Hypertension 21: New Specialist Supports Less Stress At Work

Stress in any workplace, and its impact on workers, is a controversial issue. Ask any union representative. These days, many workplaces are dominated by pressure to produce. That can be fair enough, hey we have to compete, or provide good service to clients, or whatever--although at times the human element can be lost. Workers are people, not robots.

I think Scott Adams, who writes Dilbert, would agree.

Stress related to a disability is also controversial, although you'd think that there is a clear medical/scientific connection between the disability, the stress, and a negative impact on the patient. I had been cautioned most specialists would stay away from making a connection between Hypertension and workplace stress. In part this is because treatment of Hypertension involves one's entire lifestyle. It is not, as you have read on this blog, just a matter of popping pills. Treating Hypertension involves exercise, dieting and calming one's life generally--i.e. where possible, reducing stress.

It never made sense to me that stress in the workplace should not be linked with Hypertension. Anxiety can, temporarily, increase blood pressure. Who could doubt that? Whose heart has not 'pounded' in one's chest during a crisis? Does not a crisis include pressure to produce more and more (ask any worker who's producing more, and working more overtime, in the hope that his or her job will not be outsourced overseas)?

My friends, we spend about half our waking hours at work. How can it be that what happens at work does not have a direct impact on us? Think about it. We sleep for eight hours. We work for eight hours. That only leaves eight more hours for everything else, including shopping, eating, driving to and from work, and watching television to relax after working.

Denial that workplace stress has an impact on the worker, arguing that Hypertension is a 'lifestyle' issue with no relation to the workplace--that position certainly helps the employer avoid any responsibility for any negative workplace situations. Helps the employer but doesn't help the rest of us.

I'm writing this because today my union forwarded to me the letter sent by specialist number two. The letter I'd been waiting for. A short letter. Here is the key part:

"Mr. Schwartzman has a medical condition that is exacerbated by high levels of stress at work and this makes the treatment plan difficult. He is certainly adherent to our suggetions and follows our recommendations for treatment. It would be appreciated if there was an alternate arrangement such that there are lower levels of stress at work which would hopefully make the treatment plan more efficacious as well. We thank you for your cooperation in advance."

This should be the information my employer and union say theyneed to make a change in my workplace situation. If you have Hypertension, I hope it gives you something to look forward to, as well.

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 12: Doctor vs. Doctor vs. Doctor, and Then There's None (cause I'd be dead)

There are the doctors, and then there is you, the patient. And let me tell you, as a patient you have to be.

The family doctor thought his prescription medications were fine but that the Chinese herbs were, probably, unscientific and therefore not to be trusted. The specialist approved of the herbs.

One doctor prescribed a Hypertension medication that I had to quit after three days--all I wanted to do was sleep. Another doctor told me that medication was 'contraindicated' because of my weight.

I developed 'floaters' (little dark spots in your vision which come from crud in your eyeball). One doctor said the floaters could be related to Hypertension. An eye specialist laughed. My optometrist was not sure.

One specialist said the side effects of the medications he prescribed were not caused by the medications he prescribed. A second specialist changed the medications because of the same side effects.

One doctor said the side effects would go away. A second doctor said over time I would get used to them. A nurse told me they would stay forever.

Several doctors, over several years, have suggested I take an anti-cholesterol drug. When I finally agreed to start on one—as part of my Hypertension treatment--the doctor said it did not matter what time of day I took it. But a nurse (nurses seem to consistently provide the most realistic information) told me I should take it in the evening, after dinner, as that was when my liver started producing cholesterol.

One day, a specialist and his intern discussed in front of me (he was training the intern, and I appreciated their honesty in using me as education) changing my medications to reduce the negative side effects. The intern recommended increasing the dosage of a med I was already taking. The specialist told him that would only make the negative side effects worse. Instead he changed one of the prescription medications I was taking (from Caduet to Adalat XL). I told them listening to their conversation was like watching "House" on tv, except for the sarcasm. We all had a hearty (haha) laugh.

Most doctors who have prescribed anti-cholesterol medications told me I would have to get regular blood tests to check for liver damage, but never explained much about it. One never even mentioned possible liver damage, just said I would have to get regular blood tests. When I asked that doctor about what damage it could do to my liver, he was actually offended. Offended! He told me that he had prescribed it to many patients with no problems.

He never answered the question.

Him I never saw again.

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.