Tuesday, May 31, 2011

D.O.

I have always been a fan of the idea of going to a doctor of osteopathy.  (A DO takes a very whole body approach to medicine).  Two of my best friends recently went to Dr. Stuart Porter, DO and I heard great things from both of them about him.
Thursday, I got to visit with him.  What an amazing difference between virtually every MD I've visited with and this DO.
First of all, I'm not sure if I can call what I've done with MD's "visiting".  I see them for about 10 minutes and they ask few questions other than what are your symptoms.  Don't you care about the extensive medical history and list of medications I just spent 30 minutes filling out for you?  Didn't your nurse write down all my symptoms when she asked me 15 minutes ago what they were?  And didn't you hear me when that I told you that "triptans" don't work, in fact they make my migraines much worse? So why are you now prescribing me a triptan? 

I spent about 3 minutes with what I assume was his nurse - she took my weight, temperaure, and blood pressure.  Then I spent about 30 or 45 minutes with the doctor.  That's right - I had him all to myself for more than half an hour!  And that extensive family history and medical history form I filled out.  He looked at it.  Right in front of me.  Ask me questions about it.  Then he went through an even more extensive questionaire which included things like, "how are you sleeping?", "do you feel fatigued during the day?", "do you suffer from seasonal allergies?", "do you crave sweets?", "how often are you menstruating?" (not just what is the date of your last period).  With certain answers that I gave him, he would then explain how that may or may not help with the headaches. Finally, he wanted to perform an allergy test on 13 known and common food allergens.  And explained that sometimes you have a food allergy that goes unnoticed because it doesn't give you a stomach ache or make you feel the same way you do with other allergies.  Also, he wants to test all of my hormones and also my Vitamin D levels.
This is where I stop him - oh, I've already had a Vitamin D test ran and the results came back that I am fine.
He says that he's going to run it again because headaches are a result of low Vitamin D levels.  And what the lab says are "fine" are not fine to him.  The lab will approve Vitamin D levels above 32, but he considers anything lower than 50 as too low.  And for someone suffering from headaches it best to have them closer to 100. 
Just as we're about to wrap up he sees the paperwork I had my neurologist send over.  What's this?  I tell him what it is and he says, "let's see if your Vitamin D test results are in here."
Sure enough.  And you know what my "fine" level is?  32.5 
So I'm taking Vitamin D, but he also recomended a few others. 
Follow-up in two weeks when we'll have the results back of my hormone and food allergy tests.

Falling Apart? Or Bad Week?

It all started with the wonderful, and yet painful, massage on Tuesday.  I was sore for several days after that.  Then the severe chest pains on Wednesday morning that had me thinking I may need to run to the hospital. 
To make matters worse, I had a little fall Thursday morning.  (I lost my balance while sitting on the counter in the bathroom.  Are you finished laughing yet?)  The fall hurt my hip (where I landed), my shoulder (which hit a small cabinet I have in my bathroom), my foot (which hit against the side of the door on my way down), my lower back, (I guess from the jarring landing I made), and my wrist (which I can only assume I tweaked while trying to catch myself and soften the blow). 
I'm off the Cymbalta, which was making me sick and is now REALLY making me sick - I'll discuss that in a minute. 
The Trazodone which is supposed to help me sleep is not really working any longer.  And besides that, the side effects of the trazodone add to my inability to sleep.  The side effects are congestion and dry mouth.  So as soon as I lay down I begin to feel congested so I can't breathe through my nose anymore.  And then it causes dry mouth which is exponentially worsened by the fact that I have to breathe through my mouth.  The final and most exciting side effect is the blurred vision.  So when I can't sleep, I can't do anything else, because I can't really see.
Then to top it all off - I think I sprained my pinky toe Monday night.
So now I hurt everywhere and feel like I am just falling apart!

Wednesday, May 25, 2011

Cymbalta Side Effect?

Sometimes I worry about reading the potential side effects of a medication because then I may experience them simply because I expect them.   Like a placebo - sort of.
But I looked up the side effects of Cymbalta anyway and I saw insomnia.  Well, as you know, my faithful blog reader(s), I am suffering from insomnia.
I have never had heartburn in my life until about a year ago.  And then ONLY when I took a peppermint pill for my tummy.  But for the last two months I've had heartburn quite often.  I tried to identify what it was - was it caffeine, was it chocolate, was it spicy foods?  It almost didn't seem to matter.  I'd get it on an empty stomach.  Everything but water gave me heartburn.
I learned in physiology the difference between all the heartburn medications and which was the weakest and which was the strongest.  So I went to the pharmacy and picked up the strongest heartburn medication available.  It was even a time release one so that it would work all day.  It didn't help.
When I had I looked up side effects of Cymbalta, there it was - heartburn. 

