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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by Anonne on July 29, 2003, at 3:22:12
Hello.
I have suffered 3 hypertensive crises during a 15 year (more or less) time of taking Nardil (phenelzine sulfate). The first two times in two separate ERs, I was basically 'dismissed', and given an anxiolytic which did eventually help reduce the severe shotgun headache.
However, the 3rd time, I was lucky enough to go to an ER (all 3 in the US) that knew to give me a head CT - which led to finding that I had had a cerebral hemorrhage. An MRI with and without contrast was given to confirm, and a followup 3 weeks later. The hemorrhage had then resolved, so calcification was ruled out. I am no longer taking Nardil due to that complication.
OK. So this is the deal: I got the hospital records of the time I had my 2nd ER visit (I couldn't recall the first ER, and it had been over 10 years). The ER records clearly state "Anxiety Reaction/Panic Attack", and no head CT was given.
What I want to do now is find some literature on the management of hypertensive crises, esp. mentioning that a "slight" elevation of blood pressure CAN be serious; it's not just the numbers. (For example, my 'normal' bp on Nardil was around 100/70 or not much higher; my ER bp was recorded as 155/95, quite a difference, but not deemed to be such by the 2nd ER).
I am simply wanting to EDUCATE (not litigate, tho' I am thinking of filing a complaint w/ the Physician Quality Assurance, AMA, and whatever else is relevant) the 2nd ER and attending physician, who happens to still be on staff.
Further, I think this medical literature would be helpful to all who are on MAO-Is, in case they have to deal with health care professionals in an emergency situation. (Believe me, most are not trained in food/drug interactions, at least when it comes to MAO-Is)
I had found this literature before on the web, but I simply cannot locate it. I'm searching Medline, Medscape, google, this site, emedicine... and fail to find it.
Any experiences with hypertensive crises, head scans, doctors, good succinct educational literature?
Thanks in advance.
Posted by avid abulia on July 30, 2003, at 14:56:23
In reply to Info on proper managmnt. of hypertensive crisis, posted by Anonne on July 29, 2003, at 3:22:12
I don't have the resources readily at hand... maybe if I have time later I will go find it... but I saw on two different websites regarding use of Nardil for migraine that patients should always be given Procardia to have on hand in case of hypertensive crisis.
That's very odd that you weren't given a head CT at your hospital... I used to work as an EMT/clerk in an emergency department *way* back in the boondocks, a place where they never even *heard* of triptan drugs *or* phenothiazines to treat migraines, which i found out when I had my first one, but it was SOP to give *any one* with a headache a head CT scan, with or without significantly elevated bp, esp. if there was concurrent MAO-I use... that is very bizarre that my boonie hospital knew to do that, I would think that every hospital would do that, it is just common sense...
~AA
Posted by Anonne on July 30, 2003, at 17:54:04
In reply to Re: Info on proper managmnt. of hypertensive crisis, posted by avid abulia on July 30, 2003, at 14:56:23
Hi AA, thanks for responding.
Yes, I thought I was so knowledgeable about meds at the time, but somehow the "potential of cerebrovascular accidents" never crossed my mind - I was focusing on stroke/coma or death. And even tho' stroke involves the brain, I guess I just didn't think it through. Duh! But the ER personnel - they shouldn't have been that daft.
So I'm putting together a packet of info to mail to the ER and to the Physician Quality Assurance board of my state.
I found this on phenelzine off a Canadian monograph, here: http://www.mentalhealth.com/drug/p30-n01.html
I even brought in a pamphlet by the makers of Nardil to the ER, and altho' it doesn't address HOW to treat a hypertensive crisis, it certainly includes it in the WARNINGS. Now I need to find that paper and add it to the pile.
If you do find the information that you talked about, can you send the link?
Thanks a lot, Anonne
> I don't have the resources readily at hand... maybe if I have time later I will go find it... but I saw on two different websites regarding use of Nardil for migraine that patients should always be given Procardia to have on hand in case of hypertensive crisis.
>
> That's very odd that you weren't given a head CT at your hospital... I used to work as an EMT/clerk in an emergency department *way* back in the boondocks, a place where they never even *heard* of triptan drugs *or* phenothiazines to treat migraines, which i found out when I had my first one, but it was SOP to give *any one* with a headache a head CT scan, with or without significantly elevated bp, esp. if there was concurrent MAO-I use... that is very bizarre that my boonie hospital knew to do that, I would think that every hospital would do that, it is just common sense...
>
> ~AA
This is the end of the thread.
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