The Angry Migraineur
UPDATE (12/18): Welcome spine-health message board visitors!
I'm not sure what I wrote that set this reader off, but he or she let it all hang out. Spelling errors, inappropriate use of the 'enter' key, satanic curses, graphically violent revenge fantasies about healthcare workers (me and Nurse K, primarily), and suicide threats. A cornucopia of crayzee.
Read it yourself (starting at the 19th comment). Or I'll save you the trouble of clicking:
Scapel,
You need to get out of the er.You are too much of a risk to be giving care there and way to uninformed.
How I wish someone would bang you upside the head with a frying pan every day when you get up and at least 5-10 times throughout the day when you least expect it.That pain still would not come close to what a chronic migraineur goes through that has a high level migraine constantly.(...)
I hope you become a migrainuer.I hope you get it so bad that it never stops.I hope it goes to the highest level so that you want to put a gun to your head to make it stop and that no one cares.And that they tell you that you don't matter.
I hope it for you and everyone with the same attitude that you have.I hope that it happens to you soon.I hope your life becomes a living hell,so that all you want to do is die.No one deserves it more.You are ignorant.You deserve the pain.And you deserve it now and for you to never get releif no matter what treatment you seek.
You are an educated idiot.There is so much information out there about migraine.But you don't want to be informed.You want to sit on a throne and judge.I hope the throne that becomes your closest friend is a toilet that you're dry heaving into.
You've made yourself judge,jury,and hangman.I hope I see you hanging right there with the rest of us.
and...
You really are a dumb ass.Take your degree and wipe your ass with it.Wishing discomfort,no,I don't wish you discomfort,I want you to suffer the tortures of hell.I want you to feel what you try to make people feel with just your words,let alone your ignorance.You are a disgrace to the human race.
I may wish this on you,but you bring it to people.And by the way,how the hell do you know what I do?You are a coward.
If I diserve this for wishing,imagine what you deserve you scumbag.
Oh my,big shot."That's the difference between me and you, and why I'm "in the ER" and why you are in the waiting room at the end of the line behind the truly sick and injured people." Truly sick,that would be you.The thought of you treating any paitient for anything is disgusting.
You are a self centered moron.And nurse k,chronic pain by definition is not an emergency.Define this.Stick your head in a doorway.Now,slam the door on your head about 20 times.How do you feel.Better yet,do it to scapel and don't treat him.
Migraine is a disease.It's not just chronic pain.
As I read scapel's idiotic writings,I'd say he's a disease that needs to be gotten rid of.
It's bad enough to put up with the pain,throw up for hours then have to face a pain in the ass like scapel.It's doctors like him that make people go home and slit their wrists due to the mistreatment he enjoys giving out.
He needs to be banned from coming near any patient ever.What a dumb ass.
Wow. I hope you get the help you need.
And thanks to KevinMD for the Kevilanche.
And here's some commentary by other bloggers that you might want to check out: WhiteCoat Rants, ER Nursey, The Physician Executive
I'm not sure what I wrote that set this reader off, but he or she let it all hang out. Spelling errors, inappropriate use of the 'enter' key, satanic curses, graphically violent revenge fantasies about healthcare workers (me and Nurse K, primarily), and suicide threats. A cornucopia of crayzee.
Read it yourself (starting at the 19th comment). Or I'll save you the trouble of clicking:
Scapel,
You need to get out of the er.You are too much of a risk to be giving care there and way to uninformed.
How I wish someone would bang you upside the head with a frying pan every day when you get up and at least 5-10 times throughout the day when you least expect it.That pain still would not come close to what a chronic migraineur goes through that has a high level migraine constantly.(...)
I hope you become a migrainuer.I hope you get it so bad that it never stops.I hope it goes to the highest level so that you want to put a gun to your head to make it stop and that no one cares.And that they tell you that you don't matter.
I hope it for you and everyone with the same attitude that you have.I hope that it happens to you soon.I hope your life becomes a living hell,so that all you want to do is die.No one deserves it more.You are ignorant.You deserve the pain.And you deserve it now and for you to never get releif no matter what treatment you seek.
You are an educated idiot.There is so much information out there about migraine.But you don't want to be informed.You want to sit on a throne and judge.I hope the throne that becomes your closest friend is a toilet that you're dry heaving into.
You've made yourself judge,jury,and hangman.I hope I see you hanging right there with the rest of us.
and...
You really are a dumb ass.Take your degree and wipe your ass with it.Wishing discomfort,no,I don't wish you discomfort,I want you to suffer the tortures of hell.I want you to feel what you try to make people feel with just your words,let alone your ignorance.You are a disgrace to the human race.
I may wish this on you,but you bring it to people.And by the way,how the hell do you know what I do?You are a coward.
If I diserve this for wishing,imagine what you deserve you scumbag.
Oh my,big shot."That's the difference between me and you, and why I'm "in the ER" and why you are in the waiting room at the end of the line behind the truly sick and injured people." Truly sick,that would be you.The thought of you treating any paitient for anything is disgusting.
You are a self centered moron.And nurse k,chronic pain by definition is not an emergency.Define this.Stick your head in a doorway.Now,slam the door on your head about 20 times.How do you feel.Better yet,do it to scapel and don't treat him.
Migraine is a disease.It's not just chronic pain.
As I read scapel's idiotic writings,I'd say he's a disease that needs to be gotten rid of.
It's bad enough to put up with the pain,throw up for hours then have to face a pain in the ass like scapel.It's doctors like him that make people go home and slit their wrists due to the mistreatment he enjoys giving out.
He needs to be banned from coming near any patient ever.What a dumb ass.
Wow. I hope you get the help you need.
And thanks to KevinMD for the Kevilanche.
And here's some commentary by other bloggers that you might want to check out: WhiteCoat Rants, ER Nursey, The Physician Executive
Labels: blogging, crayzee, migraineurs, rants
posted by scalpel at 1:25 AM
107 Comments:
Hmmm...nice. I personally love the chronic pain reference not being an emergency. Of course an analogy of banging your head in the door makes perfect sense! I mean, isn't that *acute* pain...feel the love man!
It makes me wonder if this person knows the difference between the role of a primary care physician and an emergency room. Cause, obviously she has some issues she needs to address with her family practice doc if she's in this amount of pain.... People, going to the emergency room for "pain" looks like you're an addict. Period.
With crayzees like this out there, we may need more speedloaders. Nice to know that at least one anonymous poster is sane. Thanks for that!
Or maybe I'll move up to one of these.
(drool)
With all this pent-up self-pity and anger, it's no wonder he/she has chronic headaches. I have a headache after trying to decipher the poor grasp of the English language. S-C-A-L-P-E-L.
This patient was in my ER tonight with some sort of similar verbal abuse (directed at her "uncaring" primary care physician and pain specialist), and I just nodded a few times, left the room, affixed her pain contract to the chart only to re-appear a few minutes later with her instructions to follow up with her primary care specialist or pain doctor.
Is a migraineur a snobby migrainer?
If she went to the local CVS pharmacy and complained about her migranes, she wouldn't expect anybody to be willing or able to help, so why the emergency department?
I think she misses the point that patients like this frustrate us not because we don't want to help, but because they refuse to learn how to help themselves.
I'm drooling over that gun too.
It makes my Pro Covert look like a toy.
hahahahaha....priceless...
For Christmas, I would like the Sig, Nurse K, emergencyem, MMT, or Jeanne Assam.
Just goes to show how many crazy nutjobs there are in the world.
I want to say that you are such caring people.I really don't think that person yesterday knew what they were talking about.
I have relatives in the medical field and I am going to make sure they take a good look at this blog.
I am so sure they will be interested in it.I just wanted you to know that.And that there will be others in the med field coming along and joining you here and the other blogs such as emergency em.
It's very important that you med people stick together.I'm so excited to share this with them and so many others.
thank you so much!
I also get chronic migraines, try a neurologist rather than the ER.
Joints
Where is your tree?
