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.

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