High blood pressure !

[Enough!Participant @enough]

Posted by Georgineer on 29/01/2020 20:56:10:

My wife's a nurse, and she told me that if you suspect that all isn't well with your heart, the magic words are "chest pain".when speaking to the doctor's receptionist. it certainly worked for me!

Not on this side of the pond. Say that to a doctor's receptionist here (Ontario) and she'll immediately tell you to go to emergency.

[Raphael GolezParticipant @raphaelgolez]

Good day to all! Getting ready for my morning ward rounds at work. Just scanning through. Chest pain as a clinical presentation had a vast differential diagnosis ranging from a benign musculoskeletal cause to a life threatening condition such as acute myocardial infarction and pulmonary embolism. An experience clinician, one can tell this right away (patience presenting very unwell). However experience will guide a clinician to take a very good and detailed clinical history supported by a very good clinical examination and diagnostic work up. A disease or pathological condition can presents in so many ways and sometimes even the best professors in medicine will take a while to diagnosis conditions that are very difficult and rare. We do discuss constantly with our colleaagues for second opinions and we don't work alone. So many different fields and specialities. Even in my practice I sometimes see cases that are very hard to diagnose despite extensive work up. Each case are also different and as one would find cases that would present as a "classical" text book presentation, one can also find "atypical" presentation and a diagnostic challenge.

Raphael

Edited By RAPHAEL VAL GOLEZ 1 on 30/01/2020 06:05:56

[Clive HartlandParticipant @clivehartland94829]

Yesterday I received notification of my appt. for Lumbar steroid injection, go there on 14th Feb. need someone to take me and bring me back. At age 82 it takes a while to get motivated in the morning but a dog is a great companion now. I have to move to let her out.

This spine problem has crippled my workshop time and I sit and think of all that tooling going to waste in the garage, maybe I will have to move it on soon. Along with this I have been unable to work my bees, I lost last years honey harvest and all my customers. Not sure I can carry on now.

Has anyone noticed when stuck at home how lousy the TV programmes are, repeats and stupid concepts? I have now gravitated to Stargate and of all things Tipping point ! Seriously now thinking of dumping Sky when the TV licence starts again for over 75's.

[David George 1Participant @davidgeorge1]

Second day on the tablets ( Amlodipine ) slight raise in BP from 135 -91 to 142-95 I thought these tablets were supposed to reduce BP. All well I suppose I am expecting too much too soon.

David

[Michael GilliganParticipant @michaelgilligan61133]

Posted by David George 1 on 30/01/2020 07:40:12:

Second day on the tablets ( Amlodipine ) slight raise in BP from 135 -91 to 142-95 I thought these tablets were supposed to reduce BP. All well I suppose I am expecting too much too soon.

David

.

Difference like that are ‘in the noise’ … but the change from your 180-70 seems “interesting”

I would certainly request that 24hr monitor.

MichaelG.

[CirclipParticipant @circlip]

Had horrible nightmares when on Atorvastatin, changed to Simvastatin. Atenolol change to Bisoprolol, said it lessens coldness of extremities.

Clive, re TV, Freeserve is free and with a Humax box, so is Freesat, plugs in to your Sky dish.

Regards Ian

[David George 1Participant @davidgeorge1]

I have my own monitor and intend to keep a check my self daily.

David

[EmgeeParticipant @emgee]

Posted by David George 1 on 30/01/2020 07:40:12:

Second day on the tablets ( Amlodipine ) slight raise in BP from 135 -91 to 142-95 I thought these tablets were supposed to reduce BP. All well I suppose I am expecting too much too soon.

David

First mention of Amlodipine in this topic, I was beginning to think I was alone with taking this tablet. Was on 5mg daily dose for 17years, now been increased to 10mg daily but BP still over where it should be.
Like David I check BP at home but not now as frequently as I used to.
It seems BP lowering tablets come in pairs, I take Amlodipine and Ramiprill but have found since drinking the occasional cup of coffee and mainly tea my BP has dropped 5 points.

Emgee

[JAParticipant @ja]

Posted by David George 1 on 30/01/2020 09:46:15:

I have my own monitor and intend to keep a check my self daily.

David

I did that over half a year, the average of three readings three times a day.

You get an awful lot of numbers and the whole thing becomes a statistical exercise. The one thing you realise is that a single BP reading by itself is not that meaningful.

