And the Beat Goes On

Happy New Year! After a night of thinking about my life and where it’s gone in the last almost 71 years, I remembered some events from a long, long time ago. For example, when I was a young woman in my late teens, I used to go to the clubs in New York City and dance the night away. I had a drink or two – never more – but I was there to dance… and that’s I did. I danced until I felt my whole body pulsing. Pulsing. That’s the word we used, but it has a very different meaning for me today over 50 years later.

High blood pressure can damage your kidneys. Maybe, like me, you’ve been ordered to take your blood pressure daily even if you are taking medication for hypertension. But what is this pulse/min reading I see at the bottom of the blood pressure monitor face?

Back to the beginning. According to the Merriam-Webster Dictionary at https://www.merriam-webster.com/dictionary/pulse, this is the way we used the word in relation to our dancing:

“rhythmical beating, vibrating, or sounding”

The same dictionary tells us that this is the way my blood pressure monitor uses the word:

“a: the regular expansion of an artery caused by the ejection of blood into the arterial system by the contractions of the heart

b: the palpable beat resulting from such pulse as detected in a superficial artery; also: the number of individual beats in a specified time period (such as one minute)

I knew that. I’ll bet that you did, too; but I keep forgetting why that’s important.

Verywell, a conglomeration of information from doctors, dieticians, and personal trainers, at https://www.verywell.com/pulse-pressure-1763964 answers that question for us:

“Sometimes pulse pressure does provide important information. There’s research showing that pulse pressure can be valuable when looking at a patient’s overall risk profile. Several studies have identified that high pulse pressure:

• Causes more artery damage compared to high blood pressure with normal pulse pressure

• Indicates elevated stress on a part of the heart called the left ventricle

• Is affected differently by different high blood pressure medicines

So if you’re diagnosed with high blood pressure, your doctor may consider it when designing your overall treatment plan.”

Now I understand why my physician’s nurse gets that look on her face after taking my pulse sometimes. Since I have no heart problems, although Chronic Kidney Disease can easily lead to them, my hypertension medication may have to be adjusted or the ones I’m taking replaced with others that won’t raise my pulse level.

But what about the possibility of “elevated stress on a part of the heart called the left ventricle?” And why only the left ventricle? Wait a minute; what is a ventricle anyway?

I have definitely forgotten more than I ever knew to begin with! Enough grousing.

Let’s see how precise a definition of ventricle we can get. The Oxford Dictionary at https://en.oxforddictionaries.com/definition/ventricle offers the following definitions:

“A hollow part or cavity in an organ…..

Each of the two main chambers of the heart, left and right….

Each of the four connected fluid-filled cavities in the centre of the brain.”

It’s pretty obvious we need the second definition.

But why is the left ventricle the only one that may experience “elevated stress”? Healthline (The same organization that included SlowItDownCKD in the top six nephrology blogs of 2016 & 2017.) at https://www.healthline.com/human-body-maps/left-ventricle explains:

“The left ventricle is the thickest of the heart’s chambers and is responsible for pumping oxygenated blood to tissues all over the body….. Various conditions may affect the left ventricle and interfere with its proper functioning. The most common is left ventricular hypertrophy, which causes enlargement and hardening of the muscle tissue that makes up the wall of the left ventricle, usually as a result of uncontrolled high blood pressure.”

So here I am, taking three blood pressure medications, and it’s possible to still have uncontrolled high blood pressure?

Apparently so, the American Heart Association at https://www.heart.org/HEARTORG/Conditions/HighBloodPressure/MakeChangesThatMatter/Managing-High-Blood-Pressure-Medications_UCM_303246_Article.jsp has some interesting information about this.

“Because different drugs do different things in the body, you may need more than one medication to properly manage your blood pressure…. Different people can respond very differently to medications. Everyone has to go through a trial period to find out which medications work best with the fewest side effects. Give yourself a chance to adjust to a drug. It may take several weeks, but the results will usually be worth it. If you don’t feel well after taking a medication, let your doctor know so he/she can adjust your treatment.”

Considering that Chronic Kidney Disease causes high blood pressure as well as high blood pressure causing CKD, I intend to keep doing just that.

We’re not finished with the pulse just yet. I wanted to know the basic connection between blood pressure and pulse and I wanted a simple explanation of it.

But first we’ll need a definition of artery. No problem, that’s what the glossary in What Is It and How Did I Get It? Early Stage Chronic Kidney Disease is for.

“Arteries: Vessels that carry blood from the heart.”

Let’s get to the heart (That’s funny. Get it? Heart) of the matter now.

HealthCentral at https://www.healthcentral.com/article/pulse-rate-and-high-blood-pressure-defining-the-connection had exactly what I asked for.

“Because high blood pressure causes tension and complicates cardiovascular normal activity, it may cause stress with your pulse activity. Meaning, the arteries experience resistance against the flow of the blood. The pulse rate calculates the number of times the heart beats per minute. The rate measurements indicate the heart rate, heart rhythm and the strength of your pulse. Therefore, high blood pressure slows down normal blood flow causing the arteries to demonstrate difficulty with expanding.”

Got it! Now, if I can only remember it….

Here’s hoping this New Year is your best year yet – as I say to my grown children every year. Wishing you health first of all, then love from your friends and family, and finally kindness to share with others.

Thank you for being my readers and thank you for helping to make this an award winning blog not once or twice, but three times.

