Friday, December 21, 2007

Getting a Physical?

Some advice:

If you are going in for your annual physical exam, these are often scheduled for the morning, in order to check blood sugar and what not. Means you can't eat anything, though the nurse will tell you that black coffee is okay.

Actually, it's not. Skip it.

A lot of people have what is called "whitecoat hypertension." What this means is, your blood pressure goes up because you are in the doctor's office. At home it might be normal -- say, 120/80, but as soon as the nurse asks you to roll up your sleeve, it can shoot up ten points, bam, just like that.

So, 130/80 or even 130/90 is not great, but still marginally within the green zone.

Drink two or three cups of strong coffee, and the caffeine in it, a stimulant, can cause your BP to rise ten points, too. Some authorities say it won't, but mine does, and when I was working in the clinic, I saw it often enough to know that more than a small percentage of people will have the same reaction.

Now, this is transient and not dangerous if you have normal blood pressure; however, if you get nervous at the M.D.'s, and if you've had coffee, the combination might drive you over the 140/90 border and into the red zone.

Not dangerous per se, since if you exercise, your BP will shoot a lot higher than that while you are huffing an puffing. But: If they write down that number -- and they will -- and if it is into what is considered high, that will be on your chart forevermore. And the next time you go to get health insurance and they check your records, you will, at the least, get rated for it, and -- if you can get insurance at all -- it will cost more.

And, oh, yeah, if you put a little cream in your coffee and they do a blood sugar check, you might get diagnosed with diabetes because your fasting level is too high. There is sugar in cream, enough to skew the test.

Just so you know ...


Anonymous said...

Several years ago I was surprised to learn that I had "white-coat" syndrome. Even when I feel calm and relaxed in the doctors office, it still comes up high.

My doctor had me record some readings at one of those pharmacy blood pressure machines. Surprise surprise. Every time I checked my bp at one of those I came out fine.

The doctor kept a record of my out-of-office readings for my file. And every time I go in for a checkup I should have some outside readings.

Steve Perry said...

Hey, I worked in a doctor's office for five years, and my BP would go up there. At home, using the same cuff, perfectly normal. Go figure.

Tiel Aisha Ansari said...

hm, looks like Blogger fixed the weird header stuff.

Tiel Aisha Ansari said...

Forgot to mention I kind of wish I had white-coat syndrome: it might make giving blood easier. They wouldn't have to dig so damn hard to find the veins.

Kai Jones said...

If I have it...then the 110/74 reading I got last week at the doc means my BP has gotten really low.

Steve Perry said...

Normal blood pressure varies for a number of reasons. Women are usually lower than men, and size matters.
Check it at home and see if it is lower than it is in the doctor's office. If it isn't, you don't have white coat syndrome.

Hypertension has a plethora of causes, and I won't list them so people fall prey to Intern's Disease. Probably the most common is due to athero- or arteriosclerosis, due to ageing or cholesterol build-up in the blood vessels. The lumens narrow, the pressure goes up because its the same amount of blood going through smaller pipes. This is bad for a lot of reasons.

People with very low pressure -- hypotension -- can sometimes pass out if they stand up in a hurry. Even normal BP can fall precipitously if you dilate the vessels by, say, drinking a couple glasses of wine and then sitting in a hot tub for half an hour.

On the other hand, low BP is easier on the kidneys, liver, and less likely to result in strokes.

Come out of a dead sleep, leap up, and hurry to the bathroom, you might pass out.

It's a weird system. Generally speaking, I'd rather have it be a bit too low than a bit too high.