January 26, 2004

Last week at chat, my friend Heather listened to my complaints about my symptoms and reminded me to ask for a catecholamine and metanephrine test the next time I saw No Name.  I will be forever grateful to her for reminding me of these two tests.

I had tried to get an appointment with No Name on January 9th but he was unavailable.  kBecause of the back log of patients, I could not get an appointment with him until today, January 26th.

When I got to the appointment, the nurse asked me why I wanted to see No Name. My answer was that I was concerned about my blood pressure spikes, the continuing, all consuming bone pain and the gross boil under my arm. She proceeded to take my blood pressure and when I asked her if it was within the “stroke zone” she looked up and gave me a funny look. My blood pressure was 234/110 sitting down. I was then told that I had malignant hypertension and would not be allowed to leave the doctor’s office.

Thankfully, I had prepared some notes for this appointment. After Heather’s reminder at chat I had done some research on metanephrine and catecholamine tests. I very quickly realized that the two metanephrine tests I had done at the local lab had not been done under the right conditions. No one told me that I had to avoid caffeine, bananas, vanilla, vanilla extract, chocolate and a lengthy list of other foods for two days before the test. Many foods can cause false positives, but caffeine is the most frequent cause of false negative results.  Acetaminophen or any drugs containing acetaminophen can be a problem as well.  I know that prior to my previous metanephrine tests I had taken Tylenol for leg pain at night. I also was not aware that the plasma metanephrine test has a much higher accuracy rate than the urine tests. I also found out that the metanephrine test should be a fractionated metanephrines and not total metanephrines. I spent some time explaining this to No Name.

The lab work No Name requested will help to determine if I have a pheochromocytoma. Pheochromocytomas are usually benign. They may occur in or near the adrenal glands, or anywhere along the sympathetic nervous system roughly from the base of the skull to the bladder. The most apparent symptom, caused by the increased secretion of epinephrine and norepinephrine, is hypertension, or high blood pressure. This hypertension may be constant or intermittent. Attacks may occur every few months or several times daily. Physical and emotional stresses can initiate an attack.  During severe attacks, patients may experience headache, sweating, apprehension, palpation, tremor, pallor or flushing of the face, nausea and vomiting, pain in the chest and abdomen. There may be a tingling, burning, or crawling sensation on the skin of arms or legs or urinary difficulties. I of course, have been experiencing these symptoms for quite some time along with “adrenaline rushes” and orthostatic hypotension with blackouts. Maybe this would also explain the nodule I have near my hepatic artery which the radiologist called a “maybe swollen lymph node.” It might also explain the “cyst” I have behind my sinuses.

My blood pressure was taken again about half way through the appointment. It had fallen to 198/120. Apparently it was not low enough for me to go home so I was sent to emergency at the hospital. When I got to emergency I was given Adalat 10 mg. sub-lingually and an EKG. Finally after an hour my blood pressure was down to 145/100 and I was allowed to go home.

Hopefully the new blood pressure medication will put a stop to these spikes. I have been told that high blood pressure is “silent” but I have always been able to tell when it gets too high. My vision blurs and I get an uncomfortable pressure and pounding in my head and chest.

I can only hope and pray that the resulting test requisitions from today’s experience will finally lead to a diagnosis. Almost six years of these symptoms is enough.

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