The patient is rather anxious as expected. In the meantime his hypertension was finally controlled after several combination of drugs for which I was relieved as he had subscribed his high blood pressure on anxiety when meeting with a doctor. In fact his former doctors did not really treat his hypertension as they agreed with him that he was suffering from a "white-coat" hypertension. However studies have shown that this so-called condition has to be treated as the sufferer is liable to a stroke.
He was referred to an urologist who was going to perform a cystoscopy ( a visual probe up the urinary tract) on him but was postponed on the patient's request. The patient did not turn up to my clinic for his subsequent appointment. Instead he took it upon himself to to consume a concoction of herbal mixtures to dissolve the stones ( by the way stones were not really visible on his ultrasound). He took the concoction on his own assumption.
He finally came to my clinic last week and apologised that he could not come earlier but according to him his medication was still adequate. I found his blood pressure had shot up compared to the four previous visits, I asked him what else he was taking besides his prescribed medications. He vehemently denied taking anything else. Then I offered to test his urine for blood which he promptly agreed. The urine microscopy was surprisingly clear. I persisted asking him what else he took for his condition. Elated at the urine result he finally admitted he was taking a herbal concoction for dissolving kidney/bladder stones.
I told him that his hematuria (blood in urine) may be relieved but the herbs are doing something to his blood pressure! He was crestfallen. He went home to bring back the herbal samples and I noticed that all sorts of flowers, one of them the periwinkle which is supposed to contain an anti-cancer agent were labeled as ingredients of the concoction. He also took a herbal drink made of lemon, mulberry, screwpine etc. So this patient has been self-medicating himself much to my amazement. Apparently he was frightened of the cystoscopy!
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| Periwinkle plant |
I told him that I cannot monitor him on the herbal use as there are no guidelines as to its dosage and frequency of use and I am not going to be responsible for his deteriorating blood pressure if he insisted on his own "medication". I painstakingly advised him to stop the herbal medication and take his regular medicine and return in two weeks for review of his blood pressure.
This is the frustration that we doctors face when our patients do not tell the truth about what they take and yet expect us to solve their medical problems based on a false premise. Unfortunately this patient thinks that he can make a difference in the management of his case by surreptitiously taking other agents. Another factor which makes me worried for him is that his herbal concoction could be masking his symptoms while the process is still going on in his body. This would be a tragedy for him.
I am waiting to review his blood pressure on his next visit. I hope he returns to his senses for his sake.
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