Effects of aging Part 2

[braumeister]

I went to a doctor once who insisted on taking BP readings himself rather than let his nurses do it. He was quite insistent that the manner of taking the reading was critical.

He placed the cuff on my upper arm and had me stretch the arm out on a table that was almost shoulder height. That's noticeably higher than the typical setup, but actually just about at the level of the top of the heart.

I think the key is to take regular measurements at varied times of the day and use the best practice you can. Trends will show up over time and that's something you can rely on.

 

[W2R]

I went to a doctor once who insisted on taking BP readings himself rather than let his nurses do it. He was quite insistent that the manner of taking the reading was critical.

He placed the cuff on my upper arm and had me stretch the arm out on a table that was almost shoulder height. That's noticeably higher than the typical setup, but actually just about at the level of the top of the heart.

I think the key is to take regular measurements at varied times of the day and use the best practice you can. Trends will show up over time and that's something you can rely on.

Thanks. After reading your post I just took my BP out of curiosity (since I usually take it first thing in the morning), and it was 102/60.

About 15 years ago I used to make the doctor take my BP manually, and his readings were like mine, rather than like what their machines were reading. But time has passed, my BP monitor is getting a year older every year, and that may not still be the case.

The reason I want to know is that my doctor might want to increase the dosage of my BP meds at some point based on their readings. But if MY readings are correct, any significant further lowering of my BP might bring it down to a level that could verge on being dangerously low.

Besides, like many on the forum I was a scientist/engineer and my mindset is such that once I get fixated on something I can be insanely curious.

 

[Oz investor]

Thanks. After reading your post I just took my BP out of curiosity (since I usually take it first thing in the morning), and it was 102/60.

About 15 years ago I used to make the doctor take my BP manually, and his readings were like mine, rather than like what their machines were reading. But time has passed, my BP monitor is getting a year older every year, and that may not still be the case.

The reason I want to know is that my doctor might want to increase the dosage of my BP meds at some point based on their readings. But if MY readings are correct, any significant further lowering of my BP might bring it down to a level that could verge on being dangerously low.

my GP considers less than ??/60 less than desirable in my case , that may or may not be because of the other medications ability to damage liver/kidney function .

 

[Telly]

.........Results were that the systolic was still 141, whereas the highest I recorded with my daily home measurements in three months was 123, with only 2 days out of 90 being over 120.

Diastolic was 94 at the doctor, and the highest at home in 3 months was 71, only 1 day out of 90 being over 70.

My BP monitor doesn't seem to need calibration but as time passes I wonder if it is just getting too old to be trustworthy. Maybe I need a new BP monitor. I just ordered another online. If I get the same low BP's with it, I'm taking both into the office next time I go to the doctor, to see what's what.

I'm intrigued.

Just a suggestion... when measuring BP yourself at home or them doing it at Dr. office, look at, or ask, what your heart rate is at the time of measurement. All the electronic devices do it simultaneously.

I suffer from the white coat syndrome, even with me taking it at home, until I do it enough times to settle down (meaning, that the inflation, holding, and slow deflation of the cuff doesn't make me tighten up anymore).
What I consistently find, is if my heart rate is elevated, so is my BP, with systolic more affected than diastolic. When my BP has been taken at Dr. office or Dentist, they all are looking at BP, and not really looking at heart rate.

So I measure BP at home, and note heart rate. Then at office, they see a higher BP. And I have to ask about the heart rate, or they have to do it over so they can tell me. Surprise! My heart rate is up quite a bit... and so is my BP! Duh! It's a Pump! Run it faster, pressure increases!

 

[bmcgonig]

Beyond the prostate issues... A few personal observations, and not medical advice..

The Afib... Best to look up Afib in WebMD, for a good explanation. Basically, AFib worries concern blood flow and the threat of a clot. I have Afib, but rather than the irregular kind, mine is permanent and alway irregular. Instead of bump-de-bump-de-bump-de-bump-de-bump... it goes bump-de-bump-diddy-bump-de- bump. It's always like that. A stethoscope records it that way, all the time. For me, It's asymptomatic so I don't notice it and so far no problems.

The recommended protection is Xarelto, but that comes at a ridiculous price. Against Dr. recommendations, I just use a baby aspirin, as even with a Plan D supplement, it still comes to over $1,000/yr.

