Hypertension 47: More Whining

Yes, I have not posted very much in the last while about Hypertension. Put up some poems, yep. But mostly, been mulling it all over. About, mostly, repeating myself.

It's easy to get sick and tired about side effects, because that is mostly what they do for you: make you sick and tired.

The studies I'm aware of show that by taking the powerful prescription medications I am taking, I increase my chances of avoiding a heart attack or stroke by about 5%. That is not much to begin with, and even less when placed in context: 82% of unmedicated people with my level of high blood pressure will not have a stroke or heart attack in the next ten years (maybe it's only five year, but in this society it'll seem like ten), while 87% of medicated people won't suffer those effects.

The odds are truly excellent I won't suffer anything really bad in the next ten years to begin with--yet, ironically, I seem to be increasing my odds of suffering bad stuff from taking the medications.

I have made another appointment next week with the WMD. I am also waiting to hear from the third specialist about an appointment.

When I started the prescription medications last fall, I weighed around 214 or so. It fluctuated, yes, but it was under 220. Today I weigh 230. I still exercise regularly (although it is hard to do it every other day while I work full time), I still watch what I eat, but I've gained 15 pounds, and have definitely moved into the obese category.

Why? My understanding is that it is two factors: the medications lower my metabolic rate so I burn less calories off, while at the same time I tend to eat more to give me some energy because the same medications make me feel so tired.

I'm 61, but these days feel more like 71 or 81. If I stand for an hour, my legs begin to ache and I get tired. My wife worries that this may also be due to decreased circulation to my legs. Two hours on my feet, shopping or doing anything else, and I'm pretty tired and cranky.

I went to a stress workshop on Thursday. It was an all day affair. A good workshop, interesting points about stress in the workplace. But just sitting there and concentrating and participating all day long left me wobbling and struggling to stay awake in the last hour.

Is this worth the 5% improvement? Is it worth bringing my blood pressure under 140 almost all the time?

It's that ol' quality of life issue. It takes a while to realize what happens with these medications. Or perhaps it is the cumulative impact of taking them every day. I don't know. It's hard to find a doctor to explain it to me.

But it is now becoming an issue of whether the weight gain is more damaging than staying off the pills. Being obese also increases the risk of heart attack and stroke, along with other serious medical conditions. At what point do I pass the point of no return? At what point does it make more sense to give up the prescription medications and take my chances, lowering my weight?

Try looking for an answer on this one through Google or Wikipedia. Good luck, mates!!

Why, when so many people suffer the same situation, are there so few answers?

Hypertension 46: Never getting used to the side effects

As I've often written, the big problem with Hypertension is not Hypertension. That condition is one of the future, not the present--it's what could happen to you (a stroke, a heart attack) not really what is happening to you.

The big problem with Hypertension is the treatment.

I've already written enough about this, of course. To the point of obsession (well, almost obsession but not quite getting there--I hope). I started heavy duty prescription medications in September, 2006, then in early October was upgraded to Teveten Plus and Caduet XL and Lipitor. In mid November, the Caduet XL was changed to Adalat XL, and in March I was taken off Lipitor. The change from Caduet to Adalat definitely helped--while I want to take a nap each day, I no longer have to.

So, with a bit over half a year's experience with very strong prescription medications, where am I?

The meds (perhaps in combination with regular exercise) have kept my blood pressure below 140 systolic, except on rare occasions. I think if something really horrible happened, say if I had to give George W. Bush a campaign donation, even then my blood pressure would not go up. It's been above 150 systolic only a handful of times.

But I don't think it is possible to ever get used to the side effects of the medications.

I am often dizzy or light headed during the day, especially when I get up after sitting for a while. A few times I've actually had to put a hand against a wall, to support myself for a moment. My days have to be planned carefully in terms of activities, especially physical activities. If I just sit and read reports or make phone calls, it's okay. But getting up and sitting down a lot, driving off to do an interview, and being in person-to-person interview situations: those all drain my energy pretty fast. On such days, by the late afternoon I'm groggy...irritable..forgetful. Going home and having a nap doesn't help that much, and if I do take a late nap, then I'm up too late, and then I'm tired the next morning because I have not gotten enough sleep.

