Blood Pressure/Medical (longish)

Tina writes:

Readers of the group should know hypertension is commonly defined as
a blood pressure in excess of 140/90.

Well, no. The threshold has been regularly lowered. Now some people are
saying that anything above "normal," which seems to be defined as 120/80, is
hypertension.

The FAA disqualifies those with blood pressures in excess of 155 over
something.

A threshold BP of 155/95 is the FAA's suggestion.

So the universe of those disqualified by the FAA is smaller than the
universe of those who have hypertension.

Not really. If the examiner determines that the applicant is hypertensive,
he's disqualified. The examiner has a certain latitude in this determination,
so one cannot say that a person with a BP of 140/95 (which makes him
hypertensive according to some) will not be disqualified.

Sorry about the delay, Jay. Just noticed your reply now.

On Sep 27, 8:40 am, Jay Honeck wrote:
Anyway, congrats on getting the medical. But you may be surprised at how well
the meditation could work at getting off the meds.

Indeed. I discovered Benson's book, "The Relaxation Response," about
20 years ago and it works.

Care to expand on that, Jon? How's it work?

Ok, you asked for it


I'm not a doctor, so I can't give you the details but more of just a
subjective take on it based on my own experiences. Benson has decades
of research, so it's not like he's selling some the latest brand of
snake oil that's going to magically transform you. The site has some
good info, if you're looking for charts based on experiments.

Sounds trite, but there's just more stuff to deal with now then there
was growing up in the 60's. For me, it's basically about, big
surprise, relaxing It's tough, what with having to run around to
get things done, attempting to set records for sleep deprivation to
recover lost schedule on n projects at work , dealing with the
mircosecond pace of life, traveling around the world, trying to avoid
the high cholesterol diet that existing in Coach tends to bring Of
course, no one on here has ever BTDT, right?

Again, not scientific, but when the body isn't feeling 'right', it
affects the mind. It can manifest itself but one getting irritable
over little things. being confrontational, defensive, etc. And then
sometimes this whole feedback loop thing starts executing and just
exacerbates everything. Snap decisions without thinking things
through. I'm sure we all know how that goes.

I had an uncle, whose motto for dealing with things, was "F*ck It"
Yeah, it was kinda cute and I could see where he was coming from to
some extent. And if he felt it worked for him, far be it from me to
try and prove him wrong by obsessing on Google, textbooks, etc.

Then again, he went about 10 years ago at only 52. A fair amount of
abuse, diabetes, kidney failure, coma. I found him on the bed one
morning, completely unresponsive with eyes wide open yet starting off
into space. His body temp was ice. Rushed him off to the hospital and
they were able to get him back. but the body just had nothing left and
it was only about a year after that.

Sad, but I'll tell ya, there's no textbook or research that drives
home the point like experiencing it first hand. It really caused a re-
awakening inside that "hey, there are no guarantees in life, but I
ain't going down like this if I don't have to!' And I decided it was
time to get back into repairing the whole.

I had already cut way down on the drinking years ago. Still a social
drinker but no where near the crazy college days of unlimited
quantities. More recently, I've cut out a lot of the daily junk/fast
food diet habits, virtually eliminated adding salt to food (other than
when cooking calls for it), manage to walk a bit each day to catch the
bus/train. And just generally to slow the whole thing down.... "don't
sweat the small stuff; it's all small stuff" yadda yadda....

You can't eliminate, or at least I can't, all of the stressors that
life seems to take this sick pleasure at ensuring will come at you.
You wouldn't be human if you didn't feel anything or tried to pretend
that emotions aren't part of who you are. But I found the technique
provides a way of minimizing the impact over the long haul and it's
maybe, what ~15 minutes out of the day? My opinion is, if you can't
find 15 minutes somewhere, you're waaaay to freakin' busy and it's
time for a reassessment

They claim that 15 minutes of it is equivalent to hours of sleep. I
can't say for sure, but I do find that I feel better afterwards and am
able to approach the working set of problems for the day, with a
better overall attitude that helps me to just get stuff done.

Can't prove that it's going to get me past 52, but I'll let you know
in 6 years

That's about all I got

--
Jay Honeck
Iowa City, IA
Pathfinder N56993www.AlexisParkInn.com
"Your Aviation Destination"

Regards,
Jon

On Tue, 25 Sep 2007 19:59:05 -0400, Wizard of Draws
wrote in
:

But the BP was enough to have him start me on 5 mg Lisinopril
and 25 mg Hydrochlorothiazide daily.

