Kaiser Obsessive Compulsive Disorder and Blood Pressure

Kaiser has OCD about BP

The ‘letter to my Doctor’ follows below. Here is some background for others:

Every time you visit Kaiser, they take a blood pressure reading. “High Blood Pressure” has now been redefined with a “pre-hypertensive” category that basically means “you are inside normal, but near the upper bound, so we want to get a head start on being obsessive compulsive in case you do develop a real disease later”. Due to this, patients are constantly harangued about their blood pressure. This, of course, tends to make them worry and raise their blood pressure…

So I’ve gone to Kaiser with a variety of real illnesses over the years. Universally, they obsess far more about BP than about my petty painful complaints. This, of course, causes me some modest annoyance … that raises my blood pressure … that triggers their OCD.

So I’ve gone with a bleeding lump on my neck (that was eventually removed and found to be benign) thinking I might have skin cancer. First up? BP lecture with tongue clucking. Now just WHY can’t I be relaxed when I’m thinking maybe it’s my last days on earth? Silly me.

I’ve gone with eyes on fire from toxin ( NEVER pluck spurge or other euphorbia without safety glasses on. That stuff makes a hot poker in the eyes sound like a reasonable option… probably got in my eyes from fingers, so wash well after yard time and do NOT rinse face until hands scrubbed with soap.) Bright Red, tears flowing like Niagra Falls, (I’d already hit the medicine cabinet for Visine and antihistamines – crushed under the tongue for most rapid absorption) and I’d done an emergency eye wash (but might have had some residue on my hands so who knows how effective it was… ALWAYS scrub with hot water AND soap after spurge / euphorbia pulling as the sap is oily and does not rinse off well)

So, in comes the Emergency Room Doctor to see a patient about eyes on fire from probable exposure to toxic stuff. (One would expect an immediate trip to the eye wash fountain… Nope.) After a terribly long time taking a patient history, he left to get something (it was during the history that I realized that it might have been from the spurge and suggested it to the Doctor – later I did the 20 second Google search to discover it is in the euphorbia family and they have nasty toxic sap known to cause corneal erosion and related issues). So I “hit the sink” while he was out of the room and did a full hand scrub and more eye rinsing. Upon the Dr. return, I told him what I’d done and he did comment it was probably the right thing (gee thanks..). I was given a prescription for some eye wash and a nice lecture on the fact that my blood pressure was “a bit high” at 150 ish. Well DUH. My eyes are on fire….

Nothing like going to your doctor with, oh, a complaint that you might have some strange tropical disease eating you alive and getting a nice little lecture on the importance of avoiding fried foods to bring a balanced state of emotional well being.
/sarcoff>

So that’s your context. I go to the hospital when I have something I think might be major. I “have history” with hospitals (you know, the usual stuff. Knives and electric drills to body parts. Friends and family who “check in, but never check out”… ) and they are not what I would think of as prime ‘relaxation’ territory.

Now I’m off to the doctor again. (The issue will be left out here as it isn’t germane. Just realize that I think it isn’t major, but it’s a damn PITA.) So I actually have a very nice and very caring doctor as my primary care doctor now. She listens and even goes the extra mile on my “issue”. Golly, I think: I’ve won the Doctor Lotto at Kaiser. I’ve got one of the especially good ones.

Then comes the obligatory BP OCD worry.

Realize that it’s in my record that I’m a “white coat hyper” person. My last visit (for something else that I actually cared about…) had me given a BP monitor to wear for 24 hours. One of those harness things that takes the BP every hour around the clock. They already have a nice record of me being about 150 at Kaiser and 120 at home. But hey, what good is a little OCD if you don’t Obsess about it… So I’m assigned to ‘record my BP every day for a week’ and email it to my doctor.

I went a little beyond that… but when I went to email it, the Kaiser “private email to doctors’ is limited to 1000 characters. That being about enough to say “In our last visit you asked me to watch {name of illness} and I felt { not much but …} and certainly not enough to give a fun and interesting response…

So having no way to email this to my Doctor, I’m now going to post my blood pressure ‘experiment’ to the world. And send the Good Doctor a link to read.

These are real BP measurements. There is humor injected along the way, but the numbers are real. Since I can’t send them to my Doctor (over 1000 char and the only attachments you can send are JPEG – and yes, it looks inside and barfs if you have text marked with a .jpg suffix) I’m just going to post it here for the world to see.

And folks wonder why I don’t like to run off to the Hospital for minor medical issues, like, oh, chopping off a toe or malaria ;-)

Letter to Dear Doctor

Dear Doctor,

Here is a preliminary blood pressure report. I know you only asked for one reading per day, for a week, but I’m a bit more ‘thorough’ than that. (Besides, Kaiser is rather OCD – Obsessive Compulsive Disorder – about BP and forces that attitude onto its Doctors and Nurses and through them onto the patients, so I think I can be forgiven for responding with an ‘in kind’ OCD type response.)

I’ve tried to intersperse some humour throughout. This isn’t a cynical act, it’s just that I can’t stay dour for very long. If I’m doing something a bit dreary, I’m going to find some fun in it. With that said, the results here are still sound. I’m a fairly good lab tech and I’m a careful worker. Levity does not imply sloppy.

I’ve put a couple of days into creating this information, it will take you a couple of minutes to read it. Please take the time to read all of it, even if it is a bit long. There are some bits of whit and wisdom buried in the detail of numbers. Besides, I might deliver a ‘pop quiz’ at our next appointment ;-)

OK, on with the show:

I was asked to get one BP reading per day. But Nyquist sampling theory says that you must sample at about 2 times the highest frequency you wish to adequately capture and detect. Aside from a 24 hour daily cycle (implying a 12 hour minimum sample rate , or twice daily, to even detect it); there are swings as fast as a few minutes.

How could I possibly “cherry pick” my best BP reading, my most normal moment, randomly? Clearly I would need to do a finer grained series to find my “normal moment” best schedule. Further, it would be valuable to know if there were any environmental or other factors influencing faster swings. A log of activity at the time would also be needed. Finally, it might prove of benefit to “calibrate instrument error” in a gross way. To find any factors that might induce bias into the readings and figure out how best to avoid (or exploit) them.

So I decided to sample on a “every few minutes to an hour” basis.

I’ve left out those periods where things did not change much for several hours or where the changes were already explained by prior observations. This is a “time ordered sequence” of BP readings with what was observed, filtered for ‘mostly interesting bits’. We start with the office visit we just had.

(Please note that the early readings do not have a ‘time stamp’. I had needed to change batteries in my meter before the office visit and did not notice that the instrument had lost it’s clock setting. I also didn’t expect you to be scrolling through it looking at date stamps. I thought I was the only person who was going to be playing with it. So after the visit I reset the clock. Time and date stamps begin at the point where I have valid data available).

So, I got up on the morning of 2/18 a bit apprehensive. Once Again I’d need to deal with hospitals. Once again I’d be confronted by folks in white coats thinking they control my life, know more than me about me; and here I was intending to tell them I had a problem they would likely not take seriously.

Oh, and once again I would go in with what I cared about and most likely just be “beaten with the blood pressure stick” because they are OCD about it while MY issue was likely to be brushed off. OK, once more into the breach… So my emotional state was not exactly ‘relaxed’.

Series , in chronological order,of 2/18 begins:

Systolic Diastolic Pulse – from an Omron wrist type meter: model HEM- 629

141   84   61   At Wakeup, but after digging around to find meter. Sitting.
124   76   61   Supine and relaxed, meter at about heart level
135   83   59   Sitting with wrist resting in lap.
131   77   60
125   80   58   A couple of more, swapping arms.  Not much difference.
141   85   55   Preparing to leave for Kaiser.  A little angst creeping in.  
Sitting.

At Kaiser, my BP was taken by the nurse. This was after a hike in from the parking lot and a brisk walk to the far window side (where the station was in use) then a walk back to the nurses station side (where the station was in use) then a minute or two of standing around waiting for the station to open. If I recall correctly, the reading was:

135 89 pulse? At nurses station at Kaiser. Not too bad, I think. Almost representative of what I had at home. Lower than my “worst” for systolic, but diastolic is a bit higher. Though my “best” blows the doors off of it…

I’m taken to the ‘examination room’ and decide to see if the wrist cuff is at all close to the nurse’s readings, though I know I’m not doing a valid A/B comparison since the time and seating are different.

I’m “perched” on the edge of the exam table. A slightly slippery “paper over upholstery” surface without any back support (so abdominal muscles will be ‘splinting’ to provide support) and I’ll be keeping both hands busy with the gauge so I’m going to be using feet and body to brace and balance. Not exactly relaxed (and in retrospect I ought to have used a chair, but wanted to be “where told” should The Doctor walk in…)

156 105 70 Well, that’s not good. Clearly either I’ve blown the reading or…
156 110 69 Nope. Reading is valid. So I guess being all “perched” with tight abdominal muscles is not going to give me a valid calibration of my meter.

(For what it’s worth, the other readings you saw in the meter were from about two years ago when I was playing around with it – the last time Kaiser was OCD about BP and had me go through the hoops and circuses about it. And wear the monitor.)

On to the future.

We “wrapped up” but you were clearly alarmed at some of the odd numbers in the meter (some were from times like, oh, walking and stair climbing…), so I’m off to do a “one BP a day for a week” assignment. In retrospect I realise I never should have let you see MY meter and just left you a bit stressed over the “slightly high but normal” that the nurse took… Oh Well, live and learn.

Note to self: NEVER take personal meter to Kaiser without audit of readings.

But now I have an assignment, and I guess I might as well start to “play around” with readings and see what the whole pattern is. After all, you can’t pick the cherries if you don’t know where the orchard is….

So I put the meter on as I walk to the car. I sit down and dig out my keys, but before driving off, take a “baseline after walk to car when first seated”:

157 85 67 Well, systolic is about the same; at least diastolic has come down.
my guess would be that the seat support and lack of “perching” muscle tension lets the diastolic drop, while the “fresh from a walk” takes a while to let the systolic drop. Working theory for the moment.

Drive away. About 5 minutes out:

136 87 65 Not at all what I expected. Thought traffic would be stressful.
128 79 66 Pulled over reading papers. Realise I forgot lab. Turn car around.
137 84 65 Driving back to Kaiser. Odd, the dropping has reversed…
153 100 70 Sitting in the lab leaning forward, waiting for number to be called.
136 83 66 At home, newly arrived.

Fascinating. I can directly map my BP as a function of distance from Kaiser… Though the nature of the seating has some influence. Car seats allow a very relaxed and supported back / abdominal muscles. Further, exact posture matters a lot. Just perching or leaning forward in the chair causes a modest jump.

Tomorrow is Another Day. Begin formal time series.

