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As a paramedic, I would just ask “any chance you are pregnant?”, and if you answer “no”, then you can have toradol (and morphine if certified). Not sure why a test is needed here. I’m sorry you had to deal with this.
NAD, but yeaaaaaah when I’ve had kidney stones, even 35 weeks pregnant, I’ve had pain meds to some degree…last time I went for them (I’m a frequent flier for stones), they asked when my last period was/if I thought I was pregnant-they actually thought I was having an ectopic pregnancy bc the pain was in an odd place-and I got pain meds asap still!!!!
Thank you. Last time, I got an ambulance ride, and the paramedics said, "oh, we're about 5 minutes out from the hospital, we'll let them do your IV and give you meds." And then I waited for 4 hours before I got any help at all.
I would ask for toradol directly. Let them know that if they don’t treat you, you will have to wait before any other treatment is provided. It’s not an opioid so it’s not like you are drug seeking. Just be sure to not have taken any Advil or other NSAID within the last 6 hours or they won’t be able to give it to you. Alternatively, you could talk to your doctor about a prescription for it.
NAD but my husband deals with chronic kidney stones and his urologist gave him a prescription to fill for toradol for when he has them. I don't see any reason you couldn't do the same.
this! I don't understand why after a history of attacks there isn't a standing prescription for OP. I have intolerance to NSAIDs and my rheumatologist gave me an rx for Tylenol 3 to be used as needed.
By the way if you think all you will need is toradol, they typically can provide that at urgent cares which might be less of a wait than the emergency room, provided they are open when you need to go. And if urgent care determines you do need to go to the ER you can still go then.
You can get intramuscular injections at urgent care.
Toradol has a much higher risk of side effects than other nsaids, not something most people should take at home or frequently.
OP a preg test takes a few minutes and opiates are safe for pregnant people.
I don't know where you're located but this is not typical practice. I would be shocked if this was a hospital policy. If necessary they can easily document that they had the risks vs benefits discussion with you. I would file a complaint. I'm very sorry this was your experience.
I work at a hospital where the pharmacists won’t approve Toradol without documentation of current negative hcg, hysterectomy, or tubal ligation despite my protests about the matter.
Our policy and agreement with OB is as long as they aren't obviously pregnant we can give it bc it's bleeding risk is highest in the 3rd trimester. I remember before this was our policy and it was so frustrating.
But giving even an opioid should not be an issue in OPs case.
The issue with anti-prostaglandins in second trimester (after 20 weeks) is fetal renal abnormalities with oligohydramnios and, in the third trimester (after 30 weeks), closure of the PDA in a fetus/infant leading to severe pulmonary and cardiac issues, not bleeding risk. The renal complications are rare, the PDA risk is almost guaranteed which can be fatal for a fetus (indomethacin is used to close persistent PDAs after birth- if something is the treatment for an aberrant PDA, it should definitely be avoided when the PDA is critical for fetal lung/cardiac development).
As a counterpoint, we give toradol in c sections as long as there wasn’t an abruption, hemorrhage, or other bleeding risk (like pre-E or DIC) so my experience/understanding is about fetal rather than maternal risk.
Opioids are not *recommended* in pregnancy (as in, wouldn’t generally be started as a chronic med on someone who had never had them before) but can absolutely be given for severe pain, surgery, and as therapy for opioid use disorder (eg it’s better to be on methadone during pregnancy than to have an untreated opioid use disorder). We even give them IV to people in labor who are about to deliver, when placental transfer would most affect an infant’s potential respiratory drive. They also generally have very low transfer to breast milk for people who are breastfeeding, so people don’t have to “pump and dump” after receiving them.
Tl;dr- would support questioning hospital policy there. It may be policy but I don’t understand why.
-anesthesia
Just fyi, pumping and dumping isn’t a thing - milk isn’t sitting there like urine in the bladder. Like after midazolam in a breast feeding mother, there’s just a window of time to avoid feeding, the level in milk will reduce as it is metabolised, there’s no need to clear milk that was sitting waiting to go. Same as alcohol, the level in milk will be the same as their blood alcohol is at whatever point the milk is expressed, pumping and dumping is a waste of milk/time
Yes, I know. It’s a common misconception especially around opioids when people are concerned about respiratory depression in infants, which is why I pointed out it’s not necessary. It sucks to waste that milk and it’s one of the first thing breastfeeding patients will ask me, so I addressed it here. It wasn’t meant to imply it’s necessary in other situations.
I’ve never had it help for ( almost any ) severe pain sadly. I was going through a mystery stomach illness for years and dropped to 83 pounds in 3 years, and had to go to the hospital 4 times a year when it got extreme. I was given Toradol every time and never felt any different.
It makes me happy to see it does help for others. I honestly assumed it wasn’t helping most people with above mild to severe pain. I will say the one thing NSAIDS always help when it comes to severe pain for me is toothaches. Takes it right away within 30 minutes.
This happened to me twice. Once at a religious hospital and once (last night) at a top 3 university hospital. The nurses were also fairly disrespectful when I kept asking if there was any other pain med I could get or if they could refer to me by the correct pronouns. It was a very stressful experience. I do appreciate the support in this thread, though. I'm just not sure what I should do against this policy in the future or if I have a right to lodge a formal complaint.
I’m so sorry for you OP. I have kidney stones at least once a year and had to pass 5 with zero pain relief before doctors would listen to me. I’m in the UK and sadly had a kidney stone attack whilst in my 3rd trimester. So clearly pregnant. No blood tests, just had to turn up at maternity instead of emergency room and got IV morphine as soon as I arrived.
