It was 1916. Harry had graduated from medical school and was doing his residency in general surgery. He took care of all sorts of patients, but one changed his career. One patient, and one physician who asked questions, provided treatment for millions of patients – including me.
Harry’s patient experienced a tremendous tragedy.
The patient had his kidney removed because of a cancerous tumor. After the kidney had been removed, the surgical team realized too late that the patient only had one kidney. It was years before the technology was available that made hemodialysis possible. With no technology to replace the missing kidneys the patient was doomed to certain death. Harry was tasked with taking care of this patient and doing whatever he could to help him. The patient died 6 days later. But as Harry took care of him, he found a surprise. The patient did not develop high blood pressure.
Harry had seen many patients die of kidney failure before. Each and every time the patients developed tremendous elevations of their blood pressure. His patient who had no kidneys did not develop any high blood pressure. Harry reached an interesting conclusion: the kidneys must be responsible for causing high blood pressure.
Harry got called to serve in World War 1. In 1924 Dr. Harry Goldblatt returned from the war to Western Reserve University. There he began to research his theory that the kidneys were the cause of high blood pressure. He developed a clever technique of applying clamps to the renal arteries (the arteries that supply the blood to the kidneys) of lab animals. He found that by restricting the blood flow to the kidneys he could cause the animals to develop high blood pressure. Once he developed this consistent reproduceable model of high blood pressure, research was able to move forward. Eventually this led to the understanding of the renin angiotensin aldosterone system.
In October 2018 I went to surgery for resection of a large mass near my left kidney. At the time of the surgery they noted that my cancer shared a blood supply with part of my left kidney. My surgeon called a urologist to the operating room to discuss options. They clamped the artery and waited. The kidney looked ok. It is not unusual for our organs to have collateral (duplicate) blood vessels. This means that the organ can have two different blood supplies. They concluded that I might have enough collateral blood flow to protect my left kidney. They tied off the artery to the cancer and removed it. They didn’t really have any choice and it looked like it was not going to cause a problem.
I went home from the hospital two days later. Three days later I developed progressively worsening back pain along with shaking chills and fever. I had my wife bring me back to the hospital. In the emergency department I told the physician that I thought I might have a renal infarction (death of part of the kidney due to impaired blood supply). They gave me some morphine and took me to the CT scanner. I was right. The upper half of my left kidney was dying.
I was like a Goldblatt dog. Like Harry’s dogs, part of the blood supply to my left kidney was blocked off. I had never had high blood pressure before. Would I get high blood pressure I wondered?
I went to the pharmacy with my wife and bought a blood pressure cuff. I started monitoring my blood pressure. Just as consistently as in Harry’s experiments my blood pressure starting rising. The next week I was going to have an appointment with Dr. Hammer at the University of Michigan. I became worried that if I showed up with my very high blood pressure they might end up hospitalizing me. I called one of my colleagues on a Saturday and asked her if she would be willing to prescribe a high blood pressure medicine for me. She phoned in a prescription for amlodipine and I started on it right away.
Amlodipine works by acting directly on the arteries to cause them to dilate (enlarge). It is a safe and effective high blood pressure medicine. But it does not directly counter the activation of my renin angiotensin system. The amlodipine helped but it didn’t completely control my blood pressure.
A few months later a vender for a new home monitoring system for heart failure patients was meeting with us. Their device included a blood pressure cuff. To demonstrate the system, they put the cuff on me. The machine registered a blood pressure of 205/115. I laughed that maybe I had a little too much caffeine that morning. I reassured them that I was fine. After the meeting I went up to the clinic and measured my blood pressure again. It was 185/105. That was a little bit better but still not good enough. My amlodipine alone was not doing the job.
I called my primary care physician. I asked if he would consider prescribing an angiotensin converting enzyme inhibitor for me. He put me on lisinopril. That medicine blocks the hormone that Harry discovered in his dogs that would cause high blood pressure.
I tracked my blood pressures. Within a few days my blood pressure was trending down very nicely. Eventually my blood pressure was low normal. I talked with my PCP again. He told me to start reducing my dose of amlodipine while I continued to monitor my blood pressure. Eventually he had me stop the amlodipine and my blood pressure remained in good control. Later I changed to the medication candesartan (an angiotensin receptor blocker). This is another medicine in the class of medicines discovered because of Harry’s work with the dogs. I continue to take candesartan to this day.
The other evening, I was taking my evening pills. As I grabbed my bottle of candesartan it occurred to me. I am like a Goldblatt dog. I laughed and wrote it down and promised myself that I would someday write a blog post about it.
- Because of an inquisitive mind that asked questions, Harry Goldblatt concluded that high blood pressure must come from the kidneys.
- Because of his clever techniques, Harry proved his theory with his special clamps on the arteries of lab animals.
- Later Harry isolated a chemical from the kidneys of his lab animals that later led to the discovery of the system that drives a lot of the cases of high blood pressure.
- Because of all of this work, and dozens of clever scientists, I have one tiny little single pill that effectively and consistently controls my blood pressure.
I am like a Goldblatt dog. Thank you Harry Goldblatt for what you did. You would have never realized that your work would change the life of a cardiologist become patient in 2018.
But why do I write this post? Is it just about the one tiny pill that controls my blood pressure? There is more to it than that.
Because Harry was curious he did a tremendous amount of good. He was bothered by the one thing that didn’t fit.
Let me explain more.
When I was in medical school we had huge amounts of material to learn. In class we would take notes. Later I would go through the notes studying. When I did I would look for the things that I didn’t know. There were things that made sense, things that I had already learned or things that I could determine by common sense or logic. But the things that I hadn’t remembered or seemed to not make sense or surprised me, those were the things that I needed to learn. I developed a technique of taking notes off of my notes. As I went through the all the material I would end up with just a few pages of things that I really needed to learn. I could then go through those notes again and again and even once more just before the test.
That is a valuable principle in life. Look for what surprises you or doesn’t fit.
We can spend our lives only looking at what fits nicely and comfortably into what we expect. But if you look for what doesn’t fit – that is when you will learn and grow.
In medical practice we look for abnormal labs or test results. The important ones are often the ones that don’t fit or make sense. When we see those, they can drive us to look harder. It might be the key to finding the problem that has been missed.
When I study the Bible, I look for things that surprise me or catch me off guard. This then drives me to start digging deeper and asking questions. When I do I am rewarded with insights I would not have gained if I had just read looking for only what made sense to me.
You are sitting at coffee with a friend. They are telling you about something they have done. I would encourage you to look for things that surprise you or don’t quite make sense. Tease those things out. When you do I suspect you will be nicely surprised with wisdom and insights that you might have otherwise missed.
Harry noticed what didn’t fit. His patient didn’t develop high blood pressure. He asked questions. Because he did, my blood pressure is nicely controlled on a single tiny little pill.
Thank you Harry Goldblatt!
