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What Causes Fluctuating BP Readings Along With Difficulty In Losing Weight?
Question: Hello!! I am a 47 yr old female that just relocated to fla. I started swimming 5 weeks ago . 7 days a week for 2 3 hrs a day. And haven't lost a pound. I have cut out carbs. And eat a lot of chicken and salad. I went to the dr for a check up in XXXXXXX and my blood sugar was 104 when I went back to the dr 3 months later my gloucose was 124 now I metformin. And it seems like my blood pressure flucksuates between 117 /85 and 135/92 do I need blood pressure pills. That's why I started swimming to avoid taking pills. The only thing I have is sore muscles. And still haven't dropped a pound. I have just taking my blood pressure 448pm and it said 126/78. I went swimming this morning at 630 am for 1 hr and then sat in a hot tub for 25 minutes . And I came home and checked my blood pressure for the 1 st time at 9:30am and my Bo wAs 134/77 than I went to publix to use their Bo machine and I got a different reading it said 134/89. How come when I go to. My dr my Bp 140/90
Brief Answer:
Blood pressure fluctuates from minute to minute.
Detailed Answer:
Hello - I think you are asking about a few of things:
Why you haven't lost weight with exercise
Why your blood pressure is higher at the doctor's office or fluctuates.
Do you need anthypertensive medication for your blood pressure.
First about the weight loss:
Newer studies are indicating that exercise, while important for general fitness and cardiovascular health, does not cause much weight loss, especially for women.
The main mechanism for losing weight is decreasing calories. It sounds like you are already doing that. Things to also watch out for are alcohol (which can also effect your blood pressure) and sugary drinks.
If you have done all of these things and loose no weight, and if you are significantly overweight, you may want to ask your doctor for a referral to a weight management clinic such as at a university hospital if you have one nearby.
About the blood pressure:
The swimming and exercise in general will ultimately be a good thing. Alcohol, as stated above, can drive up blood pressure. Also some people's blood pressure is affected by salt intake.
I usually put people on blood pressure medicine when their pressures are consistently over the following:
Upper number (systolic blood pressure) over 140
Lower number (diastolic blood pressure ) over 90
Some recommendations now are to start BP lowering medicine when the systolic is consistently over 130.
By consistently elevated I mean at least 3 readings.
Blood pressure fluctuates somewhat from minute to minute depending on many variables that affect the maximum and resting pressures in your arteries. Physical activity, stress, etc can make it higher temporarily. When you go to the doctor's office, you may be slightly stressed. It is so common that there is even a name for having blood pressure go up initially at the doctor's office - "White Coat Syndrome"! So, if I am concerned because of a mildly elevated blood pressure at an office visit, I have a patient keep track of their blood pressure in non-medical settings and then let me know what they are.
I hope this answers your questions. Please let me know if there is anything further I can clarify.
Blood pressure fluctuates from minute to minute.
Detailed Answer:
Hello - I think you are asking about a few of things:
Why you haven't lost weight with exercise
Why your blood pressure is higher at the doctor's office or fluctuates.
Do you need anthypertensive medication for your blood pressure.
First about the weight loss:
Newer studies are indicating that exercise, while important for general fitness and cardiovascular health, does not cause much weight loss, especially for women.
The main mechanism for losing weight is decreasing calories. It sounds like you are already doing that. Things to also watch out for are alcohol (which can also effect your blood pressure) and sugary drinks.
If you have done all of these things and loose no weight, and if you are significantly overweight, you may want to ask your doctor for a referral to a weight management clinic such as at a university hospital if you have one nearby.
About the blood pressure:
The swimming and exercise in general will ultimately be a good thing. Alcohol, as stated above, can drive up blood pressure. Also some people's blood pressure is affected by salt intake.
I usually put people on blood pressure medicine when their pressures are consistently over the following:
Upper number (systolic blood pressure) over 140
Lower number (diastolic blood pressure ) over 90
Some recommendations now are to start BP lowering medicine when the systolic is consistently over 130.
By consistently elevated I mean at least 3 readings.
