Do they need extras for the AMC series “The Walking Dead?”

I have had heart issues for over 4 years.  I have learned to live with a recurring issue that sometimes frightens the medical professionals who take my vital signs.  Some of my vital signs are on the low range of normal, or even sub-normal!  From the startled reactions I sometimes get, I wonder if maybe I should be looking for employment as an extra in a zombie movie or television series.

My temperature runs low, usually 97.6 or even as low as 96.6.  This does not seem to be disconcerting to the any of my doctors or nurses.  The most apparent vital sign that has alarmed some medical professions is my extremely low blood pressure.  I don’t want to be too critical of their concern.  Some of the blood pressure readings I have are disconcerting:  80 over 60, 78 over 53, 78 over 58.  The readings are a little out of bounds given that current guidelines list a normal blood pressure as lower than 120 over 80.  A blood pressure reading of 90 over 60 is generally considered as low blood pressure  So yes, I can see initial concerns if people see that my pressure is 78 over 53 and do not know all the facts.  
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Additionally, to be fair, the first person I can remember who was shocked at my blood pressure was a trainee with the ambulance crew.  Given his training status, I may have been one of the first patients he ever encountered with blood pressure this low.  Having just suffered an issue with a blackout on a treadmill, I was a little out of it and I was not picking up on his panic.  But my brother-in-law noticed that the technician reacted as though I was a talking dead person.  He reassured the technician that “her blood pressure does run low.” 

But since that time, many people who are not in a training status have been taken aback when they take my blood pressure.  So I decided to put my lawyer skills back into use and make a case for what low blood pressure is and why medical professionals should listen to me and just accept that this is “normal” for Melanie.

The term for low blood pressure is “hypotension”.  If you research hypotension you will learn that some heart conditions that can lead to low blood pressure include extremely low heart rate (bradycardia), heart valve problems, heart attack and heart failure.  You will also learn that these conditions may cause low blood pressure because they prevent your body from being able to circulate enough blood.

So when we aim at the low blood pressure target, I score pretty near a Bull’s eye!  Almost all of those conditions, with the exception of a heart attack, are conditions that I have.  Since I have 3 of the 4, is it surprising that my blood pressure can be so low?     

First, let’s look at the condition of an extremely low heart rate.  In the first three months of 2013, the
bradycardia was so pronounced that I blacked out several times and was profoundly dizzy many many more times.  My heart rate was so low that within two weeks of the diagnosis of bradycardia, I went to the hospital to have a pacemaker planted inside me.  Thankfully this device inside me now makes sure that the pacing of my heart is regular.  I think the pacing is now in an acceptable range, as a monitor checks it every day.  But I have learned that regular pacing does not necessarily equate to raising my blood pressure to a normal level.  

Second, a normal resting heart rate for adults ranges from 60 to 100 beats a minute.   My resting heart rate is usually in the 60 -70 range.  So it is on the low side of normal but still normal.  I assume that this regular and normal heart rate is largely a result of the pacemaker function in my cardiac device.

Third, let’s not forget that for four years, I have been diagnosed with the condition of “heart failure”.  Again, heart failure does not mean a heart has failed to the degree that it is not functioning at all.  Rather, it means that the heart isn't pumping as well as it should be.  I know I’m not a doctor but I think the fact that my heart is not pumping as well as it should again means that the pressure to pump the blood can be low. 

Fourth, I also have a leaky mitral valve.  The leakage causes some of the blood that is pumping out of my heart to fall back into my heart and have to be pumped back out again.  As you can imagine, this is not an efficient manner of pumping blood to your organs.  No wonder I can’t exercise or climb stairs quite like I used to!!!   No wonder my blood pressure, in essence a measure of how your heart pumps blood, is low!!!

Finally, let's not forget those pesky medications they give me to address my heart failure.  There are about 3 or 4 that I take - two I take a few times a day, one I take once a day, and one every other day.  They all seem to have warnings that they may lower blood pressure.  I think I am living proof of the validity of that that warning label.  But you don’t just stop taking medication because of a warning label.  You balance the risks of having your heart failure get worse absent the medication versus the risk of low blood pressure. Since I am still functional despite the side effects, then it makes sense to continue on the medication that can help my heart so much.

Finally, I have heard for a number of years that athletes and people who exercise regularly tend to have lower blood pressure and a slower heart rate than do people who aren't as fit. Additionally, people who do not smoke and who eat a healthy diet and maintain a normal weight tend to have lower blood pressure and heart rates than those who smoke and do not watch their diet and weight.  Well, here is another bulls-eye.  While I am not an Olympic athlete by any stretch of the imagination, I have exercised daily for years, I don’t smoke, I eat a healthy diet and other than water retention caused by my heart failure, my weight has been stable for years.  So wouldn’t this healthy behavior also be a factor in my unusually low blood pressure.  So I view this as a positive thing that my lifestyle overall is healthy, and not a danger sign.

​Because I do understand the initial shock that medical professionals can have when they see my blood pressure reading, I try to give them advance warning.  “Hey – just a heads up.  My blood pressure can be very faint to register and can run very low.  It’s okay, I have heart failure and my heart doctors are aware and not concerned at this point.” 

Sometimes it works.  But sometimes what the person is reading on the blood pressure monitor overtakes any reassurance I might give them.  I remember one technician who took my blood pressure asked me  "are you sure you don't want to sit down for a few minutes before I take you back to see the doctor?"  I told her "Trust me, the pair of high heels I am wearing has a greater impact on my balance and ability to walk than my low blood pressure."  She did not seem to be reassured by this statement.

So I have made the following sign for those people who need just a little more proof that I am not in danger.  And if this does not work, I’m thinking of trying out for the next extra position in “Walking Dead.”
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"This is the new energy efficient version of the heart failure patient.

Do not be concerned if her blood pressure is that of a zombie!!!