Benefit of hindsight

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Benefit of hindsight

Postby trailgumby » Fri Aug 16, 2013 9:58 pm

Last weekend I split my shin open on a wooden log when I hesitated and lost my balance riding a narrow elevated bridge at Hornsby's Old Mans Valley MTB circuit.

Went to the medical centre that day to get it cleaned and sutured.

5 days later its gotten much more tender over the afternoon and I've realised the redness and pulling sensation with certain movement isn't from the impact injury, its infected. I've gotten some antibiotics tonight but have set the alarm for early this morning (1:30am) and if it continues to deteriorate I'm taking myself off to emergency.

The hindsight is that the doctor didn't spend as much effort examining and cleaning the wound as I expected and I should have been more vocal.

We'll see how it pans out over the next few hours. .
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by BNA » Fri Aug 16, 2013 10:08 pm

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Re: Benefit of hindsight

Postby Mulger bill » Fri Aug 16, 2013 10:08 pm

Fingers crossed Gumby.

I hear a well aged single malt or a bottle of Pussers rum helps greatly in these cases :wink:

Good luck mate.

Shaun

EDIT, push 'em HARD onto an embedded foreign body check, took ages and day surgery post injury before all the splinters were out of my thigh.
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Re: Benefit of hindsight

Postby QuangVuong » Fri Aug 16, 2013 10:17 pm

Amputation is an option :twisted:

Nah, do get better soon, and hopefully it aint something serious.
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Re: Benefit of hindsight

Postby TraceyG » Fri Aug 16, 2013 10:21 pm

Ouch! Hope you recover quickly and are back on the bike soon.
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Re: Benefit of hindsight

Postby foo on patrol » Sat Aug 17, 2013 4:03 am

Mulger bill wrote:Fingers crossed Gumby.

I hear a well aged single malt or a bottle of Pussers rum helps greatly in these cases :wink:

Good luck mate.

Shaun

EDIT, push 'em HARD onto an embedded foreign body check, took ages and day surgery post injury before all the splinters were out of my thigh.


This works even better when taken with mates around! :mrgreen:

I hope this old bridge was not arsenic dipped TG. :(

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Re: Benefit of hindsight

Postby trailgumby » Sat Aug 17, 2013 5:08 pm

Well it didn't improve so I went to Manly Hospital where I managed to catch a lull between the Friday night drunks and the start of the Saturday sports injury wave about 9 this morning.

The intern said they don't usually suture the area due to poor blood flow and prefer adhesive closures. Made a lot of sense. They were going to remove the sutures and thoroughly clean the wound and look for foreign material.

When the sutures were removed there was a moderate amount of pus from the holes but the wound itself stayed closed. Seems to me therefore it was the stitches that were the foreign body infected not interior of the wound.

He massaged some more material out of the suture holes, gave me a strong IV antibiotic, a script for additional antibiotics on top of the ones the doc prescribed last night and some strong painkillers. He gave me orders to keep it elevated and dry - no dressing except at night.

I wasn't aware you could take full adult doses of paracetamol and ibuprofen concurrently :shock: and oxycodon on top of that :shock: :shock:

Anyway things seem to be trending the right way again. Less pain and the inflamed looking area is a lot cooler to touch.
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Re: Benefit of hindsight

Postby Mulger bill » Sat Aug 17, 2013 6:01 pm

Good good good.

The GLW tells me it's a likely vector for infection if the wound site is not thoroughly cleaned before suturing.

Now, ask your GLW to nip out and buy some prunes, you will probably need them after the Oxycodone.
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Re: Benefit of hindsight

Postby trailgumby » Sun Aug 18, 2013 11:13 am

All good on that front. A teaspoon of orange flavoured Metamucil in a glass of soda water... yum! :lol:
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Re: Benefit of hindsight

Postby petie » Thu Aug 22, 2013 10:04 pm

I don't know if it was a lack of cleaning that was the cause, sometimes these things just happen.
I'm in the trade and had a similar injury that I elected to treat myself earlier this year. Didn't suture it and it still got infected despite some serious scrubbing! Took about 40 days to heal, but I did work and ride/race throughout...:oops:
Probably hang back on the grog and keep it elevated!
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Re: Benefit of hindsight

Postby briztoon » Thu Aug 22, 2013 11:19 pm

trailgumby wrote:I wasn't aware you could take full adult doses of paracetamol and ibuprofen concurrently :shock: and oxycodon on top of that :shock: :shock:


Hope everything has worked out and your now on the mend trailgumby.