2/19

124 63 66 Waking up, still supine. Much better result.
131 78 62 Didn’t record times, but about 15 min. period after waking up
129 76 62 while still being low activity. OK 3 makes a good baseline.

166 103 72 Wow!!! Look at THAT! (Seated) Time to medicate?

Nope. I was curious about a technique I’d seen on TV to make a ‘lie detector’ give a ‘false lie’ signal. One “tightens the anal sphincter”. Looks like it works… The BP meter is a great “tight ass-o-meter”.

154 107 62 Relax a few seconds. Hmmm… Let’s try this sphincter thing laying down. Still high. Seems reliable.

Note to self: Find story again, review “how to give a false ‘true’ reading” instructions.

If you sit up and lean forward what happens?

165 107 63 Yup, confirmed to work. Even rested with low pulse. Here, I’ve bounced it back about 35 over baseline with the “pucker” technique. So far, the BP meter is best at measuring anal sphincter status.

Note to Doctor: Ask patients if they have a history of flatulence and tend to keep a ‘tight one’ due to history of socially embarrassing moments…

Note to self: Avoid beans and high fibre diet prior to Kaiser visits. Eat low residual meal the day before. Ask gay friends how to ‘loosen up’.

Note to Tight Ass Bastards world wide: Avoid seeing doctor on bad days… See the doctor whenever you are feeling particularly up tight. I’m sure they can help you feel better.

139 80 62 Supine, relaxed, about 5 minutes later. Baseline confirmed.
123 70 61 After morning tea and food. Caffeine has low effect. Food swamps it.

Realised that “clock is not set” and enter proper time and date. Time will omit the AM/ PM that can be picked up from context. From here on down the heading is:

Time  Systolic  Diastolic  Pulse  Notes

2:01   144   80   64   Interesting series.  Conscious effort to 
                      “loosen up” sphincter.  Sitting on edge of bed.
2:02   120   72   58    next  two laying down.
2:03   124   77   61

2:14   150   83   67   Dealing with phone calls, daily work, taken sitting.

3:05   126   72   70   This series is while doing relaxed work on 
                       written materials.
3:08   130   76   65    Pressure readings taken supine.  
3:27   125   80   63
3:36   130   74   60

About what I’d expected.

From here on out, all readings taken laying down with meter at heart level unless otherwise noted. Will need to do a series of “seated on edge” vs “seated in comfy chair” at some point to disambiguate abdominal muscle tightness effects.

4:00 146 84 81 The neighbours Siamese cat was stalking my rabbits. Chased it from the back yard and sprinted about 1 block down the street. Then brisk walk home. Odd. I expected to really blow out some big numbers after a cold start hard sprint with elevated respiration and really being peeved at the cat wanting to eat my bunnies…. Pulse is up but BP is slow to respond.

4:08 153 91 70 Interesting. The numbers RISE after I’ve stopped the activity. Perhaps the lactic acid metabolism? Maybe it just takes time for the event to pass? Maybe my BP changes slowly with lag of a couple of minutes? Interesting implications for the “walk in from parking lot, tour nursing stations looking for open one, relax on command in 10 seconds” process at Kaiser.

Note to self: Avoid chasing cats prior to Kaiser visit.

5:35 154 108 70 Realised back muscles have modest strain pain. Using
5:37 144 89 63 chest and abdominal muscles to minimise back motion.

Moderate pain from aggravating old lower back muscle pull ( in high school. I was out on medication for a couple of weeks and had back spasms for a few years afterwards). Feel that “need to lay down or risk spam episode” pain / tightness. As long as I work out and keep muscle tone, it’s not an issue, but cold starts sometimes are ‘not good’. About once every few years.

Note to self: REALLY a bad idea to chase cat from cold start before Kaiser visit.

6:30 122 76 66 Resting after cooking and eating dinner. Spaghetti with
6:41 128 74 67 vegetarian marinara, lima beans, bread and butter. Water.

6:54 106 65 61 Aprox. 4 oz. Scotch Whiskey as muscle relaxant for back.
7:26 110 61 61 Persistent effect… Can I get a prescription for Glenfidich?

Note to self: Scout out bars near Kaiser. Remember to pack Altoids breath mints.

10:32 103 54 61 Just before dropping off to sleep. Gee, didn’t know I could get this low. I’ll need to look up “low BP” spec and see how close I am. Wonder if BP medications mixed with Scotch have ‘recreational potential’ or ‘risk factors’?

But at least now we know why The Bard said “Alcohol, now there’s the great equivocator. It provoketh the desire but taketh away the means.”. Hydraulics not going to work well on no pressure…

Note to self: Drink iced tea on dates. In emergency, chase cat.

2/20 Series

8:10 105 64 59 My God, that IS a persistent effect. Wonder if this is ‘just me’ or other folks react this way too? Lets test some things. Position. Motion, Waking up process. This first reading is with the meter on my right wrist (Rt) and at mattress level. Lets swap things around.

8:12 123 76 60 Laying on Lt side, Rt wrist at heart level (hand on chest)
8:25 129 78 63 Flat on back, Lt hand with meter at side
8:41 117 71 54 Laying on Rt side with Lt meter hand curled resting on Rt arm to keep meter at heart level.

Not much arm selection or posture effects while flat. Movement, muscle tightness and time (variation over time) more important. Basically, moving around changing position seems to pop the systolic about 10-15 points more or less. Pulse rate shows the times of movement and the fairly direct systolic match.

10:20 147 81 61 During midmorning, after breakfast and coffee, while transcribing meter to paper to make this list (and thinking about hospitals…)

10:40 135 82 59 After washing dishes, supine.
10:44 141 107 74 Back at the sink, standing, arm resting on counter. Meter about 10 inches below heart level (about 40 cm).

Hmmm… So diastolic comes up about 25 points when standing. I suspect the bump is partly due to meter being below heart level. If I recall correctly, it’s about 2.5 mm of mercury for each 1 inch of water height (roughly, need to check that, implies Specific Gravity of 10 for mercury). [ I have since checked this, the SG of Mercury is 13.5 but I’m leaving the rest of the letter as originally written. ]

So that 10 inches would be 25 mm of mercury, about what the meter shows. Need to run some position tests to calibrate degree efficiency of compensation for hydraulic column by the body. Oddly, systolic is not effected much (more or less in proportion to pulse increase). I would speculate that systolic is proportional to pumping effort / pressure while diastolic is proportional to static pressure / hydraulic column.

OK, it’s Saturday. On Saturday we go visit the Mother In Law in the nursing home. She likes “MacDonalds” and it’s a ‘treat’ for her, so we get MacDonalds. I don’t like it much, but you do what you must. I can’t eat the fish as it has a bit of corn in the coating (and I developed a corn allergy at about 30 years old after eating corn chowder when I had a 105 F fever… now I know why they say “starve a fever”… but I digress. Note to self: Eat foods you hate when you have a high fever). I also don’t like whatever they coat the chicken with (and the “salad” has a chicken lump on top…). So I have my once a week “Big-N-Tasty” burger, fries, coke. I’d rather have sushi, or ramen, or… but I can’t. So, back to M.I.L. visit with MacD’s from a bag in a nursing home room with a porta-potty for “ambience”…

11:50 153 91 64 Sitting in car, just after visit with Mother-in-Law.
12:07 135 87 68 Driving home. Seated.
12:15 142 86 67 At gas station, filling car with overpriced gas. Seated.

Clearly a visit with the Mother-in-Law in the nursing home is about the same as a trip to Kaiser… ;-)

12:53 118 67 69 At home, watching 2001 A Space Odessy. Johan Strauss music Blue Danube Waltz playing during ‘approach to the moon’ sequence.

Note to self: Buy set of Waltz CDs with emphasis on Strauss. Use at Kaiser.

1:10 113 66 61 Persistent relaxed state watching 2001. Rt arm at heart level
1:28 114 68 61 while continuing to watch A Space Odessy.

1:59 124 73 59 Changed channel to news as a test. +10 on systolic…
2:05 121 75 61 Changed channel to history channel.
2:42 131 78 61 Back on 2001 – Exit music; but now leaning propped up on Elbow with some body and muscle tightness to maintain posture. Sad that movie is over.

OK, so BP measures TV content a little bit and posture / muscle tension rather a lot. Lets explore “content” effects a bit more:

3:11 129 80 63 Watching news again. News not good.
3:13 144 77 60 Laughing at show a little, propped up on Elbow
3:48 156 108 69 Laughing a lot and emotionally engaged with show. Seated.
3:56 167 109 67 Strong shot of “Heartburn” and gas

(darned burger… part of why I don’t eat fried foods much. Clearly pain makes for a BP spike. Also a ‘sphincter moment’ as trying to suppress things wanting to exit. Perched on edge of bed. Clamping stomach / abdomen.

OK, so I’ve managed to “print” a high reading. Guess this day is “blown” for staying low. May as well go for it. Lets see just how high we can make this puppy go.

It’s time to go grocery shopping, so we’ll be doing physical activity: driving, pushing a cart, carrying bags, etc. Lets pick up, at Pacific Coast Coffee, a nice: 20 Ounce Coffee Mocha! Surly a nice shot of espresso can get things up.

4:30 Add 20 Oz of Mocha while shopping…. estimate 2 to 3 shots espresso.

5:27 126 76 58 Oh Damn. Plenty of time to absorb the coffee and nothing.

Resting watching the History Channel, but still I can FEEL the coffee jitter.

5:42 148 84 66 Making dinner. Bare foot, cold feet. Peripheral circulation low. Don’t know if it is the activity, caffein, or the poor circulation.

5:55 133 82 59 Making dinner, still cold toes. (Caffein vasoconstrictor?)
6:04 143 80 61 Dinner ready, folks called to table.

Coffee does not not seem to have raised absolute relaxed numbers much, but when active, they seem to bump up a bit more. Still, far less of an issue than a bit of heartburn pain or a bit of belly tightness. Estimate 10 points max.

6:58 133 80 64 Relaxing after dinner. Watching movie.
7:04 143 82 62 Very (positive) emotional moment in Close Encounters of the Third Kind (the alien greeting moment). Nice 10 point pop from emoting.

7:15 126 79 63 Toes finally warm (after snuggling under blanket). Relaxed
7:34 124 72 64 watching History of the Lost Ark.

Hmmm… Don’t know if the caffein is wearing off or if it’s just that I finally got my toes warm and dinner digesting so blood flow is more diffuse.

Note to Self: Wear heavy socks instead of sandals on next Kaiser visit. Eat meal one hour in advance. Avoid alien encounters.

(At this point I did an “arm position test” series. It shows a significant effect from the meter being away from heart level. Body posture only seems to matter as it influences abdominal muscle tension, but meter position is good for about 30 points more if the arm is hung off the bed or 30 points less if held straight up. Well beyond accidental positions, though. At lap height looks like +10.)

