Kind Of Burned Out On Practicing Medicine

[Pepe']

I have avoided perticipating in this forum to date because I am somewhat burned out on practicing medicine.

Been in family practice for 12 years with some research here and there.

I don't know why but the spirit moved me tonight.

I'll help as I can...

[cathyy]

Your help here is certainly both needed and appreciated. I try to limit the scope of my "practice" here to nursing. That mostly means telling someone they ought to see a doctor for something if it sounds serious. Just got my 2005 Drug reference book in the mail, so I'm good for another year of dosages, contraindications, and nursing considerations in that arena.

Looking for info on a blood pressure med called Avalide. It's not in my book. I am willing to bet it is a combo of Avapro and a thiazide diuretic, though. Know anything?

[Pepe']

Why is this Avalide medication prescribed?

The combination of irbesartan and hydrochlorothiazide (Avalide) is used to treat high blood pressure. Avalide/Irbesartan is in a class of medications called angiotensin II antagonists. Avalide works by blocking the action of certain natural chemicals that tighten the blood vessels, making blood flow more smoothly. Avalide/Hydrochlorothiazide is in a class of medications called diuretics ('water pills'). Avalide works by causing the the kidneys to get rid of unneeded water and salt from the body into the urine.

How should this Avalide medicine be used?

The combination of Avalide/irbesartan and hydrochlorothiazide comes as a tablet to take by mouth. Avalide is usually taken once a day with or without food. Follow the Avalide directions on your Avalide prescription label carefully, and ask your doctor or Avalide pharmacist to explain any part you do not understand. Take Avalide/irbesartan and hydrochlorothiazide exactly as directed. Do not take more or less of Avalide or take Avalide more often than prescribed by your doctor.

Avalide/Irbesartan and hydrochlorothiazide controls high blood pressure but does not cure it. It may take 2 to 4 weeks before you feel the full benefit of Avalide/irbesartan and hydrochlorothiazide. Continue to take Avalide/irbesartan and hydrochlorothiazide even if you feel well. Do not stop taking Avalide/irbesartan and hydrochlorothiazide without talking to your doctor.

What special Avalide precautions should I follow?

Before taking Avalide/irbesartan and hydrochlorothiazide,

tell your doctor and pharmacist if you are allergic to Avalide/irbesartan, hydrochlorothiazide, sulfa drugs, or any other medications.

tell your doctor and pharmacist what prescription and nonprescription medication, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: aspirin and other nonsteroidal anti-inflammatory medications (NSAIDS) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn); cholestyramine (Questran); colestipol (Colestid); lithium (Eskalith, Lithobid); medications for diabetes; narcotic pain relievers; oral steroids such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), and prednisone (Deltasone); other medications for high blood pressure; phenobarbital (Luminal, Solfoton); and tolbutamide (Orinase). Your doctor may need to change the doses of your Avalide medications or monitor you carefully for side effects.

tell your doctor if you are on dialysis and if you have or have ever had asthma, lupus (SLE), diabetes, heart failure, gout, or kidney or liver disease.

tell your doctor if you are breast-feeding.

you should know that Avalide/irbesartan and hydrochlorothiazide may make you drowsy. Do not drive a car or operate machinery until you know how this Avalide medication affects you.

ask your doctor about the safe use of alcoholic beverages while you are taking Avalide/irbesartan and hydrochlorothiazide. Alcohol can make the side effects from Avalide/irbesartan and hydrochlorothiazide worse.

you should know that Avalide/irbesartan and hydrochlorothiazide may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. This is more common when you first start taking Avalide/irbesartan and hydrochlorothiazide. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.

you should know that diarrhea, vomiting, not drinking enough fluids, and sweating a lot can cause a drop in blood pressure, which may cause lightheadedness and fainting.

What special Avalide dietary instructions should I follow?

Talk to your doctor before using salt substitutes containing potassium. If your doctor prescribes a low-salt or low-sodium diet or an exercise program, follow these directions carefully.

