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blood pressure

Money, Medical Practice, and the Patient

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So you’re no doubt all on the edge of your seats: WHAT did the Mayo say about the endless blood-pressure conundrum, in the wake of the Affair of the Phantom Heart Attack?

Mwa ha ha!

Friday morning I stock up the covered wagon, yoke the oxen, climb into the seat, snap the bull-whip, and head across-country to that fine organization’s doctor’s offices — from my house, about halfway to Payson. Traffic isn’t bad, for a change — it’s the tail end of rush hour — and I get there in less than an hour.

That notwithstanding, they call me right in. I present the current three months’ worth of twice-daily blood-pressure measures called up by my cardiologist “in the wild” (this is what we call doctors who practice outside the coveted Mayo system), explain why I thought I needed to make a fast run on the ER at 2 a.m. the other morning, and fork over a long list of questions and observations:

The main question/proposal: We need to treat the causes of this supposed elevated BP, not the results.

Factors: There appears to be a correlation between what I tag “annoyance” (comprising annoyance, frustration, anger, and related negative emotions) and higher numbers. A correlation also exists with hot flashes. And another factor appears to be pain: headache, musculo-skeletal, dental, etc.

  1. Hot flashes: These episodes occurred before I started on the amlopidine & they continue, but it wasn’t until after I started taking it that they began happening with some frequency. Whatever is causing them, they clearly are directly connected to BP spikes. BP is elevated every time I test during or shortly after a flash.

What is causing these hot flashes? Could there be an ovarian problem? Can we address this issue?

  1. “Annoyance”: I seem to have developed a problem coping with minor (and major) daily aggravations, such as computer hassles, urban driving, work stress, bureaucratic bullshit, & the dog yapping. Unclear whether a causal relation exists between mild anger or irritation and spikes: the “annoyance” tag also appears many times in the absence of a spike — often when numbers are in the low 120s and 110s.

Some of these issues cannot easily be dispensed with:

  • To live in the city, I have to drive.
  • My business partner declines to fire the infuriating client.
  • I can’t do business or function socially without dealing w/ a computer.
  • I am not getting rid of the dog.

What can be done to address a physiological reaction to frustration, annoyance, and anger?

  1. Pain. This is a constant: at my age, you just hurt as part of life. Chronic sources of pain:
  • Headache. Probably sinus; occasionally migraine. Sometimes stress.
  • Hip pain. Undoubtedly related to osteoporosis.
  • Mastectomy scars.
  • Dental pain of unknown etiology.

Recently learned that pouring cool or cold water over your head can stop a stress or migraine headache, and this drops BP reading rapidly. Otherwise: I can’t take acetominophen, ibuprofen, or aspirin.

Got any other ideas? Is there a way to determine whether I actually am allergic to OTC pain-killers? Or to desensitize me to at least one of them?

  1. “Supposed” elevated BP. There appears to be a great deal of controversy over what is dangerous and what is not.
  • Mayo’s ER doc called me, three times, a “very low-risk patient.”
  • British NHS guidelines differ from US guidelines.
  • HALO-3 researchers (Lonn et al.) found BP-lowering drugs led to no change in mortality & morbidity after 5 years.
  • New AHA guidelines have been criticized on several grounds.
  • Pharmaceutical companies fund the American Heart Assn., confounding the issue with an obvious financial motive
  • Other studies (e.g., Diaou et al, BMJ) suggest guidelines are too low and many people are overtreated

What, really, is the science-based, proven significance of BP spikes that occur in response to external stimuli? Is an average BP in the mid-120s/high-70s to mid-80s something that needs to be treated? Show me the science that proves it!

To my astonishment, the woman they assigned to me — a P.A. who specializes in cardiology — actually sat down and read all this bullshit! Instead of just glancing at the figures I’d compiled for the cardiologist (which is what he does: gives a cursory glance at the overall average), she sat there and studied the spreadsheet. She read my questions and thought about them. (I hafta ask you: when have YOU had a doctor behave like this?)

