Batik

The Dry Eye Zone is an excellent website for anything to do with dry eye. It sounds to me like it might be a muscular problem, though. Do you have ME/CFS? That causes visual problems, partly muscular and partly neurological. You're having problems with accommodation. I remember mine being written up as "accommodative inertia", which always amused me. I'm not lazy, I just have accommodative inertia.

I should mention that I'm appreciating all these articles! Unfortunately I'm really brain-fogged at the moment, and my PDF viewer is playing up so that I'm finding it next to impossible to read PDF files at the moment. (Adobe Acrobat Reader - does anyone know what's up with that?) So I'm concentrating on the ones I can make sense of right now. The last one is interesting. The diagnostic criteria are a little different, I noticed: 35bpm rise instead of 30bpm, or above 115 instead of 120. Does it matter that it's about children? I'm nowhere near adolescent, being 35. How is it normal to interpret a TTT? Is it done purely on HR? If BP is part of it, at what level do they consider BP changes to be noteworthy? What about symptoms? They were writing mine down, although apparently they thought that if I mentioned a symptom near the start and not later on, that meant it stopped. Thankfully that came up in the discussion afterwards, so I could tell them that no, the visual symptoms persisted throughout the test, I just didn't want to be talking all the time.

To make it a bit clearer, my problem is that I didn't happen to get tachycardia during the TTT. I'm not entirely sure why. I don't get it every single time, and on this occasion I'd had an anti-nausea tablet about 7 hours earlier which I realised halfway through the test is also an anti-vertigo tablet. So when I talk to my GP or the cardiologist, assuming I even get a return appointment with the cardiologist, I will probably be told that I failed the TTT and there's no reason for me to continue seeing them. It'll be my job to convince them that the results warrant further investigations. I was moderately symptomatic, but so far they've been pretty uninterested in symptoms. In other words, "tachycardia causes narrow pulse pressure" probably won't be the best line to take, since I didn't get tachycardia that time. I don't think it helps that I was only allowed to lie down for 5 min before the test. My BP was only taken every five minutes, and apart from that and the HR monitoring, there was no other monitoring done. They just stood me up for 45 minutes and that was it. No nitroglycerine either.

Thanks for those. I read the first and skimmed the second (very fuzzy-headed today), and they seemed to be talking purely about high PP. Do you know of any sources on low PP? I've had high PP too, 90 was the highest I've recorded, but since I was the one recording it, it doesn't count. My GP has made it abundantly clear that my home BP readings don't count.

Can someone please find me a medical article on pulse pressure that I can print out and give to doctors? Something that makes it clear that having a pulse pressure of 8 is NOT normal, and explains why. Right now I almost never come across medical professionals who have even heard of PP, and earlier today I had a heart helpline nurse tell me that the reading of 94/86 during my TTT can't have happened, must have been an error, even when I pointed out that the previous reading had been 86/76. PP was the main sign that went wrong during my TTT, so it's the one I think I need to concentrate on.

I've not watched it, I find videos difficult. Is this one of the ultra-low-fat diets? There are very strong health concerns, and huge amounts of bad science on the MacDougall website. I'm saying this as someone who's been vegan my entire adult life, and always eaten a healthy whole foods diet. We need fat in our diet, it's an essential macronutrient.

How do you know he doesn't have CFS or ME, though? It's very common to have that together with POTS. Considering what a dangerous medical condition it is, this is something you'd want to find out.

