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[Katrina Oniseki]

Please note that a majority of this thread has become a political debate about private vs. national healthcare, unrelated to the intent of the OP. Relevant updates are linked below.

UPDATE 1
UPDATE 2

TL;DR
I might have a fractured rib, and I have no medical coverage. Wat do? (American & Low-Income)

So, let's start at the beginning..

Week 1: Around the beginning of September, I came down with flu-like symptoms. For the following week, a 102F degree fever was the norm, along with headaches, body aches, and general lethargy and mild nausea.

Week 2: Fever was fading away, but a cough had set in. It was a heavy rattling cough that did not 'produce'. Nausea and fever were mild, around 100F. Headaches were gone, body aches came and went with fevers.

Week 3: Fever is gone, cough is much worse. Coughing fits became the norm and were strong enough to cause dizzy spells and difficulty relaxing my muscles after. Near the end of Week 3, I had somehow caused a sprain or other injury in my abdomen. Coughing was producing phlegm, but not consistently or enough to stop the 'rattling' or 'itch' that fueled the fits.

Week 4: Coughing had not improved, but was finally producing consistently, relieving the whooping and wheezing spells. Since I was actually coughing phlegm up, the fits would be over immediately after and allow me some rest and recovery before the next urge to cough. Unfortunately, I had now developed sinus problems, which caused post nasal drip. During week four, I had several more exertion injuries during coughing fits that I assumed were sprained muscles. Two in the chest, one more in the abdomen, and one in my lower back.

Week 5 (now): We're now in the fifth week. The cough is finally dying down, my sinuses are clear, but one particular spot in my chest has not gotten any better. In fact, tonight, at work, it came back with a vengeance. It's located around the second from bottom rib on the right side. Pressing on the breastbone makes it hurt a little bit more, but not too much.

QUESTION: How serious is this for somebody who cannot afford to seek medical treatment? I can apply for local medical assistance (charitable free clinics that provide emergency care and medications to those who qualify for it), but that will take up to a month to get approved, and they are typically very overbooked. I'm not sure if the hospital in this area (Gaston County, North Carolina) is even on board with any low income assistance programs.

The real question I need to know is... should I just try to rest and let things heal up, or is this a medical emergency? What sorts of signs should I watch for that could be life threatening? It hurts badly, but so does a sprained ankle... and that's not life threatening. I don't even know if it's the rib. It could just be a muscle sprain.

Also... am I the only person who didn't know you can break a rib just by coughing?

[Katrina Oniseki]

Update: My mother is a retired RN and has dropped off some sort of stretchy chest brace-compression thingy for me to wear, says it is what they made my grandpa wear when he broke a rib.

[Ollie]

It's hard to make a diagnosis on history alone, particularly history without the opportunity to cross-examine with relevant questions. Diagnosis is about 90% history and examination combined, with the remaining 10% made up of targetted investigations ... so take what I say with a grain of salt.

The first thing is the brace won't help you, not really. It depends on the brace, to some extent, but it goes something like this.

Pain due to fracture or muscle strain is usually best relieved with a combination of analgesia and immobilisation. The problem with the latter in the context of a rib fracture or muscle strain involving the chest is that you can't immobilise it - you stop breathing and you die, after all. Furthermore, limiting the mobility of your chest in order to decrease the pain (such as you do with a brace) typically exposes you to the risk of underinflating your lungs and the complications that arise from that (pneumonia, pleurisy, etc). So ... a soft/elastic brace might help somewhat while sleeping if pain's waking you in the night, but the mainstay of treatment is going to be regular simple analgesia (like paracetamol, or a combination of paracetamol/codeine) combined with a non-steroidal anti-inflammatory (ibuprofen, for example). The non-steroidal needs to be taken with food and water, following strict maximum daily dose guidelines and for every 3-4 days you use it regularly you should have 2-3 days off it to allow for some of the adverse effects it can have your renal and gastrointestinal system to subside.

So, the usual thing I prescribe:

1g paracetamol (+/- 16mg codeine) four times a day, orally
400mg ibuprofen three times a day, orally (following the rest day guidelines above, 3-4 days on out of every 7)

If you've got any sort of problem with stomach ulcers, gastrointestinal bleeding, severe reflux symptoms, etc or pre-existing problems with renal function avoid the non-steroidal (ibuprofen). If you've got a productive cough, fever, other signs or symptoms of an active chest infection avoid the codeine as it will suppress both your cough reflex and autonomic control of your breathing (to a minor extent) meaning you're unable to clear the infection from your chest as effectively which could make your condition worse or extend your time to recovery.

