![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 139 to 163 of 488. Go back in thread:
Posted by jsarirose on July 19, 2002, at 14:55:45
In reply to Re: hypertensive experiences?, posted by LLL on July 19, 2002, at 9:03:44
> I'm glad to hear so many of you are so luck to have found a competent doctor. After moving here almost a year ago I discovered that all the competent and cutting edge doc's are in the Houston Medical Center (which is comprised of about 6 major hospitals and Universities). However, with panic/disorder/agoraphobia (thus the need for the Parnate - only MAOI's have ever helped)driving from the suburbs to the inner city (about 2 hours with traffic)is like asking me to skydive. My current doc (closer) who reluctantly agreed to begin to prescribe again the Parnate refuses to also prescribe Procardia for a hypertensive crisis, since cardiac drugs are out of her area of expertise (this is a common anecdote for patients to carry and is prescribed with the MAOI). Soooooo, does anyone out there know how I can find a competent psychiatrist who's not afraid of MAOI's in the WEST Houston,TX area????
Have you ever seen another psychiatrist who prescribed Parnate? If so, he/she might be willing to do a phone consultation with your regular doctor and your local doctor could prescribe it with the other doc's blessing, so to speak. My regular doctor didn't feel comfortable prescribing all the meds I was on one time and I had her talk to my psychiatrist. After talking with the pdoc, she fell comfortable enough to let me get my prescriptions through her.
It's worth a try. Maybe one of the docs at Houston Medical would even talk to your regular doc without an in-person consultation with you first, especially if she's willing to prescribe the Parnate but not the "emergency" pill.
-Jessica
Posted by LLL on July 19, 2002, at 17:31:51
In reply to Re: hypertensive experiences?, posted by jsarirose on July 19, 2002, at 14:55:45
Thank you for your help and support - it's much appreciated I will attempt to get some communication going between my psychiatrist and my general practioner. I just feel if this psychiatrist was really competent she'd take the time to investigate the possible ramifications of this drug and be willing to invest the time with me to prescribe the "emergency pill". I'm very frustrated by the the degree of ignorance about MAOI's by medical professionals.
Lisa
Posted by jsarirose on July 19, 2002, at 17:54:07
In reply to Re: hypertensive experiences?, posted by LLL on July 19, 2002, at 17:31:51
> Thank you for your help and support - it's much appreciated I will attempt to get some communication going between my psychiatrist and my general practioner. I just feel if this psychiatrist was really competent she'd take the time to investigate the possible ramifications of this drug and be willing to invest the time with me to prescribe the "emergency pill". I'm very frustrated by the the degree of ignorance about MAOI's by medical professionals.
> Lisa
Absolutely! Many doctors are afraid of them because they have so many restrictions and ramifications. And they don't take the time to fully understand them. But they are also extremely good drugs for those of us who haven't been helped by anything else. And I'm constantly shocked by how many people I've talked to who get an MAOI prescribed without any type of "emergency" pill. Usually their doctors tell them to go to the hospital if they have a crisis. Well, in my experience that's not necessary if you have a little pill! I take thorazine (only in an emergency, not regularly). I like it because even if my blood pressure hasn't spiked it's still safe to take.Good luck,
Jessica
Posted by cybercafe on July 20, 2002, at 5:00:04
In reply to Re: hypertensive experiences?, posted by jsarirose on July 19, 2002, at 17:54:07
>been helped by anything else. And I'm constantly shocked by how many people I've talked to who get an MAOI prescribed without any type of "emergency" pill. Usually their doctors tell them to go to the hospital if they have a crisis. Well, in my experience that's not
Actually my doc says it's pretty much impossible for me to have a hypertensive crisis... and if I do, it will be mild and I should just be able to take some ibuprofen or acetaminofin or something....
... and my doc is by far one of the most knowledgable docs i have ever seen, so i am quite prone to believe him -- though yes, i would feel much better with some nifedepine (Adalat??) ...
