Breathing Difficulties

[ThaiPauly]

On Thursday I went to my local hospital to find out if I had cracked any ribs from a fall I sustained during Songkran.

The pains had got a lot better, then mysteriously got worse last week, I think due to some strenous activity of heavy lifting. As a diabetic, things always take longer to heal for me.

I had an ultrasound test at the hospital whereby they confirmed that I had indeed cracked three ribs.

The Doctor recommended that I have injections in my chest that would numb the pain for 2-4 weeks.

I agreed to this, they were excrutiatingly painful, but within half an hour I was left fighting for breath. The Doctor who injected me said he had never come accross this before.. but I seem to get more than my fair share of "Bad Luck" at this particular hospital.

I should have been in and out within an hour..but it was six before I went home.

48 hours on ..I can breate a bit easier, I am not "Gulping " for air.. but nevertheless breathing is diffucult. I can not take a deep breathe without it hurting ,so I dont. I never had this problem before I had these injections.

One of the places I had fractured was (so the Doctor said) was too low for him to inject a "Pain Blocker" he could only numb it. After the injection I was getting even more pain from this area and still am as I write. I have also developed a hacking cough, which does not help at all.

I have just spoken to one of my freinds who said that maybee he had punctured a lung!

Anybody else any idea... I am thinking of going back and checking myself in until they sort it out, but it would be good to know if any of you Guys have any experience of anything like this.

Thank You

TP

[Sheryl]

TP,

What you describe sounds like either an allergic reaction to the drug injected or a pneumothorax (puncture of lung). If it were the second you probably would not have improved; also it would be evident on Chest Xray. Did they do a chest film after you had trouble breathing? If they did and it didn't show anything (othe than of course the fractured ribs) then you probably had a severe allergic reaction. In which case it is imperative you get the exact name of the drug used and be sure never to have it again. Such reactions can be fatal and each time exposed to the same drug will be worse. If that is what happened, you should continue t gradualoly improve as the drug clears your system. Antihistamines may be of some help. Cortisones are the best choice but as a diabetic you should not take them except in consulation with the doctor who manages your diabetes as all drugs in that group increase blood sugar and it would effect your insulin or oral hypoglycemic requirements.

If they did not do a chest X ray after you had trouble breathing they were negligent in the extreme and you should get one immediately, preferrably at another hospital and certainly by a different doctor as this one sounds, to be frank, highly incompetent. I cannot imagine why he would say he never encountered such a thing before; pneumothorax is a known risk with both fractured ribs and with any deep injection in the thoracic region. And any physician ought to be thoroughly aware of the risks of allergic reaction and its symptoms. I do find though that Thai doctors in general are rather negligent on this point, don't know why; possibly the incidence of severe allergic reactions are less than in the west? Anyhow -- I've seen anaphylactic drug reactions many times, even in patients who had previously tolerated the dame drug, and I've seen respiratory arrests from it and in one case, death. It's no small matter.

Anyhow in terms of what to do:

1) If they did a chest Xray after the breathing difficulty, and if it continues to slowly improve, assume it was an allergic reaction, get the name of the drug and NEVER get it again, try antihistamines if you like and if you want consult your diabetes sepcialist about the safety of taking prednisilone (a corticosteroid readily available in all pharmacies), explaining that you've had a drug reaction, and follow his advise on that.

2) If they DID NOT do another chest film after you had this reaction, or if they did but your difficulty breathing gets worse, go at once to another hospital (or at least another doctor), explain what happened and demand that they do a film to rule out pneumothorax. If. the film shows nothing wrong with the lungs, revert to advise #1. If it does show something, they'll need to treat it.

In either case I would not recommend going to that particular doctor ever again and if you live somewhere there is a choice, reconsider the hospital too.

By the way, the best thing to do for the pain of fractured ribs is just immobilize them with heavy duty adehesive tape and/or ace bandages; you can also buy a sort of velcro corset thing at many drug stores like Boots etc. Immobilization + pain killers + time is the usual treatment.

Edited June 24, 2006 by Sheryl

[ThaiPauly]

Thank you for the time you have taken to post your response Sheryl,

I did in fact return to the hospital as an emergecy case on Saturday as things got so bad.

I was seen by the "Emegency Doctor" who immediatley operated on me as an Xray did indeed show my lung was punctured.

My Wife happened to pass by the Doctor who performed the original surgery and said that I had a punctured lung and that it must have happened whilst undergoing his treatment, to which he replied "possibly"

Well today they took the tubes out and released me... However they still produced a bill but I refused to pay it. So they called the clinical Director who went off into a rant, saying that if I did not pay who was going to pay?

He summoned the Doctor who performed the surgery and I put it too him that he had made an error ..to which he said he "probably" did!!

This did not appease the Director and he kept shouting at me that I should pay.. with me shouting back telling him HE should pay as it was his hospital and I could have died owing to an error by one of his physicians and he was ultimatley responsible as it was HIS hospital.

