Doctor, Does This Drug Have Any Side Effects?

Standard

cartoon-doctor

Hello again. It’s Dr. Louella, just winding up my weekend here. I’m a bit tired but still very much excited that I got some time to do this post.

You see, yesterday I was musing on a young patient I had seen earlier this week. He had asked me one of the most frequent questions I get from patients.

But let me give you the context of this case first. It was another busy chronic disease clinic. The ‘patient care attendant’ told me about a walk-in patient to be seen who had chest pain.

I asked for his age. He was 22 years old. Cool. I ordered an ECG ( EKG, electrocardiograph; or ‘heart tracing’) and said that I would see him later.

A few patients later they brought a perfect ECG for me in ‘normal sinus rhythm’ with no abnormalities. Good. No serious heart problem. I saw him a few patients after that.

Normal-Master

He was a healthy looking young male. It was easy to make the diagnosis. He told me he had central chest pain. I asked him why (because most of the times patient already know the cause). He confessed to having lifted some heavy boxes of meat the day before.

I did a brief examination of the heart, lungs and chest wall. He had a muscular strain. Case closed.

But not quite. When I attempted to prescribe an analgaesic (pain killer) for him I was confronted with the oh too familiar question…

“Does this drug have any side effects, doc?”

I think this is where public education should step in because I am asked this question repeatedly nowadays. People need to understand these simple concepts so they can make informed choices.

I start by replying, ‘Of course. All tablets have side effects.  If you look in my book right here (the British National Formulary on my desk), each drug has a long list of side effects.

And there is no way for anyone to remember all of them. That’s why I walk with my book. Doctors usually know the most common and/or most serious effects.

BNF 2009

I like to refer to them as potential or possible side effects because it does not mean that you are going to get them.

Research is done so they know how many people suffer with each side effect of a drug and it is usually a very small number, like 5% or 0.5%. If many people are affected they wouldn’t allow the drug to be sold.

Now for the most, you may get one side effect of a drug. Or if you are really ‘bad lucky’ (Trinidadian for ‘unfortunate’) you may get two.

No one can predict whether you will get a side effect. It is only if  you use the drug you will know the effect. If something happens we  will deal with it. But we would not want to lose the benefit of this drug for no reason.’

Now there are some conditions where I can tell patients that using a medication is optional, such as for pain, itch or stomach discomfort but for diseases such as diabetes and hypertension which can ravage their lives, I urge them to take their pills everyday.

Many of our patients have heard from friends and family that these medication damage their kidneys and liver. They often do not take them as a result, or take them intermittently to mitigate these supposed effects.

Liver and kidneys

I stress to them that chronic diseases (especially diabetes and hypertension)  are the ones that have been proven to damage their organs. The pills are given to them to protect them.

Yes, sometimes the pills themselves can damage organs but this is rare compared to diabetes and hypertension which ALWAYS impair kidneys, whether to a minor or great extent.

People get complications and die of chronic diseases all the time. I don’t really hear of people dying from their medication. But I know it probably happens.

Our patients are also exposed to television advertisements where side effects of drugs are rattled off. But without the explanation I gave above we can see this turning people further away from conventional medicine if they believe that all these negative effects would happen to them.

The young man I saw that day accepted my prescription in the end. He understood that the likelihood of him getting a side effect of the drug was slim and we would deal with that if and when it occurs.

I also explained to him that although he was young and fit there was no reason to strain his body beyond its capacity as he had done recently because he would suffer for it. Damaged muscles often take several months to heal.

chest-muscle-strain

Unlike the young man, some patients turn to alternative medicines. They are free to do so but I let them know my position on it.

I let them know that the medicines we use originally came from plants but they have been purified and from them synthetic ones were made.

All our drugs are extensively researched and the effects documented. Yet allopathic medicine is still far from perfect.

Many herbal products are not purified and contain several chemical compounds with varying effects. There is very little in the way of formal study of these chemicals.

Claims are based on anecdotal accounts (of people’s personal experiences) rather than on large controlled studies. Anyone can sell anything and claim anything about them because there is no regulation of these products. But not everything ‘natural’ is safe.

Alternative-Medicine-of-Pros-and-Cons

But the thing is, it’s not that herbal products don’t have side effects. It’s just that the people distributing them don’t know, so everyone pretends like they don’t. And when people experience them, does anyone sue the herbalist? No! But sue your doctor, because he is rich!