(it's too bad... my father just stopped taking the drug and used up his last pill)
Posted by cybercafe on July 20, 2002, at 5:02:01
In reply to Re: hypertensive experiences?, posted by LLL on July 19, 2002, at 9:03:44
okay so you can't get nifedepine without the expertise of a cardiologist
you can't see a psychiatrist cuz they are all too busy or not knowledgable of MAOIs
but how hard would it be for you to get an appointment with a cardiologist?
... i'm not sure how things work in the states... would you have to pay to see a cardiologist? ...
> I'm glad to hear so many of you are so luck to have found a competent doctor. After moving here almost a year ago I discovered that all the competent and cutting edge doc's are in the Houston Medical Center (which is comprised of about 6 major hospitals and Universities). However, with panic/disorder/agoraphobia (thus the need for the Parnate - only MAOI's have ever helped)driving from the suburbs to the inner city (about 2 hours with traffic)is like asking me to skydive. My current doc (closer) who reluctantly agreed to begin to prescribe again the Parnate refuses to also prescribe Procardia for a hypertensive crisis, since cardiac drugs are out of her area of expertise (this is a common anecdote for patients to carry and is prescribed with the MAOI). Soooooo, does anyone out there know how I can find a competent psychiatrist who's not afraid of MAOI's in the WEST Houston,TX area????
Posted by LLL on July 20, 2002, at 10:08:36
In reply to Re: hypertensive experiences?, posted by cybercafe on July 20, 2002, at 5:02:01
I am seeing a psychiatrist, she's the one prescribing the Parnate. My point is, since this is the drug she is prescribing and psychiatric literature clearly outlines what to do for the patient in case of a hypertensive crisis, including Procardia sublingual 10-20 mg., as well as a trip to the ER (I've had 2 such experiences and do not want to go through it ever again),then she should provide the antedote. Instead I have to now involve my PCP who because he is not a psychiatrist is not familiar with MAOI's and see's them all as "bad" drugs. Good care should not be fragmented! I've had excellent psychiatrists in the past in other parts of this country, this doesn't encourage me as receiving good care.
Regarding hypertensive crisis and it being rare - I consumed a small piece of teriyaki chicken breast and had a "ride to hell" as a result. Not only did I require a trip via ambulance to the ER, I was subjected to terrible care by personnel who kept asking in unsympathetic fashion "why did you try to kill yourself"?
Posted by cybercafe on July 20, 2002, at 11:38:27
In reply to Re: hypertensive experiences?, posted by LLL on July 20, 2002, at 10:08:36
>is the drug she is prescribing and psychiatric literature clearly outlines what to do for the patient in case of a hypertensive crisis, including Procardia sublingual 10-20 mg., as well
ahh so it actually says in the literature to perscribe it but she won't?? ... that sounds rather strange ... :)
>not be fragmented! I've had excellent psychiatrists in the past in other parts of this country, this doesn't encourage me as receiving good care.
believe me i can totally relate...
.. i was caught off guard in london because i waited 4 months.. and then had an *excellent* doc ... i was like "i bet you want to put me on valporate" and then "holy shit YOU have heard of lamictal?? You have USED lamictal??" ... VERY impressed.... and then i moved a few blocks away and it was like "sorry i cannot legally see you anymore because you are no longer in my area" ... if i had known you could go above 200 mg on lamotrigine, i would have raised it myself, .. but i wasn't very knowledgable back then...
to this day i wonder if lamictal might have been a wonder drug for me... and if i have lost 3 years of my life unneccessarily ....
but i feel much much better now that i have taken things into my own hands .... (thank you Parnate)
> Regarding hypertensive crisis and it being rare - I consumed a small piece of teriyaki chicken breast and had a "ride to hell" as a
hmmm.. i wonder if it is easier on my system because i am tall and slim? ... i can't think of what else it could be...
i just had some teriyaki chicken in fact, .. but there was no soya sauce on it, if that is what did it for you?
Posted by may-b on July 20, 2002, at 11:43:51
In reply to Re: hypertensive experiences?, posted by LLL on July 20, 2002, at 10:08:29
> Regarding hypertensive crisis and it being >rare - I consumed a small piece of teriyaki >chicken breast and had a "ride to hell" as a >result. Not only did I require a trip via >ambulance to the ER, I was subjected to >terrible care by personnel who kept asking in >unsympathetic fashion "why did you try to kill >yourself"?
