Argument with new doc on first meeting [Archive]

Uff-Da!

12-06-2005, 08:22 PM

LOL! I just met my gastroenterologist for the first time. Am sure glad he is not my PCP or he wouldn't be my doc for long. He noted that my blood pressure taken by the nurse when I entered the office was 157/82 and that I was not currently on BP medication. I told him that I'd taken myself off the meds almost a year ago and that for most of the year, I'd averaged about 125/72 at home. "But," he insisted, "home readings don't count." Only the readings in the doctor's office count as to whether one really has hypertension or not, and one should be medicated accordingly. Sheesh!

What an egotist! I feel lethargic as blazes and don't want to do a thing when my SBP gets much below 115. And that was happening quite often while I was still on the meds. I should have told him that it was only a couple of months ago that I had two days of readings around 99/58 unmedicated. Can you imagine what I'd have been like if I'd been on BP meds at the time?

Well, I get my colonoscopy done in a couple of weeks. I hope they don't find anything of consequence, not only for my health, but also so I won't feel a need to see any more of this doc.

Sponsor

redherring

12-06-2005, 10:03 PM

pal7778

12-07-2005, 12:53 AM

Everything counts, which is why medicine shouldn't be prescribed based on a single reading. It's amazing that a MD would do anything without getting a number of readings in various settings.

lateeth

12-07-2005, 04:10 AM

And I had a similar experience. My doctor's appts are always in the AM when my pressure is good. It was skyrocketing almost every evening, but they insisted every time i came in it was perfect...well I guess i need to make an 8 pm appt at that docs!
Good luck on your colonoscopy! Not a fun exam. And my guy told me it was a piece of cake, could not figure out why everyone complains because it was not at all a bad experience. He looked under 50 to me so i asked him if he ever had one himself. Guess what his answer was!!! So he is an expert on how it feels!

Lenin

12-07-2005, 08:48 AM

Uff-da,

I'll bet you wanterd to scream out something like:
"Hey s&%head, agstroenterologist means from my mouth to my %#$hole...not my BP. You are out of your specialty...thus no more informed than my mailman!"

Or, "I hope you're not thinking of CHARGING for commentiing on my BP....that's not why I'm here." :D:D:D

It doesn't surprise me, though. We white coaters take SOOO much guff from the doofs.

Moxie75

12-07-2005, 09:10 AM

zaboz

12-07-2005, 11:49 AM

My doctor has said, and I agree, that a mix of readings is necessary. I do at-home readings and while she doesn't dismiss them, she makes a good point that we're most relaxed at home so those readings by themself may not be the most accurate. She has me take them at grocery stores and other places, as well as in the office, for the fairest assessment.

I don't think your doctor's comment was completely out of line, although the way he phrased it came across as a bit ridiculous. Of course home readings count, but you need more than home readings for a full picture. Most of us have to deal with traffic, work and stress on a daily basis so you do have to account for your blood pressure during those times too.

Good luck in dealing with him!

starsofglass

12-07-2005, 12:02 PM

Well, there's stress and stress... Even when I'm stressed out, preparing an exam or something, I still have normal BP, 110 or 120 (unstressed it's on the low side), or sometimes even extremely LOW BP because of the lack of sleep. However, at the doctor's it's 140-160...
No doc is going to prescribe me BP meds, unless he wants to get fired :D

zaboz

12-07-2005, 12:08 PM

Have you tried taking it out in public in other places? For me, getting ready for an exam isn't that stressful compared to dealing with crowds or heavy traffic for example. My readings vary a lot too, I've seen 90/58 and 170/110. I've had great readings at the doctor and bad readings, which didn't match up to my numbers earlier that day. That's probably why it's all about averages. It's frustrating, isn't it?!?!!

Lenin

12-08-2005, 10:22 AM

I even get good readings in a HOSPITAL setting...consistently below 120/80 but in a doctor's office my brain is filled with:

Make sure THIS test is done,
ASK for this drug...if he balks show him THIS evidence.
Make sure to get the referral to X and definitely NOT to Y.
I want that refill made renewable 10 times...NO not twice.
WHY is he taking my BP to torture me.
Is he going to say AGAIN "Yes, but we are concerned what happens to your BP when under stress."
If he mentions STROKE again, I'll stick a ball point into his eye.
Why is he ignoring what I came in here for and babbling about BP.

That's why I have White Coat.

mursy

12-08-2005, 10:48 AM

Solair

12-09-2005, 12:34 PM

My cardiologist seemed to think that a 24 hour ambulatory BP monitor that takes your BP every 20 mins over a normal day of activity was the only real way of diagnosing hypertension.

Try asking for an ambulatory BP monitor test. He will get a very accurate idea of what your BP along with graphs etc over a 24 hour period.

Uff-Da!

12-09-2005, 01:01 PM

I inquired about an ambulatory BP test several weeks ago. Not even the hospital, let alone the doctors' offices in my county, has them. Okay, I live in a small rural community. Population in the whole county is only about 67,000 people. The modern world will find us some day. :D

I don't feel any concern about my daytime BP. I'm retired and can take my own pressure often enough that I feel I know what is going on. I'm enough of a hermit that what my pressure is elsewhere wouldn't be much of a factor in exerting pressure on the blood vessels. What I was concerned about, though, is whether I am a "dipper," "non-dipper," or "reverse-dipper," meaning does my pressure go down at night like normal, or does it stay the same or actually go up. Because the total number of sleeping hours would have a definite impact on blood vessel damage, this could be important. And I haven't figured out a way to take my own pressure while I'm sleeping. :p

At any rate, I'm only concerned about reaching my own conclusion, not convincing a doctor. If I reach the conclusion that I need to go back on meds, I'll inform my PCP, and she'll be happy to accommodate.