;>)
I wish she would have just come out and say how she really feels. How I hate it when people beat around the bush.
you know, it really is a shame that not even one of you can look past the humor of this outburst, and get to the real issue. The real issue of course being that "real" chronic pain in this country is so undertreated as to be a shame.
My neurosurgeon just told me that we were getting into a chronic pain syndrome with the disc problems in my back. Knowing the way I would be treated by the very people who are supposed to be helping me has scared me more than dealing with pain 24/7. So, I have opted for a 3 level fusion that will make my lower back totally stiff and does not give any guarantee whatsoever that I will be pain free. It is certainly a gamble. Also, he will clean up alot of arthritis in my spine. I take 3-4 tramadol daily and will not go to the stronger stuff because of this exact attitude that is very apparent in this comment thread. I also would never go to the ER for pain no matter how bad they were. I would instead use the sig sauer 9mm of my husbands, to get rid of the pains.
So while you are having a great time puting down and passing judgement on chronic pain patients, you maybe should be thanking your lucky stars that you are not where many of us are at.
Anonymous: I'm not in the medical field, but I'll admit that I've gone to the ER for non-emergent things, yes even the dreaded toothache. However, I don't lose my temper, and I have even told the doctor "I know what this looks like, I don't want pain medicine, can you do a nerve block?" My partner has had to get one, which is why I know about them.
Back to the point.
Nobody is saying that Chronic Pain isn't a real thing. What they're saying is that the ER isn't the place to manage Chronic Pain. If you're having constant migraines, you really should see a Neurologist and not an ER doctor, as the ER doctor isn't equipped to handle that type of thing other than giving pain medication, and even then it's only at their discretion.
Yes, occasionally the bout of pain that comes from a migraine may be Hell, and you will have to go to an ER occasionally for it, but going to the ER every time they get bad instead of taking the action of seeing a specialist about the problem is the height of lunacy.
I agree with the way the doctors and nurses speak on here about chronic pain, even migraines, because they aren't something to be managed in an emergency room setting, that's why it's called the EMERGENCY ROOM
To those of you wishing pain on these doctors and nurses, with all that they do, I hope one of them refuses to treat you when you really need it. They won't, their oath to "Do no harm," prevents them from doing that, but with the way you talk, I wouldn't treat you. They're better people than I.
Get a neurologist if you're having migraines, and manage them with Imitrex (I believe that's what the commercial said) rather than going to the ER every time one comes on.
RagingServer.com
Holy Cow! What a nut job.
Anon:
I do suffer from chronic, debilitating pain, but I also don't use the ER as my pharmacy or a clinic. If someone knows they have a condition that is painful and chronic then they should have pain meds available from their physician that they see to manage it. The condition and the pain are neither emergent nor acute. Should that status change, by all means head to the ER.
I see a LOT of people with "chronic pain", a lot of them go to one or two pain specialists. A lot of them are on methadone. I see a lot of vikes from multiple ERs, a lot of methadone, lots of multiple scripts.
Oh, yeah, these folks aren't breathing, either. There are plenty of folks walking 'round with chronic pain. Unfortunately. The pain isn't the problem, the drug use and being someone's supplier is.Browning22
Do people not die of brain aneurysms anymore? do you suppose some of these pain patients might be having the worst headache of their life and might just be very concerned? Last year I lost a good friend who was only 40 years old from a brain aneurysm. She came home early from work with a terrible headache and didn't want to go to the ER. When her husband came home he found her in bed with a headache. She still didn't want to go to the ER. Instead the next morning she was not able to be arroused so her husband called an ambulance. She died during surgery and she had 2 aneurysm. Just a year before a lady my husband works with who was also in her 40s died of the exact same thing and she also did not go to the ER, believing she was just having a bad headache. So when you have a horrible headache how does one know for sure what they are really having, or should we still stay home and assume if it is an aneurysm we will still most likely die regardless of medical interventions and we will also make alot of ER employees happy by not burdening them with our useless nonsense?
Also, William the Coroner, do you indeed see "alot" of folks with chronic pain? I would think it would not be so bad anymore once they got to you. This is quite disturbing that pain continues at that level!
The overwhelming majority of these patients don't want any workup whatsoever; they just want treatment. They've had the CT scans and the MRIs and the LPs. Not only were these tests normal (and therefore worthless to them), but they were expensive and provided not one teeny-weeny bit of euphoria.
Maybe that's why we have some degree of animosity about these types of patients. We both know they don't have an emergency, and yet they demand to be treated as promptly and aggressively as those who do...but without the annoying "workup" that would interfere with their buzz... strike that, I mean their life-saving, stroke-preventing, suicide-deterring pain relief.
Wow. Sorry you got the Migraineur Troll. Pain does suck. I had trigeminal neuralgia as one of the three symptoms of my cancer. That was the most pain I have ever felt; thankfully it was only in occasional flashes. But I know that no narcotic would have touched that level of pain. I hope your troll finds some pain therapy that works--if he isn't just a seeker. And I hope he leaves you alone.
Thought I'd weigh in with my two cents - first - I now undertand why so many ED docs are tooled up. Yikes.
Secondly - I think the relief of pain is an important part of ED work - why should severe migraine be any differnt? I realize a lot of people with chronic pain conditions fail to seek out specialist care for their ongoing management, but I don't think it is unreasonable for someone with severe pain thats uncontrolled with simple analgesia to seek additional therapy at there ER. There seems to be a "personality" that is associated with chronic pain suffers, and as such, there is a bit of a stigma attached to patients who come into the ED with the tag "chronic pain" - but all patients need the benefit of the doubt.
I wonder too why it is so odd for someone to come to the ER with chronic pain? Pain usually does not stay at one level and there are times when you cant get in to see a dr. sometimes it does get out of hand. On the contrary, it seems odd to me that patients who would not be in pain would seek ER care. Realistically how many patients do you see who report that they are feeling fine and have no pain but think they may have a kidney stone? I would think this would not be an emergency in any way. pain is the main factor that drives many (most) ER visits. Shouldn't a person with RUQ pain be better off to call their primary and get an appointment with a surgeon or get scheduled for an ultrasound? I dont know it just seems to me if people in pain should not come to the ER then I dont think we need many ERs or many people staffing those ERs.
You know I have been reading the medical blogs for awhile. It is not the people that come in with breakthrough pain for a chronic condition that are the problem. It is the ones that constantly come in every month, week, day for drugs. Those of us that have primary care drs and specialists and use them and provide the ER drs with the info willingly are not the problem. It's the ones that come from 2 cities over to get treatment. I realize that now. Nurse K and Scapel have said that on their blogs. If you truly have pain, if you are truly there for a legitimate reason, then it's ok. It's the ones that don't follow the rules, don't follow up, visit multiple times, and don't give their true drs names that are the problem. Too bad these guys that do that give the patients that follow the rules a bad name.
I didn't write it, but I mostly agree with it.
There seem to be a lot of Doctors and Nurses who feel that it's better that 100 people in genuine pain suffer than that one junkie slip through and get his fix.
I see far more glee in the blogs about spotting a purported junkie and cutting him off than I ever see about helping someone who is ill.
I have trigeminal neuralgia. at one time so bad that my doctorsa allowed that "rational suicide' was acceptable in my case.
I was on a TN support board for a long time. Many of the posters talked about how poorly they were treated in ER's. Some, no question about it, were expecting treatment that no one could give them; they needed psych support and neuros who took them more seriously. Often their ER trips came on the heels of an app't wth their pain doc or neuro that was so unsatisfactory to them that they saw the ER as their only option.
I worked for a time as an ER ward clerk. I know how I felt when I had to sign in someone who was abusing the ER, either because it was a cold that had lasted for 2 months or because they appeared to be drug seeking.
Please, let's remember most people with chronic pain do not get enjoyment from their medications. It is accepted by the pain community (or the majority of them) that people in chronic pain rarely are addicted to narcotics, rather they are dependent, a very different issue than using their meds for fun.
A few of the posts on the TN board were like this "crazee" post cited.
