Insomnia

I have written about my struggles with insomnia previously, thankfully though its not been something I have struggled with since around 2016 when I was prescribed melatonin and the antidepressant Mirtazapine . Both have improved my sleeping habits immensely. I also take a low dose of amiltriptyline to prevent migraines and again this helps me sleep….until last Sunday night (18th November).

Sunday nights have been a sleeping issue for me as long as I can remember. I think the sleeping problems started over the anxiety of going back to school on the Monday. Throughout my school years I was bullied, so going to school was a cause of anxiety. If ever anyone says to me their school days were the best of their lives I want to punch them in the face. For me they were a source of misery and I never knew who would be gunning for me next. Primary school was particularly awful, comprehensive school was slightly better but I just felt so out of place there having come from a tiny school of less than 400 pupils to then be amongst over 800.

After school I then had the Monday morning work anxiety. I would be ok on Sunday until about 5pm and then I would begin to worry about events that would take place at work during the week. Again I was the target of two bullies unfortunately both were my boss and when one left the business the other one jumped right in and took their place. I loved my job and was good at it but it did absolutely nothing for my mental health.

So now after years of Sunday night anxiety its ingrained in me and I can never sleep or settle down for sleep very easily on a Sunday evening. So when it happened this Sunday I just shrugged my shoulder and thought oh well I’ll sleep Monday. Yet when Monday came around the same thing happened no sleep. I put Mondays lack of sleep down to having bloods being done on Tuesday morning. Its always a drama getting blood out of me. It was it took 2 people three attempts. I’ve got a lovely blown vein on the back of my hand. 

Tuesday was also dramatic as our washing machine broke down, well died to be more accurate. It was about 5 years old and had been a really good machine – washing machines don’t seem to last very long in this house. Probably due to the dogs stuff that fills the waste pipe with sand. I have a Rug bag  which is what horse owners put their horses rugs in to stop all the dirt etc going into the machine – its a bit like a lingerie bag for horses lol! A new machine was ordered and set up for delivery the following day. We can’t be without a machine when we have two elderly dogs who have accidents.

So when I lay tossing and turning last night I presumed I was anxious about the new machine being delivered. I wasn’t remotely anxious I just couldn’t drop off to sleep and if I did drop off I was only staying asleep for ten minutes or so. Today I am exhausted three nights of very little sleep has destroyed me after being used to sleeping again. On all three nights out of desperation I have increased my melatonin, added in an extra amiltriptyline and then last night I toyed with taking my last diazepam which is my emergency pill for either the dentist or when my neck pain is off the charts. I don’t have the doctors until next week  and I will ask about an additional prescription of diazepam as when the neck pain is bad its the only thing that relives it.

Last night well technically this morning I didnt drop off until gone 02.30am , at 7am I received a text message to tell me that our new washing machine would be with us in 20 minutes. So bang went any chance of managing to sleep for a bit longer. Jay has gone back to bed. He can fall asleep pretty much whenever and wherever he wants. I am unable to do that and I am always terrified if I sleep during the day I wont sleep at night. So today I will push through until I can’t go on any longer. My plans of using my embroidery machine have gone out of the window. I am so out of it I’d be a danger to myself holding a pencil let alone using machinery. If I didn’t have a load of things being delivered today I would have crawled back into bed right now, regardless of not being able to sleep tonight.

Insomnia causes my pain levels to increase, my mood to plummet and makes me thoroughly miserable. I hate not sleeping because the knock on effects can last weeks. Its been so long since I have had a run of three nights that I had forgotten how bloody awful insomnia makes me feel. 

Fingers crossed that at some point this week I fall asleep before 2.30am!

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Insomnia Cure? (and other stuff this week)

**I haven’t been paid to provide a review of this product, I have also not received payment for advertising this product. This is an honest review of a product where no gain be it financial or through goods etc has been made.**

 

If you live in the UK, use social media platforms such as Instagram or Facebook or  read the newspapers and haven’t heard of Lush’s new wonder product “sleepy” then where have you been? The print media has been full of gushing reviews for this product, autistic children who have never slept more than a few hours at a time were now sleeping a solid 8 hours, insomniacs were rejoicing. Doctors were claiming it was a breakthrough in the treatment of sleep disorders. Ok so I may have just made that last sentence up but you catch my drift. The media, including social media were full of praise for the product that was allowing the sleepless to finally get some sleep.

 

So desperate had I become for a decent night’s sleep. I wanted to believe the hype. The product isn’t cheap at £13.95 for a measly 215g, ( Link to Lush website here) obviously the cure for insomnia is priceless but for most people in the real world spending £13.95 on a body lotion that may not even work probably seems a little extravagant. I have repeatedly moaned on here about how since giving up the fags (cigarettes) I am no longer sleeping. Initially when I stopped the first two weeks were heaven, then after that I was having problems with dropping off to sleep and then staying asleep.

 

I have two types of insomnia, onset insomnia – where you can’t drop off and maintenance insomnia – where I can’t stay asleep. I don’t know which is more infuriating actually I do, its maintenance insomnia as that can happen to me within 30 minutes of falling asleep. I wake up and I am wide awake immediately and I can stay that way for hours. Onset insomnia is frustrating but I just get up and do something, read, have a cup of tea. I am currently in a pattern where one or two nights a week I am having trouble falling asleep. Every night I am waking up for several hours during the night. I knew the chances of Sleepy the Lush body lotion helping me be able to stay asleep was remote but at this point I was willing to give anything a go.

 

 

I can’t remember which day I ordered the body lotion but it arrived within two days which is pretty good for ordering a product online and not paying extra for a named day delivery, I paid for standard delivery. The packaging wasn’t excessive and it arrived in tip-top condition. I was looking forward to trying the lotion when I went to bed.

 

 

The colour is a little off-putting to me with it being a lurid purple. It really smells strongly of Lavender which is a scent known to aid sleep. I have tried dropping lavender oil on my pillow and using an oil burner in my room for an hour before going to bed in the past but it’s made zero difference. It also contains sweet Tonka bean but to be honest I can’t differentiate the smell from the lavender. As expected the product does feel gorgeous on my skin and a little goes a very long way. So now the £13.95 doesn’t seem so bad as it is going to take me awhile to get to the bottom of the pot. I applied the cream to my neck, back, arms and chest, all the areas close to my nose as it is the smell of the product that is going to help me sleep. I did also use it on my feet as they are dry with the change of the season. My skin did feel lovely the following morning, including my feet.

