This is the first Thanksgiving holiday that I didn’t spend with my father. My father passed away recently, but his illness and deterioration were three decades in the making. There are images that I will never forget in the last year of his life, things that have changed my view of health care: end of life pneumonia, cachexia, cyanosis which fills me with anger and an ache that won’t dissipate.
This year, my father would’ve celebrated his 80th birthday. People have tried to comfort me by telling me he’s gone to a better place, or that he lived a long life, but I feel cheated. I would retort angrily to them, “People in Japan live to 100. Why didn’t my father?”
The reasons that my father died are complex, interconnected and took several, successive stages to fully realise, but it all began 30 years ago, in 1989, when my dad was first diagnosed with hypertension and started an irrevocable course of medication and lifetime polypharmacy that would eventually steal his life away.
My father, a Captain in the Air Force who was promoted to a Major after the Vietnam War. He received two Air Medals for his service by the President of the United States.
In 1989, my father had been working for the Chevron Corporation. He began his career as a pilot in the Air Force, and soon moved up the ranks to Captain, where he became a decorated officer and won two medals from the President of the United States during his service in the Vietnam War. He was promoted to a Major, but the trials of war had changed my father’s perspective on life. He had witnessed the worst of humanity during a prolonged war and watched his best friend die. Although, military service had allowed him to travel all over the world, he realised that a peripatetic lifestyle wasn’t the way he wanted to start and raise a family. As he was flying over the Sierra Nevada mountains, he decided to settle down in California. In 1980, he gave up his military career, to begin a new one at the Chevron Corporation.
The oil industry was for many years, what gave economic stability to American families. It allowed men to provide for their families during a time when there was a distinct shift in the United States, where a lifelong career at one company was soon disappearing. My father had wanted to return to university to pursue a degree that would have put him on the Professor track, but he made the decision that being a student again wouldn’t allow him to have a family, and so he chose the path that would allow him to be able to comfortably provide for a family.
My father, second row, third from the right, with his colleagues at the Chevron Corporation in the 1980s.
As I was going through my father’s documents, I found that in 1989, he had received a letter from the doctor, recommending that he can no longer hold his position at the Chevron Corporation due to his increasingly high blood pressure. My father had been an athlete all his life; he didn’t smoke, he rarely drank, and he had always been physically active in great form. However, due to his work, where he was actively working in dangerous conditions and under pressure in an oil refinery, he was most likely, exposed to many toxins in the environment. Oil refineries are notorious for its hazardous wastes; the high amount of nitrogen, hydrogen, hydrofluoric acid, carbon monoxide and volatile hydrocarbons probably became direct catalysts to increased blood pressure as the body’s magnesium reserves become depleted when exposed to toxins. And so my father began a course of medications that would eventually take his life: calcium channel blockers, beta blockers, angiotensin-converting-enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs).
HOW ANTIHYPERTENSIVE MEDICATION STOLE MY FATHER’S MEMORY
I remember as a teenager, I would ask my father what the definition of a certain word was, and he would always have the answer. As a young man, my father was the first in his class, excelled in every subject and attended Seoul National University. He was fluent in several languages, had a photographic memory, and probably knew the definition of every word in the dictionary. My father would wake up at 5am every morning to tutor me in math, science and essay writing before he would leave for work.
However, in 2008, I started to notice something strange; I would ask my father what a certain word meant, and he would give me a blank stare. He began not to understand what people would say to him in telephone conversations, and so we assumed that perhaps he was suffering from progressive hearing loss. He would suddenly leave the room in anger as we were dining in a restaurant. We had the best health care coverage at the time and he had seen many doctors and specialists who previously prescribed him hearing aids, but he would never wear them because my father said they never helped him. None of his doctors thought to schedule an MRI or to order a carotid or cranial ultrasound of his brain.
House Minority Leader Nancy Pelosi is one of many politicians on Capitol Hill who are showing signs of memory loss and dementia, a possible effect of long term usage of anti-hypertensive medication and/ or benzodiazepenes. A pharmacist who provides medications for politicians had initially said that many members in Congress have prescriptions for dementia conditions such as Alzheimer's.
