OP45
01-24-2009, 04:05 PM
My elderly mother a few months ago for the first time in her life got a high blood pressure medicine.
It became Trianterine/Hydrochlorothiazide.
A few weeks later she additionally got a calcium/vitamin D supplement.
Then all of a sudden two days later also for the first time in her life she got a TIA.
As an extra medicine she then immediately received a daily dose of asperine.
Now two months after starting with Trianterine/Hydrochlorothiazide she got a stroke.
According to the neurologist that the TIA appeared only two days after starting with the calcium/vitamin D supplement is just a coincident.
She also insists continuing using Trianterine/Hydrochlorothiazide although she promised not using the calcium/vitamin D supplement together with it.
In the mean time I discovered Hydrochlorothiazide influences kalium, magnesium and calcium levels in the sense you can get to high levels of it in your blood.
All of these can cause irregular hart beat, which my mother all of a sudden also happens to have.
Additionally I understand Trianterine thickens the blood.
Personally to me it is clear the above mix is a quite unhealthy one, however the neurogist insists: just a coincident.
It became Trianterine/Hydrochlorothiazide.
A few weeks later she additionally got a calcium/vitamin D supplement.
Then all of a sudden two days later also for the first time in her life she got a TIA.
As an extra medicine she then immediately received a daily dose of asperine.
Now two months after starting with Trianterine/Hydrochlorothiazide she got a stroke.
According to the neurologist that the TIA appeared only two days after starting with the calcium/vitamin D supplement is just a coincident.
She also insists continuing using Trianterine/Hydrochlorothiazide although she promised not using the calcium/vitamin D supplement together with it.
In the mean time I discovered Hydrochlorothiazide influences kalium, magnesium and calcium levels in the sense you can get to high levels of it in your blood.
All of these can cause irregular hart beat, which my mother all of a sudden also happens to have.
Additionally I understand Trianterine thickens the blood.
Personally to me it is clear the above mix is a quite unhealthy one, however the neurogist insists: just a coincident.
Sponsor
flowergirl2day
01-25-2009, 04:03 AM
Sorry to hear about your mother. I wish her luck and hope she is doing well.
You do not mention any coexisting medical conditions. Is is possible that, in addition to being hypertensive, she has other medical issues? A combination of two diuretics is not the usual recommended first-line hypertensive therapy, especially in an older person.
Combining a potassium-sparing and a potassium-wasting diuretic often, but not always, prevents a potassium imbalance. For this reason, the combination of the two can be a good thing IF the potassium and other electrolyte levels are closely monitored and the diuretics are not contraindicated. Who prescribed her medication and why this particular one? Had there been a sudden onset of hypertension?
Long-standing, untreated hypertension damages organs and blood vessels. Ischemic strokes are caused by blood clots or pieces of fatty deposits from an arterial plaque in damaged, narrowed blood vessels. Other possible causes include insufficient levels of oxygen getting to the brain tissue due to anemia or hypotension and certain heart problems. Has the exact cause of her stroke been determined?
Diuretics are known to cause electrolyte imbalances. Thiazides inhibit renal excretion of calcium. Free (unbound) calcium is required for coagulation. A healthy balance should be maintained by frequent labwork. Mineral metabolism and absorption vary with each individual. The use of large amounts of calcium or vitamin D supplements with the diuretics can lead to excessive plasma calcium levels, especially in people being treated for osteoporosis and certain thyroid conditions. There is also a risk of metabolic alkalosis over time. People on diuretics wanting to supplement with high doses of calcium and/or vitamin D should check with their doctors and have their calcium levels tested frequently.
Elderly people have lower drug tolerance. That is why dosage adjustments to their medication are often needed, and the least possible effective dose must be determined. Unfortunately, drugs affect everyone differently. They can be safe for some, ineffective or even harmful for others. When in doubt, it never hurts to get a second opinion. A visit to a cardiologist could also prove beneficial.
flowergirl
You do not mention any coexisting medical conditions. Is is possible that, in addition to being hypertensive, she has other medical issues? A combination of two diuretics is not the usual recommended first-line hypertensive therapy, especially in an older person.
Combining a potassium-sparing and a potassium-wasting diuretic often, but not always, prevents a potassium imbalance. For this reason, the combination of the two can be a good thing IF the potassium and other electrolyte levels are closely monitored and the diuretics are not contraindicated. Who prescribed her medication and why this particular one? Had there been a sudden onset of hypertension?
Long-standing, untreated hypertension damages organs and blood vessels. Ischemic strokes are caused by blood clots or pieces of fatty deposits from an arterial plaque in damaged, narrowed blood vessels. Other possible causes include insufficient levels of oxygen getting to the brain tissue due to anemia or hypotension and certain heart problems. Has the exact cause of her stroke been determined?
