OT - Way off topic, but I need advice

[Ysabel Kid]

Guys, I recently had a physical through work - something my employer offers every few years. I flunked. Three problems:

(1) I am "under-tall". Apparently, my body thinks it's ideal weight is 200 lbs, because whenever I lose weight, I seem to eventually snap right back to that point, but rarely exceed it. I am 6 feet tall, so I need to either lose 25-35 pounds (and keep it off) or gain 4 inches in height - to meet their concept of ideal weight. I am not that overweight nor that out of shape, but I guess my opinion doesn't count.

(2) I have high cholesterol. Real high a couple months ago when I had a blood test for another reason. I started taking fish oil supplements, and these have helped, but I still have a total figure of 220, with the "bad" LDL at 155 (my "good" HDL was 45, in the "normal" range of 40-59). This is not horrible, in and of itself, until you consider the next point.

(3) Now the biggie - I have really high blood pressure. REALLY HIGH. It was 165 over 120 when they read it. I have had high blood pressure for years - since my 20's (I just turned 44). The nurse administering the physical used to be a cardiac nurse, and advised me to seek immediate medication.

Therein lies the problem. I damaged by liver severely in a car accident 25 years ago. Lots of scar tissue. Damaged both kidneys too - but not nearly as bad (and lost my spleen altogether). Most medication interacts with the liver, so many blood-pressure meds may be off the table. In any case, I have set an appointment with my primary physician (especially after I measured my BP today after a stressful work telephone call and it was 214 over 145! ) for 6/23 (earliest he could see me).

So, my question is this - for any of you on BP medication, what do you use, and what side effects did it/does it have? Feel free to PM me if you'd rather not discuss this in front of everyone (you can tell I'm not bashful! )

Thanks guys!!!

[Malamute]

I'm slightly "undertall" also, but the doc told me to go to the health club and have them take the pinch meter thing and check my actual body fat index. That gadget says I have body fat in the low end of normal, I just have a lot of muscle mass. I don't float worth a hoot either, someone said that's a good indication you don't have much fat. I'm shorter than you a couple inches, but about the same weight. Might be worth going to the health club and seeing what they say about your fat index.


Fish oil has taken care of my slightly high blood pressure and cholesterol for several years, no meds. Sorry I can't help in that instance. I also (dog) walk every day, and take longer walks every weekend in the higher mountains.


Hope you get it sorted out, high blood pressure is a bad deal for your body in the long term.

[mescalero1]

Girlfriends mother & brother both had high blood pressure, she swears blood pressure medication contributed to thier demise.
You really need to consult a physician and lay ALL the cards on the table.
I went through a health crisis in 2006, and I was checking out,
two GREAT doctors pulled me back from the abysis!

[Ysabel Kid]

When I am home I work out of a home office. I try to hit the treadmill at lunch, and walk briskly for an hour (3 miles) at a 6-12% incline (depending on how my back feels). I probably average this 3 times a week.

I do have muscle, but suspect I would also register a bit on on the fat side too. I consider myself pretty normal or average for me age - starting to show a bit of a spread around the middle. 38" waist pant's size is a bit loose; 36" is a bit tight - so not that bad...

I'd love to work out more regularly, but I travel quite a bit, and it makes for long and strange hours...

[Andrew]

kid I am glad that you are addressing the issue instead of ignoring it like some people tend to do.

1) When you see your doctor ask him about setting up a diet. He should be able to guide you in the right direction. I advise exercise too.

2) Your cholesterol can be helped by exercise and certain foods. Again, your doctor can help you there, and maybe even get you on somethng like Lipitor.

3) Broken record: Exercise is good for high blood pressure(hypertension). I can't remember why at the moment, but it has something to do with the way your vessels open when your muscles work lowering the resistance of the flow. As we all should know:pumps(hearts) don't create pressure. Pumps(hearts) create flow, and resistance to flow creates pressure. Hydraulics 101 man.

[sw41mag]

So, my question is this - for any of you on BP medication, what do you use, and what side effects did it/does it have? Feel free to PM me if you'd rather not discuss this in front of everyone (you can tell I'm not bashful! )

Thanks guys!!!

