The $500 U.A.

I'm fired up.  Not only does visiting a pain specialist cost an arm and a leg, they also feel it necessary to test my urine for drugs.  Do they assume the worst and figure that if someone is coming to see them that there is a chance they are not in pain, but making it up to seek narcotics?  I suppose that scenario does play out on occasion.

The pain clinic I now go to has a drug testing policy.  There is a mandatory urinalysis (UA) on your first visit, and they can randomly select you for UAs at future visits.  So I go along with their policy and submit a specimen to them on my first visit.  It's not a big deal to me at the time.  It turns into a big deal when I get a statement from my insurance showing that the urinalysis cost $500.00.  No, that was not a typo.  Apparently a pee test there costs $500.00!  Are you kidding me?  Holy cow.  I've had to take pre-employment drug tests in the past and I know those only cost approximately $50.00.

I called the clinic and inquired if they had made a typo, maybe keyed in an extra zero in their figure when they billed my insurance.  They informed me that they had not.  They said that they ran ten different tests on my sample and each test costs $50.00.  Wow. 

Here's my beef with the situation...I'm not seeking any heavy duty painkillers or narcotics of any sort.  I'm simply seeking therapeutic Botox treatment.  Even the doctor agreed that there isn't anything else left to try at this point.  I also made it clear to him that I'm not agreeable to any sort of narcotic pain medication because I just don't want to go down that road.

No wonder insurance is so expensive.  $500 pee tests are just one tiny example of exorbitant costs.

Botox: Take 2

I went in for my second Botox treatment the other day.  I felt like whomever has that voodoo doll of me was relentlessly stabbing pins all over its head.

I must say that the injections hurt less this time, but the after effects were worse.  I awoke at 2:00 a.m. the next morning and couldn't sleep much after that because of throbbing pain at the 20+ injection sites.  Ice packs helped some with the pain and less than 24 hours later I was feeling much better.

I have a ton of little red spots on my forehead from the injections and some of them are accompanied by tiny bruises.  It could certainly be worse.  Last time I had one big goose egg and bruise on the center of my forehead for several weeks.  Eventually the bruise turned a lovely yellow color so at least it was less noticeable than the deep blue/purple color it began with.  To me it felt like I had a unicorn horn sticking out of my head, but I doubt it was that noticeable to everyone else.

I felt I looked like this with my goose egg/bruise.

My doctor is pretty cool.  He and his nurse let my husband take pictures of the treatment to use on this blog.  (Thanks doc!)  The procedure doesn't take long at all.  Here's a couple of before shots:

Syringes of Botox and whatnot

Me being over dramatic about the injections.

Here are some pictures of the procedure:

We've got a bleeder!

My doctor was asking questions and making me laugh during the procedure.  Not cool.  I was trying to go to my happy place where I can be completely still, a technique I've learned from living with chronic pain, giving myself injections of medication, and getting several tattoos.  (Sorry about the tattoos Mom, I know you're not a fan and are probably rolling your eyes as you read this.)

I think the temple is the most painful injection.
The doctor was making me laugh in this pic, but I was trying to be still.

Am I the only one who is kind of freaked out about pregnancy ultrasound pictures some people post on social media?  I wish people would just make the announcement that they are expecting without the visual aid of an ultrasound photo.  Seriously, it feels like a flashback to biology class or that scene in Spaceballs where the alien pops out of the guy's stomach.

Scene from Spaceballs

Well, the doctor suggested taking pictures of the ultrasound when they put the Botox injections in my neck, so here it is.  I guess it shows the needle going into my neck muscles, but it just looks like a bunch of wavy lines to me.  At least there's no freaky alien looking thing in my ultrasound picture.  You're welcome.

They only used the ultrasound on the neck injections because they have to insert the needle deeper and need to make sure they get it in the right spot.  I've heard that if they get it in the wrong spot there is an outside chance that it can mess with muscles associated with respiration.  YIKES!  What would happen in that situation?  Would I have to live in an iron lung until the Botox wore off?  That's a few months!  I snap back to reality and decide to push the thought into a dark corner in the back of my mind.  The thought will probably creep up again and my subconscious will produce an associated nightmare in the next couple of months.

