Dr Chung /meds comments please



B

Bnd777

Guest
87 yr old female as previously posted

Suspicion that Arcoxia 60mg a day may be the reason for current uncontrollable BP (has been on it
for 2 months for pain of severe Osteoporosis/RA/OA that other painkillers do not touch )

Has been taking Atenolol 50mg Tritace 10mg Bendrofluazide 2.5mg and Plendil 2.5 mg was added
2 weeks ago

Has irritating dry tickly cough swollen ankles tired slow eyes watering (but also has cataracts )
noisy breathing/breathless

Comments welcome
 
"bnd777" <[email protected]> wrote in message
news:[email protected]...
> 87 yr old female as previously posted
>
> Suspicion that Arcoxia 60mg a day may be the reason for current uncontrollable BP (has been on it
> for 2 months for pain of severe Osteoporosis/RA/OA that other painkillers do not touch )
>
> Has been taking Atenolol 50mg Tritace 10mg Bendrofluazide 2.5mg and Plendil 2.5 mg was added 2
> weeks ago
>
> Has irritating dry tickly cough swollen ankles tired slow eyes watering (but also has cataracts )
> noisy breathing/breathless
>
> Comments welcome
>
>
>
Cataracts as well and still driving! see this for Arcoxia
http://www.irf.dk/en/reviews_02/arcoxia.htm Derek.
 
"bnd777" <[email protected]> wrote in message news:<[email protected]>...
> 87 yr old female as previously posted
>
> Suspicion that Arcoxia 60mg a day may be the reason for current uncontrollable BP (has been on it
> for 2 months for pain of severe Osteoporosis/RA/OA that other painkillers do not touch )

Though I am not familiar with Arcoxia specifically, as a class, NSAIDs do make hypertension more
difficult to control. Would suggest you ask about narcotics or "alternative" methods of pain control
(acupuncture?)

> Has been taking Atenolol 50mg

Atenolol is not a good beta blocker for the elderly who tend to have decreased renal function (it is
renally cleared). Would suggest you ask about a change to a non-renally metabolized beta-blocker.

> Tritace 10mg

Given you describe what is likely an ACE inhibitor cough, this may not be a good choice either
especially if the cough is causing sleep deprivation, which can also make hypertension more labile
(difficult to control). Would suggest you ask about ARBs (angiotensin receptor blockers) as an
alternative.

> Bendrofluazide 2.5mg

Thiazide diuretics are less effective in the elderly especially if there is decreased renal
function. Would suggest you ask about a change to loop diuretics.

> and Plendil 2.5 mg was added 2 weeks ago

Calcium channel blockers can worsen edema. They may not even be necessary if the rest of her
medications were more "optimal."

> Has irritating dry tickly cough swollen ankles tired slow eyes watering (but also has cataracts )
> noisy breathing/breathless
>
> Comments welcome

Hope my comments help.

Humbly,

Andrew

--
Dr. Andrew B. Chung, MD/PhD Board-certified Cardiologist http://www.heartmdphd.com
 
"Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote in message
news:[email protected]...
> "bnd777" <[email protected]> wrote in message
news:<[email protected]>...
> > 87 yr old female as previously posted
> >
> > Suspicion that Arcoxia 60mg a day may be the reason for current uncontrollable BP (has been on
> > it for 2 months for pain of severe Osteoporosis/RA/OA that other painkillers do not touch )
>
> Though I am not familiar with Arcoxia specifically, as a class, NSAIDs do make hypertension more
> difficult to control. Would suggest you ask about narcotics or "alternative" methods of pain
> control (acupuncture?)
>
> > Has been taking Atenolol 50mg
>
> Atenolol is not a good beta blocker for the elderly who tend to have decreased renal function (it
> is renally cleared). Would suggest you ask about a change to a non-renally metabolized beta-
> blocker.
>
> > Tritace 10mg
>
> Given you describe what is likely an ACE inhibitor cough, this may not be a good choice either
> especially if the cough is causing sleep deprivation, which can also make hypertension more labile
> (difficult to control). Would suggest you ask about ARBs (angiotensin receptor blockers) as an
> alternative.
>
> > Bendrofluazide 2.5mg
>
> Thiazide diuretics are less effective in the elderly especially if there is decreased renal
> function. Would suggest you ask about a change to loop diuretics.
>
> > and Plendil 2.5 mg was added 2 weeks ago
>
> Calcium channel blockers can worsen edema. They may not even be necessary if the rest of her
> medications were more "optimal."
>
> > Has irritating dry tickly cough swollen ankles tired slow eyes watering (but also has cataracts
> > ) noisy breathing/breathless
> >
> > Comments welcome
>
> Hope my comments help.
>
> Humbly,
>
> Andrew
>
> --
> Dr. Andrew B. Chung, MD/PhD Board-certified Cardiologist http://www.heartmdphd.com

