A patient wants to know your thoughts on frequent fliers... - page 3

by Clusterhead, BSN, RN | 4,719 Views | 34 Comments

First of all, forgive me, as I'm sure this will be a long post. Also, it's my first... so hello. To be clear, as the subject states, I am a patient and not a nurse. But given my history I'm thinking more and more that being an... Read More


  1. 0
    Quote from Clusterhead
    Esme, you'll have to forgive me... I have no idea what you're talking about with "offering legal advice"??? I wasn't asking for any... not trying to be combative, I just really don't have the slightest idea which post or part of my post you're referring to.

    dudette, I will respond later on tonight, thank you for sending it!
    I drifted for a moment....medical advice....medical..... I was only trying to commiserate with you that we feel your frustration and empathize with your predicament....and to ignore the mean people..I guess I shouldn't multitask so much...sorry if I confused you....it was perfectly clear this afternoon....
  2. 0
    Sent you a PM. Best wishes to you, it's certainly no kind of life you'd wish on anyone else.
  3. 1
    Another general thanks to the responses!

    Esme, I wasn't asking for medical advice, sorry if that was confusing I just thought it might be helpful for anyone who was interested to see, especially those who work either on the floor in neuro or in the ED. As I've already said, it's not a common disorder and many people who land in the hospital find themselves misdiagnosed... not that an image of my eyes during an attack is going to fix that, I just thought it might be of interest to some. If that's not allowed for any reason then I do apologize. But no, I wasn't asking for any advice, I was just thinking maybe someone would find it of some educational value.

    PS: To those of you who sent me PMs, an extra thanks to you. Hopefully I'll be able to respond soon, but new members can't until they have 15 posts... that's why you haven't heard from me :/
    Last edit by Clusterhead on May 21, '13 : Reason: PS
    monkeybug likes this.
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    I work on a medical/surgical floor but when I see a frequent flier I don't care unless the pt is someone I dread taking care of. To me this means someone who yells a lot, ( is completely oriented) , rings for silly stuff (move the call bell half an inch) when s/he is a walkie talkie. Yells, " NURSE, HELP ME" when they need a ginger ale etc. Or who do not understand, that while yes s/he is in pain I have OTHER patients who may be even more sick and I have to prioritize care, and pain is not often a priority even if the person is yelling about it. I don't care when pts need narcotics to function even if that means I have to page a doctor. I don't understand why some nurses get so worked up over it. We see a lot of frequent fliers for cystic fibrosis, sickle cell, copd, dka, chrons, all sorts of things. That's part of having a chronic medical condition.
    monkeybug likes this.
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    The whole " patient doesn't look to be in pain" is so subjective for many patients. Yeah some fake it to get dilaudid but some people are more stoic then others. I always go on my smart phone as a means of distraction or try to focus on the tv.
  6. 0
    My father has dealt with chronic pain for several years. I've tried to coach him how to seek relief without looking like a drug-seeker. I have also discussed with doctors--his (not so much) and on-call for my patients (more often, and sometimes heatedly) that some, maybe most, drug seekers are seeking drugs for relief. (Maybe all, but some for the wrong kind of relief. Drug abusers are self-medicating, but they're using the wrong meds.)
    I work in neuro and have seen cluster headaches. I wish you success in finding treatment. I see you are young, so I hope you may "outgrow" them, as some apparently do. As far as how nurses may perceive you, as others have suggested, it shouldn't matter. We have a job to do, and judging you isn't part of that. But I can imagine if I were in your shoes, I'd have the same concerns. I see a lot more patients with migraines than clusters. What I've seen of clusters--you don't wonder if they are in pain. You wonder how they survive. I do recall a time I was awaiting a transfer from our ED and saw on the Kardex that the patient had migraines and fibromyalgia and thought to myself it was going to be a long night. I don't honestly know whether fibromyalgia is a real condition. It has been debated for awhile and the concensus seems to be leaning toward real, but poorly understood. Anyway, we treat it, and some people seem to get some relief. In the past, and perhaps still outside the hospital, a migraine diagnosis had a similar reputation. A lot of times, though, we have imaging that's pretty definitive and you'd have to be pretty stubborn to think the patient was faking.
    Still, I wasn't wrong about it being a long night, and migraine patients can be awfully frustrating. You can educate until you are blue in the face and they still want Percocet, because Tylenol "doesn't work." The oxycodone in Percocet lowers the threshold for migraines. Narcotics are contraindicated. Percocet "works" because it also contains acetaminophen (Tylenol) which is so good it can work in spite of the oxycodone. And a significant number of our "migraine" admissions are headaches from drug abuse, secondary to actual migraines. That is, they do have migraines, but the present headache has more to do with inappropriate meds. It's a very hard case to argue, and on top of everything else, when you are in a lot of pain, unconsciousness can look pretty darned inviting.
    And don't even get me started on spines. You've been maxing-out Percs for a year-and-a-half before you finally have surgery. If you are lucky you get a day on a PCA, then it's one Lortab every six hours, and you're so resistant from the oxycodone that the Dilaudid in the PCA wasn't getting the job done, and you look at these people with a straight face and tell them it will be better when they go home tomorrow and have other things to do than lie in bed and think about how much it hurts (which is probably true) and that it will be worth it when they heal (which you hope is true).
    Patients in pain are a pain. Most of the time, it isn't their fault. And you do have the occasional ortho or trauma with new-onset acute pain and all you have to do is get their ordered meds on time and they're happy campers. Getting a percocet out of the Pyxis every four hours and handing it to someone is NOT the hard part of pain management. Would that it was. And if all you're looking is to get high, hell, that's easy. I can see you three times in a shift and keep you stoned the whole time. But that's rare.
  7. 0
    Thanks for that very enlightening response, mike.

