Posted by Keith Talent on June 10, 2004, at 8:44:03
In reply to Re: Anyone have a *BAD* experience with Parnate? » Keith Talent, posted by don_bristol on June 9, 2004, at 11:53:15
> I must say I am worried that I might be too careless about my food. I try to be careful but I seem absent minded. And that is a worry.
Everyone is "absent-minded" every now and then. The problem is that it takes just one boo-boo to set off the nasty chain of events that both of us are discussing.
After this horrible experience (at the start of this year) I came to the conclusion that in our multicultural societies (all the developed countries - I live in Australia and at a guess I'd say you live in the United States), a fun part of life is to try different types of cuisine. This almost inevitably involves ingesting SOMETHING containing one or more monoamines, whether it be in soy sauce or sauerkraut or fermented cheese. It's one of the benefits of living in multiracial, multicultural, multireligious communities. For example, I love Japanese food, but I was too nervous to eat any whilst on tranylcypromine.
> Can I ask you some questions?
Feel free.
> What sort of blood pressure did your hypertensive crisis reach?
About 240 mm Hg/130 mm Hg
> Did you go to ER?
Definitely. Those events are burned into my memory for ever: it was a Saturday afternoon, about 14:00 when I had lunch. I was relaxing, reading a book, when I noticed (over about half an hour) that my heart rate had become very slow and very strong (as in contractility of the heart). My pulse was what physicians know as a "water hammer" pulse. Even as I remained lying down, I noticed the gradual onset of a severe headache. I tried to shrug it off, put it down to a migraine and go to sleep. It did not go away - it steadily got worse.
I got up, with the thought of a hypertensive crisis in the back of my mind. I gathered my wallet and car keys and went downstairs. By this time I was feeling really weak. My parents were there and I said what I thought was happening. I tried to measure my blood pressure with one of those digital finger-cuff-inflating devices, but kept getting an error message (not reassuring!). I told my parents that I was going to drive to the Emergency Department of a hospital about five minutes drive from my place. Looking back, this was foolish and dangerous - I should have called an ambulance.
When I got to the ED, I said exactly what was going on, but was made to wait, even to see a nurse. The nurse put me on a bed, took my blood pressure and said that she would get a physician soon. Thoughts of having a stroke and dying or being paralysed were rushing through my head, at the same time as I had the worst headache of my life (throbbing, from occipital to frontal regions).
This particular hospital is one I won't be going back to - the ED is staffed by primary care physicians. When one finally took a history and examined me, he did not seem confident to take action to reduce the blood pressure. All he did was conduct an electrocardiogram, take blood samples and arrange a CT brain scan. He deferred (by phone) to an on-call cardiologist, who took an hour or two to arrive.
This guy and I formed an instant mutual dislike - I kept saying "Please, can you give me an alpha-1 antagonist to reduce the blood pressure and (hence) reduce the pain and risk of stroke?", which was even listed in the patient information dispensed with the drug. He dismissively said that my blood pressure was not that high for a young person (I'm 28) and that during weight training exercises, blood presure can go over 300 mm Hg systolic without harm. I have to say that I love that type of exercise, but I have never had any headaches while doing it (even long and intense workouts). He stated that following my suggestion could lead to "cardiovascular instability" - as if having bradycardia alternating with tachycardia plus malignant hypertension did not constitute same. As an aside, it took enormous effort not to vomit in the car. As soon as I arrived, I started vomiting regularly, which went on for six hours.
The CT scanner copped a huge load of vomit when I was insdie it. The radiologist's report said that there was neither any cerebrovascular events nor damage. The pain and vomiting persisted. All the arrogant cardiologist would do was offer two milligrams of morphine (with metoclopramide for the nausea), even though I weigh 110 kilograms. Now, I happen to know that patients who come into the ED with heart attacks are given ten milligrams TO START WITH. He also offered some uselessly low dose of diazepam to calm me down, though I wasn't inappropriately anxious, just extremely ill and weak. He left the hospital ASAP, obviously not wanting to be there on a Saturday night.
I was transferred to a ward. My Mum and girlfriend visited that night. My girlfriend was extremely upset at seeing me like this. My Mum had never wanted me to commence this medication, knowing the dangers. I got virtually no sleep all night, with an electrocardiogram and recorder fitted and hourly nursing observations. In the morning, it was discovered that, due to some mistake, the ECG machine hadn't recorded anything!
Needless to say, my psychiatrist, when I consulted him again a couple of weeks later, agreed with me that a drug should have been administered to lower my blood pressure. He said that every Psychiatry Registrar (trainee) knows this and what to do. After two weeks, I was able to recommence sertraline. When I next saw my primary care physician, I told her about the unpleasant cardiologist, and she said that she has had many similar complaints about him.
> If so then how long did they keep you for?
Overnight
> Did they use anything to reduce your hypertension?No
> Was your lasagne from a restaurant or the supermarket?
Neither, it was home-made.
> Was it particularly cheesy?
Yeah, I guess it was, but I also thought that perhaps the cheese had been broken down a bit overnight, resulting in greater concentrations of tyramine and other amines.
> When you say you had a lot of lasagna, can you quantify it in some way?
From memory, I had about 250 mm long by 150 mm wide by 40 mm deep (cut from a baking dish).
> And when you say you had a small amount, can you quantify that too?
Probably only about 50 mm by 50 mm by 40 mm.
Hope this is of benefit to others, including yourself, Don.
poster:Keith Talent
thread:354280
URL: http://www.dr-bob.org/babble/20040608/msgs/355351.html