by Dr. Iain Corness
Saturday, March 17, 2018 - March 23, 2018
Why the sphygmomanometer is a liar
Before we delve into this, please
understand that the sphygmomanometer is merely an instrument that measures
Blood Pressure (BP), but the difficulty in using a “sphyg” is that it
measures something which is not stable. The other problem is that people
(including doctors) take the reading as absolute, which it most definitely
Many factors can influence the reading.
For starters, the size and position of the blood pressure cuff can affect
the accuracy of blood pressure readings. If the cuff is too small, the
measurements will be falsely elevated.
As a general guideline, if your arm
measures more than 33.02 cm around as its widest point, you will need a cuff
in which the inflatable bag portion is at least 33 cm long. These large
adult cuffs are available at most hospital and medical supply stores.
Secondly, your blood pressure may vary
considerably from day to day and from moment to moment. Blood pressure also
tends to be higher in the morning and lower at night. Stress, smoking,
eating, exercise, cold, pain, noise, medications, and even talking can
affect it, so you can see it is not a stable number you are measuring.
A single elevated reading does not mean
you have high blood pressure (hypertension). Conversely, a single normal
reading does not necessarily mean you do not have high blood pressure.
The average of several repeated
measurements throughout the day is more accurate than a single reading.
First off, buy a blood pressure
measuring device from the pharmacy. Not expensive and read the instruction
manual. Now read it again. The simplest to use has a circular cuff you put
one arm through. The ones in shopping centers are like that.
Record your blood pressure while you
are seated in a comfortable, relaxed position. Try not to move or talk while
you are measuring your blood pressure. Be aware that the blood pressure
readings may be 10 to 20 mm Hg different between your right arm and your
left arm. For this reason, use the same arm for every reading. Blood
pressure readings also vary throughout the day. This is normal.
For electronic models, press the on/off
button on the electronic monitor and wait until the ready-to-measure symbol
appears next to zero in the display window. Then press the start button. The
cuff will automatically inflate to approximately 180 mm Hg (unless the
monitor determines that you require a higher value). It then begins to
deflate automatically, and the numbers on the screen will begin to drop.
When the measurement is complete, the symbol stops flashing and your blood
pressure and pulse readings are displayed.
Now repeat the same procedure two more
times, for a total of three readings. Wait 5 to 10 minutes between
recordings. Record your systolic and diastolic pressures, the date and time.
Inspect your blood pressure cuff frequently to see that the rubber tubing,
bulb, valves, and cuff are in good condition. Even a small hole or crack in
the tubing can lead to inaccurate results.
Generally, as long as you don’t have
symptoms such as lightheadedness or faintness, the lower your blood pressure
the better. If your blood pressure is usually below 90/60 mm Hg and you feel
well, don’t worry. However, if your blood pressure “normally” runs high
consult our health professionals.
Do not adjust your blood pressure
medications based on your own home blood pressure readings without first
discussing any change with your doctor.
Early detection and treatment with a
combination of medication and lifestyle changes (weight loss, diet,
exercise, cessation of smoking and stress reduction) may reduce the health
risks associated with high blood pressure. If you are under treatment for
high blood pressure, monitoring your blood pressure once a week is
sufficient, though more frequent monitoring may be useful if your blood
pressure is not well controlled or if your medications are being changed.
Talk to your treating physician about how often you should monitor.
A large difference (greater than 20 mm
Hg) between the blood pressure measurements of the right and left arms can
indicate a problem. Once again, take this information to your doctor.
Saturday, March 10, 2018 - March 16, 2018
“How are you?”
I was standing in
the queue at the local 7-Eleven when an attractive young lady, whom I
swear I had never seen before, put her arm around me and said, “How are
you?” This took me aback a little, not expecting such direct questioning
from a stranger, while thinking about food rather than “fun” at that
time of day. Of course, the young lady in question was not really asking
about my inner health, but more about my availability. My rather
embarrassed “Mai ow’s” were accepted with a smile and she sauntered off
with a wave (keeping all her options open, I suspect), but over lunch I
began to ponder on her words - and how was I?
Not the usual place
for a truthful assessment of my physical health, but I stopped to think,
what about me? Greying (I hate admitting it and it’s rather more like
white, considering I once had Chinese blue-black hair); balding (I hate
that even more but fortunately the bald patch doesn’t show in the mirror
as I face it for shaving); face showing the ravages of time and the
Aussie sunshine; getting a bit of a “tummy” (from the beer because
wine’s too expensive in this country to drink socially), but overall,
not bad for a man who races cars under the team [email protected] (say it
quickly) and the oldest surviving male in the family ever (and you think
you’ve got a lousy family history!).
