Hypertension

Hypertension https://www.dailykos.com/news/Hypertension News Community Action Copyright 2005 - Steal what you want Mon, 27 Jan 2020 07:47:52 +0000 Mon, 27 Jan 2020 07:47:52 +0000 Daily Kos rss@dailykos.com (Daily Kos) Daily Kos rss@dailykos.com (Daily Kos) Advice needed: Medical/Housing/Medicare/etc. https://www.dailykos.com/story/2017/10/9/1705634/-Advice-needed-Medical-Housing-Medicare-etc Ended up back in the ER tonight as my home healthcare nurse checked my bp and it was 189 over 188. She also said I looked flushed and when I tried to stand up I almost fell down. I have been diagnosed with hypotension and hypertension. Treatment for one causes the other to worsen, etc. Either way I end up at risk for falls (Which I have done a lot lately) and since I am on coumadin I am doubly damned. Basically was given saline in the er to combat dehydration but since it was not a medical emergency per se they said there was nothing they could do and to follow up with my PCP and my cardiologist… both of which I have appointments for on Wed and Thurs for already. But basically I have been told by everyone, friends, nurses and doctors that I should no longer live alone (Or with my roommate I have now as she is not helpful… and that I should move into an assisted living facility. Thus the problem. The one I was at before basically takes up all of my medicare SSI check and medicare does not pay for such things. Thus leaving nothing left for my own medical bills, pet bills, caregivers, etc. I have no idea where to turn or what to do so any suggestions would be much appreciated. rss@dailykos.com (BFSkinner) AssistedLiving Health Hypertension hypotension Illness Medicare Question _1705634 Tue, 10 Oct 2017 01:07:26 +0000 ICYMI: Surviving Childbirth Complications - and the Healthcare System https://www.dailykos.com/story/2017/8/3/1686770/-ICYMI-Surviving-Childbirth-Complications-and-the-Healthcare-System NPR and ProPublica teamed up to present an important health story: <a href="http://www.npr.org/2017/08/03/541191480/if-you-hemorrhage-dont-clean-up-advice-from-mothers-who-almost-died" target="_blank" title="">'If You Hemorrhage, Don't Clean Up': Advice From Mothers Who Almost Died</a>. Adrianna Gallardo, Nina Martin, and Renee Montagne have assembled a sobering picture of how healthcare can fall tragically short from complications of pregnancy and childbirth. A number of factors can lead to fatal results. <blockquote> Four days after Marie McCausland delivered her first child in May, she knew something was <a href="https://www.reddit.com/r/BabyBumps/comments/6d1osm/reddit_saved_my_life_post_partum_preeclampsia/" title="">very wrong</a>. She had intense pain in her upper chest, her blood pressure was rising, and she was so swollen that she barely recognized herself in the mirror. As she curled up in bed that evening, a scary thought flickered through her exhausted brain: "If I go to sleep right now, I don't know if I'm gonna be waking up." </blockquote> What happened next could have gone very wrong if McCausland hadn’t been aware that her symptoms were serious. A rush trip to the hospital saved her life — but only after she resisted being sent home again, and consultation with a second doctor got her the treatment she needed. <blockquote> McCausland's experience is far from unique. In the months since ProPublica and NPR launched our project about maternal deaths and near-deaths in the U.S., we've heard from 3,100 women who endured life-threatening pregnancy and childbirth complications, often suffering long-lasting physical and emotional effects. </blockquote> There are a number of factors the report identifies that people need to be aware of. <ul> <li>Women and their partners may not know enough to recognize symptoms of developing serious problems — childbirth education doesn’t often address them adequately.</li> <li>Doctors and nurses can be slow to recognize the problems, and discount what the patient is trying to tell them.</li> <li>Not all hospitals are equipped with staff and equipment to diagnose these complications. Not all of them have measures to deal with them when they occur. </li> <li>Medical staff doesn’t always do well communicating or sharing information, especially in the middle of dealing with complications.</li> <li>Support from family members can be critical, when a patient is in no condition to make decisions. They have to be prepared to step in when the patient can’t act for themselves.</li> <li>Asking the right questions — of the right person, being educated on potential problems, being prepared to insist on answers, can be critical.</li> </ul> There’s much more at the article. The report has a number of stories and links to more information. Anyone planning to have a child or currently expecting one <a href="http://www.npr.org/2017/08/03/541191480/if-you-hemorrhage-dont-clean-up-advice-from-mothers-who-almost-died" target="_blank" title="">should read the whole thing</a>. It could save lives. If you have a story to share, <a href="https://www.propublica.org/getinvolved/item/help-propublica-and-npr-investigate-maternal-mortality" target="_blank" title="">they want to hear from you.</a> rss@dailykos.com (xaxnar) AdriannaGallardo bleeding Childbirth clots complications HealthCare hemorrhage Hypertension NinaMartin NPR preeclampsia Pregnancy ProPublica ReneeMontagne stroke _1686770 Thu, 03 Aug 2017 23:52:11 +0000 Saturday Morning RN Health Blog- Hypertension https://www.dailykos.com/story/2017/7/15/1680838/-Saturday-Morning-RN-Health-Blog-Hypertension A lot of you know me as a the emergency department nurse running for state legislature here in Virginia, against the guy listed atop the Trump Leadership Team here in Virginia, in the Trump Winery district. But I’m also a current Family Nurse Practitioner student- and along with that, comes a whole slew of important information which I thought might be cool if I shared here on Saturday mornings, as I find time to, while I’m campaigning. As long as I have this megaphone, I want to use it for as much good as I possibly can. So, please; enjoy, learn, ask questions, comment, contribute, and hopefully take something from this that’ll help improve your life or someone else’s. HYPERTENSION Hypertension is defined, simply, as the sustained abnormal elevation of the arterial blood pressure. I emphasis the sustained part, because it's important- you don't have