Category Archives: medicine

How do you know if it hurts enough or if you’re just whinning?

May 22, 2009  Note:

This is followed up by two postscripts as my illness progressed. You’ll see them at the end of this article. In the meantime, here is the beginning of my narrative for all it is worth :

I have a skewed sense of pain. After a childhood of growing up with my dad saying, “Oh hell, that doesn’t hurt” when we hurt ourselves, I am learning to refine what pain is. My parents never took us to doctors. While I was in junior college, I was very sick  with some kind of flu or sinus infection that not only hurt, but I was dizzy and ran a fever. and I may have lost some hearing because of i, because there’s a  gap in hearing that I can’t account for. I do know one thing. Before  I got sick, I used to ride the roller coasters laughing. After being so terribly sick, I couldn’t.   Dad did take me to get stitches when I had a gaping wound in my forehead when I was about nine, so I had one Emergency room visit during my entire childhood. I didn’t visit another ER until well after I was married. When I was a teenager, both mom and dad had medical insurance through their jobs. It never occurred to them to add me to either of their policies, and I endured a lot of things I shouldn’t have had to live through. Dad should have known better because he’d had access to doctors as a child. Mom didn’t unless she had red streaks going up her leg, but still, she’d seen doctors when she was pregnant. She should have know what they were. After the required shots to start school, the next shot was about the age of 7 when my sister took me to the health department to have a tetanus shot. Then I didn’t have another shot until I was in high school. I didn’t see a dentist until I was 22, and that was merely out of curiosity. I was 21 and my friends were having their wisdom teeth out. I decided I’d better check the status of mine. I didn’t have them. I did have three cavities which weren’t causing me any pain. I was very, very, lucky.

Because my dad taught me to ignore pain,  as an adult I walked on a broken foot, unaware that it was broken because I didn’t think it hurt enough to be anything but a mild sprain. A doctor showed me the healed break on an x-ray a year later. It had healed well. I was lucky. The last time Dad had the gall to tell I wasn’t in pain was when I was in my 30’s and visiting home. I ran my toe into a chair leg and nearly swooned.  Dad took one look at a very  purple swollen toe, and made his usual pronouncement “Oh hell that doesn’t hurt”.  For the first time I answered him and said, “Of course not.YOU don’t feel a thing. But I do”. My sister gave me some open toed sandals that were the only thing that I could wear for weeks. When I returned home and recounted the whole story to my doctor, he looked at me startled and said, “You broke your toe.” I guess that’s a good reason for it to swell, turn purple, and hurt like hell to walk. A broken toe just might do that.

I tend not to notice bladder infections until they get to the point where I’m screaming.  My family doctor has mentioned maybe doing a urine test to check every time he tests my cholesterol, which is four times a year. The last infection finally got my attention when I realized that I was uncomfortable enough that I was NOT going to sleep. I agonized over going to the ER because to me, it was mere discomfort, and I was afraid that I would be wasting the ER staff’s time. I wasn’t. They agreed that I did indeed have a bladder infection, and that there was a good reason for my discomfort.

This morning I woke up with a  VERY painful sore throat on one side Because I wasn’t congested or coughing, I ignored it all day, even though it hurt to swallow. I was in agony, but I ignored it as being obviously minor. In the evening, I took some mild sore throat medicine and sucked on some cough drops. Usually when I have a sore throat due to a cold or something,  I feel better within the hour. Tonight, the medicine didn’t touch it. While thinking about going to bed, I realized that this sore throat was going to keep me up, because every time I swallowed, it took my breath away. I finally sat myself down and asked myself just where this was on the pain scale. It was a nine on a scale of one to ten. That made me say “hmmm” to myself, and I began to think that just maybe I should go to the ER. Steve agreed to take me. He didn’t realize the extent of the pain until he saw me gasp every time I swallowed.

Still I felt that I was being frivolous by deciding to go and get seen. This was a sore throat, not a broken bone or a life threatening injury. I wasn’t even running a fever.  My mind kept going to the few times I’ve had strep throat.  I had another “hmmm” moment. At this point, I would have welcomed strep, because strep, as uncomfortable as it is, doesn’t come even close to hurting like I did tonight.

