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Jerked Around By The Va Or Just Bad Luck?

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Vync

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  • Content Curator/HadIt.com Elder

just got home from from the VA Emergency Room for the second time in two days, and wanted to write all of this down while it was still in memory, along with a little bit of history. i'm going in order here of what happened, so i am sorry if this is so long and clumped together, but tonight, i am loaded up on a lot of IV steroids, two morphine shots, 3 breathing treatments, 2 shots of something for nausea, and a lot of albuterol puffs. i had a really crappy last 3 days.

Warning - some of this is really gross. i'm being straight up and honest about how i feel and what i experienced. It was AWFUL!

Day before yesterday

About 10 days ago, VA primary doc raises me to tylenol 4 and some miralax to help control my TMJ pain. i took tylenol 4 only when i was really hurting, but also took the miralax 2x day. after several days of rotating between squirts and agonizing constapation. i walk up to my girlfriend holding my tummy and nearly in tears. explained i took the dump of the millenium. asked he if she would look at it. she works in surgery, so this stuff doesnt phase her. she asked did 'that' come out of you? it was really huge like an orbiting asteroid. toilet paper had only blood on it, no poop. it even stopped of the toilet when she flushed, but she plungered it all down. she hugged me, i took my miralax and then we went to bed.

Yesterday - ER visit #1

i was at the VA hospital visiting a clinic. i felt my tummy telling me to hurry to a toilet. i found a private lockable toilet and it took me almnost 30 agonizing min to take a dump. felt like i was going to die. the heavy straining caused my TMJ pain to shoot through the roof from gritting teeth and lower back discs (previously herniated, currently degenerated) to hurt like utter mad despite getting my 3rd pain block last wednesday (which actually worked). glad i was wearing my tens unit on my lower back or it could have been worse there. pain from straining and everything was so bad that it sent me into a major asthma attack while i was on the toilet. glad they had those hand rails, but only on one side. finally got everything out. i stumbled into the ER and told them i couldnt breathe. they gave me a breathing treatment and hooked my up to an EKG which they said was haywire, like something they never saw before. i told them i had a tens unit and i turned it off, EKG was normal. asked nurse if my girlfriend could be called. also asked them to call my pschologist because she said if i ever experience extreme stress, to call her. this definitely qualified. loving girlfriend leaves work and arrives 40 min later. psychologist never arrives. After few hrs, my breathing stabilized. during the whole visit, my heart rate was from 32 to 90, but 48 is normal for me. my o2 occasionally dipped into the 70's, alarms buzzing. blood pressure was high once, heard the alarm but could not see it on the screen due to glare from the light. lady doc told me to come in and get a nebulizer next day. she gave me a 6 day prednisone taper, colace, and some supposotiories (gross). Was able to drive home slowly. went to girlfriends house because i didnt want to be alone when i slept. Took my tylenol 4 and my colace. she was glad i was with her. I woke up an hour later with a horrible nightmares about some bad experiences i had in the army. took asthma inhaler because i was short on breath. it worked. couple hours later, more horrible nightmares, asthma inhaler, breathing normal again. dozed off briefly then alarm went off. total maybe 2 or 3 hrs sleep.