I had the TTT yesterday, and I don't know how useful it will be. As per the cardiologist's instructions, I fasted from the evening before and ran myself into the ground, including exercising and repotting half my houseplants. The result was that the night before I was up half the night with pai and nausea, and eventually took an anti-nausea tablet at 3 am. I don't think I got more than 3 hours' sleep in total. I checked my HR on waking up and standing, and it went up about 40, then went down to a 30 rise and stayed there. I kept on getting dizzy and breathless while showering, dressing, or indeed moving at all, so I thought it would show up nicely for the TTT at 10.30. Nope. I think one problem was that they only let me lie down for 5 min. It takes way longer than that for my vitals to return to normal. Halfway through the test, I remembered that the anti-nausea tablet is also an anti-vertigo tablet (Buccastem, also known as prochlorperazine or Compazine). This is possibly why I just didn't get tachy. I had no idea how much my HR went up, but after a while it was pretty obvious that it wasn't jumping around, and when I said to the physiologist (who was a sweetie), "I'm not getting tachycardia, am I," she said, "No." Tachycardia is something I don't get every single time I stand up, but I do get it a fair amount. I've done a lot of poor man's TTTs at home. Half my usual symptoms were either missing or normal. Not much itchiness, mild visual disturbances but no blackout, no fainting, no tinnitus. What I did get was breathlessness on and off throughout the test, hands and feet got colder while my torso got very hot and sweaty, pain around the head and neck (not sure how much that was the angle of the pillow), and for the second half of the test I kept on going into convulsive jerking. I've occasionally had the convulsive jerking before. We don't know what it is or what's causing it, although it's been suggested that it's a vasovagal thing. I did get a chance to discuss that with the physiologist and stress that it wasn't shivering from cold, it's an entirely different thing. As for my BP, it was about 115/84 when I was lying down (my usual BP is 105/65), and then went down. Usually my BP goes up after standing, but they were only measuring every 5 min, so I'm guessing they missed the rise. The lowest was 86/76, although it varied between that and about 105/70, and the lowest in terms of pulse pressure was 94/86. Does any of this sound like enough to warrant further investigation? I'm really worried that I won't even get a return appointment with the cardiologist, let alone the referral to Prof Newton.

Thanks, that helps. The thing that worries me is that if I don't fit their criteria, and they've messed me around before in that respect, I won't get that referral and probably won't even get another consultation or any medical advice at all. I think I'll ring on Monday, ask to speak to a nurse, and ask about the monitoring, anyway. I rang the secretary of the specialist I'm trying to get referred on to and she said it sounds unlikely that they'd only check at 5 min intervals, maybe it's just a bad patient info leaflet. For instance, they need to know your highest and your lowest numbers, and for that they need continuous monitoring. She said maybe it means that they leave the monitoring on for later analysis, but check on it every five minutes during the test. I hope this doesn't mean that they leave me alone in the room while the test is going on! A lot can happen in five minutes, considering that some people's hearts stop during a TTT. The current plan is to put a couple of fleece blankets in my wheelchair bag. I really don't think shivering would help the staying still part of things. I suspect the itching I get on standing up will be the most annoying, and will make it the hardest not to wriggle. So I am definitely not stopping the antihistamines beforehand, although I've just taken the B12 out of my meds box for the next few days, as I think that's helping me a bit with things in general. I have booked my support worker, who normally comes in at lunchtime, to come in at 9 instead to get me showered, covered in calendula oil (helps the itching) and dressed. It should help wake me up at least, and hey, being tired from a shower should also help knock me out for the test.

I just spoke to the department. Not sounding terribly promising. The test lasts an hour, which I assume includes the lying down part and indeed quite a while to set everything up. I explained about being cold, and she said that they have blankets, but it sounds like they're the thin cotton hospital blankets which I find to be totally useless. Oh well, at least they're warned. She also read out the info about the test, and said that they check my BP and HR every five minutes. That rang an alarm bell. I thought they were meant to check it continuously? Possibly they check the HR continuously and the BP every five minutes? I know that Julia Newton has said somewhere that you need to do continuous fingertip monitoring for ME patients, and I'm wondering whether it's worth digging that out, printing it out and bringing it with me.

I saw the cardiologist today, and it went reasonably well, I think. The TTT has been booked for Tuesday at the Western General in Edinburgh. I've been told to stop salt on Sunday, take my meds as usual ("because I doubt they'll have an effect" - I didn't even try to go into possible mast cell stuff), and stop eating and drinking, I think 12 hours in advance. Any advice? Bear in mind that I definitely have severe ME/CFS, that I have a friend coming with, and that I don't mind pushing myself into a relapse if it means diagnosis and referral. Should I just run myself into the ground over the next four days? I messed up my Holter monitor by making myself so ill that I fell over before my HR could climb more than 26bpm, but am I right in thinking that the worse I am, the more it'll show things up? I could probably knock myself out reasonably well by exercise, and I'm not sleeping well at the moment anyway. Next problem: how do you stay warm during a TTT? I run cold with occasional hot flushes (they handed me a nice cool wad of wet paper when that happened today, it was surprisingly helpful), and I mean really cold. People are suggesting a loose cotton short-sleeved top and jogging bottoms over on the Facebook POTS group, and that sounds perfectly reasonable, but unless something surprising happens, that is likely to leave me shaking with cold. Today, for instance, I wore cord a strappy top, a long-sleeved cotton top, a lightweight sweater, a very heavy ankle-length cardigan, and a big scarf, plus cord trousers, two pairs of socks (one very thick), and heavy winter boots, and I still needed fingerless gloves. But then if I wrap myself up in lots of layers, can they get at me to put the equipment on? And what if I start overheating? Or will that actually help show up my symptoms for the test?

