Monday, February 11, 2013

A 'Knot' Which Causes Nausea

I AGREE TO USE MD STAT FOR EDUCATIONAL PURPOSES ONLY, THAT NO DOCTOR PATIENT RELATIONSHIP IS FORMED BY MY PARTICIPATION IN THIS EXCHANGE, AND I UNDERSTAND THAT MY QUESTION AND ANSWER(S) WILL BE POSTED ON THE WEBSITE AND WILL BE VIEWABLE BY VISITORS TO THE SITE.: Yes, I agree.


 How tall are you (feet and inches)?: 6'0
 What is your weight in pounds?: 230
 How old are you?: 40
 How long has this been going on?: A week or two
 Check all symptoms you are currently experiencing:
 Chest Pain
 Nausea

My husband has been complaining of a "knot" in his chest, a hair to the right of his xiphoid process. It hurts to push on it and when there's pressure applied it makes him VERY nauseous! He's a very tough man. He's not one to complain of pain at all which worries me enough to come here to you. We've been to the Dr. and she gave him clairatin and omeprazole. Its NOT indigestion! He was in the military so its a VA hospital. His Dr. ordered an ultrasound but haven't gotten a call back yet. Its been two three days. I used to be a paramedic and my first "field impression" is gallbladder. He's miserable! Unlike him! He's also exhausted everyday. Fatigued. Headaches daily.

 What have you done so far to remedy this condition? Please include tests and relevant studies here.
 : Waiting on ultrasound appoint.


 Only meds he's on is Clairatin and Omeprazole.
 Please list any chronic medical problems and also list any prior surgery: No medical problems. Has only had two surgeries. One for wisdom teeth six years ago. Before that three screws in his patella after falling and shattering it. Over all excellent health. Low BP, good heart rate, typical high cholesterol.

 Check all conditions present in your immediate family... :
 Cancer
 Cardiac Disease
 Diabetes
 Please list any medication allergies that you have : : Nka
 Please list any medications you are currently taking (and dosage if known) :: Clairatin 10mg
 Omeprazole 40mg

Periodic tylenol and aleve for headaches and knee pain.
 Are you currently using or do you have a history of tobacco use?: Yes
 Are you currently using or do you have a history of illegal drug use?: Yes
 Please describe your alcohol consumption :: Occasionally

I guess I just need to know if I need to FORCE him to the ER because he doesn't want to go. I'm also planning to pressure the VA to get him in sooner.

Gallbladder? Muscular?
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So hard to say without an exam. Would be nearly impossible to feel the gallbladder even if it was enlarged or inflamed. I have a very good friend who is a docot for the VA and I understand the delays. It's now up to one year for a hip replacement.

That being said I think the more important thing to realize is that just with what you have told me I do not thing delay is an appropriate thing in your husband's case. He needs that ultrasound but he needs a chest Xray and an EKG and yesterday. He needs a provider to examine him and these days the only place to get answers to complex medical questions in a timely fashion is in the ER.

Also, it's unclear to me from your question above if you are referring to yourself or your husband in many of the questions.

If his pain worsens, if he develops shortness of breath, fever, or vomiting you must get him to the ER. I can't put together this problem very well though I do agree that the Gall Bladder is suspect.

If you sish to clarify your responses or ask further questions in the comment section please feel free to do so.
 

Sunday, February 10, 2013

Chicken vs Eye

I AGREE TO USE MD STAT FOR EDUCATIONAL PURPOSES ONLY, THAT NO DOCTOR PATIENT RELATIONSHIP IS FORMED BY MY PARTICIPATION IN THIS EXCHANGE, AND I UNDERSTAND THAT MY QUESTION AND ANSWER(S) WILL BE POSTED ON THE WEBSITE AND WILL BE VIEWABLE BY VISITORS TO THE SITE.: Yes, I agree.


I was sitting outside when one of my chickens jumped up on my lap looking for a treat. I did not have a treat to give her. I was looking at her and she was looking at me. She then poked me in my left eye. Chickens are FAST and their strong with their pokes and they are not known for having clean beaks. My whole eye is bloodshot and there was a small pool of blood gathered at the bottom of my eye. I flushed it with saline solution. I can see and it doesn't appear that my eyeball itself is bleeding (except for the fact it is totally red and bloodshot). It doesn't seem to have changed my vision. It's not bleeding anymore though I am not sure where the blood came from as I can't seem to find where the actual wound is. My eye feels like there is something in it but like I said, I can't find the actual wound. It's not really painful but only feels like there is something in my eye.

My question is, is cleaning it with saline solution a good antiseptic? I flushed it for a good 3 minutes (I'm soaked as the solution ran down my face, neck, etc.) What are signs of infection in case I need to be seen?

 Gender: Female
 How tall are you (feet and inches)?: 5"3
 What is your weight in pounds?: 125
 How old are you?: 53
 How long has this been going on?: A few days
 Check all symptoms you are currently experiencing: Eye

 What have you done so far to remedy this condition? Please include tests and relevant studies here.
 Cleaned it with saline solution.

 Please list any chronic medical problems and also list any prior surgery (lacerations don't count!): High blood pressure.