Today - day from hell - ER visit #2

went to work an hour early. was awake anyway, feel like walking zombie. took my meds on schedule like always. less than two hours later, tmj pain was driving me nuts because i coudlnt concentrate. had minor asthma attack. inhaler took care of it. left and went to vet center. talked to counselor about my pain and problems. first visit, so he said to come back and talk again next week. nice guy. went to primary care doc to get my nebulizer. as i arrived, he had his coat on and said he was leaving, but i managed to talk him into seeing me due to the er visit. everythign was so rushed i felt like he cared more about getting out of there than providing me the care i needed. he ordered me a nebulizer and the liquid to put in it. he said he could not give me pain patches for my tmj, but chronic pain clinic can. got referral. went there because i am in some serious TMJ pain. they said they say the nurse was there about 20 min before i showed up. they said i needed a referral and then the nurse would have to schedule an appointment. i nicely explained i am in some serious chronic pain, worse than ever before, and felt like my head was going to explode. they paged and tried to call the nurse in charge of the clinic several times. 30 min later, she tried again. gave her my cell number, just in case the nurse returned the calls or pages and i went to pharmacy to get nebulizer stuff. went to visit psychologist to talk about the pain and frustration i had been having. i even presented her with a full clinical study showing showing i had classic symptoms of major depressive disorder due to dental problems, in addition to the less impacting adjustment disorder. we talked briefly, but she said she still felt i had an adjustment disorder with chronic mood, but asked me to present the clinical study for review by my regular counselor when i start seeing her next month. she said i very likely could be diagnosed with major depressive disorder due to chronic pain, but it would take several more visits to nail down. she also talked about what happened yesterday at the ER. i told her that i asked the ER staff to call her but she said nobody did. she said she would have came if they would have called her. she also got me a consult to see a psychiatrist today, in addition to my appt next month, because the anxiety/depression meds the primary care doc gave me had seriously unnerving side effects. i don't want to go into details about that here. went to his clinic, got seen an hour later he changed me to buproprion and got rid of a couple of the others. he basically said the primary care docs dont have a clue how to treat people with anxiety or chronic depression. he wants to see how these med changes do until i see him next month. back to pain clinic. they still could not get in touch with the person. i walk around pacing in circles for an hour with my hands on my jaws to try to alleviate the pain. still nothing and they were getting ready to close. i rushed to the travel office window next to the pharmacy. i hate this woman. every time i approach the window, she says i will be with you in just one moment. then she spends a few minutes finishing up some menial administrative task before attending to my request. yesterday, she walked around her office pulling stuff off the laser printer and reading it. today, the was hand writing some addresses on several envelopes. i gave her my id and she said i would have to get MH clinic to print my papers. great. just great. back up to there. the dude printed the papers and i rushed downstairs to collect my $8 and change. back to chronic pain clinic and i kindly the lady asked her to walk back and see if they were there. she checked, but nobody was there. she commented that they normally tell them when they leave, just in case. she apologized. i'm pretty pissed off by now and went to patient rep and she said called pharmcy, who said my primary care doc can write for the patches. told me to go back to primary care clinic and any doc there could review my records and write my pain patch script. i also complained about the rude travel desk nazi. the patient representative just laughed, nodded her head, and said she would address the issue tomorrow. from her reaction, i had a feeling that there have been other complaints. back to primary care clinic. dude at desk said all docs left early and he is only one there and was going to leave momentarily. he said i could call 24 hr nurse line and they would pager my doc who would then call me and call me a script into the pharmacy, which never closes. i did this 3 times in last month with no problem. i called the toll free nurse line. woman on phone was from another area and rude as all hell. she said docs dont call patients just because a patient wants to talk with them. i said yes they do. she said no you are wrong. i said let me explain. she said no you will not explain. my stress level went through the freakin roof! i said just please give me two minutes to explain and you will then understand. she did. i explained i needed my primary care doc paged to call me because i found out that he actually can call in the pain patches to the pharmacy which was still open. she said that primary care docs cannot do that. i explained that my patient representative just talked with the pharmacy and found out he can. she said she could send a messager, but i will not get a response probably until tomorrow morning if he is even working. got off the phone with the devil woman. talked to pharmacy. they said only option left is the ER. great, another wasted day, but my nerves were shot and my TMJ pain was a lot worse. went to release of information office and luckily they were still there. got printout of my ER, psychologist, and psychiatrist visits, but she said my primary care doc didnt note anything in the computer other than the referral to pain clinic and the nebulizer request. went to er. checked in. pain level about a 7, holding hands over side of head to compasate. the triage nurse was super nice and said she understood how i feel because she had two TMJ reconstructive surgeries. she started to tear up a bit by seeing what kind of pain i am in. when i was being triaged by the er nurse, i found out that lost 2 pounds since yesterday morning because i have not been able to eat anything at all today. i just wanted to get pain patches, get out, and eat, but nooooo i am in the ER again. 