Question about refills on meds

Hi everyone.  I had a problem yesterday that I want to ask y'all about.  As I have posted before, my neurologist has put me on a regime of meds to help abort my migraines.  Well, thankfully, it has been working wonderfully.  His instructions to me 6 weeks ago were:  at the first sign of any headache or when you see on the weather that there will be a high pressure system moving in, take 1 Relpax, 1/2 prednisone, 1 zofran 8mg ODT and 1 2mg Dilaudid.  If this seems to be working but still have headache, repeat the Relpax in 2 hours and the Diluadid every 4-6 hours until headache is resolved.  Well......it has done great.  I haven't been to the ED since starting this 6 weeks ago and that is a record since my migraines started last summer.  I was feeling great about the whole situation.  My only complaint has been that the Relpax makes me sleepy but if I can rest for 2 hours, I am fine - even the Dilaudid doesn't make feel like I am drugged or sleepy or anything.  I am able to function without having to go to bed for 3-4 days!  So, everything should be great, right?  Not so fast.  When the doc wrote the scripts, he wrote 6 refills on all.  When I had them filled, the pharmicist told me that docs arene't allowed to write refills on Dilaudid.  I called the doc's office and told his "nurse".  She said that he should have known better.  I told her that I just wanted to let them know so that when I needed a refill, they wouldn't think I had already had it refilled 6 times.  Understand that every prescription he writes is copied and put in my chart before I leave the office so that anyone who looks in the chart will know what meds he has prescribed.  Anyway, last week, I called and told the "nurse" that I had 3 Dilaudid left and that we were expecting bad weather over the weekend.  I did'tn want to get stuck without any.  She said that the doc was out until Monday and that although she could write the script, for Dilaudid, she didn't like to.  I said that was fine but could she call me on Monday after speaking with the doc.  Well, she never called so yesterday afernoon, I called her and she was not nice.  She told me she would have a script for me but I would have to come pick it up.  I told her I understood and would come by the office.  She then asked me what mg of Dilaudid I used and I told her they were 2 mg tabs but sometimes I took 2 -3 (not at one time but spread out every 4-6 hours).  Well.......she informed me that I was not allowed to do that and that if I did that, they would not refill my scrip early.  So...what is early?  I thought I was doing exactly what the doc told me.  I told the nurse that the ED usually had to give me 8-10mg Dialudid to resolve the pain.  She told me that was the ED and that I was not allowed.  So, when I went and go the script, guess what?  She had only written it for 6 tablets.  So now, I don't know what to do.  I guess I will reserve them when the pain is at it's worse - that is exactly what the doc told me not to do - he said never to wait until the pain was bad or this regime wouldn't work.  What should I do?  This "nurse" made me feel like the biggest piece of drug seeking garbage in the world.  I am scared to call the doc and complain - first, she probably won't let me talk to him and second, if I complain, she will never, ever, help me again.  What do all of you think?

Thanks for listening (reading) - sorry this is so long!

Schedule an appointment WITH THE DOCTOR, state your concerns and be calm, sounds like nursey nurse is stirring up drama. I had this type of situation once where the nurse mis-relayed information and the doctor refused to treat me any longer...after talking to the doctor and getting a chance to hear what I really had said it was a different story.

Stand up for yourself, no one else will!

WHOA there Baseballmomof3,

First of all, your doctor prescribed a whale load of drugs for you to take, especially heavy on the narcotics.  The normal procedure would be to just take one Relpax when you felt a migraine coming on.  It is an "abortive drug" which is normally a "stand alone" medication.  If it is augmented at the beginning of a migraine, it would by an anti-nausea medication like phenergan. 

The narcotic medications, like the Dilaudid and Lortab, are considered "emergency" meds, to control the pain ONLY if the abortive (Relpax) fails to work.  Narcotic medications usually cannot be prescribed with refills.  A refill authorization can't be made prior to the timeframe the original prescription was written to cover.  For instance, if you are prescribed 1 Lortab to be taken every 6 hours, and the prescription is for 28 pills, you can't get a refill authorized prior to seven days from the date the original prescription was filled.  If you try to get it filled to early, it is interpreted that you are taking the medication more often than prescribed.  That's the quickest way to get labeled as a "drug seeker".  And as bad as it is to talk with someone other than your doctor, you have to be careful, because if some medical personnel thinks you are drug seeking (for recreational purposes) they can put it in your chart and you can be permanently screwed with that doctor's office, as far as getting additional narcotic medication...EVER! 

What also struck me as way off the scale is when you said that you get 8-10mg of Dilaudid at the Emergency Room.  The absolute max I've ever had a doctor prescribe its 2-3mg of Dilauded, and I've had migraines for 34 yrs, since I was 8. 

The 1/2 prednisone, 1 zofran(?) 8mg ODT(?) are baffling to me.  Can you check the names of those medications?  I haven't heard of them before.  I'm clueless as to why your doctor would prescribe a steroid (the prednisone) to take at the beginning of a migraine, since its purpose is to reduce inflamation in joints and muscle tissue, not an occurrance that just "pops up" at the beginning of a migraine.  I also saw that you have Lidocaine Nasal Spray prescribed.  What are you using that for? 