Blood pressure fluctuates somewhat from minute to minute depending on many variables that affect the maximum and resting pressures in your arteries. Physical activity, stress, etc can make it higher temporarily. When you go to the doctor's office, you may be slightly stressed. It is so common that there is even a name for having blood pressure go up initially at the doctor's office - "White Coat Syndrome"! So, if I am concerned because of a mildly elevated blood pressure at an office visit, I have a patient keep track of their blood pressure in non-medical settings and then let me know what they are.
I hope this answers your questions. Please let me know if there is anything further I can clarify.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello!! Again I am 5ft 5 in and I weigh 225 pounds. 45 pounds over weight. I was on resperdol for 27 months because I did something stupid. I smoked that synthic marajuna. And believe I gained these extra pounds from the medication. The dr in nj took me off the medication in XXXXXXX 2015. I've been off of the med's for 6 months now. But the medication resperdol says can cause diabetics. So when I moved to fla in dec 2014. I found a dr for a check up and my gloucose was 104 than 3 months later I went back for a follow up and had more blood work done that 2nd gloucose test came back at 124. So the dr out me on metformin. To help lower my sugar. She said I would become a diabetic it I didn't take the metformin. I thought your gloucose level had to be over 165 to start taking metformin.do I really need to take this medicine. Or is my gloucose going up because I'm not taking resperdol anymore.
Brief Answer:
A1C test of 7 or higher indicated the need to start a medicine.
Detailed Answer:
There is a blood test called Hemaglobin A1C or just "A1C" which gives a better picture of your blood sugar and when to start treatment as it is an average of your blood sugars over approximately a 2-3 month period.
Medicine to lower blood sugar is usually started when the A1C is over 7 or more.
The Risperdal could very well have caused the increased weight gain. This is a common side effect with this class of medication. It can also predispose or aggravate diabetes while taking it.
I do not think that going off of the Risperdal would cause your glucose to go up.
My guess is that your doctor prescribed the metformin because she was concerned by your weight plus what appeared to be increasing blood sugars.
You can ask her to order an A1C test to see what your sugars have been on average, although it would be hard to tell what your baseline is now that you have been on metformin. But if you just started the metformin recently, such as the past couple of weeks, the A1C test will still show what your glucose levels were on average in the past 2-3 months.
I hope this information helps.
A1C test of 7 or higher indicated the need to start a medicine.
Detailed Answer:
There is a blood test called Hemaglobin A1C or just "A1C" which gives a better picture of your blood sugar and when to start treatment as it is an average of your blood sugars over approximately a 2-3 month period.
Medicine to lower blood sugar is usually started when the A1C is over 7 or more.
The Risperdal could very well have caused the increased weight gain. This is a common side effect with this class of medication. It can also predispose or aggravate diabetes while taking it.
I do not think that going off of the Risperdal would cause your glucose to go up.
My guess is that your doctor prescribed the metformin because she was concerned by your weight plus what appeared to be increasing blood sugars.
You can ask her to order an A1C test to see what your sugars have been on average, although it would be hard to tell what your baseline is now that you have been on metformin. But if you just started the metformin recently, such as the past couple of weeks, the A1C test will still show what your glucose levels were on average in the past 2-3 months.
I hope this information helps.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello again!! My A1C was less than 7 It was 5.7 or 5.9. And yes I have just started taking the metformin. I picked up my 2nd perscriptions yesterday morning.
I really don't want to be on a long term medication it I don't have to be. You know once u start it hard to be taking off of. With my A1c level being less than 7. Should I or do I really need to be on this metmofmin. Like I said earlier I cut out suger. And watch what I eat and starting swimming regularly. Wouldn't u think by me changing things my gloucose level would go down. Without taking the metformin.
Hello again!! My victim in D level was also low. So I started bit D 1000 MLg 2 tx's a day. Just went back for blood work on Friday. I also had my med records fowarded from nj. Turns out I gave a cyst on my liver it's been there for about 30 years. I gastrogaslogist reviewed my cat scan and told me it's not cancer. When this new practicing dr saw my results it seems as though she panic ed. Which scared me . The cysts on the liver run in the family it's seems to be a genetic thing. So when the dr frightened me I agreed to go for another cat scan last week and go this morning for my results.
