![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 56. This is the beginning of the thread.
Posted by SalArmy4me on August 8, 2001, at 15:10:09
If you're about to do the unthinkable, or can't see a way out, talk to me first. My screenname is "SalArmy4me" on AOL Instant Messenger and Yahoo Messenger...
Posted by adamie on August 8, 2001, at 15:21:43
In reply to Suicide, posted by SalArmy4me on August 8, 2001, at 15:10:09
> If you're about to do the unthinkable, or can't see a way out, talk to me first. My screenname is "SalArmy4me" on AOL Instant Messenger and Yahoo Messenger...
also consider ECT, VNS, or other things. What do you have to lose if you're going to commit suidie anyway? if you feel completely horrible and see no reason to live then know that it's just the depression talking, because when it's gone, life is great. I have felt hopeless during my worst periods but i knew it's just the depression causing those thoughts of how can I ever be better.
if meds fail then VNS will be for me. only side effect is voice alteration. it's a pace maker for the brain. Although it doesn't even touch the brain. it's a tiny box in your chest with a little cord going around your vegus nerve. this cord gives it a small pulse every 3-6 minutes which over weeks or months of time make you feel more normal. response rates for true treatment resistant patients is around 45%. nothing to lose. if you're suicidal then move to canada and get VNS or just try ECT. You can scare people with the robot voice so that is always a plus.
Posted by JahL on August 8, 2001, at 15:28:55
In reply to Re: Suicide, posted by adamie on August 8, 2001, at 15:21:43
> if meds fail then VNS will be for me. only side effect is voice alteration. it's a pace maker for the brain. Although it doesn't even touch the brain. it's a tiny box in your chest with a little cord going around your vegus nerve. this cord gives it a small pulse every 3-6 minutes which over weeks or months of time make you feel more normal. response rates for true treatment resistant patients is around 45%.Do you know if 45% is a 'response' (ie 50% improvement) or a 'remission' rate?
>nothing to lose.
Quite.
>if you're suicidal then move to canada
Nice part of the world.
Ta,
J.
Posted by susan C on August 8, 2001, at 16:03:14
In reply to Re:VNS. » adamie, posted by JahL on August 8, 2001, at 15:28:55
If we are looking at ECT, VNS, drugs and combinations there of, look also at Alpha Stim 100. It is microcurrent stimulation (MCS), similar, but different from a TENS unit, which used for chronic pain, has had studies done for depression and in the process of getting approved for use. I used it successfully for a year or so when I was very depressed and nothing worked. I was ready to try anything, and, unlike VNS, which requires an operation to install unit and wrap nerve and later to replace battery, Alpha Stim 100 just clips to your ears. Just thought I'd mention it.
> if meds fail then VNS will be for me. only side effect is voice alteration. it's a pace maker for the brain. Although it doesn't even touch the brain. it's a tiny box in your chest with a little cord going around your vegus nerve. this cord gives it a small pulse every 3-6 minutes which over weeks or months of time make you feel more normal. response rates for true treatment resistant patients is around 45%.
>
> Do you know if 45% is a 'response' (ie 50% improvement) or a 'remission' rate?
>
> >nothing to lose.
>
> Quite.
>
> >if you're suicidal then move to canada
>
> Nice part of the world.
>
> Ta,
> J.
Posted by adamie on August 8, 2001, at 19:28:42
In reply to Re:VNS. » adamie, posted by JahL on August 8, 2001, at 15:28:55
>
> > if meds fail then VNS will be for me. only side effect is voice alteration. it's a pace maker for the brain. Although it doesn't even touch the brain. it's a tiny box in your chest with a little cord going around your vegus nerve. this cord gives it a small pulse every 3-6 minutes which over weeks or months of time make you feel more normal. response rates for true treatment resistant patients is around 45%.
>
> Do you know if 45% is a 'response' (ie 50% improvement) or a 'remission' rate?
>
> >nothing to lose.
>
> Quite.
>
> >if you're suicidal then move to canada
>
> Nice part of the world.
>
> Ta,
> J.I'm sorry if my message was somewhat rude.
Regarding VNS, if you are part of the 45% that it works for it is like a perminent improvement it creates for you (unless you take it out). the 45% is for I think response rates but for a good portion of that it has been remission. I just dont know the percentage. For those that VNS works for it is supossed to work very well. A lot of severely depressed people who's cases were severe enough for them not to be able to work or do other such things, many of them who responded to VNS have. Perhaps I will look for an article soon.
