When to call - how do you really know

[If*]

Do you struggle with when to call the Dr. or go to er? It can be pretty confusing sometimes. What makes you say, uh oh, better do something? There are some situations that are no brainers (bleeding excessive, fever, uncontrolled vomiting, pain that does not let up) but with IBD some things can be borderline.

Your thoughts.

 

[CrohnsChicago]

I always just tell myself better safe than sorry and at least call my GI's office. They are fortunately pretty attentive and if I feel concerned about something he will give me a call back and tell me what to do or tell me not to worry/keep an eye on things depending on the situation.

I DO however have trouble deciding what is worth the $300 emergency visit co-pay. So I always call my GI first.

What makes it even trickier for me is the fact that the more flares I experience, the more I realize I have built a tolerance level up for pain which makes it hard to decide what is emergency-worthy or not.

But if there are fevers and severe bleeding and vomiting that persists and I cannot see or speak to my GI, I would definitely go to the ER as it is better to be safe than sorry in those situations.

 

[darster]

I absolutely hate going to the ER, knowing the nasogastric tube is coming out. So I don't go until it is obvious that it is an obstruction, and it's not going to clear on it's own. When the vomiting and nausea get intolerable. When the pain is ridiculous. That's when I go.

 

[Cross-stitch gal]

One thing that I've been told is this. "Usually, if you're asking yourself if you should go to the ER or call the doctor then; it's time to do so."

I have to admit that I get really tired of having to talk to doctors in order to get/keep me well. But, sometimes there's no choice. Sending hugs your way.

 

[DustyKat]

This was a list the GI gave to me when we first met him:

When to call the Doctor:

Once you get to know your Doctor you will have a better understanding of what he/she wants you to phone about. These guidelines should be followed for most situations and it is hoped you will find them useful.

Telephone calls to your Doctor need to be separated into there categories-

Routine

Urgent

Emergency

It can also be helpful to take time to get to know your Doctor's secretary or any office staff. This can assist when you are trying to reach your Doctor, whether you are telephoning or visiting personally. You should prepare a clear list of questions to ask, be concise, do not make the list of questions too long and decide what is important before you telephone or visit.

Find out your Doctor's timetable, i.e. when he/she is available at the consulting rooms/surgery you attend. Remember they may attend more than one surgery during the week. Endeavour to ascertain:

Telephone numbers (one or more)
Surgery hours
Most convenient time to call
Whether convenient to leave a message asking the Doctor to return your call

Routine Call

You should arrange to call your Doctor's surgery after a visit, to obtain results of blood tests, laboratory tests, or to report any changes in your symptoms or side effects of new medication.

Urgent Call (but not an emergency)

Any symptom, e.g. nausea, headache, a rash on your body, which you think might relate to your disease or its treatment. It may even be a new symptom of your illness, such as painful tender bumps on your legs which often indicate the start of a flare up (erythema nodosum).

Emergency Call

Dramatic change in your illness could include any the following:

Severe abdominal pain which persists for longer than 1 hour
Significant or new rectal bleeding
Persistent vomiting, accompanied by stopping of bowel movements
Drastic changes in bowel movements without passing gas
Sudden weight loss of over 2 and half kgs in a few days

If you are unable to contact your Doctor in an emergency, you can go directly to the nearest Public Hospital Emergency Section, or the hospital you usually attend. Explain your illness, etc. Give your Doctor's name and identify any medications you are presently taking.

Through being able to determine (routine - urgent - emergency) nature of calls, you will greatly enhance the relationship with your Doctor. Also it will give you and your family better judgement about when to call your doctor and many people are hesitant to call their Doctor at times.
Remember, always carry with you your Doctor's/Surgeon's card.

Another good idea is to place your Doctor's timetable and telephone number near the telephone. Note any dates your Doctor will be unavailable, plus details of another backup Doctor your Doctor recommend.

I have taken my kids to the ER 4 times in total and each time they presented they were admitted.

My daughter's two ER visits were when she was undiagnosed. The first was for severe pain that I could not alleviate at home. The second was again for severe pain plus vomiting.

My son was diagnosed when he had his two visits. His first was also for pain that I could not control at home and his second was also for severe pain plus vomiting.

Neither have ever had bleeding and diarrhoea (pre surgery) as a symptom of their disease.

Dusty. xxx

 

[UnXmas]

I avoid going to A&E whenever possible, but then I rarely have emergencies. I have been a couple of times in the past, before I learned that A&E really is for when you need immediate attention, not when I just want stronger painkillers or when I am confused by some new symptom and want to know what's going on.

Because I have such rare illnesses and an extremely complicated medical history, no doctor in the emergency department has a clue what to do with me, and they generally play it safe and try to admit me, which usually just ends up being a waste of everyone's time, and I hate going to hospital so much so I try to avoid it. The times I have been have been to keep my mum happy.

 

[Earnellzwifey]

Wow Unxmas u sound a lot like me. My medical history either leaves the dr scratching his head or the think in lying about my history.

