Infection from Hell/Pain Scale Epilogue

[FZ1Tom]

Whew! Glad to just be able to sit here and post again!

Last time I was here I had just visited the ER Fri the 20th - simply couldn't stand that prostate agony (and paying $133, almost half my first paycheck, to hear the followup MD say my urinary tract was just "irritated" by being cathed did not improve my mood either :angryfire ) any longer. Anyway, it was a long wait but the doc said yep, acute prostatitis. D/C'd the Levaquin, started Septra DS and also got a Rx for Vicodin 5/500. Finally, I thought, some definitive relief!

I was terribly wrong in my assessment. :o

Saturday at work (14 hr shift) around 1330 I started getting dizzy, figured I'd possibly taken too much Vicodin (1 or 2 tabs po q 4hrs, I took 2 tabs around 0900 and 2 again at 1300). From there I quickly deteriorated, raging fever, chills with severe shaking, cold even with 2 shirts on and the room temp over 80F, then meltdown with prodigous sweating. Called the on-call to get a staff in to relieve me, he was miffed, said I was getting to be unreliable and he couldn't find anyone, so just hang in there. Yeah, right! The rest of the day was pure hell, me sitting on the couch barely conscious and the client I work with throwing tantrums (kicking stuff, throwing objects, etc) because I couldn't take him out (I did try to explain, but no luck). Staggered home at 2300 and spent a very restless, sweaty night, then right back to work at another ISL for 11 hours this time because I had to assure the on-call I'd work Sunday so he wouldn't ask my supervisor to fire me (he tried anyway). Again another hellish day - was cold even OUTSIDE in near 90 degree weather with sweat pants and a black long sleeved shirt, going between nuclear meltdown (one of the more laid back clients said I looked like a giant red Roman candle to him) and freezing purgatory. My tempurature fluctuated between 103 and 104 degrees, possibly even higher. Also constant dry heaves, couldn't and didn't eat a single thing at all from Friday afternoon through Tuesday evening. My blood sugar slid all the way down into the low 70's, probably the lowest it's been in 2 years.

Tuesday morning around 0515 I wake up and instantly I know I have a SERIOUS problem. I can't breathe right. Actually, I couldn't take a deep, full breath. Sat up and was able to take a bigger breath with some difficulty. After brief consideration of the situation (high cardiac risk, no good reason for the fever to go on, etc) I drive to the ER, for the third time in 17 days. ER was about empty, they took my vitals straightaway and after me describing my respiratory distress leads me straight to one of the medical rooms, the one with the heart monitor and all those scary gizmos. Hooked up and damned if my heart isn't gone all crazy. Not those nice 'beep, beep' steady spikes you always see but sheer chicken scratch. Now I'm getting REALLY worried. They did an EKG, chest X-rays, took blood, then the doc ordered a CT scan. During CT scan the nurse practically RUNS into the rooms with a plastic cup FULL of these ENORMOUS blue/white capsules and says "Your potassium is really low.....take these NOW". Turns out my potassium level was just 2.6 (normal ref range 3.5-5.0 per lab printout)! Eventually they ER finds a doc to take my case and I'm admitted, they started me on IV potassium and went back to Levaquin, IV as well.

The hospital stay was pretty straightforward, but LOTS of blood draws! I think they got me 11 or 12 times, 7 or 8 the first day alone. My left elbow is a horrid black and blue mess, got me on the top of the left hand a couple times too after a nurse was forced to give up on the elbow (IV was in the R elbow, the ER nurse mumbled something about the CT protocol requiring it there, true?). My sodium has been constantly below normal (128 to 132) for sometime, too. Blood sugar took off like a rocket soon as I started eating, so had to take insulin along with my PO meds (glipizide, atenolol/chlorthalidone, Lisinopril, Avandamet) to keep it down (it went between 200-350 or so).

The nurses and assistants were all great, very nice and helpful! :) I was lucky that the doc who admitted was a nice guy that was always willing to stay and listen to any of my questions and explain things all the way through, even if I didn't like to hear it. Normally I would have wanted out of hospital just as fast as humanly possible, but the doc said he was concerned if I got out too soon I'd relapse (indeed every day my temp would rise over 100) and I'd be back in hospital. After 3 weeks of ghastly misery in all forms I couldn't agree more. If I had to stay at work for 3 days in agony again I'd find a sword to throw myself upon and be done with it.