As an Emergency Room Trauma Nurse for 17 years, an ICU Nurse for 1 year, the Manager of a Cardiac Telemetry Unit for 3 years and a Clinical Nurse Educator for 3 years I can tell you that you don't want advice from random people about random B/P meds. There can be many different reasons that your BP is high. Kidneys to PVD, etc etc and every med(and there are lots of different BP meds, lots!) is designed to work in different ways and affect different parts of your body. Sometimes it takes the Doc quite awhile to work out what different combos of meds work for your body and it's specific problems. Just because something worked, or didn't work, for someone else doesn't mean a thing when it comes to your situation. Be very careful about taking advice from civilians. Example: There are many different types of NSAID's ie advil, aleve, aspirin, and on and on. I got some free samples and took "Voltaren" for some aches. Didn't do a thing for me, didn't help my aches and pains at all. Does that mean they were "bad" meds? I then gave them to my Father and he loved them. Took his aches away like crazy. He wanted all the samples I could get and when those ran out he went to the Doc and got an Rx for more.

[Ysabel Kid]

kid I am glad that you are addressing the issue instead of ignoring it like some people tend to do.

1) When you see your doctor ask him about setting up a diet. He should be able to guide you in the right direction. I advise exercise too.

2) Your cholesterol can be helped by exercise and certain foods. Again, your doctor can help you there, and maybe even get you on somethng like Lipitor.

3) Broken record: Exercise is good for high blood pressure(hypertension). I can't remember why at the moment, but it has something to do with the way your vessels open when your muscles work lowering the resistance of the flow. As we all should know:pumps(hearts) don't create pressure. Pumps(hearts) create flow, and resistance to flow creates pressure. Hydraulics 101 man.

Andrew -

Good advice. I do eat a pretty varied and heathly diet - due to my wife's excellent cooking. Lots of fish and chicken - little red meat. Lots of vegetables and fruits.

I also agree on the exercise. I have a digitial BP kit at home, and have begun tracking it so I can be well-prepared for my doctor's visit. It has been the lowest right after I exercise! It has been the highest (except for the telephone call today) right when I first wake up... go figure!

I think the other thing he is going to suggest is that I try to get more than an average of 5-6 hours of sleep a day. Might interfere with my posting here!!!

Good night!

[C. Cash]

Stay off those Polygamy posts Ysabel!!!! I think I better do the same.....

[JP_TX]

I don't have the organ problems you have but I am about 25lbs overweight and my untreated colestoral and Trygliserides make your numbers look good. I had so much fat in my blood that I was pretty sure that that I could stick a wick anywhere in my skin and be my own lamp.

Anyway. It turns out it was an inherited problem, my two savior drugs may not be useful if you have liver problems, but I will give you the names anyway. For you to check with your Doc.

For Trigliseride (sp?) Tricor. There is only one drug for this problem and this is it. Thank God.

For Colesterol, Crestor. There are lots of drugs for colestorol on the market but this one keeps it from getting into your blood stream. It really works for me.

How well? My untreated colestorol was 330. My trigliserides were over 1000. I'm not exagerating. Normal is under 200 and 150 respectively. Treated with the above drugs 180 and 175 as of 2 weeks ago.

The other and most convenient things you can do is walk. I know it's not sexy but just walk for 30 minutes a day 5 days a week. If you can walk with someone fine so long as they don't think it is a stroll. You will slowly build up your speed, but no need to jog or run. Just walk briskly. In a few weeks you will be up to two miles n 30 minutes. 15 minutes out 15 minutes in.

Next, and this is hard. Till you lose the weight you need to get your bp down, cut out all, yes ALL sugers, simple and complex. Includes fruit juice, cokes pasta, doughnuts, all of it. It will take you about two months to do it. But it works. Your numbers will improve. Even without the meds. Its just harder to keep up. But you have a good incentive. Think about it!

Take care, you can do it.

JP

ps: You might start thinking about another line of work. Just a suggestion. I mean are they paying you enough to literally kill yourself. If not, make a change.

[arjunky]

I started out on Lipitor and it made me dizzy.
Take Metoprolol now and keeps it in check.
Symvastatin and Triamterene/hctz for Cholesterol.

Everything is good now after 2 years of pills.

