Regarding white coat hypertension, the shot isn’t always necessary. Some people’s blood pressure just goes up from the stress of the clinical setting.
replies(14):
At least you have more than 24 hours to find out!
I have high blood pressure, managed with a low dose of medication. I've had plenty of advice from my PCP and other actual doctors on how to take blood pressure - how to sit, how long to sit still, how to position your arm, etc.
It is remarkable how many medically-adjacent professionals are bad at this. My dentist starts my sessions with a blood pressure reading - theoretically in case they have to numb me or something, probably because it's billable or whatever. What always seems to happen is that I get in for my appointment (driving, which can be stressful even if I'm not running late), they take me to the chair within 2 minutes max, immediately put some sort of wrist cuff on me, hold my arm at an angle that is not what most actual doctors have recommended to me and take a reading that is often high enough to surprise both the hygenist and myself.
The thing is that I have two sufficiently-calibrated Omron units, one at home and one at the office. I take my blood pressure often enough to know what it usually is (and my real doctor takes it at least twice a year). That is to say that no, it's not 200/160 or whatever nonsense the dentist thinks it is and you'd think that with a very small amount of reading they'd know better.
It also never helps to explain that this has happened many times before and that I have a reasonably high quality BP measurement device at home (most recently the exact same Braun model) that gives me decent measurements when I'm at rest/relaxed. They just look at me like I'm an idiot. How could a civilian conceivably perform such a complex measurement?
Then I get the predictably insanely high measurement and they look satisfied. Gotcha!
Please bring on the AI doctors.
Just spent half a day reverse engineering a Windows virtual printer driver (for work) and had to force myself to stop spending the rest of the day doing it.
They all give me different numbers, by a lot sometimes
btw you think they ever clean those devices?
you think healthy people go to pharmacies?
I won't even touch the signature pen, imagine what's on that
This often isn't possible, but it's a reason doctor visits usually drop you in a room by yourself with a machine that will take multiple measurements with a lengthy delay between. Though that's where the white coat thing comes into play and people are stressed about a doctor coming in, etc.
They wanted me to start on all sorts of medications immediately.
The second-last time, they got a reading of 220/130, and were going to get an ambulance to take me into hospital immediately.
Er, hang on a minute, folks.
That's beyond "hypertension crisis" and well into "incompatible with life" levels. That's the kind of pressure I see in hydraulic servo feedback channels, not living things.
They grudgingly agreed that someone with high blood pressure probably ought not to be making as much sense as I was, although what would I know about it, they're the professionals, etc etc.
The next time I noticed the automatic blood pressure cuff had a fresh new calibration sticker on it.
130/90. Not bad, for a reading taken at the doctor's surgery.
I wonder how many people are on medication they just plain don't need because of a plainly faulty sphyg though?
I have to take daily BP measurements during titration for ADHD medication. (Using an _A&D UA-611 Plus_ machine at home.)
I can put the cuff on my arm and sit at my desk for 20 minutes to be nicely rested and calm, and then take 5 different measurements with a few minutes between each one. They'll vary quite wildly (anything from, say, 115/75 to 135/90) despite not moving between measurements or having any reason to be more or less agitated. I generally just ignore the low/high outliers and average the others. There's no pattern either, sometimes the outliers are first, sometimes last.
Also it's not just the monitor I have at home, the same is true of a probably more trustworthy machine in a clinical setting. I mentioned this to my doctor when I last visited and we saw the same thing with multiple measurements using a more sophisticated machine at the clinic.
* the position of both of your arms, and the angle your elbows are bent at matters. make sure the edge of your desk isn't pushing into your forearm.
* same goes for both of your legs. make sure you're sitting with legs uncrossed, relaxed angles, make sure the edge of your chair isn't pushing into the back of your thighs excessively.
* control your posture. slouching seems to have an effect too, but I'm unclear on the mechanism.
Anecdotally, the nurses at the doctor's offices I go to rarely (~never) bother to control for any of this other than telling me not to cross my legs. So while I fully believe white coat hypertension is a thing, I also think there's a lot of poor control of variables here. If you look up the AMA/AHA guidelines for blood pressure, the ranges they offer are predicated on some very prescriptive protocols for measurement.. which I virtually never see adhered to.
