Modified duties to return to work

So I gave my oc-health paperwork that I filled out and my physician signed off of to the hospital. Turns out they're suspicious of it. UGH, it never ends. Some other physician has to check out the paperwork and determine if my physician has to write a more "official" letter to explain why I need restricted shifts. In the paperwork it's indicated that I can work fri, sat, sun - evenings or nights. They don't understand why this is important - even after I explained to them that I would be taking narcotics mon-thurs since I get my seton tightened on mondays - and I can't work when I have been taking narcotics. Pretty sure my patients wouldn't want me as their nurse who's flying high (not exactly true) plus there's the thing of malpractice. Ya wouldn't want something to happen when I'm on those puppies! Plus once I have my seton tightened I'm in crazy amounts of pain and it's difficult to sit or walk - heightens the pain for sure.

So ya, don't know what I'm going to do. All I want to do now that I'm feeling better is go back to work. Unemployments/short term disability is done and so I need some money rolling in!!! Plus I have to pay for next semester's tuitio in a matter of weeks. Kinda hard to do with no money!

Not just an ordinary infection

So a week's worth of pain, once I got back home the next day I had an appointment with my surgeon.

Turns out I have a NEW abcess. UGH! When I knew that I was right, I started crying. I was FINALLY starting to heal (somewhat anyways) or at least experiencing less pain, I go two steps backwards.

I knew from talking to the surgeon's receptionist that he wasn't back in his clinic for almost a month and so I asked when he was on-call again at the hospital. Figured that if I had to have an incision & drainage (I&D) that I would prefer to have MY surgeon do it. Turns out he was on-call that very same day.

I just had to head to the hospital while he was on-call. Then once there I had to wait another 2 1/2 hours for him to show up.

He was able to do the procedure and while he tried to be more empathetic and caring - I requested morphine so he gave me 4mg SC of it. And he tried to make sure I was good and frozen. Ya it didn't help much. Holy hell did it hurt!!! Then he gave me another 4mg of the morphine post procedure considering I was crying it hurt so much.

Now two days out, the surgeon actually called me this morning to ask how I was doing!!! How sweet eh?! I guess I must have made a bit of an impression. LOL

I have to see him again Monday for a follow-up. I also have to have home-care though in a clinic to pack the wound. Hurt the last time so I don't expect anything different this time around.

Surgeon says he won't know whether a fistula formed for another week or two. My goodness I hope and pray I didn't.

ANOTHER infection???!!!

The day we were supposed to leave my pain started to increase - always indicative of an infection. The tract felt like it was getting more and more swollen so i went to my family doctor's walk-in and saw the Dr there. She agress, another infection rearing it's ugly head.

Now I'm on Keflex - this makes my SIXTH antibiotic in less than 4 months. UGH when will this end??!!

I'm on vacation - I shouldn't have to deal with this crap. I however, am starting to wonder whether it IS the tract or whether I've developed another fistula because what I'm feeling is a hard lump at the top - but when I press on it (not hard cuz it hurts MASSIVELY) there's no discharge. So I'm at a loss. Hubby says to wait and try to let the antibiotic work and not head off to the ER here. Ya we'll see.

Anyone have any suggestions??? \the sitz baths aren't doign anything - certainly aren't helping with pain or burning or itching. Clearly they aren't helping with the infection. The keflex I've been taking now for 24 hrs - and that hasn't done anything yet. I just want the pain to stop. Ibuprofen isn't really helping. I don't want to be put back on the morphine if I can help it.

When will I get back to work???

That's the $1 000 000 000 question!

Had my follow-up with the surgeon today. Finally. I SHOULD have gone to him 2 weeks after surgery (2 weeks ago) but I didn't call his office right away. I was angry that the anesthesiologist screwed up my throat and the fact that the surgeon didn't call my hubby to update him after surgery or talk to me after the surgery. Good thing he apologized today for that (about his part anyways) and tried to answer questions about my throat.

