Third's the charm

I waited at UCLA Westwood for hours, and it never felt like I was getting closer to the front of the line. Understandably they had higher priority patients. Much of the ER staff vanished up to the helipads to bring in trauma patients.

So we went to Century City Doctor's Hospital. I checked at it was Dr. Asshole on duty, so we picked up and headed for UCLA Santa Monica. New ER, twice the number of beds of the old ER.

Got through triage in a snap, and got attention fairly quickly. But they started me off with morphine, which didn't hit the headache that well. By the time all was said and done I had 8+mg of dilaudid, two doses of Benadryl, one of Toradol, and an anti-emetic whose name I didn't catch.

Broke the migraine too, nice and solidly. It's over 24 hours since I decided I had to go in, and I'm only having a slight headache right now.

I have to give their ER the thumbs up. Clean, and all the staff was very nice and attentive--a screaming baby was put next to me and they moved me as soon as they noticed.

The completist in me feels I should have tried St John's Hospital, but the rest of me is quite okay with not knowing everything about every hospital within a few miles of my home.

Google backs me up on it. Magnesium is making my stomach miserable. I emailed my GP about it--even though I was taking it with food and topping it off with yoghurt I was ending up with an aching stomach and a feeling of fullness that lasted hours.

He suggested I lower the dose, but I can't do that with these pills, or stop altogether.

I'm thinking I'll stop because I wasn't noticing any positive changes to the migraines anyway.

That was the week that was

And I'm focussing hard on the past tense of that title.

Monday I go to my GP, fill out my prescriptions, and come home instead of my normal sociable Monday evening.

Tuesday I leave work before 11am because I need to come home and lie down--the pain is bad enough that I'm having difficulty keeping my eyes open. Some time and two Percocet later I grab a ride to the ER. I like to try and hold out, but this puppy isn't going anywhere and I can't do anything.

Push comes to shove, I have a could-be-worse ER visit with an asshole doctor, which requires me to sneak out the back door. The pain was startlingly bad, but I need to get home for a number of reasons, even before you get to my typical anxiety attack.

Wednesday is not great. Wednesday is the sort of day that would send me to the ER. Except so was Tuesday. I bite down and pretend to be useful and don't seek medical attention. I do get to test the injectable Imitrex, which worked for at least a while. I inform my GP who suggests sticking with injectable, and perhaps stronger narcotics.

Thursday kicks my ass. No point going in to work. I make the decision to lie back down and sleep till almost noon. I end up taking too many painkillers for my liver's health, but we're both still here so it worked out.

But that was a lot of pain. Each of those three days would have recalibrated my 1-10 pain scale all by their lonesome. Together? We're talking post-concussive-syndrome level of pain.

Not sure what I did to provoke that.

But today is Friday. The pain was bad, but not staggeringly so. In fact, the first headache didn't come on until about an hour after I woke up, which is just like a vacation.

And tomorrow is Saturday: my acupuncturist is back in town. I'm hoping he can break the cycle that the ER failed to. Otherwise I'm shackled all too tightly.

It's never a good sign when your doctor uses the phrase "uncharted territory."

Ah, well. He was talking about the supplements.

I've been on the riboflavin like clockwork, and have fallen behind on the Mg. I'm taking recourse in the internet to find both, since the dosages seem a bit extreme for the stores I've been in these past two months.

As may be evident, no big change. Hopefully the Mg will come in soon. This hurts.

Monthly GP Status Report

Well, I haven't noticed much clear difference in headaches since the last visit, and told him so. Perhaps some mood improvement, but it's hard to tell (sadly I feel I may have developed PMS at my advanced age, but...as noted: hard to tell).

He's given me boxes of Namenda (anti-Alzheimer's meds which some people find drastically effective as a prophylactic) in case my September 5th appointment with the migraine specialist involves putting me back on. He's also upped my Depakote to 500mg 2x a day, and Celexa to 20mg 1x a day.

The exciting bit, though, is injectable Imitrex.

Okay, not that exciting. And I know I'm going to have a bitch of a time deciding which headache warrants it. But I want to know if it makes a difference, since the last big idea (Frova) didn't at all. It may be a little while before I find out, though. GP suspects that insurance won't approve it right away.

I finished off my Percocet prescription right on time, so that's re-upped for the same amount. I am, however, going to shift how I take it, hopefully to result in taking less.

Basically, I intend to give up more. Instead of trying to muddle through at home I'm going to give up and go to bed more often.

I'm not sure how much "more often" is left, but I'm stopping teaching or pretending to train on Mondays, so that's a start.

About last week

Monday's migraine stayed all day, and worsened towards the evening. I couldn't see any way of making it disappear with what I had to hand, so ER it was.

In many ways the visit was crazy and confusing, but I'd say the most basic problem was that when I woke up there around 3 in the morning, still in pain, I wasn't able to get more pain medication for two or three hours. Report is that I metabolise this stuff very quickly, so the more space inbetween doses, the less efficaceous it is.

I'm not going to harsh on the ER in question for that delay--there had been a fight involving staff and a patient, and my nurse needed medical attention himself. It was just unfortunate all round.

At about 7 they asked the fish-or-cut-bait question, and I decided to fish, to get admitted so they could administer more pain medication and monitor my vitals.

Oy.

Each ER visit costs me $75. Not inconsiderable. Any given admission means the ER cost is waived, but then it'll cost $250.

For a long time Tuesday morning I regarded my breakfast as the most expensive ever, because no one came to see me.

They sent in nurses, to take readings. I complained to them that if I wasn't going to get medication, they should just let me go home.

