Problems with my GP...

I'm having a problem with my GP, and I'd like some advice. It sounds
like he is trying to hold my repeat prescriptions for insulin and
syringes (etc.) hostage to his views of what my treatment regime should
be. Can he legally do this? If he decides to throw me off his list,
what do I do from there - I'm looking for a new GP, but the only
practice whose normal coverage area includes my postcode is his. Others
slightly further afield might accept me, but it's not certain. Can I be
left with no means of getting insulin and syringes?

Background: I've been Type I since 1981, when I was 15. Over the last
2-3 years, I have had a couple of urine samples turn up (about a year
apart) with low levels of albumin, definitely at the microalbuminuria
level, but others without. My GP has expressed concern about this, even
though the big OCDEM clinic up at Oxford that took the samples doesn't
seem concerned and he referred me to see a renal specialist at the same
Oxford hospital where OCDEM is located. None of the conversations I've
had with doctors anywhere about this has taken into account my exercise
regime - half an hour of workout each weekday morning, plus five hours a
week of jujitsu. This is a "full contact sport" (no, it's not really a
sport at all, but it is full contact), involving body strikes and other
ways to get impact in the ribs and back, e.g. break-falling, being
thrown, ...

That visit is still pending. At my last local review, he looked at the
notes about the albumin, and decided that as nothing else had been done,
he would prescribe an ACE inhibitor, specifically Ramipril, (as he said
at the time) to help with the kidneys.

I've done some reading, and from what I have seen, Ramipril is normally
prescribed as a *blood pressure* medicine. So, let's talk about my
blood pressure. I have a history of high readings at doctors' offices,
which is a well-documented effect, sometimes called "white coat effect".
These days, I monitor it at home (twice daily), and have an average over
the last few months of about 127/68, average resting pulse rate 67. The
home readings go up to 140-145/75 or so when work is more stressful, and
when I've had less sleep than normal, and back down when work quiets
down and I get more sleep.

Anyway, on the visit when my GP prescribed the Ramipril, he asked me to
come back in after a couple of weeks for a second check of my blood
pressure. I phoned him yesterday to tell him that I cannot come in
before the New Year because I cannot get any more time off, and what
about the "next review" date on the last prescription form. Then he
said that he needs me to come back in so that he can do a blood test (?)
and check on how the Ramipril is doing. The Ramipril that he prescribed
for my blood pressure, that is. I haven't started taking the Ramipril
yet because I want to talk to the renal specialist first. I'm left with
the impression that he isn't concerned about the circumstances in my
life - the heavy, strenuous exercise called jujitsu, my home blood
pressure monitoring, my stressful job, anything. When I mentioned my
home results, it was like I'd been burbling about the weather.

It sounds to me like he is (a) telling me things that aren't true - is
the Ramipril for my blood pressure or my kidneys - and (b) holding me
hostage - getting repeat prescriptions from GPs is awkward in my
experience when the "review date" has passed. The surgery where he
works is the only one that covers the place where I live. There are a
couple of other practices in the area who will allow me to switch (they
also have more convenient hours) if my request is approved by a panel of
their GPs.

Other relevant facts: 5' 7"/170cm, 11st/70kg (not flab), last A1c 6.8,
good diet with low salt intake, 2.6 units alcohol/week. My fitness is
pretty good, better than some of the students (sometimes half my age)
who also do jujitsu.

Can anyone offer advice on the best way to proceed at this point?

Thanks in advance,
--
SteveR
(throw away the dustbin, send to stever@... instead)

This was found in family papers throughout the US:
http://www.chron.com/apps/comics/sho...e=Judge_Parker

- This is hopeless, Mr Parker...I'm a complete klutz!

- No, you're not, April, you've almost got it!

- Okay...now what do I do?

- Work them like a claw...and call me Randy!

http://www.accidentalcreditor.org.uk/

In article <mieUo9JoizeFJwwQ@grandfathersaxe.demon.co.uk>,
dustbin@grandfathersaxe.demon.co.uk says...
> Can anyone offer advice on the best way to proceed at this point?
>
go with the GP.

