What is my Doctor thinking (long)??

Discussion in 'Health and medical' started by Jim, Feb 11, 2004.

  1. Jim

    Jim Guest

    I'll try to make this as short a possible. Recently went to give blood right after work, got
    rejected from donating due to blood pressure of 143/101, very stressful day at work. Went to see my
    regular doctor the next day and bp was again elevated at 140/102, I expected this though due to
    anxiety. I have pretty good white coat hypertension and it always elevated on a regular checkup,
    when I know I'm going to get it checked, it sky rockets along with my pulse. Had a physical last
    year and all was good, including bp. Been with this Dr for about 12 years and always had good bp but
    always a little elevated in her office.

    Dr. told me to get a blood pressure thing and monitor at home. Measured at home for about a month
    and average was about 125/81, sometimes a little lower, sometimes little higher. Went to see
    Dr's nurse to check bp and check home device for accuracy and determined home device was
    accurate but only glanced at the bp readings and determined it was close to the readings she
    got. At the Dr's office that day bp was 135/100.

    I checked bp for about a month and went weekly with my summary sheet to Dr. but never saw Dr just
    assistant. Got a call last week to make an appointment with Dr since bp looked good at home but not
    in the office, she wanted to see my home device and verify it again. Went yesterday, brought along
    my little sheet of paper as she was looking it over she suddenly announced that she was not letting
    me leave the office without an ecg and that she was going to schedule a stress test for me. After
    looking at my results for the past month all of a sudden she declared that my blood pressure was
    good but my pulse was high in my recorded results from home and she thought it was too high and
    immediately declared that I could have heart disease. My recorded pulse results from the bp device
    were between 85 and 105 but averaged around 90. She did an ecg, looked at it briefly and said it
    looked okay. As I was leaving however she was telling her staff that she was very far behind and
    then mumbled something to me about how it could just be anxiety. What really concerns me about this
    is that she never asked me any of the following which I think would be critical before suggesting
    that someone has heart disease and scaring the crap out of them, here's the questions she never
    asked and what my response would have been:

    E: Never asked me when I was taking my bp measurements at home
    F: Take bp and pulse in the morning before getting ready for work and after exercise(25 minutes on
    treadmill or bike)
    G: Take it at night either while dinner is cooking or after dinner

    H: Never asked me about my eating habits
    I: Eating low carb during the week but usually cheat on the weekends, lose the same 4 lbs then gain
    it back. Usually eat 3 to 4 salads for lunch per week, just oil and vinegar dressing. Dinner is
    meat and non-starchy vegetables but do have a sweet tooth at times.

    J: Never asked about drug or alcohol use
    K: Usually have 8 or 10 beers on one weekend night.

    L: Never asked if I was taking any supplements
    M: for the last 10+ years, take a multi, b-100, e-400, c-1000 every morning.

    N: Never asked about stress
    O: Very stressed at work, full time and work at home at night. 2 Kids, 1 dog, 3 birds, bills and
    planning to leave on vacation this friday(packing, house in disarray, getting everything caught
    up before leaving) and I absolutely do not like flying and I've been anxious about flying for
    over a month. Just thinking about the vacation that we planned over 1 year ago being only 2 days
    away can get my heart racing.

    P: Any coffee or other stimulants
    Q: Been trying to quit smoking and chew nicotine gum almost constantly from waking until going to
    sleep, but still have an occasional butt.
    R: Stopped coffee about a week ago but was drinking 1 or 2 16oz cups a day before that.

    There's probably more but these are the ones that I think she should have at least asked. I never
    knew how or when I should test resting heart rate until yesterday but from what I understand now
    that checking after exercise or smoking and checking while trying to make dinner or after eating
    is probably not the optimal times. I did start to check it yesterday and today and when I'm
    really relaxing or sitting at my desk it's been between 72 and 85. When I'm stressed it goes a
    little higher.

