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MAB32
04-27-2016, 13:46
I am curious to know whether the old manual cuff is more accurate than those Omron's that Docs seem to be using with more frequency?

Here is my situation.

Every time I am cuffed by one those electronic cuffs my BP goes something like this: 150/97.

Now when I get my pressure taken by the manual cuff I am around 130/80. My cardiologist uses the old method and tells me to not to worry. My PCP who uses the electronic monitor has put me on an additional medicine to get it lower.

I am active and do both jogging and rucking.

So I get flagged for high BP every time I go to my PCP. I told him this last time that I refuse to take any more heart medication to get it lower. I'm on Lisinopril 40mg for BP and for kidney protection (Type II Diabetic).


So basically what is your all opinion on this subject of which is more accurate?

PedOncoDoc
04-27-2016, 13:50
I am curious to know whether the old manual cuff is more accurate than those Omron's that Docs seem to be using with more frequency?

Here is my situation.

Every time I am cuffed by one those electronic cuffs my BP goes something like this: 150/97.

Now when I get my pressure taken by the manual cuff I am around 130/80. My cardiologist uses the old method and tells me to not to worry. My PCP who uses the electronic monitor has put me on an additional medicine to get it lower.

I am active and do both jogging and rucking.

So I get flagged for high BP every time I go to my PCP. I told him this last time that I refuse to take any more heart medication to get it lower. I'm on Lisinopril 40mg for BP and for kidney protection (Type II Diabetic).


So basically what is your all opinion on this subject of which is more accurate?

Manual blood pressures, when properly taken, are always more accurate.

Using an appropriateky-sized cuff is also important, but this is typically more an issue in pediatrics than in adult medicine.

I would trust my cardiologist and any time my primary care provider wantsa to change a medication related to my cardiovascular system I would contact my cardiologist and ask for their recommendation on how to proceed.

VVVV
04-27-2016, 14:28
Is the nurse who takes your BP at your PCP hot?:o

MAB32
04-27-2016, 14:38
WCH,

can't be that. All of the ones at my doctors are severely overweight and old. Now the Dentists office is different. Was hoping to get it checked there but alas, no cuff. Maybe if I brought my own...:o

Thanks Doc. It seems around Northeastern Ohio everybody is changing over to those electronic monitors. I hear even Cleveland Clinic has gone that route.

PedOncoDoc
04-27-2016, 15:08
WCH,

can't be that. All of the ones at my doctors are severely overweight and old. Now the Dentists office is different. Was hoping to get it checked there but alas, no cuff. Maybe if I brought my own...:o

Thanks Doc. It seems around Northeastern Ohio everybody is changing over to those electronic monitors. I hear even Cleveland Clinic has gone that route.

They're quicker for sure, but abnormal blood pressures should be rechecked manually if there is concern for spurious results.

MAB32
04-27-2016, 15:28
Doc,

that's the way he wants me to do it via my own manual BP cuff. Take it everyday for a week and then send him the numbers. It is like he doesn't believe in manual monitors anymore and wants proof.

Sdiver
04-27-2016, 16:13
The automatic BP devices were meant to be used in an environment were using a manual BP cuff and scope were difficult, at best, to use. In environments where it is noisy or difficult to hear, such as in a helo or the back of a moving ambulance with the sirens whaling, or when needing to get a generalized assessment over a short period of time, (while the medic was busy with something else attending to the Pt.) you can set the machine to take a BP at different time intervals, every 5 mins, 10 mins, etc. to watch if there is any change. It has now become a "lazy way" of taking a BP in a clinical setting and in some instances, a pre-hospital setting.

As a patient, whenever the tech, nurse, etc. begins to "hook you up" to the automatic cuff, stop them and tell them you would like it done manually, and professionally, because they are going to get bent out of shape you telling them you want it done manually. You have rights ... rights that they MUST follow.

DON'T trust that electronic feldergarb. Just like GPS' v. maps and compasses, trust the old ways, if you want solid answers.

DDD
04-27-2016, 16:56
The automatic BP devices were meant to be used in an environment were using a manual BP cuff and scope were difficult, at best, to use. In environments where it is noisy or difficult to hear, such as in a helo or the back of a moving ambulance with the sirens whaling, or when needing to get a generalized assessment over a short period of time, (while the medic was busy with something else attending to the Pt.) you can set the machine to take a BP at different time intervals, every 5 mins, 10 mins, etc. to watch if there is any change. It has now become a "lazy way" of taking a BP in a clinical setting and in some instances, a pre-hospital setting.

As a patient, whenever the tech, nurse, etc. begins to "hook you up" to the automatic cuff, stop them and tell them you would like it done manually, and professionally, because they are going to get bent out of shape you telling them you want it done manually. You have rights ... rights that they MUST follow.

DON'T trust that electronic feldergarb. Just like GPS' v. maps and compasses, trust the old ways, if you want solid answers.


