Sunday, March 13, 2011

Yeah, really

Orders for some lady who checked in for effin menstrual cramps:
8 mg Morphine IM
Vicodin 5 mg po
Zofran 4 mg po

Yeah, how about 6oo mg of Motrin and a swift kick in the ass? Really? Listen, I am not unsympathetic to the cause of menstrual cramps but this shit is getting ridiculous. I just don't understand. If you have pain and you know what's causing it, since when do you need to go to the ER? I had pretty horrible cramps until I got on birth control, and when I got them, I took some Midol and curled up in fetal position with a heating pad and dry heaved like a normal person. Now when I get them I just drink margaritas until the pain stops. No ER necessary.
Even if you don't think this is acceptable solution, take for example a friend of mine who has legit, documented lady problems that cause her to have the cramps from hell. She goes to her doctor, who prescribes her Vicodin, which she takes AT HOME. By the way, she is a college student who works and she is uninsured. So no, as far as I'm concerned there is no excuse for this foolishness.
Unless... maybe this is first line treatment now. Sign me up! I'll be there in a little less than a week, which is probably why I'm so crabby. Have the Propofol ready, I'd like to be asleep for the first three days of this. I'll take some Phenergan for my nausea and some Lasix for my bloating too, if you don't mind.


  1. Pharmacologically the most effective approach is to take an NSAID (Motrin, Aleve, etc.) at the first sign of cramps or better yet, menstrual period, and keep taking the NSAID according to the recommended schedule on the bottle until the danger period passes. Works like a charm, unless there's something more serious than cramps at play.

    Or tequila. Good stuff. :-)

    What is wrong with the physicians willing to indulge these people??? Did no one pay attention during pharmacology class?

    - not a physician, nurse or pharmacist; a veterinarian, but we learn how NSAIDs work, too

  2. Sometimes Advil doesn't cut it for my cramps, so I grab some Robaxacet & a heating bag. Better than screaming if you ask me.

    Pharm.Tech. RDC"06

  3. geez. There is always voltaren (diclofenac). That works like a hot damn. I suggested it to my massage therapist because she had the worst menstrual cramps ever and the regular NSAIDs weren't working for her - and she couldn't thank me enough. I can't believe they would use a narcotic...

  4. Naproxen works for me. However following a nasty accident I now have severe osteoarthritis in my ankle Celebrex solves my ankle pain and period pain. Before anyone starts on the dangers of cox 2 inhibitors yes I know them all but as a young patient I want to keep as mobile as possible and further surgery is not an option. It may make the situation worse. Cox 2 inhibitors are brilliant for period pain.

  5. I am starting mental-pause, but in the past I have had cramps so badly that I have screamed at the top of my lungs, between vomiting, and that was after taking (or trying to take) 800 mg of ibuprofen. I can have periods so heavy that my red blood cell count drops to kool-aid levels. My regular MD wanted me to have a hysterectomy, it was so bad. Things did get better for the brief 4 years I was on birth control pills, but one teeny blood clot and no more birth control pills.

    I've never gone to the ER for screaming, barfing menstrual cramps, even when my blood sugars are wildly all over the place, because I was sure I'd be treated like a drug seeker and thrown out. On the other hand, I'm still amazed nobody's called 911 on me. I've taken morphine -- a medication I have a supply of, but take infrequently [15 mg 5-6 times a year] -- for menstrual cramps but it doesn't resolve the problem. Morphine can only resolve pain, not the spasms that are occurring and causing the pain itself. I do not drink alcohol.

    I am sure that some of these women are abusing the system, but, geez, there's nothing like the old "It works for me, therefore it should work for everyone" thing to make bad medicine. Not everyone drinks alcohol, not everyone can take birth control pills, not everyone can take this OTC drug or that one.

    I wish you could feel the pain that I've felt with this. I've had kidney stones that were less painful.

  6. Yeah. Hence the disclaimer that if someone has some kind of additional pathology happening such as endometriosis in the case of my buddy or many other ladies out there, I understand the use of narcs, by prescription of a provider who knows you, in your own comfy bed. Completely acceptable. I even understand the occasional ER visit when shit gets real for an otherwise managed condition.
    But an otherwise healthy person like this lady, who had been worked up before and came back because "I was here last month and they gave me a shot" acting a fool and demanding to be seen immediately? With no efforts to take anything at home or follow up? No ma'am.
    It's not even a drug seeking issue. It's just refusing to address a chronic problem yourself and being rewarded for it with a bucket of narcs. If that makes me an unsympathetic douche, so be it.

