Posts filed under 'hypertension'
Today would be no exception to my rule that men really don’t see a world that has consequences until they are old enough that they see the consequences happening to others their own age, or even to themselves.
I spent part of yesterday evening in the emergency room with my nephew who had finally conceded that three hours worth of rapid heart beat (85-110) and high blood pressure (160/110 as measured at Walmart) was reason enough to see a professional. He is 38 years old and by his own admission, inactive and at 6′3, 250, overweight.
I cut him some slack last night, but today let’s discuss his experience. His self admission of being overweight was actually cutting himself some slack. He knows about body mass index (BMI) as well as I do and he knows that his build puts him solidly in the obesity category. “Overweight” is a way many of us use to gloss over the fact that obesity carries with it a number of potential health issues, only one of which became all to real to him last night.
As we waited for lab results and talked, he admitted that he hadn’t been to a doctor in three years. This is a guy who reads my blog and knows my opinion of guys (yes, including me) and their stupidity about their own health. He confessed that his real concern with the labs that were being worked on was that he would be found to have type 2 diabetes, one of the risks of obesity, a risk he knows about all too well because he is also a life insurance agent who works with diabetics frequently. He admitted that he has had concerns about his blood pressure because of his lifestyle. All that is to say that he was aware that he was probably due for some health problems.
My nephew was no different than my average client laying in the emergency room last night. He knew he has been heading down the wrong road for a while. He knew that, at some point, his lack of attention to his health could hurt him or kill him, yet he did very little to change that direction. He bought a bike that he doesn’t ride. He doesn’t like to walk, so he doesn’t. The only thing last night that set him apart from the average guy is that he went to the ER knowing that he has an adequate amount of life insurance in force.
So, why regular checkups? For my nephew, one good reason would be that he would be hearing from a professional that he was treading on thin ice with obesity, a recipe for disaster. For all of us it could well give us that advantage of an early diagnosis of something that can be serious left undetected. If we flip through life with our immortality shield up, never getting checkups, a heart attack could be how you find out you have heart disease or diabetes. A stroke could be the way we find out about hypertension, the silent killer. Regular checkups are wake up calls that don’t hurt.
Bottom line. Prayers were answered last night and my nephew, with a fresh look at life, should be fine. We should all work harder at being proactive about our health. There are people that would miss us.
December 14th, 2008
If anything, I hope I’ve driven home the point over the years that life insurance underwriters look at any health issue not just from a pure mortality standpoint, but from a compliance and control point of view. If you look at the overall bucket of potential insureds, some of the old school underwriters will still look at it from the angle that all people with hypertension should be treated the same.
But the key for those underwriters who truly analyze each case is compliance, does the client truly follow the doctor’s instructions and control, how well is it working? The truth is that while the dynamics of different health and mental issues may differ, the end result given an underwriter who isn’t trapped in the old school box of “everyone in the same bucket”, can vary dramatically in favor of those who take their issues seriously and strive for control.
A few examples of companies and underwriters who are acting outside the industry box with hypertension are Banner and Minnesota Life. While no other companies will allow their best rate class if a person is treated for blood pressure, these two leaders do just exactly that as long as control is demonstrated. Given good control most companies will only bump these clients to their second best rate class, but that is usually a full 20% higher than the best class. That can mean hundreds of dollars a year depending on age and policy size.
More and more companies are allowing that kind of treatment with cholesterol, but there are still plenty of old school companies and underwriters who believe that people should be penalized for treating their cholesterol, even when that treatment is preventative or if it’s for a borderline issue.
While certainly more complicated in what it takes to call bipolar disorder controlled, there are a few companies with underwriters that understand that the bucket approach is completely inappropriate. There are people with bipolar who are completely functional, stable and far from being a mortality risk.
Bottom line. Whatever your health challenge, if you believe it to be well controlled, if you believe that you are truly in charge of it and not it of you, seek out the independent agent who can capitalize on that for you. In many cases there is simply money that doesn’t need to be spent.
September 26th, 2008
A lot has been made over the years about diet and exercise being key components of a successful battle with hypertension or high blood pressure. But from the fringes we keep hearing snippets about drinking a glass of wine a day, eating dark chocolate and other things that seem oddly out of place.