clinical hypertension unless you've got a sustained elevation of your blood pressure. If you're sick, physically exerting yourself, or watching Fox News, you can probably expect to see an elevation in your blood pressure; but as long as it doesn't stick around, you don't have hypertension. This is one reason why confirming you have hypertension is actually a bunch harder than you might think, because blood pressure is a very anomalous thing. "Normal" people can have periods of what would be considered hypertension with no ill effects; similarly, someone who actually HAS hypertension might have times where their blood pressure is fantastic. This is why we don't diagnose hypertension from one reading; people will often come into my ER, see their pressure on the vital signs monitor, and freak out. I always have to explain to them, no- that number, by itself, isn’t worth freaking out over (not if they don’t see me freaking out over it, too, anyway). By the textbook, you take the blood pressure after the patient has been seated for thirty minutes, with no caffeine or alcohol in their system, and them being calm. We take the pressure twice during their visit, and then arrange for another visit, because we have to do this process on two separate visits to officially diagnose hypertension. Home blood pressure readings are becoming more acceptable, too, because consumer grade blood pressure machines are becoming accurate enough to allow it. Hypertension is one of the most clinically common disease processes we see in the United States; approximately one in three US adults over the age of 20 (!!) has hypertension. As you get older, this ratio increases until about age 60-65 or so, when it's more common to HAVE hypertension than not. Yep; once you hit about 65, hypertension becomes "normal", and having normal blood pressure makes you "abnormal". Hypertension comes from one of only two things; either you have too much blood (volume), or your blood vessels are conferring too much resistance- say, like when you put your thumb over the end of a garden hose. Every treatment or drug available today addresses one of these two factors. Oddly enough, hypertension is also a unique disorder, because the only thing we're basing it on is comparing your blood pressure to a bunch of other people. And those other people may lead incredibly different lives than you! Different culture, diet, genetics, physical fitness levels, etc. But we throw all of that out, and effectively take a population average of what their recorded blood pressures are- and then score you based on how many standard deviations from the mean you end up. This means that "hypertension" is somewhat subjective... but there's no good way to really decide what's normal for you, personally- so we just go with the mean. Among hypertensive adults, those with clinical (sustained) hypertension: <ul> <li>About 80% are actually aware they have it;</li> <li>71% are on medication for it, and</li> <li>only 48% of people with hypertension actually have their blood pressures under control.</li> </ul> A further 25-37% of the entire country suffers from pre-hypertension, the borderline area between normal and abnormal; this is all ages, sexes, and genders. Before I keep mentioning these numbers, you probably need a benchmark to know exactly what they mean; otherwise, there's really no point. So let's discuss the values associated with "normal", "high", etc. This differs slightly depending on who you ask, but generally, the blood pressure values go something like this: Normal blood pressure- anything under 120 over 80. Now, it's important to note here- BOTH numbers have to be under 120/80 for your blood pressure to be considered "normal". Prehypertension- 120-139 over 80-89. Stage I Hypertension- 140-159 over 90-99. Stage II Hypertension- 160+ over 100+. The first number is what we call the "systolic pressure", which refers to the relative pressure in millimeters of mercury when the heart is actively in the pumping stage- so, in the middle of the contraction that sends the blood to the body. The diastolic pressure is the pressure at the moment the heart is relaxed, it's not in an active pumping stage; so the diastolic is effectively the "resting" pressure of the blood. Now, back in the day- and by that, I mean about ten years ago- they used to say anything under 140/90 was just swell. As long as you sat below that level, no worries! But that standard was based on incredibly incomplete information- and not only that, the people they used to derive those readings from, to determine what we'd call "average", were from an incredibly small test group of not entirely healthy people from New England- specifically around Cambridge, New Haven, since the Ivy League medical schools did a lot of the groundwork setting up these metrics. So they took the information derived from this small group of relatively homogenous people, and applied it to the rest of the country- regardless of sex, gender, race, genetics, et cetera. I’m sure you can see the problem inherent in that- namely, we’re a country of over 325 million people, so we’re not all alike. The newest guidelines have rectified that to a great deal, but there’s always still wiggle room, and really no way to test an average for each person individually. So, to recap- if you have: 1) A sustained elevated blood pressure (meaning over days and weeks and months) 2) And it's over either 120 mmHg systolic, 80 mmHg diastolic, or both You've got some form of hypertension! So, turns out you're back at your primary care physician, and guess what? Your blood pressure is elevated again, the second or third time in a row that you've visited them, and we've ruled out the possibility it's White Coat Syndrome (a legitimate medical condition where your blood pressure hikes itself when you go see the doctor). Dang. But we're not done yet; we have to figure out what *kind* of hypertension you have. Primary? Or secondary? Usually, this is an easy answer; primary hypertension is by far and away the most common type, affecting about 95% of people. The difference between primary and secondary hypertension is pretty easy, though, because secondary hypertension always- always- has an underlying cause that you can point to, and will make you hypertension problem disappear as soon as you fix it. An example would a kidney tumor, or being pregnant. If I take out the kidney tumor, or