Took a hard spill today. Go to urgent care or tough it out? (1 Viewer)

[belljr]

How's your wittle boo boo today?

 

[Willie Neslon]

I just checked the medicine cabinet and all I have on the pain reliever front is some Advil that expired in 2020. I do have some unexpired Colace though. Will that help?

careful with the oxycodone / percocet they'll be giving you

you will ignore the poll and go to urgent care in the morning, right?

Does the local urgent care do x-rays? If not, I'm not sure it's worth it.

When I needed non-hospital care, I went to the 24-hour emergency room. It was fantastic. At 2AM, I was the only patient. No wait times at all. Lovely people. Real doctor. Real drugs.

Yeah they do xrays but the wait is likely many hours.

 

[Willie Neslon]

How's your wittle boo boo today?

I think at least 2 of the toes are broken. The top 1/3rd of toes 2 and 3 are bruised. Big toe has bruising but only in inside of toe. What is causing me the biggest issue is the top of the foot near the ankle. Looking at a picture of the foot anatomy I think I injured the talus bone. I can't walk on it. Also, sore all the way up the leg. Moderate neck and back pain. Mild elbow pain.

 

[belljr]

How's your wittle boo boo today?

I think at least 2 of the toes are broken. The top 1/3rd of toes 2 and 3 are bruised. Big toe has bruising but only in inside of toe. What is causing me the biggest issue is the top of the foot near the ankle. Looking at a picture of the foot anatomy I think I injured the talus bone. I can't walk on it. Also, sore all the way up the leg. Moderate neck and back pain. Mild elbow pain.

So a normal Tuesday morning?

 

[DA RAIDERS]

I just checked the medicine cabinet and all I have on the pain reliever front is some Advil that expired in 2020. I do have some unexpired Colace though. Will that help?

careful with the oxycodone / percocet they'll be giving you

you will ignore the poll and go to urgent care in the morning, right?

Urgent care will not give you either of those…. Speaking from experience.

They may not want to prescribe controlled substances, but can in most states, sometimes with the blessing of a physician.

In my experience UC is an absolute hard no to anything above Tylenol 650. the physician’s blessing comes after one sees their PCP. Not in UC.

 

[DA RAIDERS]

How's your wittle boo boo today?

I think at least 2 of the toes are broken. The top 1/3rd of toes 2 and 3 are bruised. Big toe has bruising but only in inside of toe. What is causing me the biggest issue is the top of the foot near the ankle. Looking at a picture of the foot anatomy I think I injured the talus bone. I can't walk on it. Also, sore all the way up the leg. Moderate neck and back pain. Mild elbow pain.

Sounds like a muscle/ligament strain. Aka a sprained ankle. Any swelling in that area? Tape the toes together. ice the ankle. NSAIDs. Rest. elevate it. Call me in the morning. It will probably get worse before it gets better.

Not a DR.

 

[Willie Neslon]

How's your wittle boo boo today?

I think at least 2 of the toes are broken. The top 1/3rd of toes 2 and 3 are bruised. Big toe has bruising but only in inside of toe. What is causing me the biggest issue is the top of the foot near the ankle. Looking at a picture of the foot anatomy I think I injured the talus bone. I can't walk on it. Also, sore all the way up the leg. Moderate neck and back pain. Mild elbow pain.

Sounds like a muscle/ligament strain. Aka a sprained ankle. Any swelling in that area? Tape the toes together. ice the ankle. NSAIDs. Rest. elevate it. Call me in the morning. It will probably get worse before it gets better.

Not a DR.

Maybe a little swelling but not much. Also have some soreness in the upper calf right under the knee. Like you said I think everything is just strained.

 

[Terminalxylem]

I just checked the medicine cabinet and all I have on the pain reliever front is some Advil that expired in 2020. I do have some unexpired Colace though. Will that help?

careful with the oxycodone / percocet they'll be giving you

you will ignore the poll and go to urgent care in the morning, right?

Urgent care will not give you either of those…. Speaking from experience.

They may not want to prescribe controlled substances, but can in most states, sometimes with the blessing of a physician.

In my experience UC is an absolute hard no to anything above Tylenol 650. the physician’s blessing comes after one sees their PCP. Not in UC.

That’s crazy, and likely a regional phenomenon.

