White Coat Syndrome

Geico266

Geico266

Touchdown! Greaser!
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Geico
I went in for my medical last exam and all went well until it came to the blood pressure. The DR took it right before checking my prostate and a hernia check. 150/ 98 :eek: I was all shook up! :hairraise

Well, it was 7:30 am, (BP is always higher in the am) I had about 8 cups of coffee ( caffein raises BP) and I'm thinking of the heavy work load with school starting and lots of leases to sign. And I'm about to get prodded like a cow at a sale barn. :no: Bad mojo.

Dr. says go home, come back in a few days and we will try it again. He wanted 2 consecutive days of lower readings to pass me. :eek::eek: First day was last Friday 130/ 85, today 134/ 84. Passed! He was happy, and I was happy.

Where the "white coat syndrome" comes in is I started taking my BP at home on a BP machine I verified accurate at my regular DR's office. It was not unusual for me to get 120/ 70. When I walk into the Dr's office my BP goes through the roof. :dunno:

"White coat syndrome" is real!

What can you do to reduce your BP?

Lose weight ( I'm not over weight, but could stand to lose another 10 pounds)
Excersize ( I had been slacking because of summer months)
Stop caffeine 48 hours before exam ( I'm a junky)
Take exam in the after noon ( worked for me)

Any other ideas to lower BP?

Anyone on BP meds that may not need them due to reading high in the Dr's office? Obviously, I'm not a Dr so don't take my advice and stop meds, but this was very interesting to me. My BR jumped off the chart just by walking in.
 
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Re: White Jacket Syndrome

Try jiaolugan tea...google that name and decide for yourself.
 
Re: White Jacket Syndrome

Relaxation techniques, including slow and deep breathing, and listening to soothing music. Reults in a slower heart rate and a reduced BP.

Last exam I asked nurse to give me 3-4 minutes after I was shown into the exam room. I was allowed to sit in a chair and not on the exam table. I went into my quiet place with my earbuds on and some nice smooth jazz going. I don't remember the exact numbers, but both nurse and doc remarked that my pressure was down from previous exam a year ago and were happy to see it there.

Another item that I discovered that raises my BP... talking during when they are taking the reading. I was nervous and chatty. When I was measured again at end of exam, and quiet, the difference was significant.
 
Re: White Jacket Syndrome

White coat hypertension is very real. I will have patients take pressures at different times of the day outside of my clinic and bring log to me at a later time.

You mention it was higher in the am, do you snore? Elevated am blood pressure can be linked to sleep apnea.

In the ideal world we would allow patients to sit 5 minutes before taking their vitals. Things would be much more accurate that way.

Congrats on passing the test!
 
Re: White Jacket Syndrome

Seriously, eight cups, before the exam? Schedule it early and have the coffee afterwards.
 
Re: White Jacket Syndrome

Actually JH and I are likely both aware of a really "nice" study that concludes "guys with white coat syndrome have the same morbidity and mortality over time as untreated hypertensives".

So the question, "is anyone out there on meds who shouldn't be" is a bogus question.
Don't end up like Rose Kennedy. Act now so that your 70s are fun years, not chair years.
 
Re: White Jacket Syndrome

I recommend reducing all salt and sugar intake for at least 2 weeks prior to exam, also drink water, water, water, water, even when your not thirsty, I can almost guarantee you will see a decrease in your BP readings in that short amount of time.
 
Re: White Jacket Syndrome

Ask the doc about a wearable BP device that will take readings periodically throughout the day. You will get a much more realistic picture of your true pressure. If you just want to fake out the doc to get an inaccurate diagnosis then try all the tricks mentioned. Also do some aerobics a few hours prior to the visit.
 
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Re: White Jacket Syndrome

Get off the coffee and salt before the exam.find a relaxation exercise you can do to relax you.A lot of people use them before they take written tests like the comm.I like to sit for a few minutes with my eyes closed and think of waves rolling in while I rub my thumb and finger together,that works as a trigger ,also take long slow breaths.good luck
 
Re: White Jacket Syndrome

bbchien said:
Actually JH and I are likely both aware of a really "nice" study that concludes "guys with white coat syndrome have the same morbidity and mortality over time as untreated hypertensives".

So the question, "is anyone out there on meds who shouldn't be" is a bogus question.
Don't end up like Rose Kennedy. Act now so that your 70s are fun years, not chair years.
Click to expand...

I've been border line hypertensive for decade, runs in the family. My 86 year old mom is on BP meds now. Maybe it is time? I'm almost 60. :dunno:

I would like to stay noff the meds by losing another 5-10 pounds, and getting more regular exercise. I'm pretty sure I can manage it naturally, but this had been a wake up call for sure. I am starting a monitoring program and will give the results to my regular Dr.
 
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Re: White Jacket Syndrome

JOhnH said:
Ask the doc about a wearable BP device that will take readings periodically throughout the day. You will get a much more realistic picture of your true pressure. If you just want to fake out the doc to get an inaccurate diagnosis then try all the tricks mentioned. Also do some aerobics a few hours prior to the visit.
Click to expand...