30 min go by. place is packed. i get up and am pacing back and forth again. sat down. repeat couple of times. the whole time getting madder and more wound up over how the day started of nice then went to crap. while waiting, i decided to read my records from today. checked my GAF score. It was previously 65, 62, but today it was 55 before all this hellstorm occurred. a couple of dudes walked in smelling heavily of cigarettes. few min later, i start wheezing so i move around corner. asthma gets worse. tried to calm it naturally through controlled breathing deal recommended by my psychologist. that crap didnt work. coughing and wheezing got a lot worse, i took my albuterol. no change. most of the wheezing is in the upper and central chest. i think i had a massive panic attack triggered by the hell days i had plus the smoke off the cigarette guys. lucky me. getting dizzy so i know i am screwed so i tell the dude at the desk and they wheelchair me back quickly. just like deja vu again. 2 immediate nebulizer treatments and no change at all in my wheezing or coughing. it took two attempts for the nice nurse to get the iv port inserted. first try failed because i was coughing really bad and she kept missing because i could not remain still, so there was blood all over my arm. that hurt like hell. because of the daily aspirin i take for my heart, i have some nice bruises all over my arm. nice nurse was very apologetic. as a mater of fact, she was probably the best ER nurse i have ever work with me. my doc walks in and lucky me. it's the resident doc who treats me for my allergies each month. what a bit of relief to see someone who kinda knows me. the nurse gave me 130 mg of some steroid. over the next five minutes, my breathing improved quickly but my hands went numb for about 5 min. in between wheezes and coughing he took my recent history info and i explained how my day degraded. he was very attentive. he said he can give me toridol, but i reminded him i am allergic to toridol. doh, he should have checked my records first. i now got to thinking. for some reason, they did not give me an allergy bracelet, only a patient id. but they gave my both yesterday. doc said he could not order a narcotic because he is still a resident, but he would check with his attending. he was also worried about me driving myself, but i asked for my girlfriend to come and also for my psychologist to come. he said he wanted to get some meds in me first, then listened to my chest. nice nurse brings me the phone and i call my girlfriend. orders a chest x ray. i ask again about calling the psychologist, but he said he felt uncomfortable calling a psych doc in unless someone is homicidal or suicidal. i was in so much pain that i didnt have the strength to argue. some dude wheels me into the x-ray room. he helps me stand up against the target wall, tells me to grab the handles in the back. then he swiftly lifts the wall up and it hits me smack in the bottom of my chin. i dropped to my knees instantly, uttering profanity and in tears. i told him that my TMJ pain was the whole reason i was in the ER to start with. he was really apologetic. after a couple of minutes, i i overcame the initial shock of the pain and he helped me up. took x-rays carefully. wheeled back to room, apologized again. i was even more pissed because i came in with pain of a 7 and this dude's carelessness sent it straight to a 9 or 10. hands back on jaws, in tears. knees curled up and i am rocking back and forth. few min later my doc comes in and notices my condition. told him what happened and that i am seriously hurting like hell now. morphine ordered by the attending. i let him know that i only had morphine once after shoulder surgery and it made me nausaated. he requested another shot of somethign starting with a 'z'. nurse gives me both injections, very slowly. 10 min later, my pain gets better, now back to about a 7. breathing finally normal, but i my chest muscles are exhausted. i ask nice nurse if i could get something to eat because i was starving, she brings me couple of ham sandwiches, milk, orange juice and was even kind enough to get some hot sauce i requested. my sweetheart gets the food ready for me and i slowly sip down the orange juice over 20 minutes. it was tough. she gives me a nibble of the sandwich but it hurt so bad to chew it. pain goes back up to a 9 and i eventually just swallow the bite whole. couldnt eat anything else, so i told my honey that she could have it. explained to the doc that i could not eat because it was too painful to chew. doc ordered third breathing treatment. this time, i cant open my teeth wide enough to fit around the mouthpiece. doc said to just put my lips over it, which worked. an hour later, doc wants to release me. told doc i felt like it was a waste being there because the TMJ pain is still a 7, which was where it was when i came in, despite resolving the asthma. he said he could not give me any more pain meds. he tells me to change the way i take the prednisone pills from last night and also says he will get me some lortabs to deal with the pain over next few days. he would write it down in my release instructions he would give to my girlfriend before we leave. i asked what the x-rays showed. he said i did not have pneumonnia, but could have a mile viral bronchitis. 10 min later, nice nurse walks in to discharge and i tell her i think i am going to throw up. she walks out, comes back in shortly and gives me more anti nausea 'z' shot and another morphine shot, both injected slowly. i get all loopy and amost pass out. im sort of coherent after a couple of min, but still hurting. after a while doc comes in to check on me. TMJ pain level at a 4 or 5 now. i honestly did not care about anything at that point. finally ready to be released. i had to pee. nurse brought a plastic bottle and stayed with me because i was loopy and made sure i did not lose my balance. my pee color looked really dark, like tea, not yellow or clear. nurse wheels me the after hours pharmacy to pick up some lortabs. during the visit my heart rate peaked out around 130 or so, but spent most of the time between 90 and 100, o2 never got below 90 despite the coughing and wheezing. blood pressure was actually somewhat low, but only checked twice. gathered my belongings, and got wheelchaired to the car by the nice nurse.

