HIGH BLOOD PRESSURE DUE TO WHITE COAT SYNDROME

[krismimo]

I could really use a friend a prayer and I wish a drink. I have been stressed out the last couple of weeks, I had perfect and I mean perfect numbers for blood pressure. The first time it hiccup was when I had to see the surgen and discuss the surgery that was almost a month ago. It hit 140/80. I worked out was eating right and when I had to come in today I was a bundle of nerves, my blood pressure hit 159 I got really scared I was freaking out because I knew that my transplant coordinator was going to freak out and they were going to put me on the 24 hour blood pressure monitor. They think I have white coat syndrome (Basically I do ok at home but when I have to see the doctor or go near a clinic my blood pressure goes up and I have anxiety.

I was perfectly doing ok until my coordinator kept brining up the one time my blood pressure shot up she said she understood I was nervous but I should keep an eye on it. No offense but how do you keep an eye on somehting when your nervous? So today was our final cross match and everything was going fine until they drew my blood pressure I was trying my best to stay calm but low and behold my numbers were out of wack. When I did my number at home they were ok during different times of the day they spiked but brought back down. This test will make me or break me If those numbers are not to their liking they will TERMINATE the transplant all together. How am I suppose to deal with that? No pressure given just dont get nervous or else. I had a panic attack afterwards and I was crying for most of the day, I'm doing a little better. But I need advice anything to help me keep my BP under control even for jsut one day to shut them up. I'm so frustrated I really want this for my hubby and me, I know I'm my own worst enemy and I'm trying to calm down. Please pray for me I'am FREAKING out.

[Joe]

Hoping that you can find it in you to relax and take it easy while hooked to the monitor. Try and just forget that it's there (easy for me to say) and hope all goes reasonably well.

[MommyChick]

Hello Krismimo,
I wish I knew what to say to help your BP at this time. I will though say many prayers that you will be able to donate to you hubby!
I know how frustrating it can be to wait for that match to come along. Let alone if you know your a match, yet there is a tiny hiccup standing in the way.
    

Many thoughts & prayers to you & your hubby!!!
Good Luck & God Bless
~ Marna

[Bill Peckham]

This article from the American Medical Association offers a solution ( http://www.ama-assn.org/amednews/2007/06/11/hlsa0611.htm ):

"measuring a patient's blood pressure with a device set to automatically take a reading every 2.5 minutes. The patient was left alone, to minimize the white-coat effect, and the final six readings out of 10 were averaged. Researchers found that this achieved results comparable with ambulatory monitoring."

It would require having an automatic BP monitor (or non-stress inducing spouse) but it sounds promising.

One thing I would say too is make sure your blood pressure is being taken properly; taking it properly might have the added benefit of being less stressful.

http://www.billpeckham.com/from_the_sharp_end_of_the/2009/04/how-to-take-an-accurate-blood-pressure-reading.html ( from the NIH )

• Before the test, sit for five minutes with your back supported and your feet flat on the ground.

• Rest your arm on a table at the level of your heart.

• Wear short sleeves so your arm is exposed.  ...

• Get two readings, taken at least two minutes apart, and average the results.

I think if you sit for five minutes, with no one talking to you - seriously tell people to stop asking just one little question and give you time to finish properly taking your blood pressure. Not to put too fine a point on it but tell everyone to STFU. I can not tell you how many time I've seen people asked questions while their BP is being taken and does anyone in a dialysis center take their BP with their back supported and both feet flat on the ground? But I digress, sitting quietly for five minutes, is a rare luxury but this is how BP is suppose to be taken. While you are sitting quietly you can use visualization and breathing exercises to calm yourself. I thinking this plus taking two readings, two minutes apart might be less stressful since one reading wouldn't feel like all or nothing.

The important thing is that you want BPs that accurately represent the state of your health.

[Jean]

I have the same disease you do. When I go to my regular Dr. no problem, but when I go to my neph look out. Mine had me take my BP every day at the same time at home and I kept it in a log book. It never went high, only in the nephs office. So,he believed me and did not up my meds. Call them maybe and see if they will go with that??

[Gonyeau]

I have the same issue. I try to arrive early for my nephrologiy appointment. The front desk immediately tells me that I am too early. We have a heated conversation about that fact. (I live abouit 150 miles from the clinic and allow times for traffic, rock slides and other things such as cattle drives.)

