Anyone on this list have high blood pressure?  If so, what are you doing about
it besides watching your diet and exercising regularly and watching your salt,
alcohol and tobacco intake?

My blood pressure has been high for about 4 weeks now, but today, at the docs,
it was 158/124.  She was not happy.

I have been using essential oils known to lower blood pressure and I have been
making teas and tinctures with herbs known to lower the bp.  None of this has
helped, although the doc said I should keep trying.

Today, she started me on Cozaar, a bp med.  She made the comment that it would
be interesting to find a drug which would lower my bp when I am already doing
the eo's and herbs and watching the diet and such.

Sooooo, I am curious, what are you doing for your high blood pressure?  When
it is running really high, what symptoms do you have?  How long does it take
for it to go down once a good remedy is found?  How long before the symptoms
disappear?  What advice do you have for a person new to this dilemma?  Do you
take your own bp?  Is your reading as accurate as the ones at the docs office?

Anyone for discussion?

48 responses total.

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.

One time I had a high BP reading and they told me it was because of
antihistamines for pollen allergies.  I stopped the antihistamines, and the
BP returned to normal.  Maybe psychosomatic? 

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.

I thought my BP incident may have been psychosomatic.  

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)

I have noticed that if I do strenuous exercise (pushups, weights) enough to
get my heart working faster, minor symptoms of sinus problems, allergies, etc
clear up and stay cleared up for a long time.

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

My wife has been monitoring her blood pressure with an automatic (deflating)
monitor, and has found it appears to read low, compared to readings taken
by the LNP (at the same sitting). She just got a fully mechanical one in the
hope that will be more consistent/accurate. Does anyone have observations
of similar comparisons?

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.

Many years ago, when the automatic bp machines were coming out, one facility
I was at was testing several models against manual bp checks.  The results
were all over the place.  Here's a 'short course' on taking bp which may help
you understand why machines are not (usually) as accurate as a trained human,
and can explain the findings in the responses above.

Without any external pressure over your artery, the blood flows by a process
known as laminar flow, and there is (theoretically) no turbulence in the
stream.  this kind of flow is silent...think about trying to hear the sound
of water running through a hose if it is at full blast and all the air has
already gone through...it's pretty quiet.

If you cause turbulence in the flow it results in noise...just pinch off the
garden hose a little, and listen to the sound near the pinch, but away from
the source.  If you pinch the hose completely closed the flow stops, and so
does the sound.

Now, for some hemodynamics.  Your BP is the result of the volume of blood,
the strength of your hearts contraction, the speed of those contractions, and
the resistence against the flow from the destination (capillaries.  AKA
peripheral resistence).  Within your body you have several different kinds
of "sensors" in several locations which monitor the pressure, rate, etc. 
These operate responses which can be likened to a thermostat switching a
furnace on and off.  When its too cold, the furnace comes on, when it heats
up beyond a certain point it switches off.  the process repeats itself so,
if you chart the actual temp, you'll discover a wave form.  The range between
the wave peaks and valleys is a function of the sensitivity of the thermostat
and efficiency of the furnace, and the insulation, etc.


Back to taking your BP (I'll skip the physiologic sensors, but they are many).
When you put on the BP cuff it is placed over an artery.  Most people use the
brachial artery and place the cuff at the same level (relative to sea level)
as the heart.  After all, you want to measure the pressure within the heart,
don't you?  Since fluids in a closed system have the same pressure at the same
(elevation) level (due to gravity, athmospheric pressure, etc), any artery
can be measured to get a measurement of heart pressure _as long as it is at
the same level as the heart_.

Ok, you place the cuff on, and pump it up.  Why?  You want to pump it up so
that there is more pressure in the cuff than in the artery and the flow is
completely blocked.  this means there is _no sound_.  Put a stethescope over
the artery and listen...there should be no sound.  Now, _slowly_ release the
pressure in the cuff until it is equal to the maximun pressure the heart can
pump out.  The flow begins to seep past the blockage you've caused with the
cuff and you will begin to hear the sound of the heart beating (pulses of
turbulence).  Notice the cuff pressure...this is the systolic pressure (top
number).

