[ARCHIVED THREAD] - Medical advice and prayers request (Page 1 of 2)
Posted: 12/25/2004 5:43:26 PM EDT
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Gentlemen, if any of you is a doctor, I'd apreciate if you tell me your aproach to this situation as I have the feeling something is very wrong here... Prayers and thoughts also welcomed. I knew my father's girlfriend was on a hospital, but I was under the impression that is was just a simple sciatic inflamation thing, as I had dinner with my gf's family for Christmass and they all seem to be pretty cheerful. I just found out about pretty much all of this, the same as my girlfriend, as her mom kept telling the family that everything is ok, that there's nothing to worry, and I'm not so sure this is the case, considering the prognosis I just found out (don't ask me how in the hell I just found out, they're a VERY strange family... Mother and grandmother think of sick people as "stuff that bothers other people" and the wife is actually yelling the father at the hospital for being so problematic... All the while he spent Christmas Eve alone as the hospital kicks visitors out at 7pm) Well, here's the story I've compiled and translated in the last 2 hours. About 20 days ago, my girlfriends father came from work with a severe pain on the side/lumbar area. The next day, the pain persisted, so he went to the emergency on clinic #1 (a very well respected clinic here), where the doctor diagnosed inflamation of the sciatic nerve and gave him some antiinflammatory pills. The next day the pain was worse, so he went to the emergency on clinic #1 again and he got X-rays, and based on that, a doc diagnosed a beginning of column arthrosis and the same inflamation of the sciatic nerve as the day before, so they prescripted him the same drug, but via injections this time (more powerful) He went back home, and they called a nurse to give him the shots, and some hours later he began to feel really bad, so they called a doc to go home (from the same medical insurance clinic #1 is from) and it turned out that the doc at the ER gave him a prescription for an antiinflammatory drug dissolved on a Sodium solution (even he told them he had a heart attack 4 years ago and is still with medications/diet for his blood pressure...) So this doc changed the prescription for the same drug but dissolved on a Potasium solution. So far, he could walk, it hurted a lot, but he could go up and down the stairs, very slowly though. Next day he went to saw a column specialist on clinic #2 (a special traumatology clinic on his medical insurance) and they prescribed him a wrap for his lumbar/abdominal area and some kinesiology sessions. He went two times to the kinesiology sessions (no physical massages, some electrodes on the waist instead) Two days later (I don't know why the delay) -all the meantime keeping the antiinflammatory shots- he went slowly walking to a shop to buy the wrap (3 blocks from his house) with his wife, and the next morning he was unable to walk anymore... They called a doc to go home (dunno about the US, this is a very common service provided by the medical insurance here, I used it several times myself) and they gave him another antiinflammatory, this time, oral administrated. By that night the pain was worse again so they called again and they send the same doctor that went on the morning and he said everything was ok, that the pain was going to pass when the meds started kicking in. Next days he was in pain, but could go to the bathroom by himself, but at one time, the right leg got really tensed (the leg flexed in a way that the knee articulation got at 90 degrees while he was laying on his back), so they called the doc (another one responded this time) once again and they said that he should rest more time and that they should take him to get some kinesiology sessions again. They couldn't move him so they called a masseuse that gave him some massages and he got a little better for a day or two. Then he started to have an incredible sharp pain, so they gave him morphine as other medication would raise his blood pressure. This was last Saturday, exactly a week ago. Last Monday -still being able to get up to go to the bathroon and still with the bended leg- the docs tell him it could be a "clamped nerve" (don't know how to translate this properly) or a lumbar disk hernia, so that he should call an ambulance to get him to clinic #2 to get an MRI. On Tuesday, the ambulance arrives, they take him to the clinic #2 but as he had the leg flexed and the pain stops him to move it, they can't perform the MRI as he doesn't fit on the tunnel. Wesdnesday they discuss other options to see what they do about the leg to get the MRI done, and on Thursday an ambulance comes again and takes him to clinic #3's ER to leave him internated there to see what's going on. Clinic #3 is another very well respected place. They gave him an anestesic, made the MRI and some blood tests and all of a sudden over 30 people got in due to a massive accident, so they send him to clinic #2 to leave him internated for good, for a better care. Once he's there on clinic #2, not on the ER area but on the regular clinic area, the results of the tests performed on clinic #3 arrive and they show that there's a small column arthrosis, but that's "regular" and it's not what's causing the problems... The real problem is an infection on the mussles that support the kidneys (the leg thing is just the leg mussles tensed because of him staying on the same position for long due to the pain) That night they start medicating him for the infection and tell the family to wash carefully all bed sheaths in really hot water and to iron the matress and pillows he used. My girfriend just spoked with her mom and it seem that the infection spreaded to the blood stream now (but this could have been there the entire time, as you can tell by the prologue of the story...) The docs say it's the same bacteria of Pneumonia, but that he has it on the blood instead of the lungs. According to the tests, he has 11 million white blood cells that ate most of the red ones, causing him to be anemic now. He also has a 10 on hemoglobin on blood. So that's it so far, any advice is greatly appreciated, I'm going to the hospital with my girlfriend tomorrow to see if I can get some more info, as I'm very concern about this and my mother's girlfriend doesn't seem to be of great help here... Thanks much! |
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Oh boy, I'm gonna regret reading this one. For what it's worth I had a feeling where this one was going right off the bat. Did he ever have fever? If so that was a dead give away, as was the fact he was getting worse, much worse, instead of better. Do you guys not have CT scans down there? Sounds like a psoas abscess, or a retro peritoneal abscess. Both bad, and if he has bacteremia or septicemia the prognosis is much worse. Probably staph but that doesn't cause pneumonia too often, at least not here. Sometimes... He will need a considerable course of strong IV antibiotics. Have to wonder if he had a recent appendicitis, diverticulitis or cholecystitis, etc. It does just happen to some people without explanation though. The risk is septic shock and/or DIC(disseminated intravascular coagulation). The former is cardiovascular collapse leading to death due to bacterial toxins. The latter is a situation where the blood's clotting system goes awry using up available clotting factors and leading to profuse bleeding. It is usually fatal. Probably won't get to that. He needs careful monitoring of vital signs and blood counts. Any bleeding or loss of blood pressure should raise concern. He may need to go into an ICU if any of this begins to happen. White blood cells don't eat red ones but the diminished RBC count is a little disturbing. I would wonder if it is new or old. The WBC is just slightly elevated which might be good or bad. If he has bacteremia I would expect much higher or it could be going down which might be bad. Just depends and I don't have enough info. What exactly did they grow from his blood cultures? Further, he may require surgery to deal with the abscess as they are notorious for not resolving with just antibiotics. Limited info deimos, but you did a good job of trying. I'm making some educated guesses here.
