To all you who hate going to the doctor...

Miscellaneous and Personal Stuff I Must Share
1

A little background:
My boyfriend detests going to the doctor. He especially hates going to the ER. In all the years I’ve known him (11.5), he has been to the ER 3 times. One of those times I forced him to go.
The first time I took him was because he woke me up in the middle of the night and asked me to take him. He ended up having back surgery.
The second time I took him was the time I forced him. He felt that having both eyes swollen shut and oozing pus was not important enough for a trip to the ER. He had a massive eye infection which his eye doc later told him could have blinded him.
Today was the third time I took him to the ER.

He spent the entire day yesterday working on his jeep so he was very sore when he went to bed. This morning, he was going to Home Depot to buy supplies and woke me up before he left. I decided at the last minute to go with him. When we got to the store, he started complaining that his arm hurt. We both assumed it was from all the work he did yesterday. As we walked through the store, he kept complaining about it (which is odd for him). While looking at soldering irons, I stretched his arm for him and he said it helped but then a minute later the pain was back and his hand started going numb. I looked him straight in the eyes and said, “Are you having a heart attack?” He said he wasn’t and that it was just from the car work. We paid for our stuff and left. As we got in the car, he said that his whole arm was going numb. Not numb and tingly, just numb. We got about 10 minutes down the road and he said, “Can you please take me to the ER?”

I nearly drove off the road in shock just from him asking that question. He said that his arm was completely numb and he had tightness in his chest. He was also lightheaded and hot. Of course, I panicked. He was somehow oblivious to what his symptoms indicated, he just knew he felt really bad. Of course at that point, we were closer to the small hospital in our town than to all the huge hospitals in Worcester so we continued to our town.

We walked into the ER and all I said to the triage nurse was, “chest tightness, right arm pain and numbness.” In about 30 seconds, he was in a johnny and being hooked up to machines.

They gave him and EKG and took some blood. While waiting for the blood work to come back, they sent him for a head CT and a chest x-ray. Almost right after we got back to his room, the doctor came back and said that his EKG was normal (thank god) and that his brain was fine (double thank god*). BUT, she said that one of his blood tests indicated a very small possibility of a blood clot so she was sending him back to Radiology for a chest CT with contrast. After that we spent about an hour waiting in his room. We assumed everything was ok because they didn’t hook him up to anything when we got back to the room.

The doc finally came back and started listening to his lungs, feeling his arm, asking him strange questions (any long trips lately, any injuries lately). She also hooked him back up to all his monitors (something I have NEVER seen a doctor do). Then she said, “You have a blood clot in your lung and I have no idea why.”

We could tell from the look on her face and the way she said it that she definitely was shocked at the news. I think she assumed he was having a panic attack or something.
So…
My boyfriend is spending at least 1 night in the hospital for extensive testing. He will not be allowed to leave unless they’re confident he’s not in danger. He also has to be able to give himself Coumadin shots in the chest before they’ll let him leave. If he can’t give himself the shot, he’ll have to stay for 3 days while the pills take effect.

THE POINT TO THIS STORY (and I bet you thought there wasn’t one) is that he could have passed it off as being out of shape and sore from working on his Jeep. He chose to go to the ER just in case. While waiting for his results, he kept saying he felt like a fool for going to the ER. If he had followed his natural course of refusing to go to the doctor, that blood clot in his lung could have killed him.

IF YOU THINK YOU MIGHT BE HAVING A HEART ATTACK GO TO THE ER!!!. Even if you aren’t having one, there could be another cause to the symptoms you’re having.

My boyfriend keeps apologizing for being a pest. I keep telling him that today he made the best decision he’s ever made in his entire life and I will be eternally grateful to him for it. He had a valid reason for having a sore arm. He has asthma so he had a valid reason for chest discomfort. We could have passed this off as asthma and hard work related.

