When do you decide to go to ER?

[mascarim]

I've basically been fighting with myself for the past week on whether or not to make the trip. Have had awful pains, black stools, nausea. But it seems like every time I end up going I am sent home with no answers. I am just at a point where I can't control my own pain and it's interfering with my daily life. So I am wondering when other people decide to go in? What symptoms are too much for you?

 

[mseve]

I went to the er when the pain became unbearable or my fever was 103+

In my experience there isn't much an ER will do for you. They might runs some tests and give some pain meds, or they will admit you if you are sick enough. Other than that they will want you to see your GI Dr.

 

[my little penguin]

Have you called your GI to update them on what has been going on ?
They can suggest better med plans and testing

 

[mseve]

Yeah, I wouldn't want an ER Dr treating me for crohns. They are clueless. Only go there if you are so sick you don't have a choice. In all other situations, best bet is to call/visit the GI.

One time I was at the ER for terrible abdominal pain, and the ER Dr gave me not one, not two, but THREE pelvic exams when I sitting there telling him I have Crohns and this is where the pain is coming from. I personally think he was looking for gold nuggets in my vagina.

 

[24601]

These are my general but hard and fast rules (satisfying one would be enough in most cases) for when I would definitely go to an ER instead of seeking help from my gastroenterologist:

1)abdomen rigid
2)no bowel sounds
3)rebound tenderness
4)high fever
5)severe dehydration/unable to keep any fluids down

Outside of those situations I think it can be really hard for those us with chronic pain and fairly constant symptoms to know when to seek urgent help because we get used to living with pain and symptoms and even if they're worsening, if it's a progression we don't always notice how bad things have got. Added to which of course we don't always get much help at an ER.

Have you talked to your GI about your worsening symptoms? Because you need some help from someone and hopefully your GI can respond to your situation quickly - that's what's good treatment of Crohn's requires. I hope you get some help and start feeling better soon!

Edit: just want to make it clear my list above wasn't meant to be exhaustive and this is my checklist for my stricturing disease and there are of course many other ways Crohn's can cause a person to need urgent medical attention.

 

[mascarim]

It sucks because I do call them and last time they said "well we have nothing left we can do for you unless you want to come into the ER" my GI is through the big medical college here. I'm just worried about having black stool. I've never had that as a symptom before, same for the constant nausea. My case has kind of hit a point where they are confused as why I keep having issues because they can't find out why. I certainly think I may be dehydrated by now though :/ I feel like I get sick every time i ingest something so I've sort of been avoiding it.

 

[24601]

Mascarim - I think if you are not getting help from your GI then that alone is a good enough reason to go the ER but I think I would be hoping to get help from another GI. Can you go to a different hospital where they could consult with a different GI?

You know that you are not well and that your symptoms are significantly affecting you so to be quite honest telling you that "we have nothing left we can do for you" is simply not good enough. I really do not believe it. I've heard that myself from a consultant when I'd lost almost half my body weight and it wasn't true then and it's hard to imagine when it can ever be true because there are many many treatments for Crohn's and these treatments can be used in different combinations and even potentially re-tried in different circumstances. I think sometimes when they get frustrated at not being able to explain what is happening with you they give up - but we don't get to give up and the disease doesn't give up so I'm not sure why they think they can! Whatever is causing it (and I agree it would be nice to know but sometimes we just don't) it sounds like you need different treatment and perhaps for that you need a different doctor. Is that possible for you?

 

[mseve]

It might be time to get a second opinion from a different GI Dr. It's very concerning that you are having new symptoms and the Dr doesn't want to talk with you about it.

 

[Adam1971]

Have they tested you for c-diff? Its one of the super-bugs hanging out in hospitals. Black stools, pain, and nausea can be symptoms. For me, the cramps from hell got me to go in, and they admitted me. I had been to the er a week before, and an er doc, in all his brilliance, gave me an antibiotic as a shotgun approach fix to what no one knew was crohns pain and inflammation. That wiped out all the good bacteria amd gave the c-diff a free lunch, and I got sick. If you did have this bacteria, it can be serious without treatment. It could be worth finding out.

