BTW, I’d like to point out that this is actually much, much less gross than most of the alternatives that were coming to mind. (At least it was his own blood. At least it was his own piss. At least he didn’t do something to make the blood come out of the same place as the piss…)
-lv
I am an RN on a med-surg floor. We handle all the detox patients that are not in ICU on a vent. Daily I deal with manipulative patients who seem to think I have never dealt with a detox patient before. Either that or I am gullible as hell.
For opiate withdrawal, we use a paragoric tapering dose and treat the GI pain, nausea, muscle spasms. For alcoholics, we give liberal doses of ativan or valium based on a CIWA score. (Clinical Institute Withdrawal Assessment)
The CIWA score is calculated by the severity of detox symptoms, there are 10 we assess and grade. For example, nausea=2, tremors=4,sweats=3 and so on. The assessment is based both on what I see and what the patient tells me.
The dose is determined by a sliding scale. <7=no meds, 7-10=1mg ativan, 11-15=2 mg ativan, 15=20= 3 mg ativan, >20 4 mg and call the doctor to increase the frequency of the dose .
People who are just sick of being drunk or stoned really want help and are truthful about how and what they feel. Their complaints usually match their physical state.
Sometimes people come in because they are in trouble at work, or wife is going to leave them or they are in legal trouble. Many of them elaborate symptoms. Their complaints are often not in keeping with their physical condition. My favorite is when patients try to fake tremors. Their hands will be shaking like they’re playing a tamborine yet their tongues don’t quiver a tiny bit (impossible-they get a 1 for tremors from me)
I’ve seen everything try to be faked at one time or another-- sweats, tremors, vomiting, hallucinations and orientation are the most common. I am not a hard ass but if you tell me that you threw up all your pills in the toilet and flushed it so could you have another 10 mg valium please, I’m gonna have to see the pills in the vomit before you’ll get another dose.
Our main detox doctor is great, when I call him about an acting out patient, he will sometimes ask me to take the cell phone to them where he will chew them out and tell them to straighten up or he will discharge them. At any rate, it’s never dull.
After due consideration of the pleas from the porcine kindness and appreciation committee, I have now recommended that my patient should go stick his head in a pig who died of natural causes.
Thanks all for listening to my tale of mirth and woe.
More anecdotes of the incarcitorial variety will doubtless follow.
And I guess I should have mentioned in the first post that he was purposefully putting his own blood in the urine sample. I was blinded by the obviousness of it, but it was obvious to me because I work with drug addicts for a living. Most people don’t. Or at least I don’t think so.
Have to agree with you wholeheartedly here. I have a client who was finally cut off all narcotics by her physician. She changed physicians. Luckily the new one was in the same network and had access to the records, etc, and was able to catch the possible addiction. One day, though, the client went to see an associate of the new Dr and he was not as aware…and gave her a big ol’ script for Percocet.
She then got a whole bunch of dental work done and got Vicodin and Flexeril from her dentist. I realize that she is in some degree of pain (she has chronic pain issues as well), but I honestly think insurance companies need to be shelling out more money for people to receive and learn pain-management and not just get a subsidized addiction.
Indygrrl , some people really DO go to all that trouble just for a few pain pills. You’re right, it is people like that who make it hard for the folks who are truly in need of pain meds.
I’m in much the opposite boat of many; narcotics make me sick. I’ve had bad reactions – ranging from one regular dose putting me to sleep for 18 hours to spontaneous vomiting accompanied by a headache I could best describe as multiple steel spikes bring roughly shoved through my skull, then removed and re-shoved. Percoset, Demerol, and Dilaudid have all refused to play nicely in my body, so I try to stay with the drug that tends to dull my pain pretty well without making me sick, and that’s Toradol.
The problem with Toradol is that it has a lmited dosage over a 24 period, so when I had my last bout of kidney stones, I got the stink eye when I said that I only wanted Toradol, and had bad reactions with all of these other pain meds. An ER doc came and sat beside my bed and took my hand and said “Sweetheart, you’re in pain and we don’t want you to be. But I can’t help you if you’re not honest with me. Are you asking us to stay with Toradol because you have addiction issues?”
Fortunately my husband was there to vouch for me and my reports of bad reactions and finally the docs settled on trying something I’d never had before: morphine. :eek: It worked, though. But I can only imagine that if I get sick again, it’s going to be even worse. “I know that I can handle Toradol and Morphine. Anything in between is a bad idea.” Talk about presenting an image of drug-seeking!
