pain control admissions

[theseeker4]

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I didn't miss anything. I read all your comments. I took myself off pain medications. In hopes it would help things long term. I use oils, I've changed my diet and entire life. And still, during a flare, IV pain meds PLUS, fluids and anti nausea meds are the quickest and most effective in getting a flare to stop. Did you all ask or just judge?! You are all so damn judgmental you seriously can't see past yourself. Just judge judge judge. I really wish you all could get a chronic illness for a few years. Have your lives flipped upside down and be treated the way you doctors treat us. Would be a real eye opener. Good luck "doctor".

While I understand the desire to push blame for everything onto someone else, that doesn't make it someone else's fault. I am sorry you are miserable, but you probably should look in a mirror more, rather than blaming the greedy, heartless doctors who give up large portions of their lives for the opportunity to treat people who really need our help. Maybe, just maybe, our lack of respect for a demanding, judgemental, ignorant patient with a personality disorder and an extreme sense of entitlement is justified. I take no pleasure in the fact that you are in pain, but I can guess from your posts here that you would probably be a much happier person if you spent half as much effort on improving your own life as you do on blaming others for your misery. Good luck to you, too, "patient."

 

[Psai]

Hearing the way you all have talked about gastroparesis makes me want to just give up. How completely deplorable that you talk about a disease you clearly don't understand this way. I suffer DAILY! I'm up right now since 4am pooping my brains out. And this is just a normal morning. I'll have you know I ONLY go to the ER when I have been vomiting for hours-a day. I've tried it all at home (zofran, phenergan, pain meds). When you can't keep the meds down, and your body is clenching up with dehydration, what are we supposed to do?! Sit at home and die so we don't inconvenience you and your opioid conscious?? I am truly DISGUSTED!! Basically what I took from this article is we should just go ahead and kill ourselves because you have us labeled and refuse to help us; because junkies are using our disease, and you aren't good enough at your job to tell us apart! This judgmental "everyone is a drug seeker" BS had got to stop!! If you don't know and understand enough diseases to help people, go back to school or STOP practicing medicine. You have become hardened, cynical dinguses and I for one don't deserve your judgment and hate when I'm at my weakest!! I will remember this is how you talk about us, and during my next flare, I won't go to the ER. I will just stay home and die

This is exactly why I can't do EM

 

[BAM!]

Our admin is similar, though maybe not quite as militant about it. Why hospitals would want these losers to come back is beyond me.

because they're on medicare.

 

[BAM!]

You are all so damn judgmental you seriously can't see past yourself. Just judge judge judge.".

Well isn't this the pot calling the kettle black! BTW, the karmic universe doesn't look kindly on "patients" who wish illness on others.

 

[theboo]

We have a huge cadre of bogus "gastroparesis" patients in Vegas too. Huge. It's all actually narcotic addiction and acute withdrawals but they know the game.

I have started to admit more and more chronic pain, "I want a Dilaudid holiday." patients. I had a complaint from one who I sent home and my administration crucified me so **** 'em.

"Yes sir! Yes sir. 8 mg you say? Right away sir. Please remember to give me high marks on your customer satisfaction survey sir. Is there any thing else sir? Benadryl sir? Absolutely sir. Wouldn't want you to get itchy while you enjoy your Dilaudid sir. Now then can I **** your **** or is the only sucking here going to be you on my soul?"

