Archive for the ‘Medicine’ Category

Return of the Dizzy Dame

October 5th, 2009

Wooo! The world is spinning! No, it’s not really much fun. A year ago when I was first seeing my former neurologist I was being evaluated for vertigo, which I was experiencing very frequently. I had an ENG (Electronystagmogram) – a test to determine if my vertigo is vestibular (inner ear-based) or brain-based (Migraine associated), and the results indicated that I had some of each.

At the time I was experiencing vertigo nearly daily, strongly during and after Migraines, but also at changes in position, walking up stairs, turning, etc. It was August and September of last year when the problem was at its worst. I started Topamax in mid-September, and the vertigo seemed to quiet down and leave within a couple of months. I thought the Topamax was clearing up the vertigo. But since then I have gone up to 75 mg of Topamax and back down to 25 without any change in the amount of vertigo. I’ve been on 25 mg for the last 4 1/2 months now. I am going to eliminate the Topamax in a few weeks, as I have been phasing in nortriptyline for the past month.

For the last week or so I’ve had a sudden return of vertigo. It came in with the pro-drome of a long Migraine last week, and has yet to leave town. I can’t imagine it is related to the Topamax, because I haven’t changed the dosage in months. I don’t see dizziness listed as a nortriptyline side effect anywhere. It’s not constant at this point, but I can’t hang my head over, or bend or straighten up quickly, without getting very dizzy. I’m actually wondering if the vertigo could be related somehow to seasonal allergies, since my fall pollen allergies are kicking in right now as well. I guess a call to my new doctor is in my future.

When I was a kid my brother and sister and I used to spin around and around in the living room until we got so dizzy we would collapse on the carpet. Why isn’t that any fun any more?

- Megan

Spinning break dancer image courtesy of Katie Weilbacher.

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Posted in Medicine, Musings | Comments (0)

Cocoa for Migraine Prevention?

September 28th, 2009

Results of a research study presented at the International Headache Congress in Philadelphia this month show preliminary indications that a diet rich in cocoa may aid in preventing Migraines. Animal studies suggest that cocoa supresses inflammatory responses in the trigeminal nerve, the main nerve involved in Migraine.

There’s some irony here as chocolate is identified as a common Migraine trigger food. This may be because of caffeine or tyramine content, however, rather than cocoa content. I don’t know whether the caffeine or tyramine are present in the cocoa, or in some other ingredient of chocolate. The researchers caution that these are early results. If see benefits in humans as well, maybe they will find a way to isolate the anti-inflammatory parts of the cocoa from any potentially triggering parts.

I would expect to see cocoa supplements or extracts coming down the pike. Since I have the good luck not to be triggered by chocolate (in fact, I get some relief from a Migraine by eating dark chocolate) I am going to start now. Cool weather is here – hot cocoa everyday? Why not! Mole sauce? Yum. I think I can come up with a diet rich in cocoa without too much trouble!

- Megan

Chocolate plate image courtesy of avlxyz/Alpha.

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Posted in Current Affairs, Medicine, Musings | Comments (3)

October Blog Carnival Coming Up – On Alternative Therapies

September 26th, 2009

Diana Lee of Somebody Heal Me will be hosting the October 2009 Headache & Migraine Disease Blog Carnival on the theme “Alternative therapies – your experiences (good or bad), thoughts about trying them or any other take on the subject.” To participate, send your link to a blog post on the topic, new or old, along to Diana, through the form on the carnival website or directly to her by e-mail.

Submissions are due by midnight (the end of the day) on Friday, October 9. This is a great opportunity to gather a number of posts around a topic of interest to many of us. About 6 weeks later Dr. Christina Peterson will be addressing the same topic on the November Managing Life with Migraine Teleconference, so between the two events we should gather a lot of great advice!

- Megan

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Posted in Managing, Medicine, Weblogs | Comments (0)

Don’t restrict Acetominophen – Educate, don’t Regulate

September 22nd, 2009

Please sign the American Pain Foundation‘s petition to the Food & Drug Administration asking them to educate the public about the dangers of overuse of acetominophen (Tylenol), rather than restricting its use.  The FDA is considering banning pain medications such as Lortab, Percocet and Darvocet which contain acetominophen as a second ingredient in combination with a narcotic pain reliever, as well as making extra-strength acetominophen formulations available only by prescription.  As the petition states,

When used as recommended, acetaminophen is a safe and effective pain reliever and fever reducer and has been used by millions of Americans for decades.  This medicine, like all medicines, has risks when used beyond the recommended amounts.

