The Pain in the Anus
"Hmmph," said the patient, "I thought you had forgotten about me."
Great way to start the visit, lady. "Thanks for your patience. So what can I do for you?"
She complained of rectal pain and bleeding for one week, which evidently became emergent around 3 am that morning. She had an anal fissure, mild in severity, with no active bleeding and a normal hematocrit.
After a detailed discussion of the pathophysiology and treatment of her disorder, she seemed upset. "You mean I waited all this time and you aren't even going to do anything for me? I read on the internet about all these treatments..."
Like what? You really just need to eat more vegetables, take some stool softeners and try some warm tub soaks. If that doesn't work you can follow up with the specialist for other options.
"But aren't you even going to prescribe me anything...some lotion, or maybe give me a shot? And what about this pain?"
Pain pills will just constipate you more and make the problem worse. Unless you start having softer stools more often than once a week there isn't any cream in the world that's going to help you. And we don't give botox shots in the ER, sorry.
"This is ridiculous," she fumed. "I could have just gone to the drugstore and gotten all of that stuff."
Yes it is, and you certainly could have. Good luck!
ooooooooooooooooooooooooooooooooooooooooooooooooooo
That reminds me, if you've never read the story of Bob the Anal Fissure, then you are in for a treat. Here's a teaser:
"At first Bob wasn't so bad. Occasional itch and discomfort. Nothing that I couldn't handle. A mint flavored suppository now and again seemed to do the trick.
read the rest!
Great way to start the visit, lady. "Thanks for your patience. So what can I do for you?"
She complained of rectal pain and bleeding for one week, which evidently became emergent around 3 am that morning. She had an anal fissure, mild in severity, with no active bleeding and a normal hematocrit.
After a detailed discussion of the pathophysiology and treatment of her disorder, she seemed upset. "You mean I waited all this time and you aren't even going to do anything for me? I read on the internet about all these treatments..."
Like what? You really just need to eat more vegetables, take some stool softeners and try some warm tub soaks. If that doesn't work you can follow up with the specialist for other options.
"But aren't you even going to prescribe me anything...some lotion, or maybe give me a shot? And what about this pain?"
Pain pills will just constipate you more and make the problem worse. Unless you start having softer stools more often than once a week there isn't any cream in the world that's going to help you. And we don't give botox shots in the ER, sorry.
"This is ridiculous," she fumed. "I could have just gone to the drugstore and gotten all of that stuff."
Yes it is, and you certainly could have. Good luck!
ooooooooooooooooooooooooooooooooooooooooooooooooooo
That reminds me, if you've never read the story of Bob the Anal Fissure, then you are in for a treat. Here's a teaser:
"At first Bob wasn't so bad. Occasional itch and discomfort. Nothing that I couldn't handle. A mint flavored suppository now and again seemed to do the trick.
But then about a year ago my cruel master Bob began requiring more and more from me. Itching on a scale that can only be described as "hellish" was the order of the day. I had a permanent brown stain on my index finger from trying to scratch the inside of my colon through my troubled anus. 
I had lost all sense of decorum. I no longer cared what people thought. I often walk around in public with my hand down my pants, finger firmly implanted, trying to appease the evil God Bob.
In my spare time I would daydream about modifying various farm implements to deal with the overwhelming itch. I even went so far as to order a tined hand trowel.
Finally, I went to see a doctor..."read the rest!
posted by scalpel at 8:04 AM
7 Comments:
For those cases I usually prescribe some viscous Lido. At least then you "did something". (yes I know you can buy stuff like that over the counter but at least now you can salvage your Press Ganey score!)
A wonderful, hilarious post!
Oh, Bob! I haven't read him in five years, but will have to go back and do it again.
Ha! I start my ER rotation tomorrow... cannot wait :)
If you had an emergency department, you'd probably have a minor procedures room where you could do botox.
As for you, Zac, just warning ya - your attendings will give you the slapdown if you call it the "ER" in front of them.
It took me 3 days to finish reading about Bob. The baby has been keeping me waaaaay too busy of late. No napping. No sleeping. (Does the ER have something for insomniac babies?)
Anyway, that was funny. Thanks for the link.
M
That was VERY funny Scalpel! LOL!!
I loved where he said he "tried to enjoy himself."
Maybe a ureteral stent isn't so bad after all. ;)
Thanks for linking that.
I may print it out for some doctors and mail it to a couple of ED nurses I worked with. :)
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