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Bad doctor + unexplained prescription = frustration.
August 20, 2011 9:06 AM   Subscribe

I've been prescribed a blood-pressure medication by a doctor that I don't trust. I'm concerned about taking it for reasons that might be irrational. In the meantime, I need to deal with my blood pressure *somehow* to have surgery. I need someone's reassurance and knowledge.

This is sort of a long story, so I'll make it short as I can:

- I've had a really terrible sinus/staph infection and a newly deviated septum for the entire summer - because I can't have an MRI (metal in head) and my CT scan came up with my right sinuses totally opacified, it's impossible to know whether part of the symptoms are being produced by polyps or some unwanted tissue growth - so that's gone effectively undiagnosed. After two months of aggressive antibiotic treatment with only mild improvement, my ENT specialist recommended endoscopic surgery with a cellular biopsy, to be undergone Tuesday of next week. (The appointment discussing this was this past Monday.) As part of the run-up to surgery, I would need an appointment with my primary-care physician to get clearance.

- As such, my PC physician saw me on Wednesday, and two things happened: 1. he acted in such an unprofessional, insulting manner that I don't feel comfortable seeing him as my primary-care doctor anymore; and 2. he denied me clearance due to hypertension - I am a 27-year-old male, with 160/110 blood pressure when he measures it. I have reason to believe the reason it's so high right now is a combination of white coat syndrome - it's incredibly stressful to see this doctor - and the fact that the sinus infection and its nasal congestion have brought back my sleep apnea, big-time - my blood pressure is significantly higher than it was when measured by a different doctor at the start of the summer. But either way, I have it, and my ENT is not willing to do the surgery while I'm recording blood pressure at that level.

- I have zero intention to see this primary-care doctor again. I refuse to unless its life or death - it's that simple. But in the meantime, he prescribed me Lisinopril, a hypertension medication, and then didn't answer my questions when I asked if taking this medication is a permanent choice, or people ever get off it. I *really* am hesitant to start taking a medication for life if I don't have to do so.

- I've made an appointment to see a new potential primary-care doctor next Thursday. In the meantime, my ENT has recommended that I start taking the blood-pressure medication, whether I switch my primary-care doctor or not.

So, I have a few questions:

1. Is Lisinopril a life sentence? Is it possible/likely to stop taking it after some other lifestyle changes are made?

2. Is it okay for me to take the medication I was prescribed by my old PC doctor, while then switching over to a new PC doctor to whom I can explain why I'm taking this medication? Or do I need to get it presribed by the new doctor, therefore delaying things further?

3. I pretty much need to start taking this new medication, huh? In the long-term for my general health, but in the short-term particularly if I want to have this surgery *sometime* in the next few weeks - I'm already feeling pretty bummed that I'm going to have to wait at least a few weeks longer, as the infection's side-effects, not to mention the various anti-biotics' side-effects, have sort of ruined the last few months.

4. Any advice on switching primary-care physicians?

I'm sorry if this is rambly/weird, I've just been extremely flustered about this since the Wednesday appointment - it was so unexpectedly unpleasant that I felt depressed the next day, when I haven't felt that way in a *long* time. (I can go through the details of it if need be, but the basic upshot is that he openly mocked questions and concerns I had over sensitive health issues, and clearly didn't listen to issues I brought up to the point that I genuinely don't feel comfortable entrusting this person with my health - but apart from not answering my questions about the timespan for taking this medication, none of that had to do with him prescribing the medication per se. I've wanted to get a different primary doctor for a long time now, but this has made it something that I can't put off any longer.)

AskMe, what should I do?
posted by Ash3000 to Health & Fitness (23 answers total) 1 user marked this as a favorite
 
My mom had a particularly high BP reading at her latest physical, even after doing a bunch of lifestyle stuff to bring it down. Her doc recommended she go buy a home blood pressure testing cuff and take readings twice a day for a month, just to eliminate the white-coat factor - and sure enough, at home her blood pressure is pretty much normal. This might be a quick and relatively cheap way for you to get an idea what your BP is without the asshole doctor factor, and give you a little more info to use to make the medication decision.
posted by restless_nomad at 9:11 AM on August 20, 2011


Thanks, restless_nomad - any idea how much those cost without a prescription?
posted by Ash3000 at 9:12 AM on August 20, 2011


I did what restless_nomad described to reassure my gyn. that it was okay to give me birth control. My blood pressure is normal except at the doctor's office, it turns out. The cuff and machine cost me about $50 at Costco.
posted by charmedimsure at 9:19 AM on August 20, 2011 [1 favorite]


(this is all anecdata...but that seems kind of like what you want)

1. No. High blood pressure runs rampant in my mother's side of the family. Christmases are spent exchanging info about who's on what, who's lost some weight/made some lifestyle changes to go off meds, yadda yadda. Looking after your blood pressure (esp. when it's high at 27 years old) is a life long thing. But treating it (or not) will certainly change.

