I've had what they call "white coat syndrome" or "white coat hypertension" for years. I go into the doctor's office, they do a routine check, my BP is high. If I make them take it again when I'm ready to leave, it's much lower.
R. and I traveled to see relatives at Christmas. While there, the cold I had progressed to bronchitis and I was very, very sick. I ended up at the emergency clinic in my hometown a couple of days after Christmas, begging them to stop the coughing. They did the routine BP check, and the doctor's eyes went wide. I'm surprised he didn't make me go to the hospital then and there, it was so high.
I'd been sick for weeks, had been coughing hard for days, hadn't been sleeping, had been surviving on hot tea and the occasional two bites of food, was sitting in a doctor's office on my "vacation", had been taking OTC cough meds that the doc said was probably not helping, and was dealing with massive family drama. No wonder my blood pressure was through the roof!
The doc was understanding, but did give me a short talk about keeping an eye on it and getting it checked out. Fair enough, and I appreciate the kind but firm way he handled it.
Now that I'm back at home, it's been in the back of my mind. I come from a perfectionist and workaholic family; I've always lived an incredibly high-stress life; I have some social anxieties and tend to stress out about things. Thankfully I don't have a family history of BP issues. I wouldn't doubt that I have mild hypertension, and I'd bet a lot of money that it's due to stress and genetics rather than the dreaded fat.
Nonetheless, hypertension is one of the classic "fat diseases," and I'm quite honestly scared to have it checked into and only get a lecture about losing weight. I'm taking some steps on my own: I'm trying not to stress as much (which half the time leads into stressing about getting stressed, oi). I'm keeping an eye on my sodium intake, although I am not restricting. I've stepped back from a couple of projects, and given myself permission not to take on every activity in the world at once. I'm trying to do yoga more often, and am considering trying out meditation.
I should probably buy a home BP monitor - they're not all that expensive on Amazon - but deep down I don't really want to know. I don't want the castigation and shame that comes with having a "fat" disease. It's on my "list of things to go to the doctor about this year," but it's pretty far down that list.
A while back I saw a link on one of the fatosphere blogs to a page describing how to tell if you need to ask for a larger blood pressure cuff. I've since lost the link; does anyone have it? Not once has a doctor used a large cuff on me, and the cuff is always so tight it hurts a lot. Maybe a too-tight cuff is causing some of it too?
There's so much shame and guilt at the intersection of being fat and needing medical assistance that I feel guilty for even asking if improper equipment might be causing a misreading of my blood pressure. How screwed up is that? It's like when I asked to have my thyroid tested because I have a family history of thyroid issues, and the doctor treated me like I was using it as some sort of excuse for being fat. The smugness when the tests were negative was awful.
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I don't have a link to the article, BUT, there is a 20 or so point difference for me between using a regular cuff and larger cuff. When I use a larger cuff I'm always right in the low end of normal, BP wise. When it's the regular sized cuff the velcro can hardly stay closed (I've been asked to hold it closed with my free hand) and it hurts a lot and the result is ALWAYS high BP.
As stupid as this is, I've always been convinced that the cuff hurting is some personal failing of mine, and that I'm just being whiny even bringing it up. At the emergency clinic I did suggest using a larger one, and they sort of blew it off. I was too tired and sick to care.
If the cuff they use isn't large enough, your pressure will read high. The cuff my doctor's office uses is barely large enough for my upper arm, and when the nurse pumps it up, it hurts, a lot. And my pressure is usually around 132/80. When she was all up in arms over my weight gain causing my raised blood pressure, it was 166/90 (160/90 used to be considered normal back in the 80's, before they lowered the standard), mainly because I knew she was gonna go off with the calories in/out crap over the weight gain (which was regaining what I had lost the year before, and I don't know why I lost it or regained it, I wasn't dieting, and nothing had changed). When I went back 2 weeks later, my BP was 144/82, and she was satisfied with that and said I didn't need to come back to have it checked again.
However, I did go to amazon.com and order a blood pressure cuff (one of the wrist ones), cost me $30.86, with shipping and handling (it's the ForeCare 1315, and is fairly accurate, reads a little higher than the arm cuff the doctor uses). I check my BP a couple of times a week now, just to have a record to show her if my BP is ever high again.
Vesta, was 160 really considered normal? Wow! The first Google result says that 120 is considered normal now. Isn't 40 points a tremendous difference?
My BP was 181 over something at the emergency clinic and you could tell that the doctor was pretty freaked out. It generally changes about 20 points if they do it twice at the doctor's office; when they did it a second time at the emergency clinic, it only went down 10 (unsurprising given my mental state).
I don't have any kind of baseline to work from - doctors don't generally give me the numbers when I'm there - so maybe I should buy the $30 one just to get some sort of feel for my general levels.
If your arm circumference is larger than about 13", you almost definitely need the larger cuff. This caused a big issue when I was pregnant, because the weight I gained in pregnancy pushed me right over that, and so my blood pressure started reading higher than it was.
