Two weeks ago I had BP of 220/180 a.k.a doctors are fucking useless...

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#1
This is a venting thread.

Back in 2012 I went into emergency room with extreme blood pressure reading of 220/190. It started with me going to a local urgent care with headaches and blurry vision. The doctor there literally started yelling at me to go to the emergency room ASAP after taking my BP readings.

After a 4 day stay at the hospital with battery of tests, all they could tell me was that I had "intractable hypertension" and can't pin down the cause. Basically, I need to find meds to bring them down. It was Harbor UCLA, a big hospital in LA. I was to visit them for next 4 months once every two weeks but they weren't able to find the combination to bring them down. Frankly, the doctor assigned to me seemed too green and stupid. I caught him several times prescribing the same med combo that I previous tried with no results. After about 2 months, I started keeping my own records since it was clear that this guys was just winging it. After the 4th month and BP still way too fucking high (180/140), I decided to go seek another hospital and doctor.

I decided to try a local doctor in Ktown who use to be head of USC medical center or something. The dude is old but whatever. He is also full on Korean dad mode. But I put up with it since he might find the right med combo. It takes him about 2 tries. 3 meds combination. My BP starts coming down. it eventually settles around 140/90, which is a HUGE improvement. Good.

But then 2 weeks go, I suddenly get this throbbing headache that won't go away. I take aspirin but no worky. after 2 days, I start to worry and google. It says headache at the back of your head is hypertension. Ah fuck... So I go to my local Ralphs where there is a super accuratae BP machine. 220/180. WTF... Back to square one after 4 years? Meds no longer working? I go home and do more googling. This time about my meds. One of my meds is Metoprolol. First website plainly says about the dosage: "introductory dosage 50~100mg per day. Maintenance dosage after few months, 150~450mg per day." WTF! I've been on introductory dosage of 100mg for 4 FUCKING YEARS! Thanks for nothing doc! I immediately increase my dosage to 200mg per day. After two weeks, I now get reading of 116/82 on that same machine.

I could have totally had a fucking stroke two weeks ago. And this fucking doctor just kept charging me for each visit and new prescription. I want my fucking money back. The only reason I need him now is to write me prescriptions every few months. He gonna act all grumpy when I bring this up probably. He does that when I question him about anything. Fuck this guy. I guess I'm ordering meds off internet.
 
#3
To be quite frank, doctors are atrocious in most "unusual" diagnosis. I vaguely recall their success rate is around 70% or so? I'll have to look it up. Either way, the point was they have a lot of trouble the second that you don't fit the mold of people coming in 24/7. It's actually perfectly natural if you think about a doctor's usual work day, but it's still incredibly frustrating.

I had the exact same thing happen to me, and it was an absolute nightmare to find a doctor who even believed me.
I think Google should start working. on doctor.google.com and save us from shitty doctors.
 

xxracerxx

Don't worry, I'll vouch for them.
#4
So have you been back to him after four years or just using him as a med dispensary? Like if you know your BP spiked, why not go directly to your doc?
 
#6
My experience has been that the majority of doctors are quacks.

Don't listen to patients, and I swear they use a dartboard or roll the dice on whatever treatment to try. If it doesn't work, it doesn't matter they get to bill you anyway.

Results and care would improve if they don't get paid when they don't help you.
 
#7
So have you been back to him after four years or just using him as a med dispensary? Like if you know your BP spiked, why not go directly to your doc?
I'm just doubling up on my current med so I don't need to see him until my prescription runs out. When I realized my BP spiked, I had two choices: go to ER again (fuck that. last time almost bankrupted my ass) or wait until next day to visit my doctor. I chose option 3, which was googling and self dosing that night.
 
#8
Unless you can prove malpractice in court, you're not going to get your money back, and usually by then, you would have spent a lot of time + money.

American healthcare. Maybe you can take a vacation to Korea and get a diagnosis there.
 
#9
This is a venting thread.

Back in 2012 I went into emergency room with extreme blood pressure reading of 220/190. It started with me going to a local urgent care with headaches and blurry vision. The doctor there literally started yelling at me to go to the emergency room ASAP after taking my BP readings.

