flomax)

Alpha blockers are sometimes used to treat high blood pressure, Raynaud’s disease, scleroderma, and other conditions. They are also helpful in men who have difficulty urinating due to benign prostatic hyperplasia (BPH). Alpha blockers are generally not the first treatment option chosen to treat high blood pressure because they have not proven to reduce long-term risk of heart attack and stroke, but they are commonly used, often in combination with other drugs, when blood pressure is difficult to control.

Like beta blockers, alpha blockers block the action of receptor molecules (called alpha receptors) from receiving certain chemical messages. Specifically, alpha blockers attach themselves to alpha receptors found on blood vessels, in the prostate, and in special blood pressure sensors called baroreceptors. In doing this, alpha blockers prevent alpha receptors from receiving signals from the hormone norepinephrine (noradrenaline) to stimulate the muscles in the walls of smaller arteries and veins and cause them to constrict. By preventing this communication, alpha blockers cause the vessels to remain open and relaxed, improving blood flow and lowering blood pressure.

Alpha blockers fall into two categories—short-acting and long-acting. Short-acting alpha blockers work quickly, but their effects do not last as long. Long-acting medications take longer to begin working, but their effects last for longer periods of time. Your doctor will advise you on the type of alpha blocker that is best for you.

When you start taking alpha blockers, you may have what is known as a “first dose” effect. This effect may cause you to experience pronounced low blood pressure and dizziness which may make you faint when rising too quickly from the sitting or lying position, a phenomenon known as orthostatic hypotension or postural hypotension. To prevent this from happening, be sure to rise slowly whenever you begin to stand up. Your doctor may try to reduce the first dose phenomenon by starting you at a low dose and gradually increasing it until you reach the proper amount. In addition, most doctors recommend that you take alpha blockers before bed, which may help to lessen this effect. Other potential side effects can include headache, pounding heartbeat, nausea, weakness, weight gain, and small increases in LDL levels (“bad cholesterol”).

If you are pregnant or may become pregnant, speak with your doctor about whether continuing treatment with alpha blockers is right for you. Also tell your doctor about any medications (both prescription and over-the-counter), vitamins, and supplements that you may be taking, especially other blood pressure medications, NSAIDs, immunosuppressives, impotence therapy agents, antibiotics, anti-fungals, HIV medications, anti-depression and anti-anxiety drugs, diabetic medications, and certain asthma medicines. Stay away from diet pills, caffeine, and over-the-counter cough, medicines, cold medicine, and anti-histamines while taking alpha blockers, since these medications may increase blood pressure. Also avoid grapefruit and grapefruit juice because grapefruit interferes with the liver’s ability to get rid of certain substances, allowing them to accumulate to toxic levels. Alcohol can have a similar effect, so people taking alpha blockers—and all people with high blood pressure—should limit alcohol use.

Central Alpha Agonists / Central-Acting Agents

• Clonidine hydrochloride (Catapres)
• Clonidine hydrochloride and chlorthalidone (Clorpres, Combipres)
• Guanabenz acetate (Wytensin)
• Guanfacine hydrochloride (Tenex)
• Methyldopa (Aldomet)
• Methyldopa and chlorothiazide (Aldochlor)
• Methyldopa and hydrochlorothiazide (Aldoril)

Central-acting agents work to lower your heart rate and blood pressure by preventing your brain from sending signals to the nervous system to speed up heart rate and narrow blood vessels. As a result, your heart does not have to work as hard and the blood flows more easily through your blood vessels. Central-acting agents are not commonly used because they can cause strong side effects, including extreme fatigue, drowsiness/sedation, dizziness, impotence, constipation, dry mouth, headache, weight gain, impaired thinking and psychological problems like depression. Tell your doctor if experience these side effects, but do not stop taking your medication unless directed to do so by your doctor. If you are to stop taking central-acting agents, your doctor will advise you on how to gradually taper your dosage. Treatment with central-acting agents should not be stopped abruptly, since this can cause a sudden, dangerous increase in blood pressure. Also, be sure to speak to your doctor about any other medications you may be taking, since certain drugs may interfere with these medications.

Combination Therapies

Several combination therapies are available to help control, lower, and/or maintain your blood pressure. Common combination therapies are listed below. Your doctor can advise you of any special considerations regarding these medications.

General Combination Therapies

• Atenolol and chlorthalidone (Tenoretic)
• Bisoprolol and hydrochlorothiazide (Ziac)
• Nadolol and bendroflumethiazide (Corzide) 
• Propranolol and hydrochlorothiazide (Inderide)
• Timolol and hydrochlorothiazide (Timolide)

ACE Inhibitor/Diuretic

• Benazepril and hydrochlorothiazide (Lotensin)
• Enalapril and hydrochlorothiazide (Vaseretic)
• Lisinopril and hydrochlorothiazide (Prinzide, Zestoretic)
• Moexipril and hydrochlorothiazide (Uniretic)
• Quinapril and hydrochlorothiazide (Accuretic)

