Tag Archives: Migraine

Misunderstanding

The other day, at the office, a receptionist told me a story about her recent emergency room visit. She was having a migraine, and when she came into her room, they asked for a urine sample. She had just used the restroom, and told them that she would be unable to give a sample. They told her they would not be able to give her any medication without the urine sample. She was so angry that she left and went to a different ER.

At the different ER, she was eventually treated and given a prescription for her regular migraine medication. She complained that every time she sees her neurologist, he only gives her seven pills. She understood that insurance would only pay for that amount, but she felt if he wrote for more, then she would just pay out of pocket for the extra. She gets more than seven migraines a month.

I explained to her that in the ER they took her urine to test for pregnancy. A lot of medications cannot be used in pregnancy, and tests such as CT scans can cause radiation and affect a growing fetus. She argued that she told them she was menstruating, to which I replied that sometimes women can have  bleeding that resemble their periods even while being pregnant.

I also explained that when pain is involved, sometimes they need to do drug screening to make sure the patient is not using recreational drugs, or abusing prescription medications. I told her that doctors have become suspicious when patients aren’t willing to give a urine sample because many drug-seekers use this tactic to avoid getting caught and obtain pain medications for recreational habit or to sell.

I then explained that the reason she only gets seven migraine pills is because it is an as needed medication to be taken only when she has a migraine. It is a quick onset medication to be used when the migraine symptoms begin so it will not worsen. If she is having such frequent migraines, it may mean that she needs to be on a daily medication to prevent migraines.

She agreed to see her neurologist, and that’s when I realized so much of the discord between doctors and patients is due to simple misunderstanding. By simply educating patients, we can empower them. So in an attempt to keep the air clear, I’d like to answer any general questions you may have. Send me your questions, and I will post them with my answer. Here’s your chance to “Ask the Doc”

Please keep in mind that I cannot offer medical treatment advice.

My Story: Part 3- Residency Continued

Although I was glad to be able to finish residency, it was not easy. There were days when the pain in my knees would be so bad I would be limping from room to room. The fatigue had gotten better with the high dose of steroids sending me into a state of jittery high, but after I had spent all my energy, I would crash hard.

I remember one overnight call, where it was an especially busy night. I was stuck in the ER doing admissions. The floors were also busy with critical patients, and nonstop codes. Perhaps it was a full moon. I kept finishing one task, hoping to be able to sneak off to the call room , eat something, and take my meds, but only to have another urgent task awaiting me. I watched the clock, 10 o’clock, 11:30, midnight.

I eventually caught fifteen minutes to eat, but after that it was back to the grind. The work seemed endless, my body ached, and I could barely keep my eyes open.  I remember finishing up my admissions, and as I was walking out the ER at 4 AM, the ER attending tells me he’ll have another patient ready for admission in another hour. I went to lay down for the hour, and prayed that would be the last one before sign out.

There was also the time when my left eye vision became blurry. I was in the middle of interviewing a patient in the ER, and I didn’t want the patient to feel I was incompetent, so I finished the interview, squinting to write my notes. Twenty minutes later, after I finished the admission, I ran to the clinic to speak with my attending. She didn’t know what was wrong, and told me to call my rheumatologist.

I went to the ER at a different hospital, and after a neurology consult and MRI, it was determined that I was having migraine auras. It turns out the constant lack of sleep and stress was causing me to have these painless migraines. I left grateful that it wasn’t any serious problems with the blood vessels in my eyes, which is what my rheumatologist had feared.

There were several other incidents here and there, and sometimes I had to be seen in the ER I worked at. Many times, I’d lay in that ER bed, embarrassed as my colleagues and other attendings would walk past, catch a glimpse of me in a hospital gown, then ask what was wrong. I never looked sick, and I always feared they would think I was just trying to get out of work.

It was a tough journey, but I made it through with lots of prayers and the support of loved ones.