Q & A: Chronic Health

January 22, 2010

Successfully managing and treating a chronic condition such as hypertension, diabetes or chronic kidney disease requires a great deal of knowledge and understanding. For this edition of Q&A, Dr. Napisvadee Wongchavanich, a board-certified specialist in internal medicine and nephrology (kidney), answers reader questions about these serious chronic diseases.

Q:  I have been experiencing good results taking anti-hypertensive medication. But I do hope that I won’t have to keep taking it forever. Is there a point when it’s considered okay to stop taking the medicine?

A: While there have been documented cases of patients successfully discontinuing their anti-hypertensive medication, it’s quite a rare occurrence. In these rare cases, patients are usually given very strict guidelines that must be followed to remain healthy. Guidelines usually include avoiding smoking, maintaining a healthy diet, and  exercising regularly.

Patients are closely monitored as a precaution against potential hypertension-related complications that can affect the heart, kidneys and major arteries. When damage is suspected, doctors typically recommend the patient continue or resume the anti-hypertensive regimen. Along with a proven record of safely and effectively controlling blood pressure, anti-hypertensives have also been shown to produce additional health benefits to other areas of the body.

Finally, be aware of the “rebound” effect; this term describes the situation whereby a patient experiences an abrupt rise in blood pressure after discontinuing a hypertension medication regimen such as clonidine or beta blockers. While there are situations requiring a medication reduction or stoppage, doctors more often recommend a gradual reduction in the dosage over time. As with all medications, always follow your doctor’s recommendation before making any changes to your medication routine. ENend.gif

Q: Can kidney dialysis be done at home? Are there any restrictions or considerations that patients need to consider? 

A:  At-home peritoneal dialysis is becoming increasingly more common. Patients must first learn the proper way to load the catheter with dialysis fluid intended for the peritoneal cavity along with the correct method for drainage of fluid and waste after blood filtering. One potential hazard of this at-home procedure is the risk of infection of the area around the catheter entry point, which can then spread to the abdominal wall.

At-home dialysis patients need to be vigilant about following all procedures exactly as trained. And patients who have had abdominal injuries may not be eligible for at-home dialysis.

Patients suffering from diabetes are usually required to have a nurse or other specialist on hand to help with the dialysis procedure, as many diabetes patients incur vision problems that limit their ability to perform the procedure without help. ENend.gif



Q: My friend recently gave up some of her favorite foods because of worries about cholesterol. It got me thinking; since medication can help lower cholesterol, she would probably be much happier if she started taking a cholesterol-lowering medicine and no longer needed to worry so much about her diet. From a doctor’s perspective, is this a practical idea?

A: It’s definitely not a good idea. Medication can help control cholesterol in combination with a proper diet, but it’s not a substitute for a proper diet. Patients who don’t follow a healthy diet are likely to need higher dosage levels of cholesterol medication – a situation that can leave patients more susceptible to side effects including myositis and nephritis. ENend.gif

Have a question? You can submit your question for possible inclusion in future issues of Better Health, by e-mail [email protected] or by mail to Editor, Better Health Magazine, Bumrungrad International, 33 Sukhumvit 3, Wattana, Bangkok 10110 Thailand.

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