Earlier this week I had a patient that apparently comes into the ED frequently always with abd pain, they can never find anything wrong with him. He must have thought I was an easy target because I have never seen him before. (I only started on the unit in August) Chief complaint? Constipation x 2 days. Takes multiple narcotics, hx of abuse, ect. He is complaining that he has 10/10 pain, as he is sitting up calmly, and is asking for pain meds. I went to the doc and was like, this guy claims 10/10 pain, but look at him. So he goes and does the abd exam with no tenderness on palpation. I had 9 patients that night (some of them really sick) and his wife was harrassing me every minute for something, I was like (in front of the patient too) I have a lot of patients, many sicker than him, that I need to attend to right now, I cant get a pill/give him dilaudid/get him another blanket. The nice lady in bed 2 is about to be intubated and she needs my attention right now. Give me a minute please. He starts saying to me that he is very sick and dying and that I need to focus my attention to him mainly. Than he tells me that I need to order Klonopin for him NOW because he takes it at home and he missed his dose and if he doesnt take now it its "very dangerous". (The doc was getting the d/c papers as we were speaking). He than becomes mad when he finds out he was being d/c'd, he "demanded" to be admitted. Sorry, but a clear CT and x-ray is not going to buy you a day or two free drug stay!
Thank you all for listening to my vent!! I love this site, I can vent about this and you all have been there done that and understand!
You are SO right. I just read in the paper that the DEA is starting to invesitgate how doctors prescribe narcotics, and legitimate patients who NEED these drugs are being shorted because their doctors are so paranoid about prescribing them. I know that one place where I did a clinical won't take a chronic pain patient because of the risk of liability. What are people going to do? :angryfire
Well apparently, take a truck load of NSAIDS and grin and bear the side effects. At least that's my experience but I've already mentioned it in a different thread altogether!
Oh, by the way, I had a patient that signed out ama last night because the doctor would not order demerol instead of percocet because percocet does not help her...did not even try it
Sounds like a drug seeker, but again EVERYONE is different. I used to get horrible, labour-like cramps with my period, have diarrhea, N&V. Before they FINALLY got me onto NSAID's like Ponstan and naprosyn, they tried me on Percocet and Percodan. Turns out my body can't metabolize hydrocodone very well. The stuff takes hours to kick in, then leaves me stoned and barely able to function for the next DAY. I'm fine with ordinary codeine, though. Just the way MY body works. I eventually took my bottles of Percocet and Percodan and flushed them down the toilet. Once the doctor prescribed Ponstan (Mefamic acid) for me, I didn't need them! All those years of pain were a thing of the past!
Remember all the useless stuff they used to do for menstrual cramps? Like VALIUM, for pete's sake??!!! I used to think some awful things about gynecologists... wish they (especially the males) could experience what I was experiencing, and have a doctor say, "Here, try a valium...it's all in your head!" :angryfire :angryfire Yeah, tell me that next time I've got my head in the toilet bowl, puking my guts out!
Specializes in LTC, CPR instructor, First aid instructor..
I'm with you Jay jay. I have resorted to taking my 2mg of Dilaudid with 800mg of NSAIDS when my pain gets real bad. I have reached the end of my seeking relief rope. I was in so much pain three nights ago from the flu bug I think. It even felt like my hair hurt. I had a fever, and was all plugged up with congestion and had IBS and stomach pains. I then decided that I was going to take matters into my own hands since I was treated and released from the ER earlier the same day with a band aid treatment.
I took my Dilaudid followed by 800mg Ibuprofen, and when I began to cough I drank the cough medicine straight from the bottle. It knocked me out. I unfortunately had to resort to doing that same thing three times during the night. By morning I began to itch, so I decided to take 200mg Atarax accompanied by 50mg of Benadryl. I slept on and off for the next three days. And I'm now happy to say, "I'm still here, and the pain is gone."
Specializes in LTC, CPR instructor, First aid instructor..
