Last Wednesday I encountered the reason for the sometimes crappy treatment I get in the ED concerning my migraines. I actually met a real life in the flesh migraine faker! :
I was waiting in the Ed waiting room, waiting for my boyfriend to get off work, and noticed a couple sitting across from me. They were chatting happily, laughing and pigging out on candy bars and chips and cokes. I noticed the hospital bracelet on the girl and after about 10 minutes, I couldn't help myself.... I asked her what brought her to the ED at 3:00 in the morning. She looked at me and says..."Migraine"
I'm in shock at this point but then I get angry!
I say" YOU have a migraine and you can EAT and DRINK? Isn't the light bothering your eyes? You do NOT have a migraine and you know it!"
I turn away disgusted. Well....guess what...she goes into "migraine mode". Gone are the chips, the chocolate and the cokes, and out come the dark sunglasses, the cold ice pack and she puts her head down on her boyfriend's shoulder and starts to grimace in "pain"
I start laughing out loud. :chuckle I could not believe it! I still can't!
I have to drag myself into the ED, feeling half dead, wishing I was, and I get the red flag because the staff encounters people like this girl!
When I finish nursing school I want to work in the ED and I'm guessing I can't do what I did Wed, but I think I'm going to have a hard time keeping my mouth shut.
Honestly, I never quite understood how the cynicism towards migraineurs came about until now. Another part of me can't see how the real thing can be confused with these obvious cases of faking it. A dilemna that shouldn't exist I suppose.
How do you handle people like this? Can you get your license taken away?
I just had a severe injury that landed me in the er a few times last month. The first time was because I took Motrin for it, and while I am not allergic, I have reflux issues and it put me in so much pain I thought I was having a heart attack.
Anyway, each of the 3 times I was in the er, they offered me narcotics first. Quite frankly, they sometimes take away the pain, but i know they send you home feeling good and then a few hours later you are back to where you started. I have little kids, so there is no way I want to keep taking stuff like that at home either. One doctor gave me a shot of Toradol. That stuff worked miracles. I would much prefer that to morphine. Is there a reason that would not be given first for something such as back pain or migraines? (still a pre-nursing student here so I have not had pharmacology yet.)
Well said! This is all similar to the "back pain" pt's that present to the ED. I had a pt. the other day who apparently had a previous back injury that he had been through physical therapy for. He had just finished physical therapy and conveniently had just moved to our area and did not have a PMD or pain management doctor. After given him a shot of toradol and some prescriptions for cyclobenzaprine, Naproxen and Ultracet and taking an x-ray he decided to debate me and the doctor because he said that he had not had any pain relief and that he had tried all of those prescription medications before without any relief. The doctor and I reminded him of the role of the ED to evaluate the pain to be sure that there was not any damage from his fall that day. We told him that he was welcome to get the prescriptions filled and he was welcome to get a second opinion at another facility if he wished but he would not be getting any stronger pain medicine from us. I love it when we have doctors that don't just give in every time!!!
I just had a severe injury that landed me in the er a few times last month. The first time was because I took Motrin for it, and while I am not allergic, I have reflux issues and it put me in so much pain I thought I was having a heart attack.
Anyway, each of the 3 times I was in the er, they offered me narcotics first. Quite frankly, they sometimes take away the pain, but i know they send you home feeling good and then a few hours later you are back to where you started. I have little kids, so there is no way I want to keep taking stuff like that at home either. One doctor gave me a shot of Toradol. That stuff worked miracles. I would much prefer that to morphine. Is there a reason that would not be given first for something such as back pain or migraines? (still a pre-nursing student here so I have not had pharmacology yet.)
Toradol is a wonderful drug. We use it for kidney stones, pulled muscles, back injuries and often times headaches. It is an antiinflammatory pain medicine and that is why it works wonders with kidney stones. I have given kidney stones 10mg of morphine IV with no relief and you give them 30mg of toradol IV and they are pain free. A lot of our doctors do give that as a first try, however a lot of drug seekers have realized this and are now conveniently "allergic" to Toradol. Long term toradol everyday can cause some problems, if I remember correctly it could cause GI bleeds however this is when you take it everyday, because it does come in PO form as well. Hope that helped explain the mystery of it....:)
Well said! This is all similar to the "back pain" pt's that present to the ED. I had a pt. the other day who apparently had a previous back injury that he had been through physical therapy for. He had just finished physical therapy and conveniently had just moved to our area and did not have a PMD or pain management doctor. After given him a shot of toradol and some prescriptions for cyclobenzaprine, Naproxen and Ultracet and taking an x-ray he decided to debate me and the doctor because he said that he had not had any pain relief and that he had tried all of those prescription medications before without any relief. The doctor and I reminded him of the role of the ED to evaluate the pain to be sure that there was not any damage from his fall that day. We told him that he was welcome to get the prescriptions filled and he was welcome to get a second opinion at another facility if he wished but he would not be getting any stronger pain medicine from us. I love it when we have doctors that don't just give in every time!!!
