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!

Neurology –> Neuropathy –> New To Me

With all the medical messes at my house lately, I hadn’t expected yet another one.  You’ve been reading about the established ones and how they affect Chronic Kidney Disease.  Here’s the new one: neuropathy.

I can’t tell you how long it took for me to simply pronounce the word correctly. I knew neuro comes from the Latin for nerve and pathy, also from Latin, is a “word-forming element meaning feeling, suffering, emotion, disorder, disease.” (Thanks for the help on pathy goes to The Online Etymology Dictionary at: http://www.etymonline.com/index.php?term=-pathy&allowed_in_frame=0.) There was no connect in my brain until my family doctor sent me to a neurologist.

Why you ask?  I wondered aloud in her office why I was feeling such tingling in both of my hands and, sometimes, my feet.  I found no discernible pattern to the tingling, although I could tell it was stronger in the hands than the feet.sad

Next thing I knew, I had an appointment with Dr. Maninder S. Kahlon at his Arizona Neurological Institute, better known as ANI, all the way out in Sun City.  That’s a bit away, but I agreed to the drive because Dr. Zhao recommended him so highly.  That’s also why I agreed to a male doctor when I usually prefer females.

This turned out to be a good move.  Dr. Kahlon is not only a good neurologist, but charming.  Now while that’s not usually my criteria for choosing a doctor, it was very necessary in this case since it was deemed necessary to have EMGs on both my upper and lower extremities.

EMG means Electromyography. Big help, huh? Back to basics (Yes, I do know how often I use that phrase, but let’s face it: you can’t build a house without a foundation.). According to eMedicineHealth at http://www.emedicinehealth.com/electromyography_emg/article_em.htm, “… electromyography involves testing the electrical activity of muscles. “

Next question: why in heaven’s name would anyone want to do that? I suspected it might have to do with a trapped nerve since I’d had carpal tunnel surgery 27 years ago and remembered a little bit of the process for diagnosing it.carpal tunnel

MedicineNet.com at http://www.medicinenet.com/electromyogram/article.htm answered that one for me: “When muscles are active, they produce an electrical current. This current is usually proportional to the level of the muscle activity.”    

So did that mean I had carpal tunnel again?  Oh, sorry, carpal tunnel is when the median (middle) nerve in your wrist is trapped by the ligament.  Ligament surgery was pretty painful.  I’m hoping things have improved in the last 27 years… just in case, you understand.

Back to why.  I found an answer I could live with on my old friend The Mayo Clinic’s website at http://www.mayoclinic.com/health/emg/MY00107/DSECTION=why-its-done:

“EMG results are often necessary to help diagnose or rule out a number of conditions such as:

  • Muscle disorders, such as muscular dystrophy or polymyositis
  • Diseases affecting the connection between the nerve and the muscle, such as myasthenia gravis
  • Disorders of nerves outside the spinal cord (peripheral nerves), such as carpal tunnel syndrome or peripheral neuropathies
  • Disorders that affect the motor neurons in the brain or spinal cord, such as amyotrophic lateral sclerosis or polio
  • Disorders that affect the nerve root, such as a herniated disk in the spine”

I was floored.  I hadn’t remembered that both my family physician and Dr. Kahlon explained this.  I only concentrated on the possible carpal tunnel.  Come to think of it, it would have had to be something else in my feet.  Lesson learned; you need to keep reminding yourself to listen to your doctors’ explanations even if you think you know the information already.

Scuttlebutt had it that this was a very painful test, but Dr. Kahlon distracted me with a constant stream of chatter about CKD, neurology, families, and even Landmark while he worked on my lower extremities. By the next day, we’re weren’t chattering anymore but having serious discussions.  This distracted me so much that I was barely aware of what he was doing.

Thank you, Dr. Kahlon from a stoic coward, which means I bear with the pain, but I hate the thought of it. This time, pain wasn’t a problem.

Time to tell you what the good doctor actually did to me. I was asked not to use any lotions or creams the days of the tests.  When we were ready to start, Dr. Kahlon asked me to lay down for the lower extremities test and sit up on the examination table for the upper extremities test.

EMG needlesFrom my side, the tests were simple.  First, electrodes were applied to different parts of my legs or arms (depending on which were being tested that day). Once he had recorded the readings from the electrodes, he pierced my skin with needles.  I cannot say any of this hurt, but there was some discomfort.

Bear had the test years ago and had expected me to come home in extreme pain.  Instead, I went to meet a friend for coffee one day and to the Landmark Center the other.  It really didn’t hurt.

Dr. Kahlon gave me the results of both days’ tests as well as those of the blood test he’d ordered for TSH, B12, folate, and vitamin D.  Apparently, a deficit of any of these could cause the tingling I had. None of my readings for these elements were out of range.

What I really got a kick out of was watching him use Dragon Medical to write his notes.  That’s the doctors’ version of the same program I’ve been struggling with since Christmas!

So far, I don’t need anything.  He suggested a follow up visit.  I suggested ten years.  He didn’t laugh.  I suggested a year.  He still didn’t laugh and told me six months would do.  I guess being on the borderline of having carpal tunnel is more serious than I thought.

How does this impact CKD?  There is medication that can help, but I didn’t want to discuss it yet since it is eliminated via the kidneys. I’ve become pretty good at doing without medication these days.  More on that should it come to a point when it’s a necessity.

Book news!  I have just paid off the cost for printing the book.  I’m going to keep this little game up, though.  Now I want to recoup the cost for converting the book to digital form.  You know I’m still going to keep donating, no matter how much I recoup or not.  I am thankful to have the money to be able to do this.Book Cover

Until next week,

Keep living your life!