I occasionally see comments about people going to the ER for their PsA. I'm assuming a severe flare. I'm wondering what an ER can do for you?
I went once, on Christmas day, 16 years ago because I was in so much pain I was shaking all over. They gave me a couple Vicodin. Now, ER's don't give out pain meds for chronic conditions (ours has signs starting in the lobby, through the elevator, and in the waiting room letting people know).
So I'm curious what necessitates a visit to the ER and what they can do for you. I'm also wondering if I've been cluelessly sitting at home when maybe an ER visit was necessary, but I'm so used to waiting things out I don't go.
I've been in so much pain I could scream and I thought about going to the ER, but I knew it would be pointless. Though I do know of someone who went during a real bad flare to get steroids IV.
I have been admitted to get IV steroids and have pain meds given IV as well. That’s pretty much it as far as how they can help. I don’t need to go now, since I have an emergency steroid script and meds for severe pain if I need them. If I get really bad, and my doc is closed, I just use my emergency drugs and limp through it until I can see him. When I was first diagnosed though, I didn’t know how to manage the pain and I didn’t cope very well, so I needed those patch ups at the hospital. I don’t think that they would deny someone who came in with every joint red, swollen, and inflamed care. I think they are targeting a specific audience with those signs, but it’s not someone like you, Marietta.
A little off topic, but The ER can’t deny treatment to people. At least they’re not supposed to do that. It seems that they are trying to ward off “frequent fliers” who come in seeking narcotics because of an addiction. It makes me a little angry that they would do that. A lot of people became addicts because of the ER and now they don’t want to deal with the problem that they helped to create. Addiction and withdrawal are real medical problems too and so is pain. steps off of soap box
The two times I've been to the ER for something PsA related it has been because I had so much inflammation in my neck and shoulders that I couldn't lift my arms. I was also in extreme pain. They gave me injections of steroids, muscle relaxants, and pain killers. One of these times was when I was off PsA meds due to medical testing and possible complications from the med I was on and the other was after a horrible reaction to a massage just days before my Remicade infusion.
I've never had any issues - and have been to the ER plenty with five active kids.
My advice is to take the time and find a Doctor that REALLY cares about you as a person. This can be really hard to find… a lot of time people with PSA are looked at like we are not really in pain when that is the farthest thing from the truth…
I was at a stage where I couldn’t walk ,drive ,work ,sleep,etc… And made it a point to find a DR that would treat me like a human not another insurance policy that he could have a field day with…
So once I found a amazing dr he opened my eyes to acupuncture , topical pain releavers , and made sure when I was doing things that would make my PSA flare that I had break thru pain meds for emergency flare ups.
I guess my point is don’t settle for the 1st rheumatologist / pain Managment Dr you see if you are in serious pain there are so many options for pain you just have to find a Dr that is knowledgeable and willing to prescribe even if that
pharm company is not lining his pockets with green !!
My hospital here in N Calif has given me pain medication but was not for any autoimmune disease. I had a giant cyst the size of grapefruit. So all the ER did was give me small amount of pain medication than said see your OB in the am. I Did and had emergency surgery.
But going to ER when i am sicks, here is my reasons when i go. If i feel something is really wrong, that is not within 'normal' for me....everytime i have had life threatening health problem had nothing to do with autoimmune.
Other reason which does have to do is if i feel any serious kidney pain or infection is happening within my body. Usually within a few hours i will go up from 101 temp to 103 or higher...so again that take it seriously and have helped. I have had to tell them what to use though!
Lastly, if vomiting does not stop and dry heaves are going on for hours plus i cannot keep any fluids down. Usually for me, after few hours of being sick, it slowly gets better so if the above happens, i have gone in to get help to stop vomiting plus fluids.
Otherwise, I am like you, i tend to just wait it out. I just figure it is part of my life. I know my doctor and i have had this very conversation more than few times. She was like me...just could be very sick but as long as i know what it is and what is going on...all eventually is going to be okay, we both wait it out. We both agreed ER is for life/death emergencies where something is clearly very wrong, seriously wrong and the person does not have clue how serious it is. Which she said includes not being able to keep fluids down for more than few hours.
But i can completely understand about pain and why people would want some help. I think they at least give a person with any kind of autoimmune disease some high ibuprofen if nothing else. It really does help if you can take it.