Ramipril is a first choice drug to help with both blood pressure and
protecting your kidneys. It is also important that you go back after
starting the ramipril to ensure there are no side effects.

He might want to do a liver function blood test to rule out any problem
there, which ramipril can cause in a small number of patients. I had
that done when I started on the stuff after the first month or so.

If anything your GP sounds more thorough than many. If he has prescribed
ramipril then start the treatment, it's a very common move and
especially for patients who have shown a few indicators as you have. It
seems to sit alongside statins and metformin as being a routine
medication for many diabetics.

Ratty

"SteveR" <dustbin@grandfathersaxe.demon.co.uk> wrote in message
news:mieUo9JoizeFJwwQ@grandfathersaxe.demon.co.uk. ..
> Can anyone offer advice on the best way to proceed at this point?

Could you get OCDEM to be your PCP for the diabetes? - I was quite impressed
with them when I visited a few weeks ago, they're on the ball, and I talked
Korean karate with one of the office types, so they might understand about
the exercise?

But as Ratty says, the Ramipril is fairly standard protective treatment.

Nicky.

--
A1c 10.5/5.5/<6 T2 DX 05/2004
100ug Thyroxine
95/72/72Kg

SteveR wrote in message ...
>I'm having a problem with my GP, and I'd like some advice. It sounds
>like he is trying to hold my repeat prescriptions for insulin and
>syringes (etc.) hostage to his views of what my treatment regime should
>be. Can he legally do this? If he decides to throw me off his list,
>what do I do from there - I'm looking for a new GP, but the only
>practice whose normal coverage area includes my postcode is his. Others
>slightly further afield might accept me, but it's not certain. Can I be
>left with no means of getting insulin and syringes?
>
>Background: I've been Type I since 1981, when I was 15. Over the last
>2-3 years, I have had a couple of urine samples turn up (about a year
>apart) with low levels of albumin, definitely at the microalbuminuria
>level, but others without. My GP has expressed concern about this, even
>though the big OCDEM clinic up at Oxford that took the samples doesn't
>seem concerned and he referred me to see a renal specialist at the same
>Oxford hospital where OCDEM is located. None of the conversations I've
>had with doctors anywhere about this has taken into account my exercise
>regime - half an hour of workout each weekday morning, plus five hours a
>week of jujitsu. This is a "full contact sport" (no, it's not really a
>sport at all, but it is full contact), involving body strikes and other
>ways to get impact in the ribs and back, e.g. break-falling, being
>thrown, ...
>
>That visit is still pending. At my last local review, he looked at the
>notes about the albumin, and decided that as nothing else had been done,
>he would prescribe an ACE inhibitor, specifically Ramipril, (as he said
>at the time) to help with the kidneys.
>
>I've done some reading, and from what I have seen, Ramipril is normally
>prescribed as a *blood pressure* medicine. So, let's talk about my
>blood pressure. I have a history of high readings at doctors' offices,
>which is a well-documented effect, sometimes called "white coat effect".
>These days, I monitor it at home (twice daily), and have an average over
>the last few months of about 127/68, average resting pulse rate 67. The
>home readings go up to 140-145/75 or so when work is more stressful, and
>when I've had less sleep than normal, and back down when work quiets
>down and I get more sleep.
>
>Anyway, on the visit when my GP prescribed the Ramipril, he asked me to
>come back in after a couple of weeks for a second check of my blood
>pressure. I phoned him yesterday to tell him that I cannot come in
>before the New Year because I cannot get any more time off, and what
>about the "next review" date on the last prescription form. Then he
>said that he needs me to come back in so that he can do a blood test (?)
>and check on how the Ramipril is doing. The Ramipril that he prescribed
>for my blood pressure, that is. I haven't started taking the Ramipril
>yet because I want to talk to the renal specialist first. I'm left with
>the impression that he isn't concerned about the circumstances in my
>life - the heavy, strenuous exercise called jujitsu, my home blood
>pressure monitoring, my stressful job, anything. When I mentioned my
>home results, it was like I'd been burbling about the weather.
>
>It sounds to me like he is (a) telling me things that aren't true - is
>the Ramipril for my blood pressure or my kidneys - and (b) holding me
>hostage - getting repeat prescriptions from GPs is awkward in my
>experience when the "review date" has passed. The surgery where he
>works is the only one that covers the place where I live. There are a
>couple of other practices in the area who will allow me to switch (they
>also have more convenient hours) if my request is approved by a panel of
>their GPs.
>
>Other relevant facts: 5' 7"/170cm, 11st/70kg (not flab), last A1c 6.8,
>good diet with low salt intake, 2.6 units alcohol/week. My fitness is
>pretty good, better than some of the students (sometimes half my age)
>who also do jujitsu.
>
>Can anyone offer advice on the best way to proceed at this point?
>
>Thanks in advance,
>--
>SteveR
>(throw away the dustbin, send to stever@... instead)


