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Re: Hypertensive crises, update » Elizabeth

Posted by Lorraine on September 13, 2001, at 11:06:20

In reply to Re: Hypertensive crises, update » Lorraine, posted by Elizabeth on September 12, 2001, at 3:51:20

9/12/01 elizabeth to Shelli

> > I don't even *get* the difference between residual effects and an unresolved hypertensive crisis. Really.
>
Ø The difference would be whether your blood pressure is still high! (People whose BP runs low seem to have worse symptoms than those with higher baseline BPs.)

Elizabeth, help me understand this. When you have a hypertensive crises your blood pressure shoots up because of vascular contraction (veins get smaller) and your pulse rate decreases to compensate for this. When you take the antidote, it lowers the blood pressure by dilating the veins and the pulse rate returns to normal? (I’m sure my language is all wrong, but you get the gist.) So that crick in my neck was probably the result of residual the vascular contraction in that area. It would make sense, although my BP came down very significantly (well within the average range) after the antidote it did not return to pre-hypertensive readings (which were low because the Parnate had decreased my BP readings generally) until about 5 days later.
.
9/12/01 elizabeth to Lorraine

> > I'd be curious what elizabeth thinks of a Nardil and Desipramine combo.
>
Ø It could be worth a try, and I think it would be safe (although I'd suggest monitoring your BP closely). I haven't had any appetite loss on desipramine, so I'm not sure it would counteract the weight gain from Nardil very effectively.

Thanks for the info. Just want to have a next step in mind if the Nardil doesn’t do it. I know I am jumping the gun so to speak but it makes me feel better emotionally to do this. Then when things don’t work out, I don’t panic or go too low, but just take the next step and distract myself.

9/12/01 elizabeth to Lorraine (msg 2)

> > > > Doing my washout from Parnate to Nardil with adderal and neurontin. Took 10 mg adderal this > > >[re hypertensive crises]Took blood pressure 165/97, i think.
> > >
Ø > > That's about the point where I was instructed by my pdoc to take nifedipine. (BTW, "bite and swallow" seems to work better than SL.)

I had searched Psychobabble and believe that I found a post of yours saying your pdoc had used these levels.

> >
> > I think if I had to do it over again, I would start the nifedipine right when the headache starts rather than based on the blood pressure.
>
Ø I wouldn't. People have differing levels of reactivity depending on various factors (e.g., baseline BP). You want to have a number, you know? It's a bad idea to take nifedipine if you aren't sure that your BP has reached a certain level. Also, although it's high, 160-170/90-100 isn't terribly dangerous -- it's just a good safe point to take nifedipine if the BP is still rising.

I know, it’s just that it took so long for the episode to fully resolve. I was very out of sorts (although functional) for a good 5 days. I felt like I’d been in an auto accident and had whiplash. (Although I don’t suppose you’d know how that felt? How are the driving lessons going?)

> > Is the Desipramine still doing you good?
>
Ø Yes, it is.

I am so pleased to hear this Elizabeth.


9/12/01 elizabeth to Shelli

> > So I went back in again, caught him in the hall, and he told me that I should watch for my diabolic BP going above 110.
>
Ø "Diabolic?" You mean diastolic, right? < g >

I thought she was referring to him when she said diabolic < vbg >.

> > I'm going fax him tomorrow and ask him what the deal is; why can't I have one--isn't that what they would give me at the hospital, anyway?
>
Ø No, they'd give you phentolamine or nitroprusside. They'd also monitor you to make sure you were okay (no BP crash, etc.).

Yes, but aren’t you looking at a significant delay to treatment (driving to the hospital; getting admitted; having them draw blood to make sure you’re not on cocaine?; treating you like an idiot?) Bad attitude, I know.


> > If I remember correctly (and I may not, really), I think some pdocs think their MAOI patients might take it too early and then the nifedipine might make them very sick.
>
Ø Yes. It can make your blood pressure "crash," which can progress to shock (worst-case scenario).

OK, I’ll be careful. Elizabeth, how long to hypertensive crises usually last? I thought about taking another BP reading 5 minutes after my high one to see if it was coming down, but got too scared to wait.

Lorraine


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