I've been having a most interesting issue with my stomach and esophogus and chest the past month or so.  Whenever I eat (it doesn't matter what, it doesn't matter how much) I get that feeling like something is stuck at the bottom of my esophogus and top of my stomach.  Each swallow - stuck.  I knew that it wasn't, but it was that sort of feeling.  Only this was painful and would radiate up my esophogus giving me pain in my chest.  It would only last a few seconds, but it was very irritating.  Then when I finished eating I'd have this pain that would start at what I imagine to be my esophogeal sphincter and would radiate up my esophogus.  It came in waves and could be quite painful.  It would last 10 or 15 mins after I finished eating.
This weekend I experienced it a few times and my chest hurt so bad I thought for a second - what if this is a heart attack?

This morning, after I ate breakfast, that pain was back - and with a vengeance!  I doubled over, I saw stars, it was hard to breathe, I was in tears and swearing like a sailor!  Each wave just a minute or two apart was excrutiating!  I thought I was going to have to go to the emergency room.  And it lasted nearly two hours!  It slowly subsided after about an hour and fifteen minutes - enough so that I was no longer constantly thinking about where the nearest hospital was. 
I decided that since Cymbalta is quite possibly giving me heartburn, I'd look up the other side effects.  I saw "abdominal (stomach) pain" listed.  Well, that's not exactly informative.  What KIND of stomach pain?  What did it feel like?
I continued my search - this time turning to websites that were not drug specific - and I found a blog that's meant to be a support to those suffering from depression.  It had postings about antidepressant medications and the side effects people had suffered.  One woman posted "Ever since starting Cymbalta several weeks ago I have had horrible heartburn.... There are times when the pain in my chest is just a huge pain in the center of my chest. It gets so bad that I take the Extra Strength Vicodin that is prescribed for my disk degeneration". 
YIKES!
So I called my neurologists PA and told her about my experience and that I wonder if maybe it's from the Cymbalta.  Well, I'm going off Cymbalta immediately to see if this stomach/esophogus problem goes away.

Potentially Great News

Spoke with my neurologists PA today and it turns out I may qualify for Botox injections to treat my migraines.  The best thing about this (versus the plastic surgeon who suggested Botox injections) is that it is quite possibly covered by my insurance.
The FDA has approved Botox as an acceptable treatment for migraines in certain circumstances and Paula, my cute PA, has said that I am an excellent candidate.  To be a candidate I have to:
1) have more than 15 headaches a month - CHECK
2) not respond to several preventative medications - CHECK
so she's working now with my insurance company to get it covered for me.