So... as for diagnosis... First, the Dr. uses a stethoscope... if the irregularities are indeed irregular, then the common check on this us the use of a Holter Harness, worn for a given period, and then used to plot out the irregular beat.

In my case, the follow up was first an EKG. After that, I was prescribed and had an echocardiogram... followed later by a Cat scan... to determine if the major heart arteries were occluded. All of this under the care of the Heart specialist.

The Echocardiogram provides a graph of how the heart actually beats. Should you get one, ask for the CD that shows the beat... this is used to determine what kind of irregularity is going on, and interesting to playback. Reading the chart is a science in itself.

You probably won't have any of these tests and scans, but it's worthwhile to understand what for most people is a mystery.

While my Afib is permanent and very regular, those with intermittent irregularities often have them "shocked" back to normal... a common event for some people.

Again... not medical advice, but a first person understanding of what is going on.
..................................................................................................

Off topic for this, but a bit about what happened when jeanie had a TIA many years ago. What happened was a blood clot, that was in the carotid artery... blocking blood to the brain. The blood stopped on the artery of the neck, from the ear to the throat. The clot is like what happens when you have a small cut... the blood congeals and dries. Often, as in DW's case, that clot gets stuck on the way to the brain, on the wall of the artery. In her case, lucky... Florida's #1 surgeon was there on a visit. A five inch incision in the neck and then cutting into the artery itself to take out the offending clot... and stitching the artery after the removal. Very delicate.

I think this is kind of the way that heart attacks happen. The CT scan looks for damage that might have occured in (typically) the descending artery,according to the doctor. a potential location for a clot.

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

For medications... We enter all of our meds into this WebMD drug interaction check, and pay very close attention to what shows up... A double check on the doctor's recommendations...

https://www.webmd.com/interaction-checker/default.htm

Sorry for rambling on, but frankly, until some of these things happened to us, I really didn't have a clue. So... observations from an amateur.

Respectfully, you're playing with fire.

I heard one cardiologist calling aspirin "worse than useless" for AFib. His point was that it doesn't help against strokes and causes as much risk of bleeding as the blood thinners. Lots of articles out there like this.


https://www.everydayhealth.com/atri...-patients-better-blood-thinners-less-aspirin/

"Studies have shown that aspirin does very little to lower stroke risk in afib patients, while at the same time being associated with a bleeding risk as high as some of the newer anticoagulant agents,” says*Hugh Calkins, MD, professor of medicine and director of the Cardiac Arrhythmia Service at Johns Hopkins Medicine in Baltimore."

The new blood thinners are expensive but the old warfarin isn't and it's very effective although you might need regular blood tests.

 

[Alan]

Respectfully, you're playing with fire.

I heard one cardiologist calling aspirin "worse than useless" for AFib. His point was that it doesn't help against strokes and causes as much risk of bleeding as the blood thinners. Lots of articles out there like this.


https://www.everydayhealth.com/atri...-patients-better-blood-thinners-less-aspirin/

"Studies have shown that aspirin does very little to lower stroke risk in afib patients, while at the same time being associated with a bleeding risk as high as some of the newer anticoagulant agents,” says*Hugh Calkins, MD, professor of medicine and director of the Cardiac Arrhythmia Service at Johns Hopkins Medicine in Baltimore."

The new blood thinners are expensive but the old warfarin isn't and it's very effective although you might need regular blood tests.

That is also the guidance from NICE in the UK (NICE provides guidance to the NHS trusts)

https://pathways.nice.org.uk/pathwa...ion#content=view-node:nodes-preventing-stroke

Do not offer stroke prevention therapy to people aged under 65 years with atrial fibrillation and no risk factors other than their sex (that is, very low risk of stroke equating to a CHA2DS2-VASc score of 0 for men or 1 for women). (For information on CHA2DS2-VASc see the ACC atrial fibrillation toolkit.)

Do not offer aspirin monotherapy solely for stroke prevention to people with atrial fibrillation.

 

[Jerry1]

Thanks. After reading your post I just took my BP out of curiosity (since I usually take it first thing in the morning), and it was 102/60.

About 15 years ago I used to make the doctor take my BP manually, and his readings were like mine, rather than like what their machines were reading. But time has passed, my BP monitor is getting a year older every year, and that may not still be the case.

The reason I want to know is that my doctor might want to increase the dosage of my BP meds at some point based on their readings. But if MY readings are correct, any significant further lowering of my BP might bring it down to a level that could verge on being dangerously low.