". . . .the last few months of about 127/68, average resting pulse rate 67.
The
home readings go up to 140-145/75 . . . ."

A bit on the high side.

". . .last A1c 6.8. . . ."

A1c of 6.8 correlates with 24/7 average bG of 164

A bit on the high side

" . . . . I have had a couple of urine samples turn up (about a year apart)
with low levels of albumin, definitely at the microalbuminuria
level, but others without. . . ."

Well, mine always turn up "non-detectable", so I consider "low levels" to
be a bit on the high side.

Sorry, but I don't see the problem with adding an ACE to your diabetes
therapy.

I know folks in trouble with kidney function. Very scary. I am quite
happy to take my ARB (took an ACE but developed the cough) My doc
prescribed an ACE because I produced too many systolic b.p. of 140-145
associated with stressful times at work.

FWIW, ACE and ARB have some weird effects on kidneys. When you surf the
medical literature, kidney-protective effects independent of blood
pressure effects are cited over and over again.

1. Manley, HJ. Role of angiotensin-converting-enzyme inhibition in patients
with renal disease.
American Journal of Health-System Pharmacy, 2000 Oct 1, 57 Suppl 1:S12-8.

". . . .. Patients with diabetes or hypertension are at increased risk for
development of renal disease. . . .Therapy with enalapril [ACE] or
lisinopril [ACE] has been shown to limit the progression of renal disease in
normoalbuminuric patients with diabetes. Long-term therapy with enalapril
(up to seven years) has demonstrated the ability to preserve renal function
in patients with diabetes and microalbuminuria. Over 4.5 years, patients
with diabetes and at least one other cardiovascular risk factor had
significant reductions in the risk of overt
nephropathy with ramipril [ACE] therapy compared with placebo. . . ."

". . . .These positive effects of ACE inhibition cannot be explained by
reductions in blood pressure alone. ACE inhibitors have renoprotective
properties beyond systemic blood pressure reduction. . ."

2. http://www.medscape.com/viewarticle/532233?src=mp

". . . BENEDICT is the first large scale trial to demonstrate that
development of microalbuminuria can be reduced in hypertensive patients with
type 2 diabetes and normal urinary albumin excretion. . . ., reduction in
the onset of microalbuminuria exceeded expectations based upon reduction of
BP alone. Given the alarming CV mortality and nephropathy associated with
microalbuminuria, BENEDICT adds to an already compelling case for ACE
inhibition as a first-line antihypertensive therapy in type 2 diabetes. . ."

3. http://www.kidney.org/atoz/atozItem.cfm?id=37

". . . .About 30 percent of patients with Type 1 (juvenile onset) diabetes
and 10 to 40 percent of those with Type 2 (adult onset) diabetes eventually
will suffer from kidney failure. . . .The earliest sign of diabetic kidney
disease is an increased excretion of albumin in the urine. This is present
long before the usual tests done in your doctor's office show evidence of
kidney disease. . . ."