Note to Self: Test sitting posture with arm on back of couch at heart level vs laying in lap 9 inches below heart level. Could easily explain the +15 or so points between ‘sitting’ and ‘laying down’. Thesis: it’s not the posture, it’s the meter height.

I also did a “right vs left” wrist series that I’ll leave out. The conclusion was that there MIGHT be about 5 points of difference, but the variations from movement, from minor position changes, from activity, etc. all swamped the measure with noise. To properly sort this out would require 2 meters run at exactly the same time. I’ll just include a couple of samples here:

8:05 118 69 61 At side, resting laying down.
8:12 132 82 66 After moving around
8:20 125 70 61 Resting again.

8:53 124 77 59 Two random quick points.
8:57 133 82 58 So we can get a 10 point ‘jitter’ in systolic or 5 in diastolic just from moment to moment runs. Perhaps I’m not reacting the same way each time to that “snake tightening on the arm while humming” effect when the meter kicks in? ;-) So it looks like at least a 10 point “error band” ought to be put on any number for decision making uses.

MIDNIGHT

2/21 Series, just before falling asleep:

12:21   130   75   52
12:38   126   75   54
12:46   128   80   52   Then fell asleep after the movie ended.

Next Morning:

8:01   116   69   61  OK, so when I first wake up I’m an inert slug... 
8:06   110   63   60   and laying in bed a while doesn’t do much.
8:30   149  107   69   But jumping up to make coffee does!
9:10   134   78   67   But drinking it doesn’t have much effect.

OK, I’m filling out this list seated on the couch watching old movies. And I decide to test the ‘well supported arm at heart height’ set. Run the meter:

12:31 139 79 52 Feet up, braced on coffee table. Arm resting on seat back.
12:33 114 66 51 Feet on floor (so legs etc. more relaxed) arm on seat back

Golly. 25 points of difference from where my feet are placed. Posture matters.

Note to self: Investigate charm school for posture lessons. Keep feet off coffee table (thanks Mom…)

OK, some conclusions (remembering this is from a sample size of 1 person):

First off, BP meters make a Great “Sphynct-o-meter” and a decent “mood ring” but they don’t seem to say quite so much about circulatory condition as one would have liked. The error band on individual readings can be quite large. Posture matters.

The exact position of the meter and various extremities changes the reading rather a lot. Best is laying down (whole fluid column at one level and no more than 9 inches thick. Maximum meter positional error about 4 inches from mid point. The wrist meters will be more subject to this effect than arm bands as the wrists can be moved around a lot more than elbows.

Making decisions about medication based on a non-Nyquist sample size has a very large risk of error. Especially if the other factors are uncontrolled or biased. (Like perched on an exam table or after Mexican lunch…)

Caffein has much less impact on BP that I would have expected. 10 pts max.

Scotch (and, one presumes, Gin, Vodka, Beer, and Wine) may make a dandy BP medication. (So drink Irish Coffee ;-) instead of plain.

Note to self:: Conduct further research in this area to assure the effect is present in each type of beverage. Do not shortcut and leap to conclusions on too little data. Be diligent and remember, you are doing this for Science, so it is a reasonable cause for self sacrifice. Ask friends to confirm results. Several times. ;-)

Even modest excursions of emotional state (positive or negative) or modest pain can cause a BP spike (of short duration). With folks in hospitals being almost universally in an emotional state and / or in pain “this matters”. Think about it.

Corollary: Hospitals are a terrible place to measure BP.

OCD is a bad idea. Especially when institutionalised. Though it can be useful for purposes of illustration and during investigations / data analysis.

Since I now know where to “pick cherries” expect normal readings this week… After dinner while watching The History Channel ought to yield 120-130 / 70-80 ish range readings fairly reliably. If you prefer another number, let me know… Looks like I can give you anything from 110 / 70 to 160 / 100 if I try hard and you loan me an ice pick…

About E.M.Smith

A technical managerial sort interested in things from Stonehenge to computer science. My present "hot buttons' are the mythology of Climate Change and ancient metrology; but things change...
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40 Responses to Kaiser Obsessive Compulsive Disorder and Blood Pressure

  1. Michael says:

    Talk about OCD…….

  2. Doug Jones says:

    Love the icepick line- reminds me of the old joke:

    The lawyer was interviewed last, and again the final question was, “How much is two plus two?” The lawyer drew all the shades in the room, looked outside to see if anyone was there, checked the telephone for listening devices, and then whispered, “How much do you want it to be?”

    Substitute “Climate Scientist” for “lawyer,” of course.

  3. P.G. Sharrow says:

    Your observations brought a smile. I had a simuler experience last year. Went to the VA with a terrible lower back and body pain. the nurse took my BP and pulse and remarked on the spectacular numbers.

    I replied Grrr I grrr am passing a grrrrr kidney grrrrrr stone. :-(

    She said “that could be the cause”. :-)

    A hour later the numbers were much better and we were both relieved. :-)

    I would like to hear more about the Scotch experiments. ;-q

  4. Ruhroh says:

    I always thought that ‘bio-feedback’ was bogus until I realized I can use it to avoid the lecture from the practitioner.

    The main trick is to leave enough time after you get into the room to modulate your blood pressure down.

    OK, yes, and also avoid maniacal driving en route and chasing of cats, etc.

    As long as you can use it consistantly, the wrist meter is ~OK, but you run the risk of having the numbers disregarded by purist practitioners.

    Try to get more sleep, guy!
    RR

  5. Janet says:

    OMG I could die laughing right now. From one white-coat-freakout to another, thank you so much for this.

    I second Ruhroh. I become angsty to the point of hysteria around medical professionals. I learned to control my blood pressure during my last pregnancy under the tutelage of a most wonderful midwife. Got to where I could peg the number just about anywhere I wanted at home. At the doctor’s office it wasn’t as easy, due to hospital induced temporary insanity, but still made things better.

  6. Jeff Alberts says:

    Different people take BP slightly different ways too. In doctors’ offices they tend to use the old fashioned method, not a machine. So some nurses not being as good as others could account for drastic differences too. But taking a BP once and calling it a meaningful result is as valid as “global mean temperature”.

    Oh, and caffeine takes a long time to get into the system, hours, I’m pretty sure. So taking a reading right after tea or coffee wouldn’t show any caffeine results.

  7. Ian Beale says:

    Thanks for this.

    I’m noting the Scoth finding for future trial.

    And adding another observation.

    As a rancher who has just done his annual personal accident medical it seems that bulk rain after about 10 years of drought also work wonders on lowering BP things

  8. E.M.Smith says:

    @Jeff Alberts:

    I waited until I felt the caffein to do the meter. For me, it’s about 1/2 hour to 1 hour depending on how much food is in the way. The Mocha was on a more or less empty stomach and started to hit in about 30 minutes. I’d really expected about +30 / +20 from it. Very surprising… Though I’m glad I can, with some authority, state that I’m not going to give up coffee… (though I might give up fries and soda from McD’s)

    @All: FWIW, I undertook this experiment in the hope that I could have a standard copy to hand to each Doctor as they needed to learn about me (and to avoid wearing the BP harness for each time the doctor changes…) I was actually a bit surprised at some of the things I learned. Especially since folks make major decisions about medicating you 24 x 7 based on a fairly narrow set of values. ( To Kaiser’s credit, they do not. They put the harness 24 hour monitor on you first.)

    In particular, some of my “low near sleeping” readings were a bit of a surprise. I’d hate to think what happens to a 105/60 when you mix in a BP med. But it is in keeping with my peculiarities. I’ve been measured with a daily temperature range from 97.4 F at the low point to 99.7 F at the peak on the same day. (though not doing exercise, just mid afternoon about 3 pm. ) I seem to be built with a very high dynamic range. When I’m down, I’m a lizard near hibernation. And when I’m up, I’m really up. So my basic metabolism cycles somewhat extremely. Not surprisingly, at 8 am I’m not worth a damn and at 2 pm I can think with startling clarity.

    I once worked for a guy who was a ‘morning person’. Insisted on having everyone at their desk at 8 am to “Get the best from them before they ran down for the day.” (He would start to fade shortly after lunch, was worthless at dinner meetings.) But he was sure he was getting everyone “while they are still fresh”.

    No amount of talking would convince him that I was a large paper weight between 8 am and 10 am. The good news was that I could knock out enough bright ideas and code between noon and 5 pm to get more done than most folks did in a day. Then I had my whole evening to myself at peak performance… Oddly, some of my best work has been done between 8 PM and 2 AM… But I still have bad memories of the occasional 7 am “motivational meeting” and trying to guzzle enough coffee to follow the conversation and not look completely stupid. ( Just think about those 8 am numbers above and what it would be at 7 am. Slumped in a comfy chair… what do you think? 105 / 60 with 52 pulse and 97 F temp? Yeah, one notch above comatose… and it felt that way too. I learned to never offer an idea unless it was one written down the night before… or I’d been up all night.)

    Eventually I learned that if I ate sugars and starches for breakfast I was going back to sleep in an hour (think pancakes and syrup), but a nice high protein breakfast got things going faster. So a “Coffee, Ham & Eggs” breakfast would get me about +1 F and a few extra mm Hg of pressure and I could “pass as normal” until I woke up for lunch ;-) Not too surprising, reversing that at night works best. Bowl of cereal with sugar and I’m ready for bed by 10-11 pm. Steak at 6-7 pm and I’m up until 2 am cooking on some project. At lunch, anything goes

    Now here I am with this ‘wide daily range’ with lower lows and higher highs. And at work I’d get whacked for not being “stellar” at my lows of the day (but praised for overall production) and now the Doctors whack me for being too “tense” during my peaks. Lord help you if you don’t fit the 1 Standard Deviation Procrustean Bed.

  9. Peter Dunford says:

    Very nice article, very informative. I think the humour dropped in is at about right level to maintain interest in a long article. Well, it is for me.

    My readings are usually 25/10 higher in hospital or GP surgery than at home. The old fashioned way by the GP is slightly better than the BP machines.

    I did a clinical trial for a drug with monthly check-ups a few years ago. The BP machine had a loud angry vibrating noise as it pumped air in to increase the pressure on the veins, it was quite alarming and made you jump when it started. Readings in the 160/110 range were quite common.

    I suggested to the nursing staff several times and a doctor once or twice that it was not fit for purpose, but it never got through to them. Fortunately the drug trial was not BP related.

