Benign Prostate Hypertrophy (BPH) and hypertension and......

My 52 year old patient RM has been on my hypertension clinic follow up for the last 12 months. Before that he was seeing other doctors. As he is a serial defaulter of his treatment, he keeps changing doctors earlier on to avoid, most probably, being rebuked by  some of them.

RM is an educated man holding quite an important senior position and he also travels outstations quite often. Besides having signs and symptoms of an enlarged prostate and a history of hypertension, he also suffers from chronic constipation and urinary retention, strangury, frequency and nocturia. All these symptoms are likely to be the effects of  his enlarged prostate.

I also observed that RM always looked depressed and not forthcoming about his condition especially with respect to his medications. I found out that he also defaults his urology clinic appointments (for the management of his prostate problems).

On his third visit I noticed his blood pressure to be rather low, 108/72. I asked him whether he was taking any other drug beside the blood pressure lowering drug that I have prescribed for him. He denied this. I was worried and after the consultation, told him to return any time he felt an unusual discomfort. He looked, as expected, rather depressed.

His following appointment was in August 2011 but he never turned up.

He came in early October with the complaint of  numbness on the left side of his body. He had defaulted for two months. He also failed to keep his urology appointment. At first I thought he was suffering from a mild stroke due to a high blood pressure as he admitted he had not taken anti-hypertensive drug for the last two months. But his blood pressure was strangely  within normal limits. I also could not elicit any signs of a weakened left side of his body. His  sensory and motor responses were normal so as his muscle tone and power and there was no other neurological deficits.

I was scratching my head as to what was going on with this "non-compliant" patient. I asked him again what other medication he was taking and he had better tell me if he wanted me to help him. After what seemed a long time, he admitted he was taking a drug to increase his urine flow. Then it dawned upon me that RM has been taking a drug called terazosin which also acts as  a blood pressure lowering drug.  That explained the low blood pressure recorded on his last visit. He was taking a double dose of "anti-hypertensive"!

It is therefore no wonder he experienced discomfort due to a low blood pressure whenever he was taking my prescribed drug. When he stopped the medication, he felt better and so he defaulted. I painstakingly explained the accidental blunder to him. I might not have continued the anti-hypertensive's prescription had I known he was on  terazosin.

On this non-scheduled visit, he admitted his urinary symptoms, accompanied by  back pain were getting worse. Wanting to be referred to the hospital , he came up with  the complaint of  left-sided body numbness which was, however, not verified by specific physical examination.

Giving him the benefit of the doubt, I referred him to the emergency department of the hospital for further evaluation and observation . Prior to that I took the opportunity  to advise him to always cooperate with the doctor so that his condition can be better managed.

And honestly, it takes  great patience not to dislike this kind of patient. Despite his reluctance to cooperate and his defaulting  twice on my clinic,  I have never admonished him, that is the reason he keeps returning but unfortunately he stretches it a bit too far and ends up not helping himself.