42, 210, 6', 1 1/2 packs a day , way more caffeine than I should , never excercise, on purpose anyway .

[mescalero1]

s&w41mag,
that is what I meant to convey in my post,
a doctor needs to manage this thing for the kid

[AJMD429]

PM sent. Physicians are like gunsmiths; find a good one and they will really do good things for you. The consequences of one you don't hit it off with are more dangerous, however!

[Griff]

PM sent. DON'T WAIT TO SEE DOC ON BP ISSUE! DO THE "DROP BY - I'M REALLY SICK" THING FIRST THING TOMORROW MORNING!

[ole pizen slinger]

Dear Kid,
I think you need to be under a doctor's care. No other advise.
ole pizen slinger

[Tumbleweeds]

BP is usually lowest in the AM. High BP in the AM is a sign of sleep apnea, and you may need a sleep study. Do you snore a lot?

Remember the club cab pickup ad where one guy was sleeping in the cabin and everybody else was sleeping in the truck? Not funny. That stuff can cause brain damage if your oxygen level drops low enough, often enough.

The best advice you got (from 41SWmag) was to see a doctor and work with him. I tried 3 medicine combos before my doc found one that worked for me.

[shooter]

Ysabel,

I don't have any of those problems, except for being "undertall". I haven't weighed less than 200 pounds since my junior year in high school, and I'm right at 6"1'. The doctors have always told me I was overweight for my height, but I don't pay much attention to them.

My dad has high blood pressure, though. I'm not sure what medication he takes but I'll find out for you. He also takes garlic pills. Those have helped a bit, too. Excercise is always good for you, too. I don't know if you're in to this kind of thing or not, but I always try natural, or herbal alternatives to medicine. I don't like medicine, and I think a lot of times it does more harm than good. With your liver being damaged I would think that could very likely be the case. Try researching the herbs and other natural foods that are supposed to help cholesterol and blood pressure. Just my little piece of advice.

[Jaguarundi]

Ysabel Kid-your BP is tooHIGH see your MD ASAP!

[gamekeeper]

YK, I too have high BP and my doctor has put me on Perindopril after being on beater blockers for a few years. I had a medical yesterday and my BP was high again so I may have to take another drug with the Perindopril. Both drugs however can affect the kidneys etc. so be guided by a good doctor, lose weight and exercise more often. I don't now if you can buy the same stuff in the US as I use but I buy a cholesterol reducing low fat spread called Benacol. It contains plant sterols and it does work for me.
But the best advice is see your DOCTOR and relieve stress by goin' huntin'

Good luck buddy.

John.

[20cows]

The weight height chart your dr uses was made by insurance companies who look only at longevity, statistically. They don't look at body build, age or anything else.

Look at the chart the US Army uses.

http://usmilitary.about.com/od/army/l/blmaleweight.htm

At your age and height, your right where the Army thinks you ought to be.

The blood pressure is worthy of attention, the weight is not.

(This is coming from a guy that has gone from weighing 320 to 175, I've looked into it seriously)

[Ysabel Kid]

Guys -

Thank you for your advice. By no means was my intent to have you all "do the doctoring" for me. Rather, it was just research on my part. I have a very good family physician. He will direct the plan. I just like to come to any meeting - professional or personal - as well prepared as possible. Considering the size of the pool we all swim in here, I thought I would tap into the collective experience of our group. Seems to work pretty well concerning levers, guns in general, and many other things!

Going to have my liver numbers done, and going to move up my appointment. Will let you all know how things progress. Thank you for your replies and concern!

[Rusty]

AS has been said, high BP is nothing to fool with. Something you might want to try is to add some magnesium to your intake. The easiest way to add it is to get yourself a bottle of Mag citrate. Take 3 or 4 tablespoons a day to start and add more every day until your bowels start to let you know you have enough.
The advice of sitting in the waiting room and telling them you feel sick isn't a bad way to go either.
Personally I won't take anything to alter cholesterol, but that's a personal thing. My dad was an old school doctor ( a GP back when they called them that ) and I lean on his teachings. If you can do it through diet and exercise then so be it, but I'd stay away from the drugs for that. They are also hard on the kidneys.

