Blood Pressure

[ignis]

I have Diabetics and low blood pressure for over 12 years, still take the same pill every day to rise the blood pressure... If is makes any difference I am male aged 62

Blood pressure is now getting worse, Just spend another 24 hours in Hospital on a drip + pills every few hours, this is the 2nd time in 6 months, Dr say blood pressure is dangerously low 47/41.........

Leaving Hospital yesterday 93/60 and Blood Sugar 127.... Dr a different one say I am fine and can now leave

What I don't understand I was given 6 different tables to take... but just 3 days supply and no info as to what I should or could do to keep the blood pressure higher. asking if I should buy there tablets from a Pharmacy told no need..

This time a different Hospital, so now 4 Drs and no info given in 6 months, all have said the Blood pressure pills I take every day are good, but they cannot be working or why must I go back to hospital ?

Hoping someone has same sort of problem and how they manage it

Edit: reason in changing Hospital, last Hospital was 1,200 baht for a bed in a ward of 6, this time 1.100 baht for a private room

Edited April 14, 2012 by ignis

[Sheryl]

To clarify,

1) Do you mean diabetes mellitus ("sugar diabetes") or diabetes insipidus?

2) Is your low blood pressure constrant or just when you change position?

3) What is the name of the "blood pressure pill" you take every day?

[ignis]

1, "sugar diabetes"

2, No idea maybe constant get worse after time, often fall when standing up or moving, light headed, can just be sitting in a chair and vision gets blurred.

3, Thai Enaril.20MG......... ?? Now doing a search on Google shows this is for High Blood Pressure ?? maybe years ago Pharmacy gave me wrong ? always take the old bottle and get new one the same....... Never thought of looking before at the pills

+++ take PRENOLOL 100MG table at day ???????? No idea what is for

+++ take GLYCON/CLAZIDE 60MG a day ??? No idea what is for

+++ take Bestatin 20MG day ??? No idea what is for

+++ take NEOFORMIN 500MG 2 x 2 a day [Diabetic pills]

+++ take Miracid 20MG a day [acid stomach]

[PMNL]

1, "sugar diabetes"

2, No idea maybe constant get worse after time, often fall when standing up or moving, light headed, can just be sitting in a chair and vision gets blurred.

3, Thai Enaril.20MG......... ?? Now doing a search on Google shows this is for High Blood Pressure ?? maybe years ago Pharmacy gave me wrong ? always take the old bottle and get new one the same....... Never thought of looking before at the pills

+++ take PRENOLOL 100MG table at day ???????? No idea what is for

+++ take GLYCON/CLAZIDE 60MG a day ??? No idea what is for

+++ take Bestatin 20MG day ??? No idea what is for

+++ take NEOFORMIN 500MG 2 x 2 a day [Diabetic pills]

+++ take Miracid 20MG a day [acid stomach]

To my opinion, Could it be that you had heigh blood pressure several years ago and were prescribed Enarapril and Atenolol? And now your blood pressure is lower (might be weight loss, exercise, diet control or something) but you still be on the same pill which off course lower your blood pressure even more. You definitely need your meds to be adjusted. There is normally a reason that doctor prescribed you the meds ie Enarapril for Diabetes with Proteinuria, Atenolol for DM with angina, so you should go back to talk to the one prescribed them for you or one who can talk and advise you properly. I do believe they will cut down the two meds or leave a half dose of Enarapril depends on your curent blood pressure.

For the neoformin; metformin is blood sugar lowering agent, bestatin is cholesterol lowering pill, glycazide is another blood sugar lowering meds. Miracidvis for gastritis/GERDSo you must have been diagnosed with

1 Diabetes

2 Hypertension with hypotension ( side effect from high blood pressure pill)

3 Dyslipodemia

4 some type of gastritis ( I guess they as well prescribed you with aspirin?)

Your problem seems to be lack of communication and information regarding your condition and meds informations, hope you get it sorted out soon.

[tropo]

This is what happens when you leave everything in the hands of doctors. You end up with a big bag of medicine and not a clue what it's for. That's all these guys can do for you - control everything with drugs.

I don't know about the low blood pressure, but please do some home study about diabetes. You've had it for over 12 years and still don't have a clue.

