Saturday, March 3, 2012

Higher and Higher

The last few times I've seen a doctor, my blood pressure readings were unusually high, in the pre-hypertension range, around 136/90, bordering on the Real Thing. It happened again yesterday.

My doctor knows I'm a prime candidate for "white-coat hypertension," which occurs when a patient gets so stressed from being in a doctor's office that her blood pressure soars despite being normal the rest of the time. My doctor knows I'm the anxious type, so she chit-chatted with me about mundane things and then took another reading. High. She put the cuff on my other arm. High again. I helpfully pointed out that, although I've always been the anxious type, my previous readings over the years were always on the low side, around 110/70. They've only been high for the past year.

It seems I'm bordering on hypertension. We examined possible reasons for this. I don't smoke or drink. I'm not under a ton of stress, but more than I'd like. ("You seem pretty mellow," said my doctor, as I tucked my legs into a yoga pose on her examining table.) But I feel stressed at home practically all the time because I'm uncomfortable living here. I need a place where I don't hear other people's TVs and the details of their conversations. I wake up to that in the morning and it goes on until bedtime. Such endless, low-grade stress can't be healthy. We've got to move.

My weight is in the normal range, although it's higher than I think is ideal for me; I've gained extra pounds in the past couple of years. I get a decent amount of sleep. I exercise moderately (according to my pedometer) for about an hour every day by walking 10,000 steps. Since I injured my hand in early December, I've been skipping my strenuous twice-weekly strength-training classes, but my blood pressure was high even when I was getting that extra exercise.

What else could be causing this? My mother and paternal grandmother had high blood pressure, so I have a hereditary predisposition: Strike 1. I'm middle-aged, another factor that can increase blood pressure all by itself: Strike 2. I don't take medications that increase blood pressure except — drat — the Pill. Strike 3.

I love the Pill. Not only for the usual reasons but because it stopped my migraines, which I'd relieve by banging my head against the wall when nothing else helped. It also stopped my cramps, which were so intense I'd white out and find myself on the floor. (One bedridden, painful day in my 20s, I calculated that I'd already experienced what I believed was the equivalent of labor pains that, cumulatively, added up to about a month of my life.) I'm also less moody on the Pill, although that may be hard for some to believe. And I have much clearer skin; I had terrible acne from the age of 9 until I started the Pill in my 30s. Clearing my face and curing my headaches and cramps were perhaps all I needed to be a much happier person. Right now, the Pill is probably saving me from night sweats, hot flashes, and all the other crap that hits middle-aged women. I've been blissfully free from all of it, but it's looking like the good times will soon be over. (Another big worry is that going off the Pill can cause major hair loss. Bald is not a good look for me.)

High blood pressure scares me. Just thinking about it, I can feel my blood pressure rising, as it does at the end of an eBay auction or during a Red Sox World Series game (such a long time ago). Blood pressure tests freak me out now. The third time my doctor tried it, on my other arm, it jumped up so much that she laughed and gave up.

My doctor didn't want to jump to conclusions, thinking it might still be "white-coat hypertension," so she told me to buy a home blood-pressure monitor and bring it to her office next week so she can make sure it's accurate.. Then she wants me to use it a couple of times a day and report back to her. If it's consistently high, I'll need to stop taking the Pill and see if that helps.

Did you figure out the problem here? I didn't, until I set up the monitor and quickly scanned the directions. You're supposed to be relaxed when you take a reading. Just holding the monitor upsets the hell out of me. My first try, I got a super-high reading of 188/94, and I practically fell out of my chair when I saw those numbers. I soon figured out that I had the cuff on upside down, but that didn't calm me down much. The next reading was still higher than it was at the doctor's.

I didn't have the courage to take more readings today. I'll wait until my doctor's assistant checks it out and makes sure it's accurate. I have no idea how I'm going to calm myself down enough to get decent readings, though.

In the meantime, I'm going to try doing everything I can to lower my blood pressure. I wrote and edited articles on this subject when I worked in healthcare so I know that, for overweight people, losing even 5 to 10 pounds can often be enough to significantly lower blood pressure. I'm now firmly committed to losing that much, via portion control, eating healthy foods, and cutting out 90% of the insane amount of candy and dessert I have every day, rather than going on an extreme diet (unless not eating candy eight times a day counts as extreme). I've only ever dieted for aesthetic reasons; this feels different. I feel I can succeed because the stakes are higher. My sugar habit is nothing compared to my peace of mind.