The medical assistant than calls me and immediately has me step on the scale. I am always certain that my wait will be horrid. Finally she sits me down and says that she hopes that my BP will be lower than last time. Guess what. It is HIGH>

I do see a cardiologist in the same clinic. My BP is generally about 125/65 then. Between the two of them they decided to put me on lisonpril. I know spend a large part of everyday at 92/40 or even lower.

We now chart the BP taken four times a day and bring them into every appointment. Still get the drugs, but I skip the lecture.

[bleija]

heres my advice, when they take it close ur eyes and think of a calm open meadow with deer or other springtime animals. do not think anything about relax or they're taking my blood pressue, and do not look at them or  the meter. i find when i look at them or the meter my numbers are higher everytime, idk if i psych myself out or what but i know i get good reading when i do this.

[krismimo]

Thanks for all the replies everyone I do not feel so alone after all. My husband and I are set to do our surgery August 21, 2012. (I’m the donor he is the recipient). Basically in two weeks. For about a month I have been stressed out especially more so since my transplant coordinator said my blood pressure was too high at one appointment (I’m 28 years old) which happened to be the Surgeon’s appointment I was anxious and hungry and had to wait for about a hour or so. She warned me saying well if your blood pressure is creeping up then keep an eye on it and if it is high then they can’t do the transplant oh great no pressure right?. Then she wanted me to take a few blood pressure measurements  on my own. I did my numbers were ok but I was stressed out especially since she told me if my numbers were not good they would call it off. My numbers fluctuated through the day.  Now before then before the surgeon and all this negative impact on me my numbers were like 115, or 120. She said my numbers were fine and the Surgeon said go ahead with the transplant. That scared me they were going to all it off because of one blip there.  I did all I could for a few weeks to take care of myself. Her threat to call it off still bothered me.  My coordinator said oh we will take your BP again when you do your cross match. Great let the anxiety kick in.



The second appointment which was Monday this week for the final cross match. I was nervous I knew today was do or die. I went in today and I knew if my numbers weren’t perfect they would strap me on the 24 hour machine because they said they would if that happened. So I’m trying to stay calm my blood pressure shoots up to 159. I cussed. And I was scared. They asked me a few questions. After a few minutes they placed my husband and I were in a room. He was talking to me trying to calm me down he knew I was scared. Maybe 5 minutes later a RN comes in and says honey you need to calm down they are not going to let you do the transplant with your blood pressure being that high. REALLY? LADY? LIKE I DIDN”T KNOW WHAT WAS AT STAKE HERE?. So about 10 minutes later one doctor shows up and he makes it worse he says your nervous? I said Yes. He said yeah your blood pressure is high. And it is ok to feel nervous and anxious but my concern is because your African American, he KEPT SAYING IT OVER AND OVER!!!!You have a higher chance to get it. (Keep in mind there is no high blood pressure or diabetes in my family.) And we will figure out if it is just nerves or symptoms , we can call it off and it might happen if we feel that your blood pressure may be a issue, it is not your fault these things happen.  As we are having this wonderful  talk guess what they do? The RN and the same woman comes back in the room with the BP machine. (Maybe like 10 minutes have passed). They take my measurements and everyone is staring at me . My husband helps me breathe as I’m taking this. It drops to 145. Still high but a little better. 

Ok so after this doctor talks to us for about another 5 minutes, scaring me. Then guess what he does? He asks me to sit on that stupid chair thing and he takes my blood pressure, he says oh yes it is high. We are going to do the 24 hour monitor. The RN tells me oh we told your coordinator everything she knows, I said oh great. My husband looked and I we talked for a few minutes he calmed me down for a little bit I was crying at this point. I said I don’t want to do it. And before I get to really figure out anything they schedule for the appointment for me to get strapped on. They wanted me to come in tomorrow which was Tuesday because they have their meetings on Fridays. I said I guess so and they gave me this stupid paper to come in… the very next morning. I was shocked I hoped I was given a day or two to breathe but noooo.


