Hair Dye and A Relentless Pain Patient

Today was quite interesting in the ER. It was busy as usual for this time of the year, but the doctor who was my attending for the day is very efficient and enjoys seeing some of my patients as well when he gets in a grid-lock in his area. Anyway, that's besides the point. One of my first patients this afternoon was a middle-aged white female who is complaining of having an allergic reaction. Guess to what? None other than the hair dye that she has used for years. This occurred about two weeks ago, her daughter applied the hair dye as usual. The patient claims she felt like it was burning more than normal so immediately washed her hair. Unfortunately, it had done enough damage to cause her whole scalp to be inflammed. One week later, she began to break out in a generalized rash over her entire body. Now she presents to the ER, lacking a PMD (as most patients I see), wanting help. She presently is losing a lot of her hair and her ears are swollen to twice their size with fluid draining from the cracks around her ears. Her vitals are stable, as expected since it's a 2 week old rash. The generalized eruption on the rest of her body was a commonly seen delayed allergic reaction (erythematous, papular, well-demarcated, blanching rash). Upon further history, the patient called the hair dye company and found out that the company had added more avacado oil to their new products. The patient has never eaten avacado before so I felt it was safe to tell her maybe she should avoid them just in case it was the avacado oil that caused the reaction. After reassuring my patient that her ears were not going to fall off and it was only a mild cellulitis that could be treated with antibiotics and steroids, she was a happy camper. I love patients who are thankful and nice! Very few that enter the gates of my "Hall of Pain" in the ER.

Speaking of the "Hall of Pain," a relentless drug seeker appears for the third time in the past week for more drugs. He is a middle-aged white male who has a history of a broken ankle. 4 months ago, surgery was performed and he then developed a post-operative infection and was being treated by the orthopedic and infectious disease doctor. However, the infection resolved and the orthopedic informed the patient he would have recurrent problems with the ankle due to the permanent pins that are in there (nothing atypical after a surgery). (For background, before this patients ankle injury he has been treated multiple times in the ER for chronic back pain and drug-seeking behavior). The patient now presents to the ER with ankle pain. The patient walks into his room without any difficulty and still gives a 10/10 on the pain scale. The first time I see this patient, I informed him he needs to see his surgeon again, if the pain is that intense but will not prescribe narcotics for his chronic pain. Five days later, I see him again in the ER, with the same complaint. This time he has an ace-wrap around his ankle so tight that it has made an indention just superior to the wrap and he is complaining that it's swelling terribly now. After removing the ace wrap the swelling "miraculously" disappears. I once again reiterated no narcotics for his chronic pain and to stop wrapping his ankle so tightly. This visit was yesterday. And lo and behold who graced my presence today with the same complaint. No other than the same patient!! Except this time he added his back is starting to hurt now because of his ankle pain. Yet, I have visibly seen him walk up to my desk to ask how long it would be before I saw him. And yes, once I again he received no narcotics and a referral back to his orthopedic doctor! I'm off tomorrow, hopefully I will not see him again when I go back on Monday! Wouldn't that be just lovely?

So the moral of today's lesson.... Don't visit the ER for non-emergent situations and Don't Dye Your Hair (Chrissy that means YOU!)