The improvement that the VNS does create is like a perminent one. Say without meds you can be very severely depressed. With VNS it can improve your situation so that without meds you may be just moderately depressed. This is just an example because of course the effect will vary. So then the meds will have to deal with a much milder which would be easier to treat. the way I am talking it seems too good to be true but I am just extremely convinced over this VNS and am actually going to try it myself if meds dont work well enough for me.
I really see it as perminently making your depression much more mild (unless you take out the VNS) and therefor the remaining depression more treatable by meds. But of course how much it works will vary.
There was a better study but this is one which I just found right now-
Background: Vagus nerve stimulation (VNSTM), as delivered by the NeuroCybernetic Prosthesis (NCP®) System, is an approved therapy for treatment-resistant epilepsy. We examined the safety and potential antidepressant effects of VNS for treatment-resistant, major depressive episodes (MDEs).
Methods: Adult outpatients ( n = 30) with nonpsychotic, treatment-resistant, major depressive ( n = 21) or bipolar I ( n = 4) or II ( n = 5) (depressed phase) disorder, whose current MDE was >2 years in duration or who had >4 MDEs in a lifetime and who also had failed at least 2 robust medication trials in the current MDE were eligible. Each participant completed up to a 4-week baseline (preimplantation) period, while on stable antidepressant regimens or while not taking antidepressants ( n = 5). Thereafter, the NCP System was implanted, followed by a 2-week, single-blind, recovery period (no stimulation). For the next 2 weeks, stimulation parameters were adjusted. Thereafter, VNS was provided at a fixed (maximum comfortably-tolerated) dose for 8 weeks.
Results: In the current MDE, patients had failed to respond to 2 ( n = 9), 3 ( n = 2), 4 ( n = 6), or >5 ( n = 13) robust antidepressant medication trials; 57% had also received ECT. Mean length of the current MDE was 10.3 years (median = 4.7) (range = 0.3-49.5). Baseline 28-item Hamilton Depression Rating Scale (HDRS28) scores averaged 38.0 >5.5. Response rates ( >50% reductions in baseline scores) were 40% by HDRS28, 50% by the Montgomery-Åsberg Depression Rating Scale (MADRS), or 40% by the Clinical Global Impressions-Improvement (CGI-I) (1 or 2). Several subscales of the Medical Outcomes Survey (MOS) Short-Form (SF-36) revealed substantial functional improvement in responders. As of this writing, improvements obtained acutely have been sustained in acute study responders seen in longer-term follow-up ( n = 10).
Conclusions: These positive open trial results in a severe, treatment-resistant patient group suggest that VNS is a safe and effective treatment for a significant proportion of these patients
57% of these patients actually had ECT. For such severely ill patienst I think VNS has worked amazingly well. At least it will make the remaining depression a lot easier to treat. take care. and sorry for over stating it as complete remission earlier, although for some that can be the case. take care
Posted by adamie on August 8, 2001, at 19:35:13
In reply to VNS Operation vs drugs vs ECT vs MCS, posted by susan C on August 8, 2001, at 16:03:14
hi. Regarding VNS the battery has to be changed just every 11 years or so. I feel if it works well for a person then such simple operations wouldn't be a big deal. Having very severe depression is complete mind torture. I am not in that state anymore but even in my current state I am not affriad of having an operation. Anything to make me better. Hopefully I will just get better soon and therefor not need VNS. VNS is extremely safe though. People get operations to have VNS when they have Epilepsy. And people get pace makers for when they have heart problems. Depression I would consider the absolute worst and most serious decease of them all. Therefor I see absolutely no problem in having such an operation.I will look into what you mentioned. take care
> If we are looking at ECT, VNS, drugs and combinations there of, look also at Alpha Stim 100. It is microcurrent stimulation (MCS), similar, but different from a TENS unit, which used for chronic pain, has had studies done for depression and in the process of getting approved for use. I used it successfully for a year or so when I was very depressed and nothing worked. I was ready to try anything, and, unlike VNS, which requires an operation to install unit and wrap nerve and later to replace battery, Alpha Stim 100 just clips to your ears. Just thought I'd mention it.
>
> > if meds fail then VNS will be for me. only side effect is voice alteration. it's a pace maker for the brain. Although it doesn't even touch the brain. it's a tiny box in your chest with a little cord going around your vegus nerve. this cord gives it a small pulse every 3-6 minutes which over weeks or months of time make you feel more normal. response rates for true treatment resistant patients is around 45%.