  10. Gene Zeien says:

    I’ll have to print this out for my wife. She’s in the upper-normal BP range, for the same reasons you are (‘cept she’s a morning person). I’d figured out the muscle tension trick some years ago. Since then, my BP readings are borderline low :-D

  11. Ruhroh says:

    Hey Cheif;

    To really control your BP, I recommend meditation while staring at this fine Fortran output file. I know you get off on this kind of thing…

    http://www.drroyspencer.com/global-percent-water-coverage-grid-at-one-sixth-deg-res.dat

    Study of this will undoubtedly lower your blood pressure.

    Global 1/6 deg. lat/lon grid of percent water coverage
    numbers range from 0 to 100 (percent)
    original from Fleet Numerical Oceanographic Center (FNOC), circa 2001
    converted by Roy W. Spencer from original binary file
    1080 rows, startin at North Pole
    2160 (x 3) columns, starting at the dateline
    Written with Fortran95:

    do ilat=1,1080
    write(lun,19)(iH2Ocoverage(ilat,ilon),ilon=1,2160
    19 format(2160I3)
    end do

    note that water is indicated where there is no land under the Antarctic ice sheet

    REPLY: [ Well, if anyone ever complains about my posting a report full of numbers instead of a graph I’ll just have to point them at that link ;-)
    -E.M.Smith ]

  12. Roger Sowell says:

    E.M., very entertaining and informative. I have but one word to contribute: “Salt.”

    I went salt-free about 20 years ago, and blood pressure dropped and stayed low – much to the surprise of every medical – person I have ever seen. It only takes a few days to flush the system of salt, and food tastes just fine without added salt. At least to me it does.

    REPLY: [ On my ToDo list for “someday” is a no-salt trial and a KCl trial. It wasn’t something I thought I could work into my 4 day experiment without having too many variables to keep it all straight. But since Kaiser seems stuck on this, I’m going to put the effort into finding a way to, on demand, print about a 100 / 50 ;-) so they will leave me alone… I already do a hypnotic state for the dentist and I remember that in class we would get pink eyes – the instructor said it was due to the vasodilation from the state and we would all show low blood pressure. Need to check that one too, but don’t know how the nurse would take to a guy who looks like he’s passed out and has bloodshot eyes when he wakes up… 8-0 Frankly, I just wish they would look at what problem the patient presents with and deal with it first. Oh, and I’m going to do a “Drink a gallon of water” trial too. Isn’t Kitchen Science fun? -E.M.Smith ]

  13. Rod Smith says:

    This is a very interesting post. It seems to me that there is a loose parallel in today’s “climate Science.”

    Scientists look at the patient (earth), diagnose the ‘problem’ as global warming, using a single parameter (many from “questionable meters”), and then predict future climates (there is no such thing as a single world climate) using global average temperatures feeding models. Using model outout they then prescribe ‘cures’ for the problem.

    Am I the alone in thinking this is somewhat bizarre?

    Slightly OT: Many years ago, when I was the NCOIC of a weather editing site I had a young editor come to work looking and acting like death warmed over. I immediately, over his objection, sent him to the base hospital on sick call. I later found out that he had seen a doctor who had prescribed some pills. While walking back to the lobby, he was stopped by a passing doctor who asked where he was going. When told about the pills the Doc said that he looked as if he had pneumonia, and escorted him back to the doctor that had diagnosed otherwise, who then maintained that he couldn’t have pneumonia because, “He doesn’t have any X-rays.” He did have pneumonia.

  14. A Medical Professional says:

    Quite entertaining. As a cardiologist, I was particularly amused to read this post.

    In defense of your hapless primary care doctor, It is not surprising that physicians employed by an institution like Kaiser Permanente would be obsessive compulsive about treating blood pressure. In an environment where doctors are being judged by their “performance” and “outcomes,” a physician who blindly follows all treatment recommendations has less explaining to do to the powers that be when s/he has deviated from the recommended treatment goals for various diseases. Since blood pressure and other cardiovascular risk factors like blood cholesterol are measured numerically, it is very easy to track these values and rapidly identify (and counsel == fire or dock the pay of) offending HMO doctors who deviate from the recommended values.

    This is all well and good, until you look under the hood. Let’s do a little audit of the practice of primary prevention of cardiovascular events by treating hypertension and elevated cholesterol. For those not familiar with the vocabulary, primary prevention refers to preventing events in patients who have never had a cardiovascular event before, like a heart attack or stroke. Patients with established disease are a different group, and justify a more obsessive approach.

    The easiest measure for me, a physician who forgot most of his statistics by the second year of residency, is the number needed to treat. Abbreviated NNT, it indicates the number of patients who need to be treated over a given time period to prevent one event.

    Consider this: the number needed to treat (NNT) to prevent a stroke in a hypertensive patient is about 30. Not a bad number, really. Until you consider that this benefit is seen ONLY in patients with AVERAGE diastolic blood pressures in excess of 115 mm Hg treated for FIVE years. Wow. There are some people out there with blood pressures in this range, but most of the patients sentenced to expensive multi-drug therapy have diastolics much lower. When you lower the pre-treatment diastolic range to 90-110, the NNT goes to 118. In other words, less than 1% of patients will derive a benefit from treatment.

    I hope this makes you feel better about forgoing antihypertensive therapy for your occasional diastolic hypertension.

    The numbers for cholesterol are even more striking. Again, this is only for primary prevention – those patients who have never had an “event” before. However, for the multi-biliion dollar pharma industry selling the cholesterol lowering drugs, this is the biggest target population. The NNT is 250 over 5 years. That’s right, two hundred and fifty. Wow. If you want to prevent a death, the number goes up to 500. Think about these numbers and these drugs. They cost each patient hundreds of dollars a year, both in drug cost as well as the lab and physician costs associated with following their cholesterol and making sure no problems are setting in, like muscle or liver damage. They also cause lots of side effects, mostly muscle aches and pains.

    One of the reasons we are having so much trouble paying for our healthcare right now is expensive treatments like these with relatively limited benefit given to a large percentage of the population. It would be far cheaper and more effective if we could just get everyone to eat right, exercise, and quit smoking.

    The list of these marginally beneficial or inappropriately applied treatments goes on and on. Has your cardiologist told you need a stent in your asymptomatic blocked coronary artery to prevent a heart attack? He’s lying. Coronary angioplasty and stents have NEVER been shown to significantly reduce the risk of heart attack. NEVER. To be fair, there is some evidence that in diabetics with a certain pattern of blockage, there is a small risk reduction, but it is definitely slight. Thinking about back surgery for back pain? Don’t ask your surgeon to provide statistics to ease your mind about the operation. There aren’t any. The benefit of all the back surgeries done in this country, and really the world, have never been verified in large-scale randomized clinical trials. Cancer chemotherapy is another area where tremendous amounts of money can be spend for little objective benefit.

    In the internet age, no patient should take anything their doctor says at face value when it comes to expensive or invasive treatments. All these statistics I have cited above are available online with a quick Google search. The good doctors will be honest with their patients about the benefits of the treatments they are recommending. If your doctor can’t tell you the statistics associated with his specialty, you are well advised to seek another opinion. Sooner or later you’ll find a good one.

  15. pyromancer76 says:

    E. M. Smith, you ARE good and thorough. I imagine your PCPhysician trembles when he sees you on his appointment list.

    As a fellow Kaiser member I have had both atrocious and excellent treatment. Also the same for private physician care. (Kaiser experience — bad gall bladder — runs in family I found — misdiagnosed for three years, nearly killed me. PCP said she had saved many women from male MDs mistaking physical complaints for women’s real emotional ones — in my case anxiety for the number of times I asked my that severe back pains and illnesses be checked as “very different from any other flu I had ever had”. To be fair, I saw a number of drs [urgent walk-in] and had many blood tests with no correct diagnosis — until I was near the end of my life. Then PCP came through.)

    I very much appreciate A Medical Professional’s comments. I hope everyone reads it. Seems like a knowledge of statistics and internet research is crucial in every area. Also,”take charge of your care”. Are you ever taking charge! What an example!

  16. Ruhroh says:

    One easy one is a well-timed Valsalva maneuver .

    Upon release from the ‘strain’ phase, you get a ‘reflex’ tachycardia for a few beats ,then a reflex bradycardia for a few beats, and then return to baseline rate.

    By modulating the intrathoracic pressure, you cause less venous return during the strain, and then a bolus of inflow causes the heart to have an ‘impulse response’ .

    Perhaps it is because I used the breath-hold-and-release as a trained ‘cue’ for my ‘conscious relaxation’ training, I also am able to lower my BP after it.

    Another cue is to ‘focus’ on feeling your heartbeats in your fingers and toes. This is more readily accomplished when you are not having (arterial) vasoconstriction.

    Also, there are special bypass valves in your palms and soles, (ArterioVenousAnastamoses) which exist to increase blood flow through these heat transfer surfaces.

    A fun experiment would be to see the effect of cold immersion vs warm.

    At least they don’t stick cold thermometers down south anymore…

    Maybe you too will be awarded membership in the
    Data Manipulation Fellowship…

    In Your Abundant Free Time
    RR

  17. M. Simon says:

    Dying requires much less effort. Thus your blood pressure will be lower.

  18. Michael Jankowski says:

    Some things to consider when self-monitoring your blood pressure, from my experiences as a patient, reading literature the doctor provided me, reading my meter instructions, etc.

    (1) You are supposed to sit there and relax for a few minutes before taking your readings. Your goal isn’t to measure the instantaneous blood pressure while you are stressed, exercising, etc (although that may be of interest if you were sent home with a halter). It is your “resting” blood pressure that you want to identify.
    (2) Most people’s blood pressures are low in the morning and peak in the afternoon. It can vary from day-to-day and person-to-person depending on stress, food/beverage/drug intake, sleep, etc.
    (3) You should be taking your readings with your upper arm level with the heart. If you take readings at home sitting at your kitchen table and then take a reading while pulled-over by the side of the road, you can get much different results because you’re not positioned consistently. Typically, you are supposed to be seated upright and relaxed (although substantial differences in readings between lying down and sitting up may need to be brought to the attention of a doctor).
    (4) Yes, alcohol can interact with BP meds.
    (5) Yes, eating tends to lower BP temporarily, depending on what you eat. Specific ingredients can lower BP, too (such as garlic). Conversely, overloading on a salty meal might keep it elevated for a prolonged period of time.

    REPLY: [ Yeah, I know how you are ‘supposed’ to do it. I was mostly interested in finding what happened during the ‘unusual’ times of activity and to see what the actual range of values might be. I was also interested in what ‘carryover’ there might be from those active periods. The need for positional consistency came through loud and clear from the ‘experiment’, that’s why I standardized on the most consistent possible after the initial trials – at least until I thought of something ‘interesting’ to try ;-) With the wrist meter, it needs to have the meter level with the heart for consistent and comparable readings. The upper arm looks to matter when using the upper arm cuff. And at the end of the day what I found most interesting was the range of values. There is this 120 / 80 mantra that is just wrong … it bounces around so much based on mood, food, sphincters, warmth of toes, posture, etc. that I find it a very poor proxy for other things. At least if you have numbers like mine. -E.M. Smith ]

  19. M. Simon says:

    It would be far cheaper and more effective if we could just get everyone to eat right, exercise, and quit smoking.

