Author Topic: Trip to the ER (long post)  (Read 1588 times)

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Offline daniel1948

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Re: Trip to the ER (long post)
« Reply #15 on: December 28, 2016, 06:57:15 PM »
My roommate knee is hurting really bad but has no medical (not working)
Barely able to walk. I have been trying to tell him that he should go to the ER anyway.

I'm sorry to hear about that. At the ER they will treat him regardless of his ability to pay, but I believe they will send him a bill and pester him for payment. And if you don't have insurance, the rate they bill is significantly higher than the rate they bill insured people. Sometimes as much as double. It's a crappy system all around.

I got a follow-up call (to let me know the monitor is working and transmitting) (it calls and does a data dump about every half hour or so) and I found out they want me to wear this thing for a month. It's a nuisance, and the electrodes itch, but it will be worth it because I'll find out definitively if there's any a-fib or other irregularities of concern, in my occasional bouts of tachycardia.
Daniel
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Offline Mr. Beagle

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Re: Trip to the ER (long post)
« Reply #16 on: December 28, 2016, 07:38:16 PM »
My roommate knee is hurting really bad but has no medical (not working)
Barely able to walk. I have been trying to tell him that he should go to the ER anyway.
Check to see if there is a "federally qualified community health center" (google FQCHC) in your area. They are non-profit and must offer a discount payment schedule based on income to get their grants. Ask up front to qualify for they fee reduction. They can usually work it out.
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Offline Desert Fox

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Re: Trip to the ER (long post)
« Reply #17 on: December 28, 2016, 11:03:22 PM »
My roommate knee is hurting really bad but has no medical (not working)
Barely able to walk. I have been trying to tell him that he should go to the ER anyway.
Check to see if there is a "federally qualified community health center" (google FQCHC) in your area. They are non-profit and must offer a discount payment schedule based on income to get their grants. Ask up front to qualify for they fee reduction. They can usually work it out.

Thanks, I will let him know tomorrow. There is one in Matthews County.
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Offline brilligtove

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Re: Trip to the ER (long post)
« Reply #18 on: December 28, 2016, 11:22:17 PM »
Daniel thanks for sharing this - a frightening and disturbing experience. Once a year or so I get migraines that are almost indistinguishable from strokes. I've had them often enough that I don't panic - but now I'm old enough that I have to start wondering if it's a migraine or a clot. The uncertainty might be the most unsettling part.

I hope the tests are helpful and reassuring.
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Offline daniel1948

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Re: Trip to the ER (long post)
« Reply #19 on: January 05, 2017, 09:34:35 PM »
I don't know if this is related to my (possible) TIA, but since it's all happening now, I'm posting here as possibly connected.

Over the past week or so I've been having dizzy or lightheaded spells. The first one struck just as I was getting out of the shower after exercising, so maybe ten minutes after, give or take. It was pretty severe for a few minutes, and then diminished. Of course my first thought was "Oh, shit! Is this another TIA? Do I need to call 911 and go to the ER again?" But I didn't have the mental confusion. But I wondered if maybe it was just that on a second event, having experienced it once, it wouldn't be as confusing. I didn't have any of the symptoms of stroke: drooping, weakness on one side, etc. Nothing but the dizziness, which subsided into a feeling of lightheadedness. So I didn't make the call. It subsided after a while. But then a few days later it happened again. It subsided again, but during the course of the day it would hit, just a slight bit of lightheadedness.

I talked to my friend the cardiac rehab nurse, who thought it sounded like hypotension. She recommended staying hydrated, eating something when I felt lightheaded, and moderating my cardio workouts by interpolating some very brief rest periods and not pushing my heart rate all the way up to the top of my cardio zone. She thought I was right not to rush to the ER, but suggested that if it kept happening, I should call my doctor's nurse and see if they wanted me to come in.

Those episodes were after exercise.

This morning I felt a bit lightheaded when I got out of bed, and still felt the same 2 1/2 hours later when my clinic opened, so I phoned and talked to a nurse. Based on the negative results of all the tests they did after the TIA, she thought it did not warrant a trip to the ER, but suggested I see my doctor, and she got me an appointment for this afternoon.

After that I ate a light breakfast (one egg over easy with half a slice of bread and a cup of artificially-sweetened hot chocolate made with skim Lactaid milk) and felt noticeably better, though not 100%. Then I did an easy cardio workout, after which I still felt pretty good.