Massage

Let me tell you about the  most professional, most caring, most amazing massage therapist I've ever been to.  His name is Garret Sueltz at Studio 603 in Draper (801-571-5331).  Yes he was so good that I am going to give him a plug.  If you live near Draper or don't mind driving to Draper for a massage, he is well worth the drive and well worth the money.
I had a Groupon for a 60 min massage at Studio 603 which is how I came across Garret.  I was the last client of the day.  When I went in Garret asked me why I had come to see him.  I explained that I have chronic headaches and frequent migraines.  He asked if I wanted him to focus on my back, neck and shoulders and I said yes.  If he could get that worked out then he'd move on.  Otherwise he'd spend all of his time there, he explained.  He asked if he could do a deep tissue massage to which I gave him a very affirmative yes.  I love deep tissue massage (I'm not one for the nice relaxing Swedish style massages - I want it to "hurt so good"). 
Garret began to explain what he was going to do, where he would massage, and warn me that it will hurt.  The muscles that need the most work are very deep, but also, they sit right on top of a bunch of nerve bundles.  And then the usual - let me know if it hurts too much.  I think only one time have I ever told anyone it hurts too much.  You can have me in tears (and some have) and I won't tell you it hurts too much.  I know pain - I deal with it all the time.  A deep painful massage is the type of pain that I know will come to an end in just a few minutes when the therapist moves on to another muscle or body part so I will just take it.  Also, I know that it's a healing pain. 
So Garret works and works and works; knots in my muscles are popping, I am cringing, pain is shooting all the way down my arms when he works on my shoulders.  But Garret keeps plugging away.  Knot after knot after knot gets massaged and pushed on and stretched out.  He was determined to get everyone of those knots out and those muscles relaxed. 
I am laying there thinking - this is the longest massage I've ever had!  Or does it just feel that way because of how much pain it's causing me?  Or is it because we're working on only a portion of my body and I can usually gauge how much time I have left by what body part they've moved on to or if they've asked me to roll over?
In the end it was the longest massage I've ever had.  When I looked at the clock I noticed that Garret had given me a 90 min massage for about the price of a 30 minute massage.  He didn't charge me extra, didn't even say anything about going over the time.  He was so determined to help me, to relax my muscles, to remove those "toxins" from my body, to get those painful knots out that he just kept going.  That's why I say he was the most caring and most amazing massage therapist I've ever been to.  I don't think he ever looked at the clock and he certainly never had a timer going. 
He's also the first massage therapist to ever massage my stomach and my face.  Incredible!
When I took a massage course at the age of 18 from the college of massage therapy they taught me to massage the stomach.  But I've never actually had anyone do it until Garret.  Another reason I think he's amazing.
And then in the end when it was finished he showed me stretches to do for the muscles that were massaged and for complimentary muscles.  This is why I think he is the most professional massage therapist I've ever been to.  It wasn't just a massage to him, it was a therapy session. 
He told me that I'd need a follow-up massage in about 3 weeks when those knots and muscles would be more pliable and gave me a coupon for 50% off my next one in case I wanted to return to him for that follow-up.

So, again, Garret Sueltz at Studio 603 in Draper (801-571-5331). 

Monday, May 23, 2011

Pre-Med Conference

I attended the first annual Intermountain Pre-Med conference this weekend.  I knew that most of the information and topics at the conference would not suit me, but I did see a workshop on Women in Medicine, How to be an Outstanding Applicant, and a presentation on Osteopathic Medicine.  Also, there were a  lot of colleges there who have PT programs that I was not aware of.
What I found most interesting at the conference was all the osteopathic colleges and universities there were there.  It seems there were more of them than more "traditional" (if I may use that term) medical schools. 
I have always been fascinated by osteopathic medicine and in fact, my GI doc and my GYN doc are both DO's.  I tried finding a neurologist who was a DO but to no avail and so ended up with Dr. Reichert instead (who I do respect and know he's doing the best he can for me.) 
I became convinced that I can no longer put off calling Dr. Porter, DO who's practice is in Provo.  I was reluctant about going so far away for a doctor, but clearly the medications aren't working so it's time to get another opinion.
Wish me luck!

Friday, May 20, 2011

Occipital Nerve Block : Day 5

I have a headache again.  I know this comes as no surprise.  But what is a surprise (although it probably shouldn't be) is that the nerve block appears to have worn off already.  My neck hurts - and not just in the injection sites, but all over.  And there is pain again in the back of my head.

I took excedrin in the late morning - I don't know why I even try anymore.  I guess because I haven't completely given up hope that SOMETHING will help. 

Trazodone

Wednesday night I finally dared take the trazodone I'd been prescribed on Monday.  When I picked up the prescription the pharmacist asked if I'd ever taken the medication before.  When I replied no he proceeded to tell me to be careful with it and that I may want to take it at night as it is known to cause extreme drowsiness among other things.

Drowsiness?  YAY!

So I took my first dose Wednesday night and I slept quite well.  Question was .... was it the trazodone finally working?  Or was I just so exhausted that my mind & body finally gave in?

Thursday nigh I took my second dose of trazodone.  I am happy to report that I had another great night of sleep.  I hate to speak too soon, but we may have found a winner.  (At least with regards to the insomnia.  Still working on the migraines though.)

Zombie

An hour and a half.  That's all the sleep I got Tuesday night.  Went to sleep late - about 11 (partially because I was out too late and partially because it took me awhile to fall asleep.)  By 12:30 AM I was wide awake.  I tossed and turned for about an hour.  Then I played sudoku and checked email and such for about an hour.  (Darn it!  Why did I leave my book in the car?)  Then I decided to watch some TV.  That would use less brain power than sudoku so maybe it would help me relax.  Watched a 2 hour episode of Celebrity Apprentice.  By this time it is 4:30.  I AM actually starting to feel a bit tired, but my alarm is going off in 30 mins since I need to be at work early for meetings.  I think I had just shut my eyes and began to drift when it's time for me to get up :(
I can't recall a time when I've ever felt so exhausted before.  I felt like a zombie!  And one of my co-workers lovingly told me I looked like one, too.
I am experiencing postdrome in addition to the exhaustion - what a lovely combination. 
Trapezius is still hurting on the right side in the shoulder region.  But no headache in the morning and only a mild one the rest of the day.  The exhaustion was enough to deal with anyway.