They sure explain a lot but to get them changed to what you suggest would mean sending her doctors
back to med school !!!!!!!!!!!!!
 
"Derek F" <[email protected]> wrote in message
news:[email protected]...
>
> "bnd777" <[email protected]> wrote in message news:[email protected]...
> > 87 yr old female as previously posted
> >
> > Suspicion that Arcoxia 60mg a day may be the reason for current uncontrollable BP (has been on
> > it for 2 months for pain of severe Osteoporosis/RA/OA that other painkillers do not touch )
> >
> > Has been taking Atenolol 50mg Tritace 10mg Bendrofluazide 2.5mg and Plendil 2.5 mg was added 2
> > weeks ago
> >
> > Has irritating dry tickly cough swollen ankles tired slow eyes watering (but also has cataracts
> > ) noisy breathing/breathless
> >
> > Comments welcome
> >
> >
> >
> Cataracts as well and still driving! see this for Arcoxia
> http://www.irf.dk/en/reviews_02/arcoxia.htm Derek.
>
>

My sentiments precisly .........but as i said before if Opthalmologists and doctors in the UK are
not required to report the matter it makes it hell for concerned friends and family
.........because blame will be thrown on them by the patient who simply will not see it as in the
wider public interest
 
"bnd777" <[email protected]> wrote in message news:<[email protected]>...
> "Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote in message
> news:[email protected]...
> > "bnd777" <[email protected]> wrote in message
> news:<[email protected]>...
> > > 87 yr old female as previously posted
> > >
> > > Suspicion that Arcoxia 60mg a day may be the reason for current uncontrollable BP (has been on
> > > it for 2 months for pain of severe Osteoporosis/RA/OA that other painkillers do not touch )
> >
> > Though I am not familiar with Arcoxia specifically, as a class, NSAIDs do make hypertension more
> > difficult to control. Would suggest you ask about narcotics or "alternative" methods of pain
> > control (acupuncture?)
> >
> > > Has been taking Atenolol 50mg
> >
> > Atenolol is not a good beta blocker for the elderly who tend to have decreased renal function
> > (it is renally cleared). Would suggest you ask about a change to a non-renally metabolized beta-
> > blocker.
> >
> > > Tritace 10mg
> >
> > Given you describe what is likely an ACE inhibitor cough, this may not be a good choice either
> > especially if the cough is causing sleep deprivation, which can also make hypertension more
> > labile (difficult to control). Would suggest you ask about ARBs (angiotensin receptor blockers)
> > as an alternative.
> >
> > > Bendrofluazide 2.5mg
> >
> > Thiazide diuretics are less effective in the elderly especially if there is decreased renal
> > function. Would suggest you ask about a change to loop diuretics.
> >
> > > and Plendil 2.5 mg was added 2 weeks ago
> >
> > Calcium channel blockers can worsen edema. They may not even be necessary if the rest of her
> > medications were more "optimal."
> >
> > > Has irritating dry tickly cough swollen ankles tired slow eyes watering (but also has
> > > cataracts ) noisy breathing/breathless
> > >
> > > Comments welcome
> >
> > Hope my comments help.
> >
> > Humbly,
> >
> > Andrew
> >
> > --
> > Dr. Andrew B. Chung, MD/PhD Board-certified Cardiologist http://www.heartmdphd.com
>
>
> They sure explain a lot but to get them changed to what you suggest would mean sending her doctors
> back to med school !!!!!!!!!!!!!

That shouldn't be necessary. Having them read this should help them rethink things.