    Yeah. And it would be nice to have a mild anti-depressant that acted instantly and was available cheaply over the counter. And with fewer side effects than tobacco.

    There is one. It is illegal.

    REPLY: [ Golly, I’d forgotten about those options… Here in California there is a medical use law. Wonder if anyone has done a BP series. Might be a whole new industry ;-) but somehow I suspect it’s been tried already. -E.M.Smith ]

  20. M. Simon says:

    “It would be far cheaper and more effective if we could just get everyone to eat right, exercise, and quit smoking”

    Yeah. And it would be nice to have a mild anti-depressant that acted instantly and was available cheaply over the counter. And with fewer side effects than tobacco.

    There is one. It is illegal.

  21. E.M.Smith says:

    Trivial update:

    This morning I went back for a follow up for ‘my issue’. So far I’ve been seen 4 times by 3 different doctors and had two diagnosis with no real treatment. (Ointment to suppress symptoms – that didn’t work.)

    In an “Alice’s Restaurant” moment

    (For those not familiar with it, I can’t hope to describe it, just listen to it:

    http://www.google.com/url?q=http://popup.lala.com/popup/360569449464275612&ei=5gaQS4LkDYWmswOo_q2hCA&sa=X&oi=music_play_track&resnum=1&ct=result&cd=2&ved=0CAoQ0wQoADAA&usg=AFQjCNHpz97GBTZ8X1jjklBCT6QqNswI9Q

    or read the lyrics:

    http://www.arlo.net/resources/lyrics/alices.shtml

    The pertinent bit is:

    “where you walk in, you get injected, inspected, detected, infected, neglected and selected. I went down to get my physical examination one day, and I walked in, I sat down, got good and drunk the night before, so I looked and felt my best when I went in that morning. `Cause I wanted to look like the all-American kid from New York City, man I wanted, I wanted to feel like the all-, I wanted to be the all American kid from New York, and I walked in, sat down, I was hung down, brung down, hung up, and all kinds o’ mean nasty ugly things. And I waked in and sat down and” … )

    So as I was saying, in an Alices’ Restaurant Moment I decided I wanted to show up looking and feeling my very best so the night before, this very night before, I stayed up ’till 5 am. I stayed up and I was dealing with blog trolls and all kinds of restful things until I couldn’t stand one more troll, or even stand up well, then I had a nap, but not a real nap, just about an hour to get my body all messed up, so I was feeling hung down brung down and all kinds of mean nasty ugly things… and I had coffee, lots of coffee, like a Zombie on coffee… and I walked in and sat down and I said:

    “Nurse Obie, I’ll not be taking a blood pressure reading today.”

    And they all moved away from me on the “Group W” bench… and Nurse Obie began to write in the medical record with circles and arrows and a paragraph on the back that I was not cooperating with Amercian Medical Justice… or Kaiser… And I was put in a small room to wait for The Doctor…
    ;-)

    But seriously:

    I ‘declined to participate’ in the ritual flogging with the BP stick. So I now have ‘notes’ in my record. (FWIW, the readings I did in the car just before were about what I typically get at Kaiser. It was a ‘principle’ thing for me. I want attention on MY issue, and I’m willing to use an Aikido approach to get it. Step off the line of attack… let them become unbalanced … )

    So Dear Doctor and I had a nice chat. About why no progress at all was being made on My Issue. About Zebras and the need to look for “Whatever is making the noise” and not just looking for Horses. (Medical Schools typically indoctrinate with the mantra “If you hear hoofbeats, think Horses, not Zebras”. I advocate for “IF you hear hoofbeats, look around for whatever might be causing them, it could be a Sony tape deck or even a donkey.” Never bring pre-conceptions to the data.)

    And at the end of the session I got a (thankfully brief) tongue wagging about why it was important for Kaiser to take a BP reading even on days like this as it was part of my normal life to be in this state and they needed to make decisions based on what happens in my regular environment. I declined to participate citing that there was “No Medically Valid Information in the reading.” NMVI is an interesting acronym. I think I’ll keep it ;-)

    Thankfully, pulling an all nighter isn’t part of my normal life. I generally avoid trolls and try to get 7+ hours a night almost all the time. But sometimes you get roped into things… And folks wonder why I don’t want to indulge in other folks requests for Food Fight Fodder and Troll Feeding Sessions…

    At any rate, I’m now exactly where I was $60 of co-pays and pharmacy, 3 visits and 4 doctor inspections ago; but with 2 obligatory BP lectures…. and two “answers” neither one of which looks correct and neither one of which has lab work or tests done to support it. But I can always apply ointment and try to relax…

    I think I’m beginning to understand why my neighbors are into homeopathy. I don’t know what it is, but at least it doesn’t raise their blood pressure… and they always smile so much ;-)

    Maybe I’ll give them a call…

  22. P.G. Sharrow says:

    Say Chief; some advice on your problem. To lower BP and reduce cholesterol have a bowl of cooked oats for your first meal of the day. This will also help with the other problem.:-)
    Make sure it is well cooked as poorly cooked oats will cause gas and loose bowels. :-[ not good. I take mine straight as the stuff people put on or into the cooked oats is not helpful.
    There is another immediate solution for the other problem and it involves a small finger sized piece of raw potato where the sun don’t shine. An old woman told me that one, she says it works much better then the ointment.

  23. Ed Forbes says:

    LOL…….Loved the post…It will get passed about

  24. Jeff Alberts says:

    Though I’m glad I can, with some authority, state that I’m not going to give up coffee… (though I might give up fries and soda from McD’s)

    I’ve pretty much given up caffeine, mainly because of reflux.

    You sure it wasn’t the sugar you felt? Assuming you have sugar with your coffee.

  25. P.G. Sharrow says:

    Amen to the above! Coffee cause me no problems but sugars and wheat starches (pasta) cause me awful heart burn, reflux and GI upset. The whole nine yards. Oh so good going down and then HELL to pay.

    Meat, potatoes, vegetables, Ok. Rice and oats Ok,

    Rye,wheat and barley (emmur type) grains bad if not sprouted.

  26. vjones says:

    You have brightened my day no end. Very funny!

    I note Roger Sowell mentions salt. I would also suggest paying attention to hydration.

  27. Viv Evans says:

    Aww – you’ve got all my sympathy, Chiefio!

    Its been reported over the years that people with dogs have much lower BP than the comparable age group. Apparently its not an Urban Myth. The stroking of the dog’s fur is said to reduce stress and thus lowers the BP.

    Well – if you can, get yourself a nice dog who loves cuddles, so preferably not a yappy little terrier, but otherwise any scruffy reject in your dog rescue centres will do.

    Works for me …

  28. e.m.smith says:

    @all: My Goodness, so many interesting things to try…

    Who would have thought that “Kitchen Science” could take on not only Global Warming but the Scourge of High BP!

    OK, on the ToDo list: Try NaCl (reduction) and KCl (loading – though particular care must be used as an overdose can be lethal, so don’t exceed ‘normal salt’ on food via a “No Salt” type product), Pets ( I have a few, but have begun to have modest allergy issues with The Cat… have to borrow the neighbors dog and turn one of my “free range bunnies” into a “house bunny”, H2O levels (reduced and maximal – use military “overdrink” rules for desert as ‘upper bound’ as hyponatremia can be lethal if you guzzle faster than a L/hr or so ), vegetative loading (oats, beets, etc.) and medicinal vegetables (garlic, alliums in general, flax seeds as omega3 source and flax seed oil as omega3 overload, etc.) and whatever else comes to mind…

    Golly. This is much more fun than dealing with the AGW Trolls … and yes, I am compulsively driven to the scientific method. As taught to me by Mr. McGuire. A process anyone can do, for just about anything needing understanding, using only a couple of rules, common sense, and some observational care. ( It’s that “observational care” part that seems missing in “climate science”…) So now I’ve got another project to play with. “What are the bounds of Blood Pressure and what factors can be used to modulate it”.

    @P.G. Sharrow – A friend as problems with wheat. It was first diagnosed as “hypoglycemia” then as “gluten intollerance” but since then he has found he can eat some other grains with gluten in them so it’s looking more like an actual wheat allergy, but at the end of the day, he can’t eat wheat. You might want to do a trial of wheat vs non-wheat to see if that is your issue.

    FWIW, I’m pretty good at cooking “wheat free” as we have meals together frequently. I’ve got a pretty good wheat free corn bread (substitute rice flour or sorghum flour for the wheat flour folks add to corn bread – if it’s too crumbly, add a second egg and cut the other liquids back about an ounce)

    And I make a pretty good Rice Lasagna (noodles from Whole Foods – notice it is a 10 oz package not a 1 lb package, so I use 1 1/2 packages for a typical batch in my regular recipe; I use spaghetti sauce [ Prego, Classico, whatever] about 24 oz, 1 lb ricotta, 1 lb shredded mozzarella, 1/4+ lb parmesan , 1 can [drained] spinach or cooked fresh, chopped, about 1 Tbs “itallian herbs seasoning”. Mix the chopped spinach and cheeses in a bowl. Layer: sauce, noodles, cheese mix, sauce, noodles, cheese mix to the top. I put a sprinkle of the italian herb mix on the bottom, one on the top, and some in the middle layers. Top with a layer of parmesan such that everything is covered well. Variations: You can swap around the sauce for kinds that have additions like mushroom, veg, sausage, etc. I sometimes add a “few” cloves of crushed garlic to the sauce (depending on what other folks will put up with ;-). I’ll add a can of drained mushroom slices to the cheese layer, or sometimes olives, or both. The top may have olives ‘dotted’ over it. I’ve made it with hard boiled egg slices in the cheese layer once – nice… Pretty much whatever you like can go in… And I think it is particularly good if you use real Sheep Milk Parmesan (the same stuff that has been correlated with longevity in a ‘hot spot’ in Italy with 100+ year olds…)

    Per the “other issue” you mentioned: Thanks, but that’s not “my issue”. While I did have The Big H once (about 30? years ago?) I traced it back to food allergies and by avoiding the food in question, I’ve had no problem.