4. http://kidney.niddk.nih.gov/kudiseas.../kdd/index.htm

". . . .Diabetes is the most common cause of kidney failure, accounting for
nearly 45 percent of new cases. Even when diabetes is controlled, the
disease can lead to nephropathy and kidney failure. . . .The benefits of
captopril [ACE] extend beyond its ability to lower blood pressure: it may
directly protect the kidney’s glomeruli.

ACE inhibitors have lowered proteinuria and slowed deterioration even in
diabetic patients who did not have high blood pressure. . ."

Regards
Old Al

"SteveR" <dustbin@grandfathersaxe.demon.co.uk> wrote in message
news:mieUo9JoizeFJwwQ@grandfathersaxe.demon.co.uk. ..
>
> I'm having a problem with my GP, and I'd like some advice. It sounds
> like he is trying to hold my repeat prescriptions for insulin and
>
> Can anyone offer advice on the best way to proceed at this point?
>

Most folks who do as their doc advises will live a little bit longer than
those that don't. I'd do as the doc suggests. People on news groups don't
know you or your medical history as well as your doc... I'd be very cautious
on advice you receive from someone on a news group.

Slap wrote:
> "SteveR" <dustbin@grandfathersaxe.demon.co.uk> wrote in message
> news:mieUo9JoizeFJwwQ@grandfathersaxe.demon.co.uk. ..
> >
> > I'm having a problem with my GP, and I'd like some advice. It sounds
> > like he is trying to hold my repeat prescriptions for insulin and
> >
> > Can anyone offer advice on the best way to proceed at this point?
> >
>
> Most folks who do as their doc advises will live a little bit longer than
> those that don't. I'd do as the doc suggests. People on news groups don't
> know you or your medical history as well as your doc... I'd be very cautious
> on advice you receive from someone on a news group.

Bingo!!

Best,
Kurt

Don't worry about taking Ramipril. I've been taking it for a while
with no ill effects. As my endocrinologist says, he'd prescribe it in
a heartbeat for diabetics, even those not having particularly high
blood pressure. The idea is to proactively protect your kidneys, which
is a serious issue when there are *any* readings of microalbuminuria.
I've never had microalbuminuria (I do have slightly elevated blood
pressure) and yet I still take the Ramipril.

Slap wrote:
> "SteveR" <dustbin@grandfathersaxe.demon.co.uk> wrote in
message
> news:mieUo9JoizeFJwwQ@grandfathersaxe.demon.co.uk. ..
>>
>> I'm having a problem with my GP, and I'd like some
advice. It sounds
>> like he is trying to hold my repeat prescriptions for
insulin and
>>
>> Can anyone offer advice on the best way to proceed at
this point?
>>
>
> Most folks who do as their doc advises will live a little
bit longer
> than those that don't. I'd do as the doc suggests.
People on news
> groups don't know you or your medical history as well as
your doc...
> I'd be very cautious on advice you receive from someone on
a news
> group.

There has also been no mention of how the OP's doc is
attempting to withhold the insulin scripts. Is the doc
actually doing it or threatening it? Sounds also like the
doc has just prescribed a medication (the ACE) without
actually doing much explaining. Sounds like a communication
problem more than anything.

Kurt <kurtwheeling1965@hotmail.com> wrote:

: Slap wrote:
: > "SteveR" <dustbin@grandfathersaxe.demon.co.uk> wrote in message
: > news:mieUo9JoizeFJwwQ@grandfathersaxe.demon.co.uk. ..
: > >
: > > I'm having a problem with my GP, and I'd like some advice. It sounds
: > > like he is trying to hold my repeat prescriptions for insulin and
: > >
: > > Can anyone offer advice on the best way to proceed at this point?
: > >
: >
: > Most folks who do as their doc advises will live a little bit longer than
: > those that don't. I'd do as the doc suggests. People on news groups don't
: > know you or your medical history as well as your doc... I'd be very cautious
: > on advice you receive from someone on a news group.

: Bingo!!

: Best,
: Kurt

If you notice, Krt and slap, most of the responses have been tellin this
poster that he should go along with his GP and take the Ramipril, as
recommended.