I'm in and out of the clinic in about 30 minutes.  I walk out looking like my forehead was attacked by a small swarm of angry bees.  The procedure is non-invasive and I could drive myself home, but not this day since I've got my chauffeur/husband with me.  (I drove the hour to the clinic so he will drive the hour home.)  The worst side effect I have after these treatments is muscle weakness in my neck that starts about two days after the procedure.  I experienced it last time and it lasted approximately two to three weeks.  It is painful muscle strain sort of feeling and I feel like a bobble-head.  I am most comfortable sitting in a high back chair where I can let my neck rest against the back of the chair and I don't have to hold it up.  When nobody is around I sometimes put on a cervical collar to allow my neck muscles to relax.  The muscle weakness also makes doing yoga a bit more challenging, but I can get through it with some slight modifications.

The Botox is helping.  I still get migraines, but my pain level is less intense.  I will go back for another treatment in three months.

Voodoo Doll

If this blog had feelings I suspect it would feel neglected right about now.  My husband hijacked the Mac so he could work on an important project with a looming deadline.  I've had a difficult time sneaking it away from him over the past few weeks.  Ever since my PC took a dump a couple of years ago we've shared his laptop.  Sharing a computer has been a fantastic exercise in marital compromise.

Sometimes I wonder if somebody out there has a voodoo doll of me and is stabbing pins into it to give me migraine headaches.  If there is I think the voodoo doll would look something like this:

There's a screw jutting out of its head to represent the migraine headache.  The eyebrows are wonky, like someone who has had Botox injections as a migraine treatment and their brow line is a little skewed as a result.  One eye is bigger than the other.  I'm sure I'm not the only migraineur who experiences incredible pain behind one or both eyes that makes me concerned that my eyeball(s) might pop out of my skull.  Then there's the slight smile on the face.  I'm a big smiler, but my smile is hampered when I'm having a migraine.  Sometimes it turns into a frown, but I try to smile through the pain to cheer me up a bit.  Do I sound like Pollyanna now?

For those of you who may not be familiar with Polyanna, she is the unnaturally cheerful character in a series of books by Eleanor H. Porter as well as a movie version made by Walt Disney in 1960.  She is an orphan who is dealt a lot of crappiness in her life.  She doesn't let the crappy stuff bring her down, instead she plays something called the "Glad Game" where she finds something to be positive about in every bad situation.  She spreads her happiness and cheer throughout her town and lifts up the spirits of the many curmudgeon residents.  The story is so sugary sweet that it makes me want to vomit.  Pollyanna is just so damn cheerful that I wonder if she's doped up on Xanax.  I think that the lesson in the movie of having a positive mental attitude and optimism is a good one to share.   But, I also think it is important to face and accept the crappy circumstances we can't change in life so we can put them past us and move forward.  So I guess I'm a little bit like Pollyanna, but not as oblivious to reality or freakishly cheerful.

Hayley Mills as Pollyanna

I can't change the fact that I have migraines, but I am not angry about it.  I'm certainly not excited about the migraines and it does bring me down from time to time.  When I'm feeling bummed out I seek out things for which to be thankful.  For example, I am thankful for the fantastic migraine medications created in recent years, I am thankful for each day I don't have a migraine, I am thankful for an understanding boss when I have to call in sick to work, I am thankful for my parents who are supportive of seeking out new/different treatment options, I am thankful for my husband who is willing to take care of me when I can't take care of myself, and the list goes on and on.  I'd continue, but won't for fear of sounding too Pollyanna-ish.

In addition to being thankful, I have found a fabulous tool for dealing with chronic pain is laughter.  Having a laughter-filled conversation with friends and/or family, or watching an episode of Saturday Night Live is medicine for my soul.  Laughter elevates my mood and helps keep me smiling.

If there is someone out there with a voodoo doll of me who is giving me migraine headaches, give it up already.  You'll never make me stop smiling for long.  I can handle these migraines.  I got this. 

The Twilight Zone

I'm often left alone with my thoughts.  Migraines render me useless and I have to lay down because sitting and standing is far too painful.  When I'm stuck laying around I spend time thinking about work, family, friends, things I wish I could be doing, dream vacations, fabulous shoes, and what I would do if I won a huge lottery.   After hours, or sometimes days, of laying around waiting for a migraine to disappear I run out of normal things to think about.  It's as if my mind goes into some sort of Twilight Zone (cue Rod Serling and the Twilight Zone music) and I start thinking about ridiculous, unimportant things.