Hair mineral analysis is, erm, not regarded as reliable by the medical profession. I find it easiest to buy a metal water bottle and keep refilling that, by the way. Much better for the environment, tap water is better quality than bottled (OK, there are some areas where the tap water is vile, I'll grant you that), and you can put it in the dishwasher.

This is what I use to make my electrolyte drink, sometimes mixed with ordinary sea salt: Tesco Reduced Sodium Salt. 89p for 350g. I only recently realised that it provides twice as much potassium as sodium, despite having equal weights of the chloride salts, but it seems to suit me. I might go back to mixing it 50:50 with plain salt to change the ratio, but then I add plain salt to my food in abundance, so it probably evens out that way. I'd suggest that you start by simply salting water and seeing how a) you like the taste it makes you feel. Start with adding a pinch to a glassful and keep going. If you go for a water bottle, try something like 1/4tsp to 800ml or so and work up from there. I think a water bottle is easier, as you can give it a shake to mix and you tend to drink more that way. Mixing salt into a glass with a fork is a little odd. Some people like a splash of lemon in their salty water to improve the taste. If you can handle the taste of salty water, it's a much cheaper way to get your salt, and potassium too if you choose. The electrolyte tablets have much less potassium, probably not really a useful amount, and sometimes very small amounts of other minerals. If you try coconut water, that gives you plenty of potassium but almost no sodium, and costs a lot. I get the Vita Coco coconut water with pineapple (the plain tastes odd to me, and the other brands all have sugar or cost even more) from Tesco as an occasional treat. It was quite soothing when I had a cold with a sore throat the other week.

I'm thinking I'd be better having the TTT in Newcastle, assuming the referral goes well. If they want to do one here, would I be OK to ask something like, "I understand you need to keep the test going for longer to check for Neurally Mediated Hypotension, is that something you can diagnose?" I've printed out the STARS leaflet on POTS to give to the support worker who is coming with (I hugged her with relief when she told me. Of course, this means two or three days where I don't get washed or fed will be coming up in the next few weeks.) but I'm not planning to give it to the specialist. Under the "treatment" section, it just has CBT. I really, really don't want to get sent down the "it's all in your head, you just need to think the way we tell you" route. It does enough damage with ME patients already. *looks up Papworth* Cambridge? Ahahahahaha no. My memory is appalling due to the ME - remind me what happened with your TTTs?

Personally I simply put salt in my water bottle. I use low-sodium salt, so I get a mixture of sodium and potassium. I think I should probably go back to the mix that was half low-sodium salt, and half ordinary salt, as that's probably a better balance of sodium to potassium. Anyway, 1/2 tsp to a 800ml/27oz water bottle. Try something like that and see how you get on. Commercial electrolyte drinks are expensive, full of sugar or artificial sweetener, and generally have very little potassium in them, but they do work well for many people. As for salt loading, have you tried just adding more salt to your food? Do you crave salt?

I feel worse before and during my period, and I react badly to hormonal contraception. I haven't been on the combined pill as they flatly refuse due to my migraine history, but I've been on (and hated) a few progestogen-only forms. Is there a pattern here?

Thank you, that does give me some idea. Do you mean my weight and height, or my heart's measurements? I'm not quite sure what a heart film is either, do you mean an ECG? I am discovering that water without salt in it now tastes really weird and is strangely unsatisfying. I'm absolutely freezing now I've reduced the salt, and if I could manage stripping off enough to get the BP cuff onto my upper arm, I wonder what it would show.

I think I'll stop, it's not the end of the world and it won't mess me around as much as stopping the antihistamines does. What kinds of tests are you talking about? I assume he'll take my BR, HR, listen to my chest and so forth. Actually, what sort of physical exam is usual for a first cardiology appointment? I'm concerned about how much I'll have to undress, partly for personal reasons, partly because it's physically difficult and exhausting to undress and then I get nastily chilled.

