Hypertension 36: Really Gross Stuff

WARNING: this post contains graphic descriptions of bloody nasal discharges. If you do not have a fetish about boogers and blood, read a gardening blog instead.

Yes, this is another side effects sad sack whiny story. As it is gross, I will try to keep it short. However, if you are turned on by gross stuff, by all means reread it several times.

Like anyone, on rare occasions when I’d blow my nose there would be a little blood on the hanky. Nothing unusual. However, since starting the combination of Teveten Plus, Adalat XL and Lipitor (none of which may be responsible—and one problem is, who knows?—I also take ‘baby’ aspirin to help prevent a stroke)…uh, where was I?

Oh yeah. I started that combination of meds November 22, 2006. Staring in early January, 2007, I began to notice that when I blew my nose (which has always felt stuffed up) there was blood on the tissue. Not just a speck here, a bit there. Nope. Fairly large splotches of bright red blood on the pure white tissue. I also began to notice, as I, uh, felt around in my nose, hard crusts. The hard crusts were congealed blood. This is disturbing.

I must add: I do NOT like digging around in my nose. Normally I do NOT look at what I blow out of my nose. And, if you are thinking the worst, nor do I eat it.

In addition to Hypertension, I have sleep apnea. That condition involves you not breathing for significant amounts of time while asleep. In my case, I was tested in a hospital and stopped breathing for a minute at a time. This condition, if untreated, can lead to congestive heart failure and other problems, not to mention you’re tired all the time because you ain’t sleeping so good. The treatment is not a medication, but instead a breathing machine. The machine at your bedside, pumps air through a face mask into your nose all night long. When going to bed, say good-bye to romance and hello to Elephant Man.

It appears that, possibly, the constant air pressure through the breathing mask, combined with the prescription medications opening up my blood vessels, leads to some rawness inside my nasal passages. This irritation leads to some bleeding, and crusts forming. Hence, when I apply pressure by blowing my nose, the blood on the tissue. Followed by the large pieces of bloody crusts.

(If you are reading this and getting off on it, ugh.)

So one very unpleasant side effect of the medications I am taking (which have indeed significantly decreased my blood pressure, I hasten to add!) appears to be blowing up blood. When, that is, I blow my nose.

While we’re at it, I may not have mentioned occasional eye sight problems. Apart from ‘floaters’ (black spidery dots in the corner of your vision, which can occur at my age), sometimes when I wake up in the morning everything is blurry. I have three pairs of glasses: reading, computer glasses (a form of progressive lens), and distance glasses (a bifocal with the lower portion adjusted for reading). None of the three help. Everything remains blurry. I can read, yes, but it takes an effort. Watching television is much less enjoyable.

There is no predicting when this will happen. Normally, my eyesight can get a bit blurry when I’m very tired. But this particular blurryosity happens whether I feel stressed or calm, fine or unfine. I gather, again, it has something to do with the blood pressure affecting my eyes internally, with the focal length changing as the blood pressure changes. It happens once every two or three weeks. Usually it lasts for much of the day.

And oh yeah, my gums are still inflamed--but not as much.

I know the medications are worth it, and that playing the odds I won’t have a stroke by suffering these side effects is worth it. I know that. Know it know it know it. Yep, I am grateful for what the medications are doing for me, and, yes, I know that life is a bowl of bloody tissues…ooops, cherries!

Hypertension 20: The New Specialist

I'm not bored, I could write about me all day. But why are you still reading? Is it late? Have you been drinking? I will admit, at times it is difficult for me to understand the blogosphere. Maybe I should have a blogoscomy.

Be that as it may....

An earlier post mentioned the change in prescription medications in November, along with a change in specialists. Here is the whole story.

Specialist #1 was one swell fella. We got along fine, he was knowledgable about the Chinese herbal treatments and approved of them (as long as they continued to work), and he wore the most-in-need-of-a-wash labcoat I'd ever seen. He saw me on October 4, 2006, and felt I needed significantly more medication (sigh) and much more time off work (okay!). I saw him again three weeks later, at the end of October. At which time, we said good-bye because he was moving to Alberta.

Alberta is not a shampoo company, but another province in Canada.

