I Wasn't Drug Seeking Dammit-I Had A Broken Rib!!

[+ Gar1eth]

Well I wasn't seeking a lot of drugs ?

What happened was...

 

Back in October I either had a cold or maybe bronchitis. I started out with this cough. It gradually became more severe. One night after a coughing paroxysm I felt something pop in my chest. I coughed a bit the next day. But I was mainly ok until that evening. Then I had a bad coughing paroxysm where I couldn't stop coughing for a while. But what made it worse, was the fact that every time I coughed I felt a pain like a knife stabbing me in my right chest.

Immediately after the paroxysm, my chest hurt so badly I couldn't sit down for a while. Standing seemed to slightly lessen the pain. I slept that night sitting mostly upright in a recliner. The following morning I started with the coughing paroxysms again and the accompanying knifing pain in my chest. These occurred multiple times an hour. I went to the ER. They did a CXR which was read as normal, and diagnosed me with a cold-or something. And prescribed me an antibiotic and a cough medication.

The problem with that was that while I was having paroxysmal coughing episodes, what was really bothering me was the chest pain. I'm not sure I was really able to make that point clear enough due to the pain and not wanting to seem like an addict trying to get his fix

The ER was really busy. I never even had a real room. The PA examined me in the triage room and sent me to x-ray from there. Even if I had been able to make the point about the pain, they are so worried about prescribing narcotics these days that it probably wouldn't have mattered.

The codeine cough medication did nothing for me.

Later in the week still in pain and coughing I saw an internist from the group I go to. I hadn't seen her before. But I wasn't able to get into my internist. She actually prescribed some Tessalon Perles for the cough which helped more than the codeine ever ha. I can't remember if she gave me any narcotics. She may have given me Flexeril-a supposed muscle relaxant. I've had it a few times before. As far as I can tellit's never done anything for me.

But the internist was wondering whether I might have a rib fracture. She sent me for rib films. Later she sent me a message that the rib films were negative. But the radiologist wanted to relook at an area on my right side. When I recontacted her office, I was told that -No the x-ray was still being read as normal.

Now 8 months later, I just had a new chest x-ray (taken at a different hospital than the one in October) for the cardiologist a few weeks ago because I was having some chest discomfort. He sent me a note shortly afterward saying there was nothing for me to worry about.

Today I noticed the actual report of the x-ray was in my portal. I read it. LO AND BEHOLD it talks about a HEALING RIB FRACTURE ON MY RIGHT!!!

I'm really glad to know now that I wasn't making up the agony I went through for 10 days.

If any of you ever sustain a rib fracture, I feel for you.

I wonder if they might have given me some narcotics if they had diagnosed my correctly. I know they don't want to suppress your breathing as they don't want you to develop a pneumonia from not expanding your lungs. That's the same reason they don't bind your chest anymore. But I would have been willing to risk a light chest binding.

 

Gman

[+ Italiano]

I fractured a rip 3 times in my life. It's PAINFUL. Getting up from the bed was the hardest.

[+ purplekow]

You probably had a non-displaced rib fracture, more like a crack in a windshield as opposed as a rock through the windshield. As a result, it may have been missed on Xray and then when it healed, the calcium build up of the healing process revealed that there was a fracture. The codeine in the cough medicine along with some Tylenol might have been all they would have offered if they knew there was a fracture there. If it continued to hurt, the most that can be prescribed in NJ in a 5 days supply of opiates. Depending on what other medications you are taking, you would also receive a prescription for Narcan if the opiate dosage exceeds a daily dose of 90 mg of morphine equivalent, As some opiate medications can run for as much as $20 dollars or more a piece on the street, there is scrutiny in the supple of these medications.

At my hospital, we have regular visitors to the ER who come in with a litany of pain complaints in order to procure a prescription. Some have gotten very proficient in this so as to get admitted to the hospital and have a regular supply of narcotics. I now say that these patients are on a hos-cation. Three meals a day in bed with a private room, cable TV and narcotics around the clock. It sometimes takes several hours of patient interaction with staff to get these patients to leave the hospital. It is sad that life in a hospital is that much more suprerior to their actual life.

