When the Haemo-Globbin Comes Throb-Throb-Throbbin’ Along…

With immaculate timing the current Coronavirus panic set in just as I was due to have another colonoscopy. Predictably, things did not proceed as planned…

It had been expected to just happen as normal: first the purge, then the laying prone on the gurney, unconscious, while the medics did the dirty work; usually a short and painless procedure, but alas, it was not to be! First I screwed up with the purgative, and then, on the day, my blood pressure was too high. Again. And again. The nurse in charge decided that the colonoscopy could not proceed because of the danger of accidental bleeding resulting from any internal injury during the procedure and decided that it had to be postponed (!) until my blood pressure had been stabilised at a more “normal” reading, and I ended up discussing it with a cardiologist, who put me on Norvasc (calcium channel inhibitor) for fourteen days and gave me a little book to write my daily readings in. Readings that I would take with my little Panasonic BP meter that I bought back in 2008 and appears to still be going strong. Alas!

Now, when it comes to the reading of blood pressure, I personally have a few gripes. When I went back into education in 1985 (because the job situation in the UK was so atrocious), one of the first things we studied was physiology, and we were trained in how to use an actual sphygmomanometer in combination with an actual stethoscope to listen for the Korot’koff Sounds and measure blood pressure, so I already have a very good idea about how to do this with the most basic equipment… but when the new regulations about annual health checks for foreign employees in South Korea kicked in at the end of 2007 (immediately after Lee Myung-bak was elected – remember?), I decided to get my own dumb-bell set plus my own BP meter (as the local Hi-Mart in the centre of Changwon had a range of different models available at the time). I also paid close attention to the technique required in order to avoid systematic errors when taking my BP each day. What I discovered was:

Posture was very important: Whereas the use of the sphygmomanometer/stethoscope pair allowed a range of body positions so that an optimum body posture could be employed (and most specifically, avoiding abdominal compression which would render misleading pressures), not only my own wrist BP meter but also a lot of the ones commonly available in public places involved a position in which the user has to sit down and lean forward. When the patient is overweight, this results in the abdominal fat deposits being compressed, increasing abdominal pressure and giving an elevated reading, so care is needed to find a posture which avoids this error. At home, I now take care to sit with my back straight and no pressure on the abdomen, and abdominal muscles relaxed, measuring elbow on the desk and supported by the other arm, as recommended in the device’s operating instructions.

Muscular exercise (for example, with weight training or more aerobic forms of exercise) causes the muscles to absorb fluid from the rest of the body, lowering the overall blood pressure. This can be seen by monitoring your BP some time after exercise.

Blood pressure taken in the early morning after awakening is usually the lowest (except actually during sleeping) because all body muscles have been relaxed during the night and have yet to tighten up due to normal diurnal body movement. BP peaks during the afternoon and evening and then begins to decline again. At one point (about eleven or twelve years ago) I would get up in the morning and measure my BP and get results like 50/30 (!). A normal (or more accurately, nominal) reading should be approximately 120/80 and even moderate daily exercise should maintain this. Again, measuring your BP some time after a long walk (for example, but allowing time for your body to relax first) should give a reading very close to normal.

My gripe with the typical automatic BP monitor seen in many public places in Korea is precisely this: that they encourage a bad body posture by forcing patients to be slumped forward, increasing abdominal pressure. To this I would add that in Korea, one is not allowed time to rest before taking a seat and being expected to take a measurement. The result is that (again) readings are too high and in the wrong posture to isolate the readings that you are trying to take. I have lost count now of how often – going back at least ten years – I have had to move rapidly between hospital departments for things like routine medical exams. Ridiculous!

Now obviously, with training in biomedical science and having twenty-four-hour Internet access, I do a lot of research online. Norvasc (which was prescribed in the first instance) is supposed to reduce ambient BP by up to 12/6 (systolic/diastolic), but so also is beetroot juice because it contains a lot of nitrate, which the body reduces first to nitrite and then to nitrogen (II) oxide, a potent agent for several processes including the relaxation of the artery wall muscles. I bought a liquidiser but unfortunately it wasn’t powerful enough to cope with raw beetroot, so whilst shopping at Lotte the other day I noticed that they sold at least two beetroot/apple juice combinations (one more expensive than the other). As it happened, after only nine days the Norvasc took my BP down to normal levels, but laboratory blood tests on sample taken concurrently with the initial consultation indicated that I was hyperlipidaemic (i.e. had a level of blood lipids deemed above normal range) and the consultant has now put me on Atacand and Lipitor. The actual blood pressure medication was therefore changed, although I was instructed to finish the last of the Norvasc pills (one per day) before changing to the new prescription.

Although this might seem a rather negative outcome, we have to remember that a lot of what has been observed is the result of an enforcedly static lifestyle. The walking distance between either work and home or home and wherever I would buy food and drink is very short and not likely to result in sufficient exercise; likewise, there is a great shortage of entertainment around here, so the result is an oversupply of food, boredom and a sedentary lifestyle. The human body did not evolve for the urban environment. Also – of course – people are being asked to stay at home while the Coronavirus issue is current, further compounding the problem. The consultant said that I should get at least thirty minutes of walking exercise per day, something which used to be normal until about two years ago because there could often be a long distance between home and work (or, at least, the nearest bus stop). If it had been possible to return to the area here where I used to live – in the north of the city, thirty to forty minutes’ commuting time – this would have been less of a problem, but last year, my manager was very insistent that she wanted me to be living as close as possible to the office in case of the need for a sudden interview. We have had no “sudden interviews” since I returned here, so that seems to have been a waste of time; now we discover that it has been deleterious to my health too.

Happily, at least according to the cardiologist yesterday, this is not an irreversible situation but it does involve a number of lifestyle changes which – to some extent – had already been in place. My alcohol consumption has generally been low recently as I have tended to want to hit the sack rather than stay up; the only trouble being that what I have been drinking has tended to be two or three cans of foreign cider on special offer, the issue here being not just the minimal alcohol input but also the deleterious effects of the sugar – fructose – which is a natural component of cider. My online research seems to suggest that this should also be avoided, but the trouble here is that it is a sweetener added on a truly industrial scale to a whole range of foods and beverages; very difficult to avoid. However, the cardiologist said that for a person my age, this should perhaps be expected, but could be mitigated eventually by diet and sufficient exercise. Now, if it would just stop raining…

Great Stuff!

Had to add this once I saw it. A whole load of stuff at Ill Will Press.

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More great Quotes . . . from Tommy Cooper!!!

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