What's up, Doc?

It is official. I am ill, doctor… and you are the cause.

Fifteen years ago, my grandmother was diagnosed with hypertension. To keep a story short: a custody battle (plus age) between my mother and my grandmother took a hold of my grandmother’s body at the age of seventy-one. That was her only complication–aside from the expected side affects of the beta-blockers she was given.

My grandmother is an octogenarian and deemed hypertensive by professional, local, and distant quacks who think a woman her age should have the blood pressure of a twenty year old. She has been taking Sulfa-based and Beta-blocker [not together] blood pressure medicines for about fifteen years. It has been assumed she developed an allergy over time into the only one she has: sulfa-based drugs. No more sulfa drugs for grandma!

Imagine a strong and educated woman (of doctorate status) telling multiple doctors this basic information (that she received from her own research, her daughter-in-law that works at Duke Medical Center (formerly the head of the Outpatient Cancer Treatment Facility), and me, her grandson (with one year experience of Nursing School at East Carolina)–read this story and watch how your colleagues ignore her.

Two years ago, my grandmother started having problems urinating and she experienced discomfort in her lower abdomen. Her exact words were, “it feels heavy and uncomfortable.” What does her local doctor do? He throws a blood pressure pill at her as that is the only problem he can easily diagnose. Hydrochlorothiazide and lisinopril (just to name a couple) are sulfa-based drugs that were prescribed to her during this time. My grandmother doesn’t have access to the Internet, so she can’t hop online like most ripe sixty year olds. She calls her daughter-in-law and she calls me… what’s our immediate reaction, doc? DON’T TAKE THE PILLS! She gathered by our reactions that those drugs were sulfa based. I would like for you to review what I said earlier: “It has been assumed she developed an allergy over time into the only one she has: sulfa-based drugs.” I cannot even begin to digest the stupidity. Even with my average intelligence, I could see the hole in that one! Drugs.com anyone?

About the same time, my aunt and I recommended to my grandmother to have tests and scans done on her renal system starting with her bladder. She asked the reasoning. We figured that discomfort in her abdomen, the problems urinating, and the continuous rise in her blood pressure might be from a mass in the bladder. The local hospital denied these tests and scans. When and should a hospital deny treatment especially when it makes for a fatter wallet and a happy patient? It’s a somewhat balanced equation.

Our family’s genome does not suggest renal problems. About six months down the road, I did some research on the side. I had dropped out of Nursing School for similar reasons of why this thread (and others) exists, so I didn’t have my usual resources for research. Could it be that restricting geriatric blood pressure (that is expected to be higher) cause problems where most cases of elevated blood pressure usually starts (in the renal system)? Since we excrete waste through the renal system, would it be unreasonable to think that a buildup of toxins from these drugs occurred? Would that be why her allergy took so long to develop?

Further down the road, I had moved to Utah to work for Microsoft. A career and geographical change had prompted my grandmother’s worry; thus, her health got worse. She went to Duke, and requested the same tests and scans on her bladder. She was ignored once again and given more blood pressure medicine… good listening skills fellas.

Now she sits… currently emaciated and now has the ability to piss upright, thank you! Ethics 101, ladies and gentlemen:

Why was her allergy ignored by more than one doctor?
Why were those tests and scans denied by more than one hospital?
Why do you throw a pill at a problem?

By all means, I welcome input for the questions on the limited research that prompted more questions:

Could it be that restricting geriatric blood pressure (that is expected to be higher) cause problems where most cases of elevated blood pressure usually starts (the renal system)?
Since we excrete waste through the renal system, would it be unreasonable to think that a buildup of toxins from these drugs occurred?
Would that be why her allergy took so long to develop?

If you take this thread seriously, you’ll see that I am not confident in doctors or research assistants that bump people off as ignorant. That is not an excuse; nor, is it your job or enlightment to belittle others. It is your job to educate about the body, and it’s also my priority and mission to find out why in the hell doctors end up shrugging their shoulders. Age is not an acceptable excuse because she’s totally recovered in three weeks the surgery she underwent; whereas, most geriatric patients her age wouldn’t recover. Ignorance vs. Indifference? Think of that before you reply. There are too many damned I’s in this equation and we do end up going to you for help. I stand humbled and apologetic for those folks I’ve insulted, and I hope to hear from you as I’m guilty of doing the same to you.