For example, my washing machine has three settings...Regular, Super Clean, and Ultra Clean.  Both Super and Ultra sound awesome, but I can't help thinking about what criteria the manufacturer used that ranked Ultra higher up on the cleaning scale than Super?  Why didn't they just use titles like Clean, Cleaner, and Cleanest?

Then I wonder if I were on The Price is Right and made it to the big wheel how would I spin it?  Would I be one of those people that reaches up as high as I can, grabs two of the wheel's spindles (one with each hand), then jumps up and throws my entire body weight into the spin?  No, I couldn't do that.  I hate it when other people do that.  The wheel goes around way too many times and the audience gets bored waiting for it to stop spinning.  Then, what if the wheel stops at 75 cents?  Would I spin again if I were the first contestant?  I probably would, even against my better judgement.  If I ever made it to the big wheel I'd just hope to be the third contestant because that's the power position.  You know what number you have to beat and it takes the guesswork out of your decision for stopping where you're at or going for more spins.  I don't have any desire to go on that game show so why am I making a plan for how I would play the game anyway?

What is Grimace?

A moment later my mind is barreling along another tangent.  I wonder what the hell is that weird McDonald's character named Grimace?  I know the the Hamburgler and Mayor McCheese are guys with hamburgers for heads.  Ronald is, of course, a clown.  There's Birdie, who is an easily recognizable bird.  But what is Grimace?  Is he a part of the chemical compound of food preservatives used in the food that the mere mention of makes one grimace in disgust?  Perhaps if you took the food preservative and studied it under a high-powered microscope you would discover that the structures of the preservative look like purple, inverted candy corn-shaped, blobs?  Who was the marketing genius behind the creation of Grimace and what was their thought process?
 
It would be rewarding if I spent my downtime thinking about solving the problems of the world and having philosophical epiphanies.  Alas, I find it is difficult to think straight when my head is pounding.  At least half of my attention is diverted to how badly my head hurts and how I hope the migraine will cease sooner rather than later.  I guess thinking about stupid stuff helps distract me to some extent and keeps me from focusing on feeling that my life is passing me by while I wait for a reprieve from the migraine.

Emotional Baggage

Migraines come with their own set of emotional baggage.  When I have a migraine it is closely followed by feelings of guilt that I let someone down by having to call in sick to work or cancel plans. There are feelings of worry that I am going to miss a deadline because I had to call in sick to work, or that friends will view me as unreliable for canceling plans with them.  Then there are feelings of anger that my body betrayed me yet again and forced me to call in sick or cancel plans.  There is also frustration that the migraines keep screwing up my life.  The cherry on top is the sadness that I'm missing out on something fun that I had planned.  It's a formula that looks something like this:

Migraine + Guilt + Worry + Anger + Frustration + Sadness = Migraine Hell

I remember one evening in particular about four years ago when I was living alone in Portland, Oregon.  I had leased a super cute apartment with floor to ceiling windows on one entire wall that extended through the living room and into my bedroom.  I moved in during the winter, not giving much thought to the fact that these windows got the evening sun.  By the time summer rolled around, the afternoon sun heated my apartment every night.  There was a tiny air conditioner in the apartment, but it couldn't keep up with the intense sun...it just moved the hot air around so I felt like I was living in a convection oven.  The apartment was often 80 to 90 degrees Fahrenheit and it was absolutely miserable in there.  If I have to suffer through those kind of temperatures I think I should be on a sandy beach, working on my tan, being served daiquiris by a cabana boy.

I had been stuck inside my inferno apartment for several days straight because I was sick with a migraine.  I'd missed a couple of days of work and was feeling guilty about that.  We had an important, upcoming event and there was a lot of preparation I needed to handle.  Let's just say that not all bosses are understanding about missing work for chronic migraines, so I was worried that the boss would be angry with me.  I was also not looking forward to how much work was piling up for me to deal with when I returned.

Several of my friends had invited me out to First Thursday in the Pearl District in downtown Portland.  First Thursday is basically a walk through various galleries in the area to look at different art exhibitions.  After that we'd planned to go out for dinner and cocktails.