Never mind that, if you see Dr. Louella dying, bring me the tablet, bring me the ‘erb, the weed, bring anything!!!

But while I’m living and can make a rationale choice, bring me the evidence to support your medicine!

Dr. Louella saying, do enjoy your day! Laugh! Sing! Dance! … I do!!!

1098096_10151778645293588_2106210918_n

But No One Told me I am Diabetic, Doc!

Standard

Hi. It’s Dr. Louella in a sombre mood today. I keep thinking about this patient I had today in chronic disease clinic; a young guy in his thirties.

No drama here. I started off with my usual verification of what the patient suffers with. I’ve been doing that a while now, since discovering that patients attend our clinics for years with only a vague idea of what they’re being treated for.

I don’t know if it’s a Trinidadian thing with the responses I receive but I’ve asked this question so many times that I’m no longer surprised…

hospital

‘What are you suffering with sir/madame?’

Some patients get offended. They start to stammer that I am the doctor and therefore I should know. So I let them know it’s a big file (we use handwritten patient notes) and we would move a lot faster if they tell me rather than me having to go through all these notes.

Furthermore I remind them that they are the patient. It is their health and their responsibility to know what they are afflicted with.

‘So, would you like to tell me, sir/madame, what are you suffering with?’

There are other patients who begin everything with ‘they say’. For example that, ‘They say I have diabetes’. When I try to confirm that they mean that they have been diagnosed with diabetes, they respond consistently, ‘So they say’. So in my estimation, they are in huge denial!

Sometimes I would make a check in the notes only to find that they have had this said to them for five years or more. I let them know that ‘they’ say it only because it is true and it’s very important they learn to accept it and deal with it.

Then there are those patients who try to respond correctly but leave out diagnoses. When I check the notes there may be an additional diagnosis such as ischaemic heart disease or chronic kidney disease that they are clueless about and which they sometimes deny vehemently.

So then I need to backtrack to find out where that came from, if they were diagnosed at hospital or presumed to have the disorder or what. I need to know if a diagnosis is true or not to convey this to the patient sitting in front of me.

Stapel

Finally there are patients who give additional diagnoses to what are documented. Something may have happened since the last visit or more likely they had been suffering with some disorder and didn’t think it necessary to inform us.

Our patients attend several different doctors, clinics and institutions simultaneously. Very little official information is shared between these groups.

It is often up to the patient to let us know what is going on. To some of them it is a secret. Others forget or don’t think it relevant. Me, I grab up this stuff, because I want to know everything.

I use the diagnosis as a starting point to inform and educate the patient. It’s not that you maybe sometimes could probably have hypertension. You HAVE it and you need to deal with it. It’s not about a bunch of numbers but really debilitating complications that you could get but we are trying to prevent.

Getting back to the case at hand… When I had my usual discussion with this young man about his diagnoses today, I was a bit thrown. He knew he was overweight and had elevated cholesterol but knew nothing about having had diabetes.

But it was staring at me in his notes! He was newly diagnosed as a diabetic on the previous visit. Apparently he had not been told. Oops! That was a problem. And he seemed intelligent enough that he would have remembered.

CR112K13-LT-AccuChek-Aviva

I proceeded to take the time to double check his blood investigations. Those results pointed to pre-diabetes, which as I explained to him, was in between ‘normal’ and ‘diabetic’. He was becoming diabetic. Steps had to be taken to try to prevent, or at least delay, full blown diabetes.

(The term ‘Impaired Glucose Tolerance’ is an older term that was and is still used for this condition. I much prefer the simpler ‘pre-diabetes’ when dealing with patients as ‘pre-‘ indicates ‘before’.)

While advising the patient about his condition, I needed to reassure him as well. He had been started on the appropriate medication (metformin). I actually increased his meds for now because his glucose level was high.

I advised him strongly about weight loss, that that in itself may reverse his condition and referred him to the dietitian (they make our life so much easier).

I spoke a lot about exercise because I know that if you’re not into it, it could take you a while to get started. I wanted to get him thinking that this thing was doable.

I threw out different ideas of different types of exercise he could attempt and explained how the day-to-day routine he described was physical activity but not intense enough to be classed as exercise. And he had the size to show for it.

A_Black_and_White_Cartoon_Overweight_Man_Jogging_Royalty_Free_Clipart_Picture_110117-172043-033053

In the end he was really grateful for the information. But of course, other patients were waiting.