Wendy

[[ This message was both posted and mailed: see
the "To," "Cc," and "Newsgroups" headers for details. ]]

In article <mieUo9JoizeFJwwQ@grandfathersaxe.demon.co.uk>, SteveR
<dustbin@grandfathersaxe.demon.co.uk> wrote:
>
> I've done some reading, and from what I have seen, Ramipril is normally
> prescribed as a *blood pressure* medicine.

FWIW, and YMMV, I was diagnosed about a year ago as Type II and was
immediately put on Ramipril by my PCP and endocrinologist, with the
stated reason of "to protect my kidneys."

My normal blood pressure is 90/45.

A quick look at Wikipedia finds under the article at
http://tinyurl.com/yekbgq

> Clinical use Indications for ACE inhibitors include:

<snip>

> € Prevention of nephropathy in diabetes mellitus

--
To reply, substitute .com for .invalid in address, i.e., john.101a (at)
*yahoo.com

Of all the things I have been thru wih my diabetes, it is the seeming
lack of communication between me and the various docs, that challenges
me the most. Fix this ASAP, before it makes you do something like
witholding meds, because you don't trust what they are for. Am I too
late for that!? If it will make you feel
better, I too, have that white coat thing ... 170/90 in the dr's ofc
100/60 at home. Find a way to make the
doc talk to you. I just got a new one that I hate! He talks in circles
and his info is really old fashioned, and he simply will not listen to
me. We're going to get "divorce" real soon, but since I am on public
assistance, at the moment, I got who I got.
I shouldn't tell this part of the story, but I will. I saw him on a
Thursday and the next day I was at the hopsital with my sister for her
appt. I was guarding the bathroom door whie e was in it, and who came
walking by but this new doc. Now, understand, I was not behaving in a
deceptive way, but I do wear differnt wigs alot. (It;s fun, it;s less
expensive than getting my hair done, and I can have a variety of looks).
This guy was a total jerk to me in his office. I mean, REALLY a pig. I
was not wearing the same hair, and I was wearing a rather large piece of
my beaded artwork, which I had been wearing in his office. He smiled at
me, not knowing at all who I was ... and remarked on the necklace. He
was so sweet about it, I did not identify myself because I was intrigued
about his behavior ... I have seen him twice since then in the hall.
Bith times he was polite. But a couple of days ago, was wearing the
same wig, I had on in hs office. He was very rude to me. To be fair, I
was kinda foolin' him, I did;t give him any indication of who I really
was ... All the same, it kinda hurt my feelings, to see hi interacting
with others and me, when he didn;t know me, in a nice way, but a total
jerk to the woman in hs office. He mad no attemptat all to build any
kind of relationship with me on our visit, and was so negative and rude.
I was completely disappointed. I was complaining of low blood pressure
and some other problems and he just didn;t give a remote shit. I was
not rude or demanding at all. In fact he entered the room in a "mood".
In regard to my weigt, BG's and BP and diet, he actually called me a
liar. The way it ended up, I did not get my questions answered at all. I
was kinda tryin' to wait it out a little longer, but I am going to have
to see about getting some medical attention really soon, and bypass
this jerk. Because of the "system" of public assistance here, it is
practically impossible to change the doc you get. My alternative is to
present myself at an emergency facility, or quick care, and have myself
checked out, in regard to the problems. I actually am planning the day
go, so that it goes in my chart and he has to ackknowledge it. Oh, and I
have already altered my lab request to get studies I thought I needed,
at that time. I did this one time before, about 4 years ago ... It just
required a little check mark! LOL! I'l just blame it on whomever handed
me the request form! Gee, somebody messed up!
Rainbow

John101 wrote in message <091220061920408083%john.101a@yahoo.invalid>...
>
>FWIW, and YMMV, I was diagnosed about a year ago as Type II and was
>immediately put on Ramipril by my PCP and endocrinologist, with the
>stated reason of "to protect my kidneys."
>
>My normal blood pressure is 90/45.
>
>

I've heard that from others, all medical professionals. . .i.e. it's a
good idea to put all diabetics on an ACE, even those with normal blood
pressures.