I don't think he moved because of something I said. He was going up in the world, to a University position, and more power to him!

This meant proceeding to another specialist. My family doctor was fine, but I wanted a physician who lived, breathed, ate and was obsessed by Hypertension. Well, okay, also a specialist because my employer would not be all that interested in a family doctor's recommendations. Specialists carry more weight. I knew that from my work.

He recommended, at my request, another specialist, who was in the Adult Cardiac unit of a local hospital. It took several weeks for the appointment, in part because first my family doctor had to make the referral--that is how the system works. Civilians can not just phone up and make the appointment on their own.

The weeks went by. Down to the hospital I went, where I registered and actually was given a white plastic wrist band for while I was there. Then I went up to the unit, waited a relatively short time, and was called into a waiting room. Where, of course, I waited.

Not for long. A nurse came in, took my blood pressure, interviewed me, and then said the doctor would come in. A few minuts later, a quite nice student doctor came in. He explained he was a student, or intern, or resident, or at least "not quite" a full doctor. He was very efficient, to the point of being brusque: but very politely brusque. This is Canada, after all. He took my blood pressure again, examined me, asked more questions. Then he explained he would leave, review everything with the specialist, and they would both come back in.

I was absolutely wallowing in attention.

A short time later the student and the specialist came back in. The specialist asked some more questions. He reviewed the side effects which I had mentioned to the nurse and intern. He asked the intern what changes should be made. The intern suggested increasing the Tevetin. The specialist said no, that would increase the negative side effects. It went back and forth like that for a little while. I commented to them it was like being in an episode of "House", and we all had a rather jolly laugh.

Eventually the specialist changed the caduet I had been prescribed, giving me two new prescription drugs instead, adalat and lipitor (which I had heard on from the relentless tv ads). He said the new combination should help with the feelings of weakness. He recommended continuing exercising. Regarding dieting, he had no recommendation to my query about the circular nature of feeling weak so I ate more, except to note the new medications should leave me less weak, so that should certainly help.

He was quite done when I noted to him my last concern. In a couple of months, after continued exercise, dieting and adjusting to yet more new medications, I would return to work. My concern was that the stressful nature of my work would bop up my blood pressure again as soon as I returned. To my surprise--stress and high blood pressure are controversial, at least for employers and their human resource departments--he and the intern completely agreed, and said they would write a letter to my union, recommending I be given less stressful work on my return.

For the first time in a long long time: really good news!

Hypertension 19: Meds vs. Meds vs. Dieting

There are many conflicts involved in being treated for Hypertension, and speaking of being treated I wish there were treats. Halloween candy would be very nice. But too often there are just tricks. Eggs on your windows, and the yolk is on you.

Generally, all doctors agree part of treating Hypertension is that you should lose weight and exercise. After that, agreements end. There can be conflicts between family doctors and specialists, between specialists, between different Western medicine and "alternative" treatments.

Many of these conflicts stem from differing opinons on the medications.

It isn't even just between different new meds. There are new meds and old meds, and every physician has his/her preferences. Some physicians listen well to patients, some think they know best and the patient should just lvie with it. A relative of mine has taken Western Hypertension medications for many years. He was concerned that his older medications created problems for him, compared with the newer stuff. His doctor thinks those meds are just fine, and won't change them. My relative is now in therapy for depression (one of the known side effects of those meds).

The side effects can have unexpected impacts. For example, on weight loss (dieting).

A previous post addressed dieting. Speaking of that, I wish I could really address dieting, preferably out of State. Or stamp it--out--or just plain stamp it and mail it somewhere else.

Where was I? Ah. The previous post looked at the less obvious problem--sodium in prepared foods. In writing that post, I figured that we all know about the truly awful "eating less" part of dieting, so why write about it?

But there was more. Losing weight is not as simple as getting your head around eating better foods (is there a better food? is a Hazlenut torte truly not as good as a whole wheat noodle that tastes like cardboard?), or eating less. There was an insidious side to losing weight in my situation.

By early October I was down to around 208 pounds, depending on where and how I was weighed.

Now, I really must stop here for a moment and talk about getting weighed, which is a weighty topic about the way to go in waiting to lower high blood pressure, as Tom Waits once sang. Ahem.