After a 4 day stay at the hospital with battery of tests, all they could tell me was that I had "intractable hypertension" and can't pin down the cause. Basically, I need to find meds to bring them down. It was Harbor UCLA, a big hospital in LA. I was to visit them for next 4 months once every two weeks but they weren't able to find the combination to bring them down. Frankly, the doctor assigned to me seemed too green and stupid. I caught him several times prescribing the same med combo that I previous tried with no results. After about 2 months, I started keeping my own records since it was clear that this guys was just winging it. After the 4th month and BP still way too fucking high (180/140), I decided to go seek another hospital and doctor.

I decided to try a local doctor in Ktown who use to be head of USC medical center or something. The dude is old but whatever. He is also full on Korean dad mode. But I put up with it since he might find the right med combo. It takes him about 2 tries. 3 meds combination. My BP starts coming down. it eventually settles around 140/90, which is a HUGE improvement. Good.

But then 2 weeks go, I suddenly get this throbbing headache that won't go away. I take aspirin but no worky. after 2 days, I start to worry and google. It says headache at the back of your head is hypertension. Ah fuck... So I go to my local Ralphs where there is a super accuratae BP machine. 220/180. WTF... Back to square one after 4 years? Meds no longer working? I go home and do more googling. This time about my meds. One of my meds is Metoprolol. First website plainly says about the dosage: "introductory dosage 50~100mg per day. Maintenance dosage after few months, 150~450mg per day." WTF! I've been on introductory dosage of 100mg for 4 FUCKING YEARS! Thanks for nothing doc! I immediately increase my dosage to 200mg per day. After two weeks, I now get reading of 116/82 on that same machine.

I could have totally had a fucking stroke two weeks ago. And this fucking doctor just kept charging me for each visit and new prescription. I want my fucking money back. The only reason I need him now is to write me prescriptions every few months. He gonna act all grumpy when I bring this up probably. He does that when I question him about anything. Fuck this guy. I guess I'm ordering meds off internet.
Ok, I could see why you'd be mad. Let me explain.

The most important question here is how often you went for checkups. The protocol is NOT to increase your meds without reason. Metoprolol is a beta-blocker and does not require tapering to a high dose. If 100mg of Metoprolol gave you good control for 4 years, there was no reason to increase the dosage while it was effective. Higher doses ALWAYS have their own set of risks. Beta-blockers slow your heart rate down, and too high a dose could result in fainting or even a deadly arrhythmia. What happened was your body's tolerance to the medication changed. That's not uncommon whatsoever. People have this notion that our bodies are static vessels but that's not true at all. Our bodies are ever changing. The exact opposite of what happened here could have occurred where the metoprolol becomes TOO effective at 100mg and your blood pressure gets dangerously low. I know because I've had that happen to my patients.

You should be at least seeing your doctor once a year at the bare minimum, especially when you know you have a potentially life threatening condition. Your body's tolerance can change over the span of several months, which is likely what happened here. Or you started taking something else that interacts with the drugs you're already on. It's very possible that the issue isn't with the metoprolol at all but rather with another BP medication to which you're no longer responding. What you should have done was schedule an appointment with your doctor after your symptoms persisted for a few days.
 
#11
Any look on whether it might be whitecoat hypertension?

I have BP of 122/79 normally but when I go to the Drs it goes sometimes as high as 170/90.
 
#12
Ok, I could see why you'd be mad. Let me explain.

The most important question here is how often you went for checkups. The protocol is NOT to increase your meds without reason. Metoprolol is a beta-blocker and does not require tapering to a high dose. If 100mg of Metoprolol gave you good control for 4 years, there was no reason to increase the dosage while it was effective. Higher doses ALWAYS have their own set of risks. Beta-blockers slow your heart rate down, and too high a dose could result in fainting or even a deadly arrhythmia. What happened was your body's tolerance to the medication changed. That's not uncommon whatsoever. People have this notion that our bodies are static vessels but that's not true at all. Our bodies are ever changing. The exact opposite of what happened here could have occurred where the metoprolol becomes TOO effective at 100mg and your blood pressure gets dangerously low. I know because I've had that happen to my patients.