you have that baby, and your blood pressure goes back to normal, boom. Secondary hypertension gone. So we don't worry about the hypertension parts of those diseases; we worry about fixing the underlying problem. Primary hypertension, by comparison, is much more tenuous and doesn't have one specific, underlying, CUREABLE cause. It's usually a constellation of problems; age, diet, physical fitness, genetics, et cetera. As such- and this is very important- the vast majority of patients in the pre-hypertension category will absolutely develop full-blown hypertension without some sort-of lifestyle modification. But there's good news here- because many, if not most, of those same people can be just fine with only minor lifestyle modification! It doesn't mean you have to start running Tough Mudders or go on a crazy diet; walking more, taking the stairs instead of the elevator, watching your diet a bit more; these small steps are sometimes enough to make the difference. Which is good; hypertension is one of the most deleterious diseases to our health and well-being. Your blood vessels are tough, but months and years of excessive pressure will eventually wear on them; it wears on your kidneys, wears on your heart; your eyes and brain. The longer you let it go untreated, the worse things get. Paradoxically, though, with advances in medical technology, people with hypertension aren't dying sooner, necessarily, than other people... but uncontrolled hypertension can dramatically affect the quality of life you have over those later years (my pathophysiology professor at UVA was always pretty blunt on this point- "Golden years, my ass!") So, that's great, you say. We know how dangerous hypertension is to our health. Why is it such a big deal, then? We should be able to just treat it as needed. But, as is often the case, it’s not that easy, because hypertension is what we call a "silent" disease. More often than not, people suffering from hypertension have no symptoms whatsoever- they only get it diagnosed after having their blood pressure taken, and then only after successive tests have shown it to be a sustained elevation. That's the biggest problem category we have today; we're getting a lot better about treating and controlling hypertension in general, but there are millions of people who have it that don't know they do. Worryingly, we're also finding it more and more amongst people we didn't automatically associate with being in risk categories before- teenagers, people with obesity, etc. The other factor about hypertension being a "silent" disease is that it doesn't hurt. That's why most people don't know they have it- but it means that even when they DO know they have it, it's hard to get them to act on it. Now, I want to to imagine this- you're a healthcare professional, talking to your patient, who's a fifty-five year old male. He's otherwise relatively healthy; a bit overweight, maybe, but not obese. No major medical problems. Relatively active lifestyle. But you've now diagnosed him with hypertension- so you prescribe him a medication for it. Great. Oh, and by the way- you have to tell him he's got to take this medication every single day possibly for the rest of his life; he's going to wake up two or three times in the night to pee; he's going to have sexual dysfunction; he might literally pass out onto the floor if he's not careful about when you take it... et cetera. I can already tell you what his reaction to this is gonna be- "What?!? **** you!" The problem is, people are pretty bad at managing risk. If I tell you, hey! You better listen to me, because though you might not die sooner, your quality of life there at the end is gonna suck! Odds are that's a pretty nebulous thing for you to relate to. Not only that, but even with a perfect approach on that, it's a hard sell to make. It's one reason that nurses work so hard on the concept of "partnering with patients on their own care". We want folks to buy into this on their own, not try and beat them over the head with it. It doesn't matter how "right" we are- and yeah, I could go all fire and brimstone on a patient, and if they choose not to listen to me, I could just shrug my shoulders and say, hey- I tried. It's not my fault. It's not my fault, no. But that doesn't matter, because ultimately, if I'm not successful at getting the patient to buy into the care plan we make, we ALL pay for it. The patient will, via their health. I will personally, because I'll more likely than not be seeing them back eventually for their condition being uncontrolled. And, again, we ALL pay for it- eventually, that patient'll be on Medicare and/or Medicaid, and then we're all on the hook for the cost. But it really doesn't matter how persuasive your nurse or doctor is; we still find the best chance we have to get people to get and take their medications is only after they've been hospitalized related to it, or an associated condition. They have to state the consequences in the face, have it impact their lives in a meaningful way, before we can get them to do anything about it. And even then, it's contingent on effective inpatient care and education- the better inpatient care they get related to that, the better their outpatient care will be, and vice-versa. RISK FACTORS FOR PRIMARY HYPERTENSION Age! Age is the primary risk factor for... pretty much any chronic malady, actually, but hypertension in particular. As I said before, after the age of 60-65, it's more common to HAVE hypertension than not. Other risk factors are: <ul> <li>Obesity</li> <li>Sedentary lifestyle</li> <li>Family history of hypertension/heritability</li> <li>Smoking</li> <li>Trump presidencies</li> <li>Low dietary intake of potassium, magnesium, and calcium (which is almost, if not exactly as bad as the next category!)