Posted on Friday, 10th May 2019 by

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I have two short updates to cover before starting Trust but Verify. First, Joe wrote after reading It’s Time to Get Real that you need to check your individual state’s document requirements when applying for the new REAL ID. Your State may require different forms of ID and residency documentation than what Pennsylvania requires. He lives in Illinois and went to renew his driver’s license, upon arrival they advised him that only certain state driver’s license facilities accept REAL ID applications.

I also mentioned in the same article that I recently ordered replacement birth certificates. My daughter and her husbands’ birth certificates were rejected by the Post Office when they applied for passports. According to the Post Office, birth certificates must now include the names of both parents and a raised seal.  I also discussed how to replace lost documents that you may need for your retirement application and for other purposes in a recent article titled Replacing Lost or Stolen Documents.

I received a full refund from the PA Office of Vital Records because I am a veteran. I originally checked veteran status on my replacement birth certificate application and thought I had to pay for my wife’s certificate. They returned the check stating that both the veteran and spouse receive replacement birth certificates at no cost! A welcomed surprise. We need new certificates to apply for passports.

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Trust but Verify

Doctor’s visits create significant anxiety for many patients of all ages. According to a recent study,“30%–40% of patients who are diagnosed with hypertension on the basis of their office blood pressure measurement alone have normal out-of-office blood pressure, according to ambulatory blood pressure measurements.”

Many suffer from what is called White Coat Hypertension. Anytime they get near a doctor, any doctor, their blood pressure goes through the roof causing erroneous blood and intraocular eye pressure readings. I believe this syndrome may result in premature high blood pressure diagnosis and treatment. High blood pressure also elevates eye intraocular pressure causing concerns for glaucoma patients. This is far more common than previously thought.

If you have been diagnosed with high blood or intraocular pressure (glaucoma) consider whether or not you suffer from White Coat Hypertension. Buy a home blood pressure wrist monitor and compare your home readings to those taken at the doctor’s office. Your office blood pressure readings may not be a reliable indicator and comparison to your home readings may put an entirely different light on whether or not you have a problem or need treatment. 

The impact of White Coat Hypertension on your eye’s intraocular pressure (IOP) is more difficult to ascertain. Your doctor has a variety of tools to measure IOP; the Goldmann Tonometer, Tonopen, and the new ICare Tonometer. All have their advantages and disadvantages. If you have thicker corneas the Goldmann may not be as reliable, it is calibrated at a fixed cornea thickness. They do have compensation tables available however many doctors hesitate to use them. The Goldmann and the Tonopen use numbing drops while the new ICare Tonometers require no medication to measure IOP. An easy to use ICare Home model is now available from some physicians. The ultimate indicator of glaucoma progression is loss of sight and optical nerve damage as indicated by the perimeter and Optical Coherence Tomography (OCT) tests, not pressure alone.

There should be a national protocol established for patients that exhibit white coat hypertension tendencies to avoid misdiagnosis and unnecessary treatments. If your doctor doesn’t use the techniques listed below, ask your physician to use them for your checkups.

The following office procedures make sense for patients that suspect they have this condition or know they have this tendency:

  1. The doctor should annotate white coat hypertension tendencies on your chart.
  2. Initially limit the patient’s exposure to the primary care physician. When the patient has to see a medical assistant, then a fellow, complete scheduled tests, and finally see the doctor; the patient’s blood pressure and IOP readings won’t be reliable. With each medical provider interaction, the patient’s anxiety escalates.
  3. Shortly after signing in, a highly trained medical assistant or the doctor should take the patient’s blood pressure and IOP readings. A patient’s anxiety increases as time passes in the office. The sooner they take the patient’s baseline pressure readings the better. 
  4. Glaucoma patience with this condition should request their IOP readings be taken before any other checks including blood pressure readings. Basically, the patient’s blood pressure readings are always high in the office so they obsess over this. High blood pressure is known to elevate IOP.
  5. Scheduled testing should be done after the baseline blood pressure and/or IOP is taken either by the doctor or trained medical assistant.
  6. The doctor should Provide breathing instructions to patients during blood pressure and IOP tests. Holding your breath causes elevated pressure readings. Doctor’s should offer pamphlets that include breathing exercises and suggestions on how to reduce anxiety.
  7. The patient can purchase a home blood pressure cuff monitor and take the readings to your next doctor’s visit. For patients with glaucoma, ask the doctor to provide an ICare Home IOP monitor for several weeks and bring your readings with you to your next office visit.
  8. Have the physician compare the home monitor readings to the office visit baseline readings to determine the patient’s true blood pressure and IOP readings.

If you suffer from or believe you may suffer from White Coat Hypertension, discuss this with your physician and have them incorporate the above protocol for future office visits. It makes sense to be an advocate for your health issues; question your doctor, ask for clarifications and get a second opinion if warranted.

Request a  Federal Retirement Report™  today to review your projected annuity payments, income verses expenses, FEGLI, and TSP projections

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Opinions expressed herein by the author are not an investment, health care, or benefit recommendation and are not meant to be relied upon in investment, health care or benefit decisions. The author is not acting in an investment, medical, tax, legal, benefit, or any other advisory capacity. This is not an investment or benefit research report. The author’s opinions expressed herein address only select aspects of various federal benefits and potential investment in securities of the TSP and companies mentioned and cannot be a substitute for comprehensive investment analysis. Any analysis presented herein is illustrative in nature, limited in scope, based on an incomplete set of information, and has limitations to its accuracy. The author recommends that retirees, potential and existing investors conduct thorough investment and benefit research of their own, including detailed review of OPM guidance for benefit issues and for investments the companies’ SEC filings, and consult a qualified investment adviser. The information upon which this material is based was obtained from sources believed to be reliable, but has not been independently verified. Therefore, the author cannot guarantee its accuracy. Any opinions or estimates constitute the author’s best judgment as of the date of publication, and are subject to change without notice. The author explicitly disclaims any liability that may arise from the use of this material.

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