I more thing, when she did my bloodwork she also checked my liver. And those results came back normal.
I really don't want to be on a long term medication it I don't have to be. You know once u start it hard to be taking off of. With my A1c level being less than 7. Should I or do I really need to be on this metmofmin. Like I said earlier I cut out suger. And watch what I eat and starting swimming regularly. Wouldn't u think by me changing things my gloucose level would go down. Without taking the metformin.
Hello again!! My victim in D level was also low. So I started bit D 1000 MLg 2 tx's a day. Just went back for blood work on Friday. I also had my med records fowarded from nj. Turns out I gave a cyst on my liver it's been there for about 30 years. I gastrogaslogist reviewed my cat scan and told me it's not cancer. When this new practicing dr saw my results it seems as though she panic ed. Which scared me . The cysts on the liver run in the family it's seems to be a genetic thing. So when the dr frightened me I agreed to go for another cat scan last week and go this morning for my results.
I more thing, when she did my bloodwork she also checked my liver. And those results came back normal.
Brief Answer:
Some more information:
Detailed Answer:
With a normal Hgb A1C, I would be hesitant to start a patient on metformin. I don't want to second guess your doctor's reason for starting it, but perhaps she can explain to you further why she feels you are needing it. Perhaps she has other reasons that I don't know about. So do ask her and let her know that you would rather not be on a medicine long term unless it is absolutely essential.
One thing that she may be thinking about is that people who are overweight have more risk of developing insulin resistance (and therefore need glucose lowering meds when their cells don't take in their own insulin). But again, I usually do not start medication until the A1C is 7 or more as being overweight does NOT absolutely mean that you will become diabetic.
About the liver cyst, given that your liver function tests are normal, and the cyst has been there 30 years, I would not be frightened. But I think it is not unreasonable to have a repeat CT scan to see what the situation is now.
It is good that you are taking Vitamin D as it is important to have Vitamin D3 levels in the normal range.
I imagine this doctor checked you for thyroid problems to see if that may be why you are not losing weight. Tests for this are TSH, T3 or T4.
I hope this information helps.
Some more information:
Detailed Answer:
With a normal Hgb A1C, I would be hesitant to start a patient on metformin. I don't want to second guess your doctor's reason for starting it, but perhaps she can explain to you further why she feels you are needing it. Perhaps she has other reasons that I don't know about. So do ask her and let her know that you would rather not be on a medicine long term unless it is absolutely essential.
One thing that she may be thinking about is that people who are overweight have more risk of developing insulin resistance (and therefore need glucose lowering meds when their cells don't take in their own insulin). But again, I usually do not start medication until the A1C is 7 or more as being overweight does NOT absolutely mean that you will become diabetic.
About the liver cyst, given that your liver function tests are normal, and the cyst has been there 30 years, I would not be frightened. But I think it is not unreasonable to have a repeat CT scan to see what the situation is now.
It is good that you are taking Vitamin D as it is important to have Vitamin D3 levels in the normal range.
I imagine this doctor checked you for thyroid problems to see if that may be why you are not losing weight. Tests for this are TSH, T3 or T4.
I hope this information helps.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Oh yes!! I more thing they weighed me yes and it does appear I have lost over 4 pounds. So the swimming is working. I went for my cat scan results yesterday . But when they reviewed my cat scan they saw another spot on my liver . And I guess when they the injection the contrast didn't didn't appear to look the same on that new spot. So she said since u now have insurance I want u to go see a gastrointerigist. I told her I don't have good insurance.it also appear I have 2 dots above my kidneys but she seems to think there kidney stones. Which I did have a long time ago. But if there r why didn't they ever pass.
Oh and I don't drink acholic.
Sorry my spelling is terrible. Oh and when the dr told me I had high Bp. I told her that's impossible. It has never been high so she also suggested that I start a log and keep track of my Bp. So thank goodness my mother has a machine. So I did make a log. And when I went to the dr yesterday they took my Bp again and this time it read 165/ over something. And my mother stepped in and said that's wrong it's never been that high. So the teck rechecked it and it was still high 144 over ?. But when I showed the dr my log. She said it looked good. I mean one day/ or evening I came home from swimming and checked my Bp 8 minutes after swimming and it was 150/92.but later on that night it went down. To 123/78. I guess the swimming raised my heart rate.