After I’d had time to calm down (nothing makes me more miserable or more nervous than going into a doctor’s office or a hospital, except possibly a face-to-face encounter with a home invader), she took my blood pressure and pronounced it non-alarming. She was familiar with the HOPE-3 study and knew about its five-year finding that blood-pressure-lowering drugs had exactly zero effect on mortality and morbidity among its large sample population.

And finally she opined:

• 108/75 is too low for me. This is why I have been feeling so dragged out I can barely haul myself down to the bathroom.
• The occasional spikes into the 140s are not very out of the ordinary, nor are they anything to get hysterical about.
• I should quit taking the drug ASAP. (Beat her to that one!)
• I should knock off tracking my blood pressure every damn day, for godsake.
• She was ordering a stress test and a full blood panel. Go downstairs now, please, to get the latter done.
• Make an appointment, please, for the stress test. Seeya soon!

It was pretty clear that she did not think I needed to be on a $125/bottle calcium-channel blocker — or anything else. Nor did she think there was really much of a problem. The average BP compiled over the past three months of 123.4/81.9 struck her as within the safe range.

Wow.

When I staggered out of her office and bounded down the fire-escape to my car, I felt more like crying than celebrating.

Sumbiche. I’ve been through two years of this torture, with doctors in the wild trying to pressure me onto these drugs by repeatedly telling me that if I don’t take them I’m going to drop dead of a stroke or heart attack.

One hesitates to state the obvious: that I was gratified when her opinion echoed my own. But yes: I was gratified that her opinion echoed my own. But that is because my opinion is grounded fairly solidly in science: I do know how to read a research report, and I certainly can distinguish between science and woo-woo. Those traits follow naturally on several years as a technical editor.

* * *

Some years ago, my beloved, long-time, and much trusted GP, Tim Daley, quit his private practice and went to work for the Mayo. He had done his residency at the Mayo in Minnesota and was delighted when they opened for business here in Arizona. Despite the pleading and dismay of his partners, LIKE A ROCKET he shot out of downtown Phoenix and off to Outer Scottsdale.

Naturally, I followed him. One does not easily let go of a competent, intelligent doctor imbued with experience and common sense. Getting insurance that would cover the Mayo was sometimes challenging, but in the occasional years that My Beloved Employer dropped the ball, I would go out on the open market and buy my own.

Eventually, Tim retired.

His parting shot to me was this: Never hire a doctor who relies on a private practice to make a living. Get yourself a doctor who is paid a salary. All other doctors are motivated to “discover” reasons that you need treatment and medications that will keep you coming back to their office for endless consultations and further rounds of treatment.

“Holy shit!” said I. “Where does one find a doc who gets paid a salary, this side of Luke Air Force Base?”

“In Arizona? Your only choice is the Mayo. Or,” he added, “doctors who have ’boutique’ practices, whereby you pay a stiff annual fee for the privilege of becoming one of the limited number of patients they see.”

Toward the end of my tenure at The Great Desert University, the state offered PPO coverage that included the Mayo, so I was able to stay on their rolls that way. (Wander off, and the Mayo will dump you: especially if you’re on Medicare, whose bureaucracy they prefer not to deal with). Once I got on Medicare, I was a legacy patient and so they could not gracefully boot me out.

I hadn’t thought much about Tim’s advice in recent years. But now on reflection it comes back to me. Get a patient with BP in the 120s or low 130s believing she has “high blood pressure,” slap her on the smallest dose of BP meds you can prescribe, and you’ll get her locked in to coming back every three months for a consultation, now and forever. And that will be a consultation for which you can charge Medicare and her Medigap insurance, to the max. She will, in a word, represent your bread-and-butter.

So, my friends. Bear in mind that medical practice is not a religious calling. It is a business. You are a cash cow, no less for doctors and hospitals than for vendors of televisions, communication systems, real estate, and cans of beans. In America, you have to be an alert and aware consumer of medical treatments, same as you need to be an alert and aware consumer of anything else.

And good luck to you…

Flyin’ Low…

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Wow! Last few days have fallen into the “Whirlwind” category. Yesterday — yeah, flyin’ low — I got through not one but two interminable scholarly emanations for our client journal, each about 30 pages long.