I had a similar experience -- disrespectful ER 'care' and the same offensive question. The idea that I would have to deal with more unenlightened medical personnel has scared me away from using Parnate, the only AD that has actually helped.
Best wishes,
may-b
Posted by Bobbiedobbs on July 20, 2002, at 12:50:15
In reply to Re: hypertensive experiences? » LLL, posted by may-b on July 20, 2002, at 11:43:51
In response to the last few posts:
(1) I've had teriyaki chicken breast and teriyaki on lots of other thinks - never a reaction. Could it possibly be the type of soy sauce used? The watered-down soy used in most commercial sauces and even some Chinese restaurants (soy blanded to suit American tastes) is probably harmless.
(2) Re yeast in frozen dinners. That is all I eat. I would estimate that I have eaten approximately 3000 frozen dinners since taking up to 60 mg. of Nardil and 50 mg. of Parnate and narry the slightest hint of a reaction (you do have to be careful not to have a TV dinner with cheese, broad bean pods, etc.) I take this to reflect the amount of yeast in these dinners and the condition of it by the time it gets combinecd with the thousands of other chemicals.
3) I too get the "no one has ever heard of what you're taking" or (they stopped prescribed that in the 60's, for good reason) type of reactions from doctors and others. One good thing about this on-line community is that you realize you are NOT the only one taking an MAO - and I've gotten better info here than from some doctors.
Posted by LLL on July 20, 2002, at 13:09:52
In reply to Re: hypertensive experiences?, posted by Bobbiedobbs on July 20, 2002, at 12:50:15
I agree, I've received more help from this site than from any health care professionals (at least while living here).
The teriyaki chicken was prepared in a restaurant and from the saltiness I remember, it may have in fact been soaked in soy sauce. I used soy (stuck with the same brand) in small amounts with no problem.
Regarding frozen foods, I'd stay away from the autolyzed yeast extract, at least I'm not going to chance it. I found canned chicken stock and some frozen foods in the Kosher food section with all natural ingredients as well as some frozen foods with no additives in the organic food section. My remaining concern is with eating out for in the past I felt confined to boring sauce free/cheese free dishes.
If you are able to get the info on the soy protein and soy flour I'd much appreciate it.
Thanks,
Lisa
Posted by jsarirose on July 20, 2002, at 13:49:58
In reply to Re: hypertensive experiences? » LLL, posted by may-b on July 20, 2002, at 11:43:51
> > Regarding hypertensive crisis and it being >rare - I consumed a small piece of teriyaki >chicken breast and had a "ride to hell" as a >result. Not only did I require a trip via >ambulance to the ER, I was subjected to >terrible care by personnel who kept asking in >unsympathetic fashion "why did you try to kill >yourself"?
>
> I had a similar experience -- disrespectful ER 'care' and the same offensive question. The idea that I would have to deal with more unenlightened medical personnel has scared me away from using Parnate, the only AD that has actually helped.
>
> Best wishes,
> may-bMay-b: I hate to see you avoid a potentially positive drug because of the ignorant out there. It is a lifesaver for me as well. I do find I need to periodically educate pharmacists (luckily I have a good psychiatrist). I have never had to go to the emergency room because of a hypertensive crisis however, and I've had three. All doctors should be required to prescribe some sort of "emergency" pill. I'm shocked at the number that don't and refer people to the emergency room if in crisis.
I take Chlorpromazine (Thorazine) for at attack. It works great, I just take one pill, and the best part is that if I'm not actually having a blood pressure spike it won't hurt me. The first two attacks, the doctor's on call asked what my blood pressure was. Of course I had no idea as I wa at home! Then my doctor told me it was safe to take if I thought I was in crisis as it won't bring my blood pressure too low if it's not elevated.
I highly recommend giving Parnate another try if you are still searching for something. Just make sure you have some sort of crisis pill. And I think a home blood pressure kit is a great idea.