Occipital Nerve Block : Day 2

I didn't get much sleep Tuesday night as I had chemistry lab until 10.  Felt quite tired all day as a result.

By afternoon I had a serious headache.  I took excedrin early but it offered me no relief.  As I analyzed the pain and areas of pain I noticed that it was both stabbing and throbbing pains and it was all in my jaw, temples, side of my head (in front of my ears), top of my head, forehead, and behind my eyes.  No pain in the occipital area (back of my head).  Interesting! 
It finally occured to me that I was having a migraine, it just didn't feel like my usual migraines because of the nerve block to my occipital area. 

So nerve block not entirely pointless, but clearly I need other areas injected as well. 

Took fioricet later in the afternoon.  It helped take the edge off.  Unfortunately, I am running dangerously low on it.  Which I guess I shouldn't be too upset about since it isn't helping as much as it should.

Occipital Nerve Block : Day 1

Monday, May 16 I got the Occipital Nerve Block.  It was probably a good day to do it since I'd had some headaches and migraines over the weekend and was having a moderate headache at the time.  Paula pressed on the base of my skull on each side until I told her she had hit the tender spot and then injected the blocker.  Shortly after the injection I felt tightness in my forehead - almost like I had a rubber band around my forehead.  But aside from that everything seemed fine, no faintness or nausea.
I discussed my restlessness and lack of sleep and it was decided that the amitriptyline must not be working and I am being switched to trazodone. 
After the shots I had to go to physical therapy to get a massage and some stretching to help the steriod get into my tissues.  On my short drive there I noticed a lot of pain and tightness in the shoulder area of my right trapezius.  Also sharp pain in my temples and behind my eyes.  The tightness in my forehead continued. 
After PT my shoulder no longer hurt at all - it felt great!  But the pain was still in my temples, behind my eyes, and the pressure and tightness was still in my forehead.

 

Headache Log : Insomnia....Still

I know that Ambien is not really supposed to be taken every single night so I'm trying to be careful with it. I also take my 10 mg pills and cut them in half (sometimes even into quarters).  My first few nights with it I seemed to have slept fairly well, but was still a little tired in the morning.  Fortunately, not groggy or in any sort of drug haze, just still tired.  And tired all day long.  I chalked it up to not being completely caught up on weeks and weeks of restless sleep or no sleep at all. 

I thought that maybe on nights when I had a minor migraine I could sleep it off with the help of the Ambien instead of resorting to heavier medications.  Also, all the OTC's that I take for headaches or migraines just keep me up - and that, I believe, exacerbates the problem.

Well, I'm still getting very little sleep and I'm still exhausted during the day.  I trade off the Ambien with melatonin, but I really shouldn't be taking either every night (and I'm not!)

Tuesday night / Wednesday morning was a bad night.  I was up about half the night with a migraine.  So I decided to get to bed early tonight and to take Ambien.  I took the Ambien at 9PM and by 9:45PM I still wasn't very tired, but I didn't have TOO much trouble FINALLY falling asleep shortly after 10PM.    However, I was wide awake at 3:30AM.  And exhausted with a headache this morning.

I guess I'll try a higher dose next time - maybe the whole pill :(

Monday, May 9, 2011

Headache Log : Suicidal or Homicidal?

After a wonderful week with no headaches or migraines at all.... (Yes, I can hardly believe it myself - it's a new record!  I went for 5 days without a single headache!)...I had a weekend full of migraines.  Fortunately these were not drug resistant - at least not completely - the drugs took the edge off.   
Saturday night was a family dinner and I listened to kids screaming.  One nephew in particular has an extremely shrill and high pitched squeal and he let it loose that night.  UGH!  MY ACHING HEAD!

Then Sunday I went to Target to fill a prescription I had run out of.  Sunday was Mother's Day (a day that used bring me some amount of heartache).  There were lots of mothers and fathers there with their children.  One child was yelling for a least 10 minutes near the top of his lungs "double chin!" over and over and over again.  I could hear him clear across the store.  GOOD GOD SOMEONE SHUT THAT KID UP!  And another child was squealing in delight at having found her mother for her father, a few seperate times. 

