Article on how to deal with the ER

View previous topic View next topic Go down

Article on how to deal with the ER

Post  Migrainegirl on Mon 16 Jan 2012, 9:27 pm

This is an interesting story from the perspective of an ER doctor on treating migraine patients in the ER.

http://migraine.com/blog/expert-featured-article/guest-expert/migraines-from-an-er-doctor’s-perspective/

Given all the horror stories I have heard here, I'd be interested in people's feedback on it.
avatar
Migrainegirl
Four Star
Four Star

Posts : 331
Points : 377
Join date : 2011-02-13
Location : Arizona

View user profile

Back to top Go down

Re: Article on how to deal with the ER

Post  Cluelesskitty on Tue 17 Jan 2012, 1:49 am

Don’t ask for opiates. Opiates (morphine, Dilaudid, Demerol, Fentanyl, Vicodin, Perocet etc.) are terrible treatments for migraines.

Oh, really?? Percocet happens to be a very effective for my migraine pain when combined with triptan.

The use of these medications will also make you less responsive to more specific migraine therapies. Fortunately there are so many alternative treatments for migraines.

So many alternatives they may be, only so ineffective, sadly.

Over all, I am not impressed. I just got lectured!

Risa

_________________
I feel sorry for people who don't drink. When they wake up in the morning, that's as good as they're going to feel all day.
Frank Sinatra
avatar
Cluelesskitty
Admin

Posts : 1534
Points : 1963
Join date : 2011-03-18
Location : BC Canada

View user profile

Back to top Go down

Rant:sorry!

Post  30yrsofheadache on Tue 17 Jan 2012, 12:39 pm

Once I get to the "Narcotics are not an appropriate treatment for migraine and you should kiss our feet for witholding them" part, I stop. Oh how I wish that guy could have a migraine that lasts 5-10 days no matter what treatments are tried along the way. He would be at a level10 (yes, I do get there), his blood pressure at 210/115 and I would like to see if he would refuse narcotics even though it has worked every time its needed over the last 30 plus years.

Wow, I wouldnt want to reset that lovely brain of mine and make it hurt more!!!!!!!! I will say right now if it werent for narcotics, I would probably have killed myself along the way. I thank God in my prayers daily for the compassionate Dr.s I have that allow me to have as decent a life as I can with this horrible disease. Rant over!
Hugs,
Cindy

30yrsofheadache
Four Star
Four Star

Posts : 452
Points : 535
Join date : 2011-02-15
Age : 57
Location : VA

View user profile

Back to top Go down

Re: Article on how to deal with the ER

Post  Migrainegirl on Tue 17 Jan 2012, 9:53 pm

I am not saying I agree with it all, just that it's useful to hear his perspective.

One thing that is interesting is the idea that they don't believe you have 10/10 pain (likely because they themselves have never been there). I have given birth without benefit of pain relief. I have had gallbladder attacks(which many people say are worse than labor). I have torn the ligaments in my knee and had an ER doctor twist my leg until I threw up. And I have had tremendous migraines that were indeed a 10 out of 10, and much more painful than any of those other experiences. I think this is because it is pain in the head as opposed to elsewhere. I think if we were not in so much pain none of us would even try to go the ER. But because they don't have that experience, and don't know how much daily pain we live with, they don't believe us when we show up at the extreme levels of pain. Lesson: say you have a 8 or 9 rather than a 10, even if you are at 10 and they are more likely to believe you.

The other item is to have a written care plan from your doctor. If you know what works for you in a serious extreme, get your doctor to write that up. While I have heard of some people having the ER ignore doctor's recommendations, it is certainly worth a try.

As for the line about opiates, unfortunately this is what we are up against with the profession at large. If they had something else that worked, I think we'd all sign up. But until that happens I agree we are stuck with them just to maintain any life at all. We need to counter educate them about this reality. Otherwise our community of sufferers will be fighting this battle from the losing side for a long time to come.

Personally I have not ever been to the ER when in the throws if a major migraine. I dont think I could be cognizant enough to get there or talk to anyone about it at that point. I'm pretty much in a dark room checked out. But it is illuminating for those of you who do periodically go there.
avatar
Migrainegirl
Four Star
Four Star

Posts : 331
Points : 377
Join date : 2011-02-13
Location : Arizona

View user profile

Back to top Go down

Re: Article on how to deal with the ER

Post  30yrsofheadache on Thu 19 Jan 2012, 5:06 am

MG, sorry I didnt mean to say that you agreed with the article. I just get a little worked up on this issue. My local ER has actually improved somewhat over the past few years. I started writing letters to the Director after I had a really good or really bad experience.