Two years ago, I was walking with my father on a bike path, when I suddenly made a quiet remark about the horizon. My father was perhaps 30 feet ahead of me, but he suddenly turned around when he heard me. I realised then that my father never had any hearing problems. What had happened was that his understanding of language was beginning to break down, and he had developed an advanced case of logopenic variant of primary progressive aphasia. Three decades of taking antihypertensive medication had finally come into full focus. The quiet enemy we never saw coming was now here: dementia.
My father, who had been so proud of me for graduating from Columbia University, despite the fact that I had initially wanted to drop out during my junior year to travel to France, and the ensuing conversation at the airport that led him to convince me to continue my studies, could no longer remember where I had gone to school. My father, who could solve any puzzle, could no longer be able to put two pieces together. My father, who wrote beautiful prose, could no longer write his own name.
THE FINAL STROKE
The MRI of my father’s brain showed that he had suffered a series of transient ischemic strokes in several regions of his brain over the years. The anti-hypertensive medications could no longer bring my father’s blood pressure down to normal. There is a point when after decades of taking them, that they stop to work. No combination of blood pressure medication would decrease his blood pressure; the new normal was 200/100 putting him in danger for another cerebral infarction. Instead, the medications continued to steal his memory. First, it was his long-term memory; then his short-term memory, then his working memory. However, for a year, my father was starting to recover under a combination of allopathic and holistic treatment. Things were looking up, and just when our family began to think he might recover from dementia, on one day in June 2016, my father had decided to leave the house against the orders of our family, by himself, to go on a walk when he was found several hours later in a minimally conscious state. It is unclear what happened in the hours he was gone, but this final ischemic infarction is what would finally take away any remaining aspect of my father’s personality.
A cranial ultrasound can detect blood vessels in the brain before a stroke occurs.
Cartoid ultrasound can detect blood flow in arteries before a stroke occurs. A cartoid ultrasound and a cranial ultrasound should be standard diagnostic tools for early detection of stroke and dementia in individuals taking medications such as anti-hypertensives. Had my father received a cranial and cartoid ultrasound as part of his annual physical, his transient strokes would have been detected early and would never have progressed into dementia.
At the hospital, I noticed that his blood pressure showed 118/76, a normal blood pressure I had never seen my father have before for many decades. I asked the nurse what he was being given in his IV and she told me it was intravenous magnesium. I asked her, "if intravenous magnesium is able to bring down his blood pressure to normal, then why was he prescribed all these anti-hypertensive medications for decades?" She gave me a blank look, and said it was “just hospital policy”.
Several days later, I see my father’s neurologist outside the hospital building, chain-smoking cigarettes. I approach him to ask him about my father’s condition and he tells me that he has "never seen cases like this ever resolve. I suffer from depression because I cannot help the people I treat," he tells me. "I have no answer for you. There is no cure for his condition." We discuss a bit more about dementia research, acetylcholine receptors in the brain, photobiomodulation, hyperbaric oxygen therapy, but the last is a treatment that is not covered under my father’s insurance, nor was there a facility nearby that would allow him to have hyperbaric oxygen therapy treatment. In the end, I realised, the insurance companies run the show. Insurance companies decide what kind of treatment patients are allowed to get and how and where people would die.
My father’s neurologist tells me that my father probably has around 6 months to live and that it’s best that we make him as comfortable as possible before he dies. When I enter the hospital, I see my father in his room and it is an image I will never forget. The nurses had tied his hands to the bed’s railings because he kept pulling out his IV medications and just left him there like that, all day. I see my father, the athlete, the war hero, and he is tied to his hospital bed, like an animal. I wondered where is the humanity in the way we treat the elderly? How is it, that my father, who had worked hard all his life, an immigrant who represents the American dream, would end up like this?
My father didn’t die within the 6 months that his neurologist predicted. What my father needed was physical therapy and hyperbaric oxygen therapy, but these were the resources that were out of our reach; resources that we did not have access to as a modest, middle-class American family.