When I first became aware of high blood sugar (I noticed high FBS (about 250 mg/dl) on a blood test which the doctor missed - and I had to ask him about it) - the doctor gave me 2 types of medicine - Metformin and Gliclazide. I got myself a glucometer and started working on the problem myself. I now have perfectly normal readings by taking control of my diet and exercise and haven't had a diabetic drug for over 6 years. The blood pressure improves a lot with exercise too.

Start taking control of your own health and study, study, study. The doctors run a business and don't really care.

Edited April 15, 2012 by tropo

[NaMah]

One thing I do almost every doctor visit is bring my medications with me and line up the bottles on the counter in the examination room and make the doctor discuss each one and reaffirm why I must continue to take it. Doing that has got me down to two low-dosage meds for somewhat high BP.

You must deal with your low BP condition as it can cause kidney damage according to my nurse GF here in the US.

We wish you good luck and improving health sir.

[tropo]

One thing I do almost every doctor visit is bring my medications with me and line up the bottles on the counter in the examination room and make the doctor discuss each one and reaffirm why I must continue to take it. Doing that has got me down to two low-dosage meds for somewhat high BP.

That's a smart strategy. A bit of research done on each drug before you get to the doctor would be a huge help too.

[ignis]

Many thanks, yes guess time I found a Dr........

Last time I went to see my own Dr as it were was in the UK in 2003, he gave me 3 moths supply to bring to Thailand and a copy of my Prescription, about September 2004 ask at a Thai Pharmacy about Thai meds the same, [the med for stomach same as UK Dr prescribed was over 1,000 baht for 14 day supply imported from Switzerland, Thai version 185 baht...... had in UK 2 Opps and told to take this med for rest of life]

Did find a Dr here but pills not discussed, just went for check up, flue injection every year, sadly he died over a year ago, not found another Dr anywhere near, now just ask in a Thai Pharmacy wife of my dentist, she gives me meds which always appears to help.

I have asked a couple of people in the Village but appears if a Dr is needed they go to the Government Hospital, only 2 km away

Edit: Dr gone = No flue injection last year, just got over a bad bout of flue, maybe a reason for low BP ?

aspirin yes I take 1x per day but that is off my own back reading 1x day helps prevent heart attacks

Edited April 15, 2012 by ignis

[Sheryl]

You are on 2 medications, enalapril and prenolol (atenolol) which are for hypertension and have the effect of lowering the blood pressure. Furthermore you are on high doses of both. These are undoubtedly the cause of your problem.

You clearly need to reduce dosages or stop one or both of these medications but need to do so carefully. It would be best if you did so under medical supervision but regardless you need to get a reliable home BP machine (the type that wrap above the elbow are best) so you can monitor your BP daily. Do so at rest.

As for your other meds:

the gycon/clazide and neoformin are both for your diabetes. I hope you are either measuring your own blood sugar or getting regular blood tests, as just as the BP medication proved too much and led to the opposite problem, these medications can lead to low blood sugar.

The betstatin is to reduce fats (LDL cholesterol and.or triglyceride) in the blood. For this too you should be having periodic (i.e. once or twice a year) blood tests.

And, given that you are diabetic and also given that you rae on various serious medications, your liver and kidney function need to be tested at least once a year (simple blood tests).

It is never a good idea to take medications the purpose of which you don't know, and especially not in a case like your where you have lifelong chronic health conditions. In that situation it is essential to be fully informed of your condition and the treatments prescribed and to take an active role in your own medical care. You need to find a doctor who is willing to communicate, answer questions and involve you in decision-making. Where do you live?

Diabetes, hypertension etc are condition s that change over time and in response to things like diet, age, changes in activity level etc. Regular monitoring is necessary as is frequent adjustment of dosages and drugs. Simply refilling the same original prescription year after year is asking for trouble.

Let us know where you live and members or I may be able to suggest a doctor. In the meantime, contact your original physician in the UK and get a written medical summary. A new doctor will need this. Chances are that what they did in the hospital besides just giving fluids was to withhold the antihypertensive drugs until your BP came back up. What they failed to do was make a comprehensive assessment of your condition and recommend medication changes accordingly. Probably because the level of care was just not good (often the case with small private hospitals, especially upcountry) but it may also be that the doctor was hesitant to meddle with a complicated set of prescriptions not knowing the full medical history behind them.

