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Old 15th June 2021, 21:14   #3211
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Re: Calling doctors/dentists/specialists on Team-BHP to provide free consultations

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Originally Posted by Rahul Bhalgat View Post
My mother, age 71 has the BP consistently around 195/80 to 205/85.

BP consistently around 200/80 all these 12 days.
Not a doc, but father was hypertensive & mother is. So based on my knowledge from there, 180-190+ systolic is considered as hypertensive crisis. Can lead to a stroke and/or damage of blood vessels.

Also when (time of the day) is this? Best time to check is early in the morning before eating. What position is the person - sitting or standing? Do you take 2-3 repeated readings each time? Have you checked the calibration of your blood pressure monitor - Are the readings at home roughly in the same ball park as that measured at the doctor's clinic?
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Old 15th June 2021, 21:24   #3212
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Re: Calling doctors/dentists/specialists on Team-BHP to provide free consultations

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Originally Posted by carboy View Post
checked the calibration of your blood pressure monitor
How do you calibrate these electronic BP monitors? I have one wrist based device and wouldn't know whether it is accurate.
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Old 15th June 2021, 21:34   #3213
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Re: Calling doctors/dentists/specialists on Team-BHP to provide free consultations

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How do you calibrate these electronic BP monitors? I have one wrist based device and wouldn't know whether it is accurate.
No option to calibrate. You can check the reading with the manual BP machines and accordingly see the margin of error.
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Old 15th June 2021, 21:39   #3214
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Re: Calling doctors/dentists/specialists on Team-BHP to provide free consultations

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Originally Posted by carboy View Post
Not a doc, but father was hypertensive & mother is. So based on my knowledge from there, 180-190+ systolic is considered as hypertensive crisis. Can lead to a stroke and/or damage of blood vessels.

Also when (time of the day) is this? Best time to check is early in the morning before eating. What position is the person - sitting or standing? Do you take 2-3 repeated readings each time? Have you checked the calibration of your blood pressure monitor - Are the readings at home roughly in the same ball park as that measured at the doctor's clinic?
Thank you for the response.

Yes, I too read that it is hypertensive crisis above 180. But it seems that the doctors aren't surprised; neither of them expressed a sense of emergency.

The BP is checked at around 9 am and 9 pm. While checking, she sits upright on a chair and rests for a few minutes before checking. We check thrice with 2 - 3 minutes interval (strap loosened) between the readings.

The readings taken at the clinic roughly tally with those shown on our meter. The meter is new and it is of good make (Omron).

We asked the MD (Medicine) doctor about the reasons.

Looking at the reports (stated in my first post about this), the doctor says that all other organs like liver, kidney, pancreas, gall bladder etc. are functioning normally and these organs aren't the cause of elevated BP. He said that it happens in this age. Sometimes because of hardened blood vessels, sometimes because of age related degenerative changes in the various areas of heart.

The question now is, whom shall we visit for another opinion? Which kind of specialist? And who, in particular?

Besides the expertise and experience, trust factor too is important.

Last edited by Rahul Bhalgat : 15th June 2021 at 21:42.
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Old 17th June 2021, 10:15   #3215
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Re: Calling doctors/dentists/specialists on Team-BHP to provide free consultations

Need help from ENT doctors on the forum.

Since Sunday I have been feeling a bit of fullness/packed feeling in my left ear. It felt as if something is stuck in the ear and probably needs to be pulled out with a pair of forceps or tweezers. Suspecting some kind of blockage, went to an ENT on Wednesday who did a suction cleaning of my left ear. He even examined my throat and nostrils and checked hearing using a tuning fork. I do not have any loss of hearing in either ears. He said that there is nothing wrong with my ear, everything is clear till the ear drum. The diagnosis was post covid symptom - Otomycosis (I had covid in second half of April) and prescribed Otodac CL ear drops.

However the situation has not improved at all. The doctor says there is nothing wrong but I still have the fullness/packed feeling. Also yesterday I noticed that when I get up in the morning the feeling is more prominent and during the day it gets slightly better (my guess is that the fluid kind of settles down due to gravity). I suspect fluid build up because of two things; every time I swallow I can hear a pop kind of sound in my left hear and if I try to pop my ears by closing nose and blowing out, while I can feel right ear pop up, in my left ear I get a popping/gurgling kind of sound/feeling.

I googled up and one option was that it could be infection/fluid in the middle ear which is causing this.

While there is no pain as such, the left ear is causing discomfort and at times the sound I hear from the left ear seems slightly different as compared to the right one, muffled if I may say so.

