Blood Pressure: Pills vs Walking

Blood Pressure And
An Unintentional Baseline Experiment

Note: I intend to break this into smaller chunks, later.

As well as Related Thoughts on Measuring and Evaluating

This is a longer piece than I originally intended. In the meantime I’ve had a couple of tries at an article, gotten a bit behind and then started again. I sometimes covered the same territory and sometimes other topics. What I will do here is to collect the bits and pieces and arrange them under various headings. So you may find some duplications of information. I would try to do a tighter edit but it is time to get this out. It has been nearly 12 months since I started.

The intent was (and is) to send this to my doctor with the database. Each time I think I am almost ready something else shows up which leads me to think that my data is not yet ready. Maybe it will never really get there but at some point there should be enough data to at least look at it overall. So, with apologies for incompleteness, here goes.

Headings Below

Before-Walking and After-Walking Baseline
Communicating Across Divides
Lessons From The First 7 Months
Conditioning, Walking and other Exercise
Lifestyle versus Pills
Database Creation and Modifications
Fixed-Interval Sampling:
Event-Load Sampling:
Design of Blood Pressure Monitors
The Readings Themselves
A Couple of Queries From the Database
Averages by Month
Along the way
Pain Meds
Other non-habits
On And Off the BP Pill
May 4th, 2015 – BP way too low
October 6th, 2015 – from just right to way too low
Back to the present
A Reflection
A few more dated entries in October 2015

Before-Walking and After-Walking Baseline

I will start with this chart prepared from a little more than 2,100 individual blood pressure readings, before and after walking and averaged for each month. This is a little less than 12 month’s worth of readings (not a full April and not a full March). This is the frame for most of the rest of the discussion. I’ll repeat this is better detail later in various ways.


If you are reading the clinical reports they will show higher blood pressure readings. I’m not entirely sure why this is. I have a number of possible factors but for the most part it just seems to be higher in the clinic (VA and dentist). There is the “White Coat” effect but I also run into this at times here, depending on how much time I give myself to relax into the “mood.” I’ve never quite pinned it down. That makes it a bit irritating because I want the clinic reading to reflect what I get at home. I go into that later under “Measuring.”

Communicating Across Divides

Software developers and their users share some similarities with doctors and their patients. Both sides of the conversation are often talking to each other with the same words but understanding different things. Both sides of the conversation are trying to make “it” work whether “it” is a human body or a software program. And both sides think they are having a conversation when there may not be as much meeting in the middle as hoped for by both sides.

As a decades-long software developer I am always aware that no matter how long I’ve been in the game I can never relax into thinking that I know how each user or machine operator will understand and use my programs. I still remember an early set of user interfaces I created for a mailing-list program in the early 1980’s.

The firm I was working for decided to try out their first computers and would use them for a 20-year anniversary for old and current clients. They needed to enter all their old clients as well as new prospects across the country. So I needed to construct an entry program usable by temps and an envelope and letter printing program also easily usable by temps. This is what I found:

⦁ The temps needed to understand what to type into the address fields (seems easy at first glance)
⦁ But the information in the cards and phone books and class listings didn’t conform exactly to the fields I had designed. There was always some other format for names, or added information or another category not originally planned for
⦁ So the temps found ways to shoe-horn information into the fields where it didn’t belong such as putting things in parentheses after a name in a field (last or first), or after a comma or vertical bar (|) and so forth. The equivalent of writing in the corners of a paper form.
⦁ Because the temps were trying to make the job work out and
⦁ Because the temps were not understanding (or even seeing) all the screen prompts and
⦁ Because the temps didn’t always know what to bring to my attention because they thought they understood or they didn’t recognize errant behavior on the part of software or a need to add a field type
⦁ And because the temps “made do” with something just to get on with the job and then forgot to get back to me or they assumed they had taken care of “it”
⦁ I quickly realized I needed to monitor the temps (over their shoulders) to catch mis-understandings and non-fitting data as well as to open up dialog so that they better understood what to bring to my attention
⦁ So that I could make changes at my end based on my observations of what worked and what went sideways, which as developer, was my responsibility (both the “worked” and the “sideways”)

Everyone was trying to make the “whole thing” work. There were no “slackers.” Everyone seemed eager. We just didn’t always meet in the same place in the same center. And we didn’t always realize it. I, as developer, would catch on to problems sooner only because I knew what I had in mind and I could more easily detect when things were going sideways. But I still managed at times to miss early signs that an operator might not quite understand some parts of the task.

I caught something similar in my conversations with the doctor. I don’t watch my health that closely and tend to let possible health needs slip at times. For example, I totally let my periodontal disease go for too long. I had to be convinced that what I thought was minor, because my mouth didn’t match my expectation for pain, might be major. It was.

I also tend to either push on through things like headaches or take as few pain relievers as I can. So I found myself in a similar position to those temps we once hired for data input. I thought I was doing “the job” but I wasn’t really hearing and comprehending everything I should have been watching for. Also I had somewhat different concerns. Money for example.

I think the doctor figured me for an anti-vaxxer because I hadn’t gotten any of the current shots recently. I am anything but. I was one of those kids back in the 1950’s who stood in lines for the first polio vaccines that you see in pictures. No pictures taken of me, just that I was in one of many such lines across the country. I remember the concerns. And I remember how many people I knew then and later who had been crippled by that disease.

