August 14, 2010

When the Kids Just Say No

Ringo broke his arm skim boarding. A minor detail I forgot to put in last night's post. Hence his being covered in sand from head to toe; he took a spill the wrong way and his wrist dislocated, snapping the radial.

What has been interesting is the 'drug fight'. When we got there, he wasn't in pain, and immediately they wanted to put him on morphine. I kept saying, "Are you sure...?" and finally the PA said, "Did you see his wrist? It's going to start hurting soon." I explained that I'd just had a full on experience with morphine in Hospice and I was a bit drug shy... she promised me not to give him Hospice sized morphine doses.

Which evidently they didn't because the pain did set in and he swears the morphine didn't touch it.

Flash forward to his arm being set and our getting ready to leave. The ER doc said he was giving us a script for Loratab. That's some pretty heavy duty stuff for those of you not in the know.

The look on my face was pretty indicative of how I felt about that drug in my son's body.

He started out by telling us all the AWFUL things that could happen to him taking this drug so young, the awful side effects on young people and then ended with, 'But he's going to need it. He's going to be in BIG PAIN the next couple days. I'm giving you 15 of them..."

We spoke of ibuprofen, but he went on about how he was REALLY GOING TO NEED this drug.


The nurse came in, the one who had been tending him all day, and she informed us that Ringo was going to be in a heaping lot of pain and that Loratab was going to be his friend and that we didn't want him suffering through the night... he needed the drug.

I kept saying, "Are you sure? It seems that as soon as you popped it back in place, he should feel MUCH better..." and she said, "No, no... he needs this."

6PM, my son ate a sandwich and I said, "Hospital scale, happy face =1, frowny crying face =10, where are you?" He said, "Eh... a four. Can I have some advil?"

So I gave him three with a bunch of water and he went back to sleep.

Midnight, I stayed up until 1AM because I had some stuff to do with his cast throughout the night, he said to me, "Mom, I'm a 4 pushing a 5. Straight face. Can I have some Advil?"

I gave him 3 more.

6AM: I was up to do his cast adjustment. He woke up, wiggled his fingers for 10 minutes and fell back to sleep. I never said a word about meds.

9AM this morning: I get "Mom, I'm a 5." I gave him 3 Advil and 30 minutes later he said, "That's great. I'm back down to a 2..." and he fell back to sleep.

6PM TONIGHT, he said, "I need to eat. I need Advil... I'm pushing a five again..."

AND, I have a house full of teenage boys and other than his hand having to be elevated... this is a non-event to him. As a matter of fact, he's out seeing SALT right now with his buddies.

Folks, what is up with the drug pushers? Seriously, I LOVED the staff... LOVED THEM, and I am glad we had it as back up, but they were all over about how he was going to be a suffering fool wanting to slit his throat in pain last night and the kid has had FOUR doses of Advil in 24 hours.

10:1 says we're fine until tomorrow and we'll probably drop to a lower dose.

But seriously... what's that about?

(I do have the picture and will post it in an extended entry later in the week with fair warning.)

Posted by Boudicca at August 14, 2010 09:01 PM
Comments it okay to be taking advil? Just asking as I was not allowed to take it after my surgery as they say it slows down the bone growth. With a break in his bone, I wonder if it'd do the same thing?? I'm only allowed to take tylenol OR lortab.

Posted by: Sissy at August 14, 2010 11:39 PM

They were pushing ibuprofen... however, I think he doesn't need it anymore. Last night he took 2 at 11PM, we're bringing it down in dose, and when I spoke to him at 4AM, he said 2 worked. I suspect we'll be off it all together in the next day or two.

That lortab stuff is wicked. All the things it can do to kids? Even my son heard it. He said, "Why would I WANT to take anything that has such bad side effects?"

Posted by: Bou at August 15, 2010 08:26 AM

Never have done Loratab, but with the late unpleasantness, I discovered how well dilaudid works for head pain. But, I still prefer demoral. When they took me off morphine after my back surgery, they put me on demoral. It didn't really fix the pain, I just didn't care about it. I closed my eyes and there were green elephants and orange giraffes dancing on my eyelids. Demoral is the number one drug of choice of nurses who abuse drugs.

Seriously, you were good to keep him off the hard stuff. I've got some hardcore stuff for my foot pain, but I only use it once or twice a year when the pain becomes really unbearable.

Posted by: Denny at August 15, 2010 03:25 PM

Pain management is a pendulum that swings with the whims of PC'ness. It makes no sense, but so it is. The medical establishment is no more sane than the political establishment for the most part. I give credit to the medical staff for wanting to make sure Ringo wasn't in pain. About 20 years ago that would have been a completely different conversation!

For quite a while there was such a swing to "no pain meds necessary" so that even people who were dying couldn't get pain meds because they might "get addicted"!!! How long for the next 2 weeks before they die??? Seriously???

