URI/Bronchitis

[+ Gar1eth]

I have had the worst illness. About two weeks ago, I developed a scratchy throat and runny nose. A few days later I went to an Urgent Care for some albuterol and to get a home nebulizer prescription. I've never been formally diagnosed with asthma-in fact pulmonary tests in the past have shown no effect. But often it seems to help with the cough that invariably follows the initial symptoms. Maybe it's all psychological.

 

So about three days later I've developed an occasional cough. Now when I get a cough it can stay for months. So during one coughing paroxysm, I coughed so hard it felt like I popped something in my chest. And boy did that hurt.

 

The following day -Sunday I was basically fine until after dinner when I developed repeated coughing spasms so severe I was developing pain in my chest and my abdomen just to the right of my belly-button. And when I say pain-I kept coughing and the pain kept happening. After I stopped coughing for a while, I had to stay standing (leaning against a chair) for about 2 hours until the pain relaxed enough and I could sit down. Due to pain, not breathing issues, I ended up sleeping semi-upright in a Queen Anne recliner.

 

Monday the coughing fits started again -with the accompanying pain in the abdomen. I called 911 to go to the ER as I was in severe pain and obviously couldn't drive. The ER did an x-ray-no pneumonia. And sent me home with cough medicine, a muscle relaxer (Flexeril), and Augmentin (antibiotic) even though the PA's official diagnosis was a URI with chest strain. Let me tell you though that it wasn't only chest strain-the right side of my ribs felt almost the same as they did a few months ago when I tripped and fell on my chest. My rib cage hurt for three weeks after that.

 

In addition the frequent coughing paroxysms would induce a burning pain in my abdomen in the area over the liver, and could also cause burning pain in my right chest and also very lateral portion of my back.

 

The ER visit was a week ago Monday. My cough has decreased. But I woke Monday night again with another coughing paroxysm, and the accompanying soreness kept me from lying down completely. Last night general right sided chest wall soreness made it difficult to lie down.

 

Today (Tuesday) I keep having spontaneous coughs that cause momentary bursts of fire along my ribs. But I seem to be getting better at last.

 

I have to tell you the pain has been miserable. In the past I've coughed so much that my central (middle) part of the abdomen has been sore. This is the first time I can remember so much right sided chest/abdomen and back pain. I think I must have popped or stretched some ligaments last week with that big cough I had. It's made it so I don't want to take a deep breath because it will trigger a cough-I don't mind the cough so much. It's the burning pain from the muscle contractions.

 

As a side effect-I've coughed so much that my diaphragm feels extremely weak. And I've had problems (TMI here) visiting Nature because I can't push down.

 

I luckily have had some Vicodin to help with the pain, because the codeine cough medicine didn't seem to help at all. And yes I've used the Vicodin very sparingly. Currently it's been 24 hours since my last dose. And I just took one, so the chest pain doesn't keep me from laying down flat. Really if the pain had continued much longer, I was wondering if there was some kind of nerve block they could do.

Oh and while binding my chest might have helped give it support, they don't do that anymore because they are afraid if you don't expand your chest, secretions will build up and cause pneumonia. But I was about ready to risk it.

 

So how was everyone else's last 10 days?

 

Gman

[Guest]

Try getting to know one physician instead of going to the ER repeatedly. You're likely to get better care. ER physicians tend to be bottom of the barrel. It can be difficult to diagnose asthma if a person has only intermittent asthma, because spirometry (lung function test) will be normal with a regular test. There are provocative tests such as a methacholine challenge or exercise spirometry which can tease out asthma in people whose symptoms are intermittent. You may benefit from a good 7 to 10 days of prednisone. You've been sick for weeks. Have you considered contacting your primary care physician?

[+ Gar1eth]

Try getting to know one physician instead of going to the ER repeatedly. You're likely to get better care. ER physicians tend to be bottom of the barrel. It can be difficult to diagnose asthma if a person has only intermittent asthma, because spirometry (lung function test) will be normal with a regular test. There are provocative tests such as a methacholine challenge or exercise spirometry which can tease out asthma in people whose symptoms are intermittent. You may benefit from a good 7 to 10 days of prednisone. You've been sick for weeks. Have you considered contacting your primary care physician?

 

You make good sense. But...

 

Basically 12 days ago I went to Urgent Care - three days after that I went to ER- not because I wanted to but because I couldn't stop coughing and was in pain.

 

The ER wanted me to follow up in two to three days with my doctor (I do have an internist, but I've only seen him 2 or three times). I tried to make an appt with him -and he was full for a week. The best they could do was get me in to someone with their group practice in a special Saturday clinic.

 

 

So I went last Saturday. She did a flu test which was negative, negative rib x-rays, gave me more cough medicine and albuterol. I have an appt with my doctor today for follow-up.

