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Update August 2016

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Update by Natrakorn Paewsoongnern

Doctor's Consultation  by Dr. Iain Corness


Update August 27, 2016

Hypertension needs 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.

This heart-arteries-veins-heart 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 blood pressure.

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-normal: 130–139/85–89

High blood pressure (hypertension):

Stage 1: 140–159/90–99

Stage 2: 160–179/100–109

Stage 3: 180 or higher/110 or higher

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 mode.

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 too high.

Update August 20, 2016

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 Attack’.

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 hospital.

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!

Update August 13, 2016

All choked up

Heimlich maneuver.

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 blockbuster!

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!

Update August 6, 2016

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 of them.

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 problems).

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 Tourette’s syndrome.

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 or books.

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 be enough.

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.

HEADLINES [click on headline to view story]

Hypertension needs more than one reading

Is your Coronary Conclusion around the corner?

All choked up

Who has taken my “effing” pen?



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