That really worked well, and is good for me! :D

I was hoping to keep off BP meds for as long as I can. I'm gonna drop 10 pounds and start a year round work out routine. I would rather do it naturally, but don't have any issues with meds, I just want to stay healthy and fly.
 
Re: White Jacket Syndrome

JOhnH said:
Ask the doc about a wearable BP device that will take readings periodically throughout the day. You will get a much more realistic picture of your true pressure. If you just want to fake out the doc to get an inaccurate diagnosis then try all the tricks mentioned. Also do some aerobics a few hours prior to the visit.
Click to expand...

Good advice. :yes:

Not really wanting to fake out the DR just to pass, but I need to overcome the "White Coat Syndrome".
 
Re: White Jacket Syndrome

Geico266 said:
I was hoping to keep off BP meds for as long as I can. I'm gonna drop 10 pounds and start a year round work out routine. I would rather do it naturally, but don't have any issues with meds, I just want to stay healthy and fly.
Click to expand...

That is the best course of action. I suspect that starting a little aerobics and losing 5-10 pounds would probably work great for you. For me, it takes a lot more of that to keep my meds down to a minimum, but I am pretty much under control at ~125/75 even though I still weigh in at 220 (down from 265 two years ago).

Just remember, "borderline hypertension" is only a warning and has a real tendency to turn into HIGH blood pressure suddenly. And they don't call it the "silent killer" for nothing. It gradually destroys your other organs, including your brain. Just thinking of THAT raised my blood pressure.
 
Re: White Jacket Syndrome

Just an interesting note on the relaxation thing when I was in college 30 years ago this very cute young lady asked me if I would participate in some study. Well of course I would. The study was basically a bio-feedback study it consisted of putting some probes on your face and if you relaxed your facial muscles the sound in your ears went away.

Long story short she took my pulse (no blood pressure) and it was 70 or so resting and then we started the experiment. When she took it at the end it was 46. She had to take it a second time to be sure. So I guess it worked. Have to imagine it lowered the BP as well. I was in the hospital one time for a procedure on a monitor and a was using this technique to show my wife I could control my heart beat to at least a minor extent.

On a personal note the other day I was out with the fire department at a controlled burn. Wasn't working to hard but it was hot and I had my bunker pants and boots on and I suspect I was a little dehydrated. Had one of the EMTs take my blood pressure since I hadn't had it done in a while I think it was 140/98. I wasn't happy about that but took it again when I got home after a few bottles of water and was 130/80 and took it again the next day and it was the same 130/80. I am down about 30 pounds (still a long way to go to goal) and counting so hoping to see some more improvement so maybe I can eventually get the doctor to cut the meds back some.
 
Re: White Jacket Syndrome

If it makes anyone feel any better at all the same exact bloody thing happened to me. I lead what most would call a very healthy lifestyle, and I had bp issue with which to deal. Do whatever you must, the good Doctor is right. Hypertension is a long-term insidious killer. Don't let it get you.
 
Re: White Jacket Syndrome

Eastern Breathing.

I can drop my blood pressure 20 points, and my heart rate about the same just by using Eastern breathing techniques. Got my pulse down to 46 once. Nurse was :eek: If I focus I can get my systolic below 90.
 
Re: White Jacket Syndrome

EdFred said:
Eastern Breathing.

I can drop my blood pressure 20 points, and my heart rate about the same just by using Eastern breathing techniques. Got my pulse down to 46 once. Nurse was :eek: If I focus I can get my systolic below 90.
Click to expand...

If you can get it down that way and keep it down great.
The problem is, unless you can concentrate on doing those things 24 hours a day, the high BP is still going to be there and destroying your other organs in a relentless process.
 
Re: White Jacket Syndrome

Greg Bockelman said:
What action would that be?
Click to expand...

Whatever action will reduce your BP. It might be a healthier lifestyle, weight loss, exercise or whatever lifestyle change will result in lower BP. It might be soliciting medical expertise and going on a pharmaceutical that will reduce BP. But the condition should not be allowed to continue unchecked. That is a good way to enter the world of cardiovascular illness.
 
Re: White Jacket Syndrome

Everyone talks about how to "check" under the requirement.
Only Prof W and I (Steingar) talk about the long term effects of just "checking" under the requirement.
"But I feel fine"......until you don't and it's irreversible.
 
Re: White Jacket Syndrome

bbchien said:
Everyone talks about how to "check" under the requirement.
Only Prof W and I (Steingar) talk about the long term effects of just "checking" under the requirement.
"But I feel fine"......until you don't and it's irreversible.
Click to expand...
Hey, what about me? Didn't you read any of my posts?:dunno:
 
bbchien said:
Everyone talks about how to "check" under the requirement.
Only Prof W and I (Steingar) talk about the long term effects of just "checking" under the requirement.
"But I feel fine"......until you don't and it's irreversible.
Click to expand...

I'm listening too you, and agree.
 
Re: White Jacket Syndrome

bbchien said:
Everyone talks about how to "check" under the requirement.
Only Prof W and I (Steingar) talk about the long term effects of just "checking" under the requirement.
"But I feel fine"......until you don't and it's irreversible.
Click to expand...