The letters were generated by extreme anger and frustration. "Maybe if these guys really knew what pain felt like, maybe then they would treat me like a real person."
The writer needs help, no dubt about it but one wonders if a large part of the letter was the result of being treted like dirt by some in the medical profession.
(And I also agree with the person who wrote about pain being a sign of something else. If you see the chronic pain patient as an annoyance and/or seeker of drugs, you may well not hear the one sign or symptom they report that indicates somethinng else is going on.)
Thank you.
Carol Jay Levy
author A PAINED LIFE, a chronic pain journey
member, cofounder with Linda Misek-Falkoff, PWPI, Persons With Pain International
member U.N. NGO group, Persons With Disabilities
Oh dear...that was quite an interesting dissertation...:-P
For the record, I don't consider myself uncaring, I consider myself a crusader against rebound headaches. I suspect many of the "chronic" migraineurs have this problem, the only solution of which is to not take so many damn medications. A lot of the stuff we give causes rebound headaches, and I know the customer is going to go seek for more drugs for the rebound headache until they are just a hopeless addict who screams at doctors and nurses.
I'm confused, primarily because I couldn't wade through all the spelling and grammatical errors, but...
...was she offering to let us bang her head against a door repeatedly?
Cool! Where do I sign up?
I think a lot of people really needs drugs like anti-psychotics, anti-depressants, tricycles...
etc.
So many pain issues are truly somatic (and nerve pain may be helped by them too).
If someone s in so much pain they are thinking of suicide, perhaps they need a stay in the inpatient psy ward.
I just think that this is a major issue that is not being addressed. Not because of ER docs, but because there are usally limited mental health resources.
I worked for a pain management clinic and I have to say the majority of my patients were not the "drug seeker" type.
Yes, we would get weekly calls from a pharmacy saying that there was a patient who was doctor shopping for scripts, falsifying scripts, going to multiple pharmacies around the state, going to the ER for medications, etc.
We had even got a few calls from family/friends saying they saw/new the patient was selling their scripts, snorting them, taking more then they should, etc. Or the local police were doing an investigation because a patient had sold their scripts which lead the person who purchased them to O.D. and die.
Whenever I mentioned I worked there, people would assume that I must be around alot of negativity and that it must be a difficult job to do. I'd hafta say that it was quite the other way around. It broke my heart to see people who were truely in pain, and unfortunatly everyone is different and sometimes it takes a while for the providers to figure out what combinations of things work for a particular patient. But it also filled my heart with joy to see people who were doing well on them. We not only managed their pain meds, but we also did random UA's on patients to monitor their medications for compliance.
I had an uncle who suffered from muscular dystonia along with alot of other things that stemmed from that, and a few experimental type surgeries he had as a result of it. His doctors didn't know what to do for him and handed him scripts for pills without him even asking. His house looked like a pharmacy of pills and patches. Enough to kill hundreds of people. But he refused to take alot of them because of his fear of becoming addicted or the fact that being on all those narcotics would render him unfit to have a "normal" life or be able to function. After he passed away, we took all his medications to a pharmacy to have them disposed of.
As alot of you know, depression is a huge thing with pain suffers. Any pain management clinic should have staff on hand for such and they should be giving depression meds if needed.
You can't just walk into an ER and expect for them to take it all away, they don't know your history. They don't know the avenues you have tried. They aren't the cure all.
To the poster who said just to take Imitrex for migraines...... lol! If it was that easy. Imitrex isn't a cure all for people with migraines, there is alot more that goes into that.
It's unfortunate that there are people out there with and without insurance that uses the ER as their primary care/specialist.
-Nicole
Damn! This person sounds exactly like my first wife. She was addicted to going to hospitals, feigning terrible pain and illness and demanding that the doctors admit her and start pain medication via IV right away.
I put up with 9 years of that bitches shit and finally had enough. I tried everything I could to help her in those 9 years but when there is nothing wrong but addiction and the person does not really want help, there is little that can be done.
I bought her a one-way ticket to Denver in 1988 and haven't seen her since. I hear from my son that she is still living between hospital stays and the street pushing a shopping cart.
God help her soul. I know I couldn't even though I tried with everything I had for many years. The doctors and nurses did their best with her too.
Some people just enjoy being sick and laying around in a hospital all doped up all the time. It's a mental illness in my opinion. She, just like this crazy bitch needs to be locked up in a psychiatric facility and dried out for about 3 years.
I have no doubt once you get the dope out of her and the mind set that she is always in pain and sick, she might yet one day become a good useful member of society.
Time is running out for her though. I still pray for her every night and I have not seen or spoke to her in almost 20 years.
Thank God and Greyhound she's gone.
When I read the original post, I could only think about how right you are. I have migraines. I have never had one treated at the ED. I see a physician, and I have my own medication. If the medication doesn't work (which is rare), I call the doctor in the morning! I don't run to the ED.
Frankly, when it comes to migraineurs, you're a jerk. You're so bent on nailing junkies that you fail to believe anyone could be a real patient. You've been trying to "poke the anthill" for months, and I'm sure you received this letter with glee. What exactly have you proven? Only that our medical system is broken when it comes to adequately treating pain. I agree that this letter is over the line and spiteful, but it comes from a place of pain and frustration that is completely human. There is nothing noble about kicking a person who is already down.
Rebound headaches are a major concern, but there are many chronic migraineurs who are carefully managing their medications under the care of specialists. We have regular doctors and regular treatment plans. Unfortunately, chronic pain is difficult to treat. Sometimes there will be severe breakthrough pain, and we will need some form of emergency treatment. Furthermore, many of us are not given rescue medications by our specialists for use at home. I have a migraine specializing neurologist who tells me I must go to the ER if my abortives fail, it's after hours, and my pain is that bad. Believe me, I've fought this because the last thing I want is to end up on *your* doorstep.
The problem I see with these blogs is the gross amount of stereotyping and generalizations. Chronic pain patients will continued to be treated like crap as long as health care providers hold the same contempt that has been repeatedly displayed here. I'm not talking about the frustration displayed toward true drug addicts, I mean the contempt shown to the actual pain patient. You'll tell a nice little story now about how compassionate you are, but look around, this blog is full of examples of just how uncompassionate you really are.
It's nice that you get to be healthy and improve people's lives every day, but you should be acutely aware of how quickly that can be taken away. Tomorrow it could be you who is the three car pile up with the broken back, needing surgery, and looking at a lifetime of chronic, unmanageable pain. Do you think any of us woke up one day expecting our lives to be like this? So next time you see me, can you try to remember that I'm just a person trying my best to get through things.
I've had the gammut from mild to severe migraines. If you can wait until the morning to call your doctor because your medication failed, then you have a mild migraine. If you're dehydrated from continuously throwing up, in severe pain, been in pain >72hrs, and out of medication options, then the ER probably is appropriate because you have a severe migraine.
Seeing a primary doctor or specialist is absolutely necessary to good care, but finding an appropriate treatment for migraine doesn't happen overnight. Many people struggle for years to find a treatment regimen that works for them. There is an incredible amount of trial and error that goes into finding preventatives and abortives that are safe and effective.
My question is, how many of these patients who repeatedly come in for treatment of chronic pain at the ER do so because they lack access to adequate health insurance to see a primary or specialist? And how many do so because they lack the appropriate medical guidance to see a specialist? (aka: Do you talk to them about their condition? Do you give them referrals or recommendations to follow up with someone?)
It would be nice if all chronic pain sufferers didn't think that each and every single post about a drug seeking (insert chronic pain syndrome here) is only about you as a person and how you personally deal with your pain. If you see yourself in these general and stereotypical posts, then a change is indeed needed. It is highly more likely that those people who are the references for these types of posts are not out reading medical blogs but instead out somewhere trying to find their next fix.
You miss the point. There's an issue if those stereotypes and generalizations lead to pain patients being treated like second class patients (and I content it does lead to this). You think this is about pain patients being too sensitive, but really it's about an inadequate healthcare system when it comes to understanding and treating pain.