I realized in that moment, in Target, and thinking back on just the night before, how incredibly blessed I am not to be a mother.  I thanked the heavens and the earth in those minutes in Target that I don't have children.  Because honestly, with these migraines, if I did have a child and that little bundle of joy and/or misery screamed or yelled like these children this weekend - I'd either kill her/him or I'd kill myself. 

Headache Log : Info on Occipital Nerve Block

I decided that if I'm going to have it done, but I may as well know what it is.  So I did some researching. 
You can see for yourself here
http://www.medcentral.org/main/OccipitalNerveBlock.aspx
or you can read my summation.

Basically they inject a type of steroid into the tissues surrounding (and possibly irritating or pinching) my greater and lesser occipital nerves (two nerves that come out of the base of your skull - if you don't want to wiki where the occipital nerves are).  The steroid is supposed to reduce any inflammation in those tissues that may be aggravating the nerve. 
Obviously there can be some soreness and tenderness at the injection site - the needle goes into some very deep tissues.
But they also apply a local anesthetic to help with the soreness and that will also, at least temporarily, help with any occipital neuralgia. 
The steroid is supposed to work anywhere from a few days to a few months.  (I suppose this depends on the person, the steroid, and the dosage.)

My hope is that it lasts several months.  But my sneaky suspicion is that there is more than one type of neuralgia causing my migraines.  I believe a branch or two of my trigeminal nerve is also involved and to blame for some of the pain.

*sigh*  At least I'm trying something, right?

Thursday, May 5, 2011

Headache Log: Insomnia

A year ago, I'd fall asleep as soon as my head hit the pillow.  And I'd sleep through most of the night (only getting up once to potty) I'd wake 2 or 3 minutes before my alarm was set to wake me.  I may have a day here or there where I felt a bit tired during the day, but I rarely felt so exhausted I was actually unhappy and depressed.
Now, it takes me 30 minutes to an hour to fall asleep.  (This is what happens on a good night.)  Then I'll wake up every hour to an hour and half.  I'll wake to potty 2 or 3 times (or perhaps its just because I'm already awake that I notice that my bladder feels a little on the full side.)  It will take me several minutes to an hour to fall back to sleep once I'm awake.  When my alarm goes off in the morning I hit snooze for 30-50 minutes before I can finally drag my ass out of bed.  Consequently, and rightly so, I'm exhausted all day long.  Exhausted to the point that I feel depression knocking on my door.
But I want to repeat, this is on a good night. On a bad night, I can't seem to turn my brain off.  The tiniest thing could upset or excite me and I won't sleep.  Sometimes I can't sleep because my head hurts too bad.  And of course the lack of sleep only exacerbates the condition of  my head.  When I finally do fall asleep around 5 AM in the morning, I wake about 2 hours later.  So not even sheer exhaustion can make me sleep longer than 2 hours at a time. 
But caffeine, you are my savior.  Which may be unhealthy and may lead to some of the waking in the middle of the night to potty.

Everyone at work tells me I should try Ambien.  They tell me how wonderful it is and how much it has helped them.  They tell me it allows them to shut off their brain so that they can finally sleep.  They tell me that you never have that drugged and groggy feeling in the morning.  I was also told that it doesn't require 8 hours of sleep - that you can get by on just 7 and still feel wonderful in the morning.

How do I get my hands on such a wonderful product?

Remember my recent story about the doctor who asked me what I wanted  him to get me?  No, he didn't prescribe me Ambien - or any sleeping pill at all.  (Although I kick myself that I didn't try to get some out of him!)
Well, I was relating the story to a friend of mine who's father is a doctor.  And I joked with her and asked her what she could hook me up with. 
"What do you want?"
"Ambien"
And that was it.  Her father called in a prescription for Ambien for me.

WOW!
Now I REALLY feel a bit like a junkie!  But I am sleeping (on the nights that I've dared to take it, anyway).  Still waiting to feel less exhausted during the days.  Maybe that will take weeks. 

P.S. Cymbalta, which I've been on for nearly 2 months now - side effect is insomnia.

