[wobblykate]

So, I had my 6 month check-up at the cardiologists' today. At the beginning of the year I was having some high blood pressure and palpitations, which we later discovered were bcp related. After going off the bcp, my blood pressure has returned to normal, and was in fact never that high according to the ambulatory bp cuff they had me wear for 24 hours the first time I went to the cardiologist. I've been having prenatal care since August and they take my blood pressure every time. It's always been great. I had my bp taken yesterday at an office health screening. It was great. Today I go in and, of course, it's high. The nurse takes it a second time after we've sat and chatted for a minute and it's low again (like 126/68). To me, this can obviously be attributed to nerves. So the dr comes in and takes it again and it's high (like 138/70 or 80) and says she wants me to go on an ambulatory cuff again. Well, I blew up

:. I told her i was fine and there was nothing wrong with me. That it's only high when I come to the (this is a quote) "frickin' doctor." Then, of course, I started crying out of frustration b/c I was expecting to come in and get a clean bill of health. Anyway, I refused the bp monitor (they're terribly painful and when I was way heavier and on bcp they showed no problems). She tried to tell me that because at one point in time I had high bp (due to meds) that I was at higher risk for preeclampsia and because I have palpitations I'm at a higher risk for some sort of tachycardia...blah, blah. Oh, and if I don't sleep on my left side I'll kill my baby or something. Well, maybe she didn't go that far. But please, is it just me or would the human race have died out a LONG time ago if successful pregnancies were reliant on sleeping on one's left side?

Is it just me or does this seem like over managing? *Sigh* Did I overreact? Anyone ever been in the high bp only sometimes vote? Like only when you go to the cardiologist

:. I'm totally late for a meeting, but let me know what you think. I love you guys

 

[lynxeyedkat]

That's called White Coat Hypertension, when your BP is only high bc you're anxious at the doctor's office. If there's a name for it, it must be widespread. You are the one who knows yourself best, and you have every right to refuse any diagnostics/tests/treatments etc. you know to be unnecessary.

I also love that "they" preach to stay on your left side and off your back, but then expect you to labor in the lithotomy position, when your baby is already under more stress and receiving less oxygen due to contractions. Doesn't add up.

Anyway,

and don't worry about it. Her job is to read the scripted response to your "high" BP and your job is to react and respond with what's best for you. She's looking out for her heiny and you're looking out for you and your babe.

 

[lilgreen]

Aw, Kate. Sorry you had to go through that. It seems not so much a case of over management as it is a lack of properly considering your individual case. The blanket mandate is likely the cuff for anyone who has high bp because they don't have the time to weigh out the specifics of individual patients. It harkens that notion that you're just a number rather than a person in the medical system.

Good for you for having the clarity and guts to stand up for your self!

 

[wobblykate]

This is why I love MDC. *sigh* You guys are awesome

.

lynxeyedkat the side-sleeping thing really doesn't add up, does it? Go figure. I mean, I'll sleep on my left side as much as I can, but I'm not a side-sleeper when not pregnant and I find it painful on my hips, so I have to switch between right and left to keep the pain manageable. Last night when I got up for the third time to pee I was just dreaming of stumbling in to my bed and plopping on my stomach. It was like a food or drug craving...very intense.

I definitely have the white-coat thing. Luckily, I must like my midwives, because it's never been an issue there.

lilgreen - thanks, I definitely didn't feel like she was looking at the whole picture.

 

[mayakas]

sorry you were frustrated.

Quote:

Originally Posted by wobblykate But please, is it just me or would the human race have died out a LONG time ago if successful pregnancies were reliant on sleeping on one's left side?

Most people on this planet, esp. the third world (and historically in general), have sub-par or no medical care. Yet we've managed to pop out billions of babies

 

[riversong]

This is exactly what happened to dh's boss. Well, not exactly because he's a man.

But...he hated going to the dr and would have really high bp when he went in. They were going to put him on meds for it. I guess he must've had that ambulatory cuff you had because they had him get bp readings at home over a period of time. His bp was totally normal at home. When he went back to the dr, it was high again. Total white coat syndrome.

If your bp is normal when you're at home or more relaxed with the nurse and then shoots up with the dr, doesn't that show them something? I especially wouldn't worry if your mws are taking your bp and it's normal with them.