There is alot of information in this comment thread. It is disturbing that you wi,ll ignore all of it except the one's who are in the medical field and who also find extreme humour in someone else's pain. Or the few who have not ever expereinced any type chronic pain and completely believe they know what it is all about, when they dont have even one clue. but, these are the ones who put you up on a pedestal and laugh at your uncaring insensitivites. When one of their family members end up in your ER and you treat them as a drug seeker, I promise you they will no longer think you are quite so funny.
As one of you said "anyone who comes to the ER for pain is treated and assummed to be a drug seeker." Do you not even know how unfair of a statement that is? Yes, we are angry and we are frustrated but we are not metally ill, unless you want to consider the way we are treated by the medical profession as a cause for that mental illness. To be very honest, I wonder about the mental health of professional medical people who are so warped by their career choice, that they pass judgement on folks they dont even know. That sounds like mental illness to me.
"this blog is full of examples of just how uncompassionate you really are."
I challenge you to find even one example. It would be nice if you guys would read what I actually write instead of mischaracterizing me as the prototype of all the mean doctors who have ever mistreated you, although it would make these comment discussions much less interesting.
ER Staff = people working to keep other people from death. You know, like in emergencies.
Migrane = not going to cause death. Not an emergency. Therefore ER = wrong place to go.
Seriously, I've only had severe pain twice (threw up, passed out both times). In my case it was neck pain. I could not for the life of me, not at gunpoint, have gotten up and been transported by any means to the ER. Even if I had been able to be instantly teleported to the ER, I would not have thought to go. I knew my pain was in no way dangerous. I waited it out and in a few days it got better. My self-treatment: Aleve and a heating pad. No co-pay!
(to the first anonymous below my comment above)I don't think every person suffering from chronic pain who reads these posts are being too sensitive. There are real addicts out there in this world who will say or do anything to obtain pain medications. They need that fix just as an alcoholic needs that next drink. Does this mean all pain sufferers are addicts? No. If you have ever met one of these addicts, you would know it. These are the ones who are 'allergic' to everything but their drug of choice. These are the ones who go through their month's prescription in 1 week and call for refills giving usually unbelievable reasons, like 'the bottle fell out of my truck window and I ran over it.' These are typically not isolated events. These are also not 'emergency' situations unless the withdrawals are so bad the person is seizing or not breathing. Other withdrawal symptoms can be treated effectively, but they don't want that.. they want to be high. Now, chronic pain is not an emergency. No airway = emergency. Not breathing = emergency. Bleeding = emergency. MVC = emergency. Heart attack/stroke = emergency. Acute (sudden onset) pain = potential emergency. Documented chronic pain with plan of action and treatment does not equal an emergency. That is why they wait in the ER, like everyone else who arrives without an emergency. I am sorry you feel 'pain' people are treated as second class citizens. I am also sorry that there are people out there who abuse the system over and over again, making 'pain' such a stigma in the medical world. And JCAHO makes certain that we, as medical professionals, don't ever forget about pain or about treating said pain. It just doesn't necessarily constitute an emergency.
Well it may not make it an emergency, but if you are honest here, you also know that true emergencies are not what keeps the majority of ERs open. How many true emergencies do you have on every shift of every day of every week? I think alot of you would be out of work if you only had REAL emergencies come to the er for treatment.
Are all these children whose parents bring them in for a slight fever and a cold an emergency? Are all the people who come to be treated for another case of bronchitis a true emergency? Is the person who has had stomach pains for 3 months and just thinks he better get it checked out at 3 AM an emergency? Are toothaches an emergency? What about the guy a few months ago who was sent in by his pcp because his potassium was 3.3. Is he an emergency? Scalpel certainly didn't so. He also thinks rape victims should not come to the er for treatment.
So we have all these people going to the ER for non emergent reasons, and yet, you always single out the pain patients who you choose to discriminate against. People who you dont even know and have no idea whatsoever of their history. Dont give me this BS that you can spot the drug seekers a mile away because that is not true. I realize you may think you have those powers, or you may even hear voices inside you that make you believe you have the right to judge, but you dont. You treat anyone who is there for pain control as though they are a seeker. It is also immature to say "We see lots of true drug addicts (Im sure thats true) so therefor everyone must be a drug addict." That is as wrong as the woman who has been raped believing that every man must now be a rapist. That is unfair to almost all men for any woman to think that, and when you bunch all pain patients together just because you know of some who abuse the system then you are also wrong.
The concept of triage is little known outside the medical field, and the anonymous posters should look it up, right now! Almost every emergency room has a triage person, usually a nurse, who evaluates all registrants and assigns a priority number or rating. Within a given rating, the ER attending may have some discretion as to who gets seen first. Regardless of the specifics of the system employed, a person with an exacerbation of chronic pain, or who has flushed his prescription down the toilet or his dog ate it, is likely going to be at or near the end of the list.
I haven't seen a single pain patient here say that they expect to be bumped to the top of your ER wait lists. We understand triage. We understand there's a wait. We understand that the guy who's going to die RIGHT NOW, needs to go first. I'm sorry that there are addicts out there that ABUSE legitimate medical disorders to angle drugs and are lazy, rude, inconsiderate asses in the process, but that does not mean you can bunch all pain patients into that category. It is a stereotype and a generalization. It is why pain patients have been treated like second class citizens in ER's and on this blog.
"I challenge you to find even one example. It would be nice if you guys would read what I actually write instead of mischaracterizing me as the prototype of all the mean doctors who have ever mistreated you, although it would make these comment discussions much less interesting."
The mere posting of the letter by this patient so that they could be ridiculed and shamed purely for your enjoyment is exactly the lack of compassion I'm talking about. Obviously this person is speaking from a deep place of hurt and frustration because they're dealing with a difficult medical condition and a healthcare system that's unable to adequately treat them. You could have tried to be understanding (or at least overlooked it), but instead you turned the wolves loose. Kicking a person while they're down, shouldn't that be against your hippocratic oath?
Kicking a person while they're down, shouldn't that be against your hippocratic oath?
Patients who start threatening or swearing at the staff are promptly escorted out, no matter how "frustrated" they are with their "syndrome". If this person started saying this to anyone, from the housekeeper to the physician, within my earshot, I'd have security give them one last chance before they were escorted out. We have no duty to treat people who are threatening to assault or kill us if we don't do what they say (barring some sort of mental health emergency or other obvious exceptions).
You know, for me, as an EM physician, the biggest problem with the chronic pain/migraine/etc. patients is that they come in demanding what they want instead of letting us decide the proper treatment path for them. Getting the headache broken is half the battle, usually.
For my migraine patients, I typically start with the reglan/IVF/toradol route, and increasingly, i'm using steroids due to some literature out there that's suggested that migraines may be due to inflammatory changes in the vasculature around the trigeminal nerve. Most of the time I can get this to work, even in people who are in status migrainosus. If the patient shows a willing attitude to me trying things my way and in an evidence based way, then I'll gladly give them something more for pain when thing's don't work out the way I'd hope.
I *can't* stand when the patients come in and before I ask them what's wrong, they state they have a migraine and the only thing that works is something IV that starts with a D...demer...dil...uh, something like that. That's when I get suspicious and start looking further into the patient's record and then I see that they've got 3 visits this week for low back pain, migraine, and toothache. When I suggest that I try things the way I usually do, then they get all huffy and puffy and want to blow my house in because I don't understand what works for them.
I've gotten close with one of our chronic pain patients who comes in. I've asked him what it is about certain drugs that he likes and dislikes and he stated that sometimes, it's all about the rush that they get with Dilaudid or Demerol (which is a horrifyingly awful drug, IMHO). They can't get that same rush from their actiq or their oxycontin because of the controlled nature of oxycontin.
Some guys will be brutally honest with you and I appreciate it. Some just flat out lie in order to get their fix.
Joints, you are doing it again. you just absolutely cannot or will not seperate the addicts from the real pain patients, you still lump us all together.
