BP induced damage to organs

[kylho]

I am sorry to have to say this but what is an Advanced Practice Nurse? Are you talking about a Nurse Practioner ARNP? I have never heard of such a title as you give yourself. No matter what 2yrs of nursing school does not equal 8yrs of medical school and residency. We are operating on different levels. Nurses have their jobs and physicians have their roles. I dont tell my
nurses how to start an IV and my nurses dont tell me what therapies to use.

You are correct about one thing that we are not reading the same journals. One of the early signs of renal damage is micro protein in the urine. The use of ACE inhibitors and ARB blockers help significantly. Here are a few articles that agree with what i am saying as far as ACE inhibitors and ARBs being renal protective. I can post 20 more if you like. Just ask. If you read the studies, they also mention how ARBs are even better tolerated than ACE inhibitors to address one of your other points.

**broken link removed**


Renal protection with angiotensin receptor... [J Nephrol. 2011 Sep-Oct] - PubMed - NCBI

http://www.diabeticmctoday.com/HtmlPages/DMC1004/PDF%20FILES/dmc1004_Barnett.pdf





You said it yourself 120/80 and under is normal. 120-130 is pre-hypertensive. If it is not normal then it is abnormal. There is no way around it. If it was considered normal then it would be under the NORMAL heading. You are right that with my normal patients (NOT ON GEAR) i would recommend life style changes, sodium reduction, etc etc but with someone that cycles several times a year and off gear their BP is 130 and on gear is 140 or greater, no amount of sodium reduction is going to reduce that BP. HCTZ is the usual drug written for initial diagnosis of hypertension but gain this may apply to the general population. One thing a smart physician and practioner does is to not treat everyone with the same cookie cutter type treatments. We have to evaluate every single person on their own clinical case and what is different about their case. A younger healthy male that is on gear that already has a BP of 140 most of the year because he cycles a few times a year would not benefit from HCTZ. It may actually be detrimental that the dehydration from HCTZ may cause worsening of renal function. In that patient i would always recommend a low dose ace inhibitor or ARB blocker.


I hope i didnt come across too harsh. But you have 2 posts on here and you came across very aggressive so i had to make sure i address your points. No hard feelings i hope.

Ok First of all An Advanced Practice Nurse is any nurse w/ a BSN (that's a 4 year degree), a Masters Degree in Science (another 3 years), and 3-4 yrs of postmasters clinical experience. I also received my Advanced Nursing Degree (including the 3-4 yrs of clinical experience) from one of the best medical schools in the country - Northwestern University. I have full prescription writing ability and see patients just as any MD would do. And the fact that you do not know what an Advanced Practice Nurse is just confirms my suspicion that you are no MD. You also made another post yesterday which said, "Getting a 2D echocardiogram of the heart is the only way to check for signs of damage such as cardiomegally." First of all, you didn't even spell cardiomegaly correct - cardiomegally!! And secondly, really a 2D echo is the only way to check for signs of damage such as cardiomegaly?? What's the first line method of detecting cardiomegaly - doctor? Maybe a Chest X-ray. Sorry but any true MD would know these very simple things.

You make generalized statements above that have nothing to do w/ the issues that I contradicted. You made a statement also such as Benicar is a first line med to give and it has "extreme kidney protective issues". If you simply go to the Benicar website it states all over that it can cause renal problems and should not be used in known renal insufficiency, and that its side effects are "kidney problems". Any MD would know this and would not even have to go to the website.

You go on to state that Lisinopril never drops "crashes" a persons BP, which even a dumb 2-year RN would know that's not true. I'm sorry but you can not be an MD. You seem to have some medical knowledge, but nothing you've said is something that someone w/ google could find out for themselves.

And I'm sorry that I have come across harshly, but the advice you are giving is just simply incorrect and any medical professional would know this. Its not an issue of, well you do things one way and I do them another. Your statements are just totally wrong. And even your trying to initially rip nurses gives you away. You stated, "whats an Advanced Practice Nurse, you mean a nurse practitioner", and then you go on to say my 2-year degree does not equal your 8 year one. Again, ANY MD would know that an Advanced Practice Nurse has alot more schooling then 2 years! Every doctor knows APN's have script writing ability and you think that they allow 2-year nurses to have the same privileges as an MD? You could not do your residency in any hospital and not know what an Advanced Practice Nurse is. They work right along side the MD's in every clinical setting. And to associate that w/ a 2-yr associates degree just shows me that you have no real clinical experience.