Now, continue to _slowly_ reduce the cuff pressure and you will hear the
quality of the sound go through several subtle, but identifiable, changes.
There are six sounds identified by the experts here, but the important thing
to remember for a BP reading is the cuff pressure _at the point the sound
disappears_.  That will be the point at which there is no deformation of the
artery caused by the cuff, so laminar flow is re-established and there is no
turbulence.  That point is called the diastolic pressure (bottom number) and
is roughly equivelant to the pressure within the heart when it is most
relaxed...the minimum pressure.

I say "roughly equvilent" because you are not measuring the heart pressure
directly, but indirectly.  there are muscles and other soft tissues in the
way, and you are somewhat limited by the sensitivity of your hearing and the
stethescope you use, as well as the accuracy of the gauge you use.

for kicks, do this with your arm over your head.  You'll get a low reading.
Now, lie down and hang your arm over the side of the bed, below you.  you'll
get a high reading.  try taking your BP at your ankle (artery behind the
"ankle bone" at the inside of your ankle) when you are lying flat.  It should
be roughly the same as your heart BP (this is called the phlebostatic
position).  Now repeat this while standing up.  Notice anything remarkable?
Maybe 200mmHg-300mmHg higher reading?  This is due to gravity (no _wonder_
my feet swell up as the day goes on!).

As I said, BP is the result of cardiac output, resistence, total volume and
rate.  You affect these things by exercizing, with drugs, with stress, even
as a response to taking your BP (hence the reason to take it three times and
use the middle result.  If the 3 results are way out of line with each other,
get someone else to do it).  The most accurate measure of cardiac pressure
is to place a sensitive monitoring device _directly into the heart, or close
artery (such as aorta)_.

The mechanical machines have different levels of sensitivity to "hear" the
turbulence, so they give different readings.  The better ones, now used in
many hospitals, are very expensive for just that reason...they are "more
accurate", but more importantly, they give reproducable results which are
statistically accurate.  I prefer listening to the six variations of sounds
and using a _baumanometer_ (one of those glass ones with mercury inside). 
After all, with the analog meters you are trying to measure "milimeters of
mercury"...why not measure them directly using mercury?

End of todays lesson.  Tune in again to learn about how the oxygen and
pressure sensors help control your heart rate so your brain remains adequately
oxygenated...

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.

(actually, that was a lab experiment in hemodynamics we did in a physiolgy
lab at UoM _many, MANY_ years ago ;)

(it's easier if you have a partner, heh)

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. 

Yep.  That's the standard of care for r/o myocardial infarctions.
And the rationale is indeed malpractice litigation.  We are the
only country in the world that holds to this standard.

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.  

This item has been linked from Health 27 to Intro 57.
Type "join health" at the Ok: prompt for discussion of
bodily topics.

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.

I don't think I would refuse any *protective* "doctor's order", even if
I thought it to be unnecessary or mistaken. I have on occasion,
however, convinced doctors they have made a mistake, where I was convinced
the order would cause harm. In this case, the doctor was aware that
the ECG symptom could be either normal or serious, so I can't be critical
of his knowledge. I know that people can become hypochondriacal, thinking
every minor symptom to be serious - do doctors become hypochondriacal
too - about their patients' symptoms?

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.

Over-treatment is not only expensive but it often carries its 
own risk.  I've seen it happen hundreds of times.
I'm not sure a lay person could do anything about it.

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.

I'm glad everything worked out for you Rane...
I find that I have trouble convincing doctors, when I have to change them as
I did recently when moving, that I am a capable person who keeps an eye on
my and my kid's health.  I try to serve healthy meals, limit useless calories
and keep them and myself moving (exercise).  I know the symptoms of ear
infection and strep throat.  It is most annoying to have a doctor repeatedly
tell you that they must see you or your child when your diagnosis has been
repeatedly confirmed by same doc.  It is as if they never learn that I am not
stupid.  I know when to take my kids and myself to doctors and when it should
be a simple case of get rid of the infection.  I get frequent sinus
infections.  My symptoms are the same each time.  Each time I call for an
antibiotic, because it is the only thing that knocks it out when it has become
an infection, I have to go in.  Each time, I am correct and get the
antibiotic, but I alwo have to pay for each visit.  Is this just a money
making ploy?  I don't think so because the doc gets paid XXX amount of dollars
per month whether I come in or not.  The only person out the money is me...for
my co-pay.  Is this also the liability factor coming into play?