Humbly,

Andrew

--
Dr. Andrew B. Chung, MD/PhD Board-certified Cardiologist http://www.heartmdphd.com
 
"Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote in message
news:[email protected]...
> "bnd777" <[email protected]> wrote in message
news:<[email protected]>...
> > "Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote in message
> > news:[email protected]...
> > > "bnd777" <[email protected]> wrote in message
> > news:<[email protected]>...
> > > > 87 yr old female as previously posted
> > > >
> > > > Suspicion that Arcoxia 60mg a day may be the reason for current uncontrollable BP (has been
> > > > on it for 2 months for pain of severe Osteoporosis/RA/OA that other painkillers do not
> > > > touch )
> > >
> > > Though I am not familiar with Arcoxia specifically, as a class, NSAIDs do make hypertension
> > > more difficult to control. Would suggest you ask about narcotics or "alternative" methods of
> > > pain control (acupuncture?)
> > >
> > > > Has been taking Atenolol 50mg
> > >
> > > Atenolol is not a good beta blocker for the elderly who tend to have decreased renal function
> > > (it is renally cleared). Would suggest you ask about a change to a non-renally metabolized beta-
> > > blocker.
> > >
> > > > Tritace 10mg
> > >
> > > Given you describe what is likely an ACE inhibitor cough, this may not be a good choice either
> > > especially if the cough is causing sleep deprivation, which can also make hypertension more
> > > labile (difficult to control). Would suggest you ask about ARBs (angiotensin receptor
> > > blockers) as an alternative.
> > >
> > > > Bendrofluazide 2.5mg
> > >
> > > Thiazide diuretics are less effective in the elderly especially if there is decreased renal
> > > function. Would suggest you ask about a change to loop diuretics.
> > >
> > > > and Plendil 2.5 mg was added 2 weeks ago
> > >
> > > Calcium channel blockers can worsen edema. They may not even be necessary if the rest of her
> > > medications were more "optimal."
> > >
> > > > Has irritating dry tickly cough swollen ankles tired slow eyes watering (but also has
> > > > cataracts ) noisy breathing/breathless
> > > >
> > > > Comments welcome
> > >
> > > Hope my comments help.
> > >
> > > Humbly,
> > >
> > > Andrew
> > >
> > > --
> > > Dr. Andrew B. Chung, MD/PhD Board-certified Cardiologist http://www.heartmdphd.com
> >
> >
> > They sure explain a lot but to get them changed to what you suggest
would
> > mean sending her doctors back to med school !!!!!!!!!!!!!
>
> That shouldn't be necessary. Having them read this should help them
rethink things.
>
> Humbly,
>
> Andrew
>
> --
> Dr. Andrew B. Chung, MD/PhD Board-certified Cardiologist http://www.heartmdphd.com

In the UK if you dare go to your doctors with anything printed off the internet they show you the
door !!!!!!!!!!!!

Doctors and Specialists in the UK often never ever update their knowledge from the day they left
medical school

BTW ........Arcoxia is a Cox2 inhibitor which is not really a NSAIDs but it certainly does have the
side effect listed of rare cause of Hypertension As no other NSAIDs touch the pain and difficulty
she suffers due to collapsed spine from osteoporosis and it took 9 months of waiting to even see the
specialist who prescribed Arcoxia there will be little point trying to get any meds changes

I am very grateful for your help and astounded by your depth of knowledge ......seems our doctors
need to go back to med school fast
 
"bnd777" <[email protected]> wrote in message news:<[email protected]>...

> In the UK if you dare go to your doctors with anything printed off the internet they show you the
> door !!!!!!!!!!!!

Is that true (others from the UK should chime in here) ?

> Doctors and Specialists in the UK often never ever update their knowledge from the day they left
> medical school

Really? No continuing medical education (CME) or recertification requirements?

> BTW ........Arcoxia is a Cox2 inhibitor which is not really a NSAIDs

Actually, Cox2 inhibitors are still NSAIDs.

> but it certainly does have the side effect listed of rare cause of Hypertension As no other NSAIDs
> touch the pain and difficulty she suffers due to collapsed spine from osteoporosis and it took 9
> months of waiting to even see the specialist who prescribed Arcoxia there will be little point
> trying to get any meds changes

Would still recommend an unconventional approach (e.g. acupuncture, Tai Chi, meditation,
chiropractic manipulation etc) since there seems to be an intolerance for NSAIDs.