Try as I can, it's hard to adjust to getting so tired so easily. It's hard to adjust to feeling dizzy or lightheaded so much. It's hard to adjust to some short term memory loss.

Right now I have nine "cases" at work--I asked for more, and got three more. I think I could handle more than ten. But, when it gets to fifteen, and especially to twenty...I don't like having to say this about myself, but I don't think I could juggle all those "cases". I'd end up sitting there, looking at all the files. And feeling tired.

I know it improves my chances of not having a stroke or heart attack by about five percent, and I guess it's worth it....

Hypertension 45: Waiting for Dr. Godot

Getting the right doctor, without appearing to be "doctor shopping", is always a big challenge for someone with an ongoing medical condition.

The interpersonal politics are significant, at least underneath the surface. You depend on your doctor to give you the right medications, to support you in life and workplace issues, to keep an eye towards your future. You need a decent personal relationship for those reasons. Cheese off your doctor, and you have problems. Also, if you're going to get down and dirty about very private matters, at least you should have a rapport with the person on the other side of the desk.

Yet, if you start changing doctors, you are looked upon with suspicion. Other doctors, and in particular your employer if your medical condition affects your work, start to wonder: are you doctor shopping--continually changing doctors until you find one which will not only stick a needle in your ass but kiss it (the ass, not the needle)? It is a delicate balance--finding and keeping what you need, weighed against what will work with your employer and other doctors.

Doctors are business people, most especially general practitioners. They rely on a steady stream of clients. Apart from all the normal human niceties (is that a word?) of wanting to keep their customers happy and healthy, the doctors also want a happy and healthy cash flow.

For specialists, the elite, this is not a big issue--they have a steady flow of referrals. But for the general practitioner, clients can often be lost to other family doctors. Even when a family doctor is relatively well booked, it still can't be good to lose a client. As a result, general practitioners often appear to be much more vulnerable to patient demands.

Patient demands as in: I need a week off work, gimme a note.

I've seen it happen. It is why the word of a general practitioner in legal issues is helpful, but never nearly as good as that of a specialist. Of course, every g.p. is different. Some are more resistant to pressures than others.

Specialists are another breed. They are the elite. They, in particular, can often appear suspicious of their own clients, and of being manipulated. Ain't no one going to tell a specialist what to do--which is why their evidence is more respected.

I actually had one specialist (none of the ones mentioned in these posts) who appeared to be anti client. I told him that I felt sick and needed a couple of days off work. He was an internist in a medical clinic, I saw him thru the luck of the draw. He almost sneered and refused the sick note request, and only took a throat swab when I insisted. A few days later, the throat swab results came back and I was called in--I had strep throat. He started to talk about how good it was he'd gotten the swab, as if it had been his idea and he was Dr. Kildare. When I pointed out that I had to insist he swab my thorat, and he'd refused me time off work, he actually got angry. I never went back to that guy.

And he is a guy...a human being...even if he is a doctor.

Anyway, I am waiting for a specialist on Hypertension. And it ain't doctor shopping.

The last time I saw my WMD, I gave him a 'diary' he'd asked for about my work experiences. It listed about ten negative side effects. He did not ask a single question about any of the diary, including the side effects. Then I told him I had aching legs, and he did the right thing, ordering a blood test and taking me off Lipitor (no aching legs since then, by the way). I'd gotten his attention in my ten minutes with him. But he never asked a single question about the other nine side effects.

I needed a specialist, someone who would spend more time with me, in particular on the side effects. The prescription meds I'm taking have been very successful in bringing my blood pressure down to "near normal" levels. It's feeling dizzy a lot, forgetting things, getting exhausted easily--that's what I need help with.

My first specialist moved to Alberta. The second was in a hospital clinic who normally did not do follow-ups.

The WMD apparently has done the referral, perhaps a month or so ago, and now I am waiting to hear back. I think in the States it would happen a lot quicker, but maybe not--I do not live in a major population centre, I live in a small city in a small province. There aren't that many specialists to go around. It isn't the fault of socialized medicine, it's the fault of not living in Toronto or Vancouver.

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.