OneohOne

I have songs and poems memorized that have pleasing cadences and alliteration, and when sounds get to me, I run over them in my head. Sometimes out loud, but quietly. It's like a mental coping soundtrack.

I just learned that epi can cause sudden drops on potassium that can cause motor issues and paralysis. Not common but something to store in the back of my mind. Made me think of how often the (usually asthmatic and female) patient with "anxiety" is suddenly "hypokalemic with chest pain" when the labs come back, and then the doctor jumps to the EKG we should have just done when she came in complaining about chest pain. I wish we could get a CBC w Diff and Electrolyte panel on EVERYONE who comes in our doors.

That happened to me for years until I started breaking out in giant welts. Took me a while to make the connection. Either way, why would you want to take a pain medication that puts you in pain? I think we're all way too Tylenol-happy, and I wish people would consider aspirin more often. I think most people think of it a a heart drug and don't know that it's also a good painkiller at the right dose, and is less likely to mess you up than other NSAIDs unless you're allergic. Tylenol is hailed as this great analgesic that doesn't interact with most medications, but the cost is that it will trash your liver over time. I wonder how many of these people who have issues with tylenol are poor metabolizers for CYP450? If there are a bunch of allergies/"allergies" listed from this chart, I'd be more likely to think there's something metabolic rather than something psychological going on.

As far as I'm concerned, if a patient says it's an allergy, it's an allergy. I'm totally aware that my allergy chart makes me look like a psychotic addict, and it's absolutely impacted my care before to the point of not getting an IV during an actual anaphylactic attack (speaking of allergies!) because a nurse decided that I must be a druggie because I'm allergic to tylenol and have a history of GI bleeding, so no NSAIDs. That wasn't even what I was having a reaction to; they were clearly afraid I was going to AMA and shoot up, but I was in no shape to be standing up, let alone walking out. Everything was PO, no fluids. By the time they had to get a needle into me because I wasn't stabilizing they had to call the flight nurse because my veins were blowing left and right. So while I get it, and it's a PITA when someone says they're allergic to... the #1 life saving allergy medication, it's not about me, and given my experience I tend to believe patients on other medication allergies. If they want to pay more for non-generic, I really don't care, that's their money and not mine. I do educate on Epi, because it's a life saving medication I love pretty dearly. I tell them "someone very close to me" has to carry an epi pen everywhere for allergies, and it's saved "his" life several times, and usually they "suddenly remember" that they're not "allergic in that way". No skin off my back. As for hydromorphone? It does have a low bioavailability through oral route and I have to bite my tongue every time someone goes "guess what H13 wants IV?" because really, we use these meds and have no place getting snobby at people who observed something super basic about how a drug works. If you're a patient and insist it works better than morphine, and your history in the Rx database isn't sketchy, then we start with a small dose so you don't hurt as much and don't stop breathing on me. Either that or we see if we can co-administer benadryl with the morphine. I can totally understand why someone might think morphine itching is an actual allergy. That's how we want them to be thinking. If the Rx database is a red flag, I tell them that we're going to take care of their pain, but before we do that we need to know what they've taken today so we don't make them sick, because we can see they've picked up 6 different narcotics in the last month. If you assure them that you're going to take care of their pain, they open up. If they're just non-compliant with a pain management regimen and don't understand that a painkiller =/= a cure, and that jumping from one painkiller to another isn't going to make anything better, I explain that while we can control the pain in here, they deserve to not be in pain when they leave and that they have to take their medication as prescribed for that to happen, which pain medication worked best when they took it so we can start it here and then you can take it as prescribed when you get home. If they "lost all the prescriptions", then I just say "We're going to get your pain under control, but would you like information on where to get help for any issues you've been having with these medications when you leave?" If they're an addict, they need referrals to treatment. Addicts can actually be in real pain, and I've seen too many people with poor pain control turn into addicts out of desperation... and lots of people with either too many specialists who aren't communicating or who are just idiots making their patients look like/turning them into addicts. My job isn't decide if you're an addict or if your allergies are real or not. It's to stabilize your condition, control your pain, and make sure you don't end up back in the ER, but also to treat you like a person and make sure you come back to us if you do need us. I can tell you flat out that I will never, ever go to the ER that treated me terribly until I went back into shock. I could have died because I got pegged as an addict when really, I'm just legitimately allergic to tylenol and have a history of ulcers. That turned into a soap box really quick.