 

[Gatorade]

I took a spill yesterday too. Walking down the steps behind my wife. She got to the bottom and cut the light out. On my next step, I partially missed the step and my foot slipped off the step. Luckily, I was holding the handrail, so I didn't go too far. Left elbow hit the wall, right elbow hit the steps, butt cheek hit the steps and body twisted , but I held on and only went down one step. Neck and back both felt twisted so I did a few easy yoga moves. Put a Salonpas patch on my neck , took an advil and drank some wine . this morning I was a little stiff but much better. my wife woke up with her neck hurting. karma. good thing my life insurance is paid up.

 

[Terminalxylem]

How's your wittle boo boo today?

I think at least 2 of the toes are broken. The top 1/3rd of toes 2 and 3 are bruised. Big toe has bruising but only in inside of toe. What is causing me the biggest issue is the top of the foot near the ankle. Looking at a picture of the foot anatomy I think I injured the talus bone. I can't walk on it. Also, sore all the way up the leg. Moderate neck and back pain. Mild elbow pain.

It’s likely a severe sprain of one or more of the ligaments connecting to the talus, but the bolded will likely buy you an x-ray, to exclude a bone injury. Sounds like you’ll need an air cast or walking boot + crutches for the short term, followed by PT for range of motion and proprioception (position sense) exercises - the latter is important to decrease your chances of reinjuring it.

Are you planning on seeing a medical professional?

 

[jvdesigns2002]

How's your wittle boo boo today?

I think at least 2 of the toes are broken. The top 1/3rd of toes 2 and 3 are bruised. Big toe has bruising but only in inside of toe. What is causing me the biggest issue is the top of the foot near the ankle. Looking at a picture of the foot anatomy I think I injured the talus bone. I can't walk on it. Also, sore all the way up the leg. Moderate neck and back pain. Mild elbow pain.

It’s likely a severe sprain of one or more of the ligaments connecting to the talus, but the bolded will likely buy you an x-ray, to exclude a bone injury. Sounds like you’ll need an air cast or walking boot + crutches for the short term, followed by PT for range of motion and proprioception (position sense) exercises - the latter is important to decrease your chances of reinjuring it.

Are you planning on seeing a medical professional?

I have to say that I’m personally very appreciative of your contributions to the forum. It’s really cool that you are so willing to take the time to share your knowledge with us. Good stuff.

 

[Peggy]

I just checked the medicine cabinet and all I have on the pain reliever front is some Advil that expired in 2020. I do have some unexpired Colace though. Will that help?

careful with the oxycodone / percocet they'll be giving you

you will ignore the poll and go to urgent care in the morning, right?

Urgent care will not give you either of those…. Speaking from experience.

They may not want to prescribe controlled substances, but can in most states, sometimes with the blessing of a physician.

In my experience UC is an absolute hard no to anything above Tylenol 650. the physician’s blessing comes after one sees their PCP. Not in UC.

That’s crazy, and likely a regional phenomenon.

It may be regional, but it's in a lot of places. The whole get people hooked on pain killers thing absolutely ruined it for the rest of us normal people.

I had a chisel taken to my jaw to chip down the bone and the doctor said don't worry we'll give you something for the pain. At the end he was shivering about it and ended up giving me Tylenol and Ibuprofen 800. I called him up the next day from work and let him have it because I was in so much pain. He apologized and said he'd give me a script if I came in to get it, they can't call in. But by that time it was too late, the worst of it was over.

You used to be able to get percocet for dislocated joints, bad sprains etc. Now they don't give any of that. They try and get creative with muscle relaxers that either has zero effect on me or just put me to sleep.

 

[Grahamburn]

I took a spill yesterday too. Walking down the steps behind my wife. She got to the bottom and cut the light out. On my next step, I partially missed the step and my foot slipped off the step. Luckily, I was holding the handrail, so I didn't go too far. Left elbow hit the wall, right elbow hit the steps, butt cheek hit the steps and body twisted , but I held on and only went down one step. Neck and back both felt twisted so I did a few easy yoga moves. Put a Salonpas patch on my neck , took an advil and drank some wine . this morning I was a little stiff but much better. my wife woke up with her neck hurting. karma. good thing my life insurance is paid up.

Just reupped the life insurance policy?

