Medical Questions I'd Like Answered...

JonSetanta · Post by **JonSetanta** » Sun Oct 02, 2016 3:42 am

I've suffered from silent migraines for three years now, after taking Ativan and Valium in extremely high doses back then.
It seems to have permanently affected my brain structure to the point where I can't overheat, do anything exertive, watch a TV screen or movie for more then 15 minutes, or drink caffeine/citric acid (the tart flavoring, not from fruit).

I take Xanax 3 times a day for 2 hour durations of relief. After that, I have a "panic attack" for 8-12 hours, which is a silent migraine that just causes... fear.

What's the best drug for this? I'm considering Topamax since that worked for an aunt's simliar condition, but my appointment is in November.
I need to know if anyone else has a similar disorder.

Nachtigallerator · Post by **Nachtigallerator** » Sun Oct 02, 2016 6:03 am

@LR: Decongestants reduce swelling of the nasal mucosa, they don't stop it from producing mucus if there's serious inflammation going on. The intended effect is usually to facilitate a runny nose by opening the way, so whatever virus you have up there can be flushed out with your snot and your sinuses clear up. Whatever your problem is, it's probably not just allergies if antihistamines don't do anything to the runny nose. I'd suggest getting an ENT to have a look at it, but I guess that's not on the table?

@JonSetanta: What exactly do you experience during those "silent migraines"? I don't want to be rude, but from what I understand right now, it sounds very much like benzodiazepine dependency and withdrawal symptoms. The fact that you get panicky after using a short-acting tranquilizer for relief comes as no surprise there. There is no "best drug" for coming down from tranquilizer dependency, except carefully reducing the dosage of said tranquilizer under medical supervision. Don't try to detox on your own, prolonged withdrawal can be physically dangerous.

Topiramate can be used in preventing migraine attacks from happening, but that's migraines as in "the actual neurological disorder called migraine, not headaches or head problems in general", and even then there are less dangerous drugs. You should stay the fuck away from any anticonvulsants until an actual doctor who knows your history and the other stuff you take prescribes them. It could very well be that you need an anticonvulsant during detox if my suspicion is true, but that's not the kind of drug you should experiment with at home - they all have an impressive list of side effects and can potentially kill you if you mess up the dosage or have a contraindication.

JonSetanta · Post by **JonSetanta** » Sun Oct 02, 2016 7:36 pm

I went the entire first year of this disorder without Xanax and it was hell. Every time I had a trigger, I would just suffer it out for a day or two, sleepless nights, days spent lying in bed pressing on my eyes that would not stay shut.

So, no, it's not Benzo withdrawal.

Nachtigallerator · Post by **Nachtigallerator** » Sun Oct 02, 2016 9:24 pm

That's good to hear. That you get a rebound like that (and take a short-acting tranquilizer for an extended duration at all) still makes me queasy, so I'd suggest to ask your doctor for an alternative to Xanax. Ideally something that's not technically addictive. I can't really say more about possible treatments without going for the full psychiatric interview, which is way beyond what I can responsibly do at this point. Let's talk about possible causes instead:

I'm still not clear what "silent migraine" means for you in particular - the term encompasses a number of symptoms - but what you did say points towards vegetative arousal or anxiety. You may have developed an anxiety disorder or depression secondary to your original benzodiazepine use, so your original idea is actually not bad. I'm pretty sure you took Ativan and Valium for a reason back then, so it may also be related to that problem.

I still strongly discourage experimenting with topiramate, or whatever other drug you can dig up on your own. There's too many ways you could mess up your brain or the rest of your body, and you need a diagnosis before you start eating brain candy. Since we can't do that here, hold out until you have that appointment.

I hope that's somewhat helpful, I'm afraid I can't offer you more specific information.

JonSetanta · Post by **JonSetanta** » Mon Oct 03, 2016 1:48 am

Will do! I'm not taking anything without doctor approval, or in this case neurologist.