Right now I drink electrolyte drink throughout the day. It's just potassium and sodium in water, and I feel a lot better when I do it. I also salt my food heavily. Is it worth stopping this a day or so before I see the cardiologist?

BP can change quite a lot from one minute to the other. You need to take a lot of readings over some time in order to see if there's a trend. Don't take the arms in the same order every time, that could affect the results too. Were you lying flat or on your side?

I wish I knew. My sleep's all over the place right now, what with horribly itchy skin and my antihistamines being changed all the time. Whatever you do, do NOT drive if you're this short of sleep.

Yes, a lot of people don't realise how serious ME is. Considering that it's one of the most disabling medical conditions in existence, and that it knocks twenty years off your life expectancy, this is something of a problem. I'm hunting for that leaflet you mentioned, but so far all I've found is a PDF file which isn't displaying properly. Do you have any links you could recommend? Thanks.

Ask your gynaecologist?

I'm finally getting to see a local cardiologist on Thursday next week. He's a general cardiologist, not an electro-physiologist, and quite frankly I'm lucky to be seeing anyone at all, considering that some other random cardiologist cancelled my first referral, without telling me, based on the results of my 24 hour ECG (Holter monitor). The woman from the complaints department who got me the appointment (I had to go through her as they'd been messing me around with the waiting list) said that she's spoken to him and he's aware of POTS. Before anything else, please remember that this is in Scotland, on the NHS. If you're in America, don't assume that our medical system works the same way as yours. Also the main point of this visit is not to get a POTS diagnosis necessarily, but to get referred to Professor Julia Newton in Newcastle, who is an expert in both POTS and ME/CFS. Unfortunately, Scottish referral rules mean that I can't just be referred to a specialist outwith my area by my GP, I have to be referred by a specialist. If I turn out not to have POTS but some other form of dysautonomia, she's the one to see. I've got severe ME/CFS, Auditory Processing Disorder, memory/concentration problems, and will be generally exhausted and have trouble remembering what to say. So I'll be turning up with notes, which doctors don't tend to warm to, but it's better than forgetting everything. I'll be coming with a friend, who will push the wheelchair and take notes. I need to find some info on POTS to show her beforehand too. Problem 1 is this wretched 24 hour ECG. I think I may have a mast cell problem, but no one around here has heard of it let alone can tell me how it will affect tests, so I went off my antihistamines in advance, and also stopped eating salt that day and was less careful than usual about meal timing and avoiding sugar. The result was that my resting heart rate was much higher than usual, 90 instead of the usual 60s, with lots of heart thudding that day, and when I stood up, not long after a nap, I lasted two minutes before blacking out and falling over. At that point my HR had gone up by 26. Whoever looked through my test had just been told "30 bpm rise", not the full "within ten minutes and from lying to standing", so didn't realise that a) it was from sitting to standing, and I would no doubt have gone up higher than 26 bpm if I'd managed to stay on my feet, and c) blacking out and falling over is a sign of problems in this area. I've taken plenty of readings at home, and while my HR doesn't always go up by 30 within ten min, or takes a bit longer to do so, it does so on a regular basis. A lot of those tests are from sitting to standing through necessity, and I am incapable of staying completely still when I stand up (if nothing else, the itching that starts up a few minutes in makes it impossible to stay still), so that's probably affecting the test. Plus I never even try to do the test on days when I feel really bad, it's not possibly for me to manage all the getting out of bed and faffing around with BP monitors. I don't know if a cardiologist will be interested in my home readings. My GP wasn't, when she was telling me about how I hadn't shown up as POTS on that test. I'm also worried this will turn into an argument about how to diagnose POTS! So my first question: is there a short, simple handout I can print out which explains about POTS, and makes it clear that it is *not* something you can simply rule out by seeing how much someone's HR goes up from sitting to standing within two minutes. Nor do I want them thinking it's something you can test by merely taking my HR when I'm sitting down and then immediately after standing. As for TTTs, I'm nervous about having that done locally, since they're not POTS experts, so I'm not sure what to do if they offer that. Next, advice about bringing in home readings? When I wrote to Prof Newton, I included the following: ---------------------------------- Here is what is more typical for me, using a blood pressure monitor recommended by the British Heart Foundation. Lying down - heart rate usually in 60s, sometimes 50s or 70s. Sitting - heart rate usually 70s, sometimes 60s or 80s. Standing - anywhere up to 120s. Heart rate changes from lying to standing, various times in the morning, not standing up for long: 11 Feb - 63 to 101 17 Feb - 55 to 95 21 Feb - 62 to 96 8 March - 63 to 103 9 March - 64 to 98 10 March - 67 to 101 When I've managed to stay more or less upright for longer (not this week, as I'm getting a lot of pain in my feet at the moment), it's dropped a bit after that, and then taken anywhere from 2 to 15 min to rise again, although sometimes it's just steadily risen, sometimes going up to 123 or so. My blood pressure usually goes all over the place after I stand up, e.g. from 109/62 to 142/116 at 4 min and then down again. Usually my pulse pressure goes both up (e.g. to about 132/70) and down (e.g. to 90/75) after standing. I also tend to get quite low blood pressure, sometimes down to 75/40, though I've had higher readings such as 167/103 and 152/62. This is all since going on the antihistamines and some of it since going on the other meds - it was worse before this, but I wasn't monitoring it. I've had quite a lot of collapses, numerous blackouts or whiteouts, and a few times where I think I actually lost consciousness during a fall. --------------------------------------- I decided that was better than waving graphs about or indundating them with data. Should I just print that out to show the cardiologist? Next question: which symptoms do I mention? The problem is that I have umpteen symptoms due to the ME, and indeed umpteen diagnoses by now. A lot of doctors glaze over when they have an ME patient and wave off everything as "it's probably just the ME". Some of my symptoms will be relevant to POTS, some won't. And do I mention the possibility of EDS, including a cousin who has it (and who also has POTS)? Actually, by this point it's probably easier to just copy in the whole letter I wrote, especially since I have my support worker due in a few minutes. --------------------------------------- Dear Professor Newton, I am writing to you about the referral my GP, Dr [name], has been trying to organise on my behalf. I understand that you have communicated with her about the 24 hour ECG I had three months ago, and told her that in your opinion it does not look like POTS. Unfortunately, I was not told the results of the ECG until a few days ago. It wasn't at all typical for me. Dr [name] said that my resting heart rate on that day was 90, so that when it went up to 116 before I collapsed, this was less than the 30bpm rise necessary to suggest POTS. (Although isn't that meant to be from lying down to standing? I was going from sitting to standing, quite slowly in order to reduce dizziness, as I'd just woken up from a nap with my heart pounding and feeling overheated.) As well as all the times my heart rate has been checked by doctors or nurses, I've been keeping an eye on my heart rate for a while now, and my heart rate when I'm lying down is mostly in the 60s, though occasionally 50s or 70s. The other issue is that I can't stand up for long at all, and when I do stand, I have to lean against something, move around and clench my leg muscles in order to keep upright, right from the start. On the day of the ECG, I blacked out and fell over after two minutes of standing propped up. Judging from other times, my heart rate would have continued to rise if I'd been able to stay on my feet. This mix-up is possibly my fault! I've been experiencing these symptoms particularly markedly for a year now, since I had gallbladder surgery, and since the referral process takes a long time, I've been put on quite a bit of medication by now. I was put on two antihistamines (cetirizine and alimemazine) for the dermographism in August. A few months later I had a particularly bad episode one day after lunch. As well as the symptoms I frequently experience from standing up or eating - dizziness, heart racing, breathing problems, pouring with sweat, feeling hot, painful cold extremities, tinnitus, nausea, abdominal pain, itching, flushing, swelling, shaking, blacking out (not all of them every time, of course) - I also developed a rash over my upper body, and the itching was more severe and went on for days. I don't have any food allergies. So at that point I was put on cimetidine, and recently omeprazole was added for stomach pain. Anyway, I noticed that these symptoms, including problems I get all the time with temperature fluctuation, vulvodynia, dizziness, GI problems, nausea and the like, were markedly improved on these medications. Nowhere near gone, but enough of an improvement to notice, and my heart rate and blood pressure were also varying less. No one was able to discuss why this might be with me, and I didn't want the meds to mask my symptoms for the ECG, so I went off them beforehand. I also didn't get as much salt as usual, and was a bit less careful about eating - lunch was an hour late and I had a sweet dessert. I honestly didn't mean to mess things up. I'd noticed that my heart was thudding a lot that day, but hadn't realised it was going that fast, and chalked it up to being exhausted from