    Okay, so I know that I'm not the picture of health, 41 years old, 235 lbs, 5'11". There are some
    things that I need to change and in a way this has been a wake up call. Stopped smoking as of
    yesterday. Cut nicotine gum consumption down to as few a day as possible. I use my treadmill on
    average about 3 times a week for about 20 minutes each. I feel good for most of the time but do have
    classic symptoms of stress or anxiety.

    So now Dr isn't available today or Thursday and I'm leaving Friday for vacation but can't help
    but thinking that I'm about to drop dead from what she told me but I can't see how she could
    even suggest any type of diagnosis from just looking at the spreadsheets that I've brought in
    without verifying the equipment I was testing with and without asking any other questions. What
    do you think ?

    Thanks....
     
    Tags:


  2. listener

    listener Guest

    On Wed, 11 Feb 2004 13:00:52 -0500, "Jim" <[email protected]> wrote:

    >
    >I'll try to make this as short a possible. Recently went to give blood right after work, got
    >rejected from donating due to blood pressure of 143/101, very stressful day at work. Went to see my
    >regular doctor the next day and bp was again elevated at 140/102, I expected this though due to
    >anxiety. I have pretty good white coat hypertension and it always elevated on a regular checkup,
    >when I know I'm going to get it checked, it sky rockets along with my pulse. Had a physical last
    >year and all was good, including bp. Been with this Dr for about 12 years and always had good bp
    >but always a little elevated in her office.
    >
    >Dr. told me to get a blood pressure thing and monitor at home. Measured at home for about a month
    > and average was about 125/81, sometimes a little lower, sometimes little higher. Went to see
    > Dr's nurse to check bp and check home device for accuracy and determined home device was
    > accurate but only glanced at the bp readings and determined it was close to the readings she
    > got. At the Dr's office that day bp was 135/100.
    >
    >I checked bp for about a month and went weekly with my summary sheet to Dr. but never saw Dr just
    >assistant. Got a call last week to make an appointment with Dr since bp looked good at home but not
    >in the office, she wanted to see my home device and verify it again. Went yesterday, brought along
    >my little sheet of paper as she was looking it over she suddenly announced that she was not letting
    >me leave the office without an ecg and that she was going to schedule a stress test for me. After
    >looking at my results for the past month all of a sudden she declared that my blood pressure was
    >good but my pulse was high in my recorded results from home and she thought it was too high and
    >immediately declared that I could have heart disease. My recorded pulse results from the bp device
    >were between 85 and 105 but averaged around 90. She did an ecg, looked at it briefly and said it
    >looked okay. As I was leaving however she was telling her staff that she was very far behind and
    >then mumbled something to me about how it could just be anxiety. What really concerns me about this
    >is that she never asked me any of the following which I think would be critical before suggesting
    >that someone has heart disease and scaring the crap out of them, here's the questions she never
    >asked and what my response would have been:
    >
    >Q: Never asked me when I was taking my bp measurements at home
    >A: Take bp and pulse in the morning before getting ready for work and after exercise(25 minutes on
    > treadmill or bike)
    >A: Take it at night either while dinner is cooking or after dinner
    >
    >Q: Never asked me about my eating habits
    >A: Eating low carb during the week but usually cheat on the weekends, lose the same 4 lbs then gain
    > it back. Usually eat 3 to 4 salads for lunch per week, just oil and vinegar dressing. Dinner is
    > meat and non-starchy vegetables but do have a sweet tooth at times.
    >
    >Q: Never asked about drug or alcohol use
    >A: Usually have 8 or 10 beers on one weekend night.
    >
    >Q: Never asked if I was taking any supplements
    >A: for the last 10+ years, take a multi, b-100, e-400, c-1000 every morning.
    >
    >A: Never asked about stress
    >Q: Very stressed at work, full time and work at home at night. 2 Kids, 1 dog, 3 birds, bills and
    > planning to leave on vacation this friday(packing, house in disarray, getting everything caught
    > up before leaving) and I absolutely do not like flying and I've been anxious about flying for
    > over a month. Just thinking about the vacation that we planned over 1 year ago being only 2 days
    > away can get my heart racing.
    >
    >Q: Any coffee or other stimulants
    >A: Been trying to quit smoking and chew nicotine gum almost constantly from waking until going to
    > sleep, but still have an occasional butt.
    >A: Stopped coffee about a week ago but was drinking 1 or 2 16oz cups a day before that.
    >
    >
    >There's probably more but these are the ones that I think she should have at least asked. I never
    >knew how or when I should test resting heart rate until yesterday but from what I understand now
    >that checking after exercise or smoking and checking while trying to make dinner or after eating
    >is probably not the optimal times. I did start to check it yesterday and today and when I'm
    >really relaxing or sitting at my desk it's been between 72 and 85. When I'm stressed it goes a
    >little higher.
    >
    >Okay, so I know that I'm not the picture of health, 41 years old, 235 lbs, 5'11". There are some
    >things that I need to change and in a way this has been a wake up call. Stopped smoking as of
    >yesterday. Cut nicotine gum consumption down to as few a day as possible. I use my treadmill on
    >average about 3 times a week for about 20 minutes each. I feel good for most of the time but do
    >have classic symptoms of stress or anxiety.
    >
    >So now Dr isn't available today or Thursday and I'm leaving Friday for vacation but can't help
    >but thinking that I'm about to drop dead from what she told me but I can't see how she could
    >even suggest any type of diagnosis from just looking at the spreadsheets that I've brought in
    >without verifying the equipment I was testing with and without asking any other questions. What
    >do you think ?
    >
    >Thanks....

