To call A&E where my sister is an insist they find a fucking heat pack for her sore back...?

[GayByrne]

Ok, gotta make this quick, bedtime and all.

Sister has mental health problems and is an alcoholic. She started a binge on Fri and had 5L vodka and God knows what prescription drugs, tramadol, codeine etc. Anyway, she called on Tues having lost two days and mum had to call an ambulance for her as she was out of it, crying uncontrlably, thowing stuff around, shouting, saying she wanted it to end etc.

So she's taken to A&E, put on a drip and librium and is currently there in observation detoxing and has spoken with the mental health team etc. We actually think that this episode could be the catalyst to getting her the help she so desperately needs.

To say that some of the staff haven't been supportive of her or willing to lessen her discomfort is fair. She has been judged for coming in as she did, i.e. alcoholic who od'd, albeit accidentally. She's had to fight for lirbrium even though she's shaking, throwing up, headachey, trembly inside, anxiety through the roof...when the alcohol nurse saw her she was so cross that she'd been denied librium and made a point of putting it on her notes the amount she can have within any 24 hr period. For the record she's well within that limit, well within it - so she's not taking the piss.

So she's obviously addicted to codeine etc and has a terribly bad back, that's how the addiction started. They won't give her anything for it, fair enough, but two nights in the hospital bed is killing her back and they've just told her they can't get a heat pack or V pillow for her...this is a big hospital.

AIBU to call them (I am 3 hrs away, was there today after driving overnight to get to her but had to come home for kids, husband going away with work etc). Can I ask to speak to the ward sister and insist that they try, at the very least, to help her out?

Thanks, could really, really do with some advice. My sis in vulnerable and unable to express herself as she normally can at the moment. I wish I was able to be with her right now.

This is all so distressing.

I don't understand why you're so cross about the nurse recording the drugs she's allowed over a 24 hour period. You've mentioned that twice now. Isn't that exactly what they're meant to do??

FWIW, I think YABU. You are only getting your sister's version of this and she is not going to be rational right now.

Whilst I think Yabu and that if she wants a v shaped pillow she can ask someone to buy one. As quite frankly two pillow set an angle are exactly the same.

But heat packs are available in hospitals. The physio department has them for treatment. Now that is not to say that they will go and get one, as it needs to be for a physio reason, and as a treatment. It won't be done by the nurses and won't be available as and when you fancy it. But should anyone be in hospital and need one then it is an option.

It's likely that her pain relief options are very limited by what she overdosed on - if she overdosed on codeine etc she can't have that, if she overdosed on paracetamol more would be dangerous and so on. Most hospitals don't keep TENS machines outside of labour ward and steroid injections aren't done for back pain outside of a pain clinic.

It sounds awful for her but what they can offer will be very limited.

The problem, I think, is that without a diagnosis of what is causing the back pain, the pain relief cannot be addressed effectively. Nerve pain for example would require different approach to muscular etc.

If she has a severe spinal problem causing lots of pain, a disc problem or similar, with the best will in the world, heat patches and pillows, whilst they may ease symptoms slightly, aren't going to alleviate the pain.

She needs to get the back pain investigated properly and then addressed. She may well need someone to advocate for her, I know from bitter experience how hard it is even without her other issues.

So, YABU to call and ask for patch etc, YANBU on your next visit to find our exactly what steps are going to be taken to investigate her pain.

breakhard I don't understand why you're so cross about the nurse recording the drugs she's allowed over a 24 hour period. You've mentioned that twice now. Isn't that exactly what they're meant to do??

Yes, that is what OP is saying. One of the nurses wouldn't give the Librium, but then the addiction nurse realised what was happening and specifically noted the amount the patient was allowed to have so that the other nurses could see this. So OP is thankful to the addiction nurse for recording what her sister can have, not critical.

Can they do local anaesthetic in her back to ease the pain? Maybe couple with anti-inflammatory drugs? additionally has she tried tens - the hospital may have tens machines?

Can she have some warm baths each day?

Oh and ask about physio also

Local anaesthetic/steroid injections are v unlikely to be available acutely - there is no harm in asking but in many hospitals these would be outpatient only and after many months wait.

I work in an nhs hospital and we certainly DO have heat packs. Clearly not a good idea for patients who can't tell someone they are too hot or otherwise contraindicated, but sounds a bit ridiculous that some hospitals won't let anyone have one. Absolute godsend for some types of pain that even morphine won't touch.

