My ER experience....what do you think??

kburns0016 · Mar 28, 2008

As an intractable migraine sufferer myself I have many times wondered if the staff I was seeing did not think I was drug seeking nothing was ever said to me and none of the different Dr's on call at the only hospital I went to never refused to treat me or even gave off a suspicous vibe the fact i never ASKEd for narcs might have something to do with it though..i was often to the point that I would take anything ... and i mean anything if there was a slim chance it would help me ...(often 8/9 out of 10 pain happening 6-8 times a year and with no relief from preventative meds like Imitrex and DHE 45)I was told by my PCP if an attack hits in the early am to take one dose of perscrption narcotics and Phengran I kept on hand and if in 2-3 hours I had no relief to head to the ER ASAP as I usually wound up needing an admitt and rehydration from the vomiting:barf01:...and not to mention that treating the pain at an earlier stage requires less medication than if you wait until the pain is more severe!

I can see forcing the drive in early stages to aviod the hell I knew would be coming that is for sure..and be thankful you knew what would work for you...my PCP wound up trying everything from toradol to morphine , IV talwin (sp?)and then as a last ditch effort thorazine, finally we concluded my headaches had a course to run and unconsciousness was my best friend to ride them out ...put her to sleep and keep her there about a day then wake her up and eval. the pain..pain still here , put her back down!:zzzzz:sleep: :crying2: :sleep:

Finally almost 3 years ago after the birth of my twins I had a tubal ligation...I can count the headaches I have had since one less than both my hands :yeah:literally maybe 6 and only one the required an actual hospital stay....and as more time passes I have much less frequency and much less severity! makes sense now why the meds weren ot working as well as they had hoped ...I was riding a hormonal tide and until it turned there WAS no fixing it, absolutely NO fixing it!

Blee O'Myacin, BSN, RN · Mar 28, 2008

There are primary docs that do not make a 'plan-of-action' for pt that only have migranes 4 times a year. My doc certainly didn't. Now my mother has them at least once a month - he jumped on that one! Don't always assume that people could be seen somewhere else for migranes. If they happen in the middle of the night where else do they go?

Honestly, more PCPs will jump to prescribe something (that they have a drug rep visit them with samples) rather than do nothing to address the problem. This way everyone benefits from that PRN imitrex (or whatever). The patient has to be proactive with the PCP and ask for what they need. If it doesn't work, I'm more than happy to give the IM toradol/phenergan cocktail - no matter the time of day.

But people shouldn't be afraid to talk to their PCPs or have to suffer all night -- and the next day due to lack of sleep, even for something that "only" happens 4-6 times per year.

To futher break it down - the cost of each ER visit is way, way more expensive than a copay for a PCP visit and the PRN med. You don't even have to wait for the next migraine - make an appointment and talk to your doc. There is no reason to have to suffer. I'm sure the OP did not get any sense of enjoyment out of going to the ER at 0200.

Blee

KrissyPRN · Mar 28, 2008

I suffer from migraines. I usually get them right before my period and they will last 2-3 days. Occassionally I will get one in between. They are absolutely horrible!!!!! At times I can't even get out of bed. We have gone as far as to put black fabric over the windows in our bedroom so that when I have one come on I can be in complete darkness. I also have sensitivity to noise, become nauseated, have difficulty concentrating, vision disturbance, and sometimes my speech is affected. I have tried everything under the sun. I recently also started having seizures. They put me on Keppra and at first my migraines decreased but after being on it almost a year at the max dose for the seizures it doesn't seem to be helping with the migraines. I tried Topamax but it made me extremely confused and I couldn't continue on the med. Maxalt will sometimes stop the migraine but for the most part just takes the edge off. I have gone to the ER for a migraine before. I had worked 3 nights in a row and had a migraine 3 nights in a row. By the end of the 3rd night I couldn't take it anymore. I went to the ER before I went home. The doctor came in and before she said anything else she said I am not going to give you narcotics. I told her that was fine and I didn't ask for narcotics to begin with. She gave me Imitrex which I had a reaction to. The Toradol and Zofran did help. IMO rest and sleep along with Maxalt at this point works best for me.

kristenncrn · Mar 28, 2008

I've had migraines and irretractable headache at various times for 24 years. I'm now well managed now (thank you Topamax), but I just want to say that I can drive a ways with a migraine if I need to.

I can parent with a migraine if I need to.

I can run the vaccuum. I can even cook for my kids.

I know because I've needed to do all those and more.

I can't work, calculate drugs or study. But - at least for me, I can do a lot more than I thought I could before I had kids!

And I know I have actual migraines because I have an AVM that causes them.

So just want to say to the OP - while yeah, it may raise the suspect level up a bit that you drive - I don't think it's at all conclusive.

And I was pretty sure that scientific research teaches us that pain is complex and relative - so one person's horrific pain might mean they can drive, while someone else can't. That''s just the nature of the beast.

That being said - the ED doc sounds like a hard case, but who in the ED isn't? =) Honestly, they do have to be. I'd try and let it roll off your back. My gosh, they sent you out with Vicodan, which I think has the highest street value right now of any pill. They had to have thought you were authentic by the end, right?