    OK, just to avoid endless speculation: “My Issue” is a small spot or three on my skin (mostly forearms) where I have a small “rashy area” that does not resolve. It wanders around and can be moved to a new area if I scratch the itch, but that’s about it. I think I know what it is (protozoan, and I have treated it once with success, but think I used too little meds for too short a time, so it’s come back). But Kaiser is still wandering around trying to decide. I am giving them a shot at it as a “second opinion” and so my spouse is happy… then I’ll fix it myself with higher dose and longer duration of what I know resolves them on a temporary basis (when I used flagyl at 1/2 the PDR dosing and 1/4 the duration recommended – didn’t ‘score’ enough for full treatment; so any sporulated individuals would have survived.) And yes, I shared that history with Kaiser. One complicating factor is that my immune response has gone ‘way high’ this week and things are resolving on their own, so I may not get to “experiment” on myself over this issue in the future… if I’m lucky. I’ve had this “issue” for about 8 years, so it’s not exactly “pressing”. I’m just tired of it… I’ll post an article about it once it’s dead and buried (unless I’m dead and buried with it ;-0 ) so no need to hash it over here, we’ll just wait for answers…

    Finally, I’ve done another interesting “experiment” last night. Remember the state: Nearly no sleep, very cranky, highly stressed (both physical from no-sleep and mental from going to Yet Another Wasted Kaiser Visit). But…

    Ruhroh had reminded me of breathing issues.

    I’d had some classes in various ‘stuff’ over the years. The usual dabble in ‘eastern things’ like yoga (one class…) a brief trip through Buddhism (that I still lean toward) some martial arts (where one of my regular ‘issues’ was not breathing at the moment I would throw a punch – a bad thing since a counter punch can pressurize your innards, you want to be breathing out slowly…) So I decided to “play with breathing”.

    Guess what? Tantric Breathing works. And not just during “recreational activities” ;-) So I took a “before” reading, then did a series of long modest rate deep breaths, with emphasis on abdominal breathing and continuing even after I was way past oxygenated and had no natural “urge” to breath. Like when preparing for a ‘free dive’ to 50 feet. I can “hold my breath” for about 2 1/2 minutes (useful when diving – I’ve stayed down at about 40 feet for several minutes ‘touring’ to friends to get a ‘top up’ from their SCUBA gear every minute or two. Much freer feeling than with the tank on your back.) Then I did the meter. The results were, er, surprising.

    I did this run 3 times, and the results were roughly the same each time. The first reading is supine at the start. You can see that the pressure is a little on the high side for me while resting. Earlier in the day (reading no longer in the meter) I’d been at about 145 / 90 with about an 80 pulse so between the two, the ‘cranky baseline’ is higher than my typical. The first series is just testing “breathing while the meter runs”.

    I had tended to just “not breath” while readings were taken on the theory that it would be better to not be jiggling things. Wrong. Yeah, it’s an old habit of mine to ‘not breath’ when something needs more attention (probably all the diving experience where you don’t breath when the interesting stuff is going on ;-) and you want to stretch your air as long as possible…) but I found that “just breathing” makes a big difference I repeated it 3 times to be sure. Then I went for a major ‘over breathing’. Not quite the full hyperventilation we would do before a deep dive, but lots of steady breathing. (Folks sometimes pass out from hyperventilation, so use care. Occasionally they pass out after starting a dive and ‘wake up dead’…)

    7:12 135 85 68

    7:13 127 78 67
    7:15 121 71 65
    7:18 121 68 81

    Transition to full “tantric breathing’ with deep filling of belly movements:

    7:19 116 63 77
    7:20 119 62 76

    WOW. Not quite the 100 / 50 that was my end goal and far enough from 90 / 50 to avoid a ‘hypO tension” issue, but you don’t want to suddenly jump up. I’ve had positional hypotension before and at those levels, suddenly standing up is likely to make you dizzy and falling down…

    I’d also expected all the belly movement of a full tantric cycle to cause pressure excursions. If it does, it’s to the downside.

    OK, so here I am in a highly “high pressure” biased state and I’m able to “print” a 116 / 63 ? Golly. Also, somewhat unexpected was the pulse going to 81 at the 7:18 reading. No idea why. Perhaps the effect of suddenly breathing a whole lot after not using any muscles at all for several minutes? OK, we “don’t do anything” and drop back to my usual “breath when you really have to”. Then do another series of breathing games:

    7:24 132 70 72

    7:29 124 80 69
    7:31 126 66 69
    7:39 120 75 65

    Go “tantric”:

    7:45 112 71 67
    7:42 113 64 67
    7:43 118 75 67

    revert to normal breathing:

    7:47 124 75 66
    7:52 140 85 69

    Well. 112 / 71 is a fine number. And if I don’t breath unless I ‘need to” it’s 140 / 85 just 7 or 8 minutes later. OK, so the BP meter measures your tendency to breath and your breathing habits. Once more, just to be sure:

    7:55 131 75 66
    7:55 112 68 71

    Yup, it works. OK, I’ve now gotten into the habit of breathing a bit more and I’m pretty much devoid of CO2. What happens if I just breath a little more than “I have to”?

    8:19 121 78 67
    8:33 124 76 63

    A full half hour later… Still a ‘fine normal’. I may test this again on a day when I’m rested and feel good ;-)

    Those 7:55 numbers are interesting. Here we can see the baseline (a bit high for resting supine but showing some effects from the repeated breathing) then with 1 minute (yes, I double checked the time stamps, it all happened inside one minute) of “over breathing” I dropped to near “hypo-tensive”. Even 20 minutes later I was still cruising a bit more relaxed.

    I think I can work with this…

    So now I have a technique to hit ‘marginal low’ with tantric breathing (even starting in a bad state) and a technique to hit ‘OMG High’ with a sphincter moment. To the best of my understanding, neither of those two are monitored or recorded or even noticed during ‘typical’ BP measuring sessions.

    Hmmm. Wonder what happens with “Tantric Scotch”? 8-)

    At this point, I can see an easy set of behaviors to put my BP at just about any point between 115 / 60 up to 160 / 110 and with some minor influence on heart rate. Looks like finding a way to modulate perspiration is all I need to be able to give a “lie detector” any reading I want as well. Golly, this is fun.

    Sidebar: Clearly, the O2 level is already at about 98% with normal breathing (I watched the Kaiser meter) so I’m saturated with O2 long before Tantric Breathing begins. So this effect is related to CO2 flushing (pH changes? whatever). Well, I can only presume that (wait for it…) all the added CO2 in the air from Global Warming must be causing my BP to rise! Yes, clearly “Man Made CO2” causes BP problems. Who do I sue? 8-} Or maybe I ought to just apply for a grant… I already know I can make the numbers come out right ;-)

  29. Ruhroh says:

    Maybe isopropyl/vinegar swabs Ntimes/day?

    In combo with anti-inflam to manage the urge to scratch?

    Heck maybe orange oil or that tea-tree stuff?
    Not sure what might dissolve spore walls.

    Or, my now-gone father-in-law remedy of choice;
    turpentine…

    RR

    REPLY: [ I was afraid this would happen. Technical folks just can’t resist a problem that isn’t solved ;-) OK, I’d like to avoid turning the thread into a “how to kill the mystery bug” thread. I’ve tried dozens of things (but turpentine is a new one on me… had not thought of it, but the terpenes from which it gets it’s name do show up in a variety of medicinal plants and oils so has potential). I’d really really like to avoid playing 20 questions over what has / has not ‘worked’. So I’m going to dump the whole story here in the hope of killing this direction.

    The short form is that quinine from tonic water helps (but you can’t really get a therapeutic dose from the OTC tonic water, though at that level the Gin is helping the attitude a lot… What? You expected me to drink the tonic water straight?) and a couple of anti-protozoan natural oils help (IIRC it was neem that worked the best, tea-tree not so much) but does not get ‘under the skin’ enough – i.e. systemic, and tastes horrid enough that even I can’t swallow much ;-) I’ve been through a few antibiotics over the years (for other things) that did nothing to it.

    Albendazole worked. But I think I had too low a dose for too short a time for eradication of the spores (used the ‘sheep dose’ for mass calculations but that is the ‘worming’ dose not a protozoan eradication dose). It’s widely available and I’ll possibly try it again now that I know the proper dose (from recent work on protozoan problems in folks with AIDS that did not exist when I last tried it). Doesn’t even taste bad in the “sheep wormer” white liquid form… (And for anyone wanting to rant about using animal drugs for people, don’t. If I would not drink it, it does not go into my animals. Their lives are as valuable to me as my own. It was made by Pfizer and is incredibly benign. Compared to bad Gin, this stuff is pristine and pure.) That was an early trial about 5? years ago ( 2 years after I gave up on the first doctors…), again: IIRC and from memory for the dates. Since then I’ve found dose information for albendazole for use on another protozoan that is about double the dose level I used and about 5 times the duration… with notes that too short a course of treatment will result in relapse from the spores. (In the last 1/2 decade I’ve become a bit of an “amateur expert” on protozoan diseases and the drugs that treat them. )

    Then I found my ‘magic bullet’. I’d had a ‘large outbreak’ on one arm (about 6 sq. inches) of rosy patch and it was in the “first rosy and spreading before settling in to long duration with the eventual formation of a lesion stage” and I was a bit worried about a 6 sq. inch lesion… the others have been ‘pea sized’ at most. Flagyl is rather strong stuff. The PDR (Physicians Desk Reference) page on it will make you think twice about ever using it for anything other than mutating frogs into salamanders ;-). I found many references for using it to clear protozoan diseases on the web (including one about arthritis from protozoans – and I’ve developed one slightly arthritic joint in a shoulder just above the lesions; that modulates with the lesions…) Most advised months of treatment (in various dosings) to assure full spore eradication. I was able to get 1/2 the dose level for 6 days course. It resolved the rosy patch (from itching, pebbly and wet ooze spots and spreading to gone) in 3 days and almost completely cleared all the lesions. Almost…

    Now, a couple of months later, one of the two remaining lesions has, I believe, put some spores under a fingernail and let me make a new rosy patch (of about 3 sq inches total area). So figuring I had this thing more or less worked out, I decided to give the Good Doctor a shot at it. And, to her credit, she has humored me on my theory as a ‘possible’.

    Then they called “Dermatology” for a consult. Well, 2 different dermatology “doctors” have looked at it. One said it was excema and prescribed cortisone ointment (that does nothing). And it’s not contact dermatitis that was also suggested.. I have that regularly with various things from poison oak to various critters. I know what it is. This isn’t it (and I’m darned near pathological about ‘washing up’… see the above story about spurge juice, eyes on fire, etc. from contamination AFTER I’d rinsed my hands and then used them to hold water for washing my face… Now all outside work is followed by full soap hot water scrub…) The other diagnosis I’ve gotten is “some bacteria”. This from the second specialist and further up the food chain. But no antibiotics and no biopsy and no culture. Why? Because it was looking sort of like it was healing by that time and was a bit ‘drying’ and she thought there was a risk of both false positives and false negatives in that stage.