Once you find doctor you like and who takes the time to explain things to you thoroughly, continue to see him/her regularly (not less than every 6 months, more often if a medication was changed) and get regular blood tests (Hb1AC, fasting sugar, HDL, LDL Cholesterol,. triglycerides, creatnine and liver panel) .

I too am hesitant to make even a short-term recommendation without knowing your full medical history and the reason why those 2 particular drugs were prescribed and in those dosages. The safest course pending a thorough medical evaluation and availability of full medical history would be to monitor your BP at home daily and if it starts to drop, cut the dosages of the 2 drugs prescribed by half, i.e. enalapril to 10mg and prenolol to 50 and see how that does. But this is just stop-gap advice to help you avoid a repeat hospitalization and is no substitute for what you really need, which is to get a thorough evaluation by a doctor who has access to your complete medical records.

[ignis]

Many Thanks Sheryl, as for where I live out in the sticks in a very small Village.on north-west most edge of Nonthaburi, 6km from Sai Noi..[bang-Bua-Thong and Bang Yai both about 15km away]

[Sheryl]

You're going to have to travel a bit. Siriraj Hospital would be your best choice for anything requiring hospitalization (bring a Thai speaker with you to help navigate the red tape), otherwise can find some of the best docs from Siriraj doing private practice at Thonburi Hospital. Suggest Dr. Apichati Vichayanrat Thonburi Hosp (specialist in diabetes) there.

Or if you would be willing to travel a bit further (into downtown bkk) to consult a western doctor, Dr. Nick Walters at the Bangkok Adventists Hospital (US & UK trained) is excellent. In fact for your situation probably the best odea as he is thorough and will take the time to explain everything clearly to you. It is a non-profit hospital. While in Bkk proper it is not far over the river via Rama 8 bridge http://www.mission-hospital.org/new_mission/map/map_en.php

[lopburi3]

http://www.rattanatibeth.com/

Above may be one of the hospitals you were previously in as near junction of Ring Road 9 and Rt 302 in Bang Bua Tong. I was visiting a patient about 7 years ago and appeared to be a modern facility but, as said, that is not a guarantee of good doctors.

[tropo]

you need to get a reliable home BP machine (the type that wrap above the elbow are best) so you can monitor your BP daily. Do so at rest.

I think the Omron wrist type are the best because they are far easier to use and I've found my results are very close to the arm band type they use at my local lab. I've done a head to head comparison on a number of occasions just to check the accuracy.

[ignis]

http://www.rattanatibeth.com/

Above may be one of the hospitals you were previously in as near junction of Ring Road 9 and Rt 302 in Bang Bua Tong. I was visiting a patient about 7 years ago and appeared to be a modern facility but, as said, that is not a guarantee of good doctors.

Yep was there a couple of years ago for an emergency Opp Burst Appendix [expensive] ......... Now any problems use Chonlada Hospital in Bang Bua Tong itself, [less the 1/2 the price]

[ignis]

You're going to have to travel a bit. Siriraj Hospital would be your best choice for anything requiring hospitalization (bring a Thai speaker with you to help navigate the red tape), otherwise can find some of the best docs from Siriraj doing private practice at Thonburi Hospital. Suggest Dr. Apichati Vichayanrat Thonburi Hosp (specialist in diabetes) there.

Or if you would be willing to travel a bit further (into downtown bkk) to consult a western doctor, Dr. Nick Walters at the Bangkok Adventists Hospital (US & UK trained) is excellent. In fact for your situation probably the best odea as he is thorough and will take the time to explain everything clearly to you. It is a non-profit hospital. While in Bkk proper it is not far over the river via Rama 8 bridge http://www.mission-h.../map/map_en.php

Many thanks......... Silly never thought to ask, my Thai neighbor in the next house in the Village is something to do with management at Adventists Hospital, his wife is an Accountant at the Military Hospital on ? Rama 4 not far from HSBC, they leave home at 4:45 every morning for the long drive into BKK, as there not back until 21:00 have always watered there garden for passed 8 years..........

Last few years rarely go to BKK [use to have to go to Immigration 1x year in BKK] but now if I do, I leave me car at home and go with them, so to arrange an appointment there would be simple

[lopburi3]

As said what you seem to need is routine care as these hospitals stays appear to have been to stabilize and treat immediate issue rather than as a long term treatment of your chronic conditions. It may not need a top doctor as much as having a schedule of inexpensive visits and tests made. But if no review of your pill taking was made during your low pressure hospital stay I would not go near that hospital again.