Angtiotensin II Receptor Antagonist/Diuretic

• Irbesartan and hydrochlorothiazide (Avalide)
• Losartan and hydrochlorothiazide (Hyzaar)
• Valsartan and hydrochlorothiazide (Diovan HCT)

ACE Inhibitor/Calcium Channel Blocker

• Amlodipine and benazepril (Lotrel)
• Enalapril and felodipine (Lexxel)
• Trandolapril and verapamil (Tarka)

Combined Alpha and Beta Blocker Action

• Labetalol hydrochloride (Normodyne)

The question i really want to ask is: why is Propranonal the leading referrer to my blog? are there that many people out there desperate for propranonol info? i've let you people down. forgive me.

ok, so i cant spell the word (proprananol?) but heres

What i know about Propranolol

1. It's hard to say, easy to swallow.

2. It's a beta blocker. People take it for migraines, heart attacks and hypertension (and other things. im not a doctor. surprised?). i take it because i have a nervous breakdown when i have to speak in front of more than 3 people. Otherwise known as Anxiety. This beta-blocker works for anxiety because its magic! and it blocks the adrenaline/epinephrine that is released in your body so you can do that whole fight or flight thing [flight or flight in my case]. i know what you are thinking: "What a pussy she is," right? Who doesn't get nervous when they address a crowd of 3+ people? I'm totally with you. Hear me out: when i went back to school 3 years ago my "nervous" was turning into something my doctor calls "Anxiety" - whole body flushing, chills, sweating, shaking hands, knotted stomach, searing back pain, dry mouth, blank mind, hours of dread before the event, panic attack minutes before, during and after the event, obsession with the event before, during and after, coupled with suicidal thoughts. In sum, I was really starting to lose it. I didnt know about the magic! pill and i was embarassed to tell my doctor what a complete idiot i was (thus confirming what a complete idiot i was). Naturally, i counseled myself and came up with 3 possible solutions: a) quit school, b) commit suicide, c) get drunk. "C" was obviously the correct choice, right? So things started to get better: i came to school every day an hour early, secured a nice cozy parking spot on campus and then drank in my parked car until i could muster the courage to go in to class. As illustrated in paragraph 1, I'm a catch. I know.

3. Now that im on Propranowhatever, things are really really drastically insanely much better. I don't have to self-medicate with alcohol. I take between 2-4 pills only one time, an hour or so before the anxiety producing event. This stuff starts to work pretty fast. It makes me stray dog thirsty, so I have water with me on the days i take it. Propranolol doesn't get rid of the anxiety (like vicodin or valium does), but it gets rid of the physical symptoms. So, i'm still nervous on the inside but im confident knowing that it is not showing on the outside. for some reason, this brings comfort, and all the obsession goes away. I know nervousness is normal, and that i can handle it. Its the whole fashioning-my-sweater-into-a-noose-and- hanging-myself-in-the- broom-closet stuff that i have trouble dealing with.

4. Weird side effects include profuse sweating and heat on the small of my back. Its like all that fear and energy is cut off (or blocked! get it?) from climbing up to my overactive brain. it can only reach the middle of my back --and it goes wild in there apparently.

5. The doctor won't admit it, but it will keep you up. I can pretty much set my watch to it- about 8 hours after i've taken 2, 3 or 4 pills i have this burst of I'M AWAKE energy and i cannot sleep. Usually I stay up all night or get to sleep around 5:30 am. Totally sucks but i'm not suicidal from the anxiety anymore so its a small price to pay. The End.

Yes, i want to punch people who say "im nervous when i make speeches, i should get on that." Are you really that nervous that it requires drugs? Is the nervousness affecting your ability to function normally in everyday life? Is it something that goes away minutes after the speech? I hate having to take prescribed drugs, i wish i could flush them all down the toilet. i dont understand why someone would WANT to be on uneccessary drugs (that dont get them high. being high- THAT i can understand). Its not cool to be depressed, anxious and suicidal, or a prescription drug idiot, okay??

now its 12:58 AM, i have to get up at 5:30 for work and (thanks to magic! propranolol) i can't sleep. I took some vicodin (PDI!)* to make me sleep but so far, nothing. now im wondering if mixing those 2 drugs can be fatal? i guess we'll know for sure in the morning...

*prescription drug idiot

This is the third high profile doping violation in shooting in the recent past, two other athletes Andrija Zlatic, of Serbia and Ann Potter of New Zealand were stripped of their quota spots for the Beijing Olympics for doping violations prior to the games. 

You really have to ask yourself "what were they thinking",  I don't condone drug use but I can see the draw in other sports, namely that being the money.  I can also see that in other sports the users feel they can get away with it because the drugs aren't required to perform, but to increase the volume and level of training so that performance gains can be realized.  As they aren't using them at the time of competition they feel their chances of getting caught are slim, even with random drug testing.  A shooter has to be actually using the drugs during competition to gain any benefit. Maybe they thought that there friends in communist China would fake the results.

Of course it comes from a country where their image is more important than anything, sport is used to show their superiority over the rest of the world. The downside is little as the likelihood of the people of North Korea finding out the truth is relatively remote and even if they did it really doesn't matter they will just blame it on the rest of the world picking on them.