    It's interesting that you brought up the appropriateness (or rather inappropriateness) of these meds for migraines, and the same generally applies to clusters. In fact, I was in pain management once before for a recurring pilonidal cyst and my headaches started right after going cold turkey off a very large dose of oxycodone because the nurse practitioner who was treating me was cutting down my dose by huge amounts each time we reduced. I figured that if I was going to be sick anyway, I wanted to get it over with. Anyway, the clusters started not four or five days after the worst of the withdrawal symptoms subsided and at first I just assumed they were (very bad) rebound/medication overuse headaches.

    I made sure that the first doctor I saw kept that in mind in terms of treatment and spent a really long time just "toughing them out" and waiting for the preventive medicine to kick in, as is usually the case when treating rebound headaches. After a few months of this and the headaches getting worse the doctor thought it was unlikely to simply be rebounds. To the best of my knowledge, different medications cause different quality rebound headaches, and for the most part I believe narcotics cause rebounds which are very similar to migraines. I'm sure it varies from person to person, though. I still stayed away from the narcotics for a long time and continued to tough out the majority of attacks and treat the worst ones with imitrex... but here we are.

    Sadly, that was a long time ago and being a chronic sufferer as opposed to episodic, I think part of the issue is simply not having the same resolve as I did when they started. I had one sort of remission with a headache or two a week for a couple of months back in 2011, but other than that it's been relentless and boy oh boy does it wear you down. When I look in the mirror I hardly recognize myself these days, compared to the person I saw a few years ago. Rebounds continue to be a concern when using opioids to treat the clusters, but I guess right this very second we're just trying to worry about the pain I have right now versus the pain I may have as a result of using these medications.

