| T: hi Michael it's good to see ya well glad you came in today when I douse up | |
| C: well I came back here because I had to I had to make an appointment so I could get my prescription for my blood pressure medicine refilled and they wouldn't do it it wouldn't refill it it's a drugstore unless I came back here so | |
| T: you're you're angry what | |
| C: well I'm not angry at you but I'm angry at the situation and I gotta come back in here take time off from work just to get that prescription filled but but you know you do what you got to do and | |
| T: well I appreciate your bringing that up that is does sound frustrating but by coming in it gives us a chance to to sit down and and and talk and see how things are going with the medication which is what I'm most concerned about I know we started at about three months ago or so and I am real interested to hear how you're how you're doing on | |
| C: well uh yeah whenever I get my blood pressure checked at the drugstore it looks like I'm that it's working and that respect but it does seem to take away all my energy you know | |
| T: kind of fatigued | |
| C: yeah yeah my I got no get up and go if you know what I mean | |
| T: so kind of has taken the wind out of your sails | |
| C: absolutely yeah | |
| T: how long have you noticed that oh I don't know I | |
| C: at least since I've been on this medication at least that long yeah | |
| T: doesn't sound like it's working well too working too well for you have you tell me about how you're taking the medication have you taking it very regular | |
| C: oh yeah I take it I take it just like it says take it on the bottle you know I take it every morning when I get up | |
| T: okay so you've been pretty consistent and taken the | |
| C: all yes | |
| T: anything else going on in terms of symptoms no just this overall lack of energy which I know my wife doesn't particularly care for | |
| T: your wife tell me a little bit more about how it affects the relationship between the two of you | |
| T: well as I say I get up and go got up and went and there's not much going on between the two of us like there used to be | |
| T: so sexual performance is not as good as it as it might be | |
| C: nope but I think it's because of that damn medicine | |
| T: so does this sound like something that you want to continue or should we talk about possibly other other options for you it sounds like it's kind of affecting your life negatively | |
| C: well yeah yeah but you know I I'm worried about my blood pressure because my my mother had a stroke not long ago and I know it was so they told us it was because of her high blood pressure so I don't want that to happen to me | |
| T: soyou're concerned about having a stroke | |
| C: well yeah I mean would you be you know it sort of runs in families I think | |
| T: yeah so taking care of your blood pressure is is very important to you | |
| C: yeah yeah absolutely | |
| T: again it doesn't sound like this particular medicines working out too well for you if it's okay I could talk to you about possibly changing the medication so on the one hand we'd be keeping your blood pressure under control but on the other hand we wouldn't be causing these types of side effects hopefully would that be okay | |
| C: well are you talking about on more medications or just a different medication | |
| T: yeah so uh I think probably it sounds to me like probably changing medications at this point as a start we can always add another medication later if that becomes necessary | |
| C: yeah well I'm not real interested in adding any more but if changing it it would keep my blood pressure down but not take away all my energy than I might that give better idea | |
| T: so you'd at least be willing to try a change and and see how that goes | |
| C: yeah yeah I know | |
| T: well if it's okay I can tell you about a group of medications that I I like but if but first if it's okay that they give you a kind of my rationale for using that medication to start with so you know one of the things you'd mentioned to me was some of the financial concerns and the medication that you're on is pretty dirt-cheap and for most people at this dose particularly a low dose because you have mild hypertension most of the time it doesn't have many side effects obviously for you that was different does that make sense | |
| C: yeah yeah | |
| T: so the medication I'm thinking about is something called an ACE inhibitor ACE inhibitors are very very well tolerated and occasionally people will get a dry hacky cough with them but it's fairly rare but there's very low risk of side effects in terms of sexual side effects in particular and most people as a matter of fact it's one of the the drugs that actually helps your heart beat a little bit stronger and better and many people don't have any kind of a decrease in their energy so how does that sound | |
| C: yeah it sounds though it sounds like a good idea if it still controls my blood pressure but doesn't take away my energy it sounds like a good idea | |