[+ Cock Eyed Optimist]

I certainly can sympathize. I'm still recouping from a crack rib from about a month ago. Every morning I started by taking several deep breaths to keep my lungs expanding as you mention in your post. That was the worst pain aside from actually getting out of bed.

[Daverwr]

Ribs are a nasty break. But, I also understand the point you’re trying to make. Drs have gotten overly concerned about prescribing opioids. I have generalized pain and got some pain relief crap that was like taking a tic-tac. Since I have great relationship with my primary dr, I sat him down and told him I’m not an addict and we’ll be able to monitor my use between you, me and the pharmacist, also a friend. Give me the good stuff! I now have a stash of Vicodin in my cabinet for the bad days.

[+ Gar1eth]

It's funny-I hurt my back a week ago. And I went to a doc-in-the-box. He gave me 10 Tylenol #3's. I've only used one so far as it made me light-headed when I took it. I would have killed for one when I had the rib fracture.

 

Gman

[+ WilliamM]

I was in an accident in Italy 15 years ago and fractured multiple ribs. I flew home from Milan without any medication. The Italian airline was wonderful, helped lift my luggage and made changing planes at JFK easy.

 

Very great full to Alitalia and friends in Philadelphia.

[+ Pensant]

With all the physical activities I do, I’m surprised that I haven’t broken a rib yet.

[Guest]

Sorry for what happened to you. If it hasn't been done, I advise you ask your primary care provider for a DEXA scan to check for osteoporosis (brittle bones), and also to check your calcium and vitamin D levels.

[Guest]

I must say that the pendulum has swung from opiates being considered the safest form of pain control ever, should be the first thing you think about for pain control, to opiates should never be prescribed for more than a few days. Both extremes are ridiculous in my view. Unfortunately, new laws have made it very time-consuming for physicians who want to prescribed opiates for longer periods. Laws went from mandating that physicians consider opiates promptly to punishing opiate prescribers. It's one of those things that makes me look forward to my upcoming retirement...

[RealAvalon]

Well I wasn't seeking a lot of drugs ?

 

What happened was...

 

 

 

Back in October I either had a cold or maybe bronchitis. I started out with this cough. It gradually became more severe. One night after a coughing paroxysm I felt something pop in my chest. I coughed a bit the next day. But I was mainly ok until that evening. Then I had a bad coughing paroxysm where I couldn't stop coughing for a while. But what made it worse, was the fact that every time I coughed I felt a pain like a knife stabbing me in my right chest.

 

Immediately after the paroxysm, my chest hurt so badly I couldn't sit down for a while. Standing seemed to slightly lessen the pain. I slept that night sitting mostly upright in a recliner. The following morning I started with the coughing paroxysms again and the accompanying knifing pain in my chest. These occurred multiple times an hour. I went to the ER. They did a CXR which was read as normal, and diagnosed me with a cold-or something. And prescribed me an antibiotic and a cough medication.

 

The problem with that was that while I was having paroxysmal coughing episodes, what was really bothering me was the chest pain. I'm not sure I was really able to make that point clear enough due to the pain and not wanting to seem like an addict trying to get his fix

 

The ER was really busy. I never even had a real room. The PA examined me in the triage room and sent me to x-ray from there. Even if I had been able to make the point about the pain, they are so worried about prescribing narcotics these days that it probably wouldn't have mattered.

 

The codeine cough medication did nothing for me.

Later in the week still in pain and coughing I saw an internist from the group I go to. I hadn't seen her before. But I wasn't able to get into my internist. She actually prescribed some Tessalon Perles for the cough which helped more than the codeine ever ha. I can't remember if she gave me any narcotics. She may have given me Flexeril-a supposed muscle relaxant. I've had it a few times before. As far as I can tellit's never done anything for me.

 

But the internist was wondering whether I might have a rib fracture. She sent me for rib films. Later she sent me a message that the rib films were negative. But the radiologist wanted to relook at an area on my right side. When I recontacted her office, I was told that -No the x-ray was still being read as normal.

