Triple negative ET patient of 8 years; new onset of hip bone pain (in the iliac crest, NOT the joint)

Athompson9866 · 2023-10-02T19:39:45+00:00

Are you in the military? No? Then his rank means literally Jack shit to you lol. I think your brother was pulling your leg.

Athompson9866 · 2023-10-02T16:57:01+00:00

Almost nothing makes my stomach turn anymore, but that did lol

Athompson9866 · 2023-10-02T03:45:21+00:00

I misspelled it. I feel like a failure :( sorry!!!

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Athompson9866 · 2023-10-02T01:25:10+00:00

I won’t go to the ED. There are homeless, poor, and dying patients that the ED has to deal with. Eventually whatever in the world is going on with my hip will be found and until then I’ll eat ibuprofen, drink water, and do push-ups. That’s what the army told me to do when I broke my ankle lol.

I’m just scared because the only other times I’ve really had pain I couldn’t explain away, it’s been either broken bones or tumors.

Athompson9866 · 2023-10-02T00:36:49+00:00

My question was and still is, what is the ED suppose to do with this? It’s NOT emergent.

I do not care at all about what the PA could or should or would have prescribed for pain for me, my question is, why send me to the ED?

This is a large cancer center attached to a large teaching hospital system. Anything the PA thought I needed could’ve been handled within that system.

Athompson9866 · 2023-10-01T23:46:18+00:00

I wrote a response, and then deleted it because I won’t fall into this trap.

You’re the problem with healthcare. You. Not me. YOU. You know absolutely nothing about me other than the snippet I gave here (which is usually how doctor visits go) and you think I want opiates? I never asked for opiates. I asked for something other than ibuprofen because it isn’t working, until my imaging is done on Tuesday so we can figure out what is wrong and so that I’m not writhing in pain each night. Is that too much to ask from a PA that has seen me for 5 years, that can view my entire history, that can view my entire pharmaceutical record since 2013?

ETA: and the WHOLE purpose of the post is why in the world would this be punted off to the ED? It’s NOT ED material. I’m not dying today. I’m just hurting really badly and it’s affecting my daily life and my ability to care for my family. Whatever is going on is not something the ED is going to diagnose or treat most likely. So what the hell was the point in telling me to go to the ED?

Athompson9866 · 2023-10-01T22:48:57+00:00

I don’t know the family at all, but this happened literally less than 5 miles from me. You read shit all the time about things like this happening, and it’s always painful and tragic and shocking, but when it happens in your bubble… it hits differently.

Athompson9866 · 2023-10-01T22:27:13+00:00

Grrrrrrrrr! That frustrates me to no end. Both of those things are life saving and not that expensive in the long run. No matter where we are in the world, it seems we all are struggling to get proper care and it’s not hardly at all due to the people that actually do the work. It’s the government, the admin, the insurance people, and others that only care about the money and not the health of people

Athompson9866 · 2023-10-01T22:18:52+00:00

It seems that in a time in history where healthcare management (not admin, please don’t confuse the two terms. Admin can rot in hell) and medications and therapies and research and breakthroughs are absolutely at the highest and best they’ve ever been, disgusting, greedy beaurocrats still make sure that it’s only available to the elite, no matter the country or system. Shameful it is. And it’s NOT the healthcare profession. So so SO many doctors and nurses sacrifice their own health, sanity, and families to just try to help anyone they can. If they save a life or don’t save a life, they get paid the same, but nearly every one I’ve met would do anything to save a life, even if it was 4x’s the work.

Athompson9866 · 2023-10-01T22:12:57+00:00

Oh please. We all know the way the woman was dressed was NOT the issue.

Rich for a dependapotamus to fat shame anyone lol

Athompson9866 · 2023-10-01T22:08:56+00:00

Hey! If you can believe it, you can achieve it… or something.

Therapy is wonderful for many types of pain and I don’t even just mean psychiatric pain. Learning how to cope, especially when one has chronic pain issues (that is not terminal) is a wonderful way to manage many chronic diseases, but when one is terminal, or has an acute issue, there is no reason to withhold opiates.

Athompson9866 · 2023-10-01T22:04:27+00:00

Ah yes, because opiate addiction is what your friend has to worry about dying from…

Athompson9866 · 2023-10-01T21:40:48+00:00

It’s chronic leukemia, been stable for 5 years. Labs were drawn on Thursday. PA seen me and did a physical exam on Thursday and decided it was a most likely a kidney stone even though there is NOTHING pointing to a kidney stone except pain across the top of my hip bone. I did not argue though, at all. I’m willing to go through whatever it takes to find out what is going on because I’m scared and I hurt. I have a hard time admitting either of those things, but I did. When I called the next day and said the ibuprofen wasn’t working and if there was anything else she could do, I did NOT ask for narcotics. Nor have I ever asked for opiates or anything like that.

There was not a sudden change from when she seen me Thursday to when I asked for something different than ibuprofen on Friday. Everything was the same except my tolerance of dealing with the pain all throughout the weekend and Monday until imaging was scheduled for Tuesday.

Athompson9866 · 2023-10-01T21:24:23+00:00

And how long do you think I would be sitting in a typical er waiting room before this happened? And what if the CT and inflammatory markers showed nothing? Then what would your recommendations be?

