Friday, December 28, 2007

Trying to Make Me Normal is Going to Kill Me

In the two weeks since I last saw Dr. G, I’ve come to a frightening conclusion: his determination to treat me as though I’m one of his normal patients is going to be the death of me.

Since my first visit with Dr. G, it’s become increasingly clear that he’s a pretty conservative practitioner who believes that the less we mess with the body, the better. He’s given me reason to believe that he feels drugs cause more problems than they fix, and should therefore only be used as a last resort. This, of course, means that the copious variety of drugs I take every day drives him crazy -- as evidenced when a review my current medications caused him to blurt out, “I have no idea why you’re alive.“

These are not encouraging words to hear from the person you’ve charged with your health and well-being.

In addition to his desire to solve problems without the use of prescription medications, Dr. G also exhibits little patience for the unconventional. I discovered this when we first discussed the cellulitis that had popped up on my right thumb -- he couldn’t keep from rolling his eyes and letting out a derisive little snort when I told him how we’d taken care of other outbreaks I’d had in the past year.

Initially, I was fine with giving his approach a try. I’m usually all for conservative when it comes to my health -- with as many odd conditions as I have to deal with and the number of drugs I rely upon, trial and a lot of error taught me that introducing new factors into the equation can throw my body into a state of total chaos. Besides, I desperately wanted to be back in the care of a doctor in whom I could trust, who understood that I knew my body better than anyone else and treated me as an equal partner.

That’s why I agreed to give his recommendations a try. First, he told me to keep the cellulitis protected by a clean dressing, and to stop treating it with anything, including Neosporin or the acetic acid solution we’d used with great success in the past. Second, he wanted to try to put an end to my severe problems with retaining water by drastically reducing my fluid intake and cutting out the diuretics. And finally, he prescribed a ten day course of Cipro, a broad spectrum antibiotic, in the hopes of it knocking out both my urinary tract infection and the gunk that had invaded my lungs with one shot.

Even though these all sound reasonable in theory, they have all proved to be disastrous in practice.

I stuck with Dr. G’s directive to leave the cellulitis alone, doing nothing more than changing the dressing so it stayed clean and dry. Two days later the infection had grown much, much worse -- the original blister area had blistered again, and the entire region was deep red and angry looking. I knew from past experience that I stood a good chance of ending up on IV antibiotics, so I started to treat the area with the acetic acid solution. There was noticeable improvement in less than a day, and it was almost completely healed in less than a week. Unconventional -1, Dr. G -0.

Next, reducing fluid intake. This was a hard one for me -- I’ve trained myself to drink massive quantities of water each day in the hopes of flushing bacteria out of my urinary tract before they can take hold. (Ever since having a dangerous brush with low potassium due to water toxicity, I am extremely careful to make sure I’m eating bananas and other potassium rich foods to keep that from happening again.) This high volume intake seemed to be working pretty well -- I hadn’t had an infection in seven months, a record for me. But per Dr. G’s request, I cut way back right after I finished taking the Cipro for my last UTI -- I went from drinking a dozen 16 oz bottles of water each day plus some cranberry juice down to drinking only four bottles.

What a mistake. I developed a new infection in less than a week. And now that I‘ve started to increase my intake again, I’m having horrible problems with retaining water -- my legs, ankles and feet are horribly swollen, and there’s enough abdominal bloating to restrict my breathing. So I’ve been forced to do another Dr. G no-no: take Lasix to get rid of the retained water. It’s astounding -- within four hours of taking the diuretic I’ve been putting out almost four liters of urine. You *know* that feels damn good. Unconventional - 2, Dr. G - 0.

And then there’s the infections. If I were just trying to knock out a UTI, a 10 day course of Cipro would have worked fine. But I have pockets in my lungs from bronchiectasis, and it’s all too common for bacteria and other gunk to lodge itself down in these pockets and hang on. My former pulmonologist not only prescribed at least three weeks worth of antibiotics for me when I developed infections, he also gave me a prescription to keep on hand so I could start taking the meds as soon as I saw the telltale signs of a lung infection.