 

The first night was a raging disappointment, despite falling off to sleep easily (which was nice) I was woken up by the pain of gastritis and the sound of a dog pacing around downstairs on the laminate floor at 1am. Usually a dog pacing around downstairs in the middle of the night is not a good sign, it’s normally a precursor to a dog vomiting. When I got into the lounge I found Frankie who seemed very out of sorts and very shaky on his feet. He had been fine the night before so I was very concerned. He didn’t want to eat when I had a banana and normally he’d sit and drool for that. When I returned upstairs I noticed that he was having great difficulty climbing the stairs. I managed to get him into my room and onto the bed (thankfully he jumped up unassisted) and I put the electric blanket on hoping that heat would help whatever was causing the problem. My husband got up a few hours later, I was still awake having not gone back to sleep. Frankie was worse again so I explained to hubby what had gone on earlier. The dogs were taken out for a very short walk and the alarm was set so we would get up early and ring the vets once they were open.

 

I did finally manage to get a few hours sleep but it was a dreadful night and the quality was awful due to being stressed out over Frankie being ill. In an ideal world a product tester wouldn’t have all this drama going on.

 

Frankie went to the vets with Mr Myastheniakid at 09.30am, due to Frankie’s age (he is 11 this week, as is Willow) I had convinced myself that this was the beginning of the end. The vet said she felt it was probably a flare up of Hip Dysplasia (a diagnosis I have never been entirely happy with as he has only ever had one problem with his hop and that was over 10 years ago. Of course that diagnosis made pet insurance ridiculously expensive.) Or he has developed arthritis in his hip. Frankie was a very good boy at the vets allowing them to take blood but he wasn’t happy at having his legs moved around. He came home off his face on painkillers, he can’t take the normal medication metacam or rimadyl as he pees blood, so he had no NSAID just a painkiller.

 

 

Friday was an incredibly long day for me, hubby was late night meaning he wouldn’t be home until gone 9pm, so I would be dealing with a hallucinating dog by myself for the day. You could see Frankie was hallucinating as he was watching stuff that wasn’t there. Thankfully at about 2pm he went to sleep beside me and slept the rest of the day. Normally I am in bed by 7pm as sitting on the sofa makes me sore but that day I had to stay downstairs all day as I didn’t want Frankie injuring himself further by running down the stairs when Jay got home. BY the time Jay did come home the injection was starting to wear off and Frankie was more with it.

 

I applied the Sleepy body lotion that night and was out like a light, I did wake up about 3am and was awake for a few hours. Again my skin was loving the lotion and was feeling very smooth. So that was two nights out of two where I had no problem getting to sleep and where I didn’t wake up within the first couple of hours of dropping off.

 

Saturday morning it was clear that Frankie was in pain again, he was panting very hard, although he was moving better. When any of our dogs get an injury I try to treat them naturally by giving them Maxxiflex  a tablet that can be bought on Amazon (and again I am not being paid to promote or advertise this product and each dog may react differently to this product so please speak to your vet). After two doses of this tablet Frankie was completely back to normal, bouncing around all over the place and no heavy panting or showing any signs of pain. We kept him as quiet as it is possible for a Weimaraner to be quiet. By the time hubby came home on Saturday evening Frankie was jumping at the front door wanting to go out for a walk and he  leapt into the back of the car without any issues. For the previous 24 he had been unable to get into the back of the car and had been lifted by hubby onto the back seats.

 

 

Despite all the stress involved with looking after Frankie and having a Grandmother who was in hospital, I did remember to apply the Sleepy body lotion. I had the best nights sleep I have had in ages, I slept all the way through the night and woke up almost feeling refreshed.

 

Frankie continued to improve Sunday, his blood test results would be back on Monday which may have given us an idea what was going on with him, be it arthritis, soft tissue injury etc. He was so much better today, we were quite surprised he had improved so much in the space of 48 hours. We were still “attempting” to keep him as quiet as possible, we were just very happy he wasn’t in pain.

 

 

Sunday night I did the same ritual I had been performing since Thursday evening covering myself in the Lush Sleepy body lotion. I will be honest Sunday nights are a real problem for me at the best of times, I have had problems sleeping on a Sunday night since I was a child. I have always suffered from anxiety if there is a break in my routine, unless I was at home. So finishing school on a friday was fine as I would be at home but starting school / university / work on a Monday and the anxiety would stop me sleeping. Despite not working anymore and not having been in education for over 20 years, Sunday evenings are still angst ridden. Which means most Sundays I lie in bed for hours, sometimes until gone midnight before I drop off. This Sunday was no different, so the body lotion didn’t do anything at all for me, it was a tall order not even medication works on a Sunday evening.

 

Monday, Frankie was completely back to normal, following me from room to room, annoying his mum / sister and me! He really was feeling an awful lot better. The vet rang late Monday afternoon and I found out that Frankie had a soft tissue injury his blood work had shown this and the vet was very pleased at how well he was doing, although Frankie still has to take it easy for bit. Yeah the vet has clearly never owned a Weimaraner! Due to Frankie’s age and size (39-41 kilos) he has developed a heart murmur. The vet said you can hear that one of his valves is leaking but it is very mild at the moment. He then went into signs that I need to look out for which will tell us that his heart is starting to fail (although the vet never said this, it was a case any of these symptoms and bring him in but I am not an idiot and know the score). So our boy isn’t a spring chicken anymore but he’s happy as Larry as long as his pack is together and that’s all that matters.

 

Monday night – slept like a log, woke up at 3am was awake for two hours and then slept until 8am.

Tuesday night – dropped off really quickly but woke up at 3am and stayed awake until gone 6am. Then slept until 8am.

