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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by 4WD on October 6, 2012, at 7:27:24
What do you do when you have (presumably) postural jhypotension too intense to stand up longer than 7-8 seconds without fainting? BP won't read on either machine except occasionally if sitting in the floor it's about 80/50 sometimes. Maybe 90-95/ 65 occasionally.. Below 60/40 it gives error messages. I haven't taken any Parnate in 36 hours (stopped it when this fainting thing started)and am taking 20 mg Adderall about 6-8 he'hrs apart and drinking lots of water & eating salt and am sweaty off & on with a little chest pain, which is a feature of Adderallr for me. all by itself anyway. But not being able to stand up, literally for a day and a half is very annoying during what was supposed to be my two day vacation from hell. Today will be the last day on Adderall and it would be nice if I could get at least a little something accomplished. Some ginkgo maybe? A dopamine antagonist ? or agonist? I have quite a stable of meds here available' and every supplement.
Posted by 4WD on October 6, 2012, at 7:50:18
In reply to 36 hours of can't stand up, posted by 4WD on October 6, 2012, at 7:27:24
And is my heart rate so elevated sometimes because of the hypotension or just from the Adderall primarily? I'm eating enough here and there.
I am not worried about oh dear I might have a heart attack etc. I am simply annoyed at being physiologically crippled during this very short spell of mental and physical functionality I'm supposed to be having instead. I will have to pay for my break. I should at least at least get some good out if it and to go out on a high note. Crap, now there'a a headache, too. I'm going to bed.
Posted by bleauberry on October 6, 2012, at 9:34:28
In reply to 36 hours of can't stand up, posted by 4WD on October 6, 2012, at 7:27:24
If it were me I would probably be trying to decide whether to call 911 or to drive myself to the hospital. Blood pressure that low is very close to medical emergency and needs to be treated immediately, or at the very least looked at by an MD. Any thoughts on med issues needs to take a back seat for the moment because medical attention has taken priority over that. imo
Posted by phillipa on October 6, 2012, at 10:18:27
In reply to Re: 36 hours of can't stand up, posted by bleauberry on October 6, 2012, at 9:34:28
Blueaberry is so right. 4WD please get to a hospital. This isn't funny remember broken back on nardil and all the misery? Please please get there and fast. Love You Phillipa
Posted by ChicagoKat on October 6, 2012, at 13:17:06
In reply to 36 hours of can't stand up, posted by 4WD on October 6, 2012, at 7:27:24
> What do you do when you have (presumably) postural jhypotension too intense to stand up longer than 7-8 seconds without fainting? BP won't read on either machine except occasionally if sitting in the floor it's about 80/50 sometimes. Maybe 90-95/ 65 occasionally.. Below 60/40 it gives error messages. I haven't taken any Parnate in 36 hours (stopped it when this fainting thing started)and am taking 20 mg Adderall about 6-8 he'hrs apart and drinking lots of water & eating salt and am sweaty off & on with a little chest pain, which is a feature of Adderallr for me. all by itself anyway. But not being able to stand up, literally for a day and a half is very annoying during what was supposed to be my two day vacation from hell. Today will be the last day on Adderall and it would be nice if I could get at least a little something accomplished. Some ginkgo maybe? A dopamine antagonist ? or agonist? I have quite a stable of meds here available' and every supplement.
Hi Marsha,
Scott has recommended a drug called Florinef to me if my BP gets too low while on an MAOI.
And, bad me, I always tell myself I can have a smoke if BP gets too low, cos that always brings it right back up ;)
Kat
Posted by ChicagoKat on October 6, 2012, at 13:19:39
In reply to Re: 36 hours of can't stand up, posted by 4WD on October 6, 2012, at 7:50:18
> And is my heart rate so elevated sometimes because of the hypotension or just from the Adderall primarily? I'm eating enough here and there.
> I am not worried about oh dear I might have a heart attack etc. I am simply annoyed at being physiologically crippled during this very short spell of mental and physical functionality I'm supposed to be having instead. I will have to pay for my break. I should at least at least get some good out if it and to go out on a high note. Crap, now there'a a headache, too. I'm going to bed.Hi again Marsha,
Yep, HR goes up if BP goes down, and the Adderall certainly doesn't help. For a high HR I have no solution for you; I've put out a question to Scott, but as far as I know, there is no drug that will help that without lowering your BP even more.
Kat
Posted by ChicagoKat on October 6, 2012, at 13:20:58
In reply to Re: 36 hours of can't stand up, posted by bleauberry on October 6, 2012, at 9:34:28
> If it were me I would probably be trying to decide whether to call 911 or to drive myself to the hospital. Blood pressure that low is very close to medical emergency and needs to be treated immediately, or at the very least looked at by an MD. Any thoughts on med issues needs to take a back seat for the moment because medical attention has taken priority over that. imo
I'm chiming in late, and hopefully the prob is resolved by now, but bleauberry makes a VERY good point.
