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Forum Name: Hypertension

Question: "White Coat Syndrome," can't control anxiety


 fdnyhopeful - Fri Mar 07, 2008 12:20 pm

Hello doctors. I am a 26 yr old male, healthy, and and pretty supreme shape. My problem is that I have a bad case of "white coat syndrome." Now I wouldn't worry too much about this, except for the fact that if might stop me for getting my dream job of a city firefighter. I have purchased an Omron home blood pressure monitor, and at home or at work, it ranges from 115/70 to 125/80. At some point in my life I must have developed anxiety going to the doctor's office. Once I enter a clinic's office, I get tachycardic. Then I get a BP reading as high as 160/100. Now I am a pretty relaxed individual, and this never happens at any other point of my days. The doctor recently made get an ekg and echocardiogram in order to get a clearance form filled for school. He told me I have a heart of an athlete and great function. So my problem is that when I get the fire dept medical, they're not going to like these numbers. I'm trying to meditate, and even considering yoga. Vitamins I take include fish oil and b-complex, and I eat pretty healthy. Aside from these steps I have taken and bringing my BP monitor to the medical to show them regular numbers, do you recommend any other herbs or vitamins to supress my epinephrine from being released at the wrong time?? Im not too keen on taking xanax or valiums..
 Dr. A. Madia - Thu Mar 20, 2008 12:19 pm

User avatar Hi,

White Coat Syndrome is a well recognized and a relatively common problem. I fully understand your predicament getting clearance form the medical board.

White coat syndrome occures from psychological conditioning. One you are conditioned that way it is going to strike with more force every time you enter a doctor's chamber. Adrenalin is the hormone which starts flowing and increases the heart rate [fast pulse] and force of contractions [high BP].

One way out is to wait in the chambers for about 15-30 min while reading some un-important magazine, before entering the cubicle. However this does not work many times.

When a clinician suspects a white coat effect, she generally advises a test called 24 hours' ambulatory BP monitoring. This is akin to Holter monitoring. The patient is wired up with electronic BP apparatus with a recording box the size of a Walkman and asked to go home and do the daily routine. The next day the box is decoded and a seires of BP readings of the previous 24 hours gets printed out. Thus one can easily check what the readings have been while one is not in the clinic and involved in his/her daily chores.

You can ask your doctor to get this test done and produce this result at the time of your medical board examination.

Apurva
 Dr. A. Madia - Thu Mar 20, 2008 12:21 pm

User avatar Hi,

White Coat Syndrome is a well recognized and a relatively common problem. I fully understand your predicament getting clearance form the medical board.

White coat syndrome occures from psychological conditioning. One you are conditioned that way it is going to strike with more force every time you enter a doctor's chamber. Adrenalin is the hormone which starts flowing and increases the heart rate [fast pulse] and force of contractions [high BP].

One way out is to wait in the chambers for about 15-30 min while reading some un-important magazine, before entering the cubicle. However this does not work many times.

When a clinician suspects a white coat effect, she generally advises a test called 24 hours' ambulatory BP monitoring. This is akin to Holter monitoring. The patient is wired up with electronic BP apparatus with a recording box the size of a Walkman and asked to go home and do the daily routine. The next day the box is decoded and a seires of BP readings of the previous 24 hours gets printed out. Thus one can easily check what the readings have been while one is not in the clinic and involved in his/her daily chores.

You can ask your doctor to get this test done and produce this result at the time of your medical board examination.

Apurva

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