This does not surprise me as I saw both my elderly parents suffer through the horrible pain of recovery from total knees being replaced. OS's give about the worst pain control to their post op patients I ever seen, and yes, you do treat these old 75-80+ year old people who have many times never in their life taken anything stronger than OTC tylenol as though they are drug seekers when they beg you for help from the pains of having their knees ripped out. You should be ashamed of yourself.
Real pain patients dont do any of those things you just listed nor do they report losing their medication due to some simple minded animal eating them or whatever. We are talking about REAL pain pts and you keep talking about addicts. That sums it up for me right there.
It is interesting to me that anon remains anon while everyone else has a clear identity no matter their stance on the issue.
The fact of the matter is people who suffer migraines and other chronic pain who choose the ER/ED for treatment clealy do not get consistant care across the board can we at least agree on that?
Can we also agree that from the medical perspective; the ED staff see many, many people that come in seeking narcotics to satisfy an addiction and however good or bad it may be when chronic pain sufferers who have legitimate pain come in, the ED staff must vett them to ensure they are not contributing to an addiction rather than helping a pain sufferer. More likely than not the person presenting at the ER is a drug seeker and it is just something we have to deal with.
I presented with gallstones last year and other than the usual triage and qestions, I was wisked back to a bed and they treated my pain and kept me comfortable until I could be seen by the attending and admitted. They know what they are doing and can spot a true emergency vs. a non-emergency, that is their job.
Wow....scalpel you opened up a can of worms with this one. We who work in the ER and in other parts of the hospital can talk til we are blue in the face and people who don't do the job will never understand...to anonymous - you are rare if you know the meaning of triage and are willing to wait, the vast majority of chronic pain sufferers are not so willing....I suggest you go and volunteer at your local ER for a while and get a picture of what really goes on....it is easy to give your opinion intellectually -you haven't been there in real situations...volunteer and then get back to us.
Anon is certainly more than one person. I know I posted one of those anon's but not any of the others.
Girlvet, do you hear yourself? You are telling them to do exactly what you are refusing to do. When you are the chronic pain patient sitting in that waiting room for hours on end, and then get talked down to and treated like an addict, why dont "you" get back to us then?
Not to mention I am confused about a "Girl Vet" working in a human ER?
In all my years with trigeminal neuralgia (30) I went to the ER only once. Yes, it was not a life threatening situation but I could not get the pain to stop no matter what I did or how many pills I took. I needed to go where they might be able to help me.
I waited my turn, just like any patient. They listened to my story, and I had physical manifestations of the 6 major neurosurgs I had had for it.
Maybe that was why they were willing to try and help me. They gave me a shot of something, had never heard of it but if they said it might help whatever they tried was fine with me. It may have helped slightly but so too did the passage of time. Sometimes even ER's need to give a patient the best help they can along with 'tincture of time'. I also needed to be in a place where I felt someone might be able, and willing, to help me.
Since I went only once I do not know from personal experience how pain patients as a group are treated (absent the anecdotes from posters at support site.)
I can only say I was very grateful that night for the doctors and nurses who tried their best to help me.
(As for ladyk~ak47 "If someone s in so much pain they are thinking of suicide, perhaps they need a stay in the inpatient psy ward." I was an inpatient for a month in a pain clinic. In reference to suicide, before I left the director, a psychiatrist, and the staff psychologist told me; "We hope you won't but we will understand if you do."
(A neuroophthalmologist also agreed suicide was the only option left for me at that point.)
Thank you.
Not to mention I am confused about a "Girl Vet" working in a human ER?
She's a military vet, dummy. :)
Doc, you are one hell of a fellow. You jumped right into the Lion's Den with this one didn't you. I'm just like you though. I tell it like it is and let the Lion's roar. I love this blog. It's one of my favorites.
Good luck with the dopers.
Ya know Nurse k, it's kind of hard to tell that, when someone doesn't have a public profile. I come from a long family of military men and women and I guess it just didn't occur to me that she might be one.
Im very sorry I made that mistake, and Im also sorry that if someone makes a mistake around you, they leave themselves open to verbal abuse.
However, if you want to google "Vet" you will see that I am certainly not the only stupid person. In fact, "you" may well be the smartest of us all!
Brian and Jennifer,
As a chronic pain patient that works in health care, I think you have the right idea. Unfortunately my doctor right now tends to "pass the buck" to the ER more than I like.
Some doctors have a protocol. If it works for me. Great! If I try it and am still in pain, then I hope they will help me out or call my doc.
When a doctor asks me what works, I hand them the letter from my physician on their letter head with his cell and pager number and a "suggested protocol". If they decide to follow it, great! If they have a better idea, I am willing to give it a shot.
Not a doctor, so take it for what its worth. I think a patient who is willing to try anything, is in enough pain that they are desperate for anything to fix it. But doc's when your patients show that they are willing to try anything, please do whatever you can to help them.
My suggestion for doctors who are unsure if they have a chronic pain patient or a druggie, offer to have the nurse give dilaudid 1/4 ml at a time IM. If the patient is willing to get several shots and a slow release, then they are probably legit. If they stomp their feet, whine and pout, well, that is your answer. (Sorry nurses, I know this is a pain for you guys... But in that case, ask the doctor if you can give the dilaudid (or whatever) diluted in 500cc of NS... Have to imagine that doesn't give a junkie the high they want)
Right.Between this topic and the "I carry a gun because I can" story, you have been in a rare form.
Can't wait for the next controversial topic you will not fail to pick so we can see them all run with it, carrying their pennants :)
"The mere posting of the letter by this patient so that they could be ridiculed and shamed purely for your enjoyment is exactly the lack of compassion I'm talking about."
I didn't post the original letter to ridicule or shame the commenter. I posted it because I thought other people might benefit from my compassionate and honest advice, and I anticipated that it might stimulate a lively discussion.
The "angry migraineur" comments were posted on my blog by another anonymous person during that discussion. I just gave his comments more visibility.
"I posted it because I thought other people might benefit from my compassionate and honest advice"
God, you are funny! In the original comment thread, you called him a "fucktard"....Is this your definition of compassion?
That anon wasn't the reasonable gentleman who wrote the original letter. He had arm pain, not migraines.
And no, I'm admittedly not very compassionate toward fucktards who want to bang me in the head with a frying pan.
Oh, man, I love this blog!
Sometimes the most compassionate help that chronic pain patients who have entered the unhappy world of addiction can be given is to say "no" and "you need help I can't give you but I will refer you to people who can". Sadly, many of these people can't, or won't, recognize the compassion that is being shown to them.
Joints-
;)
Good gracious Scalpel. I thought you were a good doc and caring person but I think this person has you nailed. It is, as you no doubt have come to realize, impossible disagree with the construction or flow of argument. You are an asshole. "Wipe your ass with your degree", I mean, how can one argue with that. Sorry friend, count me convinced.
Chronic pain blows! I had a back injury once. I took pain meds only to lose consciousness every time I stood up. I tried different ones, including non narcotics and half tablets. I really hated the feeling of not having control when the meds took effect. They made me feel sick. After ending up on the telemetry unit from my med reactions, I decided I would rather not take any pain med ever again. Instead, I went to acupuncture where my pain disappeared. I found acupuncture worked for other situations also.
I had my wisdom teeth removed not with analgesia, but acupuncture. The best part was not dealing with side effects.
I have found allopathic medicine being "evidence based" and relying on symptoms to fall into a box to be analyzed for a proper diagnosis leaves a large group of people falling through the cracks. If this medicine has failed you, try another. Each type of practice has its successes.
I hope all of the chronic pain sufferers find the comfort they are seeking.
As for compassion, be the change you want to see. Check in with yourself.
Crazies or not, we have to deal with obnoxious patients.
http://executivephysician.blogspot.com/2007/12/chronic-pain-malingering-and-difficult.html
"Joints, you are doing it again. you just absolutely cannot or will not seperate the addicts from the real pain patients, you still lump us all together."