 

My overall verdict on the Lush Sleepy Body lotion, well it probably needs a bit longer really to give a really good review. However if you are suffering with onset insomnia not linked with anxiety, I’d say it was definitely worth a go as long as you are also practicing good sleep hygiene. If you aren’t I would suggest trying that first. If you have no problems getting off to sleep but suffer with maintenance  insomnia then I’d say don’t waste your money, unless you apply it when you wake up in the middle of the night. I don’t know if it would help at all but it is something to try. It does smell really nice and it leaves your skin beautifully smooth. An added bonus I have discovered is that it is quite good on acne, probably due to the lavender in it. I get hormonal acne on my chin and this has calmed it right down and made it not look so red.

 

Sleep and other fairy tales

When I gave up smoking (nearly 7 weeks ago) I thought I had discovered the secret of a good night’s sleep. Initially on giving up I was sleeping like a baby, I have never understood that expression as most babies I know don’t do the sleep thing! I was dropping off within 30 minutes of turning off my bedside light and then sleeping for a good 10-12 hours. It was bliss, my back hated it but I actually started to feel something I hadn’t felt in years….refreshed.

 

Fast forward four weeks and the problems started, I also noticed at this point how unhappy my joints seemed about staying in. The slightest thing was bringing on a subluxation or a dislocation. My feet were also regularly spasming forming almost a tight ball, imagine the top of your toes touching the sole of your foot. Initially I put it down to stress, we were choosing the new colour schemes for the kitchen and the lounge, that sort of thing will keep me up at night, worrying that I have got it right. Not sleeping or poor quality sleep always seems to effect the stability of my joints. Which is why it is so important that I get a reasonable amount of sleep of average quality. When I get neither the hours or the quality not only are more joints increasingly unstable but I also end up with increased pain levels.

 

I take Melatonin and an antidepressant called Mirtazapine to help me sleep and for a good year they have been highly effective. However in the last 4 weeks it suddenly feels like I have become immune to both of them. I never go to bed until I feel tired and up until about 4 weeks ago within an hour of taking those medications I would be out like a light (about 85%) of the time. So to suddenly go from them working to still being awake two to three hours after ingestion is just bizarre. It’s also incredibly frustrating.

 

Many doctors don’t get it when you speak to them about lack of sleep or lack of good quality sleep. This is especially true if you are chronically sick, it seems that if you aren’t working and don’t “have” to do anything due to illness, lack of sleep really shouldn’t bother you. I have had this from doctors myself, it wasn’t until I was effing and blinding, crying hysterically that my gp got how desperately at that moment I wanted and needed to sleep. It shouldn’t have come to that as I had been talking about sleep issues to my hospital consultant and gp for months. It shouldn’t have been a surprise to either of them that I was now on my knees after months ( actually years) of ineffectual or absent sleep. Now when I complain about my lack of sleep I am immediately listened to. Maybe it’s the thought of the horrid, angry, crying Myasthenia Kid turning up in the waiting room that prompts such a rapid response.

 

At the moment I am soldiering on, I don’t want to get involved with doctors at the moment. Especially after Julys appointment and the hemifacial spasm (or I’m a neurologist and I will make it up as I go along) diagnosis. I am fed up with the whole of the medical profession at the moment. This is quite a typical response from me after a shitty appointment, I withdraw. My confidence has been knocked and I don’t feel I could advocate properly for myself if needed. I have found when you are chronically sick you need to be at the top of your game when dealing with any medical professional or all sorts of shenanigans can take place. You know meds being withdrawn, stupid suggestions made etc etc. At the moment it is better that I ride this out, regroup and then decide what I need to do next.

 

The joint instability is really bugging me at the moment, yesterday I battled my left hip all day. I could feel it grinding against the socket every time I moved. It kept subluxing and then popping straight back in again. There was no particular movement which was worse than any other. This meant I had zero ways of avoiding it, other than lying completely flat, which I was not prepared to do. Not after spending so much of my life last year horizontal. Today I have had issues with slipping ribs, every time I bend forward the rib is slipping and hurting like crazy. It is a weird feeling, so now I am trying not to bend forward but sometimes you don’t have any choice.

 

My body is still wracked with muscle spasms and they really have got a lot worse over the last 6 months. My feet spasming have been a problem for years, it always used to happen at night when I had gone to bed. Now it happens day or night regardless of what I am doing. The spasms can be so violent they dislocate my big toe. There is nothing I can do to stop them, I just have to attempt to massage the spasm away or wait for it to pass. My thumbs are also starting to spasm and get stuck (not like trigger finger) clamped to the palms of my hands. These do quickly release by me pulling the thumb away from the palm and stretching it out. It’s a strange one and I know that it’s not helped by the current sleeping situation.

 

Sleep, such a natural thing to do but at the moment it seems to be nothing but a fairy tale. I’d have more chance currently of meeting three bears in my house eating porridge than having a decent night’s sleep.

 

* * *

Breaking news on Saturday 16th September I actually had a good night’s sleep and dropped off quickly. I will probably go back to not sleeping from tonight!

And then it went straight back to not being able to drop off and lying awake for hours in the middle of the night.

Side effects

Last week was a bit manic by my standards, a gp appointment followed by a trip to hospital for my caffeine infusion. Add in visits from friends and a surveyor to look at the damage a water leak had caused (thankfully none but there is cosmetic damage as part of a wall had to be removed) it was too much for me. Most of these events occurred before Thursday’s trip to hospital, so when I wasn’t feeling well on Thursday I put it down to doing too much.

hole-from-leak-repair

The caffeine infusion was a bit of a nightmare as my veins were not playing ball. If I am tired and cold my veins tend to hide and I knew that my blood pressure was low, so I was constantly drinking to try to give it a boost. After nearly a litre of oral fluids I managed to raise it to 112/83, I have no idea what the starting point was but I would hazard a guess of between 90/60 – 100/70 both of these readings although considered in the normal range make me feel rank, I feel better the closer I get to 120/80. By the time the infusion had finished it was reading 125/85.