Posted by 10derheart on October 6, 2012, at 13:46:44
In reply to 36 hours of can't stand up, posted by 4WD on October 6, 2012, at 7:27:24
Posted by Willful on October 6, 2012, at 16:10:24
In reply to please go to ER or urgent care ASAP (nm) » 4WD, posted by 10derheart on October 6, 2012, at 13:46:44
Posted by 4WD on October 6, 2012, at 23:20:23
In reply to Re: 36 hours of can't stand up, posted by 4WD on October 6, 2012, at 7:50:18
Thank you all for posting, for caring. I did go to a doc in the box thus afternoon to ask if they'd check my bp, that I was about to faint. They checked it and it was lower. They asked if I wanted to for an apt with the but I felt decent emotionally and didn't want to waste that sitting in a waiting room for 3v his. They didn't volunteer to get him sooner either and I walked back out bent at the waist.
Its worse still, 48 hours now. I'm not making a lot of sense when I write or talk and the chest pain is incredibly annoying. It kind of burns now too. I got real sleepy about 8 after no last night and a little Klonopin at 7 om ate a little at 8 aahs went to bed for a nap at nine. (also took 20mg Adderall about 8 our 7om. But when I lay down I just got kind of emotional feeling, weepy. I lay there an hour talking to either myself or God or anyone I thought of I had some words for, feeling pretty irritable and pissed off at pretty much everyone I though of. Eventually cried a little, gave up on sleeping and started trying to get up. Took bp when it would finally read- and took blood glucose to. Sugar at 80 and bo something lireI told my husband I'd go to that doc tomorrow. But y'all missed what I was trying to say in large part. As far as not fearing a heart attack etc. See, I am about evenly divided there. Is been over a year since the first time I asked God to please get me on out if here.
Posted by 4WD on October 6, 2012, at 23:45:59
In reply to Re: 36 hours of can't stand up, posted by 4WD on October 6, 2012, at 23:20:23
It has been nine years of very very bad. Then three years ago it got way worse. I can barelyv tolerate being alive/aware now. I wake up every day physically horribly sick feeling. For 2-3 hours I can't open my eyes our speak our get up for the bathroom even. I feel too bad to walk there and back. Like severe flu plus bad overdose if alcohol hangover plus jet lag. Plus horror, despair, dread, guilt, fear, doom. By the 4th hour I can start to move around some if I gather up every ounce if self will I can work up and force myself to try to move . Chronic, total exhsustion, more mental than physiological. Flat, dead apathy and lethargy. On topof the plain depression. Plus fear that only piece of
Xanax can take the edge off. And those are the good days. On the bad ones, when the pain transcends the emotional ability to handle it and it becomes physical pain even. (not muscles, its horror that squeezes my chest and shudder and stomach. Praise God for Zyprexa. 5mg plus 1mg Xanax will still effectively lessen it enough to endure. After I've been awake maybe 6 hours, I can notice where I am, if its raining, etc. I get about two or three hours of feeling just physically drained and weary and sick but ok emotionally n then I have to to to bed so it can start over again the next day. Been diagnosed w fibromyalgia, and maybe chronic fatige. I don't leave the house, literally, not the couch. I used to still make myself do things to try and help myself but I have finally reached the point where I have lost the ability to even msgs myself try anymore. I do not have it in me to feel motivation if any kind. My husband does our housework stuff. I sit there's guilty a
Posted by 4WD on October 7, 2012, at 1:08:48
In reply to Re: 36 hours of can't stand up, posted by 4WD on October 6, 2012, at 23:45:59
My mobile phone has deleted mytwo attempts to wrap this up quickly land jm I just cantbdo it again. so in short, when the ParNate exhaustion surprise hit me bad I grabbed onto the intention of stealing a couple if days from the monster by taking a stimulant, knowing the rebound was coming and willing to consider it an acceptable trade off to tolerate that crash along with its potential fatal results in exchange for having two or three practically human days with energy and the ability to experience pleasure again briefly first.
So I had my pleasant, almost normal time jerked away because of the bad Adderall plus Parnate recently interaction abduction have ended up back in the couch anyway. But its ok. I am not depressed. I Had maybe 4 good Adderall hours before my bp Bottomed out.
Ill take what I got. Its still the best couple of days I've had emotionally in a while .
