September 16, 2015

From Blood Pressure Log to Health Journal

I started keeping blood pressure records at home years ago, even before I became concerned about the levodopa "off" period pressure spikes. Why? As it turned out, the supplement 5-HTP that I’d been taking for years was causing high upper (systolic) numbers.

5-HTP boosts serotonin, just as levodopa boosts Parkinson’s-depleted dopamine. It took me a while to recognize that the carbidopa used to enhance levodopa’s effectiveness has the same impact on 5-HTP. The result was a pressure-spiking serotonin overload.

At first when I decided to keep a log, I simply entered my pressure numbers – top number over bottom diastolic number. Recently, I’ve added explanatory notes, too – what I was doing and how I was feeling at monitoring time. The log has become a good resource for someone with a failing memory… and a kind of health journal.

The log has been helpful. Next to an entry with high pressure numbers, I may have entered “3  hours at the computer -- missed 6 pm pill.” These notes helped me confirm the connection between pill intervals and pressure readings.

Next to an entry with lower numbers, I may have written, "after 20 minutes meditating.” I learned something there, too.

Most people with Parkinson’s (PWPs) know when they’ve waited too long since the last pill: their tremors worsen. I’m in the 30 percent minority of PWPs who have no tremor. Instead, my warning signs are smaller, cramped handwriting (micrographia) and shortened walking stride. It’s easy for me to miss those symptoms, especially if I’m working on the computer or reading in my chair.

So far, I haven’t devised a foolproof method to make sure I take my pills every three hours. There's a big difference between three hours and four.

My increasing forgetfulness doesn’t help. I’ll find myself standing at the bathroom sink where my pill bottles are arrayed, wondering, "Did I just take those pills?"

Now, there’s a way for me to know for sure: I’ll take my blood pressure once, and again in about 15 minutes. If the numbers are going up, I didn’t take the pills. If the numbers are going down, I took the pills.

Each time I take my blood pressure, I wait a minute and take another… and then another after a minute or two. Multiple readings are recommended, though I’ve noticed it rarely happens in doctors’ offices.

My typical schedule for taking my evening levodopa pills is 6pm, 9pm and 12 midnight.

Here’s what I wrote in my journal last Monday night:
  • 9pm -- 171/88 – 152/85 – 134/69 -- pills
  • 9:30pm -- starting to feel my gut tightening while at the PC. I'm pretty I took pills at 9 but let's do another check. 176/96 – 170/95 – 161/93 – 159/90
  • the initial number makes me think I didn't take the pills but the next numbers make me think I took them. This handwriting [cramped] argues that I didn't take them.
  • 9:45pm -- recheck - 183/106 – 175/101 -- 173 /98 -- 184/94. OK--  pill time
  • 10:15pm -- 152/90 - 145/89 - all's well
Here's an example of "normal" pressure entries in the journal before and after yesterday’s 6pm pill time:
  • 5pm -- 138/88 – 134/70
  • 6pm -- 179/105 – 173/98
  • 8:15pm -- 148/95 – 157/92
Usually, I only take my pressure around pill times – my “off” periods, which bring the highest numbers. When I take my pressure at other times – like the 5pm above – the numbers tend to remain under 140.

Not too long ago, 150 was introduced as an accepted systolic upper limit for those over  60. Click here to see the Mayo Clinic's  guidelines. Medical authorities are still arguing about that change and a few days ago new guidelines were announced urging everybody to get under 120. Before I weigh in, I’ll let the experts duke it out on this new development.

More pressure commentary tomorrow.

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