    Saying you could have heart disease from a somewhat elevated HR was unfortunate. Who knows why she
    said it? Your ecg was ok.

    I think you really might want to focus on YOU and how you feel. Losing a few pounds would really be
    helpful in many ways. Stopping smoking is the best thing you could have done. (I know it's not
    easy.) Your BP would most likely drop from those two things alone. I'm not sure about your resting
    HR around 90. It does seem a bit high. Of course with stress, coffee , nicotine gum, etc..I wouldn't
    be surprised at an elevated resting HR. Mine is around 95, but I have chronic atrial fibrillation.
    (I am not a doctor).

    All your questions are good ones and you should discuss them with your doctor (not the assistant).
    Nothing wrong with getting checked out further when you get back from vacation. If you're concerned
    about your heart, go to a good cardiologist.

    Stress, too much coffee, a bunch of beers - yeh...all bad, especially the stress. Go on your
    vacation and relax big time if you can!

    (By the way, I used to hate flying too - and didn't fly for many years. I got over it by popping a
    low dose valium (2mg) before the flight. It worked.)
     
  3. Jim wrote:

    > I'll try to make this as short a possible. Recently went to give blood right after work, got
    > rejected from donating due to blood pressure of 143/101, very stressful day at work. Went to see
    > my regular doctor the next day and bp was again elevated at 140/102, I expected this though due to
    > anxiety. I have pretty good white coat hypertension and it always elevated on a regular checkup,
    > when I know I'm going to get it checked, it sky rockets along with my pulse. Had a physical last
    > year and all was good, including bp. Been with this Dr for about 12 years and always had good bp
    > but always a little elevated in her office.
    >
    > Dr. told me to get a blood pressure thing and monitor at home. Measured at home for about a month
    > and average was about 125/81, sometimes a little lower, sometimes little higher. Went to see
    > Dr's nurse to check bp and check home device for accuracy and determined home device was
    > accurate but only glanced at the bp readings and determined it was close to the readings she
    > got. At the Dr's office that day bp was 135/100.
    >
    > I checked bp for about a month and went weekly with my summary sheet to Dr. but never saw Dr just
    > assistant. Got a call last week to make an appointment with Dr since bp looked good at home but
    > not in the office, she wanted to see my home device and verify it again. Went yesterday, brought
    > along my little sheet of paper as she was looking it over she suddenly announced that she was not
    > letting me leave the office without an ecg and that she was going to schedule a stress test for
    > me. After looking at my results for the past month all of a sudden she declared that my blood
    > pressure was good but my pulse was high in my recorded results from home and she thought it was
    > too high and immediately declared that I could have heart disease. My recorded pulse results from
    > the bp device were between 85 and 105 but averaged around 90. She did an ecg, looked at it briefly
    > and said it looked okay. As I was leaving however she was telling her staff that she was very far
    > behind and then mumbled something to me about how it could just be anxiety. What really concerns
    > me about this is that she never asked me any of the following which I think would be critical
    > before suggesting that someone has heart disease and scaring the crap out of them, here's the
    > questions she never asked and what my response would have been:
    >
    > Q: Never asked me when I was taking my bp measurements at home
    > A: Take bp and pulse in the morning before getting ready for work and after exercise(25 minutes
    > on treadmill or bike)
    > A: Take it at night either while dinner is cooking or after dinner
    >
    > Q: Never asked me about my eating habits
    > A: Eating low carb during the week