I don't have just "white coat hypertension"--I actually get really phobic about getting BP checks! So now even if I wait until the end of the visit, my BP is still high. I do take it at home, and it's always normal, unless I'm really anxious about something.
I am pretty sure that I will have hypertension at some point. I come from a family with a long history of hypertension--regardless of size, all of my mom's siblings ended up on BP medication before they were 50--and I have panic disorder, which is associated with high blood pressure as you age. I have no doubt that the reason I stress so much about getting my BP taken is because I'm afraid they are going to lecture me about being too fat. And in my case I've never had a doctor give me a weight lecture, so I can't even imagine the stress I'd feel if it had ever happened before!
One thing I'm really careful about is exercising regularly. I know that, when I was pregnant, my blood pressure began to go up, and they had me on partial bed rest, and for me that just made it go up more. (That's obviously not the case for everyone!) Regular aerobic exercise will generally help to lower somebody's blood pressure after about 1-3 months, and it will stay down as long as you keep up exercising. For me it also makes me feel psychologically better about it, like if a doctor were to blame my high blood pressure on my being fat, I could point out how active I am to them. ;)
Amplestuff has measurements for the cuffs they sell at http://www.amplestuff.com/standardbloodpressurekitandcuffs.aspx
Their L cuff is recommended for arms 13" - 19" around, XL for arms 17" - 26", and XXL for arms between 26" and 35".
I've had to insist a few times on the larger cuff; some medical staff have said to me "Oh, your arm isn't THAT big," when obviously it is. So I do insist. One appointment I had recently, they couldn't find the large cuff so used the regular one and the nurse said "Huh, your blood pressure is unusually high. Must be the cuff. Eh." and let it go. Which I appreciate.
I've also had nurses use longer than usual needles for shots for me, specifically the DPT booster. I had no idea longer needles for boosters existed, and was told that the longer needle ensured the drug actually entered the muscle and not just the fat. I'm pregnant and have no rubella antibodies, which means I need a booster after I give birth, and that I'm lucky I wasn't exposed to rubella earlier in pregnancy. I wonder if the failing is because the MMR boosters I've gotten in the past weren't delivered properly because the needles weren't long enough.
Vesta, was 160 really considered normal? Wow! The first Google result says that 120 is considered normal now. Isn't 40 points a tremendous difference?
Yes it is. And they are ratcheting down the definition of "normal" for everything. Imagine the financial disaster we'd have on our hands if they didn't sell more and more and more pills!
What's really aggravating about that is that doctors don't get the insurance company spiff for lowering someone's numbers in a way that really would save their life -- say, taking down someone's systolic BP from 200 to 150. They get them from converting "borderline high" into "ideal" -- say, taking down systolic BP from 150 to 115. Don't even get me started on that.
It might help you to know this: There are two basic components of hypertension, and they are increased vascular pressure and increased cardiac output. The former is much more dangerous than the latter; fat people who have elevated BP are more likely to have it as a result of the latter. Therefore, as long as your BP is not off the charts, or is not escalating, it probably does not pose a lot of threat to your health. But if you have insurance, the insurance company pressures the doctors for numbers, numbers, numbers. That's all they care about.
And if they're too stubborn to use the correct sized cuff, definitely take those numbers with a (cough) grain of salt.
My doctors always have larger cuffs along with the "reg" one. I have large arms and assumed that's why they were used and then heard you can read high if they don't use them.
When my primary told me about a year ago that I had HBP my first reaction was to say but I'm walking on the treadmill etc... to say hey I'm exercising what else can I do. Be basically told me to relax and that at my age, never mentioned the weight, it could happen. He also has it and many people have HBP and you should be medicated for it. So basically he was trying to tell me it's happens especially because of my age and my walking wasn't going to keep it at bay. So now I take medication for it and it has been normal since then. I also am on medication for high cholesterol and medication for type II diabetes and hypothyroidism. I basically am on all the meds that "teh fat" take.
I suppose my age has something to do with the fact that I have acquired many of these medical conditions but I also know that my size has probably attributed also along with a major genetic factor. I also have sleep apnea and sleep with a CPAP machine. Due to the fact that the Lap band didn't work and was removed I'm still left with dealing with these issues. I know many people in the fatosphere are free of many of these issues but I seem to have ALL of them, lol.
Because of all these conditions and my depression/anxiety I seem to have lost a lot of lust for life shall I say.
Caffeine - Sandy had a couple of posts on Junkfood Science about the lowered standards for blood pressure. I printed it out and am going to give it to my doctor the next time I see her. Hypertension was defined pre-1997 as 160/100, in 1997 it was changed to 140/90. Then in 2003, normal BP went from less than/equal to 130/85 to less than/equal to 120/80. The first post I read was Obesity Paradox #15, the second post was from October 14, 2008. My doctor is getting copies of both of those posts, just as an FYI.
