The View From the Outback© 2000 Richard C. Rhodes
A great deal of what we read in newspapers, magazines, and books, and what we see in the movies and on TV is written and produced in New York City or Los Angeles. Much of the "political wisdom" comes from the PR machines of the White House, the Congress, and from the Washington media corps. In short, one might conclude that all knowledge, wisdom, and wit are confined to those who inhabit New York City, Washington DC, or Hollywood. I am now a senior citizen, in my 7th decade. My experience was gained in many cities in the U.S. and in about 30 foreign countries. That experience has included the U.S. Marines, law school, the ATF, the CIA, Fortune 500 executive, writer, public speaker, educator, editor, and publisher - for openers. Some insights come from talking with ham-radio operators in every major country and such idyllic places as the Cook Islands. For over 20 years, I have written articles off and on for various magazines and newspapers. I've had an enormous number of letters published in major national publications. The Outback is the rural area in Northeast Texas where I have lived for the past 15 years. Every other Saturday I will attempt to post a new set of musings from the Outback - with dated updates as appropriate. Click on a Topic to go directly to that topic. March 15, 2005: In the Outback for Nov. 6, 2004, speaking of the Monday Night Football commercial with Nicollette Sheridan ending up dropping her towel to show her bare back, I said: "An FCC fine should be out of the question. I see letters to the editor in the Dallas paper where people were shocked and are calling for fines. Think about what fines would mean folks, before you dash off these emotional letters. What kind of precedent would it set and where would it end?" In a unanimous decision on March 14, 2005, the FCC said the segment "simply is not graphic or explicit enough to be indecent under our standard." Was there ever any doubt? I still have that commercial saved on my DVR. It was a classic. Indecent? Give me a break. The bra and pantie ads come closer to being indecent. March 12, 2005: The tragic shootings in the Atlanta courtroom focus for me on two points. The local law requires that defendants not be handcuffed as they enter the courtroom, so the sight of handcuffs doesn't unfairly influence the jury. What PC nonsense. This is not the only time a prisoner got loose in a courtroom with a weapon. Criminal's rights are protected by an elaborate series of laws and court decisions. I submit that there should be NO public policy that it is better not to "prejudice" a criminal defendant by requiring handcuffs in court - when balanced against the potential for an unshackled defendant to cause injury and death to people in the courtroom. Are murderers and rapists somehow going to be on their good behavior while in court facing long prison sentences or perhaps the death penalty? In Texas, those who have Concealed Handgun Licenses are prohibited from carrying a licensed handgun "on the premises of any government court or offices utilized by the court." This makes no sense. CHL holders are not the problem. It is people like the criminal defendant in Atlanta who are the problem. We can always second-guess. But, all judges should be armed and trained. And if a state has a Concealed Handgun Law, those persons ought to be able to carry their weapons into courts. In Atlanta, the outcome might have been different if someone with a concealed permit had been in or near the courtroom. Or if the judge had a pistol. Spare me the lecture about how an innocent person might get hit in the crossfire. For sure, three innocent persons died in Atlanta. More thoughts about the Atlanta shootings. The training of the armed court officer whose weapon was wrested away appears to have been deficient. Was she too close? Did she walk out in front of the prisoner? Was her holster not one of the captive types that takes a particularly unusual motion to unleash the weapon? She is 51-years-old and the prisoner is 6 ft. and about 200 pounds. Whose idea was it to have her be his sole guardian as he came into court? All the circumstances may eventually come to light. March 10, 2005: In the Outback for Jan. 12, 2005, I noted that I had installed Pest Patrol from Computer Associates. But, that I could not recommend it because it updates all the files, rather than simply updates the last set of files and definitions you had on disk. Especially on a dialup connection, this a very long process. PC World, April 2005, ran tests of several spyware programs. Pest Patrol was rated only 48% efficient, while Sunbelt Software Counterspy was rated 85% proficient. That was enough for me to uninstall Pest Patrol - another $39.95 down the drain. In a sidebar, PC World mentioned that the Beta release of Microsoft's Windows Anti-Spyware seemed to do a good job and had a robust real-time monitoring mode. I downloaded Windows Anti-Spyware (6MB +) and set up the real-time monitor. The active monitor keeps track of several
