Hi- This is my second post at this board. I first posted about higher bp readings before dinner . This one is about white coat anxiety. Generally at home my bp is in a good range. I do get a spike before dinner. And, I get a big scary spike at the docs.
I have reviewed recent threads and looked at those relating to white coat. Many are complaining about it but I don't see much in the way of solution. That is the tough part.
So, I am thinking of yogis , you know the one's who have such incredible control over their body that they can do things that really can't be done by anyone without the training. Well, I can't help but think that there must be techniques to deal with white coat. In my own way, with cd's I have tried visualization exercises- they were interesting , pleasant but it really hasn't helped at the docs office. Also at various times I have done slow breathing as written about by Dr. Andrew Wiel. Very pleasant doing this at home. Again, it doesn't do it for me at the docs office.
I can't believe however that there isn't a time proven technique that will do it- allow us to get over white coat.
I see some have tried hypnosis and self-hypnosis and say it didn't work.
Does anyone have any ideas?
P.S. If there are any Yogi's reading this thread , we would so appreciate your sharing!
Have you considerated Biofeedback? I took about 5 sessions. But my apha/beta blocker is at such a high dose that it interfered with the technique. The therapist did have success stories using that method. I think it would have worked with me if I was able to get off my med for a period of time & learn to do it.
I,too have "cuff anxiety" brought on by some horrendous experiences at the Dr's offices. I've learned some tips to help however.
1. Allow plenty of time to get to the appointment.
2. Exercise (walking) for an hour before the appointment but allow about two hrs in between exercise & the appointment. Try to get a early morning appointment so you don't have time to stew.
3. Have an agenda written for the Dr with questions etc.
4. If you are seeing a new Dr, pick up the patient history form a few days ahead. Then you won't be pressured to fill out the paperwork while expecting any moment to be ushered into the exam room.
5. I take about 200mg of Lebetalol ( alpha/beta blocker) about two hours before the appointment. Most patients wouldn't have to take that much. My Dr. approves of this.
This drug helps keep my b/p in check at the Dr's office.
6. Limit your fluid intake to about 4 ounces before the appointment so you decrease blood volume for a short time
which will help keep b/p down.
Last appointment with my PC Doc my b/p was 120/70 whereas it is usually 160/80 or higher. In constrast, I took a canceled appointment on the spur of the moment for GYN & had to gather up my records etc quickly & get out the door having just taken my meds. So I didn't have time for my usual preparations. Needless to say my b/p was up.
I find deep breathing actually makes my b/p higher. Although breathing techniques helped me get through 5 labors.
Good question. Hope you get a lot of responses. Fam
You know, I just got home from the dr. and he says I have high blood pressure. At the office it was 148/85. Now I've been taking it at home for the last 2 weeks and it's been 120's/80 or less every time. He says that doesn't care about white coat syndrome. (In a nicer way of course) He told me that when I'm taking it at home, I am stressfree and relaxed. He said that's not life. During any day we have stressors coming at us all the time. Therefore, if it's high there when I'm having some anxiety, then it's high when I'm in traffic, when the kids are misbehaving, when I'm late, etc etc. He said he recommends me to take meds. I told him I was scared so he said for me to come back in one month for another 5 day check and if its high, I need to take the meds. He said my heart doesn't care if its working so hard because of anxiety, etc. The heart doesn't care WHY its working hard, only that it IS working hard. Seems to make sense I guess.
Have you taken your b/p when you've been stressed out at home? There is a difference between "cuff anxiety" at the Dr's office & real life b/p increases in reaction to stressful events.
There is no point in taking b/p meds which can have very serious side effects & alter one's lifestyle dramatically just so you can show up at the Dr's office with a textbook blood pressure. I have permanent damage to my arms, hands, & knees that have altered my plans for a active retirement. My daily life revolves around when I take my meds & what I can do there after. You have to do the legwork and get a good picture of your b/p during your normal activites stressful or not. It will probably be an eye opener. For example, you would think calling to report a faulty product & to insist on a refund would hike up one's b/p. Making that kind of call doesn't faze my b/p. Whereas interpersonal conflicts especially with relatives does. However, cuff anxiety raises my b/p the most whether at the Dr's office or at home. Fam
Your body is designed so that your blood pressure is going to flucuate throughout the day depending on physical or emotional activity or lack thereof. So if your blood pressure goes up during aerobic exercise for instance, does that mean you need BP medicine? Of course not. Same way if you are stressed or fearful, even subconciously (white coat syndrome). Your BP is going to raise. It's called fight or flight.
It is consistant High BP that is the problem--when it is high all the time--that's what causes all the damage and needs to be controlled. If you have true HBP, you might have lower readings at home but they would still be high, they would never be really good ones. A doctor should understand that, and if he doesn't he really doesn't know the human body at all.
As far as breathing, I find just breathing evenly and normally as possible is best.
I have White Coat S. Right now, I'm trying NLP. It worked for me when I would get this at home. It is where you imagine having good readings at the doctor's over and over again. Because your subconscious can't distinguish between imagination and an actually memory, if it expects it will have good reading at the doctors, it will, in actually begin to happen (as long as it is really WCS and not HBP). Supposed to take about a month of daily practice. Will report back.