This has become do-able thanks to the machinations of The Kid, my ineffable and amazingly entrepreneurial young business partner. She has devised A System, and it works. First, she assigns Incoming Flak to her assistant, a.k.a. The Underling. This young woman actually enjoys performing tedious chores — sort of like some of us enjoy ironing in front of the television. And she’s pretty darned good at it.

The journal in question has not come unstuck from the 20th century. Instead of using Word’s “Styles” function to format MSS for the designer, the new editors still indulge in, God help us, manual mark-up! We have tried to persuade these folks to quit that, but to no avail.

Manual mark-up on a computer entails entering what we call “fake HTML” tags before and after every. single. god. damned. design. element. in. the. document. <i>Every</i> italic. <b>Every</b> boldface. <ext>Every indented block quotation</ext>. <pext>Every quoted passage of poetry</pext>. <t>Every Title</t>… and on and on and interminably, idiotically ON. It is an utter, total waste of time, given that a file set up correctly in InDesign will import a Word file formatted with “Styles” and convert the styles automatically to fit the designer’s layout.

We have suggested using “Styles” and even have gone so far as to create a Wyrd template for the purpose, to no avail. The last time we did that, for a variety of reasons the strategy proved to be more hassle than it was worth, and so we gave up.

So, where you are is where you’re at. Starting at that point, The Kid has created an assembly line.

  1. Copy arrives in our precincts (this also is stupidly complicated for different reasons, but I’ve gone beyond complaining here…)
  2. The Kid reviews documents for our purposes. Once approved,
  3. Copy moves to The Underling.
  4. Underling enters all the mark-up tags and checks formatting of references (another mind-numbing and annoying chore).
  5. Copy moves back to The Kid.
  6. Kid reads copy and does first edits, checking references section with some care.
  7. Copy moves to The Old Bat.
  8. Old Bat reads and edits copy behind The Kid, applying the benefit of an eye jaded by 40 years of academic bullshit.
  9. Old Bat generates “clean” and “edited” version; posts to DropBox.
  10. Kid gives copy a final read.

Great stuff, ain’t it? Foisting the tedious mark-up chore onto Underling eliminates a large part of the annoyance factor entailed in editing this content. When you’re not thinking about that ditz, it becomes relatively easy to edit language, style, and fact-checks. So much so that yesterday I read least twice as much content as I could normally plow through with that journal’s offerings.

In more altruistic precincts, on Sunday we — the choir — went over to the home of a member who’s knocking at Death’s Door, brought there by a case of pancreatic cancer. He has planned his funeral service, including his choice of music, and wanted us to sing it for him so he could hear how it sounds. So that was kind of a {gulp!} moment…

But in fact it was really cool and none of us started to cry whilst singing. Despite having reached the wraith-like stage, he was still able to walk around, sit in his favorite easy chair, and hold court with some élan. Would that we could all go out with so much class.

Friend on the choir came over afterward — we dined, consumed a fair amount of wine, and plotted the destruction of the Ruling Class. 😉 Actually, what we plotted was a scheme for the two of us to acquire voice lessons from the choir’s astonishingly talented new organist, who has a gorgeous singing voice, knows how to coach singers, and is classically trained every which way from (heh!) Sunday. Haven’t heard back from said organist since I e-mailed an inquiry, but it being a three-day weekend she probably hasn’t checked the job-related email.

In the interim, I managed to write a few words in the noveloid in progress. And tried to talk to our marvelous Web Guru about a multi-site WordPress template for Plain & Simple Press, which would allow me to publish several works at once, a passage or a chapter at a time. Then YOU, my fine readers, could sample them online and could buy the finished products as PDFs, paperbacks, or e-books. Whether I will bother to put these things on Amazon or not remains to be seen — Amazon embargoes the content if you market a book for less than $2.99, and since the only effective way to “sell” a book on Amazon is to give it away, I figure I might as well give it away for free to my readers than give it away for 99 cents minus Amazon’s share. WTF? I’m retired…I don’t care if any of these things makes me rich or not.

