87yrs old and a BP of 214 even on meds??



B

Bnd777

Guest
My mother who is slim but certainly eats the wrong foods has had high blood pressure for probably 20
years ........been on meds but even then it was 180 ( she only knows the top numbers I cant get the
lower ones )

One doctor said she has white coat syndrome but i think thats a bit of a stretch with a BP of 214
when on meds

Recently despite them trying every different BP meds her BP is now 214

Exercise is now out of the question as severe Osteoporosis has distorted her spine

There are times when she seems to have laboured breathing and i suspect she has had several TIAs
although she denies it

Just how likely and how soon is a massive stroke or heart attack /kidney damage going to be
 
bnd777 wrote:

> My mother who is slim but certainly eats the wrong foods has had high blood pressure for probably
> 20 years ........been on meds but even then it was 180 ( she only knows the top numbers I cant get
> the lower ones )
>
> One doctor said she has white coat syndrome but i think thats a bit of a stretch with a BP of 214
> when on meds
>
> Recently despite them trying every different BP meds her BP is now 214
>
> Exercise is now out of the question as severe Osteoporosis has distorted her spine
>
> There are times when she seems to have laboured breathing and i suspect she has had several TIAs
> although she denies it
>
> Just how likely and how soon is a massive stroke or heart attack /kidney damage going to be

It sounds like her cardiovascular risk is very high. I would guess about 20-25% per year.

Humbly,

Andrew
--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/
 
Sounds like she has multiple problems. You may try to prevent her from breaking her hip - that's
usually curtains within two years. A doc specializing in the elderly - gerontologist, might be a
good idea. Her risk of stroke is very high - there may be a dietary measures that can help besides
meds. You might try using some of the risk calculators on the web to assess her life expectancy.
She's also at high risk of Alzemheimers - if she doesn't already have it. All cardio risk factors
are also Alzemheimers risk factors.

"bnd777" <[email protected]> wrote in message news:<[email protected]>...
> My mother who is slim but certainly eats the wrong foods has had high blood pressure for probably
> 20 years ........been on meds but even then it was 180 ( she only knows the top numbers I cant get
> the lower ones )
>
> One doctor said she has white coat syndrome but i think thats a bit of a stretch with a BP of 214
> when on meds
>
> Recently despite them trying every different BP meds her BP is now 214
>
> Exercise is now out of the question as severe Osteoporosis has distorted her spine
>
> There are times when she seems to have laboured breathing and i suspect she has had several TIAs
> although she denies it
>
> Just how likely and how soon is a massive stroke or heart attack /kidney damage going to be
 
On Fri, 12 Dec 2003 23:18:00 +0000 (UTC), bnd777 <[email protected]>
wrote:

> My mother who is slim but certainly eats the wrong foods has had high blood pressure for probably
> 20 years ........been on meds but even then it was 180 ( she only knows the top numbers I cant get
> the lower ones )
>
> One doctor said she has white coat syndrome but i think thats a bit of a stretch with a BP of 214
> when on meds
>
> Recently despite them trying every different BP meds her BP is now 214
>
> Exercise is now out of the question as severe Osteoporosis has distorted her spine
>
> There are times when she seems to have laboured breathing and i suspect she has had several TIAs
> although she denies it
>
> Just how likely and how soon is a massive stroke or heart attack /kidney damage going to be
>
>
I might comment that you can never really understand her risk, statistically, accounting for over
nearly 300 known risk (an unknown) factors for heart attack, stroke, or any of the other multiple
problems for complications of atherosclerosis (including TIA) without understanding just how much
atherosclerosis she currently has.

Perhaps the doctor who says she has white coat hypertension is correct. Perhaps not. Perhaps her
blood pressure is an accurate assesment of risk for her atherosclerosis. Perhaps not. How can you
know? We can discuss statistically significant associations, but we are not discussing millions of
people. We are discussing one person, your mother. There is no one on earth just like her, with the
same past and the same future. Mathmatical calculations as to her risk are reduced to utter
speculation, and nothing more. Considering the potential risks of different medications used to
treat atherosclerosis it would be wise to consider basing her therapy on something other than a
house of cards.

What is right for your mother may not be right for you, or anyone else for that matter.

Her atheroslcerosis management should be individualized specifically and precisely to her current
level of disease. How is this done? How can someone take the out the guesswork? Take some time to
learn how at our website. Registration is free to all.