All my info about hypertension is directly taken from the NIH, and therefore all your rambling about different types of people and meds is just that rambling. You are an MD who knows more then this stupid APN, then answer the questions that I made initially that you made no response to. You made no response b/c you can't - its simple issues!! NO, a 2-D echo is not "the only way you can detect heart damage, such as cardiomegally", oops I meant cardiomegaly! Any person w/ any real clinical knowledge would know that the simple chest x-ray is the first line method for detecting cardiomegaly. Lisinopril absolutely has the ability to crash the BP and 95% of all health-care practitioners write parameters when they prescribe this medication, including myself. Benicar is not a first line choice when initiating anti-hypertensive meds, and it does not have "extreme kidney protective properties" as you stated, but the EXACT opposite. It needs to not be used at all in pts w/ known kidney disease, and one its major side effects is kidney problems - which all you have to do to check this is to go to their web-site. Again, ANY MD would in no way make the statements you made.

And I'm sorry but your giving advice to youngsters and others stating your a physician and thus guys may take your advice and that's dangerous - especially here where they have access to foreign pharmacies and can obtain anti-hypertensive meds on their own. What if that kid/gentlemen that you told to take 10-20 mgs of Lisinopril w/o any worry of your BP "crashing" did just that and he went hypotensive passed out and died? Can't happen? Absolutely it can, and it does. I told you my own use of Lisinopril 5mgs and what it did to me, AND that is NOT an uncommon event which again, any MD would know. Luckily the guy that asked that question PM'd me thanking me for the advice and stated that he now was just going to start at 5mgs of Lisinopril. Or what if the person did have kidney issues and he chooses to take Benicar d/t your advice of 'its a great med for those on AAS b/c it has great kidney protective properties'? Reality is its CONTRAINDICATED in those cases yet some guy would be thinking he is actually helping his kidney's by using that med.

I don't think I need to say anymore - what I've said speaks for itself. I too am a vet BB'er w/ 20 years in the BB'ing world besides my profession, and I know how it is to look to others for advice. And when your touting yourself as an MD and giving information that in no way would be coming from an MD, then sorry I'm going to take my time and try to help the person out in the right fashion. It may not sound nice but its simple facts!

 

[Stewie]

Sorry Alpha, I know what an Advanced Practice Nurse is. That's the degree I'm going after post LPN. Advanced practice registered nurse - Wikipedia, the free encyclopedia

Granted alpha posted up his credentials shortly after becoming a member here, I still question his based knowledge on certain topics related to hormone therapy, point specific to a comment related to T3 in the peptide forum,as well as making a statement that my physician is out in "left field" ....? Even though I feel my physician FAR EXCEEDS any of my previous physicians, I feel as I've been brought back from the dead.

Welcome aboard kylho

Ok First of all An Advanced Practice Nurse is any nurse w/ a BSN (that's a 4 year degree), a Masters Degree in Science (another 3 years), and 3-4 yrs of postmasters clinical experience. I also received my Advanced Nursing Degree (including the 3-4 yrs of clinical experience) from one of the best medical schools in the country - Northwestern University. I have full prescription writing ability and see patients just as any MD would do. And the fact that you do not know what an Advanced Practice Nurse is just confirms my suspicion that you are no MD. You also made another post yesterday which said, "Getting a 2D echocardiogram of the heart is the only way to check for signs of damage such as cardiomegally." First of all, you didn't even spell cardiomegaly correct - cardiomegally!! And secondly, really a 2D echo is the only way to check for signs of damage such as cardiomegaly?? What's the first line method of detecting cardiomegaly - doctor? Maybe a Chest X-ray. Sorry but any true MD would know these very simple things.

You make generalized statements above that have nothing to do w/ the issues that I contradicted. You made a statement also such as Benicar is a first line med to give and it has "extreme kidney protective issues". If you simply go to the Benicar website it states all over that it can cause renal problems and should not be used in known renal insufficiency, and that its side effects are "kidney problems". Any MD would know this and would not even have to go to the website.