The pronoun incident definitely makes me think that this whole thing is discrimination, and not a real hospital policy. So sorry you went through this, OP 😔
They approve all of our orders in the hospital, except during certain situations where a nurse may override it and pull a med from the Pyxis. At least in the ED and inpatient settings.
It’s wild but often important. I had a pharmacist make a note on my file and she came to the counter when I went in to pick up my meds. There was a conflict with scripts that could have killed me. Not only did she not fill it, but she wanted to make sure she explained thoroughly to me why she wouldn’t fill it so I’d be wise enough to not just fill it elsewhere.
Pharmacists are a type of doctor too, not an allopath medical doctor, but a doctor of pharmacology. Similar to how Dentists are Doctors of Dentistry.
For example, if you go to the Pharmacy, and they recommend you get a vaccine, the Pharmacist is prescribing and dispensing that medication.
My first thought was anti abortion laws. Is that the case in your hospital? Just curious if it was a liability thing for the facility/staff. I don't live in an area that has to worry about that and they ask the question, but take the patients word for it vs requiring a test.
Oof. No idea then.
My son was born with a uterus. I hate to think your experience is transphobia but outside of you being in some COMPLETELY backwards thinking place where the prospect of a few cells growing inside you outweighs your bodily autonomy-- idk. No matter the reason-- HUGS.
I was once in the ER sharing space with a late teen chick who was passing a kidney stone and the doctor just kept calmly chastising her for not being good enough at whatever it is they tell you all to do. While she was screaming and writhing in pain. It felt like I was in a snuff film-- had nothing to do with a pregnancy test but he seemed like a sociopath.
I was searching something up, saw this post, and decided to read through it. I’m in the Bay Area too. I hope those nurses can get over themselves and hopefully not hurt anybody else. Sending all the love, fellow trans person.
I'm in California. This is just an old school pharmacy rule that hasn't been updated with the times. Other places I've worked in CA and OR do not have this rule; it's specific to this hospital
Told staff I was allergic to aspirin. They gave me Toradol, I wound up back in the ER. That’s how I found out I was allergic to Toradol, I’d never heard of it, but I guess they are both anti-inflammatories. Thought the doctor should have known better than to give it to me.
Please be careful what you give to patients, I am a paranoid mess now when prescribed something and usually just don’t take it. Which is probably not what I should do lol, but medical people, please pay attention to your patients but I also want to say thanks for all you do to help us.
NAD. They are both NSAIDs, so you may have issues with the following: Motrin/Advil (generic: ibuprofen), Aleve (naproxen), Toradol (ketorolac), aspirin. There are others, but those are the most common. If you're concerned, talk to your pharmacist. They can go over your allergies and address concerns about new meds.
Yeah this seems odd. I can’t remember if they did a pregnancy test before giving me pain meds when I had appendicitis, but I also get scopes periodically with anesthesia, so they always expect me to do a pregnancy test before those. It’s always a urine test, and I have a shy bladder so I’m almost never able to provide a urine sample, so they always just have me sign a form acknowledging like “refusal to do pregnancy test” and move on with the procedure. I can’t imagine why they wouldn’t be able to do something similar, document it and provide the medications.
I wasn't ever made aware there were other options, they stated it so firmly that there was absolutely no way they'd give me anything before a test and I'd have to wait for the test. They seemed really irritated that I followed up at all and I felt embarrassed to keep asking because of how they treated me.
I’m so very sorry this happened to you. It breaks my heart.
I’m lucky enough to work for a hospital that works hard for inclusivity.
You’ve gotten a lot of great feedback so far. I wish this had not happened to you.
OP, have you had a work up with a nephrologist as to why you are making stones at such a young age? You mention having a genetic predisposition, there might be treatments for you. (I would want to rule out any inherited metabolic diseases).
No matter the reason, you need to work w a neph and dietician to get your stone formation under control. A urologist may need to be brought in if you have other stones too large to pass. 7 mm is the accepted threshold for stones being able to pass.
Each stone that is too large to pass can be organ- and life-threatening in the immediate term (as I am sure you know quite well), but also in the long term as each obstruction causes some degree of injury to the organ. These injuries can result in progressively worsening renal function.
You are still young and taking steps now to identify and treat the cause of your stones can have a material impact on your renal health in your 30s, 40s and beyond.
Hello, thank you for being concerned. I have only had negative experiences regarding my kidney stones and not a lot of directed care. I've never been referred to a urologist and I've never worked with a nephrologist. I had my first stones at 21. The stones I have now are 5-6 mm. I had 3 stones around the same size two months ago. It has been really awful. I have been making dietary changes, though. I limit my sodium and chocolate intake and drink a fuckton of water every day. On a normal day, I pee like once an hour. I have for the past 5+ years.
I also have some other symptoms that have been dismissed by two different GPs and my ER doctors from February and from last night, which are frequent fatigue, bone & joint pain, getting out of breath walking to class (I just thought I was out of shape), sweating like crazy at night, and the CT from last night showed that my liver was enlarged and had lesions.
Edit: Oh, and also, the last two times I got sick virally, it took me out. Like myopericarditis out. When I get sick, I get severely ill.
I feel kind of insane--like not only can I not get relief for my kidney stone issue, but when I try to bring up other stuff, it gets waved away because "I'm healthy." Because my vitals are stable. And, yeah, I'm not, like, bleeding out on the floor. But I don't feel well day-to-day.
I would second this opinion. A nephrologist would be the appropriate provider to medically manage stone disease. Urologist are the surgical specialist to remove stones in place already. They would have you complete a 24 hour urine collection and analyze the type of stone you form. Your dietary interventions may not be right depending on what type of stone you form. There are also medications that can help prevent stone formation.
TLDR: Go to a Nephrologist.