 

As for prednisone, I've been on it chronically for over a year due to my Myasthenia Gravis. I'm on 15 mg daily down from 60 mg last winter. The internist wanted me to go up to 30-more for stress replacement than treatment. The neurologist thought I should stay at 15 if my myasthenia was at stable. So I stayed at 15.

 

As for asthma, I've been to pulmonologists in the past for my cough-I never wheeze-although I know not all asthmatics wheeze. And while my PFT is not normal, it doesn't really change with albuterol-at least not in the past. I've also had negative allergy skin tests in the past.

 

Part of my cough is probably post nasal drip (and I think obesity is also a cause for coughs). But I keep the cough even after the drip stops. I also have fairly significant reflux. But I haven't felt it as much lately on my Prilosec. And I don't think I'd tolerate a fundoplication well.

 

Gman

[MikeBiDude]

And I've had problems (TMI here) visiting Nature because I can't push down.

I luckily have had some Vicodin to help with the pain

Reminder that Vicodin can add to blocking up “nature’s visits”. Take Lots of water, fiber too if you can.

[Prime Muscle]

I agree that finding a primary doc is one of the best things you can do and make sure you're comfortable with telling him everything about your lifestyle. In addition to establishing a history, the primary doc has a full network of specialists and can often get you immediate appointments if needed.

 

And never settle for advice you're not comfortable with. No one knows your body better than you and your the one that suffers from poor diagnosis

[+ oldNbusted]

I feel for you, because I've had the same experience my whole life. I'm not an M.D. so I can only speak for myself, but eventually I learned that it was absolutely critical to not cough. Otherwise I would not get better or it would take forever. Almost all over the counter cough medicine is a combination of Dextromethorphan and Guaifenesin. Guaifenesin is an expectorant, which means it makes people more inclined to cough, which is appropriate if you have phlegm build up that needs to be eliminated, but that was not my scenario, so it was actually making the problem worse. I'm pretty sure I had pleurisy a couple of times over the years, it's a miserable experience.

 

Eventually I found cough pills that are just Dextromethorphan and when I feel an episode coming on, I start taking them. A lot of them, like one every two hours. It's been highly effective over the years. Sadly, when "robotripping" became a thing, my preferred pills became somewhat hard to find and pricing is all over the place.

[+ Gar1eth]

Thanks for all the advice. I did see the internist today. I don't know how they bill (I thought they had to document an exam to bill-although the nurse took my weight, BP, temp, and oxygen level) as he never even listened to me-although he did fill out FMLA paperwork I needed for what I laughingly refer to as my job. Of course work doesn't have to accept what he's written.

 

Anyway he prescribed Tessalon perles. Where codeine and dextromethorphan are supposed to work on your brain. This stuff is supposed to numb the stretch receptors in the airways.

 

 

As for the pain in my chest-maybe I haven't emphasized it enough-although it seems like it to me-considering it felt like my chest was ripping apart-but everyone must be so concerned about the opioid epidemic that no one has even offered any hydrocodone. I've been in agony for almost two weeks with pain daily. I've taken about 6 Vicodin that I had in th time period.

 

I don't want to become addicted either. But my G-d this has hurt.

 

Gman

Edited November 7, 2019 by Gar1eth

[gallahadesquire]

I'm in the market for a new Primary physician. One of my criteria is that they must be ready, able, and willing to prescribe opiates as needed. I read Gar1eths post above, and know that Tessalon and dextromethorphan are completely ineffective when i have bronchitis. Codeine works, and incredibly well.

 

I had a hip replacement, and could not explain to the bloody Nurse that I wasn't "escaping" my analgesia; rather, I wasn't getting enough analgesia. I didn't spend half-a-year training in Pain Management, nor doing Acute Pain Management for six years, without learning something.

 

And if anyone is still prescribing "oxycodone 5 mg with APAP 325 mg," point them to me so I can teach them the error of their ways.

 

I had a particularly intelligent Orthopedic surgeon, perform my knee replacement. I was on a low-dose opioid analgesic (like oxycodone 5 mg thrice daily) prior to surgery. He told me post operative analgesia would be a problem.

 

Post-op: 15 mg oxycodone every three hours, was just about right. For like 6 weeks. My Surgeon said he would prescribe as much as needed, along wiht Physical Therapy, for three months, then it was gone.Over. Don't even bother.

 

And so I was.

 

Part of the "opioid crisis" is lack of oversight by the prescribing physician. In my Pain Clinic, we paid expecial attention to the patient's opioid consumption and interactions regarding any additional requests for medications. But we saw thirty patients a day.

 

The "crisis" is one of bureaucracy. It is not inappropriate medicine.