"stupid in ways that made me think" is (IMO) a really good summary of how AI is useful, as well as its pitfalls.
I was at the Dr last week and my first BP reading was 154/95, a second reading a few minutes later was 141/89. The doctor asked for one more reading before I left.
The medical assistant gave me my vaccines and then took my BP, 130/81 right after a Hep B and COVID vaccine. I told the tech that needles didn’t bother me at all, she believed me after she saw my blood pressure :)
[0] https://www.garmin.com/en-US/p/716808/ [1] https://www.withings.com/us/en/bpm-connect
Maybe? Do they clean the shelves? Arm-to-arm contact isn't exactly a big threat.
> you think healthy people go to pharmacies?
Yes. Of course. Those free blood pressure machines are generally found in drug stores that have a small pharmacy section. The vast majority of people there are there because they're shopping. There are probably more people who come in to buy mascara than people who come in because they're sick. If you're sick, someone else goes to the pharmacy for you.
https://www.nordicsemi.com/Products/Development-tools/nRF-Co...
It really amazes me how people whose job it is to take blood pressure don’t recognize the stress situations that people are in might result in abnormal readings.
Doesn't it take more than a few minutes for one's circulation to return to normal after a BP measurement?
These have been around since I last used WINE in anger on macOS. Basically think of it as a container for running an app in WINE with all the settings predefined for best compatibility. The homepage doesn’t really highlight this but you can look through the docs for more information.
It was kind of interesting watching my blood pressure tick down back to normal over the course of about 4 days though.
I guess the lesson is don't rip your bicep off, it will transiently elevate your BP. ;)
If you've heard of Lutris, Bottles is essentially the same thing, but aimed at general software instead of only focusing on games
It's been a long time since I used wine (or any windows software really... Yay!) but I'm sure the requirement will pop up again sooner or later.
Should I check out bottles the next time it comes up?
year: bits 0-6 reversed
month: bits 6-10 reversed
hour: bits 13-18
minute: bits 18-24
day: bits 24-29 (maybe reversed)
y mo d h mi
25 11 10 11 3
25 11 10 11 31
25 11 10 12 1
25 11 10 12 35
25 11 10 13 0
25 11 10 13 31
25 11 10 13 31
25 11 10 14 0I feel healthier after reading this.
AKA - the government might pay your eye clinic more if they screen you for high blood pressure. (Among other things).
Edit: Well, it will stop bleeding… once you lose enough blood.
It took me a minute to understand (and neither of us think this is 100% true) but it's both funny and a good point.
* those people would be considered to be in a hypertensive crisis, and sending you for emergency care would be the right thing to do, normally.
Although I think you need to be quite critical to have such a mindset, and assume you are wrong rather than right.
It’s not the cuff position as I used multiple positions, cuffs, and sensors. All 140/90. Plus I feel it.
It’s wild. My BP/HR fluctuates alot outside of clinical, but inside clinical it drops.
Walked into the ER because my Dr forced me too. After walking into and chilling for a bit. 130/70. $3000 later no answers.
So, it does happen to people.
This prompted me to do some research, and it turns out there's very strict guidelines for how to 'accurately' measure blood pressure, almost none of which were followed by most specialists. There's a laundry list of things that can each increase your blood pressure by 10-15mmHg (eg. drinking water, sitting cross legged, recent physical exercise, not sitting with the right posture, not sitting for at least 15 minutes).
Given this lackadaisical approach to measurement, I seriously question the diagnostic validity of blood pressure tests 'in the wild'.
Blood pressures at this level can be observed from time to time. It’s not an instant death level.
Getting multiple readings is a good idea, but I would caution against picking the reading you like the most as the one which you believe to be correct.
You should also know that there are some conditions where high blood pressure can be transient. Some of these are very serious (tumors which secrete hormones which spike blood pressure). Having occasional scary high readings mixed in with occasional normal readings is actually typical with some of these conditions.
If I had any measurements show up that high I would invest in a cheap at home blood pressure device. They can be as cheap as $20. Then I’d collect a lot of measurements over several days.
For example, "Bottles is a wrapper around WINE"
There's nothing groundbreaking about it, but it's a straightforward way to run apps with Wine with an intuitive and pretty interface.
(They're currently working on a 2.0 release, though that's probably gonna take a while.)