> >
> > Do you know if 45% is a 'response' (ie 50% improvement) or a 'remission' rate?
> >
> > >nothing to lose.
> >
> > Quite.
> >
> > >if you're suicidal then move to canada
> >
> > Nice part of the world.
> >
> > Ta,
> > J.
Posted by susan C on August 8, 2001, at 20:21:02
In reply to Re: VNS Operation vs drugs vs ECT vs MCS » susan C, posted by adamie on August 8, 2001, at 19:35:13
Hi,
really appreciated your response. It got me thinking again. I have read about studies and results (10,000 people have used it for epilepsy and it helps where nothing has helped before...I understand that that is how they found out and then investigated the effect on depression, etc.) I really do have to keep it in mind as an alternative as nothing seems to work, or work very long and pdoc thinks there is some kind of seizure thing going on. I guess I don't want an operation because of ones I have had and I think I am frightened of the anesthesia more than anything else)
-s
>
> hi. Regarding VNS the battery has to be changed just every 11 years or so. I feel if it works well for a person then such simple operations wouldn't be a big deal. Having very severe depression is complete mind torture. I am not in that state anymore but even in my current state I am not affriad of having an operation. Anything to make me better. Hopefully I will just get better soon and therefor not need VNS. VNS is extremely safe though. People get operations to have VNS when they have Epilepsy. And people get pace makers for when they have heart problems. Depression I would consider the absolute worst and most serious decease of them all. Therefor I see absolutely no problem in having such an operation.
>
> I will look into what you mentioned. take care
>
> > If we are looking at ECT, VNS, drugs and combinations there of, look also at Alpha Stim 100. It is microcurrent stimulation (MCS), similar, but different from a TENS unit, which used for chronic pain, has had studies done for depression and in the process of getting approved for use. I used it successfully for a year or so when I was very depressed and nothing worked. I was ready to try anything, and, unlike VNS, which requires an operation to install unit and wrap nerve and later to replace battery, Alpha Stim 100 just clips to your ears. Just thought I'd mention it.
> >
> > > if meds fail then VNS will be for me. only side effect is voice alteration. it's a pace maker for the brain. Although it doesn't even touch the brain. it's a tiny box in your chest with a little cord going around your vegus nerve. this cord gives it a small pulse every 3-6 minutes which over weeks or months of time make you feel more normal. response rates for true treatment resistant patients is around 45%.
> > >
> > > Do you know if 45% is a 'response' (ie 50% improvement) or a 'remission' rate?
> > >
> > > >nothing to lose.
> > >
> > > Quite.
> > >
> > > >if you're suicidal then move to canada
> > >
> > > Nice part of the world.
> > >
> > > Ta,
> > > J.
Posted by jojo on August 8, 2001, at 21:02:17
In reply to VNS Operation vs drugs vs ECT vs MCS, posted by susan C on August 8, 2001, at 16:03:14
> If we are looking at ECT, VNS, drugs and combinations there of, look also at Alpha Stim 100. It is microcurrent stimulation (MCS), similar, but different from a TENS unit, which used for chronic pain, has had studies done for depression and in the process of getting approved for use. I used it successfully for a year or so when I was very depressed and nothing worked. I was ready to try anything, and, unlike VNS, which requires an operation to install unit and wrap nerve and later to replace battery, Alpha Stim 100 just clips to your ears. Just thought I'd mention it.
>
> > if meds fail then VNS will be for me. only side effect is voice alteration. it's a pace maker for the brain. Although it doesn't even touch the brain. it's a tiny box in your chest with a little cord going around your vegus nerve. this cord gives it a small pulse every 3-6 minutes which over weeks or months of time make you feel more normal. response rates for true treatment resistant patients is around 45%.
> >
> > Do you know if 45% is a 'response' (ie 50% improvement) or a 'remission' rate?
> >
> > >nothing to lose.
> >
> > Quite.
> >
> >
>if you're suicidal then move to canada
> >
> > Nice part of the world.
> >
> > Ta,
> > J.Susan-
Do you have any references for MCS?
Posted by susan C on August 8, 2001, at 21:53:53
In reply to Re: VNS Operation vs drugs vs ECT vs MCS » susan C, posted by jojo on August 8, 2001, at 21:02:17
This is the place where I got mine. Basically the technology has been around in slightly, but significantly different ways and is sold in various ways. This one, Alpha Stim 100 is the only one FDA approved. I asked for a MD referral and they called with my (old) pdoc name. Turns out he had used it with some success clearing up confusion with a brain injured patient. I ended up arguing with him about how it helped me with sleep (3 days) mood (10 days), he didn't believe me...that is one of the contributing factors to why he is now my (old) pdoc. Also, a psychologist in his practice has used it with over 100 patients, with significant but, of course, varying degrees of success. There is a section on research.