More likely not. 😀

Connie the Trucker calls to report that her dog, a Weimeraner that lives in the truck with her, has developed the same vehicle neurosis that almost killed Charley the Golden Retriever. Unlike my skeptical son, though, she decided to try a Thundershirt, and lo! It works. The dog is much calmed when wrapped tightly in a kind of canine straitjacket. Thereby, we may add, rescuing Connie from having to quit her job.

The blood pressure drug is working: it not only pushes the BP into the 110s or, at worst, the low 120s, it stabilizes the numbers so they don’t jerk up into volcanic spikes every time I lose my temper. Which is often. And — unheard-of miracle!! — it seems to have NO side effects.

And speaking of losing my temper, I have yet to re-wire the robo-call blocker. This will entail a call to customer service, since I cannot remember how to do it — it’s much more complicated than simply attaching it in line, because I have so many devices running out of the same cable connection.

And lookee here! The Kid has sent another pre-edited, pre-formatted article for me to finish off. And so, away…

Oranges and Rain

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At last it’s raining here, and raining steadily. Has been all day. The plants thank the gods, the ground thanks the gods, the fishes in the streams (whatever those are) thank the gods.

And especially the citrus thanks the gods.

Citrus trees are high-water plants: short them on water, and even an old and established tree will shrivel up and die. And you don’t want them to do that….

Interestingly, too, citrus trees can tell the difference between rainwater and irrigation water. They much prefer water that falls out of the heavens. You can pour the irrigation to the things, but if it doesn’t rain at least a few times during a year, they will yellow out, drop leaves, produce pathetic fruit. And…no, you don’t want them to do that.

One of the best things I did when I moved into this house lo! these many years ago — maybe the best thing — was to plant oranges, lemons, and a lime. An Arizona Sweet orange is possibly the greatest joy that a human can experience. These oranges are so sweet they’re like candy. Incredibly juicy, delicious candy.

And this is orange season. Every day I’ve been scarfing down four or five oranges at breakfast. If I happen to wander out in the yard during the day, I’ll grab another. Even a single orange tree produces so much fruit, I’d have a hard time eating all of it. Two produce twice that many.

Almost. One of the trees is suffering. I think it’s because the hateful paloverde beetles have made their way over to it — last summer I saw an emergence hole inside its dripline. The rain will help it, but whether it will revive as the days grow longer, I do not know.

The lime tree also is at risk. Luis damaged it when he hacked out a whole limb, apparently misunderstanding what I meant when I said I wanted to be able to walk around it freely. This exposed the interior branches and trunk to the blast of the summer sun. Though I tried to protect them by wrapping them in strips of shade cloth, it doesn’t seem to have done the trick.

So it was already suffering when the house had to be painted. The other side of the tree had grown over the roof, so a lot of its canopy needed to be cut back. That gave the tree a serious shock, from which I doubt it will recover.

Citrus trees do not like to be pruned. Contrary to what the roof-rat fearers will tell you, you should NOT cut their limbs up away from the ground. You shouldn’t prune them at all, except to clear out any branches that are truly dead. So I’m pretty sure the lime is a goner — we’ll know, I expect, by this time next year.

Should have fertilized them before this wonderful rain came along, but was too lazy and hurting too much from the weird hip thing to get to the Depot and haul a 40-pound sack of citrus food home. After the rain clears, I will go and do that…a day late and a dollah short, as usual.

Expect another thing I could do for those two trees is spray them with Miracle-Gro. They do absorb nutrients through their leaves, and Miracle-Gro is plant nutrients on steroids. If part of the trees’ problem is that they’re not getting enough water falling on their canopies, dousing them with water & fertilizer should help them. I hope.

The pained hip is mostly recovered…but now I can’t go walking or biking because of the rain. Nevertheless have lost weight by dint of starving myself: not eating after about 2:00 p.m. does cause the poundage to drop. It would work better if you could burn off a few calories, but on its own it will peel off a few ounces a day.

Oh well.

Since I gave up the fight and succumbed to taking the blood pressure pills, the threatening numbers have hovered pretty much in the normal range. And amazingly, this is happening without benefit of dizzy spells and disorientation!

