RachaelRachael Rachael, a mom of two daughters, is a freelance editor and writer who enjoys gardening and dreams of keeping chickens in her suburban St. Louis backyard. In her spare time, she helps to edit her husband’s science fiction books. Read more of Rachael's work at www.rachaelsjohnston.com or contact her by emailing rachael@mumblingmommy.com.

I get nervous about doctor’s appointments. I mean really nervous. Nothing all that terrible has ever happened to make me fear doctor’s visits, at least that I can remember. I suffer from a condition called white coat syndrome, or white coat hypertension, which makes my blood pressure spike to impressive levels.

Most people get a little nervous prior to doctor appointments, but it’s different for people with white coat syndrome. Here’s the best way I can describe it: I know it’s important to be calm when having my blood pressure taken, but that’s like being told not to blink or swallow for a minute. Suddenly, you get the overwhelming urge to blink or swallow. When I know it’s important to feel calm while having my blood pressure taken, I get nervous.

It’s a vicious cycle. Over the years, I’ve come to anticipate the nerves. Knowing that I’m most likely going to feel nervous and have a high blood pressure reading makes me more nervous. I get uptight before I arrive in the doctor’s office, and it slowly builds.

My worst experience happened when I had been married for about eight months. I was living in a new city and needed to find a doctor for my annual well woman checkup. I also was looking to vet out a potential doctor to deliver my future babies. I found an ob/gyn office in the phone book. It was close to where I lived and had female doctors, whom I prefer, so I booked an appointment to see their nurse practitioner. My blood pressure was high. When I tried to explain and even showed her my normal readings taken at home, the nurse practitioner told me I had an anxiety disorder and needed medication.

“But it only happens at the doctor’s office,” I said.

“Some people only need anxiety medication in very specific situations,” she replied. “Like people who are anxious about crossing bridges might take some Xanax before crossing a bridge.”

What?!

I ran far and fast from that office and found an excellent ob/gyn office with three doctors who have guided me through both of my pregnancies. I have a blood pressure monitor I use from time to time at home, and my readings are always normal. I still have high blood pressure on occasion in the exam room, but the nurses and doctors understand the phenomenon. During my last week of pregnancy with my second daughter, my doctor was out of town, so another doctor in the practice saw me for my last prenatal visit.

“I see your blood pressure has been all over the place during your pregnancy,” she said in a matter of fact tone as she glanced over my chart.

“It sometimes gets high in the doctor’s office,” I said sheepishly.

“It’s called white coat syndrome,” she said. “It happens a lot.”

I could have hugged her. Instead, I spent some quality time with her when she delivered my daughter after I went into labor less than 12 hours later. During my hospital stays when I had both of my daughters, I never had high blood pressure. That’s probably because it’s a more long-term setup and my nerves have time to settle.

If the day ever comes when my blood pressure remains high outside of the doctor’s office, I’m willing to take blood pressure medication, which is different from the anxiety drug Bad Nurse Practitioner wanted to dose me up with. Research indicates that white coat syndrome sufferers are more likely to develop true hypertension as they grow older. What I don’t want to do is take medication for the normal emotional ups and downs of life. Everyone has times when blood pressure spikes, whether it’s a job interview, tensions with coworkers, or misbehaving children. I worry that too much of life is becoming over medicated.

In the meantime, for fellow white coat syndrome sufferers, here are a few methods I’ve developed for coping:

Coping With White Coat Syndrome

1.Visualize your doctor’s appointment. I spend time picturing myself walking into the waiting room and back into the exam room, chatting with the nurse, and getting my blood pressure taken. It helps to take away some of the mystique and the anxiety about the unknown.

2.Visualize positive events that will happen after your doctor’s appointment. I like to give myself something good to look forward to, whether it’s a visit from my parents during the upcoming weekend or taking my girls to story time at the library the next day. Sometimes it’s as simple as going to the grocery store without kids immediately after my appointment. I might also reward myself for getting through my appointment by picking up Taco Bell afterward for lunch. I am very specific and envision just how good those Nachos BellGrande will taste and how they’ll crunch when I bite into them. The more specific the mental image, the less I focus on the unpleasant experience of sitting for my blood pressure reading.

3.Breathe deeply. This suggestion comes from my mother-in law, a nurse, who says it really does work.

4. Compartmentalize. This is another suggestion from my nurse mother-in law. Tell yourself that you will not think about an upcoming stressful situation (like a doctor’s visit) until a certain time. I might tell
myself I won’t think about it until the morning of my appointment when I’m getting ready. This is easier said than done, but it helps me avoid dwelling on the issue for days in advance.

5.Take blood pressure readings at home, or on the free machine at the drugstore. Knowing my blood pressure is normal at home gives me confidence, which helps me relax in the doctor’s office. It may also help desensitize me to having my blood pressure taken.

6. Find a new doctor. Some doctors understand white coat hypertension and are willing to work with patients. Others instantly want to prescribe medication. Like I mentioned earlier, I have no problem with
medication, but I don’t want to take medicine to “treat” a normal reaction to what my body perceives as a stressful situation. There are other treatments besides medication, too. Exercise, weight loss, and relaxation techniques may solve the problem. If you’re uncomfortable with your doctor’s approach to managing your blood pressure, go elsewhere!

I’ve also read that something called cognitive behavioral therapy works wonders, although I haven’t tried it myself. My methods above aren’t foolproof. I still get nervous sometimes in the doctor’s office. My blood pressure was slightly elevated at my last well woman visit a month ago. But every little bit helps, and at least I have another year before I’ll start worrying about it again.

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Category: Babies

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