Second-guessing the Nurse Practitioner

[kaytieeldr]

Okay, I don't have the healthiest bones. I leaned on the arm of the couch last week to turn down the heat and heard a sort of thud, and my ribcage started hurting. Called the doctor's office after a couple of hours of discomfort and was told to come in, they had an opening in 25 minutes. The NP checked me out, listened to my lungs, pressed where it hurt, sent me for x-rays.

She left me a message the next day that the x-ray showed nothing, I'm fine, it's a pulled muscle. So why does it hurt worst when I breathe, not at all when I don't move (don't answer that ), only a little when I stretch my arm or something, and only a little more when I lift anything?

 

[Jennasis]

Because you pulled a MUSCLE. You use those muscles to breathe (as your chest expands and contracts). Grab some Ibuprofen and take it easy.

 

[Cinderella94]

She left me a message the next day that the x-ray showed nothing, I'm fine, it's a pulled muscle. So why does it hurt worst when I breathe, not at all when I don't move (don't answer that ), only a little when I stretch my arm or something, and only a little more when I lift anything?

Because you use the muscle that you pulled differently when you do each of those things .

 

[JessicaR]

Rib fractures don't always show up on x -rays. Most fractures will heal on their own and take up to 6 weeks to do so. Make sure you take deep breaths to prevent pneumonia. If you believe you may have an internal injury return to your doctor.

 

[Cinderella94]

Rib fractures don't always show up on x -rays. Most fractures will heal on their own and take up to 6 weeks to do so. Make sure you take deep breaths to prevent pneumonia. If you believe you may have an internal injury return to your doctor.

Definitely do this!!

When I was in the hospital for 9 weeks this winter I developed pneumonia. Soooo painful.

 

[FredinFL]

At least call the doctor back and ask about it. Can't hurt.

 

[Abbie]

I'm not sure what there is to second-guess...you had a minor trauma, were worried about a rib fracture, and the xray ruled it out. Doesn't mean you haven't bruised yourself....is it tender when you touch it? If so, you may want to look up costochondiritis. It can develop as response to minor trauma and the pain will increase when you take a deep breath, then subside when you are still and breathing slowly.

ETA: Hope you are feeling better soon! An anti-inflammatory will help.

 

[dis-happy]

Maybe you could try wrapping it for a day or two and see if that helps. Pretty sure there's not much they do for fractured ribs anyway except let them heal. Hope you feel much better in a day or two.

 

[hambirg]

Do you have a chiro? I have several times bent over to pick something up and heard cracking noises and then been in pain. People can say what they want about chiros (whether they think they are quacks or not.) I just know that when this happens to me, my chiro has said that I have ribs out. . .he does an easy adjustment. . .lots more cracking and popping in the area, and it is instant relief for me.

 

[kaytieeldr]

Thanks, everyone! Yep, ibuprofen no matter what I did and yes, it's tender when I touch it, and yes, I know there's really nothing else that can be done. I do have a hot/cold pack, so I'm prepared for everything

If it is a fracture, it's just a small crack on the front of my rib. Nothing that's going to do any damage. If it's a pulled muscle, that's actually pretty cool - with all my klutziness, I don't think I've ever done that one before!

 

[KPeveler]

Thanks, everyone! Yep, ibuprofen no matter what I did and yes, it's tender when I touch it, and yes, I know there's really nothing else that can be done. I do have a hot/cold pack, so I'm prepared for everything

If it is a fracture, it's just a small crack on the front of my rib. Nothing that's going to do any damage. If it's a pulled muscle, that's actually pretty cool - with all my klutziness, I don't think I've ever done that one before!

If it does not get better after a week or gets worse (if you are resting it of course - it wont get better if you overdo it), then it is worth asking more questions. My mother cracked a rib when she had pneumonia last winter, and she could not even lay down and it took weeks of sleeping upright on the couch before she felt better.

It sounds like a pulled muscle but if it does not get better, then go back, but give it a few days

 

[sbtrfly74]

I had a pulled muscle that was sooo bad that I was up all night and almost called an ambulance at 5am. I ended up in the ER at 7am and they also dx'ed it as a pulled muscle and a mild upper resp. infection. Gave me antibiotics and sent me home. I've never felt pain like that before, I swore my spleen was ruptured or something lol. Use heating pads to relax the muscles and make sure your breathing properly to prevent pneumonia. Its tender because the tissue is swollen which the heat should help.

 

[LuvOrlando]

The fact you started this off to say you don't have healthy bones makes me think you have previous experience with issues so I say push for a second opinion. I respect Nurses and Nurse practitioners but they are light years from a Dr and if Dr's make mistakes then the incidence must go up for lesser trained professionals.

My Dr would have done an x-ray for something like that. I'd call back & ask to speak with your real Dr and ask for either an x-ray or for a visit with him/her. If they say no then I'd visit an urgent care facility.

My kids had a friend where a Dr misdiagnosed a broken ankle for nearly a year. By the time they finally admitted they may have made a mistake the poor kid needed tons of surgery to fix the mess and a cast for over a year. Try to remember healthcare professionals are giving an opinion, an educated opinion but it's still an opinion and opinions can be wrong. The ones who forget this aren't worth the ink their diplomas are written with IMHO. Humility is important in a good healthcare professional and if I don't sense it I have no use for them.

