Would you be going to a+e again?

Conkers2 · 2024-12-18T23:20:57+00:00

Dw has got bad pain in her arm and I'm not sure if I'm doing the right thing about it Since Saturday, she's had intermittent shooting pains. It started as mild and now she is having bouts of being okay but then pain every hour or so where she's panting, squirming and making the same noises I did in labour On Monday, gp never called back, we went to pharmacy who gave mild cocodomol. Tuesday gp called back recommended physio and gave a self referral link. Came home to her rolling in pain despite beng on the max of medication so trundled off to a+e. A+e gave a stronger dose of cocodomol They put it down to a trapped nerve from a car crash a few months ago. Recommended physio Now despite the higher dose of cocodomol she's still crying out, crying in pain etc. Spoke to gp, who couldn't speak to her today. Spoke to 111 who said they will get an out of hour doc to call (it's been 12+ hours since original call) Would you be going back to a+e? It feels like everyone is saying it's par for the course and whiplash so just get routine physio but watching her wake up whimpering, and making such awful noises. When it's bad she can't talk etc. I feel completely useless

cansu · 22/12/2024 08:41

Yes gabapentin. It was the only thing that helped me with a trapped nerve.

Original poster

Conkers2 · 22/12/2024 08:28

Jellycats4life · 21/12/2024 11:16

Are you confident in their diagnosis that it’s definitely a trapped nerve and needs physio?

The only reason I ask is that last year my elderly FIL suddenly lost mobility, complaining of not being able to use his arm. He couldn’t get downstairs, let alone see a doctor. The verdict was he needed to see a physio. My gut was telling me this was an emergency - an elderly person stuck upstairs in terrible pain and unable to do anything other than shuffle to the bathroom needed an ambulance. I said this, but MIL refused.

Long story short, he ended up in A&E but only when the GP made a home visit and could see what a state he was in. And the diagnosis of “muscular issue” was totally wrong. He had multiple myeloma and had multiple bone fractures, including his spine.

It’s an extreme example but I’m wary of the NHS kicking the can down the road and saying that only painkillers and physio are required.

I've got no idea really.
I'm happy that at least one of the a+e consultants put hands on her but it's tricky.

In good news
Our gp finally called yesterday (with a vague apology about being distracted the night before so forgetting!)

We have a physio appointment with the GP physio and the gp has started some of the recommended pain killers. Although again (presumably because she hasn't seen her level of pain) didn't want to start her on the "big guns" so it's a small dose of another one rather than what the consultants who've actually seen her have recommended. No scans booked

Just the start of amitriptyline and then a review in 6 weeks..... which isn't able to be booked so will be a fight

It's a personal annoyance for me as working in addiction services I see how dangerous unmonitored prescriptions can be, and it feels crazy the amount that's been thrown at her with zero follow up plans etc.

OP posts:

Jellycats4life · 21/12/2024 11:16

Are you confident in their diagnosis that it’s definitely a trapped nerve and needs physio?

The only reason I ask is that last year my elderly FIL suddenly lost mobility, complaining of not being able to use his arm. He couldn’t get downstairs, let alone see a doctor. The verdict was he needed to see a physio. My gut was telling me this was an emergency - an elderly person stuck upstairs in terrible pain and unable to do anything other than shuffle to the bathroom needed an ambulance. I said this, but MIL refused.

Long story short, he ended up in A&E but only when the GP made a home visit and could see what a state he was in. And the diagnosis of “muscular issue” was totally wrong. He had multiple myeloma and had multiple bone fractures, including his spine.

It’s an extreme example but I’m wary of the NHS kicking the can down the road and saying that only painkillers and physio are required.

Growsomeballswoman · 21/12/2024 11:16

Did you ask for an ECG?

UnitedOps · 21/12/2024 11:07

Can you afford to go for a private scan and ECG? I know it’s not the best but they seem to be dragging their feet. The only other thing I can think of is being really stern and firm at A&E- basically kick a fuss. That’s what I had to do for my sister- they were utterly useless, lacking completely empathy leaving my sister in unnecessary pain.