Finally got discharged today, I have to take the Levaquin for a MONTH this time ($$$$$$!), also some Vicodin and my usual meds. Need to get hooked up with a clinic and get some help paying for my Rx, espescially the Avandamet (been off that for some time), and schedule a follow up with a (hopefully good) primary care physician that my hospital doc has recommended ASAP to evaluate and set a medication regimen for the long term.

OK, finally to the pain scale epilogue.....

I'm convinced the scale is useless now! See, every time I called the nurse to tell her I needed some pain meds (Narco...Vicodin by another name) she would come and ask what kind of pain, any specifics and oh yes, how would you rate it on a scale of 1 to 10? Well......its better than it was on Tuesday but it still hurts enough I wouldn't have called and asked if I didn't think I could take the pain! Friday night the nurse simply gave me Tylnenol....nope, that didn't help. Still gotta take the heavy stuff. The lab culture ID'd Enteroccocus as the offending bacteria, by the way. Its pretty difficult to eradicate, according to the doc. Eradicate the infection, and you eradicate the pain.....till then my rear end is just gonna be sore :imbar

My .02: be careful assuming that a guy's pain is suddenly gonna improve from Vicodin level to Tynenol level (so to speak) with an active infection. If you try to titrate (and mind you, while I don't think the doc had any such order, I can understand the logic of trying to titrate to a milder, non-narcotic agent perfectly well) and the patient says its not working.......it probably isn't. My Saturday morning nurse was aghast that I hadn't gotten any pain med all night and morning even though I'd requested it several times, apparently there had been some kinda 'breakdown' and who knows, maybe the Friday night nurse had been distracted or something. But she said emphatically if I didn't get a pain med in 15 minutes to call again and complain - loudly (alas, I'm the type that would rather suffer than appear to ***** about something).

I need to go lie down now Your responses, rants and rebukes are welcome as always.

Regards,

Tom

[leslie :-D]

so what was this?

when they originally dx'd you with prostatitis, the infection was so severe that you were beyond po abts?

if i remember correctly, you were started on levaquin on a friday and were admitted on a tuesday? and that's when they started the iv abts?

were you septic or was it contained to the prostate?

i'm trying to understand what happened...it sounds like you should have been admitted on the friday when you were dx'd, or did they give you an antibiotic wasn't susceptible to the invading organism?

i'm glad you're starting to get relief....it sounded like pure hell for you.

leslie

[FZ1Tom]

I posted the original details in an earlier thread, neglected to link to it. Sorry about that. Short version is I went to ER on 8/7 dx pyelonephritis, started Levaquin for 14 days, returned to ER on 8/20 dx acute prostatis, d/c the Levaquin (had 2 doses left) and start Septra, relapsed over the course of the weekend as the infection went systemic (doc's words), returned to ER on Tuesday morning with respiratory distress that turned out to be a result of critically low potassium (2.6, normal 3.5-5.0) which IN TURN was likely a result of extreme fluid loss (>10liters/day or more, just no telling) combined with no food intake whatsoever for 4 days. They admitted me around noon Tuesday, treated me with IV therapy (potassium and Levaquin), released me late today with Rx for Levaquin (this time for a month), Vicodin for pain and my regular blood pressure/diabetic meds as before. That helps, I hope? :chuckle :) :rotfl:

Regards,

Tom

[leslie :-D]

ok, thank you.

so you really had 2 different infections, kidney and prostate.

phew tom. that's a long road back. now i'm even gladder you're feeling better. :chuckle . you were really one sick puppy dog.

just rest, drink and take those meds.

welcome home.

leslie

[jemb]

Glad you're finally on the road to recovery!

[traumaRUs, MSN, APRN]

Poor Tom - please take care of yourself...and unless you have wireless internet and you're lying in bed - you shouldn't be on the computer either - tee hee hee!

[SmilingBluEyes]

I am so sorry for all you went through. It sounds like a hellish nightmare to me!!! Regarding Pain meds ( I am not addressing other interventions such as positioning, heat, visualization here):

I am of the FIRM belief that pain meds MUST be given on routine if a person has pain. I give the Percoset/T-3 every 4 hours, and NSAID (Toradol/Motrin) q6 hours---- without fail to my patients, as if they were routine meds like ABX. If on PCA, I re-educate everyone when I come on as to their intended use and encourage liberal use if there is pain, e.g. do NOT wait til the pain is moderate to severe before using the button.

