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Ok, my wife is tougher than you

A

AndrewR

Lifer
Holy crap! :Q Poor woman was brutalized at the Navy hospital yesterday so they could rule out meningitis. Her lower back is a mess, with two bruised areas where they were continually inserting the needle. She was such a difficult "stick" that they called down the anesthesiologist from the OR to do it, and it took HIM more than a few attempts to get it. They needed three vials of spinal fluid, and it just wasn't happening easily.

Oh, and all this came after she was given three bags of IV fluid to ameliorate the dehydration brought on by some horrible antibiotic that an idiotic USAF doc prescribed (and for which he is going to answer some serious questions by me, need to find out how I can initiate a medical review of that doc visit). Needless to say, it was not the best of nights.

All those spinal taps, and it was negative, which they were assuming from the beginning (I'm not complaining about that). End result? No firm diagnosis, just "unknown infection". It's a real b!tch when the diagnosis is worse than the sickness...

Poor thing spent all day in bed and likely will spend most of tomorrow there, too. 🙁 Say a prayer for her if you don't mind.
 
rose.gif
Get well soon Mrs. R!
 
Ick, I've been through that, it's not fun. Laying there with them doing it is very uncomfortable, you can feel it, it's not a sharp pain, but it is a deep pain, hard to explain, but it is a pain you feel deep in your back. It's just very uncomfortable, not really holy crap that hurts hehe. Think it took them about an hour for me.
 
amateurs. I do most of these lumbar punctures in 1 stick. 3 max.

Just bring the patient down to radiology where I can use the fluoroscope to guide my needle into the spine. Easy as pie. The only tough patients that I've come across are those with severe back problems (degenerative spine, scoliosis, etc) and morbidly obese.

Next time, tell those doctors to ask the radiologist do the LP for you. Anesthesiologists are good but nothing beats the good ol x-ray machine.
 
After all that, she's not tougher than me right now. A couple body slams, and maybe an elbow to the face, and I'm pretty sure I could take her in her present state.
 
Wow, I'm sorry that's happening to her. Sometimes the military docs leave a bit to be desired.

ith that many punctures she may have some side effects, I've seen a few people have horrible headaches for weeks after a tap that leaks CSF after the procedure.

Get her to drink lots of fluids if she can tolerate it, and if she develops headaches, ask them to consider a "spinal patch" where they replace the fluid that was taken & leaks out.
 
Originally posted by: Wallydraigle
After all that, she's not tougher than me right now. A couple body slams, and maybe an elbow to the face, and I'm pretty sure I could take her in her present state.
Click to expand...

you've been watching too much WWF. Even the big tough guys have come crying at the site of the big needle I was about to stab into their backs. LOL
 
Originally posted by: iliopsoas
amateurs. I do most of these lumbar punctures in 1 stick. 3 max.

Just bring the patient down to radiology where I can use the fluoroscope to guide my needle into the spine. Easy as pie. The only tough patients that I've come across are those with severe back problems (degenerative spine, scoliosis, etc) and morbidly obese.

Next time, tell those doctors to ask the radiologist do the LP for you. Anesthesiologists are good but nothing beats the good ol x-ray machine.
Click to expand...

right, so we can expose them to all the ridiculous radiation from flouro unnecessarily. i and most docs can do LPs easy on the floor(except for that one 400 lb woman)... i can't speak for the competency of everyone though
 
Originally posted by: dethman
Originally posted by: iliopsoas
amateurs. I do most of these lumbar punctures in 1 stick. 3 max.

Just bring the patient down to radiology where I can use the fluoroscope to guide my needle into the spine. Easy as pie. The only tough patients that I've come across are those with severe back problems (degenerative spine, scoliosis, etc) and morbidly obese.

Next time, tell those doctors to ask the radiologist do the LP for you. Anesthesiologists are good but nothing beats the good ol x-ray machine.
Click to expand...

right, so we can expose them to all the ridiculous radiation from flouro unnecessarily. i and most docs can do LPs easy on the floor(except for that one 400 lb woman)... i can't speak for the competency of everyone though
Click to expand...

It's funny how clinicians will order countless CT scans needlessly but would rather needle a patient's back 30 times to avoid the "ridiculous radiation".

I'm not advocating fluoroscopic LPs, but it's an option. It's better than needling a patient 30 times and risk having them develop hematomas.

I'm all for more judicious use of radiation. Clinicians should have some balls and order fewer CTs. And in this case, grow some brain and consider LP under fluoro.
 
I had meningitis a couple of years ago, and to be honest, I was so out of it that the lumbar punctures were nothing compared to the incredible headache. They probably could have done it several times and it wouldn't have made any difference at that time.

Best of luck to your wife, though, AndrewR. It's not a pleasant thing to go through by any means.
 