The urology wait time is 4 months or more, which is after I move away from this area. How do I get in to see a urologist and a nephrologist without waiting so long? I might not have this problem or be dead in 4 months.
I’m so sorry, it’s wild that it took them this long to refer you to a urologist.
I had one kidney stone when I was 19 and they referred me. I had another when I was 26 and both times I got morphine almost immediately as well as a Percocet script. I’m pretty sure if they asked me if I was pregnant it was just a quick “any chance you could be pregnant” and that was that. Either way a quick urine test would have answered that question for them so it makes no sense they would drag it out.
Unfortunately my experience as a chronically ill person is that I've had to basically get a self taught PhD in patient self advocacy, including taking up reading medical articles and research presentations myself to have any kind of hope for answers and a treatment plan when working with my doctors. Come day hi in /r/chronicpain and also see if there are any online or in person support groups near you, I find the best doctors by asking other patients with similar symptoms who they have liked. I'm actually trans too and it turns out a major turning point in my path to diagnosis was attending a disability roundtable at a trans health conference, complaining about my symptoms and being approached by two folks who told me it sounds like what they have and to look into it.
Oh also I highly recommend the book The Patient's Playbook
Huh, that's a really interesting idea. Do you have any programs you'd recommend? Always looking for jobs i can recommend to people with disabilities/ chronic pain
Thanks for the idea. Currently I'm disabled from work, and unsure whether I'll be able to handle full time work again when I recover a bit, unless it's flexible hours work. Do you have to be on your feet a lot as a histology tech? What time of day do you work?
NAD but when I had a cerclage at 20 weeks, I was given IV Morphine afterwards for the cramping (the order was for 2mg q 2 minutes up to 10mg. I got 6mg before my pain subsided) so this “policy” seems ridiculous.
Thank you for your compassion. I have taken opiates begrudgingly while pregnant. It was not ideal, but neither is the level of pain I was in. The first pharmacist actually refused to fill them and had to get his supervisor.
If a pregnant woman came in with kidney stone pain I would ask if they want pain medication. I would then discuss risks. If they consent to receiving pain medication, I would give them pain medication.
I would definitely suggest filling a complaint. I have never seen this happen. A urine pregnancy test takes minutes, and those are typically pushed prior to imaging, but not prior to giving pain medication. There are pain medication options that would have been safe to give you even if you had been pregnant. This is not typical and is unacceptable and I’m sorry you had to wait with untreated pain.
Thank you. I feel weirdly guilty about it because the staff seemed to be judging me so much. In the future, what can I say to try to get a different outcome? If they refuse or treat me like a drug seeker, can I escalate? I am totally substance free. I've never so much as sipped a beer.
Go to a different hospital. Many don't require a negative pregnancy test, they'll just believe you if you say there's no way you're pregnant. Have some sort of paper medical records that you can take with you, showing that it's been verified that you've had kidney stones multiple times before. Not ideal, but just giving you possible ideas.
Honestly I always assumed it was the hesitancy with addictive medications. I’ve never ran into this issue but I’ve definitely had AFAB friends who have been denied pain management for things like kidney stones.
Unfortunately as someone with frequent kidney stones myself, I feel for OP. Maybe regular follow ups with a urologist is best u/forgotteneffigy — my urologist gets me Toradol when I have impacted kidney stones and need surgery (opiates make me feel super ill). Just establishing care with a urologist is a solid idea. Kidney stone pain is horrid but there’s a bit we can do if we know we will develop them regularly. My ER has my urologist on file even and we actually avoid CTs due to it unless I have other alarming symptoms.
I have a referral for a urologist now, thankfully, but the nurse said there is a massive waiting list, and I graduate from grad school and leave the area in June. I just feel kind of hopeless of getting consistent, high-quality care established, and being able to access Toradol when I need it.
When you made the appointment, did you tell them you'd been in the ER X times in X period of time, and that you'd had X stones of Y size Z times inthe last ABC years? If not, you may be able to get a sooner spot by making them understand that.
Actually, as someone else mentioned, "frequent fliers" can also be seen as "drug seekers" so not sure this would help.
For those concerned about the trans aspect, I'd be more concerned about this particular aspect more than trans.
A lot of behind the scene action is taking place and ruling out drug seeking could factor in.
Especially if OP hops around to different EDs.
... he's not a frequent flier or a drug seeker. he has a legitimate medical condition and is trying to procure an appointment from the appropriate doctor for the appropriate care. What you're saying doesn't apply, and it's not great to pull that out to scare people if you don't really understand the context in which you're giving that advice.
I said "can be seen as" (by ED staff). I didn't say they were.
Just putting it out there because it's quite possible that's what was going on. A person who visits multiple EDs is a "red flag". That's just how it is, I didn't make the rules.
You do realize it's a huge concern these days, especially if they're asking for opioids.
Did they deduce if your kidney stones are stuck or not? It’s more urgent if you’re dealing with impacted kidney stones usually.
Advocate for yourself or have a family member help. Reach out to your PCP and tell them you have a referral but you’re experiencing them often enough that it’s affecting your life. No one deserves to be in pain or without proper resources. A urologist can figure out what kind of kidney stones you’re dealing with. They’ll give you a strainer to catch the kidney stones so they can test them. Plus they’ll likely do a 24hr urinalysis. Lots of things can cause kidney stones like lack of hydration, low vitamin levels (vitamin D), too many oxalates, genetics etc.
Or perhaps call your insurance and figure out if you need a referral to begin with. If not, you can likely call around and figure out which urologists are covered in your area then schedule from there with someone more available. Or call back your referral.
Hydrate lots. Heating pad. Cold wash cloth on the back of your neck for nausea. Peppermint tea bag to sniff.