    And she may well be right. Since then I’ve gone ‘way high’ on immune response ( I’m real good at gauging it, over the years…) and both the rosy spot and the lesions are presently resolving. So I’m just going to wait a couple of weeks, see if my tendency to allergies has finally paid off in (what it’s designed to do, attack parasites better) a final cure. If it does ‘resurge’ I’m supposed to go back and get some kind of tests (biopsy, cultures, whatever). In a month or two, if it’s back and I’m grumpy and Kaiser is doing what they are doing now, well, I’m off to Mexico to buy a 6 month supply of Flagyl. I know exactly what “magic bullet” works, and I’m not afraid to use it…

    So hopefully that satisfies the insatiable curiosity… -E.M.Smith ]

  30. e.m.smith says:

    Oh, and on the question of “what causes my heartburn”:

    It isn’t all that often, so I don’t have it completely pegged. It’s not wheat, though. (I *love* cream of wheat and eat LOADS of noodles with no issues at all). Sometimes coffee can be an issue, though almost always it isn’t, and only in the accompaniment of something else (I think it adds the acid or promotes stomach acid). And it isn’t sugar. I can eat a bowl of sugar with a spoon of milk and and ounce of cereal in it and be fine ;-) And it isn’t all fried stuff. I’m fine with fried fish, chicken, steaks, chops, etc.

    What does cause it? Well, “acidic things” don’t help. I actually suspect it’s the Coke more than the burger or fries. (Home cooked french fries cause me no problems in unlimited quantities, nor do home cooked burgers, but I don’t make fries often due to the mess of the deep fat frying.) But the ‘meal’ comes as a set and i do get a HB episode about 1 in 10 or so from them. I can also get a similar thing from a very acidic tomato sprinkled liberally with salt (something I love, but rarely get, as I’m in a cool zone where it’s hard to grow tomatoes and the store bought ones… well, they are more like tasteless rubber balls than tomatoes.)

    So it could be the tomato slice with salt on it in the burger, or the mix of tomato and fried patty with “mystery sauce” or… As a result, things like “Tomato Salad with Coke” is a meal I would avoid. Top it with a ‘mysterious white oily sauce’ and I’d definitely avoid it. But a fried lamb chop with potatoes and peas? No problem. Side of bread and butter? No problem. Coke washing down fries and a fried burger with tomato and mystery sauce? Yeah, problem possible.

    I mostly suspect it’s a mater of foods that over stimulate the release of digestive fluids while having too little fiber to soak them up. If I add some sturdy vegetables (like beans, peas, spinach, parsnips, broccoli, cabbage, etc.) it seems to be preventative. Loads of bread helps too. Heck, even adding a slice of pie dampens the risk.

    That leaves the “load of fried protein, soaked in fats, acidic, washed down with Coke” as the risky formula. (Though bacon with coffee and no bread / eggs is a risky combo. Put pancakes and eggs with it, the acids get consumed. No problem.) FWIW, smooth root beer, like A&W, prevents the “issue” too. There is a definite acidic component. There is a nitrosamine component. There is a possible caffein component. There is a ‘lack of fiber’ component. There is a ‘low anti-oxidant level in the food’ component. And that was enough for me to (usually) assure no heartburn. At that point I kind of stopped looking for more. But once a week I roll the “McD Burn Burger” dice on a 1 in 10 bet…

    Oh, and “milk” quenches (though yogurt works better as the milk has an acidic phase after about 10 minutes of digestion so ‘burn can return’ if you don’t add more milk). Maybe I just ought to order an ice cream type desert and be done with it ;-) Yeah, that’s the ticket. I can make my McD “Burger, Fries, Coke” meal more “healthful” with some added Ice Cream 8-}

    FWIW, I’ve never had any “issues” with sushi, rice and all the wasabi and ginger any human being can survive. It is not ‘spice’ related at all… (I usually eat wasabi to the level where my eyes water and breathing is ‘challenging’ due to the vapors. If there is wasabi on the plate, it is used completely and I’ve sometimes asked for more… ) I also have “no problem” with Gung Pao chicken (that I like to call Gun Power Chicken – though I’ve been told there is another different dish by that name somewhere) and tend to eat all the ‘little red chili peppers’ that you are supposed to set aside… and I make a “mean chili” with enough heat to cause hair matting and a damp shirt. While the mouth may complain, no heartburn… Oh, and curry. Love curry. Use the yoghurt sauce to dampen the tongue when it needs a break, but the stomach? No Problem.

    So I’m pretty sure it’s just a “fried stuff with acid and low fiber” problem. Made worse with salt ( I suspect some reaction frees some Cl- radicals? Or makes nitrosamines worse? ) and made a little worse with ‘mystery sauce fats’ (that I think causes more stomach / digestive secretions). Easy enough to avoid almost all the time. Trivial to fix ( CaCO3 tablets, yogurt, Alkaseltzer, etc.) when it does pop up. Heck, just give the stomach something to work on and it seems to drop off. I’ve been known to use a chunk of neutral high fiber foods to fix it.

    Final note: Citrus if highly acidic can cause a brief heartburn like effect, though it is transitory and not the same intensity. Easy enough. If I’ve got very acid citrus, I just have it with some other food too. A nice sweet tangelo? No problem ;-) Big glass of somewhat sour OJ? Only if washing down the pancakes…

  31. vjones says:

    I read somewhere that eating an apple prior to a meal can prevent heartburn. IIRC it was something to do with the acidity of the apple reducing excess acid production and meant the stomach did not overreact to the subsequent meal.

    I’m sure you can think of plenty of other mildly acid things to try for comparison if you feel like experimenting ;-)

  32. P.G. Sharrow says:

    Chiefio; Thanks for the recipe, next time my woman just has to build a lasagna I will give her yours.
    Sounds like you have a handle on the skin problem. One trick on your proposed treatment is, after you feel you have reached the proper dose level, do something that raises a good sweat for an extended period. This will concentrate the treatment in and on the skin and not in your organs, and drink plenty of water. This was told to me by an old doctor that knew about treating fugial/yeast and protozoan infections in the skin and under the nails.
    Modern doctors can understand bacteria and enviromental problems but not the others. Topical ointments will reduce the irritation but not clear out the infection.
    Years ago in the Philippines I got skin infections that lasted years. The Navy doctors gave me all kinds of salves and ointments none of them worked. I guess they were just practicing. ;-]

  33. E.M.Smith says:

    @P.G. Sharrow:

    Oh, I forgot to state that the lasagna noodles get cooked prior to assembling the lasagna. It’s about a 16-20 minute cook. Sometimes they start to get a bit soft and break, so you can finish a bit sooner than the package says. I then run cold water into the pan to cool the noodles, drain, and now they are cool so easy to position. It’s a standard 13 x 9 pyrex oven dish (though it you add a lot of ‘stuff’ it can be a bit full… don’t use a small dish ;-) and I put it in a 350 F oven for about 35-45 minutes depending on how hungry I am, how full the dish ended up (how much added mass from sausage coins or mushrooms or…) and how much pre-heat time I got into the oven. Basically, I wait until it is ‘bubbly around the edges’. If you like it crustier, you can turn it up to 375 or even 400 F. For an interesting variation, put an ounce or two of cheddar shreds on top …

    They also sell rice noodles in other shapes and they make a variety of nice pasta dishes. Everything from pesto to alfredo sauce can be put on them just fine.

    Oh, and on the Tantric Breathing working, I’ve noticed that since I did that test earlier in the day, I’ve been generally breathing a bit more. Just did the BP and it was:

    3/6 1:35 am 118 68 48

    This is while slouched on the couch with arm at heart level on the back of the couch – feet straight out, legs relaxed.

    So I think I’ve found my “magic bullet” for the “BP Stick”. Now I just need to practice mild hyperventilation for the hour or two before I next have a visit and see if it stands up to “White Coats” ;-)

    I find the 48 pulse a bit of a surprise as I’ve been “back and forth” to the kitchen a couple of times and I’m also typing and… but such is the power of CO2 purge, I guess…

    I find it interesting to ponder what a BP med that knocked, oh, 20 points off my readings would do… 98 / 48 ? Wonder if I could stand up and not pass out!

  34. P.G. Sharrow says:

    Thanks, added to the recipe captured to my file. pg

  35. E.M.Smith says:

    More on Tantric Breathing:

    I’d intended to do a “just as awakening – unmoving” this morning, but I’d left the meter near the couch. So I woke up, and found I had to wander into the living room, find the meter, and wander back to bed….

    Give it about 2 minutes to ‘idle down’ again. And took a “baseline”. Realize that this is a lousy baseline. I’ve already been up and doing laps…

    But the good news is that, with a little self suggestion, I’ve been breathing a bit more all night long. You can sense the O2 / CO2 ratio in the blood… it’s a kind of a ‘freshness’ feeling when CO2 purged and a ‘stale’ feeling when air deprived with a bit of lethargy thrown in for seasoning… by telling yourself that’s what you want, more breathing and that feeling, your behaviour will change.

    After a night of such, I’d have expected low readings, but at this point, then, I’m going to read a bit higher than I would have, had I not run around.

    3/6 9:13 114 66 57

    Not bad. Very similar to some of my other “first wake-up” readings but less than the 124 / 75 type readings I’d get after just changing positions in bed a few times. Next, on to the Tantric Breathing. Not Much, just a minute or so:

    3/6 9:17 91 57 56

    Goal!

    I know, I’d said I was going to shoot for 100 / 50, but I think this is close enough. You have a 150 sum vs a 148 sum.

    Close enough. I might play around with it a bit more to see if I can tune it up to exactly 100 / 50 but frankly, I don’t see the value at this point… And if I hit something like 80 / 51 trying to reach a 50, well, I’m not sure what happens then…

    90 / 50 is hypo tense land. So I did a hypo tension test. I rapidly got out of bed. Yup, light headed (almost a momentary dizzy) and can feel the blood leaving my brain headed for my feet. One squeeze of the leg muscles, though, and its over. What happens if you don’t stop the blood rushing out of your brain?

    The next step is ‘irregular descending” blackout. You get tunnel vision, then black as vision leaves early, then things start getting quiet and you begin to get a numb feeling. I was “aware enough” when this once happened to me ( about 30 years ago ) to realize I was going to fall over, so I put my arms up into the “front fall” position and assumed a “crawling stance” by bending my knees (squat) as sensation ended. Muscle control lasts longer than sensation, so you can still ‘do things’ just not sense anything. I never completely lost consciousness ( I think…) though I came close. As sensation returned, I discovered I was on hands and knees on the floor, but had not taken any ‘fall injury’. So if you get to the point of ‘light headed on rapid standing’, it’s time to be very careful about pushing it further in that direction…

    So I’ve extended my ‘lower bound’ down to where I’m at risk of passing out from positional hypotension. I wonder if that will be enough to satisfy Kaiser … 8-{

    It would be amusing (but not worth the effort or risk) to get one of the harnesses again and spend the day with Tantric Scotch. If I didn’t pass out from low BP, I’m sure they would send the meter off for “repairs” ;-)

    At this point I’m going to end the experiment series postings (unless some way cool idea comes along, or I managed to make some truly spectacular numbers happen.) I’ve pretty much reached my goal and I’ve got reasonable techniques that require no “devices” or “chemical aids” and yet let me range from hypo-tense up to OMG 160/110. Breathing and sphincters. It really is that simple. Golly.