Diuretics are known to cause electrolyte imbalances. Thiazides inhibit renal excretion of calcium. Free (unbound) calcium is required for coagulation. A healthy balance should be maintained by frequent labwork. Mineral metabolism and absorption vary with each individual. The use of large amounts of calcium or vitamin D supplements with the diuretics can lead to excessive plasma calcium levels, especially in people being treated for osteoporosis and certain thyroid conditions. There is also a risk of metabolic alkalosis over time. People on diuretics wanting to supplement with high doses of calcium and/or vitamin D should check with their doctors and have their calcium levels tested frequently.
Elderly people have lower drug tolerance. That is why dosage adjustments to their medication are often needed, and the least possible effective dose must be determined. Unfortunately, drugs affect everyone differently. They can be safe for some, ineffective or even harmful for others. When in doubt, it never hurts to get a second opinion. A visit to a cardiologist could also prove beneficial.
flowergirl
famnd
01-25-2009, 08:47 AM
I agree, get a 2nd opinion right away. Ask for her lab test reports-you don't need a MD to see if her calcium levels are excessive.
Make sure she is drinking enough fluids throughout the day. It is important that she not drink too much at once because 16 oz of fluid consumed in a 15 min period will raise one's b/p 20 points for two hours. If her urine is pale yellow she is getting enough fluid.
BTW she can drink hot water for some of her fluid intake- that's what I have learned to do. In fact I learned that from a 80 yr old woman who had lived through the depression. It cuts down on the calories for me cause I like my tea with lots of sugar & I don't like the fake sweeteners.
I take HCTZ too & have trouble with my various Dr's wanting me to take excessive amounts of calcium when my diet already contains the 1200mg of calcium that is recommened. Plus my diuretic causes some calcium to be retained.
Is she taking anti acid over the counter meds? Some of them contain a lot of calcium too. My cousin got into trouble with them because she did was taking a lot of antiacid meds & got so constipated from the extra calcium.
What other meds is she taking? Fam
Make sure she is drinking enough fluids throughout the day. It is important that she not drink too much at once because 16 oz of fluid consumed in a 15 min period will raise one's b/p 20 points for two hours. If her urine is pale yellow she is getting enough fluid.
BTW she can drink hot water for some of her fluid intake- that's what I have learned to do. In fact I learned that from a 80 yr old woman who had lived through the depression. It cuts down on the calories for me cause I like my tea with lots of sugar & I don't like the fake sweeteners.
I take HCTZ too & have trouble with my various Dr's wanting me to take excessive amounts of calcium when my diet already contains the 1200mg of calcium that is recommened. Plus my diuretic causes some calcium to be retained.
Is she taking anti acid over the counter meds? Some of them contain a lot of calcium too. My cousin got into trouble with them because she did was taking a lot of antiacid meds & got so constipated from the extra calcium.
What other meds is she taking? Fam
OP45
01-25-2009, 09:18 AM
Thank you Flowergirl for your insightful reply!
Basically what you are saying my point of view has foundations.
The left arm and left face are effected mostly, the left leg possibly also but she can still move it, thalamus they say.
However I am hardly able to talk to the hospital people, they are of the opinion they can do anything they want and don't need to consult me at all.
I am baffled I have nothing to say about the treatment of my own mother however and think they are on the wrong track in assuming the high blood pressure has been the cause of everything.
The high blood pressure (160/80) is a recent thing caused by whatever what.
What the hospital is doing now (5th day) is keeping the blood pressure down to 120/50-140/54 + adding a powerful blood thinner, so much so it can become risky.
However they didn't use this initially I think.
Also they added something to stabilize the heart beat, which works, resulting in a 144/52 blood pressure, 84 heart beat.
Especially the 52 figure concerns me, I am afraid they are weakening the system such there won't be enough oxygen available for the brain to recover.
This is what I am seeing as well.
Initially at home my mother recovered rapidly, however at the hospital this first stopped and is now starting sliding down (fingers can't move anymore, face becomes more stiff).
Furthermore I am asking myself if a rapid shift or lessening the amount of the blood pressure medicin (I would prefer nothing at all, since I trust my mother's arteries, she ate healthy always and her head is very clear) would be problematic.
Basically what you are saying my point of view has foundations.
The left arm and left face are effected mostly, the left leg possibly also but she can still move it, thalamus they say.
However I am hardly able to talk to the hospital people, they are of the opinion they can do anything they want and don't need to consult me at all.
I am baffled I have nothing to say about the treatment of my own mother however and think they are on the wrong track in assuming the high blood pressure has been the cause of everything.
The high blood pressure (160/80) is a recent thing caused by whatever what.