Acetaminophen: Educate, Do Not Regulate.

The FDA’s proposed regulations are due to concerns about liver damage from overuse of acetominophen.  Proper labeling could do away with much of this concern, and avoid leaving pain patients without medications they need to get by on a daily basis. Without proper labeling, it’s easy to overuse the medication even at lower doses. More importantly, people who rely on these medications to get through their daily lives will be left without help.

You can also leave comments directly for the FDA – the comment period ends September 30th.

Please take a few minutes to take action on this important issue!

- Megan

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Posted in Advocacy, Managing, Medicine | Comments (0)

Fatigue, Fibromyalgia & Denial

September 21st, 2009

Hello friends. I’ve been quiet lately. Had a marathon summer with a lot of work and a daughter to get off to college. She is off, settled in, working hard, and having the time of her life. I flew back from three days away, moving her into her dorm, and then I attended the International Headache Congress in Philadelphia for two days, then I spent a lovely day in Manhattan with cousins from the west coast, then I spent a day working, then I went back to Philly for a first appointment at the Jefferson Headache Center, then I collapsed.

I will post about the IHC, and about my appointment at Jefferson, (both of which were great) later. What I want to talk about today is “then I collapsed” part. Well I do have to touch on the appointment at Jefferson… mostly what was discussed was my Migraines and my anxiety level. I was very happy with the care I got, the thoroughness of the history taken, the look at Migraines in the context of a whole life. I have new treatment options and new hope.

It felt like almost a side note to the exam, when the doctor pressed certain points on my body which hurt tremendously.  Once he had pressed a half dozen, I realized what he was doing – pressing the fibromyalgia tender points.  One of the diagnostic criteria for fibro is pain in at least 11 of the 18 points – well, I had a great deal of pain in 14! He asked me if I feel pain in my body on a daily basis and I said there were days when I’m achy all over, but I’m not aware of much pain in my body much of the time.

But over the next few days I couldn’t stop thinking about it. My 10 day marathon of travel, launching a daughter, conference, appointments, left me bone weary and aching. You know when you first notice something you haven’t seen before, and all of a sudden you see it all around? I had this sense of a puzzle piece clicking into place. Why do I fatigue so easily? For the last few years when I exert myself in any way, whether it’s physical exercise, mental or emotional stress, or just being on the go for a number of days in a row, afterwards my entire body aches. For days. I have become terribly sensitive to touch, where someone bumping into me actually hurts, instead of just being jarring.  My husband and I were lying on the bed talking the other day and he had his hand on my calf. His thumb was resting on my shin, and after a few minutes just the weight of that thumb began to actually hurt.

I know people with fibromyalgia, and there are plenty of Migraineurs who also have fibro. I’ve read about it, and I have wondered for some time if I might have fibro too. You’ll see in my profile that I say I have chronic fatigue, but I’ve always had some question about that diagnosis, which was more of a suspicion by my family doctor than a real confirmed diagnosis. Up to this point, though, I have avoided looking into it for myself. I don’t want to face having another chronic illness. I want to live in the illusion that my limitations will go away someday. Ha! Oh well, a girl can dream.

I will investigate this further; I will talk about it at my next headache appointment. I know there are treatment options and support available. It’s kind of silly, really, to prefer denial. Having all the symptoms I have and no name for it really isn’t better than having the symptoms with a name. Knowledge really is power. I hear that the drugs used to treat fibro are really good for treating Migraine too, and many people’s Migraines improve when their fibro is treated. We’ll see. I still kind of want to stick my head back in the sand. Except I know my neck would hurt for days afterwards.

- Megan Oltman

Logan Square fountain image courtesy of Conspiracy of Happiness; shoulder image courtesy of Barbarellaa.

