Sunday, March 2, 2014

Defining "Rebound " Headaches

A few of my fellow 'Trochlear Migraine' buddies have asked me to put on the blog how I define what a rebound headache is... So here goes.

After reading "Heal Your Headache" by David Buchholz, MD I finally understood what was meant by a re bound headache.  But I still didn't think I was having trouble with that.

Our neurologists tell us we are only allowed 2 days a week of pain meds.  This is not comprehensible if you suffer from chronic almost daily headaches/migraines.  What do you mean I can't take SOMETHING when I have a headache?!  

I was at a point of taking 100mg of Indocin daily with a narcotic for the really bad days. It was no longer working... That's when my neurologist explained it to me best. 

Dr. Bucholz explains that when you take a pain reliever, the pain receptors in the brain are 'bound' with the medicine, and the pain receptors are quieted... but after the pain receptors have been trained to expect the pain med to bind them, the now will sort of SWELL looking for the pain medicine when it wears off.  They want to be 'rebound' with the medicine.  They stay LOUD and searching searching, searching, looking to be bound with pain medicine. 

Then my neurologist explained the next step. She told me what I have is a 'monster of a problem'.  Daily Headaches.  But after a while it becomes a Tyrannosaurus Rex and you just can't feed it enough pain meds to keep it happy.  Soon you land where I was at... Nothing is working....NOTHING! 

I was devastated, but I knew she was right.  I had to stop my daily pain meds.  Ibuprofen, tylenol all of it.  I cried all the 3 hours home mostly because I knew she was right.  I was scared.  I had to loose what I thought was my safety net.

I am happy to report however, after making it through the rebound stage, ( two days)  I wasn't any worse off than I was before and maybe a little better.  My stomach was the happiest as all the years of meds had chewed holes in my stomach.  

Best part is that when I did take pain meds.  They actually stopped the pain, and I got a two day break, enough to build up strength to face the pain once again.

Fun fact?  According the to infamous HoneyChuck... you can have meds round the clock if you need on those two days. Its not the amount you take its the length, it can't be longer than two days or else you train the pain receptors all over to expect the pain meds.

You could discuss maybe trying a prednisone taper while getting off your pain meds. 

Now... my next adventure should be caffeine headaches... I'm just not ready to give up my Jo though.

Tuesday, November 26, 2013

The difference between Ophthalmologist and Optometrist's

Recently I went with one of my dearest friends as she took her 6 year old to the optometrist who also specialized in Vision therapy. Another dear friend referred her to this optometrist .  I'm interested in the subject immensely of course,  so she allowed me to go along.

If I hadn't been through so much with my own eyes, I would have never batted an eye at this subject. This optometrist was excellent....But I knew... She is still not a medical doctor.

The optometrist was very kind and very seemingly very smart.
The clinic had all sorts of high tech equipment.
We were in a smaller town in central MN.  I am used to going to the Mayo Clinic in Rochester and this little clinic had equipment that appeared to be of higher tech than the revered Mayo...

This appointment was very important as my little friend Lane, seems to be struggling to learn sometimes in school.  We wanted to make sure his eyes were not contributing to his struggles.  Turns out, yes! He needs a new prescription.  He favors one eye affecting his depth perception etc.  but as I looked at the perscription I found it odd that the child needed equal prisms in each eye and now bifocals at age 6.  I was a little worried about how hard it might be for a child to adjust to bifocals when it is sometimes quite difficult for adults to adjust to them.  I was worried he'd be just frustrated and take the glasses off altogether.

Optometrist, as I understand it, have not gone to medical school. They go to four years of optometry school.
Ophthalmologist, have gone to 8 years of medical school. And some have gone on to 2-3 years of subspecialty training.

Optometrist, specialize in eye exams, vision changes, managing already diagnosed eye issues and they can refer you to an ophthalmologist.
Ophthalmologist, specialize in comprehensive eye health, they can see the 'larger picture' of overall health, in regards to cause and effect and treatment options of various issues.  After an issue has been diagnosed, and optometrist can be quite capable of monitoring a condition.

I like to think of it as the optometrist is the ophthalmologist right hand man in caring for patients.

Apparently, this is a hotly debated item in eye world, especially in the USA.

As far as the fancy equipment.... well, come to find out.  Sometimes the best equipment is the doctors knowledge.  Sometimes simply doing something like dilating the eye is much more accurate than snapping a picture of the back of the eye.  Although, I'd like to add the machine is more comfortable.    That being said.  Nothing can out shine the human brain.