-Jessica
Posted by jsarirose on July 20, 2002, at 13:55:18
In reply to Re: hypertensive experiences?, posted by cybercafe on July 20, 2002, at 11:38:27
I've started augmenting the Parnate with Lamictal. I was on it once before by itself (the Lamictal) but we only went up to 400mg. After I got off, my doctor consulted with someone else who recommended pushing it much higher - up to 800mg if necessary. At that time we didn't. Now that Parnate is working well, we're slowly tapering down the Parnate and up the Lamictal. We'll go up to 600-800mg if necessary. It may be that a balance of Parnate and Lamictal is necessary, or if I'm lucky, I'll be able to go off Parnate and just be on Lamictal eventually.
I'm doing it very slowly as I absolutely don't want to lose the positive effects of Parnate and any gains I've had in my depression.
Something to think about!
-Jessica
(Treatment Resistant Depression often requires very high doses of meds, most can go higher than the pharmaceutical companies originally state.)
Posted by jsarirose on July 20, 2002, at 14:27:41
In reply to Re: hypertensive experiences?, posted by cybercafe on July 20, 2002, at 5:00:04
> Actually my doc says it's pretty much impossible for me to have a hypertensive crisis... and if I do, it will be mild and I should just be able to take some ibuprofen or acetaminofin or something....
>
> ... and my doc is by far one of the most knowledgable docs i have ever seen, so i am quite prone to believe him -- though yes, i would feel much better with some nifedepine (Adalat??) ...
>
> (it's too bad... my father just stopped taking the drug and used up his last pill)Why does he say that? I've never heard of that? Does that mean you don't have to follow the diet? If you do have to follow the diet - why? If there is no danger of a hypertensive crisis (according to your doctor) why would you need to watch what you eat?
Sorry - don't mean to sound accusatory, I'm just baffled by the reasoning. Also, I've had severe migraine (a common effect) without have elevated blood pressure from something I ate while on Parnate. The Thorazine greatly helped the migraine. I'm wondering if while you may not be endangering your heart/life if you are still prone to a tyramine migraine.
-Jessica
Posted by LLL on July 20, 2002, at 14:53:54
In reply to Re: hypertensive experiences?, posted by cybercafe on July 20, 2002, at 5:00:04
Re: My doctor says I won't have a hypertensive crisis - suggestion - get a new doc!
He/she's obviously never had one. It's not just the rise in B/P (which doesn't have to go very high) but also the terrible head pain and all the fear that goes with knowing you might have precipitated a cranial bleed. Think about it.
Posted by may-b on July 20, 2002, at 16:44:33
In reply to Re: hypertensive experiences? » may-b, posted by jsarirose on July 20, 2002, at 13:49:58
Hi Jessica
Thanks! I will ask the doctor about Thorazine. (I really enjoy your posts.)
best wishes,
may-b
Posted by jsarirose on July 20, 2002, at 21:14:30
In reply to Re: hypertensive experiences? » jsarirose, posted by may-b on July 20, 2002, at 16:44:33
> Hi Jessica
>
> Thanks! I will ask the doctor about Thorazine. (I really enjoy your posts.)
>
> best wishes,
> may-bWell, there is so much in life that I know nothing about. I've been through the anti-depression med gamut for so many years that when I actually know something I love nothing more than telling anyone that will listen! As always, imho.
-Jessica
Posted by cybercafe on July 21, 2002, at 1:06:12
In reply to Re: hypertensive experiences? » cybercafe, posted by jsarirose on July 20, 2002, at 14:27:41
> Why does he say that? I've never heard of that? Does that mean you don't have to follow the diet? If you do have to follow the diet - why? If there is no danger of a hypertensive crisis (according to your doctor) why would you need to watch what you eat?
the only things i can't have are soy sauce, marmite, broad beans and alcohol (he says not to take alcohol with any drug cuz it does not allow the drug to be metabolized which makes good sense to me) ....
basically i got the feeling that if i ate any of those foods i would have a mild headache... i don't particularly want any kind of headache...i suppose i do fear getting a migraine or worse .. even if there's only a 0.1% chance, i still wouldn't want to risk it...
