Drugs and Change

Recently I got an ear infection. Not shocking, given my childhood propensity for them and the fact that I’ve been almost continuously sick since Sadie started kindergarten in September, culminating with and resuming after a quick bout of flu and about two days of feeling better than I can remember feeling since… I don’t know. Possibly as far back as 1977. Yet shocking in that I’ve tended not to have ear infections as an adult, or even as an older child. I used to have respiratory infections every couple winters, but my ears have never behaved like this.

I’d had the normal sniffles and stuffiness. In a meeting before work in the wee hours, I was especially stuffy. Near the end of it, fluid started dribbling out of one of my ears. Freaky! It kept doing so during the shift, then I went home and searched online for the symptom and what the properties of the fluid meant. Clearly it was not cerebrospinal fluid and I didn’t have meningitis. I didn’t even have a fever.

That was Saturday. I ended up going to emergency care at my doctor’s practice on Sunday, seeing an excellent doctor and getting diagnosed officially with a middle ear infection. That meant antibiotics, which were a bit slow but did clear it up. It stopped briefly right after I started those, but then the leaking ear went on leaking for a few days.

More importantly, this was the first time I had been to a doctor since last May. I’d been shirking, since they like to monitor my blood pressure regularly. Because I simply couldn’t afford to go! We got kicked off of MassHealth as of the end of 2009 for having the audacity to have low enough income to qualify, but an employer who offered insurance we couldn’t afford to buy or use. That’s just the two of us, not the kids, who remained fully covered, because we had low enough income to qualify, but…. what? Insurance from the employer that would have cost too much wasn’t good enough for them, just for the adults? In reality, looking at the rejection, there was some level of care they covered even for us, but it was unclear how to use it. Apparently it was a safety net thing where the doctors and hospitals were supposed to figure out what not to charge us for or something. Also, other people who were required to buy insurance got part of their insurance cost reimbursed at borderline levels of income, but if we were supposed to once we obtained it, I was never aware of that. Perhaps this year, if they ever get back to me, they’ll be clearer. That’s a whole other story, the kids being thrown off and our having to reapply from scratch. They’re seriously taking their time, and we’re overdue for checkups for two kids. Ugh.

Anyway, our insurance meant the first 12 visits to the doctor, or a lower number and some testing, since that’s not unusual, would have cost me entirely out of pocket. I can totally afford 10% of my income before insurance starts to pay 80% of the cost. Yup.

Plus I’d been off and on, mostly off, the three blood pressure meds since early 2009. When I saw the doctor the last time in 2009, I took the drugs for a couple weeks ahead of time, enough to have a passable blood pressure but have him mildly concerned about edema. See, the meds made me feel like crap, and left me almost unable to work. I’d take them, and after a fairly short time the managers would wonder why I was so darn slow. I’d wonder why I was so darn slow, and my brain didn’t work right. Not that this should have surprised me, since one of the meds was a beta blocker. The second doctor to treat me for hypertension avoided giving me beta blockers because they affected me so badly the first time. Arguably I lost my very first tech support job because I was on one. I couldn’t remember anything, couldn’t think as clearly as I ought to be able to, and had a total lack of ambition that went beyond ordinary levels of lazy or disinterested. Took me a long time to blame it on the pills, and I seem to recall that was only when I stopped taking them and transformed back. The second doctor to treat me was happy if he could keep me from going much about 150/95. The next time I went to that practice, seeing a different doctor because mine had left, after being off meds a while my pressure was 185 or something and they flipped. I sat in the waiting room for hours, waiting for meds they gave me on the spot to kick in and lower my BP enough that they’d let me leave. I don’t remember what that doctor gave me, but he specialized in hypertension and set out to determine a root cause.