I had some reluctance to take the vaccines right at the moment because I didn’t know how much it was going to cost me. I was still used to needing to have the money up front before I headed for the doctor’s office. Even though I was getting treatment at the student dental clinic it could sometimes be quite a hit on my income. But they would tell me ahead of time how much to expect to pay. I wasn’t unwilling, I just needed to plan.

As an adjunct my income has dropped below half what it was as a response from the UM system to cut hours to avoid benefits from the ACA. Pretty shitty of them. I’ve taught at UMKC, mostly online, in 1999-2000 (grant program) and then from 2003.

So I was worried about cost at the VA. I was new to the VA so I didn’t realize how much I wasn’t going to pay. I was (and am) pretty impressed.

I would recommend what the VA does for the rest of the country. I’m guessing the doctor didn’t give me a dollar figure because he doesn’t have to think about that for his patients. This is the way health care should work for everyone. I just wasn’t used to it.

I hope that I’ve learned enough from that to communicate a little better with the doctor.

Lessons From The First 7 Months

When I was first prescribed blood pressure pills at the VA I really meant to be a “good boy” and follow the instructions. But after three days I nearly collapsed with an 85/61 pressure. So I dropped the pills temporarily, intending to return to them after a few personal experiments.

I’ve never really gone back except for one occasion. I keep thinking I wasn’t ready with the information I need, that my measurements are not adequate enough (yet) to be either conclusive or at least useful.

Still, I did have some early observations which I figured I could probably support. Not being a doctor I decided that I needed to come in with data.

1 – Walking will lower blood pressure, dependably, (I have a data trail to show it)
2 – A lot of us with active schedules or work actually have sedentary work
3 – Sedentary is dangerous
4 – Blood pressure is both a “thing” (hydraulic pressure) and a symptom
5 – I’m want to fix what causes the “symptom” rather than “hiding” the problem with a pill which gets me the “right” numbers
6 – Walking also conditions the rest of me including breathing
7 – I prefer to change lifestyle rather than taking pills in place of life changes (though I am grateful for medications which do the job)
8 – the usual way blood pressure is measured and recorded gives inadequate data
9 – the BP monitors are all similar, and all need updated engineering

Conditioning, Walking and other Exercise

I learned three things when I started walking:

1. My blood pressure could be lowered just by walking (no running needed)
2. My overall conditioning got better (better breathing)
3. I had gotten sedentary despite an active, hard-working, long-hours schedule and had been so for a long, long time. Because it was such a full schedule I didn’t recognize that it was also sedentary. Working well into the wee hours of many mornings grading classes online or working on pictures and video on computer is busy and intense and also sedentary.

Walking (rapidly, as if I am late for something) gives me the pleasure of being outside, open air, sunshine (usually), under my own power, especially because I am buried so long inside, on the computer, toiling away. Sometimes I listen to the radio or to music from my “phone” or take a camera and shoot the “scenery” just to have something to do. I also usually head for the grocery store giving myself a small task to do, something to pickup, a chicken tender to eat, frozen orange juice to fix later, a few grocery items or other errands. I like to save small errands for my walks.

I worked out various distances from the house using Google maps. Heading north to work at PACE on the UMKC campus is 1 mile and to the performing arts center in the Dance Division another 0.3 miles. Heading west to The Market in Brookside is 1 mile, to Price Chopper is 1.2 miles. I prefer Price Chopper as it is more blue collar, also because the extra 2-tenths of a mile means that I have a 2.4-mile round trip instead of a 2-mile round trip. For a little more distance I may go to a shop on the far west end of Brookside for a 1.4 mile distance one way.

On the return I may stop at one of the Quick Trip type stores to get a large unsweetened iced tea to sip on on the way back and to finish later. It may not be gourmet tea but it is tea and I really don’t care for sweet drinks and very seldom for sodas.

When I first started it might take 10 minutes or so for my breathing to catch up. Within a few weeks that was down to no time at all, literally. Better still, I began to notice that going up a couple of flights of stairs on campus was now taken smoothly. It had not been labored or difficult previously but it was breathy for me. I had gotten used to this condition when I should have realize that it wasn’t right.

Changing a part of my lifestyle to “fix” a one problem turns out to have all around benefits and an overall better feeling for problems I hadn’t considered. I’m reasonably sure that the BP pills would have given me the right numbers but wouldn’t have produced these other benefits.

Lifestyle versus Pills

I am often enough tempted to take a pill without changing anything else. It does seem easier at times, especially when I seem to have higher blood pressure than whated I want to see.

For me, what I’ve found is that I not only feel better all around with lifestyle changes I also feel more in charge and I feel better physically in several ways. I’ve also found that looking at blood pressure not just as a condition but also as a symptom gives me a monitor, an instrument on my “dashboard” to tell when other things go wrong. If I am having other problems I want to know about them, not find that I’ve hidden the indicators.

I would rather change lifestyle than take pills. That is a bit glib and I don’t mean to just throw it around. I am fully ready to take meds as needed. Once in a while I really need to push myself out the door but once out there I am just fine.

Database Creation and Modifications

Whether shooting pictures, designing a survey, creating online learning software or setting up a database you need to determine what your data or record represents and what to sample.

I started with basics: Date/Time, Systolic, Diastolic and Pulse. For most purposes that is enough. As measured BP I found that I wanted to look at the data in different ways. That meant changes and additions to the database.

