DR. KEITH ROACH For Herald and Review
DEAR DR. ROACH: My husband, 75, suffers from low blood pressure. Her cardiologist gave us a blood pressure monitor to use at home every morning, and the readings are sent directly to the doctor’s office. Its readings range from 98/62 to more normal readings such as 116/70, but most are lower, closer to 98 to 105 for the top number.
He feels fine, has no dizziness or lightheadedness. He has a good dose of energy. He exercises about 3.7 hours a day regularly. He has no artery blockages and no history of heart attack. He fainted once several years ago. It was when he got a bad flu with a fever and it happened when he got up to go to the bathroom at night. I called an ambulance at that time, and they determined he was fine and did not need to go to the hospital.
My question is about a drug that our cardiologist wants him to take. He wants him to take midodrine. After reading about it, my husband is afraid of side effects including dizziness and lightheadedness. Also, the dosage seems to be difficult, taking it around meals and lying down. Our general practitioner is totally against him taking it.
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So far, we’ve managed to save him from having to take it. Her cardiologist advised her to eat more salt and drink more water. My husband thinks if he feels fine and has no complaints, why would he want to trade that in for a drug that could possibly give him the same side effects that low blood pressure is NOT giving him?
A: Low blood pressure is a problem when it causes symptoms, and you made it clear that he does not have common symptoms of low blood pressure, such as dizziness (especially when standing up) and fatigue. People with low blood pressure generally benefit from a reduced risk of heart attack and stroke, except in people with blockages in the heart’s arteries, where too low blood pressure may not be desirable.
In general, low blood pressure is treated only when it causes symptoms. Increasing salt and water is the first line of treatment (this is the exact opposite of what we recommend for people with high blood pressure or hypertension). Midodrine and similar drugs are helpful if people remain symptomatic despite salt and water.
I’m on the side of your husband’s general practitioner: I don’t see why he needs it. If I was his primary care physician, I would call the cardiologist and see if he knows of any reason why your particular husband should be taking that particular drug. Doctor-to-doctor communication is essential and unfortunately does not occur as often as it should.
DEAR DR. ROACH: Can taking 10mg of prednisone daily for three weeks affect the antibody test for an HIV test?
A: No, prednisone does not significantly lower antibody levels. The HIV test is extremely sensitive and if the person being tested has been infected for more than about three weeks, the test is likely to be positive. Positive antibody tests are confirmed by a Western blot test, which is very specific.
Except in cases of very recent exposure, a negative HIV test using the latest technology means that the person tested really does not have HIV. There are very few exceptions. However, a positive test should be considered along with a person’s risk factors. In a person without risk factors, even a very good test like the HIV test will still have some false positives, so a test for the virus itself is usually done. This is called a viral load test, which looks at the RNA of the HIV virus.
DEAR DR. ROACH: I was recently diagnosed with a blood clot in my left leg. The reason I went to the ER was that in addition to the calf pain, I had heel numbness. This has now become the bottom half of my foot. I had a stomach injection in the hospital and am currently on Eliquis. I was told it would take time to heal. I’m concerned about the numbness.
A: A blood clot in the leg most often causes swelling in the leg – sometimes painful, sometimes not. Heat in the leg is common, but numbness can also occur because the clot can compress the nerve in the foot. Large clots can also disrupt the blood supply to the nerve.
The blood thinner injection you received and apixaban (Eliquis) will help the body reabsorb the clot, but it will take months. The numbness may stay with you for a long time, but most people will regain full sensation.