</li> <li>High sodium intake</li> <li>Poor diet in general</li> <li>Glucose intolerance (not necessarily diabetes, though that's obviously included in this lecture</li> <li>Trying to reason out the actions/results of, or simply watching, the UVA Football Team</li> </ul> Of the above, heritability is probably the biggest single risk factor, but environmental factors- lifestyle, diet, etc- is almost as important. That's because environmental factors can affect your body's genes, and can affect how those genes relate to and act on the body systems that manage blood pressure. The Trump and UVA factors may not necessarily be backed up by medical literature, but I say to that, they’re not backed up yet, and I would bet plenty of money on that hypothesis being right. Your Actual Blood Pressure Number Isn’t That Important Wait, what?!? What do you mean, the blood pressure number isn’t important?!? You just told me what the numbers meant, and how deleterious hypertension is, but the number isn’t important? Well, yes and no. No, we're not really concerned about the pressure part, per se, unless it's particularly dangerous; 200/100, where it might imminently cause a stroke or a cerebrovascular accident of some sort. We’re concerned about what the pressure represents, in what is going on with the rest of your body. For instance, hypertension can cause blood vessel remodeling, which is like a bad episode of “Trading Spaces”. If you remodel the vessels in your eye, you get hypertensive retinopathy, and can lose your vision. In the heart, you get coronary artery disease, and can have a heart attack or heart failure. In the neck and head, you get cerebrovascular disease, and can have an aneurysm. In the kidney, you get renal disease. Et cetera. With the heart, for example, if you make your heart work harder- it had to beat harder to get the blood out to the body, because it’s got to work against more pressure- your heart gets bigger. The problem is, your heart isn't like your bicep, where bigger is better; no, your heart is pretty much designed to be exactly like it is now. When you take a rubber band, and snap it- ow! It hurts, right? But it still works well! However, if you stretch that rubber band waaaaay out, or get it worn down, how effective is it at snapping now? Not nearly as well. The same principle is true with your heart. TREATMENT Once you decide a patient has uncomplicated, "essential", "primary" hypertension, then what you want to do is start them on those lifestyle modifications we talked about before- and, yes, potentially medication. It used to be that we’d tell people to do lifestyle modifications first and alone; just get on that treadmill, c’mon now. You don't need medicine. What we've discovered, however, is that if you couple lifestyle changes WITH medication, you get better results- because people will often see the results more rapidly, and they'll buy into keeping them up more effectively. In the previous example, you’d too often see people do a bunch of lifestyle changes, not see much difference, and then go "Forget this, it ain't worth the hassle!". Then they'd get really bad- hypertension back in a big way- because they were non-compliant with the lifestyle changes they were supposed to be making. The old drugs we used to give, and still occasionally give today, just lowered your blood pressure- but it's a lot like taking sudafed when you've got a cold. The cold didn't go anywhere; you just muted the symptoms of it for awhile. But as soon as it wears off… boom! It’s back! We find the same principle true with drugs like beta blockers and calcium-channel blockers; all we’re doing is treating the symptoms, but not the underlying disease process. So it's not just about getting your blood pressure down, it's about fighting what's causing that blood pressure to rise- which of the factors listed above is most responsible- and choosing the right way to target it. Oh, and one last thing: lowering blood pressure with drugs is the only pharmacological method we have to reducing the risk of dementia. The higher your blood pressure, the higher your risk for dementia. How this works with Politics So, now that I'm not just a nurse, but a politician (kinda), how does the information here relate to what I want to accomplish, or problems that I see? Well, if you don't have a primary care provider, or health insurance, how likely is it you're going to either be able to know you have hypertension, or continue to treat it? And if you aren't able to treat it appropriately, it only gets worse and worse, until you end up in the ER- the lease efficient place in the health system to deliver care- and which generally means all of us end up having to pay for it anyhow, the Republicans' pusillanimous whinging to the contrary. If we gotta pay for it-- and since the Republicans ARE arguing against the Individual Mandate, also known as the No Free Rider law, and simultaneously NOT arguing against the Emergency Medical Treatment and Labor Act, which is the "everyone can go to the ER" law-- it's clear we DO have to pay for it. Even they're admitting it, though desperately trying to frame it as not being the case. If we gotta pay for it, then it ought to be in the most efficient way possible, where we can maximize the effect of that money, and help power people's ability to pursue their own success. That's why I'm unashamed advocate of Single Payer. Let small businesses run their business, not figure out healthcare. Let people not have to wonder if one medical catastrophe will end their lives, ruin their future. People aren't lazy, they're risk adverse- if we help them mitigate that risk, we can set them on the track to succeed. Alright- that’s today’s bare-bones lecture on Hypertension. Feel free to ask questions in the comments, points of elaboration, or whatever you’d like to know more about. And have a great day! <a href="https://secure.actblue.com/contribute/page/squireforyou" target="_blank">Kellen Squire is an emergency department nurse from Barboursville, Virginia. Donate to, volunteer for, or get the word out about our people-powered campaign today.