 

[Mrs. Rannous]

You used to be able to get percocet for dislocated joints, bad sprains etc. Now they don't give any of that. They try and get creative with muscle relaxers that either has zero effect on me or just put me to sleep.

Back in the day, my dentist gave me a prescription for 10 Vicodin just in case my tooth blew up before the root canal.

 

[Terminalxylem]

You used to be able to get percocet for dislocated joints, bad sprains etc. Now they don't give any of that. They try and get creative with muscle relaxers that either has zero effect on me or just put me to sleep.

Back in the day, my dentist gave me a prescription for 10 Vicodin just in case my tooth blew up before the root canal.

Seems like dentists are frequently mentioned among the most egregious overprescribers of both pain pills and antibiotics.

 

[Mrs. Rannous]

You used to be able to get percocet for dislocated joints, bad sprains etc. Now they don't give any of that. They try and get creative with muscle relaxers that either has zero effect on me or just put me to sleep.

Back in the day, my dentist gave me a prescription for 10 Vicodin just in case my tooth blew up before the root canal.

Seems like dentists are frequently mentioned among the most egregious overprescribers of both pain pills and antibiotics.

Not my dentist. He knew me and knew I wouldn't abuse the stuff. And there was a about a two week gap until the endodontist could fit me in. Having it go horribly wrong in there would have been nasty. I would have needed them anyway. At the time, most people didn't really know how bad those things can be. He was one of the best dentists ever.

(I was the one who told him I needed a root canal. I don't think he'd ever had a patient do that before, and he knew I hadn't had one. He looked at me funny.)

 

[3C's]

You used to be able to get percocet for dislocated joints, bad sprains etc. Now they don't give any of that. They try and get creative with muscle relaxers that either has zero effect on me or just put me to sleep.

Back in the day, my dentist gave me a prescription for 10 Vicodin just in case my tooth blew up before the root canal.

Seems like dentists are frequently mentioned among the most egregious overprescribers of both pain pills and antibiotics.

My ortho surgeon for an upcoming surgery said the opposite regarding antibiotics. He said dentists typically won't prescribe them because they don't want to give any ammo to lawyers if there's an infection after a procedure. The theory is prescribing antibiotics before a procedure points to the possibility that their work led to an infection. And I found that to be true. The surgeon wants me to take antibiotics before dental procedures. I called the dentist's office since I have a cleaning coming up and they said the surgeon would have to send a request/prescription first.

 

[Terminalxylem]

You used to be able to get percocet for dislocated joints, bad sprains etc. Now they don't give any of that. They try and get creative with muscle relaxers that either has zero effect on me or just put me to sleep.

Back in the day, my dentist gave me a prescription for 10 Vicodin just in case my tooth blew up before the root canal.

Seems like dentists are frequently mentioned among the most egregious overprescribers of both pain pills and antibiotics.

My ortho surgeon for an upcoming surgery said the opposite regarding antibiotics. He said dentists typically won't prescribe them because they don't want to give any ammo to lawyers if there's an infection after a procedure. The theory is prescribing antibiotics before a procedure points to the possibility that their work led to an infection. And I found that to be true. The surgeon wants me to take antibiotics before dental procedures. I called the dentist's office since I have a cleaning coming up and they said the surgeon would have to send a request/prescription first.

With all due respect, your orthopod is off-base. While I think practices are getting better, dentists remain among the most frequent prescribers of antibiotics. That would be fine if they were indicated - after all, the mouth is filled with bacteria. But as it turns out, seeding things like implants is not as common as we once thought.

An older article on the topic.

Conclusion and Relevance More than 80% of antibiotics prescribed for infection prophylaxis before dental visits were unnecessary. Implementation of antimicrobial stewardship in dental practices is an opportunity to improve antibiotic prescribing for infection prophylaxis.

I don’t know the whole story, but I’m guessing your dentist was correct not to recommended antibiotics. Some orthopedists think they are necessary to prevent infection of prosthetic joints before simple dental procedures (like cleanings), but that view is incongruent with current guidelines. Same goes for many heart conditions. The guidelines changed over a decade ago, when it was discovered all those prescriptions were causing more harm than good.

 

[3C's]

You used to be able to get percocet for dislocated joints, bad sprains etc. Now they don't give any of that. They try and get creative with muscle relaxers that either has zero effect on me or just put me to sleep.