Another point I find lacking in this discussion of the treatment of
high blood pressure with diuretic drugs is the failure to mention the
necessity to supplement dietary potassium to compensate for that
flushed out through increased urination.

Has you doctor mentioned potassium? Are you aware that you may
require supplementing it while on your course of diuretic medication
(Hydrochlorothiazide)?

I took the liberty of doing some fundamental research:


http://en.wikipedia.org/wiki/Lisinopril
Lisinopril (lye-SIN-o-pril) is a drug of the angiotensin
converting enzyme (ACE) inhibitor class that is primarily used in
treatment of hypertension or high blood pressure, congestive heart
failure, heart attacks and also in preventing renal and retinal
complications of diabetes.

Historically, lisinopril was the third ACE inhibitor, after
captopril and enalapril, and was introduced into therapy in the
early 1990s.[1] Lisinopril has a number of properties that
distinguish it from other ACE inhibitors: it is hydrophilic, has
long half life and tissue penetration and is not metabolized by
the liver.

Pharmacology
Lisinopril is the lysine-analog of enalapril. Unlike other ACE
inhibitors, lisinopril is not a prodrug and is excreted unchanged
in the urine. In cases of overdosage, it can be removed from
circulation by dialysis.

Clinical use
Its indications, contraindications and side effects are as those
for all ACE inhibitors. Its long half-life allows for once a day
dosing which aids patient compliance. The usual daily dose in all
indications ranges from 2.5mg in sensitive patients to 40mg. Some
patients have been treated with 80mg daily and have tolerated this
high dose well. Lower dosages must be used in patients with higher
grade renal impairment (glomerular filtration rate (GFR) lower
than 30ml/min). Lisinopril has an iGuard risk rating of Blue[2]
(general risk).
----------------------------------------------


http://en.wikipedia.org/wiki/Hydrochlorothiazide
Hydrochlorothiazide, sometimes abbreviated HCT, HCTZ, or HZT is a
popular diuretic drug that acts by inhibiting the kidney's ability
to retain water. This reduces the volume of the blood, decreasing
blood return to the heart and thus cardiac output and, by other
mechanisms, is believed to lower peripheral vascular resistance.
Hydrochlorothiazide is sold both as a generic drug and under a
large number of brand names, including: Apo-Hydro, Aquazide H,
Dichlotride, Hydrodiuril, HydroSaluric, Microzide, Oretic.

Activity
Hydrochlorothiazide belongs to the thiazide class of diuretics,
acting on the kidney to reduce sodium (Na) reabsorption in the
distal convoluted tubule. This reduces the osmotic pressure in the
kidney, causing less water to be reabsorbed by the collecting
ducts. This leads to increased urinary output.

Indications
HCT is often used in the treatment of hypertension, congestive
heart failure, symptomatic edema and the prevention of kidney
stones. It is effective for nephrogenic diabetes insipidus
(paradoxical effect, which decreases urine formation) and is also
sometimes used for hypercalciuria.

Hypokalemia, an occasional side-effect, can be usually prevented
by potassium supplements or combining hydrochlorothiazide with a
potassium-sparing diuretic.

Side effects:
Hypokalemia
Hypomagnesemia
Hyperuricemia and gout
High blood sugar
High cholesterol
Headache
Impotence
Nausea/Vomiting
--------------------------------------


http://en.wikipedia.org/wiki/Hypokalemia
Hypokalemia is a potentially fatal condition in which the body
fails to retain sufficient potassium to maintain health. The
condition is also known as potassium deficiency. The prefix hypo-
means low (contrast with hyper-, meaning high). The middle kal
refers to kalium, which is Neo-Latin for potassium. The end
portion of the word, -emia, means "in the blood" (note, however,
that hypokalemia is usually indicative of a systemic potassium
deficit).

Signs and symptoms
There may be no symptoms at all, but severe hypokalemia may cause:

Muscle weakness and myalgia
Increased risk of hyponatremia with resultant confusion and
seizures
Disturbed heart rhythm (ranging from ectopy to arrhythmias)
Serious arrhythmias
EKG changes associated with hypokalemia

Flattened (notched) T waves
U waves
ST depression
Prolonged QT interval

Causes
Hypokalemia can result from one or more of the following medical
conditions:

Perhaps the most obvious cause is insufficient consumption of
potassium (that is, a low-potassium diet). However, without
excessive potassium loss from the body, this is a rare cause of
hypokalemia.