[Guest]

Thanks for all the advice. I did see the internist today. I don't know how they bill (I thought they had to document an exam to bill-although the nurse took my weight, BP, temp, and oxygen level) as he never even listened to me-although he did fill out FMLA paperwork I needed for what I laughingly refer to as my job. Of course work doesn't have to accept what he's written....

If your internist didn't listen to you or examine you, change doctors without any further hesitation. And, yes, your employers do have to accept what he's written, although they can probably seek another opinion (i.e. require you to see another physician).

[+ Gar1eth]

I'm in the market for a new Primary physician. One of my criteria is that they must be ready, able, and willing to prescribe opiates as needed. I read Gar1eths post above, and know that Tessalon and dextromethorphan are completely ineffective when i have bronchitis. Codeine works, and incredibly well.

 

I had a hip replacement, and could not explain to the bloody Nurse that I wasn't "escaping" my analgesia; rather, I wasn't getting enough analgesia. I didn't spend half-a-year training in Pain Management, nor doing Acute Pain Management for six years, without learning something.

 

And if anyone is still prescribing "oxycodone 5 mg with APAP 325 mg," point them to me so I can teach them the error of their ways.

 

I had a particularly intelligent Orthopedic surgeon, perform my knee replacement. I was on a low-dose opioid analgesic (like oxycodone 5 mg thrice daily) prior to surgery. He told me post operative analgesia would be a problem.

 

Post-op: 15 mg oxycodone every three hours, was just about right. For like 6 weeks. My Surgeon said he would prescribe as much as needed, along wiht Physical Therapy, for three months, then it was gone.Over. Don't even bother.

 

And so I was.

 

Part of the "opioid crisis" is lack of oversight by the prescribing physician. In my Pain Clinic, we paid expecial attention to the patient's opioid consumption and interactions regarding any additional requests for medications. But we saw thirty patients a day.

 

The "crisis" is one of bureaucracy. It is not inappropriate medicine.

 

Is the 5 mg oxy/325 Tylenol not strong enough in your opinion?

 

Twenty years ago I broke my left leg just below the knee-the fibula (little toe side) and tibia (big toe side) at the ankle. I was in a long leg cast for about 3 weeks before they put a shorter cast on. -I think the longer cast may have been on a bit longer than normal as the surgeon went on vacation.

 

The doctor wanted me to keep the leg elevated 23 out of 24 hours a day. But my leg would throb-especially during my one hour with it down. I was using frequent pain medications for weeks. My parents came to help me as obviously I couldn't do much with my leg elevated 23 hours a day. My mother was worried I was going to get hooked. But gosh my leg throbbed. I needed them. And I didn't get hooked.

 

Gman

[+ Gar1eth]

If your internist didn't listen to you or examine you, change doctors without any further hesitation. And, yes, your employers do have to accept what he's written, although they can probably seek another opinion (i.e. require you to see another physician).

 

There's a company that they employ to vet FMLA claims and special accommodations. The company can reject what the doctor suggests. They've already done it on another matter. I might have been able to appeal. But I didn't get around to it.

 

As for not examining you, I think it's becoming more common. I've been to Urgent Cares where they haven't done much of an exam. At one of my last endocrinology appointments (I had thyroid cancer),

the endocrinologist went over labs but never palpated my neck (an ultrasound had showed no thyroid tissue or significant nodes-so I know she wasn't expecting to palpate anything-but still). For several visits my neurologist's office documented my temperature when they never took it (of course in that case the doctor wasn't in the room and was going by what the nurse or medical assistant falsely documented.)

 

 

Gman

[Islesguy]

I'm in the market for a new Primary physician. One of my criteria is that they must be ready, able, and willing to prescribe opiates as needed. I read Gar1eths post above, and know that Tessalon and dextromethorphan are completely ineffective when i have bronchitis. Codeine works, and incredibly well.

 

I had a hip replacement, and could not explain to the bloody Nurse that I wasn't "escaping" my analgesia; rather, I wasn't getting enough analgesia. I didn't spend half-a-year training in Pain Management, nor doing Acute Pain Management for six years, without learning something.

 

And if anyone is still prescribing "oxycodone 5 mg with APAP 325 mg," point them to me so I can teach them the error of their ways.

 

I had a particularly intelligent Orthopedic surgeon, perform my knee replacement. I was on a low-dose opioid analgesic (like oxycodone 5 mg thrice daily) prior to surgery. He told me post operative analgesia would be a problem.

 

Post-op: 15 mg oxycodone every three hours, was just about right. For like 6 weeks. My Surgeon said he would prescribe as much as needed, along wiht Physical Therapy, for three months, then it was gone.Over. Don't even bother.

 

And so I was.