We shall see how long this lasts: I’ve gone several days at a time before with numbers in the low one-twenties and teens. It looks like the spikes into the 140s — and, hevvin help us, the other day into the 160s — happen about once every four or five days. The headache that I thought was a migraine and then decided was maybe a sinus thing seems to have mostly cleared up. I suspect it had something to do with the 165/105 spike…but which was causative of which, I could not say.

Nor, one might add, do I wish to say.

At any rate, I’m going to choir in a couple of hours, having fled between rehearsal and the Sunday morning service, and having missed the Sunday evensong. Better to err on the side of caution when it comes to driving with these dizzying headaches: once I was flying up 7th Avenue full-out at 50 mph when suddenly I realized I could not see the street signs. Fortunately I was almost home, fortunately I was in a part of town I know so well I don’t really need to see it to navigate it, and fortunately the effect passed quickly. But it was damn scary.

Try to stay out from behind the steering wheel when you think you’re having a migraine. 😉

{moan} Life in the Land of Old Age..

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So….yesterday along came what appeared to be another migraine. This, during rehearsal for Sunday’s service; in addition to that, I was also looking forward to singing along at last night’s Evensong service.

Better get on the road while I can still drive without picking off any of my fellow homicidal drivers, think I. That thought thunk, I excuse myself from the service and slink away.

Back at the Funny Farm…holy ESS AITCH AI! The damn tattling Omron informs me that I’ve spiked a blood pressure reading of 165/105!!

Obviously, I soon will be leaping off the edge of this hole in the ground here and pulling the dirt in after me.

Now I’m wondering…is this really a migraine? Or am I having a stroke? Or…WTF?

Last major spike — which was nowhere near that high on either side of the slash mark — came when I was having a fine hot flash. (Can you imagine? Damn near 73 years old and having hot goddamn flashes again?)

After some recourse to the Hypochondriac’s Treasure Chest, I discover that a headache can be associated with high blood pressure. But such headaches are not migraines. Elevated BP, interestingly, is not associated with true migraine.

Uh huh. Are you saying, dear Google, that I am having a stroke?

These antics proceed through an irritable, headachey, cranky day. I do, however, get through the current Chinese math paper by about 9 p.m., which is…something. I guess. My head still hurts, which, one imagines, could be caused either by detailed discussion of F-tests and p-functions as they apply comparatively to the evolution of state-owned and privately-owned corporate boards or…by an impending stroke.

Stroke. Definitely a stroke.

Meditating this thought, of course, is not conducive to sleep. Not only does the headache proceed, I’m enjoying palpitations and vertigo, too….just like the ones that initially drove me to the cardiodocs.

At 1 in the morning, I get up and go back into the office and lash myself back up in the damn Omron. Still spiking at a mere 146/93 on the initial reading. This figure falls to 123/89 in the course of the full testing maneuver (which entails wasting about 15 minutes with repeated measures between resting periods — it really is an amazingly annoying procedure). But 146 is still not at all a good systolic reading. And 93 on the diastolic side? Pushing 90 at the lowest ebb? Remarkably not good.

So finally I throw in the towel and decide to swallow the first of the blood pressure pills dispensed by cardiodoc.

Here’s the problem with that. See these here?

Those are pretty typical figures over the past week. Every number in blue is a figure in the “safe” range.  Black: not great, but not life-threatening, either.

If average blood pressure is in the low 120s or the the mid-teens, then a medication that pushes it down still further will cause severe, dangerous vertigo. That’s dizziness of the fall-down-and-break-your-hip variety. Dizziness of the you-dare-not-drive-your-car variety.

This, we already experienced with the previous cardiodoc: the stuff he gave me made me nonfunctional. And believe me: with all my heart (heh!), I do not want to do that again!

New Cardiodoc was concerned enough about the occasional spikes — which usually go into the 140s but can go as high as 155 or so — that he pressed a new variety of pill on me. I’ve been resisting, because when I’m not in his office and not surrounded by strangers prodding me and yakking at me and making me take my clothes off, my average BP over the course of a typical week is about 128/83 — and that includes the spikes. Over the past week, though, as I’ve lost weight the blood pressure has lost elevation. Even with the batsh!t 165/105 spike and a couple other spikes in the 140s, this week’s average has been 125.4/84.2.

