White Coat Syndrome:
White coat hypertension, also known as white coat syndrome, is a situation in which people have high blood pressure readings in a clinical or healthcare setting, but not when they are in other settings. It’s believed that this is due to anxiety with doctors, fear of doctors, or general anxiety related to the visit in the clinical setting. It’s called white coat syndrome because of the white coat or jacket that is worn by the health care professional that you are visiting.
There are conflicting opinions out there as to whether or not white coat syndrome carries any health risks. Many medical experts see it as a harmless condition. Studies that have been published indicate that white coat hypertension could carry a higher risk for cardiovascular disease compared to people who have normal readings at the doctor’s office. Other studies indicate that the risk is limited to older people (over 60) who already have at least 3 risk factors associated with cardiovascular disease (smoking, obesity, diabetes, etc.).
White Coat Syndrome and me:
It’s my first trip to the dentist in years. We’re talking more than a decade type of years. “You have less tartar on your teeth than people who had their teeth cleaned 6 months ago”, the good dentist says.
“See, ” I tell myself, “now you can stop worrying about how long it’s been….you’ve been good to go all along.”
That was about the only good news of that visit.
The assistant kept taking my blood pressure and finally asked me if I was feeling nervous or anxious.
“I’m anxious about why you keep taking my blood pressure.”
“Well,” she said, “it’s better now, but it’s still really high.”
Honestly, I’d never kept an eye on my blood pressure and I was clueless as to what a “normal” reading should be. Let me just say that, depending on which Google hit one might click on when trying to determine the significance of such a reading, some contained words like “hypertensive emergency”. Yikes. That was the last day I was uninformed about what a healthy blood pressure reading should be (120/80-140/90 fyi). Knowing now what I know about myself when it comes to medically related visits, some of that reading was simply due to the fact that I was at the dentist. But not all of it….. far from all of it.
Fast forward 4 months:
Things are good. I’ve learned a lot about ways to lower my blood pressure naturally and have a good regiment in place. My BP is mostly in the normal or just barely above range both in the morning and at night. But, later today, I have an appointment with a dermatologist to determine if this “thing” on my skin is anything to be concerned about. Just THINKING about going to my appointment sends the anxiety monsters rushing in.
…….what’s my problem about this doctor stuff? Why do I get so nervous?…..
So, I make sure to check and note my morning reading that day. All good; normal. Normal to me is 120/80 or lower.
2 p.m. in the dermatologists office:
“Your blood pressure is high. It’s not high enough that I need to report it to your doctor but you need to keep an eye on that.”
Ugh….. nothing like ushering in the rest of the anxiety ensemble onto the red carpet.
“It was good this morning,” I explain, feeling like somehow I have to defend myself.
….. nothing like confirming this underlying unexplainable dread that yes, you are now being judged……
On this day, I was so glad to learn that my skin “stuff” was normal and harmless that I was quickly able to transition into not making a big deal over the blood pressure. Just keep doing the work, I told myself.
That evening at home; BP totally normal.
A year later…….
My blood pressure readings have been so consistently normal that I’m now only checking it once or twice a month. As long as I keep doing the work……. diet, exercise, weight management, a little Carditone every now and then……. it’s all been so consistently good. But, this morning I wake up remembering that I have an appointment with the doctor and I feel it rising; the fear – fear of bad news? Fear of judgment?
What IS this?
So, I take my blood pressure in the morning. All good; normal.
3:30 p.m. in the doctor’s office:
“Your blood pressure is above 140/90.”
“Hm, well, it was normal this morning but yes, I do have to work at keeping it down,” defending myself, again.
“The doctor might want to put you on something for that. I take blood pressure medication and my blood pressure is fine now.”
No. Hell no.
It’s not so much about taking the meds.
Yes, I’ve heard that there are side effects that I don’t want, especially the persistent dry cough. But there’s something else going on here…………….
- I’m not ready to throw in the towel; admit defeat.
- I can do this.
- I have been doing this.
- I DON’T want to go on blood pressure medication.
- Plus……. there’s the little problem of these things seeming to follow you around for the rest of your life once it lands in your medical record. I’ll be labeled as hypertensive for life…….. I have no idea how health insurance will be structured in the future………This could hurt me if I let them write it down.
Enter the doctor:
“Your blood pressure is quite elevated. It’s 160/100.”
“Hm, well it was normal this morning.”
I go into the history of the dentist and how I’ve made changes in my life and that I’ve been successful in keeping it in the normal range for about the past year and a half.
We agree that I will check it several times a week and then bring my tracker to the next appointment and we’ll go from there.
I checked it twice a day, every day, for 2 weeks. Normal, normal, normal…….even after my morning coffee……
I wonder if my blood pressure monitor might be out of whack……..
2 weeks later at the doctor’s office:
147/85. Ok, better than last visit but still, much higher that it was that morning and much higher than any reading on my tracker.
I hand the nurse the blood pressure monitor I use at home. I want to calibrate; make sure it’s working correctly. 145/82. Ok, well, at least it’s not broken.
“I think it might just be the fact that I’m here, in the doctor’s office.”
“Some people DO experience a thing called white coat hypertension, where they have elevated readings during doctor visits. Keep tracking it and we’ll review it again at your next visit.”
