more than one reading
One swallow doesn’t make a summer,
and one high blood pressure reading does not mean you have hypertension.
One of the tests when you see a
doctor is a blood pressure reading, usually denoted as “BP”. Now I take
blood pressure tablets to keep my BP within the normal range, which they
do, provided I take them!
For many reasons, including
forgetfulness, I had not taken any for over a week. When I remembered I
had forgotten, I got the nurse to take my BP. It was 158/87. Too high. I
need to remember to take my tablets! However, about 30 minutes later I
had my BP checked again. This time 147/76. Even more recently before I
had an Exercise Stress Test my BP was recorded as 160/80. Half an hour
later it was 123/70. Explain that!
Was one machine faulty? No, but
what you have to understand is that BP is not a constant, but being
dynamic, fluctuates for many reasons – rushing, coffee, anxiety,
cigarettes and a whole host of others. This is why, if your doctor tells
you that you have “hypertension” (high BP) on just one reading – don’t
believe him (or her).
So how do you find out if your BP
is too high? Quite simply by repeated measurements.
As part of the routine in most good
hospitals and clinics is the measurement of your blood pressure. You
should get this done at least twice a year. Rising or elevated readings
do mean you should get medical advice.
So why is BP important? Because if
you don’t you don’t have BP you are definitely dead! However, if your BP
is too high, it can mean you could be claiming early on your life
insurance policy – or your relatives will.
High BP is otherwise known as the
“silent killer” as there are very few symptoms of the increase in blood
pressure, until a vessel bursts somewhere, generally catastrophically!
The good thing is you are dead within minutes, so you don’t linger.
Blood Pressure is needed to keep
all the organs of the body supplied with oxygen. This is done by the red
blood cells which carry the oxygen, with the pump to drive the system
being the heart. The tubes from the heart heading outbound are the
arteries, and those returning the blood to the heart are the veins.
system is a “closed” circuit. In other words, no leaks, otherwise you
would be continually losing the life-preserving blood, but to make it go
around, there has to be a pumping pressure (just like the oil pump in
your car engine).
The heart squeezes the blood inside
itself and pumps it out into the arteries. This squeezing pressure is
called the Systolic, and is the upper number quoted when we measure your
After the squeeze, the heart
relaxes to allow the blood to fill the chamber, ready for the next
squeeze. The pressure does not return to zero, because there has to be
some pressure to refill the chamber. This resting or ambient pressure is
the lower number quoted and is called the Diastolic. BP is then
typically quoted as 120/70, being 120 (systolic) / 70 (diastolic). The
actual pressure number is measured in a millimeters of mercury scale.
So what is the correct BP? The
following table shows the categories of BP measurements.
Optimal: less than 120/80
Normal: less than 130/80
High blood pressure (hypertension):
Stage 1: 140–159/90–99
Stage 2: 160–179/100–109
Stage 3: 180 or higher/110 or
The problem with running at high
pressure is that the heart is having to work harder, and therefore may
be subject to heart failure. The arteries are also subjected to higher
pressures than they were designed to cope with and can burst, making the
risk of stroke so much higher. Other organs don’t like working at the
high pressures either, and kidneys, in particular, can go into failure
No, if you really have
hypertension, get it treated – but remember to have repeated
measurements done, and don’t let the doctor classify you as being
“hypertensive” until repeated measurements confirm that your BP remains
Is your Coronary Conclusion around the corner?
Readers who are avid health (or
sickness) watchers will know I really mean “Coronary Occlusion”, but it was
too much temptation to use Mrs. Malaprop and end up with “Coronary
Conclusion”. Because quite simply, that is what it can turn out to be – your
conclusion, if you don’t follow some simple rules.
The sad part of all this doom and gloom
is that nine times out of ten you can actually avoid the Coronary Occlusion,
the fancy name for the condition also known as a “heart attack”.
Before launching into the real factors
in the situation, a little understanding of what constitutes a heart attack
is in order. I think everyone understands that you have both red blood cells
and white blood cells. The function of the red ones is simply to carry
oxygen to the tissues, so that the tissues can survive. The heart muscle is
no exception to this rule. This hollow muscular pump needs oxygen just like
all the other organs you keep inside you – spleen, kidneys, lungs, bowel and
so forth. Take my tip – keep them inside you if you possibly can!
However, the inside lining of the heart
(muscle) is smooth and impermeable to the oxygen tied to the red cells. In
other words, the heart does not get its nutrition from the blood it pumps
through it. In fact, the blood supply to the heart is through some
specialized arteries called the “Coronary” arteries. These run along the
outer surface of the heart muscle and then split up into smaller tributaries
which dip into the heart muscle to supply it with oxygen.