I told him why I waited so long - about the infection - and that I was in major pain and I wasn't about to go to him and have him prodding around my bum when it hurts so much. Then he asked me why I didn't call him - well I did, I even told his secretary about the fact that I was having complications and she wouldn't give me an earlier appointment than today (he didn't address that) then asked me why I didn't go to the ER and have him paged!!! YA RIGHT!!!!

What surgeon do YOU know who wants to me PAGED when there are NOT on call???!!! I don't know a single one.

Either way, surgeon said that I'm off work til Nov 1st and more than likely another month after that but after Nov 1st he wants to take it week by week. He knows that I'm a nurse and considering walking exacerbates the pain, he figures it would be too difficult to go back. So I'm off for a bit longer.

The up side of this is that I can focus on my school work and make sure I get the best grades I can. Unfortunately it means no paycheck.

He wants to see me weekly to start tightening the seton and told me to pre medicate myself because it WILL hurt.... damn that's going to suck!!!

On a happy note - I just got back my pediatric assessment paper back and I got 99% - missed it by 0.5 of a mark because I forgot the birthdate - UGH! Stupid mistake. So far I'm 87% for one course and 93% for the other.

I may be behind in school work but damn am I getting good grades

Since I had the surgery it has put me MAJORLY behind for school work. I've been TRYING to keep up, but damn do these teachers load the work and readings for each week.

I had been having major pain and irritation to the site - not sure how normal this is. As of yesterday the discharge has turned purulent and smelly. Went to my GP and he swabbed the area and sent it off for testing. I should know more Thurs. He didn't want to put me on anymore antibiotics since I've been on quite a bit lately. All good in my book since we are at least doing testing.

Because of the pain I was prescribed Dilaudid - I'm allergic to codeine, demerol and percocet - throat swells so ya, not having any of them. The unfortunate side effect is that I got MAJORLY dizzy from it. THEN I was getting nauseous from it (and gravol or maxeran weren't helping) and subsequently vomitting for an entire day. NOT good when i'm trying to make up all this stuff. Because of the dizziness I lost 4 days - finally I just had to stop taking the pills and deal with the agony in order to get SOME work done.

Pain's still pretty bad, especially after activity. So off I went to the GP yesterday to see if I can get morphine instead. I know it makes me nauseous but at least I know that maxeran will cover it and I SHOULD be ok.

I have a follow up with the surgeon on sept. 30 - looking forward to seeing him and hearing what he has to say about this entire mess.

Cut lip AND uvula from anesthesiologist - they messed me up good!

Had surgery yesterday... Got bumped by an emergency in the AM, was scheduled for 1330 hrs and was ALMOST cancelled - only reason they didn't was because I worked at the hospital (yay for small favors). Went in for surgery at 1730hrs and woke up in recovery at 2030hrs.

My throat was killing me when I woke up. wouldn't know what they did to me until I got home and looked in the mirror... little about that later - I have pics

The surgeon didn't even stay til I woke up to give me any information about my surgery, NOR did he call my hubby (which I indicated to do)... asked the nurse what they did, was told that the surgeon did a fistulectomy. Was surprised by this because surgeon told me that he couldn't do that because it was aimed at my vagina and the muscle there was too thin to do this. I also clarified with him about this prior to going into the theatre, asked him if he saw the CT scan I had a couple of weeks back. He said that he had, and that he thought that I also had a abcess but wouldn't know for sure until he got me knocked out and could peek around. So ya, the fistulectomy information came as a surprise. Also before going under I asked him to write a script for a pain killer seeing that I'm allergic to codeine, demerol and percocet and I didn't want him to "forget" about this and give me one of these and I would up the creek without a paddle and in tremendous amounts of pain. He gave me dilaudid which was good in my books.

When I got home and looked in the mirror - wondering why my throat was killing me so much, I found this...........