[aussie]

Kid.
I fought the BP and cholesterol issue for years. I really didn't want to start taking pills. I guess that if I admitted I had to take pills for my blood pressure and cholesterol I was admitting that I am mortal and that my body is no longer young and perfect............Well, a couple of years ago my doc put me on Karvea for blood pressure and Pravachol for cholesterol..... no big deal now, I take one of each every day plus 100mg of Aspirin and that's that..... guess I'm not Superman anymore and the old body is wearing out. Guess also that one day I am going to die.....no one has beaten it yet, not even Christ. Don't worry about it, it ( the pill taking thing ) comes to all of us. That's life............
cheers,
aussie.

[rjohns94]

YK -

Your health is THE most important thing. Without, you cannot enjoy all of life's blessings or fulfill what God has planned for you. Advice above is see your Dr. IMEDIATELY!! I agree. After that, you need to loose the extra weight. It will help in all the areas you mentions. Three times a week is not enough cardio. Your travel can't be used as an excuse. Take the stairs instead of elevator, knock out the wasted caleries either in snacks or sodas or...., etc. While on travel, get your walks in, either at the airport between flights or once at your destination. Almost all hotels have a work out room in them so weather is not an excuse either. Up your cardio to at least 5 times a week and add basic strength exercises like crunches, squats, pushups to build mussle mass and thereby increasing your caloric burn, expediting loosing the weight. Take your family on a walk after dinner and make it a family time event, kids on bikes or trikes, wife walking with you. You can take the family pet and the extra calories add up. The point is, make this a priority like taking a shower everyday and you will soon establish a life style that will trim you down, add muscle, lower your BP and increase the years to enjoy the blessings of your life. Best of luck. blessings

[Buffboy]

First thing first, take your digital blood pressure tester to the doctor with you. I went through a "your blood pressure is extremely high" thing when I showed up for LE training. This lead to to a prescription for a blood pressure meds and a slowly building allergic reaction to same. I got pretty sick from that medication and I won't go into detail. They changed the meds and I slowly returned to semi normal. The (non)funny thing is: when I took my digital blood pressure tester(same as the school's & got the same numbers) to the doctor's office after I got out of school, it was WAY OFF(high). On some people they will not work right. I went through a couple months of physical/financial/anxiety hell because of those stupid digital testers.

Still, I agree with Griff, get thee to a doctor ASAP, cause those readings are too high to put off for two/three weeks.

[Hobie]

See a doctor you trust and don't listen to people who's credentials you can't check...

Of course you can trust me, I told you not to!

Seriously, get to the doctor!

[shawn45]

I have high bp the cardiologist ask me "do you snore?" It seems I had sleep apnea for years and it is one of the biggest undiagnosed reason for hypertension according to him. There are lots of treatment options for that and none of them are meds.

[Bluehawk]

I woud call my doctor back IF he insists that the earliest date he can see you is still a month away Id ask him then who he recomends that can see you NOW . If not id even go to the nearest ER with that type pressure.
DO NOT follow anyones advice on specific meds . MY cholesterol WENT UP with Fish oil products My doctor had me go off them ASAP that was ME and I am certainly ATYPICAL to that type "supplement " .YOU MAY BE TOO ! WHO KNOWS? same thing with any other type med or supplement . MY BP was lower than yours and MY doctor WAS VERY CONCERNED . IM on two types of BP meds now and im controlled better than i have been in 10 years . BUT IT TOOL MY DOCTOR A WHILE to get me there and trying three types of meds .
What the long tgerm answeres are onoy you and a DOCTOR YOU CAN TRUST will be able to figure out. BUT right now you need to be on something to get it down NOW if it doesnt and you have an event, it wont matter what the long term answers are .

[CJM]

Follow sw41mag's advice; and work with your doctor ASAP. There are many causes of high blood pressure, and many different medications which address the different causes.

Just don't let your doctor ignore you - like it sounds they are doing. My Mom tried for over a decade to get her high blood pressure under control; the doctors gave her various medications but none of them worked and it never seemed like any of the doctors she went to cared enough to find out why. Finally the second doctor she went to after moving to Pueblo did a blood test, determined that her kidneys were calling for the high blood pressure, and put her on the correct medication. Now her blood pressure is normal, her diabetes is MUCH easier for her to control and she is starting to feel better again. It took her over a decade to get the right medicine, but now she is doing pretty well.