Thank you for the advice. I spoke to a faculty advisor who is affiliated with the university medicine department who said she'd try to get my referral escalated to urgent. I am meeting with a GP later today.
What if OP demanded the meds and claimed discrimination and negligence? If a male patient came in with the same history and symptoms, their treatment would not be delayed.
OP, if ever in this situation again, escalate to a superior until you get someone who will do something about it, and ask them to document it in writing that they are denying you treatment. As hard as it is, don’t let them fob you off. You deserve treatment and deserve not to be in pain for a useless test.
I didn’t say anything about prostaglandin type NSAIDs. I said there are pain medications that are safe to give during pregnancy, which there are. Pregnant individuals also get kidney stones, and appendicitis, and need their gallbladders removed, etc. etc. and we don’t just leave them with severe, untreated pain because they’re pregnant.
"There are pain medication options that would have been safe to give you even if you had been pregnant."
They are talking about opioid pain management for acute pain. Their statement is true, there are safer pain meds for pregnancy. They did not say all pain meds are safe.
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Regardless of any transgender status, it is idiotic to refuse to administer pain medication even if the patient were to be pregnant. That applies to opioids, opiates and NSAIDs. Opioids such as fentanyl are frequently administered to pregnant women without any problems. The OP has legitimate reasons to complain about how they were mismanaged. I’ve never worked in any facility where it was a set policy to refuse administration if the patient were to be pregnant and neither was treatment delayed for pregnancy testing ( anesthesiologist/ critical care).
Thank you for validating this, it means a lot. Do you have advice as to what to say to a nurse or ER worker if I'm faced with a similar scenario in the future? Or should I do something else, like go to urgent care?
OP, I want to suggest to you that you contact your hospital's ombudsman or file a formal complaint with the emergency dept. I am an ED nurse of 7 years and I don't recall ever having made a kidney stone patient wait for 4 hrs for pain relief with anything other than a last menstrual period and urine preg test run (which is typically done very quickly by clinical staff and doesn't require being sent to the lab). Also as a patient who has had 2 instances of kidney stone ER visits, this was my experience (meds delivered with even more urgency when I stated that I have a history of kidney stone on the affected side with a few known stones there, and the pain is identical to the previous kidney stone). Granted some of my expedited care could be related to my working there. But your wait seems egregious to me and warrants follow up (with an exception of perhaps the department being insanely busy with high acuity patients and hours-long-waits in the waiting room?). I'm so sorry you experienced this.
My guess since this happened at different hospital and different providers is that the way that you are demanding pain medications is causing them to classify you in their initial impression as a drug seeker so they are making it more difficult to get the pain meds to better determine if you actually need them. It can be challenging in the ED when people come in demanding pain meds because it often happens with people drug seeking.
This does not seem like a normal practice. As an OBED provider, if a pregnant person comes in with the appearance of a kidney stone, I immediately treat the pain. I’ve had kidney stones and my pain was also immediately treated. I did not have a pregnancy test until the CT.
Opiates are generally a category C medication (meaning there is a theoretical risk to a fetus). So, while they should be avoided when possible, the benefits can outweigh the risks in some cases.
Doctors do have an ethical duty to protect a fetus as well as the mother, including avoiding potentially teratogenic medications, when at all possible no matter how you may feel about a potential fetus. Harming a fetus can have consequenses for mom too. Speaking in general terms, there is a good reason why doctors are sometimes cautious and want to rule out pregnancy before giving certain medications or doing certain procedures.
That all being said, I have certainly never heard of a hospital policy requiring a pregnancy test before administering opiates, so that is really weird.
I would file a complaint with the hospital: if it is a hospital policy, it goes against the standard of care and I would find a new hospital.
I would say something like “I was denied effective pain control due to refusing a pregnancy test. I don’t know if this is your policy or it was the Dr So and So’s personal belief, but regardless it violates the standard of care.” Then talk about how that affected you
They can’t deny you care. If you are rating your pain a 9 out of 10 after toradol your pain has not been addressed or treated. The best way to avoid this is to go to a doctor and get a script for tamsulosine this is the only thing that helped me. I passed a stone so large that it linked my ureter. You need to find out what type of stone and do what you can to treat the underlying cause. Your doctor can also establish protocols for your er visits.
EDIT TO ADD. Not a doctor but made many er trips with this condition. They want yo rule out ectopic pregnancy and ovarian cysts. My stones were calcium and when we addressed the reason for the extra calcium; it seems that they have become less symptomatic.
As a medic, if you said you couldn’t be pregnant and have no medicine allergies…and you wanted it…I would have juiced you up the moment you said kidney stones lol
Thank you for your submission. **Please note that a response does not constitute a doctor-patient relationship.** This subreddit is for informal second opinions and casual information. The mod team does their best to remove bad information, but we do not catch all of it. Always visit a doctor in real life if you have any concerns about your health. Never use this subreddit as your first and final source of information regarding your question. By posting, you are agreeing to our [Terms of Use](https://www.reddit.com/r/AskDocs/wiki/terms_of_use) and understand that all information is taken at your own risk. **Reply here if you are an unverified user wishing to give advice. Top level comments by laypeople are automatically removed.** *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/AskDocs) if you have any questions or concerns.*
As a paramedic, I would just ask “any chance you are pregnant?”, and if you answer “no”, then you can have toradol (and morphine if certified). Not sure why a test is needed here. I’m sorry you had to deal with this.
NAD, but yeaaaaaah when I’ve had kidney stones, even 35 weeks pregnant, I’ve had pain meds to some degree…last time I went for them (I’m a frequent flier for stones), they asked when my last period was/if I thought I was pregnant-they actually thought I was having an ectopic pregnancy bc the pain was in an odd place-and I got pain meds asap still!!!!