I've had a doctor measure my heart rate right after remarking on my "elevated HR during intake" (I walked there and I was running late), after telling me some slightly distressing news on what was already a very stressful day, knowing about my white coat anxiety, and right around the time of peak effects of stimulant medication which they also know about. Wouldn't you believe it, my heart rate was high (110)!
Then I got a front seat to watch their confirmation bias kick in, and have them make some really faulty assumptions based on this bad information. They were quite sure that I had developed a certain medical condition but the lab tests quickly proved them completely wrong.
It tells you right at the start:
"Easily run Windows software on Linux with Bottles!"
That's all you need to know. If Linux wants to be more mainstream it needs to drop the "Bottles is a wrapper around WINE". What's a wrapper? What's WINE? It doesn't matter. All the user need to know that you can easily run Windows software on Linux with Bottles
FWIW the latest version of the app does export the previous day's averages to Apple Health (only when you open the app, mind, which can make it look like there's missing data.) I use BPExtract to read the PDF and export every reading to Apple Health but I'll definitely be giving your stuff a go as well (because automation >> manual every time.)
After one such episode, I decided to schedule an appointment with my general practitioner. They refused to see me if I didn't go to the ER first. I was pretty certain I didn't need an ER visit, but went anyway.
I waited hours, a doctor eventually saw me in the waiting room, and was never admitted. I think it cost $2500 or so, with insurance covering only part.
(For what its worth, I probably have this: https://en.wikipedia.org/wiki/Precordial_catch_syndrome)
Huh, that's interesting. That matches something that I get sometimes, usually after I've been driving a long distance or sitting at my desk doing mouse-heavy stuff for a long time. I put it down to poor posture.
It hasn't happened quite so much since adjusting the steering to track and centre properly so I'm not constantly pulling the car left away from the middle of the road, and raising my seat a bit by unscrewing the seat from its base, putting in about 8cm worth of wooden spacers, and screwing it back down with long studs and nuts instead of the daft wee screws, so it's not sitting at its "most extended" height.
I don't know, it might help you too.
Last week, I met an experienced top swimmer who doesn't use any devices, he just listens to his own heartbeat.
Doctor ends up telling him that he was hoping it was just the attractive nurse, but no. He'd be starting medication today.
https://my.clevelandclinic.org/health/diseases/25100-hyperte...
It was apparently the lack of control and the whizzing motor. Having direct fine control over the pump is downright relaxing in comparison.
I tried feeding a lot of this into various Als (Kagi gives you access to a few with a nice interface) and I found that they mostly were stupid in ways that made me think.
Once, I had to give my spouse an injection, and I almost passed out and threw up, once when they took the cap off the syringe and accidentally poked themselves in the finger, and then when I actually had to administer the injection.
I know I'd get used to it, but there's a decent chance that if I had to give myself insulin shots, I'd just fucking die.
You put on a cuff (supplied) to calibrate it, and then you wear a little gadget on your wrist. It takes frequent measurements throughout the day and night when it senses you aren't moving. It then syncs with your phone to store the results. Its a little pricey, but seems to work well[1]. And it avoids the faff of a pressure cuff[2] and 'white coat hypertension'.
[1] Apart from the option on the app to do a reading from your finger using your phone camera - which gives wildly different results to a cuff.
[2] You need to recalibrate it every month or so using the cuff.
Blood pressure is highly variable even moment by moment. A single data point at your yearly visit is basically meaningless. Even your posture can shift it. Legs in a different position? Too much tension in one arm over the other? Seated awkward? Have gas? Unfortunately, it's also very difficult to get a 24 hour monitor unless you have another suspected condition (such as kidney problems).
> A few times I thought they had "cracked the case" but actually they just made me waste time.
Despite trying various models and services for years now, I've come to the conclusion that the current iteration of AI services hurts more than it helps. I spend more time prompting, reading pages of babble, and trying to find signal in the noise that I would just chilling out and thinking through the problem.
The technology is neat but not productive.
I worked next to another engineer in the early eighties who was working on a different project. At tea break time we got into the habit of sitting opposite each other and explaining the problems we were having. Neither of us put much, if any, effort into trying to solve the other's problems because it often turned out that simply attempting to formulate the problem in a way that would make sense to the other party was enough to reveal the answer or at least a promising idea to try.