 

The department was exceptionally busy and this wasn’t the day for a cannula insertion to take longer than the IV caffeine takes to administer (2 hours). The staff that have experienced my veins before now tend to run away, which means it takes ages trying to convince someone else to give them a go. What was more irritating was the nurse that had the second go, wouldn’t listen to me. She was one of those nurses who just ignores what the patient tells them and carries on regardless. Three failed attempts later she decided that a glove filled with hot water might be a good idea. In the end I had five different people attempt to gain IV access, it was a naval doctor who got a vein on his first attempt. However by then he was discussing with me why I hadn’t got a port to make life easier for them and me.

 

I had already discussed this with my neurologist, whilst he was performing the occipital nerve block injections (GONIs). He isn’t actually my doctor anymore having moved departments but is often in the unit where my infusions take place. So when I know when my next infusion will be I email him so that he can do my injections. The headache nurse that did them before doesn’t do them the way he does and I find his are much more effective. The upshot of the port conversation was that I wasn’t having the infusions regularly enough, the risk of infection and the fact that they hadn’t called down the vascular access team. Believe me that is only going to be a matter of time.

 

I did manage to run into my PoTs consultant as we were leaving the unit and I asked him about the possibility of starting melatonin due to my sleeping problems. As it was just a quick check on me to see how I was doing he asked me to email him to remind him. There are such good doctors at the hospital, who have no problems with patients emailing them when they have concerns. He is the doctor that writes the prescription for the caffeine infusion each month. I email him the week before to remind him and he emails me to let me know he has done it.

 

The day after a caffeine infusion are always a bust, I need to rest all day due to the travel involved and all the stimulation from the lights and noise. Friday I spent the day lying on the sofa, I put down not feeling great to the caffeine infusion and the explosive diarrhoea I had experienced at 1am (for over an hour). Initially I put the shits down to a stomach bug but having thought about it, the caffeine infusion can act as a bit of a laxative and maybe it was that as after the one hour-long bout I didn’t go again.

 

Saturday I was floored by vertigo and my heart kept doing funny beats, where it goes slow and then returns to normal speed. I felt so ill that all I did was lie on the sofa under my heated throw. I took some stugeron (travel sickness tablets) and that did ease it quite a bit but I was very limited with only being able to lie down, using my chromebook or phone was difficult. My blood pressure was also feeling low, I didn’t measure it, I rarely do now as I know what my symptoms are, plus it was upstairs and there was no way I would manage to get it. I ended up crawling into bed at around 6pm because the stugeron had worn off and the room was spinning. I looked ghastly, white as a sheet with big black rings under my eyes.

 

Sunday followed the same pattern, woke up feeling rough despite sleeping like a log. Now along with the low blood pressure, vertigo, funny heart beats and generally feeling like crap I had developed wheals on my face. I also felt extremely low like I could burst into tears at any moment. I put being low down to feeling so awful. It wasn’t until the late afternoon I put the pieces of the puzzle together.

 

When I saw my gp on Wednesday I had told him that I hadn’t had a proper nights sleep since the end of November. I had either not been able to get to sleep at all or slept for one or two hours and then spent the rest of the night awake. This sleeping problem was then triggering anxiety, an increase in pain levels and being bad-tempered. When I don’t sleep I find that my normal aches and pains are amplified by a factor of 100. This then makes me anxious and then continual levels of high anxiety can send me spiralling into depression. Having been severely depressed previously I didn’t want to go back there.

 

For about a year I have been taking the antidepressant mirtazapine (15mg) to help me get to sleep. Initially it worked wonders but over the course of a few months it was no longer working. My gp agreed with me to increase it for a month to help me get some sleep. I started taking the increased dose on Wednesday night, it worked beautifully I was falling asleep and staying asleep. However the start of me feeling really rough coincided with increasing the medication. After a quick search on Google it was obvious that the mirtazapine was what was causing the problems. Side effects listed included

  • Vertigo
  • Low blood pressure
  • Palpitations
  • Rash
  • Changes in mood

 

And they were just a few of the side effects as there were many listed. So I dropped the dose back down to my normal 15mg on Sunday night to see what would happen. If I still had vertigo etc on Monday then I would contact my gp and see about stopping the mirtazapine altogether.

 

Monday morning however I woke up with my eyes very swollen

 

allergic-reaction

 

allergic-reaction-2

In these photos the swelling has come down considerably. My under eye area had been very itchy since Thursday which I had put down to dry eyes which is something I suffer from anyway. Monday morning I really had to stop myself from scratching as I would have scratched until I bled. I dosed myself up with antihistamines and then waited to see if the vertigo started again. The vertigo had been coming on 3-4 hours after waking up, so I bided my time before pronouncing a vertigo free zone. Thankfully the vertigo hasn’t come back since dropping the dose back to 15mg, my blood pressure is back to its low but normal state.

 

My gp rang me by chance on Monday and I managed to miss the call. He let a voicemail saying he had received an email from my PoTs consultant about starting melatonin and had written me a prescription for it. I rang the surgery back to pass on the message I had dropped the mizatrapine back down to 15mg due to the side effects I was suffering.

 

Tuesday morning there was no swollen eyelids which was fab and I had slept well due to the Melatonin I had taken the night before. I have been sleeping all night and feel more rested than I have done in a very long time. I still have fatigue but it’s no longer at the level it was when I wasn’t sleeping. I don’t know now if the mizatrapine caused the swollen eyes or if it’s something I have eaten. It could be anything at all as I can react to stuff and then the next time I have it there is no reaction.

 

So now I am back to my normal level of crappy health after four days of feeling truly awful and almost being confined completely to my bed due to the vertigo. At least however (touch wood) so far there seems to be no issues with the melatonin.

Blind Panic

By the time this blog post is published hubby and I will be up and getting ready for our trip to The National Ehlers Danlos Unit in Bath, a good two-hour journey to a hospital that has no parking. I am particularly looking forward to hubby losing his cool whilst trying to find a place to park.

Last week I was unable to write a new blog post so took the easy way out and re-blogged a piece from last year. I hate doing that but if I hadn’t there would have been nothing at all. Last week was filled with massive bouts of insomnia / painsomnia (if you’re not familiar with that term it means being unable to sleep due to high levels of pain) add in getting my hair cut on the Monday and a trip to the dentists on the Wednesday, I was good for nothing.