At last, my problem is defined. And he/she is right. I can't separate them. Maybe if the addicts would have a big red A tattooed on their foreheads... Otherwise, the real pain patients coming to the ER for narcotics are going to be hard to distinguish from the addicts coming to the ER for narcotics. Of course, the real pain patients honoring their contract with the pain specialist and not seeking narcotics elsewhere are already easy to distinguish from addicts.
holy shit!
doctors don't troll on chronic pain blogs. And besides, doctor's AREN'T the reason that chronic pain is treated like a criminal condition in ERs. Maybe if all this collective venom was directed towards the actual drug-seekers who have hijacked your cause, or towards the provision of adequate chronic pain resources so you DON'T have to go the ER.
Right now, all the personal accounts of "I am a migraineur and this is how I should be treated" come across as petty rants. The plural of anecdote is NOT data. Provide us with peer-reviewed and solid data that says that you need to be treated like x y z and that is how we will treat you.
In the meantime we will desperately try to cling to our prescribing privileges by avoiding prescribing narcotics and strong analgesics.
We will also respect your boundaries and stay away from your blogs. Perhaps you could provide us the same courtesy.
People aren't angry that pharmacies won't break the law and just throw hydrocodone at them. Why are they angry that doctors won't break their moral codes and do the same? Are ethics, morality, and trying to do the right thing somehow a less valid reason for decisions now?
"doctors don't troll on chronic pain blogs."
Good point!
Not true!
LOLOLOL
+20 for Shadowfox.
I'm liking him more and more each day.
Hehe!
We all agree that pain sucks and should be treated, but ED folks are right to hold the chronics responsible for lame rationalizations and poor disease management habits. Working the ED for narcs just to get high is pathetic. Working the ED for narcs because you have legitimate chronic pain but can't or won't take responsibility for organizing to stay out of the ED is worse. You know in advance how miserable it is to wait in that room; how likely it is that it'll be 8-10 hrs before you even get called back. Understand that your world may be pain, but trying to suck the ED people into that little world is counterproductive and deeply selfish. No matter what, you are not dying. Acting like you are does not enhance the legitimacy of your disease; it illuminates the weakness of your coping style and makes you look like a junkie: a sick role junkie. I should know. I've known for 15 years that I was an ED abuser. Only now after being clean for several years can I admit that it was more than drugs. It was the identity. I did not ask for hereditary pancreatitis. I did not know what 100mg demerol q/3 hrs for a week would feel like, 4-5 times a year from age 15-20. So what. By 20 I knew could fake acute episodes, get admitted, and check out for a week. I learned to leverage that sick role for meds and pity. Nurses would tell me educated I was about my illness, how well I seemed to cope with it. I am very thankful that smart, tough, caring nurses and doctors shut me down before I ended up dead or in prison. I only lost 15 years of my life. Having demonstrated several years of absolute compliance with my treatment plan and contract, I am not turned away at the ED, or treated with skepticism or disdain. No nurse has to call the other area ED's about me, or field calls from the Pharmacist about excessive refills. I know I won't suffer, and I know I won't be handed a bottle of 100 percs either. Thanks to all of you in the medical field, even when we fail to embrace our own autonomy you still care about us. Thank God
You know what, this is not as simple as you all think it is. There are MANY pcp doc's who will prescribe NO pain medication whatsoever. Not for the addicts nor for the real chronic pain patients. Instead, they tell patients if their pains get to bad to go to the ER. then you use the excuse that we should be getting them from our own Doc's. what you guys are really doing is refusing to treat chronic pain at any level and just shoving the blame back and forth while patients are suffering. Yes, Im sure there is a big problem with people who abuse narcotics but doctors who refuse to treat real pain are not doing their jobs.
This issues trancend the simple chronic pain-ED issue.
Read the physician comments relative to the patient comments. It doesn't matter how many patients concur on this issue or any other there is no way that the patient could actually be correct. Doctors of course know more than patients. Doctors of course know the RIGHT answer.
These guys are suffering and you guys just kick em around and make fun of them. They try and explain and you call them drug addicts. It's a losing battle for the patients as the only person any of you tards will ever listen to is another doctor. Another of your esteemed collegues. Which Nurse K is not one of by the way given the way you guys shit on the nurses and other staff.
By abusing each other through medschool and residence you teach that you CANNOT be wrong or risk getting gored by your collegues. Thus nowdays you can't admit you could be wrong, your collegues could be wrong or the whole castle comes tumbling down.
If the patient doesn't agree with your esteemed treatment plan then thy are mentally ill. If you can't figure out what's wrong with them, then they are mentally ill. If they argue or disagree, or complain about you then they are mentally ill. If they give up hope and talk about the despiration they feel after dealing with you guys then they are mentally ill. Don't the psychiatrists get sick of you guys dumping on them?
Good lord no wonder mental illness is such a stigma. I can almost feel you guys pouring with animosity and fear every time you say the word crazy. I attended a talk from a Harvard MD once who said that 1/3 of people will have a mental illness in thier lives. But I am sure that wouldn't be any of you guys.
Sorry MDs you may have a cuddly support group here but in the real world patients pretty much agree about what you guys are really like.
tina
4mg of Dilaudid + 50 mg Phenergan injection STAT!
She's desperate! And she hasn't been in this much pain in almost 2 weeks!
The last ER doc's esteemed treatment plan didn't fix the problem, but surely this time it will work!
Wow, this discussion has been fascinating.
I am neither a medical professional nor a chronic pain patient. Hope you don't mind another unknown commenter.
First of all, I don't understand why any legitimate chronic pain patient, who is responsible about managing his/her condition, would EVER need to go to the ER. Part of managing a chronic condition is having the means at your disposal to handle any flares. If there's a med that helps you when your pain flares, your doc should prescribe a small amount for you to keep around. If you're not an addict, there is no reason why a doctor would not do this.
Second, people seem to expect that doctors are going to care about their patients. Well, sorry, but they don't. That doesn't mean they can't do their job perfectly well, though. Yes they are going to leave you writhing in pain for hours if there are actual emergencies that need attention first. And no they really don't care about your suffering. That doesn't mean they think you're faking, it just means they don't care, and if you're in the ER with a non-emergency condition, it's not even their job to pretend to care.
"4mg of Dilaudid + 50 mg Phenergan injection STAT!"
Jesus Christ Doc! That's enough pain medicine to knock me (6'-2" 300lbs) on my ass for at least 24 hours. How in the hell does anyone that is not severely, traumatically injured warrant that amount of pain medicine?
As I've said before, I have been on pain management for 19 years. That amount of medicine would still kick my ass. Anyone that thinks they need that for chronic pain has a real problem with addiction and the drug tolerance brought on by it.
To this day after 19 years I still take less than 30mg (total for the day) of oxycodone. As I have also mentioned, it does not completely kill the pain because I want to remain functional and able to work and drive.
My doctor and I have always agreed to err on the side of caution and try to keep the tolerance from building up.
There is just no excuse for that much medicine unless you're laying in the ER with multiple compound, open fractures or some other such obviously excruciating injury.
I can't believe that a person would come to the ER and ask for that amount of meds. I could not look a doctor in the face and ask for that.
But then, that's the way I roll. I believe in telling the doctor the truth (withholding nothing) and let him or her make the call on what I need for relief. I think the amount of medicine above would probably put me in a coma.
Sheesh!
I feel for you doc if you have people coming in demanding that level of medicine. I say fuck'em. Do what you think is best and throw 'em out on their ass. If they get shitty, call the cops.
My opinion.
;-)
Joe
scapel,
No,the one you called a fucktart was did not have arm pain,it was migraine.And if any of you so very smart people who know so much would put it to use,it would be nice.
People who suffer from migraine,one of the things they go through,especially at a high pain level,are things such as spelling errors.
Sometimes they can't speak.A good idea might be to spend a little time learning about migraine instead of having such a good time impressing each other with how "wise" you are.
The last time I took my spouse to the er,the nurse was in doubt that she really had migraines because she said to my spouse "you don't look familiar."