  7. Moose, have you ever had a D&C or an endometrial biopsy? I'm asking because I was perimenopausal and having heavy periods like that. My primary care doc just prescribed progesterone to stop the bleeding and I just put up with it. Last year, I finally asked for a referral to a GYN for a possible hysterectomy. I was diagnosed with Stage 3a endometrial cancer - grade 1 which means it probably had been in there growing for a long time.

  8. our health care system at its finest...Am I the only one who is losing all respect for doctors?

  9. I have a friend like this. Makes me cringe every time she tells me she's been to the ER for something absolutely ridiculous. I can understand going if there's some kind of underlying problem, but plain ol' menstrual cramps are not a reason to go to the ER.

  10. for UTI...
    me: the doctor ordered motrin for you...
    girl: im not takin' no pills! they give me morphine in the IV

    it took all my might to not burst into obnoxious laughter in her face.


  11. Nurse Awesome -- I'm sorry I lost my temper. I have a few buttons that I let get pushed too easily and one is being treated like a drug seeker and/or 'creating my own problem' when I'm actually suffering. Thankfully I have found that it is the rare exception to the rule. But those exceptions have left scars in me, each the size of Montana.

    Not an excuse for my bad behaviour. I am truly sorry.

    Debbie Does Nothing -- No I have not. It's a complicated situation not worth going into here. Suffice to say that right now I have no health insurance -- and my periods have slowed down to very light & 3-4 times. [Although they did this once before and came back with a searing, screaming, barfing vengeance.]

    Who knows what's going on in there? For all I know, ET and his space alien friends have started a colony. Tomorrow a face hugger will spurt out and attack my neighbors.

  12. The insurance thing sucks. BTDT. I was covered but couldn't afford the copays - one of the reasons I didn't go to a gyn sooner.

  13. I just don't understand the prescription of narcotics for things that are not ideally treated with narcotics. Years ago I had a gall bladder attack that was treated brilliantly with toradol. I realize that's not a take-home medicine, but being sent home with the useless Vicodin instead did not make me a happy camper. On the other hand, I am all about the Vicodin for any kind of post-surgical pain, when it actually seems to be appropriate to the job.

  14. I'm with you, love.
    Hang nail = Morphine
    Cramps = medically-induced coma

  15. I have endometriosis and it makes labor seem like a walk in the park (I have 4 kids). Most months I can get by with Tylenol paired with advil, bedrest and a heating pad. When those things don't help I go to the ER. I hate narcs so I ask for toroidal, works like a charm. I given a prescription for oral torodol but it murders my stomach and as anyone with severe cramps knows eating really isn't possible while you writhe in agony, huddled with the toilet.

    I wish more medical professionals were understanding, especially when women really don't know what the hell is happening to them. It can take time to get a diagnosis.

  16. Okay, I know this post is super old, but I just found this while doing a search and I have to say that I'm feeling pretty uneasy about what I've just read. I'm sure there are women who go to the ER for menstrual cramps who are just seeking strong pain meds and should stay home, practice some self-care measures or use over the counter remedies. However, for those of us who live with debilitating menstrual pain, judgment of whether or not we need ER care is an insult. I would never go to the ER unless I was in desperate need of medical attention and there were no other options.

    I have been to the ER twice this year for a level of menstrual pain that was intolerable (accompanied by many lovely symptoms such as extreme diarrhea, constant vomiting, clots the size of the palm of your hand). I am not going because I'm refusing to address a chronic underlying condition. I have seen three gynos, have had endless tests and even two surgeries to try to find out what's going on, all to no avail. I have also talked to my family doctor about pain management (and the bonus iron deficiency that is the result of such heavy bleeding) and I'm sorry, but Naproxen and Percocet doesn't even begin to touch the pain when it gets to the point of wanting someone to hit me over the head with a rock to knock me out.

    This most recent time in the ER, I was seen by a doctor who actually cared to talk to me about what was going on. I understand why doctors don't want to hand out strong narcotic prescriptions, but in cases like mine where it could potentially keep me out of the ER while I'm seeing a specialist to hopefully figure things out, it's needed. I understand every person's situation is different but I guess what I'm trying to say is that some women might have underlying conditions that haven't been found yet and just because they're going to the ER doesn't necessarily mean they're not trying to get things figured out. Maybe the women who show up demanding drugs need to be referred to a specialist to work on a pain management treatment plan and have further testing.