Here's the real catch...

i was so stressed out and zonked out that i realized the doc never even examined or even ordered an x-ray of my jaw, even after the x-ray dude rammed the damn machine into my chin. that was the original reason why i was there to start with. the only thing i got was some morphine and a lot of unnecessary stress. that's just what i needed right now. swell... then i realized i never got given the discharge instructions when i was released. called er and talked to the doc. he apologized for overlooking this. he told me how to take my prednisone and also the lortabs. i wrote them down. repeated them back to make sure i got it right. also, as i finished typing this, he also failed to give me a work excuse for past two days, which he was supposed to write, but i will deal with that tomorrow.

got home. girlfriend makes me a fruit and protein smoothie, because i couldnt chew anything. she really loves me. i am so lucky to have her. i started to get my energy back after i finished the smoothie. my wonderful girlfriend said that the VA ER really sucks. they dont have pillows. plus, they did not even start an IV drip during either visit. i was thirsty as hell tonight. she asked if i could go to her hospital, but i told her i would have to pay 10%, which could be a couple of thousand dollars. she said when we get married, we're switching to her insurance because it covers 100%. very good point. after my experiences over past few days, it might be worth it to go into debt to get really decent care. if it wasnt for the kindness of that one nurse, i probably would have lost my mind.

i'm tired of being jerked around. i am all wired up, frustrated, still kinda shaky, but just plain worn out after the past two days. going to try to go to bed.

thanks to everyone for listening. what should i do now?

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  • HadIt.com Elder

I agree with Pete. If you have insurance look outside the VA for pain management. Your experience is why the VA gets a bad name they deserve. My VA pain management consists entirely of just pushing pills at me, or dumb things that are inaccessable to me. I live only 15 miles from the VAMC, but it takes an hour to get to the hospital because of parking problems. This makes things like PT a joke since it takes up the entire morning or afternoon just to get a treatment. These are just some of the roadblocks to treatment. There are lots of so-called programs available, but because of crowding and no parking it is more trouble than it is worth to take advantage of them. The VA says they want to "own" my medical care. I am not buying that idea because I want to live. I tried for fee base but was denied.

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  • In Memoriam

You sound the same way I did before I found out that I was allergic to Darvon. Allergic reactions to pain meds are common.

The straining and back pain can also be caused by AAA (Abdominal Aortic Aneurysm). The VA waited 4 years to tell me I had one of these. Shortness of Breath, back pain, urinary problems, leg pain, feeling of always being full..in stomach, chess pain, and many symptoms are some of the symptoms.

If you are on Medicare you can get AAA screening. The VA should also do this screening, but the VA won't unless you ask.

I sure hope things get better. If you are allergic to a med, you had better find out which one. Chart your meds and figure out when the pain begins to become worse. Be scientific with your own research.

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  • Content Curator/HadIt.com Elder

Hello everyone,

This is another long reply, but I'm finally feeling less pain and less agitation, but that's because of he medication and finally spending some time away from the VAMC. I would like to personally thank everyone who has responded, offered advice, and PM'd. Also, I would like to wish everyone a

very Merry Christmas. Thanks to my wonderful girlfriend, she has helped me get through a string of horrible experiences and I love her very much.

I'll respond first to everyone who has responded and also fill everyone in on what has happened since my initial post late last night, er, or very early this morning. There is a lot of information here.

Halos2

Thank you for your kind comments. She makes me feel like I am the luckiest man on Earth.

Deltaj

Thank you for your kind comments. I'll explain the lab work and tests I had this morning after all the personal comments. I have atrial afibrulation and have to take digoxin, a potassium horse pill, lisinopril, and simvastatin daily and my cardiologist requires I have quarterly blood tests to check for stuff like that. So far, I have not had many relapses and the only thing ever borderline is my cholesterol. I personally think the very dark urine was most likely caused by dehydration. The only thing I had to eat or drink yesterday was a soft breakfast burrito from McDonalds, a small bottle of Dole 100% strawberry/kiwi juice, and maybe 3 oz of a Minute Maid fruit punch. The ER started an IV port to administer medication, but never started a drip. I'll get into more of this momentarily below. The constipation started only after my doc switched me to Tylenol 4 (60mg of codeine). He gave me some miralax laxative, because I told him the Tylenol 3 (30 mg of codeine) would give me some minor constipation. The mirilax just could not counter the strength of the dosage change. The colace pills they gave me on ER visit #1 have helped and I actually pooped without pain for the first time today.

