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        New Message Board Archives >> 2003 Posts >> Is My Neuro Full Of Shit?
        
(Message started by: Frank on Apr 1^st, 2003, 9:23pm)

Title: Is My Neuro Full Of Shit?
Post by Frank on Apr 1^st, 2003, 9:23pm

Well I think so... I'm just counting on you all to back my opinion. Last week I posted my "Insurance Wont Approve Imitrex Rant". Well that all turned out to be that my regular doctor won't deal with me anymore now that he's referred me to a neurologist who I have seen once so far. The Imitrex deal turned out to be that my regular doctor wrote a script for Imitrex injections... and the minute he found out it needed insurance authorization... he backed out of the deal... dumped my ass in the street.

OK... so I talked with my new neurologist about it. He wanted to know how many Maxalt MLTs I am taking. I told him 12 per month. He freaked out and said I'm going to give myself a heart attack. The most I should take is 9 per month... and even that is too many because I am a smoker. I told him 9 isn't even enough, and they aren't effective for the Kip-10s anyway.
He asked what I wanted him to do. I told him that I need 8 to 12 Imitrex injections per month, preferrably 6mg/0.5ml vials. He said I should only have 6... any more than that and I'm going to have a heart attack.
I even offered to stop using the Maxalt MLT if he would prescribe Imitrex injections instead. He agreed that would be OK, but only 6.
What's up with that shit? Everything I have read says you should not take more than two injections in 24 hours, not closer than one hour apart. There are also concerns if a patient has heart disease or is predisposed to heart disease (I'm a smoker... but, do not have high blood pressure, do not have high cholesterol, do not have any hereditary predisposition to heart disease, do not have any other health problems, etc).
As far as I can tell... the only data that I can find that limits Imitrex (and virtually all triptans) to 2, 6, 9, or 12 per month is the f*cking insurance companies. I can find no medical basis for the limits. Am I wrong?

Title: Re: Is My Neuro Full Of Shit?
Post by don on Apr 1^st, 2003, 9:30pm

In my experiances the answer to your question is yes and no.

My current neuro is no shy about rxing th imitrex. In fact encourages me to stockpile when out of cycle.

My last nuero, chief of neurology at Beth Isreal, a leading teaching hospital refused to rx any at all.

Doctors are a bit skittish when rxing any drug that potentially affects your heart Some of that could valid personal ethics, some could be liability. All in all 6 per month is the going rate unless you can get a more liberal aggressive Doc to petition the ins. comp.

Title: Re: Is My Neuro Full Of Shit?
Post by catlind on Apr 1^st, 2003, 9:35pm

Don

You said it all in a nutshell. I had finally gotten a doc to prescribe the triptans and went back for more and the doc went and asked another doc (the supervising physician for the clinic) and he said NO WAY, not with her heart (palpitations and coronary artery spasms) so even though I had taken maxalt with no side effects, no way are they going to give me more, doc said it went against his ethics *sigh*

Frank, I hope you have some success and can get your meds soon.

Cat

Title: Re: Is My Neuro Full Of Shit?
Post by Frank on Apr 1^st, 2003, 9:58pm

Don and Cat, I don't know which is right....
If the doctor is genuinely concerned about my health... I can appreciate that. Except during a Kip-10+ having an Imitrex injection knowing there is a remote possibility that it could cause a heart attack is a risk I am willing to accept at the time (especially during a Kip-10+ ... it doesn't matter).
I just don't want to think that the doctor's limit of 6 per month is arbitrarily related to the insurance company's limit of six per month... with no medical basis to back it up. But the more I analyze it, that is what I keep seeing.

Title: Re: Is My Neuro Full Of Shit?
Post by don on Apr 1^st, 2003, 10:09pm

He's probably not even aware of the ins. comp. limitations.

You may be willing to take the chance with the imitrex, as I am, but he may not be willing to jeapordize his liscense to practice should something unfortunate happen. Playing devils advocate here, not defending your Docs position.

Depends on the Doc. I told my neuro how I disect the imitrex vials to double up and use a cotton swab to push it in and he laughed like hell. Others would send me packing.

Title: Re: Is My Neuro Full Of Shit?
Post by cootie on Apr 1^st, 2003, 10:19pm

Geeze Brad was takein 2 to 4 imitrex pills a day this last episode......shadows were freakin him out he had so many this time.....we have a internalist doc not a nero. Scarey......esp if it is that dangerous and docs fear malpratice stuff later if sumthin goes wrong and it's blamed on meds. Seen alota imitrex go down Brad's throat ina day Pam

Title: Re: Is My Neuro Full Of Shit?
Post by Mikey on Apr 1^st, 2003, 10:26pm

My answer to your question is yes and no too.
My doc will prescribe a limit of 12 injections per month
because he says that there is a danger in rebound CH from the Imitrex just like any narcotic. He is a very good doc and is very liberal with the meds as well. My insurance co. won'nt let me have any more than 4 injections a month anyhow, and he has tried to get them to give me more and they have refused to.

Ditto what Don said about the splitting of the vials. My Neuro did the same thing and laughed and said " it's OK as long as you don't get an infection from it".

