Good morning Gentlemen

[Scott Tschirhart]

I apologize for any concerns folks may have had since my disappearance from the Forum for a little while.

Nothing happened and I did not leave mad, I just got wrapped up in work to the extent that all extraneous things had to be put aside for a bit.

Yesterday I woke up and my blood pressure was off the charts......I needed to take a day off at least. Of course, that really isn't possible.

So, hopefully I can rejoin the conversation at the fire and calm things down a bit as we prepare for Christmas.

Thank you for your understanding.

[Bill in Oregon]

Scott, I hope you have access to the meds that can bring that BP down. I've been on them for years.
And welcome back!

[Scott Tschirhart]

I'm taking meds Brother. Been on them for years as well and for the most part they work.

I got stirred up at the end of the year meeting and I suppose I let it get the best of me. I woke up with a splitting headache and blood pressure at 182/123.

[AJMD429]

.
Blood pressure is usually really easy to fix, but important.
Typically for most situations and body builds, we set a bedtime goal of 120/80 or less at a heart rate well under 80. That is the equivalent of making sure your engine's RPM at idle is low enough to reduce wear and tear.
Daytimes it naturally rises, and arbitrarily I usually say 140/90 is "ok" during a stressful work-day or whatever, as long as it comes down nicely post-stress. This is the equivalent of seeing your engine RPM's during an uphill drive or passing. Of course reducing the stress is like driving less hilly roads - if possible, less wear and tear, but not always possible.
There are indicators in the blood and other testing that can tell us if there are other factors needing addressed.

Although BP is important to TREAT, also think of it as a SYMPTOM, so in addition to just treating it, we should look for the underlying CAUSE. Something is inflaming the plumbing somewhere, or increasing the autonomic tone, or affecting the endocrine environment, or all three. 'Stress' hits us and all those systems are designed to protect us from that, but sometimes it slips through and gets us out of whack.

The best labs include not just the 'complete metabolic panel' but ALSO include (ideal values depend on lab methods)
> fasting insulin (NOT just glucose) which should be under 10
> LDL-P (NMR lipids - NOT just the LDL-C) - should be under 1,000 but under 1,200 'ok'
> essential fatty acid profile (get your omega-3's in the top 20%'ile but it takes rather high supplement doses)
> Trig/HDL ratio should be under 2:1 - if over 4:1 something isn't right (usually insulin or sex hormones)
> Homocysteine - should be under 8 (better yet get the MTHFR gene tested for both 677 and 1298 SNP's)
> total estrogens (estrone most important maybe, but for sure estradiol, and 'total' estrogens best) - < 80 best
> free (or 'unbound') testosterone - note the 'reference range' has NOTHING to do with the 'ideal' range (the former is a statistic reflecting the bell-curve of the tested population, and cuts off the highest 2.5% and lowest 2.5%, but if 10% of the patients you test have the problem, you'll fail to treat 3 who need treatment for every 1 you wind up treating) - the reference range our lab uses for free Testosterone is 42-210, and I don't think under 120 is usually a good place to be, so with symptoms (fatigue, sluggish problem-solving, low motivation, decreased muscle strength, and yes, decreased libido - but the others are really more common and important) I'd nearly always treat a level under 120, or even 150.
> a FULL thyroid panel - not just TSH, but free T3, reverse T3, free T4, and even the TPO and TgAb are sometimes off - we were taught that only teenage girls get thyroiditis, but I see it all the time in middle-aged men - so I guess the reason "we don't see thyroiditis in middle age males" is perhaps just because we don't LOOK for it, and we don't look for it because we don't think they get it.
> symptomatic fatigued people who don't have the simple things we usually find (too sedentary, too many carbs, too little sleep) sometimes have adrenal insufficiency, and the only reliable test in MY opinion for that is the "DUTCH Complete" that looks at urinary and salivary cortisol levels. Many other tests are out there, but they are in my opinion either not reliable, or designed more to make the doctor a profit for vending the test, as opposed to determining useful medical data.

The best imaging to look for plaque is a 'Carotid Intimal Thickness Test' by ultrasound, as it quantitates very early inflammatory changes, versus looking just for thick obstructing plaque. Hard to find but detects stuff way earlier than the 'screening ultrasounds' typically done, or the 'coronary calcium scores' which require not only thick plaque, but it has to be calcified. By that time the horse is out of the barn, and although Tx still can help, and ironically, the calcified plaque is typically hard and stable - not normal, but less prone to shattering and triggering emboli that cause sudden death or stroke.