I found this out today as well, as I ended up back in hospital due to complications with a rib. Doctor said to take nurofen 3 times a day with a meal to go with the Targin, Endone, and Panadol I take each day.
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Re: Benefit of hindsight

Postby winstonw » Thu Aug 22, 2013 11:48 pm

I don't know why paracetamol is so universally prescribed for moderate to severe pain/inflammation. It is weak in managing both.
Appropriate ice application is better imho, though most people are too lazy/indifferent to applying ice intelligently.

Drug wise, IME,
for moderate to intense pain, codeine, oxycodone, tramal, and oral pethidine are better.
for moderate inflammation and associated pain, voltaren and nurofen are better than paracetamol.

generally, anti-inflammatories, and synthetic or natural opioid anaglesics can be used simultaneously.
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Re: Benefit of hindsight

Postby matagi » Fri Aug 23, 2013 7:43 am

winstonw wrote:I don't know why paracetamol is so universally prescribed for moderate to severe pain/inflammation. It is weak in managing both.
Appropriate ice application is better imho, though most people are too lazy/indifferent to applying ice intelligently.

Drug wise, IME,
for moderate to intense pain, codeine, oxycodone, tramal, and oral pethidine are better.
for moderate inflammation and associated pain, voltaren and nurofen are better than paracetamol.

generally, anti-inflammatories, and synthetic or natural opioid anaglesics can be used simultaneously.

Paracetamol together with an opiate is a standard combination for treatment of severe pain particularly long term. The paracetamol acts synergistically with the opiate and in many cases allows a lower dose of opiate to be prescribed.
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Re: Benefit of hindsight

Postby briztoon » Fri Aug 23, 2013 9:11 am

matagi wrote:
winstonw wrote:I don't know why paracetamol is so universally prescribed for moderate to severe pain/inflammation. It is weak in managing both.
Appropriate ice application is better imho, though most people are too lazy/indifferent to applying ice intelligently.

Drug wise, IME,
for moderate to intense pain, codeine, oxycodone, tramal, and oral pethidine are better.
for moderate inflammation and associated pain, voltaren and nurofen are better than paracetamol.

generally, anti-inflammatories, and synthetic or natural opioid anaglesics can be used simultaneously.

Paracetamol together with an opiate is a standard combination for treatment of severe pain particularly long term. The paracetamol acts synergistically with the opiate and in many cases allows a lower dose of opiate to be prescribed.


Pretty much what my doctors said. :wink:
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Re: Benefit of hindsight

Postby winstonw » Fri Aug 23, 2013 9:34 am

matagi wrote:Paracetamol together with an opiate is a standard combination for treatment of severe pain particularly long term. The paracetamol acts synergistically with the opiate and in many cases allows a lower dose of opiate to be prescribed.


yes I get the synergy. I am referring to the common recommendation by GPs and hospital staff to take paracetamol for moderate to severe acute pain, when an opiate like drug +/- more effective anti-inflammatory is justified...and I say this considerate of the side effects.

Further, much acute musculoskeletal pain is very often most responsive to anti-inflammatory intervention alone...and yet paracetamol alone, or opiate like analgesics and benzo class drugs are prescribed.
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Re: Benefit of hindsight

Postby winstonw » Fri Aug 23, 2013 9:40 am

briztoon wrote:Pretty much what my doctors said. :wink:


good luck if you were prescribed opiate class drugs "long term", rather than getting the underlying cause of pain diagnosed and managed effectively.
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Re: Benefit of hindsight

Postby petie » Fri Aug 23, 2013 10:23 am

matagi wrote:
winstonw wrote:I don't know why paracetamol is so universally prescribed for moderate to severe pain/inflammation. It is weak in managing both.
Appropriate ice application is better imho, though most people are too lazy/indifferent to applying ice intelligently.

Drug wise, IME,
for moderate to intense pain, codeine, oxycodone, tramal, and oral pethidine are better.
for moderate inflammation and associated pain, voltaren and nurofen are better than paracetamol.

generally, anti-inflammatories, and synthetic or natural opioid anaglesics can be used simultaneously.

Paracetamol together with an opiate is a standard combination for treatment of severe pain particularly long term. The paracetamol acts synergistically with the opiate and in many cases allows a lower dose of opiate to be prescribed.


Thankyou! If I had a dollar for every time some arse told me "panadol does nothing" I wouldn't be working (it's paracetamol! Ffffff!). Also, at recommended doses paracetamol is a much safer drug. All the other drugs mentioned by Winston can pretty easily have catastrophic side effects, it is much better to start with paracetamol and add small doses of the other drugs if required.
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Re: Benefit of hindsight

Postby briztoon » Fri Aug 23, 2013 11:32 am

winstonw wrote:
briztoon wrote:Pretty much what my doctors said. :wink:


good luck if you were prescribed opiate class drugs "long term", rather than getting the underlying cause of pain diagnosed and managed effectively.