functional areas in Windows in real time, and who better to understand the vulnerabilities of Windows than Microsoft. And they have an AutoUpdate feature, much like Windows AutoUpdate. I use DOS batch files (in WinXP yet) to do simple daily backups of my homepage, e-mail, etc. Windows Anti-Spyware intercepted each batch file and asked me if I wanted to run it, with a check box to "remember this." It viewed the batch file as a "script file." No other program has ever intercepted a batch file. Maybe that portends good things for Windows Anti-Spyware. The program expires in 143 days and then will need another download. For now, it is free. I will continue to use both Ad-Aware and Spybot Search & Destroy for periodic scans - along with Windows Anti-Spyware full scans. And we will see if Windows Anti-Spyware actually catches any spyware. My batch files could have been spyware. So what does the above tell you? If you want to do things for free, download the Windows Anti-Spyware, Ad-Aware, Spybot Search & Destroy, the free Zone Alarm firewall, and the free AVG antivirus from Grisoft.com (for personal use only). I am using Zone Alarm Pro, the paid version, and EZ Antivirus from Computer Associates, but the package of free programs ought to protect your computer quite well, unless you get off the beaten path on the Internet. Who can say how much is enough protection? March 8, 2005: The U.S government has published the "Dietary Guidelines for Americans 2005." It is a remarkably cogent publication for a government document. The new guidelines cover a broad range of topics, including nutrition, weight management, physical activity, food groups to encourage, fat, carbohydrates, alcoholic beverages, some very useful charts, and much more. A terrific .PDF file (4.2MB) of the Food Guidelines is available at: www.healthierus.gov/dietaryguidelines. Download it. You will find much of interest. It is not the last word, of course, as many doctors and scientists will disagree with some of the findings and pronouncements. On balance, it is a very good piece of work. March 7, 2005: As a long time user of WordPerfect, the news today brought joy. The Justice Department will make the latest version of Corel's WordPerfect Office software available to more than 50,000 lawyers and other Justice Department employees. For those who constantly predict the death of WordPerfect, you ought to try it. It is simply a superb piece of software. The problem began when Microsoft forced computer makers who used the Windows operating system to install all or part of Microsoft Office on their computers. Once a person had MS Word free with the computer, it was hard for WordPerfect to make any headway. Novell sold WordPerfect to Corel. The last I read, Novell was suing Microsoft over that earlier discrimination (anti-competitive practices) against WordPerfect, even though they no longer own the software. I'll testify on behalf of Novell, since I have written at least 20 times about the predatory and anti-competitive business practices of Microsoft. Once I checked into a small hotel in Europe with a couple of suitcases, one of which carried the tools of my espionage trade. I always carried the bags to my room. In my room was an adjoining door to the next room, and it had an old-fashioned "keyhole" type lock. I bent over to look through the keyhole and was staring at an eyeball, which quickly darted away. I was able to see the young lady from the hotel staff as she left the room. Then, I put a towel over the doorknob so that it covered the key hole. The next morning this same lady was my waitress. I said to her, in the local language, "Good morning big eye." I am getting one of those Crystal Ball feelings again. Oprah Winfrey is scheduled to retire in a few years. Who could possibly replace her? My vote goes to her "best friend Gail." Gail is showing up more and more and sometimes with a mike in her hand. She is beautiful, sexy, self-assured, articulate, has a pleasant speaking voice, and is very intelligent. No need for a casting call. My guess is that most people who use Google simply type in their query in the single space on Google or that single space provided on some toolbars which include Google. Most people probably know to put " marks " around a phrase when they want to search for only the exact phrase. Have you tried the Advanced Search? You can search for "all" the words, the "exact phrase," with "at least one" of the words, and "without" certain words. You can ask that only pages in English are