I hope the ISSF comes own on these cheats short bans are not the answer in shooting where careers can be long.  I think the message needs to be sent for blatant performance drug violations, that being life time bans.  Maybe even bans for the countries from where the athlete comes from, this way it will ensure their participation in removing drugs from this sport.  I'm not talking about inadvertent violations of taking substances that have no know performance enhancing effects, for which the list is large with regards to shooting sports.  I think the punitive measures have to be commensurate with the offense. An athlete that accidentally takes something on the list, such as a masking agent for steroids, should not be punished the same as an athlete that takes a known performance enhancing substance.  Both should have consequences but for the later the consequences should be swift and severe.

The sad part is that these incidents bring the whole sport into question, and all performances are then looked at with suspicion, for there really is no way of proving any performance is free of performance enhancing drugs no matter how good the testing is.

About a year ago, while sitting in a lecture on learning and memory, the idea that certain drugs can affect the emotional responses to memory long after the memory itself has been formed came up. As someone interested in addiction research, the implication for treatment immediately came up in my head:

Could we possibly reduce the effect of drug-triggers by giving people a pill?

The answer is not, in fact, that simple. Even in the studies already done in PTSD patients, the memories have to be triggered and the drug given at exactly the right time to be affective. In fact, in humans, some of the best work has been done in PTSD patients immediately after the traumatic event.

Still, a recent study in animals suggests that the theory is sound. By interfering with the activity of a neurotransmitter important in the formation of memories, researchers were able to stop animals trained to self-administer cocaine from doing so. The animals, which had been trained to push a lever for cocaine when a light went on, reduced, or even stopped the responding after a single dose of a substance that blocked memory formation. Again, this only worked if the drug was given while the light (as in the drug-trigger) was presented at the same time.

Either way, given the powerful role of triggers in relapse, this avenue of research has some promising possibilities for future treatment of drug addiction.

I'll keep you updated as more research comes out.

.

The sympathetic nervous system acts as a barometer of emotional intensity and internal conflict. Noradrenaline is a stress hormone and neurotransmitter which helps to mediate our fight or flight response which, in turn, effects anxiety levels and heart rate.

Two million people in the UK are currently treated with beta-blockers for hypertension, but The National Institute for Health and Clinical Excellence (NICE) and the British Hypertension Society (BHS) have also revised their own guidelines for its use.

Newer drugs, known as ACE inhibitors, calcium-channel blockers and diuretics, are not only more effective at reducing the risk of stroke, but also have less side-effects. Although the Blood Pressure Association does not advise those already taking beta-blockers, to stop without medical supervision, it also promotes the use of newer, more effective medicines, over beta-blockers.

There is evidence, that beta-blockers can provoke type 2 diabetes, but they are not thought to be a direct threat to users' health. For patients with angina and those who have already had a heart attack or heart failure, beta-blockers are still thought to be one of the best forms of treatment. They are also recommended for younger women who could get pregnant and those who cannot take ACE inhibitors.

For the treatment of high blood pressure, patients of African or Caribbean descent and others over 55 should be initially treated with either a calcium channel blocker or a diuretic. Those younger than 55, should be given an ACE inhibitor as their first choice of initial therapy. If these treatments do not lower blood pressure enough then other combinations of the drugs should be used.

Although Propranolol (Inderal) are the most commonly prescribed form in the UK, other examples of beta-blockers include: Sectral (acebutolol), Zebeta (bisoprolol), Brevibloc (esmolol), Tenormin (atenolol), Normodyne (labetalol), Coreg (carvedilol), Lopressor (metoprolol), and Bystolic (nebivolol).

Po pierwsze, dr Dębski mówi, że "niektóre traumy są nieodzowne", a pamięć o nich "jest częścią nas".Warto się zastanowić - które ma cechować ta nieodzowność i dlaczego by inne nie miały "być częścią nas". Uznając fakt, że każde doświadczenie kształtuje naszą późniejszą osobowość - niezależnie od tego, jak je wartościujemy i że to wartościowanie może się zmieniać w czasie - historię cywilizacji prawdopodobnie da się całkiem sensownie opisać jako historię ucieczki od cierpienia. Oczywiście, Nietzscheańska wizja "ostatniego człowieka", którego ucieczka od cierpień pozbawiła "kręgosłupa" wygląda niezbyt zachęcająco. Jednakże nie mogę się oprzeć niechęci wobec wizji świata, w której nakazujemy sobie cierpienie, bo ono ma nas rzekomo uszlachetnić. Znam wiele przyjemniejszych sposobów uszlachetniania się i wierzę, że wybór między traumami, które chcemy zachować, a tymi, których nie chcemy, ma taką samą wagę, jak każdy inny w życiu. Podejmujemy go w warunkach niepewności, a argument, że kiedyś możemy żałować okazuje się trywialnym w obliczu oczywistej plastyczności ludzkiej psychiki. W dowolnym czasie możemy żałować dowolnej rzeczy i o niczym to nie świadczy. Pozostaje jednak pamiętać, że każde doświadczenie kształtuje w jakiś sposób naszą psychikę i czasami lepiej przeżyć trochę trudu, żeby wyraźniej przyswoić jakąś ważną życiową lekcję.