Now if we are to consider that the
heart muscle is probably the most important muscle in the human body (well,
physiologically it outranks the other much more highly publicized muscle in
males!) then it becomes important that this heart muscle gets a good supply
of blood. And the quickest way that the supply can get altered is by
blocking off the coronary arteries. This is most usually done via a slow
process by which a small obstruction in the artery slowly gets bigger and
bigger until eventually it blocks off totally and the heart muscle “starves”
of oxygen and that section of the heart muscle, supplied by that artery,
just dies. We have a name for that death of heart muscle too, and it is
called a “myocardial infarction”.
This event of blocking is called a
Coronary Occlusion, which may end up as a coronary conclusion if the section
of dead muscle is large enough! The actual death of the muscle resulting in
this myocardial infarction, is often shortened to the simple M.I. (The heart
muscle is called the myocardium.) But of course, the simpler name is ‘Heart
In short, cardiac health is mainly
involved in keeping the coronary arteries clean and clear. This is where our
old friend Cholesterol comes in. You see, the deposits inside the artery are
generally made up of this chemical and other blood fats. This makes a
“sticky” patch in the artery and some blood cells get stuck there. This
causes a clot to form and you have all the precursors needed to block the
artery, with the occlusion leading to the infarction, and to your family
claiming early on your life insurance policy.
To be able to keep your arteries clear
you need to have a nice low cholesterol, which can be done by diet plus
medication if required. But first you need to know what your cholesterol
level is. This requires a blood test, which can be done at my favorite
The most likely candidates for a heart
attack are overweight, hypertensive smokers, with high cholesterol. If this
is you, do something about it today. Well, perhaps that’s being a little bit
too melodramatic, but you are certainly one of the cardiac high risk people
in the population.
As I wrote at the start of this
article, whether or not you have a coronary conclusion can be under your
control. Stop smoking, lose weight, keep your blood pressure in the normal
range and keep the cholesterol low.
You can drive your own destiny. Start
today. Get a check-up tomorrow!
All choked up
The topics to write about each week come from many sources and ideas,
and sometimes following a direct approach by one of the readers. This
week is one of those, suggested by one of my faithful followers, Mrs.
Laurance Fatus. Thank you for the interest and for the topic, which came
after she witnessed a choking.
It was only while researching the
Heimlich Maneuver that I began to see that there were elements of a good
movie in all the history of Dr. Heimlich’s maneuver. Money, family
jealousies and more money, interspersed with some ‘dodgy’ science. A
The good doctor Henry Heimlich has
been called a “fraud” by his son Peter and criticized by many in the
medical community for conducting studies on HIV patients in China -
which were banned in the U.S. - that involved infecting them with
malaria to cure the HIV. The technique was called “malariotherapy” and
was used decades ago to treat syphilis but fell out of use because
apparently too many patients were dying of malaria infections.
Heimlich (who was a thoracic
surgeon) even admitted that he had never practiced his maneuver before
publishing the details, and first tested his maneuver on dogs!
When questioned about this he is
reported to have said, “I thought about writing a medical article, but
if I waited for that to be published and for doctors to recommend it to
patients to prevent choking to death, I knew it would take months or
years for the word to spread. I did something fun, and I had a
well-known medical journalist describe my dog study in a 1974 syndicated
column picked up by hundreds of newspapers all around the country. A
week later, an article appeared in the Seattle Times describing a man
who tried the maneuver after reading about it, and he saved the life of
his neighbor who was choking on a large piece of chicken.”
So how do you perform the maneuver?
(The following is taken from Wikipedia.) “Performing abdominal thrusts
involves a rescuer standing behind an upright patient and using his or
her hands to exert pressure on the bottom of the diaphragm. This
compresses the lungs and exerts pressure on any object lodged in the
trachea, hopefully expelling it. This amounts to an artificially induced
cough. For example, WebMD recommends the rescuer placing his or her fist
just above the person’s bellybutton and grasping it with the other hand.
To assist a larger person, more force may be needed. The Mayo Clinic
recommends the same placement of fist and hand and upward thrusts as if
you are trying to lift the person.
“If the victim is not upright, the
US National Institutes of Health (NIH) recommends positioning the person
on his or her back, then straddling the torso and using chest thrusts.
“It is possible for a
still-conscious choking victim to perform the procedure on oneself,
without assistance. The NIH recommends other procedures for children and
for infants under a year old.