2. It's totally OK.

3. If the ENT wants you take it to get the surgery done, I would kind of come down on the side of doing that. That sinus thing sounds like a nightmare -- maybe get that taken care of, then deal with the blood pressure.

4. Do you have friends you can ask for recs? That's always been the best for me.

w/r/t the checking your own BP to see what it is when you're not stressed -- that sounds like a great idea. You might also try a pharmacy or drugstore that has one of those machines that can do it. But I don't know that a BP you record there will sway your ENT to not want you on the meds before the surgery. But for your own peace of mind and in the long term -- definitely a good idea.

Good luck!
posted by pantarei70 at 9:20 AM on August 20, 2011 [1 favorite]


You can likely find a local pharmacy (Safeway, Rite Aid, etc) with a free blood pressure station that you run yourself. Put your arm in, press the button, get the results right there. I was recommended to check my pressure a couple times that way after I'd barely made it to an appointment on time, and my pressure was slightly elevated. On my own timing, without being in a rush, it was just fine.

Regarding the medication, it certainly doesn't have to be a life sentence. If you make lifestyle changes than could change your blood pressure, they will reassess your need for the medication. People go to different doses, different medications, or no medication all the time depending on various factors.

Sorry to hear you had such a bad experience with the doctor you saw. I'd change too. You deserve to have your concerns heard and addressed.
posted by dorey_oh at 9:25 AM on August 20, 2011


I have no comment on your medical situation or blood pressure. However, I can say that stopping Lisinopril after you start taking it will do nothing other than allow your blood pressure to return to it's previous level. I can't quite tell from your question, but it seems as if you're afraid that once started Lisinopril cannot be stopped, which is not true. The bottom line is that your larger issues are beside the point with regards to your surgery. You can take the medication, have the surgery, figure out your blood pressure issues post surgery.
posted by OmieWise at 9:27 AM on August 20, 2011 [3 favorites]


Consumer Reports approved of the Omron 5 blood pressure monitor, which sells at Walmart for about $50. We have it, and it works well.
posted by Kirth Gerson at 9:29 AM on August 20, 2011


This doesn't exactly answer your question (and I'd stop seeing the doctor too), but after I started taking Lisinopril I felt soooo much better. My blood pressure was up around where yours is and I didn't realize how crappy I'd been feeling until I started to take the drug. It has zero negative side effects for me.

If I were you, I'd look at it as a crappy doctor getting lucky and giving you a good prescription. Take it for a while, get the sinus stuff taken care of, and then start exercising/eating well/doing other daily maintenance stuff to see if you can manage your hypertension. You might be able to. You might not -- it could just be genetic.

If you can manage the blood pressure, talk to your new doctor about discontinuing the medication. If not, keep taking it. If you do have to take it for the rest of your life -- don't look at it as a 'life sentence.' Look at it as a relatively cheap and easy way to feel better and maintain your health long-term.

It's a little white pill. It won't make you feel bad. Taking it shouldn't be a big deal.
posted by mudpuppie at 9:47 AM on August 20, 2011 [2 favorites]


Wait, are you telling us that this doctor prescribed you Lisinopril based on one isolated high blood pressure reading? Frankly, that sounds bizarre. Typically, a patient is prescribed blood pressure medication after a series of elevated readings. If you do not have a history of high BP and were prescribed the Lisinopril based on this one reading, I would certainly seek a second opinion ASAP - glad to see you already have that appointment made.

IANAD, of course, and I certainly can't tell you whether or not you should take the Lisinopril in the meantime. You said your ENT recommend you take it - does the ENT know the details of the situation? I.e., does the ENT know you have no history of high BP and that you were prescribed the med based on one reading? If not, can you call the ENT to discuss this with him/her?

Almost anyone could have one isolated high BP reading. Stress and white coat syndrome can both artificially/temporarily elevate BP. Anecdata: my mother once had a BP reading of 165/112 after an argument with her sister that happened just before her physical. Her BP is normally around 115/75.
posted by pecanpies at 10:46 AM on August 20, 2011


Also, to address your actual questions, it's tough to answer those without more information. First, do you actually have hypertension (HTN), or is this a possible misdiagnose based on an isolated reading? I know you don't know the answer yet, but that's really the essential question here. If you don't have HTN, everything else is really moot.