My queries:
1) What should be the next course of treatment, oral medication, ear drops or something else? What should I ask the doctor to check on further?
2) Any recommendations for a good ENT in Chandigarh whom I could consult should this doctor continue to say that there is nothing wrong and it will get better in a few days.

Thanks in advance.

Worried,
S
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Old 21st June 2021, 17:57   #3216
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Re: Calling doctors/dentists/specialists on Team-BHP to provide free consultations

I just have a technical question for the esteemed doctors in this forum.

I had accompanied a friend of mine to a hair transplant clinic in Dubai for consultation to transplant some of his hair towards the front where he is bald.

The doctor in this particular clinic checked the blood pressure which was abnormally high at 186/114. Now, my friend doesn't have a history of blood pressure and it has always been normal for him (last checked one month back during vaccination). The doctor said (understandably) that they would need a clearance letter from a cardiologist before doing the procedure.

Now, here is our doubt. He gave a letter which said that my friend has a 'history of high Blood pressure' when my friend had never recorded high BP before and that clinic has no access to his old medical records. Just to clear our doubts, we visited a GP and got his BP tested THRICE - three consecutive days and it was always between 120-125/90-95 i.e normal. This means that the high BP which was observed at the hair-transplant clinic was an anomaly as the high BP has never been replicated before or after the visit to the clinic.

Now, my friend is unsure whether he can show the letter to a cardiologist to get the clearance as its written 'history of blood pressure' when it was just an one time anamoly. Was the doctor from the hair-transplant clinic right in giving a letter saying my friend has a 'history of blood pressure' just based on one reading?
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Old 21st June 2021, 19:23   #3217
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Re: Calling doctors/dentists/specialists on Team-BHP to provide free consultations

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Originally Posted by Rahul Bhalgat View Post
Consistently high BP
Consult a cardiologist at the earliest. Probably she needs to be admitted and the drugs need to be given by IV route to bring down the bp.

My 80 year old mother's BP was found to be 205/90 during last April. I had taken her to a nearby cardiologist clinic because she complained of some uneasiness, and this was found. He termed it a crisis and prescribed Olmesartan Medoxomil 40 mg for morning and Cilnidipine 5 mg for night. He made me buy the tablets from a nearby pharmacy, made her gulp down both tablets together immediately and only then allowed us to go home. From the next day she had to take one in the morning and one at night. After a week we checked and the BP had come down. She is still continuing the medicines.
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Old 22nd June 2021, 10:11   #3218
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Re: Calling doctors/dentists/specialists on Team-BHP to provide free consultations

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Originally Posted by Rahul Bhalgat View Post

The readings taken at the clinic roughly tally with those shown on our meter. The meter is new and it is of good make (Omron).
The readings taken with a led based sensor (photoplethysmogram) is far more accurate than the cuff based sphygmomanometer. My wife suffers from high BP and I have mercury type sphygmomanometer as well as an electronic sphygmomanometer which showed consistently high BP: 150/85 most of the time. The doctors , over a period of time gave her antihypertensive tablets. Last year I bought a Sanket LED based sensor which shows normal BP these days - 120/80. I compared the readings with the other 2. They still show 130/85. I went to a doc and her reading was again high - matched the home readings.

The doc reasoned that the patient may have anxiety or tension which can cause a spike. The cuff system may not be accurate with obese patients.
Here is a link to an authoritative source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6603632/
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Old 22nd June 2021, 18:42   #3219
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Re: Calling doctors/dentists/specialists on Team-BHP to provide free consultations

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The readings taken with a led based sensor (photoplethysmogram) is far more accurate than the cuff based sphygmomanometer.
Thank you for the useful inputs. So far I wasn't aware of photoplethysmogram based devices.