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

Actually, it could be both.  There are _some_ capitation plans out there (the
doc gets paid for assuming you as an account, even if s/he never sees you)
but they have proven expensive, and they encourage poor...or at least...under
treatment.  My guess is thaT the doc gets paid something if you don;t come
in, and a little more if you do...plus the co-pay.

There is also the liability issue, as well as the wide-spread mis-use/abuse
of antibiotics.  Sometimes, even though you _know_ you have an infection and
require an antibiotic, an exam is necessary to diagnose what type of organism
is infecting you so the proper antibiotic can be used.  The 'shotgun'
antibiotic approach has helped to create super-bugs which are resistent to
many of the drugs we now have.  Tuberculosis is a seruious example of how the
bugs can change.  We don't have anythiong that can kill it any longer.

Why in the world would a doctor what to stick out his or her nose and
write a prescription based on your evaluation and diagnosis?  He worked
hard for that license and pays a whole lot of money for malpractice
insurance and the type of service you describe would leave him vulnerable
to all kinds of trouble.  For what?  Your convenience and to save you
maybe $10? 

Well actually, there are times I don't go to the doctors because I don't have
the $10.  But, then, if the doctor is truly a knowledgable person, and they
have repeatedly confirmed that you know these two or three illnesses and their
symptoms and you have a trusting relationship with said doc,  then they also
know that you come in when you don't know the symptoms or if something is
presenting differently.  I have gone to the docs when I had strep because the
symptoms were different from previous streps I had and it was enough that it
needed to be checked out by someone more knowledgeable...ergo, a visit.  I
think that if a trusting  (both ways) relationship is developed, then this
should be possible.

Besides, chelsea, it isn't just 10 bux...it is also the hour and a half drive
and the prescriptions AND the matter of trust between patient and doctor. 
Why on earth do I want to keep going to a doctor who will not recognize that
I am not stupid or who won't believe me when I say I have already tried this
or that for x amount of time?  Also, why would I want to rely on someone who
won't listen to me.  If you ask most doctors, they will tell you that the
patient's evaluation of the symptoms, plus their own exam is what helps to
make the initial determination of illness.  Of course, if one does not pay
attention to ones own body, then that person would need to always see the doc.

On another note, my daughter had to have a rather large mole removed this past
monday and I got to watch the procedure.  Boy, was it neat!  I always wondered
how they created flaps and how they sewed the skin up.  It was way kool! 
Anybody else ever get to see something like this?

BTW, chelsea, are you a nurse by any chance?

Well, something like that - I watched my kids being born.

The first rule of thumb in avoiding malpractice litigation is
to not stray outside of the standards of care.  Doing so puts
the patient at risk as well as the physician.  If you can find
a doctor willing to prescribe medication based on your (remote)
diagnosis, cool.  He or she obviously trusts your judgement and
your medical assessment skills and is willing to risk the
results of a mistake.  But I don't think that makes doctors
who won't assume these risks greedy or insensitive or anything
other than cautious good physicians.

I'm a nurse.  

Aaahhh!  I thought so!  Yes, there are doctors who won't do this because of
liability.  After you have developed a working relationahip with them, they
will usually tell you this is the reason for their care.  But there are also
doctors who are greedy and not interested in developing a working relationship
with you.  This is the old school of doctors who want their patients to trust
everything they say and do and won't trust a thing the patient says.  Here
in Beckley, there were doctors who refused interviews with me, though I was
willing to pay for their time, when I was looking for a new family doctor.
In my opinion, the best care is given when both the patient and the doctor
work together, both trusting the skills of the other.  I live in my body,
therefore, I know my body better than any doctor possibly could.  If the
doctor does not trust my judgement about things concerning my body, then this
doctor is not using all the information at hand and will unlikey be able to
help me.  (Not an impossibility, but much less probable.)  Same goes for my
children.  Now that they are older, I encourage them to ask questions of the
doctor and fully participate in their medical care.  I may be with them
everyday, but they actually live in their body and can best  answer questions
about what they are feeling.  I say, if it is not a give and take on both
sides, then that doctor is not really interested in treating and caring for
you, but looks on you as just another $ in his/her pocket.

In what part of nursing do you work?

Post Anesthesia Care Unit for the past 15 years and the Emergency
Room for ten before that.  Gawd, makes me feel old talking about
those kinds of numbers. ;-)

Sounds like an interesting job though!  I have several friends who are nurses,
though I'm sure they don't work in those areas...one is an intensive care
nurse...we have some interesting conversations.  We'll have to talk sometime.
I bet the emergency room kept you hopping a bit!