I really feel passionate about helping younger patients prevent and manage chronic diseases. That’s why I spend extra time with them.

It is often more difficult for them to come to terms with their illnesses than older adults. They want to enjoy their youth and do not want to be saddled with strict diets and medication.

I let them see that I take their health seriously and they should too. But I also try to inspire hope within them because without it they wouldn’t even try.

I will continue to ask patients the question ‘What are you suffering with’ or seek verification from the patient as to his/her diagnoses because it is important. It is only when people properly understand what is going on with them can they make informed decisions and live healthier lives.

I feel better now that I’ve shared that. I’d like to think I am making a difference in this world, one dot at a time. Dr. Louella is out!!!

1098096_10151778645293588_2106210918_n

Hypertension 10 – Summary

Standard

Hi folks! It’s Dr. Louella and we’ve reached the grand finale of our discussions on hypertension. Yeeaaah!!!!

Image

This one you should definitely keep for your records because I’ll be reiterating and reminding you of all the important points, having already explained the mechanics of this disorder in detail.

Firstly blood pressure is derived from the pumping action of the heart as it forces blood into large blood vessels. This causes the blood to circulate around our bodies. The force with which  the blood flows is called the blood pressure.

Just as we are unable to feel the blood circulating around our bodies, we are unable to feel our blood pressure. It is a common myth in Trinidad and Tobago that high blood pressure causes neck pain.

95% of high blood pressure cases are caused by the kidneys by an unknown mechanism. The other 5% have an identifiable cause, usually in younger individuals.

Certain emotional states, such as anger, pain and anxiety, as well as increased physical activity, can cause a temporary rise in blood pressure. This is not hypertension, which is a chronic condition. For this reason, not just one, but a few blood pressure readings need to be taken before a person is diagnosed as hypertensive.

Factors which predispose to the disease include a family history of hypertension, increasing age and certain ethnicities such as Afro-American or Afro-Caribbean.

Dietary associations of hypertension include a high sodium intake (salt, not fresh seasonings), low potassium intake, heavy consumption of alcohol and obesity. Increased oats and fruits in the diet help to reduce blood pressure. Physical inactivity is also associated with a higher blood pressure.

General guidelines for hypertension are that a reading of 120/80 or less is normal and ideal; a target of less than 140/90 is used for those on treatment; less than 150/90 is now used for those over 60 and 130/80 or less for those with certain diseases such as diabetes and heart disease.

Complications of hypertension are the dreaded stroke, heart failure, heart attack, kidney failure, aortic aneurysm and eye disease. Hypertension damages the inner lining of blood vessels allowing cholesterol to enter the wall and form a plaque that partially blocks blood flow.

If it a blood clot forms at the site it seals up the blockage long enough for no blood to flow and permanently damage brain or heart cells. The person then gets a stroke or heart attack.

250px-Main_complications_of_persistent_high_blood_pressure_svg

The DASH diet has been shown to help lower blood pressure. It includes less salt, alcohol, red meat, fat and sweets including sweetened drinks.

But it also includes more fruits, vegetables and high fibre foods (whole grain products such as whole wheat/meal bread, bran, oats, as well as more peas, beans and nuts).

Weight loss for the overweight and obese is important in controlling hypertension. This can be achieved by a combination of dietary control and exercise. To lose weight you need to eat less and have a lower calorie intake but frequent little meals, and not starvation, is the key.

Exercise is beneficial in lowering blood pressure on its own, even in those of normal weight. Aerobic exercise can take many forms including running, skipping and dancing.

Some people can have their hypertension controlled through diet and exercise alone but most will still need the assistance of medication. Medication is varied but it must be stressed that it needs to be taken everyday, as prescribed by the doctor, unless the person is experiencing ill effects, which he must inform his doctor about.

So there! We’re done. That’s the end of hypertension. I’ve taught you almost everything I know. Feel free if you have questions or comments. See you next week. Dr. Louella is out!!!

Hypertension 9 – Treatment and Compliance

Standard

291978-3541-12291978-3541-12

Hi everyone! I’m on time today. This is Dr. Louella checking in from the office. This ought to be our final post on hypertension but I feel the need to give a summary afterwards to draw all the essential points together. Let us finish up on treatment.

So, let’s say diet and exercise (as we discussed previously), fail. You ask what I mean by fail… well you just don’t do them or you make a half-hearted attempt to do so. Then they will fail. Or, better yet, say you do try, and get some results but not sufficient for your blood pressure to be called normal, what do we do?