 

[yellowamc]

For me it is when it feels like some one parked a car on my stomach. Thats when i head for the for door. Hope you feel better

 

[mascarim]

I have been starting to look into a new GI. I am just tired of feeling like they are constantly telling me it's all in my head. Which is essentially what has been going on the last few months. I ended up calling the on call GI at my hospital and they said they'd call back and let me know if I should go in or not....it's been 2 hours and they haven't. And I feel like actual death. I have had C-diff before actually and it was just awful... if that's what's causing this I'll be so mad. Last time I had it they could barely get rid of it for me. I'm wondering if I should just go in and say screw waiting on them....

 

[4javids]

Hey there. Let me tell you something. If your ever in that much pain never hesitate to go to ER. I've had crohns for so many years and end up going probably 5 or more times a year. You never know what you got going on inside of you and it's always best to get it looked at. I always used to sit there throwing up and in terrible pain and I would always second guess myself but no more. If I'm throwing up and in pain I'm going to the hospital. I know a lot if times they do the xrays give you some dilaudid and Zofran and it helps. But again you never know what's going on inside of you and in my opinion there's nothing over the counter that can help with the pain

 

[Adam1971]

It kind of sounds like its a good idea...they could at least test for c-diff and do a ct. It seems the more you press, they become more willing to do more testing at the er.

 

[24601]

I think if it feels like you should go the ER then you should trust that feeling. You wouldn't be thinking that if you didn't feel really bad and you don't need for it to be a "we need to take you into the OR stat" kind of scenario for it to be justified or for them to be able to help. There are a bunch of things they can do to make this pain and nausea easier to deal with - and also test to see what might be causing it. It really doesn't sound like your GI has been doing anything to help you for a while and you deserve help to deal with this. Sending you hugs. :ghug:

 

[Lady Organic]

Hi there, if I were you, I'd go in person trying to find my GI where he works. talk to a secretary, a nurse at the GI department and insist. When your GI sees you, I am sure he'll be happy to help.

as others have mentionned, finding a GI who is easily accessible is key for the future.

 

[sunflowermeadow]

My BF had pain for a week.. he went to his doctor, they said it was sciatica. A few days later we went to the ER...they said the same and sent him home with pain killers, the next day we went back to the ER, they almost sent us home but we insisted his leg was swollen and needed a CT scan. He ended up having a massive fistula in his Jpouch that was draining into his leg.

My boyfriend is still in the hospital due to major complications this just-diagnosed Crohn's. We thought he just had UC before and his large intestine was removed six years ago. He's been in the hospital 11 days and counting now because the j-pouch he's had for six years ulcerated, ruptured, and drained into his leg. He hasn't been able to eat or drink much the last 10 days, but his stomach bloated and swelled with bile. A few days ago they put an NG tube in his stomach so any food he eats isn't really being absorbed. Before the NG tube he only had sips of the following: Sprite, Gatorade, lemonade, and of course water.
My main concern at this point is the food that is being given to him. His parents bought him Lifesavers(high fructose corn syrup) to suck on. Now today he ate four popsicle sticks from kroger (likely to have corn syrup). I am concerned because his stomach has not has food in 10 days (just IV fluids), and I fear this food may upset his crohn's more. Soon hopefully the NG tube will be taken out and I feel this may be the time to make sure his parents understand how important this is to his health. Do you think there is need for concern about a crohn's patient in ICU having a corn syrup? My main struggle is getting people to listen to me about eating healthy food. I need some powerful advice, articles, or information, because coming straight from me isn't working fast enough. His family are practically advocates for junk food/fast food, they have no apparent knowledge on food nutrition. They keep talking about junk food and eating it around him while he is stuck to a hospital bed. It's so wrong. Please help me if you can.

 

[Justanothercp]

I've only gone once, when I had a bowel obstruction. If it isn't truly "emergent", I'd suggest to try liquid diet and make GI follow up ASAP.

 

[UnXmas]

I somehow sense when something's really wrong. The last time I went was when my bowel was blocked. It perforated soon after, but at the time I decided I needed to go it was just blocked. The pain was not the worst pain I've ever had. I had no output from my stoma, but only for half a day or so at that point, which isn't unusual for me. I'm usually sceptical about it when people say their body is trying to tell them something, but I can't think of another reason why I knew I had to go. I was sceptical about myself too, so it took my parents urging me to go before I agreed. What's more usually the case is that my mum urges me and I refuse (and I've been correct to refuse). So I suppose I would say that, if you're like me (who hates hospitals), if you need to go, you'll know.

