In the interest of NOT FUCKING AROUND WITH THAT LIST

Pyridostigmine can have a nasty paradoxical effect: instead of making muscles work better, they can make them... stop working.

The heart is a muscle. So you know.

About 9:30am, took the med for the first time with a small amount of cheerios. Helps with the nausea. Which did kick in about 20-30mins later.

Now it's important to know that nausea is often "standalone" but *can* come with vagus nerve dysfunction, common in people with hEDS. Like me. That nausea is because the heart is actually having a problem. There's no way to tell immediately... I have to let it progress. Also, this is a very normal side effect. No big deal. GI issues are normal for the first 2-3 weeks. Bloating, followed by a minor adrenaline rush, was also pretty normal by 10:15. That adrenaline rush COULD be a reaction from bloodflow to the abdomen because of the pain, OR it could be... you guessed it, the heart freaking out.

I get dizzy when standing up *anyways,* often followed by more nausea and a brief sense of wanting to vomit. This is blood pressure adjusting. Normal for 20 years or so.

Wait. All of that together can't be good. Ever hear me harp on how when YOU'RE the one compromised, you don't always know? Right. When you figure it out, it might be later than sooner. Minutes count.

By 10:40, HR is 41 (half of my usual) and BP was 137/65. Fast arrhythmia. The lower heart rate goes, the higher blood pressure goes to compensate for it. This drug had not kicked in all the way yet. Which means it could get worse. oh shit. fuck. ... k. I can handle a lot of bad heart-related shit at home, but if it gets worse, I won't have time to call emergency services.

CPR actually only works about 12% of the time outside the hospital and I'm pretty sure it CANNOT work if you have med-induced muscle failure. Do not let yourself think that CPR is amazing and it's fine to be careless because CPR will save you. Pretend it won't and 88% of the time, you'll be right. What I'm saying is that even if someone with me HAD been trained, it literally would not fucking matter. 0% matters.

You know who can fix that? An ambulance. An ambulance can immediately assess you for stroke and seizure, which can happen with cardiac fuckery, put saline in you to hopefully dilute the drug and stabilize your BP, and do other stuff to keep you alive.

Not someone driving you to the hospital. Even if there is a second person in the car who can "check on you," what the fuck are they going to do. Functionally, what will they do. Nothing. That's what.

I called the specialist who prescribed it and told them I was going to the hospital. It's 20mins away at most, I could still likely drive well enough.

Then the adrenaline started to wear off and the slurring kicked in. Still mentally pretty capable, but physically losing it. Only in my face, though. I can drive with a numb face. It's practically muscle memory. I've spent years driving with migraines and painful auras. Had to.

Less than two miles from home, I felt the coolness of the adrenaline wearing off. ...... oh shit. I called 911, but while I was on the phone, I started slurring more and could feel my driving getting worse. Marginally but Enough, and I wasn't going to try it. I told them to meet me at a nearby parking lot a few blocks away, where I knew the business wouldn't tow my car (bonus perk.) By the time the paramedics arrived, I'd be there already.

I wrote the drug, dose, time taken, hEDS, and POTS on my wrist where they'd see it. Phone PIN on the other. My ICE (that's In Case of Emergency) number is my lock screen but my doctor's numbers are in my Contacts by specialty and name.

I compensate for losing control with extra caution, so parking wasn't actually difficult. I pulled up right after they did, but they were at the other end of the lot. I put my feet up on the dash and leaned the chair all the way back. This helps with blood flowing back to the heart. Wasn't sure if they'd be able to understand me once they got there. Would I pass out in that minute or so? It could happen without more than 2-3 seconds of warning.

This was extremely useful, as it turned out. When I was slow to recall things or couldn't say them because of the muscles going numb, I could still read/write and had already written it out. On my hands and wrists, where they'd put an ID bracelet.

One of the medics thought to turn off the hazard lights. Good man. I had completely forgotten. That happens as your brain loses oxygen.

I could still somewhat carry a conversation. What was normal for me, what wasn't. Left-sided face not responding; possible FAST mark, but normal for me post-TIA. When that happened, that it wasn't diagnosed as a TIA, described the cascade and after-effects (needing to re-learn writing, getting words wrong for over a year, my face never quite going back...)

I couldn't always get the drug name right. Pyroxi-dine? Pyramidox... Pyr... misti... gine? Good thing I wrote it while I could remember.

Third adrenaline wave was short, after I was checked in to the hospital. I was lucid, I felt FINE again. A little tired, but overall fine. Like I could just call it a day and get back to chores. (Remember: adrenaline waves LIE. What's in between is true.) I had a short problem with right-side leg shaking, which has happened a few times when pain gets really bad. I'm not on CNS depressants anymore so I'm more prone to localized seizures and other odd neuro stuff.

I could thank them and keep track of answers and not-joked about how ADHD + stress turns me into a hyper-organized, focused person. I'm really not that afraid. I called before that could happen this time. They can't help me either, if I let myself get worse... they don't deserve that.

Their info was relayed to the ER for me. They confirmed it, but if I hadn't been conscious anymore, it would have (probably) been fine.

By 1pm or so, I was finishing a bag of saline and a second round of bloodwork. Hospital standard, but also, helps me to see if maybe I have a deficiency that altered the medication (like anaemia or magnesium deficiency, which can cause localized seizures to amplify.)

My "improved" BP was 148/92, HR 65. ::sighs:: Not Great. BUT safer than forty-fucking-one.

I walked only some blocks to the bus, which I *just* caught and the very sweet bus driver let me take the one stop to the transit station without paying. Which was great because I had just one fare on me. It's all an app now and my phone died in the ER.

y'all guess who was at the transit center? the same fire rescue/paramedic team that picked me up. haaaa, cool.

Since they had a larger team loading up the person, I took a moment to thank them again and let them know that I'm fine. I was in bad shape some hours before, but full recovery. Having that drug info written on me helped. I wasn't overly cautious.

I hope this never happens to you.

I consider this event very "minor," but it was only "minor" because it could have been much worse. I've had a lot worse.