So I have 2 reports from the radiology imaging associates of PSL and 1st one says there r scattered small normal sized mesenteric, retro peritoneal and upper pelvic lymph nodes.since oral contrast was not administered as ordered by the referring phy the bowl loops cannot be evaluated. Impression mild diffuse fatty infililtration of the liver of unknown etiology. Multiple hepatic contract enhancing mass lesions. These were present previously however measure slightly larger than reported on the prior ultrasound. These are almost certainly certainly benign cavernous hemangioma a. 6 month CT follow up to reassess stability recommended. 1 cm left adrenal gland mass that does not have imaging characteristics typical of a benign adenine. Six month follow up to reassess stability recommended. Alternatively MRI can be useful on characterizing adrenal adenomas and can be useful in further characterizing the hepatic masses. 8 mm right renal lower pole benign angiomyolipima. Birateral renal small subcontinent hypodense lesions too small to accurately and further characterize with imaging studies at this time. If not otherwise clinically indicated 12 month CT follow up recommended.
2nd report says: findings: the lower lung fields and posterior lung base appear unremarkable. The gallbladder and biliary tract appear unremarkable : however ultra sound is more accurate than CT. There is mild diffuse decreased CT attenuation throughout the liver relative to the spleen. There r 2.5 cm x 2.5 cm right hepatic lobe superior segment, 6 cm right hepatic lobe superior segment( immediately adjacent to the above - referenced mass or could be part of the above referenced mass) 2.5 cm x 2 cm right hepatic lobe inferior segment and 3.5 cm x 1.75 cm left hepatic lobe medial segment contrast-enhancing masses. The masses completely or nearly completely contrast- filled on delay equilibrium phase contrast enhancement. The 6 cm x 6 cm right hepatic lobe mass does not become completely contract filled while the other masses do become completely contract filled on delayed equilibrium phase. The spleen, pancreas, and aorta caliber appear unremarkable. The right adrenal gland is unremarkable . There is a 1 cm left adrenal gland contrast enhancing mass. There is an 8 mm x 8 mm right renal pole mass with density measurements as low as -60 CT units indicative of an andlomyolipoma . There are smaller sub centimeter bilateral renal hypodense masses too small to accurately characterize with density measurements and therefore too small to accurately and further characterize with imaging studies.
Oh and I don't drink acholic.
Sorry my spelling is terrible. Oh and when the dr told me I had high Bp. I told her that's impossible. It has never been high so she also suggested that I start a log and keep track of my Bp. So thank goodness my mother has a machine. So I did make a log. And when I went to the dr yesterday they took my Bp again and this time it read 165/ over something. And my mother stepped in and said that's wrong it's never been that high. So the teck rechecked it and it was still high 144 over ?. But when I showed the dr my log. She said it looked good. I mean one day/ or evening I came home from swimming and checked my Bp 8 minutes after swimming and it was 150/92.but later on that night it went down. To 123/78. I guess the swimming raised my heart rate.
So I have 2 reports from the radiology imaging associates of PSL and 1st one says there r scattered small normal sized mesenteric, retro peritoneal and upper pelvic lymph nodes.since oral contrast was not administered as ordered by the referring phy the bowl loops cannot be evaluated. Impression mild diffuse fatty infililtration of the liver of unknown etiology. Multiple hepatic contract enhancing mass lesions. These were present previously however measure slightly larger than reported on the prior ultrasound. These are almost certainly certainly benign cavernous hemangioma a. 6 month CT follow up to reassess stability recommended. 1 cm left adrenal gland mass that does not have imaging characteristics typical of a benign adenine. Six month follow up to reassess stability recommended. Alternatively MRI can be useful on characterizing adrenal adenomas and can be useful in further characterizing the hepatic masses. 8 mm right renal lower pole benign angiomyolipima. Birateral renal small subcontinent hypodense lesions too small to accurately and further characterize with imaging studies at this time. If not otherwise clinically indicated 12 month CT follow up recommended.