This is a great thread with two important topics. Some open-minded doctors are finally starting to accept that home-monitoring of bp is more important than their own readings in the office. For instance, Dr. Cameron advocates this, although many doctors still don't want to give up control and they mistrust their patients!
White coat syndrome has contributed to many many people being on drugs that don't need to be. As already pointed out by others, our bodies are designed to fluctuate in bp to meet requirements and circumstances. It shouldn't take a genius to recognize that many people will spike in bp when they visit the doctor, especially when so much is resting on it! So does this merit a prescription?
If you have a quality monitor and take your readings carefully and consistently I would insist on using these for your doctor's diagnosis. Furthermore I would refuse a prescription based on white coat syndrome when home readings indicate lower bp.
As for preventing white coat syndrome I think this is very difficult if you are of this nature. There are various ways to control anxiety, such as biofeedback, but they are difficult and time-consuming. And why bother... other than to convince your doctor that your bp is under control? Why not just monitor your bp at home under normal stress conditions?
Having said that, you can learn ways to control and lower your bp (and anxiety) consistently - and that is far more important. But "deep breathing" is a double-edged sword. I wish people would do away with the "deep" part altogether. It's misleading and dangerous!
Deep breathing, the way usually recommended, causes hyperventilation and increases blood pressure! Slow and gentle breathing is the answer. We don't need more oxygen. That's a myth. When we're relaxed and at rest, during a breathing session, we need very little oxygen. You want to relax and slow your breathing. To do this correctly you have to breathe very gently. It's the slow rate, plus extending the length of your exhale, that lowers blood pressure, not deep breathing. I've been doing this for years and it's the only thing I need for keeping my bp in check.
Most relaxation and anxiety relief programs ignore this. Spoken programs don't use breathing either. Therefore, these offer only temporary relaxation. Research sponsored by the Resperate people shows that only the correct type of slow breathing can bring lasting lower blood pressure.
But the Resperate is awkward to use and totally impractical for white coat syndrome.
There is a newer slow breathing system on CDs or mp3 with music that can be used for specific situations. I've actually used it effectively it for this purpose but the results of one person are meaningless. And I don't really care any longer what my readings are in the doctor's office because I know what they usually are! I just use the program regularly at home.
Last edited by moderator2; 07-14-2007 at 10:12 AM.
Reason: posted commercial website
After checking the rules it looks like I'm allowed to name and describe a product. I use the Breatheasy system. I'm not claiming it's a miracle cure but it's done wonders for me. I recommended it to a friend and, even though she loves the relaxation she gets from it, it has only had a small effect on her bp. But it has a huge effect on me. Like most things I think it depends on the individual and what you put into it. I was super motivated to avoid drugs and I just took to it. If you use it regularly and correctly it really works. And it's inexpensive too.
The one I use goes to 7 breaths per minute and it's not difficult at all. I can easily do 5 on my own but at a certain point it gets a bit silly.
5, 6, 7... it's all effective when you get the pattern right. That's what the recordings are for because you can breathe slow all day and it won't do a whole lot if you don't have the pattern right and do it fully relaxed.
It took me a lot of experimenting to get it right but when I did... boy did it work.
I have the resperate and I find it sort of weird. The in breath is shorter than the out breath and the out breath goes forever. I easily do about 5 breaths per minute. When I am doing the resperate, I never get a relaxed feeling. I feel that I am sort of under the gun to do something specific and artificial. But, I bought the resperate, it wasn't cheap so I do it. Except for the white coat and some few before dinner high readings I am usually in the 120/80 to 114/78 ish range. So not a problem. At the docs I can be 150/92 yikes!!!!The doc wants me to do a treadmill stress test. I wonder how that will come out.
I hear what you folks are saying about not the deep breath and how that can elevate the bp. On my home reading I am doing just light, soft breathing .
Also the person who said that she doesn't drink alot of water before going to the docs office to get a lower reading is so right. I was having a procedure at the hosp. and I could not drink water after 8 am. At the docs office before the procedure, I was surprised that I didn't have my usual stratosphere reading of 150/90 but 130/84 or so. Also a few hours later , when I was being prepped for the procedure same sort of reading. I was really puzzled that I had done my usual high reading. And now that the poster said if you have only had approx 4 oz. water before the reading it will be lower has provided me with an explanation why my reading wasn't sky high that day.
The breatheasy sounds good, and probably would have been a better fit for me.
What kind of music does BREATHEASY provide? For me that's EXTREMELY important...must be good classical.
Something like MOON RIVER, Henry Mancini,or any Frank Sinatra songs would have me hanging by my nails from the ceiling worrying about having a STROKE. We won't even TALK about Hip-Hop.:
What is the format of the CD's? If ONLY mp3 that will leve me out because my main stereo system is vintage wonderful but the CD deck won't decode MP3. THus the cheaper download is out of the question.
So what is the in-out ratio of the breath...is there a hold between the two. Example, 5/minute is a 12 second breath. How many seconds in, now many hold and how many out...is there a pause before the out and the next IN? Something like 4-1-6-1? or 5-1-5-1?