Pic # 1 - uvula from yesterday - the anesthesiologist CUT my uvula and damaged the tonsillar area (mine have been removed)

Pic # 2 - uvula from today - the bottom half is DYING!!!!!! Holy crap, and I have NO idea what to do about this!!!

Pic # 3 - the anesthesiologist cut my lip as well - at first when I felt it when I came out of my anesthsia I thought maybe I bit down on it - nope, that was from the ET tube.... what the hell was the anesthesiologist doing while I was asleep - was she as well?!

To say I'm pissed is an understatement. It's frustrating that I work there and get treated like this. No wonder my hospital is getting a SUPER bad rep. UGH!!! I don't want to have to fink on these HCPs but I certainly can't stand around and expect that they get away with this. Hello people, you dropped the ball and I don't want to have to pay for it.

I went to my family doc today because the original dilaudid the surgeon gave me wasn't enough to cover my pain (from either end actually) and even when I doubled the dose myself (explained that to the family doc as well) it STILL wasn't enough.

I told my doc that I felt bad for him that I'm always coming to him to fix other dr's mistakes - when I said that he said "hmmmm" and turned back to his computer. He couldn't BELIEVE that what's happened to me (for this whole ordeal since the end of June). He asked me if the doc put me on antibiotic - nope he sure didn't. So there's another script right there (we're up to 2)

I asked him for some numbing spray for my throat (so that I can swallow and maybe eat something) but he was a bit reluctant on that one - he relented a bit and gave me a script for xylocaine jelly so that I can put it on a Q-tip and apply it to the really painful areas in my mouth/throat. (script #3)

Last night was such a horrible night for sleep that even my sleeping pills weren't covering it and so while I was at the doc's I got him to give me a refill on my sleeping pills so hopefully tonite would be better (isn't so far but meh) = script # = 5

He said he wants to see me in a couple of days, already had an appointment with him on the 10th so hopefully I'll be in a better position than what I'm in right now.

I have a big ass assignment in school due Sunday @ 2300 hrs - ya, had to ask for an extension on that one. Hopefully they grant it. I'm not in ANY position to be doing it. Too doped up on dilaudid because of all the pain, I just want to sleep all the time (my body's way of coping with pain).

Oh, and I showed the Dr my derrier and he said that there's strings there - was surprised at that, because it means that the surgeon did a seton - I had talked to him about that just before going in for the surgery and he told me that he would likely be putting one in (for the one that goes towards my vagina) but when I asked him what kind it would be - tighting or not - he said he wasn't sure until he got in there and see how much muscle involvement there was.... still don't know which one I have but I DO know that I have strings.... guess I'll find out mroe in 2 weeks when I'm expected to have a follow-up appointment with the surgeon.

Life is busy

School has started in full force. I FOUND A NP WHO WILL BE MY PRECEPTOR - THANK YOU RV!!! I can't believe that someone who doesn't know me and has never met me and has only talked to this crazy nursing student who randomly called them up would be willing to help me out. Either way, I'm eternallly grateful. Even better it that she's already sent in the paperwork AND she's been approved!!!

I caught a nasty cold - makes life a bit more difficult as the energy level has plumetted which makes doing school work & required readings tricky. I'm TRYING to keep up!

I have a cultural competence paper & test to do before sunday. I also have a teaching & learning test to do before then as well. Now the tricky bit is is that I have a scope scheduled for thurs which may take me out of commission for several days. Hopefully not any longer than that.

I did my preop stuff today. The nurse there knows what surgery I'm having and she mentioned that she didn't think that I would be back to work before the new year - holy shit batman, I can't be off work that long. I was only expecting to be off another month AT THE MOST!!!

School costs me $5,000 per SEMESTER and so I NEED to go back to work. I have school to pay for. I would rather NOT go into debt if I can help it.

I'm looking forward to getting this health stuff fixed, it hurts & is itchy and it makes walking more difficult. Not looking forward to the bowel prep though! Don't know of anyone who does. I'll know more about what the agenda is for surgery after the scope. Doc tried to call me today but don't know why - I get to find out tomorrow.