You go on to state that Lisinopril never drops "crashes" a persons BP, which even a dumb 2-year RN would know that's not true. I'm sorry but you can not be an MD. You seem to have some medical knowledge, but nothing you've said is something that someone w/ google could find out for themselves.

And I'm sorry that I have come across harshly, but the advice you are giving is just simply incorrect and any medical professional would know this. Its not an issue of, well you do things one way and I do them another. Your statements are just totally wrong. And even your trying to initially rip nurses gives you away. You stated, "whats an Advanced Practice Nurse, you mean a nurse practitioner", and then you go on to say my 2-year degree does not equal your 8 year one. Again, ANY MD would know that an Advanced Practice Nurse has alot more schooling then 2 years! Every doctor knows APN's have script writing ability and you think that they allow 2-year nurses to have the same privileges as an MD? You could not do your residency in any hospital and not know what an Advanced Practice Nurse is. They work right along side the MD's in every clinical setting. And to associate that w/ a 2-yr associates degree just shows me that you have no real clinical experience.

All my info about hypertension is directly taken from the NIH, and therefore all your rambling about different types of people and meds is just that rambling. You are an MD who knows more then this stupid APN, then answer the questions that I made initially that you made no response to. You made no response b/c you can't - its simple issues!! NO, a 2-D echo is not "the only way you can detect heart damage, such as cardiomegally", oops I meant cardiomegaly! Any person w/ any real clinical knowledge would know that the simple chest x-ray is the first line method for detecting cardiomegaly. Lisinopril absolutely has the ability to crash the BP and 95% of all health-care practitioners write parameters when they prescribe this medication, including myself. Benicar is not a first line choice when initiating anti-hypertensive meds, and it does not have "extreme kidney protective properties" as you stated, but the EXACT opposite. It needs to not be used at all in pts w/ known kidney disease, and one its major side effects is kidney problems - which all you have to do to check this is to go to their web-site. Again, ANY MD would in no way make the statements you made.

And I'm sorry but your giving advice to youngsters and others stating your a physician and thus guys may take your advice and that's dangerous - especially here where they have access to foreign pharmacies and can obtain anti-hypertensive meds on their own. What if that kid/gentlemen that you told to take 10-20 mgs of Lisinopril w/o any worry of your BP "crashing" did just that and he went hypotensive passed out and died? Can't happen? Absolutely it can, and it does. I told you my own use of Lisinopril 5mgs and what it did to me, AND that is NOT an uncommon event which again, any MD would know. Luckily the guy that asked that question PM'd me thanking me for the advice and stated that he now was just going to start at 5mgs of Lisinopril. Or what if the person did have kidney issues and he chooses to take Benicar d/t your advice of 'its a great med for those on AAS b/c it has great kidney protective properties'? Reality is its CONTRAINDICATED in those cases yet some guy would be thinking he is actually helping his kidney's by using that med.

I don't think I need to say anymore - what I've said speaks for itself. I too am a vet BB'er w/ 20 years in the BB'ing world besides my profession, and I know how it is to look to others for advice. And when your touting yourself as an MD and giving information that in no way would be coming from an MD, then sorry I'm going to take my time and try to help the person out in the right fashion. It may not sound nice but its simple facts!

 

[Stupes]

I am just a regular moron and I even knew what an APN was.

My wife went to a midwives practice during her recent pregnancy and when they wrote her a script I asked how they had the ability to do so - she told me she was an APN, and explained it to me briefly.

There is no way a doctor wouldn't know that - it seems to me......

 

[alpha6164]

kylho,

Trust me, the first thing i did when i signed up on this board was post my credentials. Several mods here already have verified who i am and what i do. I am an associate professor in a major university system in Florida. I dont need to prove anything to you at this point. Remember it is 2012 not 1960. Yes you can steer a car with your feet if you want to but that doesnt make it good damn idea. Can you diagnose cardiomegally with a chest xray? sure, but can you diagnose thickened walls, ejection fraction, valve leakage or stenosis? These are all the possible signs of long standing hypertension and cardiac damage that chest xray wont tell you shit about. I have delt with your kind before. Couldnt get into medical school so you became a nurse and now spew shit you read off the books to sound smart. Yeah you can write a script but you are still assigned to another M.D. that has to sign your controlled substances cause why? Cause at the end of the day you are not a physician. You are a nurse. And you wanna call me out on spelling? lol. i didnt know i was writing a thesis. Half the time i am replying with my phone and type as fast as i can. It is what it is.