Dalej tym tokiem myślenia idzie ostatnie pytanie dziennikarzy: "Etycy zwracają uwagę, że cierpienie należy do conditio humana i sprzyja dojrzewaniu osobowości. Podkreślają, że o Holokauście trzeba pamiętać, nawet kosztem cierpienia jednostek". Oczywiście, etycy z pewnością nadal cieszą się wielkim poważaniem, ale pewnie byłoby dobrze, gdyby zamiast tworzyć nadęte metafizyczne bajędy o "kondycji ludzkiej", zaczęli podawać możliwe rozwiązania problemów etycznych wraz z ich konsekwencjami. Wybór pozostawmy, proszę uniżenie, tym, których bezpośrednio dotyczy. Doceniam tutaj odpowiedź dra Dębca, który uprzejmie zbył te argumenty swoich rozmówców.

Wreszcie chciałbym poruszyć krótko problem, który wypłynął tylko częściowo. Chodzi mianowicie o zastosowanie propranololu (czy innego środka o podobnym działaniu) przez przestępców. Całkiem realne wydaje się, że niektórzy mogliby używać go tak, jak czasami środków oszałamiających - do ułatwienia sobie przestępstwa i wyeliminowania dysonansu psychicznego. W literaturze spotkałem się też z zaniepokojeniem, że czasami przestępca mógłby podawać środek także swoim ofiarom w celu swoistego usuwania śladów. Na wagę tego typu możliwości wskazuje także i inny fakt. Środek w typie propanololu może okazać się łakomym kąskiem dla wojska. A w konsekwencji - przyczyną eskalacji brutalności konfliktów zbrojnych. Wraz z postępem techniki, wojna staje się coraz bardziej odhumanizowana. Żołnierze względnie rzadziej obryzgiwani są krwią zamordowanych nieprzyjaciół, rzadziej patrzą im w oczy, czują ich oddech, ciężar ciała. Zabijanie bywa czymś mniejszym niż naciśnięcie spustu karabinu. Ułatwia to dokonywanie mordów, których groza do niedawna zarezerwowana była dla psychopatów. Jeśli nawet wśród piechoty odszedłby kolejny mechanizm bezpieczeństwa - jakie mogą być tego konsekwencje na polu walki, także dla cywilów? Oczywiście, pomoże to budować narodowo-bohaterskie urojenia i ukrywać, że Nasi Dzielni Chłopcy to po prostu zabójcy i nie jeżdżą na misje z pistoletami na wodę święconą. Jeżdżą zabijać. Gdyby było mniej psychicznych ofiar wśród tych, którzy przeżyją fizycznie, tego rodzaju urojenia mogłyby plenić się jeszcze bardziej swobodnie. A Nasi Dzielni Chłopcy dalej jeździliby przelewać krew, która na ekranie wygląda mniej realnie niż w ostatnim filmie.

Dagen før ablationen skulle være, havde man gjort forundersøgelsen på mig - tidligere beskrevet hér: Forundersøgelse på Rigshospitalet. Nu var jeg så klar til ablationen, som jeg blev nødt til at være. Jeg havde overnattet på Riget og lægerne havde heldigvis ladet mig tage mine betablogger - det ville ikke påvirke ablationen at jeg indtog pillerne, for jeg havde næsten konstant takykardi. Hvorfor kunne jeg så ikke bare lade være med at indtage pillerne? Sagen var den, at jeg troede på, at det var pillerne, der holdt mig i live.

Dagen før havde jeg snakket med en fyr, der havde været igennem ablation. Han havde siddet i sit hospitalstøj og set så sølle ud.

- Jeg var over 8 timer på bordet!

- Gud, tog det så længe? Men er du ok nu så?

- Det håber jeg. For et par måneder siden fik jeg foretaget ablation. Og efter et par uger kom takykardien igen. Nu må vi se..

Jeg var selvfølgelig rystet. Også fordi han fortalte, at man ikke kunne stoppe blødningerne ved indsstikstedet. Han var stor-ryger. Måske var det derfor der havde været komplikationer? Efter den skrækhistorie var det godt, at jeg havde mit stakit omkring mig - mine to dejlige veninder og min peptalende mor.

Alligevel sagde jeg ikke meget den formiddag, hvor jeg ventede på at komme til ablation. Damerne gjorde snakken. Når de henvendte sig til mig svarede jeg bare ved hovedrysten eller små smil. Hjertet var i sit værste lune - som om det ville give mig den sidste svada af takykardi. Udenfor Rigets vinduer skinnede marts-solen. Bilerne kørte intetanende rundt og København var slet ikke klar over, at det var i dag, jeg skulle dø.

Da sygeplejersken kom op med en beroligende pille og sagde, at nu kom portøren snart, kunne jeg ha besvimet af skræk. Men jeg blev ved bevidsthed - sådan en slags bevidsthed, der opfangede lyde men ikke gjorde mig i stand til at forstå så meget andet end ord som 'ablation', 'takykardi' og ' nu er det din tur'! Det kan godt være det lyder dramatisk. Men jeg tænkte om det mon var sådan dødsdømte havde det, når de var på vej til nålen med giften, der skulle sprøjte dem ud af livet?

