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EMS, Patient Care

A Reminder on Pain Control

Remember the discussions we’ve had in the past about pain?

And when I shared what my 10/10 was? (Photograph removed by request)

 

I’m updating my 10.

 

On Monday afternoon I was enjoying a day off after the holidays and tidying up around the house.  Cleaning up Christmas decorations, washing out the keg, you know, usual post holiday stuff.  As I walked back into the garage and began to close the door I noticed the sprinkler bin outside still had the lid open.  I had gotten it out to assemble a keg washer from old PVC pipe and a sprinkler.  Very clever I thought.  Half a step from the bin it felt as though my left foot had gone into a hole.

A bright light flashed in the back of my head and a bolt of lightening struck my lower back.  At least, that’s how it felt.

I collapsed to the ground faster than you could say “WTF?”

The pain caused me to begin to writhe on the cold concrete not 3 feet from the house.  As I writhed in pain, my back continued to burn and tingle, which was causing me to contort in small jerky motions.  Each time I did my back sent lightening up to my shoulders and down my legs.  Even the wind blowing by seemed to make it worse.

“h…elp” was all I could get past my clenched teeth.  For a brief moment I thought back to my burns and wished I could have them back instead.

Slowly my eyes opened and I was able to look for the hole I surely stepped in, but there was none.  I needed help, but couldn’t move.  The clothes dryer had just started and the vent was nearby.  that combined with the sounds of my girls playing loudly in a nearby bedroom meant that no one was going to hear me for some time.  I had to move.

Each and every motion except blinking sent shock waves out from the searing pain in my lower back.  After 3-4 minutes of grunting, crying and twisting, I was able to get on my hands and knees and start crawling back to the house.  Those 3 feet felt like miles.

Crawling is not as easy as you remember it.  It is very easy to lose your balance when you’re not in shape, which I apparently was not.  Each hand movement became a slide instead of a lift and my knees also never left the ground.  The movements were telegraphed from the pain in my back and I could have traced the entire nerve system through my body had you needed to know it.

An unknown time later, the 2″ tall metal door threshold behind me, I was in the garage and able to raise my voice.

“help”

“KIM!”

She came running and found me in tears, on all fours and trying to explain what happened.

A few moments later she had a cushion, ice pack and ibuprofen ready and the decision was made to move me onto my back.  A decision I would curse until supine.

Unable to stand, Kim got under my left arm and helped me shuffle into the house and onto the couch.  I would spend the rest of the day there, eventually able to get up and shuffle around the house and head for bed.

The next morning my alarm went off and I sat up to get out of bed for work.  Well, not exactly.  More like I started to sit up and the lightening struck again.  Back to sleep, no way I can go to work like that.  Awaking at 830 to a busy household, I decide a shower sounds nice and the family is off to their regular weekday routine.  As the water is turned off and I feel 100% better my hand instinctively reach to dry off my feet.

Flap!

And I’m on the floor again in worse pain than the initial injury.  Nowhere near a phone, the family gone for at least another hour and naked, and I’m wondering how long I’ll be lying there.

No way.  I have to get moving.  Crawling is worse that yesterday but I make it to the dresser and somehow am able to manage getting some clothes on, then look down the hall towards the phones.  It was a good idea yesterday to leave all the phones I need on the couch.  Now I’m wishing I had brought at least one into the bathroom with me.  Now we know why the fancy hotels put phones in the bathrooms at least.

A long crawl down the hallway and I make it to the office where my cellphone is.  On top of the desk.  Barely able to reach up and pull it down I dial the wife’s cell phone on speaker while collapsing onto my side.

Then I hear her phone ring.  She forgot to take it with her.

As I hung up I saw the number I should call and sighed.  Did I really need an ambulance?  It sure would be nice to not have to crawl anywhere anymore.  One more try first.  Able to reach the wife at one of the places she told me she was going, she advised a 15 minute ETA and I decided to call my insurance company to see about a handicap van or other transport to an urgent care.

It was there on the office floor, alone, that I realized that even though I was willing to jump off a cruise ship to get pain management for my chemical burns, I was willing to hurt someone for muscle relaxers.  For pain management I would have done more.  Thinking back to the floor of the bathroom, it clearly became my “10” on the 1-10 pain scale, pushing the burns to a close 2nd.

When we discovered the clinic was by appointment only and no openings for 4 hours we chose to get me to the ER for an assessment and some medication.

After an excruciating walk to the car we arrived at the ER and got me in a wheelchair.  The ER Doc came in and saw my knuckles white from holding onto the rails of the wheelchair, splinting my body from resting on the soft chair.

“Bad back?” he asks.

“Since yesterday, yes.” I answer, now pushing my head against the extended rails behind the chair.

“Can you show me where?” His question is answered by my strange jerky repositioning, trying to create space for him to look at my back.

“That’s far enough. You need some meds.”  When he returned not 3 minutes later I was given a Zofran tablet, Valium and muscle relaxers IM and the bad news.  I was going to be useless for at least 2 more days.

After a brief wait at the pharmacy we were home and my Valium was kicking in.

That was yesterday.  Today finds me finally able to sit up enough to get on the ol’ laptop instead of holding the ipad over my face to get my social media fix.

The decision to share my tale was to remind all that we ALWAYS need to qualify a patient’s 10 out of 10 to properly dose them based on their level of discomfort.  When I checked into the ER I rated it a 3/10.  To me that meant it hurt when I hold still, but walking, standing, most anything else instantly became an 8 or 9.  Looking at the happy faces chart now used, my inability to stand or care for myself meant I was always a 10.  Hogwash.  Get a baseline, it’s the only way to know what a 10 really is for the patient, not the provider.

And make sure to exercise your core, not just your arms, legs and cardio.

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2 Comments

  1. Too Old To Work January 9, 2012 11:49 pm

    I feel your pain. Or my accurately felt your pain, literally. It started out about 20 years ago and lasted for several years. At times all I could do was lie in bed and try to breath. Which hurt a lot. Sitting up was almost impossible, lying down minimized the pain but didn’t resolve it.

    Tests showed nothing so the generic diagnosis was “Pulled muscle.”

    I had it off and on for years, but haven’t been bother for a long time. It finally subsided when I started running. Now that I bike just about every day, it’s hasn’t bothered me in years.

    Not a pleasant memory at all.

    As to the pain scale. I consider it so arbitrary and subjective to be worthless. A 10/10 to me could be a 7/10 to you and an 11/10 to someone else. For doctors to base dosing decisions on that sort of thing seem ridiculous to me. For a doctor to make a dosing decision and risk their license if some federal bureaucrat thinks they are “peddling” drugs is insane.

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