Accurate blood pressure readings
DEAR DR. ROACH: I monitor my blood pressure at home as part of my regular wellness routine.
The instructions for the BP monitor say to sit upright, keep my feet on the floor and to not place the cuff over clothing. In addition, directions indicate that the cuff should be placed at the level of the heart.
I have rarely been in a doctor’s office where the staff taking my blood pressure follows this procedure. I am almost always sitting on the exam table with my legs dangling, and the cuff is always placed over my clothing.
When I have raised this with the staff taking the reading, my comments usually are brushed off. My BP is usually a little high when I am in a doctor’s office (compared with 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 isn’t properly administered for the only monitoring of BP he or she does?
ANSWER: You are right that your blood pressure was not measured correctly. Worse, the error in the blood pressure measurement could adversely affect your treatment, potentially causing you to be over- or undertreated. Worse still, when you tried to make sure your blood pressure was measured correctly, you weren’t listened to.
When it really matters — for example, when taking care of a person with high blood pressure — the blood pressure should be measured very carefully.
The home measurements actually may be more useful, as there are more results, which minimizes random error, and they are taken in the situation where people live, not the artificial situation of a physician’s office. However, the doctor should make sure the device is accurate before relying on the readings.
Finally, there is increasing evidence that measuring the blood pressure many times over 24 hours may be useful, especially in cases of suspected “white coat” hypertension.
DEAR DR. ROACH: I am an 81-year-old female polio survivor with many of the post-polio symptoms. I carry a card that says, “In case of surgery, DO NOT use a depolarizing muscle relaxant anesthesia or curare.”
The cards were handed out at a PP support-group meeting. I do not know the origin.
In early August, I had a “day surgery.” My physician mentioned the card when scheduling, and on the day of surgery, I showed the anesthetist the card.
I had no problems breathing. However, I woke up from the surgery extremely weak.
I spent three weeks at a rehab hospital and had four weeks of inhome therapy before I was about back to my pre-surgery abilities.
I discovered that along with other anesthetics (propofol and fentanyl) I was given succinylcholine (a depolarizing anesthetic).
Have you heard of this type of reaction in any other people with post-polio syndrome?
ANSWER: I’m not an anesthesiologist nor an expert in post-polio syndrome, but I was taught that in people with neuromuscular disease (poliomyelitis is a classic example), muscle relaxant anesthetics must be used with extreme care.
Succinylcholine in particular is problematic in people with postpolio syndrome. Newer, shorteracting agents, such as rocuronium, should be used, and at much lower doses than in someone without neurological disease.
Further, avoiding neuromuscular blocking agents entirely is recommended, if possible.
I don’t know enough about the surgery to know if that was possible or, if it was possible to use a regional anesthetic with a lower risk of the kind of prolonged side effect you suffered.
DEAR DR. ROACH: I have been diagnosed with atrial fibrillation. I am on Xarelto, which my doctor prescribed, and I seem to be doing well. However, the cost of this medicine has been rising, and I’m struggling to keep paying for it. Any chance it will be going generic soon?
ANSWER: Medication costs are a significant source of distress for many Americans, and for a few people who are unable to pay for life-sustaining medication, a contributor to disability and death. While I don’t have a solution to the problem overall, there are some sources for help.
The first is the pharmaceutical manufacturer. In the case of rivaroxaban (Xarelto), the manufacturer, Janssen, has a savings program so that people with commercial prescription coverage pay only $10.00 in copays (Xarelto.com or 888-XARELTO). Another resource is the Johnson & Johnson Patient Assistance Foundation at 1-800-652-6227 or www.JJPAF.org.
Finally, Goodrx.com is a free service where users can print coupons for their local pharmacies. The prices are sometimes below the insurance copays for my patients. Unfortunately, when I checked, Xarelto was $425 for a month’s supply through Goodrx.
Rivaroxaban will become available as a generic in 2021.
Readers may email questions to ToYourGoodHealth @med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.