Yes but he had a legitimate reason for his pain. Why are you so happy you sent him away with no relief? He had a significant amount of time to try all the meds and enough time to realize they didn't work for him. Not everybody reacts the same to meds. Maybe he really did move to the area and doesn't have a PMD, maybe he really just finished physical therapy and was still in pain. Its physical therapy, not Lourdes.
Gotta love that "We will evaluate your pain but not do enough about it...hows that?"
God forbid I ever have to go to the ER again, but if I do and they ask what I want, I am saying Toradol please, and hold the morphine. Thanks.
Toradol is a wonderful drug. We use it for kidney stones, pulled muscles, back injuries and often times headaches. It is an antiinflammatory pain medicine and that is why it works wonders with kidney stones. I have given kidney stones 10mg of morphine IV with no relief and you give them 30mg of toradol IV and they are pain free. A lot of our doctors do give that as a first try, however a lot of drug seekers have realized this and are now conveniently "allergic" to Toradol. Long term toradol everyday can cause some problems, if I remember correctly it could cause GI bleeds however this is when you take it everyday, because it does come in PO form as well. Hope that helped explain the mystery of it....:)
I just had a severe injury that landed me in the er a few times last month. The first time was because I took Motrin for it, and while I am not allergic, I have reflux issues and it put me in so much pain I thought I was having a heart attack.
Anyway, each of the 3 times I was in the er, they offered me narcotics first. Quite frankly, they sometimes take away the pain, but i know they send you home feeling good and then a few hours later you are back to where you started. I have little kids, so there is no way I want to keep taking stuff like that at home either. One doctor gave me a shot of Toradol. That stuff worked miracles. I would much prefer that to morphine. Is there a reason that would not be given first for something such as back pain or migraines? (still a pre-nursing student here so I have not had pharmacology yet.)
I have migraine often. I have tried just about every migraine RX out there. Imitrex works most of the time. But there are some that I just wake up with that are to far gone for the Imitrex to work but I will try it and do everything I can at home before going to the ER. But I have 3 kids, house, school, husband, I can't afford to be in bed for 2 weeks with a migraine. I need to get up and moving as quickly as possiable. If it's late in the week I will wait it out and see what happens. If it's been 3 days and I have used my medications and it's not gone then I have to go to the ER. Go Sun. am and my Mon. noc I am better and ready to function fully. I try to stay out of ER but there are times when it just has to happen. Torodol for me will relieve the pain on a scale of 10 down to an 7, but in a couple of hours I am back up to a 10+. Different drugs work differently on different people. I am also over wt. so if they give me a "normal" dose it doesn't work b/c of all of my body wt. I am a person who is very sensitive to pain. When I go to the dentist to have a tooth pulled It takes 4-5 shots of novican (sp) to numb it enough so he can work on my tooth. My body just requires more medication to work than someone else. Just my:twocents:
Well said! This is all similar to the "back pain" pt's that present to the ED. I had a pt. the other day who apparently had a previous back injury that he had been through physical therapy for. He had just finished physical therapy and conveniently had just moved to our area and did not have a PMD or pain management doctor. After given him a shot of toradol and some prescriptions for cyclobenzaprine, Naproxen and Ultracet and taking an x-ray he decided to debate me and the doctor because he said that he had not had any pain relief and that he had tried all of those prescription medications before without any relief. The doctor and I reminded him of the role of the ED to evaluate the pain to be sure that there was not any damage from his fall that day. We told him that he was welcome to get the prescriptions filled and he was welcome to get a second opinion at another facility if he wished but he would not be getting any stronger pain medicine from us. I love it when we have doctors that don't just give in every time!!!"
I'm afraid I don't understand. Are you saying that you love it when a doctor doesn't do everything he can to relieve a patients pain? There are such a wide variety of medications out there, and they are there to relieve pain. If one doesn't work, you try another. If Toradol worked on everyone for everything, we wouldn't need Morphine, or Demoral or anything else. But, we all know that it doesn't work that way, therefor we have many options for managing pain. To not use those options when a patient reports that the first thing you tried didn't help is terrible.