Jeg blev kørt afsted af portøren til kardiologisk ambulatorium hvor overbrændingen skulle finde sted. Min mor og 2 veninder småløb efter mig og forsikrede mig om, at det hele nok skulle gå. De jokede med lægerne - om de måtte komme med ind hvor det foregik osv..Men selvfølgelig skulle de blive udenfor døren.

Jeg blev kørt ind på stuen hvor det hele skulle foregå. Lægen der var midt i fyrrene og som skulle foretage indgrebet bød mig smilende velkommen. Der blev lagt drop (venflon) i min arm så evt. medicin kunne sprøjtes direkte ind (blodfortyndende medicin). Jeg følte mig fuldkommen prisgivet og tænkte - så nu dør jeg, om lidt!

Jeg blev dækket til med grønt klæde - hovedet kiggede dog frem, men jeg var ikke i stand til at se hvad der blev lavet ved min lyske. Lægen forklarede dog, at nu ville jeg få en lokalbedøvende sprøjte i både højre og venstre lyske og han lovede, at intet blev ført ind i kroppen på mig før bedøvelsen virkede.

At få stikket i lysken gjorde ikke ondt. Det strammede kun lidt, da det lokalbedøvende stof trængte ind i vævet. Så snakkede lægen lidt med mig og min bevidsthed fangede musik fra en lille radio, der stod i lokalet.

- På den skærm dér, vil du kunne se dit hjerte fordi vi har et lille kamera som vi om lidt fører ind i venen - i den ene lyske. Og i den anden indfører vi brænder og pacer. Men jeg kan se på din puls, at det vist ikke er nødvendigt, at fremkalde takykardi med paceren - du har det allerede! Så meget desto nemmere bliver det, at finde det punkt i hjertet, der skal brændes.

Jeg lyttede og lyttede ikke. Radioen spillede stadig.

- Kan du mærke det her?

Jeg kunne intet mærke. Og lægen sagde, at nu ville han indsætte katetrene i årerne. Det begyndte at bløde lidt, som han sagde. Men det var ok. Jeg kunne ikke mærke andet end at der blev hevet lidt i mit skind.

- Hm, jeg synes det bløder lidt vel rigeligt..Jeg må nok ha assistance!

En lille kineser havde stået og vasket hænder i et tilstødende lokale og kom nu løbende ud og sagde, at det her overtog han. Jeg bemærkede en lille sitren i den anden læges ansigt.

- Men du har lige været på i over 6 timer Chen?

Chen? Det var søreme den berømte Chen, der stod der og ville overtage det hele selv om det betød overarbejde for ham. Han smilede beroligende til mig og tryllede krisen væk!

- Når du kommer herfra, så får du aldrig mere takykardi!

Han sagde det så overbevisende til mig, at jeg - midt i min underlige tilstand - kun kunne smile og nikke. Katetrene blev ført ind i kroppen på mig via højre og venstre lyske - og det gjorde overhovedet ikke ondt! Det eneste jeg mærkede i kroppen, var en svag kildrende fornemmelse. Den var mere behagelig end ubehagelig.

- Dit hjerte kan du se på skærmen!

Chen pegede med panden over på en skærm hvor et hjerte, der skulle forestille mit - pumpede som besat. Jeg kunne se hvordan isenkrammet løb ubesværet igennem årene.

- Det er jo meget bløde og bøjelige kabler vi bruger!

Chen smilede og sagde noget på engelsk til en fyr der betjente elektronikken (radiobølgerne) ved et lille bord. Han sagde, at nu ville de prøve, at brænde - det var ikke svært at se, hvor impulserne stammede fra.

- Mens vi brænder skal du ligge mussestille. Du må slet ikke røre dig, for så risikerer vi at katetret rykker sig i hjertet og så brænder vi et forkert sted.

Jeg lå stiv som en pind. Og så advarede Chen - at nu brændte de. Det strammede en anelse i brystet, men egentlig var der ingen smerte. Hjertet hoppede lidt forvirret rundt og kom ind i normal sinusrytme. Jeg smilede og udbrød ahh, takykardien stoppede! Lidt efter kom den dog igen.

- Vi brænder igen - og du ligger musestille!

Jeg adlød. Min respekt var stor. Den mand, Chen, havde været på job i mange timer og så tog han alligevel over - sådan bare lige - sådan! Det strammede igen lidt i brystet og takykardien holdt inde. Nu gik et par minutter med normal sinusrytme. Chen var tilfreds.

- Er jeg færdig?

Chen rystede på hovedet og sagde at nu skulle der brændes godt og grundigt så jeg ville få noget smertestillende - da det kunne gøre lidt ondt. Jeg nægtede og sagde, nej - jeg kan sagtens holde det ud! Men sygeplejersken gav mig noget smertestillende i droppet og Chen bad mig endnu engang om at ligge mussestille mens de brændte.