  • At the beginning of the summer his boss went to the hospital thinking he was having stress related problems. He left the hospital with a baseball-sized glioblastoma and a 6-month death sentence. When we heard head CT, we both got a little queasy.
2

Congo, it is Lovenox shots into belly fat. Coumadin is another beast that works differently, but produces the same result in a few days. Lovenox just went generic. If insurance is a issue, WalMart has it for the least. You can expect fun with Coumadin—it is a art getting dialed in with the dose, not a science.

Hope blood tests don’t freak him out much, he’s gonna get quite a few for a while.

Why don’t you give him the shots? After all, this will hopefuly be your only chance to stab him over a few days and not be talking to the boys in blue…
The Vorlon (who picked up $6763.99 of generic Lovenox today for Mrs. Vorlon…)

3

This is seriously one of the reasons men have shorter lifespans than women - we are socialized to think that if we don’t work through the pain, we are less macho.

4

The Vorlon: Oh. I wasn’t there when they talked to him about what the shots were. I was told the shot was Coumadin. This is why I am almost always with him for important stuff. If I’m not there I will later on ask why they said, followed by his answer, then followed by me going :confused: and asking, “are you sure they said that?” They must have meant that he’s on the Lovenox for the 3 days it will take the Coumadin to kick in. Not sure. I hate trusting him with this stuff. He is a very intelligent guy but I think he’s medically dyslexic (he always gets medical shit backwards or inverted).

:smiley:

I had run home because we put the puppies in the crate assuming we’d be gone about an hour. I had to let them out. By the time I got back about 45 minutes later, his parents and brother were there, he had been moved to his room from the ER, he had seen the doctor and nurse, had eaten his dinner, had been given a talk about the shots.

Another thing he told me (and his mother backed it up - she’s more reliable) is that the doc said that if HE can’t give the shot himself, he’s not allowed to leave. It would be easier if I could do it. Hell, my best friend is a medical assistant and a nursing student. Part of her job is giving these injections so she said she could come out once a day to do them but if he needs more than that, we’re on our own. I’ll double check with the doc tomorrow. He’s really not happy about giving himself the shot.
Blood work is only an issue for him because his veins are not very good. The lab lady took 10 vials at once today and needed 3 veins to do it. Even with her skill, it took her about 10 minutes to find a vein she was happy with sticking. I am so glad I don’t have shitty veins. Anyway, he’s used to it. He has Hashimoto hypothyroidism. He spent about 4 years having blood work every 1-2 months and then having his medication adjusted. After all that time, his doctor FINALLY gave up and referred him to an endocrinologist. What do you know, it only took about 6 months to regulate him when he had a specialist doing it. :rolleyes:

5

Happened to me in a more spectacular fashion - and I almost didn’t go to the ER either, and would have died driving to work.

Good on your bf for asking you to take him!

6

It makes me queasy to think of what would have happened if I had stayed home to do my homework, causing him to have been driving (and alone) when it hit.
When you went to the ER, did you feel like you had dodged a bullet?

7

I hate going to the Dr, hell I hate going to the barber, but if I need to go I go.

8

Not really, that was much later. I was a lot sicker (from the sounds of it) than your bf. I spent several days in intensive care.

It was only very much after the fact that I realised my decision to turn around halfway to work very much allowed me to dodge a bullet, since I finally passed out not six feet away from the ER doors.

Plus, when I was in the ER they didn’t tell me exactly how sick I was. Later I found out they told my husband to “prepare for the worst”. That’s reasonably scary.

9

Quite an adventure! Sending out a wish for a speedy and full recovery.

10

These strange question were to find out if he’s at risk for a blot clot. When you take a long trip, you tend to be sitting still for long periods of time, which can cause the blood to pool in your legs and lower abdomen. When blood pools, it has a chance to clot. When you’re injured, lots of blood rushes to the spot of the injury and, again, has a chance to clot.

Ok, let’s see if I can help.