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Thank you very much, I know what to ask for tomorrow when I talk to the doc (I hope someone responsible is there, being Sunday and all) We do have CT scans here, dunno why they didn't take one, and I don't know what they cultivated from blood, but I'll definately ask for that tomorrow. No recent interventions either. Damn it, I knew this was way worse than what it appeared... |
| Sounds awful. I sincerely hope and pray that he gets the antibiotics that he needs. Please try to take the leadership role in this, as it sounds that his wife is doing more harm than good. Question those Doctors. Tell the wife to STFU if she is being negative to him. Don't let him die a painful and needless death. |
Don't assume to much. How does he look? If he looks like he is doing okay that is a very good sign. If he looks bad, likewise. If he's holding his own that is reassuring but I couldn't get too optimistic as yet. Keep me posted. What I ask from these kind of threads is that people do so and let me know what happens. Feel free to use IM if you like. |
Thanks, I was just getting ready to ask that again. The lack of fever I would consider a good sign FWIW, especially in light of a minimally elevated WBC. For now anyway. It is possible that the the blood culture grew a skin contaminant. |
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Small update: It looks like an infectologist came to look at him today, and that they're going to make a CT scan and make a punture to remove the absess. I'm waiting til 4pm (visitation time) to go there. Looks like they're on the right track now. They also said that this is a case of a disease that only happens 1 or 2 times a year here in Argentina, but I don't know the name yet. Thanx again! |
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Psoas abscess was a great call. Alot of times it mimics a lumbar disc herniation, save for the fever that ensues. A CT scan guided needle aspiration of the abscess is in order, along with lots of antibiotics. It should resolves quiclkly after that. The key question is why something like this would occur. Your GF's dad should really take this opportunity to put his health as his highest priority and start regular exercise and weight loss. Usually only people in poor health develop strange/rare conditions such as this. |
It isn't much better here in the US. My wife was in the hospital on Thanksgiving night with gall bladder issues, but her symptoms were much more than that. She flat out told the doctor that her kidneys hurt, but he said it was nothing, even though it's common for gall bladder issues to cause issues with the kidneys and liver. A few days later we were back at the emergency room because my wife was still in pain and she had pain all over her back and abdomen and was having trouble breathing. Her doctor found that she had a severe kidney infection and the beginning symptoms of Adult Respiratory Distress, which can be fatal! She was immediately started on a course of antibiotics and has gotten better. But before that she was virtually bed ridden. Remember the Alamo, and God Bless Texas... |
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There are clues from the beginning of the thread that gives you some clues. The fact that he wouldnt fit into a MRI machine tells you that he is heavy and overweight. Is this true? With that being said, doctors are people too and to some degree there is a built in bias towards people that are heavy. Its no fun taking care of someone like this because there are usually a whole bunch of complications. The weight hides a whole bunch of maladies that will be difficult to find. Even with surgery is a serious problem. They get serious infections like there is no tomorrow. MIs, PEs, dvts, pneumonia are few other problems that might occur. They also dont heal well and get seromas under the wound. A lot of heavy people end up with open wounds that need to heal with secondary intention. There also hygiene problems that exacerbate the problems listed above. We had a real heavy women code after an abdominal surgery. She weighed almost 400lbs, only 5 feet tall. There was a med student giving chest compressions as we got everything else ready. She eviscerated on the spot. Her heart started but she did die a couple days after surgery to repair the wound. We had to put in a gortex patch that costs like $50 a square inch and we put in a lot of it. If he is septic, they will not go in right away he will die during surgery. They need to aggressively treat him with broad spectrum antibiotics and supportive therapy. Once he is stabilized they may need to go after the source of the infection if he doesnt improve just on medical therapy alone. For him to get better without surgery is the best option due to the possible complications noted above. But drainage of the source will most likely be required. As pointed out CT guided needle drainage would ideal but if he is heavy it may make it impossible. This is a wake up call to get into shape. One more thing as a person gets more sick and becomes more septic, their numbers do improve. Their immune system is no longer able to mount a defense against the attack. Fevers come down. White count improves. If they are not improving clinically as well, its basically over. The infection is getting worse and body is starting to fail. This will make any surgeon have nausea and vomiting. I wish him luck and prayers. |
| Other thing that concerns me is the mothers attitude. Most girls are reflections of their mom and will become their moms one day. The lack of sympathy and blame placed on a sick man makes really gives you an insight into their family dynamics. I would run guy, fast as you can and find a normal well adjust female, if there is such a thing. |
I took it to be due to inablilty to extend the hip. But all of you guys are correct about people with other health issues have problems. Obesity and smoking are among the worst things you can do to your body.