--
~~~ Patrick Blanchard, M.D., A.B.F.P. Board Certified in Family Practice
http://www.familydoctor.org/blanchard ~~~ SonoScore Winning against heart attack and stroke
http://www.sonoscore.com
 
"Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote in message
news:[email protected]...
> bnd777 wrote:
>
> > My mother who is slim but certainly eats the wrong foods has had high
blood
> > pressure for probably 20 years ........been on meds but even then it was
180
> > ( she only knows the top numbers I cant get the lower ones )
> >
> > One doctor said she has white coat syndrome but i think thats a bit of a stretch with a BP of
> > 214 when on meds
> >
> > Recently despite them trying every different BP meds her BP is now 214
> >
> > Exercise is now out of the question as severe Osteoporosis has distorted
her
> > spine
> >
> > There are times when she seems to have laboured breathing and i suspect
she
> > has had several TIAs although she denies it
> >
> > Just how likely and how soon is a massive stroke or heart attack /kidney damage going to be
>
> It sounds like her cardiovascular risk is very high. I would guess about
20-25%
> per year.
>
> Humbly,
>
> Andrew
> --
> Dr. Andrew B. Chung, MD/PhD Board-Certified Cardiologist http://www.heartmdphd.com/
>
>
Any other warning signs we would notice ? Whats scary is she is still driving !!!
 
> "bnd777" <[email protected]> wrote in message news:<[email protected]>...
> > My mother who is slim but certainly eats the wrong foods has had high blood pressure for
> > probably 20 years ........been on meds but even then it was 180 ( she only knows the top numbers
> > I cant get the lower ones )

> > Exercise is now out of the question as severe Osteoporosis has distorted her spine

If your mother has had high blood pressure for 20 years and is still here, she's doing something
right. Can her doctor get her into a pool program for elderly and disabled? The rehabilitation
hospital where I live admits outpatients four times a week to use the supervised VERY warm pool. It
is designed so that walkers and wheel chairs can go down the ramp into the water, which is not more
than 4 feet deep. There are railings all around, and relatives are welcome to come and help.
"Exercise" is a loose description of what happens, but it is soothing and takes weight off the
affected joints and spine. MFG
 
Patrick,

Risk assessment is done all the time and is the basis for the insurance industry. It is not a "wild
guess." If someone has cancer of a certain stage and cell type, an expected lifespan can be given.
In regards to the 87 yr old woman with uncontrollable hypertension she will surely have a lower
life expectancy than a normal 87 yr old. A normal 87 yr old can expect to live 6 yrs. I would guess
3 years would be generous for a 87 yr old with uncontrollable hypertension. Would you like to
insure her?

"Patrick Blanchard, M.D." <blanchard@sonoscore_nospam.com> wrote in message news:<oprz70471mx9pqj2@news-
60.giganews.com>...
> On Fri, 12 Dec 2003 23:18:00 +0000 (UTC), bnd777 <[email protected]> wrote:
>
> > My mother who is slim but certainly eats the wrong foods has had high blood pressure for
> > probably 20 years ........been on meds but even then it was 180 ( she only knows the top numbers
> > I cant get the lower ones )
> >
> > One doctor said she has white coat syndrome but i think thats a bit of a stretch with a BP of
> > 214 when on meds
> >
> > Recently despite them trying every different BP meds her BP is now 214
> >
> > Exercise is now out of the question as severe Osteoporosis has distorted her spine
> >
> > There are times when she seems to have laboured breathing and i suspect she has had several TIAs
> > although she denies it
> >
> > Just how likely and how soon is a massive stroke or heart attack /kidney damage going to be
> >
> >
> I might comment that you can never really understand her risk, statistically, accounting for over
> nearly 300 known risk (an unknown) factors for heart attack, stroke, or any of the other multiple
> problems for complications of atherosclerosis (including TIA) without understanding just how much
> atherosclerosis she currently has.
>
> Perhaps the doctor who says she has white coat hypertension is correct. Perhaps not. Perhaps her
> blood pressure is an accurate assesment of risk for her atherosclerosis. Perhaps not. How can you
> know? We can discuss statistically significant associations, but we are not discussing millions of
> people. We are discussing one person, your mother. There is no one on earth just like her, with
> the same past and the same future. Mathmatical calculations as to her risk are reduced to utter
> speculation, and nothing more. Considering the potential risks of different medications used to
> treat atherosclerosis it would be wise to consider basing her therapy on something other than a
> house of cards.
>
> What is right for your mother may not be right for you, or anyone else for that matter.
>
> Her atheroslcerosis management should be individualized specifically and precisely to her current
> level of disease. How is this done? How can someone take the out the guesswork? Take some time to
> learn how at our website. Registration is free to all.
>
> --
> ~~~ Patrick Blanchard, M.D., A.B.F.P. Board Certified in Family Practice
> http://www.familydoctor.org/blanchard ~~~ SonoScore Winning against heart attack and stroke
> http://www.sonoscore.com
 
bnd777 wrote:

> "Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote in message
> news:[email protected]...
> > bnd777 wrote:
> >
> > > My mother who is slim but certainly eats the wrong foods has had high
> blood
> > > pressure for probably 20 years ........been on meds but even then it was
> 180
> > > ( she only knows the top numbers I cant get the lower ones )
> > >
> > > One doctor said she has white coat syndrome but i think thats a bit of a stretch with a BP of
> > > 214 when on meds
> > >
> > > Recently despite them trying every different BP meds her BP is now 214
> > >
> > > Exercise is now out of the question as severe Osteoporosis has distorted
> her
> > > spine
> > >
> > > There are times when she seems to have laboured breathing and i suspect
> she
> > > has had several TIAs although she denies it
