written on Aug 5, 2014
I woke up at like 3:56 this morning (Aug 5) – I know because the first thing I always do when I wake up and it’s dark is check the time.
My insomnia drives me crazy sometimes. Tonight it’s different though. Tonight it’s clearly just too much on my mind. I switched to the MWF shift of dialysis yesterday (Monday, Wednesday, Friday). At the end of September, the two weeks prior to the transplant, I’ll have to switch anyway. I figured I’d get it over with now, and then I can also start going during the day. Let me tell you how much I did not miss getting up with an alarm at 4:30 this morning (although what am I talking about – I woke up at 4 am without an alarm and here I am at 5:30 doing some writing). I thought dialyzing during the day might help the migraines – not so fast. Instead I experienced the worst migraine I’ve had since the first weekend in June. So I ended up in the ER again.
The ER I’ve been going to is pretty nice (this is my 4th visit in the last 3 months). This time I had to call 911 for an ambulance because I was in no shape to drive myself. My head was throbbing like I don’t know what. Normal breathing kept causing a sharp pain in the middle of my head. My eyes became so sensitive to light that I anytime I opened them, I would get more throbbing pain and the world was so blown out I could barely make out objects or shapes. That was truly the worst part of the migraine. I’ve never had that much sensitivity before. My sound sensitivity wasn’t that bad, thankfully, because the ride in the ambulance was not very quiet. Luckily I wasn’t considered an emergency so they never turned on the siren. I felt kind of dumb calling an ambulance to take me, a patient with a headache, to the ER. Although standing and walking were out of the question – aside from not being able to see, I had the worst dizziness and light-headedness I’ve ever felt. And everytime I stood up this wave of nausea would pass through me and I thought for sure my feeble attempt at lunch would be coming back to visit me. Then my left hand started feeling numb, and I was very weak. When the EMT took my blood pressure I couldn’t even lift my arm on my own. By far the worst set of symptoms I’ve had yet.
This migraine started about an hour into dialysis. I had the beginnings of a headache before I went to the center. I woke up with it. Sometimes the headaches I wake up with change during dialysis, meaning they don’t get worse, they just change position in my head.
Yesterday, no such luck.
Sitting in the chair, trying to do some work on my website and I felt this sharp pain in the middle of my head. For the remaining two hours, the pain just got more and more intense. It made my neck stiff, it made my jaw stiff. Really didn’t make for a good dialysis session.
When I left, my blood pressure was 156/96, or something very close to that (pain is a great factor in me not remembering short term items). That surprised me – maybe my doctor is right and the pain is causing the high blood pressure. When the EMT’s showed up, they measured my pressure at 150/90 (to be fair, they were measuring with their own ears, which the dialysis center and my doctors do not do – they all hook me up to a machine for blood pressure readings. So what the EMT heard may not be accurate, or it might be more accurate, I don't really know). But by the time I got to the hospital, the machine said my pressure was 196/111. Funny – the nurse and doctor were very concerned with how high this is. I laughed because my pressure has been living around there for over a week now. Even with the higher dosages of my blood pressure medications, it’s not really coming down. I have periods where it’s down around 160/100, but other than when I’m now on dialysis or right after my pills kick in, it’s still more like 175/115.
So the ER staff worked pretty quick to get it down – a dose of clonidine, an IV of dilaudid (for the pain) and an IV of dexamethasone (Decadron) for the potential inflammation in my brain. Those two worked really well. This is the third time I’ve had dilaudid (which they also give with something called Regulin, to help with the nausea) and as wonderful as it is in getting rid of the migraine pain, it’s also a narcotic, so I’m worried about taking it too often. It’s not something I’d get addicted to, per se, but it’s something that could potentially cause rebound headaches, meaning if my brain wants more of the drug, it will start creating more severe migraines to get more drug. Let me tell you how horrible a side effect that would be – give me a drug for the pain that’s going to cause more pain so I can get more drug. As Hudson said in the movie Aliens – “you can count me out.”
Once I was a little more stable, they wheeled me to Radiology and took a CAT scan of my brain, to make sure I wasn’t hemorrhaging and having a stroke. That’s been my main concern for the last two weeks – that I’ll be having a stroke with my blood pressure so high. My doctor doesn’t seem to be worried about it, but they sure were at the ER yesterday. I’m hopeful that it doesn’t happen – that would take me into a whole new world that I don’t even want to visit.
Luckily, no stroke and the medications brought my blood pressure down to a more manageable 159/101 when I left. I say luckily because I was able to go home. There’s always the chance when you go to the ER that they’ll find something more severe than what you think you have and then they admit you to the hospital. I did not want that to happen. And it didn’t.
One of the strange parts of this is that my migraine medication really didn’t help me this time. I take Frova(triptan) now for the headaches but I’ve been told you have to take it as soon as the headache presents itself, which I did not do. For whatever reason, it never really kicked in (well, maybe it did after I had the dilaudid – I’ll never know for sure). I also realized while sitting in the ambulance on the way to the hospital that I never even tried to take my Oxycodone pill – I have a prescription sitting in the bathroom for that stuff, which is just another opiod pain killer like dilaudid, so in theory if I had taken that, I probably would have been alright. Definitely would have saved me some money and the time I spent at the ER.
On the plus side, my wife and I went out to dinner together, without the kids. Strange it took a trip to the ER for us to have a “date,” but sometimes that’s how it is I guess. Next time I think I’ll hire a babysitter instead.