Events would occur, such as a headache, which would clearly seem to raise blood pressure readings. I wanted a way to correlate events or symptoms with the readings.

I wanted some way to define or certify that I had reached a baseline for my data before making a comparison with the pills. I still haven’t reached a good set of data to look for on a regular basis which might define the effects on me and how that is reflected in blood pressure.

For example I added a field to indicate when i took a blood pressure pill. I quickly added a comment field and then fields to indicate whether the reading was pre or post exercise. Then a second comment field. Next came fields to hold only averages of a set of readings, sys, dia, pulse. After a while I wanted some other types of queries which were hard to set up as designed so I added duplicate sys/dia/pulse fields for before and for after exercise.

Even a temperature field after I came up with a 102-degree temperature in late December. It doesn’t have anything to do, as far as I can tell, with BP. I just wanted to keep track of it and this was available so I tacked on the field. I’ve considered fields for diet as well and maybe sleep or lack of sleep. But so far I’ve resisted the “mission creep” of all kinds of fields. Partly because I am not that obsessed by keeping the database, though a nurse at the VA thought it was pretty unusual.

I also needed to create an entry form as well as numerous types of queries (stored/saved questions which can be repeated as wanted).

Mostly I dealt with a need for other data types by having two text fields, one of which is a memo type which is flexible in size. Of course that changes the way I would search for records in the database.

One major problem with any database is that it requires very consistent ways of referring to the data. That may mean having enough fields for types of data measured, enforcing consistent spelling (an old problem in database maintenance) or even just a usable entry form.

The one thing I am certain of after more than 3 1/2 decades of database programming and design is that no matter how much experience I have and no matter what I begin with some fields will be un-needed, some will need to be re-designed for either more flexible entry or more constrained entry and some will need to be added. Over time some entries will have to be standardized later with corrections to early entries so they all match and some will have to be teased out into other fields while I will also have to add implied fields within the context of larger text fields.


Normally blood pressure is measured during a small interval of time within the day. That sample is limited to a tiny spot of time but is usually used to represent the full day or even a particular period in someone’s life.

The data is very limited in terms of representing the state of anyone’s blood pressure. The general and most common recommendation is a measurement once a day at the same time. It is a tiny part of time compared to a year.

One year is 365.25nn days (so an average month, for easier calculation, is 30.4375 days). If the measurement takes say 5 minutes it is 1/288th of a day, 1/8766th or an average month and or 1/26,298nd of a quarter year (depending on doctor visits.

Yet that single reading in the doctor’s office is assumed to represent the larger span of time across a variety of activities. Most people say, “My blood pressure is ….” What they should realize is that is just the blood pressure in one tiny slice of time between doctor visits and at the doctor’s office. A very paltry sampling.

This is the prime measurement used for almost everyone, as a matter of daily practice. As a data guy, it bothers me that there is not more data related to more life events.

My own experience indicates that each of us needs a great many more measurements than that, distributed across a range of time, across the day and comprising more than one set of measurements averaged. I should note that while I am certainly taking more measurements than my doctor (better) I still think of my own measurements as not giving me the best information, yet. I’m always my own worst critic.

I keep promising myself I will do a better series but I haven’t gotten there yet. Which is partially why I haven’t returned to my intended series taking the BP pills. Also, even though I take a lot of readings by comparison, I don’t feel confident trying to correlate other events (meals, tea, working a concert, etc) with blood pressure in any way which is consistent, other than exercise (walking, in this case).

I should note that there is a definite correlation around other sources of pain. After a particular tooth extraction more than 3 years ago my blood pressure dropped to normal. I also realized that I must have gotten used to a considerable level of pain because suddenly I was missing something, pain. It took me several days to realize that I had dropped a certain level of chronic pain. So now when I am aware of headache or other source of pain I look for a correlation with blood pressure. In general, that seems to correlate.

Sets of measurements can be grouped around events (such as exercise) or sampled at set times during the day. There are justifications for each. Certainly the ideal would be both but I confess I am just not that obsessive. What I believe is that the patient is the best person to monitor and record the data (assuming the patient will do this) and the doctor is the best person to interpret it – as long as the patient is a cooperating/observing partner.

In looking across the web I noted that there are monitors designed to be handed out to a patient for 24 hours or so and returned. During that time these monitors measure blood pressure at preset intervals. That is a recognition of a need for better data but it also has problems and doesn’t continue for weeks or months. To get those longer times really requires that the patient does their own measurements, during which the patient may make lifestyle changes, all recorded in a secondary record somewhere. It also measures only blood pressure so I am guessing some sort of record or diary would be extremely helpful to include.


The terms I use are my own inventions, “fixed interval” and “event load.”

Fixed-Interval Sampling:

In this method we determine what times during the day we would like to have data, then try to set up measurements at those times.

This provides a nicely time-organized data matrix for the convenience of calculations. Biggest advantage is that it looks nice and makes a nice report. It has the dis-advantage of missing events which provide any kind of load on the body.

That brings up another factor. When I am testing out a piece of software or a website I need to see what kind of load it can bear up under. Testing software functions or page delivery without putting a load on the server doesn’t tell me much. I already know whether some function works but I may not know how well it works under load.

The usual recommendation is to sit upright and calmly. This all standardizes the measuring system for the convenience of the measurement process but it means stopping whatever is being done in order to change to a “calmer” mode. That is pretty much needed because the instruments for measuring blood pressure don’t function well during physical activity. That leaves a range of data unmeasured and wanting.