 

Now 8 months later, I just had a new chest x-ray (taken at a different hospital than the one in October) for the cardiologist a few weeks ago because I was having some chest discomfort. He sent me a note shortly afterward saying there was nothing for me to worry about.

 

Today I noticed the actual report of the x-ray was in my portal. I read it. LO AND BEHOLD it talks about a HEALING RIB FRACTURE ON MY RIGHT!!!

 

I'm really glad to know now that I wasn't making up the agony I went through for 10 days.

 

If any of you ever sustain a rib fracture, I feel for you.

 

I wonder if they might have given me some narcotics if they had diagnosed my correctly. I know they don't want to suppress your breathing as they don't want you to develop a pneumonia from not expanding your lungs. That's the same reason they don't bind your chest anymore. But I would have been willing to risk a light chest binding.

 

Gman

You have terrible luck

[Guest]

...They did a CXR which was read as normal, and diagnosed me with a cold-or something. And prescribed me an antibiotic and a cough medication....

This is one of my beefs with typical ER physicians. If your chest X-ray was normal, there was no reason to prescribe antibiotics, unless you have COPD or a few other medical conditions. The whole point of getting the Chest X-ray is to help you rule out pneumonia, and therefore tell the physician whether or not to prescribe antibiotics. If the vital signs and oxygen saturation are normal, and lung exam is normal, a chest X-ray probably isn't needed, and the patient sent home with symptomatic treatment. But if one is going to get the Chest X-ray, one should at least order it because it will help guide therapy. Why the Hell order a Chest X-ray if one is going to prescribe antibiotics regardless of what it shows? Similar to physicians who order strep tests, and prescribe antibiotics even when the results come out negative. Some of these patients come back to the PCP with antibiotic-associated diarrhea, yeast infections, etc.

[+ Gar1eth]

This is one of my beefs with typical ER physicians. If your chest X-ray was normal, there was no reason to prescribe antibiotics, unless you have COPD or a few other medical conditions. The whole point of getting the Chest X-ray is to help you rule out pneumonia, and therefore tell the physician whether or not to prescribe antibiotics. If the vital signs and oxygen saturation are normal, and lung exam is normal, a chest X-ray probably isn't needed, and the patient sent home with symptomatic treatment. But if one is going to get the Chest X-ray, one should at least order it because it will help guide therapy. Why the Hell order a Chest X-ray if one is going to prescribe antibiotics regardless of what it shows? Similar to physicians who order strep tests, and prescribe antibiotics even when the results come out negative. Some of these patients come back to the PCP with antibiotic-associated diarrhea, yeast infections, etc.

 

Well I understand where you are coming from; and I agree with a lot of it. But even if you are going to start antibiotics anyway, a chest film is helpful for a baseline. Say you go in, get antibiotics, but a week later weren't improving in the way the physician expected. A chest film is done at this second visit. It would be nice to have an earlier film for comparison.

 

Gman

[marylander1940]

You have terrible luck

 

and he keeps us posted! ?

[Guest]

Well I understand where you are coming from; and I agree with a lot of it. But even if you are going to start antibiotics anyway, a chest film is helpful for a baseline. Say you go in, get antibiotics, but a week later weren't improving in the way the physician expected. A chest film is done at this second visit. It would be nice to have an earlier film for comparison.

Sorry. Not a lot of logic in there. Of course, the short answer is that antibiotics shouldn't have been prescribed in the first place. They are NOT a harmless intervention. Even if you don't get a noticeable complication, they kill some of your helpful bacteria in your intestines, and they promote growth of resistant bugs in your body, the resistance which can be passed to other, perhaps more harmful bacteria. Secondly, if you're put on antibiotics and don't get better, the most likely explanation is that you shouldn't have been prescribed antibiotics in the first place. If you have the mind-set that antibiotics are a "good idea" when you get colds or bronchitis because they "can't hurt," I would encourage you to change your mindset. There have been multiple studies showing that the benefit is zero, and the risks are certainly not zero.

