Hi everyone.
Just joined today and thought I would tell a little about myself. Developed migraines as a teenager, they slacked off quite a bit until my early 40's when my neurologist said changing hormones brought them back (with a vengeance -- at present 5-6 days a week.) I am a physician (emergency medicine and internal medicine) but had to quit the practice of emergency medicine at age 40 after 3 operations for herniated discs in my neck. That was a very big loss for me. My neurologist said the neck problems contribute to the migraines. I had planned to maybe do some ambulatory care-type medicine part time after some time off for the discs (I am on disability since I cannot do emergency medicine), but that is when the migraines hit. In truth the migraines are much more disabling than the disc disease. At least my work is flexible - medical writing. I have taken every drug you can think of (currently have pared it down to Topamax 300 mg, riboflavin and magnesium, with Maxalt, Percocet or Vicodin, sometimes Compazine as needed.) Like many of you I have anxiety/depression, but the latest antidepressant (Celexa) was giving me headaches and nausea, so I stopped it. Will see about getting a new one. I used to walk 4 miles a day, but with so many headaches cannot get in regular exercise -- a Catch 22. I am well aware of rebound headaches (been there, done that, so I try to limit all medication intake) - but with so many headaches, what am I supposed to do, just sit in bed all day with ice packs on my head? (That has been my life for the past 6 months or so.) To make matters worse, my neurologist of 14 years moved to Montana and the new one does not believe anything I tell her. So I made an appt with yet another neurologist. I don't go anywhere or do anything because of the headaches. I feel like I don't even have a life and am a burden to my family (luckily my husband is understanding). Does anyone else feel that way? "Physician, heal thyself." But I can't seem to.... Sorry to run on so long. Never had anyone to tell this stuff to before who understood.
Laura
P.S. Maybe at least being a physician I can be of some assistance to you guys here.
Guess it was maybe "too much info." Or presumptuous? I don't know. Sorry.
Laura L.
Laura L.
Laura,
Welcome to the board! We all here know what you are going through and we all write long posts from time to time, so don't ever worry about being long winded. The more information you can include in your post, the more likely it is that one of our board members has had the same experience and can share it with you. Among this group, I think we've pretty much covered all the bases, but we can still be surprised by some new medication, treatment, symptom, side effect, etc...so the more details, the better.
As for myself, I've had a headache everyday since January, except for two days last month. I just found out yesterday that my disability has been approved finally, and week after next, I am seeing my 3rd neurologist. As you can see, we have a lot in common.
I hope things get better for you, and feel free to use this forum to your heart's desire. We have to stick together because the migraine-free just don't get it.
Let us know how you are doing.
Leigh Ann 
"The weather is here, I wish you were beautiful."
- Jimmy Buffett
Hi Leigh Ann,
Thank you for your kind words. Congratulations on finally getting your disability approved -- I know what an incredible chore that is, with all the reams of paperwork and doctor visits. And I know what an incredible gift a headache-free day is. Mine is not gone today, but it is bearable, so I will at least try to do some yard work (we'll see how that goes.)
I am a little worried about seeing the new neurologist. It is difficult seeing a doctor when you are a doctor, especially a doctor on disability (read "you did not hang in there, you did not try hard enough, you are not a real doctor anymore because you don;t see patients"...) And many doctors have issues with giving other doctors controlled substances (i.e., good-bye pain medicine - not that I abuse it; but as a back-up it is occasionally necessary.) So I am apprehensive. And if I don;t like this guy and see someone else I am "doctor shopping."
Good luck with your new neurologist. I hope your headache is bearable today, Thanks again for your post.
Laura
Thank you for your kind words. Congratulations on finally getting your disability approved -- I know what an incredible chore that is, with all the reams of paperwork and doctor visits. And I know what an incredible gift a headache-free day is. Mine is not gone today, but it is bearable, so I will at least try to do some yard work (we'll see how that goes.)
