Methadone or Hydrocorstisone?

An article from the September 1996 Newsletter:

We are all aware that an Addison's crisis can be stressful to say the least, but imagine how you would feel if you finally staggered into a hospital casualty department, telling medical staff you had Addison's Disease and needed an injection of Hydrocortisone only to be told, "We can't just give out Hydrocortisone to every drug addict that comes in"! Well, that ' s just what happened to one of our member's earlier this year. To make matters worse, it was only a few months after she had been diagnosed with Addison's Disease and this was her first experience with an Addison's crisis.

The member had been experiencing severe pains in her back and was pretty sick before she realised she had to get some help. She managed to drive herself to the local hospital, staggered into the casualty department, by this stage her speech was slurred and she was in tears. She fell off the chair in the waiting room three times before she was given a place to lie down. The hospital finally called her boyfriend who was unable to get there for another two hours. No one had even taken her blood pressure or temperature. When her boyfriend arrived he realised she was very sick and he asked the hospital to admit her and was told they could not do anything for her. Medical staff didn't believe she had Addison's Disease and advised they would need a letter from her doctor before they could treat her. After four hours the boyfriend had to carry the member out of the hospital where all she was only given was one Aspalgin tablet for the pain in her back. He took her home where she started to vomit and continued to vomit off and on all night.

First thing the next morning he took the member to her regular doctor. She was immediately given four injections; Hydrocortisone, an antibiotic, Maxolon (to stop vomiting) and a pain killer. It turned out the member had a kidney infection that had caused the crisis.

The member admits she could have looked like someone with a drug problem. She had only been taking medication for Addison's Disease for a short time and was still dark in colour and very thin. Her speech was slurred, she couldn't stand up straight and she did not have any medical identification. Hospitals see lots of people each week with drug problems but only see patients with an Addisons crisis once in a blue moon. All this still fails to explain why medical staff wouldn't believe her when she told them she had Addison's Disease and needed a Hydrocortisone injection. She has since received an official apology from the hospital for the way she was treated. This member now carries a letter from her doctor advising she has Addison's Disease and what treatment she should get in an emergency.

Although this case is definitely the worst, I am afraid it is not alone. We have had several members concerned at the lack of treatment they have received from hospital casualty departments.

One member had fractured the humerus on their left shoulder and went to hospital in an ambulance in a great amount of pain and shock. The member asked the ambulance man to give her the Hydrocortisone injection she always carries with her. They explained that they were not able to do this and she would have to wait until she arrived at hospital. At the hospital she explained to a nurse she had Addison's and required an injection of cortisone which was ignored. She then asked the Resident Doctor for a cortisone injection and he enquired, "What for?". She again explained she had Addison's Disease and he asked, "What's Addison's Disease?". The member was sent to X-Ray, strapped and sent home without an injection of cortisone. The member had to call her regular doctor who came to her home to give her an injection.

on another occasion a member had her right arm severely savaged by a Doberman dog. The member had taken her emergency cortisone injection to the hospital and handed it to the nurse explaining she had Addison's Disease and would need the injection. The nurse gave the injection to the member's husband and said, "We have plenty of that". The member was put on a monitor and left while medical staff attended to other patients. After a while the member went into an Addisons crisis and the monitor went crazy. A doctor came and the member explained what was happening. He then asked what he should do and where was her cortisone. The doctor then had to phone the member's husband who had taken the injection home to find out what sort of cortisone it was and the dosage needed.

In another incident a member became very ill with symptoms of tachycardia, low blood pressure, and breathlessness. Sound familiar? The hospital diagnosed either a clot in the lung or a minor heart problem. The member explained she had Addison ' s Disease and requested, at four different times, that the medical staff contact her endocrinologist and on all occasions, was told that this was not necessary! The young Resident decided to give a blood gases test but was unable to successfully find an artery. After trying both wrists he finally gave up. The member was hospitalised for three days and sent for a lung scan. She was later told by her endocrinologist that the symptoms were that of an impending Addisons crisis and that an injection of cortisone would have solved the problem.

This member wrote to the N.S.W. Health Department and was advised she could; "help prevent future difficulties in obtaining prompt treatment by having a written care plan from her endocrinologist which provides other health professionals with a clear outline of what should be done in the event of an Addisonian crisis, the presenting signs and symptoms and the first line treatment that should be instituted. The plan should alsocontain the contact details of your endocrinologist and/or general practitioner SO that the treating doctor is able to seek advise about ongoing treatment and referral for follow-up assessment."

While on holidays another member started to have an Addisons crisis. He went to the small local hospital and they in turn contacted a local doctor. The local doctor told nursing staff to keep an eye on the member. The doctor finally turned up two and a half hours later to find the member was very ill.

The hospital did not have any Hydrocortisone so the doctor ended  up using the member's own injection. Later, the doctor was very helpful, showing the member and his wife how to give an injection, so if ever presented with such a situation in the future, they could administer the Hydrocortisone themselves.

This member advised other Addisonians to seek help quickly when you feel you are going into an Addison's crisis. Don't leave it till you start vomiting. He also carries a letter from his specialist and injectable Hydrocortisone when he is away from his home area.

All these situations occurred when members were not able to get treatment from their regular doctor. We all know Addison's Disease is a condition which is not commonly encountered by health professionals but why does it take so much to convince medical staff you have Addison's Disease? Surely it's not something every 'Tom, Dick and Harry' says they have. Why should it take a letter from your regular doctor to get treatment?

It may be just a coincidence that all these cases occurred in N.S.W. We would be interested to hear about the emergency treatment received by members in other states and New Zealand. We would also like to hear from members who have received "spot on" emergency treatment.