I never had any problems with my blood pressure until one check-up when the doctor said it was 150 and I should stop being so fat so that it would go down. (This was the doctor my job sent me to and not my regular doctor.) So then I got myself a blood pressure monitor, and while I have slacked off on measuring it regularly since then it's always been 120-140 (well, a few times more like 115). But of course it is always at its highest when medical people measure it, and if I try to relax that just makes it go higher, so I come off looking like Bad Unhealthy Fatty, and doctors who aren't my regular doctor are so judgmental and weight-obsessed.
Recently I was in the hospital for eight days (for an infection)...while there, I had my blood pressure measured every four hours. This pretty much took care of my white coat syndrome, as I just got used to it. But I did discover something interesting.
The whole time I was pretty much just lying in bed (with the very occasional stroll around the ward) and my blood pressure was ALL OVER THE PLACE.
Sometimes it was 115/75 (what a good girl!) sometimes it was 155/100 (what a bad girl!) and once or twice it was 80/50 (yikes!).
All this with not much variation in activity, emotional state or medication. And it's not like it surprised anyone, or anything.
It led me to believe that taking a snapshot of blood pressure in a doctor's office twice a year is pretty much beyond useless for anyone without extreme, continuous HBP.
I too suffer from "White Coat" -- and I have a larger than average upper arm. I want to buy an automated home bp machine, but I want to make sure I buy one with a cuff that will really fit properly. My husband doesn't trust the automated ones, and wants me to just buy a regular (XL) cuff/meter -- his arms are larger than mine and he wants to use it too.
Anyways, any time I've had it tested NOT by a doctor or a nurse in a medical setting it has been fine or low. Just being at the doctor's office stresses me out. I've had to arguw ti them to get them to use a correct sized cuff, and I have to take my own tape measure to prove I need it! It's ridiculous, but I refuse to take a bp med I do not need -- since I refuse to do that, now I am "uncompliant" and "argumentative" -- so being fat also means I have to be a push over? NO.
I've gotten deeply suspicious of automatic b/p monitors - I always seem to measure high on them, and that's if they can even get a reading! During pregnancy, every time they used an automatic meter they measured high...every time they did it manually with the proper sized cuff, it was 120-125/80-85.
So.
I wonder if other fat people have had the same experience with the automated meters and, if so, if they could in part be causing some false HBP numbers.
Brigid - I don't think there is a whole lot of data about how long immunizations lasts, so it would be hard to tell.
You can read all about the importance of using the correct cuff size (and how to figure out what the correct size is for YOU) on my main website.
It also has a chart of what cuff size is needed for what arm size. I highly recommend that you measure your arm and then look up the cuff size you should have. It can make a huge difference in the readings you get.
http://www.plus-size-pregnancy.org/lgbpcuffs.htm
I have had a request to blog about this sometime soon, so check out my blog in the next few weeks; I'll have more details on the topic there soon. But if you're dying to read about it sooner, check the link above.
They've lowered standards again, and have decided that anything above 115/75 is worrysome, and blood pressure of 120/80 is now officially considered "prehypertensive." It's absurd. How long will it take before everybody in this country is considered "prehypertensive"?
That's funny, Lori. I went to the doctor less than two weeks ago and was told that my blood pressure of 120/80 was 'textbook perfect.' Not that I'm casting doubt on your assertion, just I guess the new oogedy-boogedy hasn't gotten to everyone yet.
In comment to the original post: I once had my blood pressure taken by a medical gentleman who apparently didn't hear me saying over and over that he'd caught a flap of skin in the cuff and it FREAKING HURT ALREADY!!!
When he saw the numbers, he turned white as a sheet, told me to lie still, and got someone more experienced to come over and have a second look at me.
Funny, while the number was still high the second time (some three minutes after that first reading), it seems I wasn't just about to drop dead of a stroke on the spot.
Pain raises blood pressure. It's a physical fact. If the cuff is too tight (or is applied in such a way that it causes pain), your blood pressure will read higher than it actually is.
Twistie,
I'm assuming that a lot of doctors are either unaware of the new guidelines or don't care. I've never had my blood pressure considered anything but fine when it was in the 120s/80s.
But, if a doctor does want to start putting people on drugs as often as possible, now they have an excuse to.
One of the problems I have had with the doctor I see is that they walk me back to the exam room and its a pretty good distance for a fat girl. Then the first thing they do is take my blood pressure and "duh" yes its high. I just moved 400 + pounds of me back to this room.
The doctor always says "your blood pressure is high, we should think about starting you on a medication." And I always answer "take it again before I leave and it wont be that high". He has taken it again on several occasions and it isn't high.
I have a wrist cuff at home and take my blood pressure a few times a week. If I didn't have that I would probably be on the medication because I wouldn't know any better.
Elizabeth, I have had this exact experience as well. Nursing staff in hospitals seem to understand the difference between "excuse to sell pills" and "life threatening".
Not sure if this has been left yet, I'm working (mostly, lol) so no time for comment reading. Hope it helps!
http://www.plus-size-pregnancy.org/cuffsizeprintout.htm
RosyRedLotus, that's it exactly! Thank you.
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