I noticed around that time I got follow up calls for all visits. At my worst I was going every 3 months or so. Now, my Dr. and I have stumbled upon a really strong med that has kept me out of the ER for around 9 months! Oh, I'm scared to say that out loud. affraid So glad to NOT have to go there.
Cindy

30yrsofheadache
Four Star
Four Star

Posts : 452
Points : 535
Join date : 2011-02-15
Age : 57
Location : VA

View user profile

Back to top Go down

Re: Article on how to deal with the ER

Post  Migrainegirl on Fri 20 Jan 2012, 8:21 pm

Cindy. Really glad the new med is helping and you are able to stay away from the ER. It is not where any of us want to be.

I agree with you totally on the problem with current opinion among some physicians to NOT prescribe pain meds when they dont have anything better to offer. Oxycodone is the only thing that has kept me functional for years now. I take the lowest dose available, never more and haven't increased in amount consumed in 5 years. In fact I currently take less than ever. But without it I would have had to close my business and go on disability years ago. I find it ridiculous and borderline malpractice for doctors to withhold pain medication from those with severe chronic pain that they can't cure.
avatar
Migrainegirl
Four Star
Four Star

Posts : 331
Points : 377
Join date : 2011-02-13
Location : Arizona

View user profile

Back to top Go down

Re: Article on how to deal with the ER

Post  Cluelesskitty on Sat 21 Jan 2012, 6:42 pm

Oh, no, I didn't think you agreed with the article either, MG.

And I am very thankful for the invention of triptans since the combo of percocet + triptan helped to keep me away
from ER for many years so far, knock on wood x 3 ever since.
Particularly from the "empathic" and knowledgeable doctors like the one from the link, hmmm.

Risa

_________________
I feel sorry for people who don't drink. When they wake up in the morning, that's as good as they're going to feel all day.
Frank Sinatra
avatar
Cluelesskitty
Admin

Posts : 1534
Points : 1963
Join date : 2011-03-18
Location : BC Canada

View user profile

Back to top Go down

Re: Article on how to deal with the ER

Post  steph on Wed 25 Apr 2012, 5:01 pm

Ho Hum. Those who do not suffer from Migraines have no clue what they are talking about. My Neuro has learned a great deal from me over the years, and she has migraines. Hers are only on occasion, BUT she does have a clue what it is like, and she cannot imagine having them every day! When WE as sufferers go to the ER it is because it is our LAST option. We have most likely been suffering with 8-10 level pain for hours or days on end before we have found a way to the ER. After that amount of time, everything feels like a 10.

I too have had a child, and gall bladder issues and removal, I have had broken bones, sprains, fractures, and serious cuts and gashes. None of that was nearly as painful as my migraines. In those situations I was clear headed and able to assess myself and figure out what I needed to do. With a migraine, my brain is not working on all cylinders and I cannot figure out what to do, all I know is what I have tried isn't working and I need help.

I usually never claim level 10 pain because I figure if I am not dying (even though I may want to) I am not at a level 10. Most ER doctors seem to either want to treat me and get rid of me (therefore opening another bed), or make me suffer more by making me wait forever before they dose me and send me home.

People with migraines usually know their business. I carry my DR's card in my wallet so I can offer it if they have any questions. I do not need tests or MRI's I am aware of my situation, and am only in the ER because I need emergent intervention that I cannot get at home, or from my Dr at that moment. I cannot go to an urgent care facility, because I am going to need narcotic medication (no matter what I try first to placate the ER DR) and cannot get it there.

I have no issue with the use of Narcotic meds to control pain. I have tried almost everything else and it has been a saving grace for me. The last ER visit I had was amazing. It was fast and the DR was so understanding. She asked me what helped and gave me what I needed and I was so thankful I was near tears. I wish it had been like that everytime I had to go to the ER. I might have not sat at home for so long sometimes, in worry and fear of being treated like a drug addict. I have no illusions to what other people think, most project their feelings on their sleeve, it has never been my own paranoia of a DR thinking I was drug seeking. That was how I was treated, perceived, and made to feel.