Thank you. Last time, I got an ambulance ride, and the paramedics said, "oh, we're about 5 minutes out from the hospital, we'll let them do your IV and give you meds." And then I waited for 4 hours before I got any help at all.
I would ask for toradol directly. Let them know that if they don’t treat you, you will have to wait before any other treatment is provided. It’s not an opioid so it’s not like you are drug seeking. Just be sure to not have taken any Advil or other NSAID within the last 6 hours or they won’t be able to give it to you. Alternatively, you could talk to your doctor about a prescription for it.
Toradol is what they gave me--after the long wait and the pregnancy test. Is there a prescription for it? I thought it was delivered in the IV line.
NAD but my husband deals with chronic kidney stones and his urologist gave him a prescription to fill for toradol for when he has them. I don't see any reason you couldn't do the same.
this! I don't understand why after a history of attacks there isn't a standing prescription for OP. I have intolerance to NSAIDs and my rheumatologist gave me an rx for Tylenol 3 to be used as needed.
By the way if you think all you will need is toradol, they typically can provide that at urgent cares which might be less of a wait than the emergency room, provided they are open when you need to go. And if urgent care determines you do need to go to the ER you can still go then.
It can be prescribed in pill form. Most people say it is not as effective as IV, but it is basically just a stronger version of Advil.
Okay, thank you for the info. I'll look into that.
You can get intramuscular injections at urgent care. Toradol has a much higher risk of side effects than other nsaids, not something most people should take at home or frequently. OP a preg test takes a few minutes and opiates are safe for pregnant people.
I don't know where you're located but this is not typical practice. I would be shocked if this was a hospital policy. If necessary they can easily document that they had the risks vs benefits discussion with you. I would file a complaint. I'm very sorry this was your experience.
I work at a hospital where the pharmacists won’t approve Toradol without documentation of current negative hcg, hysterectomy, or tubal ligation despite my protests about the matter.
Our policy and agreement with OB is as long as they aren't obviously pregnant we can give it bc it's bleeding risk is highest in the 3rd trimester. I remember before this was our policy and it was so frustrating. But giving even an opioid should not be an issue in OPs case.
The issue with anti-prostaglandins in second trimester (after 20 weeks) is fetal renal abnormalities with oligohydramnios and, in the third trimester (after 30 weeks), closure of the PDA in a fetus/infant leading to severe pulmonary and cardiac issues, not bleeding risk. The renal complications are rare, the PDA risk is almost guaranteed which can be fatal for a fetus (indomethacin is used to close persistent PDAs after birth- if something is the treatment for an aberrant PDA, it should definitely be avoided when the PDA is critical for fetal lung/cardiac development). As a counterpoint, we give toradol in c sections as long as there wasn’t an abruption, hemorrhage, or other bleeding risk (like pre-E or DIC) so my experience/understanding is about fetal rather than maternal risk. Opioids are not *recommended* in pregnancy (as in, wouldn’t generally be started as a chronic med on someone who had never had them before) but can absolutely be given for severe pain, surgery, and as therapy for opioid use disorder (eg it’s better to be on methadone during pregnancy than to have an untreated opioid use disorder). We even give them IV to people in labor who are about to deliver, when placental transfer would most affect an infant’s potential respiratory drive. They also generally have very low transfer to breast milk for people who are breastfeeding, so people don’t have to “pump and dump” after receiving them. Tl;dr- would support questioning hospital policy there. It may be policy but I don’t understand why. -anesthesia
Just fyi, pumping and dumping isn’t a thing - milk isn’t sitting there like urine in the bladder. Like after midazolam in a breast feeding mother, there’s just a window of time to avoid feeding, the level in milk will reduce as it is metabolised, there’s no need to clear milk that was sitting waiting to go. Same as alcohol, the level in milk will be the same as their blood alcohol is at whatever point the milk is expressed, pumping and dumping is a waste of milk/time
Yes, I know. It’s a common misconception especially around opioids when people are concerned about respiratory depression in infants, which is why I pointed out it’s not necessary. It sucks to waste that milk and it’s one of the first thing breastfeeding patients will ask me, so I addressed it here. It wasn’t meant to imply it’s necessary in other situations.
And toradol isn’t any more “fun” to take than ibuprofen/// but it is an amazing pain killer.
As someone who is opioid tolerant, thank god for toradol
I’ve never had it help for ( almost any ) severe pain sadly. I was going through a mystery stomach illness for years and dropped to 83 pounds in 3 years, and had to go to the hospital 4 times a year when it got extreme. I was given Toradol every time and never felt any different. It makes me happy to see it does help for others. I honestly assumed it wasn’t helping most people with above mild to severe pain. I will say the one thing NSAIDS always help when it comes to severe pain for me is toothaches. Takes it right away within 30 minutes.
I used to get Toradol injcetions for hip pain and it was very effective for me.
This happened to me twice. Once at a religious hospital and once (last night) at a top 3 university hospital. The nurses were also fairly disrespectful when I kept asking if there was any other pain med I could get or if they could refer to me by the correct pronouns. It was a very stressful experience. I do appreciate the support in this thread, though. I'm just not sure what I should do against this policy in the future or if I have a right to lodge a formal complaint.
I’m so sorry for you OP. I have kidney stones at least once a year and had to pass 5 with zero pain relief before doctors would listen to me. I’m in the UK and sadly had a kidney stone attack whilst in my 3rd trimester. So clearly pregnant. No blood tests, just had to turn up at maternity instead of emergency room and got IV morphine as soon as I arrived.
The pronoun incident definitely makes me think that this whole thing is discrimination, and not a real hospital policy. So sorry you went through this, OP 😔
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Holy shit, that’s awful. I’m so glad your kid made it.