Coumadin, sometimes called Warfarin, is an antiplatelet drug. It’s often called a “blood thinner”, but what it actually does is inhibit platelet formation by messing up clotting factors related to Vitamin K, which makes it harder for your blood to clot. It takes a few days for it to build up to a therapeutic (working) level in your bloodstream. Coumadin is usually taken orally, as a pill, but it can also be given intravenously (through an IV catheter placed in your vein). It is not, as far as I know and according to my drug book, available in a shot into the skin, subcutaneous tissue or muscle.

Heparin, or Lovenox, is another antiplatelet drug which interferes with other clotting chemicals (not the same ones as Coumadin/Warfarin). It is either injected subcutaneously (a needle just under the skin and fat layer in your abdomen or the back of your upper arm) or intraveneously. Heparin/Lovenox works much faster than Coumadin/Warfarin, but it has more side effects and is a pain (literally) to use, so we try not to keep you on it for longer than we have to.

So the general course of action is to put a patient on Heparin/Lovenox and Coumadin/Warfarin at the same time. While the Coumadin/Warfarin is building in the system, the Heparin/Lovenox is already working. Once the Coumadin/Warfarin levels are high enough to be protective, you can generally stop the Heparin/Lovenox, unless you have a really severe clotting disorder that requires both groups of clotting factors to be reduced.

While on Coumadin/Warfarin, he’s going to need frequent bloodtests to check how his blood is clotting. We don’t want it to clot as fast as yours and mine does, but we don’t want it to take too long for it to clot, either, or he could start bleeding and not stop. So he needs a test to see how long it’s taking his blood to clot. This test used to be called the PT. Then, because different PT tests were giving different results, the labs started standardizing their results, and called the new and improved test procedure the PT/INR. Nowadays, a lot of people are shorthanding the name and calling it simply an INR. So if you hear “PT”, “PT/INR” or “INR”, it’s all the same test, for your purposes. (And why so many nurses never tell patients this is beyond me. I’ve had patients thinking they needed three different blood sticks every month for three different tests!)

His doctor will determine what his INR level should be, based on his health and history. Very generally speaking, we like to see it over 1.5 (that is, it takes him one and a half times longer to clot than a healthy person who’s not on Coumadin) and less than 3 (takes him three times as long to clot as a healthy person who’s not on Coumadin), but that’s a pretty big range, so the doctor can tell you his specific range.

The INR is a fairly inexpensive test, ranging from $8 to $20, depending on where you live. They’ll probably want them one a week until they find the right level of Coumadin for him, and then once a month after that for as long as he’s taking the Coumadin.

The PTT (two T) test is a slightly different clotting test to see if the Heparin/Lovenox is working well, but I doubt they’re going to order that if he’s only on it for three days. They may, but it won’t be a recurring one unless they keep him on the Heparin long term.

Let me know if you have any other questions. Of course, I can’t answer specifics about your SO’s case because I’m not HIS nurse, but I can maybe help with the general stuff.

Oh, and yeah - if you have numbness down an arm, GO TO THE ER! There’s simply no reason for that that’s healthy, none at all. Overwork or exercise causes soreness, not numbness!

11

Thanks WhyNot! That was awesome. I actually understood all of that, mostly because you explained it so well, but slightly because I’ve been working on my transcription class for so long. I recognize all the tests and the drug names but why they’re specifically used isn’t so important as long as I know they’re relevant to the condition being treated.

Once we found out why she was asking those questions, the reason behind them became very clear. They were strange at that moment because we were expecting her to walk in and say the CT scan was clear. Instead she came in and started asking about his travel time (he spends about 45 minutes each way getting to work, plus a lot of driving to shoots).

12

Here’s a hint to distinguish between PT & PTT.

PT is related to Coumadin (Warfarin).

PTT, to heparin (Lovenox).

To keep this straight, imagine the two (lower case) t’s in PTT forming an H. There’s your heparin test.
mmm

13

I think you’re addressing this to the wrong crowd. It should be “To all you who refuse to go to the doctor.” Like a lot of people who hate going to the doctor, I go. I may growl and bitch every damn step of the way, but I go. Not often enough to suit my mom who wants me to have every viral sniffle no one can do anything about checked out, but definitely when it seems medically advisable.