Wings

Thank you so very much for your kind comments. I am finally feeling some thankful relief. I agree they should have admitted me, but I'll get into more details about it below when I tell everyone about my day. You are correct about the "anniversary reaction". My TMJ was caused in 1994 when the Army took out my wisdom teeth. I have been in near constant pain for the last 15 years, since the surgery happened. The cartilage in the joint is permanently dislodged and they damaged some of the bone. I went through hell to get service connected for it. It is excrutiating when I go to the dentist for an exam or any treatment. I am documenting everything - learned my lesson the hard way.

Pete53

Thanks buddy. You are so correct. They were running a skeleton crew of everyone who had no seniority or drew the short straw. Lots of dumbness going on over there this week. Today, the place was practically deserted. I do have private insurance, but I have to pay 10% of all covered costs. My girlfriend definitely agreees with your suggestion to find 'real' care elsewhere.

Carlie

As always, thank you so very much for your kind comments. I really appreciate your support. Since all the constipation started, my girlfriend said she never heard me use much profanity or be agitated, and we have been dating for a year. I am going to look into the Patients Rights and Responsibilities and go over them very carefully. I feel all they did was focus on just a couple of aspects of my and practically neglected me in multiple ways. I'll get into more about that, the bash on my chin, and contact with my PCP below.

jbasser

Thank you so much for your support and you are correct. I'll get into filing of complaints momentarily. You are correct about the short straws.

john999

Thank you so much for your support and very informative information. You were right about the laxatives in our previous conversations. They make a big difference. I can only imagine how bad things would have been if I did not bring it up to the doc when he upped me to T4's. I am in the same boat as you. The Birmingham VAMC sits right next to the main University of Alabama at Birmingham campus, smack in the middle of town. My appointments typically tie up an hour of travel each way and I live and work both about 25 miles from the place. I think I have used up almost all of my vacation time from work in the last year just going to the VAMC for treatments. They also said they want to 'own' my medical care, smells like BS to me.

Stretch

Thanks pal for your kind comments. In this case I was not allergic to the medication. I'll post my EKG reading momentarily below, as I do have some heart issues. I have been working full-time, but after what happened I doubt I will be able to be 100% for some time. I'll explain it below in a sec. Also, what is an AAA screening? Is it like an allergy test? When the VA does the skin tests, you can read the results from about 20 feet away. I visit the Allergy doc and get shots monthly. I'm allergic to everything outside that's green, but wasn't when I joined the Army. I am SC for it. I also developed allergies to foods, such as peanuts, shrimp, and potatoes.

*bergie*

Hey man, thank you so much. You are right on target with your PM. I agree completely. Thank you so much for your support and being a good friend. I am taking your advice. You don't know how much I appreciate your help.

Ok, now for the meat and potatoes.

3:45am

My girlfriend wakes up because I am not in bed. She starts thinking about a few things. First, she wonders if an incident report was filed about the x-ray tech injury. I let her know that we would have to go to the Release of Info office to get copies of the records. My sweetheart works in surgery at a major hospital and if anything stupid happens, they have to fill out a mile of paperwork. She was frustrated with the fact that she was in concerned relative mode, not medical procedure monitoring mode. She pointed out a lot of lapses in safety and again how crappy the VA is.

7:20am

I managed to get a couple of hours of sleep, but the phone rang and I was instantly wide awake, but still loopy. It was my PCP from the VA. I told him about the whole thing. He said he was surprised at how I was treated and wanted me at the hospital asap to have jaw x-rays regarding possible fracture or damage. I let him know that my TMJ was SC only after an arthragram was performed. He said he wanted regular x-rays, but did not want to step on the toes of the oral surgeons, who he advised I visit too. He also wanted a blood workup because of the dark urine. He said I could have damaged my kidneys or had a tiny kidney stone rupture a vessel. He said 10% of people have that happen and feel no pain at all. He apologized about the pain patch mix up. He talked with the pharmacy chief and found out he can write them, but he has to provide proof the patient has cancer or is on hospice. Not me there. So much for the pain patches. We got dressed and went to the VAMC. I had some more plans too when we got there.