 

Part of the "opioid crisis" is lack of oversight by the prescribing physician. In my Pain Clinic, we paid expecial attention to the patient's opioid consumption and interactions regarding any additional requests for medications. But we saw thirty patients a day.

 

The "crisis" is one of bureaucracy. It is not inappropriate medicine.

While oversight over physicians is a huge problem, the bigger problem is the money the drug companies are using as bribes to both physicians and pharmacies.

 

When a town has enough pills floating around to give 100 or more to every man, woman and child in the town, "bureaucracy" isn't the main problem.

[+ nycman]

ER physicians tend to be bottom of the barrel.

This again? Seriously?

 

Try not to make blanket statements like this.

It makes you look moronic and unprofessional.

 

If your medical care is as dated as your opinions

about ED docs it‘s a miracle you still have a license.

 

Have you ever considered that your crappy attitude towards

your local Emergency Physicians might be why your patients

get such crappy care from them? Trust me, they hate you.

 

Have you considered contacting your primary care physician?

Nonetheless, even morons occasional say something intelligent.

[Guest]

...

Try not to make blanket statements like this.

It makes you look moronic and unprofessional.

...

Nonetheless, even morons occasional say something intelligent.

Saying ER physicians "tend to be" is not a blanket statement. It comes from over 30 years of experience and seeing the interactions between my patients and ER personnel. Obviously, there are some good ones out there. Just yesterday, one of my patients came back after seeing one of the good ones, and I said to her "Thank God you saw Dr. XYZ, I think she's the best ER doctor at ABC hospital." I've never told a patient "Oh, no, you saw Dr. WXY, he's an idiot." Although I have occasionally given constructive feedback when I see something pretty outrageous, usually I keep my thoughts to myself and maybe to the medical assistant with whom I'm working that day. There is no reason to think ER physicians "hate" me (in fact, I've heard some positive comments from patients). If an ER physician were to give "crappy care" to a patient because he disliked the PCP, that would be highly unethical (and stupid), and only demonstrate why such a physician could be considered "bottom of the barrel."

Incidentally, name-calling (..."even morons occasional say something professional") doesn't make for a persuasive argument or make you look to smart yourself.

[Guest]

[+ LIguy]

I take 10mg/325 oxycodone but my primary care doc will not prescribe it. I see a Pain Management doc every 4 weeks and must give a urine sample. I had to sign a statement saying that I would not seek pain medication anywhere else.

[Guest]

I take 10mg/325 oxycodone but my primary care doc will not prescribe it. I see a Pain Management doc every 4 weeks and must give a urine sample. I had to sign a statement saying that I would not seek pain medication anywhere else.

Required by law now. Must also sign a controlled substance agreement, which needs to me renewed at least every 12 months, and do drug screens as least every 6 months, and check for prescriptions by other healthcare providers every 4 months. It's become a real pain in the ass to prescribe controlled substances. Patients can no longer go trolling to ER's or dentists getting more pain meds, but verifying all of this stuff is very time-consuming.

[Guest]

On the ER subject, just saw another winner today, from the ER of one of the hospitals near me I wish my patients wouldn't frequent. A male patient came in with left pelvic pain. The ER doctor didn't examine the patient, but rather ordered a CT scan, as they almost always seem to do. The CT scan was notable mainly for what appeared to be an undescended right testicle, which is dangerous in adults and usually needs surgical attention. Even having that on the CT report didn't pique the ER doctor's curiosity to do a genital or a prostate exam. Had he done so, he would have found out that the patient had epididymitis on the left (and, indeed, an undescended testicle on the right), rather than a "stomach flu" with which he was diagnosed. So I treated the epididymitis and sent the patient to a urologist for likely removal of the undescended (and therefore cancer-prone) right testicle.

Edited November 9, 2019 by Unicorn

[Islesguy]

I have had some bad experiences in the ER. Mostly just the seemingly endless waiting even after you are brought in from triage. I know they are busy, but when 2 or 3 hours go by between anyone checking on you, it's pathetic.

 

My worst experience in the ER was a time I had pneumonia. It was in late June, the worst time of the year to go to the hospital because all the new interns start then. I had gone up to the ER at the hospital all my specialists worked at. I got into a room pretty quickly considering my O2 says we're in the low 80s. When they decided to admit me, we specifically asked them to alert my pulmonologist that I was going to be admitted so she could see me at her earliest opportunity. They told us they had already.

 

Two days went by and she still hadn't stopped by to see me something that never happened before. All the while the interns, nurses and attending on the ward said she knew. On the third day, she happened to come to the ward I was in to check on another patient and saw my name on the board. She was furious that she was never told I had been hospitalized especially when she found from me that I hadn't been getting better in the two days I was there. Those docs and nurses got a "valuable" lesson in patient management that day.