ClicketyClickPlusOne · 21/12/2024 10:55

Disclaimer: I am not a Dr or HCP.

When one of my Dc had major surgery and procedures that involved nerve pain, they prescribed the type of painkillers that modify the brain’s recognition of pain. Amitriptyline and then Gabapentin . Alongside one of the morphine / opioid type drugs.

Both were accumulative and needing steady constant dosage, but were effective.

I really hope you find a solution soon.

Original poster

Conkers2 · 21/12/2024 10:41

ChristmasFluff · 21/12/2024 10:25

Book an urgent private physio session with a physio who specialises in musculoskeletal. They will at very least be able to tell you whether it is musculoskeletal or something else. They should also be able to give you a diagnosis, which will put your minds at rest about needing a scan etc to find out what is going on. They will also explain things fully - such as the seeming discrepancy in the diagnoses you've been given.

If it is musculoskeletal then they should be able to provide some form of treatment to help, even if they cannot do anything very hands-on due to pain - and much of this should be things you can do at home.

If the private physio is not able to do this, they should be able to refer you on to a physio who can, or if they decide further tests are needed, they can refer you to your GP and request for them to be done urgently.

In the meantime, if your DW had exercises from the physio last time, she can do those again. Being very careful not to 'push through pain' - only move to where the pain begins, or (as she is likely to be in pain already) to where she thinks the pain is about to increase. These may be very tiny movements at first, and that is fine, but they will gradually help.

Struggling to find one at the moment. The first one at the previous physio is mid jan.

Would a physio work with someone in this much pain?

The self referral nhs said an absolute no to tingly arms and left sided arm pain. It's the same barrier as doing anything via 111, because it's heart attack like and we've got nothing to say she's been cleared for that or actually been diagnosed with something else

Currently she has only some nodding type exercises because the consultant yest am that diagnosed her told her previous ones wasn't for the right thing

OP posts:

HesterLee · 21/12/2024 10:32

Gabapentin is good for nerve type pain. But appreciate you need a diagnosis and someone to actually prescribe it!!

ChristmasFluff · 21/12/2024 10:25

Book an urgent private physio session with a physio who specialises in musculoskeletal. They will at very least be able to tell you whether it is musculoskeletal or something else. They should also be able to give you a diagnosis, which will put your minds at rest about needing a scan etc to find out what is going on. They will also explain things fully - such as the seeming discrepancy in the diagnoses you've been given.

If it is musculoskeletal then they should be able to provide some form of treatment to help, even if they cannot do anything very hands-on due to pain - and much of this should be things you can do at home.

If the private physio is not able to do this, they should be able to refer you on to a physio who can, or if they decide further tests are needed, they can refer you to your GP and request for them to be done urgently.

In the meantime, if your DW had exercises from the physio last time, she can do those again. Being very careful not to 'push through pain' - only move to where the pain begins, or (as she is likely to be in pain already) to where she thinks the pain is about to increase. These may be very tiny movements at first, and that is fine, but they will gradually help.

Original poster

Conkers2 · 21/12/2024 10:24

BitOutOfPractice · 21/12/2024 10:15

I might be talking rubbish but from memory when I had frozen shoulder and took naproxen, it was a cumulative effect ie keep taking it as the effect builds, it’s not necessarily a one shot thing.

in fact I’ve just read on the nhs site that it can take up to three days to work.

it certainly worked for me, eventually.

You aren't talking rubbish! I know from my mum they said three days. Weirdly they said it should work within a few hours this time ?
She's been on it for just over three days now

OP posts:

Original poster

Conkers2 · 21/12/2024 10:21

17to35 · 21/12/2024 06:49

You say the prescribed naproxen etc "didn't work" and she hasn't taken them.
In general, pain relief has to be taken regularly on a regime. The co codalol can be taken with the naproxen. Also a hot water bottle can help.
Don't forget laxatives as the morphine and co codamol will be constipating.

We've tried to give each one multiple doses and at least 2 days

Part of the trickyness is not being able to speak to anyone to get coherent advice so it feels just chopped and changed.