-s
> Susan-
>
> Do you have any references for MCS?
Posted by JahL on August 8, 2001, at 22:16:21
In reply to Re:VNS. -study » JahL, posted by adamie on August 8, 2001, at 19:28:42
> > response rates for true treatment resistant patients is around 45%.
> >
> > Do you know if 45% is a 'response' (ie 50% improvement) or a 'remission' rate?
> >
> > >nothing to lose.
> >
> > Quite.
> >
> > >if you're suicidal then move to canada
> >
> > Nice part of the world.
> >
> > Ta,
> > J.
>
> I'm sorry if my message was somewhat rude.Not at all. Crossed wires. I was actually agreeing with you on both counts & my Q was genuine. :-)
> 57% of these patients actually had ECT. For such severely ill patienst I think VNS has worked amazingly well. At least it will make the remaining depression a lot easier to treat. take care. and sorry for over stating it as complete remission earlier, although for some that can be the case. take care
I don't think you did overstate the case. I was just curious as to what the researchers meant by 'response'. Thanks for the abstract; the whole thing looks very interesting & is definitely on my 'last resort' list.
Thanks also to Susan. I had brought up MCS with a previous pdoc. He was extremely cynical but who knows?
Ta,
J.
Posted by Cam W. on August 9, 2001, at 8:09:22
In reply to Suicide, posted by SalArmy4me on August 8, 2001, at 15:10:09
Sal - Be careful, dude! That's counseling without a licence. - Cam
> If you're about to do the unthinkable, or can't see a way out, talk to me first. My screenname is "SalArmy4me" on AOL Instant Messenger and Yahoo Messenger...
Posted by SalArmy4me on August 9, 2001, at 8:45:35
In reply to Re: Suicide » SalArmy4me, posted by Cam W. on August 9, 2001, at 8:09:22
I don't need a licence to care about somebody.
> Sal - Be careful, dude! That's counseling without a licence. - Cam
>
> > If you're about to do the unthinkable, or can't see a way out, talk to me first. My screenname is "SalArmy4me" on AOL Instant Messenger and Yahoo Messenger...
Posted by KB on August 9, 2001, at 8:47:46
In reply to Re: Suicide » SalArmy4me, posted by Cam W. on August 9, 2001, at 8:09:22
I wouldn't be too concerned about the license issue - there are several groups out there that use unlicensed volunteers to do suicide-prevention counseling. As long as everybody is aware that someone doesn't have a license, it's their choice to seek help from that person, and it's OK.
Posted by may_b on August 9, 2001, at 10:35:22
In reply to Re: Suicide » SalArmy4me, posted by Cam W. on August 9, 2001, at 8:09:22
Cal
I always read your posts. Thanks for all your good sense and information.
Would appreciate your thoughts on my Parnate decision. I started parnate 3 weeks ago, and appreciated its initial tolerability (though later I experienced fatigue and insomnia) and its early effectiveness.
I read piles of postings on the internet [I have been culling through Neuroscion too --thanks for the URL] about the food restrictions, and found that the literature differed regarding tolerability of local canned or bottled beer. Some papers (i.e., Perry's paper on Monoaxidase Inhibitors: Adverse Effects) suggested (US)canned or bottled beer was acceptable (up to no more than 2 a day). I had a bottled local beer and almost immediately a hypertensive crisis for which I sought emergency treatment. (Obviously won't test this theory again.)
My question is: what is the latest thinking on maoi users carrying emergency drugs such as nifedipine, phentolamine or nitroprusside?
Certainly the team at emergency professed to knew nothing of these interventions--i.e., the doctor said "What is the generic name for nifedipine?" They basically watched me writhe with all the symptoms of hypertensive crisis for an hour before intervening with Ativan, Gravol and eventually morphine.I have had a headache ever since the event which worsens especially after eating, nomatter how carefully I observe the restrictions.
Because I feel unprotected from other hypertensive crisis events, I haven't taken the parnate for two days now. The thought of having to rely on the questionable skill set of emergency teams has scared me away from Parnate. (Aside from adhering to the dietary restrictions zealously) any advice you could give me to help me protect myself in the event of hypertensive crisis would surely help me decide to give Parnate another chance.
