A&e, doctors or wait it out?

[autienotnoughty]

Off and on back pain for past 15 years. More on in past two years. Symptoms include lower back pain, painful spasms , shooting pains in thighs. Being managed with physio, Pilates, walking and yoga.

Last six weeks pain has got significantly worse. I keep experiencing weakness in my legs, periods of not being able to stand/needing support to walk and get up.

Today my back has locked three times leaving me unable to walk, getting worse each time. I am now laid flat on my back, I can't sit up. Dh had to drag/walk me to the toilet. I can't walk. I can't turn over. I'm applying heat and cold.
I'm also feverish . I have shooting pains/tingling in my legs plus the back pain and spasms.

Do I go a&e?
Ring doctor Monday?
Ride it out?

she might have gone in, but good response imo

I've had chronic sacroiliac joint issues and nothing shows on XRays. Not much does with the spine/pelvis. You might been SIJ stabilisation surgery.

Hopefully you've gone now. For what it's worth I'm a paramedic and as you've described your worsening symptoms for me that's clearly an A&E presentation. If it is Claudia equina sounds like you're well beyond the treatment window now so hopefully not that, but there's other things it can be which would still be treatable.

As for whether it's for ambulance assistance or not if you truly couldn't get there in a car then yep sounds reasonable too.

I would say though that if you are able to walk/lay in the car thats personally the option id advise - symptoms you describe will often code cat3 (111 triaged you as ambulance not required so 999 could even have same outcome). You could easily wait around 6-12 hours, even then 999 may still send you a taxi or private crew limited to advising you to take paracetamol/ibuprofen. If an ambulance does arrive yes whatever the cause they can make you more comfortable for the journey, but then if you can stand and walk once at hospital you'll likely be guided to the waiting room to book in yourself as if you'd made own way (handover times in most areas are multiple hours, crews cant be waiting and lots of pressure to use self handover and get back out to see another patient). - some areas at certain times are even pushed to use self handover for every single presentation if handover not taken at 45mins, at its absolute worst there's been septic patients with severe dementia been left on chairs in waiting room (effectively there's been a paradigm shift in guidance: it's no longer "do no harm" it's "do the least harm" - the theory is we've got patients this unwell/dieing alone in houses across the country waiting hours for an ambulance - it's justifiable to abandon someone in a hospital surrounded by people and medical staff to get to the unseen patient.

How are you feeling this morning? If you are in so much pain then you should call an ambulance. People call ambulances for things they shouldn’t but you need one

This! Good luck Op.

The difficulty here is that 111 and 999 have quite similar triage tools and outcomes - if the triage tool suggests ambulance outcome isnt indicated it doesn't matter which you call you'll generate a no send/sign posting outcome. So whatever the caller said to 111, if says the same to 999 they'll tell her they're not going to send an ambulance as well. So it's not that you need 111 permission to call 999, if the triage suggested ambulance then there would be no need, 111 would pass to 999.

It's quite likely if 111 generated a no send/make own way, that 999 would as well. Of course they only go on what you tell them so if that changes the outcome changes. The original call taker is not allowed to over ride what the computer triage outcome suggests, but if the caller refuses this disposition then they would flag the call to be recontacted by a clinician - that person can override the triage tool if they choose. Callbacks should be 1-2hours but can be as long as 24hrs depending on demand.

Hope your being seen today op. I had a weird vibrating sensation in my leg and was referred pretty quickly for a mri. In fact I had two. It was bone pushing into my spinal cord.

I had to go private for an MRI and consultant Privately for physiotherapist. My health board has been in special measures for eight years. Last year the auditors Ernst Young found they had mislaid 122 million, creative accounting at work.

My GP has admitted I'm on my own on this journey. So I do my exercises religiously, praying that I don't reach a crisis meaning I'm admitted to hospital with cauda equina.

@justasking111 Same here!! Though our local NHS isn’t in special measures.
I was in agony with my lower back when I went to A/E in June. Once Cauda Equina was ruled out they weren’t interested.
I now know I had a compression fracture, bulging disc & arthritis thanks to the private MRI.
I’m hoping the OP will get better treatment & some drugs that work to help her pain.

