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04-14-2013, 03:55 AM   #1
Farmwife
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ER vrs Urgent Care

This is open to all forums here.

ER or A&E verses Urgent Care or Walk-Ins. Sorry not sure what walk-ins are called else where?

I guess it's a common dilemma when you have a virus or non-related IBD ailment on whether to go to the walk-ins or to the ER because of having a complected disease like IBD.

Here's the dilemma for me at least............

You go to the walk-ins only to be sent to the ER because they want to make sure they haven't missed anything.
Of course they still charge you for wasting your own time.

-----------------------OR---------------------------------

You and or child go to the ER and they run you through all kinds of needless test and still tell you it's a virus.
Of course they still charge you for wasting your own time.


So what has your experience been with this decisions?
Any advice?
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I'm mom to............... Little Farm Girl 8 yr old
Ibd (microscopic)
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dx Juvenile Arthritis
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dx Erthema Nodosum
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Bladder and Bowel Dysfunction
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Ehlers-Danlos Syndrome dx (1/26/17)
Remicade started on (9/8/14)Every 4 wks
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Past Meds- LDN, Humira, Pred, MTX, Sulfasalazine
04-14-2013, 06:56 AM   #2
DanceMom
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I call A's GI and get his reccomendation. When she had a botched clean out he had us go to the ER. The ER doctor was in direct contact with her GI all night so her GI was actually calling the shots. I felt very comfortable with that because as the ER doc said, A is a special case that doesn't seem to follow typical medical patterns.
04-14-2013, 08:00 AM   #3
my little penguin
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Yep
We call on call Gi
They tell us general ER needed or urgent care
Or pediatric ER ( where gi practice) or pediatric urgent care ( again Gi practice)
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04-14-2013, 08:02 AM   #4
my little penguin
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Oh and we tend to go to the pediatric version since the specialists talk to the on staff docs and only order needed tests versus everything
04-14-2013, 10:33 AM   #5
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I think most doctors will recommend an ER, especially if they're affiliated with your local hospital. Many time a doctor will show up at the ER and take over. Some ER's are great and others are horrible. I guess it depends on the quality of care you get. If I think my doctor is going to admit me to the hospital then I choose the ER every time. It's my experience that Urgent Care is better if I need stitches or if I throw out my back. I prefer an ER when it comes to my CD or my wife's ovarian cancer.
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04-14-2013, 10:39 AM   #6
Farmwife
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Thanks everyone.
I guess I was pondering the question because of Grace.
She was so sick with a virus the last couple days. I thought if we go to the walk to the walk-in they'll tell us to go to the ER because she has to many medical conditions. Even though her Colitis and EGID might not even be a factor. KWIM

I was just wondering how everyone figures these things out.

Thanks again.
04-15-2013, 01:44 AM   #7
CarolinAlaska
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Urgent care if it is really obvious what needs to be done, but then you take the risk that you get someone who isn't a confident, experienced provider who might still punt.

ER seems to be the better option with sick kids who are complicated.
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04-15-2013, 01:59 AM   #8
Jennifer
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My mom always took me to the ER and it was never a waste of time (I got much needed IV fluids, pain and nausea medication, had tests done and often times had to be hospitalized). The ER doc would always contact my GI. Urgent care places around here are a joke unfortunately.
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Currently in: REMISSION Thought it was a flare but it's just scar tissue from my resection. Dealing with a stricture. Remission from my resection, 17 years and counting.
04-16-2013, 07:30 AM   #9
Devynnsmom
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We have gone to a walk in if our doc isn't around and its something like an ear infection, or sore throat. With Devynn though, we USUALLY go to the ER only because when she is not well its usually IBD related. I would rather just go to the ER because 9 times out of 10 the walk in sends you for anything other than an ear infection.
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Devynn (12 years old) was *unoficially* diagnosed with Crohn's disease in Dec 2009.
That diagnosis was changed to Ulcerative Colitis in Mar 2012.
Pentasa ASA Dec 2009-Mar 2012 (dosage tweaked a couple of times)
Mezavant Mar 2012- Nov 2012
Sulfasalazine-Nov 2012
04-16-2013, 10:25 AM   #10
Farmwife
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Thanks one and all.

This is a bit off topic....well kind of but..............

What do you make of these test results?
MCV 88 Normal is 73-87 (OK so that's not so bad)

Lymphocytes 0.5 Normal is 2.0-8.0

LDH 246 Normal is 100-190

Her stool was positive for Lactoferrin (side notes says this is a marker for leukocytes and inflammatory diarrhea.) She doesn't have diarrhea.