Taking 10 days worth of antibiotics just seems to make things worse, which is what’s going on right now. I wasn’t coughing at all or bringing up any junk before taking the Cipro, but started doing so about five days into the antibiotics. It’s gotten progressively worse. I understand that the over prescribing of antibiotics is problematic. But this doesn’t seem to be over prescribing, it seems to me to be under prescribing -- taking too little of the medication to kill off the bacteria which instead ends up helping the little buggers become resistant to the antibiotics. And that’s bad for me now -- having a death rattle in my lungs that’s adding to the breathing problems from my MS hug and the bloating is just plain miserable -- and it will certainly be bad later if these bacteria become immune to oral antibiotics.

Unconventional - 3, Dr. G - 0. Game, set, match.

Now comes the hard part - confronting Dr. G with the reality that everything he knows doesn’t apply to me and may, in fact, be dangerous. I dread it. I have no idea how I will find the confidence to stand my ground, or what I will do if Dr. G doesn’t agree to let me continue with what I know works. I can’t see sticking with him if all I’m going to end up doing is ignoring his advice and getting worse because of incomplete treatments. But this is a small island -- and the medical community is small. I’ve already been told by three doctors on island that they won’t treat me, and I’m not sure if I’ll be able to find someone else. Nor am I sure I could tolerate being rejected again -- it sounds stupid, but it really hurts to be told that you are too abnormal to be someone’s patient.

It’s a real paradox, isn’t it? I’m too abnormal for some doctors to treat me, and the ones that will try to treat me like I’m normal!

My next appointment with Dr. G is in two weeks, but I’ll be hearing from him before then when the results of the urine culture I submitted today come back. Please pray for me to have the strength to stand up for what I need, and to stand my ground until I get it. Hopefully he’ll understand that my 44 years in this body makes me much more of an expert on what it needs to function well than his 44 days of being my doctor.



Having little faith that the lab would actually send my results to Dr. G (the orders were written by my former physician), on Sunday I decided to send Dr. G a fax to let him know the culture was in process and to expect the results.

As I wrote this fax, I realized it provided me with an excellent opportunity to broach the subject of an extended dose of antibiotics that would take care of my lungs and the latest UTI. So I made my appeal, borrowing liberally from Joderson's well-crafted language about the role of doctors, and sent it off. Some may think of this as the chicken's approach -- I let the fax do the work so I could avoid dealing with this in person. I, however, prefer to think of it as my way of stepping oof the cliff -- now that this was out there, I'd have to talk with him about it.

Dr. G called me early Monday afternoon. He told me he had read my rather lengthy note -- and thanked me for it -- then asked me what pharmacy I used so he could phone in a 21 day course of Cipro. He told me that he didn't even have the culture results in hand yet, but it was important to him to get my lungs (and me) feeling better -- he would deal with the culture later if the results showed the infection wouldn't respond to Cipro.

Throughout the call, Dr. G was warm and funny, and made it clear that despite my maverick ways, he was in this relationship -- as my partner -- for the long haul.

I couldn't stop grinning for hours.

Monday, December 17, 2007

The Rescue of Love Bird Lupe

We saved a life on Friday.

The day started like any other. I was awake, sitting up in bed and watching our cats watch the world while I waited for the Hip Hubby’s alarm clock to go off. We’ve thoughtfully provided numerous vantage points from which our cats can enjoy “kitty home theater” (more commonly known as the critters that pass through our yard) through large windows that are only closed when a tropical storm crosses our path.

Most mornings, Moments after we captured the two month old Love Birdthe cats who are awake spread out -- some take in the view from a giant climbing tower that sits in the bedroom’s screened-in porch, others from the furniture the bedroom’s sitting “nook.” This morning, however, five of our ten indoor cats were jockeying for a position on the arm or back of the white wicker chair that became known as the kitty throne when our alpha cats took to curling up in it and holding court over their subjects.