Event-Load Sampling:

In this method we are measuring physical reactions before, during (as possible) and after physical events such as running or walking. I take a set of measures before walking and then after returning and sometimes during a pause part way through the activity. Each time I’ve found the after readings are in the standard BP range.


Then there is the way of measuring. I early decided that a single measurement would not suffice. There are simply too many changes or inconsistencies which crop up. Generally the first reading in a set is higher and the rest are lower overall. In particular, following exercise the range of readings depends on how soon after exercise you start reading. Immediately after, as you are cooling down, it is interesting to watch the readings steadily go downward until it starts to stabilize which usually takes about five minutes.

It is also interesting to note that systolic readings tend to vary the most and sometimes go either very high or very low compared to the other readings in the set with no apparent reason. My guess is that the monitor itself doesn’t always “listen” clearly enough for the first sound of a pulse as the pressure in the cuff is released.

There are no wires going along the air line to the cuff so that means any microphone or other pressure-sensitive diaphragm has to be in the machine with the pump, “listening” for the sounds of returning circulation transmitted through the air line and over the sounds in the monitor from the release valve and contending with room sounds or hits of the line against objects between the cuff and the monitor body. Then again maybe systolic really is that variable.

For the purpose of averaged readings I tend to throw out some measurements when they seem to be outliers. That may mean a full set of systolic/diastolic/pulse readings or just one of those readings. Although they are related they are measuring different things.

Diastolic and pulse readings are normally more consistent as are temperature readings (something I started adding in late December when I had a high fever for a few days). Though temperature readings don’t seem to have anything to do with BP I just wanted to add that data to the readings records.

While I usually try to do three readings and average them sometimes I take more readings depending on the presence of “odd” readings, some of which are clearly outliers. So the number of readings can vary. Basically if the readings across those first three are not fairly consistent I keep measuring, chasing down something which feels like a more consistent pattern.

In reading recommendations and getting suggestions from a range of people I got a variety of recommendations about how to take readings. I’m not sure they are all well thought out or tested. They vary from old tales to repeated “rules.” So basically I just kind of wing it. Sometimes I leave the cuff as is and sometimes I re-position the cuff.

Or I might measure all of them as close to each other as I can and other times I let an extra minute or so go by for each measure. I’ve had persons recommend waiting five minutes between but with that large an interval I lose a sense of a “pattern” from the measurements. Also, the way I take readings I might wind up with a long series anyway.

In a similar manner sampling blood pressure at specific set times is almost certain to miss the times when the body is under load. Something I kept finding myself wanting was information around “events” (the data content) rather than some measurement at set times which may or may not reflect the rest of the time.

Design of Blood Pressure Monitors

As a software engineer and as a tinkerer from way back I have a few suggestions for improved monitors. Apparently people have gotten used to these things as they are. There seems to be nowhere to really talk to. Right now they all copy each other’s operation pretty closely. If the original design was truly good this would be okay. For the most part the basic design is pretty handy though it does suffer from several problems. It is well past the time someone should have made a better one at the same price level.


Any good control design uses one control per function. Controls should never be cross connected or multi-modal. This is most evident in the “setup” for items such as date and time. Multi-modal controls offer too many opportunities for error and they are too difficult to “discover.” “Discovery” means that you should be able to determine function easily with little or no training or instructions. In any case the controls need to be more clearly labeled.


Monitors should have their own panel behind a protective covering. Simple things such as setting time by using a physical control for each part of the data and time. Operating controls should allow you to not only take a reading but to scroll back and forth among readings. On all the montors I’ve seen so far you get a reading, maybe a memory bank (user1, user2, etc) and you can only go backward through previous readings.


Some of the monitors take a series of readings and average them. Usually they are set to take three readings. That’s much better than one but it misses inconsistencies in readings which may require more than three readings to come up with a reasonable looking set of measurements.

Memory storage:

1 – Memory – should remain intact when batteries are jostled or changed. It should not disappear. So far they all lose memory when batteries are changed or if the gizmo is dropped or the batteries jostled.

2 – Data Export – In addition they should all offer a simple output via USB port or better, via either sdhc or micro sdhc card slot. I would prefer the larger of the two as it is easier to see and handle. This should include a simple tab-delimited export for databases or a spreadsheet format. Some monitors use wireless, such as Bluetooth, which is okay if you wish to keep and manipulate your data on a smartphone.


I would like to see it include portable software, usable by plugging the device into a USB port, which would massage the BP data stored and offer screen and printer output as well as data export to other databases. As with other portable (on USB stick) software it would not need to be installed on any particular machine but would work entirely from the USB drive.


All devices should have a holder for the instructions so you can’t lose them. And they should be printed in type large enough for any of us to see without magnifying glasses, preferably in clear language (not bad translations). It would be nice if the prompts printed on the controls and buttons on the machine were clear, in contrasting colors and fully spelled out. And as for those symbols, I really don’t read symbols. Just give me the text.

The Readings Themselves

Not every reading is all that clear. For example Jan 8th (2016) I started my pre-walk readings and they shifted from 145 systolic to 140 then 132. Usually I take about three readings and average them. When the readings change or something looks like an outlier to the other readings I take more than three. So, I took another reading and I got 120. That was low enough again so that I wanted another reading which was 118 and then a sixth reading for 117. In a good range without walking.