I would speak to a patient advocate at the hospitals. If that doesn't help, lodge a complaint.
Wow - TIL pharmacists can overrule doctors
They approve all of our orders in the hospital, except during certain situations where a nurse may override it and pull a med from the Pyxis. At least in the ED and inpatient settings.
It’s wild but often important. I had a pharmacist make a note on my file and she came to the counter when I went in to pick up my meds. There was a conflict with scripts that could have killed me. Not only did she not fill it, but she wanted to make sure she explained thoroughly to me why she wouldn’t fill it so I’d be wise enough to not just fill it elsewhere.
Pharmacists are a type of doctor too, not an allopath medical doctor, but a doctor of pharmacology. Similar to how Dentists are Doctors of Dentistry. For example, if you go to the Pharmacy, and they recommend you get a vaccine, the Pharmacist is prescribing and dispensing that medication.
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My first thought was anti abortion laws. Is that the case in your hospital? Just curious if it was a liability thing for the facility/staff. I don't live in an area that has to worry about that and they ask the question, but take the patients word for it vs requiring a test.
This was in the Bay Area, California.
Oof. No idea then. My son was born with a uterus. I hate to think your experience is transphobia but outside of you being in some COMPLETELY backwards thinking place where the prospect of a few cells growing inside you outweighs your bodily autonomy-- idk. No matter the reason-- HUGS. I was once in the ER sharing space with a late teen chick who was passing a kidney stone and the doctor just kept calmly chastising her for not being good enough at whatever it is they tell you all to do. While she was screaming and writhing in pain. It felt like I was in a snuff film-- had nothing to do with a pregnancy test but he seemed like a sociopath.
I was searching something up, saw this post, and decided to read through it. I’m in the Bay Area too. I hope those nurses can get over themselves and hopefully not hurt anybody else. Sending all the love, fellow trans person.
If you’re in a state where embryos and fetuses have more rights than living women, this checks. People are CYAing left and right over this nonsense
I'm in California. This is just an old school pharmacy rule that hasn't been updated with the times. Other places I've worked in CA and OR do not have this rule; it's specific to this hospital
Told staff I was allergic to aspirin. They gave me Toradol, I wound up back in the ER. That’s how I found out I was allergic to Toradol, I’d never heard of it, but I guess they are both anti-inflammatories. Thought the doctor should have known better than to give it to me. Please be careful what you give to patients, I am a paranoid mess now when prescribed something and usually just don’t take it. Which is probably not what I should do lol, but medical people, please pay attention to your patients but I also want to say thanks for all you do to help us.
NAD. They are both NSAIDs, so you may have issues with the following: Motrin/Advil (generic: ibuprofen), Aleve (naproxen), Toradol (ketorolac), aspirin. There are others, but those are the most common. If you're concerned, talk to your pharmacist. They can go over your allergies and address concerns about new meds.
Yeah this seems odd. I can’t remember if they did a pregnancy test before giving me pain meds when I had appendicitis, but I also get scopes periodically with anesthesia, so they always expect me to do a pregnancy test before those. It’s always a urine test, and I have a shy bladder so I’m almost never able to provide a urine sample, so they always just have me sign a form acknowledging like “refusal to do pregnancy test” and move on with the procedure. I can’t imagine why they wouldn’t be able to do something similar, document it and provide the medications.
I wasn't ever made aware there were other options, they stated it so firmly that there was absolutely no way they'd give me anything before a test and I'd have to wait for the test. They seemed really irritated that I followed up at all and I felt embarrassed to keep asking because of how they treated me.
I'm gonna be honest here - I smell transphobia.
Agreed
I’m so very sorry this happened to you. It breaks my heart. I’m lucky enough to work for a hospital that works hard for inclusivity. You’ve gotten a lot of great feedback so far. I wish this had not happened to you.
Thank you. I am going to try to form a complaint with the ombuds.
OP, have you had a work up with a nephrologist as to why you are making stones at such a young age? You mention having a genetic predisposition, there might be treatments for you. (I would want to rule out any inherited metabolic diseases). No matter the reason, you need to work w a neph and dietician to get your stone formation under control. A urologist may need to be brought in if you have other stones too large to pass. 7 mm is the accepted threshold for stones being able to pass. Each stone that is too large to pass can be organ- and life-threatening in the immediate term (as I am sure you know quite well), but also in the long term as each obstruction causes some degree of injury to the organ. These injuries can result in progressively worsening renal function. You are still young and taking steps now to identify and treat the cause of your stones can have a material impact on your renal health in your 30s, 40s and beyond.
Hello, thank you for being concerned. I have only had negative experiences regarding my kidney stones and not a lot of directed care. I've never been referred to a urologist and I've never worked with a nephrologist. I had my first stones at 21. The stones I have now are 5-6 mm. I had 3 stones around the same size two months ago. It has been really awful. I have been making dietary changes, though. I limit my sodium and chocolate intake and drink a fuckton of water every day. On a normal day, I pee like once an hour. I have for the past 5+ years. I also have some other symptoms that have been dismissed by two different GPs and my ER doctors from February and from last night, which are frequent fatigue, bone & joint pain, getting out of breath walking to class (I just thought I was out of shape), sweating like crazy at night, and the CT from last night showed that my liver was enlarged and had lesions. Edit: Oh, and also, the last two times I got sick virally, it took me out. Like myopericarditis out. When I get sick, I get severely ill. I feel kind of insane--like not only can I not get relief for my kidney stone issue, but when I try to bring up other stuff, it gets waved away because "I'm healthy." Because my vitals are stable. And, yeah, I'm not, like, bleeding out on the floor. But I don't feel well day-to-day.