I did some looking on line and saw that I could get a blood-pressure monitor at the drug store for a reasonable price, so I went out and bought an Omron 7 Series 652N, which Consumer Reports says is very accurate. Back home I took my blood pressure and looked up the blood pressure table on line, and it said I am not hypotensive, but am pre-hypertensive. I took a bunch of readings, all similar. I was glad I had the appointment with my doctor.

At the doctor's office the nurse took my blood pressure lying down, sitting up, and standing, and then once more sitting down, but with a different sphygmomanometer. (Both were the pump-and-gauge type, not the automatic ones.) Then I took it with mine to compare. Mine is way off and reads way too high. I am not hypertensive. A preliminary diagnosis is that I have positional hypotension: When I stand up, my blood pressure goes down instead of going up as it should. Otherwise, my blood pressure is borderline, but not high. (My doctor said that the category of "pre-hypertensive" on the chart does not apply, and I am okay in that region.)

He recommended staying well hydrated, and switching from my normal one big meal at noon and small meal in the afternoon, to eating several smaller meals. I'm still wearing the Holter monitor, so we'll have those readings as additional data. No medication other than what I'm already taking for my thyroid and my cholesterol.

And he wants me to call him if it gets worse, and to call him to check in early next week regardless.

If I keep having these episodes in spite of the change in my eating pattern and staying hydrated, he may order a treadmill stress test, which I kind of think I'm due for anyway. He thinks we can get that all done before my trip to Maui at the end of February. Having to eat every few hours would be a nuisance, but I can live with it if that's what I have to do as I enter my decrepitude. (I'll be 70 in a year and a half!)

I'm going to return the blood-pressure monitor tomorrow and try a different kind. This one goes on the wrist, which I thought would be okay because sometimes in doctor's offices they use those. But I'll get the kind that goes on the arm instead.
Daniel
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Offline brilligtove

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Re: Trip to the ER (long post)
« Reply #20 on: January 05, 2017, 09:54:22 PM »
It sounds like you're starting to narrow the possible causes quite significantly, and that they are likely not in the worst-case-scenario range of problems. Best of luck, man.
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Offline daniel1948

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Re: Trip to the ER (long post)
« Reply #21 on: January 06, 2017, 10:48:28 AM »
It sounds like you're starting to narrow the possible causes quite significantly, and that they are likely not in the worst-case-scenario range of problems. Best of luck, man.

Thank you. Each time there's an event of any kind, it's scary as hell. Then it passes and I feel that my reaction was a tempest in a teapot. As a heart hypochondriac, I have an event that I'm certain is a heart attack perhaps once a month, perhaps every other month. These recent events (the possible TIA and the spells of dizziness) have given me a new thing to be hypochondriac about, and for their newness they are more scary. Well, they're as scary as the "heart attacks" used to be.

I decided the hell with automatic blood-pressure monitors after reading the user reviews, nearly all very negative, on the Consumer Reports web site, of CR's highest-rated monitor. I'm going to get an old-fashioned aneroid monitor instead. The local places I checked on line didn't have them in stock, so I ordered from Amazon. It's scheduled to come tomorrow. I already have the stethoscope, which I got for listening to my arrhythmia.

Then the next time I'm at the doctor's, I'll ask the nurse to take my blood pressure with theirs and with mine, to check its accuracy, then I'll take it with mine, to check my competence.
Daniel
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Re: Trip to the ER (long post)
« Reply #22 on: January 06, 2017, 12:23:30 PM »

I decided the hell with automatic blood-pressure monitors after reading the user reviews, nearly all very negative, on the Consumer Reports web site, of CR's highest-rated monitor.

Huh, I have a cheap one and it seems to work fine - what's the problem?  Do they lose accuracy at the high end of the scale?
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Offline daniel1948

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Re: Trip to the ER (long post)
« Reply #23 on: January 06, 2017, 06:12:18 PM »

I decided the hell with automatic blood-pressure monitors after reading the user reviews, nearly all very negative, on the Consumer Reports web site, of CR's highest-rated monitor.

Huh, I have a cheap one and it seems to work fine - what's the problem?  Do they lose accuracy at the high end of the scale?

I have no idea, but the one I got was way off, compared to the reading the nurse got. I don't know why. And it wasn't high end of the scale. My actual blood pressure was on the high end of acceptable, and it said I was Stage 1 hypertensive. That's not high end of the scale. High end would be much higher.
Daniel
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Re: Trip to the ER (long post)
« Reply #24 on: January 06, 2017, 06:29:17 PM »

I decided the hell with automatic blood-pressure monitors after reading the user reviews, nearly all very negative, on the Consumer Reports web site, of CR's highest-rated monitor.