The pharmacist gave over the counter co codomol, GP text to say yep continue on that but 3 days only. At the first visit then obviously a +e upped the strength describing it as a dose for kids. At that point they offered either that or naproxen but she wanted to stay on it in order to not chop and change. A+e consultant said she couldn't take both

Then when we followed up with gp to say the cocodomol wasnt working well enough and maybe we should have swapped. Gp simply text her saying swap to naproxen with omeprazole. again nothing about taking cocodomol with it and no opportunity to ask anything luckily a+e consultant the days before had said she could also take paracetamol if taking it.

Attended a+e who said she needed to swap to something more nervy but couldn't do it and sent to gp who didn't. He thought about a one off dose of morphine but decided against it (because I think we were in the urgent care bit). We then spent literally hours on the phone attempting to sort.

Back at a+e they randomly gave her codine in the waiting room (she hasn't taken anything codeine based in days at this point) and then later some paracetamol because she was clearly struggling just in the waiting room. The Dr then saw her and gave morphine.

The original plan was he wanted to do scans, and give something else but then clearly spoke to someone else so came back and said just chase up gp on Monday.

At that point I said respectfully that we are then in the same position that lead us to spend 12 hours in a+e, and it would be at least 3 days until she wasn't in wall climbing pain. She'd had that codiene and paracetamol as well as her days dose of naproxen and he still couldn't examine her without the morphine and was being discharged just with naproxen.

He then randomly gave us a box of diazepam saying the instructions were in it. We'd actually left the department when I realised there was no dosing (dose was between 1 table to 30 tablets at "intervals'" on the leaflet) and we had to go back. Eventually we found she is also allowed to also take the naproxen with it partly because I asked if we needed to give the naproxen more time.

We didn't really want the diazepam if it was only going to be a weekend thing for the same fear of being seen as another controlled drug that she's chopping and changing. Presumably if they would have thought it would help they wouldn't have tried to discharge her onto other pain killers, twice in the same day. It felt like a "shut up and leave because my seniors say I shouldn't have done anything"

I agree about needing to give things a chance, and we will faithfully try over the weekend to make the naproxen and diazepam work.

Presumably it will be changed again on Monday though?

The pain started as a niggle a week ago, and is climbing in completely in the wrong way.

It's why I started this thread was to try and gauge how much pain she should be in before abandoning the plans and going to a+e. I'm trying to stick to the plans, but genuinely wasn't sure if she should be in that much pain and just letting it roll for several days.

OP posts:

BitOutOfPractice · 21/12/2024 10:15

I might be talking rubbish but from memory when I had frozen shoulder and took naproxen, it was a cumulative effect ie keep taking it as the effect builds, it’s not necessarily a one shot thing.

in fact I’ve just read on the nhs site that it can take up to three days to work.

it certainly worked for me, eventually.

Original poster

Conkers2 · 21/12/2024 09:47

We will a 100% go the physio route. It's what we did with the car accident, however it's obviously tricky (gp advised an nhs referral which we completed despite it clearly having lots of prompts telling us we weren't elligble). I'm worried the private physio from before won't touch her because of the level of pain and obviously christmas means places are closing.

The consultant yesterday changed the diagnosis from being whiplash related to being a trapped nerve unrelated

It's seems like physio is the best option long term but just hard to get there with what's currently going on

OP posts:

Throughthebluebells · 21/12/2024 07:52

I don't think strong painkillers are going to be very helpful anyway. It sounds like you need an urgent physio appointment. If you can afford to pay privately I would definitely go that route. I suffered for months with whiplash and it was having all sorts of knock on effects and physio sorted it in just a few short sessions.

LaurieFairyCake · 21/12/2024 07:16

Have you any money? Can you pay for an urgent private physio appointment. I've done this, there's loads near me and I saw one that saw me for £45

17to35 · 21/12/2024 06:49

You say the prescribed naproxen etc "didn't work" and she hasn't taken them.
In general, pain relief has to be taken regularly on a regime. The co codalol can be taken with the naproxen. Also a hot water bottle can help.
Don't forget laxatives as the morphine and co codamol will be constipating.