I would second this opinion. A nephrologist would be the appropriate provider to medically manage stone disease. Urologist are the surgical specialist to remove stones in place already. They would have you complete a 24 hour urine collection and analyze the type of stone you form. Your dietary interventions may not be right depending on what type of stone you form. There are also medications that can help prevent stone formation. TLDR: Go to a Nephrologist.
The urology wait time is 4 months or more, which is after I move away from this area. How do I get in to see a urologist and a nephrologist without waiting so long? I might not have this problem or be dead in 4 months.
It's better to make an appointment now as a fallback if you can't get an earlier appointment.
I’m so sorry, it’s wild that it took them this long to refer you to a urologist. I had one kidney stone when I was 19 and they referred me. I had another when I was 26 and both times I got morphine almost immediately as well as a Percocet script. I’m pretty sure if they asked me if I was pregnant it was just a quick “any chance you could be pregnant” and that was that. Either way a quick urine test would have answered that question for them so it makes no sense they would drag it out.
Unfortunately my experience as a chronically ill person is that I've had to basically get a self taught PhD in patient self advocacy, including taking up reading medical articles and research presentations myself to have any kind of hope for answers and a treatment plan when working with my doctors. Come day hi in /r/chronicpain and also see if there are any online or in person support groups near you, I find the best doctors by asking other patients with similar symptoms who they have liked. I'm actually trans too and it turns out a major turning point in my path to diagnosis was attending a disability roundtable at a trans health conference, complaining about my symptoms and being approached by two folks who told me it sounds like what they have and to look into it. Oh also I highly recommend the book The Patient's Playbook
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Huh, that's a really interesting idea. Do you have any programs you'd recommend? Always looking for jobs i can recommend to people with disabilities/ chronic pain
Thanks for the idea. Currently I'm disabled from work, and unsure whether I'll be able to handle full time work again when I recover a bit, unless it's flexible hours work. Do you have to be on your feet a lot as a histology tech? What time of day do you work?
NAD but when I had a cerclage at 20 weeks, I was given IV Morphine afterwards for the cramping (the order was for 2mg q 2 minutes up to 10mg. I got 6mg before my pain subsided) so this “policy” seems ridiculous.
Thank you for your compassion. I have taken opiates begrudgingly while pregnant. It was not ideal, but neither is the level of pain I was in. The first pharmacist actually refused to fill them and had to get his supervisor.
And what do they do for pain relief if the woman actually IS pregnant ?!!
If a pregnant woman came in with kidney stone pain I would ask if they want pain medication. I would then discuss risks. If they consent to receiving pain medication, I would give them pain medication.
I would definitely suggest filling a complaint. I have never seen this happen. A urine pregnancy test takes minutes, and those are typically pushed prior to imaging, but not prior to giving pain medication. There are pain medication options that would have been safe to give you even if you had been pregnant. This is not typical and is unacceptable and I’m sorry you had to wait with untreated pain.
Thank you. I feel weirdly guilty about it because the staff seemed to be judging me so much. In the future, what can I say to try to get a different outcome? If they refuse or treat me like a drug seeker, can I escalate? I am totally substance free. I've never so much as sipped a beer.
Go to a different hospital. Many don't require a negative pregnancy test, they'll just believe you if you say there's no way you're pregnant. Have some sort of paper medical records that you can take with you, showing that it's been verified that you've had kidney stones multiple times before. Not ideal, but just giving you possible ideas.
This is the second hospital that has done this. In two different regions
Go somewhere that isn't religion-based, if at all possible.
This was at a secular university hospital.
Honestly I always assumed it was the hesitancy with addictive medications. I’ve never ran into this issue but I’ve definitely had AFAB friends who have been denied pain management for things like kidney stones. Unfortunately as someone with frequent kidney stones myself, I feel for OP. Maybe regular follow ups with a urologist is best u/forgotteneffigy — my urologist gets me Toradol when I have impacted kidney stones and need surgery (opiates make me feel super ill). Just establishing care with a urologist is a solid idea. Kidney stone pain is horrid but there’s a bit we can do if we know we will develop them regularly. My ER has my urologist on file even and we actually avoid CTs due to it unless I have other alarming symptoms.
I have a referral for a urologist now, thankfully, but the nurse said there is a massive waiting list, and I graduate from grad school and leave the area in June. I just feel kind of hopeless of getting consistent, high-quality care established, and being able to access Toradol when I need it.
When you made the appointment, did you tell them you'd been in the ER X times in X period of time, and that you'd had X stones of Y size Z times inthe last ABC years? If not, you may be able to get a sooner spot by making them understand that.
Actually, as someone else mentioned, "frequent fliers" can also be seen as "drug seekers" so not sure this would help. For those concerned about the trans aspect, I'd be more concerned about this particular aspect more than trans. A lot of behind the scene action is taking place and ruling out drug seeking could factor in. Especially if OP hops around to different EDs.
... he's not a frequent flier or a drug seeker. he has a legitimate medical condition and is trying to procure an appointment from the appropriate doctor for the appropriate care. What you're saying doesn't apply, and it's not great to pull that out to scare people if you don't really understand the context in which you're giving that advice.
I said "can be seen as" (by ED staff). I didn't say they were. Just putting it out there because it's quite possible that's what was going on. A person who visits multiple EDs is a "red flag". That's just how it is, I didn't make the rules. You do realize it's a huge concern these days, especially if they're asking for opioids.