Diet and dark chocolate! Diet and dark chocolate! Almost seems oxymoronic. I know from my experience that when I’m munching down dark chocolate, the word diet is secretly deleted from my brain during that moment. Maybe that is the power of antioxidants. Maybe they aren’t really good for you, they just erase guilt from your mind so, a little wine, a truffle….life is good.
But such is not the conclusion of studies that show that antioxidants actually do lower high blood pressure. This happens through a process of antioxidants inhibiting something called free radicals (sounds like something out of the 60’s).
This ability to inhibit free radicals can have far reaching effects, staving off high blood pressure which can prevent strokes and helping to prevent some of the big boys like heart disease and cancer.
So, will you get lower life insurance rates if you explain on your application that you eat blueberries or dark chocolate or (yum), dark chocolate covered blueberries from Harry and Davids, daily? Well, not from the mere mention of the fact you won’t, but a healthier you is a better life insurance risk and that should lead to lower rates.
Bottom line. Do what your mom told you. Eat chocolate and drink wine….and eat your vegetables. Science is on her side.
June 24th, 2008
We all know about the link between high blood pressure and strokes and/or heart attacks. In my slightly unscientific mind it is something like blowing up a balloon a little too much a few too many times.
There is a thing called white coat syndrome, named such because of the white coats that most doctors used to wear when they would see you in their office (they’re much more casual now). Anyway, the result of white coat syndrome is that a person whose blood pressure is normally, if not always, in the normal range, will without fail have a spike in their blood pressure readings when they have their blood pressure taken at the doctor’s office.
Studies have shown that white coat syndrome has little or nothing to do with a conscious fear of going to the doctor, the doctor or nurse themselves, or the office. It is apparently some kind of subconscious reaction. But, conscious or subconscious, the result is spikes in blood pressure that, if they were the norm, would have to be treated as they are generally spikes to very high levels.
The dance I wonder about in all of this is, if a patient is determined to have white coat syndrome and not treatable hypertension, what if there are other things that subconsciously elevated their blood pressure also? Could it be blood pressure spikes are a fairly frequent occurrence and that the only place it is noted is at the doctor’s office? I wonder how a doctor can determine that, even though a patient tells them the readings at the local drug store or with a home monitor are normal, that readings if they were taken in a traffic jam or at the dentist’s office or during football games, aren’t elevated also.
If the visit to the doctor’s office is just the tip of the blood pressure iceberg, it seems that there is a real chance of people with chronic blood pressure spikes running around out there not getting the medical help they should. Call me a skeptic, but if something can trigger this subconsciously in a doctor’s office it seems that you’re talking about a fairly strong subconscious.
From a life insurance standpoint well controlled, treated high blood pressure is really not a big deal. Most companies will offered preferred, if not preferred plus rates. If you are applying for life insurance and have been told that you have white coat syndrome, tell your independent agent right up front. This gives your agent a chance to do a couple of things that may help you put the syndrome in context for the insurance company.
First, your agent can let the examiner know so they might take more than the normal three readings. Often successive readings will get lower. The examiner will also know to time a blood draw so that it doesn’t impact the blood pressure readings by creating a nervous situation. Second, the agent can let the company know about your diagnosis of white coat syndrome so that they are not surprised by readings in your medical records. And lastly, you should make sure that your doctor has, in fact, diagnosed white coat syndrome and noted it in your medical records. If it isn’t addressed in your medical records the insurance companies will not buy it as a defense for high blood pressure.
Bottom line. White coat syndrome has been a real diagnosis for a long time. Whether or not I completely buy into it, if it is well tested and documented, it can be used as an affirmative defense against otherwise damaging high blood pressure readings on an insurance exam or in your medical records.
Just a personally skeptical aside. If I was told I had white coat I believe I would asked to be tested across a broad spectrum of psychologically stressful situations. I would hate to go through life merrily believing I had some subconscious quirk that elevated my blood pressure only in one situation, only to find out when I suffer a stroke talking to a mortgage banker that the issue was more wide spread than was thought.
