To take DH to A&E

[DontGoIntoTheLongGrass]

I'll try to make this quick as I have a habit of rambling on.
Basically dh wants to be tested for a genetic condition which his dad has which fuses the spine. He has every symptom. Dh is at the point now where he cannot move for the pain and he is getting no sleep because of it. He is on strong meds but they do nothing. An x-ray is required for diagnosis but the doctors will not refer him for one. They give him more pain meds which dont touch the pain.
Aibu to take DH to a&e to try get the x-ray next time he wakes up in the night screaming in pain? Sorry if this is a stupid question but I know the consensus on mn over wasting the doctors time at a&e. I'm just struggling to see my DH in so much agony every day.

What is the treatment for that condition?

I don’t nderstand why his gp won’t refer him for a X-ray? When I had problems with my back I was referred straight away and also referred to back clinic.

My family has a history of OP, my X-ray showed up some thinning of my lumber spine.

But not an A&E case - clue is in the name

And you know that his unexplained pain is not an emergency exactly how?

@BeyondThePage surely if somebody is waking up at night screaming in pain, the cause ought to be investigated and identified as a matter of urgency? Even if there were no treatments for OP’s FIL’s condition, the gp doesn’t know that OP’s husband has the same condition if they haven’t X-rayed him.

I'd see another GP first. A & E is a manic environment, and not there to diagnose progressive or long term illnesses. If you aren't getting anywhere with your GP, ask to see another within the same surgery or see the Practice Manager.

REQUEST an X ray. Tell the GP thats what you want. You are well within your rights to do this.
Waking in the night screaming is ridiculous, he needs further investigation and diagnostic tests.

It must be frustrating that his gp won't refer him for an x ray? Particularly if there is specific treatment he can start for the genetic condition you suspect he has? (other than pain management).

Is it worth asking to see a different gp and demand an x ray referral? I don't want to advocate making a huge fuss, but could both of you make a huge fuss about this?
Perhaps printing some info out to highlight how his symptoms align with this condition and treatments available after diagnosis?

A and E is a last resort. Not only because it's oversubscribed and under funded/staffed so you may not get the time or expertise which is required, but you'll also be in for a long painful wait.

Your GP sounds useless! I have ankylosing spondylitis and it's very important to get symptoms treated because of the damage the illness causes. Can you ask to see a different GP or change to a different surgery?

An X-ray won't show up any damage to discs so asking for an MRI is worth considering. I got mine done privately because I was fed up with being fobbed off. Can you afford to go privately just to get a proper diagnosis?

Has he clearly explained his symptoms and family history to his GP?? I can't imagine there are many GP's who would refuse to test for something like AS. Esp in a male with a father with a diagnosis. Are his symptoms atypical? Could it possibly be something else that the GP has explained are the cause of his symptoms?

I would call the surgery and ask to speak to the duty doctor. A telephone triage should suffice to explain your concerns. You could probably do it on your husbands behalf as you're concerned about his pain. That's a starting point. I really don't think a&e is the right route. Alternatively, book in to see a physiotherapist. If they agree that it's AS they can write a letter to his GP with their suspicions and need for an X-ray and the GP can follow it up.

Laguna - because the condition is not life threatening. Check nhs guidance and it will define an “emergency”. I sympathise with his pain but he wont die of it any time soon.

Yes - A&E. Severe pain in the spine can have dozens of causes some of which can require emergency treatment and or surgery to prevent long term damage and disability - don't assume its necessarily one thing, needs a proper diagnosis. I used to work on a neurosurgical ward that handled emergency cases daily, majority worsening back pain. If he also develops numbness to legs or saddle area, fever, new incontinence or difficulty using the loo then its absolutely a case for A&E.

I've been admitted to hospital several times for 'period pain', ie pain in pelvis of uncertain cause, always given oramorph, anti sickness and scans etc.

If you're looking for a diagnosis of ankylosing spondylitis then A&E is not the right place to get it. There are very few reasons to x-ray a spine in A&E (in the absence of injury) and I would not order one if AS was the clinical question.

If the problem is pain then I would start with regular paracetamol and ibuprofen. If you really can't control the pain despite doing this then A&E seems reasonable for a conversation about other pain killers.

If your DH has developed severe back pain and you're worried about there being a dangerous cause then A&E is the correct place to go for assessment.

It doesn't sound as if you (and/or your DH) have much faith in this GP. Presumably there is someone else within the practice that he could see for a second opinion? An x-ray probably isn't the answer if "anykylosing spondylitis" is the question whoever you see as changes take many years to appear. Simple blood tests then onward referral to a rheumatologist are a much more likely way forward.

For those saying his condition isn't life threatening - without a medical qualification, and a CT scan or MRI no one can argue that. 90% it probably isnt life threatening BUT that doesn't mean it doesn't need a proper assessment and if he is screaming in pain and immobile that's A&E.

OK. is this ankylosing spondylitis we're talking about? Don't go to A&E for the x-ray, it might well not be done right or they might not have the expertise to interpret it. If your DH has inflammatory sounding back pain and a FH of AS then he needs to be referred to a rheumatologist who may do an x-ray, but might go straight to MRI and will also consider, and discuss with you, the pros and cons of an HLA B-27 test. Push for a rheumatology referral. There are NICE guidelines that back you up.

If it turns out to be Ankylosing Spondylitis, he will need referral to a rheumatologist, who will probably order MRI scan to see what other parts are now (or have been in the past) affected. There are many very useful drugs, and specialist Physiotherapist advice will also help enormously.
This isn't anything a GP can deal with, other than to make the referral. Please change GP if yours won't do this. Proper treatment is life changing. Good luck!

Not everyone with AS is HLA-B27 positive though. And yes, there are absolutely different treatmemts if he's diagnosed, includong biological and chemotherapy. They'd never be given without a diagnosis.

The GP is being negligent and being in screaming agony is an emergency.

Not everyone with AS is HLA-B27 positive though

no
that's why I said it's a discussion as to whether the test is useful
and you need the expertise and opinion of a rheumatologist, not a stand alone x-ray done in A&E

FGS it most certainly does NOT have to be life-threatening to be an emergency. Agonising pain in the spine could have any number of causes (and some of them are life-threatening!) which could lead to paralysis or permanent damage, life-long pain etc.

Next time it happens, call an ambulance.

Take him to A&E, say he fell over.

A&E won't investigate someone who fell over for AS.

Saying he fell over is wasting everybody's time. He needs to present with sudden onset, unexplained severe pain. Which is what he has if he wakes up screaming, and it's an emergency.

Well it isn't an accident or emergency is it so don't go. Go back to the GP.

And you know that how?

I'd probably be dead if I asked for advice on MN. I went to A & E with stomach ache a few years ago and was admitted with pancreatitis. No doubt if I'd asked on here I'd have got the same advice as above.

make an emergency appt at your gp and make sure it's with a different gp. that's what i'd do. he's in severe pain and clearly an x-ray at a&e isn't going to solve anything. he needs a referral.

DontGoIntoTheLongGrass Complain to your GP's practice and ask for a second opinion.
Your GP is being absolutely ridiculous. If your DH has suspected appendicitis or a broken leg, would he dole out painkillers?

www.gmc-uk.org/How_to_complain_about_a_doctor_in_England_0516.pdf_48911926.pdf

Do they do diagnostics in A&E? Surely they'll just treat the pain and then refer to your GP for further tests?