Avalide Side Effects

Avalide/Irbesartan and hydrochlorothiazide may cause side effects. Tell your doctor if any of these Avalide symptoms are severe or do not go away:

dizziness

extreme tiredness

upset stomach

vomiting

stomach pain

heartburn

chest pain

flu-like symptoms

Some Avalide side effects can be serious. The following Avalide symptoms are uncommon, but if you experience any of them, call your doctor immediately:

dry mouth

thirst

weakness

lack of energy

restlessness

confusion

seizures

muscle pain or cramps

infrequent urination

rapid heartbeat

lightheadedness

fainting

Avalide/Irbesartan and hydrochlorothiazide may cause other side effects. Call your doctor if you have any unusual problems while taking this Avalide medication.

What other Avalide information should I know?

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests before and during treatment to check your response to Avalide.

Do not let anyone else take your Avalide medication. Ask your Avalide pharmacist any questions you have about refilling your Avalide prescription.

Other uses for this Avalide medicine

This Avalide medication may be prescribed for other uses; ask your doctor or pharmacist for more Avalide information.

What storage conditions are needed for Avalide?

Keep Avalide in the container it came in, tightly closed, and out of reach of children. Store Avalide at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any Avalide medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your Avalide medication.

What should I do if I forget a Avalide dose?

Take the missed Avalide dose as soon as you remember it. However, if it is almost time for the next Avalide dose, skip the missed Avalide dose and continue your regular Avalide dosing schedule. Do not take a double Avalide dose to make up for a missed one.

In case of Avalide emergency/overdose

In case of Avalide overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

[Dutchy2]

In case of Avalide overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Good advice doc, we're in Thailand though and I really doubt whether anyone has thought of a 'local poison control center' here...

[cathyy]

My husband is on it for high blood pressure that did not respond to Avapro alone. It's working well for him.

I have the joy of going off my blood pressure medication and tracking my blood pressure for my doc for a couple of weeks. I developed this pesky cough, first on Altace and now on lisinopril. I was on Benicar in between, which was effective and caused no coughing, but the HMO I just switched to won't pay for it unless all the cheaper meds (all ACE inhibitors, and all with the same common cough side effect!) don't work or have adverse effects. So now we have to get rid of the cough before he'll try something else.

[Pepe']

In case of Avalide overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Good advice doc, we're in Thailand though and I really doubt whether anyone has thought of a 'local poison control center' here...

So true but what do you expect from a cut and paste job...

[p1p]

Pepe - Thank you so very much for helping out on this forum. You will be very much appreciated.

[splitlid]

Dear Pepe,

your seem to be a guy in the know,or maybe someone else on this forum can help.

about a year ago i started to get chest pains.not deep inside my chest but more in my breast muscle (im a man).

this pain is a continueous pain and in my left breast below the nipple and to the right.somedays i cant feel it but thats not very oftern.

i went to a doctor where i live and she did some tests ecg etc, and said i had angina...well being only 30 i decided to goto bangkok for a 2nd opinion.

i went to bangkok general because they have a good heart department.i had all the tests ,xray,ecg, running machine etc.

the doc could see nothing wrong with me but said it was a stress related injury and was a torn muscle or ligament in my chest (cant remember the name think it began with a 'm')

anyway he said it would clear up in a few months and stay away from stress.

well i still have it. is it possible to be the same problem?

im 30/male/smoke about 10 cigs a day/drink only on weekends.

your opinions would be greatly apprecieated.

split

[Dutchy2]

I had the same pains when I was 20 and went to the doctor to check it out. He said it was sport related, I did a lot of long distance running and it appears the muscles on my ribs were giving these problems. I'm almost 20 years older now, so it wasn't a big deal back then.

