Long day in the emergency room

So I had to go to the University of Kentucky emergency department today.

I felt fine this morning, drove to work with no problem, blood sugar was normal, everything was fine. I got to the stadium lot and felt fuzzy in my head, and when I tried walking I was uncoordinated and listed to the side. I was carrying a small orchid and nearly dropped it repeatedly, even jerking at one point without meaning too, like those jerks you have when you're falling asleep, but I wasn't.

It continued when I went into work, and I nearly fell over, even with the cane, several times. Once I got to work I dropped an open drink twice on my keyboard (good I have an overlay), I was still fuzzy, and really slow in making the computer work. I went down to the employee health nurse. My blood pressure has been all over the place today, first high with her, then at one point really low. She got me in a wheelchair and she and my supervisor took me over to UK's ED, because some of my symptoms matched a TIA like I had in July.

So after the CT and EKG and other tests, there was no sign of a TIA (although they don't necessarily do that, being transient, after all). I spent a lot of time sitting and lying in bed and the fuzziness finally cleared for the most part. I'm dehydrated, but I wasn't enough to get fluids. I have orthostatic hypotension, but I'd figured that out some time ago (I am a medical librarian, after all, and I once knew someone who had it and they were the same symptoms, such as getting dizzy when standing up). But this wasn't really that...I was a little dizzy in the beginning but it was more unsteady, groggy, disoriented, that sort of thing.

Last night between 9 and 10 PM I'd taken a small dose, smaller than usual, of a muscle relaxant, tinzanidine. I've used it occasionally for years for neck and back spasms. I usually take 14 mg, again, PRN, just as needed, but I just took 8, thank goodness. It was over 12 hours by the time I went to the ED since I'd taken the medicine, which usually is short-lived.

I was still having unsteadiness almost 24 hours afterwards. My brain's just not in the same fuzzy mode it was before. Now (11:30 PM) I feel tired and overly-wrung out.

The doctor thinks I may have a hypersensitivity or allergy to tizanidine and I shouldn't take it, but she never said it definitely caused the symptoms today. I also found in my own research that despite having a relatively short half-life, it is heavily metabolised by the liver, and since I have fatty liver disease, I wonder if that affected things.

The nurse brought me home (thank you Kathryn) just before 5 PM, and I went straight to bed for a rest. She's going to come get me in the morning as my car is at the stadium.

So it was a big maybe on what all happened, but I'm just hoping I'm back to my normal self tomorrow.

UPDATE: Thinking back through things, I find it interesting that I didn't have symptoms for about two hours when I woke up, before I to to work. If it were some strange carryover from the tizanidine, you would expect me to be impaired from the moment I woke up. The only reason I even thought of the tizanidine was before I also had some, and the last time I had some, the night before my TIA in July, (and none of them thought it should be it either time, as it does clear fairly quickly out of the body, but it seemed oddly beyond coincidental not to mention). All the symptoms I had today were symptoms I had that morning in July as well.

It also reminded me of a time I went to another hospital for weakness on one side, headache, and chest pains. They decided it was a hemiplegic migraine with a panic attack because nothing showed up on the scans. But I'm beginning to wonder if that was also a transient ischemic issue as well. The chest pains may have been a panic attack, I do get them. I rarely get migraines, but I have not had a hemiplegic migraine, either before or since.

I think I'm going to talk to my PCP. In addition to being an expert with decades of experience in internal medicine, he has worked in both neurology and emergency medicine. He's also Canadian, and so maybe the training he received might give him another perspective.

