Doctor advise us! This man’s blood pressure is very low!!!

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Hi. It’s Dr Louella. I had an awesome time dancing in church today. I promised to tell you about a sweet elderly gentleman in “Caring for others more than they care for themselves part II.” Well this is it, but with a different title.

The new title reflects how they bombarded me that day, as soon as I dropped my bags in my office. When I walked into the screening room last Wednesday, I was accosted by nurses.

They were sorry to disturb me so early but they wanted advice on an elderly man with a very low pressure. Now we hardly ever get patients with low blood pressure as a problem; unless they are in heart failure or it is from blood or fluid loss or a severe allergy.

This old timer was a regular, they said. He had been seen for low blood pressure before and had already been  referred to hospital. I looked at the BP. It was for real, 59/35. That’s quite low. I looked at the man. He looked terrible, really sunken in temples and cheeks. He looked like a homeless person.

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He was not out cold so he could speak. He complained of dizziness and some weakness. Said he was 72 years old. First thing that came to mind is if he had had breakfast. Yes he did, was the reply, after I had identified myself. He had had a coconut water. (Ok, so now I knew he did not have breakfast).The nurses had started giving him water to drink. I said, “Let’s get this man something to eat”. All we had were his crackers and my slice of chocolate cake (my lovely cake that I had baked from scratch and brought to have as a snack).

We moved him to the treatment room and gave him these things to eat. I proceeded to find out what his normal diet was like. Turns out he was married, his wife died and he lived with three subsequent women after that, all of whom had died. He has eleven children, who visit him from time to time but he lives alone. He drives his own vehicle.

He often neglected his meals now that there was no one to care for him and did not go through the trouble of preparing anything. He drank about quarter of a 1.5 litre water bottle a day. He sometimes felt weak when going to his garden.

So I was wrong about one thing. Here was no homeless person but a gentleman with the means to take care of himself but not the will to do so. I stressed the importance of regular meals and lots of water and asked if he wouldn’t mind a visit with our dietitian to advise him on meal planning.

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Water is needed for blood. It makes up about 50% of it. When we are dehydrated the blood volume decreases and there is less blood for the heart to pump so blood pressure drops. Eating helps the water to remain in the circulation by providing salt.

I explained that he found difficulty going to the garden because his muscles were weakened by old age and without eating and drinking he would feel much weaker. He was interested in avoiding that.

As soon as he had eaten the snacks he wanted to leave. I had to say “Slow down pappy. That food is not digested so it cannot benefit you as yet”. He himself admitted to still feeling somewhat ill.

I realised that with all this talk I did not do a physical exam on this man. When I did, I found him to have a bradycardia, an unusually slow heart rate. His was 48 while the normal heart beats between 60 and 100 beats per min.

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Here was another cause of a low blood pressure. I ordered an electrocardiogram (ECG or EKG), or heart tracing. It was normal except for a heart rate of 54. He was not on any medication.

I was now able to explain to him that his slow heart rate was most likely responsible for his low blood pressure. But this becomes exacerbated when he is dehydrated. Also when he does not eat, there is less salt to keep liquid in the circulation.

I explained that if his heart rate decreased further to the point where he could not support a decent blood pressure he would need a pacemaker inserted in his heart. He reacted strongly to that because in no way did he wish to go to hospital.

After a couple hours I felt pleased to see our elderly gentleman walking out of the centre, looking and feeling much improved, and with a blood pressure of 105/65. I’m sure that he would now be more empowered to manage such episodes. I’m also sure we’ll be seeing him again, if even for an update.

My next case will be what the doctor does when threatened by someone else’s body fluids. Does she save herself or play the brave doctor? My next post will tell. Bye for now! Dr Louella.

 

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My Name is ANXIETY!!!

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Hi, Dr. Louella again. I want to chat with you about anxiety today. This comes off our talk on insomnia, where I realized that anxiety was the cause of my recent bout of insomnia.

Now, this is not a treatise on anxiety. It is just want to make you more aware of it and how to deal with it. I am in the advantageous position of both having studied and treated people with anxiety disorders and having suffered anxiety myself. Advantageous? Yes, I know both ends of the stick and it is a good feeling when what you’ve been through can benefit someone else.

Now, I’m not going to pretend that I am cured of anxiety because it is usually not that easy. But I am managing it so that it does not interfere with my life. That’s the key, how functional you are. And I do function!

Well, what is anxiety to begin with? The very essence of it is fear. It may be disguised as concern or worry. It is a negative respond to stress. We allow ourselves to ruminate or obsess over a situation because we are afraid of something going wrong in the future or are unable to let go of the hurts of the past.