A more common cause is excessive loss of potassium, often
associated with excess water loss, which "flushes" potassium out
of the body. Typically, this is a consequence of vomiting,
diarrhea, or excessive perspiration.

Certain medications can accelerate the removal of potassium from
the body; including thiazide diuretics, such as
hydrochlorothiazide; loop diuretics, such as furosemide; as well
as various laxatives. The antifungal amphotericin B has also been
associated with hypokalemia.

A special case of potassium loss occurs with diabetic
ketoacidosis. In addition to urinary losses from polyuria and
volume contraction, there is also obligate loss of potassium from
kidney tubules as a cationic partner to the negatively charged
ketone, ß-hydroxybutyrate.

Hypomagnesemia can cause hypokalemia. Magnesium is required for
adequate processing of potassium. This may become evident when
hypokalemia persists despite potassium supplementation. Other
electrolyte abnormalities may also be present.

Disease states that lead to abnormally high aldosterone levels can
cause hypertension and excessive urinary losses of potassium.
These include renal artery stenosis and tumors (generally
non-malignant) of the adrenal glands. Hypertension and hypokalemia
can also be seen with a deficiency of the 11ß-hydroxylase enzyme
which allows cortisols to stimulate aldosterone receptors. This
deficiency can either be congenital or caused by consumption of
glycyrrhizin, which is contained in extract of licorice, sometimes
found in Herbal supplements, candies and chewing tobacco.

Rare hereditary defects of renal salt transporters, such as
Bartter syndrome or Gitelman syndrome can cause hypokalemia, in a
manner similar to that of diuretics.

Rare hereditary defects of muscular ion channels and transporters
that cause hypokalemic periodic paralysis can precipitate
occasional attacks of severe hypokalemia and muscle weakness.
These defects cause a heightened sensitivity to catechols and/or
insulin and/or thyroid hormone that lead to sudden influx of
potassium from the extracellular fluid into the muscle cells.

Pathophysiology
Potassium is essential for many body functions, including muscle
and nerve activity. Potassium is the principal intracellular
cation, with a concentration of about 145 mEq/L, as compared with
a normal value of 3.5 - 5.0 mEq/L in extracellular fluid,
including blood. More than 98% of the body's potassium is
intracellular; measuring it from a blood sample is relatively
insensitive, with small fluctuations in the blood corresponding to
very large changes in the total bodily reservoir of potassium.

The electrochemical gradient of potassium between intracellular
and extracellular space is essential for nerve function; in
particular, potassium is needed to repolarize the cell membrane to
a resting state after an action potential has passed. Decreased
potassium levels in the extracellular space will cause
hyperpolarization of the resting membrane potential. This
hyperpolarization is caused by the effect of the altered potassium
gradient on resting membrane potential as defined by the Goldman
equation. As a result, a greater than normal stimulus is required
for depolarization of the membrane in order to initiate an action
potential.

Pathophysiology of Hypokalemic Heart Arrythmias
Potassium is essential to the normal muscular function, in both
voluntary (i.e skeletal muscle, e.g. the arms and hands) and
involuntary muscle (i.e. smooth muscle in the intestines or
cardiac muscle in the heart). Severe abnormalities in potassium
levels can seriously disrupt cardiac function, even to the point
of causing cardiac arrest and death. As explained above,
hypokalemia makes the resting potential of potassium [E(K)] more
negative. In certain conditions, this will make cells less
excitable. However, in the heart, it causes myocytes to become
hyperexcitable. This is due to two independent effects that may
lead to aberrant cardiac conduction and subsequent arrhythmia: 1)
there are more inactivated sodium (Na) channels available to fire,
and 2) the overall potassium permeability of the ventricle is
reduced (perhaps by the loss of a direct effect of extracellular
potassium on some of the potassium channels), which can delay
ventricular repolarization.

Treatment
The most important step in severe hypokalemia is removing the
cause, such as treating diarrhea or stopping offending medication.

Mild hypokalemia (3.0 mEq/L) may be treated with oral potassium
chloride supplements (Sando-K®, Slow-K®). As this is often part of
a poor nutritional intake, potassium-containing foods may be
recommended, such as tomatoes, oranges or bananas. Both dietary
and pharmaceutical supplements are used for people taking diuretic
medications (see Causes, above).