What in the hell is wrong with you "MDs"? Are you seriously calling Gastroperesis patients drug seekers whose symptoms are withdrawal? I am flabberghasted, I dont even know how to reply to this ignorance. To this stupidity. I wish all of you could have just one flare. One flare one time. The nausea, the vomiting, the horrible bloating and pain. People have DIED BECAUSE OF THIS DISEASE! People have JTubes cause they can't eat solids. How does one "fake" the weight loss? How does one "fake" the bloating? "How can I go about "faking" the ****s? Please do tell, this should be interesting. Some of you sound reasonably educated and not like student doctors. Or are you, that would answer my 'what the hell are you thinking' question. Your terrible demeaning attitudes scare me. So the next time I am in the ER in my hometown of Wichita (I dare you to say I am faking for drugs to my face) vomiting so bad I am about to pass out. Your gonna tell me to go home because GP isn't real? I think each of you need to go back to medical school and relearn the basics of pt care. I also have barretts syndrome is this precancerous condition fake too? I have read your disgusting disheartening comments atleast 10 times and am left shaking my head in disgust. Just for fun how about you imagine you have food poisoning. Now times the worst symptoms by oh 20, no, 50 and make it happen a few times a week. There is your basic GP patient. Drug seeker my ass. Please do your pts a favor never ever go into to GI or be a PCP. Sad thing is that you need a heart, a compassionate heart to be a doctor and most of you (I said most) of you lack that. Disgusting. You should be ashamed.

 

[theboo]

Hearing the way you all have talked about gastroparesis makes me want to just give up. How completely deplorable that you talk about a disease you clearly don't understand this way. I suffer DAILY! I'm up right now since 4am pooping my brains out. And this is just a normal morning. I'll have you know I ONLY go to the ER when I have been vomiting for hours-a day. I've tried it all at home (zofran, phenergan, pain meds). When you can't keep the meds down, and your body is clenching up with dehydration, what are we supposed to do?! Sit at home and die so we don't inconvenience you and your opioid conscious?? I am truly DISGUSTED!! Basically what I took from this article is we should just go ahead and kill ourselves because you have us labeled and refuse to help us; because junkies are using our disease, and you aren't good enough at your job to tell us apart! This judgmental "everyone is a drug seeker" BS had got to stop!! If you don't know and understand enough diseases to help people, go back to school or STOP practicing medicine. You have become hardened, cynical dinguses and I for one don't deserve your judgment and hate when I'm at my weakest!! I will remember this is how you talk about us, and during my next flare, I won't go to the ER. I will just stay home and die

Amen sister!!

 

[theboo]

Well isn't this the pot calling the kettle black! BTW, the karmic universe doesn't look kindly on "patients" who wish illness on others.[/
Never mind

 

[theboo]

Feel better?

Narcissistic... check
Borderline... check

Narcissistic? No. Where did you pull that out of? Perhaps seeing a dictionary would help seeing there was nothing narcissistic about her post. Its the truth from a REAL GP PATIENT

 

[theboo]

Okay. Who's mod? Ban. Lock.

WHY? does the truth bother you? If you can crap talk us we have a right to speak up. And btw I have had an acct here for quite a while. So I ain't here for just this. Ban me I will just sign up again. Can't handle others opinions?

 

[theboo]

Dude, just shut up. There are at least two of us here with rather profound chronic illness, and I am one of them. How many times have I been in the ED for it? NEVER. So, get off your high horse, and zip it. You would rather stay home and die? Go for it. You're disgusted? Go to another country, and get none of these meds. But do NOT come to a site for doctors - NOT patients - and tell us we suck. Or, if you do, we'll respond as we see fit. But you convince no one with your histrionics and "you don't understand" mentality. You would get appropriate care from me, but not my respect. But you wouldn't know that, because I would be cordial, and caring, and polite, and solicitous. But patients like you - who think you are unique - are not.

Wow unreal. I am truly sorry you have a chronic illness. That sucks but so do we. If you as doctors dont want to be disrespected you shouldn't disrespect us. FTR I am going into the mental health field. An addictions specialist. I want to HELP people who suffer from addictions not insult them

 

[theboo]

Undermedicated (and I'm not talking pain medications)...check.

Finally someone who gets it. GP is also under diagnosed.

 

[BAM!]

Oh please give me a break. She wants you to get an understanding have one flare one time and you will stfu

How do you know "REALgastropatient" is female?
You're missing the forest through the trees. I suggest you re-read this entire thread, but this time pretend you're an ED physician. How to help the epidemic of chronic pain patients? Here's a hint; it's not in the ED.

I agree entirely with Apollyon's post.

ignore.

 

[Fox800]

Finally someone who gets it. GP is also under diagnosed.

That went completely over your head.