</a> rss@dailykos.com (SquireForYou) Elections2017 HealthCare HouseofDelegates Hypertension Medical Nurses SaturdayMorningRNHealthBlog SinglePayer SMRNHB VA58 VirginiaKos _1680838 Sat, 15 Jul 2017 12:19:43 +0000 My Shoulder and the ACA https://www.dailykos.com/story/2017/3/4/1639608/-My-Shoulder-and-the-ACA I apologize for putting that image in your head, but this is what the Affordable Care Act has done for me. I am over 51 years old, and I have high blood pressure. I also have health insurance. It is provided by a private insurer and I pay several hundred dollars per month out of pocket for it. 16 months ago, I was just a bit over 50 with the rest of the above paragraph true. One wet Saturday, I grabbed a Citibike- NYC’s bike-share program, and I was riding home when I hit a particularly slick spot. I had been heading North on Park Avenue South, my front tire went East and- Humpty Dumpty! As you can guess, the first thing that happened was that people stopped to help me. They pulled me out of the street, helped me sit up, grabbed napkins from a restaurant (I was bleeding), and they called 911. At no point did they worry that this aid was going to make me dependent on them. I spent the next several hours in the hospital. I got stitches, a tetanus shot, X-rays, and I was discharged with an appointment to their Orthopedics clinic on Tuesday. When I showed up, it turned out that my plan didn’t include this hospital for anything but emergency care. They sent me home. I called my plan because I needed to see an orthopedist. I also needed a referral first. I got an appointment with a primary care physician later that day and got my referral. The next day, I saw the orthopedist. He sent me down for more X-rays, and my shoulder was well and truly shattered. We agreed that I needed a half-shoulder replacement and scheduled the surgery before I left his office. The surgery went smoothly, or so I had thought. About 3 weeks later, as I was toweling off after a shower, the scar opened at the base. “IT’S A GUSHER!” It didn’t seem to be infected, but we decided to keep an eye on it. Five days later, as fluid was still draining, the surgeon sent me back to the hospital for more surgery. I should mention that hospital re-admissions are down 30% since passage of the ACA, so sucks for me. Eight months later, I had my final post-op appointment. The surgeon told me there was no reason to see him again. Everything looked like it was healing properly. Only, not so much. I woke up about 3-4 weeks later and the base of my scar felt tender and was slightly swollen. It was a Sunday, so I decided that I would call the surgeon for an appointment the next day. By the next morning, enough fluid had built up in my shoulder to form a bubble! The surgeon said that there was an infection, and we didn’t get it in the second surgery because the infection was under the prosthetic and he was hoping to avoid the more invasive procedure he was about to recommend. To wit: We needed to REMOVE the prosthetic, fight the infection, and then, when we are as sure as we can be that the infection is gone, go back and do a total shoulder replacement. Yeah, I thought, No. What else ya got? Well, as it turns out, that was, in fact, the best course of action. I went back to the hospital for a third surgery. I left without my shoulder and a home IV kit. After 4 weeks of home IV there was another 4 weeks of oral anti-biotics. Then I had to wait a month without any medication to make sure I was infection free. Then I was finally ready to schedule my Shoulder replacement surgery. The surgeon needed a new MRI, and after some issues with my blood work, my Primary Care Physician wanted an ultra-sound. The surgery was now nearly 4 weeks ago and the staples have been removed, and I can start to heal. This journey began in October 2015. In December, as I went to renew my insurance, I was told I was enrolled in Medicaid. Apparently, the New York exchange used my financial information from my previous application and enrolled me. I told the State that I wasn’t eligible, and they eventually agreed, but they said, “Hey, we’ve already put you on the rolls, check back next December. So, I am on my third insurance plan- Once again a private plan. So, 3 of the 4 surgeries I required were covered by private insurance, and my Medicaid was a result of the ACA’s expansion. I spent about $5,000 in premiums in 2015 and I’ll spend close to $7,000 this year. One surgery probably would have wiped that ALL out. I have private insurance with a private company. Before the ACA, they probably would have kicked me off to prevent paying for these surgeries. Is the Right really fighting to protect the bottom line of Insurance companies? Thanks for listening. rss@dailykos.com (Woody25) AffordableCareAct BloodWork CITIBIKE HealthCare Hypertension Obamacare RepealandReplace Surgery _1639608 Sat, 04 Mar 2017 18:55:25 +0000 An update on health - this time mine https://www.dailykos.com/story/2016/9/30/1576502/-An-update-on-health-this-time-mine I am 70 years old. In my adolescence and young adulthood I smoked, both cigarettes and from time to time a pipe. I have eaten far too much meat over the years. There have been periods where I was insufficiently active in physical activity. I enjoy salted foods. I have an intense personality. I have often driven myself hard, get insufficient and irregular sleep. All of this is contributory to where I now find myself. It all started with my recent physical, where my personal care physician, a physician’s assistant in an internal medical practice, detected some anomalies with my heart which concerned him, and referred me to a cardiologist. He upped my medication for blood pressure, changed what I was taking for my regular problems with allergies. Without revisiting every single step along the way, in the midst of all this I had major trouble with my digestive and excretory systems, and while these have been stabilized, it made for several difficult weeks as far as what I could eat/drink, and my ability to get sleep. I am also due for my quintennial colonoscopy in about 2 weeks. Meanwhile back to the heart and the cardiologist. I have always had a systolic heart murmer, but it never affected me. For a number of years I have been on medicine for hypertension (high blood pressure) and high cholesterol. I have at times been very active — at one point doing 7-12 yoga classes a week, for example — at others getting very little physical exercise. In the last 15 years my weight has ranged from 170 — 205, and currently is around 194, which is too heavy. I have in the past few weeks been through multiple tests ordered by the cardiological practice. A stress test cleared me to continue walk for exercise, jogging as I felt comfortable. But I was found to have leakage from all four coronary arteries, and my heart muscle was stiffening — both of these probably the result of a long period of hypertension, perhaps for a number of years before I went on medication. Further testing was ordered for a closure examination of my aorta and aortic valve with a focused echocardiagram, and what was detected there led to a CT scan with contrast of the area. I have an aneurysm in my aorta, on the abdominal side, that is 5.4 x 5.6 centimeters. At the average of 5.5, that means