My dad, though. Jeebus, my dad. He hid chest pains and shortness of breath for a day and a half because they were intermittent and he didn’t want to ruin Christmas for everybody by scaring us all half to death over nothing. We went to the ER Christmas night when the pains got worse, and the tests revealed that not only was he having a heart attack, he’d been having mini-heart attacks for probably 6-8 months judging by the scarring and dead tissue. And never said word one to anybody, even though he knew the warning signs because his dad, grandfather and uncle had all died of heart attacks and even though he knew he was at high risk due to family history, diet, and 3 packs of Camels a day.

He got a lot better about going to the doctor after the bypass (and after Mom got done chewing on him about hiding symptoms from us for all that time), but as the “OMG, I almost died” feeling has faded he’s slowly become more mulish about it all. At this point he’s still better than he originally was, but he’s gotten way worse than I’ve ever thought about being.

14

My dad probably hadn’t seen a doctor in 15 years. He hates going. But he got a bug bite on his hand that swelled up and didn’t go away after a few days so my mom made him go to the doctor. One thing lead to another and about three weeks later he was having quadruple bypass surgery. He is feeling much better now. Myself, I don’t like doctors much either but I’ve vowed to start actually getting the annual physicals that my insurance plan allows and doing as the doctor says.

(Yeah, I know, the bug bite has nothing to do with the story other than an excuse for my mom to make my dad go.)

15

Glad things are under control for now and hope for a great outcome!

Not to nitpick, but I don’t think a hospital can make a patient stay for treatment unless it’s a mental health issue - anyone shed light on this? Assuming you meant it in the sense they would force him to stay until he’s in the clear,and assuming you’re in the U.S. I’m just asing for clarification from somebody. Boy that would piss me off if I were a patient.

16

Yay! I really love the patient education part of nursing most of all. I really want to be good at it, not least because I’ve been in the hospital as a patient or family member feeling really clueless and powerless because no one had the time or skill to explain things in a way I could understand. Thanks for letting me practice my skills on you - I know this isn’t academic for you in the least bit, but still, you’re helping to educate a novice nurse while you’re going through some pretty big stuff yourself right now, so* I* thank you! :slight_smile:

That’s actually really good to hear. It may indeed be a problem, but at least he’s not one of those patients with *no *risk factors who develops a clot and we’re all WTF? His doctor (or nurse) might have some tips for him about how to reduce the risk of those long drives, like breaking them up into smaller legs with a short brisk walk at a way point to keep the blood moving. There are also some leg exercises he can do while sitting, especially if he’s in the passenger seat.

The hospital won’t discharge him through the normal process until he’s stable enough to leave and can demonstrate an ability to do the things he needs to in order to follow the therapeutic plan, but yes, you can always leave AMA (Against Medical Advice) unless you’re mentally incompetent…or a child. (In some areas, a parent *cannot *sign a child out AMA.)

17

My fiance gets so freaked out by doctors/hospitals, he freezes up and I can’t guide him (he’s blind). His bloodpressure gets out of control. The solution came in the form of a concierge plan - he can call his doctor anytime, even at night, or email him, longer personalized appointments, very detailed reports - it’s eased his mind.

Oh, ok thanks WhyNot

18

You are correct. A patient may refuse admission and leave AMA (against medical advice). A parent or guardian can sign their minor out AMA as well (but if the child were in serious danger social work would get involved and papers would be filed to prevent this).

As for psych issues, a patient may be held against their will if they are considered a danger to themselves or others for a maximum of 3 (?) days. Again, paperwork is involved.

This applies in the U.S. (maybe differs by state?)

mmm

19

If you need a PTT, do not go to Quest—they managed to frack up Mrs. Vorlon’s test 4 times—it took a hospitalization to get the test done correctly. The MD was quite eloquent and descriptve in ripping them a new one over their lack of talent.

20

I last went to the doctor ten years ago. I tell ya, she had a face of scorn when she realised all I had was a chesty cough and not the dreaded lurgy from yonder.