 

[TooMuchResearch]

WHY? does the truth bother you? If you can crap talk us we have a right to speak up. And btw I have had an acct here for quite a while. So I ain't here for just this. Ban me I will just sign up again. Can't handle others opinions?

Sure.

 

[TooMuchResearch]

WHY? does the truth bother you? If you can crap talk us we have a right to speak up. And btw I have had an acct here for quite a while. So I ain't here for just this. Ban me I will just sign up again. Can't handle others opinions?

You have 10 posts, all from now in threads at the top of the EM forum.

 

[Arcan57]

There are people who are on chronic, daily opiates. There are people whose lives would be/are improved by being on chronic,daily opioid therapy. The overlap of these two populations is nowhere near 100%. Gastroparesis is a horrible disease. Narcotics temporarily improve 1 aspect of the disease while introducing a host of other problems such as withdrawal symptoms, decreased motility, and opioid induced hyperalgesia. Unfortunately once you are dependent on opioids it is extremely difficult to differentiate between the native disease and the symptoms induced by the treatment. In the absence of effective treatment for the pain, giving an ineffective treatment with moderate to severe side effects isn't the right thing to do. It's possible the increased use of non-opioids such as IV tylenol or ketamine will improve pain control but in the absence of significant electrolyte abnormalities, inability to tolerate small frequent sips of fluids, or a serious non-gastroparesis cause for the symptoms referral for outpatient management is appropriate.

We aren't saying you're lying or faking your symptoms but it's frustrating for us to have patients that refuse to attempt PO intake, only focus on the pain control side of their symptoms, amplify symptoms in order to escalate care, and for which we have no effective treatments. When I examine the inpatient notes, even with high dose IV push dilaudid, the median pain scale stays at 9-10 for the duration of the flare until eventually whatever caused the flare passes. If the narcotic pain medicine doesn't work and has significant side effects, should we still be giving it?

 

[BoardingDoc]

You have 10 posts, all from now in threads at the top of the EM forum.

Just add this idiot to your ignore list. (click on their name, then there is an ignore button on the right side of the screen).

What in the hell is wrong with you "MDs"? Are you seriously calling Gastroperesis patients drug seekers whose symptoms are withdrawal? I am flabberghasted, I dont even know how to reply to this ignorance. To this stupidity. I wish all of you could have just one flare. One flare one time. The nausea, the vomiting, the horrible bloating and pain. People have DIED BECAUSE OF THIS DISEASE! People have JTubes cause they can't eat solids. How does one "fake" the weight loss? How does one "fake" the bloating? "How can I go about "faking" the ****s? Please do tell, this should be interesting. Some of you sound reasonably educated and not like student doctors. Or are you, that would answer my 'what the hell are you thinking' question. Your terrible demeaning attitudes scare me. So the next time I am in the ER in my hometown of Wichita (I dare you to say I am faking for drugs to my face) vomiting so bad I am about to pass out. Your gonna tell me to go home because GP isn't real? I think each of you need to go back to medical school and relearn the basics of pt care. I also have barretts syndrome is this precancerous condition fake too? I have read your disgusting disheartening comments atleast 10 times and am left shaking my head in disgust. Just for fun how about you imagine you have food poisoning. Now times the worst symptoms by oh 20, no, 50 and make it happen a few times a week. There is your basic GP patient. Drug seeker my ass. Please do your pts a favor never ever go into to GI or be a PCP. Sad thing is that you need a heart, a compassionate heart to be a doctor and most of you (I said most) of you lack that. Disgusting. You should be ashamed.

Your writing style, particularly your use of quotation marks and capitalizations makes it seem suspiciously like you're posting under multiple accounts. Or maybe you're just angry and ranting. Either way, ignore.

 

[deleted303591]

I am a former pre-med student (but quit due to having 2 rare autoimmune neurological diseases—and not being able to take a decent load) who also happens to have severe gastroparesis, severe chronic diarrhea, and longstanding (20+ years) type 1 DM.

I haven't read the entire thread, but I do agree that gastroparetics coming in to the ER for pain or nausea control is generally out of the scope of emergency department doctors.