displayed and how many result you want to see per page, and more. After you have it set up once, you can save it and allow a cookie to record your preferences. I have an icon on my Toolbar for Google Advanced. It is the only mode of Google I use. And check out the "Advanced Search Tips" at the top of the page. Sen. Robert Byrd is in verbal deep doo-doo again. The doddering old fool compared Republican threats to outlaw filibusters on judicial nominees on the Senate floor, once the nominations have moved out of the Judiciary Committee, to Hitler jamming legislation through the German Reichstag. Must we go over this again? Never in the history of the Senate had judicial nominees been filibustered on the Senate floor until the Democrats starting doing it to Bush nominees. The Republican effort would prevent filibusters on the floor and demand an up or down vote on a nominee by the full Senate - as had always been the practice in the past. A REUTERS release said that Republicans have threatened to change the rules to forbid filibusters. Whether by design (to inflame passions against Republicans) or out of ignorance, REUTERS (Mar. 2, 2005) got it wrong. The Republicans want only to limit filibusters on judicial nominees brought to the floor. Several prominent Republicans took to the Senate floor to say that they defend the Senator's right to filibuster on "legislative matters." This is what you get when a great portion of the news is promulgated by REUTERS and AP. Close is only good in Horseshoes and hand grenades. Before long, people start to believe what they read. And first impressions are the most important ones, even if the full story is later told. What a colossal waste of time it is to take up the time of the U.S. Supreme Court to decide where and if the 10 Commandments can be displayed, or if we can say "Under God," in the pledge of allegiance. The First Amendment to the U.S. Constitution says with regard to religion: "Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof;...." That was intended to prevent the U.S. Government from establishing an overaching State Religion. To even argue that it means that we can not have the 10 Commandments posted where we want them is simply moronic. I predict that the Court will decide against those who want to ban the 10 Commandment scrolls and plagues and monuments on government property. If they don't, President Bush really has his work cut out for him in getting some justices on the Court who can read and understand clear and simple English - and its historical antecedants. Any sixth grader could figure this one out. Also, pay attention to the second phrase, "or prohibiting the free exercise thereof;" What do you think that means - other than what it says? From the first announcement that the Segway balancing two-wheel scooter was going to "revolutionize" transportation, I voiced my extreme skepticism about the practicality of this $5,000 invention looking for a reason to be invented. That was back in 2001. As of Sept., 2003 only about 6,000 had been sold. You can buy one on Amazon.com if you care to, largely because the president of Amazon, Jeff Bezos, was one of the big investors in Segway. One model in "only" $3,900. If you want to see some "unsolicited" testimonials, just check them out on Amazon. One fellow says that if you live in L.A., you truly no longer need to own a car. Say what? I hope he doesn't fall off his Segway when he lights up his joint. How else can one explain such a comment? The suggestion I chuckle at the most is that you can use it to commute to work. On a freeway in Dallas or L.A.? On the crowded streets and sidewalks of Manhattan? In the rain? In the snow? In 15-degree temperature? Maybe commute in a town of 1500, if you happen to be one of the 100 people who actually works there and does not communte to another city. There are cities where the Segway is not allowed to travel on sidewalks, even after one of the most intensive lobbying efforts in history. Although I have read The Wall Street Journal for about 30 years, their glorification of wealth, mansions, yachts, expensive wines, and extravagant expenditures on clothing and jewelry that nobody really "needs," has always galled me. Check on my main Web page under "Letters" where I chide the readers of the Journal about the discussion of expensive watches. It is nice to know that I am not alone. Here is a letter from the WSJ for March 3, 2005: A Fool and His Money As a long-term subscriber, I was astounded to see the Feb. 18 Weekend Journal article "The $600 Flip-Flop -- Lowly Sandal Hops Price Barrier and It's Not Just Big Names." The only reason there are flip-flops costing $500 to $1,100 a pair is because there are too many stupid people with too much money. Nicholas Ciarlo Martha Stewart served her