> > >
> > > Just how likely and how soon is a massive stroke or heart attack /kidney damage going to be
> >
> > It sounds like her cardiovascular risk is very high. I would guess about
> 20-25%
> > per year.
> >
> > Humbly,
> >
> > Andrew
> > --
> > Dr. Andrew B. Chung, MD/PhD Board-Certified Cardiologist http://www.heartmdphd.com/
> >
> >
> Any other warning signs we would notice ?

It sounds like she is exhibiting enough already.

>
> Whats scary is she is still driving !!!

Would suggest you take her to a hypertension specialist.

Humbly,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/
 
"mfg" <[email protected]> wrote in message
news:[email protected]...
> >
> > "bnd777" <[email protected]> wrote in message
news:<[email protected]>...
> > > My mother who is slim but certainly eats the wrong foods has had high
blood
> > > pressure for probably 20 years ........been on meds but even then it
was 180
> > > ( she only knows the top numbers I cant get the lower ones )
>
>
> > > Exercise is now out of the question as severe Osteoporosis has
distorted her
> > > spine
>
> If your mother has had high blood pressure for 20 years and is still here, she's doing something
> right. Can her doctor get her into a pool program for elderly and disabled? The rehabilitation
> hospital where I live admits outpatients four times a week to use the supervised VERY warm pool.
> It is designed so that walkers and wheel chairs can go down the ramp into the water, which is not
> more than 4 feet deep. There are railings all around, and relatives are welcome to come and help.
> "Exercise" is a loose description of what happens, but it is soothing and takes weight off the
> affected joints and spine. MFG

Theres no facilities like that near her
 
Brad, because risk assessment is frequently performed does not mean it is
the best way to understand a condition or problem. Although I am by no
means an expert on numbers or statistics, I have found the following book
very helpful in trying to grasp complex situations: http://tinyurl.com/zdrr

Incalculable risk is really quite common (although it is uncomfortable to admit it), and is
manifest as a "suprise" that occurs outside of our comprehension. I agree with you that an expected
lifespan can be given mathmatically, but the calculation is unlikely to account for all the known
and the unknown factors that determine the true outcome. If lifespan does not meet expectations,
then it is considered a "suprise" statistically speaking, which is really saying that the
calculations were wrong.

Would I insure a client who is 87 years old with uncontrollable hypertension?

I don't know how to answer your question. However, if I were 87 years old, I would not want my
therapy based on speculation, but on proper assesment.

Regards, Patrick

On 15 Dec 2003 13:15:38 -0800, Brad Sheppard <[email protected]> wrote:

> Patrick,
>
> Risk assessment is done all the time and is the basis for the insurance industry. It is not a
> "wild guess." If someone has cancer of a certain stage and cell type, an expected lifespan can be
> given. In regards to the 87 yr old woman with uncontrollable hypertension she will surely have a
> lower life expectancy than a normal 87 yr old. A normal 87 yr old can expect to live 6 yrs. I
> would guess 3 years would be generous for a 87 yr old with uncontrollable hypertension. Would you
> like to insure her?
>
>
> "Patrick Blanchard, M.D." <blanchard@sonoscore_nospam.com> wrote in message news:<oprz70471mx9pqj2@news-
> 60.giganews.com>...
>> On Fri, 12 Dec 2003 23:18:00 +0000 (UTC), bnd777 <[email protected]> wrote:
>>
>> > My mother who is slim but certainly eats the wrong foods has had high blood pressure for
>> > probably 20 years ........been on meds but even then it
>> was > 180
>> > ( she only knows the top numbers I cant get the lower ones )
>> >
>> > One doctor said she has white coat syndrome but i think thats a bit of
>> a
>> > stretch with a BP of 214 when on meds
>> >
>> > Recently despite them trying every different BP meds her BP is now 214
>> >
>> > Exercise is now out of the question as severe Osteoporosis has
>> distorted > her
>> > spine
>> >
>> > There are times when she seems to have laboured breathing and i
>> suspect > she
>> > has had several TIAs although she denies it
>> >
>> > Just how likely and how soon is a massive stroke or heart attack
>> /kidney
>> > damage going to be
>> >
>> >
>> I might comment that you can never really understand her risk, statistically, accounting for over
>> nearly 300 known risk (an unknown) factors for heart attack, stroke, or any of the other multiple
>> problems for complications of atherosclerosis (including TIA) without understanding just how much
>> atherosclerosis she currently has.
>>
>> Perhaps the doctor who says she has white coat hypertension is correct. Perhaps not. Perhaps her
>> blood pressure is an accurate assesment of risk for her atherosclerosis. Perhaps not. How can you
>> know? We can discuss statistically significant associations, but we are not discussing millions
>> of people. We are discussing one person, your mother. There is no one on earth just like her,
>> with the same past and the same future. Mathmatical calculations as to her risk are reduced to
>> utter speculation, and nothing more. Considering the potential risks of different medications
>> used to treat atherosclerosis it would be wise to consider basing her therapy on something other
>> than a house of cards.
>>
>> What is right for your mother may not be right for you, or anyone else for that matter.
>>
>> Her atheroslcerosis management should be individualized specifically and precisely to her current
>> level of disease. How is this done? How can someone take the out the guesswork? Take some time to
>> learn how at our website. Registration is free to all.
>>
>> -- ~~~ Patrick Blanchard, M.D., A.B.F.P. Board Certified in Family Practice
>> http://www.familydoctor.org/blanchard ~~~ SonoScore Winning against heart attack and stroke
>> http://www.sonoscore.com
>

--
~~~ Patrick Blanchard, M.D., A.B.F.P. Board Certified in Family Practice
http://www.familydoctor.org/blanchard ~~~ SonoScore Winning against heart attack and stroke
http://www.sonoscore.com
 
