By Melissa Major, NP
When Ann first walked into our clinic, she had no outward signs of the imminent danger she was facing. I invited her into my office and reviewed her medical history and medications. It immediately caught my attention that she was on three blood pressure medications and reported frequent headaches. I scanned the remainder of her paperwork, and when my eyes fell upon her previous diagnosis of a 90% blockage to her right carotid artery (major artery in your neck), it became evident that time was of the essence. The severity of the situation further heightened when I took her blood pressure, which was 240/126 (120/80 is normal). I confirmed that she had been taking her medications and double checked the reading on her other arm. She was in a hypertensive crisis, and I knew I must work quickly to get her pressure down. She admitted it had been running high but was shocked at how high it was that day – explaining that she didn’t have a headache or blurry vision, her typical symptoms when she was in the “danger zone.”
Hypertension is notoriously called the silent killer. Values generally have to be extremely high before most people notice, making frequent monitoring essential. Symptoms of high blood pressure can include blurry vision, headaches, nose bleeds, irregular heartbeat, chest pain, fatigue, and ear buzzing.
After treating her with medication in our clinic, I decided to add two additional medicines and provided her with a blood pressure cuff to take home. After three days, she sent me a text with her list of blood pressures. Although her blood pressure had gone down, it was still too high. I stopped two of the original medications she had been taking to see if these other medicines were providing any added benefit. Based on her initial blood pressure, I doubted stopping them would even be noticeable. There was no significant change, and I was glad to have two fewer medications in the mix. During the next few weeks, she continued recording her blood pressure and called to report any that fell outside the parameters we had set. On one occasion, she called after hours with a very high reading, which led to us adding a prescription for her to use on an “as-needed basis” while adjusting her medications. Finally, after several trials and adjustments, with continuous monitoring and close communication, we got her to her blood pressure goal of 130/80 in just over four weeks.
Ann has worked in healthcare for more than 30 years and is familiar with the dangers of high blood pressure. She has frequently witnessed the consequences of untreated hypertension, such as kidney disease (resulting in dialysis) and heart disease (resulting in heart attacks). Aware of her risk, she was proactive, did her due diligence, sought out doctors and specialists, and took multiple medications. Yet, none were able to manage her as closely and aggressively as her condition required. It wasn’t due to the provider’s lack of competence or willingness to treat Ann, but rather their lack of time. Her confirmed coronary artery disease and extremely high blood pressure left her in a volatile space, and it took a personal healthcare advocate to closely follow her to the point that she was safe and out of danger. And it took time.
The timeframe from diagnosis to optimized therapy is one of the leading contributors to our chronic disease burden in our country, and the problem can be traced back to time.
Or rather, the lack thereof. Primary care appointments in 2022 are averaging a mere seven minutes. Doctors barely have time to see their patients, much less call and check up on them after hours. They certainly cannot be expected to treat them aggressively due to their inability to provide close supervision. Medical insurance requirements have reduced doctors to checking boxes, writing prescriptions, and referring patients to specialists. Typically a patient will only follow up every three months for medication adjustment and monitoring, severely exaggerating the timeframe to resolution. Knowing this, it would likely have been close to 12 months for Ann to reach her goal. Twelve months of silent damage and imminent danger while navigating the system her insurance required.
Untreated high blood pressure can damage the kidneys, heart, eyes, brain, and arteries – long-term damage results in kidney disease (dialysis), heart attack, blindness, and stroke.
At MBody Healthcare, we know your struggles and frustrations; we face the same barriers in the system when seeking health care. We decided we had to find a way to provide quality and personalized care, focusing on getting patients better faster. We found that removing the barriers imposed by insurance and restoring the doctor-patient connection allows us to give you the time and attention your health deserves. It is an entirely new way to experience healthcare, resulting in quicker diagnosis and resolution of illness.
10414 Jackson Oaks Way
Knoxville, TN 37922