[pharmseller]

See a doctor you trust and don't listen to people who's credentials you can't check...

Of course you can trust me, I told you not to!

Seriously, get to the doctor!

Today, or sooner.
Most docs have unscheduled appointment times for flexibility in the day, so they can "work in" a patient and not blow the schedule.

Be that patient.

Quinn

[piller]

As a Pharmacist, TX license 37928, I can tell you that there are some meds out there which may work and may not. Your Doctor is going to have to try you on some and take blood and check your pressure every couple of weeks until the right combination is found for you. A Cardiologist will tell you the same thing. As you are a tricky case with the liver and kidney damage, go to a specialist. Your regular Doctor is not trained enough for people with your problems. General Practitioners are good, don't get me wrong. It is just that specialists are in practice for a reason. Also, ask your Pharmacist for the list of side effects which come with the stock bottle for any medicine you are prescribed. The package insert has way more information than most people need, but you are not most people. You will want to get a magnifying glass and read the information and discuss it with your Doctor on your next visit. Also, tell the Doctor about any unusual weakness, soreness, changes in urine color or smell, nausea, diarrhea, or anything else which is different. These can all be signs of a medicine not reacting right for your body. Your Doctor will need all of the feedback to properly adjust your medicines. NOW GET YOUSELF TO THE DOCTOR MY GOOD MAN.

[buckeyeshooter]

Glad to see the army also uses the % of bodyfat chart. The height/weight charts are usless for me. I stand 6'1" and weigh 268 with a bodyfat % of 16. So the 'chart' says 208 max. Obvisously, in my cases I train and compete in weightlifting contests so I am more developed than the average guy. I can't tell you how it ticks me off to be told I am too fat, when there is little on me.
My suggestion is to get a doctors recommendation for you medical ails and start exercising 5 days a week and get fit. That will reduce some of your conditions.

[GANJIRO]

You can deal with high cholesterol naturally through diet, exercise, and supplements. Check out this book: The New 8-Week Cholesterol Cure
By Robert E. Kowalski, very good reading material on this subject.
http://www.thehealthyheart.net/8-week_C ... _Cure.html
Here's a sample: http://books.google.com/books?id=41sUzh ... il#PPP1,M1

[RIHMFIRE]

Best blood pressure medicine for me is being outdoors...
in the woods....

[JohnnyReb]

YK... let me scare you real good.....

The bottom number on the BP: your heart is not relaxing....stressing itself... you are a walking stroke.....heart attack.....or rapidly progressing to congestive heart failure........

Reason I can say all these things is because this is what my Doc told me after taking my blood pressure of 110/160. He would not let me leave his office until the medication had the lower number below 100.

GET TO THE DOCTOR! TODAY!

[Bruce Scott]

My BP medication is 300mg of irbesartan daily, trade name Avapro. There are no side effects (for me) and my BP is held in check. Having said that my liver, spleen and kidneys are all intact, and it is a matter of 'horses for courses'.

Your doctor will sort it out.

[will2002]

I have all the problems, and also have a long family history of of EVERYTHING you mentioned in your first post. I failed my physical to be drafted into the army in 1971 because "extreme" high BP. My dad died at age 42 in 1975 during by pass surgery. To make a really long, sad, story short, if it it`s bad, Ive got it. Now for a little bit of good news. I take BP meds, cholestrol meds. everything you mentioned above. The one thing that has helped me the most BY FAR is, "I MUST" do 4 miles on a tread mill 7 days a week. Every thing else did not do much good untill I added the "extreme" exercise program. Walking, and walking and walking. I know that is NOT what ya want to hear, but I promise you it is the truth Good luck and GOD bless ya.

[stretch]

From what I've read, your doctor shouldn't have let you out of the office
with BP numbers like that! Like others have said, get back to the doc, move your appointment up, and don't take no for an answer.

I've walked at lunch now almost every day for half an hour for
almost ten straight years. I'm 6'3" and 190 - 195. I should really be
10 pounds lighter - I feel better and it's noticeably easier to get
into the sitting and rice-paddy prone positions!