Now there’s any number of reasons this happens, the most common being that one of the gazillion cute little ground lizards that call our yard home has decided to sun himself on one of the window louvers. But the presence of a lizard was quickly ruled out when I noticed that none of the cats was making an effort to claw at the window screen. Since I knew I’d never be able to get close enough to the window in my wheelchair to see what had entranced them, I listened intently for signs of life other than the scores of tree frogs, crickets, and grasshoppers that happily chirp away in the bushes and flowers that grow outside of that window.

After a few moments, I heard it -- a tiny “tweet” broke through the usual morning chorus. The cats heard it too, and a frenzy of activity broke out as they climbed over each other, each trying to claim the vantage point most likely to provide an unobstructed view of the creature lurking just beyond their reach.

Soon there was another tweet, this one a little stronger and close still to the house. By this time, I’d managed to rouse the Hip Hubby enough to be conversational (no small task, that), although he was in no condition yet to grasp anything more complex than short sentences. Once I was certain that his eyes were able to focus, I waited for the next chirp to ring out, then pointed toward the window where five cats were anxiously pacing, eyes wide, ears pricked, and tails twitching with excitement.

“There’s something driving the cats crazy. No, it’s not a lizard or one of our neighbor’s chickens. Sounds like a bird -- please go look and see if you can figure out what it is.”

He stumbled out of bed and over to the window, doing his best not to trip over the cats that were now alternating between circling in and out of his legs and jumping back up on the wicker chair, eyes glued in the direction from which the intermittent tweeting originated.

“It’s a gorgeous little bird!” said the HH with a big grin. And right on cue, another “Tweet!” rang out as if to say, “Yes! That’s me! I’m found!” The feathered little critter was hunkered down in the foliage just outside of our window, his brightly colored head just barely visible. We were pretty certain that the little guy hadn’t been born in the wild.

Given how small the little fella was, we knew we were his only chance to make it . After all, Mama and Comet, the feral cats we inherited when we bought our house (and parents of five kittens we adopted and domesticated), are both excellent hunters and would quickly discover such easy prey. Although he was skeptical that he’d be able to get too close to the little bird, I convinced my Hubby to take one of our cat carriers and see if he could somehow entice the bird inside so we could take it to our local shelter.

To our great relief and delight, it took the HH less than two minutes to secure our new feathered friend inside the carrier. The tiny critter was clearly hand reared -- he was totally fearless and, after being gently nudged, climbed right on to the twig my husband offered to him as a perch. Once inside the carrier, he seemed to breathe a sight of relief, as if to say, “Thank goodness!” Guessing that he wasn’t able to adequately feed himself during his outdoor adventures, we placed a small container of clean water and some whole grain bread crumbs into the carrier. Our little bird’s relief became obvious gratitude as he dove in and ate with exuberance.

After a quick call to the shelter to make sure they could properly care for him, our tiny little visitor was loaded into the car and on his way to a safe, hew home while I proffered Pounce treats to each of our kitties who made this rescue possible.

After arriving at the shelter, things fell into place so perfectly it was as though it had been pre-planned. My hubby was me by a warm, friendly woman named Liz, the bird lover with whom he had spoken to earlier. She eagerly took the carrier and after a quick peek inside, lead the Hip Hubby into a small exam room. As they walked, Liz told the HH that this was a little Love Bird, probably not more than two months old.

As soon as the exam room door closed, Lupe in Mama Liz‘s handsLiz opened the carrier and reached inside. The little bird must have sensed that she was bird-friendly -- as soon as Liz’s hand closed gently around his small body he let out a contented chirp, then closed his eyes, sighed, and nuzzled his head against her fingers. Liz, in turn, whistled and chirped back at him, putting the baby bird totally at ease while she look him over.

After her brief exam of the bird she had already named Lupe, Liz told my husband that from the tattered condition of the bird’s feathers, she believed he’d had a rough go of it recently. We’d had abnormally strong winds blowing almost constantly for the last few days, compliments of a subtropical storm named Olga that had formed about 200 miles to our northeast, near Puerto Rico. According to Liz, who was still cradling Lupe in her hand, the poor little thing had most likely been blown all around the island, finally landing in the shelter of our yard. She was convinced we had saved his life.