I completely agree, I had a wrist cuff that I carried. I didn't trust it's accuracy, but it was consistant so I could watch a trend. It also gave the Bravo something to do..push this button every 5 minutes and tell me the number:D

Red Flag 1
04-27-2016, 17:11
Manual blood pressures, when properly taken, are always more accurate.

Using an appropriateky-sized cuff is also important, but this is typically more an issue in pediatrics than in adult medicine.

I would trust my cardiologist and any time my primary care provider wantsa to change a medication related to my cardiovascular system I would contact my cardiologist and ask for their recommendation on how to proceed.

I concur. The automatic models are very cuff size dependent for accurate measurements. If they are using a huge cuff on your smaller are, ask them to get the proper sized cuff for you.They also blow up rather tightly tight enough to hurt, and that can lead to falsely high readings. In surgery, I had a patient who is "asleep", and obtunded enough to feel no pain. The early automatic cuffs, I would put a manual cuff on the other arm, if I could, and the automated and manual readings were within a point or two.

Team Sergeant
04-27-2016, 17:20
I completely agree, I had a wrist cuff that I carried. I didn't trust it's accuracy, but it was consistant so I could watch a trend. It also gave the Bravo something to do..push this button every 5 minutes and tell me the number:D

I knew it, bastard!





;)

adal
04-27-2016, 20:50
I knew it, bastard!





;)

He could have had you out boiling water and getting towels. :)

PSM
04-27-2016, 21:47
Is the nurse who takes your BP at your PCP hot?:o

That happened to me in '84 when I took my pre-hire physical at Western Airlines. The very pretty nurse had rather large nacelles and sat in front of me with my hand tucked under her armpit. After all of the tests, the doc-in-charge mentioned that my BP was rather high. I confessed the problem and he laughed and said that he knew who I was talking about. :D

Pat

PedOncoDoc
04-28-2016, 08:41
That happened to me in '84 when I took my pre-hire physical at Western Airlines. The very pretty nurse had rather large nacelles and sat in front of me with my hand tucked under her armpit. After all of the tests, the doc-in-charge mentioned that my BP was rather high. I confessed the problem and he laughed and said that he knew who I was talking about. :D

Pat

I would've told him to have the nurse come back in and check again on that arm. then the other arm for comparison and then have her bring a friend and check them both at the same time! :D

frostfire
04-28-2016, 12:31
That happened to me in '84 when I took my pre-hire physical at Western Airlines. The very pretty nurse had rather large nacelles and sat in front of me with my hand tucked under her armpit. After all of the tests, the doc-in-charge mentioned that my BP was rather high. I confessed the problem and he laughed and said that he knew who I was talking about. :D

Pat

Unlikely the cause since the BP measurement was at your arm. At that particular instance your blood was flowing "somewhere else"

NurseTim
05-02-2016, 22:58
The manual suffers from operator error. I had an Lin take my BP by palpation then entered a diastolic number. :confused:

I look at it like a scale, as long as you use the same scale, you can measure changes.

Red Flag 1
05-03-2016, 13:23
a light year or so ago, us old guys could get the systolic right by just watching the deflection of needle on the BP cuff analog gauge.

Kat
11-29-2016, 22:48
Doc,

that's the way he wants me to do it via my own manual BP cuff. Take it everyday for a week and then send him the numbers. It is like he doesn't believe in manual monitors anymore and wants proof.

That may be to eliminate "white coat hypertension" you may experience in the office. The technique they often use in the office setting is so poor it can't be trusted, so home monitoring can be helpful.

JJ_BPK
11-29-2016, 23:51
That may be to eliminate "white coat hypertension" you may experience in the office. The technique they often use in the office setting is so poor it can't be trusted, so home monitoring can be helpful.

I have had this problem for some 10 yrs. At home I get much lower results than in the office. I have had two different cuffs and annually take them to the Doc to verify BP against his units. Minor but consistent variances..

MAB32
11-30-2016, 05:11
I may have it too. It may also be the fact that when you arrive you have typically have a 20-40 minute wait time before you are seen. The waiting room is usually full (20-30) people and it looks like something you would find at a free clinic. Plus, it smells in there. I think I just might search out another doctor because it is just not conducive to good health there.

Also, by the time I see the Doc, I am usually a little upset at having to wait that long to be seen and the rudeness of the people in the waiting room.

Kat
11-30-2016, 06:58
I have had this problem for some 10 yrs. At home I get much lower results than in the office. I have had two different cuffs and annually take them to the Doc to verify BP against his units. Minor but consistent variances..

The true way to do BP is lie in a dark room, unattended for 30 minutes...:eek: When has that every happened, never. A 24 yo medical assistant rolls a cart in, puts on a cuff that may be too small for the arm you have, read it.


The home units are quite accurate like you say. My only concern is when office reading high doc may pile on RX. I have done meditation and lowered mine significantly. Good luck with navigating your health care.

JJ_BPK
11-30-2016, 07:15
The true way to do BP is lie in a dark room, unattended for 30 minutes...:eek: When has that every happened, never. A 24 yo medical assistant rolls a cart in, puts on a cuff that may be too small for the arm you have, read it.


