PE 1st Pregnancy/Now 34wks2nd Preg BP jumped

[rerskine]

I know people believe White Coat syndrome exists, but I wish the medical community would at our HMO would communicate better with one another when a patient has repeatedly demonstrated this condition, so they don't start up all the alarms everytime she registers a high initial BP. I know they have to be careful, but I brought out readings from home in an excel spreadsheet showing her bp's at home, and at the docs throughout her pregnancy and they are always at least 20point higher on both. Instead of asking some questions and listening to what we have to say, they revert back to static numbers. I am just really sensitive to it because when they ramp up for an hour of testing, it ramps Julie up for 4hours of distress.

We talked to the doctor about meds and he said that if her bp went that high and stayed that high after an hour they would try to use meds.

I know that somewhere in this forum the various readings from the blood tests and urin samples are explained, but can someone explain them or send a link. Today the doctor said her tests values looked great, and when I asked what the numbers were, they first responded by asking me if I knew what they would mean. I really just need to know the guidelines for detemining when they are too high or too low.

quote:

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Originally posted by Caryn

Robb,

How nervewracking for you both!

I've got to say, though, that I'm glad she got checked out. What our Experts tell us isn't that they don't believe in white coat htn, but rather that if you have it, it means that something about the way your body manages blood pressure is broken. If it weren't broken, your body wouldn't spike pressures in response to stress; since you do spike pressures, the control system that manages bp has something wrong with it.

(Sorry to use the generic "you" there; saying "Julie" every time read strangely too. [:)] )

A good NST and bloodwork and proteinuria should go a long way towards easing everyone's mind. Not that you don't need to continue to keep your eyes peeled for PE, of course, but then you already knew that!

Did they say anything about bp meds? I'm no doc, but it seems to me that if she spikes up high (rarely, or only when they're taking her bp, or whatever) that that's the sort of thing they tend to use low-dose beta blockers for -- they use them for high cardiac output cases, and women with high cardiac output often have white coat htn. They also use them for performance anxiety, which is pretty similar.

I hope she (and you) get a good night's sleep, and that things stay nice and calm around there.

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[anathor21]

I'll take the easy one first [:)] - since you already have the BP numbers down (over 140/90) right? So, the second important number to know for PE is the 24hr urine test. The first number to know is 300 - that is as in 300mg/24hr and that is the total amount of protein in the sample. Once you cross over this line, you are offically in PE territory. Less than this, you are not yet in PE territory. However, "Normal" is zero so anything above zero found is not quite normal, but not quite PE so it all depends on how excited folks want to become (and really on history - rate of change, other factors etc).
The obvious next questiion you will have is "how does this relate to the dipstick test" - well, the dipstick measures the concentration in the sample that is being tested. Thus, if there is a high concentration in the sample then the dipstick will register a higher level than if there is a lower concentration in that sample. If a person is putting out zero protein, then the sample will have zero and the dipstick will register zero and all is good. If a person is putting out a large amount of protein then the concentration in any given sample will be higher than zero and thus the dipstick is very likely to register something above zero, with a higher reading more likely as the person is dumping more protein. Now I'm sure you have noticed that I am using some uncertain language here - and that's not an accident as the concentration of protein in any given sample is dependent on two factors - the amount of protein and the amount of other liquid (i.e. concentration being protein/otherliquid) thus if someone is very well hydrated (drinking a lot) and their kidneys are processing it well and putting a lot of liquids out then the concentration can be affected and thus artifically reduced. On the flip side, if a person is not well hydrated and/or their kidneys are not processing the water very well and pushing it out then the concentration can go higher artifically. The strips for the dipsticks are calibrated for a "normal average" range of expected concentration and as such are a good screening tool. However, they cannot be used to diagnose PE in the end. Just keep this in mind - many folks (and you will hear great tales if you wish to read them) have had very interesting experiences with them and thus have low level of trust in them. The 24hr collection is the only way to really know if the protein being spilled is in the diagnostic level for PE.

How's that for first number to learn? 300 is the line for protein in a 24hr.

Will try to get to the various blood tests next, but have to look them up (don't know them off the top of my head) and I'm at work right now, heh.