The best performance testing is a 'cardiopulmonary exercise test' or 'CPET', that was trademarked 'Met-Test' when the athletes figured it out and started doing it. Then it got 'medicalized' and generic. The test is unique because again, it detects EARLY disease. A guy going to have a MI at age 60 might have a normal nuclear treadmill ($5,000 test) or stress-echo (also expensive), and a normal heart cath, all the way up to age 58 or so - and in some cases the day before the infarct, but his/her CPET (women get more heart disease than men, just not as early in life) would be abnormal in 95% of cases by age 50 and probably 80% of those people would have an abnormal at age 40 - 20 years before the poop hits the fan. It is also precise enough that instead of 'ok' 'mildly bad' and 'really bad' like with the nuclear treadmills, you get a huge amount of quantitative numeric and graphic data that can respond to changes you make in diet, meds, activity, and so on. I had a lady who was only 41 and thin and fit and no 'risk factors' but had had a MI already. Her CPET was abnormal but her 'nuclear' was fine. We cranked her up on fish oil, avocado oil, olive oil, and walnut oil, fixed her methylation issue with MethylGuard Plus, and six months later there was a marked difference in her CPET for the better, plus she felt better (I'd also added a bedtime progesterone dose to help sleep and reduce breast cancer risk, so that could have helped too). None of that would have shown up on 'conventional' lab work or stress testing, but it helped guide treatment.

Anyway, lots of thoughts your 'high blood pressure' comment brought to mind.

Partly cuz I'm at the office on my 'day off' now, been on hold 52 minutes with a $#*@&^#$ insurance company just to get someone her diabetes medication they decided not to cover, and I'm experimenting with the voice-dictating feature on my computer. So pardon the verbosity....!

[GunnyMack]

Deep breath in through the nose, hold and out through the mouth, repeat 4 or 5 times.

And what Doc said!

[Griff]

I worked for a woman boss for a couple of years... and she would always come out of her office around 4ish and gather us worker bees together and ask what troubled us during the day. After the usual mini-gripe session, she'd always say, ...it's ok, it's after 4 pm, and we're allowed to be "small-minded", so tell me who really upset you off today." Even if she couldn't do anything about the other folks, just being listened to helped! Rail away Scott, I can't do anything, but, am able to listen. Stay warm Brother, it's 'bout to get chilly!

[Ysabel Kid]

Welcome back Scott! Watch that BP, it's no joke. Spend more time here... it always lowers my BP!

[OldWin]

Glad you're ok.
Be careful with stress. Some can't be helped, and I don't pretend to know what goes on in your life, but much can be let go of. I've dumped most all of mine. My goal is to stay OFF pills.
Take care of yourself sir.

[stretch]

Although BP is important to TREAT, also think of it as a SYMPTOM.....

YES!!!

As well as diabetes, various aches and pains, etc.
Would that there were more doctors like you.

I commented to my PA during a visit that I had some somewhat severe knee pain while walking.
"Well, you're getting older..." (REALLY?!?)

So, getting nowhere there, I started playing around with some stretches and discovered
that my groin was really, really, tight. Once I got that loosened up, no more trouble.

Pain is nature's way of telling you that something is wrong. So is diabetes and high BP.

-Stretch

[.45colt]

I sure hope You can get thing sorted out Scott. living in Texas can You get out and walk ? I'm in a pressure cooker being semi-retired and I get out to the local park and walk a couple miles if the weather isn't too bad here. even the local wall-mart early in the morning for a few laps around helps out. it's only a Job... make time for YOU TO HAVE FUN AND Peace of of Mind. Merry Christmas.

[Scott Tschirhart]

I sure hope You can get thing sorted out Scott. living in Texas can You get out and walk ? I'm in a pressure cooker being semi-retired and I get out to the local park and walk a couple miles if the weather isn't too bad here. even the local wall-mart early in the morning for a few laps around helps out. it's only a Job... make time for YOU TO HAVE FUN AND Peace of of Mind. Merry Christmas.

Great advice and Merry Christmas my friend.

It used to just be a job, but now I am an owner and that opened up a whole lot of new and interesting issues.

I'm blessed and I drive myself harder than any boss could.

[samsi]

Glad to see you back Scott. I was about to ask what had become of you around the time that JimT posted about having visited.

Also, thanks to the Doc for the informative post, since I'm going through something similar myself.

[AJMD429]

.
Here's another interesting and updated commentary on "cholesterol" that is worth listening to - MUCH of the stuff being looked at in the 'mainstream' clinics (including the 'lipid clinics' run by most hospital cardiology departments) is rather obsolete (and that's pretty bad, considering this update is already three years old... ).

https://peterattiamd.com/tomdayspring6/

The comments in about 30 min or so on this podcast on 'statins' are pretty good - https://peterattiamd.com/tomdayspring4/