Push that down very far, and I’m gonna be falling down every time I try to stand up from a chair or the toilet.

Reassured by the Mayo’s PA, who had the common sense to observe that I’m not required to stay on these pills, and if they have an untoward side effect, I can just…well…you know: stop taking it, I decided I’d better try the damn stuff. Despite the lovely low figures of late, these spikes are damn scary, especially so because we do not know what is causing them.

The figures are routinely low in the morning — though you can see that over the past few days (except for yesterday…) they’ve been surprisingly low in the evenings, too. Normally, the BP rises late in the day. So what would make sense, if anything in this makes sense at all, would be to take the daily dose around 4 or 5 p.m., when I won’t be driving anywhere (except for Wednesdays…)

As for the headache:

Well, it’s still in the offing, and as we scribble the morning’s average BP is 121/84. Higher than it has been over the past few days, but still: not suicidal. Whether the pill pushed the figures down or whether the pressure just dropped on its own, as it always does in the morning, is now unknown.

But whatever: it is surely NOT high enough to cause my head to hurt. Which it decidedly still does.

This suggests some other headache etiology, hm?

Well, you’ll recall the fine respiratory flap that started last March and went all the way to the end of October before it cleared up?

Yes, that may have been a cold or flu (and that is why I’m trying with all my wiliness to avoid the flu this spring). But between Cardiodoc 2 and the young Mayo doc, we suspect the issue was not an infection — or at least, not one that lasted the entire 8 months — but probably allergies. Or allergies complicated by an infection. That theory advanced, Mayo Doc recommended that I double up on the 10-mg doses of plain, unadulterated Claritin (hold the pseudoephedrine), gulping down one pill in the morning and one at night.

And damned if this didn’t work! Within a few days, the head congestion started to clear up, and within a month it was gone.

Also gone? The dizzy spells and palpitations!

Turns out that in old bats Eustachian tube and sinus congestion can cause both dizziness (this is pretty common) and presyncope. In other words: I wasn’t enjoying near-fainting spells and crazy world-spinning because of the blood pressure. Those must have been caused by head congestion…which went away when the Claritin kicked in.

Past couple of weeks, I’ve been forgetting to swallow a daily Claritin. The pill-a-day lifestyle, really, is not for me. And in the absence of the antihistamine, my head has slowly been gooping up again. It is almost March again: right when the head thing started last year. Right when things start to grow in the low desert.

And so…very likely what feels like a sinus headache is a sinus headache. And it, along with the vertigo, is coming back because I quit treating it. 😮

Imagine that.

 

Siri, RESET!

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Hallelujah, brothers and sisters! A junket to the Mayo Clinic, halfway to Payson from my house, has reset the computer where the blood pressure neurosis is concerned.

In fact I went in to discuss a different issue, which by the time today’s appointment rolled around had resolved itself. However, I decided to traipse out there anyway, because there were other things to chat about. Because I’d made the appointment on short notice, it was with a physician’s assistant and a nurse-practitioner (yahoo! two of ’em) rather than my regular doctor, who having just returned from maternity leave is maxed.

Number one headache (and today that was a literal term) had to do with the blood pressure conundrum. Took the pills out there and explained why I do not want to take the damn things, but also fessed up that yesterday I enjoyed yet another spike in numbers, into the 140s. In fact, the NP got a first reading of 159 over somegawdawful thing, though that came down considerably.

I hate doctor’s offices and I hate medical facilities and I hate having to explain myself to doctors and I’m not there unless stress and pain push me there, so of course whenever I get into one of those places, my blood pressure hovers near the ceiling.

Fortunately, a pair of the Chinese academics sent a new paper to edit yesterday, so I took the laptop with me so I could read copy while cooling my heels in the waiting room. That meant…lo! I also had my whole neurotic log of daily blood pressure readings, complete with weekly averages, an overall average, and a percentage breakdown of figures by high, medium, and low ranges.

