Psych Nurse Likely Saved My Life... long...

[laramiejane]

I thought you guys might like to know about how your colleagues (or maybe even one of you!) made a huge difference, and from what I've been told, likely saved my life.

I was not doing well emotionally, and had a lot of things going on in my life. Was married to a foreign medical graduate, marriage not going well, he had accepted a residency 1000 miles away from my home (it was the closest one he got matched into). He had moved up there to get settled, then I was to follow. My mother and grandmother weren't doing well, and I was hesitant to leave them as they'd both been in and out of the hospital over that year. I wasn't sleeping well and was very anxious. My doctor prescribed very liberal amounts of Xanax and Ambien, feeling that it was stress.

Things came to a head when I called him and a woman answered. We had a huge fight over the phone, and I couldn't sleep that night despite taking my entire allotment of Xanax and Ambien for the day at once. So I decided, stupidly, that if the medication wasn't working that I should quit it. I'd been on it about three months, with the Xanax built up to 4 mg a day. I flushed all my meds down the toilet. I thought about withdrawal to some degree, but I was stupid and didn't think three months would be long enough to become dependent. Besides, I was only prescribed half a tablet 4 times a day, that's not enough to cause a problem... (2 mg tablets). Stupid, stupid me.

Fast forward four days.

I'd progressed from anxious enough to scare my neighbor (friend I'd known for about 10 years) to blatantly psychotic. I hadn't slept at all. My memory isn't the best of this time. My friend called my mom, she took me to the ER. Was given the standard 10 and 2, and admitted to the psych ward. The shot did the trick and got me some sleep, and I woke up much more clear.

I couldn't understand why no one would let me call my husband, though, or answer me when I asked if he had been informed I was in the hospital. When my mom visited I told her about them not letting me call him. It took a copy of my marriage license and my durable power of attorney for health care naming him as my health care proxy to get them to believe that a girl from a small town in a small state was married to a foreign doctor working over 1000 miles away. Looking back I laugh, I guess I can understand. Truth is stranger than delusion sometimes.

Now here's where it doesn't get so funny...

After an interview with my mother, who mentioned that we had two schizophrenics in my family, and given my age and the fact I was admitted in severe psychosis, it was presumed that I was schizophrenic. Besides, the 10 and 2 worked, right? So I was placed on PO Haldol. I hadn't eaten much over that week, and the hospital food was very greasy to me. I vomited after every meal, and after every episode of vomiting was given IM Phenergan.

I wasn't thinking as clearly as I had that first morning. After three days all I knew was that I hurt all over, my back and neck were clenched up, I wasn't moving all that well, they thought I was schizophrenic, and I was on antipsychotics. Despite my stupidity about trying to come off of Xanax cold turkey, I had worked as a CNA for about a year in an RCF for mentally ill adults, and knew that muscle problems from antipsychotics could be helped with Cogentin. I recall saying "I'm having a reaction, I hurt all over, I need Cogentin" to the doctor that morning.

No change in regimen. Nor routine. Got sick on breakfast, IM Phenergan, PO Haldol, sick lunch, another shot. My mom and a friend came to visit. I was having a very difficult time talking, I couldn't make my tongue work like it should, and my jaw ached.

I was hurting so bad and not able to walk right, so I went to bed after they left and tried to sleep. Apparently I didn't come out to dinner so a nurse came to check on me. I remember laying there, crying, when she came up to check on me and asked me how I was doing. At that point my jaw was clenched, I couldn't answer. She felt my neck, shoulders, tried to bend my legs, they wouldn't bend. I remember her RUNNING from the room, and then it seemed like everything happened at once.

When I looked at my records, that nurse found me with a 103 fever, lead-pipe rigidity, sweating, drooling, and crying.

I'm sure you can guess the dx from that. Yep, NMS, I was transferred out of psych to ICU, all antipsychotics discontinued, given lots of other medications, and my mother was told that (since it was still presumed I was an emerging schizophrenic) it might be very difficult to treat me at all for my condition if I reacted that way. She filed disability papers that day for me.

But oddly enough, while in the ICU after they got me physically better, my mind cleared up completely. No more psychosis. The doctor then received my chart from my regular doctor, saw the amount of Xanax I'd been on, realized the benzos in the treatment they'd used for the NMS had cleared me up, and helped me taper off of it.

It's been seven years now, and no more psychosis. After I was tapered down from the Xanax, no more benzos. Ditched the husband (that helped reduce my stress level a lot, after the cheating thing wasn't a one time issue). Feel a lot better. I'm grateful to the doctor for helping me get off of the Xanax even if I am a little POed about the whole "delusions of grandeur" comment...

But considering what I've read about NMS, it was that nurse who saved my life.

Just wanted to share my story and thank you, all of you, who deal with people like I was and help them. And I hope you guys can laugh with me, too, about the whole thing about people not believing I was married. Looking back at that I don't know if I'd have believed me either!

[wonderbee, BSN, RN]

My but you have been through a lot! A good H&P is essential to the right treatment for the right disorder. Unfortunately, there are no labs or x-rays or anything like that to rely upon when diagnosing which makes it as much an art as a science. Maybe more on the art side. Your bout with NMS gives a strong argument for cogentin.

Thank you for posting and good work on ditching the husband. It was hard, I'm sure but it sounds like you came out the better for it.

[laramiejane]

Yeah, and that's the trouble.... when a patient is actively psychotic you can't get a good history. Haldol isn't the evil medication a lot of people say it is, it has a purpose and it serves it. Just like anything there can be complications. From what I read it was more likely the combination of Haldol and Phenergan, along with me being very dehydrated. Also, along with the two schizophrenics in our family we have several people with other dopamine disorders -- Parkinsons and parkisonian-like conditions are prevalent on my maternal grandfather's side (a bit inbred). I may have been naturally sensitive to the meds, but no way to know that!

Looking at the charts the doctor wrote for Cogentin PRN for EPSE and had that as a standing order on admission, but I was fairly withdrawn on the ward, they had me in the most secure/high risk unit in the facility, and I didn't seek out attention, I just couldn't hold down food. From what I read on the Internet after learning what happened, the Cogentin wouldn't necessarily have prevented the NMS (just may have made me more comfortable before it hit), and my vitals had been pretty stable, except a slight fever, for the previous 24 hours. Things like that happen, and there's nothing that can be done except to be watchful and catch it as early as possible. Someone did exactly that and I owe that nurse a great deal.

That's why I posted to share what happened. I also hadn't seen the complaint of severe muscle pain much in discussions about EPSE. It was unlike anything I've ever experienced.

As for me... it was a scary time but things worked out. I was not about to fail to follow up with psychiatrists after that, just to make sure everything was truly all right. There *is* schizophrenia in our family, I was psychotic, and I was not about to risk getting that bad again. I didn't need disability after all. I was medicated with different things for about six months, then was tapered down without problems. It took me three years before I threw out the emergency bottle of thiothixene that the doctor prescribed before I started tapering down, though. I have a full summary of what happened attached to my new Durable Power of Attorney in case it's ever needed. When I was discharged from the follow-up doctor's care, it was listed as Brief Reactive Disorder, and a notation of benzo withdrawal.

Life is good, I have a good job, a good man, a good cat. All is well that ends well.