When I got to the hospital, they admitted me within minutes (the sign said the waiting time was four hours), and within about an hour or so of arriving I'd seen a doctor, been given painkillers, had an NG tube inserted to drain my stomach, had an x-ray and seen a surgeon. When you really are an emergency, they are the place to go. They are specialists: they specialise in getting you stabilised as quickly as possible and diagnosing emergency medical problems. With Crohn's, these are often bowel blockages and perforations and dehydration.

Generally, abdominal pain that is constant is more likely to be serious than cramps. A fever is often an indication of something serious. Being unable to keep anything down, and/or excessive diarrhoea to the point of dehydration symptoms requires immediate treatment. Vomiting blood or stool, passing excessive blood with stool, pain that's accompanied with inability to have a bowel movement for many days, or severe watery diarrhoea are also reasons to go to the emergency department.

You can also go for painkillers. Going for pain relief is a valid reason. They should try to make you comfortable until you're able to see specialists as an out-patient. The emergency department is also there to give you peace of mind if you are unsure whether your symptoms indicate an emergency or not.

 

[UnXmas]

sunflowermeadow - I don't want to answer your question on this thread as I don't want to make the discussion go off topic, but if you start a thread in the Diet section of the forum, or a new thread in the General IBD forum, and copy your post there, I'll try to help, and you'll get more advice from other members there too.

Edit - I found your other thread and replied there.

 

[mascarim]

So I ended up going in. They did a rectal exam which was positive for blood. But since my blood work and CT scan seemed ok they sent me home. Today I woke up even worse. Fever, more pain, can't even drink water without vomiting. So I called my GI and they ordered me a stool sample kit. I am really hoping this is not C.Diff. again but I have that gut (haha) feeling it may be. My issue is now though the pain and dehydration! They gave me zofran and such but I still feel sick every time I drink even just water. And I feel so weak! Nothing has gotten better only worse. I'm almost mad they sent me home seeing as everything has gotten worse and I still have no real answer as to what's happening with my body right now.

 

[lisadc1]

One bit of advice my GI said to me was to be careful when I go to the ER and they want to do a CT. I had five within a short period of time and he was furious. He said they just basically upped my chances of getting cancer and they don't generally know what to specifically look for. He said when he orders CT's he orders specific things so that he can look ore in depth...I never realized the danger and just assumed. Go figure...Praying that all goes well for you! Keep us updated...

 

[mascarim]

I haven't had one on my stomach in 3 years. But I did have one on my head after a car accident 2 months ago. My GI is through the hospital I went to thought and he did look over the imaging as well.

 

[lisadc1]

Good! I had no idea of the dangers, and the ER didn't seemed concerned enough to share that info with me.

 

[mom2twogr8tkids]

My experience with the ER is....I tell them that I know it's my Crohn's. They start my IV and give me pain meds, steriods, and antibiotics. I get a CT done and sometimes I have to be admitted and sometimes I don't. If you can't control your pain with meds at home then you should go to the ER. Only you know your pain tolerance.

 

[empressentrails]

I have ended up in the er many times over the last two years. Usually what happens is I get a migraine and stomach pain and start vomiting, the pain in my abdomen is so intense that I literally scream and cry, it comes in weird waves a lot like labor pains only more intense (I gave birth without any intervention so I can say that!), in the past I would fall asleep and feel better after a long sleep, but this pain is so intense it pulls me out of sleep every few minutes, I become so completely dehydrated that my doctors have said I should be dead, I cannot swallow anything, the pain is beyond anything I could describe, this goes on for several days and that's when I crawl to my car and drive to the er, I have called an ambulance before but try not to, I also don't usually bother my husband or family members to take me, I crawl into the ER like some post apocalyptic undead zombie and they admit me right away, they always give me I steroids, antibiotics, and fluids, they usually try to get me to stay for a few days but I can't miss work, then they send me home with the same medications, finally I told them to prescribe me nausea medication to keep with me at all times, I take it at the first sign of nausea and so far that has kept me out of the er for six months or so.