> Sorry - don't mean to sound accusatory, I'm just baffled by the reasoning. Also, I've had severe migraine (a common effect) without have elevated blood pressure from something I ate while on Parnate. The Thorazine greatly helped the migraine. I'm wondering if while you may not be endangering your heart/life if you are still prone to a tyramine migraine.hey no prob i don't take it as anything but genuine curiousity :)
- remember, as a victim of ignorant and unavailable docs, my first instinct is to bombard people with questions too - it's tough to have to treat yourself :)... okay let me ask you a question.... how bad is a tyramine migraine, like what does it feel like, and can you just take regular aspirin for it?
Posted by cybercafe on July 21, 2002, at 1:10:30
In reply to Re: hypertensive experiences? » cybercafe, posted by LLL on July 20, 2002, at 14:53:54
> Re: My doctor says I won't have a hypertensive crisis - suggestion - get a new doc!
> He/she's obviously never had one. It's not just the rise in B/P (which doesn't have to go very high) but also the terrible head pain and all the fear that goes with knowing you might have precipitated a cranial bleed. Think about it.... see my message to jess... re: what does it feel like, and does regular aspirin work?
... and is hypertensive crisis a factor of age, gender, weight? .. as i am young, male, and probably underweight :) ....
... as for my pdoc... he is really really good... i totally respect him... though we disagree from time to time... unlike other docs, he can actually back up what he says with good reason...
... next time i go in i will ask why i am any different than the other fellows here i have talked to who have had hypertensive crisis
Posted by jsarirose on July 21, 2002, at 1:34:01
In reply to Re: hypertensive experiences?, posted by cybercafe on July 21, 2002, at 1:10:30
> > Re: My doctor says I won't have a hypertensive crisis - suggestion - get a new doc!
> > He/she's obviously never had one. It's not just the rise in B/P (which doesn't have to go very high) but also the terrible head pain and all the fear that goes with knowing you might have precipitated a cranial bleed. Think about it.
>
> ... see my message to jess... re: what does it feel like, and does regular aspirin work?
>
> ... and is hypertensive crisis a factor of age, gender, weight? .. as i am young, male, and probably underweight :) ....
>
> ... as for my pdoc... he is really really good... i totally respect him... though we disagree from time to time... unlike other docs, he can actually back up what he says with good reason...
>
> ... next time i go in i will ask why i am any different than the other fellows here i have talked to who have had hypertensive crisisIt's absolutely nothing like a bad headache. It's far worse and regular meds like aspirin, ibuprofen and Aleve don't do much. It begins as a pounding on the side of the head. The pain is so intense I've actually cried. Then eventually the specific point of pain will start to spread out. It spread toward the front/top of my head and eventually I have a migraine throughtout. Migraines have certain characteristics like nausea, sensitivity to light and sound, some people see auras as well. You may or may not have all of these symptoms. It's also characterized by "a moderate to severe throbbing pain for four to 72 hours that is frequently on one side of the head".
If you're on an MAOI and you ingest too much tyramine it can bring on a migraine. It has nothing to do with your sex, weight, age, health, etc. It's strictly the tyramine interacting with the med.
I'm guessing your doctor knows something we don't about your dosage. (Aren't you taking just 30mg?) I've just never heard of not having to watch your diet. Do you eat cheese, like cheddar, too? If you can eat aged cheeses with no effect then it sounds like your doctor is right. They have one of the highest tyramine levels.
Here's a 'read'-bite I found: "Because the sequela from tyramine and MAOIs is dose-related, reactions can be minimized without total abstinence from tyramine-containing foods. Approximately 10 to 25 mg of tyramine is required for a severe reaction compared to 6 to 10 mg for a mild reaction."
Sounds like it is dose related.
-Jessica
Posted by cybercafe on July 21, 2002, at 2:46:44
In reply to Re: hypertensive experiences? » cybercafe, posted by jsarirose on July 21, 2002, at 1:34:01
> It's absolutely nothing like a bad headache. It's far worse and regular meds like aspirin, ibuprofen and Aleve don't do much. It begins as a pounding on the side of the head. The pain is so intense I've actually cried. Then eventually the specific point of pain will start to spread out. It spread toward the front/top of my head
I really appreciate the info Jess -- I would have been in big trouble if I had to find out that over-the-counter meds didn't work on my own ! Ouch !