Plus the kicker was I was going to be wearing this thing at work…I work in a GYM as a receptionist..need I say more? We fold towels for our entire shift is just one of many things that I have to do. It is hard for  me to ask for time off especially for something last minute as this, I was hoping I could come in Thursday or Friday or maybe even the following Monday but they wanted me to do it before they had their meeting on Friday. They both leave, the RN comes back in and goes over my diet for the surgery next week. The good thing is they still would let us schedule for our early admission at the hospital, they didn’t cancel it. The RN leaves after that and we have to wait for the Surgeon. I just want to go home at this point.  After a few more minutes the Surgeon comes in…. HE is cool as hell. He really was. He was calm very nice, very sensitive, very positive and reassuring. He went over the procedure with us, what I like about him was his tone, he didn’t assume anything about me he already knew I was nervous.  He didn’t really say anything negative he went on as though we were going to have the surgery he already said ok See you guys on the 21st!He talked about my phobia ans acted as though I was already ok. That felt good and at the same time scary no pressure right? He said we will take a look at everything and I know you are nervous and it is ok. From him it sounded more sincere you know?

The surgeon made me feel at ease. And with that out appointment was over. We went to admission and I cried for the rest of the day like a baby my kind boss gave me some Valerian Root works wonders, I bought a bottle. The next day taken some valerian root. I was tired but a little more calm I had to come in the morning get strapped up for the 24 hour BP monitor. The doctor was really nice, I explained to him why I was there and he was very kind. He put the machine on my arm told me the dos and dont’s and I had to keep a written record through the day. He tested me and it shot up again to 159. I was horrified. He was very chill he said don’t worry it is the morning, and usually BP is elevated plus you are in here in the office and it is nerves. Your BP will fluctuate there will be HI’s and LO’s. It is going to test your arm every 20 minutes three times an hour.  After midnight it will stop beeping and take your BP once a hour. I told him what my day was going to be like and he said ok just do the best I can. 


I couldn’t take the stupid thing off or take a shower. I had a LONG DAY. A few times the BP machine went all berserk. Sometimes it took my measurements back to back, to say it was an inconvenience was not enough.  My co workers said not to stress and just try to meditate. I sat down on a mat and for half the day I was trying to stay calm and take deep breathes. I hope it helped. My arm hurt like hell though. I came home my husband help readjust it he said I had it on too tight. He put it on snug and not at the elbow it made a world of difference. The rest of the night it made it easier to deal with not as painful as it was earlier. And I felt the cuff finish faster then the first half of the day. Sleep was awkward but ok. I Went in the next morning and dropped off that bloody machine off.  I gave him my chart and I wrote everything down in great detail breaking down almost every hour until midnight. I think he was a little surprised. I told him of the discomfort and how hard it was. We talked for 10 minutes and he said the the Doctor (Surgeon who is doing our surgery) will be looking at my numbers. He will probably receive them at the end of the day no later than tomorrow. (Thursday). The board is going to decide based on my BP results but the Surgeon has the last call. I have mixed feelings I can’t say I did well because I don’t know what they were.  My husband told me he loved me no matter what happens and if my health was in danger it wasn’t worth risking it for the surgery. But he felt I was fine the whole time. I have to sit there and wait for them to give me good news or bad news.  My boss made a good point she said if my results were all mixed up she suggested if I can take it again during the weekend when I didn’t have work. I could make that argument. What would you guys do or suggest I do if the news is not so good?

[MomoMcSleepy]

You can try the weekend thing, but sitting around calmly meditating all day is not your normal m.o., you move around and fold and clean and work.  I think the test that they had you do is reasonable,  and they way they had you do it makes sense.  Maybe you can also get a cuff from CVS or something and start monitoring your pressure on your own.  I had the opposite of your problem.  I insisted that I did NOT have white coat, was ignored, and my kidney failed while no one noticed for a couple of years.

They have to be responsible and make sure that you can survive on one kidney.  I think you're getting worked up, and just need to stop seeing them as a threat or adversary, blocking your husband from being healthy.  They are looking out for both of you.

When I wanted to prove that my pressure was high, I bought a cuff and kept a daily log.  My doctors thought I was doing it wrong cause at the office it would fluctuate (as anyone's does, even 20 points throughout the day), but eventually I proved that I was doing it properly.  I learned to do it with a stethoscope. 