Yup, PITA taking care of these people. When I get one of these 5 ft 400lb women complaining of abdominal pain.... Well, I just feel like saying WTF you want me to do? It is not even easy examining or figuring out their problem and they ALWAYS have abdominal pain. For crying out loud.... I had one come in with abdominal pain like that after going out to eat. Work up incl Flat and upright. I swear she had almost 2 gallons of gastric contents. She ate like a f'ing pig! You should've seen it! Never seen anything like it before or after. Incredible her stomach could even hold it all. And no I don't think she had any kind of obstruction. Gross. Okay, rant over. Whew! |
I know all about the gallbladder...I was sick on and off for 6 months with nausea, stomach pain, vomiting, my hair was falling out, etc. I was admitted once into the hospital and they discharged me two days later saying it was medication I was on causing the problem (I was on that medicine for a year and a half with no problems). Kept going to the doctor and they didn't know. Then on the last "flare-up" of my gallbladder they finally figured it out. My bilirubin was super high, I was urinating the color of raspberry iced tea, I was jaundice. My common bile duct was blocked from a gallstone. I had chronic and acute cholecystitis. It was bad and very painful. I don't know why it took 6 months for them to finally figure it out, but at least they did. |
You have got to be kidding, 2 gallons of gastric contents, thats crazy!!! 
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I found one but I had to date about 150 women to find her. That is what, 0.7% or so?  I had fun getting there though but I don't have the energy for all that anymore. I think if anything ever happened to my wife I'd just stay single.
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I see that all the time. I don't know why it is so hard for some docs to figure out either. |
| Nothing makes me happier then seeing a 120-150lb patient. I can do an emergency c-section on a woman like that and get the baby out under a minute. You add 50lbs and you have to add a minute. Add more pounds add more minutes. People dont understand that weight is a potential killer and can endanger their life and the lives of their children. |
How did they fix your issues? Right now they're telling my wife she needs to have hers out, but after reading about the side effects after surgery, she's not so sure that's what she wants to do. GBT |
I had emergency cholecystectomy and lots of antibiotics. They took it out and I have had no problems since. I had it out 2 years ago. |
 Geez.People all too often think that a place is good. What you should be focused on is getting a good doctor. There really aren't many bad ones(very few in my experience) but really good ones may be tough to find. Point is though, it is the person, not the institutution in general. |
Yeah some doctors are more thourough than others...I work with some that do not do any testing and others that will send you for every test under the sun. THen there are those who only do the testing necessary to make an accurate diagnosis. I like those kind! |
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The blame lies in managed care. People come in with crappy insurance or no insurance and expect to the best. But you didnt buy the best. So why blame the doctor? I cant tell you how many times I ordered an antibiotic and the insurance company said no. Until recently we couldnt even tell you that it was the insurance company that said no. If we did then they would cut us off from their patients. Call up your carrier and ask some questions. What is covered and what is not. CT scans and MRIs are sometimes not covered unless its an emergency and you are going to check out. Why do you expect the doctor and the hospital to pick up the cost? What they should do is bring out a credit card machine and swipe that gold card! The thing that always makes me chuckle is when people come in with medicaid and expect private rooms. They get all bent out of shape when they have to share a room. When we tell the there is an extra charge for a private they usually play the race or economic prejudice card. They also think its the Hilton and that the nursed should wait on them hand and foot. Their job is to watch you and give you meds to keep you alive. |
I completely understand that the insurance determines what kind of care a patient gets. I also know that the physician is limited to the diagnostic testing they can order based on what kind of insurance the patient has. The physician's I am speaking of (some order a bunch of tests and some don't order any) are based on the manner in which the physician treats "everyone". It is not an insurance issue, it is a "style" of practice. |
