Saturday, March 04, 2006
Hypertension Crisis?
a 55yo gentleman came to the clinic yesterday. a smoker, he had known hypertension, untreated for 2 years from lack of funds and health insurance. he recently lost some vision in his right eye, a few weeks ago, which motivated him to find a doctor. he had the highest blood pressure i've yet seen in my career. 250/140. he was clear that he wouldn't go to the hospital, too expensive. this raised ethical and legal questions for me. what is the right thing to do? he needs treatment, that is obvious, but where? in the clinic, in an ER, in a hospital setting? what does the research show? this is clearly a hypertensive urgency, perhaps even a hypertensive emergency (i would only know if i had more lab tools at my disposal). yet research is showing that if you drop the BP too fast, you place the patient at high risk of lots of complications, so outpatient treatment isn't necessarily wrong, it's just far from ideal. the benefit of the hospital is that you can monitor the patient, intervene immediately if he starts stroking or having a heart attack, you can monitor the blood for kidney function, etc. and all that costs thousands that this man doesn't have. but what would a jury say if he stroked out overnight or had a heart attack? would they understand patient choice, system limitations, the role of a consulting doctor giving good information even if a bad outcome happened, the limitations of the patients resources? so many questions. would they understand that his high blood pressure is caused significantly by his own actions, smoking tobacco, taking in alot of caffeine? does any of that count? i believe it must so i will stand my ground, practicing medicine without mal-practice, even if it feels a little foolish now and then. after counseling him on the importance of being in a hospital, i put him on norvasc 10mg daily and clonidine 0.1 mg three times a day, with a baby aspirin. i worried about this guy all night long. he was late to his clinic appointment today, making me more nervous. fortunately, he made it to the clinic, his BP was down to 200/135, he was feeling better, slept well, and is more committed to taking care of himself, now that he has an affordable option. he was still smoking though... i'll see him back on tuesday. andru
posted by andru |
3/04/2006 11:33:00 AM |
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| cure this! |
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We've MOVED! and grown!
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| what's "to the teeth"? |
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To the Teeth is a weblog discussing issues of health justice, medicine, race in America,
public health in its broadest sense, healthcare at a local clinic level, and honest discussions around strategies in advocacy. Ok, so it's not so focused, but it's all connected. The regulars who post to this site are:
Anjali Taneja, a resident physician in Family Medicine at Harbor-UCLA in Los Angeles,
California (a recent transplant from the east coast). She also blogs at Los Anjalis and the
Harbor-UCLA Family Medicine Residency blog. She's on the national leadership of the National Physicians Alliance and previously worked as the Jack Rutledge Fellow for Universal Health Care
& Eliminating Health Disparities at AMSA. She dj'ed for several years with the
M U T I N Y dj crew and currently DJs and produces electronic music. (email: movement-at-gmail-dot-com)
and Andru Ziwasimon, a family medicine physician in Albuquerque, New Mexico, and a lead member of the Community Coalition for
Healthcare Access, a diverse group of providers/patients/advocates addressing access issues with the state hospital system, translation and interpretation issues, billing for under and uninsured patients, and other disparities locally.
He created and runs a sustainable and innovative clinic that serves
uninsured patients with quality care and fair prices. He also serves on the leadership of the National Physicians Alliance. (email: aziwa-at-null-dot-net)
and Sri Shamasunder, a resident physician in Internal Medicine at Harbor-UCLA in Los Angeles, CA. He's passionate
about health justice, good music, and spoken word/poetry. (email: elsrizee-at-yahoo-dot-com)
"to the teeth" (idiom):
-> in opposition; directly to one's face
-> completely, fully
-> title of a song by Ani Difranco
-> alotta alliteration
For them RSS lovers (more about rss here), here's the atom site feed for To the Teeth.
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| hot links |
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Inspiring spoken word from Poetic License
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| dope orgs/sites |
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National Physicians Alliance
American Medical Student Association
The Peoples' Institute
Alternet
The Policy Action Network
The Principles Project
Common Dreams
No Free Lunch campaign
Kaiser Family Foundation
Families USA
Consumer Project on Technology
Campaign for a National Health Progam NOW
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| to the teeth archives |
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| poem: history |
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They caught the peasant walking home from the field.
On the dark road they gagged him and cut off his nose.
This they took to the museum and stuck to the king's noseless statue.
Thus was born the history that is taught in schools.