2nd report says: findings: the lower lung fields and posterior lung base appear unremarkable. The gallbladder and biliary tract appear unremarkable : however ultra sound is more accurate than CT. There is mild diffuse decreased CT attenuation throughout the liver relative to the spleen. There r 2.5 cm x 2.5 cm right hepatic lobe superior segment, 6 cm right hepatic lobe superior segment( immediately adjacent to the above - referenced mass or could be part of the above referenced mass) 2.5 cm x 2 cm right hepatic lobe inferior segment and 3.5 cm x 1.75 cm left hepatic lobe medial segment contrast-enhancing masses. The masses completely or nearly completely contrast- filled on delay equilibrium phase contrast enhancement. The 6 cm x 6 cm right hepatic lobe mass does not become completely contract filled while the other masses do become completely contract filled on delayed equilibrium phase. The spleen, pancreas, and aorta caliber appear unremarkable. The right adrenal gland is unremarkable . There is a 1 cm left adrenal gland contrast enhancing mass. There is an 8 mm x 8 mm right renal pole mass with density measurements as low as -60 CT units indicative of an andlomyolipoma . There are smaller sub centimeter bilateral renal hypodense masses too small to accurately characterize with density measurements and therefore too small to accurately and further characterize with imaging studies.
Brief Answer:
More info:
Detailed Answer:
About the blood pressure, it does fluctuate and can go up a bit after exercise or when going in to see the doctor, but as long as the blood pressures that you take NOT after exercise are normal, you should be ok.
Your masses seen on the CT are described as benign. Still it wouldn't hurt to have a gastroenterologist review it. Sometimes when I get a radiology report back I go in and talk with the radiologist because a primary doctor can get more information about whether it is concerning and the need to follow up that way.
Yes, sometimes kidney stones do not pass and do not cause trouble, and are just found incidentally when people have imaging studies such as CT.
More info:
Detailed Answer:
About the blood pressure, it does fluctuate and can go up a bit after exercise or when going in to see the doctor, but as long as the blood pressures that you take NOT after exercise are normal, you should be ok.
Your masses seen on the CT are described as benign. Still it wouldn't hurt to have a gastroenterologist review it. Sometimes when I get a radiology report back I go in and talk with the radiologist because a primary doctor can get more information about whether it is concerning and the need to follow up that way.
Yes, sometimes kidney stones do not pass and do not cause trouble, and are just found incidentally when people have imaging studies such as CT.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I mean why doesn't she speak with the gastro dr. To have it reviewed. Why can't she just give the gastro dr the CT Scan. Why do I need to go in to hear his results. Is it that they all want $? Sorry I don't want to sound mean. But I am unemployed . And I lost by health ins when I moved. I tried to sign up for Obama care but I was 2 months late signing up for it. I didn't think it would take so long to find a job her. So I did sign up for short term ins. For 147.00 month. But I found out yesterday afternoon from a ins guy. That reviewed my ins and basically told me. My coverage only really covers the hospital. I have a 5.000.00 deductable. Which only means I have to pay out of pocket for all my dr appointments. But since I do have united healthcare ins. I will only get a discount. And 75% 80% off perscriptions. And my ins will only cover up to 33k $. If I am hospitalized and once 1 pay thE 5 $ deductable they will pay 70/ 30. I m sorry I am babbling your a dr. You don't need to know all this stuff. I apologize. Dr.
Brief Answer:
Talk with your primary doctor about your insurance situation.
Detailed Answer:
Sorry to hear about your insurance situation.
Some doctors will give the specialist a call with a limited sort of question. Specialists sometimes are willing to give guidance on the phone this way. The reason specialists are willing to do this is that there is an understanding that the primary care doctor will refer future patients to be seen by that specialist.