JA

[Michael GilliganParticipant @michaelgilligan61133]

Posted by David George 1 on 30/01/2020 09:46:15:

I have my own monitor and intend to keep a check my self daily.

David

.

That will be much less diagnostically informative than the data-logging

… But it’s none of my business, so I will refrain from further comment.

MichaelG.

[Peter G. ShawParticipant @peterg-shaw75338]

Been on Amlodipine 5mg, Aspirin 75mg, Atorvastatin 40mg (originally 80 – can't remember why it was reduced), bisoprolol 2.5mg, Candesartan 16mg for 5 years now. BP now about 115-140/60-70. Resting pulse rate about 60 upto about 90 when working moderately hard on the exercise bike. No problems at all.

Must admit to feeling the cold a lot more now. Old age? Heart pills? Don't know but it's controllable so why worry.

Also on Lansoprazole 15mg for stomach acid control & folic acid 5mg for something or other, can't remember what.

And finally 30mg Afatinib for lung cancer.

About home BP monitors. A few years ago my GP started requesting a weeks worth of home BP readings every 3 months, and for this they had a few BP meters to borrow, After finding a week or two's delay in borrowing one, I bought one from Boots at £40. This was the mid price of the three they had on offer, the other two being £20 & £80. I then discovered that it was supposed to be recalibrated and checked every 2 years. On finding that this would cost £30, I didn't bother and instead rely on seeing what the ones used by the various medics show, working on the basis that if their's show something similar to mine, then there's a good chance mine is reasonably ok. If not, then £20, or even £40 for a replacement isn't going to break the bank.

Tea & coffee drinking. That's a funny one, Funny as in strange. In the '70's I was a big drinker of sweetened tea. But then decided to cut out suger, which I did overnight. Coffee I gradually increased intake, and managed to reduce amount of suger, but not quite cut it out. Ditto cocoa/hot chocolate.

Prior to the cancer diagnosis I was drinking two cups of coffee, two cups of tea and one cup of cocoa per day, along with a cup of Ribena first thing. One of the side effects of the Afatanib is that it can affect taste. Plain water now tastes absolutely foul. Tea (still unsweetened) is no longer the "delicious golden nectar" it was, but it's not too bad. Cocoa is ok. But I've changed and now I have cup of Ribena, one cup of coffee, two cups of tea, one cup of cocoa & a cup of Horlicks per day. Ps a cup is 200ml. and ok, I'm aware that it's only just borderline acceptable.

I've not been a strong drinker of alcohol for 50 years now, although I did enjoy an occasional 1/2 pint of bitter shandy. Since the cancer diagnosis I haven't had any shandy so don't know if that taste has changed.

Peter G. Shaw

 

Edited By Peter G. Shaw on 30/01/2020 11:17:20

[Raphael GolezParticipant @raphaelgolez]

Posted by JA on 30/01/2020 10:51:20:

Posted by David George 1 on 30/01/2020 09:46:15:

I have my own monitor and intend to keep a check my self daily.

David

I did that over half a year, the average of three readings three times a day.

You get an awful lot of numbers and the whole thing becomes a statistical exercise. The one thing you realise is that a single BP reading by itself is not that meaningful.

JA

Totally agree with JA.

As I mentioned previously BP is dynamic. Managing Essential hypertension can be challenging at times depending on other co-morbidities.

David, did your doctor set a target BP for you. Your current BP seems to be very acceptable. As we get older our arteries get "stiffer" and less compliance thereby increasing vascular resistance and increasing our BP. They have given you Amlodipine which is a non selective calcium channel blocker which acts on the calcium channels to reduce BP and arterial resistance (muscle membrane have Calcium channels). Arteries have a thick muscle layers to control vascular compliance, this constricts or dilates and as a result generates resistance or reduce resistance thereby increasing or reducing BP. Think of it as a Hydraulic system if I may site an engineering example.This is just one system that our body adjust BP. Our nervous system also plays a role as well as our kidneys and fluid balance. ACEi acts on the RAAS system (renin-angiotensin system), Betablocker acts on negative chronothropic effect on the heart, Mineralocorticoid antagonist acts on the fluids and also mineralocorticoids, Diuretics acts on the preload to the heart (fluids exchange/absorption in the kidneys), alpha channel blockers etc. Its a dynamic system and very complicated. In clinical practice you have a target BP and aim for that range. Identify the cause of hypertension,lifestyle modification and managed other co-morbidities. Most common cause of hypertension in the general population is Essential hypertension. In my practice, especially our ageing population my main worry is polypharmacy and very tight BP control that elderly patient run the risk of hypotension and causing them to fall as a result of strict BP control. This can suppress autonomic nervous system control and hypo perfusion especially brain hypo perfusion and orthostatic hypotension. My aim for target BP for the elderly will be around 140-155 systolic. Again it would be wise to get an ambulatory 24 hour BP monitoring for they can map out your BP.