When the medical cites assert that:

". . . .These positive effects of ACE inhibition cannot be explained by
reductions in blood pressure alone. ACE inhibitors have renoprotective
properties beyond systemic blood pressure reduction. . ."

or

". . . .The benefits of captopril [ACE] extend beyond its ability to lower
blood pressure: it may directly protect the kidney’s glomeruli. ACE
inhibitors have lowered proteinuria and slowed deterioration even in
diabetic patients who did not have high blood pressure. . ."

it gets your attention.

Regards
Old Al

Ozgirl wrote:
> actually doing it or threatening it? Sounds also like the
> doc has just prescribed a medication (the ACE) without
> actually doing much explaining. Sounds like a communication
> problem more than anything.

The doc seemed to be pretty clear why he was prescribing the ACe ...
"At my last local review, he looked at the
notes about the albumin, and decided that as nothing else had been
done,
he would prescribe an ACE inhibitor, specifically Ramipril, (as he said

at the time) to help with the kidneys."

SteveR wrote:
> That visit is still pending. At my last local review, he looked at the
> notes about the albumin, and decided that as nothing else had been done,
> he would prescribe an ACE inhibitor, specifically Ramipril, (as he said
> at the time) to help with the kidneys.
>
> I've done some reading, and from what I have seen, Ramipril is normally
> prescribed as a *blood pressure* medicine. So, let's talk about my
> blood pressure. I have a history of high readings at doctors' offices,
> which is a well-documented effect, sometimes called "white coat effect".
> These days, I monitor it at home (twice daily), and have an average over
> the last few months of about 127/68, average resting pulse rate 67. The
> home readings go up to 140-145/75 or so when work is more stressful, and
> when I've had less sleep than normal, and back down when work quiets
> down and I get more sleep.
>
> Anyway, on the visit when my GP prescribed the Ramipril, he asked me to
> come back in after a couple of weeks for a second check of my blood
> pressure. I phoned him yesterday to tell him that I cannot come in
> before the New Year because I cannot get any more time off, and what
> about the "next review" date on the last prescription form. Then he
> said that he needs me to come back in so that he can do a blood test (?)
> and check on how the Ramipril is doing. The Ramipril that he prescribed
> for my blood pressure, that is. I haven't started taking the Ramipril
> yet because I want to talk to the renal specialist first. I'm left with
> the impression that he isn't concerned about the circumstances in my
> life - the heavy, strenuous exercise called jujitsu, my home blood
> pressure monitoring, my stressful job, anything. When I mentioned my
> home results, it was like I'd been burbling about the weather.
>
> It sounds to me like he is (a) telling me things that aren't true - is
> the Ramipril for my blood pressure or my kidneys

You're being overspecific. It's for BOTH.

It will lower your blood pressure a bit.

The ACE inhibitor is generally a good thing for your kidneys.

Lowering your blood pressure is also a good way to lower both
microvascular and macrovascular risks. One microvascular risk is long
term kidney damage from decades of Type 1 diabetes (and there are many
other potential risk factors too).

Others here will disagree, but in my personal case (borderline high for
many years blood pressure, deep family history in males of heart
disease, Type 1 for decades) the ACE inhibitor (Altace, which is
Ramipril) the doc put me on first was pretty much a "no-brainer". It
sounds like you are in a very similar situation.

AND while the risks of ACE inhibitors are generally very minor, there
are some people who have adverse reactions to certain kinds. Your
doctor is ethically bound to recommend and pressure you to come back or
at the very least "phone in" what progress and/or side-effects you
might be having.

> and (b) holding me
> hostage - getting repeat prescriptions from GPs is awkward in my
> experience when the "review date" has passed.

Can't help you much there, here in the US insulin and supplies are
available over the counter.

But I highly encourage you to do some research on your own and discover
that what you've described your doctor doing is entirely typical of
what a GP who cares about his patients might recommend. Your doc may be
a bit on the "don't explain it, just prescribe it" end but you're a
bright guy, you can do the research yourself.