time and is now home. For the next five months, Stewart must wear an electronic anklet so authorities can track her. She is allowed to receive her salary again and can leave home for up to 48 hours a week to work, shop or run other approved errands. I am not drawn to Ms. Stewart, since she strikes me as haughty, aloof, and probably a pain in the butt. But, I think she is getting a raw deal. If you walked into any building on Wall Street or other financial centers, you could close your eyes, throw a dart, and stand a pretty good chance of hitting someone who is rich partly because they lie, cheat, or are privy to insider information. Poor Martha. She took the fall for all those thousands of other guys and gals. She did her time and should be allowed to get back to making a few more million the old fashioned way, earning it. Martha, come to the Outback and cook me one of your fabulous dinners. I am tired of Tuna-fish salad and Chili. We might even get along, since I too have a distorted sense of self worth. In an earlier Outback, I mentioned that the "Vitamin E will kill you," nonsense had a shelf life of about two days, and then it faded from view. The Vitamin E lobby is staging a comeback. Among the many good reports was one recently that had shown that high blood levels of Vitamin E components seem to cut the risk of prostate cancer by about 50 percent. The alpha-tocopherol component of Vitamin E can also help enhance the immune system, the study added. (March 2, 2005, Journal of the National Cancer Institute). Those of you who read my tips on preventing colds and flu probably thought I was off my rocker when I said that I spray a baby wipe with Lysol and wipe down the handle on my grocery cart. (Outback, Oct. 4, 2004) Have you seen the TV commercial where the young man sneezes and coughs all over the handle of a shopping cart? The advice is "not to worry," but to use Purell, the alcohol-based hand cleaner aftewards. Let's try again. Wipe the cart handle with the Lysol soaked wipe AND after you load the groceries in your vehicle, clean your hands with Purell - or a similar germ-killing hand cleaner. It is not only the grocery cart handle that is laden with germs. It is now second nature to me to do my two-step procedure. And if I heard anyone cough while in the store, I spray my nose with a saline solution I carry in the truck and blow into a tissue. So far, knock on my wooden head, it is working. Back on July 1, 1988, I had an article published in The Dallas Times Herald about how important it was for immigrants to learn how to speak English, for their own economic well being. I said that "Bilingual education is a sham. You learn a language by desire and immersion." (See Letters on my main Web page) California finally woke up a few years back and passed Prop. 227, which required all public school instruction to done in English. Since then, fluency rates among California students with limited English skills has nearly doubled. It used to really piss me off that what seemed so obvious to me appeared to escape educators and legislators in many of our states. It helped that I worked, lived, or traveled in about 30 countries and discovered early the frustrations from not being able to speak the local language. I remember the cloistered American community in Frankfurt, where we lived even though we were "civilian" government employees. One day the PX was out of bread and I heard someone say they did not know what to do. They had failed to discover that Germans made bread, too. And that the word for bread contained only four letters and was not hard to pronounce. Brot, bitte, (bread, please) would be a terrific start on staving off starvation. If you like dark bread, "dunkle brot" would get you some. And if you liked dark beer, "dunkle bier" - as I do - it would get you a dark beer. To this day, I drink St. Pauli Girl, a German Dunkle Brau (dark brew). The patient may get only a "handout," which is an abbreviated form of the full information document and one that tries to speak more in layman's terms. Here are just a few lines from the Cordarone (amiodarone HCI) information sheet that is available to doctors and is the type of enclosure normally placed in a box of pills sent to a pharmacy. You can view the entire Cordarone information sheet at the Wyeth web site (www.wyeth.com). Actually, there are three .PDF files for Cordarone on the Wyeth site. One appears to be the old info sheet. One is a new info sheet with the new warnings, and one is a patient handout, which contains some of the new warnings. From Wyeth Pharmaceuticals: (the boldfacing in these excerpts is mine) Dear Health Care Professional: Please see the following important boxed Warnings about Cordarone Tablets. "Cordarone® (amiodarone HCl) is intended for use only