Jeg fik det pludselig dårligt og følte det som om jeg skulle besvime. Sygeplejersken, der havde siddet og holdt mig på skuldrene for at berolige mig, gav mig ilt i en maske og så fik jeg det bedre.

- Er du klar? Vi brænder nu!

Jeg var klar og lå stiv som en pind. Og det var godt jeg fik smertestillende. Det her gjorde ondt. Man brændte også længere end de andre gange. Jeg kiggede op i loftet med min iltmaske om næse og mund og tænkte, at den smerte kunne beskrives, som hvis man havde ondt i musklerne efter et marathonløb - blot var det en vedvarende smerte og fornemmelse af, at lungerne blev hevet ud af ryggen på mig. Så var det pludselig overstået. Smerten holdt op. Chen smilede og hev mig ud af mit mentale blackout.

- Se hvor fint dit hjerte slår!

Jeg bemærkede, at det var overstået. Og det var sandt. Mit hjerte slog helt normalt. Efter en hel dag med takykardi var hjertet roligt. Indgrebet havde varet 3 timer. Man må sige, at det var gået super godt - takket være Chen.

- Nu er vi færdige! Vi trækker katetrene ud af dig nu. Er du glad?

Jeg kunne tude. Men var stadig i sådan en slags ingenmandsland rent mentalt. Men ja, jeg var glad. Og taknemmelig. Jeg kunne ikke få mine øjne væk fra Chen - jeg måtte vise min taknemmelighed med øjnene - jeg kunne ikke sige noget. Jeg var så rørt.

Så blev jeg kørt tilbage til min stue af en portør. Min mor havde siddet udenfor rummet og spurgte hvordan jeg havde det. Heldigvis var mine veninder gået og min mor skulle hente min datter i fritidsordningen, så hun blev også nødt til at gå. Jeg smilede og lå mussestille. Turde ikke røre mig. Ovenpå min mave og lyske havde de placeret sandsække så der blev holdt et konstant pres mod indstiksstederne (af hensyn til blødningsrisiko). Sygeplejersken satte hjerteovervågning til og sagde at nu skulle jeg ligge helt stille i 5 timer. Intet problem. Jeg ville gøre lige hvad de sagde! Jeg levede!

Så fik jeg mit værelse på hospitalet og besked om at trække i hospitalets ikke-charmerende tøj. Inden radiofrekvensablation skulle der måles blodtryk - i bad skulle jeg også og bagefter skulle jeg have barberet hårene i lysken. Der skulle der tages EKG og lægges kanyle i en blodåre i armen - hvis det blev nødvendigt at give mig medicin under behandlingen.

Jeg gjorde det jeg blev bedt om. Gik i bad - barberede lysken og og lagde mig i sengen.

En overlæge kom forbi og ønskede mig held og lykke og så gik han igen.

Så var jeg indlagt. Og skide bange. Jeg tillader mig, at bande her - fordi - INGEN ord kan beskrive hvordan jeg havde det. Alt gik sandsynligvis som det skulle. Men ingen tænkte på, at jeg var ved at gå fuldstændigt i stykker af angst indeni.

Og - jeg ved ikke hvad der skete. Men Fanden tog ved mig. Jeg slugte en propranolol for at dæmpe mit plagede hjerte og stod ud af sengen. Så tog jeg hospitalstøjet af og iførte mig mit civile tøj. En sygeplejerske kom forbi og spurgte hvad jeg lavede.

- Jeg tager hjem!

Hun kiggede forskrækket på mig og forsikrede mig om, at dét kunne jeg bare ikke gøre nu. Lægerne ventede på mig i Kardiologisk laboratorium!

- Det er jeg ked af. Men det er aflyst! Jeg er aflyst. Det kan du godt fortælle dem. Og jeg har lige taget en betablogger!

Hun snurrede rundt på hælen og skyndte sig ud af værelset. Jeg var lettet. Satte mig i en stol og ventede på, at pillen ville virke.

Pludselig kom overlægen stormende ind i værelset og så meget stram ud i betrækket.

- Hvad i alverden har du tænkt dig!?

- Jeg vil ikke gennemføre ablationen. Jeg er bange for, at det går galt..

- Du laver sjov med mig ikke?

Jeg måtte fortælle den vantro læge at jeg ikke jokede. Og han var mildest talt shokeret. Jeg fik at vide, at nu hvor jeg sprang fra i sidste øjeblik havde jeg brugt af resourcer, som jeg slet ikke var klar over og jeg skulle ikke tro, at jeg bare kunne komme og kræve ablation i morgen!

- Jeg ved det godt. Men jeg vil bare hjem og undskyld.

Den der blev mest skuffet over, at jeg var sprunget fra ablationen i sidste øjeblik, var nok min kæreste. Han havde jo set hvor slemt jeg sommetider havde det med takykardien. Men jeg var lettet - for min angst havde været meget slemmere end et takykardianfald plejede at være

Syntes jeg på dét tidspunkt.