It is an interesting job.  At the University we have seven Intensive
Care units, one of which is the PACU.  It's a big institution and
getting smaller all the time.  (Local humor.)

Sorry for the drift.  Back to treatment for hypertension?

Actually frieda.  If your doc is the kind you say s/he is...or want... s/he
will take a quick look at you and ask a couple of quick questions just to be
sure you're not in error..._for YOUR own protection, mostly.  I've done this
with established patients at no charge (Hmmm...no wonder I'm starving, heh
;).  In fact, my established patients know that they can (usually) speak to
me, personally, especially if they come in, without charge, just to clarify
some question or concern they have...provided they don't monopolize an entire
visits worth of time for some new problem, or take away from other patients
time.  As a rule, I don't charge for that.

I also agree that the best medicine is provided in a give-and-take
relationsip.  The doc is there to advise, the patient is responsible for the
decisions.  As a doc we have to also be educators.  No patient can make an
informed decision about a diagnostic or treatment option unless they
understand the risks and benefits involved.  Unfortunately, many docs in our
current system either retain the 'ivory tower' attitude of "how dare you
question me!" (fewer and fewer, btw), or simply are so busy, and do so much
medical work that they fail to explain things in terms a lay-person can
understand...or worse, they don't take the time to be sure the patient
understands to the best of their ability.  This is not easy...and it takes
_lots of time_, a rare comodity in health care these days.

Next time, try asking your doc if you could stop by and pick up a
prescription.  That way, s/he can have it written out (considerate of his/her
time) in advance, and still have a chance to see, touch, smell you (seriously,
no kidding) to minimize a mis-diagnosis on your part and increase the docs
confidence that this is the best thing for you.  See how positive this can
be for everyone?  Sure, you might be inconvenienced by the drive, a wait to
be squeezed in between appointments, etc, but isn't the inconvenience of
suffering worse?

If your doc isn't close enough to you, you might want to scope out a closer
one.  If s/he won't modify the approach to you in a more personal way,
considerate of everyone...not merely for your convenience...you might want
to look for another doc too.

Oh, I'm a little surprized that you were allowed to watch an excisional biopsy
and rotational skin flap graft on your daughter.  Unless absolutely necessary
I wouldn't permit such for many reasons.  The first reason to come to
everyones mind is liability, and that is _one_ reason, but very low on my
list.  More importantly, your child will 'spin-off' on your attitude/response.
If you've never seen anything like this you could go ballistic.  even if you
had seen it, when it's on you, or your kid, it's _different_ (a little story
on this in a minute).  Most especially with kids we need to take great care
to make them comfortable and not traumatize them, or they will not be people
who will seek medical care in later life until it's a serious
matter...sometimes too late.  Oh, that's another story...

My kid dislocated his elbow a couple of years back and we got to the pediatric
urgent care.  He was diagnosed, then given a mild sedative to calm him down,
and tylenol to ease the pain (a little).  Then the doc relocated the radius
and he had instant relief.  The sedative also has an amnesiac effect.  He
remembers he hurt his elbow, and that we went to the docs, and it got fixed,
but he _forgot_ all about the wait in the clinic, the pain of the relocation,
etc.  His memory is "I hurt my arm and went to the hospital and it got all
fixed".  About a year later he fell off his bike and cracked his arm again
(other arm).  Pediatric Urgent Care wasn't yet open and we went to the ER
(literally accross the hall).  I asked for the sedative he had previously (by
name) but the ER doc was afraid to give it (in case he had to go to surgery
to set it...reasonable thinking, but wrong in this case).  Instead, he gave
him a shot of Demerol in the thigh.  That made him loopy, but didn't last long
enough and didn't really get rid of the pain or calm him down, so they gave
him _another_ shot of Demerol!  finally, the ortho doc put him in a temporary
cast/splint and appointed him to be seen the next day at the office by the
pediatric "arm specialist".  To this day my kid remembers the pain from the
shots, and sometimes talks about how much it hurt right out of the blue!  He
had trouble sleeping for at least a week.