I don't see why the op shouldn't phone and at least ask what else can be done for her sister.

You can phone, but due to patient confidentiality they will not discuss anything with you.

I assume your mum is NTK so I would get her to phone.

Actually the hospital shouldn't give out any information to anyone (next of kin or not) without the patient's consent.

Being next of kin gives you no special rights at all, it just means 'person we would phone first in an emergency'.

I had heat packs in an NHS hospital post surgery about 3 months ago; so they are definitely available!

My exH is an alcoholic who has been hospitalised many times. Generally, hcp treated him like a piece of crap. I witnessed terrible treatment of addicts on the ward.

Any chance you or your parents could be there?

I think some of the attitudes above are very unrealistic with regards to the capability of the NHS. It is fairly indicative of why the health service finds itself in the economic hole it is in now. V pillows? Heat packs? Really? TENS is not readily available on general medical or surgical wards, neither are staff trained in its use.

I understand you want your sister to be comfortable and pain-free, and it must be hard to be so far away, but looking at this in an unemotional manner - your sister is an adult. She is a prescription drug addict, an alcoholic and is expressing suicidal ideation. She is in an appropriate location - a monitored environment receiving psychiatric input - this is far far more than she would have received in many other countries.

She is entitled to care and respect, without doubt, and full explanation regarding the reasoning behind her care and why her 'discomfort' is not being relieved. It is then up to her whether or not she wishes to avail of the help offered.

Getting the pain team involved puts the focus on her back pain - I'm sorry but her back pain is not the main concern here - her alcoholism, addiction and psychiatric needs are, and if she is addicted to codeine, she needs to learn other coping strategies than drugs. You may be thinking, but why when she is going through such a difficult situation, does this need to be done right now... In this case it IS NOT 'negligent' to leave the patient in pain as has been suggested (or at least some measure of discomfort).

The reason why this is important - normally, when addicts attend hospital, they should receive their normal meds in a lower dose to prevent withdrawal and this should be progressively tailored down (most will resist this). In this particular case, the amount of analgesia she receives should be much lower due to the librium. I'm not saying she should have none - but it won't be what she's used to. Someone has mentioned heat rub/ibuprofen gel, or paracetamol (assuming her liver function is ok) would be fine.
Chlordiazepoxide (or librium) is not a benign drug and people should not receive as much as they want. It is provided in order to stop her going into DTs and should be kept to the minimum that will prevent her going into DTS (not prevent anxiety altogether). It will act synergistically with the codeine and opioid based pain relief to cause drowsiness. It can be very difficult to titrate. I'd be surprised if your sister wasn't also on antidepressants/benzos already as well. Alcohol liaison nurses see a lot of these patients, and even then they very often get it wrong - they're not familiar with the pharmacology of other drugs, there are massive differences between men/women, individuals.

This will surprise some posters but the biggest mistake I have seen medical/nursing staff make in these cases is to accommodate the patient too much - and I have seen it a lot. The patients drop their level of consciousness, or become delirious, aspirate/develop pneumonia and this can be fairly disastrous.

I really think the best thing you can do for her is to encourage her to comply with the medical treatment and advice, employ non-medication based strategies to manage her back pain, be supportive but she must learn to articulate for herself. She is the one who needs to get herself through this.

Good luck. Horrible situation to be in.

I work in a hospital. You will probably find that people are actually doing their utmost to make sure she is comfortable, with the resources they have.

No one is denied pain relief, even addicts, though she probably has a very high and potentially dangerous tolerance to pain meds. You have one side of story, and you are not even there.

She will be being fed, kept warm and as comfortable as possible, and safe. Which is better than the situation she put herself in.

I break my balls daily and work long hours often unpaid to do the best for my patients, as do all my colleagues. Yet whatever we do it is not always good enough for some families. Hospitals are well-equipped with adjustable beds and mattresses etc, and life saving medication. A specific pillow and heat pad is something that goes above and beyond, and if they don't have them, how can they provide them? These are staff that are probably busy also trying to save other patients' lives. Should they prioritise your suster's pillow?

Call the hospital and pester them. They don't always take account of underlying conditions - a friend of DH's was taken to A&E several years ago and was treated for alcoholism-induced symptoms. They totally missed what the real problem was, which was that he'd had a TIA (a mini-stroke) and they sent him home.