Mikey, ;D

Title: Re: Is My Neuro Full Of Shit?
Post by cluster0557 on Apr 1^st, 2003, 10:34pm

As other have said it is a yes and no. Most Neuros are worried about Malpractice and if the prescribe what we need and it is above the Drug Companies reccomended dosages they open themselves up to a suit but some idiot who ruins it for all of us.

I have found that my Neuro will prescribe Imitrex Injection for 3 days per week 2 injections per day.

I have also been lucky where recognizing I need to be able to deal with pain and not use another triptan the have prescribed a Narcotic called Nubain which I get to use on days where triptans cannot be used.

What I try doing since I went cronic and have attacks everyday is triptans (Imitrex) Day One, Nubain Day two, Imitrex day three and so on.

Also by doing this they have also prescribed my standby maxalt to help with the Nightmare.

I have been cronic for 18 months and started the above about 6 or seven months ago.

I can get enough triptans to deal with life and the Nubain for days off and to allow me to choose triptan of choice.

Title: Re: Is My Neuro Full Of Shit?
Post by don on Apr 1^st, 2003, 10:41pm

One of the problems, I think, is that many patients only describe the pain to the Docs.

What needs to be explained is the depreciation of the quality of life we experiance. I dont think the Docs realize the full implications of our pain.

Title: Re: Is My Neuro Full Of Shit?
Post by Frank on Apr 1^st, 2003, 10:46pm

Last month, I saw a neurologist for the first time since I started having clusters 14 years ago... and I am regretting that it happened. Last month I was referred to a neuro by another doctor at my HMO office because my regular GP was on vacation for a month.
My GP has been treating my clusters for 14 years... and is the same GP that I have had for nearly 20 years. At first he didn't know what clusters were... neither did I, so we wen't though lots of hit and miss. Finally after four or five years of treatment for migraines and sinus problems and all the wrong things, we figured out that it was clusters.
Since then my GP has prescribed just about anything that I have asked for... and has fought the insurance company to get it for me if necessary. Maybe not a cluster expert, but he is very helpful and is willing to learn and listen.
Right now I'm trying to figure out how to fire my new neurologist (only seen him once anyway) and not piss off the other doctor I saw while my regular GP was on vacation for a month (they both work in the same HMO office)...

Title: Re: Is My Neuro Full Of Shit?
Post by Frank on Apr 1^st, 2003, 10:51pm

on 04/01/03 at 22:26:44, Mikey wrote:

x-snip-x Ditto what Don said about the splitting of the vials. My Neuro did the same thing and laughed and said " it's OK as long as you don't get an infection from it". x-snip-x

Yes, you can use the same needle three times. No infection yet.

Title: Re: Is My Neuro Full Of Shit?
Post by don on Apr 1^st, 2003, 10:51pm

I would suggest you have a confidential discussion with your old GP and get some guidance from him about returning to his practice for treatment.

If anyone is worried about infection simply wipe the needle with an alcohol wipe and insert it into a cigarette filter until next use.

Title: Re: Is My Neuro Full Of Shit?
Post by Frank on Apr 1^st, 2003, 11:10pm

Yeah Don, that's what I'm thinking... (even as much as people hype the benefits of seeing a neurologist) it may have been a mistake in my case. Everything was fine for several years... until my GP went on vacation.

Title: Re: Is My Neuro Full Of Shit?
Post by Roxy on Apr 1^st, 2003, 11:34pm

I got lucky with my neuro. He's Dr. Ninan Matthew, at the Houston Headache Clinic. So far, he has kept my imitrex refills on an as needed basis. I get to refill all five vials, every 5 days. Thankfully, my insurance has no limits on prescriptions. It took quite awhile to get to this point....the pharmacy was the one being a hardass about it. He also prescribed maxalt, but said he didn't like zomig, and like most neuro's, he didn't explain why.

So far, the most injections I've used in one night was six.

Title: Re: Is My Neuro Full Of Shit?
Post by don on Apr 1^st, 2003, 11:39pm

Roxy,
What insurance company?

Title: Re: Is My Neuro Full Of Shit?
Post by cootie on Apr 1^st, 2003, 11:41pm

Our new doc (since the other we really liked left his practice and took an out of state hospital job) said Topomax (spelling ?) was what he wants Brad to take next cycle and is the new wonder drug......should I agree to disagree Pam

Title: Re: Is My Neuro Full Of Shit?
Post by cluster0557 on Apr 1^st, 2003, 11:47pm

Topomax is also know as dopomax. It helps many people but with too high a dosage you become a real life walking talking zombie.

It is most definitely off my drug list.

Title: Re: Is My Neuro Full Of Shit?
Post by Roxy on Apr 1^st, 2003, 11:50pm

on 04/01/03 at 23:39:43, don wrote:

Roxy,
What insurance company?

Don,

I had BCBS up until the end of January. They were only good for the basic 6 imitrex a month. What I have now is my husband's company insurance. It's called CCN, http://ccnusa.com/ , the prescription plan is http://scriptcare.com/. I LOVE the prescription plan.