Pepe, something else. Pancreas cancer is not curable, is that correct?

regards,

Dutchy

[Pepe']

Dear Pepe,

your seem to be a guy in the know,or maybe someone else on this forum can help.

p---I know some things.

about a year ago i started to get chest pains.not deep inside my chest but more in my breast muscle (im a man).

this pain is a continueous pain and in my left breast below the nipple and to the right.somedays i cant feel it but thats not very oftern.

i went to a doctor where i live and she did some tests ecg etc, and said i had angina...

p--- doesn't fit the pattern of angina from what you're telling me right now. Angina in fact usually mimicks to a greater or lesser degree symptoms of a real heart attack.

p---men do get breast cancer you know and it is on the rise. I would reccomend thorough physical exam by palpation/ feeling the area and an xray/mri.

well being only 30 i decided to goto bangkok for a 2nd opinion.

i went to bangkok general because they have a good heart department.i had all the tests ,xray,ecg, running machine etc.

the doc could see nothing wrong with me but said it was a stress related injury and was a torn muscle or ligament in my chest (cant remember the name think it began with a 'm')

p---How did he determine it was a torn muscle? Did he no any ortho-neuro streching or resistance tests? If not it's just a guess and that's never good enough.

anyway he said it would clear up in a few months

p---You should have asked him to pick you a lottery number while he was at it.

and stay away from stress.

p---When you fid the secret to that let us all in on it.

p---Did he do a chest xray?

well i still have it. is it possible to be the same problem?

im 30/male/smoke about 10 cigs a day/drink only on weekends.

p---As a physician I am trained to always assume the worst and hope for the best.

your opinions would be greatly apprecieated.

Possible differential diagnosis:

1-This is referred pain from chronically inflamed bronchia. Any couch?

2-Intercostal neuragia, a common irritation of the nerves in the spaces between the ribs.

3 The beginning of Thoracic Outlet syndrome or Brachial plexus syndrome. Neurological conditions that can usually be corrected with physical therapy and various exercises.

4- Unusual but possible, mastitis just like women get, a clogged lymph node in the breast area. Very painful but usually but not always accompanied by a fever.

5-Lastly God forbid some sort of tumor. I would stay on this until all of these thing are ruled out.

Good Health

PS Give me and yourself a break Please stop smoking...

[350torana]

Dr Pepe.. have a quick question about drinking. I drink far too much beer here at times. Anyways, have like an acid burning feeling in my tummy frequently, worry sometimes it is an ulcer or maybe just stomach lining burned away from too much booze . The burning happens in differnent areas and more frequent if i have not eaten for a whiles .

cheers and hope u haave had time to give your wheels a polish

[Pepe']

Dr Pepe.. have a quick question about drinking. I drink far too much beer here at times. Anyways, have like an acid burning feeling in my tummy frequently, worry sometimes it is an ulcer or maybe just stomach lining burned away from too much booze . The burning happens in differnent areas and more frequent if i have not eaten for a whiles .

cheers and hope u haave had time to give your wheels a polish

350torana,

Short version, I've been in and out of that club for years so I know exactly what your talking about.

If alcohol is famous for anything it's irritating the gastric mucosa.

Pain and irritation is the body waving a flag and saying look at this area there is something going on.

Be careful with this. An upper endoscopy is really not an unreasonable proceedure to have done. If your over 50 and haven't had it done I would do a lowere colonospy at the same time.

Scope "both ends." And you get to get shot up with some good narcodict by the doctor before your proceedure.

Esophageal cancer is rapidly becoming the new number one cancer worldwide at an alarming rate.

Also you know the old rules. Try not to drink on an empty stomach. Eat some food during the course of the evening.

Try to drink some water between every 3rd or 4th, well mabey every 5th or 6th beer.

Also get some good quality aloe vera juice fresh made or store bought.

Usually works like a charm.

And get scoped if you can!

[350torana]

Pepe, thanks for the advice, much appreciated. Trouble is my old man is a gastro and seen to many of those lovely spy cam endscopities which he loved to bring home and show as family viewing

[Pepe']

Try the aloe juice first and the othher reccs.

I really would consider upper and lower edoscopy prceedures.