This week has mainly been about blood pressure! When I last blogged, I was waiting to speak to a doctor about why they wanted to start me on a drug to lower my BP, when my readings at home were within the normal range.
On Monday I went back to the day assessment unit (DAU) where I had last seen the doctor who prescribed the drug on Friday. Once again my BP was high in hospital. I explained my situation to the nurse who called me in from reception. She understood my concerns and said I didn’t have to take a drug if I didn’t want to, and that she would get a doctor to speak to me. The doctor came pretty quickly and was much more open to chatting to me about it than the one I’d seen before, which was great. However, after listening to my concerns that my BP at home is fine, and therefore the drug would bring it too low, she explained that she would still like me to try the drug for a few reasons.
First, I’m only in the second trimester, when BP should be on the lower side of normal, so that it has room to increase naturally in the third trimester as the babies grow. Second, even if it’s just spiking in hospital, that’s not good for me, and they need to do something about it. She wouldn’t let me go home with such high readings that day, I would have to take the drug and it have a measurable effect there, or they’d keep me in (that would be totally counterproductive, but there we go!) Third, a couple of my readings at home were in the mild hypertension range (which the NICE guidelines say don’t treat with drugs), and even if it’s just one reading a day that high, I should try the drug. Fourth, it’s twins, so I’m at an increased risk of preeclampsia, which can show at any stage of pregnancy. I should add here that I’ve had several blood tests and urine tests at every stage of being in hospital with high BP and none of them have shown any signs of preeclampsia. I could kind of see the logic in some of her points, and agreed to take the drug there, mainly so I could get out of the place again! Thankfully it worked and my BP came down to the high end of normal so they let me go.
They gave me another 24 hour cuff to take home, and I had to go back in the next day to return it. The results showed that my BP was really quite low in the afternoon and overnight. Then the next morning they seemed to go up again to high end of normal / mildly hypertensive. However, I had seen this on the hospital 24 monitor at the time it measured, and decided to compare with my home one – mine was reading a lot lower when done at the same time! The day before my machine was reading similarly to theirs. So I’m not convinced that this wasn’t a fault. Also, the dose they gave me in hospital was twice that of what I’d been prescribed to take at home, so the large effect after the first dose was probably then in contrast to a smaller effect after the doses I took at home. Confusing!
A midwife looked at the 24 hour results and agreed that they looked very low and then much higher. She asked a doctor and the doctor said I should start taking the double dose that I did in hospital at home. I was reluctant, because it had gone so low at home after that dose in hospital, but by that point I figured I might as well do it, to get them off my back! If I fainted, that would be good evidence to show them I don’t need it.
The next day, I didn’t actually faint, but I did feel light headed when getting up, walking around or standing for a while. This wasn’t a good feeling when I had to do the school run and look after Joel on my own. I tested with my own BP monitor, and the numbers were coming out really quite low, especially when I tested immediately as I stood up. They went up a little towards the end of the effect of morning dose, before I then took the evening dose.
I had to go back in the next day for a BP check (slightly pointless being in hospital for it, but hey ho). I explained my light headedness and low numbers to the nurse, but my BP was still high in hospital. As it was Thursday, she said the twins clinic doctors wanted to see me to discuss everything that had been happening with BP that week. I’m so glad they did!
I got called in by an obstetrics registrar whom I hadn’t seen last time at twins clinic. He was lovely. He talked through my gestational history (which he said is excellent), my general health history (I’m young, fit and healthy), my experiences of miscarriage and hyperemesis (which I don’t think help my anxiety in this particular hospital where I’ve been treated for both), and the results of various BP tests in hospital and at home this week, including my home monitor readings and my light headedness. After all this he said that in his opinion, I’m fine! I’m not chronically hypertensive, and I don’t need to be on the drug at this point. I do have huge spikes in BP due to “white coat” hypertension when I’m in hospital, but he said my mean 24 hour readings before the drug were great, and he looks at the mean, not one-off results that could be explained by external factors (like anxiety). He said the DAU doctors tend to see the word twins, then panic and over medicalise it, thinking of all the things that could go wrong. He reassured me that it was nothing to worry about, and to trust that my body can do this. Of course they will monitor me, but he said all the hospital visits this week had stressed me out and they should leave me alone for a while, so I should go home and relax. I have a scan booked for next week anyway, so I’ll be back then. He admitted that the feeling of being light headed was not good, and if my BP was too low it could be more harmful to the babies if they don’t get enough blood from me, so told me to take the lower dose of drug for now (it’s dangerous to suddenly stop taking it all together as it could cause high BP!) He said he trusted that I’m a sensible person who clearly understands BP and would tell them if I had concerns that things had changed.
I came away from that appointment on cloud 9! It was so refreshing to speak to a doctor who really understood my concerns and who agrees that twins in itself is not something to over medicalise. I have no risk factors in this pregnancy other than twins, so it’s really nothing to get in a flap about. I feel so much better at the end of this week, and even my sickness has been a bit better since then, so I’ve managed to eat and drink more. I’m hoping this continues next week too!
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