It is obvious we turn to medication at this point. Antihypertensive medication is used to control but not to cure hypertension or high blood pressure. Some people’s blood pressures are so high that we have to put them on medication from the start, but this should be done in conjunction with diet and exercise.

Now I don’t need to go too much into the actual medications. There are many classes of antihypertensive drugs and several drugs in each class. One may work a bit better in an individual than another but none is clearly superior.

I do have a lot to say on “The Patient and the Taking of Antihypertensives” though. Oh my goodness! I have only dealt with patients from Trinidad but I am sure there are patients all over who behave similarly.

Many patients aren’t convinced of the diagnosis of hypertension. They say “so they say” but don’t own it for themselves. They are in denial. Others treat it like a minor irritation or joke. But I am usually quickly able to convince them of the diagnosis by giving them the normal range and showing where a number of their blood pressures, as recorded in the patient notes, are beyond that. Remember, if they were diagnosed based on one reading, they have a right to be skeptical.

I show them that antihypertensives work on everyone. If they do not have hypertension their blood pressures would run low if they took medication. Are their blood pressures running low? Or are they being maintained just normal, high normal or even too high? If your blood pressure is normal whilst on an antihypertensive, you need to continue on that treatment, or else it will go high.

blood-pressure-3399x1699

It is difficult to get hypertensive patients to take their medication because they don’t feel sick. This often leads them to rush to take a pill when they do feel something like a headache or neck pain. Recall that hypertension has no symptoms. I tell them if you are waiting to feel something, that’s when complications have already set in, and it will be too late.

A lot of our patient population think a water pill is to help them pass water and improve functioning of their kidneys, so they don’t take it because they pass water just fine. They are oblivious to the fact that it is a pill for treating hypertension, so I make this clear to them.

Many of them have their own regimen for taking medicines: once a day instead of twice, every other day, twice or three times a week, whenever they remember or whenever the blood pressure is high. No wonder the pills don’t work!!! I always ask why? What is your reasoning for this?

I will admit, years ago when I first discovered this deviant behavior I was shocked. I found out that we doctors increased the dosages of patient medication when needed but the patients themselves didn’t. So the notes may be saying as many as four tablets a day when the patient still routinely took one. My most gruesome discovery was bags and bags half-filled with medication at the homes of the elderly we visited in Cedros. I was upset and thought I was fighting a losing battle.

But I’m older and wiser now. I understand many of the reasons they don’t take their medicines as prescribed. I ask them point blank about it and spend some time on the topic. But even after explaining there is no guarantee they will follow comply. Most of our patients are unaware of the names of their medication and this makes it more difficult.

I explain to those that take their meds only when blood pressure is high is that they are doing more damage by allowing their pressures to go high and then taking a pill, as opposed to having it controlled at all times. If your blood pressure is good today it may be the pill you took yesterday. If you miss the pill today it will be high tomorrow or the next day. To decrease risk of complications blood pressure needs to be controlled at all times

Many patients are afraid of side effects. I try to explain that these side effects are only potential and nothing happens to most people. There is no automatic damage by the medication. And furthermore, the damage they will get from hypertension is more sure and worse than what the tabs will do.

For those who have decreased the dosages due to convenience, I explain to them that the drug only is effective in their system for a certain length of time and they need to take it as prescribed for it to work properly. It comes as though you’re wasting your time because the drug can’t work like that.

A few of them cannot read so I emphasise to them that I am changing the dose and ask them to refer to a relative or neighbor to read it for them. Sometimes for the elderly or mentally challenged I ask for them to bring a relative. I explain to that person and charge them with the responsibility.

That’s it folks!!! We just completed the series on hypertension. Only the summary is left. Thereafter I’ll be starting a new topic. Now if I left out anything or you don’t understand something, feel free to comment before we move on. I enjoyed this because it was like a refresher for me and as you can tell, I love to share my patient experiences. Enjoy the rest of the weekend and the incoming week!

 

Hypertension 8 – Prevention/Treatment 2

Standard

Hi. This is Dr Louella saying sorry for the late post. It was a hectic weekend! But we need to continue our discussion on prevention and treatment of hypertension. Previously we talked about how your diet can help lower blood pressure so now we go on to weight loss and exercise.