"bnd777" <[email protected]> wrote in message news:<[email protected]>...
> "mfg" <[email protected]> wrote in message
> news:[email protected]...
> > >
> > > "bnd777" <[email protected]> wrote in message
> news:<[email protected]>...
> > > > My mother who is slim but certainly eats the wrong foods has had high
> blood
> > > > pressure for probably 20 years ........been on meds but even then it
> was 180
> > > > ( she only knows the top numbers I cant get the lower ones )
> >
> >
> > > > Exercise is now out of the question as severe Osteoporosis has
> distorted her
> > > > spine
> >
> > If your mother has had high blood pressure for 20 years and is still here, she's doing something
> > right. Can her doctor get her into a pool program for elderly and disabled? The rehabilitation
> > hospital where I live admits outpatients four times a week to use the supervised VERY warm pool.
> > It is designed so that walkers and wheel chairs can go down the ramp into the water, which is
> > not more than 4 feet deep. There are railings all around, and relatives are welcome to come and
> > help. "Exercise" is a loose description of what happens, but it is soothing and takes weight off
> > the affected joints and spine. MFG
>
>
> Theres no facilities like that near her

Make an appointment for your mother with a physical therapist. Go with her. They will assess her and
develop a program of assisted movement appropriate for whatever condition she has. They will lead
her through it, and show you how you can help her. They may also suggest she walk to whatever degree
she can, even with a walker for example, in the halls of her building, or in a mall, with you or
someone to help, a couple times a week. I can't stress enough how important it is for her to get to
a physical therapist who will find appropriate and helpful movement for her. It will add greatly to
her physical and emotional health. MFG
 
"Patrick Blanchard, M.D." <blanchard@sonoscore_nospam.com> wrote in message
news:eek:[email protected]...
> Brad, because risk assessment is frequently performed does not mean it is the best way to
> understand a condition or problem. Although I am by no means an expert on numbers or statistics, I
> have found the following book very helpful in trying to grasp complex situations:
http://tinyurl.com/zdrr
>
> Incalculable risk is really quite common (although it is uncomfortable to admit it), and is
> manifest as a "suprise" that occurs outside of our comprehension. I agree with you that an
> expected lifespan can be given mathmatically, but the calculation is unlikely to account
> for all the
known
> and the unknown factors that determine the true outcome. If lifespan does not meet expectations,
> then it is considered a "suprise" statistically speaking, which is really saying that the
> calculations were wrong.
>
> Would I insure a client who is 87 years old with uncontrollable hypertension?
>
> I don't know how to answer your question. However, if I were 87 years old, I would not want my
> therapy based on speculation, but on proper assesment.
>
> Regards, Patrick
>
>
>
> On 15 Dec 2003 13:15:38 -0800, Brad Sheppard <[email protected]> wrote:
>
> > Patrick,
> >
> > Risk assessment is done all the time and is the basis for the insurance industry. It is not a
> > "wild guess." If someone has cancer of a certain stage and cell type, an expected lifespan can
> > be given. In regards to the 87 yr old woman with uncontrollable hypertension she will surely
> > have a lower life expectancy than a normal 87 yr old. A normal 87 yr old can expect to live 6
> > yrs. I would guess 3 years would be generous for a 87 yr old with uncontrollable hypertension.
Would
> > you like to insure her?
> >
> >
> > "Patrick Blanchard, M.D." <blanchard@sonoscore_nospam.com> wrote in message news:<oprz70471mx9pqj2@news-
> > 60.giganews.com>...
> >> On Fri, 12 Dec 2003 23:18:00 +0000 (UTC), bnd777
<[email protected]>
> >> wrote:
> >>
> >> > My mother who is slim but certainly eats the wrong foods has had high blood pressure for
> >> > probably 20 years ........been on meds but even then it
> >> was > 180
> >> > ( she only knows the top numbers I cant get the lower ones )
> >> >
> >> > One doctor said she has white coat syndrome but i think thats a bit
of
> >> a
> >> > stretch with a BP of 214 when on meds
> >> >
> >> > Recently despite them trying every different BP meds her BP is now
214
> >> >
> >> > Exercise is now out of the question as severe Osteoporosis has
> >> distorted > her
> >> > spine
> >> >
> >> > There are times when she seems to have laboured breathing and i
> >> suspect > she
> >> > has had several TIAs although she denies it
> >> >
> >> > Just how likely and how soon is a massive stroke or heart attack
> >> /kidney
> >> > damage going to be
> >> >
> >> >
> >> I might comment that you can never really understand her risk, statistically, accounting for
> >> over nearly 300 known risk (an unknown) factors for heart attack, stroke, or any of the other
> >> multiple problems for complications of atherosclerosis (including TIA) without understanding
> >> just how much atherosclerosis she currently has.
> >>
> >> Perhaps the doctor who says she has white coat hypertension is correct. Perhaps not. Perhaps
> >> her blood pressure is an accurate assesment of
risk
> >> for her atherosclerosis. Perhaps not. How can you know? We can discuss statistically
> >> significant associations, but we are not discussing millions of people. We are discussing one
> >> person, your mother. There is no one on earth just like her, with the same past and the same
> >> future.
> >>
> >>
> >> Her atheroslcerosis management should be individualized specifically
and
> >> precisely to her current level of disease.