I have a back injury, I've been through physical therapy numerous times with no relief, and Toradol doesn't even touch my pain. I don't enjoy taking narcotics, but I also do not enjoy being in so much pain that I can't function normally. I have a three year old son that I am not able to pick up, even with pain meds. No sane person would choose to be in my position and it hurts and scares me to know that the times that my pain was ignored in the ER, probably made some nurses day.
Because of your post, I'm sitting here wondering if when I left the ER, still in pain, if some doctor and nurse had a good little laugh over it. Would they have stopped laughing if they could have seen me go home, lie on the couch and cry? Normally, when my pain pushes me to tears I hide, because it upsets my family so much to be unable to help me, but I'd gladly show a doctor or nurse now because I truly want to know if they think it's funny.
Nursing is a profession where you never stop learning, and I hope even one person learns from this post. Denying a patient pain relief is wrong, flat out wrong. Treatment is not denied for other conditions. Can't imagine an ER doctor refusing to prescribe a different antibiotic if the patient reports that he can't tolerate the first choice, and I can't imagine that you'd love it if the doctor refused to give in and prescribe something more suitable.
Maybe I could understand better if the patient in question was a notorious FF who has tested positive for drugs or something, but that wasn't the case in your post and you come off as vindictive and nasty and I doubt that you wish to be perceived that way.
Chronic pain is a horrible thing to live with and until you've walked a mile in those shoes I imagine you cannoy understand. Your whole life revolves around your pain, and it doesn't end just because a doctor prescribes narcotics either. I figured, after 4 years of agony, that finding a good doctor who began looking for treatment options and prescribed me a rather strong narcotic, would mean an end to a life of misery. But that's not completely true. Pain still rules my life, and I pain medication rules my life as well. Don't get me wrong, I am so grateful to have medication to relieve my pain, but it's also a huge resposibility. Imagine planning your day around when you take your medicine. Or shorting yourself a dose on Monday because you know you're going to need that extra dose on Tuesday to get your housework done, or because you have to go to another physical therapy evaluation that you know from past experience is going to mess you up BAD!
I'm a firm believer in the following: It's better to make the drug seeker happy than to let the truly suffering suffer a little more.
Well said! This is all similar to the "back pain" pt's that present to the ED. I had a pt. the other day who apparently had a previous back injury that he had been through physical therapy for. He had just finished physical therapy and conveniently had just moved to our area and did not have a PMD or pain management doctor. After given him a shot of toradol and some prescriptions for cyclobenzaprine, Naproxen and Ultracet and taking an x-ray he decided to debate me and the doctor because he said that he had not had any pain relief and that he had tried all of those prescription medications before without any relief. The doctor and I reminded him of the role of the ED to evaluate the pain to be sure that there was not any damage from his fall that day. We told him that he was welcome to get the prescriptions filled and he was welcome to get a second opinion at another facility if he wished but he would not be getting any stronger pain medicine from us. I love it when we have doctors that don't just give in every time!!!"
I'm afraid I don't understand. Are you saying that you love it when a doctor doesn't do everything he can to relieve a patients pain? There are such a wide variety of medications out there, and they are there to relieve pain. If one doesn't work, you try another. If Toradol worked on everyone for everything, we wouldn't need Morphine, or Demoral or anything else. But, we all know that it doesn't work that way, therefor we have many options for managing pain. To not use those options when a patient reports that the first thing you tried didn't help is terrible.
I have a back injury, I've been through physical therapy numerous times with no relief, and Toradol doesn't even touch my pain. I don't enjoy taking narcotics, but I also do not enjoy being in so much pain that I can't function normally. I have a three year old son that I am not able to pick up, even with pain meds. No sane person would choose to be in my position and it hurts and scares me to know that the times that my pain was ignored in the ER, probably made some nurses day.
Because of your post, I'm sitting here wondering if when I left the ER, still in pain, if some doctor and nurse had a good little laugh over it. Would they have stopped laughing if they could have seen me go home, lie on the couch and cry? Normally, when my pain pushes me to tears I hide, because it upsets my family so much to be unable to help me, but I'd gladly show a doctor or nurse now because I truly want to know if they think it's funny.
Nursing is a profession where you never stop learning, and I hope even one person learns from this post. Denying a patient pain relief is wrong, flat out wrong. Treatment is not denied for other conditions. Can't imagine an ER doctor refusing to prescribe a different antibiotic if the patient reports that he can't tolerate the first choice, and I can't imagine that you'd love it if the doctor refused to give in and prescribe something more suitable.