Yes, I know you’ve heard a lot on these topics before, but not like this…

Now weight loss and exercise are not the same thing.There are so many health benefits to exercise that everybody needs to exercise (including  the skinny, the fat and the in-between; toddlers and grandmas) but not everyone needs to lose weight. I have frequently heard the retort, “What you have to lose?” when people hear that I exercise.

But I love to provoke my elderly patients by asking them if they’re exercising because they should be. It would help unstiffen those joints, reduce their pains, strengthen their bodies and lift their depression among other things.

Now if there is one thing you need to know about exercise is that it makes you live longer. Exercise increases your longevity! Did you know that? It’s been proven!.

It has been also been found to lower blood pressure about 1 to 3 months after engaging in it, as long as the person continues to exercise. It strengthens heart muscle reducing the force needed to pump the blood around the body.

Exercise is recommended for everyone for the prevention and/or control of hypertension. 30 min of moderate exercise, 5 days a week is the basic requirement for health or, if its vigorous exercise, 15 min for 5 days will do.

Now don’t get scared. It isn’t as hard as you think. Get yourself a pair of sneakers and pants, as well as a safe environment, and you’re almost there. I tell my patients these things because I am saddened to find out that many of them don’t exercise even though they know better.

I was a gym freak once, but not anymore. I’m well aware that not everyone can toil away for hours at the gym… timing, cost, distance, shyness, whatever, prohibits that. But that does not rule you out.

Remember, anything aerobic will do – brisk walking, jumping, jogging, dancing, aerobics, active sports, swimming, cycling, skipping, climbing etc. You can use a video, gym instructor, exercise equipment, a friend or do it by yourself. You can be in the house, around the house, on the street, in the park, in the gym.

Weight training is not as good for blood pressure as it may increase it. But your housework (scrubbing, mowing the lawn etc) may count, once it increases your heart rate and breathing. It has been found that physically strenuous jobs are associated with lower life expectancy because of the stress associated with them.

If you’re new to exercise 5 min may be enough and you gradually work your way up. Don’t try to overdo it. The body has to get accustomed. If you injure yourself you’ll never want to go back. Warm up first before you stretch. Never stretch a cold body but always stretch those muscles after use. Please drink sufficient water. Hydration is important.

Now, I’m going to burst some people’s bubble here. I’m going to make it clear that exercise alone  is not enough. You cannot lead a sedentary lifestyle, sit for most of the day, and think that 30 min of exercise is going to be sufficient to counteract that.

There is something called non-exercise physical activity that we must also engage in. This simply means being active throughout the day, doing the little stuff. Excessive sitting is unhealthy. If you reduce it to less than 3 hours a day it can help extend your lifespan by 2 years.

A generally active daily life is associated with cardiovascular health and longevity in older adults. So get the old people moving and get yourself active: stairs instead of elevator, walk instead of drive, manual tools instead of automatic, do it yourself instead of outsourcing, walk the dog, do the dishes, wash on hand and so on… They all add up.

Our populations are getting fatter so hypertension is rising. Remember obesity is linked to hypertension. So many of us need to lose the weight, for this and other reasons (helps lower cholesterol, blood sugar etc).

No one said it would be easy but it will be worth it. You know the drill. Weight loss entails diet and exercise. Even when you take weight loss pills you need some kind of diet.

You don’t need to get down to your ideal weight, a BMI of 18.5 to 24.9. That would be lovely, but for some it is extremely difficult. It is said that losing as little as 5% of your weight may make a difference to your blood pressure, 10% is better and more even better, if you are obese.

What I discussed previously with regards hypertension was a healthy diet but not a weight loss diet. I will mention the main features of this.

You should know by now that you must eat less (or take in less calories) in order to lose weight. Watch the content of the food: less sugar, flour and fatty/oily items. Decrease your portion size, but I stress, gradually. You don’t want to feel hungry. Use more protein, especially beans and peas, and your veggies. Increase your number of meals to 4-6 a day. You use calories more efficiently this way.

Make your dietary changes healthy and palatable and never entertain long periods without meals. In this way the diet will be easier for you to incorporate into your lifestyle and not be just a passing fad. You would not continue to lose weight indefinitely but eventually settle.

While the majority of weight loss would be achieved through the diet, exercise is also very important as it increases your calorie output, increases the efficiency with which you lose the weight, tones the body, etc. I normally explain to my patients that 30 min of exercise, 5 days a week is the basic requirement for health so if you’re looking to lose weight you may need to go beyond that.