Count Arioch the 28th · Mon Oct 03, 2016 10:16 am

This might be more of a bitch than a question, but for what earthly reason would it take a doctor two weeks to get back to me regarding a biopsy that I was told would take two days before they contacted me back? I've already ruled out incorrect contact information.

Prak · Post by **Prak** » Mon Oct 03, 2016 10:45 am

Dude, I've been waiting literally a month for a simple referral to an endocrinologist. Part of that is because the Endo's office "didn't get" the original fax.

My money's on "people are fucking lazy/overworked. Especially when their clients are broke mofos like us"

erik · Post by **erik** » Mon Oct 03, 2016 12:39 pm

Especially the overworked part. The squeaky wheel does get the oil and calling to check can remind them, or alert them to look into it if it was slipping through the cracks.

Maj · Post by **Maj** » Mon Oct 03, 2016 4:04 pm

If your doctor has an online portal, sign up. I frequently get my test results and such before they call me.

sendaz · Post by **sendaz** » Mon Oct 03, 2016 5:14 pm

Overworked and in some cases, working with outdated systems.

When my wife was in for one of her multiple surgeries in the last few years at the NHS hospital, they were waiting on doing some scans before they could proceed with the surgery. Because of the nature of what they were looking for, they were having her fast with a minimum of water on the day. Except they ended up not doing the surgery that day, however by the time they decided they weren't doing it, it was well past normal meal hours so weren't feeding her that day in case they had a opening in the morning. Same thing the next day and the third day. Fourth day rolls around and I pay a visit to Radiology to find out what the hold up was.
When I get down there and explain what is going on they go to the Book. Yes, they had a big old fashioned looking ledger that they were writing down names and times into. Which by itself was not so bad. Then they said they didn't see her name. I pointed out the doctor had supposedly submitted this three days earlier. They said, let's check the Box. On the desk is a box where slips from the doctors are dropped off by orderlies. So despite her ward and radiology both having computers at their desk, actual requests for scan time was being handled by slips of paper passed to runners to be taken to the department and eventually logged.

Nothing for my wife in the Box so there is nothing they can do for my wife.

At which point I give them a very toothy feral American grin and say I will go back up to the ward and have a word with someone. When I got back to the ward and requested speaking to someone in charge I am told Radiology just rang up and that my wife is to be taken down for her appointment that she was booked for, despite nobody on the ward knowing about it previously and just now is happening apparently.

I would have chalked it up to coincidence, except this happened twice and I can't help but wondered what happened to the folk who didn't kick things up a bit.

hyzmarca · Post by **hyzmarca** » Fri Oct 14, 2016 2:05 pm

Not a medical question, but a medical ethics hypothetical.

Lets say that there is a person with a mutant healing factor that lets her regrow vital organs in a matter of minutes and she's compatible with about 500 people who need organs. She volunteers to donate to all 500, because she isn't losing anything but time.

However, her mutant healing factor also makes her immune to all drugs. Anesthesia and pain killers don't work on her, it's litterally impossible to knock her unconsciousness or dull her pain. So she's going to be awake throughout the organ harvesting procedure and feel every part of it.

What are the chances of getting a hospital's ethics board and lawyers to actually sign off on this?

SlyJohnny · Post by **SlyJohnny** » Fri Oct 14, 2016 2:52 pm

Bone marrow transplants are incredibly painful for the donor, aren't they?

angelfromanotherpin · Post by **angelfromanotherpin** » Fri Oct 14, 2016 3:06 pm

Sounds like someone's been reading Strong Female Protagonist.

Is there any information on whether or not the donor might die from the pain?

DSMatticus · Post by **DSMatticus** » Fri Oct 14, 2016 3:46 pm

angelfromanotherpin wrote:Sounds like someone's been reading Strong Female Protagonist.