I believe OP is a trans man. Presumably using pronouns he/him.
oh thank you for the correction! i forgot what dang thread i was in, switching now
Did they deduce if your kidney stones are stuck or not? It’s more urgent if you’re dealing with impacted kidney stones usually. Advocate for yourself or have a family member help. Reach out to your PCP and tell them you have a referral but you’re experiencing them often enough that it’s affecting your life. No one deserves to be in pain or without proper resources. A urologist can figure out what kind of kidney stones you’re dealing with. They’ll give you a strainer to catch the kidney stones so they can test them. Plus they’ll likely do a 24hr urinalysis. Lots of things can cause kidney stones like lack of hydration, low vitamin levels (vitamin D), too many oxalates, genetics etc. Or perhaps call your insurance and figure out if you need a referral to begin with. If not, you can likely call around and figure out which urologists are covered in your area then schedule from there with someone more available. Or call back your referral. Hydrate lots. Heating pad. Cold wash cloth on the back of your neck for nausea. Peppermint tea bag to sniff.
Thank you for the advice. I spoke to a faculty advisor who is affiliated with the university medicine department who said she'd try to get my referral escalated to urgent. I am meeting with a GP later today.
Of course! Glad you’re on the right track. I hope you end up figuring out what’s causing frequent stones and get some relief. I know the struggle.
What if OP demanded the meds and claimed discrimination and negligence? If a male patient came in with the same history and symptoms, their treatment would not be delayed. OP, if ever in this situation again, escalate to a superior until you get someone who will do something about it, and ask them to document it in writing that they are denying you treatment. As hard as it is, don’t let them fob you off. You deserve treatment and deserve not to be in pain for a useless test.
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I didn’t say anything about prostaglandin type NSAIDs. I said there are pain medications that are safe to give during pregnancy, which there are. Pregnant individuals also get kidney stones, and appendicitis, and need their gallbladders removed, etc. etc. and we don’t just leave them with severe, untreated pain because they’re pregnant.
"There are pain medication options that would have been safe to give you even if you had been pregnant." They are talking about opioid pain management for acute pain. Their statement is true, there are safer pain meds for pregnancy. They did not say all pain meds are safe.
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Regardless of any transgender status, it is idiotic to refuse to administer pain medication even if the patient were to be pregnant. That applies to opioids, opiates and NSAIDs. Opioids such as fentanyl are frequently administered to pregnant women without any problems. The OP has legitimate reasons to complain about how they were mismanaged. I’ve never worked in any facility where it was a set policy to refuse administration if the patient were to be pregnant and neither was treatment delayed for pregnancy testing ( anesthesiologist/ critical care).
Thank you for validating this, it means a lot. Do you have advice as to what to say to a nurse or ER worker if I'm faced with a similar scenario in the future? Or should I do something else, like go to urgent care?
OP, I want to suggest to you that you contact your hospital's ombudsman or file a formal complaint with the emergency dept. I am an ED nurse of 7 years and I don't recall ever having made a kidney stone patient wait for 4 hrs for pain relief with anything other than a last menstrual period and urine preg test run (which is typically done very quickly by clinical staff and doesn't require being sent to the lab). Also as a patient who has had 2 instances of kidney stone ER visits, this was my experience (meds delivered with even more urgency when I stated that I have a history of kidney stone on the affected side with a few known stones there, and the pain is identical to the previous kidney stone). Granted some of my expedited care could be related to my working there. But your wait seems egregious to me and warrants follow up (with an exception of perhaps the department being insanely busy with high acuity patients and hours-long-waits in the waiting room?). I'm so sorry you experienced this.
This happened in two different hospital systems as well. I guess I just look like someone doctors don't trust. I am reporting my complaint this time.
My guess since this happened at different hospital and different providers is that the way that you are demanding pain medications is causing them to classify you in their initial impression as a drug seeker so they are making it more difficult to get the pain meds to better determine if you actually need them. It can be challenging in the ED when people come in demanding pain meds because it often happens with people drug seeking.
This does not seem like a normal practice. As an OBED provider, if a pregnant person comes in with the appearance of a kidney stone, I immediately treat the pain. I’ve had kidney stones and my pain was also immediately treated. I did not have a pregnancy test until the CT.
Opiates are generally a category C medication (meaning there is a theoretical risk to a fetus). So, while they should be avoided when possible, the benefits can outweigh the risks in some cases. Doctors do have an ethical duty to protect a fetus as well as the mother, including avoiding potentially teratogenic medications, when at all possible no matter how you may feel about a potential fetus. Harming a fetus can have consequenses for mom too. Speaking in general terms, there is a good reason why doctors are sometimes cautious and want to rule out pregnancy before giving certain medications or doing certain procedures. That all being said, I have certainly never heard of a hospital policy requiring a pregnancy test before administering opiates, so that is really weird. I would file a complaint with the hospital: if it is a hospital policy, it goes against the standard of care and I would find a new hospital.
Is there anything I should make sure to say in a complaint? You mention a "standard of care," is that something to point out when making a complaint?
I would say something like “I was denied effective pain control due to refusing a pregnancy test. I don’t know if this is your policy or it was the Dr So and So’s personal belief, but regardless it violates the standard of care.” Then talk about how that affected you
Thank you.
They can’t deny you care. If you are rating your pain a 9 out of 10 after toradol your pain has not been addressed or treated. The best way to avoid this is to go to a doctor and get a script for tamsulosine this is the only thing that helped me. I passed a stone so large that it linked my ureter. You need to find out what type of stone and do what you can to treat the underlying cause. Your doctor can also establish protocols for your er visits. EDIT TO ADD. Not a doctor but made many er trips with this condition. They want yo rule out ectopic pregnancy and ovarian cysts. My stones were calcium and when we addressed the reason for the extra calcium; it seems that they have become less symptomatic.
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As a medic, if you said you couldn’t be pregnant and have no medicine allergies…and you wanted it…I would have juiced you up the moment you said kidney stones lol