The one er trip,my spouse fainted.The security guard helped with a wheelchair.The er had 2 other patients,yet it took 3hrs to be seen.We sat quietly,which was easy for my spouse passed out for the 3hrs in the wheelchair.I guess that was from the hours of throwing up and the pain of migraine.
When finally getting in,I quietly,calmly explained that my spouse gets migraines and this was a 2day one(starting on a late Fri night,now it was Sunday)After speaking to the dr he said :So what do you want us to do?"
Well,they did end up finally giving some meds thru an iv and sending us home.And we did follow up with a doctor on Monday.
I guess I could have taken the chance of dehydration or death,but I felt the best and only choice was going to the er.
The trips to the er amount to about 4-6 a year.There should be more,but my spouse won't go because death is more appealing than the er treatment.
So,no,manners don't matter
I'll reiterate once again:
I received a letter from a very reasonable gentleman with neuropathic arm pain, which I posted under the title "Letter from a Chronic Pain Sufferer." I did not post this letter to ridicule or shame him. I posted it because I thought other people might benefit from my compassionate and honest advice, and I anticipated that it might stimulate a lively discussion.
In the comment section of that post, a fucktard with "migraines" made some hateful comments toward me, which I reposted under the title "The Angry Migraineur." He posted those comments, not me. I just gave them more visibility as a post of their own.
I hope that clears things up. Apparently "migraine" patients have trouble understanding stuff as well as typing properly and acting civilly.
A common theme among migraineur commenters is that they think they know more about migraines than physicians do. Sorry, but you don't. Migraines don't cause death, for example. If they did, then you would be less likely to wait 3 hours to be seen.
"When finally getting in, I quietly, calmly explained that my spouse gets migraines and this was a 2 day one (starting on a late Fri night,now it was Sunday). After speaking to the dr., he said 'So what do you want us to do?'
Well, they did end up finally giving some meds through an iv and sending us home. And we did follow up with a doctor on Monday."
Sounds like you had a wonderful visit that met all reasonable expectations. So what are you complaining about?
Science Daily:Aug 14,2007
Furthermore, migraine has long been regarded as a risk factor for ischemic stroke (stroke caused by a blot clot blocking blood flow to the brain). Few prior studies have addressed the different potential reasons for an association between migraine and stroke.
First,the point with the nurse saying my spouse didn't look familiar so she didn't think we were telling the truth.Yet if my spouse looked familiar,would've been looked at as a drug seeker.
Second,leaving my spouse unconcious in a wheelchair was not a wise thing to do.
So,it really doesn't matter when a person with migraine goes for help.
Oh,since someone like my spouse has had migraine most of adult life,yes,we may know more than the doctor,at least in our individual case.
No person with real migraine chooses to go to the er.We even tried to go to urgent care instead on a weekend,they don't deal with migraine.
The doctors that give my spouse treatment have only their office hours.If it was your spouse,and every med you tried didn't work,what would you do?
Or if it was your daughter.As we have a daughter that is getting migraines,loses her vision and is starting to get severe pain.So,we should try everything,then wait until the weekend or the doctor is in.Just let her suffer and take the chance that she may die.
I have a friend who is a nurse.Another nurse she worked with used to get migraines for a long time.One day,in the break room,the other nurse had a severe migraine and fainted.Turned out she had an anerurysm.If they had not been able to get her right to the or,she would've died.
Well,at least I know I tried for my family.But I know here,there is no use.You're too educated.
So go ahead and joke.It's really sad.But at least you're happy,right?
Whether migraine patients are more likely to suffer from ischemic strokes is irrelevant. I haven't seen any studies that suggest that prompt treatment of the pain of a migraine prevents strokes or improves mortality, or that these strokes tend to occur during a painful headache episode. Ischemic strokes are not typically painful. Patients with migraines have an overall lower mortality rate than patients without migraines.
Your "friend of a friend" had an aneurysm, not a migraine. I suggest complete workups of all new headaches to exclude aneurysms or other non-migraine (clinically significant) etiologies.
And if your wife or daughter has such a bad headache that they think they need medical attention, I would never suggest that they not seek it. But if they have a well-established history of migraines and they have had extensive previous negative workups, then they are usually going to have to wait in line behind some of the more acute patients before they are evaluated and treated.
Deal with it.
Scapel,
I wanted you to know that you won this one.There will be one less migrainuer thanks to you.Not in Texas where you are,but the local er should be sending you a thank you note.
I didn't look for your blog,I just stumbled on it.But reading how you and the other medical people here really feel,I know there is no hope to be taken seriously.
So,I'll prove your point tonight that migrainuers are just crazy.Since there is no hope for the pain to end because doctors,nurses like the ones on here don't care and really have such hatred for us,see ya.
So put another notch on your belt.Since I can't get the help I need,and you confirm for me what I've thought was true,that we're thought of as druggies,nutjobs,fucktarts,whatever There's no hope becuase there's no hope,there's no hope because people like you don't care.
So I'm going to end the pain myself.You should be proud.You just got rid of a fucktart,nutjob,sorry,no druggie here.Cheers,I quit.I will deal with it,I will end it.
Why so all the "true migraineurs" have a beef with the lock box on the narcs. A "true" migraine should respond to triptans, nsaids, triptans, phenothiazines, maybe some tegretol or steroids for an acute migraine. Chronically it should be managed with lifestyle management, SSRI's, TCA's, b-blocker, etc.
If they are getting confused with the 'seeker' then maybe they don't have true migraines.
Wow the amazing levels of disrespect, ingratitude, and dare I say it, entitlement, shown to the persons in medicine astounds me. If medicos were deities I could understand the demand for perfection. The people in the ED more than likely did not cause your pain so cut them a little slack while they try to help. If they can't help you the way you want to be helped um I think that is cost of living in this world. Own your issues.
Hey pain sucks, and makes everyone hostile but the long and the short of it is that most people do not care at all about your pain. If you find someone who does, treasure them because they are a gift to you. Stop whining! It is unattractive but makes for great You Tube vids. I have a camera phone and know how to use it!
I too suffer bouts of great pain. Yet before I found myself in this condition I made myself part of a community. I helped strangers and made friends. Now I am helped by friends and people who are strangers to me but yet part of my community. You want compassion? Mercy? Relief? Plant some of that in your community it will come back to you.
I wish I could see everyone that needs my help immediately. But I can only see three or so patients per hour, maybe a quick peek at a couple more if the first three aren't too critical. But if ten patients come to the ER in one hour, and I've already got half a dozen to see, then some of them are simply going to have to wait a bit.
It only takes one really sick patient to back things up. If you or your family member aren't that person, then you should be thankful instead of angry.
Well Scalpel, I certainly hope that this "Brillant" (said in all arrogance) post of yorus, has not caused someone to commit suicide, as was implied in a comment a few up from this one. Honestly though, I doubt you would care at all if that were to happen. What matters for you, is that you get your 10 minutes of laughs from the other physicians who believe exactly as you do.
You should though, for this persons sake, if for no other, point out that many doctors are not like you and the few that follow you on your blog. You attract the one's who are just like you, the rest giving up on you long ago, knowing full well that you are a dangerous asshole.
Real doctors listen to their patients and prescribe on an individual basis. They do not have a poisioned mind and treat everyone the same. I cant stress enough that this is the exact reason why people need a regular GP or PCP from an early age on. That way if something then happens to them that one days causes chronic pain, it can be well documented and hopefully they will then have the support of their own doctor.
It seems some here think chronic pain is like having a sprain or a toothache. For those of you who do please read the first chapter of my book to better know what "the worst pain known to man" and "the suicide disease" feels like. It may not be migraine but you need to truly understand what the experience is like from the inside. Thank you.
https://www2.xlibris.com/bookstore/book_excerpt.asp?bookid=18435
He created the post himself, and he is responsible for it. I can't take credit for the "brilliance" of it, or for the way it makes him feel. And if he chooses to commit suicide (rather than just acting like a manipulative pity-seeker), then that is another personal choice he will make for himself.
