Wednesday, August 25, 2021

Modern medicine

Yesterday I took part in something that’s currently one of the mainstays of routine medicine: I had an online consultation. It wasn’t the first time I couldn’t see a doctor in person because of a Covid Lockdown, but the results were still good.

Last year, Lockdown hit shortly after I sold the last house that Nigel and I shared, and it was only after that I started to focus on settling into living in Hamilton. Among other things, that meant I needed a doctor in Hamilton, but I couldn’t get a new doctor under Level 4 or 3. So, I set up a phone consultation with my last GP in Auckland, mainly so she could write me prescriptions to tide me over until I could get signed up with a new doctor. I also wanted a chance to sort of close that chapter, to thank her for her care and also caring: She was the last GP to treat Nigel, and she was supportive of me after he died. That phone call was the first time I’d had a true not-in-person consultation with a doctor, something the Covid Alert Level made necessary.

Here we are in August 2021, under Alert Level 4 Lockdown, and most in-person consultations are suspended. This was a problem because I was having problems with my new prescriptions, and I faced having to deal with it virtually.

On July 16, I saw the cardiologist for my follow-up at Waikato Hospital, and he changed my prescriptions, which I was expecting. First, he again prescribed the blood thinner/anticoagulant Rivaroxaban. He’d already prescribed that last October when I saw him before my cardiac ablation procedure was scheduled. I started taking that drug last July.

There were two other drugs he prescribed. First, there was a new blood pressure medication because my current one is being discontinued. It’s an ACE inhibitor called enalapril. The other drug was a diuretic called bendroflumethiazide. I put off taking those two drugs for reasons I explained earlier this month.

I further delayed starting the new drugs until after my Covid vaccinations were done, especially because I felt quite unwell the first day after the first one. I didn’t want to risk feeling unwell because of my second jab and adjusting to new prescriptions. I started the last two prescriptions on Thursday. It. Did. NOT. Go Well.

For the first four days, sometime in the first hour after taking the drugs, and for 3 to 4 hours after that, I felt the worst I’ve felt in longer than I can remember. I felt dizzy/lightheaded, not enough to make me fall over, but enough to make me feel nauseous (not actually sick, or at risk of becoming so, but enough to be miserable) constantly. My whole body also felt weary—not tired or sleepy, but weary. I sat in my chair for the entire four hours (except when I had to go to the toilet—thanks, diuretics) because I just couldn’t do anything else.

I was absolutely miserable. I cried a lot, unsure what to do because I was unable to focus enough to work out a plan. By the third day, I was dreading the storm to follow, so I decided (especially after talking to my sister-in-law) to contact my GP to get advice.

I sat down that night and wrote out all the details, provided a list of the blood pressure readings I’d been getting at home—and then didn’t send it. In thinking about it more during the part of the day I felt not as bad, I realised my GP would need to consult with the cardiologist, anyway, and I was due to see him on August 31. I knew that wasn’t going to happen due to Lockdown, but since I wanted to ring them anyway to find out what to do about rescheduling, I figured I could go direct to the source.

As it happens, his office rang me the next morning, Monday, when I was still cleaning up after breakfast. His practice administrator told me that because they couldn’t do consultations in person under Alert Levels 4 or 3, the cardiologist was offering consultations over Zoom if I was interested. I was, and it was set up for the next day, yesterday.

About the same time, I noticed something: The 3 to 4 hour hell wasn’t setting in that day. It didn’t on Tuesday, either. Or today. Apparently the adjustment is complete.

My consultation went well, and he said he didn’t need to see me again unless something pops up that needs follow-up (like after the echocardiogram I’ll get done when Alert Levels permit). Otherwise, my GP can take it from here.

He also said, as he did in July, that he wasn’t really all that worried about me taking the diuretic, and if symptoms continued to bother me, I could go ahead and stop it—being sure to let my GP know I was doing that and also making sure I monitored my blood pressure.

All the medication is aimed mainly at keeping my blood pressure lower to reduce the risk of Afib returning. I asked him about lifestyle changes like losing weight, and he said it would definitely help. The thing is, part of the reason that I’ve put on weight is that for several years I’ve been too tired to do anything physical, and even just walks would help. But, as I also said to him, I mainly need to take in fewer calories (something I’ve been doing better about, actually).

Related to that, actually, I also asked him about alcohol and those drugs, and he said he wasn’t aware of any evidence that drinking alcohol with the new drugs could cause a sudden drop in blood pressure (I knew that the diuretic increases the risk of bad hangovers, even on relatively modest alcohol consumption, because alcohol itself is dehydrating, and that’d be on top of the diuretic potentially doing the same). This is related because the main reason I’m not keen on drinking alcohol is that it’s empty calories—admittedly ones with pleasant results, but empty nonetheless. If I’m trying to reduce calories, then avoiding alcohol is an easy way to do that.

So, apparently the adjustment period for all the new drugs is over, and, so far, everything seems to be settling down. It’s too early to say that all the new drugs are as good or (hopefully) better than the old ones, but so far they seem to be at least as good (except for Rivaroxaban, which I think I can now say is definitely is better than dabigatran was).


Important note: This is about my own personal health journey. My experiences are my own, and shouldn’t be taken as indicative for anyone else. Similarly, other people may have completely different reactions to the same medications I take—better or worse. I share my experiences because others may have the same or similar experiences, and I want them to know that they’re not alone. But, as always, discuss your situation and how you’re feeling openly, honestly, and clearly with your own doctor, and always feel free to seek a second opinion from another doctor.


Roger Owen Green said...

My CT scan is the same as 6 months earlier. I'll have to write about this again.

Arthur Schenck said...

I don't know whether my scan will be the same as two years ago or not, but it's improbable that it'll show anything of concern. And, you know I'll be writing about that!