the effort of going to the hospital, as I am almost entirely housebound from the ME and have problems with sensory overload in busy places. Here is what is more typical for me, using a blood pressure monitor recommended by the British Heart Foundation. Lying down - heart rate usually in 60s, sometimes 50s or 70s. Sitting - heart rate usually 70s, sometimes 60s or 80s. Standing - anywhere up to 120s. Heart rate changes from lying to standing, various times in the morning, not standing up for long: 11 Feb - 63 to 101 17 Feb - 55 to 95 21 Feb - 62 to 96 8 March - 63 to 103 9 March - 64 to 98 10 March - 67 to 101 When I've managed to stay more or less upright for longer (not this week, as I'm getting a lot of pain in my feet at the moment), it's dropped a bit after that, and then taken anywhere from 2 to 15 min to rise again, although sometimes it's just steadily risen, sometimes going up to 123 or so. My blood pressure usually goes all over the place after I stand up, e.g. from 109/62 to 142/116 at 4 min and then down again. Usually my pulse pressure goes both up (e.g. to about 132/70) and down (e.g. to 90/75) after standing. I also tend to get quite low blood pressure, sometimes down to 75/40, though I've had higher readings such as 167/103 and 152/62. This is all since going on the antihistamines and some of it since going on the other meds - it was worse before this, but I wasn't monitoring it. I've had quite a lot of collapses, numerous blackouts or whiteouts, and a few times where I think I actually lost consciousness during a fall. There's also a family history of dysautonomia, for instance my cousin who has EDS and tachycardia. My GP has diagnosed me with fibromyalgia, and I have assorted tendon and joint problems too, possible slight hypermobility, but I've not seen a rheumatologist yet. Also random things like not responding properly to local anaesthetic, flat feet, and eye problems, which I hear may be related. Some friends have suggested that I might have a mast cell problem, especially since I have an increasing number of small brown markings over my upper body, and I've wondered about that myself, particularly since I've been diagnosed with dermographism, interstitial cystitis and so forth, and am reacting strongly to the antihistamines and H2 blockers. At the moment it feels like I'm still not getting anywhere with referrals, particularly after the strange results of this ECG, which do not appear to reflect my regular monitoring. It feels like with the particular mix of symptoms going on, no one around here can work out what to do with me. For instance, the antihistamines have almost entirely stopped the vulvodynia, and my gynaecologist is very happy about this but has no idea why it's happening. I've been taken to A&E after collapsing several times by now, and they just don't know what to do with me. I understand that your range of expertise covers many of these fields, and therefore I would really appreciate being able to attend your clinic. As I'm in Scotland, the referral to your clinic has to be done by a specialist and not a GP. I've had ME for sixteen years now, the diagnosis was long ago, and I'm not under the care of a local ME clinic at this time, so my GP seems to think that this will not be a viable path for getting referred to your clinic. My GP is now talking about trying to refer me to somewhere because of the collapsing, but the nearest Falls and Syncope clinic is your clinic. Do you think it would be useful for the referral process to do a longer ECG, with advice on how to handle medication that affects my heart rate, or an event monitor? Are there any other tests you can recommend to assess my blood pressure and heart rate, or indeed anything else, that would more accurately reflect what's happening? They haven't run a 24 hour blood pressure test on me yet. We weren't sure whether it would show up anything useful, as the changes I experience in blood pressure are relatively rapid. Is there anything else you can think of which would get this moving again? Kind regards [my name] ---------------------------------------------- Which bits of that should I mention when I go to the cardiologist? I usually make two copies of my notes, one in large print for me to refer to (and even so, my eyes skip a lot, it's best to keep it simple), and one in normal print for the doctor to read (and if there's too much, they won't bother). And in case anyone is confused, no, I will not be writing to this cardiologist, I will be having a consultation with him, which I will be bringing notes to.

I felt horrific on it, and it took me three days to realise what was causing it. This was largely because it made me too out of it to think straight. I was jittery to the level where I felt I was jumping out of my skin, I couldn't lie down comfortably, my body was twitching, I couldn't even watch a single episode of something basic on TV because I'd only last 10 or 20 minutes. It doesn't sound that bad but it was horrendous. I'm not even sure I could manage a basic conversation at the time. So if you do take it, and let's face it, all meds have potential side effects, start with a low dose and get someone to keep an eye on you.