Ever heard of "blocking"?

[Valanda]

My eldest son just went into the hospital yesterday. He had peritonitis from a ruptured appendix. The surgeon said it must have ruptured a while ago because when he cut into my son's abdomen, the pus shot up into the air and covered everything!

Now, the really wierd thing is that he did not have a fever, and the only pain he complained of was directly over his bladder. He rated this pain as a 1 - 5 depending on what he was doing. I took him into the ED because he had this really wierd look in his eyes that I've only seen on patients who were near death. He also had a sunken look on his face much like a heroin addict.

When we got to the ED, the triage nurse thought I was nuts for bringing him in (I Think) because his temp was normal, his pulse was 90 and his B/P was 124/78. He told her that he thought that maybe he had a bladder infection. When asked what his pain was he told her "1-3 it comes and goes". Granted this is a child who spilled 40 ounces of near boiling tea in his groin when he was 11, so his idea of "10" may be scewed. Anyway, the triage nurse had us sit back in the waiting room and after 2 hours we got seen by the MD who ordered labs and a CT of his abdomen.

Well, after they got the results everyone was shocked. the MD and the triage nurse both came in to take another look at him. They just couldn't believe that from his test results that he was up walking and smiling when he wasn't complaining about being there when there "was nothing wrong with him."

Ok, so the whole point of this story is that the ER MD, the surgeon, and his primary doctor all said that the pain must have been so severe that he was "just blocking it".

IS this even possible? I guess it must be, but blocking to the point that vital signs are not affected?

If so, that's pretty scary!

[ebear, BSN, RN]

His presentation was very atypical. Often the pain of appendicitis will subside shortly after the appendix ruptures. As far as "blocking" the pain, everyones pain threshold is so different. I'm just glad your nurses "gut feeling" served you well! Hoping for his continued recovery!

ebear

[nurz2be]

Yeah heard of it. Hubby actually was told he was doing this a few years ago when he literally had a broken femur. He came home with a limp and his thigh was swollen, he has chunky thighs to boot, and he simply said he thought he pulled a muscle. I didn't give it too much thought until I actually looked at it. It looked, well, odd and was swollen and was hot to the touch. I told him it might be broken he said it didn't hurt, it just felt funny to walk on, crunchy is the word I think he used. WARNING! I with all my wifely nagging insisted we go to the emergency room where he was triaged by a wonderful nurse, took his temp was fine, BP fine, pain scale he said 2 besides the crunching. Hmmm. So a few hours later, serious amounts of complaints about going to ER for no good reason, and finally the DOC. He had a Doogie Howser following him around, ortho intern. They wiggled and poked, hubby reassuring it didn't hurt just the crunchy sensation. DOC sent him for x-ray and BAM, broken femur. Ortho Howser and DOC and 2 other Ortho Surgeons came and asked if my hubby did drugs or drank, he doesn't and hadn't. ALL were puzzled and then told my hubby he was going to have to have surgery. That went over like a ton of logs on your toe. Well, after the bantering of my hubby insisting he would know if he needed surgery cause it would hurt, and he said it didn't. They went on with the, "nerves could be impinged causing a false sensation." Anyways, long story short Doogie Howser comes in with Elder Ortho and brings up something he heard of in med school, like 2 weeks earlier, that a patient presented (male) much the same only a broken back. Tests were performed and come to find out this particular man had an abnormally high level of testosterone in his body. Docs started scratching their heads, and test hubby, and I'll be darned but his testosterone was through the roof. He wasn't agitated, is not an angry guy, it is just that when his testosterone is like this his pain threshold goes out the window. Docs told us it was something to be tested further as this could cause some serious situations in the future should he have a more serious injury and his body react by producing too much testosterone and masking, that is what they went on to call it (Testosterone masking), his pain. For men, the normal level of testosterone in the bloodstream is between 350 and 1230 nanograms per deciliter. Hubbies was 5500 nanograms per deciliter.

Anyways, your kiddo isn't alone. Maybe you should have his run and see if this is the case with him as well. Never know what our bodies are capable of.

GOOD luck

[kukukajoo, LPN]

I am also "one of those" that does not show any signs of illness or infection until it is critical and acute. No pain, no fever, etc. Sucks as I get UTIs a lot and they go to my kidney before I even know and usu. end up in the hosp.

Hard thing is that it is dangerous. and I alwyas worry what will happen if my appendix ruptures. I have to be aware of this all the time.

[TiredMD]

IS this even possible? I guess it must be, but blocking to the point that vital signs are not affected?

Very atypical presentation, but this story does serve as an important reminder that there is no relationship between vital signs and pain.

[Altra, BSN, RN]

Glad to hear your son is doing well.

Thanks for sharing your story. It's a good reminder that atypical presentations will occasionally suprise each & every one of us.