BUT - if your doctor feels she needs more information than a quick phone call she will send you to be seen by that specialist so that the specialist (in this case gastroenterologist) has the time to dedicate a complete visit to you. The specialist can then get the full history, examine you, and review your CT. It is very unlikely that a gastroenterologist would do all of this over the phone. You are right that it is about being paid, but more often it is that doctors have limited time. It requires extra time for your primary dr. to curbside a specialist and takes time from that specialist's schedule as well. It is also about liability for making decisions/recommendations when the other doctor has not fully seen a patient, etc. It is one thing for a specialist to answer a general question about a case from a primary doctor, but it is a much higher level of responsibility for the specialist to have a patient's whole case run past them on the phone without having first seen that patient. And reading a CT involves time and liability for the gastroenterologist.
About the radiologist - that person was paid and had time to fully look at your imaging studies, so they usually don't mind discussing it with the ordering physician (your primary). But again, your primary may not want to take extra time to talk with the radiologist about it, OR, may feel that all the information that the radiologist had to offer is already communicated in the report.
So what to do? It might be a good idea to tell your primary that
1. Your insurance doesn't pay for office visits.
2. You have a $5000 deductible
and ask if it is absolutely necessary that you have an appt. with the gastroenterologist.
It is possible that she will want you to be seen by the gastroenterologist regardless, based on the above information.
Talk with your primary doctor about your insurance situation.
Detailed Answer:
Sorry to hear about your insurance situation.
Some doctors will give the specialist a call with a limited sort of question. Specialists sometimes are willing to give guidance on the phone this way. The reason specialists are willing to do this is that there is an understanding that the primary care doctor will refer future patients to be seen by that specialist.
BUT - if your doctor feels she needs more information than a quick phone call she will send you to be seen by that specialist so that the specialist (in this case gastroenterologist) has the time to dedicate a complete visit to you. The specialist can then get the full history, examine you, and review your CT. It is very unlikely that a gastroenterologist would do all of this over the phone. You are right that it is about being paid, but more often it is that doctors have limited time. It requires extra time for your primary dr. to curbside a specialist and takes time from that specialist's schedule as well. It is also about liability for making decisions/recommendations when the other doctor has not fully seen a patient, etc. It is one thing for a specialist to answer a general question about a case from a primary doctor, but it is a much higher level of responsibility for the specialist to have a patient's whole case run past them on the phone without having first seen that patient. And reading a CT involves time and liability for the gastroenterologist.
About the radiologist - that person was paid and had time to fully look at your imaging studies, so they usually don't mind discussing it with the ordering physician (your primary). But again, your primary may not want to take extra time to talk with the radiologist about it, OR, may feel that all the information that the radiologist had to offer is already communicated in the report.
So what to do? It might be a good idea to tell your primary that
1. Your insurance doesn't pay for office visits.
2. You have a $5000 deductible
and ask if it is absolutely necessary that you have an appt. with the gastroenterologist.
It is possible that she will want you to be seen by the gastroenterologist regardless, based on the above information.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much doc. After discussing this with mom and having her read your reply and my mom meeting the dr. She feels the dr might not have that much experience. And the other thing that bothers me is she told me I have to pick up a disk of the CT from the radiologist. When in the past my previous dr has always fowarded the results to the gastro dr. Have a good night!! XXXXXXX
Brief Answer:
Regarding: The disc of the CT
Detailed Answer:
Without meeting your doctor, I can't say if she is inexperienced. Starting metformin without an elevated Hgb A1C seems a bit different than the standard but I can't say about the other things. I tend to call specialists more than other primary doctors do, so it is possible that whoever you find may just do referrals rather than calling. I think she is more mainstream in that aspect than I am.
About having you pick up a disc of the CT, I am wondering if that has to do with the newer privacy laws.
Good luck to you. Please go ahead and close the discussion as I cannot from my end. Thanks!
Regarding: The disc of the CT
Detailed Answer:
Without meeting your doctor, I can't say if she is inexperienced. Starting metformin without an elevated Hgb A1C seems a bit different than the standard but I can't say about the other things. I tend to call specialists more than other primary doctors do, so it is possible that whoever you find may just do referrals rather than calling. I think she is more mainstream in that aspect than I am.
About having you pick up a disc of the CT, I am wondering if that has to do with the newer privacy laws.
Good luck to you. Please go ahead and close the discussion as I cannot from my end. Thanks!
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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