When to go to the ER?

[UncleHoney]

Yesterday morning I got up early, had a bowl of Wheat Chex and started surfing on the web. Just about 8 my stomach started feeling a little queasy so I headed to the john. In all of about 10 minutes I went from feeling fine to total misery. The Wheat Chex lasted about 5 minutes and I broke out in a cold sweat, started to shake and generally felt like crap. After about an hour I started feeling better and about two hours later I felt good enough to make a trip to Lowes. Not 100 % but not too bad. I just figured it was some stomach bug.

About 4 in the afternoon it hit again and this time I knew what it was, all the tell tale signs of a kidney stone. It's been 30 years since I had one so the memory was a little foggy in the morning and my stomach felt so bad it kind of covered up the back pain. This time there was no doubt about what it was.

I've had two previous stones and they passed within an hour and it was all over. All evening long this thing would flare up and I'd do the kidney stone dance trying to get away from the proverbial ice pick in the back syndrome.

About midnight it all stopped and didn't bother me all night. I felt good this morning but shortly after I got up it started up again. Now I'm trying to figure out what to do, wait till my doctor gets in at 8 or go to the ER. I waited and DW called the doctor about 8 and they said there wasn't much they could do in the office to go the hospital ER.

What was I thinking, I'll never know but I never figured the DR's office wouldn't be able do much. DUH.

So about 8:30 this morning I staggered into the hospital ER while DW parked the car. About 15 minutes later I was getting a CT scan and then they gave me some pain killer in an IV and all the pain and agony went away. Just minutes after I got there I felt a 1000% better and now I'm trying to figure why I didn't go last night.

My hospital ER experiences have been very limited and all I could envision was moaning and groaning on a gurney in some hallway while everyone took their coffee break. In the past it always seemed like no one knew what was going on, what we were waiting for or what they were going to do. At best it all seemed like controlled chaos.

Things were different this morning for sure. Within minutes I was getting vital signs taken and everything was entered into the computer. When my wife got back from parking the car the guard at the front desk even knew what treatment room I was in and showed here how to find me. Every thing went like clock work and about 4 hours later I was heading home with a nice printed out sheet of instructions and an appointment to see my urologist Friday and no pain. We even stopped and picked up a prescription and did some grocery shopping.

So far I haven't needed the pain pills and I don't know when the stones will go to war again but I'm armed and ready.

The big question I have is just when do you decide to go to the ER and when do you just wait till the doctor gets in. I'm not one that runs to the doctor every week because I have a hang nail or a little runny nose either.

Uncle Honey with two kidney stones, one 4mm and one 2mm.

 

[Rich_by_the_Bay]

Ouch. Sorry for your renal colic (to use the official term). This too shall pass, I hope. If not there's always lithotripsy.

When to go to the ER is not an easy question to answer. You did the right thing by calling your doctor first, even if the response was less than satisfactory. If nothing else, your primary doctor can help you know when is dangerous NOT to go there.

The Emergency Room is often the soft, dysfunctional underbelly of our health care delivery system, though some work very well, esp in smaller communities. In the cities they can be living hell. I admire the brave souls who work there, and did it myself for years as a moonlighter with young family.

One tip: if you can't reach your primary doctor, call the ER itself and ask to speak with the triage nurse or any other ER RN. Tell them your symptoms, that you can't reach your PCP and ask if they think you should come to the ER. Take their name. When you get to the ER tell the intake doctor that Nurse Ratchet told you it would be wise to come in. That way you're not just another PITA "walk-in" ready to abuse the ER. It helps.

Best wishes for a quick recovery. No fun. Been there.

 

[UncleHoney]

Rich

Thanks for the tips about calling the Er in advance for their opinion. Good to know little details like that.

My wife and I have had very few medical problems over the years and we just don't have the experience dealing with the system.

As for the hospital, I was really impressed at the coordination of the ER unit as a whole. It looks like they have addressed a lot of the confusion and anxiety many experience. The whole place appeared to be working as a team effort. No fewer than five different staff were involved in my treatment and each one gave me the impression that they were well trained in their job and patient relations. Every thing was very well coordinated and explained in detail.

Here's the hospital.

Riverside Methodist Hospital, Delivering the Most Advanced Healthcare Available to Columbus and Central Ohio - OhioHealth

 

[Leonidas]

DW had one of those a few years ago - that girl was in serious pain. I drove her to the ER early on a Saturday morning to find that a triathlon was being run in my neighborhood. I had to stop several times to wait for runners to clear the streets. She wanted to be in the ER 20 minutes before we left and when the car stood still too long she called out from the backseat to demand to know why I wasn't going. After I explained the situation to her, this sweet and gentle woman who I always tell people is the nicest person I have ever known, said:

Run em over and get me to the damn hospital!

 

[Goonie]

We seldom have to pay a visit to the ER, but when we have, they've treated us like we were the only people in the world! Some trips have been for what some would think of as trivial, but the ER folks always said that it's better to come in and find out that it was nothing, than to not come in and have it be something serious!