Don't be so hyperfocused on the numbers.  Breathe and see the big picture, and if it's meant to be, it will be. 

[jeannea]

I'm not convinced you only have white coat high BP. Has it happened with every doctor even when you were in early adult years or is it just with transplant doctors? They do need to know you are healthy. Think how your husband would feel if you donated only to end up on dialysis. The transplant process is stressful both before and after. They may also be concerned about your psychological state. They want to know you'll be ok through some stressful stuff. And they certainly don't want to get you in the operating room and have you stroke out.

Have you asked if you need to be on BP meds?

[krismimo]

Thank you for all the responses. I know the post came off as a crazy rant and I'm not a dramatic person I told it just the way it happened. Even my husband found it a little distateful in how they handled things with me and he is the Kidney patient! LOL ironic right? And I know that what they are doing is not a bad thing it was HOW it was done I'm fully aware of the how's and why's but it's all about you do it. I'm learning that different doctors have diffrerent styles and each doctor has a certain way of doing things. I have been with my husband for majority of his diagnosis the ups and downs and I also dealt with this growing up with people on dialysis since I was a little girl, so believe me when I tell you that I'm no stranger to this, I'm usually cool and collected which brings me to my next point, so the next day they made me do the 24 hour blood pressure test. I had a panic attack the previous day I just felt bombarded. So I did the best I could and I went to work and had pms symptoms (Didn't realise it). First time I took it they said I was high normal (of course it was) My coordinator gave me the so sorry speech and they were getting ready to boot me out. I requested to do it again. I was not going down without a fight. I looked at it this way if they allow me to take it again and the results are the same then I know I need to work on something. BUT... if my results come back normal which I expect them too then I knew I was stressed out. And need to chill out.

My coordinator called me back and said mentioned that I was thrown into doing the BP test and that it was very stressful especially since the appointment didn't go all that well to begin with. So they gave me a second shot. I relaxed during the weekend. Went to my appointment on Monday. Strapped the thing on me and calmed my self down. Got the results just now and BOOM came back NORMAL. My chances were small they were convinced my results were not going to change. But I know my body I know my self well enough. My coordinator was pleased and we talked for about 30 minutes. They KNEW that things were not dealt correctly thus my results were NORMAL. As they have always been.  Our surgery is set on 21st of August. The one thing I did learn was how to deal with stress better not to hold anything in. They want me to check in I think sometime next week.  Oh when they thought they are going to cancel the appointment orginally. I saw my BP results I was off by 1 number and the other one was 2 numbers. It actually made me feel better they made it sound like I was going to stroke out and I wasn't. Now I'm here and my results are good as I knew they would be. Plus the cuff was not put on correctly the first time it was on too tight.  

I had a fear of doctors I'm still a little nervous about them but I'm doing my best to over come that fear. And little by liitle I'am.

[Joe]

Great to hear that everything turned out ok. Hate that the whole thing was caused by their messing things up.

[MomoMcSleepy]

Oh, good.  I see what you mean about bedside manner, etc.  I hope that everything goes well for the two of you, and that you have lots of support during your recovery!

God Bless!   

[krismimo]

Hey gang so tomorrow is the big day. We have be there at 815 am. Surgery begins at 12 noon. I think they will prep us at the same time then seperate us. I'm a little anxious I hope everything goes through smoothly. Please keep us in prayer as we go through this thanks for all the support. Hopefully the next time you hear from me you will hear good news from me later on this week.

Talk to you guys soon!

Kris

[MommyChick]

Sending lots of thoughts & prayers your way !!! 
Hope all goes well for you both! 

[AnnieB]

Before you know it, tomorrow will be yesterday...I'll be thinking about you tomorrow and saying a few prayers that everything goes well! 

[Sax-O-Trix]

Good luck!  I'll be thinking of you and your husband.  My donor (brother) was out of the hospital in less than 48 hrs.  He did very well.  His advice is to get up and walk as soon as you can:)

[bleija]

hope everything went nice and smoothly, and your enjoying the pain medications...

[krismimo]

Thanks guys it is 11pm here and so I have about 8 hours I havn't eaten in two days I hope my blood pressure stabilizes. I just want everything to go smoothly. well about 8 more hours to go. Thank you all again for the prayers and support.