Dear Virtual Patient:
In order to successfully start and stick with a health “budget”, I think it’s important to get a good basic understanding of what all those numbers mean that we doctors get so excited about when you go for a visit. Just like when you read your bank statement, utility or credit card bills, or 401K statements, it’s important to know what’s what and if things are heading in the right direction. The next few blogs will address these numbers and their meanings.
The commonly used vital signs such as blood pressure, pulse, respiratory rate, and temperature offer a quick assessment of how well someone is doing when they walk in the door of the exam room. They tell us if a patient is stable enough to be seen in the office, or unstable and need to be seen in the Emergency Department NOW. When the nurse checks your vitals, she is making sure that: 1) your heart is beating in the right rhythm and rate; 2) your blood pressure is not too low or too high (we will go into MUCH more detail on this later); 3) you are taking the right number of breaths per minute; and 4) that you do not have a fever (or, very arely, have too low of a temperature). These should all be measured when one is at rest, or sitting quietly and relaxed (not talking, eating, or even crossing one’s legs). Let’s take a closer at each of these in turn.
The National Institutes of Health sets the normal resting heart rate range at 60 to 100 beats per minute. This is for adults and of course will vary person-to-person. Faster heart rates can be caused by fever, anxiety, anemia, dehydration, high thyroid hormone levels, medications, caffeine, cigarette smoking, alcohol, and stress, just to name a-not-so few. Slower heart rates can be caused by physical fitness, low thyroid hormonelevels, medications, heart muscle damage from a heart attack or inflammation, or an electrolyte imbalance (minerals needed by the body to carry electrical impulses or energy).
Blood pressure consists of two numbers, the systolic and diastolic readings. The systolic reading is the first number and is the measurement of pressure when the heart squeezes to pump blood through the heart and into the body. The second number, the diastolic reading, measures the pressure when the heart muscle is resting between beats and refilling with blood. A normal blood pressure is less than 120/80. Prehypertension is when the readings are between 120-139 over 80-89. Stage I hypertension (high blood pressure) is 140-159 over 90-99, and Stage 2 hypertension is when the readings are greater than 160 over greater than 100. Again, we will go into much more detail about these later on.
The number of breaths taken per minute for adults is between 12-18. Higher rates can be caused by fever, anemia, anxiety, lung disease, metabolic disorders, and medications. Slower rates can be due to head injuries and hypothermia (low body temperature).
Pulse oximetry is measured as a percentage that tells us how much oxygen your hemoglobin is carrying in your blood. Most healthy adults, without certain heart or lungs condidtionss, will fall somewhere between 94-99%. Readings can be affected by nail polish, a collapsed lung, narcotic medications, an irregular heartbeat, or decreased blood flow to the fingers (where the reading is taken) caused by cold temperatures or poor circulation.
A normal adult body temperature is 98.7 degrees F or 37 degrees C. Fever is usually considered significant if the temperature is greater than 100.4. Temperature measurements can be affected by mouth-breathing, drinking hot or cold beverages just before taking the temperature, and smoking. Hypothermia is defined as a temperature lower than 95 degress F or 35 degreees C.
Weight and BMI
A healthy weight for adults will vary based on gender, height, and activity levels, but the BMI is a good tool that measures how much weight one is carrying relative to one’s height. It does not measure actual body fat percentage. A normal BMI is 20-25, overweight is 26-29, and obesity is greater than 30. This is DEFINITELY a number we will be talking about much more in detail about as we discuss health budgets.
I hope this helps you understand why vital signs are so, well, vital, and why they are taken at each doctor’s visit. However, for the purposes of our future talks about your health budget, we will be focusing more on BMI and blood pressure, because they play key roles in determing one’s risk for serious health problems such as heart attack and stroke. In Part Two I will discuss common laboratory values such as cholesterol, blood sugar, and hemoglobin A1C levels and their importance in one’s personal health budget.
Feel free to learn more about Dr. Monique at Budget Your Health.