Solair

12-09-2005, 01:19 PM

Wow, Ambulatory BP montiors arn't really all that expensive thesedays. Is there a cardiology department in any of the near by hospitals?

I'm in Cork, South Coast of Ireland, not a sprawling metropolis by any means either, but the 24 hour BP monitor certainly wasn't an issue.

If you can't get the professional equipment from a hospital you could always get your own digital BP monitor at home and record a series of readings over a day:

http://www.argos.co.uk/static/Product/partNumber/4407386.htm

(I know that this isn't in the USA but, I'm sure you have similar products in similar stores)

Uff-Da!

12-09-2005, 04:12 PM

Wow, Ambulatory BP montiors arn't really all that expensive thesedays. Is there a cardiology department in any of the near by hospitals? :D I talked to someone in the cardiology department of the only nearby hospital. He told me they didn't have one and had no idea who did. :D The next nearest hospital is in a larger city and I'm sure would have them, but that is 80 miles away over a mountain pass. People in our area have to go there for a lot of specialty things, but I'm not sure this is really that serious as to warrant the extra time and trouble, especially in the winter.

I do have a digital BM monitor. That's how I have a good idea of what my BP does at home. On rare occasion, I have taken as many as 20 readings in one day. But as I said, my only concern is what happens at night. As long as I was averaging 125/72 or so in the daytime (which I've done most of this year), the night readings likely wouldn't be high enough to warrant meds even if I'm a reverse dipper. But the last few weeks I've had quite a few daytime readings with systolics in the 140s and 150s. The average is still under 135, but what happens at night could make the difference in whether or not to medicate if this keeps up. I've had intestinal problems and can't seem to handle the high-fiber, near vegetarian diet that had brought my BP down to where I was able to get off meds. I'm just hoping that whatever the GI guy finds wrong with me is going to allow me to go back to my near vegetarian diet again. Otherwise, on this lower-fiber diet I'm having to eat now, I might have to go back on meds.

I think I may start taking my BP monitor to bed with me and seeing if I can get some readings when I wake up in the night. The readings I'd get that way would be higher than when I'm actually sleeping, as I understand that one's pressure typically goes up to what is for most people it's resting peak of the day just trying to wake the body up. Besides, just moving around trying to turn on the light, getting one of my cats away from my left arm where she usually sleeps, and getting the BP cuff on would all be activity that would increase one's BP above the rate when sleeping. I doubt that all that would increase the SBP more than about ten points, though, so I guess I could make that allowance and at least have a hint of what my sleeping BP might be.

lateeth

12-11-2005, 12:22 AM

A friend of mine was trying by email to convince me to buy a measure all the time blood pressure monitor which he found on ebay. He said it was quite reasonable. I did not look for it but it should be quite easy to find. Anyway, with the cost of gas these days it might be cheaper to order one than to drive back and forth the 80 miles to have the hospital do it.

Solair

12-11-2005, 10:25 AM

Many of them can be set up to take readings automatically over a 24 hour period. Pretty much the same way as a professional ambulatory bp monitor works.

The only thing I would say about ambulatory BP monitors is that I don't think that the overnight readings are all that accurate. You can't not notice the cuff inflating and it does disturb your sleep. I guess it's as accurate as you can get though! Also, perhaps the BP being very high didn't help either... i.e. it had to squeeze harder!

Also, the brand new Delmar Reynolds monitor that they gave me left me with bruise marks on my arm. I guess, you can't really take BP readings every 20 mins and expect not to have a sore arm.

The machine I was using was set up to do readings every 20 mins during the day and every hour during the night. It doesn't actually know when you're sleeping it's just programmed with a schedule.

Lenin

12-11-2005, 10:39 AM

For some reason my last 2 doctors have briefly MENTIONED these 24 hour monitors and then dismissed it...perhaps it's an insurance company thing. For me I doubt they are as rare as for Uff-da since all my doctors are in NYC.
Perhaps they are afraid of having to stop yammering about BP in the face of home readings that they can't dismiss. :D

I had one in the hospital and even during sedation in a recovery room it managed to wake me EVERY blessed time it inflated. Damn, I wish I'd torn off the printout (like a grocery store receipt) to show my doctor <shove up his...ok, let's say NOSE?> Consistent 110/70's...right up until the time I was disconnected, dressed and caught a bus/subway/PATH train home.

You know, the more I think about it the more it seems reasonable that the AMA would discourage an infallible, at home test like this. It really WOULD be bad for business because BP testing WITHOUT A PRINTOUT is one of the few things that a GP can still DO. A friend even has her routine blood draws done at QUEST labs (where most blood testing gets done these days.)
And God-forbid, imagine if the patient had that little strip of paper to wave at the doctor every time he said the word STROKE!

Now if we could JUST get the "power of the prescription pad"...I guess that's only for countries where the doctors UNION doesn't have the force of law behind it. Imagine if it ws a crime in every state to do your own PLUMBING or EKLECTRICAL WIRING! ;)