@justasking111 and @DemelzaandRoss , please could you tell me how one goes about getting a private MRI and is it very expensive? I've had a pain behind my knee for 18 months which constantly 'crawls' with irritated nerves and wakes me from sleep, but when a couple of months of physio didn't work, I was pretty much shrugged off... an ultrasound was mentioned, but they're guarding those like dragon's gold...

Hope you're OK OP.

Sorry for not responding sooner. I stupidly ignored the advice and went to sleep.

Woke up with slightly more movement but still significant pain so dh going to drive me to hospital. Back spasmed/locked while getting ready literally screaming in pain . Managed to get on back seat back locked again. More screaming. Got there couldn't get out the car. A&e refused to help, two paramedics came and gave me gas and air and I managed to get out. Still had to queue for reception.

Got sent to urgent care waited about an hour on my knees. Giving a suppository to relax muscles. Didn't work back still spasming. Given oramorph hasn't changed the pain level just made me woozy. Given diazepam not helped.

Spent 2 hours being poked/bloods etc and waiting in waiting room. Saw ortho who has tested for cauda equina (skin prick) decided to do MRI. Been laid on my back 2 hours waiting for MRI. Still in significant pain but more bearable for lying still.

Despite caudia equina being a medical emergency they are in no rush.

So currently in significant pain, no answers and terrified that I'm still in so much pain despite having pretty strong meds

@Compash Sorry to hear you’re suffering. I get what you mean with the nerve issue.
In my case, I asked my GP to refer me privately to a Rheumatologist as I have Osteoporosis. There was an 18 month delay in the NHS.
My Osteoporosis treatment was changed & the Rheumatologist referred me for a pelvic & lumber MRI. All the issues were then revealed. Additional I had severe arthritis in my right hip, which was bone on bone, all contributing to the pain.
I was then referred to an Orthopaedic surgeon who replaced my hip, again privately, as there was such al long NHS wait.

I am so sorry that you are still in so much pain. Please don't call yourself silly. You're in a lot of pain and that can cloud your thoughts.

I am really pleased you are in hospital. It's the best place for you.

See if you can get more pain relief. Ask your husband to speak to someone.

Please keep us updated and I hope the MRI is soon.

That sounds miserable. But on the bright side you're now in the right place and will get an MRI to figure out what's going on. Whatever happens and no matter how long the wait don't go home. Wait until it's been done.

I hope the test results are back quickly

Glad you're getting treatment, OP.

For what it's worth, I'm a paramedic and think you would have been absolutely justified calling an ambulance in this case, especially as you were unable to sit in the car/waiting room. Aside from needing to go to A&E for further investigation, unmanageable pain is still an emergency.

Really hope your pain ins under control now and you get answers in A&E 🙂

OP thanks for your update. So pleased you are being seen for your back pain, appreciate you must be in agony. Sadly, I’m not surprised A/E wouldn’t help initially. If you’re still breathing there’s no immediate danger. So sad in 2024 that this has to be the norm.
As another poster has said, try your upmost to stay put now, if you get an MRI it will be a big win & you will be on the pathway to a diagnosis & correct treatment/drugs.
Wishing you all the best.

I have bloody scoliosis, 64 years, three pregnancies, visiting chiropractor for years on and off. When an MRI would have shown it. Weirdly it was a consultant doing gastrointestinal checks that pointed it out. When I was 64. When I finally crashed at 66 another consultant confirmed it as the cause of my spasms and immobility.

Fingers crossed your seen soon. Slso small mercy you got something to lay down on.

I know I'm grateful for that

Despite caudia equina being a medical emergency they are in no rush.

Sorry? You waited 24 hours to go to A&E! Gobsmacked at this comment.
I really hope it isn’t cauda equina and you manage to get sorted, whatever is causing your pain.

@autienotnoughty I'm appalled. At your treatment at the hospital. Just pray the MRI will get the buggers moving.

@Gemmawemma9 But she isn't a medical professional at a hospital is she? Regardless of when op presented at the hospital, it should still be treated as a potential medical emergency.

Op I've been there before in a hospital with an emergency and literally left for hours.
So did my dh a few weeks ago. Our nhs isn't what it used to be !

perhaps because GPs are i n a mess
and hospitals have 4 hour targets