På trods af indlæggelsen - på trods af medicinering og et noget trykket humør både hos kæresten og mig, gik graviditeten egentlig fint. Var der sommetider nogle anfald jeg havde svært ved at styre, måtte jeg tage en ekstra propranolol i pilleform. Men heldigvis skete det sjældent. Jeg kunne mærke, at betabloggerne holdt om hjertet og fik det sat lidt ned i slag. Dog sov jeg uroligt om natten, havde ofte mareridt og vågnede med sved over det hele - men det var måske pga den store mave.

Jeg var ofte plaget af svimmelhed og kvalme - men også disse gener tillagde jeg graviditeten.

Senere fandt jeg ud af, at det kunne være bivirkninger fra medicinen.

Takykardien slap mig selvfølgelig ikke. Men medicinen holdt de lange og stædige anfald væk.

Jeg var også begyndt at frygte fødselen. Ikke pga smerter - men mere pga mit hjerte. Hvordan ville det opføre sig under fødselen, som jo - selv om det er en smuk begivenhed - er et stresset øjeblik?

Lægerne sagde at jeg bare skulle tage det helt roligt. De kunne give mig alt - lige fra lattergas til kejsersnit - hvis det skulle være nødvendigt.

Og var barnet på noget tidspunkt i fare, havde man jo neonatalafdelingen på Århus Kommunehospital - min kæreste og jeg skulle slet ikke gøre os nogle bekymringer.

Jeg ville bare have så normal en fødsel som muligt.

Min næste bekymring var amningen?

Jeg fik jo betablogger og kunne ikke bare stoppe med medicinen fra den ene dag til den anden - så ville jeg jo risikere at få det dårligt - og det havde mit barn jo ikke brug for. Men ville barnet tage skade af at indtage stoffet via modermælken?

I brugsanvisningen af medicinen stod, at man ikke måtte amme, hvis man indtog Inderal retard. Men lægerne mente ikke det var et problem. Så hvad skulle jeg forholde mig til?

Jeg gik elleve dage over tiden og lægerne på Århus Kommunehospital var lige ved at sætte mig igang.

Det lille barn i mig var dog hurtigere end lægerne og en sen aften mærkede jeg et smæld over lænden, som om en elastik sprang - og så gik vandet. Fødselen var igang!

Mens jeg havde hyppige veer - ca. 1 ve hvert 3 minut - gik jeg gispende og lykkelig rundt i lejligheden. Det var ikke slemt - hvis det her var veer. Til gengæld gik mit hjerte amok. Det satte alle impulser ind på at give mig og mit ufødte barn en god portion takykardi.

Kæresten prøvede at smøre madpakke mens fostervandet sejlede rundt i hele huset.

Vi havde ringet til Århus Kommunehospital, der havde sagt, at når fostervandet er gået, så skal den fødende ligge ned. Men jeg kunne ikke ligge ned. Sålænge jeg gik rundt om stuebordet - holdt mig oprejst - var takykardien i min hue hånd. Lagde jeg mig, gik hjertet amok igen.

Ambulancen kom utroligt hurtigt og to store falckmænd hjalp mig ned ad trapperne - vi boede på 3. sal.

I ambulancen kom veerne hurtigere og hurtigere. Jeg var nu ikke nervøs. Men det irriterede mig, at de kørte med blå blink.

Det var skønt vejr i København. Kæresten og jeg var taget til staden da jeg ville holde fødselsdag med min runde mave, familie og venner. Den første dag skulle fejres med en gode veninde. Frokost og bif-tur. Jeg glædede mig.

Om morgen da jeg stod op, kunne jeg godt mærke, at mit hjerte var touchy. Det sendte små anfald ud i mit system med jævne mellemrum. Jeg var irriteret. Hvorfor lige netop i dag, hvor jeg ikke havde tid til at tage mig af dem? Desuden var maven begyndt at gøre det mere besværligt for mig mht selvbbehandling (Valsalva-manøvre) af takykardien. Det tog længere tid, at få hjertet til ro.

Jeg tog afsted til byen og ignorerede de små anfald, der kom og gik med jævne mellemrum.

Med vilje valgte jeg dog kun at spise lidt salat, da jeg sad med veninden på cafe. Min erfaring fortalte mig jo, at anfaldene ofte kom efter spisning og med min gryende graviditet, var det levet sværere for mig at spise noget overhovedet.

- Er du slet ikke sulten?

- Nah, kom lad os smutte i biografen.

Vi skulle se Kieslowskis "HVID" og jeg glædede mig. Så snart jeg satte mig i biografsædet begyndte hjertet at tale med store takker. Det piskede afsted, det bedste det havde lært. Og jeg kunne ikke slappe af - maven strammede. Og sparkede den lille? Jeg var bekymret. Til sidst måtte jeg sige til veninden, at jeg blev nødt til at gå. Jeg havde takykardi og kunne ikke styre det. Hun blev selvfølgelig bekymret men forstod det så godt.

Udenfor biografen gik jeg igang med lave mine manøvre - sådan noget med at bøje mig forover og holde vejret - lave et indre pres med bugmusklerne. Det skete ikke andet end at hjertet fortsatte sit vanvittige ridt. Så skulle jeg tisse. Jeg måtte ned ad nogle trapper for at komme til toiletterne og bare dét at bevæge nedad de trapper, gav mig en fornemmelse af, at nu kunne jeg snart ikke mere.