What the hospital is doing now (5th day) is keeping the blood pressure down to 120/50-140/54 + adding a powerful blood thinner, so much so it can become risky.
However they didn't use this initially I think.
Also they added something to stabilize the heart beat, which works, resulting in a 144/52 blood pressure, 84 heart beat.
Especially the 52 figure concerns me, I am afraid they are weakening the system such there won't be enough oxygen available for the brain to recover.
This is what I am seeing as well.
Initially at home my mother recovered rapidly, however at the hospital this first stopped and is now starting sliding down (fingers can't move anymore, face becomes more stiff).
Furthermore I am asking myself if a rapid shift or lessening the amount of the blood pressure medicin (I would prefer nothing at all, since I trust my mother's arteries, she ate healthy always and her head is very clear) would be problematic.
flowergirl2day
01-25-2009, 11:35 PM
OP45,
I am baffled I have nothing to say about the treatment of my own mother however and think they are on the wrong track in assuming the high blood pressure has been the cause of everything.
The fact is that no two patients are alike. There are established treatment guidelines that most doctors follow after assessing each individual's situation. These are designed to minimize the risk of developing blood clots, bleeding, or other complications, which is always highest during the first week after the stroke. They are just following the protocol so don't take it personally. One would hope that the cardiological aspects will be considered and investigated. Irregular heart beat and other heart problems often follow stroke. These can be a result of the stroke or its cause, or something else altogether. This is why trying to determine what caused the stroke is important.
I hope your mother's healthcare team provides sufficient guidance regarding her needs, prognosis and rehabilitation. The main thing is to remain positive and let her recover at her own pace. Patience is the key. If you have any doubts at all about the quality of her care, you should consider consulting another doctor.
Furthermore I am asking myself if a rapid shift or lessening the amount of the blood pressure medicin (I would prefer nothing at all, since I trust my mother's arteries, she ate healthy always and her head is very clear) would be problematic.
It's probably a good thing that these types of decisions can only be made by trained medical personnel. We just have to hope that the decisions they make, based on their knowledge and experience, will turn out to be the right ones for us. Ask as many questions as you can. Insist on getting answers. Good luck to you both.
FG
I am baffled I have nothing to say about the treatment of my own mother however and think they are on the wrong track in assuming the high blood pressure has been the cause of everything.
The fact is that no two patients are alike. There are established treatment guidelines that most doctors follow after assessing each individual's situation. These are designed to minimize the risk of developing blood clots, bleeding, or other complications, which is always highest during the first week after the stroke. They are just following the protocol so don't take it personally. One would hope that the cardiological aspects will be considered and investigated. Irregular heart beat and other heart problems often follow stroke. These can be a result of the stroke or its cause, or something else altogether. This is why trying to determine what caused the stroke is important.
I hope your mother's healthcare team provides sufficient guidance regarding her needs, prognosis and rehabilitation. The main thing is to remain positive and let her recover at her own pace. Patience is the key. If you have any doubts at all about the quality of her care, you should consider consulting another doctor.
Furthermore I am asking myself if a rapid shift or lessening the amount of the blood pressure medicin (I would prefer nothing at all, since I trust my mother's arteries, she ate healthy always and her head is very clear) would be problematic.
It's probably a good thing that these types of decisions can only be made by trained medical personnel. We just have to hope that the decisions they make, based on their knowledge and experience, will turn out to be the right ones for us. Ask as many questions as you can. Insist on getting answers. Good luck to you both.
FG
OP45
01-26-2009, 04:18 PM
Hello Fam,
Thank you for your great practical advises, I will treat them as gems!
By the way don't take those extra calcium tablets of course (you can also get hart rhythm problems from them, it feels like this: restrain and then boom).
Flowergirl,
Again a great overview and road map within what is feasible thank you!
I have been a ill the last two days so I didn't go to the hospital in order not being hazardous for the patients.
Yesterday I decided to contact another hospital for a second opinion.
Also yesterday however I learned the blood pressure had risen to about 170/80.
I was delighted to hear this because this possibly meant the doctors were coming to their senses, and perhaps even had been listening a little bit at last.
So I didn't proceed with the second opinion effort.
Now today I have learned that no earlier than today they have stopped using trianterine/hydrochorothiazide.
The reason for this however was they discovered the potassium level was 2 where 3.5 was normal I heard and the sodium level to high.
Both of these are amazing to me since I don't expect such imbalance to occur within just one day and my mother never uses additional salt in her food.
Also her belly (stomach) has been swollen and filled with air for a long time now (many years).
She also uses magnesium tablets for even longer, perhaps there is a connection.
However she always has a healthy appetite and was never nauseous.
This however has changed now.