This ranks number two on my list of “why I don’t ever want to be sick or hurt and in the hospital again” right below “I like my body healthy and intact.” It’s that much of a concern.
Well, there’s nothing like a kidney stone to burst your youthful bubble of indestructability! Kidney problems run in my family–I had a cousin who died in his mid-30’s (close to my age) after having horrible stones all of his life. For once, I actually did something smart: I changed my lifestyle. I totally cut out sodas, cut down on my drinking (I’m a wino now–too much beer makes my kidneys hurt in that cascade-of-crystals kind of way), drink water like it’s going out of style, exercise regularly (four times a week), and cut my animal protien intake in half (only one meal with meat in it a day) and–most difficult of all–went from 7 or 8 cups of coffee a day to only one cup when I get up in the morning. It’s been six years (damn! It doesn’t seem that long ago) and, although I’ve had some pain (the aforementioned feeling of having your entire renal system outlined by a cascade of calcium crystals) and a couple of infections, I have not had a recurrance. My (new) doctor says that, given my family history, it’s likely I’ll have problems again in the future. But I’d just as soon put that off as long as possible. And like I said, that pain is a great motivator to clean up your act.
I’m sorry to hear about your kidney, Baker. I hope you’ll get some release. Me, I can’t wait until they can grow me a fresh pair and change them out like a bad alternator when things start to go wrong.
Douglas Adams, The Hitch-Hikers Guide to the Galaxy.
“Go stick your head in a pig!” The un-official motto of the Sirius Cybernetics Corporation.
I thought all dopers knew this.
I thought that was just what the official motto looked like after the letters fell halfway into the ground?
See! CrazyCatLady knew about it.
Sorry, but demostylus was there first (on the previous page) with the ID’ing of my source for my title.
I’ll add a data point.
I had a big ol’ stone June 13.
Yes I had blood in the urine…no hang nail from this dude.
Yes the pain was a ten (or least a 9.63 from the crazy Japanese judge).
Yes Toradol (with a Fentanyl chaser) from the nice nurse and doctor knocked the pain down right nice at the ER that Sunday morning. The morphine a few minutes later was yummy btw 
Yes it did show up on the CAT scan (although it didn’t show up on an x-ray the day before at a doc-in-the-box).
And ummmm yes, I did end up having to get a stent…umm less than fun, kids.
Fucker shouldn’t be faking about that shit. :mad:
Doc?? Is that you? 
Seriously. Doesn’t this guy know there are enough people out there with real problems?
I’ll echo the :wally
He probably knows but it’s the essence of selfishness that he doesn’t care.
I’m just surprised that some blood dripped into the urine after it had been excreted looked genuine. I haven’t done the experiment but wouldn’t it take a fair bit of mixing to get it to diffuse?
I wouldn’t give him Soma either…
http://www.somasd.com/main.php
–Unless he REALLY likes The White Stripes
And it could really give him headache: Thorleif's SOMA page
Jeez, ex-cons are kinda kooky…
It’s not how it looks, it’s how it tests with a dipstick assay for blood. A single drop of blood in a few ounces of urine will test very positive on dipstick, and the red cells will appear on microscopic exam. A few swirls of the specimen cup after a drop enters is all it takes.
I see.
The only urine tests I’ve done have been for two security clearances where I would have probably been denied if there were even a suspicion of illicit drug use regardless of test results. I was watched pretty closely and I would have had to backfill my bladder with a clean sample to even have a chance of passing if my urine was tainted. I guess I forgot that he’s primarily a patient for you and that you weren’t looking for shenanigans.
Qadgop. If I missed it. What does the reference to pig mean in the title of the thread? I know that I’m gonna feel stupid.
Just a general statement of contempt for my patient’s behavior is all. It’s a phrase taken from the writings of Douglas Adams.
:smack: I missed Demostylus’s post somehow.
Thanx for the link. Demo. Great fun.
Yes, still trying to set a record for two things: a) time in graduate school and b) slowest posting rate to 2,000. I’m really busy trying to get out a grant and two papers so I can finish up in March. Then I’ll have 14 months to finish my MD. So expect to see me killing patients around May 2006. I began the program in July 1997. Edjumakashun!!!