I am a little worried about seeing the new neurologist. It is difficult seeing a doctor when you are a doctor, especially a doctor on disability (read "you did not hang in there, you did not try hard enough, you are not a real doctor anymore because you don;t see patients"...) And many doctors have issues with giving other doctors controlled substances (i.e., good-bye pain medicine - not that I abuse it; but as a back-up it is occasionally necessary.) So I am apprehensive. And if I don;t like this guy and see someone else I am "doctor shopping."
Good luck with your new neurologist. I hope your headache is bearable today, Thanks again for your post.
Laura
Laura,
You can't feel guilty about seeking out another neurologist, someone you would be more comfortable with, regardless of your own doctor status. Sometimes it takes several tries before you find someone you feel will listen to you and will work with you to construct a treatment plan, and prescribe the appropriate medications.
I have been working this problem under the health system without any insurance for a couple of years, and have found that the level of treatment from a lot of doctors is colored by my financial status. There is only one neurologist in town that sees patients without insurance, at the City Free Clinic, and takes referrals from my health center. I saw him once, and he was a total ass. He barely listened to anything I had to say, and acted like he was doing me such a favor. He paid no attention to the list of medications I was taking, and prescribed a triptan that would have had serious interaction problems had I taken it. Since I get most of my meds thru the health center, the pharmacy filling the prescription would never have had an interaction warning. The thing that really pissed me off is that I told him that none of the triptan family of medications work for me. Either they have no effect or they make me violently ill.
I got another referral, to the University of VA Neurology Clinic about an hour away from home, but this time I got to see Doogie Houser. I think he was a first or second year med student, and seemed to know less about migraines than I did. He disappeared for about a hour after my exam, I guess to confer with whoever was monitoring him, then showed back up with a bunch of prescriptions, which he really couldn't explain very well. He said I could wait an hour until his supervisor got back, but I was getting a real headbanger and just wanted to leave.
Without insurance, doctors are much quicker to assume I am simply a drug seeker, so I really have to fight to get satisfactory pain management on a fairly regular basis. Week before last, I ended up having to get three shots for pain. The worst part is that I am very hard to medicate for pain. I have had so many miscellaneous injuries, operations, etc...in addition to my migraines, that a lot of standard meds just don't work on me like they would on someone else. Right now, if I go to the Health Center, they give me Nubain and Phenergan, which knocks the pain down to a 3 or 4 level for maybe six hours, but definitely doesn't put me to sleep. If I go to the ER, hopefully I get a shot of Dilaudid and Phenergan, which gives me a little more relief than the Nubain. If the doctor decides to give me Morphine, I have to have a double dose, which will knock me out, but I'll wake up feeling like somebody kicked me in the back of the head, so I've got to have some Percocet on hand to deal with that. The Health Center I go to is very strict on prescribing narcotics, so I can't keep enough on hand to be very helpful. For instance, my doctor will only write me a script for 30 Lortab 5/500 (one every six hours) every thirty days. One of the other doctors writes the same thing for eight hours. I'm way beyond that being of much help. I need three or four times that every six hours for it to do any good. Back in the days when I had insurance, my system was use to Lortab at 7.5/500, taken as needed. I might also mention that I had a gastric bypass, so there may be an absorbsion issue involved here. Unfortunately, the doctors are also limited on dosage by center policy.
The good news is that I'm going to see another neurologist on the 9th of NOV. He is in the same office as the ass, but I'm not going to breathe a word about seeing his colleague. This guy is supposed to be very highly regarded and even gets migraines himself. Hopefully, he will be the right doctor for me. If not, I'm going to have to do some accupuncture, massage therapy, or something else(except go near a chiropractor!!!). 
OK, so who's the long-winded one now?!!!
Leigh Ann
"The weather is here, I wish you were beautiful."