As mentioned your blood pressure medications are very strong. When I was just using atenolol at 50mg for 15 years and now with combined use only 25mg. But this is not do it yourself so you do need consultation and tests. There may be someone in village that can make the blood pressure test but for me there is a big difference when doing at home or outside home so if you can afford an inexpensive unit for self testing it will likely be well worthwhile - take reading every few hours for a few days and provide to doctor (and if he ignores and only accepts his reading find another doctor).

[Sheryl]

You're going to have to travel a bit. Siriraj Hospital would be your best choice for anything requiring hospitalization (bring a Thai speaker with you to help navigate the red tape), otherwise can find some of the best docs from Siriraj doing private practice at Thonburi Hospital. Suggest Dr. Apichati Vichayanrat Thonburi Hosp (specialist in diabetes) there.

Or if you would be willing to travel a bit further (into downtown bkk) to consult a western doctor, Dr. Nick Walters at the Bangkok Adventists Hospital (US & UK trained) is excellent. In fact for your situation probably the best odea as he is thorough and will take the time to explain everything clearly to you. It is a non-profit hospital. While in Bkk proper it is not far over the river via Rama 8 bridge http://www.mission-h.../map/map_en.php

Many thanks......... Silly never thought to ask, my Thai neighbor in the next house in the Village is something to do with management at Adventists Hospital, his wife is an Accountant at the Military Hospital on ? Rama 4 not far from HSBC, they leave home at 4:45 every morning for the long drive into BKK, as there not back until 21:00 have always watered there garden for passed 8 years..........

Last few years rarely go to BKK [use to have to go to Immigration 1x year in BKK] but now if I do, I leave me car at home and go with them, so to arrange an appointment there would be simple

Perfect, then. Do so. Suggest you go in on an empty stomach and get a basic physical check up then see Dr. Walters to discuss your various conditions and meds. (Check his schedule first and make an appointment for say the afternoon, that leaves ample time for morning physical). And do try to get your history from the UK doc first as it would be helpful to know the reason behind the choice of medication. I am particularly concerned that you may have had some cardiac issues.

[ignis]

And do try to get your history

What sort of History do I need ?

I remember I had a lot of illness as a child and teenager with with lots of Hospital stays in the UK........ Cannot remember Drs names......... I have been in Hospital in Berlin, [Germany] Amsterdam [Holland] ... Frejus and Nice [France].. Toronto [Canada]... Malta... Faro and Lisbon in Portugal.... Gloucester [uK]....

The UK Drs were a husband and wife team, in the next Village, I have there names and practice address, but this would only cover less then 6 years before 2003 as from 1972 - 1998 lived and worked in many places around the World.... end 2003 came here, UK just to cold and wet.

Been searching found the old 'copy' UK Dr perspiration it says Atenolol 50MG 1x per day........ No idea when I was given 100MG, would be at least 1 year ago as only buy all medication 1x per 6 - 8 months, still have the old label and 100% states 100MG, guess Pharmacy had run out of 50MG some years in the past and gave me 100MG, never noticed, not so many pills left now so have already started taking 1 every other day, new stock will be 50 MG when I go to stock up next month.......... Or see a Dr and discuss my pills before getting new stock ?

[lopburi3]

See a doctor before getting new pills. It appears you were over dosing yourself if should have been 50mg and you were taking 100mg and not splitting them. Suspect for now best to split pills but take daily as intended. I had this happen in the Philippians about 25 years ago where they replaced 50 with 100 and I did not notice (until I was almost blacking out every time I got out of chair).

[Sheryl]

In terms of history, what is relevant is the choise of the 2 antihypertensives (atenolol and enalapril and why. In particular any cardiac problems.

Don't take the atenolol every other day. Split the tabs in half and take daily. And in future be very careful to read the dosage on pills you buy!

[mikecwm]

Google - Dr Mark Hyman and "The Blood Sugar Solution".

Try this You Tube video -

[ignis]

thanks, good video, only the websites are not so good.......... Buy books, but pills, buy vitamin.......... Did join the The Blood Sugar Solution Online Course .will start sometime soon..so the email says

Websites and Drs, even Drs and Drs say different things........ How on earth do you know which is right and wrong ?