[caryn]

I can add a link to a list of normal values:
http://www.healthcarecontent.com/reports.html

However, decisions about delivery are pretty flexible and subjective, because of that 'medicine is both art and science' thing. They'll probably take things like a headache or reported epigastric pain just as seriously as a change in liver enzymes, because they can also signal a significant change in the mother's condition. Similarly, deliveries take place for fetal indicators (baby stops moving, stops practice breathing, stops urinating, starts having heart decels) even when lab values are great...

There's a discussion of delivery indicators on page 19 (I think!) of the NIH Working Group Report: http://www.preeclampsia.org/forum/viewtopic.php?t=1918

[rerskine]

Checking in again.
So here is the current situation. My in-laws, now officially saints, have been coming over everyday and helping take care of our daughter Isabel, allowing me to focus on the many tasks we had planned to finish before the baby arrived.

Julie has been on bedrest since Tuesday of last week. Her BP is much better, but we have been unable to get consistent readings. This seems to be directly linked to her postition. When she is in a more reclined position(on back, left or right side)BP is 110-129 over 78-85, but if she sits up straight her BP goes up. The perinatal call in service tells her that she needs to be sitting up, but when we have gone in to L and D she has always been reclining slightly when her BP is taken. What position should she be in? What are people's thoughts on bedrest. There seems to be quite a bit of contradictory research about the benefits of bedrest. She has been told to reduce her activity, stop going to work and try to rest as much as possible. Is it dangerous to have too much bed rest? What about diet? The doctor said to reduce sodium intake , but other sources online suggest that for PE one should not reduce sodium, which is better?

All of her blood tests and her 24 hr urine came back negative and she is not showing signs of any additional symptoms.
35 weeks today. Two more weeks.

Robb

[anathor21]

Ok - just the facts here this time - try to keep the editorials to a minimum for you since you are likely busy and going to need all your reading time anyway [:)]. Lots of questions in there, hope I get them all.

BP readings - how to take them:
http://www.preeclampsia.org/forum/viewtopic.php?t=321

Also note here the response from Dr. Easterling in reference to the Labile phase - some of the variances you are seeing may be attributable to this as well.

Editorial note - if you read comments here you will get a sense that many folks feel that L&D and other nurses (and others also) may prefer to take BP readings laying on the side to get 'nicer' numbers - to reassure themselves and/or the patient. It seems generally to not be all that helpful from a diagnostic standpoint to do this (to put it mildly) and in fact may be dangerous if seated readings are ignored in this context. If you find yourself in a situation where someone is trying to adjust body position to lower BP and just record lowest possible reading it is likely time to challenge that act and advocate for a better approach (i.e. note the expert responses in the thread above).

re: bedrest
http://www.preeclampsia.org/forum/viewtopic.php?t=10150 (ask the experts statement)

http://www.preeclampsia.org/forum/viewtopic.php?t=12455 (link to research and more debate)

Editorial comment: Well, the debate rages - but essentially the question seems to come down to what works well for the particular patient. Some folks do well on bedrest, others end up laying there stressing out more than if they could get up and do things. Although PE is not considered a disease process caused by stress/anxiety, adding stress or anxiety to a body that is going through a difficult physical challenge is never likely to be a good thing for overall health (note, this is opinion still) so take from this what you will. If bedrest seems to be helping your wife and not causing undue harm (and it sounds like you are getting good support) then I'd keep it up as best you can.

re: diet
Editorial note: (getting this in first) There are so many bits here it's hard to know where to start. I'll focus on the sodium question since you asked about that specifically, but understand that the whole diet and PE thing opens up lots of different avenues here. There are various folks who will claim this or that diet can prevent or cure PE - not one has been validated in any reasonable manner to have truth to them that I can find. Folks of course WANT to believe that diet can prevent/cure it as it is something we can control, but it seems highly unlikely given the current understanding of the mechanism of PE development that diet really will play much of a role in the ultimate cure/prevention strategy. Perhaps it will - never say never, but don't hold your breath. Anyway - on to the salt question...