 

[momma2be_k]

Kate... that all SUCKS.
The more I hear stories like about various "issues" that come up (and stress out an expecting mom) during pregnancy... it always seems like the catalyst is the doctor/nurse/midwife wanting to cover their butt. Now with a generally "high" rate of malpractice lawsuits in our country.... this behavior is not COMPLETELY unfounded. But it is NOT ACCEPTABLE! Who is advocating for better, more thorough, less invasive (and thus more affordable) maternal care for us mommas? US (and many, many great MW's). Women who do not seek out and study statistics and current information and educate themselves remain at the whim of trusting doctors and caregivers that may over-medicalize an otherwise totally natural and normal cycle of life! The worst part is, that they don't even know any better. Why would one ever think of not trusting the advice and care of a doctor?
It's like doctors get bored when things are going along normally... and are just looking to spice things up in their respective careers (however ridiculous that may sound).
What does your MW say about your BP? I would stick with her assessment.... or is she not properly QUALIFIED to assess your health and determine if you have or are at risk for PC? I'm sure she is more than qualified.

Lie to them and tell them you sleep on your left side ALL THE TIME. That is so stupid that they gave you a hard time about that too.

:

What's the deal with treating the palpitations? Is it a dangerous condition that needs to be monitored throughout your pregnancy?

 

[wobblykate]

Here's the funny thing about the palpitations. She's not worried about them as long as they stay like they are and are "normal" palpitations. I.e., extra beats, but not racing. I don't get the racing thing, so it's not really an issue. Except she says that people who get "normal" palpitations are more likely to get "abnormal" ones during pregnancy. Whatever.

Obviously, if my heart is racing and I'm out of breath, etc., I'm going to do something. I'm not trying to harm myself or my child, for cryin' out loud

:

 

[michanders4]

I'm so sorry to hear that Kate

. That is very frustrating!! I think you did the right thing. You know yourself and have been being monitored by your midwives so I think you are fine. I'm sure its fine if you just lay on your left side as much as you can but don't stress about it. Im still laying on my backish at times because I like it even though I don't think I'm supposed to. I try to eventually end up on my left side though before I conk out.

 

[MI_Dawn]

Uh yeah. Sounds like white coat hypertension to me. If I don't practice deep breathing at the doc's, I get it, too. But I'm fine otherwise. I can take it 100x at home with normal results. If something is wrong, you'll know it. Trust your instincts, mama.

 

[wobblykate]

Quote:

Originally Posted by michanders4 Im still laying on my backish at times because I like it even though I don't think I'm supposed to. I try to eventually end up on my left side though before I conk out.

I can't help it if I wake up on my back!! What are you supposed to do when you're flat out asleep? On top of the pillow that was supposed to wedge under your back and keep you on your side? Pshaw. I'll keep trying, but I won't beat myself up about it. Sometimes the best nights of sleep are the ones where I forget.....course, I'm a stomach sleeper naturally.

Anyway, thanks for all the support everyone. I got out of that appt and I said I have got to go tell my DDC!!!

 

[smartycat]

Can I play devils advocate for a second?? I do agree with you, Kate, and the other PP, that is more likely "white coat syndrome" if your BP has been normal otherwise. BUT I get really aggrivated at the suggestion by some that the doctors are purposely trying to scare patients or are only making recommendations to CYA. Maybe, just maybe, the cardiologist has a legitimate concern about Kate's BP? If birth control altered her BP, I don't think it is such a leap that pregnancy hormones could affect it as well. And I don't think it is such an unreasonable request to monitor the BP. If a 24hr wrist monitor is not the way you want to go, how about a middle ground of checking in with your midwife more frequently? Maybe once a week for a few weeks and then back to a normal pre-partum schedule if all is OK?

I totally get that you were upset when your appointment didn't go the way you had hoped. I even empathize with you "going off" on the doc. Heck, my last doc appt I was screaming like a banshee in the waiting room and I'm not even pregnant.

But I'm sure there are doctors that are doing what they do because they actually enjoy what they do and are looking out for their patient's best interest.

I'm not trying to be difficult. On th whole, I really do empathize with your situation. But I have worked with some wonderful people in the medical field and hate blanket statements about crooked docs and such.

Kate, I'm sorry you had a rough day.

I hope you continue to have a healthy pregnancy and can find a way to continute to montior your BP that you are comfortable with.