Oh sorry about the rant, I got off topic a little. This whole business can be daunting to someone who is young or new at dealing with migraines and stuff like this burns me to no end. I look back and think so many times that if I would know what i know now, I would not have allowed myself to be made to feel bad, druggie, at-fault, etc...and I did feel that way in the past.
avatar
steph
Two star
Two star

Posts : 91
Points : 101
Join date : 2011-03-28
Age : 40
Location : Ohio

View user profile

Back to top Go down

Re: Article on how to deal with the ER

Post  Porsche Fan on Fri 27 Apr 2012, 1:13 am

I know this is a very sensative subject of our team here....

I never had a problem with the ER. My GP has given me enough medication to handle just about any problem at home and stay out of the ER.

The only time I venture in is if it's causing or interacting a heart issue. I've found that credibility is key. As our colleagues have mentioned, a 10 in migraine world does not equall a 10 in the real world. That's reserved for crushing injuries. I know, it feels like we are facing a 10 but......

If you've ever crushed even a thumb in a car door yikes, that's a true 8-10. I was almost passing out.

Docs respond to rational input and history. ER's are not magents for the greatest and brightest. They are not migraine experts. They are trained to patch people and stabilize them for surgery and admittance them for the hospital. They are not experts in migraine.

Migraines happen for a myriad of reasons--mine aren't the same of the rest of you guys. If you can through your neuros, try an whittle down what's your'e cause. I know it can takes tons of experts and years to do this...very frustrating.

The key is getting preventatives prescribed by your family doc or specialist. And yes I have pain meds but they are last resort. I think if they can control nausea, dehydration before you even get to that stage that will keep you out of the ER. Pain control is another step. This is something that you need to work with your docs on. It all depends on your own personal history.

Unfortuneatley so many idiots have presented to the ER trying to get dosed off of pain meds and getting high it has screwed all of us. Get documentation from your docs, a letter, a business card, etc (good points as already suggested). Remember, ER docs are low on the totem pole. They aren't the leaders in any field. Their job is to stabilize a patient for surgery and a specialist to take care from there. Their job is not to diagnose you and treat you. Purely it's to stabilize you. This happens for the lady or guy that gets into a car accident and shatters her pelvis. For complex patients, the ER is one of the worst places to go.

I know this is tough, but the best method is to find a good neuro or family doc. Establish a rapport and keep that strong. That will ensure the proper meds and treatment. ER is full of trainees....pure and simple. They can screw you up more than you can realize. That's why you get the quicky blood work and CT scan...to make sure you're not dying right there. Outside of that you're on your own for specialist care. Whether they hospitalize you for it, or you have to call your doc. Don't expect a Buick to turn into a Ferrari.

If this sounds harsh--well, this is reality. Most ER's aren't equpped to take care of migraine patients. Just watch your local news.....what takes headlines are morons getting shot by other morons. What is upsetting, is that they are taking vital resources from legitimate patients.
avatar
Porsche Fan
Four Star
Four Star

Posts : 352
Points : 394
Join date : 2011-05-16

View user profile

Back to top Go down

Re: Article on how to deal with the ER

Post  777Trinity on Tue 17 Jul 2012, 5:07 pm

30yrsofheadache wrote:Once I get to the "Narcotics are not an appropriate treatment for migraine and you should kiss our feet for witholding them" part, I stop. Oh how I wish that guy could have a migraine that lasts 5-10 days no matter what treatments are tried along the way. He would be at a level10 (yes, I do get there), his blood pressure at 210/115 and I would like to see if he would refuse narcotics even though it has worked every time its needed over the last 30 plus years.

Wow, I wouldnt want to reset that lovely brain of mine and make it hurt more!!!!!!!! I will say right now if it werent for narcotics, I would probably have killed myself along the way. I thank God in my prayers daily for the compassionate Dr.s I have that allow me to have as decent a life as I can with this horrible disease. Rant over!
Hugs,
Cindy

Cindy

I so agree with you. No one "wants" narcotics as their first line of defense against the migraine monster, however when everything else fails, we do need them to stop the pain.

As far as killing yourself or wishing you were dead during horrible migraine, I have been there several days every month. I wish the ER doc I saw Saturday could have a taste of this horrible affliction, he'd cut off his arm for help, believe me. That arrogant and superior attitude when is not appreciated when all you want to do is die because of the pain....I am there right now, migraine from hell....again.

Trinity
avatar
777Trinity
Two star
Two star

Posts : 80
Points : 96
Join date : 2012-07-05

View user profile

Back to top Go down

Re: Article on how to deal with the ER

Post  Sponsored content


Sponsored content


Back to top Go down

View previous topic View next topic Back to top

- Similar topics

 
Permissions in this forum:
You cannot reply to topics in this forum