If you are going to come on someone's blog and call them names, then you'd better put on your big boy pants.
Personal responsibility....what a concept!
I really don't mind the suicidal patients. A note is helpful, but not entirely necessary. Oh, and if you are prescribed 30 pills and have 5 two days later, if when I call 'round to the pharmacies and see you're getting narcs from three different docs, I will sign you out as chronic drug abuse.
The coroner always gets the last word (although maybe not here). I guess if someone comes on this blog and calls names, he/she better wear their pullups. Big boy pants are going to get stained.
Scalpel reminds me of an old Texas Ranger that used to come see me occasionally. He had a .45 Colt in his belt with a round in the chamber and the hammer back. Asked if that wasn't dangerous, he said:"Yes."
If you are doctor or pharmacy shopping then the title of drug seeker may well apply. At the least your primary pain doc isnt doing his job. If so, then the person needs to find a doc who can help with pain needs and palliation.
All we with pain ask is that we not all be lumped into the category in which the DEA, many docs, and some folks here have tried to put us into.
It also requires that docs recognize the difference between dependence and addiction. (And keep an open mind. Just as there are zebras there are also honest folk whose pain cannot be kept in check.)
Thank you.
wow- well, MY PCP and my spine doc all tell me to go to the ER when my pain gets high. I've broken my back twice and at the age of 34 I'm doing pretty damn good. But yah - sometimes I go to the ER for it (2x).
It's too bad that all the system seems broken for docs who just want to care for their patients.
Wow Scalpel...you've got a book worth of comments here! There are obviously anger issues that need to be dealt with. It's one thing to make a point but it is entirely another when you attempt to do so with such vile words against another person. And do these people read WHAT AND UNDER WHAT circumstances that meds are refused to a pt or WHY you docs/nurses get frustrated?? No brainer...really!
On the other side off the coin...that post put up by Dr Val and Whitecoat liked to it? I saw red after reading it and would put a pox on that staff for treating that woman that way. Yikes! That would never fly at our hospital!
Correction..not liked to it but linked to it.
Hey Scappie
It sounds like you have some lame ass junkies in your little world. It would stand to reason that when they present to the ER that they would be as compliant and cooperative as possible so as to keep up the ruse .What do they have to gain by being an ass ? I would be "kissin ass" vs being one. Your macho moniker is VERY telling ! Have you ever considered treating people individually ? I am surprised that you don't suffer some serious affliction due to all of the hate that you carry around. I wouldn't tolerate rude or obnoxious behavior either. But why not just turn them away put there names on a list of people not to treat ? Don't they triage ppl at your ER ? Are you against ALL migraineurs you see ? Does a legitimate 3 day , puking your guts out , compazine, toradol & imitrex proof migraine constitute an ER visit blessing from you ?
I treat everyone individually.
I don't carry any hate around.
We do turn rude obnoxious people away, after their medical screening exam.
They triage people at every ER. It's the most important thing we do.
I am against none of my patients. I am their advocate in every circumstance. That doesn't mean I'll do whatever they demand.
Anyone who thinks they need to seek emergency medical attention in the ER has my blessing. I'll gladly give them my professional evaluation and my best advice. That's what I'm there for. But some people are going to have to wait longer than others to see me. If they don't mind waiting, I don't mind seeing them. At all.
That doesn't mean I'll give them Dilaudid on request. Sorry. But if I feel that it is justified (on a case-by-case basis) I certainly will.
You guys don't read anything I write, do you?
the problem is that "yes" many of us do read most of what you write. This attitude you are seeing didn't brew up from this one post, it's been simmering for a long time.
No scalp, I don't think they are reading you. At least some. There is a subset of chronic pain patients who are so self centered and histrionic that they can't see any part of the forest because of the big tree in the way. They enjoy the victim sick role. They can't focus on anything but themselves and how they feel. They have the whole family co-dependent. There is no amount of time and patience or dilaudid available that would help them feel better. Because on some level they do not want to be better. They want to suck everyone in to their own abyss. The ultimate attention getter is the histrionic pain presentation by ambulance for the 20th time of the year and for once someone pays attention to them.
IMO, the angry migraneur is one of these. Most people who have painful conditions can stay focused on other goals and have coping mechanisms that keep them out of the ER except for rare occasions. These people can be helped in the ER. The patient that comes twice a week to your ER and twice a week to another ER cannot be helped in the ER. It would be a disservice to give them more demerol because they really need help that the ER cannot provide.
congrats on 100 comments.
"There is a subset of chronic pain patients who are so self centered and histrionic that they can't see any part of the forest because of the big tree in the way. They enjoy the victim sick role. They can't focus on anything but themselves and how they feel."
This can be said of the subsets of any disorder or illness.
I used to be an ER ward Clerk, in the 70's so maybe there was more compassion and concern then. There were 3 disorders where I was to call a nurse immediately, indications of heart attack, kidney stone, or someone presenting with migraine. The latter were immediately taken to a room where the lights could be turned out, they could rest, and a doctor would be in as soon as possible with pain meds for them.
Contrary to the beliefs expressed by some here, and nastily expressed in some posts, even if you have chronic pain it can not always be under control. Just as the controlled diabetic sometimes presents in the ER with too high or too low sugar levels so too do CP patients sometimes not have the ability to get their pain under control. Thank you.
I guess the hypotensive, septic, respiratory distress, altered mental status, penetrating trauma, backboarded, limb-amputated, blood-gushing stroke patients were shit out of luck if a couple of migraineurs came in.
Those were the compassionate good old days.
Maybe one of those headache patients are a stroke patient? How would you know until you do a work up? You are implying things that have not in any way been said by anyone. no one on here has said they should be treated first and that all others should have to wait.
What I am hearing from people, and you would also hear it, if YOU would listen, is that real pain patients should be treated the same as everyone else. They should not be labeled up front, when you look at a chart, and see they are there because of pain. They should be given the exact same compassion and treatment, you show others. unless you know this person is an addict or a seeker, and they have no real illness that requires pain control.
You have stated over and over that pain patients go to the end of the waiting list. We are not all so stupid that we believe every other patient there is an emergency. So what you do is put them behind the low grade fevers, colds, flu's and hangnails.
"Maybe one of those headache patients are a stroke patient? How would you know until you do a work up?"
The triage nurse can tell. That's what they do.
"No one on here has said they should be treated first and that all others should have to wait."
You must have missed Carol's comment above, and the anon whining about the three hour wait before the life-saving IV pain meds were given to his wife.
And I would definitely triage a migraine patient before a hangnail patient. Unless it was a REALLY BAD hangnail.
"I waited my turn, just like any patient" I wrote in the post I wrote about my one time in the ER.
"No one on here has said they should be treated first and that all others should have to wait."
"You must have missed Carol's comment above, and the anon whining about the three hour wait before."
Please reread what I wrote.
I said it was the POLICY (caps for emphasis not yelling) of our ER that migraines were one of the 3 pain presentations that were attended to immediately. That was not my decision but the decision of the doctors and nurses who trained me.
Thank you.
Symptoms of stroke depend on the type and which area of the brain is effected. Signs of ischemic stroke usually occur suddenly, and signs of hemorrhagic stroke usually develop gradually. Symptoms include the following:
Difficulty speaking or understanding speech (aphasia)
Difficulty walking
Dizziness or lightheadedness (vertigo)
Numbness, paralysis, or weakness, usually on one side of the body
Seizure (relatively rare)
Severe headache with no known cause
Sudden confusion
Sudden decrease in the level of consciousness
Sudden loss of balance or coordination
Sudden vision problems (e.g., blurry vision, blindness in one eye)
Vomiting
So,when you have these symptoms and you are a migrainuer,you should not bother to go to the er.Take your chances and stay home.
Or,the best thing to do is not tell them at the er that you are a migrainuer.Since strokes and heartattacks run in my family,I'll tell them that history and if I mention my head pain,it must be from the severe vomiting.
Your visit history and allergy list would give you away anyway, but it's best not to lie to the ER staff.
You people really are crazy.
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