Speaking of SFP, last time it came up I expressed skepticism about the comic going forward from the end of issue #5. I haven't really touched it since then, waiting for a bingeable backlog to build up; was my skepticism justified? Is it still being feel-goody, or is it right back into depressing moral quagmires?

virgil · Post by **virgil** » Fri Oct 14, 2016 3:53 pm

DSMatticus wrote:
angelfromanotherpin wrote:Sounds like someone's been reading Strong Female Protagonist.
Speaking of SFP, last time it came up I expressed skepticism about the comic going forward from the end of issue #5. I haven't really touched it since then, waiting for a bingeable backlog to build up; was my skepticism justified? Is it still being feel-goody, or is it right back into depressing moral quagmires?

It's page 89 into issue #6, and it's got both.

hyzmarca · Post by **hyzmarca** » Fri Oct 14, 2016 4:01 pm

angelfromanotherpin wrote: Is there any information on whether or not the donor might die from the pain?

I'm going to say no, no chance of that.

angelfromanotherpin · Post by **angelfromanotherpin** » Fri Oct 14, 2016 4:08 pm

Well, I don't have any particular medical background, but I'd say there's a solid chance of it going forward. The suffering is voluntary, and it saves a big pile of lives. Ethically, I think they're covered.

Nachtigallerator · Post by **Nachtigallerator** » Fri Oct 14, 2016 5:25 pm

Well, it's a very big needle and a decent amount of fluid withdrawn: Link

I imagine it would hurt plenty, since the procedure is usually done under general anaesthesia, but hopefully not hurt like burning hell - the injury is less bad than breaking an arm, but honestly I have no idea how it feels to have your bone marrow sucked out. Anyone else?

Pain by itself is not deadly - I'm pretty sure the coroner can't put "pain" on the death certificate in any country that takes this kind of document seriously. If the patient already has unstable circulation, increases in heart rate and adrenaline like pain tends to produce are something you obviously want to avoid or control, so it might contribute to cardiac arrest under those circumstances. Even if that doesn't happen, it still feels very possible to lose your medical license for neglecting pain managment. Was it one of these "oh my god, we can't give anesthesia, but still need the procedure!!" kind of situations that only seems to happen in fiction?

Grek · Post by **Grek** » Sat Oct 15, 2016 12:31 am

hyzmarca wrote:What are the chances of getting a hospital's ethics board and lawyers to actually sign off on this?

The hospital would thoroughly investigate alternatives to analgesics, of course. Can she go to sleep naturally? Do amnesiac drugs function properly? Could we reproduce this mutant healing factor in any other way? If there were no other course possible, what surgical technique would minimize the pain and danger? Will this 'healing factor' cause any complications by virtue of its mechanism for acting? Etc.

Eikre · Post by **Eikre** » Mon Oct 17, 2016 3:54 pm

I surmise they would explore direct electrostimulation of the nerves to drown out the pain. Direct TENS therapy isn't really comfortable but it has some serious upshot when you can mainline it instead of unmitigated, excruciating agony.

Or, you know. Just sever her spinal column during the procedure.

Meanwhile, the regeneration factor would actually be really fucking annoying to try and make any extractions around. If her ribcage keeps trying to close and the peritoneum keeps creeping in around the edges to glue shit back together, then it's probably more expedient to find out where the "core" of her regenerating self is (best case: her head, worst case: greatest intact portion of mass) and come up with a guillotine mechanism to just hack out as much shit at once as you can and then put it aside and disassemble it at your leisure.

Occluded Sun · Post by **Occluded Sun** » Mon Oct 17, 2016 10:16 pm

Nachtigallerator wrote:Pain by itself is not deadly - I'm pretty sure the coroner can't put "pain" on the death certificate in any country that takes this kind of document seriously.

But it can lead to deadly conditions quite easily. Extreme pain can raise blood pressure to the point of inducing strokes.

IIRC, this was a problem with burn patients undergoing tissue debridements.

Nachtigallerator · Post by **Nachtigallerator** » Fri Oct 21, 2016 11:44 pm

Occluded Sun wrote: But it can lead to deadly conditions quite easily. Extreme pain can raise blood pressure to the point of inducing strokes.

