How Special is your K?

I see my GP every 4 weeks and he handles my MS Contin. I see the migraine specialist every 3-5 weeks, and he handles, well, all the other migraine drugs. With those frequent appointments it's easy to lose sight of a big plan, but I finally remembered to ask the specialist where exactly he was headed.

Ketamine. Special K to the crazy kids. Horse tranqs. In some scenarios it's used to induce comas, but I'm rooting for that not being me. He wants to use that to break the cycle of headaches, and then find the right prophylactics, since we're currently rooting around blind.

Problem is, it's not an established procedure, and I'm not even sure ketamine's in use at UCLA Westwood. So he's wrangling with some Boston folks on my behalf.

It feels very slow. The pain's building up on a weekly cycle. I need to tough it out so that's not Thursday/Friday, but Saturday/Sunday. To make work easier. I mean, I'm here. I just want it to be easier.

Talky Meat

After getting pissed at Jennie whatserface I did go into the ER.

There's really no point pretending that there's no social component to the visits, at least at these two hospitals. The doctor saw me ahead of the next person in line because he recognised me, and he apologised for not having my dosages memorised, and let me dictate them instead. When I said I was still in pain I got more without any discussion too.

I didn't get a chance to talk to the nurse that says she'll call me next time she's going to go shooting, but I did get a wave and a frown from another nurse we'd chatted with at length during the last visit here. The registration guy waxed very eloquent about advanced directives and their scope. He seemed glad for the opportunity to chat.

A day later the pain is minor, so it was all worth it. It's still too frequent, but at least it worked.

It's my sister's last day in town, and among her errands is dropping by the other ER to leave a gift and card for the nurse that finally treated my symptoms as worthy of the proposed dosage, as well as got a line in quickly.

Two weeks here and five ER visits, if I count correctly. Quite the crash course.

In which reprieve, however temporary, is well-received

Went to the ER last night. Yes, you're counting right--I just got out of the selfsame hospital on Sunday. But Tuesday and Wednesday mornings I had woken up with a wicked headache--woken up by the pain. That's extremely rare for me. All told, I think I had less than two hours awake over the 36 hours in which the pain was less than a 5 out of 10.

So much is variable. The dilaudid hit me like a ton of bricks this time, but they didn't put me on physiological monitoring.

My migraine specialist said I shouldn't let the headaches blossom as long as the last time, but he also proved to be unreachable all day, so in order to nip the pain...well, it was way past budding time...I went to the ER. His plan was to avoid the ER with more DHE, but I don't think it works.

What they see as progress is me lying down. That always helps. But I can't live in my bed. Just this Sunday after 36 hours of DHE flushing I went home--and had my next migraine maybe 5 hours later. Not success in my book--I can probably achieve that by staying in bed all weekend without the needles.

Get to us earlier!

Easy for you to say, Mr. Migraine Specialist Man. When I go to the ER after four days of the same migraine, I feel like I'm folding early. That's what I did this past Friday, but instead of decreasing in intensity (either much or little) it decreased and then spiked.

Which meant they transferred me from that ER to a hospital where the specialist has admitting privileges and I got the DHE flush again. Tiresome, boring, cold, hot, just...not a fun way to spend your weekend.

Does it work? Hard to say. Lying down for two days has its own minimising effect on my migraines. I was discharged at about noon, and got my next migraine by six. But it was small and mostly responded to Maxalt.

Mostly.

The upshot of the visit:
a) He wants me to ping him (how? he's so very unavailable) before the ER to see if we can do the DHE as outpatient before dilaudid, etc come into the picture
b) Namenda again
c) Increase Depakote to 1750mg/day

We shall see. My fingers are crossed Namenda-wise, and I'm back on the Mg and the riboflavin, just to see how things go.

Ah, where to start? A week of multiple ERs, and not a little stress.

This particular migraine started on Thursday. Since I get about a migraine a day it might seem strange that I call some continuous and others stop and start anew. Basically, it's about the characteristic of the painful parts--are they consistent with the previous painful parts--and the characteristics of the less painful parts--are they pain free, or merely pain-lite?

Monday I tried to go to the ER. I tried to go to two ERs, but neither of them would give me much in the way of painkillers nor the other stuff in my recommended cocktail. The first ER gave me 1mg dilaudid intra-muscularly, and 25mg of Benadryl. Seems he only wanted to give me two things, and once I told him that dilaudid made me itch he took the anti-emetic off the bargaining table and replaced it with the anti-histamine.

Effect on my migraine? Sweet FA.

The second ER--well, there's a theory that I shouldn't have told them it was my second ER. But I hold onto the conviction that if I tell them everything they'll be able to treat me more knowledgeably.

Maybe not these guys. Absolutely no way they could give me more than 1mg of dilaudid. I'd never be given SIX. I told him to check my records from the last visit, but he said they didn't write things like that down.

Eventually he got through to my GP and my migraine specialist, and was willing to go as high as 2mg.

Effect on my migraine? I lied and went home.

By Wednesday I couldn't go into work. Thursday I got a last-minute appointment with my GP who called the migraine guru and not just had the explicit protocol put in my files for two hospitals, but also called one of the ERs and told them to expect me.

Push comes to shove, going to the ER alone is horrible, but I didn't have much alternative. It took them some while to bring me in, and the doctor who saw me seemed flabbergasted at the dosage, and even more flabbergasted that I've had up to 10mg in one visit. They hooked me up to all sorts of monitors, gave me the cocktail of medications, and lo! It was like unto a beam down from the heavens.

I got my brain back. Oh, a loopy brain until the dilaudid wore off, but a clear one. Ugh. Way too much work and took way too much time.

It's funny--when I go with my normal escort, I tend to get enough medication. When I don't, it becomes a crapshoot. I wonder if he'd be flattered to hear that?

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.