Liosinopril Loose Ends

Pursuant to this post and this post regarding my blood pressure, let's make some knots out some loose ends, shall we?

1. Liosinopril dose. I am not necessarily 'cowgirling' the dose. I have been instructed to halve or discontinue the dose if I have hypotension. So me dithering about 5mg vs. 10mg is something I am 'allowed' to do.

Once I get the official tilt table results, which I assume will be 'normal', then I'll go back to the PCP and point out:

1.Blood pressure medication doesn't work
2. I swing high and low along with feeling like I'm going to pass out-- it is just a matter of time before I really do pass out, I'm right on the edge when it hits.

Maybe I need a different medication?

A body transplant?

2.Pheo

Everything I'm reading suggests that pheo be ruled out as there is an obscure chance of it being pheo. It comes up again and again in the differential diagnosis. It's like it's stalking me.

I don't think my blood pressure is going high enough for pheo, I get that. The cycling though can be pheo, it doesn't have to be consistently high.

Again, I don't think I have a pheochromocytoma but I do think it should be ruled out. Does that make sense?

Also, I AM growing small little tumors in multiple places. It is not outside the realm of possibility that I've managed to grow one in a spot where it can wreak havoc.

And I keep going higher despite blood pressure medication. Perhaps it is as simple as trying a different medication. I don't know.

I am just suspicious of my body, it's guilty until proven innocent.

3.Regarding how multiple blood pressure readings skew results. I am scratching my head. They do whatever the hell they want to at the hospital and it's okay, but when I check BP at home, I have to be sitting, I can't have eaten, my bladder has to be empty. God forbid I cross my legs.

But at the doctor's office? I can be talking, laughing, standing, sitting and have my BP taken so often and so tightly here I am a week later with broken blood vessels under my skin and that? Is okay???

Makes no sense to me.

A List & Day One

1. The hydrocortisone dose is 20mg.

2.I am no longer taking Singulair. There never seemed to be a good time to mention that, it never fit the narrative I had going at the time. It's now back to being an 'as needed' medication.

Only took 9 months!

3.Slowly realizing I have more problems with muscle cramps/pain than I have allowed myself to feel. To where I almost denied having them to then endo. Almost.

There are things I just ignore. I have almost daily neck pain. My gut is still painful from the cranberry acid. These are not things I dwell on, except maybe here on the blog. I am used to ignoring muscle spasms/cramps unless they are really bad because I've had them for years.

Luckily the toddler used me as a jungle gym the other day and the pressure of her hands on my legs was enough to make me yelp. I actually didn't realize I was in so much pain, it was kind of latent. Because of the toddler, I fessed up to the endo.

It doesn't help that I always like to blame the muscle stuff on steroid withdrawal. As in, now that I've gone back to 5mg, I feel good, but my muscles are all up in arms and very pissed off about it.

4.I am now taking Liosinopril daily. I don't get it and am confused. When did I switch from having high blood pressure that didn't respond to medication, to not needing medication at all, to suddenly using one medication for high blood pressure that seems to be working?????

Or has my body now decided to do it by the book and ramp up the BP with the prednisone?????

And how will the hydrocortisone affect that? It has more mineralcorticoid activity than prednisone meaning, from what I understand, it will influence blood pressure quite a bit more, but I don't know which way things will swing.

5.Bumping up to 10mg on Friday was fantastic. It worked really well and seems to have help flip the switch so that 5mg now is feeling pretty good. I think I underdosed whatever that episode was prior to Thanksgiving which is why I was dragging for so long. A one time booster dose worked wonders.

So today is day 1 of Hydrocortisone (HC), I hope it goes well. We also have a blizzard warning and I will be so bummed if pre-school closes. Parent-teacher conferences are today and I have been waiting since August to hear what's really been going on at p-school all these months.

I would call off my tutoring tonight, between the storm and the HC, but the last time I tried to call the family, I couldn't get through to anyone.

Under Pressure

So the relative RN says to me "90 over 60 is normal for me. I am fine."

Yeah. I know.

Some people have naturally low blood pressure. I used to be one of them until this year.

I was 115/70 something for the longest time (Spring through July) and felt fine. Then my blood pressure started creeping up again despite continual weight loss and an exercise regimen that got my resting heart rate down to 60.

I cut salt. Did nothing, although if I eat salt it will increase my BP, but cutting it out didn't appreciably lower it. Yes, salt has a one way effect on me for some reason.

I cut caffeine, had a little slip and then cut it again. Did nothing.

My BP went higher still until I was in 140/90 territory.