> I am very grateful for your help and astounded by your depth of knowledge

You are welcome :) May my depth of knowledge bring glory to God.

> ......seems our doctors need to go back to med school fast

Why don't the citizens of the UK should ask for change?

Humbly,

Andrew

--
Dr. Andrew B. Chung, MD/PhD Board-certified Cardiologist http://www.heartmdphd.com
 
"Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote in message
news:[email protected]...
> "bnd777" <[email protected]> wrote in message
news:<[email protected]>...
>
> > In the UK if you dare go to your doctors with anything printed off the internet they show you
> > the door !!!!!!!!!!!!
>
> Is that true (others from the UK should chime in here) ?
>
> > Doctors and Specialists in the UK often never ever update their
knowledge
> > from the day they left medical school
>
> Really? No continuing medical education (CME) or recertification requirements?
>
> > BTW ........Arcoxia is a Cox2 inhibitor which is not really a NSAIDs
>
> Actually, Cox2 inhibitors are still NSAIDs.
>
> > but it certainly does have the side effect listed of rare cause of Hypertension As no other
> > NSAIDs touch the pain and difficulty she suffers due to collapsed spine from osteoporosis and it
> > took 9 months of waiting to
even
> > see the specialist who prescribed Arcoxia there will be little point
trying
> > to get any meds changes
>
> Would still recommend an unconventional approach (e.g. acupuncture, Tai Chi, meditation,
> chiropractic manipulation etc) since there seems to be an intolerance for NSAIDs.
>
> > I am very grateful for your help and astounded by your depth of
knowledge
>
> You are welcome :) May my depth of knowledge bring glory to God.
>
> > ......seems our doctors need to go back to med school fast
>
> Why don't the citizens of the UK should ask for change?
>
> Humbly,
>
> Andrew
>
> --
> Dr. Andrew B. Chung, MD/PhD Board-certified Cardiologist http://www.heartmdphd.com

Neither our doctors or our Health system or our government care one fig for what us citizens want
If our MPs were accountable like your Senators are things might change but with dictator Blair in
power foregt it
 
"bnd777" <[email protected]> wrote in message
news:[email protected]...
>
> "Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote in message
> news:[email protected]...
> > "bnd777" <[email protected]> wrote in message
> news:<[email protected]>...
> >
> > > In the UK if you dare go to your doctors with anything printed off the internet they show you
> > > the door !!!!!!!!!!!!
> >
> > Is that true (others from the UK should chime in here) ?
> >
> > > Doctors and Specialists in the UK often never ever update their
> knowledge
> > > from the day they left medical school
> >
> > Really? No continuing medical education (CME) or recertification requirements?
> >
> > > BTW ........Arcoxia is a Cox2 inhibitor which is not really a NSAIDs
> >
> > Actually, Cox2 inhibitors are still NSAIDs.
> >
> > > but it certainly does have the side effect listed of rare cause of
Hypertension
> > > As no other NSAIDs touch the pain and difficulty she suffers due to collapsed spine from
> > > osteoporosis and it took 9 months of waiting to
> even
> > > see the specialist who prescribed Arcoxia there will be little point
> trying
> > > to get any meds changes
> >
> > Would still recommend an unconventional approach (e.g. acupuncture, Tai Chi, meditation,
> > chiropractic manipulation etc) since there seems to be an intolerance for NSAIDs.
> >
> > > I am very grateful for your help and astounded by your depth of
> knowledge
> >
> > You are welcome :) May my depth of knowledge bring glory to God.
> >
> > > ......seems our doctors need to go back to med school fast
> >
> > Why don't the citizens of the UK should ask for change?
> >
> > Humbly,
> >
> > Andrew
> >
> > --
> > Dr. Andrew B. Chung, MD/PhD Board-certified Cardiologist http://www.heartmdphd.com
>
>
> Neither our doctors or our Health system or our government care one fig
for
> what us citizens want If our MPs were accountable like your Senators are things might change but
> with dictator Blair in power foregt it
>
>
How long did Tony wait for treatment after his recent heart scare? A new clinic has been opened for
MP's in Victoria, where they are even allowed to give a false name if they have an embarrassing
condition. Derek.
 
