nicki2

What type of things did they bill you for?

So who are you currently with?

boy do i know what you mean!! i have been reluctant to tell others i have fm. when i was first diagnosed, i did not believe it. i went to another doctor and then to the university of fl's rheumatology department. i never mentioned fm and low and behold...that is what they said. when i brought my results back to a new neurologist...he said he did not believe it and would have to reexamine me....guess what...he too said i had fm....thought i was one of a few that truly had it. and was surprised i was not a depressed fm patient. one can get depressed with it considering all the pain and other symptoms. the migraines, ibs, photosensitivity, aching like you have the flu all the time, bruising so easily, dizziness with balance issues, fatigue, numbness, ....i could go on and on...but who cares....not many of the er nurses on this thread.

i know my fm is much worse with not enough rest. until i had my restless leg syndrome diagnosed and treated (take mirapex) i was up until 3-4 am every night...i almost had to quit work. rls goes hand in hand with fm. the lack of sleep from rls can contribute to the increase in the fm symptoms.

FM is not a new illness. Fibromyalgia has existed for decades, however doctors have only recently begun to understand and diagnose the condition. Since the early 1800's physicians have recognized and written about a condition involving pain, stiffness, and disturbed sleep calling it muscular rheumatism. In 1904 a doctor introduced the term 'fibrositis' into the medical lexicon to indicate the sore spots found in patients with muscular rheumatism. Finally, in 1987, Don L. Goldenberg, M.D. reported on the symptoms and treatment in 118 patients described as having fibromyalgia. The diagnostic criteria for classifying fibromyalgia were finally established in 1990 by the American College of Rheumatology. Recently more and more information concerning the central nervous system and its connection to fibromyalgia syndrome and chronic fatigue syndrome has been emerging. There seems to be for some patients a relationship between FM and Chiari malformation. Additionally, FM was 13 times more frequent following neck injury than following lower extremity injury. Physicians from the Chicago Institute of Neurosurgery believe from their findings that patients with FM have quantifiable neurological deficits. Peter Rowe, MD, John Hopkins, wrote, "Recent studies have identified a strong association between chronic fatigue syndrome and several related syndromes of orthostatic intolerance, the most notable of which is neurally mediated hypotension. Because chronic fatigue is an extremely common symptom in those with fibromyalgia, we sought to determine whether abnormalities in response to upright tilt table testing would be evident in those satisfying the ACR criteria for diagnosis of fibromyalgia....These results identify a strong association between fibromyalgia and neurally mediated hypotension." And lastly, regarding how many of you think the pain is not real: Per Ron Kramis, Ph.D., R.S. Dow Neurological Sciences "Central sensitization, defective central inhibitory mechanisms, and/or central deafferentation can produce hyperexcitability of pain-related nociceptive spinal neurons. This hyperexcitability can provide a neuronal basis for pathologically persistent pain. It is often not recognized, however, that sensitized, disinhibited or deafferented central neurons can be drive to "painful" levels of activity by input from non-nociceptive afferents...i.e., from afferents which normally mediate only non-painful sensations associated with light touch, normally innocuous deep pressure, normal movements, and normally innocuous warmth or coolness. This type of pain, i.e., "non-nociceptive pain," can be as severe as nociceptive pain and often may be more distressing due to its apparently inexplicable origin. Unfortunately, because it is mediated at least partly by physiological mechanisms which differ from those that mediate nociceptive pain, non-nociceptive pain is often unresponsive to interventions effective in relation to nociceptive pain. Considerable evidence suggests that fibromyalgia may be one form of persistent "non-nociceptive" pain." If you are going to be in the medical profession and treat patients, then you should be informed. Yes there are patients that will "pretend" to have a number of illnesses in order to receive either drugs or attention....but just because you do not understand an illness, does not make it real.

i have been diagnosed with fm for over 10 years. a. i am not a hypochondriac b. i am not depressed...i am very happy c. i do not take any pain meds. i have learned to deal with my pain. it is not the same as simple aches and pains...i wish that was all it was...but if one sits and stays in bed, wallows in self-pity...then yes they will feel greater pain and be depressed. to those of you that have fm, i say, "get out of bed and off the couch and go to work!" it may hurt like heck, but you will feel worse if you do not move. in addition, "stay off the sleeping meds and narcotics!" so silybo...there are some of us with fm that have never visited an er for pain control for fm and do not plan to do so in the future. do not lump all of into the same basket. it is a real shame to read how so many nurses have lost their compassion, because of a few frequent fliers.

traumaRUs: Do you find assisting patients with what other resources are available has decreased the abuse of your ER? Have you been helping your uninsured patients find alternatives for care in the future?

I just moved. I am concerned over the Emergency Room Triage process here. Written into the process is the patient's first contact is the registration clerk. The clerks have received a policy that states: "Patients are registered in the order in which they arrive, except when the patient states or the registration clerk views the patient experiencing any of the following symptoms: Chest pain, jaw pain, arm pain Shortness of breath Altered state of consciousness Motor vehicle accidents Pregnant with bleeding, cramping, Pain Altered state of consciousness Headache High temperature with change in usual behavior Allergic or diabetic reactions Paralysis Gunshot or stab wound Behavior health issues or aggressive or violent behavior Any other condition causing concern The triage/ED RN will be notified immediately by the registration staff when a patient presents with any of the above symptoms. It is the triage/ED RN's responsibility to then determine if the patient needs to receive urgent care prior to registration." END OF POLICY EXCERPT If the triage RN is occupied with a patient, and another patient arrives that does not have one of the above symptoms, the registration clerk is to go ahead and register that patient. The patient has a seat and when they are finished with the current patient, the RN looks at the paperwork completed by the clerk, reviews the symptoms and determines who to take next. I understand that EMTALA now allows the registration process to proceed if it is not delaying the medical screening. However, I have great concern over who is to determine it is okay to go ahead with this registration piece. For example, how is a registration clerk to know what is a diabetic reaction? I am new and from a larger facility that had a tech assisting the RN out front making these decisions, not the clerk. I was hired to work Triage and this makes me nervous. My questions are: Is there a regulation preventing the registration staff from having this responsibility? Is there a regulation that states specifically who should have the initial patient contact? If so, where can I find this, so that I can present this to my supervisor? When I briefly mentioned my concern, I was told having the tech out front would be considered the tech was triaging and be an EMTALA violation....wouldn't a clerk doing this be more of a violation? HELP!! Thank you for taking the time to direct and assist me.