Monday, April 18, 2011

Sunday night, 8:55 p.m.

"Hi, this is Liza Shakin. I had a seizure today. You don't need to call me back, I just wanted to let you know. I'm in ER, and they're going to do a CT scan and some labs to find out why I had one. Anyway, I'm calling to leave a message for Annie, because I need my epilepsy pills called into the pharmacy since I ran out 2 weeks ago, and I keep forgetting to ask you guys for more. Thank you."

32 comments:

DrBoo said...

Do you think that the relationship between brain tumours and epilepsy is related to their increased unnecessary brain irradiation, or are they just born that way?

Grumpy, M.D. said...

This lady has no tumor.

Captain Crab said...

2 weeks? I can't go two days without scaring everyone around me to death!

Anonymous said...

Agree with above.

I had a twentysomething patient who stopped taking Copaxone for months because he didn't like the injections but oh btw also NEGLECTED TO TELL ME OR ANYONE ELSE and then came in with a raging flareup, thanks dude

I had an emogoth overweight young-adult Hot Topic epileptic who deliberately ignored the instructions on her bottle and decided she was too depressed to take the correct doses of her AEDs, OF COURSE she neglected to tell us and came in with inter-ictal psychosis, and well, ended up calling the psych unit home for a few weeks, poor thing

I had a patient who neglected an incredible dose of fifty units of Lantus nightly for THREE MONTHS and then came in with a brain so beautifully calcified the rads resident wanted to call it some eponymous super-rare disease (ps. dear rads resident if i ever meet you i will totally PUNCH YOU IN THE FACE, the ED was so very excited and wanted me to explain your nonexistent genetically inherited disease to them at 2am)

I'm still a first year neuro resident but is this going to be the story of the rest of my life?

WV: smomento

Grumpy, M.D. said...

Unfortunately, non-compliance and stupidity will be found in all fields of medicine, not just neurology.

The good patients outweigh the bad. No one blogs about the good ones. Nobody wants to read about them.

Mr Mobius said...

I imagine non-compliance is more common in neuro though, it sort of goes with the territory of some of the diseases, combined with the fact that all chronic diseases have problems with compliance to begin with.

Anonymous said...

Is it bad to wonder if the CT-induced cancer is divine retribution for omission of that part of her history in the ED?

rothase said...

so was she post-ictal or just stupid? My husband says that you can always tell when he is out of his post-ictal phase because he realizes, finally, what is going on and says GODDAMMIT really loudly. Usually while looking up at me from the floor.
In other news, I got to explain seizure first aid to my CERT (Civilian Emergency Response Team) training class. I had more experience with it than most of the other folks- lucky me! : )

Grumpy, M.D. said...

She wasn't post-ictal. I know her quite well.

medrecgal said...

Glad to know our family med patients aren't the only ones who have compliance issues; I think that would be the part of doctoring that would have driven me a little crazy had I managed to get to med school. But I think the ones that were saved and otherwise helped would have kept me coming back for more. Too bad I'm just a pencil pusher, though it still beats the pants off of my former job!

Packer said...

Uh, "Nobody wants to read about the good patient" or something like that.

Try me, just once--please.

Forgot to ask for more, or could not afford to pay for more ? See a lot of that lately, also see a lot of pill splitters lately.

Frantic Pharmacist said...

I wonder which costs more --- the ER visit, CAT scan and labs, or the epilepsy pills? ....Sigh.

PharmacyGirl said...

I don't understand how any patient with a potentially life threatening disease would be lax about taking their meds regularly as directed. It blows my mind! My husband's grandmother has stomach issues and when I was in her medicine cabinet trying to see what she had & what she should take, I saw 5 different Rx and OTC meds but she only wants to take Mylanta and the store brand generic isn't the same she says! I about flipped my lid! Sometimes I want to go off on patients when they come in asking for refills but their Rx expired and they say, "But I haven't taken it for a couple months & I have refills so how could it expire?"

a.generic doc said...

The other question is whether she told the ER docs that she had epilepsy and didn't take her pills for 2 weeks before they decided to do a CT and all the labs?

nohika said...

At least she left her name, right? ;) Instead of telepathically expecting you to magically know it.

Lois said...

Do you think a BRAIN will show up on that CT scan? I have doubts...

lovinmyjob said...

Yeah, we see this alot in the pharmacy. It's the weekend and they are out of refills and "Please, can't you give me an emergency supply?" I always check for compliance. If they are late requesting the refill; meaning they haven't been taking the med to begin with my answer is "NO!" If it's that much of an emergency they can go to the ER and get an rx for that "emergency" supply. Most of the time they do this because they know the doc wants them to come in for a visit and they don't want to.

Li'l Azathoth said...