So I have told you about exercise and the weight reducing diet, why they are needed and how to achieve them to prevent/control hypertension.  But it’s been another long day. I’m tired. But I really enjoy doing these blogs so come back for more when we talk a bit about drug treatment of hypertension. Later! Dr. Louella is out.

 

Hypertension 7 – Prevention/Treatment

Image

DASH Diet

 

Hi. This is Dr. Louella continuing our series on hypertension. But first I must mention that I did go out for the Easter long-weekend. I got to be with nature as we hiked to Edith falls in Chaguaramas, Trinidad (breath-taking when dry, I can’t imagine what it would be like with water) and to the Corvine River (we’ll reach the pool next time; it was getting too dark).

With regards to hypertension I would like to remind us just how common this disorder. Current research suggests that 1 in 3 American adults and 1 in 4 Trinidadians have this disease. Remember what it can cause: stroke, heart attack, heart failure, kidney failure, and more. These are all dreadful, debilitating, expensive diseases.

Wouldn’t it be worth your while to prevent yourself developing this silent killer, hypertension? I think so. That’s why I am going to discuss prevention of hypertension, in conjunction with treatment, because much of what can be used to prevent hypertension is used to control it as well.

Now there are certain factors that predispose a person to hypertension, that are beyond our control. These include a family history of hypertension (heredity), increasing age (from 35-40 years onward) and ethnicity, such as being Afro-Caribbean or Afro-American.

This is fairly common knowledge. So if you KNOW you fall into one, two or even three of these categories (oh goodness, I’m in all 3) and are at an increased risk then you have a special responsibility to try to prevent yourself from getting hypertension. This disease is costly.

In preventing/treating hypertension I would first like to remind us to go easy on the salt. Most of us cook with too much salt. Do not add salt to your food when at the table. Decrease your consumption of fast foods; all they care about is the taste. Be wary of canned food, sausages and bacon. The salt is an integral part of their processing but it is way too much for you.

Especially for the Trinidadians, please note that you do not need to decrease the amount of fresh seasonings you add to food because these do NOT raise blood pressure. Fresh herbs and seasonings are encouraged in place of salt. However, packaged seasoning is a different matter, because it usually comes with salt.

Many of us don’t use enough fresh fruits and vegetables (including raw). These have so many health benefits, including lowering blood pressure by increasing potassium. Make a habit of passing by the fruit stall on a weekly basis to get your daily quota of two fruits. Also prepare salads more regularly.

Eat more oats. Have it every morning for breakfast if you can because, remember, this can help prevent hypertension.

Please reduce the alcohol intake. The benefits you will derive will go way beyond reducing hypertension.

What has been shown to work best is a comprehensive diet, where foods are combined to lower blood pressure nicely. These include high fibre foods. Increase your fibre intake with more whole grain products (whole wheat/meal bread, bran, oats etc), as well as, with more peas, beans and nuts. (Nuts are also great for lowering cholesterol. A handful a day is recommended – not too much, because they are high calorie.)

Other measures like lowering the amount of meat in the diet has also been shown to help. This is red meat in particular. You can have generous amounts of fish and some chicken. Dairy products should be consumed but should be low fat. Of course, much less sweets, especially sweet beverages and fat should be consumed.

This healthy diet has been proven to reduce blood pressure. And really, is it so hard? If you need more detail feel free to research the DASH diet. It is the Dietary Approaches to Stop Hypertension.

I’ll talk more on a major factor in hypertension, obesity, next week. I’ve been up way too long for one day. Ciao!!!

Hypertension 6 – Associations

Standard

It’s the Easter long weekend here in Trinidad and Tobago!!! That means church, beach, camp or partying for many. Dr. Louella here, and I’ve got to wrap this blog up quickly because I’ve got to go dance practice for our Glorifest concert of high praise this Saturday. I need to remember all my moves and get them really tight.

But first to continue our discussion about hypertension because it is very important. Before we talk about the treatment of hypertension though, you may have noticed that I omitted a well-known topic in hypertension. That’s salt intake. Everyone knows that hypertension is associated with a high salt intake.

Earlier, in our talk on causes of hypertension, I did not mention salt as a cause. In fact, what I did say is that the real cause of hypertension is not known. And that is true.

But there are a number of important dietary associations of the disease which should be mentioned. For example we know that high blood pressure is associated with a high salt (sodium) intake. It occurs more frequently in those who consume a lot of salt. But it does not occur in all of them.

