Stents and Blood Pressure Followup

I finally got around to the story of my two cardiac stents, which was not really so short as intended. Now for some followup adventures, since I went to my primary care doctor for the first post-procedure checkup yesterday.

I have a lengthy history of hypertension. I mean, as early as my teens I would get an idle “your blood pressure’s kind of high” from people checking it, but of course those were one-off, no history being tracked, perhaps chalked up to the white coat factor. I’ve actually been medicated for it off and on since 1993, and would have been over a year sooner had I not lost my job before I could go back to the doctor who wanted to treat it once a course of antibiotics for sinus infection had been completed. (Oddly, I remember the doctor’s name despite having seen him just once.) It was super high then, when I weighed about 205 and got a serious daily workout on the job. By comparison, my highest adult weight was about 308 and my lowest, skeletal-looking adult weight was 178. Give or take 5 lbs, 205 was the stable weight I stopped at for years, until I was unemployed for a year and 14 days (which used to sound impressive, before I was un-and under-employed for, at the most charitable measure, 4 years, 8 months, 25 days and counting as we speak), followed by having desk jobs doing tech support. (Least charitable measure? 13 years, 8 months, 10 days, when it comes right down to it.) (I am awfully parenthetical tonight.)

Anyway, I have tended to ditch the drugs when between some combination of jobs, doctors and insurers, or when the side effects of the drugs became too glaringly a problem. The first doctor to treat me started me on beta blockers. While my boss at the job I’d recently gotten hadn’t wanted to hire me in the first place, and the company culture didn’t approve of my 70 mile commute each way – I shoulda been a local, ultimately I floundered because the beta blockers fried my brain and stole my metabolism and motivation. I couldn’t remember or keep track of things, going all absent-minded. It was so bad. I don’t recall just how well my BP was controlled on that first drug, but I seem to recall that he was no more stressed about getting it perfect than the second doctor to treat me, who was happy if it stayed to around 150 over 90-odd. That doctor rejected beta blockers as not right for me. After he left the practice, I lapsed until I needed dentistry that they wouldn’t do with uncontrolled blood pressure. It was disconcerting when dentists starting checking my blood pressure!

Of course, I can’t imagine it helped that I went something like ten years without dentistry, and apparently for years had an infection in the root of a tooth, which was gradually disintegrating and absorbing into my body. But dentistry is a whole other story, apart from two times it forced me to doctors for blood pressure treatment, most recently to my current doctor of about 12 years. Which happens to be how long I’ve been without dental work, except one emergency extraction. I take a lot of Tylenol as dental surrogate, and have no idea where I’ll get the few grand I expect to need for dentistry sooner or (preferably) later.

Anyway, after lapsing from one relatively long-time doctor, eventually I had a brief stint with a younger, more aggressive doctor at the same practice, whose specialty happened to be hypertension. He was curious, as am I, to know a root cause. As I always say, high blood pressure is a symptom, so what it the cause, and can it be fixed? Under that guy, I did 24 hour urine collections, twice to chase ambiguity, and had an MRI of my kidneys to check for pheochromocytoma. Got to see the kindney pictures. Pretty. Nothing foreign there. Not that it’s the only location for pheochromocytoma. Then I lapsed with that one, probably connected with my insurance expiring. After the last full time job I had, which I never expected could be the last I’d ever have, I maintained COBRA coverage for a year, discovering that the main job of the COBRA administrator was to attempt to get rid of you. Or maybe I just walked away, even with insurance still active. I really don’t remember.

I ended up with my current doctor as a result of needing the tooth removed that had the infected root. I spent a couple months on antibiotics before it was pulled, and had to have a doctor and treatment for my blood pressure. When I’d first showed up at the doctor before my current one, it was something like 180/120 and they flipped. Made me stay in the waiting room until the first meds they gave me on the spot made it come down a bit. When I showed at my current doctor, it was 220/140, but he took it a bit more calmly. The most extreme thing he did was an EKG and sending me to cardiology for an exercise stress test. Cardiology refused to do that because it was too high, so they did some sort of sonogram instead. That showed nothing out of the ordinary, no hardening beyond age-appropriate.

Fast forward. This doctor has kept my blood pressure well controlled. I have sometimes been bad, lapsing my prescriptions, or skipping every few days in an effort to feel more normal. Despite hearing the story of me and beta blockers, this doctor gave me beta blockers as one of my three meds. Somehow that fact escaped me until fairly recently, when I let the whole thing lapse and then found that I could turn on a depressed state and frazzle my brain on cue approximately a week after starting the beta blockers. Unfortunately, or perhaps fortunately, given that I am not sure I could have accepted it or would have wanted it after all, I started back on the beta blockers a week before my last interview for a full time job, with my part time employer of now almost four years. I was furious and demanded never to be on a beta blocker again.

The doctor put me on an entirely new set – well, 2 of 3 different – and it had been working well.

Then the chest pain and associated symptoms and the resulting stents.

That meant a complete change of and addition to meds. Turns out, they brought me down to only two blood pressure meds, including the lisinopril 40 I was already taking. No more diuretic. At the same time, they added baby aspirin, statin and blood thinner.

When I went for my checkup yesterday, I was back up to 150/90, from having been well in control before, and at least as low in the hospital. So the doctor consulted with the cardiologist and put me back on chlorthalidone, the diuretic. This also fit with the weight gain I’d been unhappy with. My more recent low was 229, with a lot of time spent hovering in the 230-something range, and more recently 240-245. When I left the hospital, I was at 242, which was actually a drop. Within a few days I was at 260, which is the highest I’ve been in years. Ugh! I dropped to 255, then went back to 260 after a couple days. Bleck! That, the increased BP, and slight indication of fluid in my ankles meant yet another pill, which at least is harmless.

The beta blocker has not seemed to bother me yet. Maybe it won’t, but I won’t count on it. Not sure what I’ll do then, since it’s for life this time. It apparently relaxes the heart. If it seems to make me depressed, I could try a drug relevant to that or anxiety, as I tried once before with unexpected, positive results. Including lowering my blood pressure more dramatically than any other med ever has.

We never did find a root cause for hypertension, but it strikes me like it’s brain chemistry and a fight or flight response, even if we didn’t catch the signs in urine.

While I was at it, I told the doctor about my problem with needing 8-10 Tums a day. The maximum is, I believe, 10. Maalox is currently not being made, or I’d be on that instead. Ranitidine seems to have lost its effectiveness. I reminded him that many years ago, before his time, I’d had an upper GI and gotten to watch reflux in action when I was diagnosed. I was then on Prilosec for a while, when it was expensive, followed by Prevacid when the insurer twisted the doctor’s arm. Both effective, though the latter just wasn’t quite the same. So I added generic Prilosec in prescription strength to my massive set of pills. Since it has to be taken half an hour before a meal, it doesn’t into either the AM or PM slots. The AM ones have to be taken with food. Getting too complicated.

Anyway, I see my doctor again on October 8, and the cardiologist on October 19, then we go from there. One of my meds may change to a lower cost version, for instance, once it’s been over a month since the stents were installed. I hope the blood pressure meds work properly in the new configuration, so we don’t have to keep messing around.

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