Originally posted by: iliopsoas
Originally posted by: dethman
Originally posted by: iliopsoas
amateurs. I do most of these lumbar punctures in 1 stick. 3 max.

Just bring the patient down to radiology where I can use the fluoroscope to guide my needle into the spine. Easy as pie. The only tough patients that I've come across are those with severe back problems (degenerative spine, scoliosis, etc) and morbidly obese.

Next time, tell those doctors to ask the radiologist do the LP for you. Anesthesiologists are good but nothing beats the good ol x-ray machine.
Click to expand...

right, so we can expose them to all the ridiculous radiation from flouro unnecessarily. i and most docs can do LPs easy on the floor(except for that one 400 lb woman)... i can't speak for the competency of everyone though
Click to expand...

It's funny how clinicians will order countless CT scans needlessly but would rather needle a patient's back 30 times to avoid the "ridiculous radiation".

I'm not advocating fluoroscopic LPs, but it's an option. It's better than needling a patient 30 times and risk having them develop hematomas.

I'm all for more judicious use of radiation. Clinicians should have some balls and order fewer CTs. And in this case, grow some brain and consider LP under fluoro.
Click to expand...

i absolutely agree in this case it should have gone to flouro before sticking 24 times (a number which is highly dubious in any case). however your first post made it seem like LP by xr is the best option for everyone, which it isn't. i'm sure you probably didn't mean that, but that's the way it came across.
 
The docs at my hospital care more about irradiating themselves then irradiating the patients. Consider that a healthy patient gets maybe one xray/CT every couple years, yet the interventional radiologists get irradiated all day everyday. When i started doing clinical studies with the fluoroscope, i got more radiation in one year, than i had in the last 25 years.

My research group at the hospital built a robot to do needle puntures of the spine under fluoroscopy. You basically turn it on, select a target, take an xray, and it aligns itself at the skin entry point. The doc can fix the alignment and must drive the needle himself. We've done 20 clinical trials with humans, and theres another 50 or so we need to do.

In my humble opinion, I think subjecting the patient to some ionizing radiation so that they can get the spinal tap procedure done quickly, is less harmful than getting stuck 30 times.

sorry for the pain your wife had to endure. hopefully theres no complicatons.
 
Originally posted by: dethman
Originally posted by: iliopsoas
Originally posted by: dethman
Originally posted by: iliopsoas
amateurs. I do most of these lumbar punctures in 1 stick. 3 max.

Just bring the patient down to radiology where I can use the fluoroscope to guide my needle into the spine. Easy as pie. The only tough patients that I've come across are those with severe back problems (degenerative spine, scoliosis, etc) and morbidly obese.

Next time, tell those doctors to ask the radiologist do the LP for you. Anesthesiologists are good but nothing beats the good ol x-ray machine.
Click to expand...

right, so we can expose them to all the ridiculous radiation from flouro unnecessarily. i and most docs can do LPs easy on the floor(except for that one 400 lb woman)... i can't speak for the competency of everyone though
Click to expand...

It's funny how clinicians will order countless CT scans needlessly but would rather needle a patient's back 30 times to avoid the "ridiculous radiation".

I'm not advocating fluoroscopic LPs, but it's an option. It's better than needling a patient 30 times and risk having them develop hematomas.

I'm all for more judicious use of radiation. Clinicians should have some balls and order fewer CTs. And in this case, grow some brain and consider LP under fluoro.
Click to expand...

i absolutely agree in this case it should have gone to flouro before sticking 24 times (a number which is highly dubious in any case). however your first post made it seem like LP by xr is the best option for everyone, which it isn't. i'm sure you probably didn't mean that, but that's the way it came across.
Click to expand...

At my hospital, some of the neurologists are either so lazy or incompetent that they will send the patient down to radiology without even trying an LP on the ward. LP under fluoro subjects the patient and the radiologist to radiation exposure and cost more too!

Then there are times when these neurologists decide to attempt an LP, only to miss badly. One time, I counted at least 25 needle marks on a patient's back. That doesn't include multiple attempts or needle repositioning on the same spot. Needless to say, the patient was very relieved when I did the LP with 1 stick.

What it comes down to is that there is a lot of variability to physician competency in this country. I would not want my family to be treated by some of these docs in my hospital 🙁

(I'm not saying that the physician in the OP was incompetent. I think he was just gung-ho about doing the LP and felt he could get it.)

 
I've had _one_ spinal tap and I pray that I never have to have another. 24 in two hours? People would be dead if that happened to me.

ZV <--Huge fear of needles.
 
She's doing better today though she has two massive bruises now -- each larger than a silver dollar.

Military medicine -- where the good doctors get out quick!
 
Spinal taps need to be performed below lumbar levels L2 and below because the spinal cord is all split up at that point below the conus medularis. There is less chance of puncturing the spinal cord and causing damage.

Hope your wife is okay.
 
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