...................

Since she is in the UK not the USA the NHS attitude of care and assesment is very different along
with any possible physical therapy

Her Father died of a stroke age 86

We believe she has already had several TIAs 3 yrs ago she drove into a brick wall 2 yrs ago she
collapsed at Xmas Dinner Table .....paramedics said mini stroke .....hospital discharged her She is
always saying she does not feel well but refuses to go to the doctor .... She is feisty as hell
..you cant tell her anything .....salts her food!!!.yet slow reactions /thought/and
understanding.....heaven help other drivers Has been on Hypertension drugs for about 3 yrs maybe
more BP is up and down like a yo yo but always way above160 and now as you say uncontrollable
bouncing from 180 to 214

Little we can do but await events
 
"Patrick Blanchard, M.D." <blanchard@sonoscore_nospam.com> wrote in part:

>Incalculable risk is really quite common (although it is uncomfortable to admit it), and is
>manifest as a "suprise" that occurs outside of our comprehension. I agree with you that an expected
>lifespan can be given mathmatically, but the calculation is unlikely to account for all the known
>and the unknown factors that determine the true outcome. If lifespan does not meet expectations,
>then it is considered a "suprise" statistically speaking, which is really saying that the
>calculations were wrong.

"Expectation" in mathematics is just another another word for "average." An expected lifespan is the
average lfespan for a population with the individuals characteristics and other charactereristics
typical of the full population. That is, it is an average value based on what is specifically called
out as different about the individual. A surprise does not mean the calculations are wrong. There
should be lifespans of all different values, but with an average of the expected lifespan.
--
Jim Chinnis Warrenton, Virginia, USA
 
mfg wrote:

> "bnd777" <[email protected]> wrote in message news:<[email protected]>...
> > "mfg" <[email protected]> wrote in message
> > news:[email protected]...
> > > >
> > > > "bnd777" <[email protected]> wrote in message
> > news:<[email protected]>...
> > > > > My mother who is slim but certainly eats the wrong foods has had high
> > blood
> > > > > pressure for probably 20 years ........been on meds but even then it
> > was 180
> > > > > ( she only knows the top numbers I cant get the lower ones )
> > >
> > >
> > > > > Exercise is now out of the question as severe Osteoporosis has
> > distorted her
> > > > > spine
> > >
> > > If your mother has had high blood pressure for 20 years and is still here, she's doing
> > > something right. Can her doctor get her into a pool program for elderly and disabled? The
> > > rehabilitation hospital where I live admits outpatients four times a week to use the
> > > supervised VERY warm pool. It is designed so that walkers and wheel chairs can go down the
> > > ramp into the water, which is not more than 4 feet deep. There are railings all around, and
> > > relatives are welcome to come and help. "Exercise" is a loose description of what happens, but
> > > it is soothing and takes weight off the affected joints and spine. MFG
> >
> >
> > Theres no facilities like that near her
>
> Make an appointment for your mother with a physical therapist. Go with her. They will assess her
> and develop a program of assisted movement appropriate for whatever condition she has.

Fyi, they'll likely want her blood pressure better though.

Humbly,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/
 
Sorry to hear that. Please do try to get her off the road. Have they placed her on blood thinners?
I'd suggest seeing if she'll eat oily fish (salmon, herring) or take fish oil capsules (if she's not
already on blood thinners - if she is, the dose would have to be adjusted).