I expected this elaborate spreadsheet would just confirm that I’m crazy, so hesitated to show it to her. But to the contrary: she was delighted to get the data. A-n-n-d…she was not at all fazed by the occasional spikes into the 140s. She said it’s the average that matters, and that under 130 is not very threatening, although one would like to keep it as low as possible to protect the kidneys and heart from potential damage.

I pointed out that the American Heart Association (which is partially funded by Big Pharma…) insists that ONE reading in the 140s or above is enough to put you on pills. (The British Health Service, in contrast, states that a consistent pattern of 140+ readings over time is the criterion.) I also pointed out that AHA guidelines recently changed; what used to be designated “moderately elevated” (readings in the 130s) is now considered to be “prehypertension” that must be treated, that readings in the 120s are now the “moderately elevated” range, and that the desired range is now in the 110s. She shrugged that off: clearly not impressed.

She said with an overall average of 128.4/83.3, she probably would not prescribe medication at all. However, she did agree that some of the startling spikes were a concern. And she also agreed that the drug Cardiodoc prescribed (or any of them, for that matter) had the potential to cause some serious dizziness since my BP is often in the low 120s…and even, of late, in the teens. On the other hand, she thought there was a good chance the very small dose would have no side effects at all. She suggested that I simply try the drug on a day that I don’t have to drive anywhere and see what happens. In fact, she proposed that I try it during a time when the numbers are spiking.

I said I’d been told it takes two weeks to take effect. Not so, said she: it’s a 24-hour pill, and if it’s gonna work, it will work within that period. She said it isn’t necessary to get “on” it for any length of time to see what it will do. And if we don’t like the results, the obvious response is simply to…well…stop taking it.

Wow!

So relieved was I that I decided to stop in my favorite mega-supermarket, which is on the way home from the Mayo, buy a bottle of Cabernet, and take a flying leap off the back end of the wagon. Then, go to bed and sleep away the remaining half the afternoon.

Last night was pretty terrible: after coming home around 10:30 from a choir shindig in a restaurant (nothing like a club soda instead of a glass of wine to make you the life of the party…), the evening BP readings were in the stratosphere. Then — perhaps consequently — I slept badly, woke up at 5 with a hot flash, and found readings that were still elevated by the light of dawn.

Well, the Mayo Lady pointed out that scarfing down a basket of salty French fries after having had nothing to eat since about 2 in the afternoon would tend to jack up one’s blood pressure numbers. I thought that was a long-term effect, not a one-off sort of thing, but apparently restaurant food will do the job on your BP readings right now. Yes, I do know better than to eat that kind of junk, but by 9:30 last night I was too hungry to care.

So I fly in the house, grill a lamb chop and some asparagus and serve those up with some leftover polenta and a tomato and a couple glasses of cheap red wine. Yes!!

Then I stagger into the back of the house, fall into the bed, and sleep for a good two hours. Phone rings; chat with friend; fall back to sleep.

Roll out of the sack along about 5:30. Feed the dogs, pick up the kitchen. Break out the Omron. And this is what happened:

Holy mackerel! And think o’ that: 108/74? 110/72?!!?

Clearly what is missing from my life is red wine…

Seriously: at 10:30 last night the average of six figures was 144/85.8. Less than 24 hours later, all but one of a similar set of figures is under 120.

You can guess what would happen if I took a blood pressure drug when the underlying blood pressure was in that range. I wouldn’t even be able to stand upright.

Do I have a conclusion to draw from this?

Well, yeah: One conclusion is that obsessing over the blood pressure is probably driving my blood pressure up.

The other is, I need to go to the Mayo, not to a doctor in the wild. Mayo Clinic physicians are salaried employees: they have no incentive to overprescribe treatments and medications. Not to be driven crazy or bullied into unnecessary treatment is worth the endless drive through the homicidal traffic.

And finally, what is needed is an occasional glass of wine.

Prosit!

 

Of phones and securities and numerals…

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So, to start with the securities part: We’re told yesterday’s crash is a “normal,” nay even a “healthy” correction. The US market has wobbled around all day, closing up 567 points, though that’s not true all over the planet. My investment guru doesn’t seem to be very exercised. Says he: “We were certainly due for a pullback as the market has been going straight up for some time. I don’t think it is anything to get overly worried about. We do have a position that we will sell to raise cash if the market breaks down further.” Meanwhile, at the endlessly entertaining circus playing inside the Beltway, we have this amusing story.