"Derek F" <[email protected]> wrote in message
news:[email protected]...
>
> "bnd777" <[email protected]> wrote in message news:[email protected]...
> >
> > "Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote in message
> > news:[email protected]...
> > > "bnd777" <[email protected]> wrote in message
> > news:<[email protected]>...
> > >
> > > > In the UK if you dare go to your doctors with anything printed off
the
> > > > internet they show you the door !!!!!!!!!!!!
> > >
> > > Is that true (others from the UK should chime in here) ?
> > >
> > > > Doctors and Specialists in the UK often never ever update their
> > knowledge
> > > > from the day they left medical school
> > >
> > > Really? No continuing medical education (CME) or recertification requirements?
> > >
> > > > BTW ........Arcoxia is a Cox2 inhibitor which is not really a NSAIDs
> > >
> > > Actually, Cox2 inhibitors are still NSAIDs.
> > >
> > > > but it certainly does have the side effect listed of rare cause of
> Hypertension
> > > > As no other NSAIDs touch the pain and difficulty she suffers due to collapsed spine from
> > > > osteoporosis and it took 9 months of waiting to
> > even
> > > > see the specialist who prescribed Arcoxia there will be little point
> > trying
> > > > to get any meds changes
> > >
> > > Would still recommend an unconventional approach (e.g. acupuncture, Tai Chi, meditation,
> > > chiropractic manipulation etc) since there seems to be an intolerance for NSAIDs.
> > >
> > > > I am very grateful for your help and astounded by your depth of
> > knowledge
> > >
> > > You are welcome :) May my depth of knowledge bring glory to God.
> > >
> > > > ......seems our doctors need to go back to med school fast
> > >
> > > Why don't the citizens of the UK should ask for change?
> > >
> > > Humbly,
> > >
> > > Andrew
> > >
> > > --
> > > Dr. Andrew B. Chung, MD/PhD Board-certified Cardiologist http://www.heartmdphd.com
> >
> >
> > Neither our doctors or our Health system or our government care one fig
> for
> > what us citizens want If our MPs were accountable like your Senators are things might change
but
> > with dictator Blair in power foregt it
> >
> >
> How long did Tony wait for treatment after his recent heart scare? A new clinic has been opened
> for MP's in Victoria, where they are even allowed
to
> give a false name if they have an embarrassing condition. Derek.
>
>
Next time we have a problem guess we need to find the "new clinic" and go in claiming to be MPs
!!!!!!!!!!!!!!
 
"bnd777" <[email protected]> wrote in message
news:[email protected]...
>
> "Derek F" <[email protected]> wrote in message
> news:[email protected]...
> >
> > "bnd777" <[email protected]> wrote in message news:[email protected]...
> > >
> > > "Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote in message
> > > news:[email protected]...
> > > > "bnd777" <[email protected]> wrote in message
> > > news:<[email protected]>...
> > > >
> > > > > In the UK if you dare go to your doctors with anything printed off
> the
> > > > > internet they show you the door !!!!!!!!!!!!
> > > >
> > > > Is that true (others from the UK should chime in here) ?
> > > >
> > > > > Doctors and Specialists in the UK often never ever update their
> > > knowledge
> > > > > from the day they left medical school
> > > >
> > > > Really? No continuing medical education (CME) or recertification requirements?
> > > >
> > > > > BTW ........Arcoxia is a Cox2 inhibitor which is not really a
NSAIDs
> > > >
> > > > Actually, Cox2 inhibitors are still NSAIDs.
> > > >
> > > > > but it certainly does have the side effect listed of rare cause of
> > Hypertension
> > > > > As no other NSAIDs touch the pain and difficulty she suffers due
to
> > > > > collapsed spine from osteoporosis and it took 9 months of waiting
to
> > > even
> > > > > see the specialist who prescribed Arcoxia there will be little
point
> > > trying
> > > > > to get any meds changes
> > > >
> > > > Would still recommend an unconventional approach (e.g. acupuncture, Tai Chi, meditation,
> > > > chiropractic manipulation etc) since there
seems
> > > > to be an intolerance for NSAIDs.
> > > >
> > > > > I am very grateful for your help and astounded by your depth of
> > > knowledge
> > > >
> > > > You are welcome :) May my depth of knowledge bring glory to God.
> > > >
> > > > > ......seems our doctors need to go back to med school fast
> > > >
> > > > Why don't the citizens of the UK should ask for change?
> > > >
> > > > Humbly,
> > > >
> > > > Andrew
> > > >
> > > > --
> > > > Dr. Andrew B. Chung, MD/PhD Board-certified Cardiologist http://www.heartmdphd.com
> > >
> > >
> > > Neither our doctors or our Health system or our government care one
fig
> > for
> > > what us citizens want If our MPs were accountable like your Senators are things might change
> but
> > > with dictator Blair in power foregt it
> > >
> > >
> > How long did Tony wait for treatment after his recent heart scare? A new clinic has been opened
> > for MP's in Victoria, where they are even allowed
> to
> > give a false name if they have an embarrassing condition. Derek.
> >
> >
> Next time we have a problem guess we need to find the "new clinic" and go
in
> claiming to be MPs !!!!!!!!!!!!!!
I was quoted 21 weeks for an appointment to see a Gastro consultant. My doctor got it brought
forward by 5 weeks. I complained to another doctor in the practise that it was still too long to
wait. He suggested using patient power and to angrily phone the consultants secretary. I had an
appoinment two days later. Derek.
 