The last three are what I would have expected to get after my walk. Who knows why. Because of ice and other activities I wound up not walking on the 7th so I was puzzled not at the starting higher readings but at the lower readings which were all close to each other. Remember, still no BP pill in the mix. Also remember, I have no idea why the change in the readings, just that there seems always to be a certain amount of variability which I am seldom able to predict.
So here is a chart with my readings for the 8th of January 2016: The blue entries are the pre-walk readings and the red entries are the readings after returning from my walk of 2.4 miles. (the house to the Brookside Price Chopper [1.2 miles] and shopping, to Tuesday Morning [also shopping] and back to the house)

DateTime Pre
Sys Dia Pulse Post
1/8/2016 12:36:49 PM Yes 145 85 72
1/8/2016 12:38:23 PM Yes 140 81 63
1/8/2016 12:40:04 PM Yes 132 77 60
1/8/2016 12:41:52 PM Yes 120 74 59
1/8/2016 12:44:52 PM Yes 118 74 63
1/8/2016 12:46:47 PM Yes 117 74 62
1/8/2016 2:12:09 PM 114 70 106 Yes
1/8/2016 2:14:39 PM 106 73 107 Yes
1/8/2016 2:16:08 PM 116 70 100 Yes
1/8/2016 2:17:37 PM 108 66 93 Yes
1/8/2016 2:19:18 PM 119 78 100 Yes


As per usual my readings prior to my walk are higher than the readings after the walk. That has been the pattern from the start with only one or two exceptions.

The first three pre-walk readings January 8, 2016 were puzzling which is why I took another reading. That fourth reading was low enough, and lower than my expectations, so I took a fifth reading, which, because it was close to the fourth reading, I took still another to confirm. The last three of the six readings were very close to each other.

Statistically it is tempting to say that the sampling consistency of the last three readings is cause to throw out the first three when taking an average. Instead I decided to leave the third reading (132/77) and average the last four for my blood pressure pre-walk (132+120+118+117)/4=122 and (77+74+74+74)/4=75. It might have been just as valid to use only the last three because they are closer values (would have been 118/74) and might have indicated settling down for a reading.

The after-walk readings had enough variance in the first three that I wound up taking two more readings. Because they tended to measure in the same areas I kept all five measurements for the average.

So I used these averages:
Before walk: 122/75/61
NOTE: using only the last 3 gives 118/74/61 while
using only the 1st three gives 139/81/65
After walk: 113/72/101

Basically, what I mean to say is that even choosing which readings to use in the averages is a bit of art rather than mechanical data collection. It is not totally consistent.

A Couple of Queries From the Database

Anyway because I normally take, readings before and after exercise (usually walking) I made several sets of querys comparing readings before and after walking or other exercise. After a while they got a bit long so I made shortened versions which took just the previous six weeks of measurements. Here are two separate data sets showing averaged readings before and after (copied and pasted from MS Access database).
(“Number” is the number of readings taken for the average)

A Couple of Queries From the Database

Anyway because I normally take, readings before and after exercise (usually walking) I made several sets of querys comparing readings before and after walking or other exercise. After a while they got a bit long so I made shortened versions which took just the previous six weeks of measurements. Here are two separate data sets showing averaged readings before and after (copied and pasted from MS Access database).

(“Number” is the number of readings taken for the average)

Pre-Walk query for the most recent six weeks (as of Jan 9th, 2016):

DateTime avgSys avgDia avgPulse Number
12/2/2015 6:40:33 PM 127 86 77 6
12/5/2015 1:34:07 PM 116 80 71 4
12/6/2015 3:35:37 PM 116 75 80 4
12/9/2015 10:38:19 AM 141 83 76 3
12/11/2015 11:22:53 AM 126 84 70 4
12/12/2015 11:04:59 AM 136 87 60 2
12/14/2015 12:22:48 PM 138 89 70 2
12/24/2015 1:51:45 PM 124 82 85 4
12/26/2015 11:24:53 AM 137 87 65 2
12/26/2015 11:47:12 AM 131 83 71 3
12/31/2015 2:45:50 PM 147 84 69 3
1/2/2016 4:26:28 PM 131 85 82 3
1/3/2016 12:19:54 PM 146 89 56 3
1/5/2016 2:37:23 PM 130 82 76 3
1/8/2016 12:40:04 PM 122 75 61 4
1/9/2016 12:02:15 PM 133 75 60 3

After-Walk report for the most recent six weeks (as of Jan 9th, 2016):

DateTime avgSys avgDia avgPulse Number
12/2/2015 7:55:02 PM 123 88 100 3
12/5/2015 3:28:34 PM 95 68 104 4
12/6/2015 5:21:56 PM 124 87 98 5
12/9/2015 1:10:33 PM 119 81 76 4
12/11/2015 1:12:39 PM 116 70 88 3
12/24/2015 5:41:14 PM 123 77 108 4
12/25/2015 3:01:49 PM 124 79 81 3
12/26/2015 1:11:05 PM 114 72 112 4
12/31/2015 4:15:56 PM 118 83 92 4
1/2/2016 5:56:46 PM 112 79 104 3
1/3/2016 1:56:07 PM 109 73 104 4
1/5/2016 4:15:08 PM 112 79 106 4
1/5/2016 4:20:13 PM 99 73 105 4
1/8/2016 2:12:09 PM 113 72 101 5
1/9/2016 1:58:41 PM 117 74 84 5
1/9/2016 2:01:44 PM 113 70 83 3

It takes just a quick glance to realize that the pre-walk readings are normally higher than the post-walk readings. There is a lack of walks between the 12th and 23rd of December when I was too exhausted, too busy working and/or too sick (very unusual for me as it is) to take my regular walk.