My mother was and my brother is a DRUG ADDICT. An issue we have dealt with for many many years, and is why I DO know the difference between a drug abuser and a person who has legitimate pain. I being ONE OF THE LATTER! Now, just to get things straight, I am highly ANTI DRUG ABUSE! And for any person in legitimate pain who is NOT a drug abuser, DOES NOT NEED to be LABLED as one! ENOUGH SAID!!!!! :angryfire
BTW, I take sooo many NSAIDS, I'm starting to worry about my kidneys. We've had more than one pt in our dialysis unit due to over-use of NSAIDS. Same when I worked hospice- yes- we actually had a pt in the hospice who was ESRD due to over-use of NSAIDs. Once he was in hospice, his pain was finally properly treated, and he was no longer treated as a drug-seeker. His original problem was fibromyalgia.
He was unable to dialyze. I can't remeber why- this was years ago.
I guess this shows that fibromyalgia can be indirectly fatal.
Specializes in LTC, CPR instructor, First aid instructor..
I too am well acquainted with NSAIDS. I had a 50 centimeter tear in my right rotator cuff. It happened while I was in nursing school while transfering a patient from a stretcher to a bed. I would have loved to have been able to be on the pulling side where there's much less chance of injury, but the staff quickly moved to that side first, leaving me on the side where I pushed. I felt it give, then I felt the pain. I reported it to my nursing instructor, asking if I should fill out an incident report. She told me incident reports were only for the staff. She also told me she gets the same type of pain. The following morning when I arrived in the ER for another day, I reported the incident to one of the nurses, and she just gave me a blank look.
So, I went to school and to clinicals every single day from March 16th to June 9th in pain. How did I manage to do it? Why, handfulls of NSAIDS. I had no job, no income, and was living on the money I received for the sale of my mobile home. I took so many of them I would get sick to my stomach every single day. But I received a perfect attendance certificate at graduation.
After that, while applying for work, I took some Niacin, because I had learned it was the vitamin of choice for treating hypercholesterol which I had, trying to keep myself healthy for the work force. Instead of doing what it was supposed to do, it built up in my liver, and I had an anaphylactoid reaction to it. I was then hospitalized even though I had no insurance. To make a long story short, I soon began to stutter, and was diagnosed with a chemically induced CVA.
I was then forced to apply for public assistance, because I had a high hospital bill, and no way to pay it. Now being disabled, I decided to get the rotator cuff repaired. When I went to the Ortho office, the doctor noticed multiple muscoskletal injuries and ailments. I first had a left knee arthroscopy, followed by several cortisone injections in my rotator cuff. After the injections were proven to be ineffective, I was assigned to another Ortho physician. He performed an open right rotator cuff repair. I now have a four inch long scar to prove it.
When all the treatments still did NOT take all my pain away, I was assigned to a Neurosugreon. The cervical MRI revealed severe osteoarthritis in vertabrae c-5 through T-1 with total collapse of c-5 through c-6. with multiple spurs on the left side, and spinal cord impingement. That was in 1999. I have not had a lamininectomy, because the day I was to be interviewed by the surgeon, I was hospitalized with a pulmonary embolism struggling to breathe. Then a nurse decided to place a pair of netting panties on me which rolled up into my groin, and pinched my nerve. I do NOT blame the nurse. She was caring for me with good will.
During the same hospitalization, I had a reaction to the Solu-Medrol. It gave me Steroid induced myopathy which eventually gave me footdrop in my right foot.
Since then I have also been diagnosed with chronic asthmatic bronchitis and have been declared ineligable for surgery. NOW, you see why I say just NSAIDS and aspirin do NOT alleviate the pain?
And Tom, as well as all the rest of you nurses who appear to be biased when it comes to pain relief, my pain is NOT from DRUG ABUSE, it's from my multiple ailments. And I too get up each and every day with pain. Do I run for the Dilaudid or other pain relievers first thing? ABSOLUTELY NOT! It is only when I get the horrible breakthrough pain that so often haunts me that I go for the Dilaudid and the NSAIDS.