June 2nd, 2008
I went off a bit on some of the more ridiculous combinations with smoking the other day. Smoking and asthma. Smoking and heart disease, etc. Some guy (blog name Joe Camel (clever)), took some hard swings at the life insurance industry for being so mean to smokers. Fortunately for me smokers run out of breath quick and the hard swings turn to frail flailing.
So let me throw a little different spin on this subject and see if makes the point. 120,000 people a year die from COPD (chronic obstructive pulmonary disease), almost all of them smokers. COPD is the number four killer in the US behind heart disease, cancer and strokes.
The American Lung Association shared some interesting facts about the little talked about COPD.
It seems that COPD is another one of those silent killers, not unlike high blood pressure or hypertension. Often the symptoms are shrugged off as natural consequences of smoking or lifestyle. Things like smoker’s cough, or just feeling your age or feeling out of shape. The longer they are shrugged off, the more damage your lungs suffer.
Bottom line. Whether you agree with life insurance companies and their underwriting guidelines around smoking, do the right thing. My wife and I recently vacationed in Mexico and in the duty free shop at the airport they were selling huge boxes of cigarettes. I think each box must have held 10 cartons or something. On the top was the brand name of the cigarette and on the side, in huge letters that covered the whole side of the box, it said SMOKING KILLS! Sounds like someone down there understands the statistics.
May 22nd, 2008
As the word sneaks out a little further each day, I have more and more people contacting me and asking if it’s true. Can they get life insurance at affordable rates even though they have bipolar disorder? I wish I could claim that the answer is unequivocally yes, but that isn’t true for any portion of the population.
All people have to meet criteria. If you are in the disgustingly healthy group then you to have meet all of the disgustingly healthy criteria to get the best rates. If you have diabetes you have to show that you are compliant with your treatment and have good control of the disease. If you have high blood pressure you have to show that you are compliant with your treatment and that it is well controlled.
While there are a few more disclaimers with bipolar, it is underwritten essentially the same as other health issues with about 2% of the life insurance companies. Assume going in that 98% of life insurance companies will run screaming DECLINEEEEE into the dark if you mention bipolar. The 2% that are left won’t insure you if you have high blood pressure that is out of control, diabetes that is out of control or bipolar that is out of control.
I would say something like, “At the risk of being redundant”, but the truth is I rather thrive on redundancy. I even invented my own word, redundiferous, to describe how exponentially redundant I can be. Lost my train of thought there……
The criteria for getting good rates if you have bipolar disorder are as follows. 1. No hospitalization for bipolar in the last 10 years unless it was a short stay to determine the diagnosis. 2. No suicide attempts ever. 3. You can’t be on disability for bipolar (if it disables you it hardly meets the qualification of being controlled) 4. Medical records would need to show that you are compliant with your treatment and 5. You need to be able to present a stable family and job life.
You can present an A+ report card on all of those items to 98% of the companies out there and they will decline you. It takes an independent agent with knowledge of bipolar disorder and where to find the hidden 2% in order to turn that report card into an approved life insurance policy.
Bottom line. There really is nothing different with underwriting bipolar versus heart disease or epilepsy, diabetes or hypertension. Out of control doesn’t get it. In control does.
February 19th, 2008
So, you’ve been told you have hypertension, high blood pressure in layman’s terms. Your doctor said that you need to take medication and change a few lifestyle items, primarily eating right and getting more exercise.
If you are like the majority of high blood pressureans, you’ll probably take the medication when you feel like you need it which is not what your doctor ordered. And there is clear evidence that most folks with hypertension kind of pass over that whole thing about changing their diet.
It seems to me that one of the reasons that health care costs are so high here is that so many people spend money to get a doctor to diagnose and recommend treatment. Then they turn around and ignore the treatment, which leads to further deteriored health. In the case of high blood pressure, not being compliant with treatment and recommended lifestyle changes can lead to a stroke or heart attack.
From a life insurance standpoint compliance and control are the bedrock of underwriting. When an underwriter is reviewing records and sees ongoing reminders from the doctor to take the medication daily and not when a patient feels like it, the big red flag goes up. When a person isn’t following recommendations and their blood pressure should be controlled, but isn’t, they should expect to pay a high premium or even be declined for life insurance.
