Syncope is not uncommon with migraines

Oh, yay?

It means paying much more attention to how I get up. I can't even begin to think about how it will affect my desired physical activity. I just can't.

I don't know how much changed as a result of today's visit with the migraine specialist.

My Depakote is to increase, and he wants me to take Celebrex with my triptans, right away, and see if that makes a difference. He's considering a second admission, this time with more DHE, and aggressive Namenda right afterwards.

Oh, and more steroids.

The most palpable (for non-literal interpretations of the word) change is his insistence that ER doctors page him if they disagree with his protocol, certainly before trying to argue with me. Much appreciated, let me tell you. He knows I have to be given all the meds together, up front, instead of trying a bit and trying another bit and ending up giving me more in the end.

Let's just hope his communication skills are good.

Follow up in three months.

Here's how my medical care currently breaks down:

Primary care physician. His name may currently be on some of my older migraine meds, like the triptans. He referred me to my neurologist (see below). A couple months ago he rescued me from a crisis with a prescription for Percoset and some trigger point injections. But I don't normally consider him part of the migraine regimen.

Neurologist. Poor woman. I have flummoxed her. She tries, but she can't keep up. She referred me both to a pain specialist (see below) and a migraine guru (see everywhere). She tries to be helpful. Which includes a prescription for very few of a very low dose of Percoset, and an exhortation not to go the ER. So, not the most actual help.

Pain Management Guy. He's given me trigger point injections and done the occipital bilateral nerve blocks. He's also the prescriber of my Lidoderm, lidocaine patches that I apply on my neck or shoulder.

Migraine Guru. Now, he doesn't see patients, per se. He consults with a doctor that sees you more often. He's seen me once, made the protocol for the hospital visit, and the soonest I could get back in to see him is September--and I made that appointment over a month ago. He has half a day of clinic time a week.

Migraine "specialist." Hrrmph. I was sent to her during one of the long waits for Guru. She saw me for about a year and just kept piling on the drugs and the hugs and really wanted me to take more Botox. We've come to a parting of the ways.

I emailed my neuro today with the summation of the post-DHE so far (short form: Ouch, what next?) and asked for next steps.

Contact the guru, she says. Now, I have neither an email address nor a direct phone number. He's House-like, I guess. So I have to leave messages and enter into phone tag at work about the pain.

Ah, well. That's for next week.

Also planned for next week is quite a treat. I've made an appointment with my PCP and I will plead for more trigger point injections. And...a referral to Cedars Sinai. Way less in my neighbourhood, but not prohibitively so. And a little bird emailed me to tell me that they have the area's best specialists.

Maybe they can get me in before September. We'll see.

Guru left a message this afternoon explaining why checking in Friday evening was a bad idea. Not enough manpower, and I'd likely be left hanging. Still...wouldn't it have gotten me out earlier? At least, not later?

Ah, never mind. Escort was set for Saturday morning--he's picking me up at 7:30am. The guru is understandably hard to reach. Apparently he has 1/2 a day of clinic time a week. But the scheduling coordinator doesn't answer her phone until after 4pm, I learnt yesterday. So not going to bother chasing down an earlier tee time.

His message instructed me to not take any more migraine meds because they can interact negatively with DHE. It was just a message, so I don't know if he means just abortives, or abortives and prophylactics. Still, the instructions say to show up empty handed (like, send your clothes back with your ride--so not happening), so I'll just steer clear of both categories of drugs from here on in.

Annoying, because I'm having a migraine. Not the sinusy one of yore, but what I consider my classic--it feels like my eye sockets are lined in sandpaper and my eyes are leaden and heavy.

As long as I can get to sleep, I should be fine.

I'd like to take a moment to wave at my mother--she offered to take on my anxiety attacks for me, since she'd be having one anyway.

Who knows? Maybe it'll work.