I don’t usually post very personal things on the blog, but today I am going to make an exception. I am going to post a memorandum I wrote on July 16, 2009, 17 years ago. I was 66 years old, and was still working. I had thought I was healthy, until I went to a new doctor, who didn’t seem to think so at all. He led me through about six months of physical uncertainty that, while I hadn’t forgotten about, I had not thought about for some time in detail. There are probably some lessons here – both for patients and for doctors. But I don’t expect they will be taken seriously. But here goes. Here is:

The Story of My Blood Pressure as of July 2009:

“End of December. Physical exam by Dr. A______. My blood pressure: 145/XX. He tells me I need medication. He prescribes Zestril, 5 mg., 1 per day. Tells me to return in a few weeks for blood pressure check. Other than blood pressure, everything on physical exam seems okay.

“January. I notice that my toes are beginning to hurt (sore, painful to walk on them) and they are turning red. My hands and feet are cold at night. One instance at restaurant where fingers turn white and go numb. Call Dr. A______ back, and tell him it must be the medication.

“Go back to see Dr. A______. BP 160/90. He tells me my symptoms can not come from the medication. I tell him that they must and that I don’t want to take Zestril any more. He wants me to see a rheumatologist. He calls Dr. M______ and asks him to see me on an emergency basiss. I got to Dr. M_______ directly from Dr. A______’s office. Dr. A_______ tells me from now on I should follow Dr. M______’s advice on blood pressure medication, which I find weird. Dr. A_____ tells me definitely not to stop taking the Zestril without starting the substitute immediately. I remember his words: “I can not let you go through a weekend unprotected.” I conclude from this that I have a serious condition.

“Dr. M______ takes my blood pressure. Still around 160/90. He also tells me that Zestril won’t cause the symptoms. Suggests that I have Reynaud’s syndrome, and that I should wear warmer socks. I tell him that I have never had any problems like this, and that it had to come from the medication. He disagrees, but tells me that I should switch to Norvase. He also takes blood tests to check for lupus, etc. Tests are all negative. I switch medication. All symptoms clear up within a few days. No more problems with hands or toes. That does not surprise me.

“The Norvasc (5 mg, twice a day) causes no side effects. I am pleased. In a few weeks, I go back to Dr. A______. Pressure still in the 145/xx range, as I recall. Dr. A_______ says I should get an electrocardiagram. Again, I remember what he said: “You are taking a serious medication and it is not doing any good. There might be something else going on.” I call a cardiologist for an appointment for the test. To be Done in March.

“Dr. A_______ also gives me an electrocardiogram test. I have not yet seen cardiologist. Dr. A______ tells me that the good news is that the exam did not show anything seriously wrong with my heart. No hardening of tissue. A small leak, not to worry about. But I should see the cardiologist. And, he told me that the cardiologist, not him, should be in charge of my blood pressure medication.

“I go to see Dr. R______, a cardiologist (whom I knew). He talks about relaxation, meditation, yoga, salt, etc. My blood pressure is still about 145/XX. He tells me to get a home BP reading machine, to keep records several times a day, when I am doing different things. He asks about my medication. I tell him about Norvasc. He says that he is not surprised that Norvasc does not help; he does not think of it as an effective medication. He proscribes Toporol (1.25 mg per day) and a baby aspirin. Wants me to schedule a Heart Scan. I do. The heart scan turns out very well. We schedule a stress-echo test. That also turns out well. Dr. R________ tells me that I am probably not a prime candidate for a heart attack, but that we still need to get the pressure down.

“I keep records. I take Toporol for four days. Then I have a day when the pressure spikes. Goes as high as 160. Then 170. I think again that it is the medicine. Dr. R_______ is away for the weekend when I call, but his office tells me to stop taking the Toporol.

“Dr. R________ returns. He is very surprised that his office told me to stop taking the Toporol. He does not agree. I decide to see what happens if I take no medication at all. I keep taking blood pressure readings. They are similar to what I get with the medications.

“Dr. R________ tells me to go back on the Toporol and also to take Nifedipine. I am happy with the results. For two weeks my readings are primarily in the low 120s. I give the numbers to Dr. R_______. It looks like we have solved the problem.

“The, one day, my numbers are all in the 130s. The next day, the 130s and 140s. I know this is not good enough. Dr. R________ wants everything at about 120. My numbers keep rising, now to 150. I call Dr. R_________ at home. He is going on a 2 week vacation. He tells me to increase the Toporol to the full 2.5 mg tablet. I do.

“Over the next few days, my numbers are in the 130s, not the low 120s. I know this is not good enough. I call Dr. R________’s office and the nurse talks to a different Dr. R_______, who tells me to take 2 Nifedipine in the morning and one Torporol at night. And to take my blood pressure reading only one time in a day, in the morning.

“I follow this advice for several days, but am quite tired, with my eyes especially weary. The readings are not making much progress. 130s, 140s. I think the 2 Nifedipines are too much. I call the office again. I am told not to stop taking the Nifedipines, and to come into the office. I cut back the Nifedipines anyway. I am not tired or weary any more.”

This is the end of the memo. I don’t remember if I went back to see the second Dr. R________ again, or if I went to see the first Dr. R_______ when he returned from vacation. One thing I do know. I never went back to see Dr. A_______ again. I changed my primary physician to Dr. D____, whom I still see. He told me to stop taking the Nifedipine and the Toporol He prescribed me two different medications, Labelatol and Amlodopine. They have done a good job keeping my blood pressure in the low 130s, but not the 120s. Dr. D_______ has told me that he can get my pressure to the low 120s, if I want, but it will most likely be a tradeoff as to how I feel, because he does not think it can be done without discomfort and side effects. I told him that I really didn’t want the side effects, and he said he would make the same decision. The low 130s are good enough for me, I think, and for him.

Shortly after I retired in 2012, I had one episodes are A-fib, with a clearly uneven heartbeat. I went back to Dr. R_______’s office and he referred me to the A-fib specialist in the office, Dr. M________, who assured me that he could control the a-fib. I don’t think he did anything at the time other than examine me, saying let’s see how soon I have another episode, and that he would until then just check me on a regular basis. He also told me to stop taking my blood pressure, and that even if it spiked now and the to, say, 140, it was no big deal, as high blood pressure take quite some time to lead to something serious, that it doesn’t work over night. It has been 16 years and I have not had any other episode. About two years (I think about 2), he fired me, saying his exams were not uncovering anything and doing anything. That obviously was fine with me.

During the time

I guess the point of all of this is people obviously respond differently to the same medications. It didn’t surprise me that I had to go through a number of possibilities until I found something that controlled the pressure without giving me side effects. But what was so unnerving in all of this is that the doctors didn’t believe me when it seemed clear to me that problems that I was suddenly having were in fact side effects of medications and not some brand new condition that coincidentally just showed up when I changed medications. And I was surprised when one doctor insisted that I keep taking one medication, even though it hadn’t helped and was giving me (in my opinion) side effects, and that another doctor told me that he wasn’t surprised about any of that as he thought that the medication itself was a total ineffective drug. And that one doctor said that we have to get you to 120, no matter what, while another was satisfied if I remained in the range. That Dr. A_________ couldn’t leave me unprotected for a weekend, and Dr. M________ said that blood pressure takes a long time to actually be dangerous.

And what about the relationship betwen anxiety and blood pressure. It seemed clear to me back in 2009 when I was checking several times a day. All the doctors discounted it.