Severe hypokalemia (3.0 mEq/L) may require intravenous
supplementation. Typically, saline is used, with 20-40 mEq KCl per
liter over 3-4 hours. Giving intravenous potassium at faster rates
may predispose to ventricular tachycardias and requires intensive
monitoring.

Difficult or resistant cases of hypokalemia may be amenable to
amiloride, a potassium-sparing diuretic, or spironolactone.

When replacing potassium intravenously, infusion via central line
is encouraged to avoid the frequent occurrence of a burning
sensation at the site of a peripheral iv, or the rare occurrence
of damage to the vein. When peripheral infusions are necessary,
the burning can be reduced by diluting the potassium in larger
amounts of IV fluid, or mixing 3 ml of 1% lidocaine to each 10 meq
of kcl per 50 ml of IV fluid. The practice of adding lidocaine,
however, raises the likelihood of serious medical errors [1].
-----------------------------------------

Jon wrote:
[snip long-but-important story about relaxing]
Thanks for posting that Jon. It's something we all know but need to be
reminded of every so often with stories like yours. Relaxing has become
more, rather than less, difficult with age. I thought it's supposed to
be the other way around! Society so programs us that EVERYTHING has to
move fast-fast-fast in order to be worth anything. God forbid anyone
should have to WAIT for a cup of coffee or stand in line more than 30
seconds to pay for something -- immediately people get impatient and
stressed out. WAY too much emphasis on going *faster* ... no one takes
time to see, experience or savor things like we did in "the old days"
(you know, about 20 years ago!). Grrr.

Mxsmanic wrote in
:

Tina writes:

Readers of the group should know hypertension is commonly defined as
a blood pressure in excess of 140/90.

Well, no. The threshold has been regularly lowered. Now some people
are saying that anything above "normal," which seems to be defined as
120/80, is hypertension.


Awww wassamatta, widda fat boi can't get a medical?
Believe me, even if you looked like Johnny Weismuller you wouldn't get a
medical.




Bertie

Bertie the Bunyip writes:

Believe me, even if you looked like Johnny Weismuller you wouldn't get a
medical.

I don't recall saying anything about me. I only pilot simulated aircraft, so
I don't need a medical.

Larry Dighera writes:

Another point I find lacking in this discussion of the treatment of
high blood pressure with diuretic drugs is the failure to mention the
necessity to supplement dietary potassium to compensate for that
flushed out through increased urination.

While that may be relevant with the diuretics under discussion here, it should
be noted that diuresis is not synonymous with potassium loss. The opposite is
possible as well.

Mxsmanic wrote in
:

Bertie the Bunyip writes:

Believe me, even if you looked like Johnny Weismuller you wouldn't
get a medical.

I don't recall saying anything about me. I only pilot simulated
aircraft, so I don't need a medical.

You don't pilot anything and you would never get a medical.


Bertie

Mxsmanic wrote in
:

Larry Dighera writes:

Another point I find lacking in this discussion of the treatment of
high blood pressure with diuretic drugs is the failure to mention the
necessity to supplement dietary potassium to compensate for that
flushed out through increased urination.

While that may be relevant with the diuretics under discussion here,
it should be noted that diuresis is not synonymous with potassium
loss. The opposite is possible as well.


Boggle.

Bertie

On Sep 25, 6:59 pm, Wizard of Draws
wrote:
June 2007. I failed my 3rd class medical exam and was grounded. I am 50
years old, 5'9", 158 lbs. No family history of hypertension. But due to a
number of current stress factors in my life, mother in law and father in law
both passing away recently and suddenly, the work of disposing of the
estate, a promotion at work entailing additional duties and
responsibilities,

Email me if you want to see where I posted my high BP experiences and
bi-annual med review and it's been a doozy.

Fortunately, I had and AME that referred me to a cardio guy that
treated my high BP AGGRESSIVELY (220/170)

Yes you read correctly.

I have posted my experiences elsewhere in another aviation related
forum and got some very good sound advice and opinions.

I much rather not feed the troll(s) new waters to pollute so if I
dont' recognize your name, I will not respond..

Allen
Cloud dancing to be found at http://www.youtube.com/profile?user=BeechSundowner