Our family Doc has always told our family, that if we think it's something to possibly be concerned about, then it's something that needs to be checked out. He's always told us to call him, day or night, that that is what he's there for. We try not to bother him unless absolutely necessary, but when we've gone to the ER, they've always called him anyway! He'll come strolling into the room, and ask "Why didn't you call me?" And it's like "Gee, Doc....it was 3 o'clock in the morning." And Doc, "Yeah. So? What's your point? Why didn't you call me?"

We've got a really great family Doc....and all of the ER staff have always been the BEST!

As for me personally.....I have an extremely high pain tolerance, and I don't like hospitals much, so I tend to stay away from the ER unless ABSOLUTELY necessary!!! I always just figure that I'll get better....or die! So far it's always been the first!

 

[LOL!]

I think the advice to call your doctor is simply superb. It's one reason to have a good relationship with your family physician or internist even though you might see them only once every 3 years. Indeed, the first time you visit a physician new to you, you can ask them about calling them.

I've passed 2 kidney stones. While the first one was a surprise (happened to me overseas in France), with the second one 10 years later it was pretty obvious to me what was going on, so I called my physician who called in a pain killer prescription to the drug store. I went to see the doc the next day, but only to turn in the stone which had passed overnight for analysis.

 

[FinallyRetired]

One tip: if you can't reach your primary doctor, call the ER itself and ask to speak with the triage nurse or any other ER RN. Tell them your symptoms, that you can't reach your PCP and ask if they think you should come to the ER.

Rich, do large ERs have a list of "on call" specialists who consult or come in when the patient needs emergency specialty care but the primary doctor can't be reached? For example, a cardiologist for a heart attack in the middle of the night?

 

[justin]

I'd second the "call your PCP/family doctor". If not available, most insurance plans have a nurse hotline you can call for free, tell them your symptoms, and they can "triage" you into either getting over the counter help, going to see your doctor the next available opportunity (or if the pain doesn't subside w/in a few days or so), or going to the emergency room/urgent care ASAP. Our "big-city" hospitals here typically take hours to treat anything but the most urgent cases (based on feedback from our frequent-ER-visiting in-laws that use the ER for primary care).

I like Rich's idea of calling the ER triage nurse ahead of time.

 

[happy2bretired]

When I had my pancreatitis, I had my daughter call my doctor. I would not have been able to use the phone/TDD with my pain - thank God she was home. The doctor's nurse also told us to go directly to the ER since the hospital had the equipment to handle my problem and they didn't.

I live in a town of about 250,000 people and we have three wonderful hospitals in this town. We have always had good ER service for our several visits there that we have taken over the last 20 plus years.

The only thing I wasn't happy about this time, since I was in such great pain, I still had to go thru admissions. My daughter actually told them everything for my admission...I was in no shape to even know what they asked.

I was in the ER for an hour before they gave me morphine. At that point they still didn't know what was wrong with me, but, I was very grateful for the pain relief.

We were treated very well in the ER, even tho I was there for 6 hours before they sent me to my room in the hospital.

 

[Rich_by_the_Bay]

Rich, do large ERs have a list of "on call" specialists who consult or come in when the patient needs emergency specialty care but the primary doctor can't be reached? For example, a cardiologist for a heart attack in the middle of the night?

Yes. But first someone has to figure out whether it's a heart attack, pulmonary embolism, rib strain, pneumothorax, etc. and get initial care rolling.

 

[Bigritchie]

I have sadly had a ton of kidney stones in my short life.

But I have found something that really works for me.

Lemon Juice. If I get a stone, I just go buy some raw lemon juice and chug it. it taste like crap, but you will pass your kidney stones very very fast after it. Passed alot of stones with lemon juice, where the doctors said I would have to have surgery and not be able to pass them.

I feel for you. Kidney stones are death when you cannot die.

 

[Bigritchie]

oops double post

 

[MikeD]

I've never had a kidney stone myself but do know a few people who did. One guy, an English major who I expect to be able to express himself well, told me that it hurt so much that if he could've chosen dying right then vs continuing with the pain, he would've picked death.

I hope I never get one.

Mike D.

PS - I did pass a stainless steel surgical staple once. Painlessly, only indication was a clink in the bowl.

 

[pfpelican]

I did pass a stainless steel surgical staple once. Painlessly, only indication was a clink in the bowl.

I suspect it wouldn't have been painless if it took the same path a kidney stone takes.

 

[Rich_by_the_Bay]

But I have found something that really works for me.

Lemon Juice. If I get a stone, I just go buy some raw lemon juice and chug it. it taste like crap, but you will pass your kidney stones very very fast after it. Passed alot of stones with lemon juice, where the doctors said I would have to have surgery and not be able to pass them.

There's some science to back you up here. It's the citrate. Certain types of stone can be largely prevented by citrate, and it's available as tablets for regular use in people with recurrent stones. Crystal Lite lemonade also has a cult following and contains citrate, too. Don't know of any studies.

It's proven for prevention, but I haven't seen studies using it as a treatment. Wouldn't surprise me if it helped some people like you.

 

[BigBob]

No fewer than five different staff were involved in my treatment and each one gave me the impression that they were well trained in their job and patient relations. Every thing was very well coordinated and explained in detail.