Marshall
Posted by ChicagoKat on October 7, 2012, at 7:59:29
In reply to Re: 36 hours of can't stand up, posted by 4WD on October 7, 2012, at 1:08:48
> My mobile phone has deleted mytwo attempts to wrap this up quickly land jm I just cantbdo it again. so in short, when the ParNate exhaustion surprise hit me bad I grabbed onto the intention of stealing a couple if days from the monster by taking a stimulant, knowing the rebound was coming and willing to consider it an acceptable trade off to tolerate that crash along with its potential fatal results in exchange for having two or three practically human days with energy and the ability to experience pleasure again briefly first.
>
> So I had my pleasant, almost normal time jerked away because of the bad Adderall plus Parnate recently interaction abduction have ended up back in the couch anyway. But its ok. I am not depressed. I Had maybe 4 good Adderall hours before my bp Bottomed out.
>
> Ill take what I got. Its still the best couple of days I've had emotionally in a while .
>
> MarshallHi Marsha,
I read your posts and they made me cry. How are you today? Your writing seems a bit better, so that's a good sign. How's your BP? You know, if it's so low, it could be making you feel worse physically and emotionally. If it's still so low, *please* bypass any other option and go directly to the ER. The people you saw yesterday should be sued for asking if you wanted to wait for an appt! Frankly,, as bad as you were sounding ,you needed to be in the hospital. That is why I say go to the ER if your BP is still so low. If it is, getting it corrected will do a lot for your physical/mental well-being.And, most importantly PLEASE don't give up on us and leave us. We selfishly want you to stay. And I promise you, if you can hang in there, Parnate WILL start to help and WILL make you feel better. MAOIs are wonderful drugs, better than any other, IMO, but unfortunately you have to go through a lot - washout, waiting, dealing with food and drug interactions - til they start working. But I've been through it once,, and I tell you it is well worth the wait. Chances are you'll feel better than you have in years, if not decades.
So PLEASE, PLEASE, PLEASE do not even consider leaving us. Remember, I will always be here to help you carry that 5000lb boulder up that hill.
Feel free to Babblemail me if you want to talk privately.
Kat
Posted by phillipa on October 7, 2012, at 9:34:12
In reply to Re: 36 hours of can't stand up, posted by 4WD on October 7, 2012, at 1:08:48
Marsha I know how you feel I truly do. But somehow we have to keep trying. Right foot first. If not for other circumstances do you feel this would have happened anyway? Please do go to the hospital. And please do contact me. Love Phillipa
Posted by phidippus on October 7, 2012, at 14:21:11
In reply to 36 hours of can't stand up, posted by 4WD on October 6, 2012, at 7:27:24
You need to call an ambulance and have them take you to the ER.
EEric
Posted by 4WD on October 8, 2012, at 3:16:08
In reply to Re: 36 hours of can't stand up » 4WD, posted by phidippus on October 7, 2012, at 14:21:11
Hi. I am still here, and better. I have not taken any Parnate since Thursday evening and today the orthostatic hypotension is merely a mild annoyance and even that is going away. What I don't understand is this:
I had upped the Parnate from 30mg day to 60mg for a couple if days, trying to get past the insomnia period/dosage. But the daytime fatigue got even worse. I had been having horrible fatigue before I started it-that's why I asked to be put on this "activating a/d." So I dropped it back down to 30mg for a couple days than down to 20mg one day. The fatigue didn't go away at all except that I would have 2-3 hrs of being somewhat functional a day, in early afternoon. It was doing nothing for my hours-long morning grogginess at all-still taking me 4-5 hours after waking before I could get off the couch even .(this has been going on for a couple of years now. Anyway, I figured Adderall would: raise Bp, control the fatigue and help me go from zombie to person quicker in the a.m.'s
(btw why would someone be unable to even make her bed till she'd been awake for 4 hrs? My bedtime meds are only 20mg Geodon, 1/4 mg Klonopin, 25mg Trazadone and half a pepcid, down from 4 times those dosage a year ago).
Anyway, I took 10 mg parnate Thus. Am, then waited several hours and took 20mg Adderall. I took my last of the day's dose of another 10 mg Parnate that late afternoon and my 2nd daily dose if 20 mg Adderall a few hours after that.
I didn't sleep very long, bed late and woke up early. The next morning, the hypotension started. By midday Fri., I was getting pretty dizzy on rising. I Was afraid to take any Parnate but continued with the Adderall.
I ate, and drank fluids and salt water but it didn't help. I felt fine depression wise (what a lifting of a burden. ) Bp kept getting worse but I knew if I went to hospital, they'd take away my Adderall since its a "dangerous interaction".Now I have to admit that I have for three years been sometimesabusing somewhat mainly Nuvigil. Occasionally the Adderall. Not to"get high", to get functional, and then that felt so great, I'd take an extra dose because I couldn't bear letting go of that feeling of actually having energy and motivation.
This time, however, I have taken the Add. Just as Rxed. I may not tomorrow but I have so far.
