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The Medical Profession and “Average” vs. “Normal”

My previous post expressed my sincere gratitude to the medical profession and all its representatives who have helped me through my most recent health adventure and all my previous ones. I still stand by that. But there is one area in which I’d like to offer some constructive criticism, in the face of our modern prevalence of chronic lifestyle diseases: sometimes “average” symptoms are confused with “normal”. What brought this up is that I was incorrectly diagnosed with bradycardia, or abnormal resting heart rate, during my recent hospital stay. No harm was done, it was just something incorrectly noted in my record. My personal physician, who understands my situation better, will I’m sure correct this tomorrow when I see her.

I was reluctant to show this picture because I’m not trying to make fun of the guy on the left. He may be a great guy, a first responder, the world’s best grandpa, or he does a lot of volunteer work. But his appearance is more representative of the average older adult in the modern world than the guy on the right.

In medicine, “normal” has a precise definition, it means in the absence of health conditions. “Average” refers to the statistical average of a population. The average older adult in the modern world is not active enough and does not have a healthy enough diet. So using the symptoms of an average older adult who is not sick as “normal” is misleading, especially when it comes to heart symptoms. Specifically, it is not “normal” for your resting heart rate to be in the 70s for an older adult, even though that may be the average. And it is not “abnormal” for your heart rate to be in the 50s, even though that is below the average.

The official normal blood pressure is 120/80 or less, and that is based on correct medical reasoning. But the average blood pressure for older adults is probably more like 140 for the upper number (systolic). In fact, the medical profession still refers to high blood pressure as “essential hypertension”. Essential is because older folks have “hardened arteries” so more pressure is needed to get the blood where it’s needed. But “hardened arteries” is not normal, even though it is common for the average population of older adults. The assumption that hypertension is essential led to the old rule of thumb that your blood pressure is ok if it is less than 100 + your age. By that old rule (now discredited), it would be ok if my blood pressure were less than 168! But even though the ideal is 120 or less, I think many medical professionals have it in the back of their minds that 140ish is ok for an older adult.

As for bradycardia, people that are physically fit tend to have lower resting heart rates than average. In my case, my resting heart rate has been 60 my entire adult life, then recently because I’m on metoprolol after my heart-valve replacement, my rate lowered a couple of beats into the high 50s. But for an average male my age this would be considered abnormally low. In the heat of battle of trying to deal with severe vertigo and make sure I wasn’t having a stroke, no one at the hospital checked to find out that I eat better and am much more active than the average adult my age.

As for blood pressure, that was high (but not dangerously so) during my entire hospital stay because I was temporarily taken off my blood pressure med (metoprolol) since dizziness is a known side effect. It drove me crazy when someone like a harried CNA bustling about her many duties would come in and do my vitals and say “BP 144/80, not bad for someone your age”. I wouldn’t say anything, because she was just trying to make me not worry. But while that reading may not be that bad in the context of a short hospital visit, it is bad if it is chronically that high.

As for bradycardia, there are pathological conditions that can cause it, as well as cause an enlarged heart. So it is assumed to be unhealthy if your resting heart rate is lower than average. But above-average physical fitness is now known to be an exception, a lower heart rate is fine in that case. Years ago, aerobically-fit candidates would be rejected from firefighter training because they had low heart rates or enlarged hearts. So you can be fit and still get into firefighting academy.

So my constructive criticism to medical professionals: if a patient, especially an older one, presents with what appears to be bradycardia, don’t forget to ask them if they happen to be physically fit. In that case, the symptoms are probably benign.

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