Until next week,
Keep living your life!

Oh, The Pressure!

We enjoyed a cool, slightly wet, getaway weekend and it was wonderful.  I’m a fan of historical sites and Bear is more than willing to join me in seeing them, so we went to Tumacacori, the Presidio in Tubac, and The Pimeria Alta Museum in Nogales.  I was taken with all of them, but saddened to hear of each of their financial plights. I know this is not the best economy, but this is history.

IMG_0811I was surprised to discover that The Tubac Presidio State Historic Park is manned (and womanned) by a staff of volunteers – except for their director, Shaw Kinsley, who is also the author of the well written Images of America: Tubac. The volunteers do an excellent job, as good as that done by the park rangers at Tumacacori.

That got me to thinking about the pressure they all must be under… which got me to thinking about pressure of all kinds and its effect on blood pressure.  Being on a mini-vacation gave me loads of time to think, but this time I decided to write about just that: blood pressure.

Not only have I written about blood pressure in What Is It and How Did I Get It? Early Stage Chronic Kidney Disease, but you’ll notice several blogs about it if you use the topic search on the right side of the blog page.Book Cover

So why write about the same topic again, you ask?  This time, I took a look at how to take your blood pressure and some of the machines on the market.

Have I ever told you that when I am at my sleep apnea doctor’s office, my blood pressure always starts at about 150/89?  That’s high and I tell them it’s not my usual reading. We’re way past the white coat syndrome (blood pressure rising simply because you’re in a doctor’s office) here, so they take it again on the other arm and it’s something about 110/72.  I like that, but it’s not my usual reading, either.  Back to the first arm: 130/79.  Bingo!

I asked my primary care physician why this happens and she asked me to describe the monitor they used.  As I did, she started nodding her head.  Apparently, this type of automatic blood pressure monitor is notorious for being incorrect… yet doctors still use it for its ease.

Then she asked me how they held my arm while taking my blood pressure and slowly shook her head as I answered.  It seems there is a right way and a wrong way to hold the arm and – to further complicate matters – they differ depending upon the type of monitor being used.

Allow me to return to my roots for a second: Oy gevalt!  This is fairly complicated so let’s uncomplicate it.

I went to WebMD at http://www.webmd.com/hypertension-high-blood-pressure/guide/hypertension-home-monitoring for the following:

Before Checking Your Blood Pressure

  • Find a quiet place to check your blood pressure. You will need to listen for your heartbeat.toliet
  • Make sure that you are comfortable and relaxed with a recently emptied bladder (a full bladder may affect your reading).
  • Roll up the sleeve on your arm or remove any tight-sleeved clothing.
  • Rest in a chair next to a table for 5 to 10 minutes. Your arm should rest comfortably at heart level. Sit up straight with your back against the chair, legs uncrossed. Rest your forearm on the table with the palm of your hand facing up.

Were you surprised as I was at the direction to empty your bladder?  Think for a minute.  Have any of your doctors requested you do that before they took your blood pressure reading?  Yet, it makes sense.  Not only will the full bladder itself affect the reading, so will the worry that you need to get to the restroom as soon as possible.

Okay, now we’re ready.  What’s next?

cup-of-coffee-2This time, I went to the Mayo Clinic at http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-20047889?pg=2

  • Check your monitor’s accuracy.
  •  Measure your blood pressure twice daily. (Once in the morning before you take any medications, and once in the evening.)
  • Don’t measure your blood pressure right after you wake up.
  •  Avoid food, caffeine, tobacco and alcohol for 30 minutes before taking a measurement
  • Don’t talk while taking your blood pressure.

Whoa!  This simple act of placing your arm, wrist, or finger in a monitor is not simple at all when you break it down into smaller elements. I admit it; I’m a talker and have been told a time or two to stop talking while my blood pressure is being measured.carpal tunnel

I also like to get my chores out of the way as soon as I wake up, but I see I can’t. This makes for a long morning routine for me. First I take off the wrist braces I wear at night for the carpal tunnel.  Then I clean the mandibular advancement appliance I’ve had in my mouth all night for the sleep apnea and brush it and my teeth.  Usually I would drink that delicious first cup of coffee now, but if I do, I have to wait for 30 minutes before taking my blood pressure.  Hmmm, I have to wait 15 minutes to use the bite rim to readjust my mandibular anyway. But where do I fit in the medications?  Oh, I’ll work it out.

wristWell, what about the different kinds of blood pressure monitors? I use a wrist monitor which my PCP is simply not thrilled with.  Her feeling is that I’m taking my pressure through two bones, the radius and the ulna, as opposed to only one bone, the humerus, with an arm device. There’s also the finger monitor, but that could be a problem if you have thin or cold fingers.

There are manual and battery operated versions of these monitors.  If you use an arm monitor, be aware that larger cuffs are available if needed. The one thing most blood pressure sites agree upon is that it’s not a good idea to rely on drug store monitors for your readings.

Most doctors will agree that the old fashioned sphygmomanometer is the best.  You’ll find this defined on page 135 of What Is It and How Did I Get It? Early Stage Chronic Kidney Disease:

The cuff, the measuring device and the wires that connect the two in a machine used

to measure your blood pressure, commonly called a blood pressure meter.s

I find myself wanting to make some crack about writing this blog raising my blood pressure, but in all honesty, writing the blog is still one of my joys.

Until next week,

Keep living your life!