X-Ray

We arrived and went to x-ray first. I told the people what happened and they were very kind and gentle. It took three techs to figure out all the image angles because they don't get too many requests for what the doc ordered.

DAV representative

Next stop was the DAV representative. She said I might have grounds for an 1151, depending on a number of factors. She was in with a patient and asked me to document everything that happened. I just wanted to make her aware of the indicent, so we moved on to our next stop. She's on vacation for about two weeks anyhow.

Patient Representative

We visited the patient representative, who was a very nice lady. This was the same lady I reported about the travel desk nazi woman. I explained everything in about 10 minutes. She told me to write everything down and bring it in first thing on Monday. She was going to get to the bottom of it.

Release of Information office

Release of Information office was next. Got a full printout of the events from both ER visits.

Will get to the meat of those later.

Psychologist

Next stop was to try to get in to see my psychologist because I was having a lot of anxiety. She was off today, but was going to be in on Monday. Instead, another psychologist came out. I'm telling you this straight up. The nazi's have infiltrated the VA. This lady really pissed us off. She said I did not have an appointment and asked if I feeling was suicidal/homicidal. I tell her I wasn't and she just told me I would need to make an appointment to see my regular psych doc on Monday when she returns. I was shocked. I told her I was injured by the ER team and really needed to talk with my doc about the traumatic events. She refused and said there is no way to contact her. I asked her if I was going to be able to get any treatment at all and she said no. I looked at my girlfriend and said "This is bullsh*t! This sucks!" The woman just stared blankly at me. Please note that all of this is happening in the public patient waiting area. I ask her if we could talk for a few minutes in a more private area, then she finally agrees. We go back and I tell her I was neglected and injured by the ER team, going through the events in detail and was getting wound up. She was just looking at the computer the whole time I was talking. She just butts in, raises her hand and point one finger in the air and says that she has heard enough. She said I was going into too much detail and just re-living the incident and said it was causing me more anxiety. My girlfriend and I looked at each other and realized she was right about the this working me up. My girlfriend told her what I experienced was pretty awful and that she would try to help me relax. The psych doc told me I needed to go home, eat some food, take my medication, get some rest, and try to relax. Basically she kicked us out at that point. My girlfriend noticed that the lady had some novel out on her desk and we both felt that she was more interested in getting rid of patients so she could lock herself in her office and read her book. As soon as we got around the corner, I took a deep breath and said I hate that woman. My girlfriend agreed. I am not going to repeat what she said. Because I went to the bathroom right after I woke up, we decided to postpone the lab visit for a bit. They might need urine from me.

Dental oral surgery clinic

We went to the dental oral surgery clinic. The attendant paged the person who was on duty and it took him about 30 minutes to arrive. While waiting, we start looking through the ER records. I am only posting the relavant parts.

ER visit #1

Intake info: 38 yo WM with asthma presents with SOB. Pt coughing for several days, but SOB didn't start until pt strained to have a BM earlier this morning. After the BM, pt also reported exacerbation of his TMJ pain as well as "pain all over" He is requesting pain medication. He reports good adherance to asthma meds, denies hospitalization or mechanical ventilation for asthma.

*** During breaths, I let her know my TMJ pain was a 7, I had a pain block in my lower back last wednesday which pretty much got rid of most of my pain, but now it too is up to about a 6, my abdomen was hurting from the straining, and my rectum was really hurting, told her about the bleeding after the constipation. ***

EKG: LAE, otherwise WNL. Possible L atrial enlargement.

A/P: Possible mild asthma exacerpation, depression and chronic pain likely contributing to overall clinical picture. Will give neb here and plan to discharge home later on PO steroid taper if pt does well. Pt very concerned about getting pain meds, but I informed him that I will not be prescribing pain meds here in the ER, especially since pt drove himself here and does not have a ride. Pt already took his naproxen this morning.

*** The asthma attack was not mild. It was the worst one I had in over a year and I told her. ***

Treatment prior to arrival: None

*** This is a lie. I told her I took my albuterol inhaler twice after the attack started, which gave me enough air to make it to the ER ***

PAIN (location): Chronic pain in jaw, back, and legs. Rectal pain after hard BM.

BREATH SOUNDS: Wheezing L and R

GASTROINTESTINAL: Present bowel sounds, Soft.