Can anyone else give me the high points? I’m not following the OP at all here.

It’s one of the saddest OPs I’ve ever read. The sheer futility alone is depressing.

My little sister’s best friend’s mom died from her liver disintigrating. She had been to the clinic repeatedly for pain in her abdomen they diagnosed HEARTBURN for fuck’s sake and told her to take antacids. She was an extremely overweight woman and no one wanted to take the time with her… so yeah I am with you I don’t fuckin trust doctors either.

And I am deathly allergic to amoxicillin… so what does the call nurse at the clinic prescribe for me? Yep you got it! I ended up screaming into the phone “I AM GOD DAMNED ALLERGIC TO THE SHIT!” When she called to find out why the pharmacy kept calling back for a different prescription.

My heart goes out to your grandma.

Totally of topic are you still here in Utah?

Yea, I had a doctor try to give me penecillin after I told him three times that I was allergic to it. Fucking doctors.

CrazyCatLady: I’ll do my best to clear up confusion. My main points were in regards to the ethics that were ignored and if my limited research is sound in its ability to find the source of my grandmother’s final state of being. I am rather condescending in the rant; for that, I am sorry…

Libertarian: that’s about the size of it. I have almost given up on doctors and the medical field because of things like this. Hopefully, I won’t be preached at from the gods that walk.

Krisfer the Cat: thanks for the emotional support. I’m not longer in Utah. I lived in Clearfield… about twenty minutes away from Salt Lake going about eight-five on the 15. I worked in West Valley if that helps… :slight_smile:

GMRyujin: I think the forgetfulness of doctors is definitely related to the lack of sleep and poor diets because of the stress they undergo, personally… :frowning: I know that because I did the CNA E.R. at the age of 16 at Duke…

As I stated before, I’m sorry if I’ve insulted those that are professionals; however, I’m tired of the depth perception problem. I don’t worship a god, and I’m certainly not going to worship the ones that walk around feeling that way. I’m guilty of being a hypocrite; and I am human, here on Planet Earth.

Just looking for answers…

(Usual medical advice disclaimers apply. Void where prohibited. For a free game piece, write…)

Systolic blood pressure does tend to increase with age, and while it may be expected, it isn’t necessarily healthy. I used to hear people say that a normal systolic BP was “100 plus your age”, but we now have good evidence to tell us that patients of any age will benefit from treating their blood pressure to a goal appropriate for their risk category.

Very few cases of high blood pressure developing in an elderly person, and responsive to treatment, will have a specific renal etiology. Most will be the unsatisfying “essential hypertension”, which means that there is not a discernable cause.

I would hesitate to send an elderly patient with hypertension for a full renal workup unless I saw something abnormal on a routine urinalysis or a basic metabolic panel (both of which should be done routinely for people with HTN anyway).

Not that the doctor was in the right, but given the confusing info we have here, one can’t say.

Did he give the blood pressure pills as a treatment for the other complaints, or were these treated as two separate problems?

There is nothing in Lexi-Comp about lisinopril in people with sulfa allergies. It is true for the HCTZ. This was probably an oversight, but did the doctor discuss the sulfa allergy with her at all?

I can’t say a lot else without knowing more specifics. I will address your questions, though.

No excuse for that one. The HCTZ/sulfa contraindication is frequently overlooked.

If I’m guessing, it’s because the doctor did not agree with your hypotheses, and/or he had other assurances that your grandmother’s kidneys were working well. (More on both points shortly.)

In the case of hypertension, we do it because the pills treat the problem and help people live longer and better lives.

Very, very doubtfully. As I mentioned above, we have very good evidence to support treating people of any age to appropriate blood pressure goals. BP has to be quite low indeed to cause problems in the kidneys, and the manifestations of those problems would be other than those you describe.

Not unreasonable to think so, but not likely. Certain drugs can cause problems in the kidneys, but it would be over a shorter term than I understand your story to cover. It would also be evident on a basic metabolic panel, which I would hope your grandmother got before being referred to Duke. (All hypertensives should have one annually, anyway.) Two of the measurements on that test–the blood urea nitrogen, and the creatinine–give an indication of kidney function, and if both are normal (for the patient), then the kidneys are doing their job.