So I went into the ER apologizing to the staff, who took my temperature and confirmed that I had no fever. I felt foolish until they took my blood pressure. My blood pressure goes up a bit when I am anxious or angry. I was neither. My blood pressure was the worst that I ever remember it being, and I began to think just maybe that it was stress from pain of the sore throat that had caused it, and if pain had elevated my blood pressure to that point, maybe I actually should be there.I was now beginning to think by now that I was not going to wasting anyone’s time by being seen tonight.

The ER doctor came in, and earned my admiration by sticking a tongue depressor in my mouth and NOT making me gag. No one was ever done that, and I complimented him on being a whiz with a tongue depressor. After he looked at my throat, he saw me jump because I had just swallowed. He eyed me warily. He said, “Where does it hurt?” I said, “Back here” and he felt just behind my jawbone. He asked again about the pain, and I said, “Let me swallow” and he discovered as I once again jumped because of the pain where it did hurt. I told him that I felt foolish for coming in because I didn’t even have a fever, but I admitted that this thing hurt a lot worse than strep. His answer was “This is no ordinary sore throat”. I’m going to give you something for pain, antibiotics, prednisone, and I’m going to run some tests. I got the 4th IV ever in my life put in my arm, and they drew more blood than I ever had had drained from me.  I had my throat swabbed for a throat culture which had me nearly swoon. When they started talking CT scans, I realized again that there just could be something going on. Before the cat scan, I got pain meds shot in my IV which took a bit of the edge off my pain…which was a good thing, because saliva was beginning to pool in my mouth because I wasn’t swallowing. I’d also started having trouble talking.  After the CT scan came an IV bag of antibiotics. I’ve never had an IV in an ER let alone an IV bag.

When the doctor returned and said that my white count was elevated, I realized that their fears of an infection was founded.  I was beginning to think that they were going to keep me. It was a very real possibility. They almost did. I got sent home with warnings to come back in should I lose the ability to swallow, prescriptions which got filled at an all night pharmacy.

I should be feeling very stoned on vicodin as I’m writing. I don’t and it still hurts to swallow. However I CAN swallow, without gasping from the pain and jumping every time it hits.

I’m very thankful that they paid attention to the pain despite my doubts. I’m sure that seeing me touch the side of my face and jump involuntarily in pain gave them a good idea that I was in enough pain for them to think about pain relief immediately before they did anything else. I think after tonight’s visit and my visit last year with the bladder infection that I am beginning to develop a bit of a benchmark for pain. If it’s bad enough that it’s going to keep me up, just maybe, I could be sick. If I have gotten to the point where I allow to myself that I’m at least uncomfortable,  I really shouldn’t be waiting.

So now it’s four in the morning, and I’m about as comfortable as I’m going to get. I think I’ll be able to sleep. I’m thankful that the antibiotic should stem the infection, the viodin will keep my pain down to bearable, and that the prednisone will bring the swelling down so I won’t lose my ability to swallow.  I’m now going to go to bed, and I think that the next time I feel what I consider discomfort, I’ll pay attention to it and maybe concede that I’m actually in pain. Tonight was a wake up call. I came very close to losing my ability to swallow. Had I let it go like I was tempted to, they would have HAD to keep me.  And with that, I’ll go up to bed and count my blessings until I fall asleep.

Monday,  May 18, 2009

Postscript: Steve tells me that while he was waiting with me in the ER for test results, that the outside of my neck was swollen, and that had I not immediately responded to the IV’s that my airway would have been in danger of closing. The doctor didn’t tell me that. But Steve has seen this in the various places he’s worked. I’m so glad that he neglected to share this opinion of his until this morning, and I am feeling very blessed that as a result of quick attention and my response to the IV’s that the situation was reversed and I was able to go home. Technology, and God, are indeed good!

Thursday, May 21, 2009.