Yay I'm healing

Been going everyday to get my packing done.

The nurse who did it the first day (almost a week ago) indicated that it has healed a bit, which is exciting. I'm glad that it isn't taking it's time healing. Hopefully only one more week til I'm healed up.

I think starting Sat or Sun I'll be starting every OTHER day to get the dressing changed so I'm going in the right direction.

Tried to go for a walk with hubby last night, it's an understatement to say I was in pain when we returned. It seems like the more I move, the more my butt ends up borthering me. GRRRRR

Hopefully soon I'll be back to normal :)

July 25th is a SUPER important day!!!!

That day several things will happen...

1. Most important - I have a job interview for a FT L&D position - WOOT WOOT!!!!! I am SUPER UBER stoked! I just found out Thursday, so considering what's been going on with me health wise, this has taken the back seat news wise. Plz send prayers and thoughts out as this day arrives, this is where my heart is leading me to go to deliver my nursing skills & vibes. I just hope that they see that I'm the best one for the job!

2. It's the day I follow up with the surgeon and have him poke & prode (though I hope less this time around!) and see if anything more needs to be done about my derrier. I still have a couple more days of Amox-clav antibiotic, I was nauseous for the first couple of days but that seems to have eased off. I'm still in pain intermittently, highly corrolated to how much walking or sitting on my buttock I do. Night before last, when fast was done, we met up with the in-laws friends at a restaurant and I had to bow out just after eating because I felt like I was going to pass out, hot and dizzy and nauseous does NOT a good evening make!!! Thankfully hubby was right by my side and led me out and even opened my car door for me! awww how sweet (would LOVE if this happened more often!)

3. I find out when I can go back to work - whether that be modified work duties or full scope. My back has been pretty good considering I've been resting more, but I certainly notice when I try to do stuff around the house and then it starts bothering me BIG time - had to take a nap today because the pain from my back and bumm hurt too much. Took a morphine and to sleep I went, when I woke up I felt a bit better - now I'm starting to feel it again. though the morphine has worn off and I've done a bit more around the house so who knows what exactly the culprit is. Time will tell!

I had my dressing changed yesterday and today - the woman has the same name as my auntie - funny since she's the one who's an absolute bitch! This woman is a Sweetheart!!! She puts xylocaine jelly in my wound before doing the packing!!!!!!!! Let me tell you, that has made ALLLLLL the difference!!! She and I have seemed to click which is nice. Hope I get her for the rest of the time that this dressing changes have to be done. She says it looks pretty good considering. She figures that it will take about 3 wks to fully heal. Hopefully I'm a fast healer. She says that my abcess is weird because it tunnels back towards my hip and only slightly towards my rectum - which is not usually how abcesses work. It's something that I'm going to have to bring up to the surgeon when I see him next.

Well I think it's bedtime for me - ciao for now!

I'm in so much pain!!!!!!!!

Had the follow up with the surgeon today - he did an incision & drainage - under local - HOLY SHIT DOES IT HURT!!!!!!!!!! He did the local and I STILL cried!

The first local hurt, but then he had to keep doing more and more becuase he didn't expect the abcess to be so deep - my response was "well if you thought it was that deep why didn't we do a twilight sedation or something" - he figured that it was more superficial and that abcess drainage isn't done in the OR. Which is something I wasn't getting at, that it could have been done in the ER where twilight sedation IS available and I could just stay around waiting for it to wear off.

When I got up from the stretcher there was a pile of blood on the stretcher and between my legs that the doc didn't give me anything to clean up with - good thing at least I brought wet wipes to clean myself up. And of course because of this all I have lost my fast (for Ramadan) which is irritating because I had been fasting since 4am. :( I can't fast for the next 10 days because he also put me on a different antibiotic - Amox-clav, which I haven't even heard about. Now I'll have to make this 11 days up after Ramadan is complete :(

He packed the wound and now I'm going to be having a wound care nurse come to the house daily to repack the wound - which is problaby going to hurt like a bitch. I'm certainly not looking forward to that. The doc gave me Statex but I'm not sure that that will be enough to cover the pain when they pack.