Maybe they need to develop a morning-after epilepsy pill...

Anonymous said...

I have epilepsy, and I don't understand why some people procrastinate nor take their meds as prescribed. I'll concede that some of the side effects suck and people forget, but for two weeks?! Good lord.

T said...

There's a saying: "When the reviews are good, you tell your friends & family. When the reviews are bad, you tell the Internet." re: good patients/nobody wants to hear about.

Anonymous said...

I massively screwed something up recently and ended up missing 3 days' worth of gabapentin (which I take for pain, not seizures).

Making sure I take my meds exactly as prescribed is now one of the top priorities in my life.

Anonymous said...

You know what I don't get as a patient? I'm the one who suffers when I miss my meds, not my doctor. As a conciencious patient who knows I will get a migraine if I miss singulair (asthma med) and who knows I will start wheezing...well I do accidentally miss it about twice a year. But I figure that's pretty good odds....

Melissa

Moose said...

All I can think of is how I just spent 2+ months without Lantus and 2 weeks without the short term stuff, all because of the rules of the clinic I go to. "We can't give you any of the insulin that was shipped here for you because you haven't been seen by a Dr for over 3 months. You have to show up to one of the twice-weekly open hours and manage to get signed up before we reach out cut-off for number of patients." "But I can't get out of the house by myself, and the couple of people I know out here cannot help me at those times." "Sorry, that's the rules."

Non-compliance is so much FUN! Of course, all that high blood sugar means I've lost lots of weight. All my "friends" are telling me how good I look. I'm sure that I didn't really need those heart/brain cells anyway, because how I look is far more important!

(Eventually I did get to the clinic where I saw a very nice volunteer Dr who confirmed that, yes, I am still a diabetic, but never touched me, to maybe check my heart, monitor the progression of the neuropathy I didn't have before I was poor, or anything else.)

Meanwhile I keep chanting: 4 months until Medicare kicks in. I'm not bitter.

Anonymous said...

I think docs are way too stingy with refills on meds like birth control pills, allergy pills, and other routine crap. It's a hassle to have to go in every couple months to see the doctor to get a stinking refill on basic generic meds (with no street value). I am thankful most allergy pills have gone otc now. Wish birth control pills would too. I am ok with going in annually for refills on stuff that I take every day all year but no more than that. Even so, if I had epilepsy (or other life-threatening condition) I would make sure to keep a week ahead of the prescription just in case I was late getting an appointment or something.

Anonymous said...

Maybe more meds need the nasty withdrawal symptoms that Effexor has? That stuff really punishes me if I forget to take it, starting with the leg muscle twitches and moving on the camera shutter closing loudly, and often, inside my head...

The Mother said...

Where is that study correlating NOT taking your drugs with recurrence of your symptoms?

ria8098 said...

Non-compliant patients (or for us, owners), not presenting a decent history and subsequently working up a chronic problem at the ER...good to know the problem's not limited to vet med!

Anonymous said...

I'm starting to understand why people are non-compliant with epilepsy meds. These things are horrible, absolutely horrible.
I do at least try to get my refills on time and call my doctor when I want to change meds rather than just going "hey lets just not take these anymore."

Anonymous said...

As a med student, it's stuff like this that makes me wish I was remotely interested in radiology... and private practice.

ERP said...

Thank God the ER did a head CT.

Anonymous said...

How about some labs and a CT to figure out what was going on in the "brain" of the ER doc?

Kat's Kats said...

1. "OMG. I just realized I forgot a get a refill of med X which means that disorder Q (of my multitude of comorbid disorders) is flaring. Can I get a refill or do I need to come in?" Coming in is usually due to insurance when dealing with maintenance meds... of course, there isn't a question with certain meds I take for pain.

2. "Ack!! My brain died due to stress/pain and I totally forgot to get a refill of med/s X/Y/Z. Do I have any refills available?" If I don't, I know I will have to wait since it may take anywhere from a few hours to 48 hours for the appropriate doctor's office to be able to get something faxed/emailed to my pharmacy if I don't have to be physically seen.

3.
(at doctor A'x office) "I've been having symptom B/increase of symptom C."
Doctor A - "I have you on meds X, Y & Z at x strengths. Have you been taking them correctly?"
Me a - ::face palm:: "Argh! No, that's probably why I'm having trouble. Could you please write that down for me? Obviously I'm being brain dead."
Me b - "Yes. What do you think would be the best course of action at this point?"

Seriously, why on earth would someone wonder why they were having a flare of disorder Q when they know they haven't been taking med X??

If I ever do that I hereby give my medical team permission to give me the diagnosis of http://www.cafepress.com/KatsKats/7062870">column one, row four.

 
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