You should be at least seeing your doctor once a year at the bare minimum, especially when you know you have a potentially life threatening condition. Your body's tolerance can change over the span of several months, which is likely what happened here. Or you started taking something else that interacts with the drugs you're already on. It's very possible that the issue isn't with the metoprolol at all but rather with another BP medication that has no longer become responsive. What you should have done was schedule an appointment with your doctor after your symptoms persisted for a few days.
4 years @ 100mg/d only got me down to about 140/90. With this new dosage now I'm at normal-ish range of 116/82. Shouldn't he have upped my dosage after a while seeing that it's still kinda high?
 
#14
Any look on whether it might be whitecoat hypertension?

I have BP of 122/79 normally but when I go to the Drs it goes sometimes as high as 170/90.
Yeah same thing here, whenever I go to the hospital I get absurdly high readings. But everything is normal when I test with my dad's machine.
 
#17
4 years @ 100mg/d only got me down to about 140/90. With this new dosage now I'm at normal-ish range of 116/82. Should he have upped my dosage after a while seeing that it's still kinda high?
It depends. If you're averaging around 140/90 for 4 years, meaning you some times come in under, that's fine. If a patient has been 140/90 +/- 5 mmhg for the last 3 visits, there's no pressing reason to increase the medication unless your BP is > 140/90 on two consecutive occasions. Doctors get yelled at for over-medicating too, so you can't fault a doc for sticking to a lower dose regimen that works. BP control can be a tenuous balance. The scenario changes if your BP fluctuates wildly or if you have other conditions like diabetes.
 
#19
My home machine consistently reports about 20 points under machines at hospital and at my local Ralphs. I don't trust them.
If you can't calibrate your home cuff, bring it with you the next time you go to the doctor's office. Take your BP twice with the cuff and record it, assuming you get a repeatable value. Then ask the triage person to take your BP manually twice and record the difference. Now you know how off your home cuff is. Do this every time you go in to keep tabs on the margin of error.
 
#20
I'm just doubling up on my current med so I don't need to see him until my prescription runs out. When I realized my BP spiked, I had two choices: go to ER again (fuck that. last time almost bankrupted my ass) or wait until next day to visit my doctor. I chose option 3, which was googling and self dosing that night.
...

What the Hell? Why would you google and self dose based on non quantifiable advice from strangers?
 
#21
It depends. If you're averaging around 140/90 for 4 years, meaning you some times come in under, that's fine. If a patient has been 140/90 +/- 5 mmhg for the last 3 visits, there's no pressing reason to increase the medication unless your BP is > 140/90 on two consecutive occasions. Doctors get yelled at for over-medicating too, so you can't fault a doc for sticking to a lower dose regimen that works. BP control can be a tenuous balance. The scenario changes if your BP fluctuates wildly or if you have other conditions like diabetes.
Well I've been seeing him for the last 4 years. 140/90 was as low as it ever got. It usually fluctuates a bit over that. I chucked it up to that "intractable hypertension" or whatever that actually is. Maybe I'm over reacting but pretty much every page on Metoprolol mentions introductory vs maintenance dosage difference so I got pretty fuming.

Anyways, my blood sugar and heart rate are normal, so I think I'm going to stick with this new dosage.
 

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MeisaMcCaffrey
#23
They didn't give you Nifedepine under the tongue in case of an emergency?

Usually Amplodipin and Metropolol combo should be enough. Why the fuck is your BP so high though? What's your diet, weight etc?
 
#24
...

What the Hell? Why would you google and self dose based on non quantifiable advice from strangers?
My headache was terrible. I needed to do something that night, so I found some reputable medical sites and followed the dosage recommendations. 200mg is far below "up to 450mg" guidline, so it was a safe move in my mind. It started working before the morning.
 