(I have to wait five more days for an appointment to see my Doc.)Thanks for your thoughts,
may_b
Posted by may_b on August 9, 2001, at 11:01:57
In reply to cal - parnate questions, posted by may_b on August 9, 2001, at 10:35:22
> Cam!
Sorry for the typo on your name. That'll teach me to type early in the morning!may_b
Posted by Cam W. on August 9, 2001, at 17:53:10
In reply to Re: Suicide » Cam W., posted by SalArmy4me on August 9, 2001, at 8:45:35
Sorry Sal, the graveyard is filled with good intentions. - Cam
> I don't need a licence to care about somebody.
>
> > Sal - Be careful, dude! That's counseling without a licence. - Cam
> >
> > > If you're about to do the unthinkable, or can't see a way out, talk to me first. My screenname is "SalArmy4me" on AOL Instant Messenger and Yahoo Messenger...
Posted by Cam W. on August 9, 2001, at 19:35:58
In reply to cal - parnate questions, posted by may_b on August 9, 2001, at 10:35:22
May - Sorry, I thought I answered this, but it didn't post (hmm....).
The guys in emerg are just going to do supportive treatment for anything that comes through the door. With the pace of scientific research these days, I'm not surprized they aren't up on the latest info.
I have heard of using the meds you mention; I think it was a European study (I am a community pharmacist and have little idea what goes on in a hospital). It seems everything is tried out in Europe (esp. Turkey, for some reason), before it makes it to the west. I really doubt the docs here would allow a person on an MAOI to carry hypertensive crisis meds with them. There are too many liability concerns. Dosage must be considered, as must knowing what you've taken when you reach the emergency room, if the recovery didn't work. Also, would you know if you were having a hypertensive crisis?
Have you talked to your doc about your reaction to the beer? You should phone him/her before you go in, so the doc will know how severe it was, and he/she can formulate a plan before you go in. Also, ask about carrying the meds you mention. The doc is less likely to dismiss the idea, if he/she has time to think about it (although I not sure it would be a good idea, for the reasons mentioned above. Also ask the doc about restarting the Parnate; five days is too long to wait.
I would recommend a Medic Alert-type bracelet or chain for anyone taking MAOIs. Also, learning as much as you can about the drugs you are taking (as you have) empowers a person to take charge of there illness, and not leave it all up to the doctor. You are doing the right thing by researching the meds (perhaps take a copy of any articles you have with you to your appointment), but don't read to much into the articles. It takes some finesse and understanding to properly interpret what a study is really trying to say (if anything). Also be aware of what you are ordering in a restaurant and ask the waiter or waitress to ask the chef if you have any suspicions about a dish. Let anyone who you dine with know that you have restrictions to your diet and educate them in what to do in case you should have a hypertensive crisis (call 911). Follow the food guide on MAOIs; it's better to be safe than sorry (as you know).
There is no need to fear medications, but one should respect them, no matter how seemingly safe (or dangerous) they are.
I know this isn't much, but I hope that it is of some help. Again, I stress to call the doc to see if you should restart the Parnate. - Cam
Posted by Elizabeth on August 9, 2001, at 21:53:00
In reply to Re: parnate questions » may_b, posted by Cam W. on August 9, 2001, at 19:35:58
Hi Cam.
> The guys in emerg are just going to do supportive treatment for anything that comes through the door. With the pace of scientific research these days, I'm not surprized they aren't up on the latest info.
Use of nifedipine for MAOI-associated hypertensive urgency is not exactly the latest info!
> I have heard of using the meds you mention; I think it was a European study (I am a community pharmacist and have little idea what goes on in a hospital). It seems everything is tried out in Europe (esp. Turkey, for some reason), before it makes it to the west.
Yeah, they're our guinea pigs, you know. < g >
Seriously: nifedipine is pretty commonly used for this purpose. Phentolamine isn't available in a pill form in the U.S. that I know of, but it's the recommended treatment for MAOI-associated hypertensive crisis in hospital settings (like, it's what the PI says to use). Sodium nitroprusside is another common treatment for HC in hospitals.
> I really doubt the docs here would allow a person on an MAOI to carry hypertensive crisis meds with them. There are too many liability concerns. Dosage must be considered, as must knowing what you've taken when you reach the emergency room, if the recovery didn't work.