And if she is withdrawing from alcohol, she will be on a carefully monitored regime of "Librium" that is continually monitored and assessed and administered according to symptoms, with does being adjusted frequently. I am certain they will be following strict guidelines. Drug seeking behavior is very common in addicts.

straightalker - if it is the bad back that got her addicted to painkillers and fired up the addiction then why isn't it a concern - chronic pain being treated by opioids and anti-depressents has sent many down the path to addiction

Absolutely Maddening. Being in constant pain will drive anyone to drugs. Seems pretty obvious to me.

Morning everyone and thank you for your replies.

I spoke with a nurse and they can't give her a heat pack or pillow as they don't have them. She said that she will speak to the doctor about relieving the pain but according to sis this morning nothing came of this.

My sis's friend, who is a GP, came in with a heat pack and gel rub for her so she has had some relief which is lovely for her!

This morning sis is quite anxious. She remains on the Obs ward of A&E despite being told that she was going to be moved to another ward. This in itself isn't a problem, it's a nice ward, but it's the lack of communications to her.

They were 2 hrs late giving her her meds this morning - which when it's every 4 hrs is, I believe, quite a big deal.

She has asked to reduce the librium as she is feeling more able and once she's reduced that she'll be able to move home.

I rang this morning and spoke to another nurse about her anxiety etc and that she's so vulnerable at the moment and not able to communicate her thoughts and fears as well as she might if she were in a more stable situation. Anyway, the nurse said "hang on" and just put me onto my sis, which was weird, as it was her I wanted to talk to.

The consulatant was doing his rounds so they (my mum is with her now) are going to chat with him about her meds and on-going care. She is going to go to her GP for antabuse and self-refer to a local drugs and alcohol service.

We are all so grateful for the amazing NHS and the wonderful stuff it does, stabilising her, keeping her well and fed and warm and rested.

When I had my children and recently an ectopic, the care I received was flawless - and I wrote to the hospital to say so. My eldest has a kidney problem and the NHS syste, though sometimes slow, works absolutely perfectly. I can't get over how good it is.

My sister's experience however is different and I don't know why? Is it because she put herself there? Is that a reason to be scornful to someone? I don't believe it is.

My mother, a nurse, ward sister, matron and currently private nurse, thinks that "some of the young ones just don't care". I have found, personally, that every nurse I've come across did care - but I was there with my sister for a long while and she IS being treated differently to me. I am in a different part of the country to her, is that the difference? Or is it her ailment? I don't know, but I am sad to see the once vibrant, loving, fiercly loyal, beautiful, clever, funny, popular young woman I love being scorned as some sort of skank because she drank and drugged herself to near destruction. She wasn't always like this. God willing we'll get her back.

ps - there is one nurse who is absolutely excellent and she'll definitely be writing to the ward sister to commend her care at the hands of this nurse. That's not to say she's the only 'good one' but when I was there she really stood out.

The trouble with addiction, be it alcohol or drugs is that the slide is so gradual,by the time you realise you're in trouble you are already too far gone. I take codeine for a bad back (injured during an attack by a confused patient). First you take it for the pain, then you take it in case you get pain, then to get you through a stressful day or to help you sleep and so on..............

As I work in healthcare I have been able to use my knowledge to try and ward it off and have gone without doses I REALLY wanted to take i.e lived with the pain as didn't have to work or lift DS. However the thought of running out / the doctor refusing the script leaves me cold, and that really concerns me. If you didn't know the signs and we're going through hard times I can see why you would take more and more.

Addicts always get my sympathy, they have dug themselves a deep dark hole and I understand that when it seems impossible to climb out it's easier to keep digging. There but for the grace of god go us all.

I hope your sister is starting to feel better today Gay, keep us updated.

Thank you original that's a kind-hearted and honest post.

Hello. Just a wee update:

she's been moved to a ward now, which is great. She's a lot more settled and is reducing off the lirbium nicely. She also has a plan set in place now for the future. She'll continue with AA (she breaks out whenever she stops with the meetings) as well as medical help from the GP and psych stuff.

Thanks for all your replies. x

I would complain about the attitude of staff and the fact she was left without librium its incedibly dangerous to come off alcohol without medical supervision I,m a mental health nurse so have lots of experience of working with people detoxing from alcohol ,I do know in our trust they have changed the guidelines it used to be people having an alcohol detox would automatically be prescribed a librium. Reducing regime , but now we are supposed to asess our patients over the first 48\ 72 hrs and give them librium ' as required' they still have access to it however !