If you do have HTN, then what's causing it? In many people, we're really not sure. Blood pressure is affected by numerous factors, including diet, exercise, race, age, gender, and the presence of certain diseases like diabetes. If you do have HTN and you're overweight/obese, you can typically lower your BP a few points through diet and exercise. Other factors, like age and race, are obviously out of your control.
posted by pecanpies at 10:53 AM on August 20, 2011


I just wanted to add some links you might find helpful. I know when I start a new med, or consider starting one, I like to read the inserts and such. These are from the National Library of Medicine and the National Institutes of Health, so they are credible sources. Best of luck.

MedlinePlus entry:
http://www.nlm.nih.gov/medlineplus/druginfo/meds/a692051.html

Daily Med entry:
http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=ee74bf5e-95cc-4b4a-9ebe-2980a7f3230c

Daily Med Entry found through Pillbox:
http://pillbox.nlm.nih.gov/pillimage/search.php
posted by haunted by Leonard Cohen at 11:33 AM on August 20, 2011


1. Is Lisinopril a life sentence? Is it possible/likely to stop taking it after some other lifestyle changes are made?


I've been off of Lisinopril for about 3 years mainly due to vigorous exercise. I was on it for about 3 years and then I got a gym membership. I'm 53 and I exercise routinely (3 to 5 Xs a week) for 45 to 90 minutes (depending on my schedule and how I feel) with at least 20 minutes pushing my heart rate up to 140 or higher.

I still monitor myself however. I do tend to drink too much whiskey and too much coffee which can elevate my blood pressure as can driving in bad traffic to get to my doctor's office. Learning to control your heart rate and breathing with chanting and visualizing (such as TM or Yoga) is a big help.
posted by Secret Life of Gravy at 11:38 AM on August 20, 2011


Hi - I have been taking lisinopril for a couple of years. I have significant white-coat syndrome so I also have a home blood pressure cuff (got it at CVS a while back) and track my readings daily; per the doc, I take it three times and average the readings. Yes, it's a PITA but I do get fluctuating readings at home and at the doc's. When I am eating properly (for me, this is paleo) and exercising (for me, this is a combo of weights, high intensity intervals, and long slow walks), my BP responds fairly quickly. However, my doc uses a conservative approach to discontinuing, which is basically this: series of normal BP readings over 6 months > decreased dosage > [repeat until at lowest dosage] > discontinue and monitor. Honestly, the lisinopril has been the easiest med I've ever taken, except for the time that my dose was increased and I blacked out.

I would say go on the meds while you investigate a new PCP. The side effects of long-term hypertension aren't fun.
posted by catlet at 11:49 AM on August 20, 2011


Whoops, clicked "post" too quickly. By "go on the meds" I meant if you actually have high BP. Since your ENT is denying you surgery based on BP and it sounds like you're not switching ENTs as well, why not talk to the ENT about it (especially since the ENT is also telling you to take it)?
posted by catlet at 11:51 AM on August 20, 2011


Thanks everyone for the extremely helpful answers thus far - I can't tell you how much of a comfort these have been already.

To answer a recurring question: it's clear that I *do* have high blood pressure, as I've had a series of readings over the last few years that are borderline or high; I was just also noting that my reading at his office was higher than it's ever been before, both due to to the stressful nature of the visit and due to my sleep apnea coming back big-time. (My CPAP machine is borderline-worthless while I have deep nasal congestion, unfortunately.)

I've decided that I probably will have to start taking the lisinopril, starting this weekend, and then see what the new doctor thinks of it. One thing I'm curious about, however (and this won't sway my taking it, I do just want to know):

I'm usually a social drinker (i.e. very rarely get drunk, enjoy alcohol in moderation, but won't have any unless I'm at a party, etc.), and enjoy some recreational light-drug use (i.e. will smoke marijuana maybe once-twice in a given year, was going to take shrooms for the first time with a friend in October) - but I haven't done any of those things start starting antibiotics in June, and had been looking forward to having a celebratory beer/joint with a friend once it was all over.

Are these just totally off the table once I start taking this medication, or any other ACE inhibitor? That would be unfortunate, but wouldn't stop me from taking the steps needed for my health.

Thanks again for all the help on this.
posted by Ash3000 at 12:34 PM on August 20, 2011


Your swollen sinus is pushing hard enough on neighboring tissue to deviate your septum; it could also be interfering with blood flow in those areas enough to cause your blood pressure to rise sufficiently to force flow past the constriction. That you had more normal BP readings earlier in the summer tends to support this hypothesis, I think.

In that case, your BP would normalize after the surgery-- which you might not want to delay unduly because further swelling might make matters worse, including your blood pressure.
posted by jamjam at 12:45 PM on August 20, 2011


Each of the things you mentioned directly above should be off the table for the time being. Each of them makes your body have to accommodate the chemical changes that they induce. This is tough on you while you are dealing with the other issues. After the surgery and after your BP stabilizes, discuss them with your new doctor. Don't ask, "Is it OK?" Ask whether they will do any specific harm.
posted by Old Geezer at 12:46 PM on August 20, 2011


Lisinopril is no big deal and shouldn't push you toward any lifestyle changes beyond working to get your blood pressure under control. No one upthread has mentioned this and I'll bet you dollars to doughnuts that your awful PCP didn't either: a very common side-effect when starting lisinopril is a dry cough. In fact, it's called the "lisinopril cough". It generally goes away within a few weeks to a month and generally isn't very annoying, but you could be the exception to that given the sinus issues you're having.