Ever feel like you fell off the tightrope spanning the Gorge of Unreality? 😀

Yesterday I flew into one of my fits of hummingbird rage when SDXB jangled me up in the middle of the tedious morning blood-pressure measuring ritual, causing a spike into the 140s. DAYum, but I hate the sound of the accursed phone ringing.

Once I calmed down and alit on a branch somewhere, I began to reflect upon the effing phones, which very rarely are rung by friends. Most people email me these days. Usually what’s on the other end of the line is a robocaller, and of course that’s what made me so angry — I assumed it was another nuisance call. The phone is so fucking annoying because — among other things — it is so fucking LOUD.

For safety (so that I can reach a phone if I fall), there’s an extension in every room, many of them within easy reach of the floor. All well and good, in a little-old-lady sense, except…that adds up to eight phones!

No wonder the things lift you up out of your seat when they ring in chorus!

Contemplating this state of affairs, I chanced to wonder if it was possible to adjust the volume on the things. Or even turn the damn janglers altogether OFF.

Dug out the owner’s manuals. Believe me, figuring it out was not easy — the instructions are scattered in three places through 40 pages of obscure how-to instructions for functions you do not want, never have wanted, and never will want. But finally, LO! I did discover that not only can the volume be turned way down, you actually can turn the ringers off. Not only that, but the annoying, incomprehensible talking caller ID on the ancient Panasonic hidden in the family room cabinetry — which mysteriously is compatible with the vast set of Uniden cordless phones — actually can be made to SHUT UP!

I’ve tried to shut that thing up in the past, with no luck. Even though the manual says it can be done, it directs you to a function button that does not exist on the set! Of course. But somehow, by accident, I managed to shut it off. The other handsets were pretty easy to fix; turned off all but two ringers, and those I turned down as low as they will go.

So now when the phone rings, it’ll be annoying but it should not be tooth-jangling.

Speaking of annoyances, I made a surprising little discovery. If you take a nap in the afternoon — or maybe just lay down for an hour or so, without even sleeping — you can beat the tendency of your blood pressure to rise late in the day.

Yesterday I was pretty infuriated (you wonder why my BP is high? Because I’m mad as a hummingbird about half my waking hours…) when as an afterthought I took an evening reading and found the damn blood pressure elevated into the 140s. It hasn’t been that high in weeks, even though the hip thing has had me too crippled to walk more than about a quarter-mile — and that far only in the past couple days.

Yesterday was the last day of Week 4 in my six-week effort to lower average blood pressure into the low 120s or (preferably) the 110s, and this stratospheric set of readings was the last reading of the week! To my dismay, it pushed the week’s average from 125.7/82 to 128.4/82.7. I was enraged, needless to say, since there hadn’t been a reading in the 140s for quite a while.

Think this happened because right beforehand I spent two hours with a computer on my lap and my feet crossed and propped on an ottoman, without once budging. Obviously, that kind of immobility can’t be good for you. But still…seriously??????? 146/90? Really????

This morning, though, after an hour or so of physical therapy exercises and dog wrangling, the figures were back in their more typical range: 121/82. Not as low as I’d like, but not life-threatening.

Out of curiosity, then, I decided to see what would happen if I took a nap. In the past researchers have imagined that a regular afternoon siesta may lower overall blood pressure (this is not a great source, but just now I’m feeling too lazy to look up the studies…they’re out there, though). Some speculate that the mere anticipation of an afternoon nap may lower the numbers. More recently, though, other researchers claim to have found evidence that napping increases the risk of hypertension.

Well, I’m not fond of sleeping in the daytime. Life is too short as it is, without wasting part of every day in bed. On the other hand, I sure don’t want to take those pills. So as a practical matter, I didn’t actually fall asleep this afternoon. But I did lay down and rest. The result: average at 5:30 p.m. was 118/81, one helluva lot better than yesterday, that’s for sure. And the lowest reading in that set was an amazing 114/81.

Cardiodoc would be ecstatic.