Best and glad your head is better!

luvmy3kids · Mar 28, 2008

I disagree about driving yourself to the emergency room. Sometimes there is no other choice... I drove myself to the ER (well Urgent Care to start with) and had to have my gall bladder out as an emergency surgery.

I was in horrific pain... but I didn't have a choice but to take myself there.

If it's bad enough, you will find a way to get there.

Jennifer

Eric01 · Mar 28, 2008

In our Emergency Room, we do try to take care of our patients with migraines. If I encounter a patient who tells me they are having IV what is a typical migraine for them, I will often start an IV and run a bolus of 1L NS (assuming no contraindication, and according to our department protocol) while waiting for a doc. If I can flag down a doc and they are comfortable with the story, we usually accompany the NS with 10mg Maxeran (metoclopromide) IV. For many that I have encountered, NS (sometimes even without the Maxeran) can do wonders.

My wife does not get migraines/headaches usually. Now that she is pregnant and doesn't want to take any medication, I'll usually just encourage po fluids (H2O), and that often makes her feel better.

feebebe23 · Mar 29, 2008

I want to thank everyone for their input.....I was just curious why a doc might state "I am not going to give you any narcotics" prior to even talking to me or assessing me. But in the end...like I stated she gave me a script for vicodine (that I didn't ask for BTW)

In all the years I have had migraines I have never been to the ER for them. I was concerned about being percieved as a drug seeker even before I went in.

The conversation I had with myself while vomiting in the middle of the night went something like this: "you have insurance......you shouldn't have to suffer like this....don't bother their going to think your a drug seeker.....I can pay for my medical care why shouldn't I get some relief....my ER co-pay is only $75.00 I would pay triple that not to feel like this"

And it just kind of hurt my feelings that the doctor said this to me.....but I have never worked in an ER and I can only imagine the crap you guys see....

Since then I have always kept PO Toradol and phenergan in the house and it really helps.....

loricatus · Mar 29, 2008

I want to thank everyone for their input.....I was just curious why a doc might state "I am not going to give you any narcotics" prior to even talking to me or assessing me. But in the end...like I stated she gave me a script for vicodine (that I didn't ask for BTW)

As others have said, you gave a couple of red flags in the time and mode of transportation. The 3rd red flag for a drug seeker would been a neverending response of various statement incorporating many of the manipulative behaviors that drug seekers demonstrate. For instance: "only XXX works for me..."; "I'm allergic to XXX...", "why don't you care that I am in pain...", "let me talk to your supervisor...", "I want a new doctor...", "you don't know what you are doing...", "you can give me Toradol, but I can tell you now that it won't work," "you seem like one of the best doctors here, I know you'll take good care of me..."; "the nurse said that you treat migraines with Morphine IV"; "you have no right to judge me...", "What do you think that I am, a drug addict?" {Sidebar: maybe we should start a thread on all of the statements heard by the drugseekers?}

Now, you have to keep in mind, that all these mood and behavior changes can take place in the span of 5-10 minutes when it comes to a drug seeker not feeling they are going to get what they are looking for; and, the longer it drags out, the more potential for violent behavior because of the time invested without the intended result of getting narcotics. The nature of the ER is to do a quick and focused assessment-hence, the statement made by the doc to see if she could elicit the drug seeker behavior traits quickly. Your doctor was able to ascertain immediately, by your response to her blunt and up front statement, that you were not drug seeking- thus, the script for the narcotic and the shot of Toradol.

I am sorry you had to go through this; but, you cannot imagine what the drug seekers put us and other patients through. When one comes in the ER, it takes the majority of the staff away from patient care, disrupts other patients and is never pleased-it is essentially putting psych patient (many times, with the capacity for violence) in the midst of acute care. It is best to set boundaries quickly for this type of patient or they have the capacity to come back 2-3 times in a single day.

I hope you are feeling better & that I have been able to explain a little to you.

Altra, BSN, RN · Mar 29, 2008

Since then I have always kept PO Toradol and phenergan in the house and it really helps.....

Bingo.

leslie :-D · Mar 29, 2008

yrs ago, i had an abscess as big as a grapefruit.

i walked into the er with this huge appendage growing from under my jaw.

and the nurse said to me, "if you think you're going to get narcotics, you've come to the wrong place".

i was stunned, since i had been seeing my dentist all along, but this 'thing' was growing out of control, AND dentist never returned my calls to his beeper.

truthfully, i wasn't convinced my dentist my treating me correctly and i went to the er out of desperation.

and, everyone looked at me like i was a freak (r/t abscess).

er doc ran xrays, came back w/report of "a lot of inflammation" and followed with, "you must be in a lot of pain".

:stone

yep, i was.

but more than anything, i wanted a stronger abt.

dentist had me on amoxycillin.

er nurse gave me 2 shots of demerol, w/an offer of a 3rd.

nothing was touching the pain, and declined 3rd shot.

but i did walk out of there w/script for clinda and an emergency referral to oral surgeon.

all i'm saying, is when people are feeling desperate, they go to the er.

and even 10 yrs ago, the "you're not getting narcs" was high and mighty.

some nurses need to give it a rest.

(i think they were happy to see me go that noc....heh.)

leslie