Have you ever weighed yourself on a scale in your bathroom, then later that day been weighed in the doctor's office and chugged in several pounds heavier? Feeling embarrassed as you tell the doctor's assistant you were lighter this morning, and she struggles not to roll her eyes? Then you say when you weighed yourself you were wearing, well, your birthday suit, and now you're wearing all these clothes, so that's why you are heavier, and she does roll her eyes?

I actually changed my bathroom scale, figuring that was the problem. It was not.

I can now state, based on my encounters with the superduper scale in my speciality gym, that being fully clothed can add three to five pounds to your weight. No doctor's assistant will believe this, but it is the truth.

Anyway. After I was put on a total of four prescription medications in early October, my weight began to go back up again. Right now, on December 2, it is up to 218 from the early October 208, which actually is down from 222 in November. Is that clear?

Here is what happened.

The new prescription medications lowered my blood pressure, indeed they did. At some points lately it has even been down to 110 systolic (I am still on four, but two of them are different, more on that eventually), and 110 for me similar to being embalmed. However, lowering my bp was not their only impact.

After waking at 7 am, driving my daughter to high school and then my wife to work, taking the meds, eating breakfast and spending a couple of hours reading or writing or watching some film I could never watch with in the presence of either my daughter or spouse (you have a dirty mind, I am talking, actually, of old Boris Karloff movies), by 11 am it was snooze time. That's right. Four hours of being awake and I would start feeling the need for a nap. Not just wanting a nap, or feeling tired. Needing a nap.

I do have sleep apnea, so I'm always ready for a snooze. But the CPAP machine I use each night generally gives me enough rest. This tiredness was different. I had experienced it at times before, as noted in earlier posts. It was not as bad as it had been. One medication left me unwilling to even get out of bed. These meds were better, but by 1 pm I had to nap because it was difficult to stay awake.

But I was tired of being tired. I wanted to stay awake.

Without really thinking it through, I began to eat more. Not ice cream, not chocolate. Just...more. The more I ate, the more energy I felt, and I could stay awake. Heck, even until 9 pm!

The medications created a vicious circle. They made me tired, I ate to feel energized, I then gained weight, for which I would end up needing more meds. Was this a plot of the military industrial medical pharmaceutical complex?

Although I would like to blame everyone else, including a paranoid X Files conspiracy directed against me, it was pretty simple: medications v. weight loss. The solution? Specialist number two (the first moved out of the province, I don't think it was anything I said) changed two of the meds. Now I feel less tired, and have started to lose weight again.

Took a while to figure out. No guide book. No advice. Had to be direct with the physician. As always, the responsibility lay on my shoulders. As it is for any patient navigating through the treatment maze. It is up to you to stay on top of it, make sure your doctor understands your issues, and make sure that your doctor acts on those issues.

Hypertension 16: My Favourite Prescription Medication Story

Now I was off work for several months, to adjust to the new medications, to start exercising, change my diet, and quiet down the stress in my life. The new medications came in two pills. Don’t ask for details, I avoid knowing, but there was a calcium blocker, the adrenalin stopper, a diuretic, and a cholesterol stepper-onner.

Those two pills were powerful stuff. They led to my favourite prescription medication story:

None of these medications make you hallucinate. The side effects are not always obvious. At first, I did not think the new meds had a big negative impact on me. Sure, I was feeling much more tired. I needed a nap by 11 am. It was not a preference!

I did feel a bit “out of it”, but thought I had everything, as my mom would say, “under control. True, I drove through a stop sign or two before I realized I had to work much harder at focusing when driving. I guess it was that “don’t use farm machinery” kinda situation in the warnings list on the box. But what did that matter if I did not live on a farm?

Two weeks later, in mid-October, my Cousin Lewis flew into Winnipeg from New York. I agreed to pick him up at the airport. Given I was now off work, I had plenty of time to organize myself. And organize it I did! Let me tell you, I was one on top of it puppy!

Gas in the car. Front door locked. Dog pees in the back yard before getting in the car. I even cleaned out the usual collection of newspapers, fast food wrappers and general garbage from the station wagon. Got the Shitzhu into the car. I even remembered to bring her leash. Left the house with plenty o’ time to spare. I drove to the airport without incident, stopping at every red light and only going through green lights. At the airport, I parked properly.