Back in the day, my dentist gave me a prescription for 10 Vicodin just in case my tooth blew up before the root canal.

Seems like dentists are frequently mentioned among the most egregious overprescribers of both pain pills and antibiotics.

My ortho surgeon for an upcoming surgery said the opposite regarding antibiotics. He said dentists typically won't prescribe them because they don't want to give any ammo to lawyers if there's an infection after a procedure. The theory is prescribing antibiotics before a procedure points to the possibility that their work led to an infection. And I found that to be true. The surgeon wants me to take antibiotics before dental procedures. I called the dentist's office since I have a cleaning coming up and they said the surgeon would have to send a request/prescription first.

With all due respect, your orthopod is off-base. While I think practices are getting better, dentists remain among the most frequent prescribers of antibiotics. That would be fine if they were indicated - after all, the mouth is filled with bacteria. But as it turns out, seeding things like implants is not as common as we once thought.

An older article on the topic.

Conclusion and Relevance More than 80% of antibiotics prescribed for infection prophylaxis before dental visits were unnecessary. Implementation of antimicrobial stewardship in dental practices is an opportunity to improve antibiotic prescribing for infection prophylaxis.

I don’t know the whole story, but I’m guessing your dentist was correct not to recommended antibiotics. Some orthopedists think they are necessary to prevent infection of prosthetic joints before simple dental procedures (like cleanings), but that view is incongruent with current guidelines. Same goes for many heart conditions. The guidelines changed over a decade ago, when it was discovered all those prescriptions were causing more harm than good.

His son is a dentist and echoes what he said.

 

[Terminalxylem]

You used to be able to get percocet for dislocated joints, bad sprains etc. Now they don't give any of that. They try and get creative with muscle relaxers that either has zero effect on me or just put me to sleep.

Back in the day, my dentist gave me a prescription for 10 Vicodin just in case my tooth blew up before the root canal.

Seems like dentists are frequently mentioned among the most egregious overprescribers of both pain pills and antibiotics.

Not my dentist. He knew me and knew I wouldn't abuse the stuff. And there was a about a two week gap until the endodontist could fit me in. Having it go horribly wrong in there would have been nasty. I would have needed them anyway. At the time, most people didn't really know how bad those things can be. He was one of the best dentists ever.

(I was the one who told him I needed a root canal. I don't think he'd ever had a patient do that before, and he knew I hadn't had one. He looked at me funny.)

Sorry, I wasn’t trying to attack anyone’s healthcare provider. But there is a wealth of literature implicating dentists in over prescription of both opioids and antibiotics.

That’s not to say physicians are perfect. There’s plenty of blame to go around.

 

[3C's]

I don’t know the whole story, but I’m guessing your dentist was correct not to recommended antibiotics. Some orthopedists think they are necessary to prevent infection of prosthetic joints before simple dental procedures (like cleanings), but that view is incongruent with current guidelines. Same goes for many heart conditions. The guidelines changed over a decade ago, when it was discovered all those prescriptions were causing more harm than good.

As the surgeon said, it's likely not needed but it only takes 1 occurrence to cause a lot of issues so taking 4 pills every 6 months is better than being admitted to the hospital due to an infection. And I wouldn't say the view is incongruent with guidelines. After having my first joint replacement that surgeon recommended the same. I stopped after a few years. https://www.mcleodhealth.org/blog/joint-replacement-need-antibiotics-see-dentist-2/

 

[Terminalxylem]

You used to be able to get percocet for dislocated joints, bad sprains etc. Now they don't give any of that. They try and get creative with muscle relaxers that either has zero effect on me or just put me to sleep.
Back in the day, my dentist gave me a prescription for 10 Vicodin just in case my tooth blew up before the root canal.

Seems like dentists are frequently mentioned among the most egregious overprescribers of both pain pills and antibiotics.

My ortho surgeon for an upcoming surgery said the opposite regarding antibiotics. He said dentists typically won't prescribe them because they don't want to give any ammo to lawyers if there's an infection after a procedure. The theory is prescribing antibiotics before a procedure points to the possibility that their work led to an infection. And I found that to be true. The surgeon wants me to take antibiotics before dental procedures. I called the dentist's office since I have a cleaning coming up and they said the surgeon would have to send a request/prescription first.

