Wednesday, February 02, 2011


It was my intention to post something else today, but I am unable to do so. I'm too otherwise distracted. In this circumstance, cleaving to the old aphorism of writing what one knows might be the soundest suggestion. Right now, I'm still recovering. Yesterday morning it seems that I had my second, and hopefully last hypertensive crisis. Though my pulse rate did reach as high as 120 beats per minute, blood pressure never reached elevated levels. During the last one, high blood pressure was an issue. I am always thankful for small favors. And, I should also note that frequent exercise has had an added benefit. It has strengthened my heart to the point that it does not need to beat as frequently or with greater force, even in crisis situations like these.

The cause of the emergency was a result of my having a food interaction to a strong anti-depressant. Called monoamine oxidase inhibitors, or MAOI's for short, they demand severe dietary restrictions. Eating certain types of food can trigger a hypertensive emergency of this sort. Because of these interactions, and the risk involved of people not minding their diet, psychiatrists are reluctant to administer them. If more people were prescribed this class of drug, then those who package, design, and make food would be careful not to include certain problematic ingredients. And until they do, it is still entirely possible to ingest reactive ingredients without even knowing it.

That's what happened yesterday. The culprit here is an amino acid called Tyramine, a chemical substance that the brain would ordinarily sweep out on its own. MAOI's prevent this from happening as part of their antidepressant effect. As a result, the levels of Tyramine can build to a dangerous saturation if Tyamine-containing foods are ingested. MAOI's are so rarely prescribed that I find I have to give a tutorial to EMT's and ER workers every time this happens. It's a more than a little frustrating, since they're supposed to be the experts, and I'm supposed to be the patient. But I have also learned long ago that being proactive and educating oneself on one's condition is the quickest path back to health.

My blood pressure and heart rate were closely monitored in the back of the ambulance. Pulse rate continued to be high, so it was determined I needed to go to the hospital. An IV was started, then I was passed on to the care of the ER staff. I stayed there for about two hours, at which point my pulse rate slowly returned to normal. I was then given an hefty injection of Ativan, a tranquilizer. That by itself did not decrease my pulse, but it did take my mind off of it, decreasing the worry. I quickly grew so sleepy that I could barely keep my eyes open. Once discharged and home, I slept for five or six hours, feeling much better afterward.

In any case, I discovered, the hard way, that a certain kind of margarine spread, brushed across two slices of bread for breakfast toast, also contains yogurt. Yogurt is a food I cannot have, and in any form. I knew exactly what was wrong the instant I felt the first warning signs. I knew that this was not going to be a mild reaction that could be addressed by deep breathing exercises and distraction. Sometimes during the minor ones I can take a short walk and get my mind off of it. This was not going to be the case here. Terrified, I fell to the carpeted floor, my pulse rate now going through the roof. I said a quick prayer, Please God, don't let me die. It was, in fact, unlikely that I was going to die, but panic sets in, along with fears of imminent catastrophe.

At first I tried to call my girlfriend, but it turns out that she was sitting in the Dentist chair and unable to take the call, though it was a couple hours later before I realized where she was. I then somehow decided I needed to call my father, but ended the call immediately after dialing. He would be no help, miles away as he is. The only available tool at my disposal was to call 911. Most gratefully, paramedics, followed by the Fire Department, arrived no less than five minutes later. I am fortunate to live within walking distance from both.

If I could change things around to make the process run more smoothly, I would opt for a simple solution of additional education for medics, nurses, and doctors. But before I sound too critical, I want to note that the people who worked on me in the ER were wonderfully helpful and efficient. And to return to the subject of being proactive, I somehow managed to grab the pertinent medication bottle, then sat it down on the dining room table, so that the paramedics knew the cause of the problem immediately. I've been visiting doctors and having tests run for so many months now that I keep all my insurance information in a folder, and I reflexively grabbed it, too. This saved time and spared additional hassle.

Welcome to the American health care system. If you want efficient care, make sure to have your insurance card glued to yourself at all times, else you will deal with billing snafus for months later. But I digress. My memories of this experience are not linear, so I recognized I've not written this in such form. The chain of events seems a bit like a nightmare, and I'm hoping this will be the last nightmare for a while.

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