In the ER Twice in Two Days and Misdiagnosed Both Times – Any Advice?
Question by green egg: In the ER twice in two days and misdiagnosed both times – any advice?
My friend woke up Thursday morning with chest pain when breathing in (around the middle of my chest, with some radiating pain to her right shoulder). It got worse as Thursday went along, and when she woke up on Friday morning it was really bad so we went to the ER. The doctor diagnosed her with costochondritis (inflammation of cartilage attaching her ribs to her sternum) and prescribed Indocin three times day. She took it at 11:30am, and it put her to sleep immediately. She took the second dose at about 4:30 and again it put her to sleep immediately. She took the last at 10:30pm and fell asleep for the night.
The next morning (Saturday) she woke up without any chest pain at all. We weren’t sure what to think because the doctor had told us that costochondritis would last at least 3-5 days, so I called him. He wasn’t in but I talked to another doctor who said that the Indocin shouldn’t have made her sleepy and that it clearly wasn’t costochondritis if it went away overnight but if she was now feeling fine then there was no reason to worry and she could stop taking Indocin.
However, she then started to develop a headache. It was just a mild headache when she first woke up, but it kept getting worse and then got to where she was lying in bed with the lights off and shades down without moving her head because it throbbed when she did. We went through the sheet for Indocin and one of its warnings was for a long-lasting headache that got worse with movement, and it said we should see a doctor immediately. We called and were told that she should go to the ER to get a CT scan and blood work and make sure it wasn’t a big deal. We went, and she got both of those, but the doctors were ignoring her previous symptoms and just trying to diagnose the headache on its own. Needless to say, they released her after midnight with the diagnosis “tension headache” with “two undiagnosed symptoms” – i.e. the sleepiness after Indocin and the previous chest pain. They told her to take an advil if her head hurt and left it at that.
We are positive that it’s not a tension headache, because the major symptom there is head pain that doesn’t change when she moves. Hers is such that she has to lie still without moving her head, because if she moves then the pain jumps up to a 5 or 6 on a ten-point scale (where 10 is the worst pain she’s ever felt).
Today her head was worse than yesterday. She took two advil in the morning, which helped a bit (brought the pain down from a constant 4 to a constant 3) but it’s been getting worse as the day goes along, like yesterday. She’s sleeping now but we’re not sure where to proceed from here. We need a doctor who will look at all of her symptoms as a progression and not just ignore the ones that went away, but all of her tests came back normal so we’re not sure what to do. If her headache gets considerably worse we will definitely go back to the ER, but we’ve spent nearly 10 hours there in the last two days without learning anything new. What else can we or should we do?
Thanks for your help….
Best answer:
Answer by Mel
Hi Green Egg,
Well firstly, Indocin 25mg should be given in three divided doses which is what you have been told (but be sure the dosage is only 25mg It will tell you on the label.) However in my opinion a lower dosage should have been tried first to check tollerance..It can cause something called hyponatraemia.
This is when the body retains so much fluid that it starts to expand blood volume and dilutes blood salt levels causing the fluid to enter the brain and cause headache, weakness, sleepiness and sometimes vomiting.
It is usually associated with drinking too much fluid especially during exercise, but in this case is caused by drug related means.
I personally think it might be a better idea if possible to get her GP in to see her since you are obviously getting nowhere in ER.
STOP the indocin totally, your friend is obviously reacting against them.
Costochondritis can only be diagnosed once all other more serious conditions have been totally ruled out.
Your friend definitely needs to be seen again and by someone who is prepared to listen to the story in full starting with thr chest pain.
I cannot unfortunately be of any further help to you apart from stressing that she needs a doctor to come in and see her, alternatively call 911/999/or equilivent depending where you are in the world. If she is taken i9n by ambulance she may be seen quicker and taken more notice of.
I am sorry my help is so limited, but i wish her well.
Love mel.X
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