27th April 2006
I am posting this in general topics, since I think the occasional erratic high BP is the problem to treat, but rather a symptom of another problem that is causing it. I am frustrated that my doctors only seem to care to reduce the blood pressure when it occurs and not look for the cause. Plasma catecolamine (adrenal function) and MRA (renal arterial scan) both negative, so it is something more elusive.
I am hoping desparately for some suggestions on where to turn next.
Here is what I wrote up for an endocrinologist, who barely glanced at it. I was hoping to give him any clues that might evoke some idea:
Complaint: Occasional periods of erratic high BP
Recent background:
In Nov. 2002, I was experiencing occasional chest pain, had a 2 day nuclear stress test, echocardiogram which did not indicate cardiac problems. Dr. suggested a gall bladder ultrasound, which showed 3 polyps approx. ½ cm. (recent u/s shows unchanged). I subsequently started ignoring the occasions of chest pain. The beginning of this year was a high stress period at work and chest pain became more frequent and noticeable, so I began taking aspirin often, in case of a cardiac event. I finally decided to go to the ER one morning (mid March) and they did a heart cath which was negative. An angioseal was used which popped out later.
I check my weight daily and blood pressure regularly, particularly when feeling any noticeable chest pain, even slight. I am quite aware of what is normal for my body (107-120 over 72-79, pulse 55-60). Until the beginning of this year, I usually walk 8 miles in under 2 hours at least every weekend.
Current complaint:
The weekend of 3/25/06, Saturday morning I got up and in doing some things noticed I was not feeling at all ?right?. About lunchtime, I checked my BP and found 162/111, 170/107 when sitting inactive on the bedside. Throughout the day, I monitored it closely and found lying still, it would settle down to 130-something over 80-something, but sitting up jumped it immediately to the 155-168 over 90-106 range. Walking down the hall to the bathroom would cause my monitor not to be able to read it until I lay down a little while. At about 7pm, I took a small piece of a .1mg clonidine tab.
(In Nov. 2005 I had gone to the ER with spiked BP around 185/115 and they gave me a script for clonidine. At that time, I had been taking diclofenak for lower back pain and was having so much trouble, I took more than my usual 1/day. The ER physician monitored BP several hours and when It finally came down, speculated it was one of the possible side effects of diclofenac and sent me home, since other test for cardiac was negative. Other than diastolic occasionally in the 90's during Jan-Feb, which I thought was stress, no further BP problems until this Mar 25 '06)
The following Sunday morning, BP fairly normal while moving around, shower, etc, until I began feeling 'not right' again about 11am and found the same pattern as the day before. I took the remainder of the .1 mg clonidine, which had slight but not significant effect. The on-call cardiologist advised me to stay lying down, stop clonidine and go to ER if the BP got extremely high. At 7:30pm still had 145-155 over 98-105 when sitting up, lower when lying.
The next day, Monday, and for everyday the following 2 weeks, I checked BP often and logged it, and it was consistently low and normal no matter what activity I did (work, errands up, down, stress, etc). It was mostly in 106-115 over 67-77). I assumed the problem was over.
The weekend, Saturday, 4/8/06, the same pattern of erratic high BP when sitting up repeated for the entire Saturday and Sunday.
Monday, 4/10 started the same way at 6am, by 8am was normal consistently the rest of the day, no matter what activity.
Tuesday, 4/11- normal all day at work, running errands etc until about 6pm, became high and erratic. Stayed that way Wednesday 4/12, although not quite as drastic. When for blood work at noon (thyroid, plasma catecholamine).
Thursday and Friday, 4/13-14, BP normal, regardless of activity.
Saturday, 4/15, erratically high in the morning (174/104, 156/98, 162/107) when sitting up, moving around, lower when lying still. Settled down after 10:30, and became low and normal remainder of the day, regardless of activity.
Sunday, 4/16, mostly normal all day, a few 'bumps' in the BP that came down quickly.
* skipped levoxyl*
Monday-Thursday, 4/17-20, normal regardless of activity.
* no levoxyl, ½ 112 mcg on Thurs *
Friday, 4/21, mostly normal, a couple of times to 150's/90's.
* ½ levoxyl *
Saturday-Monday, 4/22-26, consistently normal/low, regardless of activity.
* 112 mcg levoxyl * Headache for 3 days.
Symptoms/clues (may or may not be relevant):
- I have experimented with cutting any suspicious foods, ingredients, external medications, none have eliminated the occurrences.
- When triggered, an episode seems to consistently cause BP to jump quite abnormally when doing any small activity, such as sitting up on the side of the bed, or walking to the bathroom. Lying down still, reduces it.
- When normal, activity has little or no effect on BP. Stress (presentations, driving in traffic, stress and system problems at work) seem to have little or no effect.
- When occurring, I feel queasy, slightly trembly (not visibly, but internally), weak, anxious. Mentally preoccupied subconsciously, not conversational. 'not all here'.
- Only once, for a 2 hour period, did my pulse rate elevate. In the 90?s while lying still almost asleep, which is highly abnormal for me.
- occasionally feel a slight 'wave of queasiness', 'butterflies' preceding or during an episode.
- When normal, coffee, eating, walking across campus at work seems to have no effect.
- I have patches of dry skin on my back, underarms, that have not responded to treatment.
- Recently have significant headache (going on 4 days) although BP normal. Responds slightly to aspirin.
- Vision changes: distant better, close worse. Sometimes driving without glasses is better. Variations in the change.
- Some weight loss, was 165 +- 3lbs, lately 155-157. No appetite at all during BP episodes.