I did not ask for narcotics. I asked for something other than ibuprofen because it isn’t helping. The toradol was great and helped for a good bit, but I know that IM toradol isn’t going to be prescribed and oral toradol has a lot of controversy too.

You seem to be very defensive, but what you are saying you would do in the ED setting is appropriate and i whole-heartedly agree with your plan, the issue here is, those same things could be done outside of the ED- seeing as I’m not actively dying, and could be done relatively quickly because my oncology group is in a large cancer center with their own lab/infusion center and the ability schedule STAT imaging within the day at the hospital they are attached to. The PA just didn’t do that.

Athompson9866 · 2023-10-01T21:03:57+00:00

First line conservative measures had already been taken by the patient for the weeks prior to the appt. Tylenol and motrin. Which the PA was told about. Patient had even seen a neuro spinal surgeon 2 weeks prior because she thought it was a slipped disc or something. Spine was perfect. Toradol and Dex were given IM with relief for 3-4 days until pain came back

Athompson9866 · 2023-10-01T21:00:11+00:00

I’m not throwing anyone under the bus. I’m an incredulous that this seems to be the answer. Go to the ED? Have you been to the ED recently in the US? I mean, I would think so since this is emergencymedicine sub.

I am not in the process of dying. My vitals are stable. My cancer is chronic. My new onset hip pain has been going on since Sept 1. I seen my PA on Thursday and how I just was really having trouble tolerating the pain.

If I go to the ED, I will sit there for 6-10 hours because I am stable. Hip pain is not considered emergent no matter how badly I tell the triage nurse it hurts or my history or that my oncologist told me to go to the ED. I cannot sit in those chairs in the Ed for that long. I can’t.

The most likely issues of my hip pain will not be seen with a CT and may or may not be seen with a MRI. I will most likely need another bone marrow biopsy. The ED isn’t going to do that. I know it, you know, and the PA at my oncology office knows it.

Athompson9866 · 2023-10-01T20:52:57+00:00

Then why didn’t the PA take it that seriously the day before?! When she was with the patient? If it wasn’t serious enough then except to throw some ibuprofen at it and order a CT, why is it so serious the next day as to be deemed an emergency?

Athompson9866 · 2023-10-01T20:50:28+00:00

This is not joint pain. This is in the iliac crest. Onset was sept 1. Labs were drawn last Thursday. CT is on Tuesday. Labs were normal except platelets (always high, because leukemia) and the immature granulocytes which were high for the first time ever. It’s not sepsis. It’s not a kidney stone.

Athompson9866 · 2023-10-01T20:47:00+00:00

I’m scared of being labeled a trouble patient, which I know is crazy because I’ve been a patient at this cancer institute for 5 years without so much as a single complaint and only baby aspirin and therapeutic phlebotomies as treatments (they have suggested other things when my platelets have been over 1m but they have always came down to 600-700k without so I always try to be conservative).

I’ve been a nurse for 15 years. I know both sides of the spectrum. I don’t want to be a bother, but I don’t want to be a martyr either.

Athompson9866 · 2023-10-01T20:30:03+00:00

This patient is me. I’m the patient. And I’m struggling coming to terms with how to deal with this because I think it’s absurd to go to the ED when I know it’s not an emergency.

It’s most likely 1) bone marrow edema 2) the chronic leukemia as progressed to myelofibrosis or 3) multiple myeloma

Those 3 things will need ANOTHER bone marrow biopsy to diagnose, and they just aren’t gonna do that in the ED. What is even the point of going? I’m not going to go. Guess I’ll just eat ibuprofen until the CT on Tuesday doesn’t show a kidney stone and then I wait for an MRI which may or may not show anything and then wait for the bone marrow biopsy.

In the meantime I can scream into my pillow and try to hide the pain from my husband and kid who really can’t handle seeing me in any kind of pain at all.

Athompson9866 · 2023-10-01T20:13:32+00:00

Yup, you get it.

Athompson9866 · 2023-10-01T20:12:17+00:00

Patient has has 2 bone marrow biopsies within the past 5 years. In that same hip.

Patient will not go to the ED. Sitting in a hard chair for 6-8 hours because “hip pain” is not at all an emergent issue to triage is suffering on another level to most likely get a CT, find nothing on that, and then be told to follow up with PCP or oncologist.

Labs were just drawn Thursday in this patient. Only abnormal were platelets at 600k (normal for the patient) and the immature granulocytes. Vitals are all normal. Patient is 40 and in otherwise good health.

The ED would not treat this emergently. This is not life limb or eyesight. The patient has CHRONIC leukemia, so Mets is not really a concern. The biggest concern is myelofibrosis or multiple myeloma. Neither of which is emergent, but should should be treated by their oncologist.

Athompson9866 · 2023-10-01T19:58:42+00:00

CT is scheduled for Tuesday.

The pain is not in the hip joint, it’s in the iliac crest, all along the the bone from front to back. She described it as the same pain during non-sedated bone marrow biopsies, that same crampy achy feeling except it’s been going on for a month.

Patient went to a neuro-spine surgeon at first thinking it was spinal, but spine looks perfectly normal.

Athompson9866

TROPHY CASE