My father would live for another year and half in a perpetually minimally conscious state. The final stroke he had suffered from took away his speech completely, and his appetite. Once a voracious eater, who loved my Italian dishes and would always have seconds of my homemade chili, my father no longer wanted to eat and had to hand-fed around the clock. Although, he made some improvements during this time, he was still not able to eat as he normally did and he began rapidly losing weight and lost a lot of muscle tone in a short period of time. Cachexia was beginning to take its toll. In the last few weeks of his life, my father started developing sores all over his body, which the doctors told us was part of being in a perpetually bedridden state. However, what they didn’t tell us was that bedsores develop due to asymptomatic pneumonia. Healthy people are able to move around and clear their lungs, but in a bedridden state, lungs fill up with fluid, and a lack of oxygen to the body creates a situation in which sores begin to develop on the body from pressure. End of life pneumonia, cachexia, and cyanosis is how doctors say we all die in the end. In the end, my father, the athlete; my father, the war hero; my father, who had taught me that women could do anything that men could do; who had sent me to the best universities in the world, who had been my emotional support my entire life, could no longer remember who I was. My father was nothing more than a skeleton when he died, and his passing away was neither peaceful nor tranquil. All I could think of was, my father deserved better than this.
ANTI-HYPERTENSIVE MEDICATION: HOW THEY HIJACK THE BODY TO LOWER BLOOD PRESSURE
The human body is an evolutionary work of art. We have thousands of centuries of evolution to have created our body as it is. Our blood pressure naturally rises during exercise, when we eat, and when we are exposed to toxins in our environment because we need more oxygen in our bodies. Our blood pressure rises due to the environment, and falls back to normal when our bodies repair the mechanism that is failing in our system and our method of energy transport is in homeostasis. For our bodies to attain normal blood pressure, we need a perfect balance of sodium + calcium + potassium + magnesium.
However, anti-hypertensive medication hijack this system by altering the metabolic pathways for how our bodies deal with stressors in the environment.
Intravenous magnesium brought my father's blood pressure down to normal for the first time in his life after taking decades of anti-hypertensive medications, yet magnesium is not preferred treatment for high blood pressure in our medical system.
Calcium-channel blockers prevent our cells from energy transport of calcium. Without this vital pathway, memory begins to deteriorate. Although blood pressure is artificially lowered by tricking the body into blocking calcium, the prolonged effects of calcium channel blockers include brain damage and memory loss. Decades of taking calcium channel blockers developed into transient ischemic strokes that showed up in my father’s MRI. I think back to 2008, when I first started noticing that my father’s memory had been deteriorating and I am filled with so much regret. In 2008, it was possible that my father’s condition could’ve been completely reversed. His brain damage from calcium channel blockers could’ve been reversed had we known what it is that he had, but none of his physicians ordered a diagnostic scan of his brain. Despite having the best health care coverage, no one had helped my father, and I think about how his memory was failing, and how dark that place must’ve been; how horrible it must’ve been to start to lose his grasp of language. And I noticed something was wrong, but I did not have the knowledge I have now to help him, and it makes me think that there is something missing in our healthcare system that should have been able to diagnose his condition, but instead, it failed him.
Beta-blockers work by blocking adrenaline in the involuntary nervous system and blocking a hormone called angiotensin II in the kidneys. Adrenaline is released in response to stressful events to prepare our bodies for a ‘fight or flight’ response. Activation of nerves connected to the adrenal gland release the secretion of adrenaline and to increase levels in our blood. However, beta-blockers hijack the system so that it puts increasing pressure on our adrenal glands, leading to damage of the kidneys and renal function. A decreased kidney function means that the body is not able to adequately remove toxins from the bloodstream and impairs immunity. It also means that beta-blockers could have an adverse effect on moods and emotional well-being. I recall as a young child that my father would suddenly have extreme mood swings. My father is usually calm and humourous, but for seemingly no reason at all, I recall watching my father getting angry about something very trivial for the first time which was very out of character for him, according to many members of my family. I realise now that it was around the time when my father had been first prescribed beta blockers in 1989 that he would suffer from these mood swings. In addition, he would always complain of being cold for several years and would wear layers of clothes. These were signs that his kidney functions were failing due to the usage of beta blockers. Not only did anti-hypertensive medication eventually take away his memory, but they conspired to take away his spirit and happiness.
ACE inhibitors hijack the body's system to suppress hormones from the kidneys, and artificially lower blood pressure in the beginning but eventually lead to the paradoxical condition of even higher blood pressure, when these medications create a condition of having too much potassium in the blood that cannot be filtered by the body.