| T: okay so what other things can you tell me about that might affect your blood pressure | |
| C: uh-ohuh-oh my work is sometimes stressful and some of the people I work with kind of drive me a little batty occasionally and I I don't know if it I don't really know if that it causes my blood pressure to go up or not but it certainly could I guess so there's some stressors at work | |
| T: yeah and if it's okay I'm going to write down some of these things that as we talk through them so what else can affect blood pressure that you know of | |
| C: um well you know just mostly from watching TV shows I guess I am aware that alcohol and I drink some a moment that alcohol has some effect on blood pressure I think it might even say so on the label though I'm not sure it can't | |
| T: it can't anything else you can think of | |
| C: no | |
| T: well sometimes sometimes weight can be an issue and explain this little tool to you this is for what it's worth called a agenda mapping so it sounds like there's a number of things that you know of and then we can talk about that affect your blood pressure you mentioned stress and an alcohol and we talked about weight certainly you know blood pressure medication can affect you there and I would say another big one might be exercise does all that makes sense | |
| C: well yeah | |
| T: so we could we can talk about a lot of these things with which one might you want to talk about and if we need to we can set up for appointment and talk about this more if we run out of time but | |
| C: well um exercise I'm I actually like to exercise and | |
| T: tellme about the exercise that you're doing well I play golf and walk the golf course so you carry your bag or do | |
| C: Idrag it along on a pull cart my wife says that that doesn't count as exercise but I say try it yourself it is exercise | |
| T: it is exercise it is exercise Michael look at your your weight when we came in yeah and you were about or so yeah which is actually according to your BMI body mass index in the in the overweight range how do you feel about that | |
| C: well I don't think I'm overweight | |
| T: yeah you don't look terribly overweight but according to the the charts there it's in the overweight category so you're actually getting you into the normal category would be about a loss of about to pounds | |
| C: or pounds | |
| T: yes or pounds | |
| C: I haven't weighed that since I was in high school | |
| T: I understand I understand but you know I'm not saying that we need to lose pounds sometimes just a loss of pounds can make a tremendous impact on your on your blood pressure okay so pounds sounds like something that might be negotiable | |
| C: | |
| T: is the number okay let's go you do with thigh okay I think I can do all right so if you were to want to lose pounds how would you go about it | |
| C: I'd probably go back to the gym | |
| T: has that worked in the past | |
| C: yeah I mean I used to go to the gym and work out a lot and uh I've done it for a while but I guess if if I'm I'm sure I could lose pounds if I wanted to | |
| T: and that would actually kind of take care of two of these things right your weight and your exercise both of those would have a really positive effect I think on your on your blood pressure | |
| C: okay well | |
| T: sowe've talked about changing your medication stopping the medication you're on changing you to this ACE inhibitor and then perhaps looking at the weight and going getting back to the gym and starting an exercise program is that about right | |
| C: well what would it take for me to not have to take the medication at all | |
| T: at all | |
| C: yeah I mean if I did enough exercise and lost enough weight would you not what I not need to take the medicine | |
| T: I I really wonder if you would I think that's an excellent question and if you're motivated to lose that kind of weight I'm with you I can't leave I this good | |
| C: I can lose five pounds well | |
| T: it may it may take more than five pounds to get the desired effect on your blood pressure that's really getting back down into that normal weight range if you will in that one to range probably | |
| C: I I just want to make sure I understand if I if if I lose uh five pounds and I do it through exercise that I could you would recommend that I try going without the medicine for a while too and see what happens | |
| T: I don't think I'm ready to go there yet Michael but it sounds to me like you want to get off of your medication | |
| C: yeah if I can yeah | |
| T: well itthere it's a blood pressure rate that you are right now blood pressure number that you are right now I probably wouldn't recommend that that that's going to take a plan for us to work out over probably a period of months so that you could one lose a little bit more weight to exercise really regularly we might want to talk about the alcohol um can I ask you how much your you're drinking now our regular basis | |