Proud of myself, I put Willow the dog on her leash and went into the terminal early. I was there early. Cousin Lewis had not yet arrived, so I was there to greet him as he came down the escalator. Helped him get his bag. Could it have been more perfect?

And it was, only I discovered in the parking lot that:

a) the car doors were unlocked
b) the car key was in the ignition
c) the car engine was still running

Now, I'm 61. I've been driving a long time. This was a first. I have never parked the car and left it unintentionally unlocked. I’ve never left the keys in the ignition. And I sure had never before left the motor running.

Luckily this was Winnipeg, so nobody stole the car (Canada can be like that).

I was born and raised in Brooklyn, New York. We are trained in New York, from the earliest possible age, to lock everything. Leaving the car like that went against my entire cultural heritage. Leaving the doors unlocked was bad enough...but leaving the engine running? If I had done that at New York's JFK, not only would my car have been stolen, but before stealing it any responsible New York thief would have sought me out in the terminal and beaten me up for being so stupid!!!

I had thought I was on top of everything. The reality was the opposite.

Hypertension 13: Back to Square One

Up until late August, 2006, my Western specialist had accepted the herbal treatments--they were working. But, for whatever reason, they stopped working. Perhaps I had grown resistant to the herbs and required stronger ones. Perhaps none of them would work any longer. The Chinese doctor wanted to try stronger ones. But there was a problem.

Chinese medical treatments for Hypertension are not recognized by Canada’s socialized medical system. They are also not recognized by my private insurer, through work. And they appeared to carry little or no weight with my employer, either. I had developed problems at work due to the side effects of the medications I had been taking. I’d slowed down, had memory problems, was cranky.

I needed treatments that the “mainstream” would recognize. And, of course, treatments that would work quickly.

My Western specialist, who had supported the Chinese treatments until they stopped working, was the key player. He was concerned that my blood pressure readings placed me at Stage 3 Hypertension. He recommended I start back on prescription medications, and he did not say it in a way I thought I could ignore or even question.

So in late August he looked at my higher readings, and started me on a new prescription medication. That medication, in lay terms, blocks the reception of adrenalin by my blood vessels. My understanding was that when I got stressed out my adrenalin production increased, which in turn increased my blood pressure. Stress in my life, including at work, was a factor.

The specialist suggested at the same time that I consider a two week trial from work, to see if being in a less stressful environment would help. I had refused taking any time off work as I was concerned about what my employer would think. My work? Let's just say that I am a civil servant, and for 19 years have been an investigator—a professionally suspicious person. Pretty much anyone who was been in a 'front line' job will tell you that it direct service can be stressful. In my line of work someone always was angry—you had to decide if someone was right or wrong, and that left one side or the other upset.

As a Golden Employment Rule, it is rarely a good idea to let any employer know you are unhappy in your work or that you are having difficulty doing the work. Especially these days, when production is everything.

But then I had to take a work-related seminar on a Monday. To avoid losing work time, I worked at home on the weekend—but my effort was not apparently recognized and the pressure continued. The workshop? Ironically, on managing work-related stress.

That was the point where I decided to take my specialist up on his recommendation to take two weeks off work and see if being away and being engaged in less stressful pursuits, would have an impact on my blood pressure. So off I went on two weeks' medical leave.

The specialist was now directly managing my treatment.

Hypertension 11: Herbs Fail Me

The Chinese treatments worked. Worked pretty much as well as the prescription medications. “Pretty much” because they did not bring my blood pressure as quickly. The end result, in terms of blood pressure numbers, were about the same.

When I started the Chinese process, my family “regular” doctor—concerned that I had stopped prescription medications—referred me to a “regular” specialist. At that point I had been on the Chinese treatment of herbal “tea” and acupuncture for about a month and a half. The specialist was happy enough about where my blood pressure readings were, and approved my continuing the Chinese medical treatments. His only concern was licorice root—licorice root was “contraindicated”. But the Chinese doctor contacted him and explained that a small amount of licorice root was necessary as a balance for the other herbs, so he said ok.