Besides, like many on the forum I was a scientist/engineer and my mindset is such that once I get fixated on something I can be insanely curious.

Have you ever taken your home monitor to the dr office and had them both run at the same time? My dr told me to bring mine in and they were a bit different on the first number and about the same on the second number. Being boarder line high bp, it make enough difference that it’s good to know. My home unit reads a bit lower.

Also, my dr takes the bp and makes a point of using good procedure. He has also used a different cuff at times. I’m no dr, but apparently there are different size cuffs and for me, he likes to use the larger one. For some reason, the smaller cuff generates a higher reading.

 

[Alan]

aja,

If the heart monitor you wear on 10/1 does not yield any definitive results the nice thing about the Alivecor Kardia device is that it is small and very easy to carry, it even comes with a pad to stick it to the back of a smartphone if you wish. Whenever, and wherever I feel a dizzy spell it takes less than a minute to take an ekg trace. (Hold your fingers on the metal pads for 30 seconds after starting the app) When I wore the monitor for 48 hours I did all my usual exercising on a treadmill etc, but couldn’t trigger an episode. The same 2 years later in the UK.

 

[Moemg]

I had the same problems with feeling light headed and almost fainting a few times . It was because I had lost 40 pounds and my BP meds needed to be decreased . The Doctor took me off one medication and it never happened again.

 

[imoldernu]

This article about AFIB stroke risk, may help with making decisions. (The DHAD2 test mentioned by Alan, above.)

https://www.mdcalc.com/chads2-score-atrial-fibrillation-stroke-risk

Especially, note the percentage risk... In my case, the stroke risk rate is 2.8 out of 100, vs 1.9 out of 100 for a person under 75.

Recommended Xarelto medication, comes to $5100/yr.

I guess we all have to assess our risks... This is when you're going to die.

https://www.businessinsider.com/social-security-life-table-charts-2014-3

 

[PatrickA5]

Due to remodeling they only had a regular chair for me to sit on, and there wasn't any place to rest my forearm. So, I just kept my elbow bent, and I guess it was approximately the level of my heart. But it wasn't supported on a table. Hmm!! I wonder if that could have caused the higher BP readings.

If it turns out that I don't need the new BP monitor after all, I'll give it to F, who doesn't have one and would probably use it. Makes no difference to me that I'm buying another; I am in a major Blow That Dough mood today.

I forgot to mention that my BP taken at home this morning was 109/69, and 3 hours later at the doctor's office after sitting quietly in the waiting room for a half hour, it was supposedly 141/94. Honestly it's my curiosity just driving me wild. I just want to know.

I bought a new Omron 10 that takes 3 readings and averages them before you see a readout. I follow that reading with a wrist BP monitor and put the results in a spreadsheet. My average over 70+ readings is 122/70. I bet my next Drs appointment, it will show 150/90 or worse.

 

[aja8888]

I bought a new Omron 10 that takes 3 readings and averages them before you see a readout. I follow that reading with a wrist BP monitor and put the results in a spreadsheet. My average over 70+ readings is 122/70. I bet my next Drs appointment, it will show 150/90 or worse.

Yes, this is what happens to me too. That's how I probably got put on the BP meds over 10 years ago.

 

[aja8888]

aja,

If the heart monitor you wear on 10/1 does not yield any definitive results the nice thing about the Alivecor Kardia device is that it is small and very easy to carry, it even comes with a pad to stick it to the back of a smartphone if you wish. Whenever, and wherever I feel a dizzy spell it takes less than a minute to take an ekg trace. (Hold your fingers on the metal pads for 30 seconds after starting the app) When I wore the monitor for 48 hours I did all my usual exercising on a treadmill etc, but couldn’t trigger an episode. The same 2 years later in the UK.

Alan, thanks for the advice on this.

 

[MRG]

.snip...

What I consistently find, is if my heart rate is elevated, so is my BP, with systolic more affected than diastolic. When my BP has been taken at Dr. office or Dentist, they all are looking at BP, and not really looking at heart rate.
..Snip..

I don't think that's universal. When my BP goes lower, like 100/60 or less, my heartrate spikes. Typically over 100 bpm when my BP is low. When my BP is in the normal range, 120/80, today my heartrate is in the 50s.

 

[aja8888]

I don't think that's universal. When my BP goes lower, like 100/60 or less, my heart rate spikes. Typically over 100 bpm when my BP is low. When my BP is in the normal range, 120/80, today my heartrate is in the 50s.