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Posted in Communicating, Managing, Medicine | Comments (2)

The Miracle of Pharmaceutical Engineering

September 3rd, 2009

Last week Karen Lee Richards of Chronic Pain Connection let us know about a technological advance in medication – the approval of Abuse-Resistant Morphine.  The idea is that extended release opioid-containing drugs like Oxycontin have been prone to abuse because they can be crushed, avoiding the time-release built into the capsule and allowing drug-abusers to take in large amounts of the drug at one time.

King Pharmaceuticals has created an extended release opioid, approved by the FDA and marketed as EMBEDA, which also contains Naltrexone, a drug that blocks opioid receptors.  If you take the drug as prescribed, no problem, the Naltrexone passes through your system without being released.  If, however, the capsule is crushed, the Naltrexone is released and the effect of the opioid is blocked. Very clever!  Read more about it in Karen’s excellent article: Abuse-Resistant Morphine Approved.

This is very good news for chronic pain sufferers who must rely on these types of drugs to get by – societal fears of drug abuse, drug seeking in emergency rooms and similar issues have made it harder to live as a person with a chronic pain condition.  For those of us who must use an opioid occasionally for Migraine rescue, it’s good news as well.

Now, not to take away from the seriousness of this, because it is really is a great advance, it does make me wonder – What other drugs could they engineer to make them abuse resistant?  What about our society’s most prevalent Legal drug – Could we put something in alcohol to make it stop intoxicating people once they approach their legal blood alcohol limit? Just sayin…

- Megan Oltman

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Calling all Redheaded Migraineurs

August 9th, 2009

Now I know Migraine occurs in all human cultures, and people of all hair colors as well as all sorts of other characteristics, but I am interested in conducting a very unscientific study here… and certainly interested in knowing if any real studies have been done of this (I don’t know of any).

An article in the New York Times yesterday entitled The Pain of Being a Redhead discussed several studies which indicate that redheads are resistant to anesthesia, take on average 20% more medication to anesthetize (which has been known anecdotally by anesthesiologists for years), and may have a higher sensitivity to pain than the general population.

I shared this link on Facebook and very shortly got comments from 4 redheaded Migraineur friends! Now the comments were all over the place. Most of us agreed that as Migraineurs we deal with so much pain on a regular basis that we think our pain threshhold is higher rather than lower, though several of us have had the experience of being resistant to anesthetic or pain-relieving drugs. But here’s what I’m curious about – is there a high correlation between red hair and Migraine, or was my little flurry of redheaded Migraine buddies just a fluke?

Tara Parker-Pope, the article’s author, states that

a mutation in the MC1R gene results in the production of a substance called pheomelanin that results in red hair and fair skin. The MC1R gene belongs to a family of receptors that include pain receptors in the brain, and as a result, a mutation in the gene appears to influence the body’s sensitivity to pain.

If we redheads have a genetically altered sensitivity to pain, are we more prone to chronic pain conditions? I have no idea – but I do wonder!

- Megan Oltman

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Posted in Medicine, Musings, Science | Comments (10)

Migraines and Emotional Health

June 1st, 2009

We had a very exciting teleconference yesterday with Dr. Roger Cady of the Headache Care Center of Springfield, Missori.  I think everyone who was on the call will attest to what a warm and caring soul Dr. Cady is and how he puts everyone at ease. It was an upbeat call and I think everyone on the conference came away with some practical ideas they can put into use.

We discussed the extra sensitivity of a Migrainous nervous system and how to care for that nervous system – not as something wrong or diseased, but as a process of acceptance of who we are, of the unique person we are.  When we are blessed with that extra level of sensitivity, we are sensitive to emotional cues and issues as well.  Anxiety and depression are described as “co-morbid” with Migraine because they occur together but the causal relationship is not understood at this time. The connection is probably in serotonin which is implicated in Migraine and in anxiety and depression.

If you’d like to listen to the audio of the teleconference and you are already registered for the Managing Life with Migraine teleconferences, sit tight.  We will have the audio file posted within the week and will email you the link. If you aren’t yet registered, please go to Managing Life with Migraine and get on the list! This will give you access to all the teleconference recordings as well as a spot on future teleconferences.  Next month’s call on Sunday, June 28th will be with Dr. William Young of the Jefferson Headache Center.

