This is the followup to yesterdays post Good News for Me! Drinking Coffee in the Morning Reduces the Risk for Death.

Friday, January 2, 2026 started normal enough.  I went to Pender to practice my upcoming piano-organ duet with a friend.  Then, I was going to the local stand-alone emergency room to check out my thumb.

No big deal, right?

The practice went well and I went home to pick up DH to go to Inova-GoHealth Urgent Care – Greenbriar to see about my painful thumb.  This is the same thumb from my May 17 post but a different problem.

Last weekend starting Christmas Day until Sunday, December 28 we had been to NYC to visit our son and his family.  Leaving Sunday evening, we got to Moynihan Station to take the train home.  Because I had a rolling suitcase, we took the ramp to the train hall instead of the stairs.

It’s unclear what happened next but I know DH fell on the ramp and knocked me over as well as a sign.  My hand was still wrapped around the handle of the suitcase and was hurting quite a bit.

Fast forward to yesterday – my thumb was still hurting so we headed off to the Inova-GoHealth.  They do the usual, weight, height, review meds, take blood pressure.  A bit high.  Take it again – higher still.  Tech person calls in doctor.  Higher again.  He says that they can’t help me or my thumb.  I have to go to the real hospital emergency room.  NOW.

So, we drive over to the ER.  I found that my keys set off the metal detector. While I was signing in with my referral papers, they called me back to triage.  BP is higher again (mine was now over 200/90!).  White Coat Syndrome, maybe?

According to google:
“White coat syndrome (or hypertension) is when your blood pressure spikes to high levels in a doctor’s office due to anxiety or stress about the visit, but returns to normal at home, marked by elevated readings (>140/90 mmHg) in the clinic but normal readings (<135/85 mmHg) elsewhere, requiring home monitoring to prevent misdiagnosis and potential long-term risks like heart issues.”

Symptoms

• No symptoms at home: The primary sign is normal blood pressure outside the clinic.
• Anxiety/Stress: Feeling nervous, anxious, or stressed during a medical appointment or when a blood pressure cuff is applied.
• Elevated readings: Blood pressure consistently over 140/90 mmHg in the office, but below 135/85 mmHg at home.

Causes & Risk Factors

• Anxiety: The stress and fear associated with medical settings, doctors, or past negative experiences.
• Stressful environment: The clinical setting itself triggers a physiological stress response.
• Risk factors for hypertension: Being older, overweight, or having certain chronic conditions can increase risk.

Management & Prevention

• Home Monitoring: Regularly checking blood pressure at home or using 24-hour ambulatory monitoring to get accurate readings.
• Stress Reduction: Identifying and addressing the sources of anxiety about doctor visits.
• Lifestyle Changes: Adopting healthy habits like a good diet, exercise, and managing stress.
• Provider Communication: Talking to your healthcare team to rule out actual hypertension and avoid unnecessary medication.

Why it matters

• Misdiagnosis: Can lead to unnecessary hypertension treatment.
• Increased Risk: Even temporary spikes can strain the heart, potentially increasing long-term risks for heart attack, stroke, and heart failure, say Adventist Health and American Heart Association Journals.

So, I was put in a room and all kinds of tests were started, lots of blood taken, EKG leads applied, more blood pressure monitoring.  This went on for a couple hours, just watching numbers fluctuate.

Then – finally – the long-coveted x-ray of my hand!

Some more monitoring,  Various medical staff told us what some of the numbers meant.  A doctor came in.  One of the staff told him that he was concerned/confused about my EKG results.  The doctor came back and told me that he was going to do a consultation with a cardiac doctor about the EKG.

More monitoring.

The doctor finally came back and said that we could go home.  BUT.  I have to call their cardiac doctor ASAP on Monday morning followed by their recommended Orthopedic Surgeon, followed by my PCP.  I saved some time with all this and arranged the PCP through MyChart.

The nurse came back to remove the EKG leads and give me some Losartan and HCTZ  (hydrochlorothiazide) pills.  I couldn’t hold the water to take the pills so I handed it to DH.  Of course, he immediately started drinking my pill water.

Got the water back, clothes back on and finally on our way home.

Total time: 7 hours.

Test results

And that thumb?

An avulsion fracture fragment.  Google says: “An avulsed fracture fragment is a small piece of bone that breaks off from the main bone, pulled away by a strong force exerted by a tendon or ligament, often during sudden movements in sports, leading to pain, swelling, and instability, with treatment ranging from rest and casting for small fragments to surgery if the fragment is large or significantly displaced”.

Everything else normal except “Regarding her elevated blood pressure, patient has some interesting changes in her EKG while she is here including left bundle branch block but then back to sinus rhythm. No cardiac symptoms. Cardiac workup otherwise reassuring including troponin. Normal creatinine in regards to elevated blood pressure. I will discuss with Virginia Heart cardiology but generally with think that discharge on blood pressure medication outpatient follow-up might be reasonable”.

So,

Maybe more after the cardiologist, maybe surgery after the Orthopedic Surgeon, maybe just a weird day for me.