I myself have a hard time getting advice from professionals when I
think I know what's best myself. But please try to listen and do a
little research yourself in this case. Getting time off to see a doc
might sound somewhat difficult to you right now, but try balancing a
job with a family and three kids and I think you'll realize that it
actually isn't all that hard. You seem to really like your jujitsu, and
that's great, but giving a couple hours of that up to see your doctor
and read up on research might not be the worst thing in the world.

Tim.

It doesn't sound to me like he's holding you hostage, per se, just that
he's determined to do the appropriate follow-up blood work vis-a-vis
your prescription. Which is, of course, quite right for him to do given
that it's recommended he do so when you're on the meds and he doesn't
know you're not taking it.

And that is not his fault, but yours. You don't *have* to do what a
doctor recommends, but he needs to know. He's assuming you're taking
the stuff because you haven't told him differently.

There's nothing wrong with saying, "I need you to answer some questions
about this before I begin taking it," or "I want to do my own research
before I start on this drug" or "I want a second opinion before I start
on this drug" or even "I just flatout don't want to be on this drug." I
am a rather ornery patient myself that way sometimes, insisting on
knowing what the heck is going on and sometimes disagreeing when I do
know.

But... you need to have the nerve to have these conversations, rather
than just accepting the prescription and not taking it, leaving your
doctor in the dark. He thinks you're taking it and therefore wants to
follow-up with you. This is not some dark, sinister threat he's doing
here! He's acting on the information he's got.

In your head, you've blown this up into him firing you as a patient for
not doing what he wants when you haven't even discussed it with him!

That seems kinda passive-aggressive to me.

At the very least, call the office and tell them you don't need the
followup blood work just yet because you haven't started the script.
Tell them you have concerns about it, so you haven't started yet, and
make an appointment for January to get your questions answered. And
then do some research on your own so you have enough information to
discuss it in an informed manner.

shoppa@trailing-edge.com writes:
>SteveR wrote:
>> That visit is still pending. At my last local review, he looked at the

[snip]

>> home results, it was like I'd been burbling about the weather.
>>
>> It sounds to me like he is (a) telling me things that aren't true - is
>> the Ramipril for my blood pressure or my kidneys
>
>You're being overspecific. It's for BOTH.

That's fine, but the way he talks to me, it sounds like he can't make
his mind up why he prescribed it - at first he said it was for the
kidneys and didn't mention the blood pressure, and then it was the
opposite. *That's* what bothers me.

>It will lower your blood pressure a bit.
>
>The ACE inhibitor is generally a good thing for your kidneys.
>
>Lowering your blood pressure is also a good way to lower both
>microvascular and macrovascular risks. One microvascular risk is long

[snip]

>at the very least "phone in" what progress and/or side-effects you
>might be having.

OK, I don't have a problem with that. It bothers me that he hand-waved
the question of side effects - "oh, take it at night because it can
produce dizziness." "any other effects?" "mumble mumble a bit of this,
some of the usual stuff." The doctor also knows that I often don't get
more than 4-5 hours sleep, and yet he doesn't appear to be worried about
the fact that the dizziness may run into the time when I have just got
up first thing in the morning.

>> and (b) holding me
>> hostage - getting repeat prescriptions from GPs is awkward in my
>> experience when the "review date" has passed.
>
>Can't help you much there, here in the US insulin and supplies are
>available over the counter.

That was nixed over here in the UK about ten years ago. Blood glucose
testing gear is available over either off the shelf (the meters) or over
the pharmacist's counter (strips and lancet sharps), although the prices
are a bit steep. Insulin and syringes require a prescription.

>But I highly encourage you to do some research on your own and discover
>that what you've described your doctor doing is entirely typical of
>what a GP who cares about his patients might recommend. Your doc may be
>a bit on the "don't explain it, just prescribe it" end but you're a
>bright guy, you can do the research yourself.

I have done, and I'm not entirely happy about the side effects of this
thing, especially since the doctor's mumble mumble list didn't match the
list I found through research.