"bnd777" <[email protected]> wrote in message news:<[email protected]>...
> "Patrick Blanchard, M.D." <blanchard@sonoscore_nospam.com> wrote in message news:eek:prz8xf9wux9pqj2@news-
> 60.giganews.com...
> > Brad, because risk assessment is frequently performed does not mean it is the best way to
> > understand a condition or problem. Although I am by no means an expert on numbers or statistics,
> > I have found the following book very helpful in trying to grasp complex situations:
> http://tinyurl.com/zdrr
> >
> > Incalculable risk is really quite common (although it is uncomfortable to admit it), and is
> > manifest as a "suprise" that occurs outside of our comprehension. I agree with you that an
> > expected lifespan can be given mathmatically, but the calculation is unlikely to account for
> > all the
> known
> > and the unknown factors that determine the true outcome. If lifespan does not meet expectations,
> > then it is considered a "suprise" statistically speaking, which is really saying that the
> > calculations were wrong.
> >
> > Would I insure a client who is 87 years old with uncontrollable hypertension?
> >
> > I don't know how to answer your question. However, if I were 87 years old, I would not want my
> > therapy based on speculation, but on proper assesment.
> >
> > Regards, Patrick
> >
> >
> >
> > On 15 Dec 2003 13:15:38 -0800, Brad Sheppard <[email protected]> wrote:
> >
> > > Patrick,
> > >
> > > Risk assessment is done all the time and is the basis for the insurance industry. It is not a
> > > "wild guess." If someone has cancer of a certain stage and cell type, an expected lifespan can
> > > be given. In regards to the 87 yr old woman with uncontrollable hypertension she will surely
> > > have a lower life expectancy than a normal 87 yr old. A normal 87 yr old can expect to live 6
> > > yrs. I would guess 3 years would be generous for a 87 yr old with uncontrollable hypertension.
> Would
> > > you like to insure her?
> > >
> > >
> > > "Patrick Blanchard, M.D." <blanchard@sonoscore_nospam.com> wrote in message news:<oprz70471mx9pqj2@news-
> > > 60.giganews.com>...
> > >> On Fri, 12 Dec 2003 23:18:00 +0000 (UTC), bnd777
> <[email protected]>
> > >> wrote:
> > >>
> > >> > My mother who is slim but certainly eats the wrong foods has had high blood pressure for
> > >> > probably 20 years ........been on meds but even then it
> was > 180
> > >> > ( she only knows the top numbers I cant get the lower ones )
> > >> >
> > >> > One doctor said she has white coat syndrome but i think thats a bit
> of a
> > >> > stretch with a BP of 214 when on meds
> > >> >
> > >> > Recently despite them trying every different BP meds her BP is now
> 214
> > >> >
> > >> > Exercise is now out of the question as severe Osteoporosis has
> distorted > her
> > >> > spine
> > >> >
> > >> > There are times when she seems to have laboured breathing and i
> suspect > she
> > >> > has had several TIAs although she denies it
> > >> >
> > >> > Just how likely and how soon is a massive stroke or heart attack
> /kidney
> > >> > damage going to be
> > >> >
> > >> >
> > >> I might comment that you can never really understand her risk, statistically, accounting for
> > >> over nearly 300 known risk (an unknown) factors for heart attack, stroke, or any of the other
> > >> multiple problems for complications of atherosclerosis (including TIA) without understanding
> > >> just how much atherosclerosis she currently has.
> > >>
> > >> Perhaps the doctor who says she has white coat hypertension is correct. Perhaps not. Perhaps
> > >> her blood pressure is an accurate assesment of
> risk
> > >> for her atherosclerosis. Perhaps not. How can you know? We can discuss statistically
> > >> significant associations, but we are not discussing millions of people. We are discussing one
> > >> person, your mother. There is no one on earth just like her, with the same past and the same
> > >> future.
> > >>
> > >>
> > >> Her atheroslcerosis management should be individualized specifically
> and
> > >> precisely to her current level of disease.
>
>
> ...................
>
> Since she is in the UK not the USA the NHS attitude of care and assesment is very different along
> with any possible physical therapy
>
> Her Father died of a stroke age 86
>
> We believe she has already had several TIAs 3 yrs ago she drove into a brick wall 2 yrs ago she
> collapsed at Xmas Dinner Table .....paramedics said mini stroke .....hospital discharged her She
> is always saying she does not feel well but refuses to go to the doctor .... She is feisty as hell
> ..you cant tell her anything .....salts her food!!!.yet slow reactions /thought/and
> understanding.....heaven help other drivers Has been on Hypertension drugs for about 3 yrs maybe
> more BP is up and down like a yo yo but always way above160 and now as you say uncontrollable
> bouncing from 180 to 214
>
> Little we can do but await events
 
"Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote in message news:<[email protected]>...
> mfg wrote:
>
> > "bnd777" <[email protected]> wrote in message news:<[email protected]>...
> > > "mfg" <[email protected]> wrote in message
> > > news:[email protected]...
> > > > >
> > > > > "bnd777" <[email protected]> wrote in message
> news:<[email protected]>...
> > > > > > My mother who is slim but certainly eats the wrong foods has had high
> blood
> > > > > > pressure for probably 20 years ........been on meds but even then it
> was 180
> > > > > > ( she only knows the top numbers I cant get the lower ones )
> > > >
> > > >
> > > > > > Exercise is now out of the question as severe Osteoporosis has
> distorted her
> > > > > > spine
> > > >
>> > >
> > > Theres no facilities like that near her
> >
> > Make an appointment for your mother with a physical therapist. Go with her. They will assess her
> > and develop a program of assisted movement appropriate for whatever condition she has.
>
> Fyi, they'll likely want her blood pressure better though.
>
> Humbly,
>
> Andrew

"It will add greatly to her physical and emotional health."