Obviously avoid extremes of exercise that exacerbate any pain you've got, but don't lie around in bed either - walking, light exercise, doing your usual activities, etc should not be avoided as long as they're not causing you undue pain. If you've got areas of point tenderness that you can find, maybe warm packs will help you there - you can make your own with wholegrain wheat/husks, some cloth and some thread to sew the cloth into a bag (there's probably better instructions online as I'm not a home and gardens type of person ).

I don't pretend to really understand the limitations of the US health care system and health insurance and things over there. If you were where I'm at I'd be getting a few blood tests done, a nasopharyngeal swab to exclude things like whooping cough (it doesn't sound like that so much as it sounds like a bad flu or maybe pneumonia that's now resolved/resolving) and a chest xray. The latter would be to make sure you don't have a collapsed or consolidated lung (either through puncture or persisting infection) rather than a fractured rib (which is sometimes difficult to see on an xray and doesn't really change the management anyway).

The last thing I would advise is that if you're a smoker, now's the time to stop. Either cold turkey or with nicotine supplements.

To sum up, while you might have a broken rib that would be unusual in otherwise healthy adults following a chest infection or upper respiratory tract infection. It's not unheard of, but the more common things for the persisting pain you're describing in one particular spot 5 weeks after what sounds like a fairly severe infection would be ongoing infection (ie, pneumonia) or a complication thereof (ie, pleurisy - inflammation of the chest wall lining, usually following infection). The treatment for a broken rib is symptomatic and aims to avoid the complications of under-treating the pain. The treatment for ongoing infection and complications of such is obviously more specific.

As I said at the outset, I can't examine you and I don't have a clear idea of your past history so that limits my usefulness and diagnostic accuracy.

If things aren't getting better, going to see someone who can examine you and order appropriate investigations is the best advice I can give.

Get well soon.

[orange]

So, while you are low income, it may not be a bad idea to call a local doctor/clinic and see what the cost is for you to go in and get a once over.  Instead of worrying about whether you can afford it or not, ask them how much the visit is.  Then if you choose to spend the money on the visit and get the basic stuff done, you can make the next decision about what to do based on the results of that visit.

I was uncovered for about 6 months and once I was covered the doctor berated me for not spending the ~$150 for a visit, ~$20 for some bloodwork, and ~$20 for my daily medication.  And I was paying Los Angeles prices.

[Katrina Oniseki]

Advice

That's good news to hear. I have been diagnosed with IBD, so I'll try not to take ibuprofen much. I didn't know it was bad for me. >_> I won't be able to get anything with codeine without a prescription, so that's off the table as well. I do have Tylenol, and have been taking below the maximum daily dosage for a while now, stopping every now and then as suggested.

For the most part, what you've suggested is what I've been doing, with the remaining stuff simply out of my reach right now.

I'm glad to hear it's probably not a rib fracture. It really does feel like a sprain, and it feels like it's on the outside. I will stop using the brace, since it seems like making sure I take full breaths is important here to prevent complications? That's also something I'm glad to hear, because it's so uncomfortable and makes me feel short of breath (which I guess I am, since I'm taking half breaths with it).

I don't smoke, by the way, so I ought to have some pretty clean lungs.

Anyways, thank you for your help. It's really relieving to hear that I probably don't need to run up a medical bill this month. Once again, you're awesome!

So, while you are low income, it may not be a bad idea to call a local doctor/clinic and see what the cost is for you to go in and get a once over.  Instead of worrying about whether you can afford it or not, ask them how much the visit is.  Then if you choose to spend the money on the visit and get the basic stuff done, you can make the next decision about what to do based on the results of that visit.

I was uncovered for about 6 months and once I was covered the doctor berated me for not spending the ~$150 for a visit, ~$20 for some bloodwork, and ~$20 for my daily medication.  And I was paying Los Angeles prices.

Yeah. Until now I didn't have a need for a doctor in this county, so I'll need to look around and see who's available and at what prices. I figure they network a lot with each other, so someone ought to be able to point me in the right direction.

Doctor's tend to berate me a lot for not coming to see them earlier, so I can relate with that.