I took that was a specialist giving the stamp of approval, that there was no difference for him in terms of the results. I continued with the Chinese treatments because the side effects were much less negative, and I enjoyed the relaxed atmosphere of the Chinese Medical Doctor. The real issue for me were the side effects, trading serious weakness/difficulty in focusing for morning stomach cramps and diarrhea. I preferred less weakness compared to more frequent washroom visits.

At least until my blood pressure readings abruptly went up again.

Personally I am certain they went up again due to a joint conspiracy involving international pharmaceutical companies and the CIA.

For several months, the CMD had regularly changed the herbs. I progressed from “tea” to capsules to pills. She continued to regularly monitor my progress, and I recall her medications changing regularly. But it was smooth progress, with my blood pressure steadily dropping. As I noted, they worked more slowly—the Western meds hit you like Darth Vader’s light saber—but they worked.

And then, they didn’t.

We had no idea why—okay, she had no idea, she’s the doctor. She gave me a different batch of the same pills, perhaps thinking maybe that particular batch of herbs was not effective. Nope. Then different pills altogether. Nope. It was a downhill slide, losing ground which had been gained for five months.

This went on for a month or two. In July, 2006, my wife and I attended at a peace conference in British Columbia, for former war resisters from the United States (guess I haven’t told you everything about myself—and I bet if you’ve read this far, you’d thought I’d told you not only everything, but TOO MUCH!). I should have been super relaxed--a peace conference for goodness’ sake, held in the gorgeous Kootenays, fabulous valleys and mountains, driving through some of the most beautiful scenery in Canada (which means: some of the most beautiful scenery anywhere). We heard George McGovern talk, Gandhi’s grandson (a great figure in his own right) make a speech, Holly Near sing, heck, even Country Joe MacDonald was there.

If I was going to be relaxed, without stress, and with low blood pressure, I was in the ideal setting.

But on my second day in Lotus Land (as British Columbia has been called) I slipped my arm into the cuff of a blood pressure machine at the local drugstore: 191/115 (maybe a little worse). Not just high readings, but higher than ever. As if I was taking no medication at all. I was stunned. Talk about a slap in the face. I knew it had been going up again, but this was approaching Danger! Stroke! territory.

I started to take a reading each day, and my blood pressure never dropped. 190 or higher, day after day, for five days. Even George McGovern could not bring me peace!

When we returned to Winnipeg I got a quick appointment with my specialist. And in his office my reading was…131 systolic.

Huh? Whazzat about? I never had such a low reading. Probably when I was a baby I never had such a low reading!

The specialist, who was a very nice fellow, and, well, a specialist (he really knew his stuff—at one point he’d told me that in only ten percent of Hypertension cases do doctors know why the patient developed the condition, making the treatment that much easier.) explained that the higher readings might be because the drug store machines were not always properly calibrated. It could also be that the cuffs the machines used were too small for my fat arm. And, anyway, blood pressure readings can go up and down unpredictably.

I left his office relieved. Really relieved. He kept me on the herbs—obviously what I was taking was working.

But…at his suggestion…I finally bought a home device to take my own blood pressure. He suggested two possible makes, and I went across the street from his office to one of those huge drug stores. There were several spiffy devices on the shelf, and I bought a good one, with a memory and other functions.

I took it home and, after work, tried it, following the directions. Ready? None of the readings were near the low end of the pool, at 131. Instead, they were between 160 and 180. When I went back to his office three weeks later, for the regularly scheduled appointment, my device’s accuracy was confirmed—this time, his office machine’s readings were also sky high.

By now, I was not only on an emotional roller coaster, I was a yoyo on an emotional roller coaster. And back at square one. The specialist was alarmed, and prescribed a prescription medication, Teveten.

I could have continued with the Chinese Medical Doctor, whose work I trusted. I believe she would have found the right combination of herbs and acupuncture. However, there was now another problem. The specialist was licensed and “recognized” by my employer, the government’s health care system, and Blue Cross. The Chinese Medical Doctor, for Hypertension treatments, was not.

Well, it’s a class society, and I was in class, learning. I was only a student--if I wanted help, the Principal had to agree.