I can’t lie I have a terrible phobia of the dentist, which is bad when EDS has really done a number on my teeth. Apart from my front teeth every tooth in my head has a filling, my front teeth are losing their enamel and are also crumbling. I should be a regularly attending patient but three years ago I stopped going due to my health being bad and never arranging an appointment to go back. The dentist that I had built up a good relationship with, that knew about EDS and would listen when I told her to stop has left to work in the private sector. If we could afford to see her, I would but we don’t have that kind of money, so I am now having to “break in” a new dentist.

The last appointment I attended had been on my birthday, it didn’t go well as I was so tense I could barely open my mouth and he seemed not to believe me when I told him he was hurting me. Not a great start when all he was doing at the time was examining the condition of my teeth. I learned from this appointment I needed two fillings as I had developed large cavities in my rear molars. One on the right side and one on the left, the cavities were so large and deep they could be seen on the x-rays he took. You would be correct in thinking that I was not looking forward to getting them sorted out.

Before I left the appointment on 1st November I went through with him that I needed a local anesthetic without adrenaline, one with adrenaline will cause me to face plant when leaving the dentist’s chair, as one previous dentist found out many years ago before I had my diagnosis of EDS and PoTs. Due to getting my diagnosis at 37, it means I have endured more than my fair share of painful dental procedures, with dentists shouting at me that I “couldn’t possibly feel anything” because I had been given local anesthetic. It’s not only dental procedures that have been plagued by pain but also small procedures such as having part of my toenail removed and a lumbar puncture. Until the diagnosis I got shouted at a lot by the medical profession, simply because they didn’t believe that the local anesthetic they had injected wasn’t working. Now although they acknowledge that anesthetics don’t work properly they underestimate how long it will last for.

I knew in my heart I was going to be in trouble yesterday when the dentist administered the injections for both fillings at the same time. I wanted to pretend it was going to be ok and that it was a situation where it was mind over matter. The first filling went ok, although I really could have done without the running commentary of what he was doing. I spent the whole of the first filling trying not to vomit which is my normal feeling when I hear the dentist’s drill. I really didn’t like it when he told me that the next bit of equipment was going to vibrate a lot making my tooth feel like it was going over cobbles. Another wave of nausea hit me when he told me that he was removing the “soft stuff, to get down to a good hard base”. I wanted to tell him, I really didn’t want to know but as I had his hands in my mouth and the dental nurse sticking the suction device to my tongue constantly, he wouldn’t have worked out what I was saying anyway.

Filling number one went off near perfectly, this was a good dentist experience, other than the running commentary. I was a perfect patient apart from the hyperventilating at the start and gripping the armrests until my knuckles went white. I didn’t find my happy place, which I try to do when stressed to the max during medical procedures. I am pretty good at meditation and can drop off during MRI scans because I just go into my head, the dentist is a different story coloured by so many bad experiences.

I was pleased, the dentist was pleased but it was short-lived due to filling number two. I should have said something or made some sort of guttural noise (as you do when the dentist has your hand in your gob) when he blasted the tooth with cold air and then stuck the metal prong into it. I tried to convince myself that I was imagining the sharp stab of pain. Concentrating on my breathing, I braced myself for the drill, trying very hard not to panic.

Within seconds of the drill hitting my tooth, I entered what can only be described as a state of  blind panic. Until yesterday I had presumed that the state of blind panic was down to a weak mind, an inability to control one’s fears when faced with them. I have a fear of heights yet know that if my life depended on it I would overcome my fear, I really don’t like daddy-long-legs or spiders yet will deal with them if I am alone in the house. I am scared of them but I would never describe it as a phobia. People tend to throw the word phobia around quite a lot but I can say hand on heart that my “fear” of dentists has now developed into a phobia. Yesterday I experienced a state of blind panic, where I couldn’t think clearly nor see the danger I could have potentially put myself in. I know now that it is nothing to do with self-control or a weakness of mind and I unreservedly apologise to those people I have doubted in the past.

As soon as the drill hit my tooth, I had immense pain (I know my pain threshold for dental procedures is considerably lower than my normal pain threshold) without thinking I grabbed the dentist’s drill and threw it out of my mouth. I immediately sat up and had the dentist not put his arm across my chest I believe I probably would have attempted to leave the room via the window opposite me. It all happened so quickly that there was no thinking involved, I just wanted the pain to stop and to leave the chair. The dentist was really freaked out but didn’t lose his cool with me. He did say “never do that again, it’s so dangerous, you could have really hurt yourself” in a very quiet voice. I apologised and then burst into tears, not my usual tears which are quiet and restrained but full on chest heaving sobs where I could barely speak. The dental nurse gently rubbed my arm and dried my eyes. I cried so much that the shoulders of the top I was wearing were wet. When I later looked at myself in the car on the way home, I resembled something like Alice Cooper with mascara all down my face.

I think at this point the dentist didn’t think I would allow him to continue but rational Rach walked back into the room. As long as I had adequate pain relief I would be able to continue. I had told him on 1st November that local anesthetic wears off quickly with me and he would only have a small window of opportunity to get the job done. I guess sometimes they don’t believe their patients and need to see it to believe it. I wish they would take what we say as the truth because if he had, I wouldn’t have had to go through that.

I often joke that it’s been a good appointment if the dentist still has all his fingers, I guess now the joke will be it’s been a good appointment if I haven’t grabbed the dentist’s drill or tried to escape the chair mid appointment.

The dentist was a little surprised when I could feel the third injection go in, that part of my gum should have been numb but it wasn’t and proved the point that the original injection for the second filling had worn off. He waited a few minutes before beginning work again. I told him before he started that I would sit on my right hand so that should the urge to grab the drill come over me I physically couldn’t. We agreed that should I feel anything I was to raise my left hand and he would stop. This was the system I had in place with my last dentist and it had worked well, although I have never had to sit on my hand before. But then I have never ripped a dentist’s drill from my mouth either.

After all that drama the second filling went off smoothly. I left the dentist’s without face planting but by the time I got home I needed to just crawl into bed. Today I feel the same but my back is so sore from having so many days in bed lately that I am hanging on for as long as possible before returning.