So what can I do
about all these? I tried the black paint Grecian 2000 route years ago
and you go a strange brown which turns into orange after three weeks.
This look fools nobody but yourself, unless you began life with strange
orange hair. The balding? This has been creeping on for the past twenty
plus years too. In the beginning I tried the rubbing “Regaine” lotion
into the scalp twice a day as recommended by the manufacturers. All I
got was a red scaly scalp and the hair shedding continued. I console
myself with the knowledge that it shows male hormonal activity, so at
least I’m not turning into a girl, as seems to happen with a fair
percentage of “lady boys” round here.
The face? The
mirror of the soul? The mirror has no soul. Admit it, you’ve all stood
in front of the mirror and gently pulled your cheeks back to see what
you looked like fifteen years ago, haven’t you? I could fix that with
some timely cosmetic surgery, but it does mean you have to remain out of
the public eye for at least three weeks while the bruising fades. This
option remains high on my 2020 list (but it was also on the 2010 and
2015 lists as well).
The tummy? Now
that’s something I do have to deal with. There has been a slow and
inexorable weight gain over the past three years and the time to stop it
is now. Well, during 2018 at least. This means a simple adjustment to
the dietary intake - less fats, more vegetables, less Brit food and more
Asian cuisine - and a simple decrease in the alcohol intake - less beer
and more soda water. I could even be tempted to step up my physical
activity with some gymnasium work, but I know with my lifestyle and my
innate dislike of lycra leotards that it is unlikely to happen. Perhaps
I’ll put that in the 2022 list.
So what about me,
and my New Year’s health resolutions? An acceptance of the inevitable
looms high on the list, followed by some sensible dietary and social
habits and life looks pretty good for 2018.
However, it might
also be a good idea to check the inner workings with one of the
hospital’s check-up packages. Having had check-ups before, I can look at
any trends that are showing. Could even be a life saver.
And how are you?
Time to grab a check-up package?
Update Saturday, March 3, 2018 - March 9, 2018
When was your
My dear old Mum who lived to be 94,
didn’t enjoy her final years on the planet with failing eyesight (Macular
degeneration) and increasing deafness and painful joints and the need to use
a Zimmer frame. She used to say, “What am I doing here? I’ve passed my
use-by date.” However, despite the limitations in her lifestyle, it still
beat the alternative!
Some people ask me where I get the
ideas for these weekly medical mutterings from the mount. The answer is
simple - generally from you folk yourselves. Many of you will pop in and ask
me a medical question, which may stimulate my imagination and away we go
from there. This week’s is one of those.
One of these questions related to the
expiry or “Use-By” date that you see on tablets, capsules, suspensions, etc.
These expiry dates are worked out by the manufacturers of the magic
medications and relates to how long they keep their biological activity at
good therapeutic levels.
However, like 60 km/h speed limits
where 59 km/h is “safe” and 61 km/h is “dangerous” - a totally ludicrous
concept, the same exists for the expiry date on medications and even the
family loaf of bread. If it says use before 19th of August it does not mean
that on the 20th of August the medication changes into chalk. In today’s
non-risk taking world, the manufacturers are covering their posteriors. They
have to imagine that you are going to maltreat their medications and the
expiry date really represents the “worst case” scenario.
Let me assure you that on the 20th of
August, that medication is still good. In fact, many of the charity
organizations go around the doctors’ surgeries in the western world,
collecting “out of date” drugs to be used in the developing world. In
Vietnam a few years ago the pharmacies used to sell medications with the
expiry date cut off the foil wrappings. You can guess where they came from!
Another reason for short expiry times
could be that the shorter it keeps, the more has to be manufactured and
bought. But of course the large drug companies wouldn’t think that way,
would they. That’s just a thought from old cynical brains like mine!
So how should you store your
prescription medicines? Well the first thing is to look at the box and it
generally tells you the ideal storage place and temperature, but if it
doesn’t then you won’t go far wrong with storing it in the door of the
household refrigerator. This is particularly so for liquids, suspensions,
eye drops and the like; however, with opened bottles, there is always a very
short expiry on them, generally around 30 days from the date of opening. Do
not be tempted to extend this time. It is not worth it.
For individually wrapped tablets in
blister packs or foil, then a cool dark cupboard is fine, but for capsules,
it is even more important to keep them cool. Again the door of the fridge is
a good place.
There is one other important
consideration regarding keeping medications at home - children. You must
keep drugs away from all children. Many medications are brightly colored,
suspensions are sweet and children are attracted by them. Always keep
medications out of the reach of children!
With the household bread – look for
mould and discard!
So that is the expiry date story, not
exciting, but mainly simple common sense.