in patients with the indicated life-threatening arrhythmias because its use is accompanied by substantial toxicity. Cordarone has several potentially fatal toxicities, the most important of which is pulmonary toxicity (hypersensitivity pneumonitis or interstitial/alveolar pneumonitis) that has resulted in clinically manifest disease at rates as high as 10 to 17% in some series of patients with ventricular arrhythmias given doses around 400 mg/day, and as abnormal diffusion capacity without symptoms in a much higher percentage of patients. Pulmonary toxicity has been fatal about 10% of the time. Liver injury is common with Cordarone, but is usually mild and evidenced only by abnormal liver enzymes. Overt liver disease can occur, however, and has been fatal in a few cases. Like other antiarrhythmics, Cordarone can exacerbate the arrhythmia, e.g., by making the arrhythmia less well tolerated or more difficult to reverse. This has occurred in 2 to 5% of patients in various series, and significant heart block or sinus bradycardia has been seen in 2 to 5%. All of these events should be manageable in the proper clinical setting in most cases. Although the frequency of such proarrhythmic events does not appear greater with Cordarone than with many other agents used in this population, the effects are prolonged when they occur. Even in patients at high risk of arrhythmic death, in whom the toxicity of Cordarone is an acceptable risk, Cordarone poses major management problems that could be life-threatening in a population at risk of sudden death, so that every effort should be made to utilize alternative agents first.... INDICATIONS AND USAGE Because of its life-threatening side effects and the substantial management difficulties associated with its use (see “WARNINGS” below), Cordarone is indicated only for the treatment of the following documented, life-threatening recurrent ventricular arrhythmias when these have not responded to documented adequate doses of other available antiarrhythmics or when alternative agents could not be tolerated. 1. Recurrent ventricular fibrillation. As is the case for other antiarrhythmic agents, there is no evidence from controlled trials that the use of Cordarone (amiodarone HCI) Tablets favorably affects survival. And later:
The difficulty of using Cordarone effectively and safely itself poses a significant risk to patients. Patients with the indicated arrhythmias must be hospitalized while the loading dose of Cordarone is given, and a response generally requires at least one week, usually two or more.
And a little later: What is the most important information I should know about Cordarone Tablets? Cordarone Tablets can cause serious side effects that can lead to death including: • lung damage Call your doctor or get medical help right away if you have any symptoms such as the following: • shortness of breath, wheezing, or any other trouble breathing; coughing, chest pain,
or spitting up of blood Because of these possible side effects, Cordarone Tablets should only be used in adults with life-threatening heartbeat problems called ventricular arrhythmias, for which other treatments did not work or were not tolerated." (end of Wyeth excerpts) In my earlier Outback (Nov. 27, 2004), I mentioned the high number of cases where Cordarone (Amiodarone) is cavalierly prescribed by doctors for Atrial Fibrillation (AFIB), known as prescribing "off label," since AFIB is not one of the conditions indicated in the prescribing guidelines. I noted of a case that I knew of where a well-known doctor at Baylor Medical Center in Dallas had prescribed Codarone to a patient with AFIB. But, that the patient went home, did some reasearch, and threw the pills in the toilet. That person was me! How thankful I am that the answers were all out the Internet if you knew how to find them. If you have AFIB and your doctor prescribed Cordarone to you for that condition, it should seem apparent from the above partial quotes from the Wyeth "disclosures" that you doctor acted irresponsibly. I would term it gross malfeasance. This should be ample reason to seek another doctor to treat you for your AFIB. You probably should resist the temptation of smashing the doctor in the mouth as you leave the office for the last time (if you have the strength), even though you probably could beat the assault charge - given the circumstances. Patients who are taking Cordarone (Amiodarone) are encouraged to contact the FDA if they have side effects: FDA MedWatch Reporting System by phone (1-800-FDA-1088), fax (1-800-FDA-0178), via the MedWatch Web site, or by mail to MedWatch, HF-2, 5600 Fisher's Lane, Rockville, MD 20852-9787. If your doctor prescribed Cordarone (Amiordarone) for anything other than recurrent ventricular fibrillation or recurrent