*** Constipation was an option in the list, but not checked ***

Gas Exchange, due to SOB

Comfort level, alteration in: Due to rectal discomfort and chronic jaw, back and leg pains. Rx prednisone taper for a presumed mild asthma exacerbation. Pt will continue chronic meds as well for asthma. Colace BID to assist with frequent constipation in pt on chronic narcotics. Rx dulcolax suppositories. Pt offered 650 mg of tylenol PO, but pt refused because he states that he took 1000 mg of tylenol earlier this am. Pt will take one of his prn Tylenol #4 after he drives home. Follow up with PCP in January.

Here's my take

- The doc did not examine my TMJ, rectum, or back. All she did was get my breathing in order and sent me out the door.

- My legs hurt too because of the straining. This was the worst dump I ever took.

- My girlfriend told me about people coming in for surgery because of torn rectums, intestinal problems or other GI problems related to constipation. I could have had internal bleeding too.

- My TMJ pain was awful. I let her know I gritted my teeth the entire time during the BM, which caused my TMJ pain. My jaw could have been dislocated. Who knows?

- I received my third lumbar epidural pain block last wednesday. That brought my pain down to about a very satisfying 2. After all the straining, I was up to a 6 or more. I let her know I had DDD and previously herniated discs, but she never took a look at my back.

ER visit #2

CC: SOB, TMJ pain

HPI: 38 yo WM with asthma who presents for SOB. Pt seen yesterday in ER for similar complaints. He reports coughing for several days and SOB starting yesterday. He received A/A neb which improved his syptoms and was discharged with a prednisone taper. He reports good adherence to asthma meds. He denites hospitalization or mechanical ventilation for asthma. Pt notes a drop in peak flow from 550 (best ever) to 400. Also, pt has TMJ with chronic pain for which he takes T4 and flexeril in recent past and sees MH to help cope with the pain, with pain clinic referral.

O/W pt notes some constipation, nausea, and back pain

PMHx: asthma, depression, chronic back pain, TMJ syndrome, allergic rhinitis, GERD

EARS, NOSE, MOUTH AND THROAT: OP clear, with pain to palpation bilaterally over TMJ.

*** I do not remember him ever examining my jaw. He might have briefly, but I honestly do not remember ***

RESPIRATORY: Course expiratory wheeze bilateral

CARDIOVASCULAR: Fast, regular rhythm

GASTROINTESTINAL (ABDOMEN): soft NT, +BS

NEUROLOGIC: A&O x4, MAEW

PSYCHIATRIC: Anxious

DIAGNOSIS IMPRESSIONS:

Asthma exacerbation, pt reflects some anxiety exacerpating symptoms. Possibly a viral trigger.

*** I told the doc everything started due to the constipation ***

TMJ pain with acute worsening.

PLAN: Will treat with IV sulomedrol 125 mg x 1 and Albuterol nebs and CXR. Will give morphine x 1

zofran x1.

Re-eval:

pt breathing more easily

CXR: Lung fields are clear and heart border appears NL.

** after two breathing treatments, the steroid IV actually did the job, but my TMJ pain was still there, despite the first morphine **

Dispo: Home, will contine prednisone taper modified 30 mg x 2 days, 20 mg x 2 days, then 10 mg daily until gone. Albuterol nebs and singulair and mometasone. pt given 3 days of lortab PRM and will f/u with PCP and dental surgery. O/W will continue naproxen at home. Hold T4 while using lortab.

Nurse note

PAIN SCALE: 10 - worst imaginable (LOCATION)

*** this was after the dude hit me with the x-ray target, 'location' info was missing from report **

RADIOLOGICAL REPORT: Chest PA and lateral

Lungs are clear excepting minimal right basilar atelactasis. The cardiac silhoutte is within normal limits. No pneumothorax is seen.

*** X-ray was taken after I was given the IV steroid. This was from the radiologist only. I looked up basilar atelactasis and it means that the lung does not fully expand with many reasons, some serious. A frequent cause for atelectasis is not taking deep breaths, often due to pain in the chest or abdomen, such as commonly occurs after surgery. Other things that can cause atelectasis include blockage of the windpipe (for example, from a foreign body or tumor), previous scarring from pneumonia, and blood clots. ***

Here's my take

- TMJ pain was a 7 when I initially arrived, no other problems until my asthma attack. I was requesting some pain patches (after getting jerked around all day, today I found out it was a futile effort)

- They did a good job treating my asthma, except the x-ray incident, but it took a hell of a lot more to get it under control this time.