With all due respect, your orthopod is off-base. While I think practices are getting better, dentists remain among the most frequent prescribers of antibiotics. That would be fine if they were indicated - after all, the mouth is filled with bacteria. But as it turns out, seeding things like implants is not as common as we once thought.

An older article on the topic.

Conclusion and Relevance More than 80% of antibiotics prescribed for infection prophylaxis before dental visits were unnecessary. Implementation of antimicrobial stewardship in dental practices is an opportunity to improve antibiotic prescribing for infection prophylaxis.

I don’t know the whole story, but I’m guessing your dentist was correct not to recommended antibiotics. Some orthopedists think they are necessary to prevent infection of prosthetic joints before simple dental procedures (like cleanings), but that view is incongruent with current guidelines. Same goes for many heart conditions. The guidelines changed over a decade ago, when it was discovered all those prescriptions were causing more harm than good.

His son is a dentist and echoes what he said.

Again, don’t know all the details, but if you’re talking about taking antibiotics before dental cleaning to protect an artificial joint, they are almost never indicated. More invasive stuff warrants them, to protect from local infection (not the joint).

The article I linked isn’t that old. While I suppose it’s possible practices have changed, things don’t typically move that fast in medicine, and I’ve seen direct evidence to the contrary.

Current guidance from professional societies:

The American Dental Association does not routinely recommend antimicrobial prophylaxis in patients with implanted prosthetic joints before dental procedures.[39] The American Academy of Orthopedic Surgeons also does not recommend antimicrobial prophylaxis in this population, citing that there has not been any study that demonstrates an association between bacteremia induced by dental procedures and prosthetic joint infection. To date, no study has shown that antimicrobial prophylaxis decreased the rate of prosthetic joint infection.

 

[Terminalxylem]

I don’t know the whole story, but I’m guessing your dentist was correct not to recommended antibiotics. Some orthopedists think they are necessary to prevent infection of prosthetic joints before simple dental procedures (like cleanings), but that view is incongruent with current guidelines. Same goes for many heart conditions. The guidelines changed over a decade ago, when it was discovered all those prescriptions were causing more harm than good.

As the surgeon said, it's likely not needed but it only takes 1 occurrence to cause a lot of issues so taking 4 pills every 6 months is better than being admitted to the hospital due to an infection. And I wouldn't say the view is incongruent with guidelines. After having my first joint replacement that surgeon recommended the same. I stopped after a few years. https://www.mcleodhealth.org/blog/joint-replacement-need-antibiotics-see-dentist-2/

The surgeon is ignoring the potential for collateral damage from antibiotic misuse - adverse effects, promotion of bacterial resistance, overgrowth of harmful bacteria/disrupted microbiome, and cost. Moreover, there's no data the practice actually reduces the risk of joint infection. Many routine activities, like flossing and having a bowel movement, can transiently seed the bloodstream with bacteria regardless. Luckily, our immune systems are usually up to the task.

Obviously, I don't expect you to believe an internet rando over your physician(s). But for the record, a healthcare web page/blog does not necessarily reflect evidence-based standards of care.

 

[Mrs. Rannous]

You used to be able to get percocet for dislocated joints, bad sprains etc. Now they don't give any of that. They try and get creative with muscle relaxers that either has zero effect on me or just put me to sleep.

Back in the day, my dentist gave me a prescription for 10 Vicodin just in case my tooth blew up before the root canal.

Seems like dentists are frequently mentioned among the most egregious overprescribers of both pain pills and antibiotics.

Not my dentist. He knew me and knew I wouldn't abuse the stuff. And there was a about a two week gap until the endodontist could fit me in. Having it go horribly wrong in there would have been nasty. I would have needed them anyway. At the time, most people didn't really know how bad those things can be. He was one of the best dentists ever.

(I was the one who told him I needed a root canal. I don't think he'd ever had a patient do that before, and he knew I hadn't had one. He looked at me funny.)

Sorry, I wasn’t trying to attack anyone’s healthcare provider. But there is a wealth of literature implicating dentists in over prescription of both opioids and antibiotics.

That’s not to say physicians are perfect. There’s plenty of blame to go around.

I believe you. I just know mine didn't do that. He researched all the new, shiny stuff to make sure it was actually good before using it.

I miss him.