hemodynamically unstable ventricular tachycardia, you might also let the FDA know his name - and also make the circumstances known to your state health board and any state board that certifies doctors. If you thought Vioxx would engender a lot of lawsuits, it ain't nothin' compared to what the several makers of Amiodarone, and the doctors who prescribed it "off label," - or without due diligence - will see now that the "truth" has been published by it own makers. Toothless In Wal-MartHere is some free legal advice. If you are ever injured in a Wal-Mart store, or are injured by a product you buy there, hire an attorney immediately. Do NOT contact Wal-Mart and ask them to do the right thing by you. Consider the following: Some time ago, I bought a package of bulk-packed shelled Pecans at Wal-Mart. While eating a few Pecans one evening, I bit down on a Pecan shell piece and broke off a gold crown and the rest of the tooth - down to the gum line. This was not the first time I had lost a tooth or part of a tooth to a product purchased at Wal-Mart. One fell prey to an Olive pit in a can of "pitted Olives." One snapped off when I bit into a Cherry pit in a cup of Cherry Yogurt. And finally, I lost part of tooth when I bit into a full Cherry pit in a can of Del Monte Mixed Fruit. I took a color photo of the gold crown still attached to the tooth that had broken off on the Pecan-shell fragment. I sent a long letter to the Chief Legal Officer in Bentonville, with the photo. In that letter I noted that I was a long-time Wal-Mart customer and did about 90 percent of my shopping there. I enclosed a computer-generated shopping list where the items were keyed by the aisles in the Paris Wal-Mart store. It was part of my "bona fides" that I was really a good and loyal customer. I made no threats, just asked for some help. I pointed out that I had suffered in silence with the other three tooth mishaps, but this complete loss of a tooth and gold crown was the last straw. In return, I got a letter from some fellow who apparently has no title. He said, in part: "While I cannot guarantee that your claim will be accepted, I am confident that you will be treated with respect by CMI and that your claim will be seriously considered." CMI is Claims Management, Inc, one of the organizations that Wal-Mart uses to investigate claims. I got a call on my answering machine from a lady at CMI. I called her back twice and got her voice mail. In a few days, after having never spoken to me, I got a letter from her telling me that: "Our investigation into this matter indicated no negligence on the part of this store or Wal-Mart Stores, Inc,; therefore we must respectfully deny this claim on their behalf." And what investigation would that be? You are writing a former Federal agent, lady. There was no "investigation" here. I was referred in the letter to a lawyer in Dallas. When I called, I got his voice mail and did not leave a message. I had the sense that this would be the start of a monumental run-around. I gave up, as they no doubt hope most people will do. The tooth that bit the dust from the Pecan shell sheared off just above the gum line, leaving a couple of jagged peaks. My dentist said that it would cost about $1450 to pull the tooth and install a partial bridge. Since I do not have dental insurance, and it would be only a matter of time until I broke the new tooth on some foreign object in food I bought at Wal-Mart, I decided to do nothing. Every once in a while, I feel the jagged edges of the tooth remnant with my tongue and it reminds me of my vow never to shop at Wal-Mart again - unless there is no other choice for what I need. I guess I was naive, but I thought since I documented the loss of all or part of several teeth in foods I bought at Wal-Mart - that were not supposed to have hard foreign objects in them, that Wal-Mart might show some compassion and offer to pay for my partial bridge. What a dreamer. And I went to law school. I marked the date on the empty can of Del-Monte Mixed fruit I bought at Wal-Mart that took out my last hunk of tooth, and that was after the Pecan shell destroyed a whole gold crown and tooth. The Cherry pit is still in the can in my kitchen cabinet, as a reminder. The date was February 11, 2004. So, it has been 13 months since I quit shopping at Wal-Mart. Now I test everything I eat by nibbling on it with my front teeth to see if there are any foreign objects. I find something now and then, like a partial pit in a Prune, or a piece of bone in a hunk of "boneless meat." I buy only the largest pitted Olives and dice them into small piece. I no longer buy any canned goods that contain anything that might have had a pit or large seed in it, such as mixed fruits, canned Apricots, and so on. I will not eat Cherry pie from anywhere. I