Dear Dr. Roach: I monitor my blood pressure at home as part of my regular wellness routine. The instructions for the blood pressure monitor tell you to sit upright, keep my feet on the floor, and do not put your fist on your clothing. In addition, indications indicate that the cuff should be placed at the level of the heart.
I have rarely been in a doctor's office where staff who are taking my blood pressure follow this procedure. I'm almost always sitting at the examination table with my legs hanging and the cuff always placed on the clothes. When I get this done with the team doing the reading, my comments are usually ignored. My blood pressure is usually a bit high when I'm in a doctor's office (compared to my home readings), and I understand that this is not uncommon. How can a doctor really identify that I might have a blood pressure problem if the basic procedure is not administered correctly for the sole monitoring of the blood pressure that he or she does?
You are certain that your blood pressure was not measured correctly. Worse, the error in blood pressure measurement can adversely affect your treatment, potentially causing you to be over or under-treated. Even worse, when you tried to make sure your blood pressure was measured correctly, you were not listening.
When it really matters – for example, when taking care of a person with high blood pressure – blood pressure should be measured very carefully.
Home measurements, in fact, may be more useful as there are more results, which minimizes random error, and are taken in the situation where people live, not in the artificial situation of a doctor's office. However, the doctor should check that the device is correct before relying on the readings.
Finally, there is growing evidence that measuring blood pressure many times in 24 hours may be helpful, especially in cases of suspected "white coat" hypertension.
Dear Dr. Roach: I am an 81-year-old polio survivor with many post-polio symptoms. I carry a card that says, "In case of surgery, DO NOT use a muscle relaxant anesthetic or a depolarizing curare." The cards were delivered at a meeting of the PP support group. I do not know the origin.
In early August, I did a "day surgery". My doctor mentioned the card during the appointment and on the day of the surgery I showed the anesthetist the card.
I had no trouble breathing. However, I woke up from extremely weak surgery.
I spent three weeks in a rehab hospital and had four weeks of home therapy before returning to my preoperative skills.
I found that, along with other anesthetics (propofol and fentanyl), I received succinylcholine (a depolarizing anesthetic).
Have you ever heard of this kind of reaction in other people with post-polio syndrome?
I am not an anesthesiologist or specialist in post-polio syndrome, but I learned that in people with neuromuscular disease (polio is a classic example), muscle relaxant anesthetics should be used with extreme caution. Succinylcholine, in particular, is problematic in people with post-polio syndrome.
Younger, shorter acting agents such as rocuronium should be used and in much lower doses than in someone without neurological disease.
In addition, it is recommended to completely avoid neuromuscular blocking agents, if possible.
I do not know enough about the surgery to know if this was possible or whether it was possible to use a regional anesthetic with a lower risk of the kind of prolonged side effect that you suffered.
Dr. Roach regrets not being able to respond to individual letters, but will incorporate them into the column whenever possible. Readers can email questions to [email protected]
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