I don’t generally consume inordinate salt, don’t seem to be affected by it, and am aware that they’ve found minimal correlation, even though doctors still ask. I believe they have figured out 1/3 of people can go higher on account of salt, 1/3 are not affected, and… 1/3 go down! I did 24 hour urine samples for levels of catecholamines. I got an MRI of my kidneys, looking for pheochromocytoma. Nothing. My current doctor, technically the fourth to treat this, also found nothing, in part taking my word for the prior guy’s findings, since the other practice never passed along my records when asked.

Nor did anyone find damage as a result of the high blood pressure, in the past anyway. I was already about to the point of going back to treatment, sure I was being affected by it. I started losing my eyesight when we switched to compact fluorescent bulbs, but I’m not convinced BP hasn’t been a factor. On the emergency visit for the ear infection, my blood pressure was 210 over… now I forget, but not as high as my record 220/140. 120 or 110, this time. Naturally this got me an EKG, and skepticism about my chest congestion pain when taking deep breaths being normal congestion. Heck, that’s an old familiar pain to me, the breathing pain. Without being congested at all I’d get it when I was a kid, if I tried to run any distance in elementary school. Singing, bike riding (I miss my bike!) and expanding my lung capacity mitigated it, but it come back now and then.

I was lucky that the doctor I went to on the Sunday let me go with instructions to resume taking lisinopril, the least likely to cause a problem, in an effort to start controlling it some, and to go to my regular doctor in a week to followup on that and the ear. The EKG showed very minimal signs of uncontrolled blood pressure but was basically fine.

On another note, nobody ever finds I have high blood sugar or cholesterol, despite my mother being convinced from the time I was young that I was fat and was going to get diabetes, have a heart attack and die. Knock on wood.

Backing up a little, the very last time I took the combo of lisinopril, atenolol and hydrochlorothiazide was in the fall for a week. After a week it turned my brain to mush and provoked depression like flicking a switch. It was remarkable to observe! Since it had been months since I’d touched the stuff, and it was completely out of my system, it was a clear test. I’d previously observed that, at least at times I tended to get dehydrated from work and weather, hydrochlorothiazide may have been provoking gout attacks. The emergency doctor thought that made sense, and that the actions I ascribed to the beta blocker made even more sense.

About nine days later I saw my own doctor, getting an extremely prompt appointment once I finally called. You’d think they were concerned or something.

My blood pressure was dramatically lower, like 165/100. My doctor was ready to give me an EKG until I noted I’d had one several days before.

I kept me on lisinopril and added back hydrochlorothiazide, but switched me to amlodipine instead of atenolol. To be honest, I thought I’d made my feelings about beta blockers clear when I first saw him and already thought they messed me up, and I thought – and maybe it was true initially – he was not giving me one of them. Eventually I learned that one of them was, and perhaps that was true all along.

Looking up amlodipine after I got home, I was amused to see it is prescribed for angina as well.

A week went by and…. No wait! Two days went by and it was as if I’d become a new person. It improved more from there. The combo, presumably to be pinned on the amlodipine, almost seems the opposite of a depressant. Since it worked that fast and with no side-effects, I suppose I shouldn’t be surprised that the one day I forgot to take the pills caused a bit of a mood crash. There’s incentive! Skip a day, go all gloomy for two days before returning to normal? Naw, I think I’ll just keep to the regimen, thank you. My vision hasn’t improved. If anything, it’s worse. However, something else I suspected was affected by blood pressure went away, and the ear problem stopped dragging on, as it seemed to be. Google seemed to suggest that the ear symptoms could be tied in with blood pressure, apart from the fact of a very real infection.

It’s hardly perfect, since how glowingly happy can you be when you’ve gotten in a life hole with canyonesque sides, but I’m optimistic and energetic and alert and awake in a way I haven’t been for the most part in years. Not sure it was this good in the parts of 2003 and 2004 when I wrote about being on Lexapro. Who knew I needed it to counter the blood pressure drugs! Could have avoided the whole thing. I’ve also had some insight that goes deep and may help explain the blood pressure problem’s roots, while also helping me move on, but that’s another story. Time to make supper!

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