Here’s where I think your doctor went wrong. You’re doing the one thing I love for patients and families to do–you’re thinking about the problem. Even if the hypotheses you propose do not correspond to what we know about physiology or our clinical experience, that does not mean they should be dismissed without some explanation as to why. If your doctor feels that your grandmother’s kidneys are OK, he should tell you what leads him to that conclusion.

Dr. J

Hi Gnome.
Hell yes I know where Clearfield is… my inlaws are there!:eek:

And West Valley check… I don’t get down there much but I’ve a cousin in West Jordan.

Good on ya for caring but your Grandma!

GnominClature, as a grandmother, I thank you for the love and concern you have shown. Surely, you must be “good medicine” in her life.

I admire you for taking responsibility for seeing that your grandmother gets the best care. I know that sometimes it must feel like you are banging your head against a locked door.

Sometimes what can seem so terribly obvious to us may actually be the solution. And sometimes it’s not. And knowing when to trust is just this giant question mark.

Just know that there are physicians there who still care deeply on a very personal level. Some are very aware that they don’t know everything they need to know. That is painful to a caring physician. Some even go back to school when they think their training was not good eough. That takes a lot of unselfishness.

Some of the best physicians seem cold as ice. I would never know how good they are except for the confidence and awe of their colleagues.

I live in a city with a large teaching university medical school. Until his recent retirement, one of the teaching physicians there continued his practice and made house calls!

My internist has given me his personal pager number – and I’m not even in poor health, just a long time patient. My psychiatrist is nationally known but sees me for whatever Medicare will pay him.

There are genuinely good doctors who care deeply for their patients and who do their homework. Don’t give up on finding these physicians for your family and for yourself.

I also appreciate the physicians at SDMB who take the time to give us feedback and a little reassurance.

Oh, it wasn’t the tone that’s confusing. It’s the rambling. For starters, did they treat your grannie medically, or did they cut her? If they did cut her, why are you grumping about them throwing pills at her? If they didn’t cut her, what the hell is this stuff about her recovering from surgery?

DoctorJ: I think your advice clears the mud a little. I think you’re exactly on point about the family’s input into the equation of a diagnosis. Unfortunately, I’ve had many doctors ignore what my family and I have had to say. I don’t really think it is fair, either, due to the fact that the majority of us have, at least, some valid medical experience. It’s refreshing to see that you respect that in us. Thank you.

The end result of this: her bladder and one kidney were removed about three weeks ago. There was indeed a mass and it had spread. From my family’s analysis: we didn’t see the any given indications (because of the difficultly in urinating) why my grandmother’s anatomy should have stayed intact; in addition, it sounded rather uncomfortable from her description. From the start, she’s known something wasn’t right; plus, the local doctors wrote her off saying there wasn’t much they could/would do. With their conclusions giving her blood pressure medicine instead of surgery…she (and all of us) felt wronged. The doctors did discuss the allergy with her from what I understood. She described the appropriate symptoms to my aunt and me without fail, so I am confident she didn’t mind sharing the information with the doctors–she’s definitely not shy.

I couldn’t get any further with what little I had researched, so I figured the next culprit would be the drugs she’s been given over time which led me to [somewhat roughly] conclude a build up of toxins. Am I right in following your thinking that hypertension would cause renal failure (like a ceased engine with no oil ie: overworked?) as opposed to a mass being formed?

To question, why would you hesitate for a full renal workup? That was my family’s first thought in checking it out two years ago. I’m sorry to pick your brain, but I’m adamant in finding answers. I just want to know your rationale.

That’s a fine question. In either case, why would it be a good idea to give BP pills with a renal problem if there are unknowns? Good odds? Picking your brain again…

Thank you for your help, DoctorJ… I’m in another town in NC with Green in its name–definitely East of you.

Krisfer the Cat: wow… small world. I almost had in-laws in Clearfield; they live really close to Hill Air Force Base. The reason why I came back to my home state was because of a bad breakup and Microsoft breached a contract with me.

Zoe: I appreciate the support. My grandmother is also medicine in my life. She has always been there to listen to my concerns and joys. She has been my mother, and I feel that she needs me more than ever. I admit I feel very powerless in this struggle. I just hope that she gets to live her life to the fullest and not in a Nursing Home.

CrazyCatLady: maybe the above for Doctor J will help you? Sorry for the rambling…