This shouting match went on for another 5 minutes , with me still refusing to pay..until the Doctor who prerformed the operation said HE would pay!

This astounded the Director..he was not happy that his staff had admitted guilt.. and tried to cover for him again..so we continued to row until I said that its OVER.. I am NOT discussing this any further, your Doctor has agreed to pay the bill and I am going home

He stormed off in a right mood, shouting and hollering eith his entourage in tow

We Left.... and will NEVER return.

I am not going to name the hospital as I got the outcome I wanted, if they had MADE me pay I would have named and shamed. and probably sued them, though I don't know what good that would have done, the chances of winning would have been slim at most, given that I am not Thai.

Admittedly this was a "one off" case, but it just shows how difficult it is to get accountability from the medical profession here

[OneeyedJohn]

Glad to see u got ur own way, and hope u fully recover.

Out of interest may I ask:- (i) did u have the argument in English?

(ii) if ur insurance had this covered, would u have taken a diffent stance ?

[Guest endure]

We Left.... and will NEVER return.

I am not going to name the hospital as I got the outcome I wanted, if they had MADE me pay I would have named and shamed. and probably sued them, though I don't know what good that would have done, the chances of winning would have been slim at most, given that I am not Thai.

Don't you think you ought to name the hospital to warn others?

[ThaiPauly]

Endure.... Everone who lives in Chiang Mai will know which one it is.. there have been many threads about it in the past. (Good things as well as bad) However, this was just MY PERSONAL EXPERIENCE, they would not be so big if they were consistantly this useless, and they do have some fine Doctors there, in fact if it was not for the quick action of the Doctor who saw me when I was admitted things could have been a lot worse !!

OEJ......The Argument WAS in English.. except when he was conversing with my Wife)... would my stance have been different if I had insuarance?... Probably not as it would probably affect my premiums..but anyway... I was NOT in the wrong.. They were !

This has caused me a lot of problems down to their incompetance, in so much as my Son is due to graduate from Uni in the UK on July 19th.. You are not supposed to fly for at least 2 weeks after you have had a punctured lung... does not leave me much leeway does it? I don't want to miss my Son's graduation Ceremony..its the biggest day of his life, so I have to make one VERY BIG DECISION...

Two weeks from now will be 11th July.. however I am diabetic..and EVERYTHING takes longer to heal.. so what to do??

TP

[Totster]

We Left.... and will NEVER return.

I am not going to name the hospital as I got the outcome I wanted, if they had MADE me pay I would have named and shamed. and probably sued them, though I don't know what good that would have done, the chances of winning would have been slim at most, given that I am not Thai.

Don't you think you ought to name the hospital to warn others?

I'm sure if someone was desperate to know they could pm TP... ?

totster

[OneeyedJohn]

TP..I wasn't implying anything, of course they were wrong.

U did so well to stand up for your rights, especially as u aren't 100%.

I hope u make ur sons' graduation.

[Thai-Aust]

Wish you get well soon.

[Sheryl]

Glad to hear you are OK, I was worried when no response as what you described was quite serious.

The original doctor was negligent in the extreme. Not so much because he puntured your lung --- this can happen, even to good docs. But for failing to immediately recognize that he had done so and treat it at once. You could easily have died.

Congrats on taking a stand re the payment. In the West you'd have a sure fire malpractice suit here, they wouldn't even try to fight it in court. This is one of the most egregious cases of malpractice I've heard of in a while, and I've seen some lulus.

[Phil Conners]

But for failing to immediately recognize that he had done so and treat it at once.

Could this be an example of the usual problem of dealing with failure (losing face)?

[ThaiPauly]

I have since getting back discussed my position with several people.

When I was having the heated conversation with the Clinical director he said that "DrX should have told you that by conducting the "Blocking Procedure" there was a mininmal chance that you could sustain a puncture to the lung" Well he did not say any such thing and admitted the same.

So although I signed the "Usual" Document absolving them of any responsibility as the success of my prodedure, the Doctor's failure to impart this critical information to me could result in a very good case to make a claim against the hospital.

Obviously had I known that there was a chance of this happening I would not have undergone the procedure..hey I can live with a few cracked ribs and anyway the "Blocking "(of pain) will only last a few weeks anyway!

[Sheryl]

Even if he had told you, nothing absolves him of failing to recognize that the lung had been punctured and take immediate action. THAT is were it gets completely criminal. All medical procedures have risks. It is the responsibility of medical staff to anticipate known risks and recognize and treat them if they occur.

As for the loss of face part, this is so extreme and such a clear violation of basic medical practice and ethics that I think the doc is simply very incompetent. From the OP it sounds like he truly did not understand what he was seeing...hard to believe, since any first year nursing student would have. Besides he owned up to fault in front of the Director later. Somehow this guy got a medical license without undersyanding anatomy 101 much less anything more.