You should definitely get a little blood pressure machine and use it at various times of the day. That will help you figure out how much of your high readings are White Coat Syndrome versus being real.

If your blood pressure comes under control, as you seem to think may happen once you get rid of the infection and can benefit from your CPAP again, your doctor should taper you off the lisinopril. It needn't be a lifelong medication.
posted by DrGail at 1:59 PM on August 20, 2011


I disagree with jamjam that the sinuses could be causing the HTN, but IANAD and it's possible there's an underlying condition that's causing the sinus problem and affecting your BP, too. Constricted flow in the sinuses isn't going to cause an increase in BP unless there's something else going on at the same time that's impairing blood flow to the kidneys and/or intermittently activating your baroreceptors. Anyways, this is a bit of a derail - sorry.

Alcohol is not contraindicated with lisinopril according to the 2011 Lipincott drug book I'm using right now as a reference. I would not drink during the first week or two of taking the drug, until I had a better idea of how the drug affected me.

As DrGail mentioned, lisinopril can cause a dry, hacking cough in some people. In my experience working with patients, this often does not go away (or at least, not before the patient stops taking the drug because of it) and the patients often need to be switched to another BP med. YMMV. Another common side effect is lightheadness or a sudden drop in blood pressure when moving from a lying/sitting position to a standing position (known as orthostatic hypotension). This tends to be most prevalent when you first start taking the drug. If it's so severe that you faint, call your doctor (your new GP, if you've seen him by that point). This is one reason why it's a good idea not to drink or smoke marijuana during the first week or so of taking the drug. (Also, I know you didn't mention this, but in case it comes up, I'd recommending avoiding cocaine since it increases blood pressure.)
posted by pecanpies at 2:19 PM on August 20, 2011


I also had high blood pressure as a 27 year old guy. Healthy weight and everything. I used some supplements (garlic and CoQ-10) to take the edge off - they dropped it from about 144/88 to 135/84. I also started lifting. What really dropped it was starting to eat paleo/primal; in particular, I noticed a drop when I really upped my fatty meat consumption and reduced cheese. Now my blood pressure was 110/70 the last two times I checked it. It took a few months but it was well worth fixing the whole problem rather than just taking a pill that may have left whatever underlying cause there was.
posted by Earl the Polliwog at 4:34 PM on August 20, 2011


The current thinking about blood pressure is similar to the current thinking about diabetes: the effects are cumulative over time. If your BP is high right now, you are best off reducing it pharmaceutical until you can get the root cause figured out and corrected. IMHO. That's what I would do.

(I'm not sure about the sinuses causing the high BP or not. Doesn't inflammation cause a hormone to be secreted that causes inflammation elsewhere, like in the blood vessels? I seem to remember reading that.)
posted by gjc at 6:23 PM on August 20, 2011


IANAD. You and these posts give me the impression some consider taking BP meds an optional choice. You should control your blood pressure, period. If it takes meds to do it then take the meds. Yes HBP damage happens over time but there is also immediate threat of heart attack, stroke, kidney damage, etc.

Take the meds as prescribed and don't miss a dose. You can get a cheap monitor for around $20. Try discount stores like Wal-Mart. Learn to take your own BP, do it at least twice a day. Make sure you have rested for at least 10-15 minutes before taking your BP. This will tell you your BP and reduce white-coat anxiety when it's taken at the Dr's office.

Don't use any salt in your diet. Be careful about that. Lots of prepared foods have absurd amounts of salt already in them. Start reading labels for sodium content.

High blood pressure is nothing to take lightly. You must treat it.
posted by nogero at 7:21 PM on August 20, 2011


A sincere thanks to everyone for all the great help here. I've started taking the medication, have gone on my insurer's website to switch my primary-care provider, and am seeing the new doctor this Thursday; later today I'm going to be calling my ENT to talk about rescheduling a pre-surgery appointment.

In the meantime, going to be looking into how I can best change some of my lifestyle choices so I can be on the medication as briefly as healthfully possible. I *do* recognize that I need to take hypertension seriously - it's just that the old doctor handled things in such an awful way that it was hard to know whether to take his suggested route. So, thanks again - I'm tempted to best-answer every reply, every single one was helpful to read.
posted by Ash3000 at 8:55 AM on August 22, 2011


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