This is really a consequence of improperly managed outpatient care in general. I absolutely agree with that.

I found out about this thread as it showed up in my Facebook feed, and people were offended. I just want to let you know that I'm on the side of the doctors, despite having a very miserable disease.

 

[Psai]

I am a former pre-med student (but quit due to having 2 rare autoimmune neurological diseases—and not being able to take a decent load) who also happens to have severe gastroparesis, severe chronic diarrhea, and longstanding (20+ years) type 1 DM.

I haven't read the entire thread, but I do agree that gastroparetics coming in to the ER for pain or nausea control is generally out of the scope of emergency department doctors.

This is really a consequence of improperly managed outpatient care in general. I absolutely agree with that.

I found out about this thread as it showed up in my Facebook feed, and people were offended. I just want to let you know that I'm on the side of the doctors, despite having a very miserable disease.

Awesome. Maybe we can take this opportunity to educate people about proper utilization of emergency resources.

Please don't come in for your chronic issues that you already have your doctor following. Thanks.

 

[GeneralVeers]

I don't believe in admissions for "narcotic holidays". Unless you have a disorder that really would benefit from specific inpatient therapy, or a procedure, I am going to send you home.

 

[e30ftw]

Many of these CPS/fibro/gastroparesis/sickle cell patients who come to the ED at 0300 after missing an appointment with their PCP/pain-management the day before actually have potentially serious medical co-morbidities. I am happy to listen to their complaint, isolate a specific reason for their ED visit, evaluate their potentially emergent condition w/ labs/imaging and admit them if there is a reason ie: intractable n/v, deconditioning with poor social support, gait disturbance, etc. However I have never admitted one of these patients purely for pain control. Typically the dose of narcotics I give them is less than what their pain management MD prescribes, and I always make them take their fentanyl patches, etc off prior to IV medication.

The vast majority of gastroparesis patients who present with "days of intractable n/v/abdpain, unable to tol PO etc" have normal BUN/Cr ratios, normal skin turgor, moist mucous membranes, and lack ketonuria. These patients are pleasantly worked up, hydrated, and discharged as fast as possible.

 

[Ceke2002]

Dude, just shut up. There are at least two of us here with rather profound chronic illness, and I am one of them. How many times have I been in the ED for it? NEVER. So, get off your high horse, and zip it. You would rather stay home and die? Go for it. You're disgusted? Go to another country, and get none of these meds. But do NOT come to a site for doctors - NOT patients - and tell us we suck. Or, if you do, we'll respond as we see fit. But you convince no one with your histrionics and "you don't understand" mentality. You would get appropriate care from me, but not my respect. But you wouldn't know that, because I would be cordial, and caring, and polite, and solicitous. But patients like you - who think you are unique - are not.

Holy mother of thank yous! I've been reading through this thread and mentally shouting 'OMFG just shut up, and stop making us looking bad!'. Another chronic illness patient here (including Gastroparesis, for which I take Mirtazapine when it flares up too badly, otherwise I manage it through diet) and sorry, not sorry, but a chronic illness flare up does not constitute a medical emergency in my book, and therefore does not belong in an ER setting.

 

[UKEMdoc]

If every single person around you is an dingus then go look in the mirror to find the biggest ass of all.

If you've got a problem with just one doctor/nurse then it's probably not all about you. If you've fallen out with every professional whose tried to look after you then you're the problem.

Finally, gastroparesis isn't a diagnosis of it's self, it's a constellation of clinical signs/symptoms. Sometimes morphine would help, other times it'll make things worse. A lot of people feel dreadful with the sickness etc and interpret this as pain, all the opiates in the world won't help that.

 

[Ceke2002]

Because this is kind of relevant to the topic, I thought I might share a recent event just to show that some chronic condition/pain patients can be very reasonable (as I'm sure you guys already know, but a hopefully positive reminder, every now and then, surely doesn't go astray).