It was clear there was a mutual attachment growing between Liz and Lupe. As a shelter worker, Liz was required to put the bird up for adoption. But after telling my husband all about her other birds as she stroked the soft feathers on top of Lupe’s head, she confided in my husband that if no one had come to adopt Lupe by the end of the day, Liz was going claim him as her own. That was just fine with us, and seemed to be more than okay with Lupe.

And that’s exactly what happened. When the shelter closed, tiny little Love Bird Lupe was settling in with his new Mama Liz and meeting his new birdy friends, and we were feeling pretty darn good about saving the life of another animal.

Friday, December 14, 2007

Home Pharmacology at Its Best…and Worst

The HipCrip Home Pharmacy has been busy these last few days.

Despite a five hour island-wide power failure, I was able to make my follow-up appointment with Dr. G on Wednesday afternoon. There was lots of good news: my post-Cipro culture showed that my UTI had totally cleared up, Dr. G didn’t lecture me about defying his orders by using the acetic acid solution to clear up the cellulitis on my thumb, and I’d lost three pounds since my visit two weeks prior. (The latter was a totally unexpected bonus.)

The lungs, however, remain a mystery. All of my blood work looked fine -- no raging infections present, and no problems with low potassium or other blood salts. (My last trip to the ER ended with me spending the night taking potassium supplements via IV and mouth after a combination of lots of water going in and even more coming out -- thanks to the diuretic Lasix -- caused my potassium to drop to a dangerous level.)

Unfortunately, Dr. G had little to offer me by way of relief for my breathing problems. He couldn’t explain why I was suffering from such bad edema, which I told him was compounding the muscle tension constricting my lungs. (I’ve since learned that this “Michelin Man” problem is known as the “MS (Multiple Sclerosis) Hug” and is quite common among people with spinal cord lesions.) So I took matters into my own hands by taking a full dose of Lasix for the water retention and a tiny little bit of oral baclofen for the muscle constriction.

The results have been good, even if the path to get here was a bit rough.

The Lasix had an immediate effect, drawing out three liters of fluid in about eight hours. (With that much fluid saturating my body, I’m hoping I actually lost more than the three pounds that were reflected by Dr. G’s scale.) To avoid another ER potassium crisis, I’m on the two banana a day plan. It’s now been almost 48 hours since I dosed myself, and the water weight has stayed off. Do I need to tell you that I am strictly limiting fluid intake (on Dr. G’s instructions) so it doesn’t come back?

Although I haven’t been prescribed oral baclofen in years, I keep some on hand. Adding a tiny bit of oral medication to the dose has been known to help out in the past when my legs were, as my husband describes them, unbendable steel bars. Now when I say tiny bit, I’m not kidding -- anything more than a few grains from a 20 mg tablet and I’m so groggy that I sleep for the better part of a day.

Which is exactly what happened yesterday.

It seems that my visual guesstimate on the amount of baclofen I carved off of the tablets was a bit off. Instead of just getting the tension in my legs and abdomen to relax, I ended up with a bit of an overdose, which slowed my breathing and made me so stoned I was unable to do anything except sleep for over 22 hours.

It’s more than a little scary to me when this happens, because I suffered a life-threatening overdose when I had my pump replaced last year. At that time, the doctors found and repaired a small leak in the tubing that connects the pump in my abdomen to the catheter implanted in my lower thoracic spine, but neglected to adjust the amount of medication I was receiving. It seems that quite a bit of the drug was leaking out of this hole in the tubing, because I lapsed into a coma as soon as the full dose made it into my cerebral spinal fluid. It was sheer luck that one of the premier experts on Intrathecal Baclofen Therapy practiced at a different facility within the same medical center -- he was called right away and his immediate response saved me. Believe you me that if I try this again, it will be with the tiniest fleck of medication. I’d much rather get almost no relief than go through that overdose situation again.

