Roger, at forty-nine, was a twenty-eight-year veteran of the New York police force. Years of desk work had contributed to poor circulation, varicose veins, and chronic edema of the legs. When he first came to see me, he complained of leg swelling and intolerable itching. To relieve his symptoms, I prescribed 40 mg of Lasix, an often-used diuretic, and suggested that he begin a regular walking program to improve circulation. I also recommended that he cut back substantially on the processed meat sandwiches he often ate—they are infamous water retainers. He also took regularly scheduled breaks from his desk for badly needed stretches and new leg positions.
When I saw him five months later, his condition had greatly improved, but now he had a new complaint: periodic episodes of ED. Since he had responded so well to Lasix and had incorporated lifestyle changes into his daily routine, I decided to try lowering his dosage. The intention, of course, was to maintain his improved circulation as well as combat his ED. First, he tried taking the medicine every other day instead of daily. The result was a return of the edema and sporadic ED. The next step was to reintroduce the daily dose, but at lower levels. This time, the edema was reduced and the ED was eliminated.
Lowering the Dosage and Adding Another Drug
Bill was taking 100 mg of Hygroton, a diuretic used to lower his hypertension. Although the medicine worked, the forty-six-year-old soon developed erection problems. To counteract his ED, I chose to lower the dosage to 25 mg, although I knew that this alone would not be enough to control his blood pressure. So, I also prescribed a small dose °f Hytrin, a vasodilator. The combination of the two controlled the hypertension and got rid of his ED.
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