 

[mascarim]

I have a ton of anti nausea now. but the pain is still awful. i had to go back in again today for xrays and some tests. they think i have an infection and possibly a flare starting up as well. I just cannot stop having to use the bathroom. It's the most liquid D I have every had in my life. And my butt is so sore now I just don't know ho to stay hydrated at this point!

 

[empressentrails]

I feel your pain, I have so much pain even with the nausea meds, but it's the vomiting that really makes me dehydrated and have the worst pain, have you given up caffeine? That gets rid of my diarrhea, the withdrawl headaches are a bitch, but worth it. I often am in so much pain I want to a go to the er, but I just try to sleep it off, it's a drag for sure.

 

[mascarim]

I literally haven't had caffeine in weeks :/ i just took pain meds and they've done nothing. And the sounds my stomach are making along with the pain are insanely loud. My GI told me I can't take anti-diarrhea pills since I could have some sort of infection on top of this all. And now I need to use a diaper when I sleep! Which is awful. Every time I wake up I've gone in my pants. Luckily my anti-nausea pills have taken care of the vomiting for the most part. My GI only gave me Tramadol. which doesn't help my pain at all. So I'm kind of upset he said he wanted to control my pain but won't give me anything that does.

 

[empressentrails]

Wow, that's terrible! I know how no one understands how painful it is, my stomach also makes those insane noises and has weird lumps that move around, I describe it as that scene in alien where she dreams an alien is tearing out of her abdomen, it's just like that! Doctors always give me condescending looks about pain meds, so I just end up taking way too much aleve which does nothing and isn't healthy I think only people going through it understand how painful it is. Your diarrhea seems severe enough to warrant a hospital stay! Giving up caffeine, taking small doses of steroids as needed, and drinking a ton of water has helped me a lot, but I know a trip to the ER is always a possibility. People lecture me about how expensive the er is, but I know that sometimes it keeps me alive.

 

[24601]

Dear Mascarim, can I give you a big hug first of all? :ghug: It's so awful dealing with all of this I know.

Have your doctors given you a timescale for when they'll get back to you with the test results?

Do they not want to start you on anything in advance of those results coming back? I understand that it's better to know what you're dealing with before starting treatment in an ideal world but you're obviously in a bad way at the moment - have you been able to talk to your doctors and tell them exactly what you're experiencing right now? I find that sometimes actually writing down for them what your day is like in terms of how many times you go to the bathroom, or don't make it to the bathroom, how often you're in pain, and scoring it, and how long the pain lasts, what you're able to do (if anything) at those times (walk/stand/move or not) and what you can do outside of those times (if you even have any time where you can do anything normal), how long you're sleeping (if you can hardly wake up or if you can't sleep from pain) etc. can make a much clearer picture of how you are suffering.

Regarding the pain, it sounds like tramadol just doesn't work for you for this pain. But I know there are people who really like tramadol as a painkiller so it's probably not that your doctor didn't want to give you anything strong enough to help - but it's just not right for you. I'd tell your doctor that tramadol isn't helping for you and ask if you can try a different pain med.

I've had really loud gurgling bowel sounds at various times in the course of my Crohn's. The first time was when I had strictures and there would be this loud gurgling that made people turn around and stare at me. The second time was after my first surgery (resection + 11 strictureplasties) when I already had more strictures and as a result of that (plus perhaps/probably some antibiotic treatment when I had my wisdom teeth out) developed Small Intestinal Bacterial Overgrowth (SIBO) which is when the gut flora get out of balance and certain bacteria proliferate in the small intestine where they either shouldn't be or at a level you don't want them. Anyway I had issues with burning diarrhea at that time too, as well as extreme bloating and gas, which is not a good idea when combined with diarrhea. Hahaha. That was treated with courses of antibiotics - we rotated flagyl, amoxycillin and doxycycline every month or so, which did help temporarily but the problem would recur for me because I had the strictures which caused the bacterial overgrowth. I noticed that you had an ileocecal resection and removal of the ileocecal valve does predispose to SIBO so I just thought I'd put that possibility out there in case the c diff tests etc do come back negative. It is possible that it's not an infection from a harmful bacteria but just the normal bacteria in your gut completely out of balance.

Sending you healing wishes. I hope your GI gets back to you soon with a plan for your treatment.