Zinc .63 Normal is .60-1.20 (GP gave us some zinc tablets)


I know your not doctors (most of you) but any insight is appreciated.
04-16-2013, 11:58 AM   #11
CarolinAlaska
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So, her red blood cells are a little big. This is close to normal, but may be an indicator of a B vitamin deficiency?

Lymphocytes are suppressed. Is she on an immunosuppressant? Not sure if prednisone can do this... This can also indicate a virus.

LDH is typically higher in kids. Your range may not be a pediatric range. I'd check to see what normal is for kids. LDH comes from liver and bone, and kids are turning over bone quicker with growth, hence it is higher.

Lactoferrin doesn't have to mean diarrhea, it just means inflammation and white blood cells are in her GI tract, which I'm sure doesn't surprise you. Did they give you a number? With fecal calprotectin we have a number so we can follow it with treatment to see if it improves.
04-16-2013, 12:12 PM   #12
Farmwife
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No number for the Lactoferrin.
I just talked to the GI nurse who said she needs the lab report fax to her RIGHT AWAY! Never a good sign is it! Then she said I'm calling your hospital to see about the stool test.
The GI ordered a fecal Cal. test but he hasn't received it yet.

As far as the LDH. That's a roller coaster we've been on for along time. It spikes to 500-600 and then goes back to normal after a few weeks and then does it again.
04-16-2013, 12:35 PM   #13
Artisan105
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Urgent care if it is really obvious what needs to be done, but then you take the risk that you get someone who isn't a confident, experienced provider who might still punt.

ER seems to be the better option with sick kids who are complicated.
She said it best. :] 100% agree with Carolin. ER for the extreme problems like pain, extreme nausea, bleeding etc. Why? Because the Urgent Care doesn't have the proper equipment to handle them. Plus they are not your regular doctors so they don't know all the info about you or your child. It is better to go to the ER where your GI doctor is or your Primary Care Doctor. You never know if you need to be hospitalized, need IV fluids, pain meds, zolfran etc. Urgent Care can't do these things. However, Urgent Care is good for non-emergency treatments.

But the cost for ER is so expensive -_- but we Crohnies or IBSers have no other alternative. It sucks. oh well.
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04-16-2013, 01:38 PM   #14
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FW- I don't know the ansers to your questions - just wanted to send you and Grace a big - Maybe the results are so out because of the virus? when were the samples taken? xxxx
04-16-2013, 01:45 PM   #15
Farmwife
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That's what I was wondering also Suzysu. Plus she was only off off pred for four days.
I'm wondering if that is causing the problems in some of her labs.

GI nurse called and our big hospital did the wrong stool test.
So have to spend gas money and my time to go into town and pick up some more stool containers (ran out of them). I asked about the Lactoferrin but she said the GI said he doesn't need to see the results of that, he just wants the Fecal Cal..
04-16-2013, 02:41 PM   #16
Suzysu
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when is your next GI appointment? or can they call you to discuss? how long will the faecal calprotectin tests take?
04-16-2013, 04:32 PM   #17
my little penguin
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The lactoferrin is just a positive negative type of test - that is why your gi wants the fecal cal to see if the inflammation is trending up or down.
Pred can mess with blood numbers especially as long as she was on it

The Chinese University of Hong Kong reports that prednisolone and related corticosteroids inhibit the T and B lymphocytes involved in inflammation and reduce the number of eosinophils (white blood cells that help to fight infection and control allergy and asthma responses). Large doses inhibit antibody production.

Read more: http://www.livestrong.com/article/11...#ixzz2QfFvEhsX
04-16-2013, 09:50 PM   #18
AZMOM
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My understanding from a hosp stent a couple of years ago is that high MCV is not atypical in kids with autoimmune disease. Claire's numbers are always high there. Yes, I'd expect a lowered white count after long course of prednisone. No experience here with lactoferrin - just fecal calprotectin. Also no LDH experience.

J.
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04-17-2013, 02:18 AM   #19
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How frustrating when the hospitals make those mistakes! It's the poor parents who then have the stress of doing it all again. Sorry I don't know much about those bloods results, etc. Hope the nurse gets back to you with some advice/info. Sounds like they need to get Grace onto some sort of maintenance med - pity they don't know which one yet!
04-17-2013, 03:14 PM   #20
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We no longer go to Urgent Care for any child in my family. Why, you ask? Well...

With my toddler - I took him there and they prescribed meds - when I called my doctor to let them know I found out the dose they prescribed was for an older/heavier child. WAY to much for my son.

With my Crohn's child - my sister took him. After a long conversation with me on speaker phone on what they could and couldn't prescribe for him (including any inflammatory drug) - they sent him home with ibuprophen.

Yeah. I'm done with them.
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