Angiotensin-converting-enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) work by tricking the body into blocking the angiotensin II hormone in the kidneys. Although at first, this re-routing of natural human metabolism appears to lower blood pressure, however, eventually ACE inhibitors and ARBs will create a paradoxical situation of higher blood pressure after prolonged exposure, because these medications lead to a high concentration of potassium in the blood, due to the suppression of aldosterone levels in the blood. A high concentration of potassium leads to elevated blood pressure, and soon these medications cause the very situation of hypertension they were supposed to treat, in addition to damage to the kidneys. In addition, ACE inhibitors exacerbate brain damage and motor deficits and in independent studies without conflicting funding show that these medications lead to creatine increase which leads to a higher risk of dementia due to damage to the kidneys. However, I can only attest to my father’s own treatment in which he had been prescribed ACE inhibitors 2 years ago after his initial dementia diagnosis, which accelerated his condition rapidly in a matter of weeks.
These anti-hypertensive medications hijack the body, trick the body into re-routing hormonal signals and impair energy transport of cells and cause irrevocable damage to vital organs and even cause the paradoxical situation of hypertension in which they are supposed to treat. By artificially lowering blood pressure through these methods, we are creating a society in which cognitive decline in our elderly population is not only likely, but inevitable.
I miss my father’s laugh. I miss his advice. I miss the way we would watch my movie screeners together every Thanksgiving and he would tell me his opinion about what he thought about each director. I miss the way we would make trips to the bookstore whilst talking about literature, philosophy and art. The silent enemy, dementia, snuck up on my father from behind and was realised too late when the disease had already progressed to the point of no return. And I want to ask why is it that in our advanced era of hyper-advanced medicine, and living in the most technologically advanced nation in the world, was there no doctor who was able to find this at the beginning stages?
I wish I could go back in time. I think about this everyday since my father passed away. I think about going back to 1989 when my father had been first diagnosed with hypertension and telling my father that magnesium therapy would naturally lower his blood pressure, as the intravenous magnesium brought his blood pressure back to normal such as in the year before his death.
The body needs a perfect balance of sodium + calcium + potassium + magnesium for blood pressure to be normalised. Any deficiency in one would elevate blood pressure. Deficient levels of magnesium are linked to Alzheimer’s, Parkinson’s and other types of dementia. The body needs sodium to depolarise and repolarise cells toward action potential, then it needs calcium and potassium to open the channel, and it needs magnesium to close the channel. This is how energy is transferred, and any missing element or deficiency leads to increased blood pressure, heart arrhythmias, tremors, muscle spasms and seizures. By blocking one channel, blood pressure is artificially lowered but at a high cost of mental, emotional stability and intellectual capability.
If I could even go back to 2008 or even 2013 and stop these chain of events, I would’ve insisted my father begin hyperbaric oxygen therapy straight away as he was starting to show symptoms of logopenic aphasia; but I learned of all these things too late. 30 years of taking anti-hypertensive drugs slowly stole my father’s life and memories through transient ischemic strokes.
“Drugs are never as effective as exercise is for the brain.” - Dr. Andrew Josephson, UCSF Department of Neurology
“Exercise is the best thing for the brain.” - Professor Leonard White, Duke University, Institute for Brain Sciences, Neurology
My father gave me the gift of knowledge and a love of the pursuit of knowledge. In the last weeks of his life, I realised that our healthcare system needs to be changed. We need to integrate early dementia diagnosis protocols for people taking anti-hypertensive drugs and other medications. We need to support our medical team with physical therapists because drugs are never as effective as exercise is for the brain. We need to develop a society that has a network to support the elderly and for families caring for their loved ones. I think about how alone my father must’ve felt, as he was losing his memory and it haunts me. I think about how dark that place must’ve been, a confusing series of events that never made any sense, and no one in my family understood it until it was too late.
I love you, Dad. I hope we can meet again in the next life. https://youtu.be/fC3pnCMPWJI
[Disclaimer: This article is not intended as medical advice and is for educational purposes only. Consult your physician before deciding to stop taking any medication.]
By Sierra Choi