Researchers have found that those with a high potassium intake have a lower blood pressure. That’s because potassium counters sodium in the body. Whereas the sodium from salt draws more water into the circulation encouraging a higher blood pressure, potassium does the opposite.

Eating oats seems to be a fad these days but it is a healthy one. Eating whole grain such as oats and bran flakes every morning is associated with a lower risk of developing hypertension. Oats also reduces blood cholesterol as well.

An important part of some person’s diet, alcohol, is also proven to elevate blood pressure. I saw this in one of my local alcoholic patients in Cedros. Once he stopped his drinking binge, his blood pressure would go to almost normal.

Also in my practice, I have come to expect, without even realizing it, most obese patients to have an elevated blood pressure, so commonly is obesity associated with hypertension, especially in our almost half African-descended population in Trinidad.

What I mentioned above are the PROVEN associations of hypertension. Note I did not mention highly seasoned food, sweets, fat intake, cholesterol and smoking, a few of the things I have heard people mention, as associations. These may cause other problems, by not hypertension, as far as is currently known.

Remember too, that we already discussed physical and emotional states that elevate blood pressure. Next we will determine what is the best approach to a diet that helps to lower blood pressure. But it won’t be from scratch. This wheel has been invented before.

So, we have a four day weekend here in Trinidad. Whatever you’ve got wherever you live, I hope you enjoy it! Till next week. Dr Lou is out!

Hypertension 5 – Complications

Standard

3d brain image

Hi there. Dr Louella here, finishing up the discussion on complications of high blood pressure. Remember, this is to answer the question, why do we treat hypertension, especially when it has no symptoms? We already identified how hypertension causes both ischaemic heart disease, which can lead to heart attack, and heart failure. We now continue to other complications.

Hypertension is the major cause of stroke, which occurs in the same fashion as heart attack, by blockage of blood flow to parts of the brain. We can use the same picture below to demonstrate.

From: cdc.gov

From: cdc.gov

Hypertension damages the inner lining of blood vessels allowing cholesterol to enter the wall and form a plaque that partially blocks blood flow. If it a blood clot forms at the site it seals up the blockage long enough for no blood to flow and permanently damage brain cells. Persons are unable to use parts of the body which are controlled by the affected regions of the brain.

Narrowing of the small blood vessels of the kidneys leads to chronic kidney disease and in some, renal failure. In the eyes it causes eye disorders such as cataract, glaucoma and bleeding in the back of the eye (retinal haemorrhage). Less common occurrences are the deadly aneurysms (ballooning of blood vessels due to weakened walls) which can occur especially in the abdomen.

Once you have untreated or inadequately treated hypertension some amount of organ damage is bound to take place. Nowadays most people end up with complications due to poorly treated hypertension. Stroke, for example, is way too common in Trinidad. I often ask my patients if they don’t mind having a stroke and give a visual demonstration to remind them what it’s like.

Many years ago, I came home from school in the third form (9th grade) to find my granny (fond name for grandmother) in the local hospital with a stroke. Of course, life for me was never the same as she couldn’t walk or talk after that. At 83 she had been a really active woman. She was said to be bringing in the goats when it happened (yeah we had goats and I loved them; no it wasn’t a farm and none of the neighbours had; we just happened to have goats).

Granny survived four years after that. Though we never admitted it, it was a burden to care full time for her although it was also a joy. She needed caretakers when we were out to work and school.

The moral of the story is, especially for those with hypertension in the family like me, don’t get hypertension! Don’t get a stroke! Or heart disease, or cataract!

We will learn how to prevent this silent killer and its awful complications in the next talk. Ciao kids!!!

Hypertension 4 – Complications

Standard

untitled (2)

Hi guys. It’s Dr Louella again. We need to wind up on hypertension but first I must report that I did not make it to Cedros (Trinidad) for the holiday, as I had no company for the two hour drive. But there’s gonna be a next time!

Well so far we’ve been through the symptoms, causes and diagnosis of hypertension and it’s time to get to the bottom line of how to treat it. But not quite. Because the problem with many people is that they don’t fully understand WHY we treat hypertension.

And why is that so? … If you recall, hypertension has no real symptoms. It does not make you feel sick. So in many people’s minds they do not really see the need to take medication when they are not sick. Many of them only take meds when they think their blood pressure is high. But there is no way to know without testing and you cannot test 24/7.