OK. Now for that story about how it's different with a loved one...When I
started out in practice I had my wife work in my office.  Since I also do
office surgery she learned to be an assistant, and became quite good at it.
Blood and "gore" didn't bother her after the first couple of times.  Well,
we moved, and I was unpacking some boxes at 2am...she was asleep.  I slipped
with a carpet knife and cut my wrist open...not serious, no tendons or
important structures cut, just a 'clean' full thickness skin incision so i
could see the stuff inside.  I was damned if i was going to let some sleepy
resident sew me up when I could do it myself with plastic surgery techniques!
So i woke up my wife and we went to the office.  Since this was at my wrist,
I couldn't use that hand to help.  My wife had to be my second hand when it
came to pulling the knot on the suture.  She was fine (I thought), if a little
agitated.  I anesthetized the area, scrubbed it, got our the sterile set-up
flushed the wound and began to sew it up.  With the suture through the skin
and tied loosley she was to hold one end while I pulled the know secure.  She
passed out...and I had to get her to the oxygen tank in the next room to
revive her...with a suture dangling from my open wound!  All worked out well,
and you can now barely find the scar.  She continued to assist in surgery for
some time after that.  Her only problem was that the patient was _me_.

<sorry for the rambling response folks...back to topic>

So, how were your blood pressures?

I don't think he the time or the desire to take his bp at the time all that
was happening, Rane.  ;-).  

Actually, I think the doctor let me stay because my daughter wanted me to
stay.  She was freaked that she would undergo this removal by herself.  She
has been around me enough to know that I am always asking questions and that
I allow hurtful things to happen when they are for her won good.  Her  back,
in the area around the mole was completely anesthetized first and I told her,
she wouldn't let go of my hand, to let me know if she began to feel any pain.
As it turned out, later, she told me that she felt the needle poke into her
skin when the doc put the first stitch in and was going to say something, but
then it only felt like a poke and she didn't feel the others.  The curious
thing, I found, was that later, she felt sore and bruised about 2 inches from
the area worked on.  The actual incisional area did not seem to bother her
at all.  Why would she feel sore so far out from the area actually worked on?

It never has bothered me to see something constructive, though gory done to
my kids or others that I love.  I don't like leaving my children alone with
doctors and pretty much demand the right to stay...which sometimes means
suiting up.  If the doctor doesn't take time to explain things fully before
hand and does something of which I have not been informed, then I am also not
afraid to speak right up and ask questions.

When my son was admitted to the hospital because the doctor would not believe
me when I told him that he had an allergic reaction to the dpt shot, and so
gave him another before I could stop him, the head doctor of pediatrics tried
to get me to leave him in her care.  She said I made her nervous, but could
give no other reason why I should leave my 6 month old child unattended.  I
refused to leave.  She decided that she would start an IV in my baby herself,
instead of calling an IV tech.  She stabbed my son, with me standing by, 20
times before I called a halt.  Her excuse for not being able to start the IV
was me.  She called in a tech and left.  The tech came, asked about the
situation, listened  and then proceeded to set the IV up with the first stab.
Whether it was luck is debatable.  I think the doctor didn't usually set the
IVs up herself and was out of practice.  I gave her a chance...more than one
without saying anything.  I think the tech does it everyday and so is more
capable...you know, practice makes for almost perfect.  The doctor was not
a bad doctor, she just used poor judgement.

I do not trust any doctor that willnot let me stay with my children when they
are injured and getting repaired.  I am their only advocate.  I am not put
off by blood and gore.  I know when to keep my mouth shut and let the doctor
do their work.  I have been really lucky not to have any of my children
require major surgery....that would provide for a sticky wicket!

The soreness around the surgical site is most likely due to the physical
aspect of the anesthetic injection itself (needle, volume of fluid, etc). 
Most times i include a little short-acting anti-inflammatory drug with the
anesthetic and this is not encountered (my highest compliment in this regard
was from an anesthetist on whom I performed a nerve block...she was impressed
and made a repeated point to tell me I give a good block :)

I think the doc you described _was indeed_ nervous with your presence and,
perrhaps, out-of-practice starting IV's on kids.  A tech is usually more
personable, and knows how the connection between listening and doing can
help...plus the repetative factor of doing this daily.

OTOH, if your doc is distracted by your presence, you should reconsider your
insistence of remaining present.  After all, don't you want him/her to provide
the best possible level of care they can?  medicine is more of an art than
an exact science, and focused concentration is important, especially during
procedures.  But, you've got to have confidence in your doc.  You need to know
that your kids have _two_ advocates in the room...you, and the doc.  Perhaps
more, depending on the staff at hand.