Huh, I have a cheap one and it seems to work fine - what's the problem?  Do they lose accuracy at the high end of the scale?

I have no idea, but the one I got was way off, compared to the reading the nurse got. I don't know why. And it wasn't high end of the scale. My actual blood pressure was on the high end of acceptable, and it said I was Stage 1 hypertensive. That's not high end of the scale. High end would be much higher.

I have this one - had some extra money in my medical flex account one year that I had to spend... I think it was $40.



Every once in a while it kind messes up and shuts itself off in mid reading, but other than that it gives pretty consistent results, and it's real easy to use.  I can do 5 readings in a couple minutes and there's no funny ones and they seem to be accurate (about the same as when I do it at the pharmacy, and a little lower than when I'm in a doctor's office).

How accurate do you think you need to be?  I assumed you were on the high end and that's what you're worried about for being a stroke risk, but if you're getting 135/95 on your device instead of 130/90 from the nurse... I'd consider that good enough.  Actually I'm not convinced that nurses are that accurate either.  In fact, at my recent dentist and neurologist appointments, I think they both used similar automatic devices rather than a manual one.
« Last Edit: January 06, 2017, 06:37:07 PM by Friendly Angel »
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Offline daniel1948

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Re: Trip to the ER (long post)
« Reply #25 on: January 07, 2017, 09:31:03 AM »
I was actually concerned that my BP was too low, accounting for the dizzy spells. At the clinic, the nurse got something like 136/80 while I was seated, and I got something like 159/89 immediately after. I figured I'd exchange the wrist monitor for an upper-arm monitor, but after reading the user reviews decided to go with the old-fashioned aneroid monitor instead. I'm expecting it to arrive in today's mail.

FWIW, the nurse got 144/76 while I was lying down, 124/70 sitting up, and 116/70 standing. Which got me the diagnosis of positional hypotension. Then I sat back down on the chair and she took the last reading, mentioned above, and I took a reading with mine. The doctor thought an arm-band monitor would be better, but then at home I read the reviews and decided on the aneroid.
Daniel
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Offline Soldier of FORTRAN

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Re: Trip to the ER (long post)
« Reply #26 on: January 07, 2017, 10:59:05 AM »
Oh, I get panic attacks all the time. I just take an aspirin and lie down. This was different enough for me to call 911. I find the idea of a stroke much more frightening than a heart attack. A heart attack can kill you, but a stroke can change your entire personality. And the only two cases of people I knew, it turned them into very unpleasant people.

I have the same fear.  I've known one person who went through a series of strokes, one person with a significant brain injury and one person who died of brain cancer over the course of a year.  Having pieces of one's mind taken away like that is a harrowing prospect. 
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Offline daniel1948

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Re: Trip to the ER (long post)
« Reply #27 on: January 15, 2017, 04:54:38 PM »
Yesterday, Saturday, I woke up feeling okay. My blood pressure was doing it's same old thing: orthostatic hypotension (BP drops when I stand up). I had just begun to drink my morning decaf, when the lightheadedness hit hard. So I took my BP lying down, sitting up, standing, and then sitting again. On the last one, sitting down, it was 184/109, and my pulse was 106. My pulse is NEVER that high unless I'm exercising. It would have been in the 60's before all this began.

I had been told that anything over 180 is an emergency and requires immediate medical attention, so I called 911 again, and had another ride to the ER in the ambulance. They did some more tests and put a liter of saline in me, on the theory that I was dehydrated, and sent me home, telling me I don't need to call 911 for high blood pressure unless I also have chest pain. The first responders did an ekg when they got here, and told me it was a perfect sinus rhythm, even though it was much faster than normal for me.

I drank a lot of water, did my normal cardio, which felt good, and for the rest of the day my BP was its new "normal," with the orthostatic hypotension.

This morning I woke up feeling fine, BP the same, and within a short time I was feeling lightheaded again, and again my BP was high. 156/96, pulse 66, standing, which was higher than sitting or lying down: It was way too high lying down, and higher standing up. But at least well below 180. After eating an early lunch I felt better but my BP was still way high, though at least it was lower standing.

I hate to miss my cardio, so I did a very light cardio workout, holding my pulse around 90. And after my shower my BP is back down to what it's been lately. (Cardio helps? Or coincidence?)