I too have a hard time finding a balance of when I need to go to the Er. Forget calling a nurse line they always tell u to go. I usually don't go unless my blood pressure is running to high or too low and I can't fix it at home, vomiting that suppository can't stop, or the pain is not helped by any of the pain meds I have at home. Sometimes I need a shot of something strong to get it bak under control.

 

[Crohn's gal since 1989]

I absolutely hate going to the ER, knowing the nasogastric tube is coming out. So I don't go until it is obvious that it is an obstruction, and it's not going to clear on it's own. When the vomiting and nausea get intolerable. When the pain is ridiculous. That's when I go.

I know this is a little off topic, but does the nasogastric tube clear obstructions? While in the ER, they gave my case directly to a surgeon to handle (small cottage community hospital while I was on vacation). There was no GI, I talked to my own GI by telephone. I've only just had my first obstruction and experience with this. I have to say, while it sucked (please pardon the pun!). I will take it over surgery!:eek2:

 

[simplyemily]

Do you struggle with when to call the Dr. or go to er? It can be pretty confusing sometimes. What makes you say, uh oh, better do something? There are some situations that are no brainers (bleeding excessive, fever, uncontrolled vomiting, pain that does not let up) but with IBD some things can be borderline.

Your thoughts.

Okay I struggled with this same question for a LONG time, and made a few terrible decisions. I know for me personally the main issue is dehydration when and such. I have found that the biggest indicator is when you are starting to feel weak standing up (I mean seriously weak, doubled over, can't stand, ect) have a headache that will absolutely not go away and is extremely painful, turning very pale, nausea to the point of being unable to keep fluids down without throwing up, and dark circles beginning to form under your eyes. Another way I have found to check is if you only feel good laying down, this is because your heart rate is slower laying down because it takes less work to pump blood. If you stand up and your vision goes dark and your heart beat picks up to double (or at least extremely quickly) you need to go in. Hope this helps!

 

[darster]

For me, the NG tube decompressed the upper section of the blockage, enough to take the pressure off, and I usually cleared in 24 hrs. They typically put me under 'surgery' in the ER too, I think because they feel emergency surgery is imminent. And yes, it's better than surgery, but not by much!

 

[nogutsnoglory]

It's really hard to know because who wants to go to the ER and you don't wanna bother your doctor too much. Half the time their answer will just be to goto the ER anyway because they don't want to be held liable.

I base my decision on my body and know when something seems much worse. I always try to avoid rushing to the ER or making a call so if I really feel I need to than I know I need to.

 

[UnXmas]

Wow Unxmas u sound a lot like me. My medical history either leaves the dr scratching his head or the think in lying about my history.

I too have a hard time finding a balance of when I need to go to the Er. Forget calling a nurse line they always tell u to go. I usually don't go unless my blood pressure is running to high or too low and I can't fix it at home, vomiting that suppository can't stop, or the pain is not helped by any of the pain meds I have at home. Sometimes I need a shot of something strong to get it bak under control.

I've had that reaction too - why is it that when doctors don't understand something they conclude I'm lying?!

And whenever I called NHS direct (the helpline service here, or at least it used to be - they tell you whether to go to hospital, wait to see your GP, call an ambulance or whatever) they always tell me to go to hospital. I've called them about three times I think. But the problem was that I knew on those occasions that I wasn't in an emergency situation - if I had been I would have gone already instead of ringing them! I rang at the times when I was without a diagnosis and getting desperate to understand what was going on with me. I had a vague hope that if I rang the helpline they'd give me some ideas about my diagnosis. This was futile of course - no medical professional will commit to a diagnosis without definite test results, and most won't even make suggestions. Diagnosis would only come from a consultant, not a helpline nurse.

The odd thing is that medical professionals who only see me briefly - helpline nurses, A&E staff, ambulance doctors - play it really safe and always want to admit me. Consultants and most GPs, who see me multiple times, have my full medical records handy and all my test results - are always adamant I'm completely healthy. And the weirdest part of that is that is that I'm neither of those things - I've only very occasionally been an emergency (blocked intestines, infections post-surgery) but I am very chronically sick, far more than the consultants and GPs seem to want to recognise.

 

[Marcus44]

When in doubt i would go, the pain, I got use to allot of pain and it created allot of scar tissue which i am dealing with now. I have been to the ER several times but only when there is a high fever and vomitting, i know then i am blocked. I last went b/c my GI told me to meet him there as I thought i had the flu but i was actually reacting to the 6 MP which i recently started and it caused pancreatitous, which i am now off not for sure what they will do and was hoping to start tapering the pred but was told to stay on 40 a day... which i can not stand.... sometimes the big D and controling eat times is better i think...

 

[If*]

Really good advice, thank you all.
What a great list DustyCat!! They should give that to everyone

 

[Traumanurse]

Crohns Gal.

I refused the N G for my last 2 obstructions before my resection. I really haven't found that it decreases the time until the obstruction passes. It DOES help if the vomiting is very frequent though, and some say it helps the nausea. I personally would rather be nauseated than to have an NG. I absolutely hate them!