Serious pain...can't deal with the ER

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Serious pain...can't deal with the ER

Post  Pinkballerina on Sun Aug 04, 2013 5:05 pm

I have a very severe migraine that has been going on for four days now. I have used both Stadol nasal spray as well as the new Sprix nasal spray (torradol) on this headache to no avail. I just took my last Zofran, so in another 6 hrs I am going to be puking.

I feel like I am dying here yet I am unwilling to go to the ER. Last time I went I had a horrible experience with a doc who would not deviate from his particular migraine protocol...so I ended up spending 5 hours getting all these meds IV at the ER (torradol, decadron, Valium , Benadryl, and reglan) and leaving no better than when I arrived.


Then the doc proceeds to tell me that it must not be a migraine headache because his protocol "helps all true migraineurs." I was pissed. He tried to get me to do a lumbar punch so he could "properly diagnose " me. I was beyond frustrated as I have a 23 year history with these migraines, and to top it off he had access to my neuro chart for the past four years as I go to one of the hospital neuros and they use electronic charting. Yet he still treated me that way.

Needless to say, I did not give him permission to do an LP. I left in pain and stayed that way for another two days.

So I once again find myself where at home methods have failed yet fearing and loathing the ER at the same time. I cannot be put through that again! Thanks for reading this. It is nice to not feel so alone with this disease.

Pinkballerina

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Re: Serious pain...can't deal with the ER

Post  tortoisegirl on Sun Aug 04, 2013 5:42 pm

Sorry you are suffering. Chances are you wouldn't have the same doctor at the ER if you did go. Or, you could try another ER. However, yes often migraine and headache patients automatically get treated badly at the ER. They may be assumed to be drug seekers, especially those that don't respond to the non-narcotic treatments that tare typically tried first, or if they ask for specific meds (as they know will help them).

Do you have any refills left on the Zofran so you can ask someone to run out and pick it up for you? Often nausea is easier to get under control than pain, and if you start vomiting, that drives the pain up and gets you dehydrated and such.

I too have pretty much ended on the opinion that I won't go to the ER for pain anymore...the waiting process makes the pain worse, plus they've never given me anything helpful. I have strong narcotics at home, but when my pain gets to a certain point, nothing helps it anyways. I'll just treat the nausea and ride it out.

If you aren't willing to go to the ER, maybe consider urgent care? Or, could you at least get in with a doctor of yours on Monday? They could for example prescribe a steroid pack to try to break this cycle. Probably not your neuro, but do you have a primary doc? I've had better luck with urgent care centers than the ER, although more so in wait time / attentiveness than pain relief. Although most are not 24/7, they have extended hours. Also, I think most put you in an actual room (more like a doctor's office), not a curtained area.

I think unfortunately some ER doctors have the attitude that acute pain isn't an emergency. Besides that, definitely work with your doctor to come up with a plan for the next monster migraine, and ensure you have enough meds on hand. I assume the only reason you ran out of Zofran though is that this has lasted so long. Have you tried all the Triptans? My combo for the worst episodes is a Triptan + Sprix + Zofran, plus hydromorphone if the nausea isn't too bad.

There should be more abortive meds for you to try...maybe something injectable? Or, something that could help you sleep through the worst of it? Your neuro could also write up an acute migraine treatment plan for the ER so when you go in there you could ask them to look that up. That would be using your doctor's association with the hospital to your advantage. Hang in there! Best wishes.

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Re: Serious pain...can't deal with the ER

Post  dcook60 on Sun Aug 04, 2013 6:02 pm

pink ballerina, i am so very sorry to read of your experience at the ER.  i have vowed, also, to never again go there unless i think i'm truly dying.  over 44 years, i've been at various hospital ER's too many times to count, and i have to say i've never been treated as rudely as you were.

oh, i've had my share of arrogant doctors and disbelievers, but not to the degree you describe.  not once of the many times i've had my kids or a friend haul me off to the hospital have i come out better than i went in.  every time, i'd think to myself in my painful state "this time there will be something that works".  nope, never.

my kind of migraine seems to be cured only by TIME.  filling me full of every drug known to man has made me a bit numb, for sure, but when i get home again i'm worse than before, and barfing up the opiates, whether it be dilaudid or morphine.  i will never again take an opiate because not only do they NOT touch the pain, they make me throw up violently for hours and hours, making my head much worse.

i'm sorry for all of us who have to put up with this scenario.  our type of pain just isn't helped by any known method.  if triptans fail me, i know i'm in for it.   thankfully, now that i have an adequate supply of triptans, i rarely have the killer kind of head pain any more.  

wishing i could be of some help, besides just commisseration.  tortoisegirl had a lot of good ideas, and i hope something she said will work for you.  please let us know the end of the story when you are able, ok?  dianne
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Re: Serious pain...can't deal with the ER

Post  Pinkballerina on Sun Aug 04, 2013 7:13 pm

Thanks for such thoughtful replies. As far as triptans go, Relpax used to work for me until I had a coronary artery spasm from using it last year. Again, everything from that lovely experience in their ER and the resulting 3 day hospital stay all documented in my record there. The cardiologist says absolutely no triptans now.