Once your blood pressure is higher than the ideal level of 120/80 your blood vessels are traumatized by the pressure of the blood flow and gradually, over months and years, the inner lining of the blood vessels is damaged. This can lead to thickening of the blood vessel walls by increase in the muscle content in smaller blood vessels and by cholesterol-filled atherosclerotic plaques in larger vessels.

Atherosclerosis is hardening of the blood vessel walls by the growth of plaques which are filled with cholesterol. The picture below shows the progression.

From: cdc.gov

Once thickening of blood vessels occurs, the lumen or passageway of the blood vessel narrows so less blood can flow through it. This especially affects blood vessels in the heart and brain causing ischaemic heart disease, which may lead to heart attack, and stroke.

People with ischaemic heart disease usually suffer with recurrent chest pain due to poor blood supply to the heart.  During a heart attack the blood supply is cut off completely and part of the heart dies. This may result in sudden death of the individual or they may have to live with a severely weakened heart.

There are other ways hypertension can damage the heart. The high pressure of the blood can put a strain on the chambers of the heart as they contract leading to thickening of the muscle of the largest chamber, the left ventricle. This becomes stiff and less able to contract. It is further weakened by the poor blood supply in the narrowed arteries. Finally, the heart muscle starts to stretch and can no longer perform its function.

The description above is that of heart failure and is usually accompanied by an enlarged heart. The heart muscle in heart failure does not have its full strength and the heart cannot properly perform circulation of the blood without the help of medication. The individual often suffers with extreme fatigue, shortness of breath and/or swelling of the feet.

Ok! That’s a mouthful. As we can see, hypertension causes some major problems in the heart. Next week we’ll finish these complications. We have not yet spoken about a big one, stroke. I will share my own personal experience with this awful disease. See you then!

Hypertension 3 – Causes/Diagnosis

Standard

It’s another long weekend here in Trinidad and Tobago! But before enjoying the relaxation let me push a little further into our discussion on hypertension.

It slipped me to mention in my previous blog about other causes of hypertension. While the vast majority of cases of hypertension, about 95%, are called ‘essential hypertension’ where the cause is not really known and has something to do with the kidneys, 5% of cases of hypertension actually have an identifiable cause.

A red flag goes up especially in younger individuals who may develop a variety of conditions which may be hormonal, renal or otherwise, which may be associated with ‘secondary hypertension’. These include polycystic kidneys, nephrotic syndrome, phaechromocytoma and thyrotoxicosis among others. Doctors ought to actively search for a cause in younger persons.

… So you’ve heard a bit about hypertension. Suppose you would now like to discover if you have this silent killer or not, how is it done? Well checking blood pressure is so easy nowadays we are without excuse. You can check at the hospital, health centre, doctor’s office, pharmacy, at a friend’s, at home.

You can use older methods that require someone with a sphygmomanometer and stethoscope or you can do it all by yourself at home with a completely automated device. I advise all my hypertensive patients to get a blood pressure gauge at home because they are generally affordable and they can better alert their doctor as to what is happening with their blood pressure.

Diagnosing hypertension is a slightly different matter. It should not be done based on one reading unless the blood pressure is extremely high. A few readings ought to be taken and the average used. Remember we spoke about how your blood pressure could be temporarily elevated due to different states of the individual (increased physical or emotional activity). One would not want to mistake one of these readings for hypertension so a number of readings should be taken to get a true picture.

I advise my patients to take their blood pressure when relaxed so we can get the best readings. Current guidelines recommend being seated quiet for 5 minutes prior to checking it.

We’ve heard these figures over and over but we must try to remember that an elevated blood pressure is equal or greater to 140/90. Over 160/100 is severe hypertension. 120/80 and under is ideal. Next time I’ll tell you what these figures mean. It’s real simple.

I would like to remind everybody that one isolated elevated blood pressure does NOT kill. Some people panic and get stressed when they hear their blood pressure is high. What we need to do is repeat it. If the high reading is the trend then we need to treat it. But the great thing is, WE HAVE TIME! High blood pressure does not cause its deleterious effects after one day, after one month ore even after one year. It is a chronic illness and it takes YEARS for the effects to be seen so we have time to get it right and control that blood pressure.

Next time our main chat will be about treatment. … I’m thinking of going to Cedros, at the south-western tip of the island for the holiday. Usually calm sea waters for me to find peace and meditate. Also a place where I was the community doctor, so I’m known there. Let you know if it happens (keeping my fingers crossed)..