NetMapel

Guilty White Male Mods Gave Me This Tag
#25
Something seems terribly wrong with your body if you're always having these issues. Maybe you should go find another doctor to look at. That doesn't sound right or normal :(
 

Skiesofwonder

Walruses, camels, bears, rabbits, tigers and badgers.
#27
As a nurse that deals with doctors everyday in the hospital setting, I understand your frustation regarding not getting personalized care. In my work experiences, doctors at hospitals (we call them hospitalists) are assigned way too many patients, and struggle with treating anyone that doesn't respond as expected to a template of treatment used for said illness. That being said, it is not a good idea to start adjusting your medications without a MD/PA/NP's advice.

It sounds to me that you are not taking a set of vitals regularly, is that correct? As you may know, Metoprolol not only lowers blood pressure, but heartrate​ as well (along with my other side effects). I always recommend to my patients that it would be a good idea to keep a record of your vitals per day or week (if possible) to present to your doctor so he/she can get a better idea of how your medications are effecting you and make changes accordingly. Obviously if your blood pressure is 220/180, then yes your current treatment is not doing the job, and even though you bumping up the dosage to 200 mg seemingly fixed your BP with a reading of 116/82, you still need to see a doctor and report these findings because there is more at play here then just your BP. For example, if you continue taking Metoprolol at 200mg, you could eventually bottom out your BP or go into symptomatic bradycardia (low heartrate).

So please see somebody and report your findings.
 

Dr.Guru of Peru

played the long game
#28
I wouldn't increase your beta blocker without seeing your MD first. Whats your heart rate at?

Also, going to the ER for a high blood pressure is such an American thing to do. I mean, I guess you were having "blurry vision" but a 4 day stay? Was your vision blurry the whole time or something?

Honestly, I dont understand the issue. Your blood pressure was well controlled for 4 years, and now it isn't. You're made at the doctor because ....why exactly? Just go see him again and get your meds adjusted.
 
#29
They didn't give you Nifedepine under the tongue in case of an emergency?

Usually Amplodipin and Metropolol combo should be enough. Why the fuck is your BP so high though? What's your diet, weight etc?
I'm chunkier now (210 lbs 5'9") but when I had my first BP ER visit I was 185 lbs. My blood sugar lvls are normal. I reduced my salt intake back in 2012. The doctors basically told me they have no clue why my BP is so fucked up. Lucky me!
 
#30
Well I've been seeing him for the last 4 years. 140/90 was as low as it ever got. It usually fluctuates a bit over that. I chucked it up to that "intractable hypertension" or whatever that actually is. Maybe I'm over reacting but pretty much every page on Metoprolol mentions introductory vs maintenance dosage difference so I got pretty fuming.

Anyways, my blood sugar and heart rate are normal, so I think I'm going to stick with this new dosage.
You should definitely follow up with the doc at some point. Introductory doses can be final doses! It's very common! Some people need baby doses, some people need more. If you've gained a ton of weight in the past year, that alone could be the reason your meds are no longer having the effect they once had. Your ability to metabolize and respond to drugs changes with time as your body ages.

The only reason to be upset is if you had been seeing the doc regularly and nothing was done after two consecutive visits with elevated BP or after a dramatic BP spike. And even if your BP is something very high like 160/100, the doctor may not choose to increase your medications if it can be attributed to another cause such as recent stress or exertion. It's important for doctor's to know what your condition is when vital signs are taken. I'm not going to be worried if someone just ran a flight of stairs and their heart rate is 120. The key is to learn to recognize when you have new or worsening symptoms and consulting your PCP or specialist about the change.
 
#31
As a nurse that deals with doctors everyday in the hospital setting, I understand your frustation regarding not getting personalized care. In my work experiences, doctors at hospitals (we call them hospitalists) are assigned way too many patients, and struggle with treating anyone that doesn't respond as expected to a template of treatment used for said illness. That being said, it is not a good idea to start adjusting your medications without a MD/PA/NP's advice.

It sounds to me that you are not taking a set of vitals regularly, is that correct? As you may know, Metoprolol not only lowers blood pressure, but heartrate​ as well (along with my other side effects). I always recommend to my patients that it would be a good idea to keep a record of your vitals per day or week (if possible) to present to your doctor so he/she can get a better idea of how your medications are effecting you and make changes accordingly. Obviously if your blood pressure is 220/180, then yes your current treatment is not doing the job, and even though you bumping up the dosage to 200 mg seemingly fixed your BP with a reading of 116/82, you still need to see a doctor and report these findings because there is more at play here then just your BP. For example, if you continue taking Metoprolol at 200mg, you could eventually bottom out your BP or go into symptomatic bradycardia (low heartrate).

