At the conclusion of my visit with my GP yesterday I found myself admitted in the hospital. Because of a tightness in my chest and difficulty breathing he felt it prudent to order a stress test and some blood work/observation.

During the admission process one of the gagillion questions I was asked had to do with thoughts of suicide... well... since I frequently experience suicidal ideation... I answered yes.

Wrong answer... or should I say, right answer but incomplete... Although I emphasized that I had no plan to "off" myself I do have frequent suicidal ideation.

Guess who had a babysitter for the evening... How very annoying that was.
I asked to speak with the psychiatrist on duty to clear the air... and after a half hour interrogation... and arguing about not wanting any of his prescriptions or electro shock therapy.. my baby sitter was relieved of her duties.

The good news in all of this is, I barely had to beg, moan, scream and plead for 100% 02  ;D

Although the o2 was ready and available... they don't have the proper tubes and masks for ch. So... I was able to give a few folks a quick lesson in how to re-rig the junk they gave me to accommodate my ch needs. They even got to see it in action more often than I wanted.

I was released early this evening with a clean bill of health... no heart attack, the cardiologist said it was some sort of angina.

oh yes... one more thing... regardless of how hungry you may be... hospital food sucks.

with warm regards,
Tony

Quote:

regardless of how hungry you may be... hospital food sucks.

OMGs   tell me about it.   Try having a parent with dementia, in a memory care facility, who was herself a chef.  I swear the food quality was all she could talk about most days and for good reason too.  Never mind she couldn't recognize me from a nurse, or one of my sisters, but she knew the food stunk.

Tony....least you are home now....

Love you,

Pegg

Artonio wrote on Feb 11^th, 2009 at 10:34pm:

oh yes... one more thing... regardless of how hungry you may be... hospital food sucks. with warm regards, Tony

Hospitals & Airlines must get their food from the same food smugler. :o

Glad to hear you got a clean bill, look after yourself.

Cheers
Barry

Tony,

Hope you don't mind me asking but did the doc mention anything about looking for the source of the angina?  Stress test?  Cardiac cath, etc.?  Ya got me worried about you, my friend.

As far as patients mentioning thoughts of suicide.....lots of hospitals assign monitors or babysitters when a patient mentions the above.  Legal stuff, for sure.  CYA territory.

Hospital food is nasty.  Whenever I work at the hospital, my co-worker and I head out to the lunch trucks for our munchies.

Stay well.

Hugs,

Cyn

Good going Tony.

You dodged a real bullet with seeing a shrink. I used to work for one as a teenager doing odd jobs for him. Aside from being helpless, he had more than one loose hinge.

Later on, the one I saw a few times, killed himself in his office.

In short; everyone I knew is dead or around the bend.  :o 8-)

Charlie

cynjeep89 wrote on Feb 11^th, 2009 at 11:02pm:

Tony, Hope you don't mind me asking but did the doc mention anything about looking for the source of the angina?  Stress test?  Cardiac cath, etc.?  Ya got me worried about you, my friend. As far as patients mentioning thoughts of suicide.....lots of hospitals assign monitors or babysitters when a patient mentions the above.  Legal stuff, for sure.  CYA territory. Hospital food is nasty.  Whenever I work at the hospital, my co-worker and I head out to the lunch trucks for our munchies. Stay well. Hugs, Cyn

Thanks Cyndi... I had blood work and a stress test while I was there yesterday... first they tried the treadmill thingy.. My heart rate didn't get to where they wanted it... so he did the injection thingy. He said it was a pain in the ass to get a good read because of the pacemaker. I did not have a heart attack... which is way cool.

I did the cardiac cath last  may or june... they only found a 20 % blockage and said it was no biggie..

He seems to think I have some weird sort of angina that makes my arteries spasm? I forget what term he used for it... at any rate he just  upped my dose of norvasc to see if that would make a difference.

