Aug 092011

I had 24-hour blood pressure monitoring done twice this past week, sort of. The first monitor went kaput after a couple of hours. So the next day, back on the highway I went to the clinic and was hooked up to a 2-week-old one. Brand new is better than well used, except when it comes to the cuff.

A 24-hour monitor is like a regular blood pressure test in that the lab tech wraps the cuff around your upper arm on your non-dominant side, except it stays on for 24 hours and the other end of the hose that comes out of the cuff goes into a big-wallet-sized heavy rectangular box. That box inflates the cuff at fifteen- to twenty-minute intervals (yeah, ouch) and records all the data. It sits in a fabric pouch that is belted on to you, either with your own belt (can get a little tricky at bathroom time) or a supplied waist strap. I was given the waist strap the second time round, but at its smallest setting was too big. I think they make these for obese people and forget normal or overweight people use this too.

I think the cuff is a little thinner than the one at your doctor’s office, but the one on the new monitor was considerably stiffer than the old one. Not good. Softer fabric equals happier arm. A cuff that didn’t slide down over my elbow, even after some furious readjusting would’ve been nice too.

The winter is definitely a better time to get this done, for you can hide the cuff under long sleeves and the monitor under layers of clothing. Summer it all hangs out.

I went home. And stayed there … well, except for a trip to a coffee house. I put a bulky shirt on for that.

But winter or summer, there’s nothing you can do to muffle the loud beep it gives to warn you that the cuff is about to inflate, time to relax your arm because if you don’t, the reading will be bad and it’s going to go off again in a couple of minutes. Double ouch. At the end of the reading, it gives a double beep to tell you that it’s safe to move your arm again.

This is my second 24-hour blood pressure monitor test. I had the first one in early 2007 after I’d been put on atenolol for my fast heart rate. I was concerned that the test would not show my normal blood pressure but as it is under medication. How could we know what was happening to me if it was being masked by a beta blocker? But such has been my story with cardiologists since my traumatic brain injury (also known as concussion or closed head injury).

In the early years, I would have my blood pressure taken during one of those many interminable functional assessment tests, sleep tests, medical consultations, psychological tests, neuropsychological tests, and on and on, ordered either by the insurance company or occasionally by one of my doctors. Usually, my blood pressure was up. Then I’d go to one of my doctors, and my blood pressure would be down. This went on for years, and all the docs would say is everything is okay, also the same about my high heart rate. I think they’re idiots to ignore the latter. I’m not a hummingbird or a baby. I’m an adult female whose heart rate should not be above 90, never mind 120 — it’s a symptom telling them something is wrong. But I digress. I’m supposed to be talking blood pressure. Deep breathe, bring it back down. Okay. To continue.

My newish GP has started off on the right foot by convincing me to have the 24-hour test done. He’s probably done it now as opposed to a couple of years ago because I took myself off the atenolol this past winter and now he can see what’s actually happening, plus is no more relying on the cardiologists to take care of it (ha!).

For years, my yo-yoing blood pressure has not been dealt with. I should say at this point that all my life my blood pressure has been low, so low that under stress it dropped like a stone, and only willpower kept me from not following suit. At the time of the injury, it had reached an all-time high of 110/70. It never, ever rose in reaction to stress. A very smart specialist figured out that I did not produce enough epinephrine and norepinephrine normally and also during stressful situations. That’s why my blood pressure dropped instead of rising under stress, including exercise.

Stress can be mental, as in doing mentally taxing work; physical, as in exercise; emotional, as in those notorious family get togethers depicted in movies; psychological, as in not having the coping skills to deal with difficult people or situations.

To figure out out what to do about my yo-yoing blood pressure, we have to look at my coping skills (fine), the actual stress I’m under (situational, emotional, physical, mental), my physical parameters (weight, diet, exercise), and how my brain has affected the whole shebang.

A properly functioning brain is rather important to cope with stress or to learn how to do so and for your body to react in a normal fashion. Luckily, I already had excellent coping skills (as measured in a stress management course at Toronto Rehab). I couldn’t imagine trying to learn coping skills with having an acquired learning disability from the injury and, at the same time, relearning a whole bunch of things. Still, my skills were insufficient against the stress the brain injury and its sequelae had suddenly subjected me to.

So basically my blood pressure started to yo-yo because of damage to the brain area that regulates blood pressure, to the area that responds to stress, and the extreme stressors inflicted on me.

This is my theory.

To really understand all this one has to know how the brain affects blood pressure and how other parameters like weight and diet interact with that. The sympathetic nervous system affects a whole bunch of organs and systems in the body. We already know mine has been in full alert since the injury, and so it really isn’t surprising that my blood pressure goes up. What is puzzling to me is why it goes down. We also know that people with brain injuries have a harder time coping with stress, not just in lack of skills but in having damage to the brain. For example, a noisy environment can bother anyone. But the sensitivity to noise is so acute after injury that the same environment that may tire a normal person out after a couple of hours is like being under a 747 taking off, next to a jackhammer, with a bass-thumping car nearby for a person with a brain injury. You want to run and hide fast.

Another thing I should note here is that I get all my test results because care between specialists and GPs is so fragmented that if the patient doesn’t have copies of everything and can take copies to all their docs, there will always be big holes in one’s care.

I have had several Holters and blood pressure tests, and this past week I have finally, finally learnt to keep my own activity log because most labs don’t correlate the log you give them with the test results unless they correlate with arrythmias. The mainstream media may yak on about stress and heart health, but cardiologists and labs couldn’t care less about looking for signs of stress in your heart rate or blood pressure test results. I think, whether or not you have a brain injury, but particularly if you do, you as the patient should keep your own activity log, then ask for a copy of the test results and correlate your activites with the list of every reading over the 24 hours (of course this presumes the lab gives comprehensive results — kick up a fuss if they don’t — you don’t need to go through this hell for a crappy report).

There are three things the report can tell you: On average, do you have hypertension? What makes it go up? What makes it go down?

So I have borderline-mild diastolic hypertension. But it goes down at night, which is a normal and a good thing.

Emotional and financial stress make it go up. Surprise, surprise.

The 32-minute alpha-wave session on the audiovisual entrainment unit makes it go down, as does massage in my robotic chair and possibly a minimum of one-hour with the Cranial Electrical Stimulation (CES) unit on the Sleep setting. But nothing makes it drop as deeply as deep breathing does. Wow. A good twenty to thirty points.

One thing that was really awesome to learn was that the CES device has done amazing things for my skin. Its effect doesn’t last long, which is why I have to use it twice a day. But it meant when I took the blood pressure cuff off, my skin wasn’t red all over, puffy, and itchy-painful like in 2007. Sure, there were red marks at the elbow crease and a small patch on the upper arm. But that was it. When I had adjusted the cuff prior to the previous night’s CES, I had seen that angry red puffiness already beginning, and a largish patch it was too. So despite not having taken the cuff off at any time, and after two CES sessions, to have it look as good as that, and fade so quickly too, at the end of the test is amazing.

So what does this all mean? Some thinking is in order.