IIRC, this was a problem with burn patients undergoing tissue debridements.

I'd love to see a reference for that - do you have anything or are you just relating your vaguely recalled factoids? I realize we're talking about something very theoretical and you maybe mean the right thing, but I have enough time to be nitpicky about this and this IS the Den, so:

1) Burn victims have multiple problems that can directly lead to strokes - shock from the injury, sepsis from infected injuries, and even thrombosis from spending a lot of time paralyzed on the operating table recieving debridement or skin grafts. So how exactly would you assert that it was pain that caused a stroke in any one burn patient?

2) If you wanted to analyze the effects of pain specifically, you'd have to look at patients with cluster headache or similar conditions that are not caused by a serious injury. Notably, cluster headache is not associated with stroke. The name "headache" is a bit of a misnomer, because it is more precisely facial pain around the eyesocket. It is very consistently 9 or 10 out of 10 on a numerical pain scale, and usually lasts twenty minutes or more. To make matters worse, it often takes years (like, five or seven years) for those patients to recieve a diagnosis and medication that works. So they have recurrent, terrible pain for years - but strangely enough, when they finally do get a diagnosis, they do not show up with residual strokes. Why would that be if pain made people's blood pressure spike hard enough for a stroke?

3) In conditions that react poorly to external stressors, obviously pain can cause them to deteriorate, which is the reason why adequate pain control is important even if the patient is unconscious. If you put someone under for an operation, you are already setting them up for surgery, drug and intubation related risks and you do not want to add the body's stress reaction to pain to that list of problems. And if someone has trouble brewing in their cranial blood vessels, a pain-related pressure spike might well rupture them. However, the way you frame it is misleading - like terrible pain was the only factor that was needed to produce a stroke. It isn't.

4) As an example of how your framing is misleading: Let's say someone ruptured their aorta while taking a shit (actual scenario from my recent exam). In the absence of serious chest trauma, a ruptured aorta most certainly had something wrong with it in the first place, and it would be grossly misleading to say that taking a shit can be very dangerous for your health. Strictly speaking, it's true, but it's the kind of truth that leaves the audience with a very skewed perspective of reality.

tl;dr: Pain can make a lot of things worse by way of the autonomous reaction to it, but if you inflicted terrible pain on someone otherwise healthy, there would most probably not be a stroke. There are people with actual conditions like this and they don't get more strokes than anyone else does.

angelfromanotherpin · Sat Oct 22, 2016 12:20 am

Let me quote an actual doctor.

Alcohol thins the blood and inhibits healing. You really don't want to drink alcohol at any point that surgery is even being discussed. Of course: before the invention of morphine, getting shitfaced drunk was the only way you were going to not die of pain, which is an actual thing people can do. So there's that.

-Username17

I think the thing that goes on the death certificate is usually 'circulatory shock,' but referring to the proximate cause seems to be good enough for a pro, and therefore good enough for me.

Nachtigallerator · Post by **Nachtigallerator** » Sat Oct 22, 2016 12:43 am

Except that this is - again - in the context of surgery being performed. Surgery with very poor anaesthesia, too, which is certainly a situation in which pain can kill the patient, but it's not pain alone that is deadly. Which is the thing I was just saying above. More specifically, I was questioning if pain causes strokes in the absence of other factors, which is what OS seemed to be implying.

If Frank was actually saying that pain in the absence of serious injury or disease can be deadly - and I feel it would be disingenious to read it from a quote where he was really talking about alcohol as a pain killer in surgery - I'd believe it. Because you are right that he is a doctor and I am not (yet).

I'd still ask him to explain how exactly, because circulatory shock doesn't just happen out of stress.

angelfromanotherpin · Post by **angelfromanotherpin** » Sat Oct 22, 2016 1:31 am

I can't even tell what the hair you're trying to split is. The hypothetical scenario was about surgery without anesthesia, and Frank was talking about surgery without anesthesia.