Ups and Downs

I have experienced several different bodies in my life. Most women have, but my range has been a bit wider than the average woman’s. I’ve struggled with obesity since babyhood. I’ve lost more than 50 pounds three times in my life. I’ve been a gymnast. I’ve done martial arts. I’ve run 10K races. I did work and play which required physical strength. Until my wrists gave out with chondromalacia, the idea of being incapacitated was inconceivable to me. I’ve expanded with pregnancy and contracted with breastfeeding. I’ve flown airplanes and jumped out of them.

Despite my obesity, my blood pressure was always acceptable; sometimes it was even low enough that the person taking it would repeat it several times in disbelief because of my weight. Overall, I am very healthy despite being heavy, which is part of why I decided almost a decade ago to stop weight-cycling in a vain effort to be thin, and just focus instead on caring for my body at the weight it seemed to want to maintain.

My body, while not always pretty, has usually been up to the tasks of the life I chose to live. Until now.

About a year ago, I fell in love with Cuenca, Ecuador, altitude 8,300 feet. My husband and I sold 90% of our stuff, applied for residency, and rented an apartment. We shipped our comforts of home by sea, and settled in with our elderly Siamese cat. I edited an economics book, entered a short-story contest, and made progress on my first novel.
Acclimatization (the adaptation to altitude by a lowlander) takes weeks to months: the first days, before the body (to oversimplify) cranks out hormones that increase the circulation of oxygen, are the most difficult. However, over time most people adapt without incident (though blood pressure is known to increase—gradually—over months to years at altitude).  I had no reason to think I would be any different. And for the first six months, that was exactly how things seemed to be going. I didn’t experience the “magical” weight loss that some of my fellow immigrants talked about, but my blood pressure went from the 125/85 range to around 135/90 and stayed there. It remained there through my gout diagnosis and scary allopurinol reaction. It remained there as I increased my average daily walking to several miles. It remained there after I changed my diet drastically to deal with the gout and lost weight: 10 pounds so far.
Then, last Friday, I woke up feeling strangely unwell; I had a headache unlike a sinus headache or my rare migraine headaches. I felt, paradoxically, both quivery and lethargic. Unable to figure out what was wrong, I hauled out my digital cuff and took my blood pressure. 169/96! I’d never seen it that high in my life! I wondered if it was caused by the natural Cox-2 inhibitors in the Noni I’d been drinking, so I discontinued it.
Saturday, I went to a group picnic at a little country restaurant.  I got sprayed with water by some kids and bitten up by the ferocious no-see-em-type bugs they have here; I wound up with head congestion and lethargy; I went home to lie down. I took my blood pressure again: 188/99! My temperature, though, was 101.2, so I told myself maybe I was just getting sick and that was why it was up. I went to sleep…

Sunday, I woke up with no fever and a very slight stuffy nose. Hooray. Except I still felt icky. 192/98!  I figured if it were altitude-related, hyperventilating might help, so after 10 minutes of huffing and puffing I re-took it: 137/68; yay!  If only the effect lasted…an hour later it was back up again.  I began monitoring it every few hours, and during the day on Sunday it dipped into the 170/90 range a couple of times. I figured the Noni might take a while to wash out of my system, so I just relaxed all day Monday. But by the end of the day Monday, it was back up to 184/103.

Tuesday, I decided (perhaps foolishly) to take my normal nice long walk into el Centro for my English-Spanish-exchange classes. On arriving home, my pressure grabbed my attention at an alarming 204/91! It was too late to call the doctor at that point, so I lay in bed that night imagining I heard my aorta starting to dissect inside my chest (it’s not good to have too much knowledge of physiology and pathology!). I slept well and called Dr. Elizabeth and she is seeing me today at 3:30. A friend suggested taking a short trip to a lower altitude to see if that helped. Crowds are expected in beach communities for Carnival this week, but there are other places…this may be a good test for the cause of the hypertension.

Wednesday afternoon, I visited the doctor. She sent me for an echocardiogram and more bloodwork.

The cardiologist who did the echocardiogram told me my heart walls were in good shape. He computed my pulmonary blood pressure and it was mildly elevated, causing some back pressure on my tricuspid valve: a sign of poor adaptation to altitude rather than permanent heart damage from the allopurinol. The bloodwork showed no problem with the cardiac enzymes, but my kidney and liver enzymes were back up again AND my uric acid had increased by a point, despite my having lost 10 lbs. in 10 weeks on a strict anti-gout dietary regimen.

I sat down in Dr. Elizabeth’s office, and said, “I’ve been Googling like crazy, refreshing my physiology from 30 years ago. I am relieved to learn that my aorta is not about to explode inside my chest. What I keep coming back to here is a clinical picture of someone who is decompensating and failing to adapt to altitude.”
“Yes,” she agreed. “This happens to some people who move here from lower elevations.”

“The more I read about it,” I said, “the more I realize that it affects, not just your heart and lungs, but the chemistry of every cell and tissue and organ in your entire body!”
“Yes, a lot of people move here assuming they will have no problem.”

“I know I did. I’ve always been healthy and I figured my body could adapt. So, my question is this: do I need to move to a lower altitude?”
“I can give you a medication to control your blood pressure. It should help your pulmonary arterial pressure as well.”

“Ok. My next question is: will this be just a temporary fix or a longer-term solution? Like, will I take the medication and then it gradually stops working over months to years, and I’m right back where I started? Surely, as a bilingual doctor, you’ve treated many Gringos who had trouble adapting to altitude.”

“Yes,” she confirmed, smiling a little, “I have. Most of the time once they start the medication, they are fine. You should be able to live here. I’ve seen a few for whom it didn’t work and the person had to move.”

“How many?”

“One or two.”

“One or two out of how many?”
She hesitated and thought back. “Maybe 100-150.”

“Well, that’s pretty good odds. Okay, I’m ready to try it.”
We talked about the different classes of medications and settled on one. I also asked her about my friend’s suggestion of going down to a lower altitude for a few days and taking my pressure there, and she agreed that that was a very good idea.
So, I went home and called Arutam Ecotours and booked a 3-day excursion to el Oriente. I just finished packing and I’m excited!

I’m not sure what will happen next. Keep connected for further updates…and photos from the rain forest!

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4 thoughts on “Ups and Downs

  1. One step at a time eh? See what happens with medication, the odds do seem to be in your favour. In the meantime, a 3 day excursion to el oriente sounds like a good reprieve and a distraction from the days of worrying. Sending a gentle hug your way my friend.

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  2. OH dear! I didn’t know you were having these issues. I was on that BP med (lisinopril ) when I came and after my small stint in the hospital (will tell you about it when I see you) the doctors changed all my meds. Well, in control now. Don’t give up — if that’s not the right one, there are others. 😦

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  3. OH dear! I didn’t know you were having these issues. I was on that BP med (lisinopril ) when I came and after my small stint in the hospital (will tell you about it when I see you) the doctors changed all my meds. Well, in control now. Don’t give up — if that’s not the right one, there are others. 😦

    Like

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