Now they've swung back to making a push at pain alleviation before it starts to get really bad. The aim is to keep the muscles more relaxed and then healing will take place faster.

However, there is almost never a consideration toward how much pain someone actually feels. Some experience horrendous pain at such a break. It's quite obvious your son doesn't. They never even considered that he may not have lots of pain - they just expected he would - even insisted on it. *sigh*

You did just right. Heavy duty pain meds have their place in medicine. But they are not needed in a blanket fashion. I saw Denny's comment on Demerol. I had that once - hated it! It wasn't the right med for the job and it was WAY over kill in one way - plus it didn't solve the immediate pain problem in the other way. They'd have to pay me to take it again.

Every med works differently on every one.

Posted by: Teresa at August 15, 2010 04:10 PM

sounds like almost the exact same injury my nephew suffered spring break 2009. i dislike skim boards. he too managed with ibuprofin.

Posted by: arcanai at August 15, 2010 05:10 PM

My mom is a tough old bird and wanted to avoid pain medication. The doctor convinced her that the reduction in pain would shorten the time to heal. I've been told similar though I forget now exactly what the injury was. (Our family motto: "Quick healing is a good substitute for common sense.")

Posted by: Carl Brannen at August 15, 2010 07:17 PM

Just an FYI, you can alternate Tylenol and Ibuprofen every 2 hours.
IE 10am Ibuprofen
Noon Tylenol
2pm Ibuprofen

It allows you to have the pain reduced at lower doses and in different ways.

Ibuprofen goes to the pain spot and makes it stop hurting, Tylenol tells the brain you don't hurt.

Too much of any one particular drug, OTC or not, and the body gets used to it.

Posted by: Rave at August 16, 2010 07:38 AM

For some of us the Morphiates do nothing.

I managed with the countervaling Tylenol-Ibuprofen combination when I had my rotator cuff surgery and it worked where the others did not.

Posted by: The Thomas at August 16, 2010 10:11 AM

Good lord, with the mireade of drugs out there they could have given you something like Tylenol w/codine or something similar. With something weaker he could have gotten the same amount of pain relief but taking a lot less pills then the advil. Any Ibuprohen is nasty stuff, especially for the stomach not to mention the heart risks also.

I would have gone more with the tylenol then advil. Advil is ibuprohen which helps with inflamation, tylenol helps more with pain.

But be careful, they put warnings on boxes for a reason.

You also may want to stuffing come calcium pills in him, broken bones need lots of extra calcium.

Posted by: Quality Weenie at August 16, 2010 11:35 AM

@Quality Weenie - Tylenol with codeine? Well, Lortab is nothing but acetaminophen with hydrocodone - in other words, Tylenol with a synthetic codeine derivative.

I think the right course of action would have been to send Ringo home with a small supply of Lortab, along with the instructions to take ibuprofen (Advil) for the pain, switching to Lortab only if the pain got unmanageable. That's pretty much what the docs did for me when I had my kidney stone, or after my wisdom tooth extraction.

A speedy recovery to the lad!

Posted by: Elisson at August 16, 2010 07:03 PM

QW - he didn't take the pain meds for a prolonged time. If this was for chronic long term pain, even the Tylenol with codeine wouldn't be a good choice. But as Bou said above he really only took the Advil for a day or two.

The side effects you are talking about with the stomach problems would make themselves known pretty quickly and then he would be able to switch to something else. The heart issues etc are more from long term continued usage. And in this case the anti inflammatory nature of the drug is a good thing. The less inflammation around the break the better it will heal.

Tylenol, like ibuprofen has its own set of issues and side effects. Add codeine to it and then you have even more.

The right answer is the medication that works with the least amount of fuss. I think they found it.

Posted by: Teresa at August 17, 2010 08:28 AM

Hope he's doing better. Bet that's a doozy of a picture. Part of why they were pushing the prescription on you was probably out of concern that he'd wake up at 3am in huge pain and if you didn't already have the script, you'd be S.O.L. if the over-the-counter stuff didn't work... and then they'd be open to all sorts of complaints/liability for not doing enough. (don't you just love the lawsuit-prevention culture?)

Posted by: Brian at August 17, 2010 11:27 AM

All have good points... and I think Ringo may fit in the crowd for which morphine does nothing. He swears the pain was the same, but the morphine just made him too tired to say anything.

We are realizing now he may have extensive nerve damage. THAT may be why he was not in the pain they were expecting. They all saw the Xrays, something I forwent. Evidently the radius head was completely sheared off and not even on the bone... at all. I mean sheared completely off. But in so doing, medial nerve damage may have been done... so we'll see.

Posted by: Bou at August 17, 2010 12:48 PM

Oh man... poor kid. I'll be praying that he makes a complete recovery.

Posted by: Teresa at August 17, 2010 05:32 PM