Let's get physical -- 07/25/06

So... to pick up where I left off yesterday, a couple of weeks ago I went to my doctor for a physical... and, to make up for yesterday's cliff-hanger closing (sorry, I just couldn't resist) let me just say up front that I'm in good shape except for some high blood pressure.

I've had some blood pressure problems on and off for a few years now... not actual hypertension, more what they call "borderline hypertension." That is, I would sometimes have systollic readings in the 140s. This seems to be due to two influences. One is "white coat syndrome" -- i.e., sometimes I get higher readings in a doctor's office or a blood donation center than in a more neutral environment -- for example, I have never had a high reading in my eye doctor's office nor in a dental office (when there for a routine cleaning -- something like root canal work is a different story). The other contributing factor seems to be a combination of age (average blood pressure seems to increase with age) and weight. I can't do anything about reducing my age (despite my best efforts, every year my birthday finds me a year older than I was the year before) but I have found that knocking off even just a few pounds can make a difference. Still, having systollic numbers in the 120 range and diastollic in the seventies or low eighties is considered to be much better than, say, 146/88.

Anyway, she sent me off for a bunch of blood tests (well, one big blood sample that they then use for lots of different tests) and for one of those treadmill exercise stress test echocardiograms. Yesterday I got to visit with my doctor and she went over the test results with me.

There were lots of numbers flying around, most of which meant nothing to me, but made my doctor happy. The only thing out of the "reference range" was my eosinophils count (yeah, I didn't know what it was either) which has to do with the count of certain type of white blood cells that can indicate allergy-related asthma but my count was only slightly out of the no problem range and, since I have no asthma symptoms but do suffer from "hay fever" type pollen allergies, it probably simply indicates that I was having a very mild reaction to various kinds of pollen in the air.

My cholesterol numbers were all okay. Cholesterol 188 (which she noted was not bad at all for a non-vegetarian male my age who was not taking any cholesterol meds). Triglycerides 84, HDL 60, LDL 111. That indicates a relative risk factor of 0.4 where average equals 1.0. The other numbers were similarly good news (like a PSA of 0.7).

Then came the results of the treadmill test. I assume you know the concept of age-based maximum (or "predicted" heart rage) -- 220 minus age = max heart rate and you should set your normal fitness exercise efforts so that you don't exceed 85 percent of your age-based max rate. My baseline heart rate before starting the test was 64 beats per minute (which is good) and my baseline blood pressure was 134/78. They fasten a whole bunch of sensors on you (including blood pressure) and then have you start walking on a treadmill while they keep tabs on your progress on a computer monitor. Every two or three minutes they increase the speed and steepness of the treadmill. It never got too fast for me -- in fact I only had to start jogging for the last couple of settings, but the steepness was much higher than I have ever done on a treadmill.

My pulse hit 146 -- which was 93 percent of max (220 minus 63 = 157) -- and I had no doubts that I could have managed going to 100 percent (or even a bit more) of the computed maximum. However, my blood pressure was high. Very high.

How high? 216/92.

Hmmm, that is a bit high.

Oh, okay, okay, so it's very high.

So she is musing out loud about putting me on some kind of blood pressure medication or referring me to a cardiologist for a consultation... and seeing my somewhat less than joyous reaction to this line of thought, she assured me that lots of young athletes have exercise-induced hypertension. "Lots?" I asked. Okay, she replied, "Some." I told her that I rarely exercise at that intensity -- if for no other reason than that I am rarely in what I consider good enough shape to make it worthwhile to push that hard -- but I also had to admit that I really liked going to a track once in a while and doing a series of high speed laps (alternating speed laps with walking/recovery laps) and that, although I've only done that once this year, if I could get to the point where I was being really consistent about my regular workouts, I would like to do intense track work maybe three or four times a month.

I now have an appointment with a cardiologist at the end of next week. My doctor made me promise her that I would not do any high intensity high speed workouts until I have seen the cardiologist.

I had planned on going for a run after work but decided to take a bike ride instead... so I did about ten miles on my bike and checked my blood pressure when I came home. There was a short delay after returning home from my ride -- open garage, park bike, close garage, come inside, Nancy asks if I checked the mailbox, go out and jog to the mailbox, grab mail, jog back to front door (it's only about sixty feet or so from door to mailbox but I wanted to keep my heart rate up), gave Nancy the mail, lay down on the floor in my office, put blood pressure cuff on my arm and started the machine. 143/78 with pulse of 71. (Hmm, maybe I had already cooled calmed down too much). Wait a couple of minutes and check it again. 130/78 with pulse of 70.

If I go for a run after work today I will not push to see how fast I can go... and when I get home I will check my pulse and blood pressure.

Back during the spring I was considering getting a heart monitor to I could get a read-out of my pulse while I was working out... I figured that would be a good way to be certain that my workout efforts kept in the most effective and efficient zone for training. So maybe I really should get one of those gadgets to keep my heart rate in the most efficient zone and then check my blood pressure as soon as I finish running.

On the bright side, my METS score (metabolic equivalent) was 15.1 which pleased me (and my doctor) and on the Stress Echocardiogram report, the section for Exercise capacity said "excellent."

Stress Echo Results
During stress echo imaging, all myocardial segments demonstrated an
appropriate increase in wall thickening and motion.

Normal left ventricular systolic function.
Normal stress echocardiogram without any evidence for ischemia or infarct.
Hypertensive response to exercise.
Trace MR.

So, a good report except for the blood pressure.

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