Tuesday, February 05, 2008

Most Physicians Don't Understand

I saw my primary care physician yesterday.In the past, she was very supportive of my desire to maintain control of my medical treatment plan. She is an osteopath by training and very open to alternative treatments. But yesterday, she asked me why I did not have stents put in when I had the angiogram last Thursday. I told her that the purpose for the angiogram was to compare it with the one done four years earlier. I specifically crossed out the possibility of performing angioplasty, inserting stents or performing bypass surgery on the consent form I signed. As far as I was concerned, and the cardiolgist performing the cardiac catheterization agreed, this procedure was being performed strictly for diagnostic and comparison reasons.

Another reason I saw my PCP yesterday was to ask her for a prescription for Moduretic. My cardiologist refused to provide one because he said it wasn't indicated. My PCP didn't write one because she is unfamiliar with this diuretic.

This may be an appropriate place to discuss Dr. Howard Wayne's rationale for using diuretics in his treatment of hypertension and coronary artery disease. Here are the good doctor's own words, taken from his last book, Do You Really Need Bypass Surgery? A Second Opinion. It is available at


"One of the most important classes of drugs I recommend in the treatment of coronary artery disease is diuretics... Most cardiologists do not use this class of drugs in the treatment of this disease. Indeed, most cardiologists don't use diuretics in the treatment of hypertension even though the Joint National Committee on Hypertension has officially been recommending for years that diuretics along with beta blockers be the first two drugs used.

"Diuretics remove excess fluid from the body by increasing the excretion of sodium and water by the kidneys. This is followed by a reduction of the volume of blood circulating within the blood vessels throughout the body. This leads to dilatation of the small blood vessels which lowers the resistance to the flow of blood. The result is a fall in blood pressure.

"Unfortunately, many cardiologists are reluctant to use diuretics in the treatment of both coronary artery disease and hypertension. This was the result of many years of misinformation that diuretics were actually harmful because they temporarily induced certain metabolic changes such as elevation of creatinine, cholesterol, triglycerides, blood sugra, calcium and uric acid, and caused a loss of potassium. Unfortunately the complications of undertreatment of hypertension and coronary artery disease caused for more problems than minor changes in the blood chemistries. Indeed, the metabolic changes that supposedly occurred following the administration of diuretics disappeared within a few months of continued usage and the addition of supplementary potassium medication."

Moduretic is a combined thiazide and potassium blocker. The generic name is hydrochlorothiazide and amiloride. Amiloride is a potassium sparing agent and is in an amount of 5 mg per tablet. The HCTZ in each tablet is 50 mg. The usual dosage of Moduretic is one 5/50mg tablet twice daily.


Anonymous said...

Dear Jeff,
I'm sorry your doctors are giving you such a hard time.
I know what a difficult struggle it is to deal with unsympathetic doctors.
Hopefully they'll inform themselves one day.

I hope you have a support system of those that love you.
I confess I was so worried for my husband that I tried to convince him to go under CABG. Today I'm so sorry for that. I thank God I was able to go with my husband to visit Dr. Wayne. He actually changed my mind while I was there. Later we confirmed everything he told us. He was a great doctor and a great person.

About the medications and just FYI, in the very beginnig my husband was prescribed Fosinopril, Metoprolol and Moduretic. He had a lot of intolerances to them. Dr Wayne changed the medications a few weeks later and since then he is taking only Diovan and Metoprolol. Both twice a day in a dosage that kind of scares other doctors :)

Best regards

Jeff said...


Dr. Wayne started me on the same medications as your husband. We had a few problems titrating the dosage of metaprolol. Finally we hit a dosage that would keep my blood pressure at about 90/50 without side effects. That lasted almost three years before I started developing a tolerance for it.