Wednesday, January 31, 2024

Budd's Blood Pressure - Fascinating!

Here's a story about my blood pressure.

I know, “Fascinating! Let's hear it, Budd!” Then I'll tell you about my aching left foot – what a problem that's been!

Actually, I've wanted to tell this story since it happened to me last week, and I planned to adumbrate it with observations of the medical care system. Here's the very short version:

For some reason, I really don't remember why, after more than a year of not checking my BP, I checked it while I was in Maui, and found it elevated, to 142/84. Not a deadly level, but concerning, because one, it was rising, and two, when you get past 140 systolic, the danger of events starts to increase. And me, well, I always over-react. Can't help it.

So when I got back in town the next week I tried to get in touch with my PCP, my friend and long-time colleague Jim Eichel, who used to work for me and now works for Stanford. Stanford. A hospital, and thus, a bureaucracy. I messaged him and got back a message from a physicians assistant who said my BP wasn't so bad, and what about life-style? Give me a break. I'm a doctor with 31 years of education and over 30 years of practice, and I'm going to be talking to a PA whom I don't know? Next they'll be telling me to check in with an urgent care center, where I would get an unsupervised PA.

So I called and asked for an appointment. Sure, I could do a Zoom call in 3 weeks (you can't measure a BP in person on a Zoom call, Stanford) or I could see Jim in a couple of months. My blood pressure is rising (and this phone call didn't help, obviously) and they're telling me that my PCP isn't available. Yet they'll claim high quality care. NOT, people! Access is part of quality care, and personal contact with your own doctor is a part of quality care. Baiting and switching is not part of quality care, Stanford.

So I figured I'd email Jim privately, which I did, and in a couple of days he got back to me and wondered if we should start hydralazine, a 4th drug for my BP. He thought maybe yes. I wondered.

But in the meantime I figured, before Jim got back to me, let me call my cardiologist. I hadn't seen him for years, when I had a rhythm abnormality, but what the hell. I believe in specialist care, and if the US doesn't have enough primaries and a surfeit of specialists, I'll go with that flow. Turns out it took me maybe 2-3 days to see my cardiologist – it would have been sooner if I had been an “active patient.” Since I was just an old patient, they required a referral. Well, Stanford would be no help there so I got my doctor step-daughter to send in the referral – we regularly help each other in getting ourselves through the system. So, the fact of the matter is that I got to see my cardiologist before, way before, I could see my PCP. And actually, not only that, but then I got an echo-cardiogram and a renal ultrasound the very next business day. Eventually on the weekend I talked it over with Jim and we were all cool – I got to tell him what my cardiologist said about him, that he's the best PCP in the area. I love delivering good news. Jim is such a dear man, really, such a sincere and dedicated and knowledgable doctor who doesn't even tell me I'm over-reactor, although he doesn't contradict me when I confess that I know that I am. Jim's personal humanitarian instincts and practice are disserved by his Stanford system, seems to me.

But that's not really what I wanted to say in this post, enlightening as it is. When I visited Eric, my cardiologist, we talked more about the case, and he said he doesn't really like to add drugs if he can help it. Well, I want to stay in a good range, not a dangerous range, but I didn't object. So Eric said, it doesn't look like you need to lose weight. I could lose 10 pounds, I said. OK, do it, he said. But then, as we talked about the case, I realized that yes, I didn't add salt to my food, but I really didn't avoid it, either. And I eat a lot of prepared foods, which I knew were salty. I was just relying on my meds to counteract it. So I figured it's time for me to really make an effort.

And that's when I made my discovery. I started reading labels. Every goddamn thing has so much salt in it! My friend Mary Lou, whose son does catering, said that he adds salt to everything because it makes things more tasty. And that's what all the food companies are doing, the same thing. They are honoring sales and taste and shortchanging health. Salt just isn't good for you.

But, maybe that's an overreaction – I don't know, I overreact. So I figured, fresh fruits and vegetables, you can't go wrong with that. I'll just go that route. I try to eat a lot of them anyway, I'll just step it up. Which I did over the next few days. And, amazingly, here's what happened. Look at the BP change!  I went low-salt on the 25th, I think.



8:15 AM




2:04 PM




10:10 AM




7:20 AM




8:40 AM




9:15 AM




9:30 AM




8:45 AM




8:30 AM




5:25 PM




5:00 PM




5:30 PM




9:00 AM



7:55 AM




7:25 PM




5:35 PM




And not only that – when I went to work out, I got my maximum heart rate to up 151, which is exactly what my max ought to be for my age. I figure I was under toxic salt syndrome (which I just named.) How amazing is that?!

So then I went to Berkeley Bowl, our local supermarket that caters to discriminating customers, and I was able to find many low-salt items – canned tomatoes with zero salt, canned beans with almost no salt, lots of things. Plus their usual amazing selection of fresh produce.

So there it is, that's the post. I'll have to change my diet, but who knows what other good doing that will do? You just can't go wrong with fresh fruits and vegetables. Now, to figure out how to make soups with no salt – Insta-Pot, gifted to me by Sara a year ago, here I come!

Sitting down and talking with your doctor really has no good substitute, in my opinion. But then, I'm an over-reactor. But over-reactors need care, too.

Budd Shenkin

1 comment:

  1. Wonderful story. Try mine- will up yesterday, couldn’t hear out of my left ear. Costco hearing aid center diagnosed ear-wax, which they can’t clear out. Ear specialist I have gone to couldn’t see me for three weeks. PCP referred me to a mother buddy, and they couldn’t get the job done for about a month. Called Carbon Urgent Care on Telegraph Avenue in Berkeley, near Alta Bates and the job was done within 3 hours. Per my dear departed mother, “No more potatoes, there!”