So a few days ago I was having a dreadful flare up of some gastrointestinal issues - constipation lasting more than 5 days, hard and bloated/swollen abdomen with abdominal tenderness, severe colicky pain, nausea, loss of appetite, just generally feeling completely wretched and miserable. So rather than haul myself off to the nearest ER for what was pretty clearly a non emergent condition, and start throwing myself about demanding narcotic pain relief, and for someone to 'fix me', instead I took some over the counter pain medication, and a mild dose of laxatives, then curled up on the couch with a hot water bottle on my tummy, and just relaxed , watched some episodes of Doctor Who, and waited until I felt better. 🙂

 

[Psai]

Good job I guess

 

[deleted303591]

Whatever. Sometimes you can't avoid the ER.

But if you do have to go, please make sure it is an actual emergency.

Last time I had to go to the ER for GI motility reasons was January 2015. I had felt "under the weather" all day long and I was VERY tachycardic. In the afternoon, I thought my blood sugar was low but I tested, and I was 265 mg/dL and I knew that I was instead physically weak and that I needed to go to the ER.

I ended up being triaged and due to having bad vital signs, I got an EKG which came back for sinus tachycardia. I probably waited at most 5 minutes for a room.

Anyway, my potassium levels came back at 2.5 mmol/L (among many other labs being off...) due to having severe (and persistent diarrhea—that has been going on for years).

I had habitually and compulsively drank 4-6 liters of fluids per day, for years, but I wasn't able to, as I had felt under the weather and caught something contagious. It backfired.

After being admitted, I turned over my records to my GI doctor (she's the ONLY one of my doctors who is NOT at this particular hospital—although she used to work at this hospital), who decided that my diarrhea needed to be treated more aggressively.

Prior to this, the diarrhea was never high on my GI doctor's priority list when it came to treatment, and at that point I had been seeing her for about 8 years, and it gradually and insidiously got worse. I had prescriptions consistently for Colestipol and sometimes even Lomotil, though, over the course of many years.

After trying multiple medications, I'm currently on a medication reserved for fulminant diarrhea, that isn't stocked at pretty much any retain chain pharmacies. The only place I know that stocks this medication is the cancer hospital pharmacy, and it's definitely NOT convenient to get.

Anyway, sometimes GI motility related emergencies do happen—but it's not common, and there better be an emergency type of situation going on.

And whatever you do, you better follow up with your GI doctor in an appropriate time (like 1-3 days) of being discharged from the ER—like the discharge instructions say. I doubt many people with motility disorders actually do—which perpetuates the "frequent flyer" (with gastroparesis/whatever) problem.

Keep in mind that I have multiple autoimmune diseases, including 2 rare autoimmune neurological diseases that affect my peripheral nervous system, specifically autoimmune autonomic ganglionopathy and chronic inflammatory demyelinating polyneuropathy. My health is complicated as hell, but I still manage to do a decent job of staying out of the hospital.

I think some people with just one system failing of their autonomic nervous system need to chill out and keep things in perspective. I know people who deal with so much more, and way more graciously that many with just motility disorders choose to handle their issues and problems.

 

[sum dude]

My favorite are the intractable noise-makers:
http://gomerblog.com/2014/08/emesis/

 

[Bambifromnh]

Ok, not going into emergency medicine. and I thought I was a bother with dislocations because of a CTD...

 

[GeneralVeers]

Time to play "Identify all of the different Axis disorders".........GO

 

[migm]

Do we have mods? Hello? What's the reason this is still an open thread?

 

[VA Hopeful Dr]

Time to play "Identify all of the different Axis disorders".........GO

The answer is borderline until proven otherwise.

70,000 ICD-10 codes and yet that's not one of them.

 

[migm]

and you're on a physician forum spouting bull****. EM has very little to do to help chronic GP sufferers. The overlay with narcotic abuse is incredibly high as has been pointed out multiple times in this thread. This was not a thread about patients. It was a physician asking what the threshold was for pain control admissions. It has devolved and should be closed.

 

[mmmcdowe]

Closing thread. Please be aware that this is a forum the prohibits medical advice

 

[deleted109597]

Do we have mods? Hello? What's the reason this is still an open thread?

Because the volunteer mods aren't awake and scouring the threads between 430 and 6am always.