- Megan Oltman

Photo of Dr. Cady and Dr. Diamond copyright Teri Robert, used by permission.

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Time for a Change in Medication

May 23rd, 2009

I am stubborn and it takes a while to convince me. At this point I have to finally admit that Topamax is not helping me very much. I diary very carefully and keep statistics on my Migraines, and I can say that since I have been on the Topamax I’ve had about a 20% reduction in my Migraines and overall head pain. Better than nothing, but not much to write home about.  I started on 25 mg in the evening, tried that for a few months, and the first two months saw my Migraines go from 8 – 10 per month to 5 – 6, but I think that was a fluke, because every month since then has been back up in the 6 – 8 range, which is average for me.

My doctor suggested I take the dosage all at night, so that any sleepiness and cognitive side effects would be mostly worn off by morning. This was okay as far as it went, but I discovered after a while that I was having an awful lot of evening Migraines. I also learned that Topamax is pretty well out of your system after around 22 – 23 hours. So the level in my bloodstream must have been getting pretty low by evening, and Migraines were breaking through at that point. When I pointed that out to my doctor, he said that he wasn’t too concerned about it “just for headaches,” he’d be more concerned if I were on the medication for seizures. I have to say I’m getting a bit concerned with a headache specialist who uses the phrase “just for headaches.”

I decided to split the dose evenly between morning and evening and the Migraine preventive effect definitely increased somewhat, but the cognitive side effects became much more noticeable. So much so that after a month on 75 mg I decided it was intolerable; I was getting next to nothing done in the course of a day. So my doctor was certainly right that taking it all in the evening lessened the side effects, it just lessened the main effects as well! I went back down to 50 mg two weeks ago.

But even on 50 mg, I’ve been so slow I am hardly getting anything done and I have almost no days where I am full of energy. I just don’t feel like me, at all. I cut down the Topa to 25 yesterday, as per schedule with my doc. Well I took this morning’s half pill (12.5 mg) and felt all my energy and alertness just drain out of me within about 15 minutes – okay, now I’m eager to be done with the stuff!

The problem is where to go next. My doctor is recommending amitryptaline, an old tri-cyclic anti-depressant. Some people experience sleepiness, fatigue, and weight gain on it. I read on line that some of the top Migraine specialists don’t prescribe it because it is “primitive.” It’s actually off the market as an anti-depressant, but for Migraine prevention is prescribed at a much lower dose than for depression. On the other hand, some people experience no side effects.

I’d like to propose some alternatives to my doctor, but I’m feeling a little overwhelmed by the research involved. I look at side effects lists and I don’t like any of them. I read others’ experience but I know that what was true for them won’t necessarily be true for me. I just know that 6 – 8 Migraines a month is too many. I’ve had worse, and many of you out there live with worse. But I am sure I can do better!

- Megan

Still looking for that magic pill!

Block head image courtesy of Stefan; magic pill image courtesy of [O*] ‘BharaT.

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Posted in Communicating, Managing, Medicine | Comments (7)

Getting the Support you Need

May 8th, 2009

If there’s anything that makes me want to throw up my hands and give up, it’s how complex Migraine disease is. Migraine disease has multiple triggers, can take multiple forms with different symptoms and effects on our lives, and has multiple treatment possibilities. I could not manage all of this without support. It’s lonely dealing with a disease that eats away days and weeks of our lives, and isolates us where the sound and the light won’t bother us. Treating Migraine takes managing multiple aspects of our lives and health – that takes support. The people who support me remind me that every day will not be so bad, that life is still worth living, that there is hope. The things that support me give a structure to my life that I can count on when I am not functioning at my best.

We need to cultivate our support systems – building them up when we feel well so they will be there when we need them. We need to do what we can for the people who support us, when we can. In other words, we need to build our stock of resources.

What kinds of support are there? Consider these:

Where is support missing in your life? Sometimes making a list of the pieces that are missing and taking just one step at a time can make a big difference. Like finding one person to talk to, or scheduling one doctor’s appointment.  Giving a teleclass a try, or stocking up on comfort supplies.

What can you do to build your support system?

- Megan

Hands together image courtesy of Maria Angelie.

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Posted in Managing, Medicine, Tips & Techniques | Comments (4)

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