You know how I love new words, well …
… back in July, after a Facebook post about my medication increase, a good and learned friend commented: “Great, you’re getting all the added benefits of up-titration (as we call it in the trade)“. I have to admit this was ‘foreign language’ to me. So, eagerly looking it up I found a very clear and helpful definition courtesy of The Cleveland Clinic in Ohio, US. Here I quote: “Titration is a way to limit potential side effects by taking time to see how your body will react to a drug. In titration, the medication is started at a low dose. Every couple of weeks (or so) the dose is raised (‘up-titrated’) until the maximum effective dose (‘target dose) has been achieved …”
In my research I also came across these guidelines, entitled:
The NHS Protocol for Titration of Beta Blockers for Heart Failure:
How to use:
• Ensure patient has stable mild to moderate HF
• Start with low dose & double dose at not less than 2 weekly intervals
• Aim for target dose or highest tolerated dose (some beta blocker is better than none)
• Monitor heart rate, blood pressure, & clinical status (especially signs of breathlessness, swelling, body weight increase)
• Blood test to check kidney function 1-2 weeks after initiation
Advice to patients:
• Explain the benefits – given as much to prevent worsening HF as to improve symptoms &
increase survival
• Temporary side effects may occur during initiation/up titration phase
• Advise patient to report any increasing breathlessness, fatigue, swelling or weight gain, but stress that it can usually be managed by adjustment of other medication; patients should be advised not to stop beta-blockers without first consulting the clinician
• Consult clinician in the event of persistent weight gain occurring
What became immediately obvious and heartening to me is that my brilliant personal cardiac nurse, Michelle, carefully employed ‘best practise’ in my treatment, following protocols described above to the letter. This I’ve appreciated enormously, considering the potential side-effects of the particular medication in question, listed in the package leaflet:
Common side effects can include headaches, dizziness, feeling light-headed, weakness, fatigue, cold hands & feet, sickness, diarrhoea or constipation
Serious side effects could include shortness of breath (especially when exercising), swollen ankles/legs, chest pain, irregular heartbeat, wheezing, tightening of chest (which can be signs of lung problems) yellow skin or whites of eyes turning yellow (signs of possible liver problems), sleep disturbances, depression, muscle cramps.
Thankfully, I can report that side effects have been minimal – some light-headedness (days within each dose increase, but short-lived) fatigue and some sleep disturbance – but none of those other ‘nasties’ mentioned above occurred in the 5-month long process between mid-March and August when the ‘target dosage’ of 10mg daily was successfully attained. The outcome in my case it seems is that ‘up-titration’ has facilitated maximal tolerability (10mg) to the Bisoprolol Fumarate.
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REFLECTING on this experience it occurs that over many, many years I’ve been the beneficiary of what may be termed “spiritual up-titration”. I’m finding a “stretched similarity” with the phenomenon formally known among theologians as “sanctification” – that long, slow (and in my case, painful) process beginning at ‘conversion’ in February 1967 and continuing to this day, with the intention of transforming me into someone more resembling Jesus Christ.
Oh, I acknowledge there have been loads of set-backs, and lots of static (even stagnant) periods, due to my propensity for poor choices, selfishness, laziness, rebellion and other unsavoury characteristics. So, clearly I’m not talking ‘quick fixes’ here, nor suggesting anything that produces instant maturity. As one of my favourite Christian authors teaches in his classic work, “A Long Obedience In The Same Direction”. Eugene Peterson typically identifies in this work a major problem for travellers on the Way – which is both spiritual and cultural. “Everyone is in a hurry”, he writes, “the persons I lead in worship, among who I counsel, visit, pray, preach and teach, want shortcuts … they have adopted the lifestyle of a tourist and only want the high points“.
All that said, I can testify that, step by step, little by little, line upon line there is a metamorphosis occurring – I may not be what I should be, but most certainly I am not what I used to be. I simply love the description shared by St Paul in one of his letters in our New Testament. Writing to the church at Corinth he declares: “And we all (i.e. believers) with unveiled faces, beholding the glory of the Lord, are being transformed into the same image from one degree of glory to another. For this comes from the Lord who is the Spirit.” – 2 Corinthians 3:18.
That’s exactly it – the process of being transformed (up-titrated, even ?) from one degree of glory to another. I find it not without significance that the word translated ‘transformed’ here is the exact word translated ‘transfigured’ in the amazing account of Jesus’ Transfiguration – literally ‘metamorphosed’ – such is the magnitude of the change taking place in Christ-followers as they co-operate with the Spirit of God.
Other translations have:
“…we are becoming more like Him with ever-increasing glory …” – International Standard Version
“… our lives gradually becoming brighter and more beautiful as God enters our lives and we become like Him …” – The Message Bible
“… we are being transfigured into His very image as we move from one brighter level of glory to another …” – The Passion Translation
I’m mindful of similar Bible passages which speak of God’s purpose in this way – here are a couple of examples:
“God knew what He was doing from the very beginning. He decided from the outset to shape the lives of those who love Him along the same lines as the life of His Son. The Son stands first in the line of humanity He restored. We see the original and intended shape of our lives there in Him.” – Romans 8:29 from The Message Bible
“My dear friends, we are now God’s children, but it is not yet clear what we shall become. But we know that when Christ appears, we shall be like Him, because we shall see Him as He really is.” – 1 John 3:2 from the Good News Bible
There’s the “target dose” (if you like) – Christ-likeness, which will be fully realised when we finally behold him. So, now it dawns on me that I share precisely the same hope as the psalmist, who exclaimed excitedly: “As for me, I shall behold Your face in righteousness; when I awake, I shall be satisfied with Your likeness” – Psalm 17:15
OH, YES – I’m being up-titrated !!
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