 

[Peony]

Sleeping on your back isn't harmful at this point in your pg, it's not until later when your uterus is so heavy that it could decrease blood flow to the baby. By that point in time, it is usually insanely uncomfortable to lay on your back, and in the middle of the night you really aren't going to do it in your sleep because it will take tremendous effort to roll over. In other words, you'll be awake enough to know you need to switch sides.

laying on your right side isn't bad, it's just that the left is better, but any side is better then none.

And it sounds like a classic case of white coat hypertension. I'm sorry your appointment was so crappy.

 

[wobblykate]

Quote:

Originally Posted by smartycat Maybe, just maybe, the cardiologist has a legitimate concern about Kate's BP?

I don't suggest that this is a bad dr. She's one of the best in her field. I simply think that drs make alarmist statements at times. And I don't think she was looking at the whole picture for me. I do think she had the best intentions in mind. I actually really like her, but I'm also educated enough to know that sleeping on my back isn't going to kill my baby and that the rest was maybe a bit much.

Quote:

Originally Posted by smartycat If a 24hr wrist monitor is not the way you want to go, how about a middle ground of checking in with your midwife more frequently? Maybe once a week for a few weeks and then back to a normal pre-partum schedule if all is OK?

If it were a little wrist cuff, I wouldn't hesitate. This is a huge arm cuff that squeezes the hell out of your arm every hour on the hour for 24 hours. Last time it left bruises. By the end of the 24 hours I was nearly in tears when it would go off. The off-handed way that the dr suggested it made it obvious to me that she's never had one. But you're right, I did suggest that I self-monitor at the drug store, and would do that anyway to ensure baby's health. I want to emphasize that I am NOT against the medical profession. Quite the contrary. Even my DH, whom I expected to be upset with me for refusing the bp cuff, totally agreed and he's very "dr. knows best."

Quote:

Originally Posted by smartycat Kate, I'm sorry you had a rough day. I hope you continue to have a healthy pregnancy and can find a way to continute to montior your BP that you are comfortable with.

Thank you

 

[soxthecatrules]

I personally find it curious that the dr. is going spastic over 138/80. In my personal situation that was a good reading. With DD I was hitting that range and the OB didn't blink an eye. Wasn't worried about it at all. And I have a history of pre-eclampsia and chronic hbp. If my bp was under 150/100 at a visit and I wasn't spilling protein in my urine the OB didn't get overly concerned. He would always say "well if the bp stays elevated like that for around 2 days then give us a call". It never did.

To control my bp I took daily two hour rests, watched my diet, and took 100 mg of labetalol twice daily. If I had found this website earlier I probably would have tried additional natural remedies.

 

[scraphappy-Red]

No words of wisdom here...just

 

[wobblykate]

Quote:

Originally Posted by soxthecatrules I personally find it curious that the dr. is going spastic over 138/80. In my personal situation that was a good reading. With DD I was hitting that range and the OB didn't blink an eye. Wasn't worried about it at all. And I have a history of pre-eclampsia and chronic hbp. If my bp was under 150/100 at a visit and I wasn't spilling protein in my urine the OB didn't get overly concerned. He would always say "well if the bp stays elevated like that for around 2 days then give us a call". It never did. To control my bp I took daily two hour rests, watched my diet, and took 100 mg of labetalol twice daily. If I had found this website earlier I probably would have tried additional natural remedies.

I think she was concerned because when the took it when I first came in it was 140/80 or maybe the bottom number was higher something....the nurse took it 2 minutes later (after talking to me for awhile and connecting) and it was 126/70 something. Then the dr comes in and does it and it's back up to 138/80. Whatever. There's no way that's not connected to nerves. Funny thing is that I am not a nervous person. I get up on stage and sing/play banjo nearly once a week! Blah. I give up and if anything's going to give me high blood pressure it's worrying about my blood pressure

. Thanks everybody for your support

 

[sdmoose]

Kate,
Just another story for you! I can't comment on the palpitations, but I can on the BP. I also had BCP induced high blood pressure (went into the 200's/120!!!) yikes! And I've been on and off of BP meds since then. There are times when it normalized and times it spiked. I've always been really well controlled on low doses on meds. When I got pregnant the first time I took myself off meds and my BP stayed normal through pregnancy until week 36 where it went to about 160's/100's (on my left side!). I was worked up for pre-eclampsia and induced. My BP did NOT go back to normal after delivery and I ended up on meds again. I'm convinced this was my chronic hypertension surfacing, but at that point you can't mess around and I'm happy with the way my induction went.