I have exhausted my Zofran supply just over the past few days. I thought I had refills but I don't. I do have a filled script of prednisone that I could start taking. I had completely forgotten about it until someone mentioned the idea of getting some steroids from my doc tomorrow. Right now I am just trying to ride things out and get my 8 year old down and out for the night so I can try to relax a little more. I can take another dose of the torradol nasal spray at 10:00 p.m. When I do, I think I will also start the prednisone with my doctor's dosing directions. They are kind of crazy, I have to take 5 pills at once I think on the first day.

I do realize I am probably being irrational with my fear of ever going to the ER and getting that particular again. But I live in a community on the smaller side. We do have one other hospital, but they are so well known for their migraine protocol that no one I know in the community actually goes there for a migraine. No one wants their treatment standardized.

Sometimes I don't need an IV pain med for a migraine, and other times, like now, it would seem that either I do need them or else as one poster said time will break this one. I just have to make it through the miserable night ahead and then I will call my primary care doc if I make it through til morning.

If I find I give in and go to the ER I am going to page my primary care doc and perhaps he will save me from the ER docs.

But that is only as a FINAL resort, because frankly. I still can't stomach the place. I think even the idea of going to the ER has me more nauseated than the migraine at the moment.

Thanks so much for your kind and thoughtful replies. I will let everyone know how I fare tonight in the morning.

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Re: Serious pain...can't deal with the ER

Post  Cindy*W on Sun Aug 04, 2013 8:15 pm

I do feel so badly for you.

Have been in your shoes so many times and made that awful trip to the ER.

Some doctors come in and just ask what works for me and give me what I need which is really nice, but it is more of a struggle to get others to do what helps.

Of course most of them look at my charts and see I have been there many times before and that I see a PM Doctor.

I did have one about 6 months ago that pulled the protocol thing on me and made me go thru the Toradol, steroid, DHE thing and all I asked was that if it did not work for me that he would give me what does and he agreed.

I was in tears by the time it was all over because DHE makes me feel so horrible and my pain level had gone up considerably by then.

What kills me is that they look at your chart and see that you have been on narcotic drugs for years for this condition and actually think Toradol is going to work for you?  Rolling Eyes 

Anyway, I know how I agonize about going but if you really need to, please go.

Really, it seems like the times I stress over it the most, are sometimes the best visits.

I will say a prayer for you tonight hoping your pain subsides one way or another.

Take care,

Cindy
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Re: Serious pain...can't deal with the ER

Post  Pinkballerina on Mon Aug 05, 2013 7:39 pm

Hey guys!! I made it through the night and today with no medical intervention. I am just trying to tough it out. Luckily when I woke up this morning my pain level had gone down by about 3 points, so that was a significant help.

Thanks for your support!

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Re: Serious pain...can't deal with the ER

Post  Platypus on Mon Aug 05, 2013 8:39 pm

Glad to hear it. I agree with working with your doctor to develop a strategy so in in the future you know what to do when you get the killer headaches. Because it's impossible to think w/ that level of pain and the anxiety on top of it.

-Platy
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Re: Serious pain...can't deal with the ER

Post  Cindy*W on Tue Aug 06, 2013 3:09 pm

That is great news!

I was so hoping that is what would happen.

Three points probably doesn't sound like much to the average person, but in the world of Migraine pain it is alot.

Hopefully you can work out something with your Doctor that you can resort to when this type of thing happens again and won't have to worry about the ER.

One thing that my doctor and I tried was Stadol Nasal Spray.

I could take it when I was nauseated and not have to worry about it coming up and for quite a while it worked great.

My stupid body became tolerant to it far too fast though and that's why we stopped using it.

Anyway, I am so glad all worked out.

Take care,

Cindy
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Re: Serious pain...can't deal with the ER

Post  Kate on Wed Aug 07, 2013 10:59 am

I won't go to the ER for migraines either. I had an ER Dr tell me that people with migraines can't lift their heads up. Meaning, I must have not had a 'real' migraine because I was able to lift my head up. The walk in clinics are just as bad. There was only one that I recall was sympathetic and knew it was a real disease.

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Re: Serious pain...can't deal with the ER

Post  Cindy*W on Wed Aug 07, 2013 2:46 pm

Sorry I just read your original post again and realized that you said you used Stadol NS.

Sorry I missed that.

The only other thought I have is that there are a few narcotics that come in liquid form.

Don't know if that would help but gets into your system faster and you don't have to worry about throwing it up.

That was always a concern for me.

Anyway, glad you are feeling better.

Take care,

Cindy
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