September 15, 2015

So... Why the Wheelchairs on Your Colorado Trip?

Initially, I blamed altitude sickness for my health issues over our Labor Day weekend trip to Colorado. But later, I realized it was mostly the same old problem I've been dealing with for the past several years.

Here's What Happened
As I reported in my last post, we began our visit to the Rocky Mountain National Park by driving along the Trail Ridge Road, the nation's highest continuously paved road. As we headed up, I noticed that my breathing was becoming more labored. When we reached the visitor center near the road's highest elevation (12,183 feet), I decided to stay in the car while my travel mates headed for the center.

After a while, I got restless and decided to take my cane and hobble up to the visitor center. The place was mobbed, and soon I was feeling weak. I sat down and got out my cell phone to call my friends. But there was no phone signal, which exacerbated my anxiety.(I learned later that cell phones often don't work at high elevations,)

I finally asked a passerby to find one of the employees. Luckily, these National Park centers are well equipped to handle emergencies. Within a few minutes, a medical staffer arrived with a wheelchair and extra oxygen. We headed for the center's health clinic.

Fortunately, my friends showed up as we worked our way through the crowd. The clinic nurse checked me out. I had a high blood pressure reading, but there were no other danger signs. I was released with a warning to take it easy and to head down from the high elevation.

Background Information on Blood Pressure and Levodopa and Me
Before continuing my Rocky Mountain High story, I need to provide some background information.

Blood pressure spikes have been an ongoing problem for several years. They always occur during medication "off" periods, when the last carbidopa-levodopa pill is wearing off and the next one hasn't yet kicked in.

For the uninitiated, carbidopa-levodopa is the gold standard treatment for Parkinson's disease (PD). The levodopa replaces some of the dopamine that PD destroys, and the carbidopa enhances the levodopa's bio-availability. These days, I take two pills every three hours.

The systolic (upper) pressure readings can hit 180, 200 and above -- the danger zone for stroke or heart attack.

In April 2014, I stopped taking the blood pressure meds I'd been using for years. All but one of my doctors wanted me to keep taking those pills, so I went back on them for a while. But I don't take any hypertension medication now.

I always thought my pressure problems came not from underlying hypertension, but from the lapses in the effectiveness of the levodopa pills. Nevertheless, I become concerned when systolic readings exceeded 180.

One pressure med I'd taken was nifedipine, but I stopped using it because it was too effective. The minimal 10mg dose sometimes drove the systolic number below 100. But I kept the pill container with the unused nifedipine.

So, when confronted with systolic spikes that seemed dangerously high, I'd get out my old nifedipine prescription. These pills contain liquid inside their plastic covering,so they aren't designed for splitting. Nonetheless, I found a way -- by cutting a pill in half with scissors and slurping  half the dosage amount.

This solution usually did the job. My scary high numbers would quickly come down, and I could relax when I saw more normal numbers.

Dealing with these pressure spikes wasn't easy; it required constant monitoring to identify the dangerous spikes.

This May, I had a major breakthrough. I'd run out of my regular carbidopa-levodopa prescription, and was told I'd have to wait several days for the refill. I bridged the gap by using an old prescription for the extended-release version of the med. Bingo!

Just switching to the extended-release version eliminated most of the dangerous systolic spikes. The only time they still occur is when I forget and allow the interval between pills to reach four hours or beyond.

Back to my Rocky Mountain High
I continued to feel sub-par for the rest of our stay in Colorado. I had brought a small wrist blood pressure monitor with me, and noticed unusual  spikes of 180 and above. I had also packed two nifedipine pills, thinking two would be plenty to cover any pill-taking forgetfulness during the brief trip.

I used those two pills to handle spikes during the first two days of the trip. But there were two more days before we got home. We went to the pharmacy in a local Safeway, where I explained my plight and begged for a couple nifedipine pills. No luck. The pharmacist said he might be able to get the pills for me if I could provide my nifedipine prescription number. With the time difference, my CVS pharmacy at home was already closed.

He suggested going to the emergency room of the Estes Park Hospital to see if they'd give me the pills.

Off we went to the hospital. This turned into a surprisingly pleasant experience. The emergency room wasn't crowded. Everyone on the staff was exceptionally pleasant. A nurse examined me and then called in one of the ER doctors.

I gave him the short version of my blood pressure-levodopa issues. He seemed to take an interest and questioned me for more information.

The doctor said he'd worked for six months at the University of Michigan's blood pressure clinic, which he said was the only specialized blood pressure clinic in the country. Unlike my other doctors, he didn't tell me to get back on hypertension meds.

He said that nifedipine wasn't prescribed much these days, and was used only in the maternity ward at the Estes Park Hospital to deal with elevated blood pressure during childbirth.

He said he wouldn't worry about temporary pressure spikes. I told him I usually meditate for about 15 minutes when I thought my pressure was getting too high. I said I resorted to nifedipine only if meditation didn't work.

When he asked for my definition of dangerously high pressure, I said any systolic reading above 180. He said he wouldn't see a problem with a temporary reading even above 200.

I said, "Well, how about a reading of 240, which I've experienced on this trip." He answered, "Maybe I'd take a pill then."

He ended up giving me a couple nifedipine pills. enough to get me home.

The Mystery Solved
When I got home, I discovered I had packed the old regular levadopa pills, not the extended-release version.

I got back on extended release pills right away. The systolic numbers remain non-threatening , as long as I keep the interval between pills at three or -- at most -- four hours.

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