I don’t have to attend the dentist until March 2017 and that is to see the hygienist, my teeth still need cleaned. I am apprehensive about it as it seems all the nerves of my mouth are on the outer edges of my teeth. At least the anxiety of the dentist’s appointment and the recovery time needed after this little jaunt out have stopped me thinking about my trip to Bath. every cloud eh?

Could it be Postural Orthostatic Tachycardia Syndrome – PoTS?

I posted this in August last year. Due to having a crazy week (Insomnia/painsomnia)  and a dentist’s appointment today I find myself too exhausted to write a new blog post.

I had one of those moments this week when searching through the archives of my blog I realised that I had never done a straight forward, honest to goodness post about PoTS. I may have mentioned it in passing but there is no one post based solely on it. I know that many people use my blog to try to explain their medical conditions to friends and family, so I am sorry its not happened until now.

My own diagnosis has moved away from “just” PoTs (although that is still part of it) and is now called Severe Autonomic Nervous System Dysfunction, which as far as I can tell is just a long winded way to say Dysautonomia. Which isn’t a medical term that seems to have caught on in the UK. All it means is instead of just the basic PoTs stuff going on I have developed O.I (orthostatic intolerance – my blood pressure drops in to the toilet on standing), breathing difficulties which have been with me since the MG/ not MG diagnosis, bladder problems ( I get acute urinary retention on a regular basis), unable to maintain my body temperature just to name a few. This is a new and emerging area of medicine and many medics are yet to catch up on PoTS let alone Dysautonomia. Straight away please let me direct you to this website pots.uk.org so if you are currently battling to get a diagnosis you can print this guide for gp’s and take this with you at your next appointment.

The first symptom I developed was sweating heavily when sleeping, be it a nap or a proper night’s sleep. That was back in 2006 and which I now know is reactive hypoglycemia (blog post) from monitoring my blood glucose levels. Throughout my life I had been told I had low blood pressure (not a prerequisite for PoTS as people with all levels of blood pressure can have it), I had a lot of dizzy spells, odd cravings for salt, palpitations. I put my palpitations down to anxiety, as I had always been quite an anxious person. However once my anxiety issues had been dealt with and I learned how to combat them I continued to be left with a feeling of my heart wanting to beat out of my throat on random occasions. I would also on a regular basis get very lightheaded when changing from a sitting to standing position.

So many patients with PoTS are misdiagnosed as having anxiety, health anxiety or depression or other mental health labels before they eventually get diagnosed correctly that it is criminal. Unfortunately once you have had the mental health label attached by the medics it is a hard one to shake off. Even now when going into hospital as an emergency, I still get somatiform disorder brought up when it has been completely and utterly disproven. The problem is that to an uninformed doctor PoTS can sound very like anxiety, racing heart rate, tremors the feeling of adrenaline coursing through your body and an exaggerated flight or fight response. With the majority of PoTS patients also being women it can be even harder to be taken seriously. It seems the modern medical profession still believe in the condition hysteria.

By the time I discovered the little known condition of PoTS, like many I had been written off by the medical profession as overly anxious, internet searching for syndromes with probable somatiform disorder. It took me over a year of battling to finally get the test that would prove beyond all reasonable doubt I had PoTS. A medical condition at the time my old gp had told me didn’t exist. For more info on my experience of the Tilt Table Test please click here as I don’t want to bore you by repeating myself.

My main symptoms at the time of diagnosis were as follows

  1. palpitations
  2. feeling faint or fainting (aka pre-syncope and syncope. Please remember only about 30% of PoTS patients faint but many feel faint)
  3. feeling like an elephant was sat on my chest and not being able to breathe properly
  4. racing heart rate every time I changed position, even rolling over in bed.
  5. greying out, especially after eating.  (My peripheral vision greys out)
  6. Insomnia (BIG TIME)
  7. Dizziness
  8. Migraines and shockingly bad almost migraines
  9. Cognitive deficit (aka brain fog /aphasia/ short term/long term memory problems)
  10. Chest pain (too many times to mention I thought I was going to have a heart attack)
  11. Reduced sweating (some people start getting excessive sweating, I only get excessive sweating at night)
  12. Fatigue

This list probably doesn’t cover all my symptoms and unfortunately many PoTS symptoms also merge into EDS symptoms as in the gut problems and bladder problems that many of us with both conditions have. It can get very difficult to differentiate the two. For a full list of symptoms please click here.

So what can you do if you suspect you have PoTS?

I can only base this on how I went about getting my diagnosis but it is the same advice I give everyone who asks my advice. 

Firstly get hold of a decent blood pressure monitor especially one that can also take your pulse at the same time. Here is a list of blood pressure monitors that have been validated by the British Heart Foundation as accurate enough to monitor your blood pressure at home. If you can afford it get one with a memory so it records your readings so that you can’t be accused of making the numbers up. It is important to understand that blood pressure does not play an important part in getting a diagnosis. Some people with PoTS have normal blood pressure, some have low and others have high. Why you need the BP monitor is so that you can start tracking your pulse and your blood pressure. If you can’t afford a blood pressure monitor for whatever reason, a pulse oximeter ( a little device than can read your pulse by clipping onto your finger) is the next best thing and you can pick them up online from as little as £10. 

Please remember people with PoTS tend to have very cold fingers (and toes) so before using a pulse oximeter ensure your fingers are warm enough to provide an accurate reading. Before my second tilt table test (yes I was stupid enough to do it twice) I had to sit with my fingers in a bowl of warm water as the pulse ox couldn’t get a reading.

Secondly understand what PoTS is!

PoTs is a rise in your pulse / heart rate of at least 30 beats per min (bpm) or hitting 120bpm or over, within the first ten minutes of standing. In children (up to the age of 19) the rise needs to be over 40bpm. If your heart rate doesn’t increase by 30bpm or over 120bpm within the first ten minutes of standing it is unlikely to be PoTS. 