I'm off for another 2 weeks til I see him again. I'm not sure that the wound will be healed by then if he expected the abcess to be more superficial than it was. We'll see though. I just hope that the pain goes away quickly because it sucks having to lay down all the time.

Death & Dying - what I learned

I was working the other week, and one of my co workers had a patient who had been going downhill. It was such a sad story - the husband and wife came to Canada from out east to visit their children and the husband had a stroke and the wife forced her husband to come to my hospital. He of course was admitted. Now of course when ppl go on holiday they don't (always) think to get health insurance so now that they're at my hospital, there's no way to pay for the care and so the hospital goes after the children's ability to pay.

During grand rounds I learn that this person has been going through cycles since coming to the hospital - that his doctor had been trying to make him healthy enough so that he could get on a plane to go back to his parent country. Unfortunately, he would get well for about a week and then would start to spike a temperature and would have to be held up and begin a round of antibiotics, and that would be the cycle. It was like EVERY time he was well enough to get a clean enough bill of health as is required by airlines to allow sick ppl onto their airplanes, he would spike another temp and wouldn't be able to go back.

The shift I worked, I was told by the nurse taking care of him that he wasn't doing well, his BP was REALLY poor but his O2 was alright, but that he didn't look good. Thankfully the family had made him DNR so at least if things went awry we wouldn't have to pound on this poor patient's chest to revive him and keep him alive for longer than he needs to be.

The nurse came out and explained that she thought he would die during that particular shift and felt that there wasn't anything that could be done to alleviate any suffering. She called the on-call doc, who just happened to be one of my favorite docs and he ordered some dilaudid for him and some scopolamine as this med dries up secretions and the "death rattle" is less so the family isn't as upset by it.

The doc agreed that he was in the final throes of dying and that it wouldn't be long before he died. I was talking to the doctor and a couple of the other nurses when the wife comes out to the nursing station speaking Hindi - a language that not enough of us speak but we did have a couple of ppl on at that time and we pulled one of them (the male of the two) to translate as the wife was trying to speak to the doctor and pull him back into the patient room. Now when we pulled the male nurse to translate the face he was making was hilarious and it was almost as though he had NO idea why we were grabbing him and it was hilarious so I laughed.

I found out when the doc came back to the station was that her husband had just breathed his last breath and was coming out to indicate this.

I felt soooooooooooo bad that one of the last things that this woman may remember will be laughing when her pain was excrutiating. I am not someone who enjoys seeing another person in pain. I wish I coudl have spoken the language with enough fluency to apologize for any pain that I may have inadvertently causing her.

Morale of the story - get health insurance whenever you travel, you never know what's going to happen and you really do need to be covered. And never laugh at ANY point in time if someone is dying on your unit, because it may be perceived in another manner in which you meant it. ESPECIALLY if someone speaks another language. They have NO idea why you're laughing, and nothing is funny when your loved one is dying.

I need to be fixed

Well I'm still in the hospital.... it's been 6 days now, and still no end in sight. I've been attached to an IV for 3 days now, KCL 20mmol NS @100mL/hr, being that my potassium was low (probably because they put so much NS through me - like 3000mL), and they wanted to give me as much fluid as possible.

As I mentioned in my previous post - the belief was that it was either meningitis or encephalitis. Well it turns out that it's neither. At least that's according to my LP, CT and subequent MRI. All of them turned out to be normal. Well technically my LP had a cell count of 4 but anything below 6 is normal. So who knows.