The same things happen to me. Last week after my walking episode, my BP was about 90/40 with a 179 pulse rate. I measured it three times and it didn't vary much. Resting BP has been about 110/65 with a pulse rate of 60.

 

[W2R]

I bought a new Omron 10 that takes 3 readings and averages them before you see a readout. I follow that reading with a wrist BP monitor and put the results in a spreadsheet. My average over 70+ readings is 122/70. I bet my next Drs appointment, it will show 150/90 or worse.

Why do you think this is happening? I ordered the Omron 10 also, which was the highest rated by Consumer Reports and had good Amazon reviews.

 

[PatrickA5]

Why do you think this is happening? I ordered the Omron 10 also, which was the highest rated by Consumer Reports and had good Amazon reviews.

I assume it's because at home I'm rested and sitting in the proper position in a nice comfy padded chair. At the doctors office, I'm sitting in an uncomfortable chair, answering questions, etc. They also tend to use too small of a cuff at the Dr's office. I might take my Omron with me next time to cross-check, but that would be kind of a hassle. My doctor has never hinted about me needing any BP medicine, so I guess he's not concerned.

 

[Teacher Terry]

Technique is very important when taking BP. They aren’t supposed to take it for 5 minutes after walking and you aren’t supposed to be talking. I brought my machine with me to make sure it’s accurate. I replace mine every 10 years.

 

[Teacher Terry]

My doctor said the wrist ones usually show a higher rate by 5-7 points.

 

[PatrickA5]

Thanks for all the great info! I'm also scheduled for a cartoid artery scan on 10/4 as the Doc heard a slight gurgle (as he said) in one on my left side (neck).

I found out about my artery disease via a Carotid Doppler a couple of years ago. Turns out it showed I have 50-69% right internal carotid stenosis. That's when I started on my Statin. I repeat the test annually to make sure it doesn't get worse. I imagine my neck will blow up before my heart (which I have 40% cloggish of the LAD).


I had all of my tests done trying to find a reason for chronic lightheadedness. Still haven't found the reason, but we think it's probably some neurological condition.

Might want to take my SS early!

 

[PatrickA5]

My doctor said the wrist ones usually show a higher rate by 5-7 points.

Over 70 readings (actually 210 readings), the Omron 10 (arm) shows 120/70. The wrist one (taken at the same time) shows 121/72. So, they are very close.

Both have my average resting heart rate at 60. I'm not sure why my heart rate is so low, I mean it's not like I'm a conditioned athlete or something.

 

[O2Bfree]

I had all of my tests done trying to find a reason for chronic lightheadedness. Still haven't found the reason, but we think it's probably some neurological condition.

Anxiety can cause lightheadedness. Some people have chronic, low-level anxiety and don't even realize it. Maybe you can recognize times when you're not so lightheaded and see if you're in a particularly relaxed and open state of mind.

 

[TwoByFour]

DW has occasional afib which is pretty well controlled at this point but recently had a bad dizzy spell with tachycardia which she went to the ER for. Turned out it was brought on by dehydration. A friend of ours had the same thing - dehydration caused him to go into arrhythmia. So, I don't know anything about all the meds being discussed here, but it seems important to stay well hydrated if you have any cardio-vascular conditions.

 

[bmcgonig]

DW has occasional afib which is pretty well controlled at this point but recently had a bad dizzy spell with tachycardia which she went to the ER for. Turned out it was brought on by dehydration. A friend of ours had the same thing - dehydration caused him to go into arrhythmia. So, I don't know anything about all the meds being discussed here, but it seems important to stay well hydrated if you have any cardio-vascular conditions.

That's a definite trigger for my AFib as well.

 

[bmcgonig]

This article about AFIB stroke risk, may help with making decisions. (The DHAD2 test mentioned by Alan, above.)

https://www.mdcalc.com/chads2-score-atrial-fibrillation-stroke-risk

Especially, note the percentage risk... In my case, the stroke risk rate is 2.8 out of 100, vs 1.9 out of 100 for a person under 75.

Recommended Xarelto medication, comes to $5100/yr.

I guess we all have to assess our risks... This is when you're going to die.

https://www.businessinsider.com/social-security-life-table-charts-2014-3

Warfarin is considered by many as good as Xarelto, except that it needs monitoring. It's only $200-300/yr.

Yeah. We're all gonna die but how we die is the question.