Anxiety is basically a human emotion which we all feel. It can be useful in small doses. Say you are crossing a road. Next thing you see a truck come speeding out of nowhere. The anxiety you feel can catapult you to the other side of the road. That’s our “fight or fight” response due to adrenaline (‘epinephrine’, to the Americans), and we surely need it.

But there are other times when that response is misplaced. Your daughter goes out with a friend, and as the night draws later you start to worry more and more about her safety in these times of high crime. You think you have a right to worry about her as a parent. But do you? Examine it with me for a while.

You will be evoking in your body a similar but milder ‘fight or flight’ response with your worry. Hormones are going to be released. Your heart beats faster, blood pressure will elevate, digestive system is suppressed, muscles tense up, but unlike in the previous example, there is no action. You can’t run across the road and save her! You can do nothing.

You get your body in this hyped up state and the excess fuel is not used for any physical activity. Normal bodily functions are suppressed when we are ‘stressed’, including the ability to fight off diseases. You are like this, yet you can do nothing to help your daughter. I let my patients know they’re not helping her, and they’re certainly not helping themselves with their worry.

So now, imagine if you do this repeatedly. Everyday there is something new to worry about: the state of the economy, the package delivered late, the traffic conditions, murder, the failed dinner, the sick child, the list is exhaustive. What happens in our minds? What happens to our bodies?

You may be surprised by what a negative response to stress does to our bodies. Remember, everyone is faced with stressful situations on a daily basis. But we don’t all respond the same. Something one person throws over the shoulder, another person laughs at and yet another rants and raves about. So, it is not the actual stressor but our response to it that affects our bodies.

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When we respond with frequent expressions of fear such as concern, worry, fretting and anxiety, it affects us physically. We are constantly putting our bodies on alert to act but never do. Chronic anxiety affects us through: dizziness, fast heartbeat, fatigue, headaches, inability to concentrate, irritability, nausea, rapid breathing, trembling, digestive disorders, memory loss and premature heart attack.

Look again at those symptoms. Don’t you get some of those from time to time? I have sooo many otherwise healthy patients who come in with the symptoms above. I automatically think ‘stress’ when I see a young woman with mild dizziness. More often than not, there is a huge stressor in her life that she is not coping well with.

And isn’t everyone ‘tired’ or has lack of energy these days? What about stomach problems and memory loss? Hey! I’m not saying we simply dismiss these symptoms as stress-related but it is important to be aware, especially in general practice, that you may not be able to find an actual physical cause of a problem. The possibility that there are psychological factors triggering symptoms is real.

But, being a doctor and knowing my body, if I ever feel dizziness I say to myself, “Girl, you are stressing over something. You didn’t realize, huh?” And when I am forgetting a whole lot, I know I need a rest. When my acid reflux resurfaces, I don’t take meds. I just make a note to myself that I’m stressed.

I must re-direct you to the symptoms one final time. Do you see why you need a good night’s sleep before exams? For memory and concentration. And how could a healthy corporate executive just keel over with a heart attack? Extreme stress. Ever notice you’re just sitting there but you’re breathing hard?

So the long and short of it is that anxiety and excessive stress are not good for our bodies, especially as cortisol suppresses our immune system making us more susceptible to diseases. When I’m stressing myself out a lot I think, “You’re killing yourself girl; shortening your life. Stop it!”

But really, I would like to take you more inside the mind of an anxious person (you may well find that mind is your own) because it’s no big taboo. All of us get anxious, some more so than others. I want to teach you to be able to recognize the state and be able to get out of it quickly.

Ok, so I gotta go now. Will chat more later in the week. I have got an hour and 30 min to get to church, and for me, that ain’t enough. I’m not like my sis who needs an hour. Ciao!!!

 

The Very Basic Rules of Health

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474657739Hi folks. Dr. Louella here. Did you miss me? I wasn’t feeling too well these past couple days. Took two days off work. When I was younger, people, usually the younger ones, would say, “You’re a doctor and you’re sick!” and look in amazement. I would simply explain to them that we are human beings like everyone else and the same imperfect medicine we apply to them applies to us too.

But it’s worse when you’re a doctor. I recently read an article from the UK which expressed the same things I experience. You’re both doctor and patient, there’s no one to turn to, you’re not objective when it comes to yourself, you shun any unpleasant treatment.