And that may very well lower her blood pressure somewhat, at least enough to satisfy all the white
coats and leave an old woman in what peace she can find. Were it me, I would say: leave well enough
alone. Don't medicate her any more. Have the physical therapist, whom she will likely grow to trust,
check her blood pressure from time to time. PTs operate very differently from physicians or
cardiologists. They nurture their clients. At least, it is taught that they should in their training
and education. Also, I think it is part of the personality of one who would choose that as a
profession. IMHO. MFG
 
mfg wrote:

> "Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote in message
> news:<[email protected]>...
> > mfg wrote:
> >
> > > "bnd777" <[email protected]> wrote in message news:<[email protected]>...
> > > > "mfg" <[email protected]> wrote in message
> > > > news:[email protected]...
> > > > > >
> > > > > > "bnd777" <[email protected]> wrote in message
> > news:<[email protected]>...
> > > > > > > My mother who is slim but certainly eats the wrong foods has had high
> > blood
> > > > > > > pressure for probably 20 years ........been on meds but even then it
> > was 180
> > > > > > > ( she only knows the top numbers I cant get the lower ones )
> > > > >
> > > > >
> > > > > > > Exercise is now out of the question as severe Osteoporosis has
> > distorted her
> > > > > > > spine
> > > > >
> >> > >
> > > > Theres no facilities like that near her
> > >
> > > Make an appointment for your mother with a physical therapist. Go with her. They will assess
> > > her and develop a program of assisted movement appropriate for whatever condition she has.
> >
> > Fyi, they'll likely want her blood pressure better though.
> >
> > Humbly,
> >
> > Andrew
>
> "It will add greatly to her physical and emotional health."

Maybe so. However, if she suffers a hemorrhagic stroke because of her poorly controlled blood
pressure worsening during the exercise/therapy, it could adversely the financial picture (and
emotional health) of the physical therapist.

Humbly,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/
 
"Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote in message news:<[email protected]>...
> mfg wrote:
>
> > "Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote in message
> > news:<[email protected]>...
> > > mfg wrote:
> > >
> > > > "bnd777" <[email protected]> wrote in message
> > > > news:<[email protected]>...
> > > > > "mfg" <[email protected]> wrote in message
> > > > > news:[email protected]...
> > > > > > >
> > > > > > > "bnd777" <[email protected]> wrote in message
> news:<[email protected]>...
> > > > > > > > My mother who is slim but certainly eats the wrong foods has had high
> blood
> > > > > > > > pressure for probably 20 years ........been on meds but even then it
> was 180
> > > > > > > > ( she only knows the top numbers I cant get the lower ones )
> > > > > >
> > > > > >
> > > > > > > > Exercise is now out of the question as severe Osteoporosis has
> distorted her
> > > > > > > > spine
> > > > > >
> > >> > >
> > > > > Theres no facilities like that near her
> > > >
> > > > Make an appointment for your mother with a physical therapist. Go with her. They will assess
> > > > her and develop a program of assisted movement appropriate for whatever condition she has.
> > >
> > > Fyi, they'll likely want her blood pressure better though.
> > >
> > > Humbly,
> > >
> > > Andrew
> >
> > "It will add greatly to her physical and emotional health."
>
> Maybe so. However, if she suffers a hemorrhagic stroke because of her poorly controlled blood
> pressure worsening during the exercise/therapy, it could adversely the financial picture (and
> emotional health) of the physical therapist.
>
> Humbly,
>
> Andrew

What kind of 'exercise therapy' do you imagine a physical therapist is going to give a woman with
high blood pressure? She is probably going to take her blood pressure, and if it's down (white-coat
response was what her doctor said, after all) walk around the perimeter of the PT room with her, 14
ft x 20 ft. if it's like the one I attend. And the lady will probably use a walker AND one hand on
the therapist. I would imagine, if the therapist found her blood pressure up, she would do nothing
and report to the doctor. PTs are trained in medical schools, as you of course must know. Here in my
city, none I know have less than MSc, unless they just haven't finished yet. There are many unknowns
here with this lady, but IF it is white-coat hypertension, and IF there is access to a hospital
based PT clinic, then her son might investigate it. Of course, in the UK as in most Canadian
provinces, the doctor MUST write a prescription before one can see a PT. Enough safeguards for you?
But if it was me, I would refuse more medication, which seems to be what this lady is doing too.

