Friday, 7 March 2008

Unrealistic expectations

I saw a lady recently with a painful foot - it was painful when she woke up. Doesn't remember injuring it, but; 'would like an Xray please in case I broke it rolling over in my sleep'!

Now I don't know about you, but since I had my kids I've been a fairly light sleeper and tend to wake at the slightest sound. Before the advent of nippers I would sleep like a log and be virtually unwakeable. However, if I injured myself during the night, I'm sure I would wake up - probably screaming in pain!

In order to break a bone in one's foot, it is acknowledged that significant force must be applied to the foot. It doesn't just happen when you roll over in the night.

So unless someone drove a car over your foot whilst you were sleeping, a maniac came into your room and twatted your foot with a sledge hammer, or you indulge in skydiving whilst asleep. It is highly unlikely that you have a broken bone in your foot. So an Xray is not indicated, is it?

Oh, and some bastard painkillers might help as well!


Anonymous said...

I love the reasons people will come up with to justify why or how they are injured!

I did a placement at a fracture clinic during university. The Monday morning clinic always the fun one.

'So how did you do it?'
'I fell over'
'Ok you have a fractured 5th metacarpel......its known as a boxers fracture, how did you do it?'
'I fell over'
'I'm not a policeman, how did you realy do it?'
'I hit someone outside the pub'
'See that wasn't so hard was it?!'

Anonymous said...

I love this post, and am going to feature it big, big, big in NHS BLOG DOCTOR


BenefitScroungingScum said...

Does it not depend upon an individual's tolerance to pain (amongst other reasons) as to whether they wake up from an injury?

I dislocate multiple joints, multiple times in any given night but will only wake to some. I find it quite easy to believe someone can injure themselves during sleep and not wake at the time especially if factors like alcohol were involved.
Bendy Girl

Anonymous said...

direct from the man

Let us think a little more about Alice. As fatman says, it is unlikely she has broken a bone in her foot during the night. So why is her foot suddenly so painful that she takes herself to a hospital. Perhaps she has a pathological fracture. You do not need much trauma for those. You get pathological fractures with cancer. With breast cancer, for example. It would be a bit odd to find a pathological fracture in a foot, but it can happen. I wonder if fatman checked Alice’s breasts? Probably not. What else may be going on? Well, gout is a classic for a painful foot, though you would expect the foot to be red and swollen. I wonder if fatman bothered to have a look? He doesn’t say. Then there is multiple myeloma. Always difficult to diagnose and protean in its presentation. Myeloma causes unexpected bone pain. Or Paget’s disease, that’s a thought. Notoriously painful. And then osteoporotic collapse of an arch in the foot. Fatman does not say how old Alice is. I wonder if he has heard of osteoporosis? Or Paget’s? Or multiple myeloma? And then there is calcium metabolism, and disseminated thyroid malignancies and I have not even moved on to the exotica yet. I will find a medical student and ask for another twenty causes of foot pain that have slipped my brain

A little knowledge can be a dangerous thing