Bottom line. Life insurance underwriters aren’t there to tell you how to live your life. They are there to tell you about the risk you pose by not taking medical advice seriously. They do it with rates. Great life insurance rates and high blood pressure don’t have to be oxymorons.
February 12th, 2008
No. I’m not suggesting that a pre game aspirin will ward off a post game hangover. I’m afraid that those prone to toast every down and play will have to deal with the consequences post game.
There may be good reason to do some pre-game heart attack prevention though. It seems that the “big game”, whether that is the Super Bowl, or World Cup soccer, just happens to carry with it a higher incidence of heart attacks.
I’ve never been a particularly raucous football fan, but I’ve been to a few Super Bowl parties where I was certain that the average blood pressure was substantially over 120/80. When you see veins popping out on a fan’s neck or forehead, you know there’s some intensity and blood pressure to match.
Just a warning. If you see someone that looks like they may be driving themselves toward cardiac arrest, don’t think that pulling the plug on the TV is going to calm them down. One thing I am certain of is that the only thing that can jack up a fan’s blood pressure more than watching the game, is suddenly being denied being able to watch. Bad move.
I’ve often had people try to convince me in the hopes that I can convince a life insurance underwriter, that they don’t really have hypertension. Their blood pressure only goes up when they are under stress. Well folks, 180/110 causes damage no matter what got you there and an underwriter is certainly going to err on the side of caution not knowing how often you encounter stress, or what you perceive as stressful.
Anyway, back to the subject. Preventive cardiac treatment before the big game, especially if you have a history of heart problems.
Bottom line. Life insurance companies aren’t going to look any differently at a heart attack that happens during the big game than any other time. The underwriting remains the same. Provided you survive the game and the MI, you will likely have either bypass surgery or angioplasty. Once you are a year out from that event, and have had a follow up stress test to show that everything is working well, reasonable rates can be found.
February 2nd, 2008
Smoking is often touted by those who partake as a way to calm themselves. Of course, from a life insurance standpoint, calm or not, smoking carries so much health baggage with it that rates for smokers are dramatically higher than non smokers.
A recent study suggests that the feeling of calmness may be deceiving as women seem to have a significantly increased risk of high blood pressure (hypertension) if they smoke. Along with that increased risk comes the risk of heart disease.
We have discussed many times that blood pressure and cholesterol are the two most common surprises on insurance exams. Hypertension isn’t called the silent killer for no reason. Especially if it is borderline or mildly elevated, a person may not notice the symptoms, or it may come on over a period of time and it just blends in and a person doesn’t notice anything out of the ordinary.
The good news is that blood pressure is often easily controlled by lifestyle changes, and in the absence of the ability to make that change, also easily controlled with medication. Certainly a change to not smoking is going to have benefits across the board. After 12 months of no nicotine use, life insurance rates can be cut in half or more.
Bottom line. High blood pressure is just one more reason to consider giving up on smoking. The list of health issues connected to smoking is constantly growing. The truth is that there are no benefits to it, only downsides.
January 31st, 2008
I have emailed an article I read today to all of the underwriters I work with. While many are on board with the idea that all bipolar is created equal and that all bipolar should be declined life insurance, there are still some hanging on to their worst fears like a security blanket.
This well written article engages in some real life myth busting of bipolar disorder, and probably the “eason it resonates so well with me is that the myths they bust are exactly the reasons that we are placing more and more fairly priced life insurance for the bipolar community every week.
The entire article presents a case for the fact that a compliant, stable bipolar patient is a worthy life insurance risk.
Bottom line. What I hear from the best life insurance underwriters is that someone with bipolar who is compliant with their treatment and, because of that, is stable in their work and family life, is a risk that makes sense for them. While many underwriters get hung up on bipolar being a “mental” issue, the others keep it in context. Compliance and control in diabetes equals fair life insurance rates. The same criteria is used to underwriter hypertension or seizure disorders. The same should hold true for bipolar.
January 22nd, 2008
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