Posted by LLL on July 21, 2002, at 9:25:58
In reply to Re: hypertensive experiences?, posted by cybercafe on July 21, 2002, at 2:46:44
> > It's absolutely nothing like a bad headache. It's far worse and regular meds like aspirin, ibuprofen and Aleve don't do much. It begins as a pounding on the side of the head. The pain is so intense I've actually cried. Then eventually the specific point of pain will start to spread out. It spread toward the front/top of my head
>
> I really appreciate the info Jess -- I would have been in big trouble if I had to find out that over-the-counter meds didn't work on my own ! Ouch !
>
>It's NOTHING like a regular headache. Although I strongly believe in the positive benefits of taking Parnate I am currently scared to death of triggering a hypertensive crisis after experiencing two. As Jess said, height,weight and gender do not matter. 30 mg of Parnate is not a "low" dose. Please educated yourself and what happens during a tyramine reaction and learn from other's mistakes. It was one of the most painful and scariest experiences of my life. The first time I was working as a psychotherapist(now retired)in a hospital psychiatric unit, side by side with my psychiatrist and team of nurses/therapists/friends. The second time as I mentioned before, was complete with paramedics, an ambulance ride, and lousy, humiliating hospital care. Each time I used Procardia sublingualy and although can decrease blood pressure - it did nothing to stop the pain (which is like an explosion, gun shot through your head) or ease my fear. Thorazine is used as an antedote as well. Hypertensive crisis may include stroke, intracerebral bleeding, cardiac failure and death. Your age has nothing to do with it! You may need to educate your doctor as most of us have. My former very knowledgeable, very much trusted, loved and respected, "Harvard educated" psychiatrist, friend, and colleague switched me from Nardil to Parnate too quickly. I was the one who warned her against doing so and told her what the literature recommended. She instead instructed me differently and precipitated my first hypertensive crisis! This was both a humbling and learning experience for her as well!
She is now much more cautious and conservative in her recommendations. However, since she is now over 1,000 miles away I unfortunately cannot use her as my physician.
I am disturbed by some of the prior postings which report a somewhat cavalier attitude toward their diet. I suggest you err on the side of caution and go with what research supports.
I wouldn't be on Parnate again however, if I didn't think the benefits were worth it and I am one of those few who cannot take anything else.
Hope this helps.
Good Luck,
Lisa
Posted by cybercafe on July 21, 2002, at 12:55:45
In reply to Re: hypertensive experiences?, posted by LLL on July 21, 2002, at 9:25:58
>hospital care. Each time I used Procardia sublingualy and although can decrease blood pressure - it did nothing to stop the pain (which is like an explosion, gun shot through your head)
... nifedepine doesn't get rid of the pain?
what can you take to get rid of the pain then? ....
oh and if you have the pain with no rise in blood pressure is it worth taking the nifedepine at all?
thanks a lot for the info guys ... i'm going to see my doc tomorrow but i'm still a little confused what to be satisfied with
Posted by jsarirose on July 21, 2002, at 15:07:36
In reply to Re: hypertensive experiences?, posted by cybercafe on July 21, 2002, at 12:55:45
> >hospital care. Each time I used Procardia sublingualy and although can decrease blood pressure - it did nothing to stop the pain (which is like an explosion, gun shot through your head)
>
> ... nifedepine doesn't get rid of the pain?
>
> what can you take to get rid of the pain then? ....
>
> oh and if you have the pain with no rise in blood pressure is it worth taking the nifedepine at all?
>
>
> thanks a lot for the info guys ... i'm going to see my doc tomorrow but i'm still a little confused what to be satisfied withI don't know about nifedepine, but Thorazine seems to help deal with the pain for me. I've taken a pain pill (oxycodone) with and without the Thorazine when I had an attack and the Thorazine definitely helped me feel at least tolerable sooner. It also really wiped me out (but I'd prefer having to sleep for a day or two than deal with the pain a minute longer than necessary). It will also help lower blood pressure if that is part of the problem.
You may want to ask you doctor about that one as well. Especially since it's safe to take whether your blood pressure is elevated or not.
