Have I displayed drug seeking behavior?? - page 4
I really scared myself today. I've been having debilitating migraines, that last 5-10 days. Horrible, nasty migraines with dizziness, tinnitus, stabbing pains, photophobia, phonophobia, diarrhea,... Read More
Sep 20, '07From: US ; Joined: Jul '05; Posts: 856; Likes: 1,525Just got discharged from the hospital today. Was admitted by my neurologist for status migraine with intractable n/v. Given IV hydration, DHE, decadron, reglan, klonopin, upped the topamax again. Got MRI/MRA done. No aneuryisms, do have so microvascular changes in the brain??? Neuro says about 14% of the population have these changes, especially migraineurs. If I keep going into status migraine this frequently we're going to have to do a lumbar puncture to measure my CSF pressure. If my CSF pressure is to high, then we will have to change meds again. I was wrong, my admission weight was 12 pounds lighter than what I weighed in the clinic 2 weeks ago. I forgot to weigh myself at discharge to see if the hydration put some weight back on, . Also had follow up EKG, just cause I keep having chest pain when I vomit, EKG was good. It just feels so good to be able to walk outside during the daytime without feeling like someone is stabbing icepicks through my R eye, to be able to concentrate well enough to drive a stick shift, to eat without puking my brains out. Honestly, I could live with the headache, it's all the other crap that happens with the migraine that I can't stand.
Sep 21, '07Occupation: major case manager Specialty: 27 year(s) of experience in icu, er, transplant, case management, ps ; Joined: Jul '07; Posts: 968; Likes: 549Quote from elthiaI am so thankful I don't suffer from these types of headaches. In fact, I rarely have a headache.Just got discharged from the hospital today. Was admitted by my neurologist for status migraine with intractable n/v. Given IV hydration, DHE, decadron, reglan, klonopin, upped the topamax again. Got MRI/MRA done. No aneuryisms, do have so microvascular changes in the brain??? Neuro says about 14% of the population have these changes, especially migraineurs. If I keep going into status migraine this frequently we're going to have to do a lumbar puncture to measure my CSF pressure. If my CSF pressure is to high, then we will have to change meds again. I was wrong, my admission weight was 12 pounds lighter than what I weighed in the clinic 2 weeks ago. I forgot to weigh myself at discharge to see if the hydration put some weight back on, . Also had follow up EKG, just cause I keep having chest pain when I vomit, EKG was good. It just feels so good to be able to walk outside during the daytime without feeling like someone is stabbing icepicks through my R eye, to be able to concentrate well enough to drive a stick shift, to eat without puking my brains out. Honestly, I could live with the headache, it's all the other crap that happens with the migraine that I can't stand.
Sep 21, '07Occupation: IM/Critical Care/Cardiology Specialty: compassion ; Joined: Sep '03; Posts: 1,555; Likes: 656Welcome home! I'm glad you are feeling better.More importantly, I'm glad that you're neurologist hospitalized you and did a work up. I hope you don't need to have the sp.tap, but if it comes to that it tells me he is invested in helping you and is really appearing to be concerned, as we are!
Keep us posted, hope you can get full relief everyday!
Sep 21, '07From: US ; Joined: Jul '05; Posts: 856; Likes: 1,525Thanks. It's just so nice to be feeling better.
Sep 21, '07Occupation: R.N. Joined: May '07; Posts: 3,228; Likes: 3,680I'm glad to hear you're feeling better.
Please consider having your neurologist fill out the FMLA papers as soon as possible for you to protect your job. You don't have to take the full 12 weeks all at once. It can be in increments of a day (or days) at a time--- even hours if you can't work a full shift.
Sep 21, '07Occupation: Clinical Instructor Specialty: 14 year(s) of experience in Adult Care- Neuro ICU, Ortho, IRU, Pedi ; From: US ; Joined: Jan '07; Posts: 57; Likes: 31Have you and your Neurologist every discussed Pseudo Tumor Cerebri? I was told I had a "migraine" for more than 2 years. No one would listen to me. They all thought I was a hypochondriac and I was beginning to beleive it too. It took me several doctors and losing my vision overnight for someone to finally listen. I thought I was going crazy when in fact my intracranial pressure was so high that I eventually lost my vision and I was scared to death. Maybe it's worth checking into if not considered already. And definately file for FMLA soon. I am in the same situation and a panic attack is always not far away if I don't get into the doc when I am having problems. I get very high strung when my pressure goes up and nothing makes sense. I get emotional quickly. My problems have resolved after really paying attention to the stress and lack of sleep. It is so difficult when nursing is your career to relieve those things. I have to work to keep my insurance to keep me on the meds and pay my bills. If I didn't have to work of course I wouldn't but it's not realistic. I do love my job but it just a constant catch 22. My vision is more important to me than what someone else thinks of me. It also helps to know that I have a diagnosis and although I feel I may die from the pain it really actually won't kill me and it will eventually pass. It just helps to know. No one knows what you are feeling only you know. I hate calling into work with a "headache" because it's not just that but because you don't have tumor growing off the side of your face doesn't mean you're not sick. Next time tell them you have a GI bleed with explosive diarrhea. That usually never get questioned! LOL. No you are not overreacting and don't feel guilty for trying to take care of yourself. It's just a curse of being in the medical field that you put others before you. We are taught as nurses to treat patient pain as reported but it's double standard when you complain of the same pain. DON'T FEEL GUILTY.