When Thursday morning rolled around the migraine was unrelenting for the fourth straight day.  I called in sick to work.  Then I called the chiropractor and she worked me into her mid-morning schedule for a chiropractic adjustment and an acupuncture treatment.  I was hoping the treatments would alleviate the pain.  The chiropractor was quite worried about my pain level and before I left she gave me her cell number and instructed me to call anytime if the pain intensified.

Around 5:00 p.m. the pain was only getting worse.  I had to call my friends and cancel on our First Thursday plans.  I was feeling pretty depressed about missing our outing so I laid in bed and cried for a little while.  I cried because I was bummed out; because my friends might think I'm a flake for cancelling on them; because I had a Vegas vacation with the boyfriend (now husband) in nine days and I didn't know if I would be better by then; because I hurt; because none of the migraine medication I had on hand seemed to help; because I didn't know if the pain would ever subside; because it was so blasted hot in my apartment; because I hadn't slept well in days; because I was worried about work; because the chiropractic adjustment and acupuncture hadn't helped; and because I was feeling so sick I didn't think I could take care of myself.

I called my parents later that evening.   They were, of course, worried and offered to come and help me out.  I talked them out of that.  I didn't want them to drive four hours to sit in my apartment/oven while I laid in bed feeling like crap.  My Mom talked me into at least calling the chiropractor.  I had held off on doing that because I felt I was imposing on her calling after hours even though she told me I could.  She was really cool about it though and she directed me to go to the emergency room.  She told me to get ready and she'd call me back.  When she called me back she had located the hospital nearest to me and had called ahead to let them know I would be in soon.

The task of getting semi-presentable for the public was daunting.  I'm the kind of girl who never leaves the house without a hefty application of eye make-up.  I decided to wear sunglasses to mask my lack of eye make-up, and to help with the sensitivity to light that I was experiencing.  I changed out of my pajamas and put on some Adidas track pants and pulled on a sweatshirt.  It was too hot for a sweatshirt, but I figured that I didn't have to wear a bra if I wore a sweatshirt and putting on one less garment seemed ideal.  My long hair was a crazy mess.  I'd washed it when I returned home from the chiropractor, but couldn't brush it because I didn't feel well.  To make matters worse, I had laid on it while it was still wet and it had dried with a wicked case of bedhead.  Thank goodness I had a cute baseball hat to cover that.

After what felt like an eternity to get ready I then had to tackle three flights of stairs and a drive to the hospital.  That feat sounded about as easy as completing a triathlon on a good day, which is saying a lot because I don't even know how to swim.  The pain was at its absolute worst when I was standing or sitting, so getting from my apartment to the hospital was difficult.  I cried from the pain the entire way.  I had to take a few minutes to gather myself in the parking lot of the hospital before I went inside.

After I checked in with the registration clerk in the emergency room I slouched into a chair in the waiting room.  There was a young woman sitting there who was throwing up into a barf bag.  Although I felt bad for her, it did make me feel a little better about myself...I might not look too great, but at least I wasn't puking in public.  Her puking was pretty gross so I attempted to distract myself by text messaging the boyfriend about my $h*tty week.  He felt bad for me and offered to come over and take care of me, but I talked him out of it.  I don't particularly like people to see me in that kind of pain.  Besides, he lived two hours away and would have to take time off of work.  It was nice that he offered though.

When I eventually saw the doctor he ordered X-rays on my neck because I was having terrible neck muscle spasms.  He eventually sent me home with a prescription for muscle relaxers for my neck and pain medication for the migraine.  Thank goodness that the Walgreens pharmacy near my apartment was open 24 hours a day so I could get the prescriptions filled.  I returned home around midnight and with medication on board I was finally able to fall asleep and escape the pain.  The next day I felt quite a bit better.  The medication broke the migraine cycle.  The migraine wasn't completely gone, but it certainly wasn't as bad as it had been.  I managed to go to work that afternoon.  I slowly recovered over the next few days.   Thankfully, I was well enough to have fun on vacation, my friends did invite me out again, and my boss was understanding about me missing those few days of work.

That is just one of the many instances when a migraine derailed my life over the past 20 years.  It's hard to see the light at the end of the tunnel when you are in the middle of a migraine, but the headache always passes at some point.  I would like to think that chronic pain has made me much more appreciative of the little things.  Just waking up without migraine pain is a reason for me to celebrate and for that I will be thankful.  I guess I can add thankfulness to my migraine emotional baggage.