http://www.preeclampsia.org/forum/viewtopic.php?t=1305 (Expert remark - sort of side issue...)
http://www.preeclampsia.org/forum/viewtopic.php?t=1826 (Another Expert comment)

http://www.preeclampsia.org/forum/viewtopic.php?t=17822 (Perhaps useful from an inverse - note the ommision in expert response - i.e. they don't include salt reduction in their response)

Editorial note: So on the salt question, research of available expert opinions here doesn't seem to indicate that there is much support for reducing/elminating salt for PE alone. Obviously if there are other things going on there could be reasons... this actually syncs up well with what I recall from other readings I've done and with our own experience with our doctors during our PE experiences (we were told to salt to taste, but keep it down in general as it's not good for her health to over salt - pregnant or not).

Glad that other signs/symptoms appear stable. 35 weeks is great - keep an eye on things! Changes can and do happen rapidly.

E.

[blythe]

I'm so glad to hear Julie's at 35 weeks with everything good except bp so far!

I'm also glad your docs are taking the bp spikes seriously - too many docs actually seem to ignore it, and these boards are filled with women with "just" high bp. "Just" high bp can still cause lots of damage to mom and baby... But I can absolutely appreciate how stressful it is for both of you.

Anathor's info was great, so I'm just going to offer some unsolicited advice [;)]. Julie sounds like she's absolutely petrified when that bp cuff ramps up and my heart goes out to her. From my old, long-past life as a therapist, I'd suggest a therapy technique... If she's so inclined, she could write down the thoughts and related emotions she's having as she's waiting in the doctor's office and getting her bp taken. Then she could look at those thoughts, see if she can "talk back" to them, and see if she gets an emotional change. (You could try it, too, to help you calm any anxiety and stress when they send you both to L&D again!)

(for example: Thought - the longer I sit here, the higher my bp is going to be; Emotion - fear; Scale 1-100 - 100; Change Thought - even if it's high and we're stuck at L&D again, every other time the numbers have come down and all the labs have been good; Emotion revisited: fear; Scale 1-100 - 50 (not cured, but a little better). She probably has TONS of thoughts going around her head, and changing any or all of them may not actually help the white-coat high readings, but dealing with the thoughts differently might help her feel a little better...)

Unfortunately, this really is more in the line of "therapy" (cognitive-behavioral), and it's not something you can really help her with. If she's at all inclined, I'd suggest the book Cognitive Therapy, Basics and Beyond by Judith Beck - or a good C-B therapist!

Then again, she has 2, maybe 3 weeks of this left, so maybe it's easier to just endure the panic and not try to deal with it any further!!!

Regardless, have the docs given you an induction date? 37 weeks? 38? Or at least list what they will look at in deciding when to induce? And if they give you that crap (sorry, just my opinion [;)]) again about "but would you understand the lab values if we told you?", you or Julie (whoever is interested) could say no, but it would help my anxiety level to know them, I'd appreciate it so much if you or a nurse could take the time to explain them to me. You can always bring the numbers back here, too, but I'd bet you'd feel better about your doctors if they involved you in understanding what is going on. Sometimes in PE they have to move very fast and can't take time to explain, but it sounds like right now there is time.

Good luck and keep us updated!

[rerskine]

Thank you Blythe and Anathor,
Both of your responses were wonderfully informative and uplifting. THe nice thing about this cite is that no one sugarcoats the reality of PE. Some of the other cites are too positive and others give little hope. I am so happy to be one day past 35 weeks. Julie is doing great. Her BP when seated with a slight recline is about 115-125 and 74-91 diastolic. Her urine samples at home have shown trace amounts on a few occassions, and we have learned that her 24hr urine test came back positive from the local lab and negative from the regional lab. I have sent in an email asking the doctor to explain this duo lab process and why we were eventually told that the results were negative only.[?] The score was apparently around 100 by the first lab and 20 by the second. Sounds off to me, but I do not claim to be a doctor. Actually, as of last Friday I successfully defended my dissertation for my doctorate, so I guess I am now officially a doctor. I digress anyway. Thanks for your great responses.

rerskine

[rerskine]

I forgot to note the induction date. We have talked about 38 weeks as a goal, but should her BP go up and she has urine positive tests or if a sonogram shows that Eamonn is beginning to become developemntally hindered we will reevaluate and possibly induce. We really want to get to a minimum of 37 weeks. Our daughter was right at 36 or 35 and 4 days and she was great, but she weighed 4 lbs 12 ounces and as many posters here know that can add additional postnatal stress.

quote:

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Originally posted by Blythe

I'm so glad to hear Julie's at 35 weeks with everything good except bp so far!