Averages by Month
I finally decided to look at the averges across time, grouped by month. That meant another query.
So these are averages for each month.
A Table of Averaged readings, grouped by month visualized as a graph.


The systolic averages are the line pairs at the top and the diastolic are on the bottom. The topmost of each pair are the pre-walk readings and the lower line in each line-pair is the post-walk average of readings.

(Created in the Excel spreadsheet above and copied first to Photoshop, then to this page. Photoshop was used to remove the empty lower readings to save vertical space so that basically the chart’s Y axis starts a little below 80.)

(xr) xrSys and xrDia refer to readings after exercising. In this case it means walking.

Notice that the averages tend lower until October 2015 when they shift upward. This was the same time that my dental implant was put in. I went in in early October to get the implant fit determined. The titanium anchor shaft and cap were put in months before. Now the cap section was removed for fitting and then replaced. Two or three days later I had a severely stiff and painful neck (which has remained through March 2016) on both sides down the back, into the trapezius. Later in the month of October I went back to get the implant set into the anchor. The BP hasn’t been quite the same since.
If the implant were the only event occurring at that time I would have a pretty close correlation with the opening of the titanium screw in my jaw. However, at about the same time that I got my stiff neck, my partner, Nicole, also suddenly got a very stiff neck. We are still working on her neck as well although she has had other, severe health problems in the aftermath. It seems to do with exhaustion at the end of the year followed by intense work at the start of this year. She lost a lot of weight and strength. She is looking better now but her platelet count is very low.

Along the way

A couple of years ago the dental college needed to remove a couple of teeth but wouldn’t do so until I lowered my blood pressure. So I headed for a clinic where I got the same pills prescribed this year by the VA doctor and after that the dentist removed those teeth. You might stop there but some other things happened as a result of the dental work.

In lowering my blood pressure I killed all salt and a number of other items from my diet. Before long I began experiencing a much richer and more nuanced palate, realizing that salt, far from being a flavor enhancer tended to obliterate the rich tastes of the food, substituting its own taste. And I was into heavy salt. I do use salt today but very much reduced, just a touch, and spices. I get better flavor without overwhelming the food with salt. I also read labels like crazy and will not normally buy anything which claims more than 6-percent of daily salt dosage per “serving.”

More interesting, to me, after the tooth extractions was a sense of nothing or maybe I could describe it as a sort of blankness. It took me a while to realize that this was a lack of pain and that I must have acclimated myself to a level of pain in my head and possibly other symptoms such as neck and shoulder muscle tightening as a result of those teeth which were now extracted.

So far I can’t recall any similar muscle tightening, something which used to happen fairly regularly. At the time I just took the tightening to be posture or hunching over to shoot pictures. Not only did I have a lack of pain but that came with a lowering of blood pressure. So much so that I decided to drop the pills. Then I stopped thinking about it, until the VA.

It is the VA which got me started on this new track on my life.
1) the doctor looked at my blood pressure readings taken at the VA and prescribed pills
2) sent me a blood pressure monitor in the mail. Even though I already had three monitors I had not made a point of checking and working with my blood pressure. Almost all the BP readings in the database are taken with this monitor. I call it the VA monitor in the comments. It is actually a Life Source UA-767 Plus.

Pain Meds

For the most part I don’t use much in the way of pain killers. Over-the-counter Ibuprofen is about as strong as I go with. I was prescribed some industrial strength pills by the dentist (hydrocodon and acetaminephen) but stopped after taking two. I went back to the OTC pills. I don’t remember what the side-effects were now, just that they were unpleasant and as soon as I got away from the heavy-duty pain killers I felt better. The regular over-the-counter pills worked as well for me and usually I didn’t use those, except to counter inflamation (generally ibuprofen) following each dental operation.

Other non-habits

No alcohol (I did have a dark beer last summer on one very hot day so I’m not a teetotaler, I just do a good imitation of teetotalling), no drugs, sometimes vitamins but never consistently, not vegan but light on meats, mostly some chicken and fish, often with brown rice, sweet potatoes and so forth. Little sugar. Maybe one soda a week or two but usually tea – sometimes hot tea (normally loose, seldom in bags) but mostly iced tea NO sugar (I would gag).

Coffee? Seldom, though I make it fresh from beans for Nicole. I won’t usually buy ground coffee, only the beans (so much fresher). Generally yogurt each day, often as part of a lassi (yogurt smoothie). And I don’t smoke, anything. I tried to get started a long,long time ago but I just didn’t like smoking, either type.

For that matter, the type of photography I do rests on a knife edge. I shoot performance dance, in production. I have to shoot at the exact moment of right elevation, position and technique. There are no do-overs, this isn’t a studio. I need knowledge, I need to listen closely to the music and I need reactions, but mostly I need knowledge, subject knowledge.

