Monday, January 30, 2012

Grateful for a Good Doctor

Today I drove down to Indianapolis to see my old neurologist.  I actually saw a new neurologist one time since moving to Lafayette, but suffice it to say that I didn't really "click" with him.  My migraines have escalated intensely during this pregnancy.  In fact, I have had a migraine every single day for the past 19 week.  I think this is what we call "a problem."

It's not really entirely shocking that I've been struggling with migraines during this pregnancy.  I very first started getting migraines when I was pregnant with Bryn, and they've pretty much plagued me ever since, although they do tend to be worst during pregnancy.  During normal life, I have to take Topomax as a migraine preventative, and even then, I still tend to get at least one bad headache a week.  So it's perhaps not surprising that with no preventative and my hormones raging out of control during pregnancy, I'm likely to get them really bad.

I know a lot of people that get migraines and have no idea why.  I, on the other hand, know exactly why I get them:
1. They are genetic.  My sister, several of my uncles, and my grandmother all had/have them.
2. They are caused by changes in hormone levels.  Thanks to the past nearly 7 years that I have spent either pregnant, breastfeeding, or miscarrying, I've had wayyyy more hormonal shifts than most.
3. They are related to my thyroid.  Of course, taking care of my thyroid is an epic in and of itself, which involves blood tests every four weeks and shifts in my medication nearly that often.
4. They can be triggered by changes in the weather.  Winter tends to be an especially rough time for this for me.

I have a lot of friends whose migraines have been greatly helped by seeing a chiropractor or making dietary changes.  There also some fascinating books on this subject.  However, since genetics, pregnancy, thyroids, and weather are not affected by chiropractors or diets, those things do not tend to help me.  I did see a chiropractor back in Indy for about two years, and while I enjoyed the back adjustments, it didn't do a thing for my headaches.  While I admit that I haven't explored every dietary option out there, I've tried a few, and none have helped.  (Plus I have so many food aversions during pregnancy anyway that eliminating even more stuff might leave me on a water-only diet!)  I talked to my neurologist about these options today, and he, too, pointed out since my migraines have traceable causes that aren't in any way related to those more organic cures, they're not likely to help me.  Darn!!

At any rate, the neurologist that I saw here in Lafayette didn't do a darn thing for me.  Since then, I've been relying on my OBs to control my migraines.... which, it seems, was a very bad strategy.  Several months ago, they put me on Fiorecet for my migraines.  While this medication usually does eventually knock the headache out, it usually takes 2 or 3 doses.  So I'm thinking.... hmm.... I'm taking 2 or 3 doses of migraine medicine every single day, and this has been going on for several weeks.  Surely this isn't good for me or the baby.

I raised this concern with my OB at my 12-week appointment.  He reassured me that never fear, my migraines would go away in the second trimester, so I wouldn't have to keep taking multiple doses of migraine medication on a daily basis for much longer.  I pointed out to him that while I am aware that migraines do, in fact, go away for many women in their second trimesters, I kind of doubted that they would for me, since 1) I suffer from chronic migraines even when I'm not pregnant and 2) the migraines had not gone away in the later trimesters of any of my other pregnancies.  He pretty much blew off my concerns and told me I'd be fine.  (Yet another reason that this OB sucks and I will be starting to see a new one next week.  Another post on that at a later time.)

Four more weeks passed, during which I continued to have to take multiple doses of Fiorecet every single freaking day.  At my 16-week appointment (which was with a different doctor in the same practice), I again expressed concern about what taking so much medication would do to both me and the baby.  The doctor (the same one that freaked out when she couldn't find the heartbeat) assured me that Fiorecet is perfectly safe for pregnancy.  Yes, I asked, but even in these quantities?  She again said it was not a problem and that this was all we could do.  When I again explained the whole chronic migraine / usually take Topomax thing, she finally conceded to put me on Procardia as a preventative.  This drug is usually used to stop pre-term labor (in much larger quantities than what I'm taking), but she said that it could be a headache preventative as well because it opens up the blood flow.  Okay, I figured, I'll give it a try.