 Check all conditions present in your immediate family... :
 Cardiac Disease
 Hypertension
 Please list any medication allergies that you have : : none.
 Please list any medications you are currently taking (and dosage if known) :: Atenolol (50 mg)
 Hydrochlorothiazide (50 mg)

 When was your last menstrual cycle?: I no longer have a menstrual cycle
 Are you currently using or do you have a history of tobacco use?: No
 Are you currently using or do you have a history of illegal drug use?: No
 Please describe your alcohol consumption :: Rarely

How likely is an infection to my eye despite cleaning it with saline solution? Any other home remedies I should consider? So I am looking for something I should keep a lookout for in case I do need to be seen.

This all took place about an hour or so ago. I stated a "few days" above as your system would not allow me to enter "started today." It repeatedly gave me an error message that I need to enter a value. So while I stated "a few days," that is incorrect. Thanks!
_____________________________________________________

First of all, a prize to you for asking the most unique question to date on our little site here.

Secondly, you are correct to be concerned, and, correct as well that a doctor's FIRST question will be 'how is your vision', and, yours, so far, is unaffected.

Thirdly, and this may go to four, five, six etc... There is no way at this point to prevent infection as the peck of the beak either penetrated deep into or even through the sclera OR it only scratched the sclera and cornea.

I have no doubt that a chicken's beak contains all manner of nasty bacteria, and, since your eye is red and painful you MUST get seen by an eye doctor soon. Visual injuries are, thankfuly, rare, but you have one that could be serious.

As I say above it IS good that your vision is not affected, but there is simply no way to know at this point without a good exam if bacteria have been deposited deep enough into the orbit to cause infection.

IF they have then you will need AT LEAST prescription antibiotic eye drops. You also need a tetatnus shot if you have not had one in the last five to ten years.

Finally, you may well need pain control even if this is simply an abraasion. Abrasions can cause spasm of the ciliary muscle. This is VERY painful and a few days of eye dilation and mild pain medicines could to wonders.

Please do update us on this very unique injury!

Be well.

Tuesday, February 5, 2013

Post-Opertive Infection With Hardware

I AGREE TO USE MD STAT FOR EDUCATIONAL PURPOSES ONLY, THAT NO DOCTOR PATIENT RELATIONSHIP IS FORMED BY MY PARTICIPATION IN THIS EXCHANGE, AND I UNDERSTAND THAT MY QUESTION AND ANSWER(S) WILL BE POSTED ON THE WEBSITE AND WILL BE VIEWABLE BY VISITORS TO THE SITE.: Yes, I agree.

Hi i had surgery on a heel fracture 2 stainless pins inserted i had 2 cast changes they were on a little over 1 month each. finally cast was off my parents and friends questioned the color of my foot they said it didn't look right but i said doc gave it the ok.the next check up the doctor said now infected. gave me prescription 2 antibioitics 1 cream. my next appointment was 1 week later skin graph doc. at app. doc looked at wound said admit yourself in hosp now. on i.v.s 5 days now on wound vac. can infections become that critical in 1 week. when the cast was 1st off. my heel was extremely painful to touch and yellowish . now i can touch my heel after iv.s it seems to me the infection was overlooked ?

Gender: Male
How tall are you (feet and inches)?: 5 10
What is your weight in pounds?: 148
How old are you?: 52
How long has this been going on?: More than a month

Describe associated symptoms not listed above: had tingling feeling in heel while cast were on i was told bone growing

What have you done so far to remedy this condition? Please include tests and relevant studies here. Wound vac.

Please list any chronic medical problems and also list any prior surgery (lacerations don't count!): need maybe 2 more operations

Please list any medication allergies that you have : : none

Please list any medications you are currently taking (and dosage if known) :: 2 antibiotics per day doxycycline hyclate 100mg

When was your last menstrual cycle?: Now
Are you currently using or do you have a history of tobacco use?: Yes
Are you currently using or do you have a history of illegal drug use?: No
Please describe your alcohol consumption :: Rarely

What can i do if the infection was overlooked some reason i seem to be backpedaling on getting better.

________________________________________

I wish I could give you a definite answer but I can't because your question calls for speculation... guessing on my part. The fact is that you broke your calcaneus. This is from a high energy injury, in other words, an injury with lots of force transmitted to your foot. The repair of this kind of injury is very difficult to start with. The fact is that the surgery you had to repair your broken heel carried with it a known risk of infection to start with. And if your original injury was bad enough to break the skin (an 'open' fracture) then the chance of infection would be even higher. 

But let's assume that there was no infection introduced during your injury or the repair. It is possible that a small break in the skin near the surgical site introduced bacteria deep into the wound. 

The fact that you have metal screws in your foot makes the infection MUCH worse, because now the screws probably have to come out. 

To answer your question about the infection being 'overlooked', it is not that simple. There is no test that tells if there is infection or not. As you learned, a wound infection is diagnosed by physical exam. Lab testing can help, and bone scans and the like are often used to tell if the bone itself is infected, but there is no way to say if it was overlooked. 

If you wish to consult a medical malpractice attorney they can probably answer this better than I can.

Unfortunately, not even your doctors know right now how long this will take to clear and how many operations you might need (though I see you think there are two surgeries upcoming). You had a bad injury that shattered your calcaneus bone. Even without the infection your chance of getting back to near-normal was very low and you would likely have had some pain and lack of ability to fully use your foot for the rest of your life. 

With the infection the end results are unknown at this point. 

I'm not sure if I have answered your question, so if I have not, please respond in the comment section. Good luck.