-Jessica
(Pick mine, pick mine! Just kidding')
Posted by Sparkie416 on July 21, 2002, at 16:30:58
In reply to MAOI diet short list, posted by Elizabeth on August 17, 2001, at 13:43:12
> Hi. A couple of people have requested that I repost the dietary restrictions that I followed while taking MAOIs. Please don't take this as gospel; it's what worked for me and it's based on some fairly meticulous library research (I can provide a reading list for anyone who's interested). A lot of the "menus" that get handed out by pharmacies, hostpials, doctors, etc. are not very accurate because they are out of date and place extreme and unnecessary restrictions on what you can eat. This results in a number of problems. Many people are scared off by long, intimidating lists of restrictions. In other cases, a person will discover that s/he can "cheat" on some of the foods (the ones that really shouldn't be on the list) and will therefore take the entire list less seriously. There are some things that you definitely should avoid, but they are relatively few.
>
> So, here it is -- a list of some things that I felt merited avoidance, and others that I felt were safe (and had no problems with, of course):
>
> WINE is fine. Some people may get histamine-related headaches from it and think they are having a hypertensive episode when they are not.
>
> BOTTLED BEERS are usually fine (American and Canadian ones are the best studied).
>
> TAP BEER should be avoided.
>
> Most AGED CHEESES are out. Of note, the mozzarella generally used on most pizzas has been found to be okay. So unless it's some weird exotic pizza with sharp cheeses (feta, cheddar, fontina) it should be okay to eat pizza. (In general, cheeses described as "sharp" are the most dangerous ones.) Ricotta cheese, cottage cheese, cream cheese, and "pasteurized process cheese food" (American cheese -- the cheesiest kind) are okay as well. In regard to the intermediately-aged cheeses, I personally had no problem with jack or brie in moderation. I would be careful if you're going to try this, though, and it's not something I'm willing to say is definitely safe.
>
> OTHER DAIRY PRODUCTS, such as milk, yogurt, and sour cream, are generally safe as long as they are fresh.
>
> SOY FOODS are controversial: one sample of soy sauce was reported to have quite a lot of tyramine in it, but there aren't any documented interactions. My experience has been that a little bit of soy sauce is okay. I would avoid other soy products, such as soy milk and tofu. The Taiwanese dish called "stinky tofu" is probably right out. < g >
>
> Similarly, SAUERKRAUT has been found to contain a large amount of tyramine in some analyses, but there aren't any reactions documented that were associated with sauerkraut.
>
> PROTEIN-CONTAINING FOODS that have passed the expiration date or that may have been stored improperly should be avoided. Fresh milk, meat, etc. are okay. One exception that I make, just because there have been so many problems reported with it, is LIVER; it seems possible that the proteins in liver are especially readily broken down to tyramine (perhaps they include more tyrosine than other proteins do, or perhaps the bacteria that turn tyrosine into tyramine are fond of liver).
>
> Certain AGED MEATS, such as salami, bologna, and some sausages, may be problematic. Err on the side of caution. Some telltale words to look for are "aged," "smoked," "air-dried," and "fermented."
>
> PICKLED HERRING itself isn't a problem, just don't eat the brine (yuck!).
>
> To many people's relief, CHOCOLATE is fine. (If my experience with carb cravings on phenelzine is any indication, it's fine in *huge* amounts!)
>
> Some miscellaneous peculiar foods, such as FAVA BEAN PODS and BANANA PEELS, also cause problems. Shouldn't be a major issue for most people. Watch out for Middle Eastern cuisine, which sometimes contains fava beans. MISO SOUP and other Oriental soup stocks have also been reported to cause problems.
>
> I hope that people find this helpful. As I said, I can provide a list of references if anyone is interested.
>
> -elizabethElizabeth,
Please list the references. I would be interested in reading them
Thanks.
Sparkie
Posted by LLL on July 21, 2002, at 17:37:20
In reply to Re: hypertensive experiences?, posted by cybercafe on July 21, 2002, at 12:55:45
It takes an hour or two or more for the pain to subside. If you're in the ER you're being given I.V. med's at the time.
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