On Nardil I had bad Bp problem the whole three years-ververy bad ones.
My question is this: why did the bp stuff get so much worse AFTER I lowered the dose and stopped the Parnate altigether and took Adderall instead? If stimulants raise it and Parnate lowers it, what happened that the opposite occurred to me? And what do I do now? My pdoc is not ever going to go against the standard recommendations. Too by ths book.
Start back Parnate slowly at 10mg/day? At the 30 I was at? Stay off it? Stop the Adderall? pls don't say that one, I've been so miserable for so long with this total apathetic exhausted anhedonic blackness so long I need a brightener just to get off the couch, ever.Sorry for this gigantic post-I don't know but that I may end up in hospital tomorrow yet and I need some options to choose from from peopleI've given the true picture to and who aren't primarily concerned with covering their butts.
I know what I did was dangerous. But it was worth it and honestly I think that s half if why I did it.
If Parnate isn't going to work, there's nothing left. I'm not going to spend more years like theed last ten trying one augmenter after another. I'm too worn out from the last ten.
As nd part if it could be from my periodic overuse if stimulants. But I didn't get thuds way from starting that, I started that because I was this way.Thank you all for caring. I don't have to hi to bed tonight crying because I may never set my husband or my cats again.
Marsha
Posted by 4WD on October 8, 2012, at 3:26:54
In reply to Re: 36 hours of can't stand up, posted by 4WD on October 8, 2012, at 3:16:08
I was thinking- i believe last nights post was a sort of suicide note. A published record of my reasons and my last few hours.
Thank you for being there to read it.Marsha
P.s.
The big reason against hospital was actually because I dud not want to be "rescued". It would have been an attempt to save my life, and there were more reasons not to want that than to want it.
Posted by 4WD on October 8, 2012, at 3:27:22
In reply to Re: 36 hours of can't stand up, posted by 4WD on October 8, 2012, at 3:16:08
I was thinking- i believe last nights post was a sort of suicide note. A published record of my reasons and my last few hours.
Thank you for being there to read it.Marsha
P.s.
The big reason against hospital was actually because I dud not want to be "rescued". It would have been an attempt to save my life, and there were more reasons not to want that than to want it.
Posted by jono_in_adelaide on October 8, 2012, at 6:44:36
In reply to Re: 36 hours of can't stand up, posted by 4WD on October 8, 2012, at 3:16:08
Start Parnate, and also get a script for Florinef, 0.1-0.2mg each morning makes the body retain sodiaum and water and thus shores up the BP
Dexamphetamine (as in Aderal) isnt especialy good at raising BP, thats why it was introduced infact, because it kept the central effects of the original amphetamine sulphate, but dodn cause much increase in BP or heart rate,
If you stiill get bad potural hypotension with Florinef, you might have to admit Parnate isnt the drug for you?
Posted by ChicagoKat on October 8, 2012, at 9:22:01
In reply to Re: 36 hours of can't stand up, posted by jono_in_adelaide on October 8, 2012, at 6:44:36
> Start Parnate, and also get a script for Florinef, 0.1-0.2mg each morning makes the body retain sodiaum and water and thus shores up the BP
>
> Dexamphetamine (as in Aderal) isnt especialy good at raising BP, thats why it was introduced infact, because it kept the central effects of the original amphetamine sulphate, but dodn cause much increase in BP or heart rate,
>
> If you stiill get bad potural hypotension with Florinef, you might have to admit Parnate isnt the drug for you?Jono gave some good advice, but don't worry, if the Parnate helps and the Florinef isn't enough to increase your BP, there are other options. eg, you could add Ritalin to the mix. Unlike the amphetamines, it can really raise BP. It certainly does in me. And Ritalin would only make you feel better! :D
And btw, the reason the low BP took so long to resolve, despite stopping the Parnate, is that enzymes have been inhibited by it, and it takes a while for them to be replacesd by new, disinhibited enzyme. So even if you have stopped the drug, the effects still last in the body for a while.
I'm SO very glad to hear you are feeling better Marsha. I was really worried about you.
Kat
ps I didn't know you'd been on Nardil. Aside from the fact that it gave you severe hypotension, which sucks, how did it affect your mood?
Posted by phidippus on October 8, 2012, at 18:37:25
In reply to Re: 36 hours of can't stand up, posted by 4WD on October 8, 2012, at 3:27:22
I think about suicide all the time.
Eric
Posted by phillipa on October 8, 2012, at 20:01:02
In reply to Re: 36 hours of can't stand up, posted by 4WD on October 8, 2012, at 3:27:22
I know you have had so many disappointments lately. Please stick around. You are a great person. And your kitties need you & hubby as well. Phillipa
This is the end of the thread.
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