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Crash Into Me, yeah.

August 9, 2013

cuffs

One size does not fit all.

Yesterday I  had to go to Walgreens to turn in a prescription for the hubby for some pain medicine he’ll need next week when he gets a wisdom tooth removed.

As I made my way to the pharmacy department, a 10- to 12-year-old boy ran full out and crashed into me. He hit my breast with his hand and my ribs with the same elbow (I think, it’s not like I had time to see what he’d done). He didn’t even stop, just yelled “sorry!” over his shoulder as he ran out the door.

*sighs* Some people’s children, yanno?

He hurt me. My ribs hurt and grew worse as yesterday went on. I didn’t get much sleep last night because the pain kept waking me up. There were a couple people on my case about going to an urgent care center.

So, after driving a friend to her monthly doctor’s appointment (and hurting a lot more from just that little bit of activity), I came home, woke the hubby up, and had him take me to urgent care.

The good news is that no bones are broken. YAY!

The bad news is that I feel like such a fool for not waiting an extra couple of days on this. Cuz, ya know, an unbudgeted $85 for a visit plus pain meds isn’t an easy thing (especially since we just spent an unbudgeted $150 on the car last week).

All of this is to say that 1) this isn’t the post I was planning on writing last night or today, and 2) this is a post that I’ve probably written before a million times.

The urgent care I went to was one I’ve visited before, so I knew they didn’t have an anti-fat agenda.  Or at least, they didn’t last February when I had a nasty bacterial respiratory infection.  They insisted on the weigh-in, and really, I was hurting too much to argue.

However, they did have a “one size fits all” mentality with the blood pressure cuff.  They took my reading, with a normal size cuff, and it came up high: 140/104. Imagine that. The nurse taking my blood pressure told me it was “a little high,” but he wasn’t worried about it since I was in a lot of pain and pain always causes the blood pressure to be high.

I get that, I really do.

However.

One of the things that concern trolls like to trot out any time fat people talk about being healthy or Health at Every Size® is that we can’t be healthy due to our fat. They trot out things like increased hypertension and increased risk of stroke being caused by being fat. It’s not, they are co-morbidities, and correlation does not equal causation, no matter how much people want to argue it does. And, if that urgent care reports contributes medical records to an epidemiological study, I’ll surely be one of the statistics showing the “proof” of this.

However.

The proper size cuff really makes a difference.  When medical personnel use the correct size cuff on me, My blood pressure is usually in the 110/70 range, and rarely higher than 120/80. There have been a couple of times when I’ve been as “high” as 124/85. One doctor told me that my BP was “dangerously high” and that I needed to lose weight immediately or I was going to die  she was going to have to put me on blood pressure medicine. This was the same doctor who told me that I had a BMI of nearly 50 and I was going to die if I didn’t lose weight… well, yeah, I was going to die. The kicker? She did the math wrong. My BMI really is 42. Yup, still in the “I’m going to die yesterday” range, but not in the “OMG why aren’t you dead yet?!” range.

I don’t know what my real blood pressure would have been today. I was in a lot of pain, and it really does have an effect on blood pressure. And I have to say, being in so much pain, I didn’t have the ability to even ask them to get a proper-sized cuff.

I just took it as a win that my bruised ribs (because that’s what the problem is) was not blamed on my fat.

Personally, I’m really glad my rib isn’t broken, because the doctor was talking about a 12-week recovery process from a broken rib.  Even just a bruised rib is a two- to three-week recovery process. While that’s better, it’s still not good enough. I’ve got stuff to do, things to get ready for. Hopefully, the pain medicine the doctor prescribed for me will help take the edge off the pain without leaving me too loopy so I can get back to work.

Candy doesn’t make itself, and I have a big selling event coming up.  In three weeks.  And I don’t have near enough candy to sell if I can’t make any more in between now and then.

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12 Comments leave one →
  1. Lauren C. permalink
    August 9, 2013 9:11 am

    So glad your ribs are not broken! This post was a BIG OHHHHHH, that’s why moment! I have one doctor (out of 16) who can never get my blood pressure! I thought the cuff fit, but maybe not. Thank you! Feel better!!

    • bronwenofhindscroft permalink
      August 9, 2013 10:56 am

      If they use a standard sized blood pressure cuff, it’ll give a false high reading more often than not. Many offices have a size of cuffs, but I find it depends on the individual nurse whether they use them or not.

      And thank you, I’m doing my best. The medicine they gave me has made me too loopy to do anything but sit and sleep. This is probably a good thing, as I’d probably … most likely overdo it if I wasn’t so sleepy and subject to major nap attacks right now. :)

  2. August 9, 2013 10:26 am

    So few health care “professionals” are aware of the cuff size issue. And, anyway, you’d think that such places would have the larger cuff for thigh usage on smaller folks anyway. Glad you’re on the mend!

  3. Chutti permalink
    August 9, 2013 11:02 am

    Ugh, sorry to hear about your ‘accident’. Home training, whut?

    I am really struggling with how to deal with the BP issue myself. I had to see my GP for a recurring virus after having been floored by pneumonia this spring. She has never been explicitly fat shaming, but I think she’s just a really hands off lackadaisical doctor. I am good at advocating for what I want, but don’t really trust her in a pinch, either.