Feel better

 

[twinboysmom]

The fact you started this off to say you don't have healthy bones makes me think you have previous experience with issues so I say push for a second opinion. I respect Nurses and Nurse practitioners but they are light years from a Dr and if Dr's make mistakes then the incidence must go up for lesser trained professionals.

My Dr would have done an x-ray for something like that. I'd call back & ask to speak with your real Dr and ask for either an x-ray or for a visit with him/her. If they say no then I'd visit an urgent care facility.

My kids had a friend where a Dr misdiagnosed a broken ankle for nearly a year. By the time they finally admitted they may have made a mistake the poor kid needed tons of surgery to fix the mess and a cast for over a year. Try to remember healthcare professionals are giving an opinion, an educated opinion but it's still an opinion and opinions can be wrong. The ones who
forget this aren't worth the ink their diplomas are written with IMHO. Humility is important in a good healthcare professional and if I don't sense it I have no use for them

Feel better

She had an X-ray. A major fracture is easy to see on an X-ray, even to an untrained person. If she does have a minor rib fracture that was not seen and or diagnosed, her treatment would still be the same.
OP, you have been given the correct advice. Lots of coughing, deep breathing, and activity to keep pneumonia away. Good luck and I hope you feel better soon.

 

[2binak]

Someone in the medical field please correct me if I'm wrong, but if you are sent somewhere other than your dr's office for x-rays, doesn't a radiologist look them over and report his/her findings to your dr (or in this case, NP)?

I know that's happened with both me & our DD when we've had x-rays done. Neither of our pcps' offices have x-ray machines so we have them done at a local office or the local hospital. Our dr's have specifically said, "The radiologist said..." when they are telling us the outcome of the x-rays.

My point is that I don't think the NP read the x-rays and came to her own conclusion. I believe that a dr read them (whether it was a radiologist or the Op's primary dr) and that the dr concluded that there wasn't a fracture.

 

[npmommie]

I respect Nurses and Nurse practitioners but they are light years from a Dr and if Dr's make mistakes then the incidence must go up for lesser trained professionals.

a big NO to both of these bolded. but that argument is for another thread

She had an X-ray. A major fracture is easy to see on an X-ray, even to an untrained person. If she does have a minor rib fracture that was not seen and or diagnosed, her treatment would still be the same.
OP, you have been given the correct advice. Lots of coughing, deep breathing, and activity to keep pneumonia away. Good luck and I hope you feel better soon.

Someone in the medical field please correct me if I'm wrong, but if you are sent somewhere other than your dr's office for x-rays, doesn't a radiologist look them over and report his/her findings to your dr (or in this case, NP)?

I know that's happened with both me & our DD when we've had x-rays done. Neither of our pcps' offices have x-ray machines so we have them done at a local office or the local hospital. Our dr's have specifically said, "The radiologist said..." when they are telling us the outcome of the x-rays.

My point is that I don't think the NP read the x-rays and came to her own conclusion. I believe that a dr read them (whether it was a radiologist or the Op's primary dr) and that the dr concluded that there wasn't a fracture.

You are correct, when I order an xray of anything, the radiologist ( MD) "reads" the xray and gives the result to me.
Depending on the facility, I usually don't even see the xray myself.

 

[kaytieeldr]

I do trust the nurse practitioners at my doctor's office, the availabity of fast appointments was one of the reasons I switched to this practice a couple of years ago; and no, she didn't see the x-rays. They would have been read by a radiologist and transmitted to her - so I'm going to change the thread title shortly. Thanks to whoever pointed that out

As I said before, I know there's not really anything that can be done except painkillers, not overstressing, and making sure I breathe . When I broke my hip, they had to x-ray me four separate times, finally from a really strange angle, before they could see the break.

 

[mickeyboat]

When I was in college I was having terrible chest pain - I thought I was having a heart attack - and went to my Dr. on campus. He diagnosed it as costochronditis - an inflammation of the cartilage between my ribs caused by infection or injury. The treatment was, you guessed it, ibuprofen, and I was better in a couple of days.

Hope you are feeling better, soon.

 

[Jaime4004]

Someone in the medical field please correct me if I'm wrong, but if you are sent somewhere other than your dr's office for x-rays, doesn't a radiologist look them over and report his/her findings to your dr (or in this case, NP)?

I know that's happened with both me & our DD when we've had x-rays done. Neither of our pcps' offices have x-ray machines so we have them done at a local office or the local hospital. Our dr's have specifically said, "The radiologist said..." when they are telling us the outcome of the x-rays.

My point is that I don't think the NP read the x-rays and came to her own conclusion. I believe that a dr read them (whether it was a radiologist or the Op's primary dr) and that the dr concluded that there wasn't a fracture.

NP might read it initially (depending on the immediate availability of a radiologist), but the radiologist will alway look at it after and write a written report.

OP, hope you feel better!

 

[LuvOrlando]

I had a Radiologist at a local well respected hospital miss a spot on my brain for 2 years on 2 separate MRIs. Luckily, the spots are common with people who get tons of migraines so the Neuro said I shouldn't panic. None-the-less, the error is inexcusable.

DH had a Radiologist misread a test on him and he nearly had his gallbladder removed over the teensy mistake.

Nothing wrong with a second opinion ,in fact most insurance companies allow them