- No incident report about being hit with the x-ray target was ever noted, despite telling my nurse and doctor. The doctor told me he would go talk with the x-ray tech about it.

- TMJ pain was a 10 after being hit with the x-ray target.

- Before starting the third nebulizer treatment, I told the doc I could not put the nebulizer mouthpiece past my teeth because of being hit with the x-ray target. Doc told me just to close my lips around it. This was not noted either.

- Like the previous day, the doc failed to thoroughly examine my TMJ. I would have expected them to at least examine me or do some imaging because it might have dislocated or fractured something. He just gave a second round of IV morphine and after that the pain was low and I pretty much didn't care any more.

Oral Surgeon

The Oral Surgeon finally shows up. His eyes were bloodshot and he apologized for taking so long because he just finished a 40 hour shift. He reviewed my records and history very thoroughly. I got a panorex done. He did a full exam (quite painful, despite him trying to be gentle with me) and noted max incisor opening of about 18 mm. I could not move my jaw left or right, or forward or backward at very much at all. Don't know the measurements on those axis', will get records on Monday. He did note that I said the pain was exacerbated because I was hit with the x-ray target in the ER. He said that he did not think any permanent damage was done, but we will know more depending on how I progress over the next couple of weeks. No DDD of the TMJ joints, noted TMJ bilaterally. Rx 800 mg motrin 3x per day. He said I could take the naproxen too, but feels motrin provides better pain relief for people with TMJ. We changed from flexeril to baclofen (thanks to *bergie*'s recommendation the other day) and I feel a big difference of not being drunk. Doc put me on liquid/soft diet for six weeks. He said that depression and anxiety are common for people with TMJ, because it wears you down. He recommended I go to the chronic pain clinic on Monday too. Will get his records on Monday when I go back to the VA.

We left

Had to get out of that place. We get some soft food and I took my meds. Anxiety is replaced with frustration, but I still have some serious TMJ pain. Went by Wal-mart to purchase soups, fruit for smoothies, juices, and pudding. Time to blend.

What about work?

I'm worried about the fact that I practically missed three days of work, which will eat up my remaining time off. I am salaried, not hourly, and can go 40 paid time off hours into the hole if needed. I notice that if I do anything to move my jaw (eat, talk, etc...) the pain level increases. I have to talk on the phone all day with clients and remain upright at a computer. Just writing this response required several hours and numerous trips to lay down. What should I do about work coming up for next week? I know I have to tell my boss what happened (he was on vacation this week), but I honestly don't think I will be able to talk on the phone all day and concentrate well enough to perform my work. I heard that if you have surgery for an SC condition, you can draw 100% temporarily. None of the docs ever gave me any 'take X days off work' note. I never even received any written discharge instructions. I didn't think about asking the oral surgery guy about taking time off to heal or asking for a doc note. What should I do?

1155/malpractice

I like Carlie's recommendation to track down the x-ray tech, nurse, and doc to get it noted. I know that I have to file a report with the patient representative. But there are so many important details omitted. I don't know what an 1155 means. If I am not 'permanently' harmed, is there any real recourse because of the injury and almost complete lack of treatment for secondary (or primary) complaints? Can someone please tell me how this works and what it means in my situation.

Psychologist

I plan to go back to see the psychologist regarding the entire ER visit #2 episode and the fact that the psychologist I saw today acted like she could care less. The lady I normally see is very receptive. Is this a good idea?

Heart Issue

The EKG noted possible L atrial enlargement. This makes me worry about my atrial afib and hypertension problems. Should I go see my cardiologist on Monday? Could this have been a result of all the straining right before I went to ER visit #1?

Anything else?

Is there anything else I am overlooking? Does my plan seem sound? I want to make sure I leave no stone unturned, which is why I am thoroughly documenting everything.

Well, time to sign off and try to get some much needed rest. I will probably come up with more questions very soon. I truly appreciate everyone's advice and comments. I am going to try to have a good Christmas, or make the most of it.

Thanks

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  • In Memoriam

Vync,

Please look at all these pages on Aneurysm's. Symptoms are for both abdominal and thoratic aneurysm. SOB, back and chess pain are the most common symptoms.

This is the symptoms page. You can go back to page one for the intro, but page three will get your attention:

http://www.emedicinehealth.com/aortic_aneurysm/page3_em.htm

This one link second (this link has picture of AAA):

http://www.medterms.com/script/main/art.asp?articlekey=6750

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