Five years ago I went in with severe back spasms (as in, couldn't sit, couldn't stand, couldn't lay, nothing. The spasms started at about 3 am and I toughed it out as long as I could, but finally called my dad and had him take me to the ER at about 11 am. The pain was so bad all I could do was moan "make it go away." In the ER the docs gave me several shots of some kind of pain med (I'm allergic to morphine), but finally had to admit me because they had given me all they could in the ER with no relief. I was hospitalized for 3 days that time. But...that was also when I was working 100-120 hours per week and had just been on two back to back business trips (the first to Austin, TX, the second to D.C. In D.C. I ended up at the ER and got a shot of some kind then laid around for the rest of the trip instead of speaking before the Congressional Subcommittee on Education like I was supposed to). After all that I went to physical therapy and massage therapy every other day for about 6 months until my back stopped trying to spasm every single time I moved the wrong way. I also cut down my hours and started going to a Rheumy where I was diagnosed with PsA. :) I also have 4 herniated lumbar discs, so we didn't put the back spasms together with the PsA until it started doing the same thing about 2 years ago with no further back injury. In fact, the return of the spasms coincided a PsA flare, which is how we put it all together.
I have been to the ER on 2 occasions because it was so bad I could barely walk. They would not do anything for me. They didn't even do X Rays. The only time they did anything for me was when I was having chest pains. They ended up keeping me over night and putting me on blood thinners because my blood had a clotting issue. Now even if I have chest pains I don't go to ER because they wont do a darn thing for me.
PsA affects my heart which usually takes me to the ER. Diabetes, high tryglycerides and cholesterol, atrial flutter, high blood pressure can get my heart out of whack, and the ambulance already knows my address!
PsA affects my lungs. My oxygen saturation drops, and the ambulance is here again.
When the PsA flare pain peaks, it automatically flares my severe Fibromyalgia. When both pains converge, my whole body reacts putting my life in jeopardy, and back to the ER I go.
I saw a PA instead of a doctor at the ER last month. He did nothing and sent me home. The next day the ambulance came and said that there was a possibility I wouldn't be able to make it to the hospital. I did, but the health insurance had to pay for 2 hospital ERs. So, I called the health insurance and reported the hospital requesting the insurance that instead of paying both bills, stop all payment to the first one because they denied all treatment causing the need for the ambulance and the next ER hospital. They did. This I learned from Medicare. They want the patient to stop all this abuse from the hospitals not treating the patient correctly resulting in extra charges when we are forced to seek additional services to treat the same medical problem. We have the right to refuse dismissal from the hospital if we are not better when they release us. But because this first hospital did nothing, they will get paid nothing!
Gelita. So your PSA messes with your heart and lungs as well. I thought it was just me going through something. So should I be more concerned with my chestpains and shortness of breath?
PsA affects the heart on some patients-not everyone develops all these problems. My cardiologist says my heart is healthy-it's the PsA that makes the heart react. Unfortunately in these cases, patients can die of heart related issues.
Debee, I think you always need to be concerned about chest pains and shortness of breath. I’d rather make a trip to the ER to have it checked out (even if they do nothing) than brush it off and … oh, dear.
Yikes! Absolutely, be concerned about chest pain and shortness of breath. If you have these symptoms, definitely get it checked out sooner rather than later. Nurse GrumpyCat second's Seenie's reply. A quick trip to the ER is a good thing in this situation.
Debee said:
Gelita. So your PSA messes with your heart and lungs as well. I thought it was just me going through something. So should I be more concerned with my chestpains and shortness of breath?
They said my heart is good under stress test it just at times I get tiggtness and pain and short of breath. Almost like it would be a flare up. I absolutely hate going and them look at me like a hypercondriat so I usually wait it out. Drs stress me out.
I've been having chest pain/sternal pain and chest tightness lately as well but I know it is anxiety. I can't...I just can't go to the ER for that. I know they're going to treat me like I'm med seeking.
Chest Pain is something they can do something about IF its not PsA. Beyond that the ER can't do a thing for PsA (or any chronic condition) beyond giving pain meds. If they could every Rheumy in the country would be out of business. So the bottom line is pretty simple Unless you have an emergency that is not PsA related you are drug seeking no matter what else you call it, you are drug seeking. Now I'm not saying that there aren't times when that isn't appropriate but you don't just show up. A referral from your PCP or rheumy is helpful or even standing orders. (I have a tordol script on demand) Chances of them actually medicating you at all are becoming slim and none especially if you have scripts for pain meds already. In most states all narcos are on an accessible data base. they will not give you more with out the prescribing Docs orders.
They are not going to insert themselves in the middle of a treatment protocol already in place.
Now there are of course exceptions like a loss of neurolgical function etc. But again a call to your doc before presenting yourself in the ER is helpful.