| C: two or three beers a day | |
| T: two or three yeah it is okay I'd like to share with you a little bit of information about alcohol and its effect on blood pressure Merryn research has shown that for men more than two drinks a day and for what more than one drink a day really can significantly impact your blood pressure negatively it raises blood pressure how does that how does that sit with you | |
| C: you're saying two or three more than two more than three okay so two is still considered aa safe and regard to blood pressure | |
| T: that's what most of the research shows | |
| C: okay I'll do two | |
| T: you'll do two okay and you said that you did two three every day most every day yeah sometimes a little more on the weekend I guess | |
| T: can youthink of any ways to maybe cut back on that to where you wouldn't be getting as much alcohol in your system on a regular basis | |
| C: oh yeah I guess I could you know I mean uh I you know I don't I I don't have a drinking problem so I could take a day or two and not drink at all if but if if two a day doesn't hurt my blood pressure um I think I could go with that | |
| T: so two a day um keep in mind too there are significant amounts of calories involved and alcohol particularly beer | |
| C: Isuppose I could drink Light beer | |
| T: light beer doesn't appeal to you | |
| C: might as well not drink beer at all you drink Light beer but I suppose if I suppose I could do that | |
| T: scale of zero to ten zero being not willing at all to do that ten being very willing to do that where do you think you | |
| C: probably about it I | |
| T: why did you say a five and not a three or four | |
| C: just because uh you know doc habits are hard to break you know and it usually don't drink Light beer and so it would be a change it would be something different but uh well you know I'm willing to give it a try | |
| T: tell me the good things about cutting back on alcohol and maybe switching to light beer talking about the good things well I did you know | |
| C: obviously a good thing is I'd probably lose weight which is what we're trying to do here | |
| T: so you'd lose weight | |
| C: uh and there there may be other things about alcohol that has something to do with blood pressure that I did not understand but but I suppose it would help keep my blood pressure down and my weight low or if I didn't drink as much beer or if I drank light beer and so that's the good side the bad side is I don't like it as much | |
| T: on ascale of zero to ten zero being not very important and ten being very important how important is it for you to to get better control of your blood pressure | |
| C: very important I put that up really pretty high I'll give that a nine | |
| T: so interms of making a change what are some of the things that you'd be willing to do in order to make that happen | |
| C: well you know I'm willing to do the things but most of what we've just talked about which are um drinking Light beer drinking no more than two beers a day going to the gym again and sticking with a different medicine for a while | |
| T: okay so to recap changing your medication you're willing to go to the gym and exercise switch to light beer and keep the beer to a maximum of two a day okay now only you can make that decision Michael I can't do it for you is that somewhere that you're willing to go | |
| C: yeah I think I'm willing to do what it takes to keep my blood pressure at a level that doesn't concern me and if this is what it takes I'm going to give this a try | |
| T: so one more scale in terms of your readiness to make to do this zero being not ready at all and ten being ready where would you fall on that | |
| C: six and a half | |
| T: six and a half and watch six and a happen and not two or three | |
| C: because I know when I walk out of here that if I keep doing what I'm doing I I'm either going to have to live with the blood pressure medicine that takes all my energy away and I don't like that or I'm going to have to let my blood pleasure get real high and I know that can cause all sorts of bad things to happen | |
| T: so you're really worried again about the health consequences of not keeping your blood pressure under control | |
| C: people keep telling me that high blood pressure causes all sorts of bad things to happen so yes I am concerned about | |
| T: that so if it's okay I'm going to put this in your record that we talked about well we're certainly going to switch your medication but you're going to be working on losing some weight going back to the gym cutting down on your beer usage and switching to light beer is there anything I missed | |
| C: five pounds | |
| T: fivepounds that's the number now I'd like to see you back and about let's call it a month let's see back in a month | |
| C: I'm the five pounds going by then my | |
| T: pounds will be gone and we'll see how things are going and probably talk about this some more and see how successful you've been with this plan and then we'll go from there |