Wednesday, September 03, 2008

Jiggling Like Hopeful Ducks

See this. And this, the original.

A veritable foaming sea of bilious ranting. Nurse K has much to say on this, as ever. It's worth reading her blog, even if you don't agree, though it might push your blood pressure up.

The truth, I suspect, as ever lies somewhere between the two extremes. Migraines are ever a hot topic. I'm faintly curious that we seem to suffer the problem of the migraineur who may or may not be drug seeking less in the UK than in the US. Or do I just see less of it. Or maybe it's because we don't give dilaudid for migraine. I think, but feel free to offercorrections, dilaudid is pethidine. I used to dole that out like sweeties to old ladies with broken hips when I was but a young fungus. Now, I'm given to believe it doesn't work so well as a painkiller, but does get you off your tits.

I don't see much comment on this matter in the US blogs. Specially not for the patients who say it's all that will treat their pain. Put yourself in my shoes. When someone asks for a drug which, as I understand it, has no more analgaesic potentcy than, say, morphine, but does get you high, what should I think?

I'm sure it relieves your symptoms, and makes you feel better... but booze does that for an alcoholic. I haven't seen many posts advocating my prescription for Tennants Extra on demand.

I should declare a conflict of interest:
--- I don't believe in certain medical conditions, fybromyalgia, among them
---By which I mean I believe in your pain, I just think it represents a failure of coping mechanisms
---I don't believe narcotics prescribed in the ED are apt ways of dealing with these conditions

However, I recognise that this doesn't give me the right to dismiss your complaint. Just cos I don't believe in a medical label, don't make me right - plenty of folks didn't believe bacteria might cause ulcers. Plenty of folks don't buy into the theory of evolution through natural selection.... vive la difference.

I also recognise the need to spend more, not less time making sure we don't miss anything on the 'frequent flyer'. One of our regular attenders, a fella who for years laboured under the effects of his excess alcohol consumption, who for years was managed more on the basis of his past than his present was recently diagnosed with a malignant tumour. Did we miss it by dismissing his claims - "drug-seeking"; "pisshead"; "always doing this"?

I don't think so; I hope not, but a timely reminder that the boy who cries wolf daily is sometimes being chased by a big fucking dog.

Do we lack compassion? Sometimes, despite our best efforts, of course we do. It was said of Napoleon's Surgeon that he was the 'least among men'. Good practitioners sometimes lack people skills. Or does this automatically disqualify them...


jon said...

Dilaudid = hydromorphone

pethidine = Demerol

I agree that pethidine is not much more effective than morphine. Hydromorphone is very effective for pain control but gives the pt a high if not administered very slowly. Th e doctors that I work with use quite a lot of hydromorphone for conditions that in other places were covered with 1-2 mg of morphine.

Keep your chin up!

DrShroom said...


That's what I meant, honest...

Thanks for the pick up.

Chrysalis Angel said...

I had one migraine headache so bad I was taken to the ED, I couldn't even think straight - let alone ask for a specific drug...I didn't care what they gave me. I just wanted the pain to stop.