Saturday, January 31, 2015


This is the second Camp at Sg Aup Church.

I arrived at Sg Aup with the advanced party, to set up the Camp. The place offered was a Church annex ( which was a two storey building ). There were some space constrain but adequate for our purpose. The pastor was very kind and came out early to help us set camp. I decided that the screening, physicians, paediatricians, eye and pharmacy  will remain on ground floor, and the skin, OG, breast examination and dental clinic will be on 1st floor.

Patients were arriving even as the floor was being mopped and the stations were being readied.  Sg Aup is essentially in the outskirts of Sibu town ( about 45 mins journey away ).

In Sg Aup, the 4 SBs were there bright and early.

We saw 204 patients, took out 44 teeth, screen 55 eye cases and picked up 19 cataracts. 47.8% had BMI < 25, 46.5% were overweight with BMI >25 but <35 .="" 5.6="" bmi="" obese="" were="" with=""> 35. With regards to the FBS, 40.1% were normal, 29.5% had FBS between 5.8-7.0 mMols/L and 30.3% had FBS in the diabetic range.

This Camp was over by about 9 pm also. We were bussed to a nice Chinese Restaurant for dinner at about 9 pm, and returned to the Hotel at about 10.45 pm. This dinner was sponsored by FPMPAM, as we were leaving YB Oscar Ling's constituency.
Tomorrow we proceed to Bintangor, which was ADUN Ting and YB Andrew Wong's constituency.


Winston Yap said...

Doc,please allow me to digress.
I am facing a medical dilemma.
My wife, aged 71 was just recently diagnosed as having high-blood pressure by a GP, with a systolic of 170.
He prescribed Lofral 5(amlopidine), one tablet daily.
On a follow-up visit, he found that her systolic blood pressure was still
high - 144.
He wanted to prescribe a diuretic for her.
However before the follow up, we did a blood pressure check with our home Omron monitor and found the blood pressure to be 124.
I asked the doctor about this and he said that it was due to "white coat syndrome".
But he still wanted to prescribe the diuretic to her.
I then decided to bring her to see a physician.
He told her to stop taking the medicine and have her monitored for one week.
If the blood pressure went up above 140/80, she was to take one Lofral 5.
The results were:

132/76/78 (morning)
157/70/71 (4.00pm)
143/75/74 (4.00pm)
She took a Lofral 5 on the same day.
Her blood pressure was taken at 9.00pm the same day.
The reading were:
We consulted the physician again on the 22/1/2015 and informed him that we intend to start her immediately on the medication as we heard from our friends some patients suffered from stroke because their doctors don't want to start them on medication yet.
Her blood pressure from 22/1/2015 were:
22/1/2015 (morning)
126/71/82 (morning)
125/76/82 (evening)

122/66/87 (morning)

121/74/82 (morning)
131/69/75 (evening)

123/75/90 (morning)
109/59/72 (evening)
107/61/74 (evening)

123/74/82 (morning)
131/69/78 (evening)

128/76/92 (morning)
119/62/68 (evening)

122/69/76 (morning)
117/67/74 (evening)

118/69/83 (morning)
112/60/75 (evening)

121/69/78 (morning)
111/64/77 (evening)

125/69/74 (morning)
113/61/72 (evening)

125/69/77 (morning)
112/59/71 (evening)
I think that Lofral 5 alone is effective in treating her blood problem.
Her diastolic pressure after taking the medication however, is mainly in the sixties - could this be bad?
What is the lowest systolic, diastolic as well as heatrate that is still okay?
However, the main worry is that amlodipine has serious drug-drug reactions with a wide range of other drugs.
And I am very worried that she may be prescribed some of these drugs in the future.
She has always been healthy and her yearly full fasting blood test shows all her checks to be within the normal range.
I really hope that you can help me to decide whether she should continue with her blood pressure medication.
Thank you very much.

hmatter said...

This is a long one.
I am a firm believer of lie style modification to reduce BP. It is usually effective. No added salt diet, greens+++ and fruits +++ and exercise. 6-7 hrs sleep at night and home BP monitoring is better than any pill.
Amylodipine is a good drug. There are D-D interactions, but nothing major. I much prefer Norvasc as quality control is important.

What now can we do?
Suggest :-
Half the current doses, and home monitor BP wile doing lifestyle modification.
Make sure the sleep is good. Most widely fluctuating BP is due to poor sleep.

As regarding hypotension, in the absence of proven CAD, there is almost no downside to low BP. Of course if dizziness and unusual tiredness occurs, then that BP is too low, and should be avoided.
Hope that helps.

Winston Yap said...

Doc, thanks for the prompt reply.
Is it true that if the systolic blood pressure suddenly goes up too high, it can cause a stroke?
Also, based on your suggestion to half the dose, can it be finally discontinued while she is being monitored by home B/P monitor?
Thank you.

hmatter said...

Hi Winston,

The data does suggest that systolic HBP is also associated with an increase incidence of stroke. I do not think the data supports sudden surge. However, high BP variability is associated with increase risk.
Whether the drugs can be totally off depends on how successful are the lifestyle measures. Take it a step at a time. All the best