- Amitava Kumar, "History"
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| Willing to Fight |
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From Ani Difranco's "Willing to Fight":
"'cause i know the biggest crime
is just to throw up your hands
say
this has nothing to do with me
i just want to live as comfortably as i can
you got to look outside your eyes
you got to think outside your brain
you got to walk outside you life
to where the neighborhood changes"
Excerpts of lyrics to Ani Difranco's poem "Self-evident" (hear her recite this poem on her official website:
yes,
us people are just poems
we're 90% metaphor
with a leanness of meaning
approaching hyper-distillation...
here's a toast to the folks living on the pine ridge reservation
under the stone cold gaze of mt. rushmore
here's a toast to all those nurses and doctors
who daily provide women with a choice
who stand down a threat the size of oklahoma city
just to listen to a young woman's voice
here's a toast to all the folks on death row right now
awaiting the executioner's guillotine
who are shackled there with dread and can only escape into their heads
to find peace in the form of a dream
cuz take away our playstations
and we are a third world nation
under the thumb of some blue blood royal son
who stole the oval office and that phony election
i mean
it don't take a weatherman
to look around and see the weather
jeb said he'd deliver florida, folks
and boy did he ever
and we hold these truths to be self evident:
#1 george w. bush is not president
#2 america is not a true democracy
#3 the media is not fooling me
cuz i am a poem heeding hyper-distillation
i've got no room for a lie so verbose
i'm looking out over my whole human family
and i'm raising my glass in a toast
here's to our last drink of fossil fuels
let us vow to get off of this sauce
shoo away the swarms of commuter planes
and find that train ticket we lost
cuz once upon a time the line followed the river
and peeked into all the backyards
and the laundry was waving
the graffiti was teasing us
from brick walls and bridges
we were rolling over ridges
through valleys
under stars
i dream of touring like duke ellington
in my own railroad car
i dream of waiting on the tall blonde wooden benches
in a grand station aglow with grace
and then standing out on the platform
and feeling the air on my face
give back the night its distant whistle
give the darkness back its soul
give the big oil companies the finger finally
and relearn how to rock-n-roll...
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| subcity |
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Lyrics from Tracy Chapman's "Subcity"
People say it doesn't exist
'Cause no one would like to admit
That there is a city underground
Where people live everyday
Off the waste and decay
Off the discards of their fellow man
Here in subcity life is hard
We can't receive any government relief
I'd like to please give Mr. President my honest regards
For disregarding me
They say there's too much crime in these city streets
My sentiments exactly
Government and big business hold the purse strings
When I worked I worked in the factories
I'm at the mercy of the world
I guess I'm lucky to be alive
They say we've fallen through the cracks
They say the system works
But we won't let it
Help
I guess they never stop to think
We might not just want handouts
But a way to make an honest living
Living this ain't living
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| the revolution will not be televised |
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Lyrics from Gill Scott Heron's "The Revolution Will Not Be Televised"
You will not be able to stay home, brother.
You will not be able to plug in, turn on and cop out.
You will not be able to lose yourself on skag and skip,
Skip out for beer during commercials,
Because the revolution will not be televised.
The revolution will not be televised.
The revolution will not be brought to you by Xerox
In 4 parts without commercial interruptions.
The revolution will not show you pictures of Nixon
blowing a bugle and leading a charge by John
Mitchell, General Abrams and Spiro Agnew to eat
hog maws confiscated from a Harlem sanctuary.
The revolution will not be televised.
The revolution will not be brought to you by the
Schaefer Award Theatre and will not star Natalie
Woods and Steve McQueen or Bullwinkle and Julia.
The revolution will not give your mouth sex appeal.
The revolution will not get rid of the nubs.
The revolution will not make you look five pounds
thinner, because the revolution will not be televised, Brother.
There will be no pictures of you and Willie May
pushing that shopping cart down the block on the dead run,
or trying to slide that color television into a stolen ambulance.
NBC will not be able predict the winner at 8:32
or report from 29 districts.
The revolution will not be televised.
There will be no pictures of pigs shooting down
brothers in the instant replay.
There will be no pictures of pigs shooting down
brothers in the instant replay.
There will be no pictures of Whitney Young being
run out of Harlem on a rail with a brand new process.
There will be no slow motion or still life of Roy
Wilkens strolling through Watts in a Red, Black and
Green liberation jumpsuit that he had been saving
For just the proper occasion.
Green Acres, The Beverly Hillbillies, and Hooterville
Junction will no longer be so damned relevant, and
women will not care if Dick finally gets down with
Jane on Search for Tomorrow because Black people
will be in the street looking for a brighter day.
The revolution will not be televised.
There will be no highlights on the eleven o'clock
news and no pictures of hairy armed women
liberationists and Jackie Onassis blowing her nose.
The theme song will not be written by Jim Webb,
Francis Scott Key, nor sung by Glen Campbell, Tom
Jones, Johnny Cash, Englebert Humperdink, or the Rare Earth.
The revolution will not be televised.
The revolution will not be right back after a message
bbout a white tornado, white lightning, or white people.
You will not have to worry about a dove in your
bedroom, a tiger in your tank, or the giant in your toilet bowl.
The revolution will not go better with Coke.
The revolution will not fight the germs that may cause bad breath.
The revolution will put you in the driver's seat.
The revolution will not be televised, will not be televised,
will not be televised, will not be televised.
The revolution will be no re-run brothers;
The revolution will be live.
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