Maybe I could understand better if the patient in question was a notorious FF who has tested positive for drugs or something, but that wasn't the case in your post and you come off as vindictive and nasty and I doubt that you wish to be perceived that way.
Chronic pain is a horrible thing to live with and until you've walked a mile in those shoes I imagine you cannoy understand. Your whole life revolves around your pain, and it doesn't end just because a doctor prescribes narcotics either. I figured, after 4 years of agony, that finding a good doctor who began looking for treatment options and prescribed me a rather strong narcotic, would mean an end to a life of misery. But that's not completely true. Pain still rules my life, and I pain medication rules my life as well. Don't get me wrong, I am so grateful to have medication to relieve my pain, but it's also a huge resposibility. Imagine planning your day around when you take your medicine. Or shorting yourself a dose on Monday because you know you're going to need that extra dose on Tuesday to get your housework done, or because you have to go to another physical therapy evaluation that you know from past experience is going to mess you up BAD!
I'm a firm believer in the following: It's better to make the drug seeker happy than to let the truly suffering suffer a little more.
The chronic pain patients I've seen are pretty responsible. They are seen regularly by their docs and follow the recommended treatment. Usually when asked, they tell a long tale of procedures tried and failed.
It seems that MD's have been trained to relieve pain at any cost and I do have a problem (although never denied a patient) when for example, morphine is routinely ordered for headaches. If someone is experiencing daily headaches requiring shots of morphine several times a day while hospitalized, if truly in pain is going to be in serious trouble when discharged as they are not getting a script for IM drugs. Maybe it's more cost effective just to give the morphine rather than investigate the cause.
I know what it feels like to have chronic pain. I was fortunate to have a physician who spent time with me, referred me to specialists and kept me off narcotics. It took over 5 months before it was resolved which, if I was on narcotics would have been long enough for me to have been hooked.
Well said! This is all similar to the "back pain" pt's that present to the ED. I had a pt. the other day who apparently had a previous back injury that he had been through physical therapy for. He had just finished physical therapy and conveniently had just moved to our area and did not have a PMD or pain management doctor. After given him a shot of toradol and some prescriptions for cyclobenzaprine, Naproxen and Ultracet and taking an x-ray he decided to debate me and the doctor because he said that he had not had any pain relief and that he had tried all of those prescription medications before without any relief. The doctor and I reminded him of the role of the ED to evaluate the pain to be sure that there was not any damage from his fall that day. We told him that he was welcome to get the prescriptions filled and he was welcome to get a second opinion at another facility if he wished but he would not be getting any stronger pain medicine from us. I love it when we have doctors that don't just give in every time!!!"
I'm afraid I don't understand. Are you saying that you love it when a doctor doesn't do everything he can to relieve a patients pain? There are such a wide variety of medications out there, and they are there to relieve pain. If one doesn't work, you try another. If Toradol worked on everyone for everything, we wouldn't need Morphine, or Demoral or anything else. But, we all know that it doesn't work that way, therefor we have many options for managing pain. To not use those options when a patient reports that the first thing you tried didn't help is terrible.
I have a back injury, I've been through physical therapy numerous times with no relief, and Toradol doesn't even touch my pain. I don't enjoy taking narcotics, but I also do not enjoy being in so much pain that I can't function normally. I have a three year old son that I am not able to pick up, even with pain meds. No sane person would choose to be in my position and it hurts and scares me to know that the times that my pain was ignored in the ER, probably made some nurses day.
Because of your post, I'm sitting here wondering if when I left the ER, still in pain, if some doctor and nurse had a good little laugh over it. Would they have stopped laughing if they could have seen me go home, lie on the couch and cry? Normally, when my pain pushes me to tears I hide, because it upsets my family so much to be unable to help me, but I'd gladly show a doctor or nurse now because I truly want to know if they think it's funny.
Nursing is a profession where you never stop learning, and I hope even one person learns from this post. Denying a patient pain relief is wrong, flat out wrong. Treatment is not denied for other conditions. Can't imagine an ER doctor refusing to prescribe a different antibiotic if the patient reports that he can't tolerate the first choice, and I can't imagine that you'd love it if the doctor refused to give in and prescribe something more suitable.
Maybe I could understand better if the patient in question was a notorious FF who has tested positive for drugs or something, but that wasn't the case in your post and you come off as vindictive and nasty and I doubt that you wish to be perceived that way.