Mate I was hit by a semi trailer Monday week ago, have a broken collar bone and 9 broken ribs, all flail fractures. Pretty sure my doctors know what the underlaying cause of my pain is.
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Re: Benefit of hindsight

Postby Venus62 » Fri Aug 23, 2013 8:51 pm

briztoon wrote:
winstonw wrote:
briztoon wrote:Pretty much what my doctors said. :wink:


good luck if you were prescribed opiate class drugs "long term", rather than getting the underlying cause of pain diagnosed and managed effectively.


Mate I was hit by a semi trailer Monday week ago, have a broken collar bone and 9 broken ribs, all flail fractures. Pretty sure my doctors know what the underlaying cause of my pain is.


Are you sure you don't need a second opinion? :lol:
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Re: Benefit of hindsight

Postby trailgumby » Tue Aug 27, 2013 11:20 am

After 5 days of IV Cephalosporin last week with Probenicid to slow my kidneys from eliminating it, the intensity of the redness was much reduces and they put me on oral for the weekend.

By yesterday the inflamed area was back out to the pen lines marked on my shin at the beginning. To say I.was scared is a bit of an understatement. So back to A&E I went last night. More IV Cephalosporin.

This morning it is dramatically improved. IV Cephalosporin preceded by Probenicid daily for the next seven days.

I checked the medication chart and the diagnosis is cellulitis.

Unfortunately it looks like this places the NZ mountain biking trip to Rotorua with my 17yo son in jeopardy :cry:

Last time we had something major and fun planned together I dislocated my shoulder in 2009 :(
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Re: Benefit of hindsight

Postby jules21 » Tue Aug 27, 2013 3:44 pm

TG, i recently recovered from cellulitis. the IV hits always nuke it, but like you, i found that the follow-up oral antibiotics can be hit-and-miss. you need to be on the right type and to ascertain that, they need to take a swab to identify the precise nature of the infection and match it to the right type of antibiotic.

cellulitis will disappear before the symptoms (skin discoloration). this confused the hell out of my less-than-useless GP who couldn't work out why it was 'still infected' 2 months later. proper treatment is crucial.
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Re: Benefit of hindsight

Postby MichaelB » Tue Aug 27, 2013 3:58 pm

Wire brush and dettol, I say !!

Hope it heals quick so you can go riding with the son !!!
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Re: Benefit of hindsight

Postby twizzle » Tue Aug 27, 2013 4:20 pm

Venus62 wrote:
briztoon wrote:Mate I was hit by a semi trailer Monday week ago, have a broken collar bone and 9 broken ribs, all flail fractures. Pretty sure my doctors know what the underlaying cause of my pain is.


Are you sure you don't need a second opinion? :lol:


'tis but a scratch - I got beaten in a TT on the weekend by a guy with two broken ribs.


(On a more serious note...... Faaaaaaaarout! :shock: Mentally, it took me six months to get over being on the scene of a motorcyclist being pinned under the wheel of a semi a few years back. I can't image how briztoon must be feeling. )
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Re: Benefit of hindsight

Postby jules21 » Tue Aug 27, 2013 4:22 pm

briztoon wrote:Mate I was hit by a semi trailer Monday week ago, have a broken collar bone and 9 broken ribs, all flail fractures. Pretty sure my doctors know what the underlaying cause of my pain is.

ouch. heal well.
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Re: Benefit of hindsight

Postby elantra » Tue Aug 27, 2013 5:25 pm

trailgumby wrote:After 5 days of IV Cephalosporin last week with Probenicid to slow my kidneys from eliminating it, the intensity of the redness was much reduces and they put me on oral for the weekend.
By yesterday the inflamed area was back out to the pen lines marked on my shin at the beginning. To say I.was scared is a bit of an understatement. So back to A&E I went last night. More IV Cephalosporin.
This morning it is dramatically improved. IV Cephalosporin preceded by Probenicid daily for the next seven days.
I checked the medication chart and the diagnosis is cellulitis.

Unfortunately it looks like this places the NZ mountain biking trip to Rotorua with my 17yo son in jeopardy :cry:
...............................................:(

No You'll be fine to go MTB riding in NZ, as long as you don't come a cropper again. :wink:
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Re: Benefit of hindsight

Postby jules21 » Tue Aug 27, 2013 5:27 pm

you can definitely ride if you have the infection under control. it's not a risk - other than to re-opening the wound.
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