When a normal person goes from sitting to standing their pulse / heart rate will increase on average by 15-20bpm. Within a minute or so their heart rate will go back to normal. A person with PoTS could start with a baseline heart rate of 80bpm and on standing increase to at least 110bpm. Then as they continue to stand their pulse could increase further. I know on my own tilt table test my own heart rate increased to 150bpm, unfortunately I don’t know what my baseline measurement was. Usually my pulse is in the 80’s and if that was the case I certainly managed the increase of 30bpm and smashed the 120bpm threshold.

Because many people (but not all) with PoTS also seem to have low blood pressure that is why I recommend getting a monitor. It helps to see what your blood pressure and pulse are doing after specific triggers such as climbing the stairs, raising your hand above your head, eating – particularly carb loaded meals. Many people with PoTS find their symptoms are much worse after eating heavy carb meals, so it is recommended to eat high protein low carbohydrate meals which don’t cause postprandial symptoms.

Thirdly conduct your own poor man’s tilt table test.

You maybe wondering what on earth is a poor man’s tilt table test, that is ok I was left scratching my head after first hearing this term on a forum called DINET. Because none of us own our very own tilt table designed for testing people for PoTS amongst other things, we can replicate how we will respond to the actual test by completing the poor man’s tilt table test and some gp’s who are PoTS savvy will do this in their consulting room or at the very least conduct a standing test.

To conduct a poor man’s tilt table test, you need somewhere comfortable and relaxing to lie down, without interruptions and preferably away from harsh or natural light. A wall to stand against which is adjacent to the relaxing lie down area however if you don’t have this don’t worry you can still conduct the test. You also need your bp monitor / pulse ox and a handy sidekick to record your test results. Also your sidekick can rescue you should you faint whilst completing this test so please be careful and do not attempt to complete it without having someone with you. Please also ensure that the area is safe should you decide to face plant, so free from things you could hurt yourself on. Cushions or pillows on the floor can help prevent injury!

To start the test you need to lie down and relax, no talking, no interruptions for 20 minutes. If you can darken the room in anyway before starting the test do. At the end of the 20 minutes with as little movement as possible take your blood pressure and pulse readings. These are your base line readings and what you will use to compare against the reading you get during the test.

Once you have your baseline readings stand as quickly as you can placing your back against the wall. The wall just helps prevent you from moving, people with PoTS tend to be natural fidgets because we either faint or feel like we are going to faint. Moving keeps the blood flowing, we don’t want you to do that whilst you are standing up as it may mess up the results. If you don’t have a wall to prop yourself up against try and keep your legs as still as possible.

Then at 1 minute, 2 minutes, 5 minutes, 7 minutes and 10 minutes take readings of your blood pressure and pulse or get your trusty assistant to do it. After the ten minute reading has been taken, sit down get your legs elevated and have a drink of water. You may notice that your feet / legs have gone a nice shade of red or purple. Don’t be alarmed this is called blood pooling and is very common with PoTs.

Now take a look at your readings if it shows an increase of 30+ bpm / 120 bpm this is positive for PoTS. Do not despair if it doesn’t show PoTS one negative poor man’s tilt table test does not mean it’s not PoTS, it may just mean you weren’t particularly symptomatic that day. Try to complete the test on a day when your symptoms are more evident.

Other things that might show during a poor man’s tilt table test are things like orthostatic intolerance ( your blood pressure goes below 90/60 on standing), you may have also fainted, if so I am sorry. The blood pressure readings could also reveal if you suffer from hyper-PoTS, which is where you have high blood pressure and PoTS. This needs to be treated differently to “normal” PoTS as most doctors will avoid giving you medication that will increase your blood pressure.

If you can’t for whatever reason do the poor man’s tilt table test you could perhaps try what is known as the standing test. Instead of lying down you sit down for 5 to 10 minutes to get your baseline pulse and blood pressure readings and then stand for as long as you can. Taking your readings at the same intervals as the poor mans test. This can also show PoTS. Remember PoTS stands for postural (position) orthostatic, tachycardia (fast heart rate / pulse), Syndrome (collection of symptoms and no two patients are alike).

What to do next?

Print off the gp’s guide from http://www.potsuk.org/gp_guide and book an appointment with your gp or a doctor at the practice who has been the most supportive. Sometimes these aren’t necessarily the same. Whilst waiting for your appointment take a look (if you are in the UK) at the Doctors list on the same website. This will give you an idea of who you can ask to be referred to, not all cardiologists are knowledgeable in the area of PoTS so it makes sense to see an expert, rather than someone who will give you the run around. For international readers DINET also has a Physician’s list.

If you have a disappointing gp visit and they still will not listen to you even when provided with your own test results and the gp guide, do not give up. Try every doctor at the practice if you have to and if that doesn’t work contact the practice manager. If you get no joy after all of that try reaching out to one of the many UK facebook PoTS groups. They have members all over the country and they maybe able to help you find a new gp practice with more sympathetic gp’s who are aware of the condition. 

If you have a disappointing consultants visit because despite your request of being sent to a specific doctor who is knowledgeable about the condition and you didn’t get to see one, you have a right to ask for a second opinion and ask once again to see one of the doctors named on the potsuk.org website.

You will get there in the end!

Most doctors will not confirm a diagnosis of PoTS without conducting a Tilt Table Test, ECG and possibly 24 hour blood pressure / heart monitoring. I was diagnosed on my tilt table results alone possibly because from 2007-2011 I had so many other investigations conducted they decided nothing more was needed.

The good news is that many people recover from PoTS especially if they have primary PoTS. Primary PoTS is usually caused by pregnancy, a virus, trauma or prolonged bed rest. Astronauts suffer from PoTS when returning to the Earth’s atmosphere and when their bodies re-adjust to the Earth’s gravitational pull their symptoms disappear.

Teenagers who develop PoTS also have a high chance of growing out of it. Researchers believe that teenagers develop PoTS due to the hormonal changes and growth spurts they are subjected to. Patients like these tend to grow out of their symptoms by their mid- twenties.

Patients with secondary PoTS, so PoTS that has happened due to a primary condition such as cancer, autoimmune diseases (like M.S, Lupus, Sjogrens), Ehlers Danlos Syndrome can also look forward to on the whole having the condition managed through medication and lifestyle changes (exercise, increased fluids, salt, adequate rest).

