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From hospital CEO to patient: A personal journey

Posted May 30 2009 12:28am

by Nick Jacobs

"Good news," my new physician said. "You passed your cardiac stress test." "Yes," I thought. "That is REAL good news; no open heart surgery, no angioplasty, no more stents. Yeah, that is great news." Even though I know that thallium stress tests are only about 70 percent accurate, I'll take that piece of information and hold it tight while I smile a little.

"Well," he went on, "Your HDL is not where it should be, and you do have mild kidney failure. We’ll just have to keep an eye on that."

"Mild kidney failure?" I said out loud. "Wow, that was unexpected," I sighed. What did mild kidney failure mean? How mild? When does it go from mild kidney failure to kidney failure? Is it reversible? How does one go about getting mild kidney failure when you are completely compliant with every medication? All of these things were flying through my mind.

I don't know exactly how you would have felt, but this was not a phone call that I wanted to receive. At first, I couldn't even think. Then I asked, "Is it because of my high blood pressure?" He responded, "It might be." Interestingly enough, my BP has been really rather good these last several months. Then my limited medical knowledge kicked in and I began to play out different scenarios; Dialysis? Kidney transplant? Early end of life?

What the heck?

So, I decided to send my tests results to an email friend of mine who happens to be the head of cardiology at a major heart center. His response was very to the point. After he saw my list of meds, he said, "You are on two meds that, when combined, can contribute to kidney failure."

Initially, I wondered how my doctors missed this. Then, I called a pharmacist friend. He said he was unaware of this fact as well, but would be happy to check it out. Some three or so hours later, he called to inform me that a Canadian study indicated that, when combined, an ACE and an ARB could indeed accelerate the decline in kidney function. (I'm hoping that by not naming the drugs, I won't have to deal with product liability issues.)

It was the combination of these drugs that contributed to this change in only six months.

What's the point in sharing this very personal piece of information? According to a lecture that I heard some 10 or so years ago, the chances of an interaction between five or more drugs in the body is 100 percent. Well, if highly trained, extremely competent physicians and pharmacists miss the possible outcome caused by combining these two drugs, what chance does a nonmedical, nonclinical, nonscientific patient have?

Bottom line? Don't try to figure this out alone. Get help. Remember, that you are responsible for you, too. I started my diet again today, am committed to working out more and stopped my ARB. Hopefully, in six months the news will be better all around, and hopefully, you'll ask more questions when you get your test results back, too.

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