intervention is necessary, and I am being referred for a referral to prepare for insertion of what is known as a T-bar stent to cover the aneurysm, which extends over part my my aorta, but also to my illiac arteries. This is probably a result of my having been a smoker, as well as my extended period of hypertension, about which more in a few minutes. That is the immediate major issue, but unfortunately that is not the entire story. In the process of the testing a small nodule was detected on the lower lobe of my left lung. As it happens, when I had my 6 month dental checkup yesterday, my very thorough dentist noted some discoloration at one place one the lower left side of my mouth. For right now, both of these will just be monitored, but both will need to be rechecked within 4-6 months to see if there is any change, precisely because I was a smoker, even though I have not used tobacco for about 4 decades. In addition, over the past few weeks I have suddenly and for no apparent reason fallen asleep in mid afternoon with a certain amount of regularity. It has not mattered how much sleep I had the night before (I am pretty good at keeping track of symptoms). It is quite possible I now have developed sleep apnea, although we will not address that immediately either. My consultation will be on October 11. The procedure, which is necessary because I am at some risk of the the aneurysm bursting at some point, particularly if my BP gets too high, will occur sometime after that, and will require me to be hospitalized overnight. I was given my choice between a man at Washington Hospital Center, who has done the most of these procedures, another at Fairfax, which is about a 15 minute drive away, or at Virginia Hospital Center which is a couple of blocks away, is where my wife has gotten almost all of her treatment for her cancer (except for her stem cell transplant, which was at Fairfax), and where all of our medical practitioners except for her opthamologist are based. I am opting to be closer to home, to make it easier on my wife. I will have the colonoscopy on October 11. Hopefully that will be normal, or at most will have some polyps that can be simultaneously addressed, although the way things have gone recently on the medical front, I go into that with no particular level of confidence. The way things currently look, I will probably not have the stent put in until the 2nd half of October. It is quite possible that as a result I may have to be on a blood thinner for several months. And of course both my diet and my exercise will be somewhat restricted. In the meantime, I have to get my blood pressure under better control. My base medication was already increased. I have a standby that I have been taking when my upper number was over 180 or the lower number over 110. As of now those numbers have been lowered. If the upper number is over 150 or the lower number is over 90 I am to take it. This is intended to lessen the risk with the aneurysm. I should note that since this extended medical situation began, I have been regularly monitoring my blood pressure regularly. In the past two weeks I have seen both numbers start to rise, and there has been real concern about the lower (diastolic) number. I am without the standby medication, I am already up to ten pills of one sort or another daily. As it happens, I was not able to obtain a teaching job for the start of this year, and so far have not found other employment. I have a tutoring service prepared to hire me on a contract basis that could provide some income as soon as I submit the paperwork. I might be able to go ahead with that, but as of right now wonder how I can be applying for a new job, teaching or otherwise, when I know up front I am going to have to miss some work at the beginning of my employment, and when there is no guarantee of how my medical procedures will go. That is something else we have to consider. It is less the question of the medical bills: we have excellent insurance. But we do have other bills and our margin of error really requires me to bringing in an income. We will have to consider that and decide how to proceed. It would be wonderful if I could earn an adequate amount of money, even on a contract basis, by working from home or a nearby cafe online, perhaps as a writer or an editor. I suppose that could also include tutoring online. So far I have not found such opportunities, but perhaps I will get lucky. As I reflect back on my life, I have always been able to be physically active. For much of my life the worst I encountered after childhood was the occasional serious allergic reaction — to a bee sting, to food or drink. I had my share of bumps and bruises, including one serious concussion playing soccer in my late 20s. My then girlfriend, now wife, was there when that happened, which was a bit scarey to her. I have had several episodes in the past that led to testing on my heart, and each time no underlying problem was found. These had come from stress tests in the past, when there were some anomalies, but I was never required to restrict my activities. In 1984 and again in 2011 I had surgeries, first for a large cyst on my neck that only after the fact the surgeon told me he had never seen something that big that was not malignant, the other to repair a double hernia. I had a scare in March of 2014 when they thought I might be having a stroke, but after 27 hours in the hospital and several referrals to specialists afterward, as best as we could determine was that I happened to have an ocular migraine at the same time my blood pressure was too high. I am not carrying any fear of what I am confronting medically, at least not in the near future, but recognize that I have to be careful until the aneurysm is controlled by the stent: there is always some risk of it bursting, in which case death would be near instantaneous. So long as I keep my blood pressure under control that should NOT be a great risk. There is nothing I am confronting that will, except for very short periods of time, interfere with my primary responsibility of caring for my wife in her continued treatment for a cancer that remains incurable, but which can be managed. But there is no doubt how I go forward with my life is changed yet again, just as it was when my wife was diagnosed with her cancer more than three years ago. I consider myself lucky. I try to be open, and to be