I had no problem getting a script for nifedipine when I was
I was directed to bite and swallow one gelcap if my blood pressure got above 165/100 or so, and continue monitoring it. I was also told to go to an emergency room if I took any of it. It's not especially dangerous for a young woman in good cardiovascular health (such as myself), but like you say, better safe than sorry. The only problem I had (I think I used it two times during the 4 years or so that I was taking MAOIs) was when I accidentally took a double dose of Parnate and my BP shot up (not a food or drug interaction; just the effect Parnate has on me if I take too much at once). I didn't realise that dehydration would be a problem. My heart was pounding; it felt like it was going to jump out of my chest or something.If you don't have a reliable way to take your BP, I suppose it could be a problem.
> Also, would you know if you were having a hypertensive crisis?
This is always a question. I'm pretty sure I would know even without taking my BP because it's happened to me a few times. But a lot of things can cause headaches, nausea, etc. Hypertensive headache is pretty distinctive, but I don't know if a person who'd never experienced it would be able to identify it positively. And even if there is hypertension associated with the event, it may be misattributed. Before I realised that I was having spontaneous hypertensive episodes on Parnate, I was convinced that I'd had a reaction to some hummus.
> Also ask the doc about restarting the Parnate; five days is too long to wait.
I agree. MAOI withdrawal symptoms can be very serious.
> I would recommend a Medic Alert-type bracelet or chain for anyone taking MAOIs.
I had one of these. Never had to use it. The main issue is that you shouldn't be given Demerol.
But this brings to mind a question I've been meaning to ask: should I have a tag saying that I take buprenorphine? What I'm concerned about is the possibility that I wouldn't get adequate analgesia if I needed it because I probably have some degree of tolerance and because buprenorphine is hard to displace from mu receptors. What do you think?
> Also, learning as much as you can about the drugs you are taking (as you have) empowers a person to take charge of there illness, and not leave it all up to the doctor.
I agree absolutely. Unfortunately, taking charge of your own fate becomes a lot harder in an emergency situation where the medical professionals are people who don't know you. IME, they tend to make the assumption that you don't know what you're doing.
> It takes some finesse and understanding to properly interpret what a study is really trying to say (if anything).
Aren't they all trying to say "more research is needed" (i.e., give us more grants)? < g >
> Also be aware of what you are ordering in a restaurant and ask the waiter or waitress to ask the chef if you have any suspicions about a dish.
I think this only works in Italian restaurants. ("What kinds of cheeses are in this dish, and to what degree are they aged?")
> Follow the food guide on MAOIs; it's better to be safe than sorry (as you know).
And people should also know that the dietary restrictions have been greatly exaggerated. When patients are given overly restrictive dietary recommendations, they discover that they can cheat on some of the restrictions, and as a result they don't take them seriously in general (even the ones that they actually should take seriously). (Analogous to the way that the dangers of drug abuse are exaggerated to teenagers, so they don't take any of the warnings seriously.)
-elizabeth
Posted by Cam W. on August 9, 2001, at 22:06:25
In reply to Re: parnate questions » Cam W., posted by Elizabeth on August 9, 2001, at 21:53:00
Elizabeth - Thanks for the info, much appreciated. Like I say, working in community pharmacy, we don't get all the fun you see on ER.
;^)Thanks again - Cam
Posted by shelliR on August 9, 2001, at 23:40:54
In reply to Re: parnate questions » Cam W., posted by Elizabeth on August 9, 2001, at 21:53:00
Elizabeth, Cam
> Seriously: nifedipine is pretty commonly used for this purpose.So you think this is a good idea. I think there are definitely two schools of thought on this. I do have a blood pressure monitor at home, but I don't carry it with me. And nifedipine could cause harm if you take it and you are not hypertensive, right? I am in my forties, but am cardiovascularly fit.
> > Also, would you know if you were having a hypertensive crisis?
> This is always a question. I'm pretty sure I would know even without taking my BP because it's happened to me a few times. But a lot of things can cause headaches, nausea, etc. Hypertensive headache is pretty distinctive, but I don't know if a person who'd never experienced it would be able to identify it positively. And even if there is hypertension associated with the event, it may be misattributed. Before I realised that I was having spontaneous hypertensive episodes on Parnate, I was convinced that I'd had a reaction to some hummus.I had two non-serious hypertensive crises when combining nardil with adrafinil. Non-serious in the sense that my BP went up to 160 and not any higher. I didn't experience a headache, I experienced a specific tightness in my shoulders. And my pulse went very low- like 45. If your blood pressure shoots up like that, is a reduction of pulse a given? I mean can that be an accurate indication that you are having a hypertensive episode.