This pregnancy I had to see a different provider and my BP has not normalized like it did last time. It has ranged between mid 120's up to high 130's/ 90. I'm watching it closely (I work in a clinic) and my doc is comfortable watching these numbers closely...considering my history of chronic HTN. He thinks I'll end up on meds at some point, but ok with these numbers in the earlier stages of pregnancy without meds. And if I go on meds later in pregnancy maybe I can avoid an induction.

Never once has anyone suggested I wear a 24 hour BP monitor!!!!! Is that more for your BP or to catch any palpitations (ie a heart monitor)? It would seem excessive for BP monitoring. Your diastolic (bottom number) is great and since the systolic is more labile, it seems reasonable to for you to do daily home BP checks and weekly office visit checks, assuming you feel fine otherwise.

I agree that elevated BP is nothing to ignore in pregnancy, things can go bad fast...and you ARE at much higher risk for pre-eclampsia. BP normally increases toward the end of pregnancy...so with underlying history of elevated BP this could be an issue for you.

I'd be interested in keeping in touch with you over the course of your pregnancy to see what happens with your BP and how things are managed.

 

[momma2be_k]

Quote:

Originally Posted by smartycat BUT I get really aggrivated at the suggestion by some that the doctors are purposely trying to scare patients or are only making recommendations to CYA. Maybe, just maybe, the cardiologist has a legitimate concern about Kate's BP?

I'm sorry if my post came across as "anti-doctor" or that the doctor was "purposely trying to scare" anyone. (as a side note I've recently watched "the business of being born" LOL). What I really wanted to convey was that I feel that.... many doctors go from 0-60 in a matter of seconds before looking at the "big-picture" and taking the time to treat the patient as a whole (emotionally and physically) rather than as a list of symptoms, and only trying to avoid a worst-case scenario.

This happened to me and my MW too! I went from a healthy low-risk pregnancy to her telling me I needed an amnio (at the suggestion of the OB she confers with - based on a quad screen). She wasn't trying to do me wrong, she just didn't slow down and gather all the important info before speaking with me (she didn't look at the BIG picture). She freaked me out unnecessarily.

Kate - Is there any reason why the BP reading you get at your MW's office is not sufficient? Does she have any concerns for you and preeclampsia? Is she aware that you are seeing a cardiologist? What are her feelings about that? I would agree that seeing her more often to keep closer watch on your BP (if necessary) would be less stressful for you, yet effective in monitoring you (in a less painful and invasive way).

 

[wobblykate]

sdmoose - thanks for all the good info. The BP monitor was only for BP. I did it once before (when I was still on bcp) and it showed my bp was fine even back then, not necessarily high even then. But I would always show up high in the doctor's office. They tried to give me a monitor for the palpitations but they gave me one where you have to push the button and record the 'episodes' and that just doesn't work for palpitations b/c they're not long enough and you can't feel them coming. I'm going to look into getting a home bp monitor and monitoring more regularly. I mentioned my episode of bp troubles on my health history, but considered it a closed chapter in my life since all the bp readings I've been getting at the mw's are so low. Last time the nurse said 'wow, great bp reading!"

: Maybe I'll worry more about it now and start taking it on my own and mention it if it gets worse. I believe the cardiologist is going to copy my mws on her observations, hopefully they don't worry too much about it. I would be crushed if this led to me risking-out. I'll certainly give my 2 cents. Definitely keep in touch. I hope things stay low for you!

momma2be_k - I have to admit I was a little shocked at the "0-60" response I got, myself. I mean, I had all the testing done in Feb. and there was no problem. This was a 6 month follow-up exam and I didn't expect any troubles, especially with my readings at the mw office. The midwives have expressed zero concern for me with anything. I really have had a charmed pregnancy. I'm one of their 'boring' clients. No m/s, no serious complaints, no sugar or protein issues and proper weight gain...??? I have NO symptoms of pre-eclampsia. No swelling, no protein in my urine, no rapid weight gain (I'm up 12 lbs total at almost 6 mos...seems right on to me), none of the other classic symptoms....except one high reading in the cardilogist's office. ???

:

As for you seeming anti-doctor---I might feel that way just a little bit if I was you

. You've had a crazy couple of weeks. And doctors with the best intentions do say alarmist things (maybe on purpose, maybe because they aren't using their best bedside manner) that can influence our decisions. Doctors are only human.