(Can you see I'm trying to pick your brain for a freebie? )
My set has about 4 hours of excellent classical and an equal amount of what they call ambient. It sounds like New Age but without any whales or other silly stuff. I actually like it better than the classical, at least for this purpose.
I don't really think rap or even Sinatra would work too well. It has to be really slow and relaxing.
My CDs are real CDs. I don't even have an mp3 player.
So far as I can tell, I think the slow rate is 6 or 7 breaths a minute. Yes, there are pauses between breaths and you can adjust yourself to it. Sorry but I don't pay much attention to the precise timing. It would be hard to figure out. But I do know the exhale is much longer than the inhale.
I'll see if I can come up with anything more.
From what I've read about breathing exercises and reduced bps, one can achieve results simply by doing exercises 15 minutes per day for two months...the goal is to achieve 10 breaths or less per minute versus the typical 16-19 breaths per minute.
Deep breathing is important here, though...I don't know how I would define deep breathing but perhaps, like a sigh. One should take in a long COMFORTABLE breath, and take twice as long to exhale.
I say deep breathing is important based on the studies of people with sleep disorders who often experience hbp...theory is that low oxygen levels (that one experiences when one stops breathing or takes shallow breaths) reduces the amount of nitric oxide (NO) in the blood, which is important for maintaining the elasticity of the arterial walls. Another theory suggests, people who take shallow breaths do not clear their bodies of sodium as effeciently as those who take deeper breaths.
Oh, and I took my bp "normally" and got a 131/82...after taking a few deep breaths with slow exhales, reduced it to 116/69...but my understanding is that in order to maintain the lower pressures throughout the day one needs to do one's "exercises" daily.
Great info!!! You know I did my slow deep breathing while raising my arms up the side of my body) on the inhale. Then holding my breath a few seconds with my hands together above my head. After that I slowly exhaled with pursed lips. I think I went from 160 to 135 with a small decrease in diastolic. It's been a while since I did that experiment.
I've been thinking about the sleep apnea stuff & wondering if one reason some of us have HBP is lack of oxygen during the day as well as during sleep.
If c-pap causes a decrease in b/p, why not try to use some oxygen gadget during the day. I may do an experiement. Hooking up my c-pap in the kitchen when I'm cooking etc for about an hour & see if it helps. My husband will probably freak out seeing me with a mask & tubing flowing. As you can see I would rather do most anything than taking a med. Great b/p's BTW!!!
Sounds like you may have learned your breathing exercise by doing some yoga! I'm not surprised that it brought the pressures down a bit...have you tried doing the breathing without the arm movement? It may be even lower. Let me know what you find out and I'll try to experiment a bit here, too.
Originally Posted by famnd
...I've been thinking about the sleep apnea stuff & wondering if one reason some of us have HBP is lack of oxygen during the day as well as during sleep...
I think you may be correct in your hypothesis...before I found out I had sleep apnea, I blamed my fatigue on "lazy" breathing. What I've since learned is that 1. People are supposed to breath through their nose. 2. People who don't breath through their nose sometimes have allergies. Either way, it can lead to shallow breathing and therefore reduced oxygen levels in the blood---which in turn reduce levels of nitric oxide (which help regulate blood pressure). It may also explain why asmatics are prone to sleep disorders and why their conditons respond so favorably to cpap...mind you, I haven't researched the "WHY" part of this correlation, but the asmatics in my sleep support group attest to huge improvements in their conditions. It may also explain why nerves and stress elevate pressures as nervous people and stressed out people take shallow breaths and are told to take deep breaths to relax.
...If c-pap causes a decrease in b/p, why not try to use some oxygen gadget during the day. I may do an experiement. Hooking up my c-pap in the kitchen when I'm cooking etc for about an hour & see if it helps. My husband will probably freak out seeing me with a mask & tubing flowing. As you can see I would rather do most anything than taking a med....Fam
Oh, would I love to see you cooking up a storm in full attire! You should try doing this before the meter man is expected to do his reading, grin! Let me know if it works! I've read that some think that one of the benefits of exercise is that it forces one to breath harder...but of course, there are other benefits as well.
Fam, I was almost down another 10 pounds in weight but pigged out yesterday...what a downer. As for the bps? They're low tonight but not always. I'm a borderline...I don't add salt but if I watched how much salt I ate, I'd probably have good control until I took off my pounds. As for the bp meds, I'm convinced that the last one interfered with my sleep so much that it elevated my pressures...I suspect the same of the other meds but I had DIFFERENT sleep problems with them...I sleep through the night now, don't wake to pee, and DONT TAKE ANY NAPS....geez, I must be a grown up again, thank goodness.
How are you doing on your weight? I must get to the pool. I'm sweating between 2-4 pounds per day and would prefer to work out under cooler conditions.
I'm quilty as charged too. Felt like having some treats, but I had my nutrious stuff first. I think you need a break now & then. I can't believe you are almost down another 10 lbs. Way to go, Beth!!! Read these success stories of people losing wt & decreasing their b/p's is encouraging.
My dogs here so I better go as she is starting to feel neglected. Fam