Hypertension 49: Where are we at now?

It's been a long while since I have posted anything on this blog about Hypertension? Why the delay? The basic reason is that through multiple postings I was able to write down my history. Once I got that far, there seemed to be nothing particularly new.

Right now, I am waiting for a followup with my third specialist. The first specialist moved to Alberta. The second generally only saw people once as he worked out of a hospital cardiology ward. So I've now hooked up with a third specialist.

Seeing the third specialist meant going through a new battery of various tests & bloodwork. In particular, I wore a blood pressure arm cuff for twenty four hours. It is just like the home cuff I use, but it's attached to a battery pack and a an electronic data gathering device. Every half hour, it would pump up, no matter what I was doing. Kinda cool, actually.

I have no idea what the readings ended up being. I was out late that night as it was the first night, at midnight, that the last Harry Potter book went public. My 18 year old daughter had to pick up her pre-ordered copy asap, so we went down to the bookstore together. It was a marvelous experience, seeing a bookstore mobbed with eager readers! I like the Potter series, although I've only read the first two--I was partway through the third when my daughter lent it to a friend, & I've never seen it again. Tributes to Rowling for writing so well that she has brought millions of readers into bookstores!!

My blood pressure remains unstable, but is generally below 140 systolic and hovers around 80 diastolic. I gather the diastolic readings are still not good, but often my systolic readings are in the normal range. At times, though--as when I started this morning--the readings are still too high (this morning, 151/88), especially given the multiple prescription medications I take.

Life remains draggy, meds-wise. One would think that if those doctors who insist that it just takes a little time to adjust to the meds are correct, that by now I would have adjusted--it has been over two years, after all. Whether the feels of weakness and tiredness are due to low blood pressure, the side effects of the medications, or some combination of both--who knows?

But the end result is that while I can work, I can only work successfully with a reduced work load. I can still produce the right amount of completed work, provided I do not have to juggle too much. The more work, the less gets done. It is as if concentrating and focussing uses up so much energy that, if I work very hard in the morning, it is almost impossible to stay awake in the afternoon. I have yet to find a way around this.

I did stop exercising for a while after my mom was in and out of hospital due to heart attacks. She also had to move into a nursing home. I'll try restarting the gym shortly--but, interestingly, it appears to have had no special impact on either my blood pressure or my weight.

The best advice for weight loss came from my third specialist. He did not bother with calorie counting, he just told me to get used to being hungry. Believe it or not, that worked--I just don't eat when I get hungry. That approach must be combined with sensible eating, of course. I find an ice cream cone today adds a pound or more within two days. Simple as that. Gotta avoid the ice cream, the chocolate, the pizza--all that stuff. I lost the most weight when for a few days I simply ate canteloupe and cottage cheese. That was filling, but very low in calories.

Some decisions are coming up--do I keep working full time, do I retire on a small pension & find other work, do I go to part time work? At 62 I don't feel like retiring, although I would find plenty to do. We are all too much tied into our paid work ethic, I guess.

Hypertension 34: Emotional Balance

One of the toughest parts of taking some prescription meds is knowing what you are really doing. Who you really are. What impact you are really having on the people around you.

I always used to think I was calm and collected. It took years to realize I was not all that calm, not so collected. In fact, I eventually came to realize I am downright intense. And when I am in tents, it usually rains. And when it rains, it pours. Maybe that's why I'm in tents, to avoid the rain. One thing leads to another.

Okay, although I'm writing this, I'm avoiding it.

I expect I've always had a tough time seeing myself as everyone around me does. Yes, when I got angry I would know it. Usually. Mostly. Well, not always. But I would always recognize it afterwards. And apologize.

In particular, it has always been hard to know when I am being too pushy, too intense (when people stay in tents in the park, they are assaulted by bears, which I find unbearable, often because when you are in a tent you're bare). I get 'enthusiastic' and push an issue. But maybe that was just my cultural upbringing. I was born and raised in Brooklyn, after all.

My parents loved to argue. They were Communists, actually--idealists from the Golden Age of the Worker. Workers had every right to expect a Golden Age, but all they really got was Golden Arches. As idealistic commies, argument was their lifeblood, a way of exercising their religion.

So I enjoy a good argument. And that has not always gone down well in Canada. People here are very polite. Someone who argues is...of concern. Aggression here is not appreciated.