Since you have only been having migraines for eleven months, I am flabbergasted by this "drug cocktail" that your doctor has prescribed for you.  Compared to every other migraine sufferer I've ever come in contact with, you seem to be way over-medicated.  Please don't take this as personal slam.  Your post explaining your treatment just threw up so many red flags that fly in the face of normal migraine treatment, that it just really concerns me, especially since you haven't had to deal with this for very long.

This can be really serious, because you can get into a cycle of "rebound" headaches from taking too much medication too close together.  This results in having a permanent headache that nothing will make go away.  You shouldn't take migraine medication more that one or two days a week, or the rebound cycle will start.  The only way to get rid of the "rebound" is to go cold turkey on all pain medication, prescribed or "Over-the-Counter" (OTC).  This is not a pleasant thing to deal with.

My gut instinct keeps telling me that you should get a second opinion by a Neurologist not in the same office as your doctor.  Migraines are nothing to fool around with, and the medication can really screw with your system.

Please keep us updated on your status.  Posters here really care about each other, and I can be a big spaz when I'm concerned about someone.  Please post again.

Leigh Ann

Hey Baseballmomof3,

I'm sorry if my post came off as harsh.  You obviously have considerable medical knowledge, which wasn't apparent from your first post.  I am well familiar with Relpax, but it didn't work for me.  The steroid information was interesting, but it isn't used in my area, or the Zofran for that matter.  The Phenergan works well for me because it help to knock me out and I sleep off the migraine, with the help of the Dilaudid. 

Your ED apparently works a lot different than mine.  The typical treatment is to get the meds in shot form and go home.  Only one doctor every treated me by IV.  My ED is more of a "treat 'um and street 'um" attitude.  I think I've only seen the same doctor once, so every time its someone new.  Contrary to you, I have very low blood on a regular basis (100/60), and actually drops when I get a migraine.  After receiving a shot, it drops even lower, like 85/54.  One doctor wouldn't let me leave because my pressure was so low.  I had to get an IV bag of fluids before I could go home.  My ED is also the one that couldn't revive Jerry Falwell on Tuesday, so who knows how up to date they are.

The main reason I was so alarmed by your post is that our Medical community is mostly associated with one Health Service, which shares information in a central database.  I'm a hard patient to medicate, as I am resistant to many pain medications.  I don't even feel Demoral or Morphine which means lesser strength pain meds are useless.   Heck, my dentist usually needs to use this "super novacaine", and it take four tries before I get partially numb.  I never get totally numb.  Anyway, the point I was trying to make is that when I'm explaining this to a new doctor, I sometimes come across as knowing too much pharmacutical information.  A strange doctor that doesnt' know you can lable you as a "drug seeker", which gets into the big database, then you are screwed.  Especially if you are getting pain meds from more than one physician, people misinterpret the information.  I was just concerned for you falling into this trap.  I've been in and out of it on a rotating basis, and it is frustration beyond belief if you are in pain and the treating doctor thinks you are a junkie and faking it just to get high.

I didn't address the nurse with the GOD complex as well as I should, and I am greatly sorry for that.  Your treatment was just so different from all the treatments I have received from various doctors is the past.  Your cocktail would probably work well for me, minus the Relpax, but no doctor around here would ever prescribe it.  I also misunderstood that you were getting that high amount of Dilaudid via IV over time.  That makes so much more sense.  It sounded like you were getting a shot with that much, which would probably not be a good thing. 

Stadol Nasal Spray worked well for me, in place of the Relpax as an abortive.  I used it for a couple of years, but a new doctor I saw as a walk-in, in my doctor's office, decided that I had been on narcotics for too long, which she wrote in my chart.  The administrator insisted that I not be given or prescribed any narcotics for an extended time.  I'm still fighting to get that reversed.  They also sent a letter stating that I was not to be treated with narcotics to all the local walk-in clinics.  Thus, my only emergency option is the Hospital ED.

Luck for me, on one of my trips to the ED, I was given DHE as part of my treatment.  I did some research on it since it worked well for me.  Thus, my new abortive is MIGRANOL Nasal Spray.  It does the job most of the time.

Anyway, coming from my longterm treatment history, your post just sounded scary to me.  I apologize that I came across so strong.  I hope you can understand I was just concerned.

Hope you are well.

Leigh Ann

I just have to fill all of you in, though, on the ongoing saga of my prescription.  Remember, I told you that when the nurse finally wrote my script for the Dilaudid, she was ugly and only wrote for 6 - take one every day.  Well, it so happens that I saw the neurologist last week with my mom (who also sufferes with this) and told him what happened.  He was upset that it had happened and wrote me another script right then.  When I got home, i realized he had written for 1 mg tabs so I thought,  I will just take two and not bother him again.  I went to the pharmacy with it day before yesterday and they said that it doesn't come in 1mg so they called his office, and, we are still waiting.  The saga continues.....

THanks for listening to me vent.  I am so frustrated, I could scream.  Why does the doctor tell me to do one thing and then, when I do it, his staff makes me feel like some crazy drug addict????????