- Jimmy Buffett
Hi Leigh Ann,
You do appear to have some complicated medication needs. A physician should treat you no differently because of your insurance status, however - no differently as person (I am just telling you the code of ethics.) There may be circumstances in which specific medication might need to be tried (if you cannot afford a really expensive one, that sort of thing) but there should be no difference in the way you are treated as a person. That has always been one of the things I liked about medicine: it is the great equalizer: it doesn't matter whether it is a homeless person or President Bush, if they get shot in the abdomen they get the same exam. I trained in emergency medicine at UCLA so when the OLD Pres. Bush came to town we had to be ready in case anything happened (we were the designated trauma center for the President). And it occurred to me then that everyone gets the same exam no matter who they are - President or pauper. We are all the same on the inside. Doctors who disrespect patients based on insurance status should be kicked out of medicine.
By the way, Lortabs 5/500 or 7.5/500 had 500 mg acetaminophen in each tablet. You are probably aware of the 4 gm limit on daily acetaminophen ingestion. You guys seem pretty knowledgeable about all these things.
On NOv 9 if the new neurologist is in the same group as the old one, everything from your visits with the old one will be in the chart that the new one is looking at (at least that is how it usually is....) Hopefully this will not be a problem. I hope it all works out well for you.
Laura
You do appear to have some complicated medication needs. A physician should treat you no differently because of your insurance status, however - no differently as person (I am just telling you the code of ethics.) There may be circumstances in which specific medication might need to be tried (if you cannot afford a really expensive one, that sort of thing) but there should be no difference in the way you are treated as a person. That has always been one of the things I liked about medicine: it is the great equalizer: it doesn't matter whether it is a homeless person or President Bush, if they get shot in the abdomen they get the same exam. I trained in emergency medicine at UCLA so when the OLD Pres. Bush came to town we had to be ready in case anything happened (we were the designated trauma center for the President). And it occurred to me then that everyone gets the same exam no matter who they are - President or pauper. We are all the same on the inside. Doctors who disrespect patients based on insurance status should be kicked out of medicine.
By the way, Lortabs 5/500 or 7.5/500 had 500 mg acetaminophen in each tablet. You are probably aware of the 4 gm limit on daily acetaminophen ingestion. You guys seem pretty knowledgeable about all these things.
On NOv 9 if the new neurologist is in the same group as the old one, everything from your visits with the old one will be in the chart that the new one is looking at (at least that is how it usually is....) Hopefully this will not be a problem. I hope it all works out well for you.
Laura
Hey Laura,
Thanks for the quick response. Yeah, I do have some pretty strange medication requirements. I started having migraine attacks in elementary school, so that's about thirty years of medication history. I'd take something for a while, then it wouldn't work anymore, so I'd switch to something else. I didn't start taking prescription medication for my migraines until 1978, when I would have a few close together, then wouldn't have any for a few months. At that time, I started off taking Flexeril (the muscle behind my right ear would knot up) and a Fiorinal with codiene. That worked for a long time, then at some point, some doctor added in Toradol to the cocktail. I had to quit the Toradol when I got a hiatal hernia cuz it killed my stomach. At that point, I started Atenelol as a preventative. The doctor I had then thought my blood pressure might be spiking when I got a migraine - which it wasn't. My blood pressure runs really low naturally, so I spent a long time with the room zooms. At this point, I ran into all sorts of health problems, which lead to anxiety and panic disorder, as well as moderate depression. DUH.. Couldn't see that one coming, could you?!
Anyway that was several doctors, and many medications ago. The frequency of my migraines has continued to increase the more I eliminate known triggers. Unfortunately, most of mine are environmental, hormonal, or stress related.
Thanks for you advice about seeing a doctor in the same office. Luckily, I didn't see the first neurologist in his office. I saw him off-site at the City Free Clinic, so I'm sure he has no record of me. Uggh. Time for more meds.
Best wishes,
Leigh Ann
"The weather is here, I wish you were beautiful."
"The weather is here, I wish you were beautiful."
- Jimmy Buffett
Great - let me know how it goes. My husband is about to go to Europe for a week so I am a bit apprehensive having all the house and child responsibilities.....when that is the case one must slog through no matter how bad one feels....I'll make it somehow. May be painful but I always make it. Let me know how your new appt is. I want SOMEONE to get a good doctor!!
Laura
Laura