Three more weeks passed, with absolutely no lessening of the headaches.  So I'm thinking: okay, now I'm taking both a preventative that doesn't work AND two to three migraine pills a day.  This can't be good for anyone (except possibly the pharmaceutical companies).  Since it had become glaringly obvious that my OBs weren't concerned and weren't going to do anything to help, I made an appointment with my old neurologist in Indy.... which brings me back to today.

I just need to say that today was the absolute best medical care that I have received in the past 10 months.  My neurologist actually KNEW MY MEDICAL HISTORY BEFORE COMING INTO THE EXAM ROOM.  (Unlike my ridiculous OBs, who I'm relatively certain have never so much as once peeked at my charts.)  And once he came in, he actually LISTENED TO WHAT I HAD TO SAY.  Personally, I think that these should be basic prerequisites for all doctors, but sadly, in my experience, that is not the case.

Anyway, after hearing about everything I've been through in the past few months, my neurologist was appalled and basically said that my OBs have no clue what they are doing (at least as far as headaches are concerned).  For one, he said, while Fiorecet can be effective in women that get migraines infrequently, or even just during pregnancy, it's pretty much an epic fail when it comes to chronic migraine sufferers... which I am, and my doctors should have known from both my charts and what I was telling them.

Secondly, a bit of background.  When I first when to see this neurologist, nearly two years ago, it was because I was suffering from massive rebound headahces (which I explain more here).  Well, lately I've been thinking--hmm, if I'm taking 2-3 migraine pills every single day, isn't that going to lead to massive rebounding when these migraines eventually stop?  Yes, says my neurologist.  Particularly because, he says, Fiorecet is pretty much the #1 drug to cause rebound headaches.  In fact, he said, it's likely that while it feels like it, I'm probably not actually having a migraine every single day right now.  Probably some days it's a migraine, and other days it's a rebound headache, because with that much Fiorecet, the rebounds have probably kicked in already.  He says that the OBs should have known from my medical record that I have suffered rebound headaches before and therefore should never, ever have prescribed me a drug that is likely to cause them.  Awesome.  Great.  Thanks, sucky OBs.

The solution: stop taking Fiorecet immediately.  Then he prescribed me with an actual migraine preventative that is safe during pregnancy.  He said that it might take a week or two to take total effect, so in the meantime, if I suffer any migraines (or rebound headaches), there are other things I can take.  He wrote me another prescription for a medication that he says is very effective but is likely to make me sleepy (so only to take it at night), and other one that is slightly less effective than that one (but wayyyy better than Fiorecet) which I can take during the day.  (Unfortunately, I don't remember the names of any of these medications right now, as the scips are at the pharmacy getting filled.)

He then reassured me that I am NOT a freak and that my condition is totally normal, although definitely heightened from what other people usually experience thanks to the mis-medication of my OBs.  He said that plenty of migraine sufferers go through things like this during pregnancy (although again, usually with better doctors) and that it is totally handle-able.

Hallelujah.  I love this doctor.  Fingers crossed for feeling better in the next few weeks and actually being able to enjoy the second half of this pregnancy!!


Amy said...

That is awesome that you have a doctor that will liste now. You have to let me know what those meds are.

Jill said...

Yay for Progress!!! Glad you have a great doc to work with, now hopefully you can find a great OB too!!

Lora said...

Amy I am so, so, so glad that your neurologist was able to help you! Isn't it the best feeling to meet with a doctor who actually knows you and listens to you? That shouldn't be the exception. I have been dealing with the worst headaches of my life since being pregnant and my OB put me on Fioricet. Luckily I've only had to take one every few days and it's helped. I could not imagine being in your position. It's not only scary but also disappointing to hear about the care you received from your OBs. I will be praying that the new drugs work for you!