Original poster

Conkers2 · 21/12/2024 05:38

TaggieO · 21/12/2024 05:16

Are you saying A&E haven’t even been doing any obs? Because that’s very unusual. Your GP sounds utterly useless. I’d be looking to register somewhere else.

I have to ask - do either of you have a history of drug seeking behaviours?

consider a complaint to PALS, and definitely register with a new GP practice.

A+E did blood pressure, heart rate and sats the first time. Our a+e/ urgent care/ out of hours gp is all lumped in together so I suspect we are being shuttled into that part rather than a+e proper if that makes sense?

Today they did lots of things about raising arms, feeling her neck etc
Each time they ask about scans, seem surprised that there are none but then don't order any.
The two today suggested gp lead tests. The GP has only spoken to her via text

Not offended re drug seeking behaviours, it's clearly a factor! Weirdly I actually work in addiction services

Today we actually took all the cocodomol, naproxen etc back to a+e to show it's barely been taken as doesn't work, and in the hope that if they removed them they'd feel more reassured we weren't hoarding them

There's all signs around a+e stating they don't prescribe which I struggle to believe

It's a vicious circle, the more you push for them the less they want to give aonthe morenyou have to pushm the gp reception Today when I called was like we'll shes been prescribed two different drugs this week which is absolutely true but they just don't work. Now it will show in the span of 24 hours we've spoken to 111, attended a+e and called gp repetitively in pursuit of controlled drugs (albeit a+e recommended ones)
Now she'll have morphine and diazepam on that list too

Will speak to pals if we can't get it sorted first thing Monday.

I might be being overly pessimistic about the 3 days of diazepam, perhaps it will hold over the weekend

OP posts:

TaggieO · 21/12/2024 05:16

Are you saying A&E haven’t even been doing any obs? Because that’s very unusual. Your GP sounds utterly useless. I’d be looking to register somewhere else.

I have to ask - do either of you have a history of drug seeking behaviours?

consider a complaint to PALS, and definitely register with a new GP practice.

BitOutOfPractice · 21/12/2024 05:15

Oh god that sounds awful, poor woman. I hope she gets some proper help soon

Zanatdy · 21/12/2024 05:08

I’d go as only hope of some relief and getting things moving. It sounds awful, hope she gets some relief soon.

Original poster

Conkers2 · 21/12/2024 05:06

In short the saga got worse!
We managed to get a dose of naproxen from gp (who didn't even speak to her!) On Thursday finally after literally hours on hold

That didn't work so back to a+e Friday am who wrote a strongly worded letter to the gp asking for better pain relief but told us a+e couldn't prescribe controlled drugs.

Gp obviously then completely ignored it, chased multiple times, promised a call back that never happened
Call to 111- told to go to a+e, tried to call a+e but they put me on hold for an hour

So off we toddled to a + e again for the second time

In total spent 10 hours there, was given some pain relief while there but even morphine didn't resolve it. They then sent us home for gp to offer a Pregablin script on Monday

After some fighting they gave a short course of diazepam to see through till Monday

Not a single scan, ob or blood taken

I suspect we will back at a+e tomorrow

So frustrating. In short what seems to happen is that they follow a paper script of what needs to happen for muscle pain but don't seem to register that she's completely unable to speak for almost an hour at a time.

Today's Dr was lovely, promised some more morphine and scans but obviously spoke to someone else and then hurried back and borderline threw the diazepam at us to get out without a single instruction about dose.

OP posts:

UnhappyAndYouKnowIt · 19/12/2024 16:56

I knew you were going to say left arm. 🤦‍♀️

Why do they spend so much time telling us warning signs of heart problems and then ignore the same signs when you turn up?

OutIsay · 19/12/2024 14:43

How is she today?

Iamacatslave · 18/12/2024 23:54

Back to A&E. Ask for bloods and an ECG to be done.

Uokhunnnn · 18/12/2024 23:40

Absolutely back to A&E for that level of pain. Request an ECG (which really should’ve been done already). Trust your gut above everything. Hope she’s on the mend soon.