Case Study: High Blood Pressure

Phyllis B. was a longtime patient of mine whose medical problems were happily under control and who usually came in only for annual check-ups. As I’d just seen her last month, I expected today’s visit meant some new problem had emerged.

“I’m here for Kirk,” she began.

I’d only met her husband once, years earlier. An accountant, or bookkeeper, or something like that, I remembered. The phrase “Kirk never goes to doctors” had stuck in my mind. Apparently, he’d recently been going to a doctor.

“At one of the blood pressure screenings they do at his office…”

I was going to interrupt, “I know, I know, they found high blood pressure and you’re worried,” because doctors always interrupt their patients, finish their sentences, and so forth. We can’t help it. We’re the ultimate know-it-alls. But I’m working on this trait and kept my mouth shut.

“They found high blood pressure. I’m worried about him because he went to a doctor near his office who convinced him to start taking some pills. Now his blood pressure is down, but he’s not the same man.”

“Meaning?”

“For one thing, he’s depressed at the prospect of taking pills for the rest of his life. For another, he’s not as energetic, he’s become absent-minded, and as for our sex life, forget it.”

I asked Phyllis if Kirk would come in to see me. For someone who doesn’t like doctors, I thought, two physicians in his life might be a culture shock.

“No, he’ll come. He liked how you helped me. How did you remember he doesn’t like going to doctors?”

“We doctors know everything.”

Kirk arrives for his appointment
I didn’t recognize the gloomy looking man at first and then I realized it was because he’d gained so much weight since his visit years ago. I couldn’t think of any accountant jokes to cheer him up so we got right down to business.

He showed me the numbers from the office health fair where his high blood pressure was initially discovered. They really weren’t all that bad, and I told him so immediately. He’d also brought a copy of the lab tests run by the other physician and he handed them over with a sigh and worried look.

“What’s worrying you about this?” I asked.

“The doctor said it was pretty bad. The cholesterol, I mean. He wants to start me on some drugs for it.”

Like Kirk’s blood pressure, his cholesterol levels were in the mild-to-moderate range. I thought his doctor must be a cup-half-empty sort of person. Me, I’m more optimistic.
I did want to be tactful, however.

“Listen, Kirk, I agree with your other doctor that, left alone, as-is, and untreated, your blood pressure and cholesterol will knock ten years off your life. Those are the statistics, pure and simple. You’re not smoking anymore, are you?”

“How did you know I used to smoke?”

“We doctors know everything.”

Lifestyle adjustments to the rescue
Phyllis, Kirk, and I plotted out a program that would dramatically improve his numbers if Kirk followed the guidelines.

“Look” I began. “I’ll make this simple. You’ve got what we call lifestyle problems. Your lifestyle basically stinks. You have no business eating cheesesteaks for lunch. You never exercise and walking around your office doesn’t count. You’re overworking and mostly sedentary. And now your body is sending messages that it’s very disappointed in you.”

We made a plan. First, Kirk would go from our office to a pharmacy and purchase his own blood pressure monitor. He would take it to work, place it next to his computer screen, and at least once a day record his blood pressure. He’d get a notebook for this and bring it along on every visit. He’d also check out some free stress-reduction apps for his phone.

Next, he’d return for some sessions with WholeHealth Chicago nutritionist Olivia Wagner. He and Phyllis would ideally see her together, to learn the basics of healthful food shopping and preparation.

Then, one more thing. I told Kirk I’d like him to go over to the health club near his office and hire a personal trainer. It’s an out-of-pocket expense, true, but he of all people could probably finagle a tax deduction out of it for health-related purposes.

I started Kirk on the following supplements and herbs to protect his heart and lower his cholesterol a bit, recommending that he make green tea his beverage of choice as it helps with both blood pressure and cholesterol. If green tea wasn’t his cuppa, he could take green tea extract capsules, one twice daily.

For blood pressure
—Carditone (an herbal blend) twice daily.
—Omegagenics EPA/DHA (fish oil) twice daily.

For cholesterol
—Berberine twice daily.
—Bergamot twice daily.

I told him he might not need the supplements at all after a few weeks. Kirk’s BP would likely drop with weight loss, as his was mild in the first place and had been taken in a stressful situation (the doctor’s office). Once his BP was under control, his doctor would probably be willing to take him off the medication, especially if he complains loudly enough about the side effects.

Kirk looks dubious
“This is a lot of stuff you want me to do.”

I assured him it only seemed that way because he was starting from ground zero, where he’d been doing nothing at all to support his health. If he asked around, he’d probably be surprised by how many of his accountant buddies paid attention to what they were eating and worked out at a health club three or four times a week.

“All this will soon be second nature to you,” I said, “especially when you start getting your mo-jo back.”

Kirk looked over at Phyllis, “Did you tell him…?” but Phyllis was studiously avoiding eye contact.

“OK, OK, I’ll start on all of it. Say, how did you know about the tax deduction for a trainer? That’s my field.”

“Dear,” said Phyllis, “Doctors know everything.”

And because he put his mind to it, Kirk did do well. First of all, he had Phyllis for support and she wanted her old Kirk back. She became an extraordinary cook and got him interested in meal preparation. Together they found inventive ways to amp up the fruit and vegetables in their daily diet.

Kirk’s home-packed lunches were the envy of his office. His personal trainer helped him tone muscles Kirk hadn’t used since college and his wardrobe changed for the better as his waist shrank from a 42 to a 34. He stuck with his original doctor, which was fine with me. I hoped the doctor could see what patients were capable of doing if only they were guided along the right path and had the will to change.

When Phyllis came in some months later for her annual physical, she brought a copy of Kirk’s at-home blood pressure readings, his weight, and his cholesterol levels.

“These are with no medications at all. He’s very happy, although it gets a bit much as he now tells everyone what to eat and how to exercise.”

I laughed and told her that happens. “Successful patients–especially those who’ve gotten well by their own efforts–their personalities begin to resemble doctors.”

“What do you mean?”

“They act like they know everything.”

Be well,
David Edelberg, MD