31 October, 2007
Narrow Escape
Oh, I so won't be detailing all the headache nuances here. Not a pretty sight. My phone has a recorder function. I'll buy some extra memory and use that.
31/10/07
I have to admit I don't remember the details of the headaches I've had so far today. Keeping a diary of pain has always been hard for me. I'm easily distracted.
No time like the present, though.
It's almost 5pm, and I'm feeling pain across the sinuses and through the right side of my head. I haven't experienced notable auras, and am mildly nauseated. If we could the pain that sent me to the ER yesterday as a 9, this is a 5. I do want to go home and sleep it off.
I have taken nothing for it today, it being a post-ER day.
No time like the present, though.
It's almost 5pm, and I'm feeling pain across the sinuses and through the right side of my head. I haven't experienced notable auras, and am mildly nauseated. If we could the pain that sent me to the ER yesterday as a 9, this is a 5. I do want to go home and sleep it off.
I have taken nothing for it today, it being a post-ER day.
I've called the nice lady about the study I mentioned earlier. Got no feedback from my specialist about whether or not it's a good idea, but the coordinator knows my specialist (the researcher is his boss) so hopefully that will all get clarified.
There's compatibility to be determined. Something about a grade 5. That may refer to the size of the hole--I don't think mine was big, all things considered. I just googled
She's advised me to keep a headache diary, since they'll need 30 days of diary before they get started. This is as good a place as any.
There's compatibility to be determined. Something about a grade 5. That may refer to the size of the hole--I don't think mine was big, all things considered. I just googled
pfo grade and my head exploded. You have been warned. Anyway, none of those links mention a grade 5 that I saw, so I don't know what that means.She's advised me to keep a headache diary, since they'll need 30 days of diary before they get started. This is as good a place as any.
15 October, 2007
Hole-shaped heart
Got an interesting call today. Turns out my local version of the PFO/migraine study wants to have a word with me.
In short, there's a wee hole in a fetal heart that allows blood to short-circuit the lungs (hey, who needs them?) that's to close when you're out and about in the big bad world. Often, in migraineurs, it hasn't closed up. Scuba divers are put at an increased risk of the bends by having this hole, and migraineur divers who had the defect corrected also noted a break in their pain.
But it's all unofficial, and they need to do more testing. I have the hole. My previous migraine specialist didn't want me to do it because she thought there were side effects that mitigated it.
I've left a message with the new guy. The doctor running the study is a coworker of his.
We shall see.
In short, there's a wee hole in a fetal heart that allows blood to short-circuit the lungs (hey, who needs them?) that's to close when you're out and about in the big bad world. Often, in migraineurs, it hasn't closed up. Scuba divers are put at an increased risk of the bends by having this hole, and migraineur divers who had the defect corrected also noted a break in their pain.
But it's all unofficial, and they need to do more testing. I have the hole. My previous migraine specialist didn't want me to do it because she thought there were side effects that mitigated it.
I've left a message with the new guy. The doctor running the study is a coworker of his.
We shall see.
10 October, 2007
Main course or side dish
The particular feeling of nastiness I'm having right now feels familiar. Feels familiar in a third week of Namenda sort of a way.
I haven't read up on the side effects of this anti-Alzheimer drugs, but I'm nervous it's what's responsible for this 24/7 migraine with not so much pain. Sure, you might think that the pain going would be a good thing. And it is! It's just that the nausea, sensitivity to light, sound, motion, cognitive impairedness--they're still all here. The things that migraines took off the table are still off the table. And I can't even go to the ER to get them back for a little.
I expressed this concern to my migraine specialist as best I could (I have to go through a middle person to talk to him), and he's told me not to stop taking the Namenda, but instead to do week 2 again of the tapering starter pack. I'm on week 3 now, 15mg of the stuff, and really just not happy. I could sleep forever with the slightest provocation.
Hopefully that makes the difference--I'm not sure how he intends to get me past 10mg, and I'm not sure this is better than this time last week.
I haven't read up on the side effects of this anti-Alzheimer drugs, but I'm nervous it's what's responsible for this 24/7 migraine with not so much pain. Sure, you might think that the pain going would be a good thing. And it is! It's just that the nausea, sensitivity to light, sound, motion, cognitive impairedness--they're still all here. The things that migraines took off the table are still off the table. And I can't even go to the ER to get them back for a little.
I expressed this concern to my migraine specialist as best I could (I have to go through a middle person to talk to him), and he's told me not to stop taking the Namenda, but instead to do week 2 again of the tapering starter pack. I'm on week 3 now, 15mg of the stuff, and really just not happy. I could sleep forever with the slightest provocation.
Hopefully that makes the difference--I'm not sure how he intends to get me past 10mg, and I'm not sure this is better than this time last week.
01 October, 2007
October Resolution
I've tried from time to time to apply Zen philosophy to my life as a means of achieving calm especially in the face of chronic pain.
Mindfulness, the idea of being in the moment as opposed to concentrating on one thing to the exclusion of all else-denying the migraine an opportunity to bog me down by expanding my mind beyond just those physical sensations, is my goal.
Or would be. To be honest I've done very little. Some, perhaps, during biofeedback training, and my escort exhorts me to think of lounging on a beach, or to practice biofeedback, or just to plain put my shoulders down when he sees me getting worked up over anything.