I too am well acquainted with NSAIDS. I had a 50 centimeter tear in my right rotator cuff. It happened while I was in nursing school while transfering a patient from a stretcher to a bed. I would have loved to have been able to be on the pulling side where there's much less chance of injury, but the staff quickly moved to that side first, leaving me on the side where I pushed. I felt it give, then I felt the pain. I reported it to my nursing instructor, asking if I should fill out an incident report. She told me incident reports were only for the staff. She also told me she gets the same type of pain. The following morning when I arrived in the ER for another day, I reported the incident to one of the nurses, and she just gave me a blank look.
So, I went to school and to clinicals every single day from March 16th to June 9th in pain. How did I manage to do it? Why, handfulls of NSAIDS. I had no job, no income, and was living on the money I received for the sale of my mobile home. I took so many of them I would get sick to my stomach every single day. But I received a perfect attendance certificate at graduation.
After that, while applying for work, I took some Niacin, because I had learned it was the vitamin of choice for treating hypercholesterol which I had, trying to keep myself healthy for the work force. Instead of doing what it was supposed to do, it built up in my liver, and I had an anaphylactoid reaction to it. I was then hospitalized even though I had no insurance. To make a long story short, I soon began to stutter, and was diagnosed with a chemically induced CVA.
I was then forced to apply for public assistance, because I had a high hospital bill, and no way to pay it. Now being disabled, I decided to get the rotator cuff repaired. When I went to the Ortho office, the doctor noticed multiple muscoskletal injuries and ailments. I first had a left knee arthroscopy, followed by several cortisone injections in my rotator cuff. After the injections were proven to be ineffective, I was assigned to another Ortho physician. He performed an open right rotator cuff repair. I now have a four inch long scar to prove it.
When all the treatments still did NOT take all my pain away, I was assigned to a Neurosugreon. The cervical MRI revealed severe osteoarthritis in vertabrae c-5 through T-1 with total collapse of c-5 through c-6. with multiple spurs on the left side, and spinal cord impingement. That was in 1999. I have not had a lamininectomy, because the day I was to be interviewed by the surgeon, I was hospitalized with a pulmonary embolism struggling to breathe. Then a nurse decided to place a pair of netting panties on me which rolled up into my groin, and pinched my nerve. I do NOT blame the nurse. She was caring for me with good will.
During the same hospitalization, I had a reaction to the Solu-Medrol. It gave me Steroid induced myopathy which eventually gave me footdrop in my right foot.
Since then I have also been diagnosed with chronic asthmatic bronchitis and have been declared ineligable for surgery. NOW, you see why I say just NSAIDS and aspirin do NOT alleviate the pain?
And Tom, as well as all the rest of you nurses who appear to be biased when it comes to pain relief, my pain is NOT from DRUG ABUSE, it's from my multiple ailments. And I too get up each and every day with pain. Do I run for the Dilaudid or other pain relievers first thing? ABSOLUTELY NOT! It is only when I get the horrible breakthrough pain that so often haunts me that I go for the Dilaudid and the NSAIDS.
Fran...as I said earlier...I don't think anyone is referring to you or others who are truly in pain.
The reference is to those who are in 3 or 4 times a week...EVERY week...of EVERY month...they are in the ED more than me...and I work a lot!
They are the ones who we are MIS-treating...not treating appropriately.
Are there people truly in pain who are labelled a "seeker"?
Probably.
Are there people who are truly having an MI & thought to be having gas? Probably.
Are there people diagnosed with gastritis truly having appendicitis?
Probably.
It is an imperfect world we live in and we do the best we can.
z's playa
2,056 Posts
Well apparently, take a truck load of NSAIDS and grin and bear the side effects.
At least that's my experience but I've already mentioned it in a different thread altogether!