Losarten

[Love100cats]

After my annual review last week the nurse checking my blood pressure told me I shouldn't be on losarten as I was also on bisoprolol. I think I've spelt both wrong! Anyway she made an appointment then and there with my g.p. in 4 weeks. But today I saw the heart failure nurse and she was shocked. She said that losarten strengthen s the heart muscle and that's why it was given to me. The worry is that I've been discharged from heart failure clinics and only saw her because she came to see my husband. It seems so easy to refer us back to g.p. services but it's a worry as they aren't specialists in heart failure.

[Lezzers]

That is the exact reason I worry bout my husband being put under the GP's care. The GP is very supportive (usually) but she did prescribe a tablet that you should not take if you have HF. The minute his nurse found out she stopped him taking it. The GP and the nurse used to have a few disagreements re care & medication and the nurse always won. Nurse discharged husband as there's nothing more they can do at the moment (but GP/cardiologist can re-refer him at any time!) but his meds have not been optimised due to intolerence and cardiologist is in the process of tweaking them!! GP is supposed to be monitoring but not going well at the moment!!

[Celtic]

Hi Love100cats. I do hope the surgery nurse is wrong and the heart failure nurse is right. I also take take Losartan and Bisoprolol!

Interestingly, the Potassium leaflet says: “Special caution is necessary when you are treated with a B-Blocker concomitantly”. Bisoprolol is a B-Blocker! It also says: “Take special care if you have problems with your heart valves - the reason the cardiologist prescribed Bisoprolol AND doubled my dose of Losartan!

It’s a minefield out there as far as medicines are concerned, especially when you have to take multiple drugs. We have to hope that those treating us know what they’re doing! Good luck with getting a reassuring answer in your case.

[Bagrat]

My OH was on both for 14 years until a few months ago when his previously well controlled hypertension took a bit of a dive. Over a few weeks GP stopped losartanand bendroflumethiazide. He has since developed signs of heart failure. May be coincidence of course.

[Love100cats in reply to Bagrat]

Thanks. Yes it's scary. We are just humans doing the best we can but in the hands of professional people who at times are awesome but other times questionable. Thank goodness for this forum!

[Clerkenweller]

I would you suggest that you call the BHF and talk to a specialist nurse. I personally would have an immediate chat to your pharmacist. Mine is excellent and can advise if there is a problem.

[ling]

Losartan and bisoprolol - is it the worry your BP might go too low?

It's been a while. How have things been?

[Love100cats in reply to ling]

Hello Ling. Good to hear from you. Yes it's a worry because I've been discharged from heart nurses and handed over to g.p. but our surgery has become like a fort with a moat round it. The receptionist asks what's it about then says Dr. too busy. Duty doctor doesn't know you! Saw heart failure nurses yesterday because she came to see husband and always checks me out but she said that due to his complex needs they won't bevisiting again. So I have rely on this forum which works like a dream. But there is a big black hole which we could fall into!

[ling in reply to Love100cats]

Sounds like you are left stranded. Any way to get back to seeing your heart doctor?

Is your husband then getting referred back to the cardio since his case is too complex?

Are you now getting more help with your husband?

[Love100cats in reply to ling]

I have never seen a specialist though I have permanent AFib. My husband hasn't seen his for a year or more. When told his pacemaker had 6% battery life back in March we were told he would have an appointment sometime. He is such a quiet gentle man. I was told 6 months for pacemaker from March but they told g.p. 1 year. Now he has dementia, his diabetes is difficult to control with insulin, the g.p. said a blood test had shown he has cancer somewhere! No further investigation to be arranged because there is no point(her words) so it's like having all these balls in the air but not knowing which one will not ground first! But I know he his happy at home and doesn't want to be messed with so I have increased home help a little and will fight for what I can get to support us at home.

[ling in reply to Love100cats]

I'm confused.

You've never seen a cardiologist? You have permanent AF and HF, please correct me if I'm wrong. So why have u not been reviewed by a cardio?

Since we last corresponded, are you now doing less for your husband and delegating more, and having more time to look after yourself and rest?

Good if do.

Bear in mind, your husband can remain happily at home only because you are there to make it so. So you must make sure you are well.

[Love100cats in reply to ling]

I'd love to know why I've not been seen by cardio. I think they all have a wait and see attitude so IF I get chest pain, IF I get breathless again, IF I collapse I will be seen. I am starting to take my self more seriously with counselling, extra help at home and am reviewing all avenues of support. Thankyou again for your timely advice.

[ling in reply to Love100cats]

I don't like the sound of that.

The system is broken where you're at.

I don't understand why the same system works so different in different parts of the country.