    Uh-oh.

    > but usually cheat on the weekends, lose the same 4 lbs then gain it back. Usually eat 3 to 4
    > salads for lunch per week, just oil and vinegar dressing. Dinner is meat and non-starchy
    > vegetables but do have a sweet tooth at times.
    >
    > Q: Never asked about drug or alcohol use
    > A: Usually have 8 or 10 beers on one weekend night.
    >

    Uh-oh.

    >
    > Q: Never asked if I was taking any supplements
    > A: for the last 10+ years, take a multi, b-100, e-400, c-1000 every morning.
    >
    > A: Never asked about stress
    > Q: Very stressed at work, full time and work at home at night. 2 Kids, 1 dog, 3 birds, bills and
    > planning to leave on vacation this friday(packing, house in disarray, getting everything caught
    > up before leaving) and I absolutely do not like flying and I've been anxious about flying for
    > over a month. Just thinking about the vacation that we planned over 1 year ago being only 2
    > days away can get my heart racing.
    >
    > Q: Any coffee or other stimulants
    > A: Been trying to quit smoking and chew nicotine gum almost constantly from waking until going to
    > sleep, but still have an occasional butt.

    Uh-oh.

    >
    > A: Stopped coffee about a week ago but was drinking 1 or 2 16oz cups a day before that.
    >
    > There's probably more but these are the ones that I think she should have at least asked. I never
    > knew how or when I should test resting heart rate until yesterday but from what I understand now
    > that checking after exercise or smoking and checking while trying to make dinner or after eating
    > is probably not the optimal times. I did start to check it yesterday and today and when I'm
    > really relaxing or sitting at my desk it's been between 72 and 85. When I'm stressed it goes a
    > little higher.
    >
    > Okay, so I know that I'm not the picture of health, 41 years old, 235 lbs, 5'11".

    Uh-oh... You might be 80 lbs over your "ideal" body weight.

    > There are some things that I need to change and in a way this has been a wake up call. Stopped
    > smoking as of yesterday. Cut nicotine gum consumption down to as few a day as possible. I use my
    > treadmill on average about 3 times a week for about 20 minutes each. I feel good for most of the
    > time but do have classic symptoms of stress or anxiety.
    >
    > So now Dr isn't available today or Thursday and I'm leaving Friday for vacation but can't help
    > but thinking that I'm about to drop dead from what she told me but I can't see how she could
    > even suggest any type of diagnosis from just looking at the spreadsheets that I've brought in
    > without verifying the equipment I was testing with and without asking any other questions. What
    > do you think ?
    >

    Print this out and hand it to your doctor (or email it to her :)

    >
    > Thanks....

    You are welcome :)

    Servant to the humblest person in the universe,

    Andrew

    --
    Dr. Andrew B. Chung, MD/PhD
    Board-Certified Cardiologist
    http://www.heartmdphd.com/

    --
    Who is the humblest person in the universe?

    http://makeashorterlink.com/?W1F522557

    What is all this about?

    http://makeashorterlink.com/?N13D32F57
     
  4. "Jim" <[email protected]> wrote in message news:<[email protected]>...
    > I'll try to make this as short a possible. I have pretty good white coat hypertension and it
    > always elevated on a regular checkup, when I know I'm going to get it checked, it sky rockets
    > along with my pulse.