The home units are quite accurate like you say. My only concern is when office reading high doc may pile on RX. I have done meditation and lowered mine significantly. Good luck with navigating your health care.

Well aware of cuff sizing,, I make sure the large cuff is used every time..

As to meds,, I challenge the doc every visit, remind him of how long I've been on the meds and ask about kidney & liver markers..

Kat
11-30-2016, 07:50
I may have it too. It may also be the fact that when you arrive you have typically have a 20-40 minute wait time before you are seen. The waiting room is usually full (20-30) people and it looks like something you would find at a free clinic. Plus, it smells in there. I think I just might search out another doctor because it is just not conducive to good health there.

Also, by the time I see the Doc, I am usually a little upset at having to wait that long to be seen and the rudeness of the people in the waiting room.


Smells? Like medical or human ? That is unsat no matter what the source. You need to get out as soon as possible.

VA or civilian? Could be either I guess. I know my office is clean, nice, polite but the wait can be stressful. Some of us don't like to relinquish control of the situation and that is deleterious.;)

Yes, interview the new doc, check the wait times before agreeing to be seen. I go out of town as I followed my military doctor to her new TOC. Worth it as she knows me for 20 years, inside and out.


Good luck on your search.

MAB32
11-30-2016, 08:51
Civilian and smells of humans who haven't bathed in a few days. I have been seeing him for over 25+ years now. His brother was my partner for a while. He has made two major screw-ups this year alone with my wife. Both potentially very serious to her health. He is a "teaching" doc over at the university and spends more time on that. Kat, your right, it is time to find a new Doc. I have been to several of my specialists within the last 4 months and my BP was always 130 something over 80.

I am thinking of opening a new thread on "How to choose a great Doctor", but can we do it here or start the thread?

Kat
11-30-2016, 09:00
Well aware of cuff sizing,, I make sure the large cuff is used every time..

As to meds,, I challenge the doc every visit, remind him of how long I've been on the meds and ask about kidney & liver markers..

I didn't mean to infer YOU didn't but sometimes they will use a smaller. Good that you ask, again just in general not specifically aimed at you. Not everyone is on top of things as you are.

Kat
11-30-2016, 09:09
Civilian and smells of humans who haven't bathed in a few days. I have been seeing him for over 25+ years now. His brother was my partner for a while. He has made two major screw-ups this year alone with my wife. Both potentially very serious to her health. He is a "teaching" doc over at the university and spends more time on that. Kat, your right, it is time to find a new Doc. I have been to several of my specialists within the last 4 months and my BP was always 130 something over 80.

I am thinking of opening a new thread on "How to choose a great Doctor", but can we do it here or start the thread?

OK, so a 3d world environ then. That was the old TOC here years ago, I am in SoCa, and even though it was 100% military it was bad. It was as you described it, a train station in Bangladesh. family would bring 10 people into the exam room, all to be seen in a 15 visit. "As long as we are all here..."

I had a similar this summer, RX sent me to ED, 24 hours of tests, worry. Glad your wife made it out, some don't when mistakes are made.


If he is preoccupied with his first love teaching ( or so it seems) he may be just going through the motions at the office. Bad medicine.


I am new here so don't know policy but I would think a separate thread would be easier. Sort of divide it, as far as what works, what doesn't and how to navigate. Sounds good to me.

NurseTim
12-04-2016, 14:39
Manual blood pressures, when properly taken, are always more accurate.

Using an appropriateky-sized cuff is also important, but this is typically more an issue in pediatrics than in adult medicine.

I would trust my cardiologist and any time my primary care provider wantsa to change a medication related to my cardiovascular system I would contact my cardiologist and ask for their recommendation on how to proceed.

Funny, I had a patient that I could not muscle their pressure to a near normal reading. So, I thought, "Well, lets call in the experts." And sent the Pt. To cardiology. They did squat shit. Not the first time I've rolled snake eyes sending a hypertensive to "the experts" :mad: I have had much better results sending them to nephrology.

NurseTim
12-04-2016, 14:59
The true way to do BP is lie in a dark room, unattended for 30 minutes...:eek: When has that every happened, never. A 24 yo medical assistant rolls a cart in, puts on a cuff that may be too small for the arm you have, read it.


The home units are quite accurate like you say. My only concern is when office reading high doc may pile on RX. I have done meditation and lowered mine significantly. Good luck with navigating your health care.

If you are engineering the "perfect environment" to take a blood pressure, well you are wrong. That's not life. Life is adverse. I want BP medications that will keep my pressure WNL (within normal limits, not We Never Looked), after I've don't my part with diet and exercise. Ideal conditions are all well and good, but it is not life. The point is to keep my pressure as close to normal when the butt munch I front of you slams on the brakes.

I had another patient tell me their BP was normally borderline low. Comes into see me and it was ridiculously high. This Pt was newly homeless, tried 3 different agents. Then I found out there was a domestic violence component involved. I did what I could to get the Pt. Into a DV shelter. When I saw the Pt. A week later, the BP was normal and the was no anxiety radiating off of the Pt. As well.