You said ace inhibitors and ARB blockers have no renal protection i listed three studies that show otherwise. You have anything to say about that? I gave you specific clinical information. Anything can happen to anybody. Just because your BP crashed does not mean it will happen to the other 99% of people out there. You saying your ICU patients had crashed BP is so damn irrelevant to the general population that makes me chuckle. There is a reason that patient is in ICU to begin with. I ran ICUs before. They have so many confounding factors in their disease process that making generalizations that because an ICU patient's BP dropped means it is a dangerous drug is crazy.

What happens when you yourself decide to prescribe lisinopril or any other BP med to a patient? Do you follow them home with a first response team to make sure their BP doesnt drop? what a crock of shit. You prescribe BP meds, you advise your patients of risk and go from there. So the millions of BP meds that are prescribed weekly to patients across this country, then people are just fucking dropping dead left and right everywhere? I am done with this conversation.

As far as APN goes, i have never heard of the term till you mentioned it. We refer to them based on what they do. You are either a nurse practioner, nurse anesthetist, a nurse midwife etc.

 

[kylho]

kylho,

Trust me, the first thing i did when i signed up on this board was post my credentials. Several mods here already have verified who i am and what i do. I am an associate professor in a major university system in Florida. I dont need to prove anything to you at this point. Remember it is 2012 not 1960. Yes you can steer a car with your feet if you want to but that doesnt make it good damn idea. Can you diagnose cardiomegally with a chest xray? sure, but can you diagnose thickened walls, ejection fraction, valve leakage or stenosis? These are all the possible signs of long standing hypertension and cardiac damage that chest xray wont tell you shit about. I have delt with your kind before. Couldnt get into medical school so you became a nurse and now spew shit you read off the books to sound smart. Yeah you can write a script but you are still assigned to another M.D. that has to sign your controlled substances cause why? Cause at the end of the day you are not a physician. You are a nurse. And you wanna call me out on spelling? lol. i didnt know i was writing a thesis. Half the time i am replying with my phone and type as fast as i can. It is what it is.


You said ace inhibitors and ARB blockers have no renal protection i listed three studies that show otherwise. You have anything to say about that? I gave you specific clinical information. Anything can happen to anybody. Just because your BP crashed does not mean it will happen to the other 99% of people out there. You saying your ICU patients had crashed BP is so damn irrelevant to the general population that makes me chuckle. There is a reason that patient is in ICU to begin with. I ran ICUs before. They have so many confounding factors in their disease process that making generalizations that because an ICU patient's BP dropped means it is a dangerous drug is crazy.

What happens when you yourself decide to prescribe lisinopril or any other BP med to a patient? Do you follow them home with a first response team to make sure their BP doesnt drop? what a crock of shit. You prescribe BP meds, you advise your patients of risk and go from there. So the millions of BP meds that are prescribed weekly to patients across this country, then people are just fucking dropping dead left and right everywhere? I am done with this conversation.

As far as APN goes, i have never heard of the term till you mentioned it. We refer to them based on what they do. You are either a nurse practioner, nurse anesthetist, a nurse midwife etc.

Well you finally learned what an APN is, good job - and you're completely wrong, in my state I do not need any doctor to sign off on the medications I prescribe, specifically the C2 - C5. I practice independently, so again you have no idea what you're saying. I stated my schooling, and if you actually add up the years of schooling, a APN has MORE schooling then the MD nowadays. And why? B/c we're taking away the jobs from the doctors. Specifically speaking, in a recent study it was determined that the nurse anesthetist administers over 60% of all anesthesia in the country. CNRA's are able to do regional anesthesia, epidurals, all blocks, is licensed and trained in everything EXACTLY the same as a anesthesiologist (not saying that is what I am). And although anesthesiologists state that they are better trained b/c they are MD's, all the studies done comparing the two have shown absolutely no difference b/w both types of practitioners.

As far as the points I made, first of all you basically admit that cardiomegaly is easily determined through a simple chest x-ray. ANY MD would know this!! I admittedly did not take the time to read your studies b/c the way you stated them it didn't seem to make a difference. But I'm guessing that your renoprotective studies involve the Marshall Protocol. The studies that site renoprotective properties of Benicar are based on the Marshall Protocol which discusses pts w/ chronic inflammatory or autoimmune disease. These are not the kind of illnesses that you are going to see in young and middle age BB’ers.