Alvin Ailey American Dance Theatre at Kaufmann in “Memoria” – Photo, Mike Strong – the optimum moment to get everyone in grande jeté

So, no alcohol (even a few sips of wine keeps me from reacting in time, missing what I can see go by me) and no heavy meals (which keeps me too sluggish to stay on top of the action). I took a few sips of wine before a performance once at the Folly during an early promotional reception some years ago. It took me a good half hour before I could feel that I was shooting at full function. Luckily I was mostly doing video at the time, only a few stills needed.

Below, a typical warm-up set for me, here shooting sequences of repetitive actions, in this case a whip turn (fouette) on stage. The successive frames are numbered below. Note, there are no deleted numbers and there were no missing frames (although you can’t tell that from the frame numbers alone). You can’t get a sequence like this by hitting continuous (motor) drive.


Mark Geiringer in a series of fouettes. One turn per (numbered) frame, no deletes, no waiting. Photos Mike Strong

On And Off the BP Pill

I should go over the reason I turned this prescription into an experiment.

May 4th, 2015 – BP way too low – the first time

I had just started taking a course of blood pressure pills from the VA. I was several days into this when I needed to take headshots for the Wylliams/Henry dancers. This was May 4th. I started okay, just a bit weak and light headed I thought. As I moved through the session I began really stuggling. Finally, all the dancers were done and I started to re-pack my equipment. That is when I had to sit quickly on the floor as soon as I began to sense it, sweaty and clammy). I thought I was going to collapse. After I felt stable again I finished packing my equipment on the cart, headed for my car, put the equipment in the car, rested a bit in the driver’s seat then drove home (a little more than a mile).

At home I left the stuff in the car. Inside I took my blood pressure. The average of three readings gave me 83/58. Important to note, because I have something similar going on now is that I was on a course of antibiotics as well.

I had just had a root canal (Dr. Kip Sterling in Endo at the dental school) and two days prior to that I had been to the VA about a high PSA level (12.5 which should have been less than 4.0). They prescribed a pretty powerful antibiotic, Cipro (Ciprofloxacin), guessing that I might have a prostate infection rather than possible cancer and as an alternate to doing a biopsy which could be done later if needed anyway.

The Cipro solved it by the way and my PSA returned to less than 4.0. In the language I returned to a “full stream” very quickly – though it had hardly been blocked before just a little less than what I now recognize as “full” – which is where it remains (something I didn’t pay attention to before).

In any case, the antibiotic from the VA overlapped the root canal operation. Dr. Sterling would have prescribed an antibiotic for the root canal but because I told him what I was already taking we left it as is. Usually I don’t take much of anything anyway after dental work, even operations, except for anti-inflammatories.

It was possible that the antibiotic was also working against something which contributed to blood pressure. That was a matter of concern for me over whether the antibiotic or the blood pressure medication led to the near collapse. I didn’t want to shorten the antibiotic dosage. I looked at the listed side-effects of each and figured I should drop the BP pill first, then see what happened. I figured I would drop the rest of the antibiotic only if this didn’t do the trick. It did.

Ciprofloxacin has some alarming warnings about physical exertion both while taking it and for months after but I would still try to take the full course of any antibiotic unless there were very strong indications otherwise. Interrupting such a course takes me back to square one. I haven’t had many antibiotics over the years but I’ve always taken the full course of pills.

October 6th, 2015 – Tuesday – from just right to way too low

I pulled a dumb thing in October. I took one of the blood pressure pills again, after months of not taking it. I had a dental appointment scheduled for 9 am in the morning Tuesday and was concerned that I might not have time for my walk in the morning and maybe I would get a much higher reading at the dentist than I normally do.
If so they might not go ahead with the operation (happened once). Why I worried this time, unlike so many other times, I don’t know. Silly. But I might also finally get started on the comparison baseline using the BP pill. So anyway, I took the pill late Monday night. A mistake, but a useful mistake which gave me some needed information (data).

Sure enough, Tuesday morning early, without doing anything else my blood pressure was 118/77 (average of three readings). The graft operation took connective tissue from the roof of my mouth to cover the gum line in front of three teeth on the right lower front area. This took about three hours. I left the clinic a tad past noon paying the money on the way out.

At home I measured my bp at 113/73 (average of 3 readings). Then I headed out for a walk to CVS and The Market. I had a prescription from Dr. Mike Fullem, my dentist, for the antibiotic, Amoxicillin. The Brookside CVS is about 1.1 miles or so and is a regular known distance for my daily walks.

So I dropped off my prescription, headed to The Market (about 0.1 miles from CVS) for smoothie makings, yogurt and other items then back to CVS, a little waiting and finally, getting the prescription. From there I headed back to the house completing about 2.4 miles, my usual amount for a round trip to the nearby Price Chopper.

During the walk I realized that I could avoid my walks and take the pill instead. I would get the same numbers. The idea of having a low-enough BP had made me briefly consider driving to CVS rather than walking the mile or so. After all I thought, I had taken the BP pill, I had the numbers, why bother walking? With the pill I could get a “good” reading (even if for the wrong reasons).

This was much more tempting at that moment than I like to admit, though the idea really felt as though I was cheating myself. Taking the pill to replace exercise would also lose for me the satisfaction I get just by being outside and walking around. There is always a bit of inertia which needs to be overcome but once overcome leads to a satisfying activity.

Back to the readings. When I returned from the 2.4 miles I did the blood pressure as usual after my walks. I was a bit alarmed. It was 80/61 (average of 4 measurements), way too low. Also, the monitor indicated irregular heartbeat on the last of the four measurements. (I had to look up the symbol, which to me, as a programmer, is a design error.)