The neurologist believes that I have a viral migraine - that I had a virus that "bugged" my brain and the migraine was the end result. Or that I had meningitis but since I took so long to go to the hospital and see someone and find out what was wrong. The problem is is that it doesn't want to go away. It's pretty bad that I can't be upright any longer than a bathroom break without the migraine hitting me like a sack of bricks. Holy shit does it hurt!

Also, the MRP (most responsible physician) for me took the morphine away 2 days ago - she believed that I was possibly getting a rebound headache from the morphine. So pain was to be my constant companion. At least I had Toradol - until the next MRP took THAT away, with the belief that it wasn't helping so why take it. Ya, nice thought UNTIL I experienced the migraine without it... normally when I'm laying flat I can manage the migraine... well without the Toradol, it was like I was sitting or standing upright. The pain SUCKED!!!! I still don't have the Toradol, but I'm being given Motrin - it only JUST barely takes the edge off. Not really though, but trying the positive thinking.

This morning a new symptom - dizziness.... while laying flat!!! And it wasn't like I was turning my head, getting up, or doing anything AT ALL... I was laying down doing NOTHING!!!

So now I have no idea what's causing this. It sucks! I miss being at home with my family, I miss my husband and my daughter... and I know that they miss me as well.

About the dizziness, the MRP asked to have my VS taken again - they haven't changed from my original set this AM so it's not like it's from HTN or hyptension. I don't know what could have happened to cause this symptom but it's not going away - at least not yet. The MRP still hasn't come to see me since the original visit, maybe she's looking into talking to the neurologist to find out what COULD be causing it.

I guess time will tell. Hopefully I get off the IV - I've heard that my potassium is back to normal and the fluids don't seem to be improving my migraine situation. Guess we'll see about that as well.

eenie meenie minie moe

So I ended up at the hospital afterall... turns out I have the symptoms associated with meningitis or encephalitis - but which one is it... hence the title.

By the time I was fed up with meds not helping my pain, I hightailed it to the hospital. Though by then my fever had broke, or was in the process of breaking thanks to tylenol and motrin being used interchangably throughout the day, when I was FINALLY triaged it was 37.8. So when I finally saw a Dr, this is what occured.

First I had blood work done and my urine sample taken. They wanted to see if I had a chest infection or something else.

Then I had a chest x-ray done, that was clear.

Had a head CT done, that was clear.

Blood work and urine sample came back clear.

Lastly I had a lumbar puncture (PAINFUL btw, helped take my mind off the migraine - thankfully I had just received some morphine before the LP so it wasn't quite as bad but DEFINATELY hurt!).... but even THAT came back clear.

So ya, Dr doesn't know what's going on with me. My symptoms are consistent with the two - I did have a high fever before, that's now gone but the migraine and positional issues still remain. As do nausea and vomitting as well as photophobia.

I'm out of the hospital for the moment - was in since thurs evening. Pretty much the Dr wants me to go to my workplace now and be admitted there because the other hospital in my city doesn't have an MRI machine and neurologists only work at the sister hospital and there's a waitlist to see them. At least if I go to my hospital, there's both there at hand.

I'm on SR morphine - not really helping - trying to remain as supine as possible. Pretty sure I'm heading to my hospital in the AM. I would go now but I just want to sleep in my OWN bed, just once. Unless this migraine goes away tonight, tho that's highly unlikely since it's lasted for 6 days now.... sooooo frustrating.

Hopefully one of the neurologists at my hospital can actually help. Here's hoping anyways!!!

Meningitis (in the back of my head) or just a migraine?

The last couple of days have been difficult to get through. I went to the Dr's yesterday to get a sick note as I called in sick last week - still not 100% but enough to go back. I'm fighting a throat infection thingy, with a bit of a cough and I feel it's going into my left ear - when the Dr looked in my ear, she said it was clear. She did, however, say that my throat was reddened.

So I went to work yesterday and developed a headache while at work - took some Motrin around 1900 hrs and went on my merry way - working/fighting through the pain. The Motrin didn't get rid of the headache but at least took the edge off so that I could still focus on what I needed to do. Being in the DRY DRY hospital didn't help my throat either, was coughing quite a bit, think it might have irritated it more and also could have increased my ICP, not helping the headache situation.