Da jeg kom op af trapperne fór jeg ud på gaden og prajede en taxa. Min veninde ville have fulgt mig hjem men jeg afviste hende. Ville være i fred. Og hvor skulle jeg være i fred?

Mens jeg boede i København havde jeg haft en rigtig god læge. Hende savnede jeg nu. Jeg tog chancen og bad chaufføren om at køre mig til Christianshavn hvor jeg vidste hun havde praxis. Klokken var sen eftermiddag og jeg anede ikke om hun overhovedet stadig var på job, men jeg håbede. Jeg var så bange for mit ufødte barns tilstand. Takykardien havde varet ca. 45 minutter.

Min gamle læge var i sin praxis og hun blev mildest talt forundret over at se mig. Hun blev først glad - det var jo et par år siden - og nu var jeg gravid? Det var da dejligt!

Så fortalte jeg hende grædende om hvad der havde bragt mig til hende og hun ville straks have mig på hospitalet.

Jeg blev indlagt på det nuværende Amager Hospital og blev gjort klar til EKG.

For første gang fangede lægerne et af mine takykardianfald og kunne se på strimmelen hvad det drejede sig om.

Da jeg var gravid, var det jo en kilden sag hvad de skulle sprøjte i mig af medicin. Men de valgte at sætte mig i en anfaldsbrydende behandling med noget hjertestyrkende (som de sagde) adenosin - startede med små doser. Imens det hele stod på bad de mig også om at lave vagale manøvrer - som i øvrigt slet ikke havde effekt overhovedet. De gav mig også en mild beroligende pille men om jeg kunne mærke den - nej. Jeg var fuldstændig kørt op i en spids. Min kæreste kom styrtende ind på hospitalet og var grædefærdig. Dét hér - kunne det skade vores barn? Medicinen og takykardien? Vi fik ikke så mange svar men måtte "oversætte" diverse grynt og hmmm.. og det gjorde vi selvfølgelig sådan, at vi syntes at kunne spore dyb bekymring hos læger og sygeplejesker, hvilket gjorde os endnu mere nervøse.

Da takykardien blev ved øgede de dosis og da det ikke hjalp ville de prøve med et andet præparat.

Næste valg var propranolol. Og der skete en mærkbar forandring. Hjerterytmen lavede sine sædvanlige rock og rul og vendte sig og snurrede indtil den fandt sin gode gamle sinusrytme igen. Lægerne åndede lettet op. Men så slog hjertet over igen og fortsatte sin vanvittige sport. - Mere propranolol - og endelig..endelig faldt hjertet til ro.

Jeg lå helt stille. Turde ikke bevæge mig. Sommetider kunne jeg nemlig fremkalde nye anfald (efter et længerevarende ét) ved bare at dreje hovedet til venstre eller højre. Så jeg lå helt helt stille.

Sygeplejerskerne var så søde. De kom med mad - men jeg ville intet have. Turde ikke spise - turde ikke engang synke mit spyt. Jeg ville ligge helt stille så takykardien ikke "fik øje på mig igen".

- Men du skal altså spise noget - vi kan se på blodprøverne, at "du begynder at spise af dig selv". Du må også tænke på dit barn..

Og de skulle bare vide hvor meget jeg tænkte på mit barn. Jeg tog imod en skål med kogte ærter og gulerødder - kød og kartofler lod jeg stå.

Mit ophold på hospitalet blev til to dage. Man ville finde en dosis, som passede mig. Og da jeg reagerede så godt på propranolol ville det blive den form for betablogger, som jeg skulle tage fra nu af og graviditeten ud. Det stof var i øvrigt også det bedste, at give mig nu hvor jeg var gravid. Det ville ikke skade barnet når jeg fik så lille en dosis, som jeg gjorde.

Så fra den dag af og graviditeten ud skulle jeg tage en depotkapsel hver dag på samme tidspunkt for bevare et jævnt medicinspejl i blodet døgnet rundt. Ren forebyggelse, som de sagde.

Inderal retard med det aktive stof propanolol skulle være min medicin i flere år. Og min baby sparkede stadig.

Since World War II, our military has sought and found any number of ways to override the values and belief systems recruits have absorbed from their families, schools, communities and religions. Using the principles of operant conditioning, the military has found ways to reprogram their human software, overriding those characteristics that are inconvenient in a military context, most particularly the inherent resistance human beings have to killing others of their own species. "Modern combat training conditions soldiers to act reflexively to stimuli," says Lt. Col. Peter Kilner, a professor of philosophy and ethics at West Point, "and this maximizes soldiers' lethality, but it does so by bypassing their moral autonomy.

For the rest follow this link:

http://www.alternet.org/healthwellness/72956/?page=entire

Reprezentantii Zentiva, compania care producea medicamentul, spun ca au luat decizia de a exclude produsul din motive interne. „A fost o decizie a fostei conduceri, luata inainte de preluarea Sicomed de catre Zentiva."

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