Howdy neighbor. Riverside is a really good hospital - well organized and from what I hear from friends, a great place to deliver a baby. I assume it was a great place to deliver your stone. Glad you got such good service. Just wait till you get five different bills.

 

[MikeD]

I suspect it wouldn't have been painless if it took the same path a kidney stone takes.

Well, it took partially the same path. It was a loose staple from my bladder that came out the expected way. It wasn't anywhere near my kidney which I was very happy about.

Mike D.

 

[Leonidas]

I'll have to join in on commenting how well run the ER was on our visits. It moved quickly and all of the staff went out of their way to be very gracious, patient and understanding.

Rich, three questions regarding kidney stones.

Is there any truth to what DW heard, that if you get a kidney stone you are susceptible to getting more?

Are there geographic clusters where kidney stones are more prevalent? When DW was in the ER with hers there were three other people with the same ailment. One of the nurses commented that she had recently transferred from another hospital on the other side of the big city (about 30 miles away) and they had very few patients with KSs, but at this hospital they were very common.

Lastly, someone told us (I think it was the ER doc) that the pain from kidney stones is (of a type or class whose name he mentioned) about the worst that one can experience. I had never heard pain being categorized or classified before and was curious if that was accurate.

 

[Rich_by_the_Bay]

Is there any truth to what DW heard, that if you get a kidney stone you are susceptible to getting more?

Yes, untreated about 60% or more will recur sooner or later. Depends on the type. Preventive measures are availabe.

Are there geographic clusters where kidney stones are more prevalent?

Yes. The Virginia/Tennesee areas and pockets south used to be called the "stone belt." Not sure whether it was inherited or some environmental factor.

Lastly, someone told us (I think it was the ER doc) that the pain from kidney stones is (of a type or class whose name he mentioned) about the worst that one can experience. I had never heard pain being categorized or classified before and was curious if that was accurate

It's bad. Very bad. "Visceral" pain due to smooth muscle contraction against obstruction is the type. Childbirth, intestinal obstruction, kidney stones, gallstones all fall in this category.

Did I mention that it was bad? Very bad.

 

[pfpelican]

I've been told that the pain is the closest a man can get to the pain of childbirth.

 

[A854321]

You should be able to find an Urgent Care clinic to go to rather than a full-on Emergency Room. It is cost-effective, and if you can find one affiliated with a hospital where your doctor has priviledges, they can communicate much more easily with your physician. He/she would probably be able to review your chart and lab studies from their office computer if they are part of the system. I'd start by calling my Dr.'s office and see if there is an Urgent Care that they are familar with, or that is affiliated with a hosptial. You can get professionally screened there so that if it isn't a stone, they can avoid an unneccesary additional appointment. Going to the ER will guarantee about a 6-8 hour wait under less than pleasant circumstances.

 

[Leonidas]

I've been told that the pain is the closest a man can get to the pain of childbirth.

DW had two kids and one kidney stone. She said the kidney stone was like King Kong on a bad day compared to childbirth which was more akin to a slightly perturbed monkey.

When she had the kids and thought the staff was a little slow dispensing pain killer she told me "I'm having some pain, you really need to go talk to them and get them to give me something." On the way to the ER with the kidney stone, she was not kidding when she told me to run over the triathletes.

 

[TromboneAl]

most insurance plans have a nurse hotline you can call for free, tell them your symptoms, and they can "triage" you into either getting over the counter help, going to see your doctor the next available opportunity

That's if you have a good health insurance plan.

If you have a bad plan, they tell you to whack your pee pee until the stone passes.

 

[Nords]

Yes. The Virginia/Tennesee areas and pockets south used to be called the "stone belt." Not sure whether it was inherited or some environmental factor.

There's other factors that can contribute to kidney stones, especially a lack of vitamin D/sunlight. The submarine force is terrified of what a kidney stone [-]MEDEVAC[/-] can do to the [-]submarine operating schedules[/-] health & well-being of its sailors. To say nothing of their quality of life.

http://www.early-retirement.org/forums/f27/exercise-physical-fitness-er-18369-4.html#post337588

If you have a bad plan, they tell you to whack your pee pee until the stone passes.

Spoken like an honorary submariner! You want the corpsman to give you a couple gallons of water and the really really good painkillers, and then you go stand hopefully next to the ultrasonic sink cleaner...

 

[bright eyed]

Hm, I've heard from some medical student friends that the passing of the kidney stone is the closest thing a guy will experience to childbirth...

I often call the advice nurse (use kaiser) to see if i should take the little ones (or myself) in to the doctor or head to the ER...they also help us get earlier appointments the next day.

I would definitely find out if your dr. or insurance has some sort of similar service - it's invaluable - since they can help give you advice on how to mitigate symptoms till you get there and some perspective so you're not worried all nite etc.

I saw a doctor maybe 3 times between babyhood to adulthood (didn't i tell you my dad is an insurance agent? we always only had catastrophic coverage so every doc visit was out of pocket, therefore not happening), so I have a very bad gauge of what "normal" going to the doctor illnesses/concerns are and the nurse helps me weed those out so my little kiddos don't suffer...