Not 2 hours later at home: 114/72. Go figure.
Can anxiety cause high blood pressure and is the way to beat white coat syndrome an inside job?
Without needing any science to back me up, I know in my gut that going to the doctor, the dentist, the dermatologist; anything where there are “medical” people involved….I get super anxious; nervous. I can feel my heart start to race. I can feel the unease rising up in my throat, my hands going cold….. it’s like I can just watch any sense of feeling solid, grounded, and centered just float away like a puff of smoke from a chimney.
Even sometimes, if I decide it’s time to check my blood pressure at home, I’ll have the same experience and I’ll have to sit and calm myself for a few minutes before taking my 3 reading average.
I think that white coat hypertension is the physical manifestation of my mental or emotional state of being. And it’s all based in fear.
All fear, whatever form it takes, leads back to the fear of dying.
Lose your fear of dying = no more white coat syndrome?
It’s probably not that simple. Or is it?
For all the soul searching around this that I’ve done, I’ve come up with 3 drivers to white coat syndrome for me:
1) Fear of the BP reading itself:
I’ve done so much work to get and keep my blood pressure down, that I fear it will all come crashing down with one high reading at the doctor’s office. That no one will believe me. Or worse, that it will be through the roof, a true “hypertensive emergency” (that Google search did a number on me) with ambulance sirens wailing and me wondering how I’m going to get free in time to let the dogs out before they make a mess in the house.
Even at home, I take an average of 3 readings, and my first one is always the highest. As soon as I’m done with that one, and see that I in fact am NOT in a “hypertensive emergency” situation, everything in me relaxes. I know this about myself, so I throw the first reading out. Invariably, the next 3 readings are much better and are for the most part, consistent.
2) Memories:
If you’ve not yet had the experience of associating a doctor’s office to a serious or terminal illness of someone you love and care about, consider yourself blessed. My mom died from pancreatic cancer. So there is always this underlying fear that I’m going to be diagnosed with this as well. Doctor’s offices are great reminders…….
3) Judgment/disapproval/shame:
As I’ve cleaned up my act over the years, I have less concern in this area when going to the doctor’s office. But there’s always something. Instead of me perceiving all the questions about when my last mammogram, checkup, pap exam were done (all overdue) as just my doctor doing her job and being thorough, I instead interpret it as an indictment that I’m irresponsible, failing, a loser, getting at D-, etc. when it comes to taking care of my health. And why is this, when the truth of the matter is that I make healthy choices and engage in healthy behavior everyday?
The one thing I can say about all 3 of these things is that they are mostly founded in contradictions to truth. When I get settled and relieved to be done with the doctor, I reflect on this, and I see the lack of logic in my thinking. So I call the lies out for what they are. And, I learn to say, “so what.”
Getting to “So What”:
If I have a high reading at the doctor’s office…… So what?
If I explain that I’ve been tracking my blood pressure for several months and it’s normal, and no one believes me; so what?
Even if they do, God forbid, write it down in my record (gasp)…… so what?
If I can just surrender to the fact that this might happen, the walls aren’t going to come crashing down. Life will go on and I’ll be labeled as hypertensive for the rest of my life. So what?
If I die……. so what? I AM going to die, after all. No one has escaped it. When I think about WHY I’m afraid of dying, it’s not the dying itself. It’s the grief that those who care about me will go through. However, It is the nature of life to move on; that’s what people do.
There are as many spiritual paths as there are people. I am of the belief that this isn’t all there is. I believe that our consciousness continues on indefinitely. As the popular saying goes, “We are not human beings have a spiritual experience, we are spiritual beings having a human experience”. When I stop to realize that in spite of the grief and hardships that might come from my passing, the human spirit is very resilient. People really do move on and move forward. When I remember that, I am at peace with knowing that the end of my role as it is now, is not the end of me.
I’ve grown a lot in terms of learning to deal with fear. I continue to reap many a benefit from receiving spiritual guidance, meditation, and I’m one who prays.
The association of doctor’s offices and my mother’s death isn’t really about her dying, or me being afraid of getting ill and dying in the same manner. It’s about the unresolved stuff in my relationship with my mother that we never got to work out. And once I know and acknowledge this, there’s a TON of good stuff I can do, even with her gone, to find peaceful resolution.
If the doctor judges me……..so what?
The doc and I aren’t exactly bff’s hanging out together after hours. In fact, once I’ve left the office, I seriously doubt if the doctor gives me a second thought.
At the end of the day, this is really about ME judging me. Keeping myself on the hook for whatever. One thing I know to be true: your life is always speaking to you. So this is an ongoing project for me; learning to stop judging myself and learning to love myself. Another thing that I know to be true, when you stop judging yourself, then, and only then, can you stop judging others.
Getting to “so what” is not the same as saying “I don’t care”….
It’s about accepting the possible outcomes that life might hold and trusting that things will work out. It’s about embracing the uncertainty rather than trying to run away from it.
There are always choices. I can focus on the negative, or I can remain hopeful and focus on the positive. I can keep myself on the hook for whatever, or, I can open the door and breath in the fresh scent of infinite possibility. It’s my choice, daily.