    All that said, I am very happy to report that I haven't been in the ER in almost six weeks. This might not sound like a big deal, but that's probably the longest I've been able to go without a visit in a VERY long time. The one piece of bad news is that for a variety of reasons I do not think this pain management doctor is for me, but I do believe it's the place to be right now so I am going to work on finding another one who is closer by.
  8. 0
    Quote from anotherone
    The whole " patient doesn't look to be in pain" is so subjective for many patients. Yeah some fake it to get dilaudid but some people are more stoic then others. I always go on my smart phone as a means of distraction or try to focus on the tv.
    Thank you, yes!! I use distraction as a way to cope. It's one of the only ways I can keep it together. I might be on my phone, I might even read, but that doesn't mean my head doesn't hurt. I still smile when I'm in pain, because I attempt to be as pleasant and cooperative as possible. You can rarely look at me and know when things are bad for me, unless you know me very well. I look FINE on my worst days, and it's because I've been dealing with my illness for years.
  9. 1
    Quote from nursemike
    My father has dealt with chronic pain for several years. I've tried to coach him how to seek relief without looking like a drug-seeker. I have also discussed with doctors--his (not so much) and on-call for my patients (more often, and sometimes heatedly) that some, maybe most, drug seekers are seeking drugs for relief. (Maybe all, but some for the wrong kind of relief. Drug abusers are self-medicating, but they're using the wrong meds.)
    I work in neuro and have seen cluster headaches. I wish you success in finding treatment. I see you are young, so I hope you may "outgrow" them, as some apparently do. As far as how nurses may perceive you, as others have suggested, it shouldn't matter. We have a job to do, and judging you isn't part of that. But I can imagine if I were in your shoes, I'd have the same concerns. I see a lot more patients with migraines than clusters. What I've seen of clusters--you don't wonder if they are in pain. You wonder how they survive. I do recall a time I was awaiting a transfer from our ED and saw on the Kardex that the patient had migraines and fibromyalgia and thought to myself it was going to be a long night. I don't honestly know whether fibromyalgia is a real condition. It has been debated for awhile and the concensus seems to be leaning toward real, but poorly understood. Anyway, we treat it, and some people seem to get some relief. In the past, and perhaps still outside the hospital, a migraine diagnosis had a similar reputation. A lot of times, though, we have imaging that's pretty definitive and you'd have to be pretty stubborn to think the patient was faking.
    Still, I wasn't wrong about it being a long night, and migraine patients can be awfully frustrating. You can educate until you are blue in the face and they still want Percocet, because Tylenol "doesn't work." The oxycodone in Percocet lowers the threshold for migraines. Narcotics are contraindicated. Percocet "works" because it also contains acetaminophen (Tylenol) which is so good it can work in spite of the oxycodone. And a significant number of our "migraine" admissions are headaches from drug abuse, secondary to actual migraines. That is, they do have migraines, but the present headache has more to do with inappropriate meds. It's a very hard case to argue, and on top of everything else, when you are in a lot of pain, unconsciousness can look pretty darned inviting.
    And don't even get me started on spines. You've been maxing-out Percs for a year-and-a-half before you finally have surgery. If you are lucky you get a day on a PCA, then it's one Lortab every six hours, and you're so resistant from the oxycodone that the Dilaudid in the PCA wasn't getting the job done, and you look at these people with a straight face and tell them it will be better when they go home tomorrow and have other things to do than lie in bed and think about how much it hurts (which is probably true) and that it will be worth it when they heal (which you hope is true).
    Patients in pain are a pain. Most of the time, it isn't their fault. And you do have the occasional ortho or trauma with new-onset acute pain and all you have to do is get their ordered meds on time and they're happy campers. Getting a percocet out of the Pyxis every four hours and handing it to someone is NOT the hard part of pain management. Would that it was. And if all you're looking is to get high, hell, that's easy. I can see you three times in a shift and keep you stoned the whole time. But that's rare.
    Narcotics can be used quite effectively for some migraine patients. For episodic migraines, maybe not so much. Yes, triptans are a better option. But for some of the chronic patients, narcotics as a rescue med makes sense.
    nursemike likes this.
  10. 0
    Quote from Clusterhead
    All that said, I am very happy to report that I haven't been in the ER in almost six weeks. This might not sound like a big deal, but that's probably the longest I've been able to go without a visit in a VERY long time. The one piece of bad news is that for a variety of reasons I do not think this pain management doctor is for me, but I do believe it's the place to be right now so I am going to work on finding another one who is closer by.
    Hey, good for you! When you lead a chronic life, you take the victories where you can. Some days a victory is getting out of the bed.


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