have nearly quit eating popcorn, since I cannot afford to loose any more teeth. Maybe it is just my renewed diligence, and my avoidance of potentially troublesome foods, but since I quit shopping at Wal-Mart, I have not chipped or lost a tooth on a food item. Wal-Mart will not miss my contribution to their bottom line. But, I would hope that more people would stop buying from Wal-Mart. A surprising number of people in the Outback have told me that they will not set foot in a Wal-Mart. Running small businesses out of town, labor disputes, a majority of their products made in China, and on and on. There are a lot of reasons not to shop at Wal-Mart. Think about them and see if you might not join those of use who are now Wal-Mart free. My computer-generated grocery list now is keyed to the aisles in the Kroger store. You get a 10 percent discount on Kroger-branded products, and a senior-citizen discount. And for reasons known only to a higher power, Kroger has plenty of little bars you use to separate your groceries on the conveyer belt. Wal-Mart never seems to have but a few here and there, if any, in an entire store. I once made a "separator bar" from aluminum stock and carried it into Wal-Mart to use on the conveyer belt. Of course, I had to get a sticker put on it at the door, even though it had a large label on one side that said, "Private Property of Richard" and a label on the other side that said " Wal-Mart Bars --- Where Are You? The cashiers just shrugged their shoulders, like saying "keeping track of those things is not my job." Blood Pressure Medication Needs to Follow Body's RhythmsBlood pressure follows the circadian rhythm in your body. Of course, it can also be influenced by stress, caffeine, alcohol, exercise, diet, and other factors. But, in planning on what kind of medication to take for hypertension and when to take it, you should know the basic body rhythm. Blood Pressure (BP) normally declines about 10% to 20% during sleep. As soon as you awaken, your BP starts upward - while you are in bed. Then, when you move around, it jumps again. Gulp down a couple of cups of coffee, rush to get the kids off to school, and jump on the freeway - and your BP will most likely move up again. This escalating BP in the morning is one of the reasons given as to why a large number of heart attacks and strokes happen in the morning. If you take medication for your BP, chances are that you take it in the morning. Most people cannot be bothered with taking pills at noon, as there are too many distractions. And few like to take their "medicine" twice a day, such as in the morning and in the early evening hours, at or near the evening meal. So, the sad truth is that your BP medication that you took in the morning has not kicked in as you scurry about your morning ritual. In looking at the time it takes for the "antihypertensive effect" to begin, a review of several BP med information sheets suggests that it can take from two to three hours for some pills to reach their full antihypertensive potential. And the pill you took the day before may not (probably will not) be doing anything to lower your BP in the morning. For many BP drugs, the effect has petered out overnight, if not sooner. You may be left high and dry in the first part of the morning, with little help from your medications. Study the full information sheet usually available on the Web site of the drug maker and see if you can determine how long it takes to "kick in" - and what the "half-life" is, that is, how long it will remain effective in your system. And ask your doctor to go over your dose timing with you - and whether it might be appropriate to split your total dosage over a span of time. A lot of times, I think doctors tell people to take their meds in the morning because they figure that may be the only time anyone will stick to a program. As it is, a huge percentage of people on BP drugs (and others) stop taking them, even if they have no side effects. They just get tired of taking the pills. For years, I took a BP pill in the morning and one at night. At times, I have taken one three times a day, possibly of different types. But, I am retired and have my AM, Noon, PM weekly pill boxes filled on Sunday night for the whole week. I have been researching the newer BP drugs called "angiotensin receptor blockers" (ARBs). My cardiologist started me on one quite a while back, with the single full dose in the morning. I have a good BP measuring device and noticed that my AM pressures were way too high, and that it was not until late in the morning or early afternoon that they began to drop. From the information sheet for my ARB, I learned that the "half-life" of the medicine was at best 7-9 hours. After juggling split doses, sometimes with AM and Noon, and