[Hidden in reply to Love100cats]

This is a difficult one -

first the possibility of medications clashing. The pharmacist has a vast experience of drugs and has to hand the DRUG MANUAL, a huge reference book that lists all prescribed drugs and whether they may clash - It's a more professional publication that follows a pattern much like the little information sheet inside the drug packet that outlines side effects etc. The face value of this one indicates you were prescribed these drugs by the specialists and would have thought a nurse would not have commented in such a way A because of upsetting the patient B She is a nurse not a specialist or pharmacist - thats a tad dangerous thing to do. There is no reason why you should not contact your specialists secretary and to ask the question or to have an appointment to ask the question

Secondly, if I was having a clash of personalities with nurse and doctor, no matter how nice the nurse may be, I would err on the side of the doctor - after all they are doctors!. If there is a real clash of personalities or trust issues, than you are quite within your rights to change doctor within a surgery or to jump ship and register with another surgery. Both my wife and I have had no problem getting a an appointment and when asked we reply that I am a recent bypass surgery patient that needs clarity and advice - thats it. If they say no (which the have not) I would reply OK fine but if I die it is your fault - what is your name please? causes much reflection and usually changes minds.

Thirdly, the way your surgery is treating you is unacceptable. We all know they are busy and try to weed out the unnecessary keeping little time to the most needy. The cardiac nurse stating they will not be coming again because of his "complex needs" would not be re attending again, sounds to me another case of unacceptable treatment. If you feel in need, go to A&E and ask the question of medication there. Nurses can't just tell you they will not be coming back because the patients needs are too complex - well if they will not return - WHAT WILL THE NHS BE DOING FOR HIM? It was a doctor that authorised the appointments at home and it is only a doctor that can cancel them/

Looks like you and your husband are going through it at the moment - hang in there and always try and get your answers from the horses mouth and in your case it is the specialist at the hospital. However it must be said that a good doctor will know what medication is best for you and if not, they would write to the specialist and ask the question on your behalf. There are always options open to you. Good luck

[Love100cats in reply to Hidden]

Thank you for your logic. Because I'm not well sometimes they get the better of me but I'm in fighting mode and will keep searching for the support we need and have a right to.

[Bagrat in reply to Hidden]

I have to say A Clinical Nurse Specialist working day in and day out with a cardiologist may be more knowledgeable about her particular specialty than an excellent GP that is expected to know everything about everything.

[Hidden in reply to Bagrat]

May I respectfully refer you back to the original post - the one I was trying to answer and to clarify my point. It was actually the nurse in the cardiac clinic that gave the first comment - the one given during the annual review who sowed the seed of doubt which really shoots your theory in the foot. Then the "Heart Failure" nurse contradicts the first nurse with what is probably the correct assumption - but what chance does the poor patient have in such a circumstance with the conundrum of who to believe? That was why I answered in the way I did and do not believe this to be the professional way to handle such events..

Whatever a nurse might feel or might disagrees with a doctors decision, it is not their place to put doubts in the patients mind about their treatment but to refer the doubt directly with the doctor, who could well have given a doubtful decision or who may actually be found to be correct and when explained, aids the nurse in their breadth of knowledge.

[Love100cats in reply to Hidden]

You are right. So much happening I have to daily have moments of sorting and prioritizing so that I don't rush in in panic mode. I'm dealing with two lives with chronic illness and I can't take risks.

[Bagrat in reply to Hidden]

I totally agree. I was a Clinical Nurse Specialist in Palliative Care and the first thing is always to make sure the patient's faith in the medical team is maintained ( even if you have to work very hard to get the optimal treatment in place sometimes) I would never have expressed doubts to patient before discussing with GP or consultant. They of course often have different takes on matters!!So no need to be respectful. I gave that up when I retired!!

[Hidden in reply to Bagrat]

Thanks for the reply - the last thing I would want to do is to step on toes and did wonder if you may have been a Clinical Nurse Specialist. Nice to hear we actually agree and I do have first hand knowledge of such discussions between doctor and nurse and how that can turn very unprofessional very quickly with only one winner (if there ever is one) although only a fool would bite the hand that looks so well after them

[Sillyfroggy]

I would make full use of the BHF helpline, I have a couple of times and they’re fantastic. I’m lucky, my current GP (ex Addenbrookes doctor) seems to know a LOT about heart stuff, and knows the drugs do more than they say on the tin. I do wish some HCPs would accept their limitations and not give medical advice without the full facts. She absolutely should not be giving drug advice to any cardiac patients.

Does your surgery hold emergency appointments?

[Love100cats in reply to Sillyfroggy]

Yes but with the duty doctor. I phoned about 3 weeks ago with a bit of a crisis but he said " I'm far too busy with end of life patients " He did pass a message to our g.p. 3 days later!

[ling in reply to Love100cats]

Call again at a different time when it's a different doctor on duty

[Hidden in reply to Love100cats]

That is unacceptable behaviour from a surgery - nor is it anyway demonstrating a graded response to each and every situation that comes before them. What if the situation referred to a child with suspected meningitis or just a high temperature, or just spots and a high temperature? You should not be treated like that - have you the ability to change doctors?

[Love100cats in reply to Hidden]

Yes we can change. Sadly we had an amazing Dr. Who retired. We really trusted him. We were put on the list of the new Dr. Who had come from being a vet! We don't have the same confidence. But I can see any doctor so I'm going to try making appointments with the more established ones.