I'm also glad your docs are taking the bp spikes seriously - too many docs actually seem to ignore it, and these boards are filled with women with "just" high bp. "Just" high bp can still cause lots of damage to mom and baby... But I can absolutely appreciate how stressful it is for both of you.

Anathor's info was great, so I'm just going to offer some unsolicited advice [;)]. Julie sounds like she's absolutely petrified when that bp cuff ramps up and my heart goes out to her. From my old, long-past life as a therapist, I'd suggest a therapy technique... If she's so inclined, she could write down the thoughts and related emotions she's having as she's waiting in the doctor's office and getting her bp taken. Then she could look at those thoughts, see if she can "talk back" to them, and see if she gets an emotional change. (You could try it, too, to help you calm any anxiety and stress when they send you both to L&D again!)

(for example: Thought - the longer I sit here, the higher my bp is going to be; Emotion - fear; Scale 1-100 - 100; Change Thought - even if it's high and we're stuck at L&D again, every other time the numbers have come down and all the labs have been good; Emotion revisited: fear; Scale 1-100 - 50 (not cured, but a little better). She probably has TONS of thoughts going around her head, and changing any or all of them may not actually help the white-coat high readings, but dealing with the thoughts differently might help her feel a little better...)

Unfortunately, this really is more in the line of "therapy" (cognitive-behavioral), and it's not something you can really help her with. If she's at all inclined, I'd suggest the book Cognitive Therapy, Basics and Beyond by Judith Beck - or a good C-B therapist!

Then again, she has 2, maybe 3 weeks of this left, so maybe it's easier to just endure the panic and not try to deal with it any further!!!

Regardless, have the docs given you an induction date? 37 weeks? 38? Or at least list what they will look at in deciding when to induce? And if they give you that crap (sorry, just my opinion [;)]) again about "but would you understand the lab values if we told you?", you or Julie (whoever is interested) could say no, but it would help my anxiety level to know them, I'd appreciate it so much if you or a nurse could take the time to explain them to me. You can always bring the numbers back here, too, but I'd bet you'd feel better about your doctors if they involved you in understanding what is going on. Sometimes in PE they have to move very fast and can't take time to explain, but it sounds like right now there is time.

Good luck and keep us updated!

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[aundapenner]

I just wanted to pop my head in here and say how much of an awesome husband you are!!! Your wife and son are fortunate to have you as an advocate. Keep up the good work!!! (My husband also learned this during our first pregnancy last year.)

When my BP spiked, my doctor sent us to L&D where we spent all day Easter Sunday last year. Finally, he came in and told me to quit work! Ha! But he was serious. Bedrest worked for me. It bought me 5 more weeks until 34 weeks. (Super big congrats for taking it one day at a time and hitting 35 weeks and counting!)

My BP readings gradually became worse, even though I wasn't doing anything all day. It even got to the point that when I was move from a lying down position to a seated position to take my BP I had to wait 15 minutes or so to lower my BP. (And by lower, I mean to get a reading of 140/90 instead of much much higher.)

Keep up the good work and remind Julie that we're all pulling for you guys!!!

[anathor21]

The dual check of the 24hr is interesting - especially with the change that they reported. In any case I would certainly be asking for the actual numbers going forward and not settle for "negative" or "It's ok" as an answer. Knowing they do it twice (for whatever reason - I'm eager to learn about that process as I've not heard of that before, perhaps it is common and I just never ran into it...) I'd be asking for both results.

In any case it sounds like the race is on - but you are well along having reached 35 weeks and already having good support in place as well as generally knowing what is going on. This puts you in such a good position compared to so many unfortunate folks out there who just don't get the information in time. Can't let your guard down, but at least you know the game.