When I started selegiline only 5 days after stopping nardil, I had the same tighening of my shoulders and was BP was up to 140, instead of it's usual 100. But then after that I had the same shoulder thing only my BP was not up. That was my reaction to the selegiline. But it felt exactly like my hypertensive shoulder. So I became less confident that I would know if I was having a reaction. But now that I'm off the selegiline, I think if my shoulders tighten up like that I would immediately take my BP.
Maybe I should carry one of those mini ones that hook up to your finger. Are they accurate?I never ever worried about a reaction to nardil, because I ate absolutely everything, and even was given demerol during an exploratory procedure and had no reaction. But I'm thinking that parnate is not nardil and I don't know if I can be so cavilier about the whole thing. I think I read (don't know if it's true) that parnate is more likely to cause a hypertensive episode than nardil. True, false, don't know?
>>
> > I would recommend a Medic Alert-type bracelet or chain for anyone taking MAOIs.
> >So demeral is the only reason to wear one for an MAOI?None of my pdocs have ever brought this up to me. I'm going to ask my pdoc why he didn't suggest it.
I've never worn one and would rather not, but I would also not like to not put myself in crisis.Shelli
Posted by Kristi on August 10, 2001, at 1:04:49
In reply to Re: Suicide » SalArmy4me, posted by Cam W. on August 9, 2001, at 8:09:22
I think Sal is just trying to help. There are so many times I wish there are people who are just willing to listen that I don't have to fork out my money too. Sal, thanks for caring!
> Sal - Be careful, dude! That's counseling without a licence. - Cam
>
> > If you're about to do the unthinkable, or can't see a way out, talk to me first. My screenname is "SalArmy4me" on AOL Instant Messenger and Yahoo Messenger...
Posted by may_b on August 10, 2001, at 2:03:40
In reply to Re: parnate questions » may_b, posted by Cam W. on August 9, 2001, at 19:35:58
Hi Cam
Thanks for your thoughtful answer.
>There are too many liability concerns.
That's exactly what I felt was going on in emerg: do nothing, and maybe she'll pull through.
>Also, would you know if you were having a hypertensive crisis?
It was a pretty classic presentation of the symptoms in the literature--though I had only made mental note of severe headache and stiff neck. I had studied the literature re food restrictions and thought I had proceeded with my usual paranoid overcaution. Some of the detailed diet recommendations say local canned or bottle US beer is supposedly safe per the info on this very website. This is what I chose. Immediately (within 5 minutes) I had palpitations (which I ignored for about 2 or 3 minutes) and then neck stiffening and headache. By that time, I barely had time to convey the message that I had to go to emergency. In another five minutes I was nearly too weak to speak. In ten minutes I was vomitting in emergency (which helped get some attention). I knew it was hypertensive crisis: believe me, it feels like you are about to die.
>
> Have you talked to your doc about your reaction to the beer?Tried. Earliest appointment was 10 days away.
>You should phone him/her before you go in, so the doc will know how severe it was, and he/she can formulate a plan before you go in.
This is a good plan, except she doesn't take phonecalls. I'd have to tell the girl on the front desk...sigh. This requires some humility.
>Also, ask about carrying the meds you mention. The doc is less likely to dismiss the idea, if he/she has time to think about it (although I not sure it would be a good idea, for the reasons mentioned above.
Your comments are confirmation of my anxieties: I had worried that she would refuse me the nifedipine for the reasons you mention. But I will certainly try.
>Also ask the doc about restarting the Parnate; five days is too long to wait.
I agree. However, it seems too scary to pursue right now.
>
> I would recommend a Medic Alert-type bracelet or chain for anyone taking MAOIs.This would have helped.
> Also, learning as much as you can about the drugs you are taking (as you have) empowers a person to take charge of there illness, and not leave it all up to the doctor.
I wish this learning was respected in emerg. They seemed to resent it.
> You are doing the right thing by researching the meds (perhaps take a copy of any articles you have with you to your appointment), but don't read to much into the articles.
Thanks, and yes, I have detected the provisionary tone of all statements in the articles -- CYA?.
>Let anyone who you dine with know that you have restrictions to your diet and educate them in what to do in case you should have a hypertensive crisis (call 911).
This is good advice. More humility required.
:-).Thanks so much for your input,
may_b
Posted by Cam W. on August 10, 2001, at 4:48:32
In reply to Re: Suicide-sal, posted by Kristi on August 10, 2001, at 1:04:49
Kristi - I know Sal is just trying to help. I commend him on that, but you really have to be careful what you say to people, who you don't know. Without a medical history, it is almost impossible to second guess the doctor. That is why I try to stick to answering questions about medications and always caution people to check with their doctor.