So why was I not well? It comes from breaking the basic rules of health, as I am going to discuss with you, and indeed I have discussed with many of my patients. Let’s put aside all the fancy medicine for a moment, all the gadgets and the tests, the antibiotics, the vitamins and the painkillers.

The basic rules of health are to eat well, drink plenty water, sleep well, be active, exercise and don’t be stressed.

So which one did I break? … not enough rest. I am frequently guilty of that. Caused me to faint at a bank. Also think I strained my abdominal muscles lifting some very heavy books. I’m still in pain.

Now, do not take these basic rules lightly. Many people come to me run down saying they think they need some vitamins. Now, vitamins are still controversial but there’s no harm in taking them because we do have deficiencies in our diet that we are not aware about. But vitamins ain’t food! We can last a lifetime on food alone but certainly not on vitamins alone.

Are you having three square meals a day? Basic. No, you miss breakfast because you can’t eat that early in the morning or more likely because there is no time. Well have a juice or a fruit or a cup of milk, something. Pack up breakfast and take it with you to the office. You miss lunch because you’re too busy or dinner because you’re trying to lose weight or it isn’t convenient. No wonder so many of us have stomach problems or experience lack of energy.

I’m sure I explained already that to lose weight you eat small amounts more frequently. You don’t miss meals. Our meals also need to be balanced with sufficient veges, peas and beans and fibre and less of the rice, flour, meat and sweets.

Do you drink sufficient water? Many people don’t. 6-8 glasses a day is a rough estimate. You may require more but not much less. Many people do not like to or do not make the time to drink enough water but our bodies are made up mainly of water and all systems need it to function efficiently.

What about sleep? That’s my Achilles’ heel. I literally started to feel that there weren’t enough hours in the day to get a proper rest, 7-9 hours, and do everything I wanted to do.

But that’s the quickest way for your body to be run down, for you to be less alert, less focused. You make more mistakes without a good night’s sleep, have more memory lapses and are more irritable. It also feeds both anxiety and depression. We need to plan our days so that we get the essential sleep.

You don’t need a doctor to tell you to eat right and sleep right. You need to know the importance for yourself. There is no medication that can replace these things. As I say, basic.

Being active. Many of us lead sedentary lifestyles. A family doctor may sit at a desk for hours with little breaks in between. The office worker, the computer geek, often does the same. The little old lady will sit on the comfy chair all day. The housewife may whip up her chores early in the morning then relax all day. These are common but unfortunately unhealthy scenarios. We must keep moving throughout the day. Obesity is so rampant because we do not do this.

Exercise is something you need to add to that active lifestyle. It increases your heart rate, breathing and the energy you expend. But we don’t like to exercise!!! It takes up our time, and certainly takes effort. It even hurts sometimes. The exercise buff is the exception rather than the rule. But we all know we need to exercise. It’s no secret. Exercise has a long lists of benefits. You lack energy? …Well exercise.

Lastly, let’s talk about stress baby. It is a relatively new buzz term isn’t it? But it’s so real. It incorporates worry, anxieties, fears, depression, all sorts of negative emotions we allow to play on our minds and disturb our psyche. Stress is not the situation or person that is affecting you, but your response to them. Two persons can have completely different responses in identical situations. If we are stressed we cannot function properly.

We often blame others for our problems. But if we do that, we can never solve them because we cannot change the other person. We need to change our attitude to acceptance and move on.

We cannot be dwelling on our past. Those monsters can only hurt us if we bring them into the present. And worrying about the future does not help either. I tell that to clients who insist on worrying about their children and grandchildren as a duty.

We often find inadequacies in ourselves. But we should not dwell on these. Sure, we all have faults, but there are so many wonderful things in each of us that we can be grateful for and focus on instead.

I ask my patients, when last did you have a vacation, or a break? Do you have any me time, especially those wives and mothers. I’ve come across miserable housewives caring for husbands, children, parents and/or in-laws with no time for themselves and feeling unappreciated by those they care for.

For me, I know, I need a time everyday to feel like I am me. Not a doctor, daughter, sister, friend, just me. Just to exist for a few moments. Nothing to rush and do next.

So, please people. These tips I am giving here are worth thousands. Take care of yourself. Do what is necessary. Avoid unnecessary doctor visits. He cannot do for you what you ought to do for yourself. Eat right, sleep well, a little exercise wouldn’t kill, in fact it prolongs lives. And deal with the stressors.

And if you do break these rules know that you will suffer and who will put humpty dumpty back together again? …  Take care. Dr. Louella.

Hypertension 10 – Summary

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Hi folks! It’s Dr. Louella and we’ve reached the grand finale of our discussions on hypertension. Yeeaaah!!!!