----------------
I take no recreational drugs at all, only prescribed drug is Levoxyl,
take fish oil, niacin (500mg), folic acid (800mcg), multivitamin, L-lysine (500 mg).
I would appreciate any help/advice/suggestions. I can never tell when it will happen.
I am hoping desparately for some suggestions on where to turn next.
Here is what I wrote up for an endocrinologist, who barely glanced at it. I was hoping to give him any clues that might evoke some idea:
Complaint: Occasional periods of erratic high BP
Recent background:
In Nov. 2002, I was experiencing occasional chest pain, had a 2 day nuclear stress test, echocardiogram which did not indicate cardiac problems. Dr. suggested a gall bladder ultrasound, which showed 3 polyps approx. ½ cm. (recent u/s shows unchanged). I subsequently started ignoring the occasions of chest pain. The beginning of this year was a high stress period at work and chest pain became more frequent and noticeable, so I began taking aspirin often, in case of a cardiac event. I finally decided to go to the ER one morning (mid March) and they did a heart cath which was negative. An angioseal was used which popped out later.
I check my weight daily and blood pressure regularly, particularly when feeling any noticeable chest pain, even slight. I am quite aware of what is normal for my body (107-120 over 72-79, pulse 55-60). Until the beginning of this year, I usually walk 8 miles in under 2 hours at least every weekend.
Current complaint:
The weekend of 3/25/06, Saturday morning I got up and in doing some things noticed I was not feeling at all ?right?. About lunchtime, I checked my BP and found 162/111, 170/107 when sitting inactive on the bedside. Throughout the day, I monitored it closely and found lying still, it would settle down to 130-something over 80-something, but sitting up jumped it immediately to the 155-168 over 90-106 range. Walking down the hall to the bathroom would cause my monitor not to be able to read it until I lay down a little while. At about 7pm, I took a small piece of a .1mg clonidine tab.
(In Nov. 2005 I had gone to the ER with spiked BP around 185/115 and they gave me a script for clonidine. At that time, I had been taking diclofenak for lower back pain and was having so much trouble, I took more than my usual 1/day. The ER physician monitored BP several hours and when It finally came down, speculated it was one of the possible side effects of diclofenac and sent me home, since other test for cardiac was negative. Other than diastolic occasionally in the 90's during Jan-Feb, which I thought was stress, no further BP problems until this Mar 25 '06)
The following Sunday morning, BP fairly normal while moving around, shower, etc, until I began feeling 'not right' again about 11am and found the same pattern as the day before. I took the remainder of the .1 mg clonidine, which had slight but not significant effect. The on-call cardiologist advised me to stay lying down, stop clonidine and go to ER if the BP got extremely high. At 7:30pm still had 145-155 over 98-105 when sitting up, lower when lying.
The next day, Monday, and for everyday the following 2 weeks, I checked BP often and logged it, and it was consistently low and normal no matter what activity I did (work, errands up, down, stress, etc). It was mostly in 106-115 over 67-77). I assumed the problem was over.
The weekend, Saturday, 4/8/06, the same pattern of erratic high BP when sitting up repeated for the entire Saturday and Sunday.
Monday, 4/10 started the same way at 6am, by 8am was normal consistently the rest of the day, no matter what activity.
Tuesday, 4/11- normal all day at work, running errands etc until about 6pm, became high and erratic. Stayed that way Wednesday 4/12, although not quite as drastic. When for blood work at noon (thyroid, plasma catecholamine).
Thursday and Friday, 4/13-14, BP normal, regardless of activity.
Saturday, 4/15, erratically high in the morning (174/104, 156/98, 162/107) when sitting up, moving around, lower when lying still. Settled down after 10:30, and became low and normal remainder of the day, regardless of activity.
Sunday, 4/16, mostly normal all day, a few 'bumps' in the BP that came down quickly.
* skipped levoxyl*
Monday-Thursday, 4/17-20, normal regardless of activity.
* no levoxyl, ½ 112 mcg on Thurs *
Friday, 4/21, mostly normal, a couple of times to 150's/90's.
* ½ levoxyl *
Saturday-Monday, 4/22-26, consistently normal/low, regardless of activity.
* 112 mcg levoxyl * Headache for 3 days.
Symptoms/clues (may or may not be relevant):
- I have experimented with cutting any suspicious foods, ingredients, external medications, none have eliminated the occurrences.
- When triggered, an episode seems to consistently cause BP to jump quite abnormally when doing any small activity, such as sitting up on the side of the bed, or walking to the bathroom. Lying down still, reduces it.
- When normal, activity has little or no effect on BP. Stress (presentations, driving in traffic, stress and system problems at work) seem to have little or no effect.
- When occurring, I feel queasy, slightly trembly (not visibly, but internally), weak, anxious. Mentally preoccupied subconsciously, not conversational. 'not all here'.
- Only once, for a 2 hour period, did my pulse rate elevate. In the 90?s while lying still almost asleep, which is highly abnormal for me.
- occasionally feel a slight 'wave of queasiness', 'butterflies' preceding or during an episode.
- When normal, coffee, eating, walking across campus at work seems to have no effect.
- I have patches of dry skin on my back, underarms, that have not responded to treatment.
- Recently have significant headache (going on 4 days) although BP normal. Responds slightly to aspirin.
- Vision changes: distant better, close worse. Sometimes driving without glasses is better. Variations in the change.
- Some weight loss, was 165 +- 3lbs, lately 155-157. No appetite at all during BP episodes.
----------------
I take no recreational drugs at all, only prescribed drug is Levoxyl,
take fish oil, niacin (500mg), folic acid (800mcg), multivitamin, L-lysine (500 mg).
I would appreciate any help/advice/suggestions. I can never tell when it will happen.