Eating certain foods may help lower blood pressure, including berries and low-fat milk and yogurt. I'm on board with that but I'm sticking with real cheese. I'd never paid the slightest attention to sodium content in anything, but I'm paying attention now. My doctor says lowering sodium is often not all it's cracked up to be, and so I shouldn't obsess about it. But I'm giving up my tub-a-week salted-nut habit, even so.

I'm also tackling my worst habit — one or two daily glasses of diet or regular soda. I always felt I was entitled to one wicked habit, figuring that Diet Coke was far better than smoking or living on red meat, but it's still completely evil health-wise. Fizzy water with fruity flavorings and tea with a little sugar will be decent substitutes since I hate the taste of tap water. (I filter ours and it still tastes like water; bleah!)

We bought a new scale today. I hate to weigh myself but it's got to be better than taking blood-pressure readings.

What else? Stress management. I'm going take a yoga class or two every week and ease back into my strength-training classes, and maybe try some more intense aerobic exercise. I should practice deep breathing and other relaxation techniques at home. Laughter is also helpful, so I ought start watching Seinfeld reruns or something. Petting a purring cat is good; I already have that covered.

If all this fails and I still have to go off the Pill, I'll have to make the best of it. In the past 17 years, while I've been taking it, maybe they've found better ways to treat acne, migraines, cramps, mood swings, and all those ghastly menopausal symptoms.


Oh, how silly of me. I'd forgotten that those are mostly women's issues, of little interest to most of the medical establishment. They're all in our heads — or so I have been personally told, by doctors whom I no longer see.

I should warn you now that I'm likely to be very MOODY off the Pill. You readers should reap only the more amusing benefits of all that extra drama, at a safe distance.


Hmm. I wonder if I forgot to take my pill last night?


  1. Since you are prone to a rise in BP when thinking about it, how about taking some training to control it with that strong mind of yours, Biofeedback!

    Ask your doctor for a referral to the Mind Body Clinic at MGH or another good program.

    Sit quietly for 10 minutes before you take your BP. Listen to Bach while stroking some furry friend. Keep your arm up, rest it on pillows.

    And, speaking of furry friends, you have a bit of stress caring for a dear elder. I know that task certainly raised my BP.

  2. Wow - except for taking the Pill, you could be writing about me. Same age, hereditary issues, white coat syndrome, healthy-weight-but-could-lose-5, etc. I take my BP at home, petting a cat or two, and still get high numbers, although sometimes I get great numbers, but for no rhyme or reason.

    I personally have found salt to be a factor - if I keep it under 1500 mg a day (which is d**n hard to do, given how much is in certain foods), I get better numbers (most of the time).

    All your ideas are of course on the right track, and they may indeed help. I think, though, that heredity and aging are really big factors, and they aren't at all in your (or my) control. Ugh.

  3. I can't speak to the other issues that the pill moderates for you, but for the cramps, I can vouch for the effectiveness of an oblation of the uterus. I don't know if I spelled that right, but it did wonders for me, about ten years ago, and I have been free from pain and heavy bleeding since. I'm 51 and waiting for menopause, but at least I don't have to suffer that along the way. I have high cholesterol, which freaks me out since I have always eaten healthy, no meat and little dairy, and am at a healthy weight. The joys of what we don't want to inherit (as opposed to the family silver). Don't post this if you don't want the bleeding reference to show up. I think the biofeedback training is a good idea - I want to try it for my claustrophobia induced anxiety. Moving into your own space will be a good thing - noise that we can't control isn't good for anyone.

  4. Most people are deficient in magnesium in their diets. Try about 400 mg of a magnesium supplment (anything other than the magnesium oxide variety which is very poorly absorbed; the chelated versions all work well - anything with an -ate suffix like mag taurinate, mag glycinate, mag citrate, etc)). Magnesium is involved in thousands of metabolic processes. It can calm cramps, quiet restless legs, lower blood pressure, help calm reactions to stress and support metabolic function. It's best to take it with a zinc supplement since they compete for absorption.

    The only high dose effect is loose stools, so you can start with a 200 mg tab and work your way up to a dose which takes care of symptoms and doesn't cause GI effects.


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