But it was a lot worse--hindsight tells me--after I started taking prescription medications for Hypertension. Perhaps it was exacerbated by a feeling of weakness, dizziness, difficulty in concentrating. Who knows?

At the time, it all seemed normal enough. But looking back, I was irritable almost all the time. Though I thought I was taking everything in my stride, in fact I took almost nothing in my stride (unless by that I mean walking all over it, stomping on it, and then kicking it a little).

And: combine drug-induced irritability with fear to really goose up the anger factor. Fear. Fear about whether I would croak from a heart attack, get paralyzed by a stroke. Fear about losing my eyesight.

It is hard to know what's going on with an underbelly of fear. It's not like the underbelly is an overbelly.

It was like washing with sandpaper, rubbing me raw.

And without having a clue about what was really going on. Always thinking I was being reasonable, that everyone else was not getting it. Reality never kicking in--at least, not until later.

This is not an excuse, just an explanation. I take full responsibility...even though it was the medications, of course, the meds!!

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 4: A Cavalcade of Pills

Pill #1 left me dizzy and weak. Pill #2 worked as effectively as Pill #1 in reducing my blood pressure…but after a month or so my gums puffed up and bled when I brushed my teeth (more details to follow: please see, “spitting up blood”.) Plus I was really tired, all the time. Generally tired. I was proactive--I spoke to General Tiredness. He said “Son, you’re an Officer, speak to your privates.” I thought that to be odd advice, of corps, or at least that was what the loo tenant said.

By now I was leaving work in the afternoon at least once a week, too tired to work. Although I previously stayed up late writing, until 11 or 12, now I was going to bed at 9 pm or earlier. No matter how much sleep I got, though, I woke up tired.

When I reported these side effects, my family doctor moved on to Pill 3. Pill 3: the real loser. Arguably the worst (why are you arguing with me? Surely we’ve never even met! And what does Shirley have to do with it?), I took Pill 3 on a Friday evening, and on Saturday morning I could barely get out of bed. Sunday? I’m not sure I did get out of bed. It was as close to comatose as you can get with your eyes open. By Monday, I pulled the plug on Pill 3 without even asking my doctor.

You may find this strange, but I was beginning to feel I was losing control over what was happening to me. Stopping the medication on my own was a statement.

Pills 1 and 2 had been relatively subtle. It took weeks to realize what they were doing to me (apart from lowering my blood pressure). Actually, some of the emotional effects—anger, not dealing with issues properly--did not occur to me until a year later. But Pill 3 was a hammer to the head.

Later I was told by another doctor that Pill Three was "contraindicated". That is, a right wing enemy of Daniel Ortega wanted me to take it, which should have been a tip off right there. It was not recommended because of my weight (around 215 pounds). Guess the family doctor missed that, eh? What’s up with that, doc?

Given this great history, my doctor of course proceeded to prescribe Pill 4.

I had begun the pills in May, 2005. I began swallowing Pill 4 in November, 2005. Four was not the charm. All the pills caused weakness, tiredness that sleep did not help, a lack of energy and rive. And by now, because I knew what to look for, it all felt worse. Yes, it was lowering my blood pressure, but at what cost?

By January, 2006, I knew I’d had enough of prescription medications. Later, I learned some of the weakness was a potassium problem, which could be overcome by eating bananas. Typically, my doctor did not tell me that—my then 16 year old daughter told me (she’d learned a lot as an Air Force cadet).

I was taking these meds because if I did not, there was a 14% chance I would have a ‘major incident’ within five or so years. But did that not mean there was an 86% chance I would not? Where was the dividing line between helping and hurting? The whole treatment plan was worse than going to a casino.

Pills were not even the best way to go. They were just the convenient way to go. Diet and exercise was what everyone recommended.

But that was not true, either.

Diet and exercise were also a gamble. No one knew where my Hypertension came from. The odds were better (but no one could tell me what they were!) that if I lost weight and exercised, my blood pressure would improve. But I could have lost weight and my numbers would have stayed exactly the same. And exercising? Martin Sheen, bless his heart, had a heart attack while exercising.

I needed an alternative to prescription medications. I could try exercising and dieting, but those required work, and might not work anyway. My quality of life was suffering, my ability to work was suffering, it was time to take my life back!

And the best way to do that was to find someone who would stick pins in me.