However I would be remiss if I didn’t state that there are patients like me that have refractory PoTS (it doesn’t respond to medication) and go onto develop more issues relating to our autonomic nervous system. We are the minority though not the majority. I don’t want to scare anyone who has just started on this journey I just want to be truthful.

My symptoms now are pretty much the same as when I first started on this journey with PoTS / Dysautonomia. I still have Ptosis on and off which no one has ever been able to explain. I still have issues with my breathing, fatigue, syncope and pre-syncope. A good day means that my heart isn’t continually feeling like it is fighting out of my chest on every change in posture. A bad day means not being able to sit up in bed without feeling faint, my heart rate not dropping below 100bpm even at rest. 

With my combined conditions each day is very much different with a new set of symptoms to overcome. It is exhausting, it makes me angry, it makes me sad and quite a lot of the time it makes me laugh because my body is just so screwed up!

One last thing…..if you are diagnosed with any type of tachycardia, including PoTS and you hold a driving licence you must inform the DVLA. You can do that via this Link. You will also need to contact your car insurance providers.

Another great source of information is Stars another charity which helps people suffering with a variety of conditions including PoTS.

The Pain Game

I thought that I was well and truly done with the level of pain I have been experiencing for the past ten days. There has been no let up other than when I catch a break through falling asleep due to sheer exhaustion. It’s not a horrendous level of pain probably only a 6 or 7 out of 10 it is the fact that it is never-ending that is driving me to the brink.

My hips, knees and pelvis are all currently conspiring against me, each in competition with each other to see who can hurt me the most. When one eases off another goes in for the kill. I can’t actually remember ever having pain at this level for this amount of time. It’s a bone deep gnawing pain, not enough to make you cry out but enough to make you consider weeping if only you had the energy left.

I have racked my brain trying to work out what is behind this pain escalation. As my mobility is limited it’s not as if I have taken up hill walking or Zumba classes. I haven’t fallen or  done any Pilates (since the pain started) or sat in a way that would put stress on my joints. There hasn’t been a constant change in weather fronts (the weather plays a massive role in my pain intensity) or a  change in medication. There is nothing I can put my finger on that I can say “that did it”. Pain without a cause is frustrating, as how do you avoid it happening again? I don’t mind if I have done something that causes a few days of pain. I can live with that, it is when my body is punishing me for no apparent reason that I begin to despair. When will the pain end or as in my case when will the pain subside to a level that I am used to and I can cope with day in day out?

My vast quantities of pain medication are not working, which would normally be the case if I was suffering from nerve pain. This isn’t nerve pain as nerve pain has a completely different quality. Nerve pain or my nerve pain tends to be a burning, pins and needles pain. This is deep within my bones. My hips currently feel like they have been replaced with metal spikes and every movement or position is searingly uncomfortable. My knees to be fair aren’t too bad they are a dull ache only catching me out when I go upstairs, then the pain makes me squeak. My pelvis or to be more anatomically correct my iliac crests feel like someone has taken a hammer to them and my lower back is probably painful because my gait has been so badly thrown with everything else hurting.

I know the pain is bad at the moment as I am struggling to concentrate for more than a few minutes at a time. I am also waking every 2 hours, unable to keep comfortable when lying in bed. Sitting provides some relief for around an hour and then the pain comes roaring back. I could quite honestly weep I am so worn down with it all. I just don’t know how to get myself out of this pain game at the moment as I have explored all my usual tactics and nothing is working. Heat provides a small amount of relief until I become too hot, changing positions is fine as long as you aren’t trying to sleep but nothing brings relief for very long.

Remarkably so far it hasn’t brought my mood down too much yes I am fed up but not depressed, there is a world of difference between those two states. Whilst it would be perfectly understandable for a person with long-term chronic pain to have periods of depression I am just seriously naffed off.

I can’t believe that years ago I would manage to work whilst suffering this level of pain. I wonder if I have become more aware of pain or if it is just now that I am at home 24/7 that there just aren’t enough distractions. When you are running a department of 130 people and fighting battles to be treated with dignity there aren’t masses of opportunities to let the pain in. At that point even acknowledging the pain would have meant I would have lost the war. I did it all on massive doses of codeine and later oramorph when I developed bursitis in both hips and plantar fasciitis in both feet.

I am starting to think maybe on the pain front I gave up and now I am forever fighting to be back in control. To feel like you have given up is almost too much to bear. I still have doubts about my chariot (wheelchair) I blame myself for allowing myself to give in and use it when I should have pushed through. In reality I know that wasn’t a possibility. Not using the wheelchair would mean never experiencing the outside world again. Even if all I do is now get to look at people’s arses due to my eye line. I don’t know if it is the feeling of giving up or a feeling that I have failed as a human being. That I am no longer able but dis-abled.

The first part of this post was written in the midst of a massive pain flare up. Yesterday the pain settled, possibly due to a mega dose of B12. Some doctors would argue it was coincidental but I don’t think so. Why after so many days of pain would it settle 12 hours after the injections? Now however I am having a bad bout of insomnia. Chronic illness is so much fun you never know what will happen next. I was naffed off with the pain before but now I am seriously pissed off as tomorrow, well in fact now today, I am going out for a few hours with Jay (hubby) for the first time since August (2015). And yes you read that right.

Unfortunately insomnia before a big event and believe me leaving the house for a few hours when it’s not a medical appointment is a huge event, seems to send my adrenaline levels soaring. I become really twitchy and unable to settle. I have been trying to wind down since 7pm, now 6 hours ago. I have got up, I have watched TV, I have read, I have listened to the radio, I have meditated there is nothing I haven’t done to try to drift off. Yet sleep remains elusive. The good news is the pain really has settled it is the best it has been in months. I am just cross with myself that I didn’t recognise the signs of B12 deficiency, it is not as if I haven’t been down this road before. It’s just this time my left leg didn’t start burning.

The other bonus is of course I get to finish my blog post a day earlier than normal. I get to put it to bed, pun intended and do not have to worry about being too exhausted to complete it as I went out on a jolly.

I really hope at some point the sandman visits, otherwise Jay will have a grumpy Rachel to deal with whilst negotiating the city centre pushing me in my chariot.