They sent in a psychiatrist, because they saw anti-depressants on my chart. We chatted, and I finished by telling him that I didn't currently have a drug or alcohol problem, but was considering developing one since I couldn't get painkillers.

That brought Patient Relations in, and my answer to "What can we do for you?" was still the same "Get me a doctor, or get me discharged."

Eventually a doctor came in, examined me, and decided they'd do PCA (Patient Controlled Analgesia). Except he wouldn't write the orders, the pain specialist was.

Great. Another wait. Pretty sure they didn't get going until the afternoon. If not for the free internet access, I would probably have just started walking home. Not only could I take better-than-nothing painkillers there, the food was palatable. This hospital said they served Wolfgang Puck food, but it was pretty disgusting.

For PCA they give a breakthrough dose of 4mg of Dilaudid (I'd had 6 the previous night in the ER), and then the patient is allowed to administer 1mg at a time, no more often than once every fifteen minutes.

Should there be a big gap in there, they start again with the breakthough.

Needless to say, I had a big gap--the IV slipped out of place and blood and saline were being squirted everywhere. Took me forever to get a nurse in (don't have anything happen around shift change), and he made it sound like I'd purposefully removed the needle.

Yeah, sure. That makes sense.

Also during my stay I had a neurologist come in and suggest changing my anti-depressant medication and dosage. He was also very negative about the idea of me actually using the PCA. Unfortunately I'm hella suggestible that way, and did back off it until the pain guy came in again and made me feel silly.

I ended up leaving Wednesday afternoon, still in pain, but a little less. In fact, I felt pretty good until getting out of the car, at which point everything crashed in on me. Taken upstairs, put to bed, waking up a few more times in a lot of pain, but it ended up ebbing to about a 5 by the time I went to sleep.

Hmmpf. Having been admitted to both UCLA Westwood and Century City Doctor's Hospital I really REALLY really don't want to be admitted again.

But mostly I don't want to feel like hospital is the only reasonable option, ER or no.

4.5 is good

Unless you're talking Richter.

But I'd have settled for 4.5 on the pain scale as a good time to leave the hospital. Instead, I just left when my ride arrived.

I need to do some research before I can spell it out here properly--it was my first exposure to Patient Controlled Analgesia, and on top of that I had an internet connection pretty much the whole time. I just have to find those pieces and put them together in one coherent piece.

...in the morning.

In combination with my migraines, I have a fair amount of neck and left shoulder pain. I've tried to address this in a number of ways--stretching, physical therapy, massage, icing, lidocaine patches, acupuncture, and trigger point injections.

It's hard to say what works, but I gravitate towards the trigger point injections when I can--they seem to work best, longest, and naturally are the hardest to obtain.

What happens, when the shoulder tightens up, is that pain bounces up to my head and triggers migraines. The theory that my pain management guy was working on was one of a feedback loop--migraine causes shoulder pain causes migraines. So if they're both bad breaking one isn't much help. They need to both be broken.

I tried, at length, to explain this to the staff when I was hospitalised. My shoulder was over 8 on the pain scale, but they didn't want to do anything to it in case they messed with the results of the DHE experiment. Weirdly enough, they gave me dilaudid, which I'd think was more intrusive.

Still, I'm not the professional, so what do I know? As soon as I got out I made an appointment with my GP for the trigger point injections, which he provided without comment. One of the ER doctors at Century City is always open to providing them too. But even my pain management guy, the one who first gave them to me, won't do them anymore.

It's a damned shame, because they don't mess with my head, give me anxiety attacks, and they last a good long time.

Some days it's just as simple as "Ow. That hurts."

Today is one of those days.

It's also a day on which I'm glad I have a doctor that will give me useful amounts of rescue medication, because I could be spending the night in the ER worrying about side effects and aftereffects and imposing on people.

But I'm not.

Instead I'm home, waiting patiently for the Percocet to kick in, and being glad that if I have to be in pain it can be in the warmth and quiet of my own apartment.

Which counts for a lot.

I may just have to go fall asleep in front of a TV whose volume is too low. Because I can do that. Well, I could also do that at the Santa Monica UCLA hospital, but I do like my privacy.

Teeter totter

I mentioned the link between migraines and depression earlier.

The very first sensation I could point to and call depression (as opposed to unhappiness) came with a certain sort of migraine. I don't get them anymore, I now realise, but they'd start with my mouth. My front teeth would all ache, and I'd get sad and scared.

Having my neurologist point out this heretofore-unknown-to-me side effect of migraines was a real eye opener, and it was definitely strange to have it tied to such a particular migraine configuration.

As noted, I don't get that same migraine very often. But there's another one, one with a lot of strange sensation in the back of my head, that has a lot of neck pain and discomfort and makes my spine feel weak, that comes with a great deal of hopelessness. I know it when I feel it--I just wish that knowledge trumped sensation more consistently.

The migraine I had for most of today wasn't that one (I only had that one in the morning). It was one that angers me, and makes me hate the world a great deal. So, no, I don't know how I'd normally have reacted to people today. As it was, a great deal of tongue-biting was required to make it through.

I cannot bear the loss in perspective, even when I know it's happening. That's not me. That's some other mercurical and temperamental woman. I am supposed to be in control of that.

It's bad enough having chronic pain. Becoming another person is salt in a gaping wound.

I laugh to myself and call it a midlife crisis. I call some particular friends and have them talk me down. Sometimes, rarely, I grab a hand and weep like a child.

It's good to have the space to let people help me--I'm tremendously grateful and lucky for it.

I just want my spine back. My resolve, and my constitution.