We followed up with a second opinion to the local Pediatric Ophthalmologist specializing in Strabismsus in our own town to learn that Lane's eyes were actually good! Very Good. He had better convergence than most his age. He just had a small stigmatism .  He did not need vision therapy and really could see good with out his glasses.  When all was said and done. Lane's eyes were not the cause of his class room issues.  It was more behavioral.  Can you imagine if we had gone down the road of prisms and bifocals?
Turns out Lane's mom had a hunch his eyes were working fine together ( converging well) He is excellent at sports.  Never misses a ball.  So how could his depth perception be that far off?
In this case the Optometrist was way far off.  We're so glad we got a second opinion before proceeding to put Lane through even greater frustration with learning.

 Please take the time to read the link noted here.
It makes a difference.  If you get well intended, but incorrect eye care, especially at 6 years old.  It will affect your whole life.

Do your home work... See the right Doctor at the right time! If you're 6, it could mean your future.

Friday, January 25, 2013

Punctal Plugs

Yesterday, I went to see my local eye doctor to see what we could do about how dry my eyes have progressively become.
They didn't seem too dry of course on the day I actually go to the doctor. But yes, indeed, they were so dry ( especially my right eye which has had more trouble) my normally 20/15 vision they now rated 20/25 which still is good, but I was alarmed as I truly couldn't make out one letter with my right eye on the exam.
After examining my eyes thoroughly, my doctor recommended temporary punctal plugs to be inserted in my lower tear ducts. This is to keep the fluids on my eye from quickly draining off,  ( and yes, I can still cry- my coworkers were wondering this today)
They simply putting some lovely numbing drops in your eyes, (that felt a bit like isopropyl alcohol) so I wouldn't be uncomfortable at all.
I simply had to look up to the ceiling as she used what I imagined were very precise instruments to insert this tiny little plugs deep into my tear ducts.  I felt the pressure etc. of what she was doing.  It really was no big deal.  However, I've had many eye procedures this was again, not a big deal.

However, I am happy to report that already this morning I can tell a nice difference.  It didn't hurt to blink and my eye lids didn't stick to my eye ball.  Must say, it was much nicer to wake up like that!

You can't see the temporary plugs at all in my case. She chose the temporary punctal plug because it had a greater chance of staying in for the full 4-6 months.  I agreed to this as I did have a permanent plug put in some time ago that popped out after 3 weeks.  The doctor figured I itched it out of my eye during allergy season.  See, the permanent punctal plugs have the tiniest little white dot that sits just above the tear duct. I must have worked that plug right out of my eye with my allergy to ragweed that summer.

Anyway, I'm very excited to find a bit of relief from these dry, burning, blurry eyes.

Also, it was lots of fun to hear how excited this doctor was when reviewing my strab. measurements.  She just couldn't get over what a difference I am now compared to before surgery.  It really is a miracle!

Friday, April 6, 2012

Tables turn

Quite interesting to accompany a friend as she went and had surgery with the same doctor I had down at the Mayo Clinc in Rochester this past week.
Very nice, I must say to NOT be the patient!  My friend did great.  But the doctor did even better.  He hit a home run! Amazing!  He put an adjustable suture, on EACH eye. But when he went to adjust them about 5 or 6 hrs later, they were pretty much 'spot on' , no double!  So he just had to tie the sutures off and clip them.  Amazing!
Immediate success!  Very cool to see such results!
Also, Very interesting to see them do the adjustable sutures after having had them done to myself 4 different times.  I concluded after seeing it all, it's not so much the act of surgery that is amazing, it is all about getting the math correct and knowing where to land those crazy muscles on the eye ball in the first place.  As the surgeon said, " the adjustable suture gives you the ability to be as aggressive as you need to be" meaning  a surgeon can fine tune and get it exactly right all because when the patient is awake they, by way of feed back and tests the dr does while adjusting the sutures, can make sure the muscles are exactly where they need to be.
I crudely would compare it to adjusting your headlights in your car... You would put your new headlights in, then sit in the drivers seat and see if it's correct, get out adjust them if need be etc.
Very educational this week was.
I'm gaining even greater appreciation for this science.  So fun to watch someone do this, plus, all the while he was teaching others the whole time.  That was pretty neat too...  So interesting to come this full circle and now be able to see someone else go through it.  Another eye miracle -- Poof!