To quote the Big B (BoaB): "Always a pleasure. Never a chore"

Yech. That sucks I kinda feared that - like I said, my knee/hip patients seem to do better than my arm injury patients.

Just you remember (Long boring post ahead):

* All pain killers come with side effects. The most commonly prescribed contain some variety of "opiates". Generic terms (and I say Generic because "Vicodin" in the US might elicit a response of "Huh?" in the UK. Yeah, welcome to the wonders of pharmacy....) include: Hydrocodone, Oxycodone, Hyrdomorphone, Oxymorphone etc. In anycase, the point is essentially the same - most pain killers prescribed for such injuries contain "opiates" or their "derivatives". Please clarify the ingredients of the pain pills being prescribed by your physician...

* Why? Well because in almost all cases of orally administered opioid pain pills, they come in "combination". Most opioid pain pills here in the US contain a certain amount of opiate and the remainder is a common NSAID (which stands for: Non Steroidal Anti Inflammatory Drug) such as Acetaminophen (I believe the UK equivalent is Paracetamol) or Asprin (and if it is Asprin - you should or should not take the medication depending on your history/present-condition because Asprin can lead to increased "bleeding" - don't be overtly alarmed.... sometimes this is helpful! But know "why" you are taking "x drug" always. In any case, your "surgeon" who consulted on your case or the medical physician would have cleared/approved the medication).

* Why is this important? Well, take one of the most used pain killer pills here in the US: Vicodin. The standard Vicodin pill contains: 5 mg of Hydrocodone and 500 mg of Acetaminophen (in the UK I guess it translates to: 5mg Hydrocodone/500mg Paracetamol). Now, the scripts for these pills usually read:

"Patient may have: Vicodin 1-2 tabs every 4-6 hours as needed for pain"

But what most of these scripts do-not mention is that:

- Rather than stating "as needed for pain", it ought to read "if needed for pain".

* Now why the hell is some mumbo-jumbo like this relevant? It's relevant because you should try and avoid consuming more than 4000 mg of Acetaminophen/(Paracetamol to you UK folks) within a 24 hour period, because doing too much at a stretch risks liver damage.

* As with ALL OPIATE pain medications - the most common side effects are most commonly felt in yer "bowels" - please ensure that 'side effects' are addressed....
I often hear this from my patients - and I sympathize.

If you are usually an 'independent' person - being a patient is HIGHLY VEXING! Not only do you usually lose your 'general' autonomy - but you seem to steadily lose your authority too....

"Dad! You can't smoke your pipe anymore! The Doctor said..."
"Mom! Your cholesterol results are off the charts! You can't be baking this pie...."
"Dad! You've had shoulder injury - YOU of all people OUGHT to know better!! Step away from that ladder!"


So on and so forth.

When all the while a part of you is thinking - "Ummm, I'm not a cripple nor a useless bum. I've done this longer than most of you have been on Earth. Now, if you'll just let me do my own business... thank you...."

Sometimes, it's hard steppin' aside; isn't it?

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Work in the ER is a mix of can do, can't do and "sure, what the hell..."

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