I am a community pharmacist, so I don't have the diagnostic skill of a psychiatrist, no matter how bad that psychiatrist may seem. On this site we only hear their stories from one side, which is not the most objective point of view, especially if that person is hurting. People who ask for advice are, for the most part, honest in describing their perceptions of their situation, but we can't take for granted what we are reading is an objective description of the situation (although, in most cases, I do believe that we are reading true views). The impact of what is said on this site is far-reaching (so I have been finding out - eg. getting calls from journalists wanting to know what my opinion is on certain medications - that scares me, even though I may have extensively researched a topic).
First we must try to do no harm. This is why I will only answer questions posed on this site and none through my email. I always just delete any questions I get via email from people I don't know. I need other people (posters and lurkers on this site) to make sure I am not giving erroneous information. I only know my answers from my point of view; it is important, and necessary, to have second and third opinions, especially in this type of format.
If Sal isolates anyone by a Messenger system, then others cannot confirm if what he is saying is potentially helpful or harmful, especially when he is doing it without any formal training. This is why I said what I did to Sal. I am not trying to pick on him, but I wouldn't pretend that I could counsel a suicidal person. Even when working in a pharmacy and I get a phonecall from a suicidal person, I try to get them to call the crisis line, because this sort of situation is beyond the scope of what I feel I can handle appropriately.
Suicidal people should be convinced to get help in person, not over the internet. This is what crisis lines attempt to do. The operators are trained to assess the situation and to try to get the person to seek help in person (ie. in an emergency room, when necessary). Besides, if we try to help someone who is suicidal and we push them over the edge, we could be held liable for their death. This is why we try to answer questions by consensus on this site, rather than individually.
Sincerely, Cam
Posted by ChrisK on August 10, 2001, at 5:04:27
In reply to Re: Suicide-sal » Kristi, posted by Cam W. on August 10, 2001, at 4:48:32
Cam,
I applaud your efforts on this site and wish you the best in everyday life. Your answer to Kristi is dead on. Thanks for helping out in the manner you do.
Respectfully,
Chris
Posted by Kristi on August 10, 2001, at 9:00:30
In reply to Re: Suicide-sal » Kristi, posted by Cam W. on August 10, 2001, at 4:48:32
Cam,
Point well taken. But I sort of took it like he was trying to offer support. But we really do need to be careful. :-) Thanks, Kristi
> Kristi - I know Sal is just trying to help. I commend him on that, but you really have to be careful what you say to people, who you don't know. Without a medical history, it is almost impossible to second guess the doctor. That is why I try to stick to answering questions about medications and always caution people to check with their doctor.
>
> I am a community pharmacist, so I don't have the diagnostic skill of a psychiatrist, no matter how bad that psychiatrist may seem. On this site we only hear their stories from one side, which is not the most objective point of view, especially if that person is hurting. People who ask for advice are, for the most part, honest in describing their perceptions of their situation, but we can't take for granted what we are reading is an objective description of the situation (although, in most cases, I do believe that we are reading true views). The impact of what is said on this site is far-reaching (so I have been finding out - eg. getting calls from journalists wanting to know what my opinion is on certain medications - that scares me, even though I may have extensively researched a topic).
>
> First we must try to do no harm. This is why I will only answer questions posed on this site and none through my email. I always just delete any questions I get via email from people I don't know. I need other people (posters and lurkers on this site) to make sure I am not giving erroneous information. I only know my answers from my point of view; it is important, and necessary, to have second and third opinions, especially in this type of format.
>
> If Sal isolates anyone by a Messenger system, then others cannot confirm if what he is saying is potentially helpful or harmful, especially when he is doing it without any formal training. This is why I said what I did to Sal. I am not trying to pick on him, but I wouldn't pretend that I could counsel a suicidal person. Even when working in a pharmacy and I get a phonecall from a suicidal person, I try to get them to call the crisis line, because this sort of situation is beyond the scope of what I feel I can handle appropriately.
>
> Suicidal people should be convinced to get help in person, not over the internet. This is what crisis lines attempt to do. The operators are trained to assess the situation and to try to get the person to seek help in person (ie. in an emergency room, when necessary). Besides, if we try to help someone who is suicidal and we push them over the edge, we could be held liable for their death. This is why we try to answer questions by consensus on this site, rather than individually.
>
> Sincerely, Cam
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