By the time I came home the headache was starting to increase again, so I took some more Motrin and my other nightime pills and climbed into bed (approx. 0030 hrs). When I woke up, HOLY BATMAN was my head killing me! I felt sick, sick, sick. I took some motrin and stayed in my bed, figuring that I just needed some more rest or something. But a couple of hours later I felt like I was febrile. Checked my temp, and sure enough I'm sitting at 40.1 C - remember that I had already taken Motrin... So I take some tylenol headache - which has ES tylenol AND caffeine... should have helped my fever AND my headache BUT IT DIDN'T help ONE BIT! Didn't even really touch the pain.

Two hours later I couldn't take the pain anymore so I went back to the Dr. She checked my temp - yep still had a 38.0 temp. Because I'm allergic to codeine, demerol, and percocet, there wasn't a whole lot she could wanted to do about giving me something to relieve the pain... but she gave me a migraine medication.

When I went to pick up this med - for EIGHT doses, it cost me $147.47!!!!!!!!!!!!!!! HOLY EXPENSIVE! I almost crapped my pants! But honestly, I would have paid anything to make the headache go away.

The first dose didn't do a thing for the pain, two hours later I took the second dose (and now I can't have anymore for 24 hrs!) and it took another 3 hours for ANY pain relief. On a scale of 1-10, I'd put it at a 6ish... but the pain gets worse when I sit up or stand up. SUCKY! Which on that scale is like an 11 when higher than a supine position.

I hope I get better quick cuz I don't want to have to go to the hospital, I am at one enough because of my job, I know how things roll there and things take FOREVER to get done!!!!

Steven Johnson Syndrome

I don't know about those who read the blog, but this is something that I have seen several times. When I first learned about it, I thought it was a rare occurance. However, we have someone on our unit who I SWEAR has it! Not that he's been diagnosed with it - doctors just think of it as a toxicity to one of the meds that he WAS on. That being said, when I started to peruse the internet about it, I learned that it IS indeed a side effect of one of the medications the pt was on.... dilantin. Prior to my perusing, I was under the impression that those who experience this VERY PAINFUL condition, that it's mainly due to a reaction to antibiotics or NSAIDs.

When I found this I had an "a ha" moment. I honestly don't think that the doctors on our unit managed this pt's condition well because he wasn't diagnosed with this.

This is the sort of things that the pt was experiencing....

Now his appearance wasn't as severe as the flank picture, and his oral mucosa wasn't this severe - but you can see how bad it can actually get. It can LITERALLY affect EVERY part of your body - and it's just like a SUPER SEVERE sunburn, and therefore you see blisters, weeping skin, peeling, etc. And they treat this condition as they would burns - preserving the airway because sloughing can occur in/on ANY part of the GI system - from the mouth to the anus, and the respiratory system as swelling can occur and these two things can compromise the airway. It's something that should be monitored closely.

Our poor patient blew up like a balloon, he was soooo sick. And because of restraints, blisters tended to form right under those and were so painful for him. Unfortunately he needed the restraints so you often felt bad having to go into his room to do personal care because you would have to fiddle with the restraints and turn him from side to side. VERY painful.

So be cognizant of seeing something like this and that it can become WAAAAY worse in a VERY short period of time. I wish that I was around when our guy was acutely ill because I think that he would have gotten the care he deserved. But I think that if the doctors had never seen anyone diagnosed with it previously, it's hard to connect the dots and come up with the correct diagnosis and therefore the correct treatment. I just wanted to share this so that anyone who reads this blog, will know that this is possible. My patient had this occur because he was on Dilantin - for seizures, but the docs didn't recognize his symptoms as SJS but treated it like it was an adverse effect - ya it SURE was but they certainly didn't treat it as SJS. Poor guy either way.