Ticker Trouble

The big nurse with the soul patch, great sense of humor, and easy, friendly smile zoomed me and my wheelchair down the hall with purpose. Trotting alongside us was a tired-looking primary care intern. She was holding a compact machine with small, blinking lights; the wires sprouting from it connected to the chilly little conductive dots they’d stuck all over my bare chest a few minutes before.

I was wearing an open-backed hospital gown over my jeans, my purse and folded shirt on my lap, and as the crowds of Veterans Administration patients parted before us on the way to the emergency department, I tried my best to look relaxed and unconcerned. People were staring at me. I considered waving. Maybe I’d try that little, self-contained, dignified wave Queen Elizabeth uses while parading around in her horse-drawn carriage, I thought.

We arrived at the Emergency Department. No waiting in line for me: the intern knew the code and the electronic door whooshed silently open without hesitation. A nurse inside looked up from some paperwork.

“Hypertension,” the doctor barked. “230/94.” I sat there feeling foolish as she and my friendly nurse (I see him frequently; he’s one of my favorites) gave me into the emergency department’s care. He and the intern disconnected the portable heart monitor, rolled up the wires, told me to relax and not to worry, and left.

I felt just fine, I told the ED nurse as she took me to a gurney in one of the bays and had me climb onto it. After drawing the curtains around us, she busied herself attaching more wires and wrapped an automatic blood pressure cuff around my arm. Then she stuck a pulse monitor onto my index finger, and turned all the machinery on. Relax, she said with a smile. The doctor would be around soon, but in the meantime, they’d be watching me closely. I shouldn’t worry.

I really wasn’t worrying, but maybe I should have been, considering my sky-high blood pressure numbers at the time. But I really did feel pretty good, overall. Sure, my hands ached and throbbed, my rheumatoid disease at work as usual, but that was normal for me. As I listened to the machine behind me boop along with my heartbeat, I thought about how I’d ended up in this fix.

I’d come to the VA medical center for my annual lady-parts check-up. Those, I’m glad to say, were all perfectly normal, but when they took my blood pressure, it raised serious eyebrows. Was I under a lot of stress today? the nurse asked. Was I upset over anything? No, and no. They’d waited for fifteen minutes, then took it again. It was a few points higher. So my gynecologist sent me over to primary care across the hall, where they could better assess what was going on with me, and called to let them know I was coming. “Don’t go anywhere else,” she said. I promised her I wouldn’t.

The Primary Care gang checked my BP several times. Finally, my doctor, who I normally see once a year, decided to quit pussyfooting around (her words), put me on a monitor, and send me whizzing off to the ED.

“Really?” I’d asked her, surprised. I hadn’t come here today to waste hours sitting around the ED, having my blood pressure monitored. My elderly mother was home by herself, and she hadn’t been feeling very well. I hadn’t expected to be away more than a couple of hours, tops.

My doctor fixed me with her unsmiling, eagle-eyed gaze. “Yes, really,” she said. “Your blood pressure is high enough that you could stroke out at any moment.”

“Oh,” I’d squeaked, shocked. Alrighty, then! On to the ED.

There are a slew of additional health conditions associated with rheumatoid disease or its treatments. Called comorbidities, the most common is ischemic heart disease, a condition that causes narrowed heart arteries, which restricts the flow of blood and oxygen to the heart muscle. Hypertension, or high blood pressure, is a common problem as well.

Of course, in my case, rheumatoid arthritis isn’t the only culprit behind my high blood pressure. I’m also overweight. I don’t exercise enough. I’m post-menopausal and middle-aged, and I’m an ex-smoker. I try hard to eat right, but my diet isn’t always pristine.

After two hours of monitoring, the doctor in the emergency department sent me back to primary care. My BP had come back down to un-emergency-like numbers. My doctor, still concerned, put me on blood pressure medicine. It’s now one of my 12 daily pills, fitting in nicely among my RD meds and supplements.

My blood pressure is back under control, now. It’s one of my top goals to get back off the medication before too much more time passes. All it will take is some serious effort on my part toward weight loss, along with some regular exercise. RD can make that difficult, but by taking it slowly and gently, I know I can do it.

It’s easy to forget that RD is a systemic disease--meaning that it causes problems all over the body, not just in the joints. Cardiovascular disease, lung disease, kidney disease, and diseases of the eyes--all of them are associated with it. That’s why it’s so important to see your primary care provider, not just your rheumatologist, for periodic checkups.

How long was I wandering around with ticker trouble, a stroke victim waiting to happen? I don’t know, but I’m glad I had that lady-parts exam that day, and that my caregivers reacted so quickly to my high BP numbers. Without them, I might not be here writing this today.

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