So please see somebody and report your findings.
My heart rate reading for the last 2 weeks are still in normal range. (69~70 bpm). I will keep my eye on that. I need to find a new doctor though.
 
#32
My experience has been that the majority of doctors are quacks.

Don't listen to patients, and I swear they use a dartboard or roll the dice on whatever treatment to try. If it doesn't work, it doesn't matter they get to bill you anyway.

Results and care would improve if they don't get paid when they don't help you.
There's a difference between peddlers of psuedoscience and a busted health care system.
 

Auto_aim1

MeisaMcCaffrey
#33
I'm chunkier now (210 lbs 5'9") but when I had my first BP ER visit I was 185 lbs. My blood sugar lvls are normal. I reduced my salt intake back in 2012. The doctors basically told me they have no clue why my BP is so fucked up. Lucky me!
Luckily you didn't get a stroke or a heart attack. I would still recommend you to visit a doctor and get the proper dosage. Also monitor your BP regularly. You have to probably take these meds for life.
 
#34
As a fellow hypertensive I've been on 10mg of Amlodipine & Ramipril (cal-ion blocker & ACE inhibitor respectively) for about 5 years now and get a BP check when I get my repeat script every 6mobths, and an annual blood test to check kidney/liver function.

Beta-blockers are common but I couldn't take them - felt like my body was walking through soup all the time, alpha-blockers were even worse.

Sorry you've had a shit time - these threads always remind me to be glad I was diagnosed in the U.K. and live in a country (Australia) with a decent enough public health system.
 
#36
As a fellow hypertensive I've been on 10mg of Amlodipine & Ramipril (cal-ion blocker & ACE inhibitor respectively) for about 5 years now and get a BP check when I get my repeat script every 6mobths, and an annual blood test to check kidney/liver function.

Beta-blockers are common but I couldn't take them - felt like my body was walking through soup all the time, alpha-blockers were even worse.

Sorry you've had a shit time - these threads always remind me to be glad I was diagnosed in the U.K. and live in a country (Australia) with a decent enough public health system.
I had similar issues with Hydralazine. The day I started taking it, couldn't get it up. It worked OK for BP but fuck... couldn't deal with the ED. I function fine on Beta blockers apparently.
 

A Fish Aficionado

I am going to make it through this year if it kills me
#37
this may involve violating HIPAA or patient confidentiality, but what were roughly the meds given to you?

heart and lung problems are tricky. I wouldn't throw an entire educational and professional behind it.
 
#45
Seems weird to assume all old Korean dudes are bad doctors because you've internalized a bad experience involving one.
I know old Korean dudes. They don't tend to listen. They only tell you what to do. I think I want a doctor that takes times to listen to what I have to tell him. If anything, that dude is the one who like to assume not me. I'm over 40 ffs. Lecture to your own son. I already have a bone headed Korean dad and believe me, one is plenty.
 
#47
I went to doctors last week for asthma and allergies and they put me on blood pressure mess. I take 2, 5mg pills of Amlodipine besylate everyday and my BP is still 159/99. Ugh.
 
#49
I went to doctors last week for asthma and allergies and they put me on blood pressure mess. I take 2, 5mg pills of Amlodipine besylate everyday and my BP is still 159/99. Ugh.
160/95 was what I had before it shot up to 220/190 back in 2012. And guess what? I was also on only amlodipine (10mg). I would ask them to find something else to try.
 

A Fish Aficionado

I am going to make it through this year if it kills me
#50
Harbor UCLA? Believe it or not, I've been to worse. Also been to far better. Harbor UCLA is definitely on the crappier side.
And yet you backhand compliment a former "USC" medical doctor. Why, if your skeptical of docs would you see that dude?

Docs are bound to be skeptical, sometimes to the detriment of patients, but you are also having a bias.
 
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