Headache Log : Annoying

I have a minor annoying headache.
Sometimes I think this is the worst kind of headache because it's not bad enough that I can justify taking meds (especially now that I've been kicked off of excedrin) so I just suffer with it :(
(It's also not bad enough to justify my getting much sympathy)

My favorite kind of headache (if you can possibly have such a thing) is a moderate one.
It's bad enough that I can justify taking meds in the hopes they will offer me some relief.
But it's not bad enough that I can barely function (especially should the meds not work - which is most often the case.)
The effects on my school work, homework, work (all those "works") are consquently also moderate.

Wednesday, May 4, 2011

Headache Log : Postdrome

I was looking a website about migraines (http://www.migraineheadachesaids.com/) and I saw something about migraines I didn't know.  I had heart about visual auras - although I don't experience these - but what I learned is that there are three stages to a migraine (some sites say four). 

The first stage is the prodrome.  Prodrome is the pre-headache.  In some sites the prodrome includes the auras and in others the aura is a seperate stage that follows prodrome.  During prodrome the migrainuer may experience one or many of the following symptoms:
Altered mood, irritability, depression or euphoria, fatigue, yawning, excessive sleepiness, craving for certain food (e.g. chocolate), stiff muscles (especially in the neck), hot ears, sensitivity to light, sensitivity to sound, sensitivity to smells, constipation or diarrhea, increased urination, and other visceral symptoms.
I thought because I didn't have auras I didn't experience warning signs or prodrome, but after looking at this list I just might.  If nothing else I experience the stiff neck muscles.  I had thought that those stiff muscles were causing the headache and here it appears that it might be the other way around.  Also, the sensitivity to smells and sound.

The second stage is the pain stage, this is the headache/migraine itself.  I won't go into detail here.

The third stage is postdrome.  This stage is the one that interested me the most.  The day after I have a migraine (if I don't STILL have a migraine) I had experienced exhaustion, soreness, disorientation or confusion and many other symptoms.  I had always blamed the medications for my migraine hang-over.  But what I found out upon reading about postdrome is that all of those and many more are a part of the post headache or postdrome phase.  I learned last Tuesday morning that I was truly experiencing postdrome and not linger drug hang-overs because I took absolutely no medication Monday and yet Tuesday, I woke up, feeling hung-over.  I was confused, disoriented, exhausted, sore, I couldn't think straight or talk normally. 

What does this mean?  Nothing.  I guess just that I'm normal.  And maybe that I need to plan on an extra sick day anytime I have a migraine - not just the painful day, but the postdrome day as well.

Headache Log : Any Drug I Want

So the day of my last post, Thursday, April 28, was my fourth day in a row with a migraine.  The pain in my head was one thing, but the stabbing pain behind my left eye and in my temple was unbearable.  Finally at lunch time, shortly after my post, I gave in and took myself to an Instacare.  What an interesting experience!

Determined not to be treated like another migraine sufferer and given a shot or prescribed a triptan drug that I can't take I decided not to tell them I had a migraine, but tell them I had a severe headache with stabbing pain behind my eye.  Well ..... that may not have been the best approach either.  The nurse put me through a series of tests to make sure my eyes were functioning normally and my vision was not impaired. 

Finally saw the doctor, he checked my eyes as well.  And at that point I gave in and told him I was a frequent migraine sufferer and was on my fourth day with this particular migraine.  He was a little concerned about the stabbing pain behind my eye, thinking it to be a new symptom.  Then I explained that I get it often.  Not with every migraine, but it's not uncommon.

Then things got interesting.  He asked what I wanted him to do. 
I said, "I'm in pain.  I have been for four days.  I need help."
He said, "I'm just a general physician.  You need a neurologist."
I said, "I'm currently under the care of neurologist, but I can't just drop into his office like I can an instacare or an emergency room and I don't think I can take this much longer."
He asked, "What do you want? A shot?  A prescription?"
I explained that the shots don't work, unless there's one I don't know about.  And triptans don't work either. 
He asked, "Do you want a painkiller?"
"If you think that will work?"
"What do you want me to get you?"

WOW!  Really?  How about some medicinal marijuana?  Can you get me that?  Or how about morphine or vicadin? 

I explained that I was there because I didn't really know what my options were. 
He asked what had worked in the past.
I told him fioricet had worked for a time.  And recently it's been intermittent. 
He suggested fioricet with codeine.  Add a narcotic to my barbituate and maybe I'd find some relief.

The first dose didn't do it for me, but the second one did.  YAY!
Of course, I can't take it while I'm at work or at school or need to do any driving so it does pose some potential problems.