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This one you should definitely keep for your records because I’ll be reiterating and reminding you of all the important points, having already explained the mechanics of this disorder in detail.

Firstly blood pressure is derived from the pumping action of the heart as it forces blood into large blood vessels. This causes the blood to circulate around our bodies. The force with which  the blood flows is called the blood pressure.

Just as we are unable to feel the blood circulating around our bodies, we are unable to feel our blood pressure. It is a common myth in Trinidad and Tobago that high blood pressure causes neck pain.

95% of high blood pressure cases are caused by the kidneys by an unknown mechanism. The other 5% have an identifiable cause, usually in younger individuals.

Certain emotional states, such as anger, pain and anxiety, as well as increased physical activity, can cause a temporary rise in blood pressure. This is not hypertension, which is a chronic condition. For this reason, not just one, but a few blood pressure readings need to be taken before a person is diagnosed as hypertensive.

Factors which predispose to the disease include a family history of hypertension, increasing age and certain ethnicities such as Afro-American or Afro-Caribbean.

Dietary associations of hypertension include a high sodium intake (salt, not fresh seasonings), low potassium intake, heavy consumption of alcohol and obesity. Increased oats and fruits in the diet help to reduce blood pressure. Physical inactivity is also associated with a higher blood pressure.

General guidelines for hypertension are that a reading of 120/80 or less is normal and ideal; a target of less than 140/90 is used for those on treatment; less than 150/90 is now used for those over 60 and 130/80 or less for those with certain diseases such as diabetes and heart disease.

Complications of hypertension are the dreaded stroke, heart failure, heart attack, kidney failure, aortic aneurysm and eye disease. Hypertension damages the inner lining of blood vessels allowing cholesterol to enter the wall and form a plaque that partially blocks blood flow.

If it a blood clot forms at the site it seals up the blockage long enough for no blood to flow and permanently damage brain or heart cells. The person then gets a stroke or heart attack.

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The DASH diet has been shown to help lower blood pressure. It includes less salt, alcohol, red meat, fat and sweets including sweetened drinks.

But it also includes more fruits, vegetables and high fibre foods (whole grain products such as whole wheat/meal bread, bran, oats, as well as more peas, beans and nuts).

Weight loss for the overweight and obese is important in controlling hypertension. This can be achieved by a combination of dietary control and exercise. To lose weight you need to eat less and have a lower calorie intake but frequent little meals, and not starvation, is the key.

Exercise is beneficial in lowering blood pressure on its own, even in those of normal weight. Aerobic exercise can take many forms including running, skipping and dancing.

Some people can have their hypertension controlled through diet and exercise alone but most will still need the assistance of medication. Medication is varied but it must be stressed that it needs to be taken everyday, as prescribed by the doctor, unless the person is experiencing ill effects, which he must inform his doctor about.

So there! We’re done. That’s the end of hypertension. I’ve taught you almost everything I know. Feel free if you have questions or comments. See you next week. Dr. Louella is out!!!

Hypertension 9 – Treatment and Compliance

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Hi everyone! I’m on time today. This is Dr. Louella checking in from the office. This ought to be our final post on hypertension but I feel the need to give a summary afterwards to draw all the essential points together. Let us finish up on treatment.

So, let’s say diet and exercise (as we discussed previously), fail. You ask what I mean by fail… well you just don’t do them or you make a half-hearted attempt to do so. Then they will fail. Or, better yet, say you do try, and get some results but not sufficient for your blood pressure to be called normal, what do we do?

It is obvious we turn to medication at this point. Antihypertensive medication is used to control but not to cure hypertension or high blood pressure. Some people’s blood pressures are so high that we have to put them on medication from the start, but this should be done in conjunction with diet and exercise.

Now I don’t need to go too much into the actual medications. There are many classes of antihypertensive drugs and several drugs in each class. One may work a bit better in an individual than another but none is clearly superior.

I do have a lot to say on “The Patient and the Taking of Antihypertensives” though. Oh my goodness! I have only dealt with patients from Trinidad but I am sure there are patients all over who behave similarly.

Many patients aren’t convinced of the diagnosis of hypertension. They say “so they say” but don’t own it for themselves. They are in denial. Others treat it like a minor irritation or joke. But I am usually quickly able to convince them of the diagnosis by giving them the normal range and showing where a number of their blood pressures, as recorded in the patient notes, are beyond that. Remember, if they were diagnosed based on one reading, they have a right to be skeptical.

