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Chronicles of the Heart – Part 11…

Posted May 28 2011 3:37pm

I’m losing weight. So what, you might think? Well, I’ve been eating one meal a day since about 2002, and yet I’ve been unable to get, and remain, much below 15stone.

Since my heart failure diagnosis, and steady diet of diuretics, I pretty promptly lost half a stone, taking me to 14st 7lb, and there I stuck.

Yesterday, though, seeing myself in the bathroom mirror, my face looked positively gaunt, and white as a sheet – one of those very rare times in my life when I actually look ill. This morning, then, I remembered to weigh myself – 14st 4lb (90.7kg) – I suspect many Brits still grasp stones and pounds more readily in terms of body weight.

So, 3lb gone since I last weighed myself, a few days ago. And that makes me wonder – just how long have I been retaining fluid? How much of my intransigent weight isn’t flab but liquid?

I have a problem – if I get breathless there is no possibility of my knowing, most of the time, if the cause is my heart or my lungs. Certainly, when I get breathless doing sod all, like just sitting typing, that has to be my heart, but in the normal course of events, breathless is my natural state – I just can’t ascribe it, most of the time, to heart or lungs.

And did I ever have a job explaining that to the idiot doctor on Thursday! Does you heart make you breathless? She kept banging on and I kept saying it’s impossible to quantify, except in certain circumstance, because breathless, to a greater or lesser degree, is my default state – I have stage 4 COPD, after all, FFS!

I really needed to snarl at her – not abuse, just forcibly state my case in a way dimwits could understand, but she was a Muslim and I was sitting there sporting a shiny, new, No.1 (short hair is low-maintenance, it’s no more sinister than that). So me snarling “Just what part of this are you having trouble with?” when we went over the same ground yet again, I just knew would be construed as racist, so I kept my own counsel.

But here’s a thing – if that had been a DLA or ESA assessment, I’d probably have flunked it.

I did actually have an argument with Dr. Dingbat, about the effect Candesartan has on the kidneys – it improves their output. She denied it, but see below, especially red text.

This is what Net Doctor says “Amias contains the active ingredient candesartan cilexetil, which is a type of medicine called an angiotensin II antagonist. It works by preventing the action of a hormone in the body called angiotensin II.

Angiotensin II normally acts on special receptors in the body, with two main results. Firstly, it causes the peripheral blood vessels to narrow, and secondly, it stimulates the production of another hormone called aldosterone. Aldosterone causes salt and water to be retained by the kidneys, which increases the volume of fluid in the blood vessels.

Candesartan blocks the receptors that angiotensin II acts on, and so prevents its actions. The main result of this is that the peripheral blood vessels are allowed to widen, which means that there is more space and less resistance in these blood vessels. This lowers the pressure inside the blood vessels.

Blocking the actions of angiotensin II also reduces the action of aldosterone on the kidneys. The result of this is an increase in the amount of fluid removed from the blood by the kidneys. This decreases the amount of fluid in the blood vessels, which also lessens the resistance and pressure in the blood vessels.”

So, there it is as clear as day – it improves kidney function. Would the stupid bugger have it? No she would not – but by Christ she will when I take her a copy next week.

I hope the med student is there again, too, and not just because she has a smile that would melt a plaster saint (hey, I’m sick, not dead!), but because the information she took away from that meeting was deeply flawed. Hopefully, though, she’d have the sense to do her own research, especially if there was an area of contention.

I may make mistakes with some things, but not when it comes to medical matters that my life might depend on. As I’ve said before, it’s my intention to know more than most GPs, and here’s a classic example.

And one thing I’ve learned, too, if this cut-price medicine – ambitious GPs instead of consultants – is the shape of thing to come, we’d all be well advised to take along as much supporting paperwork as possible to our appointments.


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