A couple of years ago, my mother had open heart surgery, and it
woke me up to the fact thaqt I had NEVER had my cholesterol
checked. Evah. My numbers were borderline, so I lost 20 pounds
by mainly cutting fat out of my diet. I'm pretty active - no riding
lawnmower, lots of walking, shovelling snow in the winter, working
on the car, hunting, gardening and a little bit of running thrown in.
Now my numbers are MUCH better.

You're not obese by any stretch, but losing 20 or 30 pounds
wouldn't hurt you at all. Sometimes the weight loss really makes a
big difference in the BP, other times not so much.

Good luck. Get thee back to the sawbones and let us know how it
goes.

-Stretch

[Ysabel Kid]

I will get this visit moved up!

I think my friends are trying to kill me. Look at the belated birthday card I got:

[stretch]

That'll certainly raise your BP......

[AJMD429]

As you are a tricky case with the liver and kidney damage, go to a specialist. Your regular Doctor is not trained enough for people with your problems. General Practitioners are good, don't get me wrong. It is just that specialists are in practice for a reason.

I can't let that one slide by - as a "mere" family physician, I see and fix lipid and metabolic and endocrine problems ignored or mis-treated by cardiologists literally on a daily basis (and - for 'equal time' - no doubt they fix some of my CHF and arrhythmia patients I've not handled as well as they would). I certainly defer to them when it comes to positioning a stent, or treating an arrhythmia, but I find it is the rare cardiologist who does a good job treating lipid disorders, especially in the context of underlying disease. A few endocrinologists are "into" lipids when the patient is an outright diabetic, but most of the cutting-edge lipidologists actually out in practice, vs. research settings, are family physicians.

I'm not trying to insult their specialty, but they tend to be bored sitting in the office dealing with lipids, when it is more interesting/challenging/lucrative to be in the cath lab.

I will also admit that 95% of my family practice peers seem to have sold their soul to the insurance companies, or gone to work for a hospital where the pay is better, and let all those clinical skills they spent years to acquire go by the wayside. I hear the residents I teach spend more time talking about which hospital has the best vacation and benefits packages, and know darn well they will wind up in a practice where they spend 4 minutes per patient, and blow off anything that isn't a sore throat or benign rash. That is really a tragic waste of potential.

Anyway, I just had to stick up for my fellow family practice lipidologists...

90 % of good care is really about finding a doctor who gives a darn - what we do isn't all that hard (after all, you have to be semi-intelligent, and very persistent, to get through the 12-13 years of training) but like anything else, no matter where trained, or what the paper credentials say - if you get someone conscientious who cares, you'll do way better.

The secret if finding one like that - regardless of specialty...

[Jeff Pitts]

I stand 6'1" and weigh 268 with a bodyfat % of 16. So the 'chart' says 208 max. Obvisously, in my cases I train and compete in weightlifting contests so I am more developed than the average guy. I can't tell you how it ticks me off to be told I am too fat, when there is little on me.
My suggestion is to get a doctors recommendation for you medical ails and start exercising 5 days a week and get fit. That will reduce some of your conditions.

I'm with you 100%, buckeyeshooter! Like you, I am powerlifter. At 5'11" and 245lbs at 12% bf all the charts tell me I'm obese. Ain't true!

I have a family history of high BP and high Cholesterol. My siblings, parents, aunts and uncles, even my cousins have Cholesterol no less than 319 and some into the 400's even using the new drugs. After a life threatening industrial injury my own BP went up to 160/120 and Cholesterol almost 300. Then I found serious weight training 17 years ago. After my last doctors visit, my doc wanted to know what I do for health because, and I kid you not, he told me to take my official blood stats home and frame them, he had never seen anything like it. That alone made me understand how important weight training is. My BP now runs 110/70, Cholesterol was only 119 and the good cholesterol was fantastic also.

All without any drugs.

Heavy weight training is where its at

Jeff

[AJMD429]

In medicine, we've oversimplified things and yet we also miss the obvious - it isn't TOTAL weight and it isn't TOTAL cholesterol, but for both, it is how they are distributed.