I show them that antihypertensives work on everyone. If they do not have hypertension their blood pressures would run low if they took medication. Are their blood pressures running low? Or are they being maintained just normal, high normal or even too high? If your blood pressure is normal whilst on an antihypertensive, you need to continue on that treatment, or else it will go high.

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It is difficult to get hypertensive patients to take their medication because they don’t feel sick. This often leads them to rush to take a pill when they do feel something like a headache or neck pain. Recall that hypertension has no symptoms. I tell them if you are waiting to feel something, that’s when complications have already set in, and it will be too late.

A lot of our patient population think a water pill is to help them pass water and improve functioning of their kidneys, so they don’t take it because they pass water just fine. They are oblivious to the fact that it is a pill for treating hypertension, so I make this clear to them.

Many of them have their own regimen for taking medicines: once a day instead of twice, every other day, twice or three times a week, whenever they remember or whenever the blood pressure is high. No wonder the pills don’t work!!! I always ask why? What is your reasoning for this?

I will admit, years ago when I first discovered this deviant behavior I was shocked. I found out that we doctors increased the dosages of patient medication when needed but the patients themselves didn’t. So the notes may be saying as many as four tablets a day when the patient still routinely took one. My most gruesome discovery was bags and bags half-filled with medication at the homes of the elderly we visited in Cedros. I was upset and thought I was fighting a losing battle.

But I’m older and wiser now. I understand many of the reasons they don’t take their medicines as prescribed. I ask them point blank about it and spend some time on the topic. But even after explaining there is no guarantee they will follow comply. Most of our patients are unaware of the names of their medication and this makes it more difficult.

I explain to those that take their meds only when blood pressure is high is that they are doing more damage by allowing their pressures to go high and then taking a pill, as opposed to having it controlled at all times. If your blood pressure is good today it may be the pill you took yesterday. If you miss the pill today it will be high tomorrow or the next day. To decrease risk of complications blood pressure needs to be controlled at all times

Many patients are afraid of side effects. I try to explain that these side effects are only potential and nothing happens to most people. There is no automatic damage by the medication. And furthermore, the damage they will get from hypertension is more sure and worse than what the tabs will do.

For those who have decreased the dosages due to convenience, I explain to them that the drug only is effective in their system for a certain length of time and they need to take it as prescribed for it to work properly. It comes as though you’re wasting your time because the drug can’t work like that.

A few of them cannot read so I emphasise to them that I am changing the dose and ask them to refer to a relative or neighbor to read it for them. Sometimes for the elderly or mentally challenged I ask for them to bring a relative. I explain to that person and charge them with the responsibility.

That’s it folks!!! We just completed the series on hypertension. Only the summary is left. Thereafter I’ll be starting a new topic. Now if I left out anything or you don’t understand something, feel free to comment before we move on. I enjoyed this because it was like a refresher for me and as you can tell, I love to share my patient experiences. Enjoy the rest of the weekend and the incoming week!

 

Hypertension 8 – Prevention/Treatment 2

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Hi. This is Dr Louella saying sorry for the late post. It was a hectic weekend! But we need to continue our discussion on prevention and treatment of hypertension. Previously we talked about how your diet can help lower blood pressure so now we go on to weight loss and exercise.

Yes, I know you’ve heard a lot on these topics before, but not like this…

Now weight loss and exercise are not the same thing.There are so many health benefits to exercise that everybody needs to exercise (including  the skinny, the fat and the in-between; toddlers and grandmas) but not everyone needs to lose weight. I have frequently heard the retort, “What you have to lose?” when people hear that I exercise.

But I love to provoke my elderly patients by asking them if they’re exercising because they should be. It would help unstiffen those joints, reduce their pains, strengthen their bodies and lift their depression among other things.

Now if there is one thing you need to know about exercise is that it makes you live longer. Exercise increases your longevity! Did you know that? It’s been proven!.

It has been also been found to lower blood pressure about 1 to 3 months after engaging in it, as long as the person continues to exercise. It strengthens heart muscle reducing the force needed to pump the blood around the body.

Exercise is recommended for everyone for the prevention and/or control of hypertension. 30 min of moderate exercise, 5 days a week is the basic requirement for health or, if its vigorous exercise, 15 min for 5 days will do.

Now don’t get scared. It isn’t as hard as you think. Get yourself a pair of sneakers and pants, as well as a safe environment, and you’re almost there. I tell my patients these things because I am saddened to find out that many of them don’t exercise even though they know better.

I was a gym freak once, but not anymore. I’m well aware that not everyone can toil away for hours at the gym… timing, cost, distance, shyness, whatever, prohibits that. But that does not rule you out.