willing to accept the well wishes and emotional and spiritual support others are willing to offer. That is why I wrote this. Peace. rss@dailykos.com (teacherken) aorticaneurysm Health HighCholesterol Hypertension illiacarteries Recommended Smoking t-barstent _1576502 Sat, 01 Oct 2016 01:00:48 +0000 an update on my health https://www.dailykos.com/story/2016/8/10/1558943/-an-update-on-my-health Last night I informed the community in <a href="http://www.dailykos.com/story/2016/08/10/1558581/-My-wife-might-not-be-only-one-with-a-health-problem" target="_blank">this post</a> that I might be facing a health problem, given a seriously elevated level of blood pressure. As a result of seeing my physician, we made some changes. One of things I had been taking to address a severe allergic reaction had been some oral steroids. In the past when I had severe allergic reaction, I had wound up in the emergency room and got a shot of prednisone. This time the reaction had not been as severe, when I went to the medical practice they did not have injectables, so i was given a prescription for a different steroid to be taken orally. At this point, it seems that is what accounted for my seriously high blood pressure at the dentist’s office. My physician double my dosage of my basic blood pressure medication (lisinopril) from 5 MG to 10 MG. In addition, I was given a standby prescription for 100 MG of Labetalol, to be taken any time either my systolic BP was over 180 or my diastolic over 110. This morning when I took my BP, it was just high enough to warrant taking the Labetalol. For most of today, my BP was well within normal levels. So I thought that the only issue was the steroids. Now I am not so sure. Measurements this evening are higher, outside the normal range, albeit not so high has to take the Labetalol. So, as of now we do not know if there is another underlying issue. I will keep monitoring my BP, talking the additional meds if needed. I am scheduled to revisit my physician on Monday. So as of now — no crisis, but even with elevated meds not consistently within normal range for BP. When I know more, I will let people know. Thanks for your concern. rss@dailykos.com (teacherken) Bloodpressure Health Hypertension labetalol lisinopril Recommended _1558943 Thu, 11 Aug 2016 01:16:05 +0000 Fending Off the Silent Killer https://www.dailykos.com/story/2015/3/22/1372558/-Fending-Off-the-Silent-Killer <div class="dkimg-r"><img src="http://images.dailykos.com/images/135103/large/BP_Cuff.JPG?1427046175" alt="" width="275" height="235" /></div> Just a pair of numbers, but they matter. They tell you that you're mortal, and that it's way past time to pay attention to all the things you know you should be doing to protect your health. In this case, 150/100, give or take on any given day. You have to decide, in the complete absence of observable symptoms, to change your life. Just because of some numbers. And as you do this, you find out a whole lot about health, the food that you get sold, and yourself. rss@dailykos.com (James Wells) Bloodpressure Crapthatspackagedasfood Foodindustrialcomplex Health Hypertension Mortality Recommended _1372558 Sun, 22 Mar 2015 18:31:51 +0000 KosAbility: Recent Medical Journal Discussions on Obesity, Diabetes, & Related Topics https://www.dailykos.com/story/2014/7/20/1290953/-KosAbility-Recent-Medical-Journal-Discussions-on-Obesity-Diabetes-Related-Topics FIND SPECIFIC KEYWORDS BY HOLDING DOWN THE <tt>CONTROL</tt> KEY & TAPPING F TO GET A SEARCH BAR. <hr width="100%" color="#F21870" />       Browsing these 155+ linked article titles gives a good grasp of the range of professional discussion, research, controversy, argument and opinion on obesity, diabetes, hypertension (high blood pressure) and other cardiovascular topics, statins and other med/drug concerns, kidney issues, medic/patient communication, and so on. These free mostly-plain-English med journal articles also illustrate how healthcare professionals speak with each other, as distinct from how they talk to patients. Some titles apply to professionals, patients and the general public alike, e.g., <a href="http://www.medscape.com/viewarticle/772637">GET UP, STAND UP: SITTING FOR TOO LONG DOUBLES RISK FOR DIABETES, CARDIOVASCULAR EVENTS, & DEATH</a>. After this introductory section, order is alphabetical by title and numbered as a convenience for reference in this thread or elsewhere.   ▼ indicates a blockquoted exerpt after the article title/link, and  ▲ means subordinated items are directly related to the preceding. Exerpts are not necessarily summaries, and exerpted articles no more important than unexerpted ones. See <a href="http://www.dailykos.com/story/2013/12/17/1263518/--Why-MDs-Abuse-Prescription-Drugs-Medscape-article-Dec-9-2013" target="_blank">free Medscape registration info here</a>. All sources are free, and freely browsable for almost any health/med topic. This editor's <tt>views are indicated by this font</tt>. [1] <a href="http://www.medscape.com/viewarticle/826768" target="_blank">Girl Power: [Pancreas] Islet Transplants from Women Donors Work Better</a> <tt>In what way this makes sense as "girl power" is inexplicable, since the donors are of course dead and powerless, and not girls but women. It was a relief to find that a commenter at this article gave recognition to the dangerous stupidity of such a title (which makes the term "harvest" in this transplant context sound like the worst sociopathic gender exploitation in human history).