Secondly, the Marshall Protocol assumes/hypothesizes that these Chronic Inflammatory Diseases are the result of an infection. So you are talking about a small subset of the population, more specifically the elderly that have had some type of infection process resulting in an inflammatory response which then may or may not affect the kidneys. However, the vast majority of kidney problems do not fall into this category. Not to mention the fact that the person originally asking the question was concerned about his kidney function as a result of high BP, which has nothing to do w/ the Marshall Protocol. An elevated BP causes renal function problems very similar to that in renal calculi or renal stenosis, which is a contraindication for Benicar administration, and I cited areas you could check on this. You also stated that it would be great in those who use AAS d/t its kidney protective properties. Do you see a lot of Chronic Inflammatory or autoimmune diseases in AAS users?? No. Most likely if they are going to have renal issues its d/t elevated BP’s, or otherwise in younger/middle-aged people you may see renal calculi, or kidney stones. And therefore in the context it has no relevance.

As far as you showing your diploma which was veriified by the mods here, this is supposed to prove you are an MD? I can get the diplomas and licensure of friends/colleagues, even family members. And if you don’t have any family or friends info you could use, I’m sure you could get fake diplomas no problem. When I worked as a valet in my undergrad program I met several of these tools who would have fake medical diplomas and licensure just to try to get women. I just googled fake diploma’s to see what would come up, and right away you find about 10 different companies out there that will make everything from GED’s to real medical diploma’s. The first company I saw says that they can duplicate any school, at any year, in the country. All someone would need to do is look up any MD’s name and pay $200 and they have full realistic documents that say they are MD’s. And if you say, “well the mods verified it”? How did they verify it – they CAN’T, period! Like I said, you could say you’re anybody. You could use friends/families/fake documents, and even if they went to the state licensure website, it would say so and so is an MD. I could give you the name of 10 different schoolmates of mine that also are Advanced Practice Nurses and show you their diplomas and licensure. If you called the schools/institutions they attended and asked the dean directly you would get a “yes, they graduated from here”, etc., but that doesn’t mean I’m them does it?

I was thinking what you need to do to really prove it is give your medical license # as well as your DEA #. The DEA # is not found in any website, and most health-care practitioners keep that # quiet unless its absolutely needed. I could give you my real license # and my DEA #, however, I could also get you the license # of all my colleagues/friends/ and family members also. So again, there is no way to prove you truly are an MD, period. Nor can I prove I am who I say I am, and nor do I care to. Unlike you, I want to keep my anonymity as much as possible. I didn’t go through all that schooling, all that work to leave myself open to malpractice or civil lawsuits b/c I decided to give medical advice on a website where many people are engaging in illegal activities. The only way to be able to help and still remain free from liability is anonymity.

In the end I could care less what you are - a failed medical student, a paramedic, whatever. My point in finally speaking was b/c your info didn't make any sense, and still doesn't in the context of the question initially asked. And again, if you were a real clinician you wouldn't need to ask what you do in pts you send home on Lisinopril. First of all you determine if they do check their BP frequently, and if so you ask them to take it several hrs after they take the medication. That's exactly what I told the initial writer when he PM'd me. If the patient doesn't have that ability, then you start them out at the smallest dosage. Your just gonna send someone home on a new BP medication and say, "well what am I gonna do - follow them home w/ a first response team?" If you have a medical license and this was your attitude you wouldn't last long.

Fact is again, in the clinical setting if you ever see a pt w/ elevated BUN and creatinine 99.9% of MD's/clinicians are going to pull the pt off Benicar if they are on. The fact that some studies w/ very specific groups of people show some renoprotective properties b/c of anti-inflammatory properties of Benicar does not mean that is what occurs in the clinical arena - even in these Chronic Inflammatory Illnesses. Anyone out there knows there are millions of studies that state millions of things, but that doesn't mean it changes the standard of care. One day you'll hear of a study on TV that states coffee is good for you and you should drink 2-3 glasses/day, and next there's a study to refute that one - everyone out there is aware of this.

Yes, I too am done w/ this. Like I said, I don't care what you tout yourself as. But when you're making statements that aren't clinically prudent, then I'm gonna speak up.