I tell all my patients the best way to keep pain under control, to keep a steady level of pain meds in the blood. It works so much better and my p-op patients ambulate much sooner, have better appetites, fewer other complaints, and feel much better when medicated on routine, rather than waiting to report pain to me. Unless they refuse the pain meds, they get them on schedule on my shift.

Also, I teach them to continue at home on the pain med schedule for at least a few days til they are back on their feet and feeling good without the meds.

I think a lot of us have been poorly-trained as to how to treat pain and teaching our patients how to deal with it, as well. Pain scale is not without faults and problems, like any human device. One can SEE pain if one pays attention, and yet have a patient tell a nurse "it's a 2"---but look more like an "8". I have had patients report 3 or 4 on pain that appears to be 10, and when I explain more clearly the scale and its intent, often re-report a higher number. So, I think its just a tool in the toolbox to help us assess and treat pain, but only ONE tool among others. We have to be astute and educate our patients well if we are to truly address pain in the way it deserves!!!!

I hope you are on a road to complete recovery and feeling better very soon. I am so sorry for all you endured.

[leslie :-D]

I think a lot of us have been poorly-trained as to how to treat pain and teaching our patients how to deal with it, as well. Pain scale is not without faults and problems, like any human device. One can SEE pain if one pays attention, and yet have a patient tell a nurse "it's a 2"---but look more like an "8". I have had patients report 3 or 4 on pain that appears to be 10, and when I explain more clearly the scale and its intent, often re-report a higher number. So, I think its just a tool in the toolbox to help us assess and treat pain, but only ONE tool among others. We have to be astute and educate our patients well if we are to truly address pain in the way it deserves!!!!

there you go deb. there you go. in a nutshell.

this pain scale is overrated and overused.

a nurse should be utilizing different skills in evaluating someone's pain and tools would be assistive (if need be) but not diagnostic.

thank you for saying it so well.

[Audreyfay]

Glad to hear you're feeling better Tom! Take care.

[RN4NICU, LPN, LVN]

We can thank the Joint Commission for that stupid pain scale. It's something they can look for and check off their list. I agree that it is a ridiculous method of assessing and treating pain. Pain meds are immensely more effective if constant levels are maintained, but most docs were taught that they should only be ordered PRN, because there are still people who believe that patients that are in pain can become addicted to the medication. Nonsense. They NEED the medication. The body heals better when it is not having to cope with high levels of pain. I have seen a few docs starting to order scheduled pain med doses, with a separate PRN order for breakthrough pain. I think that method makes more sense.

Many nurses seem afraid to give narcs for various reasons (especially if surrounded by other nurses who don't give them - they are afraid to be the only person giving narcs at regular intervals, for obvious reasons). The scheduled doses take that out of the equation. Scheduled doses also takes out of the equation nurses that are either not responsive to their patients pain or just too darned lazy to go to the Pyxis -- or whatever -- and take out the narc. There is no excuse for that, by the way, but I'd say most of us have seen it happen, nonetheless.

[nurseygrrl, LPN]

Tom~

So glad to hear you're feeling better. I can imagine how scary and hellish that must have been for you.

About the pain scale...I can't stand it either. I also can't stand docs that think they know how my patient feels. If my patient says they're in pain...they're in PAIN! I hate it when the doc says, 'Oh, well she had that baclofen pump inserted 2 days ago, she shouldn't still be in pain?!' Oh yeah? When is the last time YOU had a baclofen pump inserted....huh jackass?!?! That drives me nuts!

[leslie :-D]

Tom~

I hate it when the doc says, 'Oh, well she had that baclofen pump inserted 2 days ago, she shouldn't still be in pain?!' Oh yeah? When is the last time YOU had a baclofen pump inserted....huh jackass?!?! That drives me nuts!

they have baclofen pumps?????????

and isn't baclofen a centrally acting muscle relaxer?

not the same as an analgesic.....hellloooooooo, knock knock knock anyone home??(knocking on doctor's head)