[+ Gar1eth]

Sorry. Not a lot of logic in there. Of course, the short answer is that antibiotics shouldn't have been prescribed in the first place. They are NOT a harmless intervention. Even if you don't get a noticeable complication, they kill some of your helpful bacteria in your intestines, and they promote growth of resistant bugs in your body, the resistance which can be passed to other, perhaps more harmful bacteria. Secondly, if you're put on antibiotics and don't get better, the most likely explanation is that you shouldn't have been prescribed antibiotics in the first place. If you have the mind-set that antibiotics are a "good idea" when you get colds or bronchitis because they "can't hurt," I would encourage you to change your mindset. There have been multiple studies showing that the benefit is zero, and the risks are certainly not zero.

 

You misunderstood what I said. Or on the other hand, possibly I didn't write what I meant to.

 

Gman

[+ RJD]

If you have the mind-set that antibiotics are a "good idea" when you get colds or bronchitis because they "can't hurt," I would encourage you to change your mindset. There have been multiple studies showing that the benefit is zero, and the risks are certainly not zero.

 

I found this out the hard way, although in my case, I was hospitalized and being treated for cholestasis, colitis, and sepsis. They pumped me with so many antibiotics that I developed clostridium difficile (c-diff) which lasted 10 days. If you’re not familiar with c-diff, the best way to describe it is nuclear diarrhea. The hospital admitted that although I needed antibiotics, they over-dosed me, which not only destroyed the bad bacteria but also the good bacteria and completely screwed up my digestive system. I was on vancomycin and a host of other meds which prolonged my hospitalization and recovery. They assigned an infectious disease specialist to my case who instructed me to be cautious, even in the future, if antibiotics are prescribed and to question whether they’re really needed. So yes, it’s not Tylenol or vitamin C and should only be prescribed when necessary.

[+ WilliamM]

Sorry for what happened to you. If it hasn't been done, I advise you ask your primary care provider for a DEXA scan to check for osteoporosis (brittle bones), and also to check your calcium and vitamin D levels.

Yes. That is standard procedure for fractured ribs.

[+ Gar1eth]

Sorry for what happened to you. If it hasn't been done, I advise you ask your primary care provider for a DEXA scan to check for osteoporosis (brittle bones), and also to check your calcium and vitamin D levels.

 

Thanks. I am at risk. And it's above normal due to my chronic steroid use to control my IVIG. But I see an endocrinologist for my hypothyroidism (from 2009 to 2017 due to Hashimoto's thyroiditis but since 2017 due to a thyroidectomy for papillary thyroid cancer). And while I've had a low vitamin D for years, for most of the last two years, I've been taking 50,000 units of Vitamin D weekly, and I also take 400 mg of calcium citrate multiple nights a week.

 

My last blood test a month or two ago-I had a decent Vitamin D level for the 1st time in I don't know how long. I had a Dexa scan back in December I think. It wasn't totally normal. But she wasn't extremely concerned. She did want me to take IV Zolendronic Acid-one of the anti-osteoporosis medications. I was scheduling it. The infusion company all of a sudden said they wouldn't take my major medical insurance for it as the reimbursement was too low. (I didn't think they were allowed to do that if they had some kind of agreement with the insurance). They would take my pharmacy benefits which were thru another company. But in addition I'd have to pay $300. I didn't really have the $300 to spare -esp when I wouldn't have had to pay anything if they had taken my Aetna Medical Insurance since I've reached my out of pocket maximum. I'm in the beginning process of seeing whether a different infusion company will take my medical benefits alone.

 

I am a bit leery though as there are websites full of people complaining about how the zolendronic acid has led to intractable permanent bone pain. And this is a side effect listed for the medicine. It's difficult to figure out what the risk of it occurring is.

 

Something else that may delay the infusion-I'm thinking of looking for a new endocrinologist. Mine is not the warmest person although for someone whom you basically only see every three months for them to interpret labs for thyroid cancer follow up and for hypothyroidism care, maybe they don't need to be the warmest person in the world. But she's screwed up on ordering my labs twice now.