So I started Liosinopril (sp?), per a pre-existing agreement with the PCP, which did nothing, just like the last time I was on it. Well, it does make me pee. A lot. Urgently.

I hadn't gotten around to adding the ACE inhibitor (which also does nothing) when the adrenals started crashing again.

While some people may feel great at 90/60, I would challenge them to stay upright as they dropped from 140/90 to 90/60 or even 80/50. Those drops threaten to bring me to my knees when they hit.

I don't know what is going on with my blood pressure. I really think there's something hormonal at play, but so far I can't seem to get anyone with a prescription pad to listen to me.

That's MISS Bitch to You & Other Notes from the Edge

Ahem.

So.

*embarrassed*

You want to know what happens to me sometimes?

I turn into a serial killer.

At least it feels like I do.

Then I eat some sugar and begin to feel better.

I had some apologizing to do tonight to the hubby and requested that, any time I behave that horrid toward him in the future, to please offer me some sugar.

Gives new meaning to the old saying 'you catch more flies with honey.'

In other news, I'm still having 'problems'. I am just so over this. If you look at the side bar you can see where I added a section for incoming lab work. This way I won't inundate you with even more posts when lab results come back (I AM posting a lot, but I usually am a prolific blogger. Also, there's a lot going on. When there is not so much going on, I will not post so much. Promise.).

My blood related cells dropped lower than they were a month ago, so I'm quite keen to find the main water valve and solder that thing shut. It would be nice to avoid anemia proper.

You know, I think part of my funk was frustration with my blood work being 'normal'. The hormones are all normal. You would never know I had to do IVF to get pregnant. So frustrating when there's clearly a problem and nothing shows up.

Although, this one time, I had a negative test, but they did the surgery anyways and it was much worse than they ever imagined (the surgeon's words, not mine). I'll have to tell that story sometime.

On the upside, my peak flow meter is not whoring around behind my back. I have no STDs. I'm not knocked up either

(Parenthetical Aside: It is always so funny when medical personnel try to argue with me about being pregnant.

-I'm infertile.

-But you could be pregnant.

-I was really infertile. Like hardcore. Dead people have a better shot at procreating.

-But you could be pregnant.

-Well, if God intervened maybe.

-Okay, so we'll check to be sure.

-Yeah, umm whatever you want to do.

Doing the test is fine, but don't argue with me about it. I am infertile. Pregnancy would be like winning the super lotto, scoring with Johnny Depp and being declared a Saint on the same damn day. Could it happen? Sure. Is it likely? No.)

Anyhoo...the next step is an ultrasound. A prescription of some kind to stop the bleeding. And probably a mammogram.

Oh and another thing. I'm beginning to wonder if I ever had high blood pressure. I think things have progressed to where I'm so wound up just by going to the doctor, that my fight or flight response kicks into gear. I don't know for sure yet. I'm still on prednisone, but the only place I have really high HIGH blood pressure? The doctor's office.

Also, tying me to a blood pressure machine just as the toddler runs off to God knows where and you* do NOTHING to protect my kid is NOT the way to get an accurate blood pressure reading. You trip the momma bear switch and you'll be lucky to have any blood left by the time I am finished with you never mind getting a decent BP reading on me.

Oops. There I go again. Maybe I need to find some more sugar.


*Yes, I know it's not the nurse's or aide's job to watch my kid, but if I'm literally attached to a machine, would you please make sure my child isn't about to kill herself/visit people in the bathroom? The same way any one of us would try to help a baby heading for the street? Thank you.

Asthma ER Tales Part III: What We All Missed & In Which I Overdose on Pickles

Part I is here and Part II is here.

Last year, my blood pressure went high. I thought it was doctor induced anxiety because I had won the asshole doctor lottery and was dealing with a real piece of work in a new-to-me HMO system. An allergist who declared I did not have asthma and wanted to discontinue all my meds tout de suite.

In fact, it was the same allergist that had replaced my first pulmonologist and sent me running for 7 years. In the time since I had last seen her, she had progressed from being a bit nutty to full bore passive aggressive sociopath. (I later learned she'd gotten a divorce and it seemed to have sent her over the edge. Not that that's an excuse.) Whereas, she had been professional before, now she was just psycho, raging on a power trip.

And I was fresh meat. She went out of her way to dominate and disempower me. It was pathological. I half expected her to hump my leg and pee on my shoes. It was bizarre, especially coming from a woman. Male doctors (and men just in general) are more likely to be leg humpers in my experience.