Here is what I think about this prima facie:
  • The BP benchmark set by the medical science is 120 & 80 mm (or whatever; I am not stressing on the figure) of Hg measured on a mercury manometer by auscultation during slow deflation of cuff placed on the arm, level with the heart. Hence the sphygmomanometer with stethoscope is the benchmark device irrespective of what is the benchmark figure. In other words, the medical science defines the normal BP as so many mm of Hg, measured on a mercury manometer by auscultation during slow deflation of cuff. So the accuracy of any other device shall be defined w.r.t. the traditional sphygmomanometer and not vice versa. Hence we shall not think that "photoplethysmogram based device is more accurate than the sphygmomanometer". The benchmark is sphygmomanometer and this hasn't changed.
  • The photoplethysmogram based device does not directly measure the "mm of Hg" like a sphygmomanometer does. It measures the Pulse Transit Time (PTT) and translates it into the "mm of Hg" by using some formulae and calculations. These formulae will not apply identically to every individual because of variables like arterial flexibility. So the meters other than sphygmomanometer need to be calibrated (validated) on specific individual if we are concerned about the accuracy of the measurement.
  • Even the values routinely measured on a sphygmomanometer in a clinic shall be deemed to be within +/- 3 mm of Hg considering the manual involvement (eye not being exactly in line with the mercury level, ear's response to stethoscope, possible hurry etc.) Hence it does matter whether the BP is 180 or it is 150 or it is 130. But it does not matter if it is 137 or 139, for example.
  • The sphygmomanometer may cause anxiety (and hence some changes in the BP itself, because of the measurement process) in some individuals. In this aspect, the photoplethysmogram based device may be better.

This is what I have understood. Views from experts and other members are welcome.

Edit: I am now curious about the photoplethysmogram (PPG) based devices. But could not find any available online.

Last edited by Rahul Bhalgat : 22nd June 2021 at 19:06.
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Old 22nd June 2021, 18:49   #3220
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Re: Calling doctors/dentists/specialists on Team-BHP to provide free consultations

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Originally Posted by Rahul Bhalgat View Post
...This is what I have understood. Views from experts and other members are welcome.
I am firmly in the other-members category ...

What I have heard is that not only does an accurate reading from the old-fashioned mercury instrument depend entirely on the expertise and training of the person doing it, but that even an experienced person can get inconsistent readings
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Old 23rd June 2021, 10:47   #3221
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Re: Calling doctors/dentists/specialists on Team-BHP to provide free consultations

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I am now curious about the photoplethysmogram (PPG) based devices. But could not find any available online.
There is plenty of information available about photoplethysmography. The PPG technology has been used in a wide range of commercially available medical devices for measuring oxygen saturation, blood pressure and cardiac output, assessing autonomic function and also detecting peripheral vascular disease.
The advantage of using microprocessor based device is many fold. Unlike the manual devices, which require periodic calibration, the PPG rarely - if ever require calibration. The sphygmomanometer's readings vary depending upon the ambient temperature, humidity and the way the cuff is set. The PPG device is designed from the ground up to factor in these variables. The technology is mature and you can find them in hospitals to Apple watches.

I am not here to lobby for PPG. I have used all the types and I find that PPG devices appear to be consistent. The last doctor I saw about this issue, told me that they have these devices monitoring patients in ICU - in critical care.

As an engineer, I can give an analogy here comparing mercury sphygmomanometer to the PPG: In the distant past people used D'Arsonval meter to measure current. Now they use digital meters.
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Old 23rd June 2021, 12:43   #3222
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Re: Calling doctors/dentists/specialists on Team-BHP to provide free consultations

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There is plenty of information available about photoplethysmography. The PPG technology has been used in a wide range of commercially available medical devices for measuring oxygen saturation, blood pressure and cardiac output, assessing autonomic function and also detecting peripheral vascular disease.
Thanks.

Which make and model of the PPG device have you purchased? What was the price and how is the device working?
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Old 23rd June 2021, 14:45   #3223
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Re: Calling doctors/dentists/specialists on Team-BHP to provide free consultations

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Which make and model of the PPG device have you purchased? What was the price and how is the device working?
I bought Sanketlife multivital or something to that effect. This reads BP, SPO2,Temperature and ECG. You need a mobile app (iOS/Android) to connect with this device. The iOS app sucks. Android app is good. It cost me about Rs.7k.
It is doing a good job as I checked its readings/report with lab ECG results. It won't replace the lab at any point in time.
But in the corona days, it was highly useful.

I have no connections with PPG device manufacturers or dealers. I am just a user who is satisfied with my purchases.
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Old 7th July 2021, 18:01   #3224
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Re: Calling doctors/dentists/specialists on Team-BHP to provide free consultations

Any urologists in the house ?
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Old 20th July 2021, 20:21   #3225
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Re: Calling doctors/dentists/specialists on Team-BHP to provide free consultations

Doctor advised me to undergo few blood tests suspecting Vitamin deficiency. Did the tests in a renowned but not high class hospital here, but the cost of these tests surprised me. Am I being taken for a ride here? Rates alongside the test names.

Lipid profile = 900
Vitamin B12 = 2070
Liver Function test plus CGT = 1300
Total Vitamin D = 3500
Creatinine Serum = 260
Complete Blood count = 440
Peripheral Smear Examination = 270

Can the doctors here please comment?
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