What do you recommend? I just tested 123 / 83 at home, with nothing other than a couple of deep breaths and holding still. 135/ 85 in the am. :dunno:

Let's not talking about me in the ME's office. ;). :lol:

I know BP meds don't automatically disqualify you from a medical, but at what level would you recommend medication?
 
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Re: White Jacket Syndrome

Geico266 said:
What do you recommend? I just tested 123 / 83 at home, with nothing other than a couple of deep breaths and holding still. 135/ 85 in the am. :dunno:

Let's not talking about me in the ME's office. ;). :lol:

I know BP meds don't automatically disqualify you from a medical, but at what level would you recommend medication?
Click to expand...
The treatment of hypertension is a little more complicated than can be explained in a forum and depends on many factors including age, other medical problems (diabetes, coronary artery disease, etc.) but many physicians will whip out the pen (or mouse) and prescribe something when the average BP exceeds 140/90. Ideal BP is probably closer to 115/70 but the data does not support treating BP this aggressively. If you want the official recommendations here they are, all 52 pages: http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf
Don't try to make medical decisions based on what you read here but you might impress (or embarrass) your physician if you quote from this official report.
 
Re: White Jacket Syndrome

Gary F is a cardiologist. He's dead on.

Understand that damage is irreversible, and that you feel fine until you don't.
Consequences include: atrial fibrillation, Accelerated Coronary Disease, Abdominal aortic aneurysms and strokes.

The longer you procrastinate the bigger the area under the "excess BP - time curve" and the more damage there is. This is like not changing oil. He who changes least loses biggest.

He who procrastinates away from his hypertension control, looses biggest.

"oh, I'll loose the weight"...........yah........uhuh.......yah.
 
Re: White Jacket Syndrome

Being from Oklahoma where obesity was rampant so were gastric bypass procedures.

Although I encourage lifestyle changes I tell folks about the gastric bypass patients. I could always stop their diabetic and hypertensive meds shortly after their surgery. However usually within a year I would be starting them back on some form of hypertensive meds. This after losing 100 plus pounds. The point being despite all that someone can do, sometimes it isn't enough and meds are required.

I also refer to the last few days I worked as a paramedic. I picked up a young lady (teacher in school) in her late 30's with a subarachnoid hemorrhage who passed away 2 hours later. Family had mentioned she had pressure issues but never felt bad so didn't pursue it.

It is the silent killer is sad to see the end effects for sure.

Good Luck, all the lifestyle changes can only make one feel better anyway. Once in awhile when I get off my lard butt it feels good...after the soreness wears off!
 
Re: White Jacket Syndrome

Gary F said:
The treatment of hypertension is a little more complicated than can be explained in a forum and depends on many factors including age, other medical problems (diabetes, coronary artery disease, etc.) but many physicians will whip out the pen (or mouse) and prescribe something when the average BP exceeds 140/90. Ideal BP is probably closer to 115/70 but the data does not support treating BP this aggressively. If you want the official recommendations here they are, all 52 pages: http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf
Don't try to make medical decisions based on what you read here but you might impress (or embarrass) your physician if you quote from this official report.
Click to expand...

Thank you Dr. Gary for the info and advice. I started reading the info on the link, and it is very enlightening. :eek: Thanks.

Thanks Dr. Bruce for the kick in the butt. I know it is nothing to mess with, I won't look good in a wheel chair. :no:
 
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Re: White Jacket Syndrome

bbchien said:
He who procrastinates away from his hypertension control, looses biggest.

"oh, I'll loose the weight"...........yah........uhuh.......yah.
Click to expand...

:lol:

I hear ya, talk is easy, actions speak louder than words. In 10 weeks I will have lost 5 pounds or more. :yes:

I have grand kids to spoil. ;)
 
Re: White Jacket Syndrome

Jthamilton said:
Although I encourage lifestyle changes I tell folks about the gastric bypass patients. I could always stop their diabetic and hypertensive meds shortly after their surgery.
Click to expand...

The link between bariatric surgery and diabetic remediation is utterly fascinating. That said, I never thought it would really work if folks didn't fix lifestyle habits.
 
Re: White Jacket Syndrome

steingar said:
The link between bariatric surgery and diabetic remediation is utterly fascinating. That said, I never thought it would really work if folks didn't fix lifestyle habits.
Click to expand...
Great article in the Annals about that in the past 3 months......
 
Re: White Jacket Syndrome

steingar said:
The link between bariatric surgery and diabetic remediation is utterly fascinating. That said, I never thought it would really work if folks didn't fix lifestyle habits.
Click to expand...

I figure that changing my lifestyle habits is the hard part, and since I have to do that anyway, I might as well focus on that and skip the surgery.

I'm down 16 pounds since January, but I still have a long way to go.
 
Don't feel bad OP. When I went for my second class medical a few weeks ago it was like I was trying to set a new high score or something, both my pulse and pressure. I've come to dislike doctors quite a bit given the experiences I and others I know have had.

Fortunately, after several tries I was able to hit the magic numbers.

Otherwise - I'm fairly active, not fat, and I'm 27. My BP problems are 100% job related.
 
My BP always checks fine at the doctor's, I guess growing up with one makes you immune lol.
 
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