    Hi Jim,

    Same here. Pulse and BP spike when the cuff comes out.

    >
    > What really concerns me about this is that she never asked me any of the following

    <list snipped for brevity>

    Quite common. Many physicians are too busy to gather those types of details about your life. Suggest
    you do your homework (which you've done), summarize all pertinent details and present them to your
    physician before they leave the room.

    > Okay, so I know that I'm not the picture of health, 41 years old, 235 lbs, 5'11". There are some
    > things that I need to change and in a way this has been a wake up call. Stopped smoking as of
    > yesterday. Cut nicotine gum consumption down to as few a day as possible. I use my treadmill on
    > average about 3 times a week for about 20 minutes each. I feel good for most of the time but do
    > have classic symptoms of stress or anxiety.

    OK, so you need to drop some weight. Also, you might want to go from 20 min, 3x/week to 40 min,
    6x/week. If you do that and drop some weight, I assure you that your BP will be close to normal. I
    believe common thinking says a 1 mm Hg reduction in BP (systolic) with every 2 lb of fat loss
    (insert some sort of disclaimer about sample variability).

    > Thanks....

    Cheers, Mike
     
  5. Ron Peterson

    Ron Peterson Guest

    > On Wed, 11 Feb 2004 13:00:52 -0500, "Jim" <[email protected]> wrote:

    > >Q: Never asked about drug or alcohol use
    > >A: Usually have 8 or 10 beers on one weekend night.

    Cut the beers to two a day maximum. Drink diet sodas instead.

    > >A: Never asked about stress
    > >Q: Very stressed at work, full time and work at home at night. 2 Kids, 1 dog, 3 birds, bills and
    > > planning to leave on vacation this friday(packing, house in disarray, getting everything
    > > caught up before leaving) and I absolutely do not like flying and I've been anxious about
    > > flying for over a month. Just thinking about the vacation that we planned over 1 year ago
    > > being only 2 days away can get my heart racing.

    My SO has white-coat hypertension in addition to normal hypertension but the doctors don't want to
    prescribe anti-anxiety medication.

    > >So now Dr isn't available today or Thursday and I'm leaving Friday for vacation but can't help
    > >but thinking that I'm about to drop dead from what she told me but I can't see how she could even
    > >suggest any type of diagnosis from just looking at the spreadsheets that I've brought in without
    > >verifying the equipment I was testing with and without asking any other questions. What do you
    > >think ?

    Get on a blood pressure medication such as an ACE inhibitor or an Angiotensin II blocker until you
    can get your weight down to 200. Then try to get down to 180.

    --
    Ron
     
  6. Ron Peterson wrote:

    > > On Wed, 11 Feb 2004 13:00:52 -0500, "Jim" <[email protected]> wrote:
    >
    > > >Q: Never asked about drug or alcohol use
    > > >A: Usually have 8 or 10 beers on one weekend night.
    >
    > Cut the beers to two a day maximum. Drink diet sodas instead.
    >

    For someone with hypertension, alcohol should be altogether avoided.

    >
    > > >A: Never asked about stress
    > > >Q: Very stressed at work, full time and work at home at night. 2 Kids, 1 dog, 3 birds, bills
    > > > and planning to leave on vacation this friday(packing, house in disarray, getting everything
    > > > caught up before leaving) and I absolutely do not like flying and I've been anxious about
    > > > flying for over a month. Just thinking about the vacation that we planned over 1 year ago
    > > > being only 2 days away can get my heart racing.
    >
    > My SO has white-coat hypertension in addition to normal hypertension but the doctors don't want to
    > prescribe anti-anxiety medication.
    >
    > > >So now Dr isn't available today or Thursday and I'm leaving Friday for vacation but can't help
    > > >but thinking that I'm about to drop dead from what she told me but I can't see how she could
    > > >even suggest any type of diagnosis from just looking at the spreadsheets that I've brought in
    > > >without verifying the equipment I was testing with and without asking any other questions. What
    > > >do you think ?
    >
    > Get on a blood pressure medication such as an ACE inhibitor or an Angiotensin II blocker until you
    > can get your weight down to 200. Then try to get down to 180.
    >
    > --
    > Ron

    Better would probably be to find another doctor who is better able to address your needs.