I had to file complaints. I had to involve my employer's benefits department. I spent 6 months arguing with this asshole and the HMO network (of which my current pulmonologist was not a part). It was incredibly stressful. I ended up cobbling together my own asthma regimen from left over medications. Skipping doses. Splitting doses. Winging it on a prayer. Looking at overseas pharmacies. Trying to decide if I should just pay out of pocket to go back to my regular doc. Wondering where the money for that would come from and fuming about the thousands and thousands we paid for a completely useless HMO plan.

By the time the HMO agreed that a) they had botched the methacholine challenge that supported the asshole allergist's tenuous (at best) position that I did not have asthma (she had all my medical records showing otherwise) and offered to redo it and b) assigned me to another doctor, I was unwilling to subject myself to their version of medical care. I was beyond disgusted and could not face that HMO without frothing at the mouth. It was August, I had 3 months to go until we switched our insurance and I could go back to my regular pulmonologist.

So I waited it out and figured/hoped that perhaps the blood pressure was high because the asshole factor was high too.

Not so.

I had hypertension and I had to face it this year now that my insurance had changed allowing me to escape the asshole allergist. So I started two blood pressure medications about 8 weeks ago.

My gut feeling was the hypertension was hormonal in origin. Nobody agreed with me. (That is pretty common). However, I did get an endocrinologist to order to some testing (unfortunately, he was an ass and I refuse to go back to him so I didn't do the test and now I've been on prednisone for a month and can't do the test anyway).

So when this latest asthma episode started, what I didn't realize was my blood pressure tanked once I started taking prednisone. It dropped like a boulder in free fall. I had ordered a home bp unit, but it hadn't arrived yet so I had no idea what was going on. I thought I was dizzy and almost passing out from the asthma. I thought I had chest pain from the asthma.

I didn't. It was low blood pressure.

The ER didn't see this because I was so stressed, my BP was moderately elevated when they saw me. The albuterol helped mask it as well.

What clued me in was staying up all night sucking nebulizer in the hospital and just staring at the monitors (I didn't have the attention span to watch television). When I saw my diastolic go down to 65 and stay there, my gut clenched.

"Uh-oh. Too low," I thought to myself.

When I got out of the hospital,I called my primary care doc. I knew that 116/65 was not hugely low but I also knew it was low for me. It wasn't urgent so the doctor's office didn't get back to me until Saturday.

Friday my BP monitor came and I started checking my blood pressure. I had intense chest pain that was much worse with the nebulizer. To the point where I was delaying the nebulizer as long as I could. I was pretty sure I wasn't having a heart attack as I'd had the full heart work up at the hospital, but I couldn't figure out what was going.

Thank God for that BP unit.

What were my BP numbers?

90/50.

87/57.

Too low.

I started eating olives by the handful. Pickles. Drinking olive and pickle brine--just trying to get salt in my system to get my BP up. I got up to 100/60 but still felt really woozy. I googled my BP meds and the damage low blood pressure could do. I panicked a bit as I realized I would have to go back to the ER if things didn't turn around. To cope, I drank more brine. A lot more brine. Buckets of brine. I'm pretty sure I pickled myself that night.

The doc covering for my doc called me on Saturday. I shared my BP readings with them. They told me to reduce my BP meds, that eating salt had been the right move, but if my BP stayed that low to go the ER asap.

To which, after I hung up, I thought, "Fuck that." The last thing I needed was to go back to the ER. I needed rest not ER trauma-drama. Besides, I had heartburn from all the brine. I couldn't stomach any more. I discontinued all the BP meds and decided I would rather be high than low for a while. I had an appointment with my PCP on Monday--just a day and a half away, the risk was acceptable to me.

Miraculously, I turned the corner at this point. I suddenly had energy. I no longer felt like I was going to pass out all the time. The chest pain stopped. I was now just dealing with asthma alone and nothing else, which was soooooooo much easier.

And I did not have to go back to the ER, which was the best news of all. Go pickles!

Postscript 1: So when I switched insurance to get away from the asshole allergist and got back in with my beloved pulmonologist, I told her about the whole experience. The asshole allergist and my pulmonologist had been co-workers. She told me that they also experienced the asshole allergist as passive aggressive. Just so you know I'm not totally off base.

I would say this asshole doctor has been independently verified by a third party. And if I ever see that bitch again... well she's lucky I can't run and breathe at the same time so she'll probably get away just fine. You have no idea what she put me through. She is the only doctor I've ever run across, ever, that I would be willing to sue, that I wouldn't let touch me for fear she would kill me. And that's saying something because I've had some pretty strange doctors. I will have to tell you about the proselytizing Jesus freak doctor next just to prove the point.

Postscript 2: I checked my blood pressure while writing this post. First high spike I've seen in 2 weeks. Last year was absolute hell.