Chronic pain is a horrible thing to live with and until you've walked a mile in those shoes I imagine you cannoy understand. Your whole life revolves around your pain, and it doesn't end just because a doctor prescribes narcotics either. I figured, after 4 years of agony, that finding a good doctor who began looking for treatment options and prescribed me a rather strong narcotic, would mean an end to a life of misery. But that's not completely true. Pain still rules my life, and I pain medication rules my life as well. Don't get me wrong, I am so grateful to have medication to relieve my pain, but it's also a huge resposibility. Imagine planning your day around when you take your medicine. Or shorting yourself a dose on Monday because you know you're going to need that extra dose on Tuesday to get your housework done, or because you have to go to another physical therapy evaluation that you know from past experience is going to mess you up BAD!
I'm a firm believer in the following: It's better to make the drug seeker happy than to let the truly suffering suffer a little more.
Ok, sorry if everyone misunderstood my post. There was some parts of the story that were left out. First of all, pt. had "just moved to area" but had had several previous visits to our ED. Second of all, the minute that I walked in the door to assess him before I could even find out what was wrong with him he said "Let me tell you the only thing that works for my pain is Dilaudid" Third of all, I understand that he had a chronic back problem, however what he doesn't understand is the role of the ER. We gave him a shot of toradol and gave him several prescriptions to get filled. He was driving home, so he wasn't going to get a shot of dilaudid. Toradol is about the strongest thing he was going to get due to him driving. We gave him several prescriptions to get filled and see if those helped his pain. If they didn't then he was welcome to return or get a second opinion. No, I am not happy and I am not sitting around laughing when someone leaves with pain. We took x-rays to see if there was any emergencies. Also, and maybe I am wrong here but if I had a chronic back problem and I was on prescription medication for it and I was moving then I would be sure to get things in order before I left. Since he didn't, we gave him some prescriptions to tie him over however the doctor did not feel comfortable giving him narcotics. So, I am sorry if I came off as a mean cold hearted nurse, because believe me I am about as far from that as you can get. Hope everyone understands a little bit better.
I know what you mean about ranking according to the "pain expectation rating" of a given condition. In addition, I think people tend to rate pain according to the pain that they have personally experienced before. Like, I would have given myself say a "6" for something back in the days before I experienced unmedicated childbirth, whereas that would now maybe rank "4" or whatever because I may think I have an idea of how much worse it can be.
It is interesting how experience gives you a different perspective.
Ok, sorry if everyone misunderstood my post. There was some parts of the story that were left out. First of all, pt. had "just moved to area" but had had several previous visits to our ED. Second of all, the minute that I walked in the door to assess him before I could even find out what was wrong with him he said "Let me tell you the only thing that works for my pain is Dilaudid" Third of all, I understand that he had a chronic back problem, however what he doesn't understand is the role of the ER. We gave him a shot of toradol and gave him several prescriptions to get filled. He was driving home, so he wasn't going to get a shot of dilaudid. Toradol is about the strongest thing he was going to get due to him driving. We gave him several prescriptions to get filled and see if those helped his pain. If they didn't then he was welcome to return or get a second opinion. No, I am not happy and I am not sitting around laughing when someone leaves with pain. We took x-rays to see if there was any emergencies. Also, and maybe I am wrong here but if I had a chronic back problem and I was on prescription medication for it and I was moving then I would be sure to get things in order before I left. Since he didn't, we gave him some prescriptions to tie him over however the doctor did not feel comfortable giving him narcotics. So, I am sorry if I came off as a mean cold hearted nurse, because believe me I am about as far from that as you can get. Hope everyone understands a little bit better.
The extra details do make the situation a little clearer. For the most part, I don't understand the things I've read about patients requesting a certain drug. I've never done that, and probably never will. I do make sure that I let them know what I cannot have, but that's it.
But as for him getting things in order before he moved, that's not always as easy as you think. My dad moved several years ago, and thought he had everything arranged with a doctor in the new town only to find out at his first appointment that the new doc couldn't prescribe schedule II meds.
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I just had a severe injury that landed me in the er a few times last month. The first time was because I took Motrin for it, and while I am not allergic, I have reflux issues and it put me in so much pain I thought I was having a heart attack.
Anyway, each of the 3 times I was in the er, they offered me narcotics first. Quite frankly, they sometimes take away the pain, but i know they send you home feeling good and then a few hours later you are back to where you started. I have little kids, so there is no way I want to keep taking stuff like that at home either. One doctor gave me a shot of Toradol. That stuff worked miracles. I would much prefer that to morphine. Is there a reason that would not be given first for something such as back pain or migraines? (still a pre-nursing student here so I have not had pharmacology yet.)