Interesting thing about norvasc is that it's a vaso-dialator...  it has an interesting side effect.  8-)

with warm regards,
Tony

Charlie wrote on Feb 12^th, 2009 at 12:25am:

Good going Tony. You dodged a real bullet with seeing a shrink. I used to work for one as a teenager doing odd jobs for him. Aside from being helpless, he had more than one loose hinge. Later on, the one I saw a few times, killed himself in his office. In short; everyone I knew is dead or around the bend.  :o 8-) Charlie

Oh My!  Charlie, Not to make light of the tragedy... but was the suicide in front of you during a session? Was it an attempt at some sort of failed therapeutic approach? I mean geeze... I've gotten a few of my therapists ruffled but I never got one to off them-self.

All kidding aside... I think it's remarkable that the percentage of psychiatrist who commit suicide is as low as it is and the number of dentists who kill them-self is quite high.

with warm regards,
Tony

Hey Tony,

Glad you and the old ticker are doing well.

Take care,

V/R, Batch

Happy to hear you have a clean bill of health sweet brother  :)

As to the question of suicide, from my own experience, the ones who really want to off themselves, will never tell anyone they are suicidal. That question is more to cover the doctor's back than anything else. Pretty useless in my opinion.

Please take good care of yourself.

Love ya lots

HUGS

Tony,

When I called and spoke to you the other day, did you tell me anything about how you were feeling?  Huh?  NO!  You shit!  LOL!

I am going to have to drive up there, and kick your ass?

In the future, if I am actually talking to you, and you are having trouble, you HAD BETTER tell me about it!  I am sure you would not like to have to go to the hospital to remove my size 11 shoe from your ass!

Now, after yelling at you ...

I am SO glad that you came away with a relatively clean bill of health.  You have to take care of yourself!  You may find it hard to believe, but there are some of us, that, for some reason or another, care about you!

Now take it easy, buddy!

Chuck

Glad things checked out OK.  Now, if that head would just settle down.
Hoping some things come through for you soon.

Much love,
Jackie

Good to hear your ok Tony, but sorry what you had to go through.

ClusterChuck wrote on Feb 12^th, 2009 at 6:04am:

I am going to have to drive up there, and kick your ass? In the future, if I am actually talking to you, and you are having trouble, you HAD BETTER tell me about it!  I am sure you would not like to have to go to the hospital to remove my size 11 shoe from your ass!

Just sitting here trying to picture all this.

Now I want to poke my mind's eye out.

Tony:

Nope. The quack didn't check out in front of me but he must have really been losing it. With all his access to drugs and knowledge of how to do it simply and painless, the moron used a gun.

You're right. Shrinks do have a high rate of suicide.

Charlie

Artonio wrote on Feb 12^th, 2009 at 12:34am:

He seems to think I have some weird sort of angina that makes my arteries spasm? I forget what term he used for it... at any rate he just  upped my dose of norvasc to see if that would make a difference.

Would it perchance be coronary artery spasms known as prinzmetal angina?  That's what I was diagnosed with and told in no uncertain terms that all triptans and ergots were off limits to me.  When I argued that I would take my chances with the heart attack as they could revive me from that, and they couldn't revive me from a .45, it was explained to me that any medication causing vasoconstriction will not result in a mere heart attack, but will cause the entire vascular system to go into spasm, causing the heart to spasm, and blood flow to essentially cease;  result is a massive coronary.

If that's what they diagnosed with you, then PLEASE sit and talk with your cardiologist to get all the details of your situation;  if they have told you no triptans and ergots, make sure you listen to them!

Cat

While I am glad you are (relatively) well, Tony, it is no surprise to me that you had to go to the hospital. With all of those bugs circling the Mule's ass, you were bound to catch something. :)

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catlind wrote on Feb 12^th, 2009 at 7:57am:

Artonio wrote on Feb 12th, 2009 at 12:34am: He seems to think I have some weird sort of angina that makes my arteries spasm? I forget what term he used for it... at any rate he just  upped my dose of norvasc to see if that would make a difference. Would it perchance be coronary artery spasms known as prinzmetal angina?  That's what I was diagnosed with and told in no uncertain terms that all triptans and ergots were off limits to me.  When I argued that I would take my chances with the heart attack as they could revive me from that, and they couldn't revive me from a .45, it was explained to me that any medication causing vasoconstriction will not result in a mere heart attack, but will cause the entire vascular system to go into spasm, causing the heart to spasm, and blood flow to essentially cease;  result is a massive coronary. If that's what they diagnosed with you, then PLEASE sit and talk with your cardiologist to get all the details of your situation;  if they have told you no triptans and ergots, make sure you listen to them! Cat

Yeppers.. it's Prinvmetal angina. I spoke with the doc today (via his nurse) concerning imitrex... he said as long as my BP was under control with the increased dose of Norvasc then he didn't see a problem using the imitrex when necessary. If it causes a problem then discontinue use.

He also prescribed Nitro Glycerin... LOL ... I know it's a trigger for ch but death is not an option.

with warm regards,
Tony

Tony, I know that every case is different and you should listen to what your doctor tells you.  You may want to consider talking to him about the nitro though;  When they had me in the hospital for an attack (and while I was using imitrex I was hospitalized 3 times for cardiac problems and none since it was taken away from me) they decided they needed to hook me up to an IV nitro drip.  I tried to explain to them why that was a bad idea, but in the end, I had to listen to them as they are supposed to know what they are doing.  As soon as the nitro hit my system it caused one of the most vicious hits I've ever had.  As a result, my vitals went crazy.  The nurses and doctor all thought I was going to have a coronary right then and there.  They have since put in my medical file that I'm allergic to nitro, as they feel the risk of the onset of a cluster while in coronary artery spasm is just to great.  They use ativan instead, and that has seemed to do the trick the following 2 times I was admitted.  

Keep in mind too, that I have had heart palpitations since I was 16, so what has happened to me may be something altogether different.  I just want you to be as informed as you can be so you can ask your doctors important questions.  Can't have you dropping dead on us :(

Again, you obviously have to rely on your doctors advice, just learn as much as you can and ask them pointed questions.  I was never able to go higher than 7.5 on the norvasc because I'm hypotensive and would pass out at any higher dose, so I'm sure that plays a part in my treatment as well.  Just be informed and be safe.

You'd be amazed at just how crazy your vitals can go when you are in spasm and get an attack brought on by nitro.  My BP skyrocketed - one reading they had was 200+/152 - I can't remember the systolic exactly, just remember it was over 200, and I went into an arrhythmia and atrial fibrillation.

Be safe, be well and take care of yourself.

Cat

Thanks Cat... sheesh... what a nightmare that experience must have been for you... I'll definitely ask about the ativan... does it work as well as Nitro Glycerin?  What exactly is it that Nitro Glycerin does... and how does it trigger a CH?

with warm regards,
Tony

I'm not 100% sure on the nitro, from what I was told it's an agent used to dilate the blood vessels, thus allowing greater blood volumes.  Morphine also works that way, and is one of the reasons it's used in association with cardiac pain.  Both those medications will bring on major attacks for me, and both are now listed as allergies in my file.  

I'm not sure if you have other cardiac problems that stem from something other than the prinzmetal angina, but for my particular case, they use the ativan to relax the body, hence relaxing the spasms.  

I am not sure as to why nitro is almost always a trigger for ch'ers;  While we know the causative factor of CH isn't vasodilation, anything that causes dilation tends to trigger or intensify attacks, and medications that constrict tend to work as abortives.  Of course that isn't true for everyone, one of the many frustrating aspects of trying to isolate a better treatment for CH.  

Because I can't use calcium channel blockers or beta blockers in doses that are even adequate for cardiac issues, let alone clusters, the primary focus when I am in spasm is to relax the arteries.  The ativan (given IV) has worked well for me;  

Like I said though, each case is very different, and you have to listen to your doctors.  It can't hurt to talk to them about the possibly dangerous effects of nitro should you be in cardiac distress and end up bringing on a cluster at the same time.