[Ollie]

No problems.

So, while you are low income, it may not be a bad idea to call a local doctor/clinic and see what the cost is for you to go in and get a once over.

Dex's advice there is excellent. Forewarned is forearmed, after all.

[Pieter Tuulinen]

Also, and I hate to do this but it's timely, anyone in the US reading this might want to reflect on one of our own NOT GOING TO SEEK NEEDED MEDICAL ATTENTION BECAUSE HE CANNOT AFFORD TO PAY CASH.

Just... You know... Keep it in mind the next time you're voting.

That is all.

[Morwen Lagann]

Not sure what you're getting at, Pieter.

What Kat's going through is extremely common in the US. He's probably just the only person in the RP community who will admit to it happening to him on a public forum.

I don't know too many details of his work situation, but I suspect Kat is either not being given enough hours to qualify for benefits at the place he works (often deliberate, and retardedly common at that - employers should be dragged into the street and shot for this practice), or his employer doesn't offer health benefits at all in the first place (also common, given the costs).

This is a fair bit of what the ACA is intended to help fix, so... uh, what?

[Odelya]

Get well soon!

[Pieter Tuulinen]

Not sure what you're getting at, Pieter.

I was kind of making the point that basic healthcare should be within the reach of all, not some sort of privilige

This is a fair bit of what the ACA is intended to help fix, so... uh, what?

So, one side of the two-party system in the US is fighting to dismantle an already flawed attempt to provide universal healthcare. I was asking people to bear this in mind, next election.

[Vikarion]

Also, and I hate to do this but it's timely, anyone in the US reading this might want to reflect on one of our own NOT GOING TO SEEK NEEDED MEDICAL ATTENTION BECAUSE HE CANNOT AFFORD TO PAY CASH.

Just... You know... Keep it in mind the next time you're voting.

That is all.

I don't actually get any benefit from my tax dollars being siphoned to treat other people's ribs. I prefer to keep my money in most situations. In this case, I actually find Kat's antics to be funny enough to willingly toss money their way, however, there are plenty of other people who I would prefer not to get medical care, especially at my expense.

Kat, if money is a problem, I can give you a hundred dollars. No strings. Paypal probably works.

[Iwan Terpalen]

I don't actually get any benefit from my tax dollars being siphoned to treat other people's ribs. [...]

Flipping that, the only people who profit off of people being unable to pay for healthcare are undertakers.

[Vikarion]

I don't actually get any benefit from my tax dollars being siphoned to treat other people's ribs. [...]

Flipping that, the only people who profit off of people being unable to pay for healthcare are undertakers.

I'm going to be paying more in taxes, fees, and insurance as part of the ACA. This makes me, a person who can already afford insurance, potentially worse off. The fact that others might benefit more than I am harmed does nothing for me, so don't bother with that excuse. Second, laws exist to help the people in power - if you think that the ACA will end up working out for the "little people", you are far more idealistic than I am.

[Pieter Tuulinen]

I don't actually get any benefit from my tax dollars being siphoned to treat other people's ribs. I prefer to keep my money in most situations. In this case, I actually find Kat's antics to be funny enough to willingly toss money their way, however, there are plenty of other people who I would prefer not to get medical care, especially at my expense.

With all due respect, I don't think you understand what Taxes are for. Taxes aren't for things  that benefit you as an individual, they are the 'cost' of the civilisation that benefits us all, indirectly. If you're feeling cerebral, go and do some research on the transition between hunter-gatherer tribes and more complex societies.

[Vikarion]

With all due respect, I don't think you understand what Taxes are for. Taxes aren't for things  that benefit you as an individual, they are the 'cost' of the civilisation that benefits us all, indirectly. If you're feeling cerebral, go and do some research on the transition between hunter-gatherer tribes and more complex societies.

I know exactly what taxes are for. I also know that much of the money extracted from me by my government neither serves my interests nor, as I see it, the interests of much of the population. I wouldn't have gone to war in Iraq for no gain. I wouldn't be paying for a defense budget of the size we have. I am not the one who is interested in an ever-expanding suite of regulations and fees. I wouldn't be funding a drug war that essentially serves to pay the wages of nosy cops and private prison companies.

Funnily enough, I am, however; and all of these things were sold to us on the basis that we needed them to protect some part of our civilization. Right. And, funnily enough, the ACA is also being sold to me on the basis that "people need it".