    Servant to the humblest person in the universe,

    Andrew

    --
    Dr. Andrew B. Chung, MD/PhD
    Board-Certified Cardiologist
    http://www.heartmdphd.com/

    --
    Who is the humblest person in the universe?
    http://makeashorterlink.com/?W1F522557

    What is all this about?
    http://makeashorterlink.com/?T2CA21267
     
  7. Mark

    Mark Guest

    Made it back from vacation alive and fortunately/unfortunately did a lot of drinking dancing,
    snorkeling, swimming and eating. Brought along my home bp monitor and tested once in a while and the
    average was 122/80, little higher sometimes, little lower others. Pulse was always in the high 80's
    to mid 90's however and that's what I think she's concerned about. Used to be that normal pulse was
    considered 50 to 100 bpm but don't know exactly how recently it changed but the recommendation has
    dropped down to below 80 bpm for resting pulse which mine does get down to if I'm truly resting..
    Have a follow up soon so I'll she what she says. Anyway now that vacation is over I'm going to start
    weight watchers, quit smoking and exercise more. Thanks again everyone for the advice and comments.

    Jim

    "Dr. Andrew B. Chung, MD/PhD" <[email protected]> wrote in message
    news:[email protected]...
    > Ron Peterson wrote:
    >
    > > > On Wed, 11 Feb 2004 13:00:52 -0500, "Jim" <[email protected]> wrote:
    > >
    > > > >Q: Never asked about drug or alcohol use
    > > > >A: Usually have 8 or 10 beers on one weekend night.
    > >
    > > Cut the beers to two a day maximum. Drink diet sodas instead.
    > >
    >
    > For someone with hypertension, alcohol should be altogether avoided.
    >
    > >
    > > > >A: Never asked about stress
    > > > >Q: Very stressed at work, full time and work at home at night. 2
    Kids, 1
    > > > >dog, 3 birds, bills and planning to leave on vacation this
    friday(packing,
    > > > >house in disarray, getting everything caught up before leaving) and I absolutely do not like
    > > > >flying and I've been anxious about flying for
    over a
    > > > >month. Just thinking about the vacation that we planned over 1 year
    ago
    > > > >being only 2 days away can get my heart racing.
    > >
    > > My SO has white-coat hypertension in addition to normal hypertension but the doctors don't want
    > > to prescribe anti-anxiety medication.
    > >
    > > > >So now Dr isn't available today or Thursday and I'm leaving Friday
    for
    > > > >vacation but can't help but thinking that I'm about to drop dead from
    what
    > > > >she told me but I can't see how she could even suggest any type of
    diagnosis
    > > > >from just looking at the spreadsheets that I've brought in without
    verifying
    > > > >the equipment I was testing with and without asking any other
    questions.
    > > > >What do you think ?
    > >
    > > Get on a blood pressure medication such as an ACE inhibitor or an Angiotensin II blocker until
    > > you can get your weight down to 200. Then try to get down to 180.
    > >
    > > --
    > > Ron
    >
    > Better would probably be to find another doctor who is better able to
    address your
    > needs.
    >
    >
    > Servant to the humblest person in the universe,
    >
    > Andrew
    >
    > --
    > Dr. Andrew B. Chung, MD/PhD Board-Certified Cardiologist http://www.heartmdphd.com/
    >
    > --
    > Who is the humblest person in the universe? http://makeashorterlink.com/?W1F522557
    >
    > What is all this about? http://makeashorterlink.com/?T2CA21267
     
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