Cien. Dr. Roach: I regulate my blood pressure at home as part of my regular wellness. The instructions on the blood pressure monitor are sitting upright, hold my feet on the floor and do not put the bracelet over the garment. In addition, instructions indicate that the bracelet should be placed at the heart level.
I have rarely been in a doctor's office where staff using my blood pressure follow this procedure. I almost always sit on the exam table with my legs and the cuff is always placed above my clothes. When I have put it with the staff who read, my comments are usually removed. My blood pressure is usually a little high if I'm in the doctor's office (compared to my home's readings), and I realize it's not uncommon. How can a doctor really determine that I may have a blood pressure problem if the basic procedure is not properly administered for the purpose of monitoring blood pressure alone, what is he or she doing?
You are right that your blood pressure is not correctly measured. Worse, a blood pressure measurement error can have a negative impact on your treatment, which can lead to excessive or inadequate treatment. Worse still, when you tried to make sure your blood pressure was properly measured, you were not listened to.
If this is really important, for example, taking care of a person with high blood pressure, blood pressure should be measured very carefully.
Home measurements can actually be more useful as there are more results that reduce accidental errors and are made in a situation where people live rather than the medical situation of a doctor's office. However, your doctor should make sure the device is accurate before you use the readings.
Finally, there is more and more evidence that blood pressure measurement can be useful within 24 hours, especially if there is a suspicion of a "white shell".
Cien. Dr. Roach: I am a 81-year-old female polio survivor with many post-polio symptoms. I have a card that says, "In case of surgery, DO NOT use depolarizing muscle relaxation anesthesia or curare." I don't know the origin.
At the beginning of August I had a "day surgery". My doctor mentioned a card when planning, and on the day of surgery I showed a card to an anesthesiologist.
I had no problem breathing. However, I woke up from the operation very poorly.
I spent three weeks in a rehabilitation hospital and had four weeks of home therapy before I returned to pre-operative capacity.
I discovered that I was given succinylcholine (depolarizing anesthetic) with other anesthetics (propofol and fentanyl).
Have you heard of this kind of reaction to any other person with postoperative syndrome?
I am not an anesthesiologist and post-polio syndrome expert, but I was taught that people with neuromuscular disease (polio is a classic example) should use the anesthetics of muscle relaxants very carefully. In particular, succinylcholine is problematic for people with post-polio syndrome.
Younger, shorter-acting agents such as rocuronium should be used, and much lower doses than those with no neurological disease.
In addition, it is recommended, where possible, to avoid neuromuscular blockers.
I do not know enough about the operation to know if it was possible, or if it was possible to use regional anesthesia with a lower risk of having a long-lasting side effect.
Dr Roach regrets that he is unable to respond to individual letters, but if possible, they will be included in the column. Readers can ask questions by email [email protected]
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