</tt> [2] <a href="http://www.medscape.com/viewarticle/824729" target="_blank">Becoming the Patient: Not as Easy as It Looks</a> A remarkably advanced physician puts himself on a  diabetic self-care/self-regulation regimen (complete with simulated insulin pump) to experience the learning-curve demand and taskload. He finds it steep going, even without having the actual disease impact as the basic burden. Printer-friendly (see near the top right corner below the title/author/date lines). <table border="6" bordercolor="#037FFC"> <tr> <td><img src="http://farm3.staticflickr.com/2867/9659479984_94c066fb53_m.jpg" width="206" align="left" alt="KosAbility logo" /><a href="http://www.dailykos.com/blog/KosAbility" target="_blank">KosAbility</a> is a Sunday 7pm eastkost/4pm leftkost volunteer diarist series, as a community for people living with disabilities, who love someone with a disability, or who want to know more about the issues. Our use of "disability" includes temporary as well as permanent conditions, from small, gnawing problems to major, life-threatening health/medical ones. Our use of "love someone" extends to beloved members of other species. Our discussions are open threads in the context of this community. Feel free to comment on the diary topic, ask questions of the diarist or generally to everyone, share something you've learned, tell bad jokes, post photos, or rage about your situation. Our only rule is to be kind; trolls will be spayed or neutered. If you are interested in contributing a diary, contact series coordinator <a href="http://www.dailykos.com/user/postmodernista" target="_blank">postmodernista</a>. </td> </tr> </table> rss@dailykos.com (mettle fatigue) Aging alternativemedicine Big Pharma BigPharma BMI BodyMassIndex cardiology CareGivers ChronicHealthConditions chronickidneydisease CKD Community ComplementaryMedicine Diabetes Diet Disabilities Doctors drug-inducedweightgain Drugs Environment environmentaltoxins Fitness Food Health Health Care HealthCare heartdisease herbalism Herbicides Highbloodpressure Hypertension insulin IsletsofLangerhans KidneyDisease KosAbility Medical Care MedicalCare Medication metabolicsyndrome Misogyny nephrology Nutrition Obesity organdonors OrganTransplants Pancreas Pesticides Pharmaceuticalindustry Physicians pillidentifiers prejudices Salt Sexism Sodium Statins Stress Teaching traditionalmedicine Water weightstigma wellness _1290953 Sun, 20 Jul 2014 23:00:02 +0000 The War on Women and the effect on Autism https://www.dailykos.com/story/2011/6/3/981618/-The-War-on-Women-and-the-effect-on-Autism <a href="http://yourlife.usatoday.com/health/medical/autism/story/2011/05/Fever-during-pregnancy-diabetes-and-obesity-may-raise-autism-risk/47160500/1">This article on autism</a>  came out today.  It is a report on research into the causes of autism, one of the growing conditions affecting children in this time. IT CONTAINS PRELIMINARY RESULTS ONLY, and is not a final answer What horrified me even though the tone of the article was optimistic about beginning to determine causes, with more research to be done, is what the effect of the Republican War on Women, particularly that which limits access of low income mothers to be to decent medical care, might be if the articles and research are confirmed. Arrrgh! rss@dailykos.com (Christy1947) Autism Diabetes fever Health Care HealthCare Hypertension Obesity Pre-eclampsia Pregnancy Republicans War on Women WarOnWomen _981618 Fri, 03 Jun 2011 13:00:02 +0000 When you're young and gay.... https://www.dailykos.com/story/2011/4/5/963582/-When-you-re-young-and-gay You never think about getting old. Never. And once again this proves that there really is very little difference between gays and straights. The young people of any sexual orientation all live as if they will be eternally young, eternally desirable, and eternally beautiful. Reality check. rss@dailykos.com (tjlabs) bisexuality California Gay Heterosexuality Hypertension Manhattan Menwhohavesexwithmen Youth _963582 Tue, 05 Apr 2011 12:36:16 +0000 The Chronic Stress / Obesity Connection And Single Payer https://www.dailykos.com/story/2010/5/4/863499/-The-Chronic-Stress-Obesity-Connection-And-Single-Payer We've all been told, again and again, about the damaging effects being overweight has on one's health. But how many of us realize that the gaining of weight around people's middles 'is not a cause, its an effect' ? Research findings increasingly show that chronic stress IS literally POISON to Americans' health, causing strongly negative, lifetime damage to people's health. The black/white health gap? Lots of evidence suggests stress is one cause. (exposures to toxics are others) Research makes it crystal clear that there isn't just "a  connection" between chronic stress and health, chronic stress is a major cause of dozens of serious, costly diseases that suck trillions out of our economy. One of them is obesity. (which scientists often call "adiposity") Obesity as well as other systemic changes to the body and brain, is caused by a feedback loop driven by the release of stress hormones - especially over time. This happens via many pathways, and the combined effects are beginning to be recognized as a cumulative phenomenon called allostatic load (or "<a href="http://www.ncbi.nlm.nih.gov/sites/entrez?term=allostasis">allostasis</a>"). rss@dailykos.com (Andiamo) amygdala cardiovasculardisease chronicstress Diabetes HCR Health Care HealthCare hippocampus hir Hypertension learnedhelplessness Learning Medicaid Medicare neurobiology Neurology noise Obesity Public Option PublicOption Single Payer SinglePayer Stress _863499 Tue, 04 May 2010 18:47:02 +0000 Johnson Story Makes Me Feel Fortunate https://www.dailykos.com/story/2006/12/14/281105/-Johnson-Story-Makes-Me-Feel-Fortunate When I heard the story about Sen. Johnson, my first reaction was concern about his how and how it may affect the Democrats' being able to control the Senate. The second reaction, as I heard about Sen. Johnson undergoing brain surgery and the diagnosis, was far more personal. When I heard that his condition could be caused by (among other things) hypertension, it really struck home for me. More below. rss@dailykos.com (alaprst) Hypertension SD-Sen TimJohnson _281105 Fri, 15 Dec 2006 03:30:52 +0000 Important New Advice for Treating High Blood Pressure https://www.dailykos.com/story/2006/6/27/222664/-Important-New-Advice-for-Treating-High-Blood-Pressure Many people will be on medication to treat high blood pressure (hypertension) so the news that there is new advice on treating it is not entirely out of place here. It comes from the British "National Institute of Health and Clinical Excellence" (NICE) but its recommendations have implications that you should note. These have been re-written in the light of research which shows that one older group of drugs commonly used has significant drawbacks for those with simple hypertension including an increased risk of diabetes. Called beta blockers, they have other side effects, including impotence (so if Rush Limbaugh is on em, that could explain the viagra for his little weekend away - well I had to get a US political link in here somewhere). More details below the fold. rss@dailykos.com (londonbear) Highbloodpressure Hypertension _222664 Wed, 28 Jun 2006 02:41:27 +0000