Another postscript: I got sent home  on Monday morning with the name of a throat specialist to call. When I realized that a throat specialist was an  ENT doctor, I realized that I already had one and called his office as soon as I could on Monday morning.  I was given an appointment  for Wednesday. I never kept it. The doctor had to come see me.  I woke up uncomfortable on Tuesday morning. It hurt to swallow again, and I ended up spending much of the day in bed,  in tears, spitting into a towel to keep from enduring the pain of swallowing. I begged my doctor’s office to see me early, crying. The nurse said that I could wait until the next day’s scheduled appointment, because the doctor had looked at the CT scan. My protest was that it didn’t show anything, and she said that this was why I could wait.  By Tuesday afternoon, I felt a bit better, precisely because I’d spent the morning not swallowing,  and a bit ashamed of my tears, and put the towel away. I started hurting again. I got the towel and started spitting into it again, and after he had something to eat, Steve took me to the ER again. I was ashamed and embarrassed to be bothering them again, because although I was in pain, it wasn’t as bad as what it had been… but I was frustrated and worried that it would soon be. It was good that I ignored my doubts once again about malingering.  This time I got a diagnosis. It’s not something that anyone would have expected, thus isn’t easy to diagnose. Since the CT scan had showed nothing, on the second night, the next ER doctor did a soft tissue x-ray.  This is how you catch what I have, along with a scope, which I got later. What he saw was dumbfounding. I had something that they almost never see–epiglottitis. Google it. It’s life threatening.  It killed George Washington, and it came up as fast with me as it did him. Had they found it when I went in the first time, I would have been kept overnight after being sent by ambulance to a bigger hospital.

But I didn’t fit the criteria. I was the wrong age,  and for an adult, the wrong gender. I hurt only on one side. I also don’t live in a third world country which is where it is going to be more common today. Here, they have eradicated it mostly because of flu vaccines in the 1980’s. I didn’t get vaccines. I never got vaccines after I started school, and I never got booster shots. In the mid ’80’s I was a young adult. I had no idea that there were vaccines that I should have gotten or should have be getting. Don’t think that you are doing yourself or your child a favor by refusing to get  vaccinated. It’s not worth the risk.  I had no immunity to the virus that attacked me and threatened my life.

The steriods given me the first night had kept the swelling from cutting off my airway. They had saved my life. I would not have lived to  daylight had they not given me steriods and antibiotics.  However, not knowing what was wrong, since this wasn’t something to really look for, they didn’t cure me. The second time at the ER, they called my ENT doctor that sees me for my ears once a year and makes me laugh. He was very confused, and said “But I see her for her ears, not her throat” to which the ER doctor replied, “Well, tonight she can’t swallow”. Since  Sentera Norfolk General Hospital is a teaching hospital associated with Eastern Virginia Medical school, and my doctor is an attending, and because I couldn’t stay where I was, I got sent by ambulance to Norfolk. After being scoped and treated to a picture of an angry red epiglottis, I spent the night and the whole next morning being filled with steroids and antibiotics. I have more steriods and antibiotics yet to take. I see my doctor on Tuesday for a followup checkup and another look with the scope.

I saw my doctor early yesterday when he should have been in his office seeing patients. I had been told that the attending would be in to see me, and I knew that the attending was in fact, my personal ENT doctor. But, the time for clinic hours came, so I didn’t expect to see him. I was wrong.  He walked in, sat down, and said, “That was odd” to which I agreed, and we talked.  He’d taken another look at the CT scan. He finally did see something, but not only did you have to know where to look, it still didn’t look like anything other than a bit of muscus. That’s not going to give you a diagnosis, and even I know that. I didn’t need any other explanation other than that…and I hadn’t even asked for that.  Then he went to his office to face the people who had been waiting for him that he was late in seeing.

His visit, even though he didn’t have the time, let me know that he was concerned about me, and interested in getting me well. I had figured that from all the attention and the transfer to Norfolk, and I know that it could be said that he was just doing his job. But he let me know he cared, and I was touched.  I’m home, tired, and now that I know what I had, I’m now starting to shake. Today I was worn out and I’m hoping to feel up to driving tomorrow.  I’m still thankful to God, modern technology, and competent medical care, and thankful as well to have been spared yet more time on this earth.

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