hypertension issues

[Unregistered]

I have an odd situation where my blood pressure goes up and down. It was starting to be more up than down, so I increased my BP medication, and it was about time to expect that anyway, apparently. I can actually feel it when it goes up (my husband has a cuff, and I've tested this). The problem is, I can't tell when it's going to do it; there don't appear to be any triggers.

My medical will expire at the end of August and I got two of my BP readings from my doctor's office, but I haven't been able to get to her office when it's down. The other problem is, what if it decides to spike when I go for my medical? In fact, I'm so worried about this now I'm almost certain it WILL spike because of my worry. So now I'm very worried that I will be denied my medical and I don't know what to do.

I just had my annual physical and, as usual, everything was beautiful--I've always had great lipid profiles and my electrolytes are fine. I used to run until my knee gave out and now I bicycle a lot, and have done several 25-mile rides in our very hilly terrain. My heart rate is low--mid-50s to low 60s. I know about white-coat syndrome, but now I'm afraid even to go to my doctor for the 3rd BP reading for the letter because I'm now in the cycle of such concern about my medical certification. HELP!

 

[bbchien]

The systolic less than or equal to 155 and diastolic less than or equal to 95 are fixed and absolute.

If you pressure is THAT labile, the doc needs to do something about it. Like a 24 hour urine collection for catecholamines. Any internist will know what that implies we are looking for.

 

[Unregistered]

Of course, I immediately looked it up. That is very interesting. I've been cutting back on caffeine and that seems to have helped. I also noticed that my BP actually went up after I drank some red wine. This is going to sound terrible, but I just want to get through my medical--then I will deal with this, immediately. But as I am basically very healthy, I don't feel I'm unfit to fly.

 

[Unregistered]

Let me just emphasize emphatically that I WILL get this looked into. But there is a huge range of symptoms, of which fluctuating BP is only one, and I haven't suffered any of the others.

This just points up a HUGE problem with the FAA medical certification system, though--it makes pilots afraid to talk to their doctors about stuff. I obviously have dealt with the high BP, but I didn't talk to my doc about the fluctuations because, partly at least, I was afraid to. I personally know at least a half dozen pilots who have told me various things they don't talk about because of this. Losing my medical would be, for me, a nightmare. No wonder I get white coat syndrome in the AME's office!

 

[Unregistered]

OK, now I've had a chance to read more. Is a benign pheochromocytoma, if taken care of, disqualifying? If both adrenal glands have to be removed and hormone supplements taken, is THAT disqualifying?

I have no other symptoms except maybe strong heartbeat and my BP has never, to my knowledge, spiked to the really dangerous levels. If I do have a pheochromocytoma, it sounds like it is eminently treatable, which indicates to me that it shouldn't be disqualifying....but then again there are a few things that are disqualifying that don't make sense, either.

 

[bbchien]

OK, now I've had a chance to read more. Is a benign pheochromocytoma, if taken care of, disqualifying?

Some are benign, some are not. But they can be removed and then you are airworthy.

If both adrenal glands have to be removed and hormone supplements taken, is THAT disqualifying?

If someone proposes to do that, RUN! That's from the FIFTIES.

I have no other symptoms except maybe strong heartbeat and my BP has never, to my knowledge, spiked to the really dangerous levels. If I do have a pheochromocytoma, it sounds like it is eminently treatable, which indicates to me that it shouldn't be disqualifying

It IS Disqualifying, because the surges in blood pressure put you at risk for heart attack and stroke.

....but then again there are a few things that are disqualifying that don't make sense, either.

Unreg, standards are standards. PERIOD. And this one is a GOOD one. So DEAL with it.

You need to get your hypertension looked into. If you don't meet standards, you need to get them looked into before you will be legal to fly. That's the reason standards are just that.

 

[Unregistered]

Some are benign, some are not. But they can be removed and then you are airworthy.If someone proposes to do that, RUN! That's from the FIFTIES. It IS Disqualifying, because the surges in blood pressure put you at risk for heart attack and stroke.Unreg, standards are standards. PERIOD. And this one is a GOOD one. So DEAL with it.

You need to get your hypertension looked into. If you don't meet standards, you need to get them looked into before you will be legal to fly. That's the reason standards are just that.

I have NOT been ignoring it. I CAN'T ignore it, or I'll flunk my medical exam, right? My doc and I recently upped the dose of BP meds. Now that you've alerted me to this possibility, I have already made an appointment to get the test. I do understand that this is a good regulation. And I don't want to die of stroke. I am scrupulously honest on my medical applications, never worry. OTOH, I really don't want to lose my medical, either.

Regarding removal of both adrenal glands, I meant only if both have tumors. I realize that's extremely unlikely--I was just exploring the parameters.

Thanks for your help, and sorry for the grousing.

BTW--what if the test comes up negative?

 

[Unregistered]

Well, the tests did come up negative. No pheochromocytoma (my doc said she really doubted I would have one, based on the fact that she's never met anyone who had one; in the meantime, I have met 3 people who either had one or knew someone who had one--go figure). So we just boosted the medication, and I passed--barely. I was fortunate to have an AME who recognized white coat syndrome. My first reading was too high. He then conducted the rest of the exam and then snuck in a new reading, which was fine, and passed me.

Here's the interesting thing, and why I'm posting this update. All this gradually went away.

I'm thinking that it was leftover from the stress I felt in my previous job, from which I had resigned only a couple of months before. I knew the stress had deleterious effects on my health; that was one of the reasons I resigned. What I didn't know was how long the effects could last.

Now my blood pressure is heading back to where it was before it started to climb. In fact, I've cut back on the meds, and am thinking about cutting back again--my blood pressure has been as low as 102/64. I have lost a little bit of weight and I've also kept up the exercise, but I really think most of it is eliminating the stress from my life. I'm a lot poorer (I took a 40% pay cut, which fortunately phases in over 3 years), but I'm a LOT happier. Now if we could just get fuel costs down...

Thanks again to Dr. B for holding my hand through this process. We are fortunate indeed.

 

[Unregistered]

Incidentally, when I said "before it started to climb" I meant back to 2000, which was when I first went on BP meds. Now that I think about it, that's when I started on the job track that led to so much stress. And I thought I was only stressed the last year of my previous job.

 

[Unregistered]

Ack...I haven't had enough coffee yet this morning. When I said "it was fine" during my last FAA medical exam, I meant it was REALLY fine, not barely fine: 120/80.

 

[bbchien]