One for the Legal Eagles among us, or those who hope to be some day.

[BuckyXTC]

>> His official medical

>>diagnosis is "chronic migraine", and this comes from a board

>>certified neurologist.

>

>Migraines are chronic conditions, so to call a migraine a

>"chronic migraine" is redundant. When chronic daily headaches

>have arisen from what was previously a migraine, the term

>"transformed migraine" can be used, but, as the name implies,

>it just means that the migraine has become a chronic daily

>headache. I have attended quite a few lectures on migraines

>and other headaches, and they always caution against using

>opiods for headaches, especially recurring ones. Opiods are

>truly a black hole which will often require inpatient

>treatment to get out of.

>Migraines are incredibly common, and I have successfully

>treated probably over 100 and never prescribed a narcotic,

>except in decreasing amounts in someone who has become

>dependent, and I'm in the process of getting the patient on a

>more sensible regimen. Usually I find that those who get into

>trouble with opiods find themselves there because they bounce

>around ER's (whose goal is to get the patient out as fast as

>possible, especially if the patient shouldn't be there in the

>first place). I'm thinking back and cannot remember a single

>time seeing a patient whose opiods were prescribed by a

>neurologist.

>If a neurologist was indeed prescribing your friend's opiods,

>he must not have a great imagination. There are more migraine

>treatments than Fabio has hairs on his head. Among the many

>classes of medications used include beta-blockers, NSAIDS,

>tricyclics, Calcium-channel antagonists, anticonvulsants,

>serotinergic drugs, MAOI's, triptans,

>Angiotensin-II receptor blockers, dichloralphenazone,

>phenothiazines, and GI motility drugs. Each of these classes

>has multiple medications in its class, some over a dozen.

>Humans do not have the lifespan to "try all of them" (at least

>not adequately).

 

The neurologist has already been decreasing the dosages of the narcotic drugs, and they are trying some new medications. This makes me happy, as I don't think anyone other than perhaps the terminally ill cancer patient should be getting the really strong narcotics, certainly not someone as young as my friend.

 

I really wish he would go to a clinic that specializes in the treatment of headaches. It is rare that even a specialist like a neurologist would necessarily know as much about headaches than perhaps another physician who has devoted his practice to the study and treatment of headaches.

[Guest]

I wish your friend good luck. He really has to understand and believe that he needs to stop the narcotics. Otherwise, he'll just doctor-shop and thwart the intentions of the neurologist. Just today, after spending a good deal of time explaining to a chronic daily headache patient the nature of her problem, she stated "But my Mom has headaches,too, and she takes 8 Vicodins every day!" x(

[joel304]

Oops ... Message to Lucky

 

"I guess you can charge whatever you want when you have no

clients! You said that you weren't working when you started

posting here, then you moved from SF to Portland"

 

1. These are the going rates honey. 2. I wasn't working when I "recently" started posting again. I took time off. The problem was that I had too many clients, and was working too hard. 3. I started in criminal law, and transferred to the far more lucrative area of corporate law. This transfer brought me from NY, to CO, to LA, to SF, with a major corporation. It also brought stress and 20 lbs. with it. 4. Portland was actually just a vacation to visit with my sister.

 

"and now you are moving to Brooklyn. Those multi-state law licenses come in handy, huh?"

 

Law licenses? I am admitted in NY, and CA. I was actually born and raised in NY, attended undergraduate at UCSB, and law school in NY (location withheld). My decision to leave SF, is partly based on bitchy old queens (enter mirror) and boredom, along with an overwhelming desire to sleep with JTbrooklyn. I also miss NY Giant's games and good delis.

 

In addition to the locations mentioned, I have also lived in Scottsdale, AZ (hated) and Galway, Ireland; maintain residences in Taormina, Sicily, and Dublin, Ireland, traveled the world (not entirely) and am a millionaire. Therefore, I am able to pretty much do as I please, all the while not hiring BN. Who could afford his traveling requirements :-)