sometimes with AM and PM, I still was not getting the results I should. I keep a computer log of my meds (the only ones I take are for BP - pretty good for an old geezer) and the times I take them, with BP and pulse readings - maybe two or three times a day a couple of three days a week. When I presented my "profile" to my cardiologist, he dug in the closet and handed me a pile of new ARB pills that he said would work for an entire 24-hour period. It takes several weeks to get the full effect, but my research in dozens of medical journal articles indicates that the ARB BP pill that I am now taking has a half-life of about 24 hours. In other words, if you take it in the morning, you are still getting some effect when you wake up the next day. And that it is probably good to also take a diuretic with the ARB. If your doctor is up to speed on BP medications, and you mention an ARB that lasts 24 hours, he will most likely know the one of which I speak. I know of only one 24-hour ARB, but there may be others. And there may be other types of BP meds, such as ACE inhibitors or calcium channel blockers, that last 24 hours. I don't have all the data on those variations. Your doctor may not think an ARB is right for you. I am just saying that it took some experimentation to arrive at my present BP medication regimen, with a med that apparently lasts for 24 hours. Medical opinion is now more or less agreed that taking your BP at home, with a high-quality "cuff" is a good idea. Too many people have "white coat syndrome," and have higher BP in the doctor's office than they have at home or work. Also, everyone agrees that you should sit still for at least 5 minutes - and not talk (talking raises your BP), and have an empty bladder, before you take your BP or have it taken. What happens in the doctor's office? Suppose you have a 9 a.m. appointment. Then, suppose you have "white coat syndrome," higher BP due to the tension of being in the doctor's office. Finally, you are whisked to an examining room, where often the nurse will almost immediately take your BP. Even if you are taking a BP medication, it probably has not yet kicked in early in the morning. I prefer to have a doctor take my BP reading after lunch, when I am pretty sure I am getting the maximum benefit from my BP medication(s). In fairness, it used to be said that those with "white coat syndrome" were not getting a fair BP reading. But, more and more doctors suggest that those with "white coat syndrome" are "reactors" to various types of stress. So, if they were to carry an ambulatory BP recorder around all day, it is probable that these "reactors" would have spikes in BP during the day's activities that others might not have. In fact, "white coat syndrome" may simply be an indicator of a broader problem. There are places on the Web where you can get advice and comparisons on home BP cuffs. You might look at the one I use, made by Life-Source, the UA-787AC. The one with the "AC" at the end has a clock and will hold in memory your last 30 BP readings and pulse rate with the time and date. The cuff is automatic. Push a button and let it do its thing. It also is the only one I know of that is certified to take accurate BP readings if you have an irregular heart rhythm. It actually blinks a different icon if your heart is out of rhythm. It costs about $90 or so and works on 4AA batteries or a supplied AC plug-in supply. The UA787 also has 30 memories, but it does not record the date/time for you. There are other good cuffs, but I recently upgraded from a UA787 to a 787AC (with the date/time stamp) because I was so pleased with the results I got over a year or two with the earlier model. Disclaimer: The content of articles on this web site are provided for information purposes only. A decision to act upon the information presented on this web site is at the discretion of the reader. No liability or responsibility whatsoever is accepted by the author(s) for any material contained within this web site for any alleged harm arising from the use or dissemination of this material. All decisions regarding health and medical issues should be made in consultation with one or more competent medical practitioners. COPYRIGHT 2000 Richard C. Rhodes You are welcome to quote sections from this page - or the whole page, as long as the source URL is included. Of course, I would be flattered if anyone linked to this page. It is very hard to be the writer, editor, fact checker, copy editor, and publisher of anything. So, I beg your forgiveness for the many mistakes that creep in. Suggested Reading From Past Columns Click Here for Suggested Reading List Archive of Back Issues Media List of Addresses and e-mails Postal Service State Abbreviations, etc. Postal Service Abbreviations - Richard C. Rhodes End |