    For the umpteenth time, despite requesting the large cuff, I got a very high reading. For the first time, she did it herself instead of the staff. I read recently about hints for proper measurements NOT including pumping the cuff up to 200 and going down. When your arm feels like it’s going to pop, ya just don’t get a true reading. I told her it HURT, and she just kind of sighed it would be over soon. She just told me it was high, and I wasn’t up for educating her when I had to get back to work.

    Guess I should start shopping for someone better before I really really need it.

    I have thought about getting my own cuff so I can actually know what my pressure is. It would be nice to know and be able to counter whatever crap is in my charts. Anyone have recommendations for a good one for fatties?

  4. Duckie permalink
    August 9, 2013 11:25 am

    I didn’t know one could take BP on the thigh….I once was at a doc’s office where they couldn’t find a cuff large enough to go around my upper arms, so they took it from my lower arm. I thought that was strange. Anywhere else you’ve seen BP taken? Anyone know the relative accuracy of BP taken from alternative areas of the body?

    • bronwenofhindscroft permalink
      August 9, 2013 11:28 am

      My friend who has a monthly doctor’s appointment has her blood pressure taken on her wrist. It’s a relatively new thing, and from what I’ve seen, most doctor’s offices don’t have that yet. I have to wonder if they have different sized for the wrist cuff, though, and how having a too small size would effect the reading there as well.

    • August 9, 2013 12:36 pm

      I also have my BP taken on my lower arm when they don’t have the right size cuff. In this case, these readings are often way too high, as BP is supposed to be taken at heart level. Since practitioners don’t usually tell patients to raise their lower arm to heart level, the readings are inaccurate. For this reason, I don’t pay attention to any readings that aren’t done with the correct size cuff because I know they aren’t right.

    • August 9, 2013 12:40 pm

      Oh, and I found this bit of info…”Talking on the part of the patient during measurement can elevate systolic and diastolic pressures by as much as 17 and 13 mm Hg respectively, while ingestion of alcohol within 3 hours of measurement has been reported to increase systolic and diastolic pressures 7 and 8 mm Hg respectively. Caffeine may elevate pressures by several mm Hg, particularly in those not used to caffeine intake—effect is thought to be minimal in individuals used to drinking caffeinated beverages. Failure to provide support for the arm can result in an error of at least 2 mm Hg (systolic and diastolic pressures), and perhaps more. Systolic and diastolic pressures may both be increased 8 mm Hg for every 10 cm the arm is below heart level, and decreased 8 mm Hg for every 10 cm above heart level. It has been reported that use of a cuff that is too small can result in a systolic pressure that is 8 mm Hg lower than the actual pressure, and 8 mm Hg too high for the diastolic pressure. However, most medical sources state that too small a cuff will result in erroneously high readings and too large a cuff will result in readings that are too low, without making a possible distinction between systolic and diastolic pressures. It is clear that even everyday activities can result in significant elevations of blood pressure from their prior levels. For example, walking, dressing, attending meetings, commuting, and talking on the telephone have been reported to increase systolic pressure by 10-20 mm/g Hg systolic and with a somewhat lesser increase in diastolic pressure. Psychological stresses, such as performing mental arithmetic, can result in significant increases in blood pressure. Also, various sources report a significant difference between blood pressure in the left and right arms in about 8-30% of patients. It is widely agreed that, on at least initial evaluation of a patient, blood pressure should be measured in both arms—though rarely done in practice by most doctors and nurses.”

  5. reeneejune permalink
    August 9, 2013 12:00 pm

    I wish they would make the larger size blood pressure cuffs a little differently. Longer than the average size, but not wider. As it is, the large cuff covers nearly my entire upper arm, which can make it difficult to position correctly, and difficult for me to let my arm completely relax.
    I was also told by a nurse practitioner once that body position can affect the reading as well. She warned me in particular to ensure that my legs are not crossed and that my feet are comfortably flat on the ground or exam table step. So many little things can make that reading appear higher.

  6. Chutti permalink
    August 9, 2013 4:40 pm

    Wow. Like many things, I am learning just how much I *don’t* know. Sigh.

  7. LittleBigGirl permalink
    August 12, 2013 12:39 pm

    I don’t know what to tell my med place about taking my bp. I want it to be accurate but I cannot stand the pressure of the cuffs. No, just making it tighter won’t help you blank blank idiot! I always end up with red marks on my arm after like it tortured…and it feels like torture when it is happening! I don’t think I can take the pressure even if the cuff is the right size.
    Gee, wonder why my bp is high – could it be the stress and agonizing pain of having it taken in the first place? >:( *sigh*

    • August 13, 2013 10:19 pm

      And the most irritating thing is that they inflate fat people’s cuffs tighter because they assume there will be a higher reading. When I trained as a medical professional, I learned to inflate to 160, unless there was a need to inflate higher because I couldn’t get an initial read. Many nurses I see inflate to at least 100, and my arm turns colors. I’m like, um, excuse me, I am diabetic, and you know you shouldn’t be messing with my circulation like that. My bp isn’t high, so there is no need for them to inflate higher than normal because of their bullshit assumptions. I imagine that is not just happening to me.

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