Title: Re: Is My Neuro Full Of Shit?
Post by cluster0557 on Apr 2^nd, 2003, 6:21am

I have BCBS of IL and I was able to get them to honor unlimited refills per month.

Only catch is I pay dedcutible on every 3rd box.

Title: Re: Is My Neuro Full Of Shit?
Post by Ueli on Apr 2^nd, 2003, 7:32am

The answer to the Imitrex/heart attack question is extremely simple:

For people with certain heart conditions any Triptans are out of question.
For people with a healthy heart there is nowhere in the literature the slightest hint that Triptans would promote the start of heart troubles.

Frank, your neuro didn't do his homework in reading the relevant literature or is eager to please the ins. co. or both.

Ask him for a reference to that heart attack horror story and why he believes that the limit between safe and unsafe lies somewhere between 6 and 8 shots a month.
Also ask him what good is an abortive that only 'works' for 6 attacks out of 30 or 100 a month.

Quote from Dr. Goadsby:
It is unethical to withhold much needed pain medication sole for pecuniary reason.

Good luck.
Ueli

Title: Re: Is My Neuro Full Of Shit?
Post by Woobie on Apr 2^nd, 2003, 8:28am

Ueli, you ROCK~~

:D

Tina :-*

Title: Re: Is My Neuro Full Of Shit?
Post by Bob P on Apr 2^nd, 2003, 8:45am

Also from Doc Goadsby (an article in the OUCH Library):

Triptans

Subcutaneous sumatriptan (6mg) is the drug of choice in abortive treatment of a cluster attack. It has a rapid effect and high response rate. In CH, unlike migraine, subcutaneous sumatriptan can be prescribed at a frequency of twice daily, on a long-term basis if necessary, without risk of tachyphylaxis or rebound.

However, in this era of a cost-conscious NHS, some practitioners are reluctant to prescribe this relatively expensive drug. We feel that, given the devastating morbidity associated with this excruciating pain syndrome, it is unethical to withhold treatment for cost reasons.

And a few other notes from the library:
Ekbom et al () reported on a 32-year-old man who received a total of 480 injections of 6 mg SC Imitrex for the treatment of acute attacks of chronic cluster headache over an eleven month period. There was no evidence of tolerance and no serious adverse events. Resolution of attacks were within 10 minutes (for 90% of the attacks treated with Imitrex) if treated with Imitrex compared with 56 minutes for untreated attacks.

Centonze et al () published a report of three male patients using higher than recommended doses of sumatriptan to manage episodic cluster headache over a one year period. The patients ranged in age from 41 to 64 years and all three treated at least three attacks daily during their cluster period. The mean duration of their cluster periods was 2 to 4 months. Each attack was treated with a 6 mg SC sumatriptan injection. No prophylactic medications were utilized due to previous treatment failures.

Title: Re: Is My Neuro Full Of Shit?
Post by Frank on Apr 2^nd, 2003, 8:56am

I think the answer is to go back to my regular GP. He doesn't think too much of insurance companys either.

Title: Re: Is My Neuro Full Of Shit?
Post by Bob P on Apr 2^nd, 2003, 9:20am

Frank,
Last cluster I dumped my neuro, who wasn't willing to go to bat for me with the ins co, and went back to my GP who had never heard of clusters. It worked out ok because I taught him about clusters and when he realized that I knew my disease, he prescribed anything I wanted and submitted authorizations to HealthNet. Marked them all urgent too.

I got around HealthNet some by having them prescribe the max monthly allotment of every triptan; 6 imitrex injection, 6 nasals, tablets, maxalt, amerge, zomig, etc. That along with O2 got me through. I think I managed to HealthNet up to 18 injections / month.

Title: Re: Is My Neuro Full Of Shit?
Post by Frank on Apr 2^nd, 2003, 11:15am

Bob, thats good to know about HealthNet because they are my HMO too. They are going to get to know me anyway cause their corporate HQ is within about a five minute walk from where I work. I can see their building from my parking lot. Blue Cross of California is a little farther away (10 minute walk). I think I'll go and talk with them about OUCH and CalOUCH.

Title: Re: Is My Neuro Full Of Shit?
Post by thsa/simon on Apr 2^nd, 2003, 8:49pm

Frank,

In a nutshell, your neurologist is wrong. After much research on clusters and treatments, I have yet to find ANYONE who recommends withholding subcutaneous imitrex or limitting the number of doses unless the patient HAS heart disease, uncontrolled hypertension, or strokes. As a matter of fact, I have read articles in which several subjects were given 3-6 shots a day for several weeks with only 4 complaining of rebound headaches 3-4 weeks after the treatments began. Many of these patients were over the age of 40 (a common arbitrary age for being concerned with heart disease).

Anyway, in my opinion, most doctors that start talking about limiting imitrex are REALLY displaying the fact that they are UNCOMFORTABLE scripting so much of a medication that is usually only used 4-6 times a month for MIGRAINE sufferers. Whether that uncomfortability stems from cost concerns or fear of overmedicating patients or unwillingness to confront insurance companies to remind them that THEY are the one with the license to practice medicine, I dont know. They need to understand that once they are confronted with clusters, all the rules have changed.

simon