 

[alpha6164]

^^^Dude just give it up. At the end of the day you are a nurse. Done. period end of the story. You couldnt get in to medical school so you are adding your years of experience to actual training. Sorry let me add my 12yrs of high school, 4yrs of pre-med, 4yrs of medical school, 4yrs of residency and 13yrs of practice on top of that if you dont mind. You are just farting at the mouth. I said credentials and not my diploma. The mods have seen my actual state license along with my ID badge from a major university system verifying i am an associate professor. Yes nurse anesthetists are taking over because this country is going to shit because it is all about money and getting away with the cheapest way possible not because it is the best.

You think we use nurse anesthetists or ARNPs cause they provide better care than an M.D.? lol you are really killing me here bro. No cause it is half the price. Just drop it.

 

[osiris]

kylho,

Trust me, the first thing i did when i signed up on this board was post my credentials. Several mods here already have verified who i am and what i do. I am an associate professor in a major university system in Florida. I dont need to prove anything to you at this point. Remember it is 2012 not 1960. Yes you can steer a car with your feet if you want to but that doesnt make it good damn idea. Can you diagnose cardiomegally with a chest xray? sure, but can you diagnose thickened walls, ejection fraction, valve leakage or stenosis? These are all the possible signs of long standing hypertension and cardiac damage that chest xray wont tell you shit about. I have delt with your kind before. Couldnt get into medical school so you became a nurse and now spew shit you read off the books to sound smart. Yeah you can write a script but you are still assigned to another M.D. that has to sign your controlled substances cause why? Cause at the end of the day you are not a physician. You are a nurse. And you wanna call me out on spelling? lol. i didnt know i was writing a thesis. Half the time i am replying with my phone and type as fast as i can. It is what it is.


You said ace inhibitors and ARB blockers have no renal protection i listed three studies that show otherwise. You have anything to say about that? I gave you specific clinical information. Anything can happen to anybody. Just because your BP crashed does not mean it will happen to the other 99% of people out there. You saying your ICU patients had crashed BP is so damn irrelevant to the general population that makes me chuckle. There is a reason that patient is in ICU to begin with. I ran ICUs before. They have so many confounding factors in their disease process that making generalizations that because an ICU patient's BP dropped means it is a dangerous drug is crazy.

What happens when you yourself decide to prescribe lisinopril or any other BP med to a patient? Do you follow them home with a first response team to make sure their BP doesnt drop? what a crock of shit. You prescribe BP meds, you advise your patients of risk and go from there. So the millions of BP meds that are prescribed weekly to patients across this country, then people are just fucking dropping dead left and right everywhere? I am done with this conversation.

As far as APN goes, i have never heard of the term till you mentioned it. We refer to them based on what they do. You are either a nurse practioner, nurse anesthetist, a nurse midwife etc.

That you did buddy and fuck credentials, you demonstrated, to me anyway, your education and knowledge. I believe I called you an ass clown the first week but I am actually impressed by your knowledge and willingness to help. You are one of the good guys here.

Question for you. My doc switched me to lotrel a few months ago for bp and its never been better BUT when I take it during the day it makes ne feel horrible. What'd going on with that.?

Sent from my HTC VLE_U using Tapatalk 2

 

[alpha6164]

That you did buddy and fuck credentials, you demonstrated, to me anyway, your education and knowledge. I believe I called you an ass clown the first week but I am actually impressed by your knowledge and willingness to help. You are one of the good guys here.

Question for you. My doc switched me to lotrel a few months ago for bp and its never been better BUT when I take it during the day it makes ne feel horrible. What'd going on with that.?

Sent from my HTC VLE_U using Tapatalk 2

Thanks bro. I am not a huge fan of Lotrel because of the amlodipine (Norvasc) in there. It is a combo med of an ace inhibitor and Norvasc. I have never been a fan of Norvasc and it is really starting to fall out of favor. It is a mild BP med to begin with and its side effect profile is not so great. Being a calcium channel blocker the mechanism is not so great. It can cause fatigue, water retention etc which are definitely not great things to have as an athlete or someone that works out etc. You may want to have your doc switch you up to straight benzapril or lisinopril and see how it goes with that by itself.

 

[Simpllyhuge]

What if renin is elevated?