Like coffee, some say good some say avoid at all costs.......? I always have 6 - 7 mugs of black coffee every morning [ 1 - 1.25 lts water] and have done so for 50 odd years, even my parents could never understand how as a kid I could drink black coffee....

Same as Pepsi Max, some websites/Drs say it is a no no, others say it is no problem..

A good one for many years is Mango, I asked both my UK Drs and the diabetic specialist both said ALL FRUIT is GOOD sugar, asked about mango as used to come here on holiday 2x year before moving here..... [friend bring from the south 3kg for me a month price range from 60 - 100 baht for the 3kg box] so eat about 13 - 16 depends on size mango's per month.. so eat one every other day.

USA websites state mango is a NO no for Dialectics as are watermelons .....!!!!!!! if you eat then 1/4 only. ? So what to believe a UK diabetic specialist or some Dr on a US website ?

Edited April 23, 2012 by ignis

[mikecwm]

thanks, good video, only the websites are not so good.......... Buy books, but pills, buy vitamin.......... Did join the The Blood Sugar Solution Online Course .will start sometime soon..so the email says

Websites and Drs, even Drs and Drs say different things........ How on earth do you know which is right and wrong ?

Like coffee, some say good some say avoid at all costs.......? I always have 6 - 7 mugs of black coffee every morning [ 1 - 1.25 lts water] and have done so for 50 odd years, even my parents could never understand how as a kid I could drink black coffee....

Same as Pepsi Max, some websites/Drs say it is a no no, others say it is no problem..

A good one for many years is Mango, I asked both my UK Drs and the diabetic specialist both said ALL FRUIT is GOOD sugar, asked about mango as used to come here on holiday 2x year before moving here..... [friend bring from the south 3kg for me a month price range from 60 - 100 baht for the 3kg box] so eat about 13 - 16 depends on size mango's per month.. so eat one every other day.

USA websites state mango is a NO no for Dialectics as are watermelons .....!!!!!!! if you eat then 1/4 only. ? So what to believe a UK diabetic specialist or some Dr on a US website ?

You sound hyper on all that coffee. How about switching over to tea? That would make a good start.

[remobb]

Hi Ignus, I have high blood pressure but no diabetes problem. Anyway my point is this: Here you have had some very good advice but it is not reliable without a proper and correct diagnoses / consultation with a doctor.

It seems to me that you just accept what the doctor says and do not question or ask questions. You need to go to a real doctor in a real hospital. Travel to Bangkok, it's not far from BangBuaThong, go to an international hospital where they speak English. Bumrungrad Hospital ( http://www.bumrungrad.com/thailandhospita l) Yes it costs more but it's your life you are talking about. Go at least once to get correct prognosis and medication, ask questions, tell them everything, don't be shy. Start anew with your medications, ask them what the medicine is for and tell them to give you a months supply then go back the next month.

I hope things get better soon.

Remo.

[Styx]

Any member of this forum who is living in Bangkok and has high blood pressure/hypertension? Wondering how the hot and humid weather, pollution, etc.

effects your state? I am in Farangland at the moment, supposed to come to BKK to work and searching for information...

[lopburi3]

There are many of us with high blood pressure from reading of forum but do not believe the weather has much effect and most take some form of medication to keep it within normal levels (and never noticed any requirement for more here than elsewhere). Air pollution in Bangkok these days seems to be much less than 30 years ago to my eyes/nose (when lead gas and dirty black diesel filled the air). CNG for taxi/public vehicles has made a huge improvement.

[Styx]

Thank you for your reply, actually few my friends who live in Bkk are complaining about the current heat - almost 40 degrees and they are healthy, so just wondering if person with hypertension can handle this, for example if there is a need to increase the dose or so...

I'm also new with hypertension, on medication about 7 months, it has been adjusted several times. From doctors not much information...

[lopburi3]

It is indeed hot. Currently only 39.3c with heat index of 49c and been this way for last week. But most people will be in airconditioned areas so not a real factor for many. I doubt any change will be required but there is good medical care available here so you should monitor.

[Sheryl]

Well over 40 out where I am..and really humid to boot.

The only issue i see for people with high BP is that if you are on a diuretic medication, you may be more at risk of electrolyte disturbances due to increased sweating. I personally tend to be rather cautious re use of diuretics in the tropics for that reason. if you are on another class of drug, no problem.

[Sheryl]

Oh another point, not related to the heat but - Thai food tends to be very high in sodium.