Raphael

[Raphael GolezParticipant @raphaelgolez]

Hi Peter,

Normally we start high dose statin (in your case 80 mg of Atorvastatin) in cases of acute myocardial infarction as a higher dose (80mg) due to the pleiotropic effect of statins IE arterial plaque stabilisation, improve endothelial dysfunction and anti-inflammatory response (yes a heart attack is an inflammatory process). After which we reduce it to 40 mg as a maintenance for secondary prevention.

Folic acid is given if you have low folate. Some medication have anti folate activity such as methotrexate. One other cause of low folate is low dietary intake of folate rich food.

Raphael

[Clive HartlandParticipant @clivehartland94829]

Drinking coffee at work, the coffee machine was the type that dumped coffee powder and then milk powder. Never thought that the milk powder would be a problem as at home I used milk. I started to get pains in the stomach at work after the coffee so checked the milk powder source, it was the same stuff they make glue out of! I cut out the powdered milk and just drank it black and within a short time my tummy was fine.

Re milk, do you use skimmed milk? I did not like skimmed milk and preffered full fat milk and that is what I use now, dietry recommendations is 20 grms. of fat a day as i cannot stand animal fat so all my meat is fat free. I prefer fish/chicken to red meat.

Amlodipine, some years back I went for an asthma check and was asked to demonstarte how I used them, I had already that morning taken the usual two puffs of both. This bothered me as I knew it would double my intake. I did as asked and she seemed pleased but then wanted to take my blood pressure which of course was up quite a bit as the Ventolin and Formoteral increase the pulse rate. Panic, you have to see a Dr. now which resulted in me being given Amlodipne. Net result was that in three days I had a massive allergic reaction to it, breaking out in hives and red rash, itchy back and dizziness. Dumped that lot and never went back to it.

At that juncture she said I could take 12 puffs of Formoteral a day but I corrected her and she pulled out the Pharma copia and was stunned when she found I was right. I could only wonder what would happen if i took 12 puffs of Formoteral a day. I then refused any further medical visits to them.

Further to this I was at that time also visiting the Chest Clinic about every 3 months and I found if i took an anti allergy pill (over the counter sales) it reduced all my asthma symptoms and I mentioned this on a visit to the clinic and was told I need not come back anymore. So to this day I have allergies but it is not always apparent what the source is, I wash clothes in Non bio stuff, soap, I use pure soap. One item, Flucloxacillin brought me out in red rash and hives, a check shows that over 50% of Flucloxacillin users are allergic to it. I have no trouble with bee stings but Wasp stings feel like the Flu.

[Ady1Participant @ady1]

I had angina at 40 nearly 20 years ago even though I humped 10+ miles over a couple of munros every Sunday

When it hit me I was just like my grandad in his 60s, grab that left arm and grimace

It was work stress, I jacked my job for a different one and was angina free within 7 days, never used any medicines, never looked back since

Got a wee minor twinge again about 12months ago when the double glazing was getting put in, lifestyle/stress has a big impact on the old tickeroo

[Neil WyattModerator @neilwyatt]

Posted by David George 1 on 30/01/2020 09:46:15:

I have my own monitor and intend to keep a check my self daily.

David

Go mine at the phramacy, it was half price because of changing stock or something

My doctor's told me to bring mine in and checked it side by side with their 'professional' ones, and told me it was spot on.

Last checkup… the nurse was using one that appeared to be the same make as mine!

[Peter G. ShawParticipant @peterg-shaw75338]

Raphael,

Thanks for that.

I think, but can't confirm it, my cholesterol was in the region of 2.3 or 2.4. After the statin reduction to 40mg from 80mg, it went up to about 3 which was thought satisfactory. Prior to the heart attack, it was around 5 or more.

I confirm that before going on the folic acid, I was advised to eat more dark green food, eg broccoli. But obviously, this wasn't enough.

Peter G. Shaw

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