Today, I’m pleased to report that I’m mostly back to being my normal self in every way. My brain is free of the baclofen fog, my abdominal and leg muscles are more relaxed than they have been in weeks, and all of the swelling from the extra water weight I’d been carrying has gone. And I’m drawing regular deep breaths without hearing that annoying little whistle-wheeze when I exhale.

I go to get my pump refilled on Monday, at which time I’ll have my doctor bump up my dosage by 10-15 percent in the hope that will be enough prevent my legs from becoming rigid and my lungs from being held hostage by the dreaded MS Hug. But there’s plenty of time to think about that, and all of the stress air travel brings on my body and mind, later. Right now, it’s time to enjoy feeling good for a change.

Tuesday, December 11, 2007

Take a Deep Breath (If You Can)

Tomorrow is my follow-up appointment with Dr. G to check on how well my various injuries and maladies are doing. On the plus side, the cellulitis on my thumb and my latest urinary tract infection seem to be completely healed. But despite taking my 10 day course of Cipro, I’m not breathing any better than I was weeks ago. Normally, that wouldn’t concern me -- since developing bronchiectasis, I sometimes need to be on antibiotics for up to four weeks to get a lung infection to clear up enough to return my breathing to status quo.

But I don’t think a lung infection is the only thing going on anymore. Last week, my DH noticed a new factor in that’s definitely contributing to my perpetual shortness of breath, and I’m worried that solving my problem just got a whole lot more complicated than just taking some additional Cipro.

A little bit of history is necessary to understand where I’m at right now.

When I had my Baclofen pump replaced last year, I discovered that my left leg will act up when some part of my body where I have limited or no feeling at all is uncomfortable. The acting up can take many forms, from twitching rhythmically to one or more muscles tensing up and remaining rigid in spite of our best efforts to relieve the spasms. This has turned out to be a very useful warning device, as it lets me know that trouble is brewing in one of the many areas on my body where I can’t feel sensations like pain, temperature changes and such. (The local nerves, which are healthy, still detect the stimulus, but the signals can’t get to my brain to be interpreted because my spinal cord is so badly damaged.)

When my leg starts acting up out of the blue, I know that something is amiss that needs my immediate attention. The problem could be obvious and easy to remedy (discovering that there’s a large dent in the back of my thigh because I’ve accidentally been sitting on the cap to my bottled water) or more subtle and complicated (internal infections).

Last month, right about the time I first noticed my lung problems, my left leg started developing knots in the calf and thigh muscles that couldn‘t be relieved (think 24/7 Charlie horses above and below the knee). At first, this didn’t concern me -- I thought it was probably being triggered by any or all of the infections that I was battling (lung, urinary tract, cellulitis on my hand). I did my best to cope with the discomfort and looked forward to it going away once I got some antibiotics into my system.

But the antibiotics didn‘t help. And now there‘s new problems that have surfaced, neurological symptoms that may mean that my degenerative spinal cord damage has gotten worse. If that’s really the case, then it may be that no amount of antibiotics will allow me to breathe easy again.

The first change I noticed started last week, after a nap. When I woke up, there was increased numbness in my right arm and left leg (both already suffer from limited sensation related to my spinal cord damage). At first I thought it was just a circulatory problem from sleeping with these limbs extended in very awkward positions. But when it didn’t go away after 48 hours, I reluctantly acknowledged that something bigger may be going on.

The next day, I was feeling particularly constricted around my midsection. I can best describe it as a cross between wearing a Michelin Man costume that‘s a size too small (e.g. feeling like there’s a tight-fitting inner tube or two around my waist) and bending over a 2” x 4” and having it press into your gut. This has been happening a lot in the last month -- I had simply attributed it to bloating from water weight or excess air in my digestive track (an annoying and embarrassing side effect of the problems I have with swallowing). When I commented to the Hip Hubby about this, he gave my belly a poke right below my ribs.

The muscles in my abdomen were rock hard. No wonder it’s been such a struggle to draw a decent breath!

Even though this was a really disturbing discovery (made even more so because it‘s happening at the same time as the other new problems in my arms and legs), it was a relief to figure out why I had been having so many problems that couldn’t be resolved using my usual tactics (diuretics to relieve bloating, etc.)