>I myself have a hard time getting advice from professionals when I
>think I know what's best myself. But please try to listen and do a
>little research yourself in this case. Getting time off to see a doc
>might sound somewhat difficult to you right now, but try balancing a
>job with a family and three kids and I think you'll realize that it
>actually isn't all that hard. You seem to really like your jujitsu, and
>that's great, but giving a couple hours of that up to see your doctor
>and read up on research might not be the worst thing in the world.

Actually, giving up the jujitsu won't help me see the doctor - the
sessions are well outside his office hours during the week, or they are
on weekends when his surgery is closed. Getting time off work is very
hard at this time of year, as my paid leave for the year is all used up,
and my company is (by British standards) fairly stingy with it anyway. I
don't suppose the NHS will write me a cheque to cover the loss of income
if I take unpaid leave (my company's policy on unpaid leave means it has
to be take in week-sized chunks).

I work 50+ hour weeks with a two-hours-each-way commute as a senior
programmer in "the City" - i.e. the City of London, the UK's equivalent
of Wall Street - and I didn't get to this position by cooling my heels
in doctors' surgeries. I pay a third of my salary as income taxes
(including my National Insurance contribution), and yet the NHS
discriminates against working people like me by not requiring NHS
doctors' practices to provide office hours that I can easily attend.
What's worse is that I have had problems getting in touch with this
doctor because he does half-day medical visits (probably paid) to a
local recuperation/rehab centre for police officers, plays golf during
office hours, and I even had an appointment cancelled by the surgery so
that my doctor could go and do charity work!

If the NHS was serious about making sure that working people can see
their doctors, they should allow people to sign up with a doctor where
they *work* rather than where they *live*. As it stands, GPs surgeries
are largely the preserve of old people, stay-at-home mothers and the
unemployed, none of whom actually pay to operate the NHS.

end-of-rant.

--
SteveR
(throw away the dustbin, send to stever@... instead)

This was found in family papers throughout the US:
http://www.chron.com/apps/comics/sho...e=Judge_Parker

- This is hopeless, Mr Parker...I'm a complete klutz!

- No, you're not, April, you've almost got it!

- Okay...now what do I do?

- Work them like a claw...and call me Randy!

http://www.accidentalcreditor.org.uk/

SteveR wrote:

snipped lots of interesting stuff

> As it stands, GPs surgeries
> are largely the preserve of old people, stay-at-home mothers and the
> unemployed, none of whom actually pay to operate the NHS.
>
> end-of-rant.
>

Be careful Steve or you'll be first in line for the pensioners curse
upon that angry head if yours. I'm in my 70's, worked all my life so
therefore paid for my NHS treatment, been on insulin for more than 50
years and don't have any complications at all. I'm in this situation
because I listened to my doctors throughout each of those 50 years and
my God I was challenge to them sometimes.

I understands your anger and frustration but take care with your
comments about us oldies. Our curse will make you suffer. So, apologise
now!

Tom

Peter C wrote:
> Ozgirl wrote:
>> actually doing it or threatening it? Sounds also like the
>> doc has just prescribed a medication (the ACE) without
>> actually doing much explaining. Sounds like a
communication
>> problem more than anything.
>
> The doc seemed to be pretty clear why he was prescribing
the ACe ...
> "At my last local review, he looked at the
> notes about the albumin, and decided that as nothing else
had been
> done,
> he would prescribe an ACE inhibitor, specifically
Ramipril, (as he
> said
>
> at the time) to help with the kidneys."

I think if the doc had clarified that although his BP may
not need treating it was still beneficial to take the ACE
for the kidney protection, it seems the OP was given half
the story which sent him off researching. It was my
impression that the doc didn't actually say that the ACE was
predominantly a BP med. At that point the OP went off
searching and and found it was a BP med. The fact that the
OP says he is wondering whether the med is for his BP or
kidneys "It sounds to me like he is (a) telling me things
that aren't true - is
the Ramipril for my blood pressure or my kidneys" is
indicitive of not enough info from the doc when he
prescribed the med.