Unfortunately, our new government/insurance-run "system" now awards physicians "quality" points for doing cookbook medicine, and using whichever medications improve the profit margins most for whoever we've sold our soul to that year (which depends on how much they'll pay us, and their vacation/benefit package, and how bad they hassle us when we step out of line). If you don't earn the points, you get less pay. Some places are already blatant about this kind of thing, and others are just now phasing it in, but it is not good.

Like anything else, read, think, and ask both physician and non-physician people for their advice and experiences. Have your "sales-pitch" radar on, and go with your gut-feeling; a good doctor will seem honest and caring, and will "tolerate" the fact that you may have other sources of information and questions. We will STILL have our "take" on things, and we may argue long and hard if we think you're doing something stupid, but the bottom line it is YOUR body, and we're just hired advisors.

ALSO - there are often many ways to treat a given situation, and likely, of a dozen ways to do it, ten will work reasonably well, and three or four will be the "best" ways.

Diet and Exercise are incredibly important; just think about what is important to farmers with their livestock - crappy feed yields crappy results.

[piller]

AJMD429, you sound like a somewhat rare Doctor to me. I agree with most of your points. My opinion is that if there were more like you, then most of the Cardiologists would need to do other parts of the field, too. I like the times I can call a Doctor and let them know that there is an interaction with something another Doctor/Dentist/ARNP/PA has prescribed and they make a change. I must say though, that getting yelled at for questioning their judgement is the norm. If you have any influence over your fellow Doctors, please lead them to your way of thinking. I suggested a specialist mostly due to the patients I see telling me that they cannot understand why their specialist wants to see them and do blood work every 6 months for the first 2 years, and yearly thereafter. All too often the patients think this is excessive because they have never had that level of care. Perhaps it is just the Doctors in the Dallas area who are that way. Plus, we have the top rated Cardiologist on the Planet within a 45 minute drive. He does not follow the training to think "Horse" when he hears hoofbeats behind him while he is standing in a pasture. "True, true, unrelated" may be something which the Doctors I come into contact with have been taught, but may not be from your Medical School.
Again, you sound like a really good Doctor to me.

[Old Time Hunter]

Until you get to the Doc, I'd follow Aussie's advice. Take a couple of asprin and call 'em in the morning. Before you get your BP checked I can offer you two items of advice:

1. Don't have your children around before or during your doctor visit.
2. Do not drink any coffee, tea, or soda pop before they check your BP.

Seven years ago I had a slight blip in my life, I was at church on a Wednesday night (kids thing, bible study class) and as I was talking to the pastor I felt as though someone came up behind me and started bear hugging me so tight that I could not breath. Fortunately, the pastor thought I was ignoring him and walked away. I managed to gather up my kids, and drive home...really didn't think I would make it, but I did. Managed to get the kids to bed and then crawled into my own bed, honestly thinking that if I fell asleep, I'd never get up. Next morning I woke up and darn if it didn't feel as though I was run over by Griff's truck. Every part of my body was sore, took a huge effort on my part to lift a finger. Still managed to drag myself out of bed and get to work, but by the time I got there I knew something serious was happening and called my doctor. His nurse called back, recorded my symptoms, and then called for an ambulance for me. I refused the ambulance (who's gonna pay?, besides if I go to the hospital and all that is wrong is gas, how am I going to get home?) and drove to the hospital. After four hours of prodding, probing, and poking, along with taking half my blood out, the doc said he knew something was wrong but all the tests did not indicate a heart attack. Then an experienced nurse walked in and asked in front of the doctor if it still felt like a 900# gorilla was sitting on my chest, I said yes. She stuck a little pill under my tongue and...Lordy, Lordy, 90% of my symptoms went away. She sent the young doc on his way and called a cardiologist, by the next day I had two stents and had been diagnosed with atherosclerosis (sp?). Suprisingly I had a stress test not two weeks before, my BP (stressed) was 155/95 and 115/65 at rest, my TOTAL cholestorol was 135, and I am 6' tall and at the time 223# with a 34" waist and a 52" chest (expanded). I also worked out with heavy weights five days a week and was 47 years old(54 now). Today I still have very good blood pressure but have to take a Atenolol 25mg (1/2 a pill a day) and Pravastatin (40mg), along with one asprin. I've also gained 12 #, but eat half as much, and my chest is falling towards my waist at an alarming rate. That might be happening since I only work with light weights (two 30lb dumbells) and more reps. Doc says that I have to eat more food that food eats, but after five years, I still can not stand eat'n greens all the time. Never liked sweets, so that is not a problem.