For more info go to www.pseudotumorcerebri.com and you can contact me through here if you have any other questions. Even if you really have migraines just constant education about your condition and current ways to treat it. Keep looking out for new things to make your condition tolerable.
Good luck. Jennifer
Sep 21, '07From: US ; Joined: Jul '05; Posts: 856; Likes: 1,525Quote from jennifer_25_nurseSo far my eye exams have been ok, but that is one reason why we will do a lumbar puncture to measure my CSF pressure if I keep going into status migraine.Have you and your Neurologist every discussed Pseudo Tumor Cerebri?
Good luck. Jennifer
I'm filing for intermittent FMLA this week.
Good news is I've been migraine free for over 24 hours at this point,
Sep 22, '07From: US ; Joined: Jan '06; Posts: 13,193; Likes: 17,911I'm glad, elthia. Pain is the enemy.
Sep 22, '07Joined: Jan '07; Posts: 28; Likes: 9Of course you are not exhibiting drug seeking behaviour. You have a pain that you want to be rid of. A few suggestions. First I think you need find out what is causing the pain. Try keeping a foods diary and see if these migrains come on after you have eaten certain foods. Also if it persists suggest to your Doctor that they investigate it further. Your back could be out of alignment and that can cause one to have migrains. These migrains dont occur for no reason. Maybe a visit to a naturopath, good luck
Sep 22, '07Joined: May '05; Posts: 153; Likes: 87I saw typical drug seeking behavior in post op patients whenever I followed Nurse Tylenol. People in real pain can and do display classic drug seeking behavior, especially when some martinet has refused to address their pain. The behavior wasn't because they were addicts. The behavior was because their pain had not been treated appropriately.
Pain is ridiculously undertreated in this country. Insurance companies are adding to the problem by trying to ration drugs in a one size fits all format.
You are having a legitimate problem and you deserve appropriate treatment. Go ahead and pitch a fit. Scream and throw things if you need to. Any of us who have ever experienced a migraine will understand. Find out if you can afford an emergency supply on your own while you drag that insurance company into arbitration.
Just don't give up. This isn't your problem, it's their problem. You're just the one who is doing the suffering.
Sep 22, '07Occupation: staff nurse Specialty: 20 year(s) of experience in Tele, Acute ; From: LA ; Joined: Aug '04; Posts: 287; Likes: 97Forgive me if this was already mentioned, I did not have time to read all post.
What about a mail order of your Rx. Usually it cost less and you can get a 3 month supply. Not all ins co. have this option but it's worth looking into.
Hope you can find some relief.
Sep 23, '07From: US ; Joined: Jul '05; Posts: 856; Likes: 1,525I'm going to start ordering axert from canada.
Sep 23, '07Occupation: RN Specialty: Med/Surg/Tele/Acute Rehab ; From: US ; Joined: Aug '07; Posts: 253; Likes: 96Ditto on getting a THOROUGH neuro workup, and cardiac workup to rule out PFO. If your migraines might be hormonally triggered (even if only some of them are), you may want to check into hormone manipulation. Consider getting a script for injectable Zofran. Sure beats po meds when you are having N/V. Also, consider trying Toradol injections...your doc can prescribe them just like oral meds. If given very early in aura stage, Toradol can sometimes actually abort the migraine altogether. If it does not abort, it definately helps with the pain, and may be used in conjunction with Triptans. Don't forget, different people respond differently to different meds. If one triptan doesn't work for you, try another.
Now, for the true gem, Botox injections as a prophylactic. Yep, the research is not promising. When using Botox treatment for migraine the dose and placement need to be tailored to each patient through trial and error over time. And, unfortunately, this doesn't work well during a clinical trial. It doesn't work for everyone. But, if used properly, you can have amazing results. AND, insurance WILL often pay for it. Yes, I said it. I did therapeutic Botox prior auth for a neurologist for two years. The process can be tricky, and the insurance companies don't really like to pay for it. But, unless they have a policy that strictly disallows payment for Botox for headaches, they can be made to pay. Depends on the particular policy. It really helps to push the auth through if the patient has neck problems/muscle spasms (cervical dystonia is the phrase/coding you want on your auth request). But, before you say, "I don't have neck problems", pay attention to how your neck feels for about two weeks. A large percentage of migraineurs have chronic neck muscle spasms they either don't realize exist or discount as sequellae of the chronic headaches. Are you constantly rubbing your neck, or trying to stretch it? Does your neck stiffness and pain increase in the days just prior to H/A onset? A daily headache diary kept for a month will show you alot about your pattern. The easiest way to get Botox paid for by your insurance is to request authorization for the neck, and have your doc obtain a vial specifically for you by sending a script for the Botox to the specialty pharmacy your insurance requires you use. That way you have the entire 100 unit vial to use on the neck, and the face as well. The specialty pharmacy will obtain the auth from ins...make sure they check under your major medical benefit AND your pharmacy benefit. I have obtained a vial of Botox for as little as $16, the patient's pharmacy benefit copay. Botox retails for about $600/vial.