If you in any way shape or form bitch about your doc not taking care of you, not taking care of pain etc etc., or ask for a referral to a different doc who will take better care of you etc etc. they will throw you out.
I think everyone needs an emergency plan in place for flares. 3 days worth of steroids, toradol, and a pain med with instructions on how an when to use the meds. It’s one of the first things a rheum should give and tell a patient how to use it, why they are getting it. If I had known how to treat myself or even had the meds to do so, I don’t think I would have relied on the hospital at all (except for that severe flare where they did admit me. I just wasnt capable of coping at that time).
I wouldn’t say that everyone who goes to the ER for PsA is “drug seeking”. Technically, this is true (semantics). When I go I want some IV steroids and IV or at least IM Toradol, so technically, I am seeking drugs. However, the term “drug seeking” has such a negative meaning in the hospital. It’s a label that a patient never wants to be given, and one that I will no longer put on a patient. A lot of times, people are ashamed enough with PsA, and inaccurate labels don’t help. Maybe I’m too much of a softie now, but I can’t even bring myself to use it when dealing with addiction cases.
I agree that if you feel bad enough to have a trip to the hospital cross your mind, then your doc needs to know. They may be able to help you avoid the trip. There are meds that can be called in, or they can even refer you to a good urgent care clinic that they work with routinely. You can get medications and treatment without the expense or time investment that the ER requires. Also, if you’re really sick, the doc who knows you best should be in the loop.
tntlamb said:
Chest Pain is something they can do something about IF its not PsA. Beyond that the ER can’t do a thing for PsA (or any chronic condition) beyond giving pain meds. If they could every Rheumy in the country would be out of business. So the bottom line is pretty simple Unless you have an emergency that is not PsA related you are drug seeking no matter what else you call it, you are drug seeking. Now I’m not saying that there aren’t times when that isn’t appropriate but you don’t just show up. A referral from your PCP or rheumy is helpful or even standing orders. (I have a tordol script on demand) Chances of them actually medicating you at all are becoming slim and none especially if you have scripts for pain meds already. In most states all narcos are on an accessible data base. they will not give you more with out the prescribing Docs orders.
They are not going to insert themselves in the middle of a treatment protocol already in place.
Now there are of course exceptions like a loss of neurolgical function etc. But again a call to your doc before presenting yourself in the ER is helpful.
If you in any way shape or form bitch about your doc not taking care of you, not taking care of pain etc etc., or ask for a referral to a different doc who will take better care of you etc etc. they will throw you out.
It is a good feelibg being on this site. I dont feel so alone with this crap. My sister has Lupus and CREST and I always say people looking at her yeh right and now she is addicted to pain meds because 10 years ago when she first got sick that was handed out like candy. Now when I go to the Dr for something that is less knoen about they look at me like here comes another one… I am a mother of two. I dont like taking pain meds. I only take whrn I have to. I usually can keep a RX for about 6 mths. I cant not take tramadol it makes my heart race. I cant take tylonal because the meds I am on bother my liver and tylonal can make it worse and Ibriprophen messes with the effects of my methotrexate and enbral. Any suggestionson what to talk to Dr about when I go in 2 weeks?
Debee, you’re not alone at all, as you can see. Your question about pain relief medications that people use is a good one, but at the moment, it’s buried in the ER thread. If you start a new thread (top of this panel, +Add) it will stand out and you may get more responses.
Debee said:
It is a good feelibg being on this site. I dont feel so alone with this crap. My sister has Lupus and CREST and I always say people looking at her yeh right and now she is addicted to pain meds because 10 years ago when she first got sick that was handed out like candy. Now when I go to the Dr for something that is less knoen about they look at me like here comes another one… I am a mother of two. I dont like taking pain meds. I only take whrn I have to. I usually can keep a RX for about 6 mths. I cant not take tramadol it makes my heart race. I cant take tylonal because the meds I am on bother my liver and tylonal can make it worse and Ibriprophen messes with the effects of my methotrexate and enbral. Any suggestionson what to talk to Dr about when I go in 2 weeks?
When my primary care doctor and I were going through the process of getting an accurate diagnosis (and getting rid of an inaccurate one), he told me to go to the ER (on post, military hospital) as I felt it was warranted because that created a record and made it more real to the military dependent system. <sigh>
I have never had any sort of good experience with an ER so I avoid it. I almost went once, saw that it was full of small children (presumably sick) and left. I figured that I would ride out the pain over the weekend which would be better than getting whatever germs the children were sharing. I don't need the extra germs while taking mtrx8.