Today I:

1. Got pooped on by a bird within 30 seconds of exiting my front door, on a day where I was happy with my outfit and thought I looked nice. Fortunately, I was in a thin but long-sleeved shirt, so I didn't get any on me.  I walked back into the house, went to the front entry closet, where my clothes are kept (left over from when I was living in the living room), and changed shirts, although things didn't match quite as well.  Everyone I've told the story to has told me that it's supposed to be lucky.  I'm not sure how.
2. On the other hand, I went to take my medicine at the beginning of work and realised that one of the pills looked off, and in fact looked a lot like something I took last night. I pulled out a magnifier I keep with me to look at the imprint, put it and the shape and colour into the drugs.com database, and it wound up being tizanidine.  They're pretty mild, really.  Each tablet is only 4 mg and you normally take three at night, but they can make me loopy.  So I'm glad I caught it.  I went through the other bins of the pill reminder box and there was one more.  I'm not sure if I consolidated some other medicine and accidentally put tizanidine into a similar bottle, then put them in the reminder box, or what.  I think that's what happened, anyway.  To be honest, I'm not sure what small white pill I accidentally substituted it for; I think it was my furosemide (Lasix, or diuretic).   Thankfully, tizanidine (also known as Flexeril) has a scored side where you can divide it into fourths, and that's what clued me in because I noticed it last night when I took them. I guess that was lucky.  Oh,  wait, we're back to the bird poop.
3. After work (which was steady) I went and picked YKWIA from our friend's house, took him home, let him rest for a bit, then went on a major grocery run on my own.  It took an hour and a half.  I got everything on the list except wine.  I got to the liquor store that's attached to Kroger just at 10.  I asked the security guard if they were closed, and he said they were.  I asked when they closed, and he says, 'They're closed now.' Well, gee.  I got that part.  So I ask, when do they normally close so I know next time.  Nine? Ten?  It was ten--so technically I came up at 9:59, but oh, well, we'll have to get wine to cook with tomorrow instead.  Most of it was fresh produce, dairy, beans, that sort of thing.  YKWIA pretty much never cooks out of a box--it's all real food.
4. I came home, he helped me bring things in, and he put them away and I did a few small things to help.  Now I'm going to go plotz on the bed.

PS I started the manual update to the April 2018 Windows Update before I left.  It's still in the downloading phase, at 18%.  This may be an all-night sort of thing.  Okay, again, time to just collapse on the bed, listen to music and pretend my back still likes me.  Oh, and maybe take a couple of those tizanidine pills. :)

PS

The kitchen can wait until tomorrow to be mopped.  I waited until after dinner since invariably some vegetable winds up on the floor (and the dogs aren't particularly into vegetables), but I'm too tired after helping prepare the salad and some other chopping, along with the cleanup afterwards.  My back is hurting quite a bit today, and so the bending to unload and load the dishwasher and then to stand and do the rest of the dishes was painful.  YKWIA did most of the cooking, and it was an excellent meal (a frittata, cream of asparagus soup, and an arugula, radicchio, shallot, and fennel salad with balsamic vinegarette with garlic dressing).  We didn't even need to get into the bread.  I've taken my nightly medicine, and I added some tizanidine, which I use occasionally on orders of my doctor, when my muscles are in spasm, as it relaxes them.  It's a tiny dose, just 12 mg (three 4 mg tablets at bedtime).  I'm also thinking of using the heating pad for a little while.  I did finish all my other tasks for the day, including my laundry. Yesterday I did his, today mine, and tomorrow I'll do the dog blankets and bath mat.

Okay, I'm going to get on that heating pad and listen to some music. I already feel a little fuzzy.  These are not things I can take and drive, for example.  Usually, I go straight to bed, and they don't make me groggy in the morning, really.  I usually wake up before my alarm.  But I stayed up once and it was a weird feeling, where I wasn't coordinated and slightly drunk.  So I use them very sparingly.

Note to self

Normally I take the tizanidine (Zanalfex) right before I go to bed. Tonight, like last night, I was having spasms so bad that at one point this evening that I gasped out oud. So I went ahead and took the pills, along with Tylenol Arthritis and menthol muscle rub. It's barely touched it all day. So I took the medicine, which is a muscle relaxer, as soon as I got home fro the day.

That was two and a half hours ago. Apparently that is my 'normal' window. After that I begin to list to the side, nod off, and I can't type a sentence without a LOT of typos. Plus, words seem to be fleeing me. Time for bed, I think. I'm no good like this. Good night.