I’m praying hard that all of these problems are just temporary glitches in my wiring, and that one morning soon I will wake up to discover that my leg hurts less and moves a bit more easily, that my hands aren’t tingling, and that I no longer feel like I’m wearing a metal cummerbund around my waist. But I’m scared -- really scared -- that they’re not an anomaly but instead represent the next level of “normal” as I lose even more spinal cord nerves to the irreversible damage caused by tethering, syringomyelia, and just plain old aging.

I will be mentioning this to Dr. G tomorrow, although I’m not sure what he can do to help me relieve the symptoms. (Who knows -- he has surprised me before.) And if there’s no change by next week, when I go to Puerto Rico for my next Baclofen pump refill, I’ll ask that doctor to up my daily dose in the hopes that it will at least relieve the tension in my legs, and at best get my abdominals to loosen up too. The option of last hope for help is to visit the island neurologist, and see what he may hold in his bag of tricks to make my life more comfortable.

If I may toot my own horn, I’m doing amazingly well in accepting the possibility that there’s a good chance these changes may be permanent. Who knows? Maybe I’ve finally taken to heart all of the advice I’ve given about panic/anxiety/worry/stress not doing a thing except making you feel worse than you already do. It may be small, but at least it means that I learned to do something good as a result of yet another neurological setback: I learned how to take a deep breath.

Monday, December 10, 2007

Body Behaving Badly - The Update

(My thanks to a new online friend, razzle51, for poking me about getting this updated.)

After reaching the end of my rope with being unable to breathe or sleep, I did go see the doctor. Technically, I saw two doctors. The first was a doctor recommended by my former primary care doctor, who retired in September. This appointment was short and sweet, as it turns out that my former doctor never bothered to learn that his chosen successor didn’t do general medicine (she focused her practice on women’s health only).

Even though Doctor #1 wasn’t going to accept me as a patient, she was exceptionally gracious and helpful. After learning that I was there because I was having breathing problems, she gave me a brief . After hearing my lungs crackle and pop and seeing the edema in my legs and arms, this Good Doctor of the West (End of the Island, that is) immediately went about making personal calls to get me an appointment that day with a colleague who could become my new primary care provider. In a textbook example of it’s not what you know, it’s who you know, she managed to get me an appointment later that afternoon with Dr. G, and internist who is also the head of internal medicine at the local hospital. Conveniently, Dr. G had taken care of me when I was hospitalized earlier this year, and already knew that I was a strong-willed woman with a most unique collection of medical conditions.

But the miracles from the Good Doctor from the West did not stop with securing that appointment for me. To make sure that Dr. G would have everything he needed to start treating me at hand, the Good Doctor of the West sent me directly to the Island Imaging Center to have a chest x-ray in time to hand deliver the radiologist’s report to Dr. G. And in a final act of pure goodness, she told us there was no charge. Rather makes me wish she was going to be one of my doctors, you know?

Since moving to our little island, we had become used to…shall we say “laid back” service from doctors. Dr. Former didn’t employ a nurse, and in the three years I saw him he never took my vital signs unless I had brought a specific complaint to his attention. Even so, he only took my blood pressure once (when I told him my last few readings had been high), my temperature twice, and never checked pulse or respiration rates, or asked about my weight. (Since I cannot stand, it’s virtually impossible for any doctor to weigh me, so most settle for asking for my best guess.)

It was apparent that Dr. G never got the memo about island docs being laid back. We were met by Dr. G’s nurse who, after learning I couldn’t stand, lead me to a wheelchair scale! After asking me how much my chair weighed, she directed me onto a rubber mat, clicked a button, and collected a printout before leading me to the exam room. My surprise at finding this very rare piece of equipment in my new doctor’s office quickly became elation when I discovered that I weighed 27 pounds less than I had been estimating for the last few years. How cool is it to lose 27 pounds just by walking into a doctor’s office? WAY FRICKIN’ COOL!