What ARE you gonna do with us old broads, eh Andrew? MFG
 
[email protected] (mfg) wrote in message news:<[email protected]>...
> "Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote in message
> news:<[email protected]>...
> > mfg wrote:
> >
> > > "Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote in message
> > > news:<[email protected]>...
> > > > mfg wrote:
> > > >
> > > > > "bnd777" <[email protected]> wrote in message
> > > > > news:<[email protected]>...
> > > > > > "mfg" <[email protected]> wrote in message
> > > > > > news:[email protected]...
> > > > > > > >
> > > > > > > > "bnd777" <[email protected]> wrote in message
> news:<[email protected]>...
> > > > > > > > > My mother who is slim but certainly eats the wrong foods has had high
> blood
> > > > > > > > > pressure for probably 20 years ........been on meds but even then it
> was 180
> > > > > > > > > ( she only knows the top numbers I cant get the lower ones )
> > > > > > >
> > > > > > >
> > > > > > > > > Exercise is now out of the question as severe Osteoporosis has
> distorted her
> > > > > > > > > spine
> > > > > > >
> > > >> > >
> > > > > > Theres no facilities like that near her
> > > > >
> > > > > Make an appointment for your mother with a physical therapist. Go with her. They will
> > > > > assess her and develop a program of assisted movement appropriate for whatever condition
> > > > > she has.
> > > >
> > > > Fyi, they'll likely want her blood pressure better though.
> > > >
> > > > Humbly,
> > > >
> > > > Andrew
> > >
> > > "It will add greatly to her physical and emotional health."
> >
> > Maybe so. However, if she suffers a hemorrhagic stroke because of her poorly controlled blood
> > pressure worsening during the exercise/therapy, it could adversely the financial picture (and
> > emotional health) of the physical therapist.
> >
> > Humbly,
> >
> > Andrew
>
> What kind of 'exercise therapy' do you imagine a physical therapist is going to give a woman with
> high blood pressure?

If her blood pressure is poorly controlled, I would imagine "none."

Humbly,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/
 
[email protected] (Dr. Andrew B. Chung, MD/PhD) wrote in message news:<[email protected]>...
> [email protected] (mfg) wrote in message
> news:<[email protected]>...
> > "Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote in message
> > news:<[email protected]>...
> > > mfg wrote:
> > >
> > > > "Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote in message
> > > > news:<[email protected]>...
> > > > > mfg wrote:
> > > > >
> > > > > > "bnd777" <[email protected]> wrote in message
> > > > > > news:<[email protected]>...
> > > > > > > "mfg" <[email protected]> wrote in message
> > > > > > > news:[email protected]...
> > > > > > > > >
> > > > > > > > > "bnd777" <[email protected]> wrote in message
> news:<[email protected]>...
> > > > > > > > > > My mother who is slim but certainly eats the wrong foods has had high
> blood
> > > > > > > > > > pressure for probably 20 years ........been on meds but even then it
> was 180
> > > > > > > > > > ( she only knows the top numbers I cant get the lower ones )
> > > > > > > >
> > > > > > > >
> > > > > > > > > > Exercise is now out of the question as severe Osteoporosis has
> distorted her
> > > > > > > > > > spine
> > > > > > > >
> > > > >> > >
> > > > > > > Theres no facilities like that near her
> > > > > >
> > > > > > Make an appointment for your mother with a physical therapist. Go with her. They will
> > > > > > assess her and develop a program of assisted movement appropriate for whatever condition
> > > > > > she has.
> > > > >
> > > > > Fyi, they'll likely want her blood pressure better though.
> > > > >
> > > > > Humbly,
> > > > >
> > > > > Andrew
> > > >
> > > > "It will add greatly to her physical and emotional health."
> > >
> > > Maybe so. However, if she suffers a hemorrhagic stroke because of her poorly controlled blood
> > > pressure worsening during the exercise/therapy, it could adversely the financial picture (and
> > > emotional health) of the physical therapist.
> > >
> > > Humbly,
> > >
> > > Andrew
> >
> > What kind of 'exercise therapy' do you imagine a physical therapist is going to give a woman
> > with high blood pressure?
>
> If her blood pressure is poorly controlled, I would imagine "none."
>
> Humbly,
>
> Andrew

Me too, because I know most PTs are well-educated and careful. But I also think physicians rely too
much on a pharmacology approach. It sounds to me like this woman has other ideas, and there is just
a possibility that insistence on telling her what she must do could negatively affect her blood
pressure. Isn't 'get some exercise' (even if only walking the length of your living room with a
walker) something we are told to do by cardiologists?

Or would you be putting her on one of the new antihypertensives, which have been shown (not by
pharma, or cardiology 'consultants', but by epidemiologists) to perform no better than a diuretic,
but with far greater side effects and cost? I think the new heart guidelines would suggest we start
her on statins, too Andrew.

And then when she gets acid reflux, pancreatitis and gall bladder symptoms (any statin side effect
list, the physician's desk ref, perhaps?) let's give her pimozide; and when she gets a helicobactor
pylori ulcer (vida supra)let's get her on an antibiotic, and then when the statin causes depression
(vida supra the PDR) an SSRI. Of course, that will keep her awake (vida supra ad nauseum)-- bring on
the Ativan to conk her out. Ooops she fell in her half numbed state on the way to the bathroom and
broke her hip... .

MFG
 
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