S G BLOG POST: Anatomy of A Bad Day - ER and Nortriptyline

    
    Like a sink that eventually rebels from too much hair, toothpaste and makeup, sometimes triggers just back-up on you.  You can be feeling pretty good for awhile (I have been off all serious medication for 10 months) and so of course you start venturing out from your semi dark and motionless cocoon and innocently begin stimulating those nerves in your sensitive head.  I have been on the Migraine Diet, hydrating well and sleeping about 7.5 hours a night.  I try to reduce my daily eye motion and protect myself from glare when I can.

     But this week I fell off the wagon.  Let me begin by saying that summers have historically been bad for me.  The only times  that I end up in the ER is during the hot summer months ( July  '08, July '14 and this time in late September '15 - we are having a record setting long and hot summer in Southern California).

     This past week I did some early morning pruning for three days (about 1.5 hours each day), I went to a movie and then out to eat with friends (ate a simple grilled chicken sandwich without the bun).  The restaurant was noisy.  I was getting ready at home for my son and his girlfriend to visit.  So, lots and lots of eye motion and light and noise and increased activity.  My eyes were sore and felt strained.  I noticed my hot flashes were back.  Then I had a thin slice of Trader Joe's Rosemary (no nitrate) ham and some mozzarella cheese and some chocolate.  By Wednesday my vertigo was back and worse when I tried to close my  eyes -  so I could not rest.  Nystagmus  was going strong to the left.  Objects on a table appeared to be moving to the left.  My balance was off and my right ear felt quite full.  Taking Advil did not help.  I was nauseous - and worse.

     Since I could not solve this problem myself,  I went to the local PromptCare where they gave me a shot of Zofran for nausea which did not help.  After 1.5 hours and no improvement I went to the ER at a local hospital, vomiting all the way.  They gave me an IV for fluids, more Zofran and 50 mgs of Meclizine.  Finally I was given 2.5 mgs of Valium and that did the trick.  I went home at 11:00 pm.

     Thursday I awoke with a headache, I slept a lot and called my doctor to ask if I should go back on Nortriptyline for a while.  Friday I took 2.5 mgs of Valium because I was having symptoms again.  I confirmed that Valium gives me a headache.  (I am one of the migraineurs who does not get  headaches, just severe Vertigo and the other symptoms).  I still have not heard from my doctor.

     Saturday I skipped the Valium and just took Advil.  That night I started 25 mgs of Nortriptyline and so far today, Sunday, I feel much better.  My balance is just a little off. I am fairly sure my doctor, when he calls, will recommend I go back on it for at least 10 weeks.  It works faster when you are already on the diet and avoiding triggers.  Although it is difficult to reduce unavoidable triggers like head and eye movements, I do promise to never again eat  rosemary no nitrate ham or prune in the heat or try to walk 5 days a week (45 minutes each).  And it may be that in the heat and glare of summer, triggers are more cumulative and unavoidable.  I am convinced that following the diet and trigger reduction does lesson the amount of really bad episodes that I will have and helps me get back on track faster.  I am happy that I know  Nortriptyline helps me, for now.  History shows that I need to go back on medication every 10 -14 months.  So be it.  Perhaps these summer hot flashes are the straw that breaks the camel's back for me.   They can't go on forever, can they?  And my doctor has to call me back, right?

S G Post:  Follow-up as of 11/23/15 ( 7 1/2 weeks)

     I am sleeping 8 1/2 to 9 hours a night.  I am 2 1/2 to 3 pounds over my usual weight.  My personal plumbing is a disaster and I am downing steamed broccoli, popping magnesium tablets morning and night and eating a pumpernickel 1/4 inch tall "bread" (Mestemacher) that claims to have 6 grams of fiber per slice and no off limits ingredients. My heart rate is up 20 points.  But my vertigo is no where in sight.  Let me back up.  On September 30, 2015, I ended up in the ER with a full-blown vertigo attack including all the awful associated symptoms.  Three days later, after 10 months of no medication and adhering to the headache diet and reducing triggers (most of the time), I went back on Nortriptyline and resumed strict adherence to diet.  But, of course, there are always unavoidable triggers. I took 25 mgs. for 3 weeks, then 50 mgs. for 4 weeks and now I am on 25 mgs (for 3 or 4 weeks) and then down to ten if all goes well.
     This medication (for me at 50 mgs.) comes with the side effects listed above, which I hate, but it does stop the vertigo for me.  I guess I can look forward to needing it every 10 to 14 months.  This has been my history so far.  The side effects are annoying and uncomfortable, but vertigo is intolerable.  By the way, if nothing else helps with the plumbing problem, eat 1 c of steamed broccoli at home and then get in your car and go straight to McDonalds for a dollar sundae (with caramel).  That will definitely do it.

S  G Post:  Follow-up as of 1/26/16  ( 5 weeks off medication)
     I have been off the Nortriptyline for 5 weeks and doing very well.  I have had no vertigo or other symptoms.  I cannot have brewed decaf except once in a while.  Maybe twice per month.  I only drink instant decaf, listed in "What To Eat".  The weather is cool and that is always a good time for me.  I can walk (50 minutes) 6 days a week and it does not seem to be a trigger.  I have stopped my Systane Eye Drops - it is probably just coincidental but I feel that it may aggravate my situation.  There is no science behind that, however.  I am trying to be more careful about triggers so no alcohol or MSG or brewed decaf or coffee or obvious chemicals.  A few raisins or chocolate chips or a little yogurt do not seem to cause problems.  I limit eggs to one per week and I have 1/2 an orange once per week.  No avocado or banana.  My eyes still get sore.  We'll see!!!



     

  (Click Here - This post is a follow-up to the past  post     "A Success Story?" Hmmm