If you want REAL health care and have more than the run of the mill muscle pull, you will have to start paying the doc directly - out of pocket. The good ones don't take insurance. They don't have to as they have enough referrals to stay in business.
Free health care? You get what you pay for. Better get ready to start paying it yourself if you are serious about getting well. |
Along with my meds that drag me down I have started taking naproxen, also known as aleve. This pretty much cures the drag me down effect for me. |
I have a question for Larryx7, In country as India and I believe also in most countries in Europe, as long as your blood pressure is under 140/90, you are considered healthy. What's up with the 120/80 in the US ? Sounds like pharmarceutical companies along with the AMA and FDA have found the scared- crow-hot spot to push meds for huge profit. |
From the January 6, 2000 issue of the New England Journal of Medicine (which is hardly a friend of the pharmaceutical industry): "The overall unadjusted relative risk of death due to coronary artery disease was 1.17 (95% confidence interval, 1.14 to 1.20) per 10 mmHg increase in systolic pressure and 1.13 (95 percent confidence interval, 1.10 to 1.15) per 5 mmHg increase in diastolic pressure." This increase in mortality began with a systolic blood pressure of 125 mmHg and a diastolic blood pressure of 75 mmHg. |
The comment by Cdc holds a lot of truth. When I first began practice in the early 70's, most health care was paid for just like your groceries. Consequently, market forces played the primary role in controlling the cost of the services just as it does in the price of groceries or any other competitive product. We took the first step toward a socialized system when third party payers started to appear in the delivery system. This divorced the cost of the service from the consumer. He no longer felt the true cost of the service anymore. With this development, over utilization has ,over the last 30 years, almost swamped our system. If we move to a total socialized system, the over utilization will force rationing which will affect those that need extremely expensive procedures and treatments. This has already started with the advent of HMO's but will accelerate exponentially as government becomes more dominant in the delivery system. This has the potential to create an Orwellian health care system which delivers care based on the perceived value of the recipient, ie, age,social status, etc. Sound crazy, just take a look at Washington right now. |
Just come across this thread, I am a family doctor working in the UK National Health Service and with an interest in hypertension. My word, by international standards, you guys are overtreated. Treat people with a systolic over 135? not in the rest of the world. There is no absolute criteria, that varies with age and general health. At my age 60, slim, fit with no concurrent illnesses, I started treatment at 150/95, with a target of 135/85. Clinical trial evidence for treating lower than this is limited and side effects, particularly postural dizziness, start to rise exponentially.
I would agree that non drug treatments are first choice, more exercise, a natural diet with reduced salt in particular and weight loss are vital. In my 30 years experience, 7 to 10lbs weight loss will make a real difference to blood pressure.
Current accepted guidelines for treatment under 60 are diuretics such as HCT and ACE inhibitors like lisinopril, which I am on. Sorry guys, but ARB's, angiotensin reuptake blockers are not better, they avoid the dry cough suffered by 5 to 20% of ACE users, depending on the brand. That is the reason to use them. ACE inhibitors have been around longer and evidence for protecting end organs, particularly the kidneys, in diabetics, is stronger.
Over 60 I tend to use diuretics + calcium channel blockers like amlodipine, both are better at reducing systolic blood pressure which tends to be a problem in the older patient. Almost nowone uses Beta blockers first line, because of side effects and recent evidence that they fail to stop cardiovascular endpoints, a euphemism for strokes and heart attacks.
The National Health service may be Socialist medicine, but it is evidence based, protocol driven and audited. All English family doctors are computerised and anonymous data for how I treat patients is downloaded and I have to be able to justify it.
Sorry for the lecture, which I am sure you audiogon MDs will not agree with. |
Hi David12..I am a US pharmacist and I agree with your treatment protocol completely. It is very perplexing to me the pervasive use of ARB's. It seems like we love to make things more complex and expensive than we have to. With the graying population we see over here, I see a lot of overly complex treatment regimens in this group. These people are so over medicated, it is really pathetic. We really do need to get back to basics and practice evidence base medicine as you have suggested. Sometimes less is more. We in this country think medication is the answer to all of our ills. |
And who's to say the so called "side-effects" aren't the primary effect while the advertised "primary effect" isn't just a side effect?
Because no one would buy a pill whose main effect is stomach lining destruction with a side effect of reduced inflammation. It's all in the marketing. |
David 12 has the idea. SODIUM!!!! We Americans have way too much sodium in our diets. A general rule of thumb shopping is stay on the outside of the store, and stay away from the center aisle. Fresh fruit, produce, meats in moderation, dairy in moderation, frozen (not processed) are all on the outside of the store.
Highly processed foods, soups, canned (and preserved) foods, instant dinners (highly preserved) chips and snack food... all reside in the inner aisle.
Of course this is over simplified, and healthy food takes longer to make than pour, heat and eat, but sodium has the largest influence on blood pressure. Sodium is also very high in fast food and restaurant food. If you have a restaurant you frequent, ask the chef to hold the sodium and sodium intense additives. Do not eat fast food!
BTW, I am or have been on virtually all the meds discussed above. I am awaiting a heart transplant and my blood pressure is 68-72/42-45. Believe me I understand the feeling. |
Only about half of us are sodium sensitive to the point it has much bearing on blood pressure from what I've read. If you're among that half, it's a total pain to try and keep your sodium intake as low as it should be if you eat anything out of a package or from a restaurant. I know it does influence my bp to a degree, as does too much meat and alcohol. Modern western lifestyles are a huge contributor to the epidemic of high blood pressure. |
Hi Jadem,
Hope your feeling a little better and our family wish you the best!
Kind Regards,
Bob |
Indeed Jadem, good luck with your impending operation. You are right, that not everyone is salt sensitive. However on a population basis, I am not so sure. A study on Amazonian Indians some years ago, found there BP's were about 90/70 and they did'nt fall over when they stood up. The suggested reason is very low salt intake, high rainfall in the Amazon basin washes all the salt out of the soil.
Incidentally, if you look at salt intake, consider Bread. It is packed with salt, why? It lasts 6 days on the shelf, not 2, simple economics for the supermarkets. |