Supposedly, prinzmetal is fairly rare.  They diagnosed mine after I failed my stress tests and they did a cardiac cath;  With other heart issues going on, you may have a completely different treatment plan, and using nitro may not be a choice :-/  Just wanted you to be sure to ask so that you don't endanger yourself with an attack sending you into further distress.

Cat

p.s. it was during that attack that they got in a fight with Clark when he was screaming at them to put me on a non rebreather mask with high flow oxygen as well - they kept arguing with him saying that I was 98% O2 sat and didn't need higher flow - they didn't understand that high flow O2 with a non rebreather was my best shot at aborting the cluster.

catlind wrote on Feb 13^th, 2009 at 9:20pm:

............................. .................................... While we know the causative factor of CH isn't vasodilation, anything that causes dilation tends to trigger or intensify attacks, and medications that constrict tend to work as abortives.  Of course that isn't true for everyone, one of the many frustrating aspects of trying to isolate a better treatment for CH.

Geeez, I love hearing someone say that besides me! +

(Sorry to hijack your thread, Tony)

Marc

Cat, and Marc, I have to disagree and agree with you two.  LOL!

From what I understand, the trigger for clusters is unknown, but the trigger DOES cause vassal dilation, which then causes extreme pain, in those that HAVE clusters.  In other words, if you don't have clusters, the vassal dilation will not cause the pain we experience.  BUT, if you already have clusters, when you take a major vassal dilator, like Nitro, you DO experience the pain.

So I agree that vassal dilation is not the cause of clusters, but if you have clusters, vassal dilation DOES cause major attacks.

Or, at least THAT is the way it was explained to me.

Whenever I had one of my heart attacks, they gave me morphine to cut the pain, and ease the stress and damage to my heart.  It never was a trigger, like it is for Cat, but at least it helped my heart.  Nitro (from personal experience) is a major trigger for me.

BUT, as Cat says, YMMV.

Do I make sense?

Chuck

ClusterChuck wrote on Feb 13^th, 2009 at 10:27pm:

Cat, and Marc, I have to disagree and agree with you two.  LOL! From what I understand, the trigger for clusters is unknown, but the trigger DOES cause vassal dilation, which then causes extreme pain, in those that HAVE clusters.  In other words, if you don't have clusters, the vassal dilation will not cause the pain we experience.  BUT, if you already have clusters, when you take a major vassal dilator, like Nitro, you DO experience the pain. So I agree that vassal dilation is not the cause of clusters, but if you have clusters, vassal dilation DOES cause major attacks. Do I make sense? Chuck

Umm no? LOL  

The *triggers* for clusters are the one variant that has yet to be correlated to all patients.  The cause of clusters remains unknown in any decisive way, although it's suspected that it's the suprachiasmatic nucleus in the hypothalamus, which then triggers the huge cascade of effects resulting in the trigeminal nerve becoming inflamed and thus causing the pain.  

Unfortunately, there is that subset of sufferers that do not suffer attacks with vasodilation, thus further complicating the mystery.  That is the main roadblock that is run into whenever trying to isolate treatments for the majority of sufferers.  To date, there is no single factor, with regards to things like vasodilation, oxygen levels, head trauma etc. etc., that can be linked to all sufferers.  With the introduction of CH as a secondary headache disorder and not just a primary headache disorder, it has opened a whole new can of worms in trying to associate the symptoms that are triggered by the cause.

Not sure if I am reading what you said correctly, but I think you are trying to say that vasodilation is not the cause of the attack, but it is present in everyone that does have CH and is the reason that nitro triggers an attack.  This is true for the vast majority of sufferers, but unfortunately isn't true for all sufferers.  One of the biggest hurdles in trying to correlate the nitro equation is the fact that it causes mild to severe headaches in the general population, and they can't isolate whether it's the nitro headache that triggers an attack (or rather the mechanisms of the nitro headache) or the nitro itself, and if it is the nitro itself, what the biochemical effect on the SCN is, as vasodilation would have to trigger an attack every time, not just from nitro, if it was the dilation itself that was the triggering factor.

Now it's my turn to get laughed at...does that make sense? LOL

Cat

Good on ya Tony, tight lines.

         Potter