 

1. There'a a substance called thyroglobulin that the thyroid produces. If it's in your blood, there's thyroid tissue there. If you've had your thyroid totally removed, there shouldn't be any there-or if there due to residual thyroid tissue-it should be very low. On the other hand if thyroid cancer resurfaces/regrows, your levels will go up.

 

So on my testing last August, it took forever for the results to come back. Plus she had ordered testing to detect Hashimoto's Disease-which is an autoimmune disease of the thyroid. The problem with that is that #1. I already have a history of Hashimoto's. It's in my chart. #2. It doesn't matter if the test for Hashimoto's is positive ( the test detects antibodies) as I no longer have a thyroid for those antibodies to attack.

 

And the thyroglobulin test that was needed -the results came about two weeks later than the rest. It was obvious that test had been ordered as an add on because it hadn't been ordered with the original labs.

 

On my most recent labs she forgot to order a T4 (or at least I'm assuming she forgot as LabCorp didn't have an order for it in their system) which is one of the standard thyroid hormone tests you order to check on how someone is doing on thyroid hormone replacement. Now there is another test which gives some of the same info. But always in the past they've ordered both. So I still think this was a screw up.

 

So if I change endocrinologists in the next few months, I'll see what the new one says about the zolendronic acid for osteoporosis has .

 

Gman

[Guest]

Im sorry your pain was so bad! Fearing the risk of dependency, I’m part of the anti-narcotic crowd. I’m amazed how much I’ve been given after surgeries, only to take three and then return the bottle to the pharmacy. I still see pain as a signal and a reminder...

[+ WilliamM]

Im sorry your pain was so bad! Fearing the risk of dependency, I’m part of the anti-narcotic crowd. I’m amazed how much I’ve been given after surgeries, only to take three and then return the bottle to the pharmacy. I still see pain as a signal and a reminder...

Why?

 

I take the amount in the bottle and then stop. People may not need a reminder. I don't.

[+ Gar1eth]

Im sorry your pain was so bad! Fearing the risk of dependency, I’m part of the anti-narcotic crowd. I’m amazed how much I’ve been given after surgeries, only to take three and then return the bottle to the pharmacy. I still see pain as a signal and a reminder...

 

You should have seen the amount I was taking after I broke my left leg 22 years ago. I slipped on a thin film of ice-it had misted and then slipped below freezing overnight.It was a classic twisting injury. I broke my fibula right below the left kneecap and my tibia at the ankle. I had surgery and was in a long leg cast for around 10 days then a short leg cast for around a month. When I had the long leg cast on, the doctor wanted the leg elevated 23 out of 24 hours a day. It didn't feel great at any time. But during the hour it was lowered, the blood would pool and the leg/foot throbbed. I think I was taking oxycodone and Tylenol to begin with. I definitely needed it. My parents came to live with me as I couldn't do anything with my leg elevated for 23 hours a day. My Mom was worried I was taking too much. But again she wasn't the one dealing with a broken leg. I had pills left over but never really touched them once I healed.

 

Gman

Edited June 29, 2020 by Gar1eth

[Guest]

Why?

 

I take the amount in the bottle and then stop. People may not need a reminder. I don't.

They gave me about 200 pills. I took 3. The street value of that bottle was probably $10,000. Flushing drugs is unsafe and the pharmacy will grind and dispose of them properly. FYI..the “reminder” to which I refer is the reminder to “take it easy” while recovering....not a reminder to “take my drugs”

[+ nycman]

I’m sorry you were in pain, but broken rib or not, you’re still better off without the narcotics.

 

Trust me.

[+ g56whiz]

A decade ago I broke multiple ribs doing a back flip on a rising escalator that jerked. My luggage wouldn’t cooperate. Degree of difficulty 2: execution 7.5. I was still walking gingerly several months later when a woman walked up behind me in line and asked “broken rib?” I said “ya”. She then related that she’d had the same and that she’d also given both without analgesics. “Giving birth was easier.” she said.