The pleasant reminders about what it’s like to work with a competent doctors didn’t stop there. Upon entering the exam room, the first thing I noticed was the laptop docked at a small desk -- one the doctor actually used to take notes during my exam. (It turns out he has to -- all docs seem to have questionable penmanship but this man writes worse than a quad friend of mine who controls the pen with his mouth.) Before I could finish my nod to my hubby about the laptop, the nurse had placed a thermometer in my mouth, a blood pressure cuff on my arm, and was taking my pulse and respiration counts. The kicker came when she pricked my finger and tested my blood sugar on the spot, which is apparently standard procedure for all their patients as I don’t have diabetes or hypoglycemia. (I wish more doctors down here would do this as diabetes run rampant in the USVI.) Long before Dr. G set foot in the room it was clear to both the hubby and I that we weren’t in Kansas anymore.

The reunion with Dr. G was amusing. He actually said, “Oh no, it is you” when he entered the exam room and saw me sitting in my chair and grinning up at him, a wicked glint in my eye. And then he laughed. When I heard that, I knew that he was willing to work with me, even though he knows that the complicated nature of my health -- and my history of not complying with any advice, rules and/or regulations that I consider to be at odds with my best interests -- will challenge him like no one he’s seen before.

After all of that, the actual exam was pretty ordinary. The lung x-ray should some evidence of pneumonia, and a urine culture I had done the week before showed an infection there, too. So 10 days on Cipro (prescribed in the hope it would be a double whammy and knock out both infections), another urine culture after the last Cipro tablet is taken, and then back to see Dr. G on the 12th.

I also casually mentioned to Dr. G that I was having another outbreak of a recurring infection that had been plaguing the finger tips on my right hand. So naturally he asks me to take off my band aid so he can take a look at it -- and he freaks out. He immediately diagnoses it as cellulitis, and starts worrying out loud that it has invaded the bone. I assure him it hasn’t, to which he asks how I know. And I tell him that I just do -- which I do. Really. I have an amazing talent of knowing when problems with my body are superficial and when they are worth worrying about. Many of my doctors eventually come to trust this (I had a neurosurgeon who told me that he was certain I could tell I was having neuro problems at least six months before an MRI could provide evidence of it). However, being a newbie to my world, Dr. G sent me off for blood tests and an x-ray of my thumb just to be sure. He also told me to lay off treating this infection with anything except a clean, dry dressing -- especially the treatment that worked best, a twice a day application of a .25 percent acetic acid solution.

And with that, off I went.

There’s something about antibiotics that do strange things with me when I have lung infections -- namely, I always seem to get worse after I start taking them. And this last dose was no exception. Even as I watched (and felt) the UTI clear, my lungs got worse. Five days into the 10 day treatment schedule, I started coughing; until that time, I had only been struggling for breath and wheezing upon exertion. It wasn’t a day later before I brought up the first bit of lung gunk in a lovely shade of neon not mean to be found in the human body. And it hasn’t eased up since, even though I finished the Cipro four days ago. The question remains: did the Cipro cause the phlegm or was the phlegm there all the time, and the Cipro just helped to get it out?

The thumb also got worse, and fast. The day after I had my blood drawn and the x-ray taken, it did bad things I won’t describe here to protect the squeamish. As soon as I saw what was happening, I set myself up for my first clash with my new doctor by starting treatment with the acetic acid. That was 10 days ago, and the wound is almost totally healed. I’m not quite sure what made Dr. G so opposed to the treatment Dr. Former had prescribed (it may have been just that: it came from Dr. Former). After all, it didn’t involve more antibiotics (I’m developing resistances and have to be careful about how much and when I take them), and most importantly, it worked. I guess we’ll find out when I see him on Wednesday, when I‘ll also get the results from the blood work and x-ray. As he handed me the x-ray orders, the good doctor assured me that if it showed there were any evidence that the bone had been compromised, “I would be admitted to the hospital for IV antibiotics so fast I wouldn’t know what hit me.” Since I’m writing this from the comfort of my own home, I’m pretty sure I was right about this being a superficial problem.

My appointment Wednesday ought to be very interesting indeed.