I certainly know how to observe, and when to keep my mouth shut or not, in
all levels of medical care.  I have scrubbed-in for surgical procedures from
head to toe, many times to observe at close hand, and sometimes to assist the
surgeon in the operation.  However, when my wife had a procedure performed,
in a hospital on which I had privileges, and by a doctor who allowed me to
observe his abdominal cases on many occasions, I was not permitted into the
operating room.  For me, this may have been easier to accept, since i could
"keep my ear on the door" and be there as she was wheeled out to
recovery...even talk to the doc about the case before he even made it to the
doctors lounge.  I don't know if she would have gotten his full attention,
and best care, if I had insisted on being in the operating room.

Okay, I see what you are saying, but having recently moved, I don't know if
I trust the doctors I am forced to deal with yet.  To me, it is a slowly
building thing.  I will proceed with caution and remain my children's advocate
until I do develop that trust.  The problem with most emergency situations
is that you don't know the person working on your child.  In that case, if
they are not willing to work with me, then I seek other help.  There have only
been a few doctors whom I have trusted implicitly...and they more than earned
my trust.  Funny, I am not that picky with doctors when it come to my own
medical treatment...just for my family.

When my grandson (of whom I am legal guardian) was discovered to have a coin
wedged in his throat, there was the possibility of a surgical removal.  In
hind sight, I can remember the instant that the object got stuck in his
throat.  One of the kids had been playing with a clothespin and popped it
apart.  The baby found the spring and put it in his mouth.  The 5 year old
saw him do it and tried to pull it out, but only succeeded in pushing it
farther in.  It was not something he thought to tell me.  Joey had the spring
in his throat for about 2 weeks before the swelling around the spring began
to close him up.  I took him to the doctor who though he was having trouble
breathing because of bronchitis and gave us some theophyline.  Joey began to
not be able to get anything down his throat and so I took him to the emergency
room.  There, in the exray lab, I remember the exclamation of "What in the
world is that?"  I looked up at the screen and knew immediately what it was
and when it had happened.  They tried to remove it by reaching in and grabbing
it, but the "skin" of the esophagus had swollen up around it and was holding
it firmly in place.  He was transferred (with paralyzing drugs and a machine
breathing for him) to George Washington University's PICU.  The doctor there
went into all this long explanation about if he did this a or b could happen.
If a happened then c or d could happen and on and on.  He was not thrilled
when I insisted on being present during what could end up being a life and
death race.  Luckily it was a teaching hospital and they had an observation
room in which I was allowed to watch.  We were really lucky with Joey and the
doctor was really skilled.  He managed to remove the clothespin spring without
having to do major surgery.  They were so afraid that if they had to cut that
they would nick the esophagus and run into all kinds of problems with
infections and etc.  Joey went home at the end of the week and really doesn't
remember the incident at all.  Surprisingly, the most problems I had at that
hospital were with the nurse who was in charge of Joey in PICU.  She
determinced that I would not be allowed to stay in the room when she was in
there for any reason.  She wanted me to leave the room when she took his
temperature, when she changed his diaper, when the tech came in to prick his
heal for the  blood tests and everythng.  She was not a very good judge of
character and I had her removed from Joey's case.  The nurses that took over
her shift with Joey were pleasant and didn't seem to have a problem with me
being there.

Since I was there, I kept track of all the xrays and shots and tests and
everything because we had 20/80 insurance at the time.  The hospital sent this
super inflated bill charging for medicines which he never received and IVs
which he never got and in room xrays which never happened.  Since I was ther
and had detailed notes, I was able to refute all of the overcharges and get
a reduction in my billing.  Sort of makes you wonder why they want you out
of the room, doesn't it?

Agreed.   Those are valid arguments as well.  You _do_ have to stay in close
contact and knowledge about every aspect of your (or your families) care...and
I would never walk away if I didn't have confidence in the doc.  You just need
to learn to see things a little from the docs point of view, and scope out
whether or not you can 'reasonably' trust a new doc with your kids.  If you
don't put them off, or come on -too- strong, any good doc will be able to
instill that confidence in you...if not, perhaps it would be mis-placed
anyway, heh.

- Backtalk version 1.3.30 - Copyright 1996-2006, Jan Wolter and Steve Weiss