Although she constantly would like to drink tea herself the hospital don't give this to her because she could choke because of it which for some reason they consider dangerous.
Instead they give her something of whatever mixed with something which thickens it and becomes thicker with time making it some sort of drab which is disgusting to my mother and I think this adds to the nausea.
She needs something fresh as orange juice but they don't let her, it must me thickened.
Also I now have learned the fluid which drips in her arm doesn't contain food.
This means she hasn't eaten for nearly a week now, which is again incredible to me.
Also I have now learned from other sources you should start practise within six days, otherwise you are to late since the secondary connections in your brain which you need are breaking down.
This has been there but minimal and in the weekend nonexistent because the therapeutist doesn't work than, incredible!
Food wise they know nothing in the hospital.
And their whole thinking processes seem to be sluggish, their knowledge basic.
It seems they can and have very narrow window of thinking without imagination, perhaps indeed only following protocols behind which they appear to be hiding so they can't be blamed to have done anything wrong.
So what I seem to need now is an obvious thing which is some kind of shake containing fruit with the freshness of orange juice but the consistency of apple-sauce, I have no experience with this however.
The second thing is curds with fruit which I am even able to buy ready.
Thank you for your great practical advises, I will treat them as gems!
By the way don't take those extra calcium tablets of course (you can also get hart rhythm problems from them, it feels like this: restrain and then boom).
Flowergirl,
Again a great overview and road map within what is feasible thank you!
I have been a ill the last two days so I didn't go to the hospital in order not being hazardous for the patients.
Yesterday I decided to contact another hospital for a second opinion.
Also yesterday however I learned the blood pressure had risen to about 170/80.
I was delighted to hear this because this possibly meant the doctors were coming to their senses, and perhaps even had been listening a little bit at last.
So I didn't proceed with the second opinion effort.
Now today I have learned that no earlier than today they have stopped using trianterine/hydrochorothiazide.
The reason for this however was they discovered the potassium level was 2 where 3.5 was normal I heard and the sodium level to high.
Both of these are amazing to me since I don't expect such imbalance to occur within just one day and my mother never uses additional salt in her food.
Also her belly (stomach) has been swollen and filled with air for a long time now (many years).
She also uses magnesium tablets for even longer, perhaps there is a connection.
However she always has a healthy appetite and was never nauseous.
This however has changed now.
Although she constantly would like to drink tea herself the hospital don't give this to her because she could choke because of it which for some reason they consider dangerous.
Instead they give her something of whatever mixed with something which thickens it and becomes thicker with time making it some sort of drab which is disgusting to my mother and I think this adds to the nausea.
She needs something fresh as orange juice but they don't let her, it must me thickened.
Also I now have learned the fluid which drips in her arm doesn't contain food.
This means she hasn't eaten for nearly a week now, which is again incredible to me.
Also I have now learned from other sources you should start practise within six days, otherwise you are to late since the secondary connections in your brain which you need are breaking down.
This has been there but minimal and in the weekend nonexistent because the therapeutist doesn't work than, incredible!
Food wise they know nothing in the hospital.
And their whole thinking processes seem to be sluggish, their knowledge basic.
It seems they can and have very narrow window of thinking without imagination, perhaps indeed only following protocols behind which they appear to be hiding so they can't be blamed to have done anything wrong.
So what I seem to need now is an obvious thing which is some kind of shake containing fruit with the freshness of orange juice but the consistency of apple-sauce, I have no experience with this however.
The second thing is curds with fruit which I am even able to buy ready.
OP45
01-26-2009, 05:49 PM
Every visit seems to have something unexpected.
Now I hear she ate without vomiting for the first time.
Perhaps some doctors know something or some take up the slack from others, I don't know.
Now I hear she ate without vomiting for the first time.
Perhaps some doctors know something or some take up the slack from others, I don't know.
flowergirl2day
01-28-2009, 10:57 PM
Glad to hear things are going reasonably well. It does not take much for electrolytes to become unbalanced. Fluid status plays a major role and any changes in efective circulating volume are soon reflected in the mineral levels.
Thank you for the update on your mom's condition.
The stroke board might be a good place for some insight and helpful information.
Thank you for the update on your mom's condition.
The stroke board might be a good place for some insight and helpful information.
famnd
01-29-2009, 07:59 AM
Here is a book that might help you understand the recovery process with a stroke. I saw the author/patient on TV along with her story. She made a full recovery.
"My Stroke of INsight" by Jill Taylor, PHD.
Glad your Mom is doing better. You might ask the staff if you & possibly family members could help in any way in her recovery.
Fam
"My Stroke of INsight" by Jill Taylor, PHD.
Glad your Mom is doing better. You might ask the staff if you & possibly family members could help in any way in her recovery.
Fam