Tomorrow, just by coincidence, I have a morning appointment with my cardiologist's assistant, a follow-up on my first visit to the ER, when they think I had a TIA. Though, I think it's too much of a coincidence that all these BP and lightheadedness issues happened so soon after the TIA, and I think it all might be one thing.

If my health is going to become so irregular that I have to quit traveling to the activities I enjoy (hiking, kayaking) than I'd just as soon die and be done with it. Each time I see the doctors they reassure me that this can be fixed and I get hopeful. And with each new incident I feel as though I'm going to have to stay within reach of medical care and life will not be worth living.

"Life is shit and then you die." I've had it better than most. Once I'm dead I won't care any more.
Daniel
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Offline daniel1948

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Re: Trip to the ER (long post)
« Reply #28 on: January 16, 2017, 04:41:35 PM »
This morning when I got on the treadmill and started to walk at a 5% grade (warm-up) my pulse shot up to 109 in about 15 seconds, which is totally crazy. I stopped, went back upstairs, and rested for a while. Then I went back down a little while later and was able to do a normal workout. I have no idea what was going on.

Then I went to my appointment with the cardiologist's RN. Basically, nobody knows what's causing my issues. Some of my symptoms are obviously panic reactions to others. They might know more when they get the results of the Holter monitor, and to that end, she suggested I exercise at the top of my cardio zone (129 bpm is the top of my cardio zone, being 85% of (220 minus my age)) so that when they look at the tracings they'll have some at that higher pulse rate. (I've been exercising at between 100 and 110 bpm with a few brief forays up to 120.) Other than that, she said that when my blood pressure is high, don't stress over it, just try to relax, and don't be concerned unless there are other symptoms, such as chest pain, shortness of breath, or weakness or drooping on one side of the body. She also said not to be concerned about a high reading unless it remains high for a while. The odd high reading is not of concern, unless there are symptoms.

I seem to always feel better after exercise. But I don't know, and she would not speculate, about whether exercise alleviates my symptoms, or the symptoms are just that transitory. I have the Holter monitor for another couple of weeks, and unless there's an event so serious that they think emergency care is needed, I won't have any results until I send the device back.
Daniel
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Offline Drunken Idaho

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Re: Trip to the ER (long post)
« Reply #29 on: January 16, 2017, 06:02:02 PM »
Wow, scary experience!

Orthostatic hypotension can be age-related. Your blood vessels should constrict as soon as receptors detect BP beginning to drop as you go from laying to sitting to standing, thereby keeping your pressure the same regardless of position. As we age, the blood vessels can become less responsive (so it takes longer to tighten up), and less elastic overall (so your maximum constriction won't be what it was in years past, resulting in a lower overall pressure). This could just be your new norm.

On the up side, it is (imo) way less dangerous than hypertension. On the down side, you need to be concerned about fainting/hurting yourself when you go to stand, so try to be very conscious about it.



A TIA could also be the cause of the confusion, but not likely to be related to dizziness or tachycardia. Both are very closely correlated with hypotension, though--so if you feel your pulse quicken, it's probably just your heart trying to boost your pressure. Designate a few contacts to be your "mental status checkers." Apprise them of the situation, and then in the future, if you're not sure if you're confused or not, give them a call and have them be the judge.

Most victims of strokes do not realize that they're having a stroke--it's almost always somebody else that recognizes the tell-tale one-sided weakness. Slurred speech and confusion are usually present too, but the victims rarely realize that they're confused.

TIAs usually mimic strokes; if you're only dizzy/lightheaded it's unlikely you're experiencing a TIA. The confusion is more serious, though.


You received the fire truck in addition to the medic unic (EMTs are not licensed to interpret EKGs, but Paramedics are) because the 911 operator selected something like "altered mental status" as the type of call, which is one of the higher priority medical calls. You get a medic, plus another unit for manpower in case extra hands are needed on scene. You were absolutely right to go by ambulance, imo.

Daniel thanks for sharing this - a frightening and disturbing experience. Once a year or so I get migraines that are almost indistinguishable from strokes. I've had them often enough that I don't panic - but now I'm old enough that I have to start wondering if it's a migraine or a clot. The uncertainty might be the most unsettling part.

You don't need to worry about the stroke aspect unless your migraines are induced by severe hypertension, which can lead to strokes.

It's true that a severe headache can be a symptom of a subarachnoid hemorrhage, but this is a rarer type of stroke, and usually caused by trauma, bleeding disorders, and defective blood vessels. 
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