Would you be going to a+e again?

[Conkers2]

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

Which arm is it? They have done an ECG if it's the left?

Left arm. No ecg or scans just blood pressure and pulse yesterday by a+e.

As a general pattern, it's better to feel silly for going to a+e than to regret not going, especially if you're usually ok at judging when to go.

I'd go to A and E.

I would go back to A&E, yes. Whatever the cause, there’s no need to be in such severe pain. And I would be after a better explanation for this pain than a trapped nerve.

Go to A&E, hopefully this time an ecg will be done.

Go to A & E, at the absolute minimum they should be doing an ECG and bloods to rule out anything heart related. If it is a trapped nerve, co-codamol isn't going to work, she needs better pain relief to allow them to work out what is going on.

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.

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

How is she today?

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?

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.

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

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

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

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.

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

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.

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

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.

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.

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

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.

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