Remember, anything aerobic will do – brisk walking, jumping, jogging, dancing, aerobics, active sports, swimming, cycling, skipping, climbing etc. You can use a video, gym instructor, exercise equipment, a friend or do it by yourself. You can be in the house, around the house, on the street, in the park, in the gym.

Weight training is not as good for blood pressure as it may increase it. But your housework (scrubbing, mowing the lawn etc) may count, once it increases your heart rate and breathing. It has been found that physically strenuous jobs are associated with lower life expectancy because of the stress associated with them.

If you’re new to exercise 5 min may be enough and you gradually work your way up. Don’t try to overdo it. The body has to get accustomed. If you injure yourself you’ll never want to go back. Warm up first before you stretch. Never stretch a cold body but always stretch those muscles after use. Please drink sufficient water. Hydration is important.

Now, I’m going to burst some people’s bubble here. I’m going to make it clear that exercise alone  is not enough. You cannot lead a sedentary lifestyle, sit for most of the day, and think that 30 min of exercise is going to be sufficient to counteract that.

There is something called non-exercise physical activity that we must also engage in. This simply means being active throughout the day, doing the little stuff. Excessive sitting is unhealthy. If you reduce it to less than 3 hours a day it can help extend your lifespan by 2 years.

A generally active daily life is associated with cardiovascular health and longevity in older adults. So get the old people moving and get yourself active: stairs instead of elevator, walk instead of drive, manual tools instead of automatic, do it yourself instead of outsourcing, walk the dog, do the dishes, wash on hand and so on… They all add up.

Our populations are getting fatter so hypertension is rising. Remember obesity is linked to hypertension. So many of us need to lose the weight, for this and other reasons (helps lower cholesterol, blood sugar etc).

No one said it would be easy but it will be worth it. You know the drill. Weight loss entails diet and exercise. Even when you take weight loss pills you need some kind of diet.

You don’t need to get down to your ideal weight, a BMI of 18.5 to 24.9. That would be lovely, but for some it is extremely difficult. It is said that losing as little as 5% of your weight may make a difference to your blood pressure, 10% is better and more even better, if you are obese.

What I discussed previously with regards hypertension was a healthy diet but not a weight loss diet. I will mention the main features of this.

You should know by now that you must eat less (or take in less calories) in order to lose weight. Watch the content of the food: less sugar, flour and fatty/oily items. Decrease your portion size, but I stress, gradually. You don’t want to feel hungry. Use more protein, especially beans and peas, and your veggies. Increase your number of meals to 4-6 a day. You use calories more efficiently this way.

Make your dietary changes healthy and palatable and never entertain long periods without meals. In this way the diet will be easier for you to incorporate into your lifestyle and not be just a passing fad. You would not continue to lose weight indefinitely but eventually settle.

While the majority of weight loss would be achieved through the diet, exercise is also very important as it increases your calorie output, increases the efficiency with which you lose the weight, tones the body, etc. I normally explain to my patients that 30 min of exercise, 5 days a week is the basic requirement for health so if you’re looking to lose weight you may need to go beyond that.

So I have told you about exercise and the weight reducing diet, why they are needed and how to achieve them to prevent/control hypertension.  But it’s been another long day. I’m tired. But I really enjoy doing these blogs so come back for more when we talk a bit about drug treatment of hypertension. Later! Dr. Louella is out.

 

Hypertension 7 – Prevention/Treatment

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Hi. This is Dr. Louella continuing our series on hypertension. But first I must mention that I did go out for the Easter long-weekend. I got to be with nature as we hiked to Edith falls in Chaguaramas, Trinidad (breath-taking when dry, I can’t imagine what it would be like with water) and to the Corvine River (we’ll reach the pool next time; it was getting too dark).

With regards to hypertension I would like to remind us just how common this disorder. Current research suggests that 1 in 3 American adults and 1 in 4 Trinidadians have this disease. Remember what it can cause: stroke, heart attack, heart failure, kidney failure, and more. These are all dreadful, debilitating, expensive diseases.

Wouldn’t it be worth your while to prevent yourself developing this silent killer, hypertension? I think so. That’s why I am going to discuss prevention of hypertension, in conjunction with treatment, because much of what can be used to prevent hypertension is used to control it as well.

Now there are certain factors that predispose a person to hypertension, that are beyond our control. These include a family history of hypertension (heredity), increasing age (from 35-40 years onward) and ethnicity, such as being Afro-Caribbean or Afro-American.