 

[3C's]

I don’t know the whole story, but I’m guessing your dentist was correct not to recommended antibiotics. Some orthopedists think they are necessary to prevent infection of prosthetic joints before simple dental procedures (like cleanings), but that view is incongruent with current guidelines. Same goes for many heart conditions. The guidelines changed over a decade ago, when it was discovered all those prescriptions were causing more harm than good.

As the surgeon said, it's likely not needed but it only takes 1 occurrence to cause a lot of issues so taking 4 pills every 6 months is better than being admitted to the hospital due to an infection. And I wouldn't say the view is incongruent with guidelines. After having my first joint replacement that surgeon recommended the same. I stopped after a few years. https://www.mcleodhealth.org/blog/joint-replacement-need-antibiotics-see-dentist-2/

The surgeon is ignoring the potential for collateral damage from antibiotic misuse - adverse effects, promotion of bacterial resistance, overgrowth of harmful bacteria/disrupted microbiome, and cost. Moreover, there's no data the practice actually reduces the risk of joint infection. Many routine activities, like flossing and having a bowel movement, can transiently seed the bloodstream with bacteria regardless. Luckily, our immune systems are usually up to the task.

Obviously, I don't expect you to believe an internet rando over your physician(s). But for the record, a healthcare web page/blog does not necessarily reflect evidence-based standards of care.

I always appreciate your knowledge and input, and I do agree with you. When I had my first joint replacement 8 years ago I questioned the need but gave in to placate the surgeon. Doing the same this time. 4 amoxicillin pills every 6 months for 2 years isn't anything I'm worried about.

 

[Terminalxylem]

I don’t know the whole story, but I’m guessing your dentist was correct not to recommended antibiotics. Some orthopedists think they are necessary to prevent infection of prosthetic joints before simple dental procedures (like cleanings), but that view is incongruent with current guidelines. Same goes for many heart conditions. The guidelines changed over a decade ago, when it was discovered all those prescriptions were causing more harm than good.

As the surgeon said, it's likely not needed but it only takes 1 occurrence to cause a lot of issues so taking 4 pills every 6 months is better than being admitted to the hospital due to an infection. And I wouldn't say the view is incongruent with guidelines. After having my first joint replacement that surgeon recommended the same. I stopped after a few years. https://www.mcleodhealth.org/blog/joint-replacement-need-antibiotics-see-dentist-2/

The surgeon is ignoring the potential for collateral damage from antibiotic misuse - adverse effects, promotion of bacterial resistance, overgrowth of harmful bacteria/disrupted microbiome, and cost. Moreover, there's no data the practice actually reduces the risk of joint infection. Many routine activities, like flossing and having a bowel movement, can transiently seed the bloodstream with bacteria regardless. Luckily, our immune systems are usually up to the task.

Obviously, I don't expect you to believe an internet rando over your physician(s). But for the record, a healthcare web page/blog does not necessarily reflect evidence-based standards of care.

I always appreciate your knowledge and input, and I do agree with you. When I had my first joint replacement 8 years ago I questioned the need but gave in to placate the surgeon. Doing the same this time. 4 amoxicillin pills every 6 months for 2 years isn't anything I'm worried about.

Thanks. I’m not trying to dismiss their concerns, but it really is an outdated practice.

As I was thinking about it, doesn’t make much sense microbiologically, either. Mouth flora are almost never isolated from infected joint prostheses, with or without prophylactic antibiotics. It’s usually bacteria that live on the skin, especially Staph.

But you’re right, it probably represents little to no risk for you. Those few pills are a drop in the antimicrobial resistance bucket compared to antibiotics in our food supply + inappropriately treated respiratory tract/sinus infections and illegitimate UTIs.

 

[Mr.Pack]

Trust me, if you broke your toe you'd know it.

Ice them, take some ibuprofen, and see how you feel tomorrow morning.

And if you did, there's nothing anyone can do for it anyway. Just have to let it heal

 

[Mrs. Rannous]

@Willie Neslon

Update? How are those tootsies?

 

[Willie Neslon]

@Willie Neslon

Update? How are those tootsies?

The tips of the first three toes are bruised and sore. Ankle/foot is stiff but not too sore. Back to walking with just a slight limp. I think I'm gonna make it.

 

[Mrs. Rannous]

Kewl.