response 1 of 48:

Jun 4 13:49 UTC 1996

Since bp changes constantly (it is a dynamic process) your measure is only
a snapshot of the problem.  Also, many people have what is know as "white coat
hypertension", that is, they get nervous at the docs office and their bp
becomes elevated.  Your reading is above what one would expect in that case,
however.

For many years in theatrical training, and in psycology coursework as well,
I studied relaxation techniques.  Many were also consumed by a "fad" called
transendential meditation.  Biofeedback work has shown that you can develope
control over your alpha and theta brain states.

I don't suffer from high bp much, but when I get really worked up, or anxious
over a serious task/problem it might get elevated.  I usually can feel the
tension (because I'm not already sensitized to it) raising in my body and I
begin to sense a head-achy feeling coming on.  Sometimes I am aware of my
heartbeat, and occasionally I feel a fluttering in my chest (PVC's).  I've
learned to be in touch enough with my body to recognize these things and take
a "step back", or a "deep breath", etc.  Actually, what i do is my own form
of meditation/relaxation.  when I can feel I am relaxed again, i resume my
activity.  If I catch it early, this can happen in less than a minute.  If
I'm really worked up, it may take several minutes.

Better to have this sort of sense of your bp that to become obsessed with the
actual numbers (however important they may be).  You can take your pulse as
well.  do this often, in the same location, so you know the feel of the
strength of your pulse, not just the rate.  If your bp is up, that pulse will
be stronger.  As you relax, it will settle down again, even though the rate
may not change.  Obviously, you can do this anywhere, anytime, without
equipment.

Keep up with your doc, though.  A diastolic bp over 90 is considered
hypertensive.  the HTN and related stress can do great damage to your systems
over time.

response 3 of 48:

Jun 5 02:46 UTC 1996

Maybe I did not make myself clear.  This is not a one time only reading.  We
have been keeping an eye on my blood pressure for some time.  It just became
high enough, for a long enough period of time, that the doc felt something
should be done about it medically.  We have, all along, been discussing diet,
exercise, extra stress in my life and etc.  I am also familiar with my pulse
and how it feels.  I try to keep stress to a minimum and back off when things
become really stressful.  Since high blood pressure and the like run in my
family, we are surmising that it is at least partly hereditary.  Of all those
in my family, I am the one with the least stress and the healthiest lifestyle.
Anymore discussion, however, would be welcome.  And, yes, I just found out
Marc, that antihistamines could raise the bp, something I had not known.  I
try not to take those anyway, instead relying on inhaling steamy peppermint
essential oil to open me up.  It works most of the time without having to take
pills.  Try it the next time you get stopped up, or inhale a steamy peppermint
tea.  It really does work.

response 5 of 48:

Jun 5 16:30 UTC 1996

The ole' hot chicken soup method can really clear up your sinuses too.  I
highly recommend it...gramma was smarter than we might think!

Frieda, I didn't mean to suggest your one-time reading was only a one-time
occurence either, just that the bp is a dynamic process.  Just last night
there was a TV article on how stress can interfere with conception, and how
relaxation is being used to aid fertility treatments.  (oops...small
problem...brb)

response 7 of 48:

Jun 7 00:55 UTC 1996

I know, isn't exercise wonderful?  Try living on a farm...you will get your
fair share of exercise!

response 9 of 48:

Jun 7 13:22 UTC 1996

I do, Rane.  I have been coexisting with mild hypertension for some ten years
now.  I bought an inexpensive bp monitor and started taking it every day
(should do it at relatively the same time).  I have just recently graduated
to a fully mechanical one and my readings are often considerably different
at home then in the MD's office and are considerably different from readings
with the old machine.  I have a new MD at the University who specializes in
Hypertension.  He has told me to take readings three times a day (three times
each. . .waiting at least 5 minutes between readings and using the middle
reading).  I have noticed some fascinating reactions:  1) my bp is
consistently lower on weekends then weekdays;  2) my bp raises whenever I take
antihystamines, phentermine(weight loss lills), ibprufen, etc.; 3) my bp
(suprisingly) is highest in the am; 3)  my pulse rate goes up generally when
my bp goes down; and other fascinating stuff.   

The MD has recently changed my meds from 20 mg of Vasotec one time daily to
Hyzaar (which contains an Ace Inhibitor as well as a mild diuretic.  My bp
is now safely within the normal range.  I have also tried 20 mgs of Vasotec
along with a small does of dyazide (a diuretic) and my bp goes way way down
too low.

response 11 of 48:

Jun 7 17:36 UTC 1996

Many thanks, rickyb, for the best explaination I have ever been given.  And
also for the chuckle you induced with the image I have of me trying to take
my blood pressure with my arm by my ankle between my legs.  I'll just take
your word for the implied difference in results.  Otherwise, I may fracture
something, and then my bp will elevate from the stress.

response 13 of 48:

Jun 12 05:49 UTC 1996

Today was an 'interesting' day. On her doctor's recommendation, my wife
had a blood pressure type treadmill stress test done this morning at
Medsport. The resident there decided he saw a "depressed ST" in the ECG,
and said that this was either common in women treadmill stress-tested OR
an incipient miacardial infarction. He therefore wouldn't let me drive
her, but called an ambulance to transport her to UM Emergency (with
oxygen, monitor....the works - but no siren) for an echocardiogram (also
ECG?). This is apparently a much better diagnostic tool than even an ECG
for heart problems and it showed - a fully normal-to-athletic heart. So,
she was discharged, and I picked her up at the hospital entrance. I
suppose we appreciate the doctor's (over)caution, in case there was a
problem, but it was a bit anxiety-producing for a few hours. Perhaps the
seeming over-reaction was a product of their concern about malpractice. 

response 15 of 48:

Jun 12 14:30 UTC 1996

Almost the very same thing happened to me last month, except they didn't send
me to the hospital in an ambulance.  I took a stress ekg and got "positive"
results.  Naive me, I thought for a second that was good.  They told me that
this was not uncommon for ladies of "a certain age" but they wanted me to
take a echo cardiogram.  I had to wait four days and that was a very stressful
few days.  The second test showed some minor problems which can be managed
with a change in meds but no ischemia (which is what they were cpncerned
about).  I am grateful they did not overreact, Rane, like they did in your
wife's case.  I am also so pleased for you both that the first test was in
error.  In my situation, I had less drama but longer, protracted anxiety. 
There are no simple solutions to the concern over malpractice litigation. 
Everyone in the health and mental health professions share concern and modify
what we do somewhat in negative anticipation of same.  

response 17 of 48:

Jun 15 21:54 UTC 1996

Partly the result stemmed from risk management, since an expensive lawsuit
could have certainly arisen if this was an insipient MI and left untreated
or undiagnosed.  OTOH, these things come up much more frequently in teaching
hospitals and other educational settings.

residents, by the very definition, have limited personal, practical experience
in hands-on medicine.  At the same time they are learning and studying about
every condition known to science, and are expected to be able to rattle off
a long litany of differential diagnoses for any presenting findings they
encounter.  very often they overlook the obvious, and jump to the conclusion
that they _absolutely must_ rule out some dreaded process so they can sleep
at night (or, perhaps they just want the experience of the additional tests,
eh?).

An ECG (AKA, EKG, or electro cardiogram) measures the electrical activity in
the heart.  These are the impulses which make the heart beat and synchrony
is very important for normal function.  An echo-cardiogram (AKA, 'echo') is
an ultrasonic image of the heart as it is beating.  sort of a sonar image.
it incorporates doppler technology to construct an image showing the flow,
volume, direction, etc, of the blood as it enters/exits/re-enters and re-exits
the heart.

You might think a resident in a MedSport specialty would have a good knowledge
of the variability of results in different populations of patients under
stress test conditions.  It sounds to me, that this one did not.  But perhaps
the ECG was far enough off 'baseline' to warrant the extreme measures taken.

this is one more of the problems we encounter in our health care system today.
Whether in fear of litigation, or merely because it is possible, there are
a lot of high-tech procedures being performed at great cost which may not be
adding to the overall quality of the care we can provide.  And just think of
the related costs for ambulance, ACLS unit (advanced cardiac life support),
ER visit, etc.  sooner or later _we all_ pay this bill.  But, if it were my
wife, I don't think I would have wanted it any different.

Glad it worked out for you Rane.

response 19 of 48:

Jun 18 17:50 UTC 1996

Some can, especially if they've either been sued, or experienced medical
mishaps they want to be sure to avoid in the future.  My point was that
medicine is not an exact science, and it involves a lifetime of acquired
learning.  that is why we "practice medicine".  Theoretically we get better
with each encounter.

As I said, if it were my wife I wouldn't have changed things.  That's where
a level of emotion comes in.  The doc, otoh, needs to try and curb the
emotion factor and be as objective as possible.  His/her experience,
supplimented by the didactic knowledge accumulated over the years, can more
cost-effectively arrive at the same conclusion as high-tech diagnostics in
a vast majority of the cases (I'd _guess_ >80%).  but, if you're in the
remaining 20% and a test was not performed you'll want to string up the doc
who said everything was OK.

I try to make a point to question every doc as to "how will this help you help
me?", "what will this test tell you (or not tell you) about my condition?",
"will the results of this test change the treatment I get?  If not, why do
it?".  I also try and explain the answers to these kinds of questions as I
present diagnostic and/or treatment options to my own patients.  It takes
time, but that's what we're (supposed to be) here for.

response 21 of 48:

Jun 18 19:48 UTC 1996

My wife ran into the diagnosing doctor again, by chance, and they discussed
the fact that no problem was found with echo. He said that he had been "99%
sure" there was no problem, but "had" to send her for the test by ambulance
for reasons of liability. While this was not a case of overtreatment - just
overreaction - one must conclude that the system is flawed, or at least
not entirely rational.

response 23 of 48:

Jun 19 06:12 UTC 1996

I think so. Few doctors will write prescriptions on a patient's say-so,
though they will OK refills based on an earlier visit.