"Derek F" <[email protected]> wrote in message
news:[email protected]...
>
>> I was quoted 21 weeks for an appointment to see a Gastro consultant. My
> doctor got it brought forward by 5 weeks. I complained to another doctor in the practise that it
> was still too long to wait. He suggested using patient power and to angrily phone the consultants
> secretary. I had an appoinment two days later. Derek.
>
>

I'm trying to get a sense of the difference between the US system (where I live) and the UK. In
the US wait times getting an appointment with a Dr. are not typically a major problem - at least
in my experience - unless you are targeting are really good one. Our problems seem to revolve more
around $s. There is sort of a hole where people earn to much to be covered by public assistance
and not enough to get insurance or pay for things on there own. Also, insurance costs are rapidly
rising causing people to cut back on their coverage. And drug costs in the US are probably double
those in the UK.

On the other hand, if you can afford it, the quality of care in the US is excellent and, as you can
sense from this board :), Drs. have a great deal of freedom.

Thoughts?

Bill
 
news:[email protected]...
>
> "Derek F" <[email protected]> wrote in message
> news:[email protected]...
> >
> >> I was quoted 21 weeks for an appointment to see a Gastro consultant. My
> > doctor got it brought forward by 5 weeks. I complained to another doctor
in
> > the practise that it was still too long to wait. He suggested using
patient
> > power and to angrily phone the consultants secretary. I had an
appoinment
> > two days later. Derek.
> >
> >
>
> I'm trying to get a sense of the difference between the US system (where I live) and the UK. In
> the US wait times getting an appointment with a Dr.
are
> not typically a major problem - at least in my experience - unless you are targeting are really
> good one. Our problems seem to revolve more around
$s.
> There is sort of a hole where people earn to much to be covered by public assistance and not
> enough to get insurance or pay for things on there own. Also, insurance costs are rapidly rising
> causing people to cut back on
their
> coverage. And drug costs in the US are probably double those in the UK.
>
> On the other hand, if you can afford it, the quality of care in the US is excellent and, as you
> can sense from this board :), Drs. have a great deal
of
> freedom.
>
> Thoughts?
>
> Bill
>
> Yes your correct .......the USA does afford freedom of choice in medical
care providing you are either entitled or can afford it Pretty much the same in the UK only
difference being those who are entitled are rationed by long waiting lists whereas the very rich can
afford to pay privately Those in the middle either have extra private medical insurance .....BUT
unlike in USA ....it only covers immediate diagnosis and treatment .....if you have certain
conditions or a chronic disease then it will not continue to pay

Since salaries in the USA are much higher than the UK and USA housing costs are much much lower and
USA taxation does not bite until you earn about 3 or 4 times UK level .............the general
standards of living in the USA even accounting for your health care costs are way better than the UK

Dictator Blair and his cronies have hit us so hard with one tax after another that many people are
now in very difficult straits

We have many wonderful USA friends who when we sit and truly compare whats going on on both sides of
the atlantic they are totally appalled at what we are going through