This is fairly common knowledge. So if you KNOW you fall into one, two or even three of these categories (oh goodness, I’m in all 3) and are at an increased risk then you have a special responsibility to try to prevent yourself from getting hypertension. This disease is costly.

In preventing/treating hypertension I would first like to remind us to go easy on the salt. Most of us cook with too much salt. Do not add salt to your food when at the table. Decrease your consumption of fast foods; all they care about is the taste. Be wary of canned food, sausages and bacon. The salt is an integral part of their processing but it is way too much for you.

Especially for the Trinidadians, please note that you do not need to decrease the amount of fresh seasonings you add to food because these do NOT raise blood pressure. Fresh herbs and seasonings are encouraged in place of salt. However, packaged seasoning is a different matter, because it usually comes with salt.

Many of us don’t use enough fresh fruits and vegetables (including raw). These have so many health benefits, including lowering blood pressure by increasing potassium. Make a habit of passing by the fruit stall on a weekly basis to get your daily quota of two fruits. Also prepare salads more regularly.

Eat more oats. Have it every morning for breakfast if you can because, remember, this can help prevent hypertension.

Please reduce the alcohol intake. The benefits you will derive will go way beyond reducing hypertension.

What has been shown to work best is a comprehensive diet, where foods are combined to lower blood pressure nicely. These include high fibre foods. Increase your fibre intake with more whole grain products (whole wheat/meal bread, bran, oats etc), as well as, with more peas, beans and nuts. (Nuts are also great for lowering cholesterol. A handful a day is recommended – not too much, because they are high calorie.)

Other measures like lowering the amount of meat in the diet has also been shown to help. This is red meat in particular. You can have generous amounts of fish and some chicken. Dairy products should be consumed but should be low fat. Of course, much less sweets, especially sweet beverages and fat should be consumed.

This healthy diet has been proven to reduce blood pressure. And really, is it so hard? If you need more detail feel free to research the DASH diet. It is the Dietary Approaches to Stop Hypertension.

I’ll talk more on a major factor in hypertension, obesity, next week. I’ve been up way too long for one day. Ciao!!!

Hypertension 6 – Associations

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It’s the Easter long weekend here in Trinidad and Tobago!!! That means church, beach, camp or partying for many. Dr. Louella here, and I’ve got to wrap this blog up quickly because I’ve got to go dance practice for our Glorifest concert of high praise this Saturday. I need to remember all my moves and get them really tight.

But first to continue our discussion about hypertension because it is very important. Before we talk about the treatment of hypertension though, you may have noticed that I omitted a well-known topic in hypertension. That’s salt intake. Everyone knows that hypertension is associated with a high salt intake.

Earlier, in our talk on causes of hypertension, I did not mention salt as a cause. In fact, what I did say is that the real cause of hypertension is not known. And that is true.

But there are a number of important dietary associations of the disease which should be mentioned. For example we know that high blood pressure is associated with a high salt (sodium) intake. It occurs more frequently in those who consume a lot of salt. But it does not occur in all of them.

Researchers have found that those with a high potassium intake have a lower blood pressure. That’s because potassium counters sodium in the body. Whereas the sodium from salt draws more water into the circulation encouraging a higher blood pressure, potassium does the opposite.

Eating oats seems to be a fad these days but it is a healthy one. Eating whole grain such as oats and bran flakes every morning is associated with a lower risk of developing hypertension. Oats also reduces blood cholesterol as well.

An important part of some person’s diet, alcohol, is also proven to elevate blood pressure. I saw this in one of my local alcoholic patients in Cedros. Once he stopped his drinking binge, his blood pressure would go to almost normal.

Also in my practice, I have come to expect, without even realizing it, most obese patients to have an elevated blood pressure, so commonly is obesity associated with hypertension, especially in our almost half African-descended population in Trinidad.

What I mentioned above are the PROVEN associations of hypertension. Note I did not mention highly seasoned food, sweets, fat intake, cholesterol and smoking, a few of the things I have heard people mention, as associations. These may cause other problems, by not hypertension, as far as is currently known.

Remember too, that we already discussed physical and emotional states that elevate blood pressure. Next we will determine what is the best approach to a diet that helps to lower blood pressure. But it won’t be from scratch. This wheel has been invented before.

So, we have a four day weekend here in Trinidad. Whatever you’ve got wherever you live, I hope you enjoy it! Till next week. Dr Lou is out!