I waited a little and made three more measurements. This time they averaged 88/61, marginally better but not what I wanted to see. No irregular heartbeat indicated but it gave me pause. This was almost the same as the May 4th reading (83/58 avg of 3 readings. This occured after taking a single pill. I decided to not take more pills without a substantial reason. I caught myself worrying about driving . What happened if I fainted at the wheel from low blood pressure?

Back to the present

When I dropped the BP pill in May I was determined to get a data set for how this affected me. Along the way I kept wondering when I should start retaking the pills to get a comparison data set. Each time I thought I had come to some conclusions about walking rather than “pilling” I decided I was uncertain about my data or reading methods or other concern and needed a longer data set.

In a very incomplete way, taking the single-pill in fall gave me a quick look at my suspicions about a pill-filled alternate data set. So, what would be the purpose of a pill? Especially when substituted for more rounded routines? (Not meaning to question the value of BP pills, I simply want to make sure I am clear on what is being accomplished and on the best method.)

A Reflection

If anything my dental “adventures” in periodontics taught me, it is that symptoms may not always be obvious and may disguise themselves. Before the last two extractions (for which I got an implant in October 2015) I had stiff neck pain and headaches but I didn’t think that much of them and either ignored the pain or simply took some Ibuprofen or Tylenol if a headache seemed to be coming on before a job. Because I wasn’t feeling any severe pain directly from my teeth I really didn’t relate those other pains to dental health. What I know now is how sneaky such an infection (perio/gum disease) can be. It didn’t feel as serious as it was.

What’s more I became acclimated to the level of discomfort and/or pain. Those last extractions eliminated those conditions and it took me a week or two to realize that I was missing something, then a bit longer to realize that I was missing pain. By the time I was first persuaded to head for perio (because of a couple of loose teeth, with no real pain) I needed a lot of work. So, I am always of two minds about medications, sometimes contradictory minds. I am thankful for the meds but I am also wary of disguising possible conditions.

If I’m taking a pill rather than working a full program of better care then a BP pill, or any other kind of pill such as a pain killer, then I am merely masking some underlying need, making me think I am healthier than I am, or at least helping me get away with the deception rather than encourage healthy habits and discourage my worst habits, such as sitting.

You may think I am kidding about the sitting. I didn’t think of myself as sedentary because I work long and hard but I also spend a lot of time sitting in front of computers, working. After I took up walking each day, moving for a good hour or so, I also found that my overall conditioning improved. Certain sets of stairs at UMKC on which I had been getting breathy were no longer breathy for me (in Royall Hall and in PAC heading to and from the dance division).

There are a couple of things I think I can state in general.

⦁ The first reading in a set (to be averaged) is usually the highest. I don’t really think anxiety is the reason, maybe more just taking time to settle down for the reading(s). This is also cited as “white coat syndrome” in doctor’s offices but after looking at a similar response when I do my own measurements I suspect this is probably normal in any situation. It may even have to do with the way I am sitting which tends to feel a bit apprehensive, certainly not relaxed an on a bit of an edge.
⦁ A mile or so of walking (roughly 45 minutes or so and with a shopping stop usually an hour) will reliably drop the reading from a pre-exercise reading which may be high to a bit high down to a post-exercise reading in the right range, nearly every time. This is very consistent. More importantly, this is repeatable, at will. My guess is that this is also duplicatable with others.
⦁ Single readings on single occasions do not provide a very good picture. They are much too limited to tell you much. I can’t imagine a doctor’s office or clinic which would normally keep detailed records, monitored over a period of time or blood pressure and other items in making a diagnoses of anything.
⦁ Being an old-time database guy I very much understand the great desire to find ways to normalize data and to standardize the collection of that data. I can’t tell you how many database problems I’ve cleaned up. It was part of the reason I wanted to find baselines for myself. But after months of measuring my own blood pressure at varying periods of time and in various sitting or other stances, and without throwing away standardized measurements, I have to wonder what exactly a standardized data-collection procedure really measures.

In particular how does a measurement sitting-still find usefulness evaluating an active working body. By changing my normal position to a sitting upright feet on the ground stance for a measurement means I’m not measuring blood pressure under my most normal sitting, standing, etcetera positions. Seems a bit of a data cheat.
⦁ When I am testing a website for load capability I want to see how it performs under a lot of loading, not a simple, in-the-office test of a page. One of my old bosses would check our programs by throwing anything un-anticipated at them. If our program could survive 5 minutes with Ken without crashing we figured it was pretty robust. So, are there simpler ways of measuring human bodies at varying levels of physical stress? And always, is it meaningful/useful?


Above is a chart prepared partially with Google’s “Datawrapper.”
These are all the averaged readings from May to October 2015 overlapping in bundles. So I drew a white line down the middle between nodes, added in the red dots and blue dimension lines with arrows. The Systolic and Diastolic are higher before exercise. The pulse is lower before exercise. I didn’t check the one red line going to the bottom. My guess is that I will find a pulse entered somewhere as zero, a clear error, unless of course we are shooting a zombie film.
Probably easier are the figures directly so I went back to the database and made a query to give me averages of all readings (leaving off decimals).

From the 275 averaged readings from May to October I got these averages of the averages
Measurement Sys Dia Pulse P.Pressure
Pre-Walk 132 85 63 47
Post-Walk 115 79 88 36


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