Yank that sucker out, bud before it becomes infected and scarred down complicating both her problem, her surgery and her recovery. An infected gall bladder can even be life threatening. Find a good surgeon. They are far from equal. My mother went thru biliary colic for 10 years constantly misdiagnosed and mistreated. I kept telling her to have her GB checked but she is stubborn and would rather have been in denial than heave surgery. It is scary I know. Finally, it was becoming constant and she couldn't even eat anymore. I really told her off then. She went in and told her doc what I said. She blew my Mom off but set her up with a Gastroenterologist who did a W/U including elevated liver enzymes and an US whcih demonstrated a thickened gall bladder full of stones. They blew her off some more and then told her they still didn't think the problem is her GB. So she finally calls me again to tell me she is on the floor every night, writhing in pain. For crying out loud. I talked to a good friend who is also fortunately the best cutter around here and I had her brought across state the next day and had her GB out. We took her out the next night for a fish fry! Anyhow, about 2 years later she has more pain just like she had with her GB but she is worried she is having an MI as now her GB is out. They work her up and once agian she has elevated liver enzymes so they tell her agian she has GERD!!!! That doesn't cause liver enzymes to elevate! She either developed a small stone in her biliary system somewhere or had sphincter of Odi spasm. She got better but what lousy experiences with these people. On top of it they refused to see her as a patient again!!!! I went thru similar with my wife and when I brought her in to the ER after talking to the surgeon they treated us like shit, told my wife she was having reflux even after her husband, a doctor, is telling them she is having classic biliary colic and needs a lap chole. They didn't even want to work her up. I did get a little irritable at that point and after an AST over 500 and a positive GB US she got her GB out. I can only imagine what your average patient gets treated like sometimes. I sent a guy to the ED last week after diagnosing probable meningitis. They didn't tap him and sent him home. He ended up in the hospital the next night with....You guessed it: Meningitis! Fortunately it was aseptic(viral) or the guy would've been dead and they'd have been getting sued up the ass. |
You nailed it right on the head...This is exactly what I am speaking of. 
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That'd be me. I take pride in my diagnostic abilities based on history and exam. Tests only help if you know what you are looking for and to rule out bad shit.
I thought you didn't like me!  |
Regardless of insurance how could they get away with no spinal tap when a physician sent him because of possible meningitis? |
And I talked to the ED physician telling him I thought this guy had meningitis! I think part of the problem was the guy had a long history of coming in for narcotics for headache and was rude even on a good day. He called in after being seen the day before( not by ME!) and the nurse brought me his concerns and those of his mother with worsening headache, fever and neck pain. Duh! No I wasn't going to just give him narcs. I almost never do anyhow. He needed to be seen though I was loath to see him in all honesty. Guy was a real POS. In my office he started calling me every name in the book when I wouldn't give him narcs which only increased my suspicion FWIW. He came out in the hallway, Yelling at me that I was a "MFing, c888ksucker!" etc. I plead innocent on that last part! Sometimes people are their own worst enemies. Wouldn't have helped the ED physician in a lawsuit though. |
Yeah now I can see why they were leary on believing him, but still, with your opinion that he possibly had meningitis he should have had a tap IMO. |
+1. Trying to secure the airway or even getting an IV (any IV) in a massive individual can be horrific. People don't realize that when the chips are down, and they are morbidly obese, that they may die because it can be technically too difficult to do what is necessary. |
Always easy to get burned on this one. I will not tap everyone I think has meningitis if it really fits a viral picture. What are you going to do anyway other than symptomatic treatment? Of course, early on, anything can be anything, right? You just try to make the best call using hopefully sound judgement and don't screw up. If you're in doubt, just do it. We even have 7" needles for the Shamus of the world. It's great working in a minefield! |
| We have had severly obese patients that we have had to send to the local zoo to do CT-Scans on. Last month we had one guy involved in a traumatic accident that wouldnt even fit in the zoo's scanner. The hospital was making arrangements to send the guy to Sea World in Sand Diego to use their scanner but the guy got better with the supportive treatment being given. |
I've heard this but am suspicious it is one of those urban legend things. Sure, there are people too big for scanners (break the worm gear in the table), but using the marine mammal scanner, if there is such a thing, I think is a stretch. No pun intended. |
They hauled a 978 pounder in not long ago here. Took 15 people to load, they had to take the stretcher out of the truck and put the pads from two stretchers on the floor. Moved him on a canvas tarp for the rear of a 5ton military truck. I saw him a few hours later in the ER...the bed had broken, and was being supported by a floor jack and 6 jackstands they had to go buy. |