I don't think I have a baseline of stress that's any worse than anyone else's--especially when you take migraines out of the vicious loop. But added stress can push me over--that vague premigrainey feeling can become the real deal with a one paragraph email or a voice message measured in scant seconds.
I've breathed my way through other pains before, tried to open myself up and just flow with breath, using breathing as my markers, not feeling. But migraines come with so much other package--thinking or feeling my way out of sluggishness and nausea is considerably more complicated.
For the simple ones, with sinus involved (by simple I mean tightly focussed pain--these are like hot knitting needles being slid up my nose) and little else, I can take my mind off for a while. But many of the rest are more complex, and require more (or less?) work.
One general thing, something that doesn't have to wait for the onset of the next bout, is to inhabit the present more clearly. If I can pull my attention away from how long I've had the current headache, how little respite I've had recently and not be throwing out contingencies for the next ER visit or the next abortive drug, maybe I can lighten the load on my shoulders some, and leave myself with less to ignore the next time.
Well, that's the plan, at least.
Mindfulness, the idea of being in the moment as opposed to concentrating on one thing to the exclusion of all else-denying the migraine an opportunity to bog me down by expanding my mind beyond just those physical sensations, is my goal.
Or would be. To be honest I've done very little. Some, perhaps, during biofeedback training, and my escort exhorts me to think of lounging on a beach, or to practice biofeedback, or just to plain put my shoulders down when he sees me getting worked up over anything.
I don't think I have a baseline of stress that's any worse than anyone else's--especially when you take migraines out of the vicious loop. But added stress can push me over--that vague premigrainey feeling can become the real deal with a one paragraph email or a voice message measured in scant seconds.
I've breathed my way through other pains before, tried to open myself up and just flow with breath, using breathing as my markers, not feeling. But migraines come with so much other package--thinking or feeling my way out of sluggishness and nausea is considerably more complicated.
For the simple ones, with sinus involved (by simple I mean tightly focussed pain--these are like hot knitting needles being slid up my nose) and little else, I can take my mind off for a while. But many of the rest are more complex, and require more (or less?) work.
One general thing, something that doesn't have to wait for the onset of the next bout, is to inhabit the present more clearly. If I can pull my attention away from how long I've had the current headache, how little respite I've had recently and not be throwing out contingencies for the next ER visit or the next abortive drug, maybe I can lighten the load on my shoulders some, and leave myself with less to ignore the next time.
Well, that's the plan, at least.
28 September, 2007
I'm looking forward to the weekend, during which I won't tempt fate, I promise.
Since Wednesday's ER visit, I haven't had that much pain. I'm having a sinus migraine right now, which is actually pretty intense, but it doesn't have the same grinding down effect as the more traditional one.
I've taken triptans at the onset--and the onset has been slow enough I've been able to catch it--and they seem to be doing their job.
That's huge. I've had two days of almost being like a normal person, although I am skittish around loud music and other potential triggers.
Since Wednesday's ER visit, I haven't had that much pain. I'm having a sinus migraine right now, which is actually pretty intense, but it doesn't have the same grinding down effect as the more traditional one.
I've taken triptans at the onset--and the onset has been slow enough I've been able to catch it--and they seem to be doing their job.
That's huge. I've had two days of almost being like a normal person, although I am skittish around loud music and other potential triggers.
27 September, 2007
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.
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.
24 September, 2007
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.
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.
14 September, 2007
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?
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?
07 September, 2007
Enquiring Minds...
I have a Google News alert set up for "migraine" (I used to also have one for "Whedon", but I soon learnt there's neither enough time nor enough interest to read those every day). There's not that much new, all told. Lots of regional "migraines are very bad--you don't realise that" stories. Which is true. I mean, I've been having them since I was in the single digits, but it's only in the last 5-10 years that I found out there migraine specific abortives, never mind prophylactics.
And the ER thing? Within the last year. How I wish I could un-know that. Not even sure why.
Tonight's Google Alert led me to The Migraine Action Association, a UK-based group. I'm poking around idly, and I notice their membership page. Pay? To be part of a migraine group? I pay upwards of $100/month on meds, $75/ER visit, $250/admission. I can't imagine paying more money voluntarily.
And I'd like to think the things they learn are disseminated outside their borders.
I don't know. It seems like buying more migraines--their graphics, for instance, do a damned good job of evoking the headache I'm already having. The better they are, the worse I feel.
And the ER thing? Within the last year. How I wish I could un-know that. Not even sure why.
Tonight's Google Alert led me to The Migraine Action Association, a UK-based group. I'm poking around idly, and I notice their membership page. Pay? To be part of a migraine group? I pay upwards of $100/month on meds, $75/ER visit, $250/admission. I can't imagine paying more money voluntarily.
And I'd like to think the things they learn are disseminated outside their borders.
I don't know. It seems like buying more migraines--their graphics, for instance, do a damned good job of evoking the headache I'm already having. The better they are, the worse I feel.
05 September, 2007
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.
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.
29 August, 2007
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.
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.
27 August, 2007
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.
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.
24 August, 2007
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.
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.
21 August, 2007
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.
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.
20 August, 2007
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.
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.
14 August, 2007
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.
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.
09 August, 2007
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.
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.
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