Anyway, get to the doc, fight about the bill, and listen to what they say.

[AJMD429]

AJMD429, you sound like a somewhat rare Doctor to me. . . . Again, you sound like a really good Doctor to me.

One reason I may think differently (aside from that time I was dropped on my head as an infant) is that my first six years of college education were spent IN PHARMACY SCHOOL! I learned more about medicine, human nature, and the many ways doctors can be pompous idiots during those years, because I was "on the other side of the counter."

I know one thing - most of the good doctors I know in primary care are leaving in droves; some to do "consulting" for insurance companies, some to do occupational medicine, and some to just get out of health care altogether. Fortunately, some of us are maneuvering to stay in practice but not contract with insurance, and we can thereby still deliver quality and ethical care.

The problem is, people are so used to never paying directly for heatlh care, that the same ones who will drop a few thousand dollars to get a better big screen television will go ballistic if you tell them that to treat their diabetes they have to come in four times a year and each visit will be ninety-five dollars.

After twenty years of that, I've come to the point that when I get that attitude back from a patient, I'm just like "Well, then you go out and have an extra supreme pizza and a couple of beers once a week, and you'll spend slightly less money. Maybe the chick at the pizza place knows CPR." A cynical attitude, but also an empowering one - my abilities aren't magical, but I'll not waste them on someone who just wants to complain.

I'd never make it now as a pharmacist, though, because I couldn't restrain myself from chewing out a customer who complained that the drug they were taking WHICH WAS KEEPING THEM ALIVE was costing $200 a month, yet they came to the drive through to pick up their prescription in a brand new Jeep Cherokee pulling a fancy bass boat. Hmmm... buy a fancy new car, or buy something that will help me live ten years longer. At least as a private practice physician I can call a spade a spade.

[OJ]

I agree - AJMD429 sounds like the kind of doctor we need more of. He describes primary care physicians leaving the practice which is very unfortunate - no other field of practice is as qualified to provide the good medical care across the board that the general practitioner does - no matter what the internists (and some other specialties claim).

We are experiencing the same problem in general surgery (I trained in the 1950s when we did everything including heart surgery, etc) and, in particular, the rural areas are hurting.

I would point out, though, that when I was in med school (graduated 1952) and did surgical training 1955 - 1960 (re-upped for Korean War knowing they couldn't win it without me - based on my WWII experience - turned out they couldn't win even with me), we were totally frustrated by the fact we had absolutely NO MEDICATIONS FOR TREATMENT OF HIGH BLOOD PRESSURE!!! What a welcome change those medications made!

We now have a very wide variety that can be tailored for the individual patient and exercise and diet are certainly important in addition to medications. Any medication producing physiological effects will have side effects requiring individualizing treatment specific for that particular patient - even "placebos" are reported to have around 10% side effects -

It seems unfortunate you can't get a sooner appointment for this, however.

[Rimfire McNutjob]

Leeches ... as prescribed by Theodoric of York, Medieval Barber.

[Noah Zark]

. . . The problem is, people are so used to never paying directly for heatlh care, that the same ones who will drop a few thousand dollars to get a better big screen television will go ballistic if you tell them that to treat their diabetes they have to come in four times a year and each visit will be ninety-five dollars.

After twenty years of that, I've come to the point that when I get that attitude back from a patient, I'm just like "Well, then you go out and have an extra supreme pizza and a couple of beers once a week, and you'll spend slightly less money. Maybe the chick at the pizza place knows CPR." A cynical attitude, but also an empowering one - my abilities aren't magical, but I'll not waste them on someone who just wants to complain.

IMO, there's one thing worse than a spoiled child, and that's a spoiled adult.

More folks need to hear "Go ahead and save the money. Go ahead and have that stuffed crust pizza followed by a large Blizzard at DQ. Then when you're on the Life Flight to (regional acute cardiac facility), remember that we had this conversation.

I watched "Biggest Loser" a year ago. What a wakeup call. It got me to lose 20 lbs and counting.

Noah