Hypertension 5 – Complications

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Hi there. Dr Louella here, finishing up the discussion on complications of high blood pressure. Remember, this is to answer the question, why do we treat hypertension, especially when it has no symptoms? We already identified how hypertension causes both ischaemic heart disease, which can lead to heart attack, and heart failure. We now continue to other complications.

Hypertension is the major cause of stroke, which occurs in the same fashion as heart attack, by blockage of blood flow to parts of the brain. We can use the same picture below to demonstrate.

From: cdc.gov

From: cdc.gov

Hypertension damages the inner lining of blood vessels allowing cholesterol to enter the wall and form a plaque that partially blocks blood flow. If it a blood clot forms at the site it seals up the blockage long enough for no blood to flow and permanently damage brain cells. Persons are unable to use parts of the body which are controlled by the affected regions of the brain.

Narrowing of the small blood vessels of the kidneys leads to chronic kidney disease and in some, renal failure. In the eyes it causes eye disorders such as cataract, glaucoma and bleeding in the back of the eye (retinal haemorrhage). Less common occurrences are the deadly aneurysms (ballooning of blood vessels due to weakened walls) which can occur especially in the abdomen.

Once you have untreated or inadequately treated hypertension some amount of organ damage is bound to take place. Nowadays most people end up with complications due to poorly treated hypertension. Stroke, for example, is way too common in Trinidad. I often ask my patients if they don’t mind having a stroke and give a visual demonstration to remind them what it’s like.

Many years ago, I came home from school in the third form (9th grade) to find my granny (fond name for grandmother) in the local hospital with a stroke. Of course, life for me was never the same as she couldn’t walk or talk after that. At 83 she had been a really active woman. She was said to be bringing in the goats when it happened (yeah we had goats and I loved them; no it wasn’t a farm and none of the neighbours had; we just happened to have goats).

Granny survived four years after that. Though we never admitted it, it was a burden to care full time for her although it was also a joy. She needed caretakers when we were out to work and school.

The moral of the story is, especially for those with hypertension in the family like me, don’t get hypertension! Don’t get a stroke! Or heart disease, or cataract!

We will learn how to prevent this silent killer and its awful complications in the next talk. Ciao kids!!!

Hypertension 4 – Complications

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Hi guys. It’s Dr Louella again. We need to wind up on hypertension but first I must report that I did not make it to Cedros (Trinidad) for the holiday, as I had no company for the two hour drive. But there’s gonna be a next time!

Well so far we’ve been through the symptoms, causes and diagnosis of hypertension and it’s time to get to the bottom line of how to treat it. But not quite. Because the problem with many people is that they don’t fully understand WHY we treat hypertension.

And why is that so? … If you recall, hypertension has no real symptoms. It does not make you feel sick. So in many people’s minds they do not really see the need to take medication when they are not sick. Many of them only take meds when they think their blood pressure is high. But there is no way to know without testing and you cannot test 24/7.

Once your blood pressure is higher than the ideal level of 120/80 your blood vessels are traumatized by the pressure of the blood flow and gradually, over months and years, the inner lining of the blood vessels is damaged. This can lead to thickening of the blood vessel walls by increase in the muscle content in smaller blood vessels and by cholesterol-filled atherosclerotic plaques in larger vessels.

Atherosclerosis is hardening of the blood vessel walls by the growth of plaques which are filled with cholesterol. The picture below shows the progression.

From: cdc.gov

Once thickening of blood vessels occurs, the lumen or passageway of the blood vessel narrows so less blood can flow through it. This especially affects blood vessels in the heart and brain causing ischaemic heart disease, which may lead to heart attack, and stroke.

People with ischaemic heart disease usually suffer with recurrent chest pain due to poor blood supply to the heart.  During a heart attack the blood supply is cut off completely and part of the heart dies. This may result in sudden death of the individual or they may have to live with a severely weakened heart.

There are other ways hypertension can damage the heart. The high pressure of the blood can put a strain on the chambers of the heart as they contract leading to thickening of the muscle of the largest chamber, the left ventricle. This becomes stiff and less able to contract. It is further weakened by the poor blood supply in the narrowed arteries. Finally, the heart muscle starts to stretch and can no longer perform its function.

The description above is that of heart failure and is usually accompanied by an enlarged heart. The heart muscle in heart failure does not have its full strength and the heart cannot properly perform circulation of the blood without the help of medication. The individual often suffers with extreme fatigue, shortness of breath and/or swelling of the feet.

Ok! That’s a mouthful. As we can see, hypertension causes some major problems in the heart. Next week we’ll finish these complications. We have not yet spoken about a big one, stroke. I will share my own personal experience with this awful disease. See you then!