“Due to the forceful nature of the
procedure, even when done correctly, abdominal thrusts can injure the
person on whom it is performed. Bruising to the abdomen is highly likely
and more serious injuries can occur, including fracture of the xiphoid
process or ribs.”
The American Red Cross, one of the
more sober organizations, removed the Heimlich maneuver from its primary
recommendations in 2006, returning to promote the use of initial “back
slaps” to dislodge the foreign body.
If the back slaps were
unsuccessful, then the Heimlich could be used, but interestingly,
removed the name Heimlich and replaced it with “abdominal thrusts”.
It should also be noted that there
is no recommendation for the use of the Heimlich maneuver for drowning
victims, and the authorities are saying that its use is contraindicated
for victims, even though Dr. Heimlich claims it works.
So what to do for simple choking?
Five forceful back slaps, then five Heimlich maneuvers. And hope a lot!
Who has taken my “effing” pen?
It has been shown to the satisfaction of the medical world that humor and a
good laugh really is good medicine. Some hospitals even employ clowns to
brighten up the days of the inpatients. And no, I am not the clown.
However, one of my favorite jokes
involves a parrot that was prone to ‘bad’ language, and consistently used
the “F” word. After threatening the talkative bird with dire consequences,
its owner put it in the freezer chest for five minutes. After being
retrieved from the freezer, the parrot was asked if it would now behave.
“Yes,” said the shivering parrot, “I won’t say the “F” word again, but tell
me what did the effing chicken say?”
“Effing” and “Blinding” are forms of
expression used by (almost) all of us when taken to psychological extremes
by some particularly vexatious situation. Shut in the freezer might be one
Inappropriate use of the F word (there
are some appropriate situations, in my mind at least) is part of an
interesting condition known as Tourette’s Syndrome. These are involuntary
movements (and sounds) and can be related to the magic “F” word, and is
usually seen in children (not parrots) around the age of 5-7 years. Boys
outnumber girls three to one!
So is this just a case of little Johnny
parroting off (sorry about that, couldn’t help myself) dirty words he has
heard at home? Actually no. This is a developmental problem that comes under
the general heading of ‘Tics’ (as opposed to ‘ticks’ that are parasitic
Tic disorders can affect up to almost
20 percent of children at some stage of their development. At one end of the
spectrum are children with brief episodes of single tics, whereas at the
other are children with chronic multiple tics, including our friend
Tics are abrupt and recurrent
involuntary motor or vocal actions. Motor tics include eye blinking,
grimacing, nose twitching, lip pouting, shoulder shrugging, arm jerking,
head jerking, kicking, finger movements, jaw snapping, tooth clicking,
frowning, tensing parts of the body, and rapid jerking of any part of the
body are simple tics. More complex ones include hopping, clapping, touching,
throwing, arranging, gyrating, bending, biting the mouth, the lip, or the
arm, head-banging, picking scabs, writhing movements, rolling eyes upwards
or side-to-side, making funny expressions, sticking out the tongue, kissing,
pinching, writing the same letter or word over and over, and tearing paper
However, the tic can also be vocal,
with simple ones being coughing, spitting, screeching, barking, grunting,
gurgling, clacking, whistling, hissing, sucking sounds, and syllable sounds
such as “uh, uh,” “eee,” and “bu.” The complex vocal tics can involve
complete phrases such as, “Oh boy,” “you know,” “shut up,” “you’re fat,”
“all right,” and “what’s that.” Take that a little further and you get
repetitive bad language (which we call Coprolalia, because we love big
words) and that is the best known example of Tourette’s syndrome.
Children who have these tics can be
looked upon as fools by their peers, and there is a no more predatory group
than other children. Parents also can feel helpless in these situations.
Form the medical point of view, one has to treat the entire family, not just
little Johnny with the foul mouth!
Most children with tics can lead normal
lives, and the tics themselves usually slow down in teenage years. Parents
should be encouraged to get support for themselves from various
organizations such as the Tourette Syndrome Association
([email protected]). With a good understanding of tics and related
problems, including acceptance from teachers and education of the child’s
peers, most children with tics do not need regular medical follow up.
Parents and children need to
understand, that although all these symptoms relate to an underlying brain
disorder, breaking the cycle may be extremely simple - for example, just
allowing the child to have a short “tic break” in a long school lesson may
Drug treatment can be used, though
there are differences in opinion on the efficacy, with some researchers
claiming only 30 percent can be helped, although tic severity and frequency
can be reduced. Studies of Risperidone in Tourette’s syndrome have shown
that it can help.