Gross.

Vomiting is never a good experience, but vomiting while having a migraine is quite possibly the worst feeling I've ever experienced.  Not only do I have a splitting headache, but puking somehow makes it feel exponentially worse.  I never know when I will get a "puking migraine" as I call them.  I can function with most of my migraine headaches because I've learned coping mechanisms over the years, but if it turns into a puking migraine I'm done.

Lucky for me, I don't get nausea with migraines often.  But when I do, I can't stop vomiting until the migraine ceases.  If I swallow migraine medication with water, it comes back up.  I get so dehydrated and crave a tall glass of water, but even the tiniest sip of water comes back to haunt me.  Oh, the humanity!

Sometimes, when I'm having a migraine and feeling sorry for myself, I will seek out comfort food to try and cheer myself up.  Years ago I ate one of my all-time favorite candies, a peppermint patty, during a wicked migraine attack.  I ended up getting nauseous shortly thereafter and the peppermint patty came back up.  Peppermint patties will forever be associated with vomit now and I doubt they will ever sound appetizing again.  Maybe that's a good thing...I don't need the sugar.

I could go on, but honestly that is more than enough on the topic of puking migraines.

Yogi

I was a competitive long-distance runner in high school.  It was difficult to run with constant migraine pain, but I grit my teeth and powered through.  I didn't race during college, but I continued to run three miles, five times a week.  I suspected the running intensified my migraines, but I couldn't bring myself to give it up.  Running was therapy for my mental well-being.  I loved listening to the fast-paced rhythm of my footsteps on the ground, my dear border collie running at my side, the quietness of being alone with my thoughts, the smell of fresh air, the satisfaction of doing something healthy for my body, and the runner's high after a run was complete.

At some point I finally accepted the fact that running was exacerbating my migraine headaches and it was time to try a different workout.  For that I'm a smidgen bitter, but I try not to dwell on it too much.  It's just one of many lifestyle adjustments I've had to make as a migranieur.  Over the years I tried other workouts like the elliptical, treadmill, and weight machines at the gym, as well as many workout videos in my home.  It was apparent that these high energy aerobic workouts weren't doing me any favors in the migraine department either.  I finally decided I'd give yoga a try.

Switching to yoga was a tough crossover for me not physically, but mentally.  I'd always been into high intensity workouts and I never thought I'd get a good workout from yoga because it seemed too low key.  It also didn't seem like it was my kind of workout.  I am a country girl and I thought yoga was for new age, vegan, yuppies who live in trendy metropolitan cities.  For the kind of folks who go out for happy hour at an oxygen bar to do wheat grass shots.  Well, my stereotype was completely off base and I've since learned that many types of people enjoy yoga, myself included.  I've been doing yoga several times each week for about two years now.  Yoga wasn't as easy as I thought it would be.  I was pleasantly surprised that it gets my heart rate up and I work up a sweat.  The best part is that that mastering a challenging yoga pose can be quite rewarding. 

Yoga Mat Thief #2

I don't know how zen I am while doing yoga.  It can be difficult at times with two goofy Labrador Retrievers sniffing around.  The moment I toss my yoga mat down they get excited.  They seem to think that if I'm on the floor I must be there to play with them.  More than once I've gotten into a complex pose requiring a lot of concentration and balance when my 90-pound chocolate lab decides to smash into me and we both go ass over teakettle.

Yoga Mat Thief #1

The lure of a vigorous dance workout recently got the better of me and I popped in a Zumba DVD.  I bust a move to a 50-minute advanced workout, totally keeping up.  I hadn't done a workout like that in over a year.  I worked up a sweat, but I never once was short of breath.  Afterwards, I surmised that yoga provides spectacular cardiovascular results since I wasn't huffing and puffing my way through the Zumba workout.  Unfortuantely, I paid the price over the next few days.  A terrible migraine started the next day and didn't go away for three days.  It was so bad that I missed two days of work.  I think it was a not-so-gentle reminder from my body that I should stick to yoga.

I guess you could say I've come around and accepted the fact that I'm a yogi.  To celebrate I got some no-slip, toeless yoga socks.  Shit just got real!