    I may play around a bit with trying to go from 90/ x to 160 / x and back again in the shortest possible time. ( I’m sure you can guess why ;-) “Nurse, I think there is something wrong with your meter, why don’t you try it again.” 8-} and it would be useful to do some more training sessions so I can learn the “feel” of any given pressure (calibration of self) as I’d like to get to where I can offer up any particular reading desired to within a 10 point band on demand. “Doctor, what reading would you LIKE to see? Ok, here you go… ”

    And I can also see some fun in exploring the interaction of techniques to see how one moderates the other and which dominates by how much ( things like “Tantric Scotch” and “Tantric Pucker” and “Scotch Pucker” and… ;-) but I doubt this would be of much interest to most folks. Besides, I’d have to go buy some Scotch and that’s not high on my “to buy” list at the moment. (Cat food and BBQ out rank it. I know, blaspheme, but the cat has to eat and I want BBQ… so I’m unlikely to have ‘the required materials’ for a month or two. ) More interesting for me right now is the question of hypnotic suggestion. I can do a modest hypnotic state with about a 2 minute induction. It would be interesting to see if I can enter a ‘hibernating but breathing deeply” state and get down to “don’t even think of standing up” land. I’ll need to recruit the spouse to push the button on the meter for that, though, as i’ll be effectively “passed out” off in another place. It’s what I do at the Dentist (minus the breathing) so I’m practiced at just ‘checking out’. And he likes being able to do a full ‘deep scaling’ in one go with no breaks and no anesthetics. I get ‘very pink eyes’ when doing this, so the vaso-dilation is quite high and BP ought to be quite low. But I can barely move then. Finding a button would be right out…

    I figure that precise and multi-factor control with rapid low/hi/low transitions will take me about a year to get really good at and to get done. Yeah, I could get it done in a month if I tried, but I’ve got other fish to fry right now. And having what I “need”, this is now a low priority task for me. (See what happens when you give a geeky engineer type a problem to solve :-) they go and solve it, and with more detail, bells and whistles than anyone else on the planet would ever care about 8-0 Oh well, it’s ‘what I do’…

    But if someone else wants to put up a comment about “Tantric Scotch”, it could be very amusing. Especially since there may be individual variations in response to different techniques. And if anyone has success with “White Coat” land using any particular technique, like breathing, it would also be nice to know. And I need to buy some KCl with the BBQ… PDQ ;-)

    [ Time Passes ]

    OK, I said I was done experimenting for a while, but this opportunity presented…

    I love Radishes. Covered in salt. And I went shopping. And they were fresh…

    So about an hour ago I ate an entire bowl of radishes covered in salt. I’d just sat down and had a bit of carryover from being active, but did basic slow breathing at the start (with the first bite of radish). And I drank the accumulated salt water at the bottom of the bowl. All of it washed down with a large mug of coffee. Since then I’ve been doing “blog stuff” and some browsing, all while in the same position on the couch (slumped against a pillow at one end, legs out flat on the couch, more or less like sitting in a pool chair. Their has been plenty of time for the salt and caffein to reach the blood (and I’m feeling the caffein). So what happens when this mix hits Tantric Breathing?

    1:20 136 81 72 At first arrival at the couch, just sat down.

    1:29 113 71 61 OK, baseline with breathing, arm on back of couch
    1:30 129 79 61 Baseline with breathing, arm in lap. So Lap is +16 or so.

    Eat the salt, drink the coffee, give it an hour+ to be well into the blood.

    2:47 104 63 59 Arm on the back of the couch, breathing.
    2:48 116 74 59 Arm in the lap, breathing.

    So I’ve dropped 9 to 13 points AFTER a big salt load and coffee. Somehow I don’t think salt is my issue…. I’m reaching the conclusion that years of practicing to breath as little as possible and force a low O2 consumption (the better to stay under water for long periods of time with oo…..0-} have left their mark on my breathing habits. AND my tendency to ‘stop breathing’ when the meter was running didn’t help. This probably also explains the “paradoxical rise on resting” after the cat chase. When chasing the cat, I was breathing, hard. After I stopped and sat down to ‘rest’, I cut the breathing way back to ‘just barely enough’ and the BP went up. Rather like I would do when diving. You swim hard, but keep a lid on the breathing rate so you don’t use up your tank of air. You can always convert the lactic acid AFTER you surface ;-)

    OK, the bottom line out of all this seems to be that each person dealing with “The Issue” ought to get a little meter and play with the parameters until they find out what each one does for them. And don’t forget to breath WHILE they are taking your blood pressure…

    (I’ll check the salt response a bit later in the day, and without breathing too, but at this point I suspect it’s just a dead end for me.)

  36. DirkH says:

    E.M., maybe you should add a zinc tablet a day to your diet (if you don’t do that already). Helped me a lot with skin problems; eczema in my case but zinc generally boosts the immune response.

    I recomment Zinc + Histidine tabs. Histidine is a non-essential amino acid and helps to absorb the zinc if i understood that correctly.

  37. Tony Hansen says:

    ‘…Oh, and on the question of “what causes my heartburn”:

    Causes? No idea. Possibly multiple, possibly interacting.
    For relief I use green leafy veges.
    Lettuce is the best to date. Cut lettuce into (roughly) one inch cubes.
    Sometimes only need one, sometimes two or three. Relief within minutes.
    It may also be useful as a preventative. Have used it as such but definitive proof is difficult:)

  38. I really like your blog! I hope you’ll keep on posting such a good posts.

    REPLY:[ Yeah, it looks like SPAM. But it’s “nice SPAM” and it’s related to the topic, so I’m going to let it through. -E.M.Smith ]

  39. Lynn Clark says:

    My brother just pointed out to me that, “Nyquist says the sample rate must be at least two times the HIGHEST frequency one wishes digitize.” Not the lowest frequency.

    Senior moment? I didn’t catch the error, which is proof-positive that I suffered one when I read it. ;-)

    REPLY: [ I’ve fixed it. I have a tendency to ‘have issues’ with relative direction in that it is meaningless without a reference point. So it’s “highest” referenced from zero and “lowest” as the first thing you run into dropping from infinity. I tend to internally think of it as ‘rate of change’ as that is an absolute measure. But it runs from infinity “down” to zero to negative infinity (phase inversion). So it’s “lowest” from my (internal) start point. Sometimes I don’t get the translation to ‘the accepted reference frame’ done when I’m in a hurry or annoyed about the topic; as I was here.

    And I’ve done that my whole life, not a ‘senior moment’ thing (Unfortunately. I don’t have that excuse. It’s “structural”…) I also have right / left issues as they depend on which way you are facing (but North / South / East / West are generally fine as they are absolutes). Nearest / furthest also have an explicit reference most of the time, so not an issue… but I usually ‘check it’ on the implicit self reference when no reference it given “just to be sure”. Clockwise and counterclockwise are usually OK as most of the time I don’t think about the fact that it really depends on if you are looking at the clock from the front of the back or if you are facing toward or away (but sometimes… when I think about it… so I try not to think about it… and have internally coded it as ‘top of head to right hand’…) And when talking about cars I always talk about ‘drivers side’ and ‘passenger side’ rather than right / left (as they depend on your position relative to the car front / rear) and try to not think about England while doing so…

    I know: far more than anyone would ever want to know. But it gives you a bit of insight into the Aspe mindset and why sometimes bright people “have issues” with simple things like right vs left…. (my right or your right? when facing what direction?) The number of times I end up saying “No, your other left!” is more than I care to think about. And yes, I was one of those kids who sometimes printed their R, S, 2, 5, Z, B, Y characters facing ‘either way’ (their shape distinguishes them and they are rotationally unique so who cares? 3 and E matter in some fonts and they are rotationally conformant, so OK, for them it matters.) But as compensation I can read and write mirror writing without thinking about it and don’t really notice if something is printed upside down some times. I’ve found myself reading posters on windows from the “wrong side” without noticing and “pushing” a “pull” because it was “push” from the outside and I was reading it from the inside and not noticing the “wrong way” letters… I also scored exceptionally high on those “fold up the image into a shape” and “which shape is different” tests as they just visually rotate / fold as needed…

    But then you get things like folks expecting “Time” to run a given direction on a graph and “why” just doesn’t make sense to me. As long as it’s marked, time could be either way on a graph with “no difference”… And just tonight the pepper grinder was not working well and I realized it was “right handed”… (maybe I’ll invent an ambidextrous pepper grinder ;-) for folks like me… a few gears, differential, a pawl or two,… hmmm a rotational diode… I’m sure it’s already been done… Probably easier to make an ambidextrous grinding stone surface.. )

    So when running into a ‘new concept’ I tend to find the absolute reference frame that works and store it internally that way (and take the “translation” load externally in exchange for “keeping a tidy mind” internally). But sometimes it has a bite… like slowing down performance on time kinds of speed tests.

    ( I was doing factors rather than memorize multiplication tables in 3rd grade as I’d figured out they were ‘hiding inside’ and using them made a smaller table… and were more fun.. Worked fine right up until we hit 11 x and 12 x “big things”… I remember doing 3 x 2 x 2 x 3 x 3 internally and the teacher interrupting just before I had the final answer with a “you’re taking too long”. Ended up memorizing the 9x part of the table as a consequence ( but via a ‘rule’ – the ‘minus one add to nine’ rule – so 6 x 9 is (6-1=x , 9-x yields 54), but the 12x is only memorized where it’s a x “prime” or x 9 and the rest are still factors… except 12 squared. All the squares are a table… ) Yeah, probably would have been ‘easier’ to just memorize the “times table” but I was more interested in the structure of these number things…. Not bad for a 3rd grader. When we were taught factors in, IIRC, about 5th or 6th grade it was just Sooo old hat… but at least I got a name for it…

    Most of the time all that ‘clutter’ is compensated for and hidden. Then a rushed moment comes… But it really is “different” in here…

    -E.M.Smith ]

  40. Don Streicher says:

    Thought it was a bit of a waste myself, then went in for Bronchitis and found I was running a heartbeat of 37… which led to finding out I had no electrical signal going to the ventricular half of my heart. A pacemaker later I’m back to work.

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