Thursday, March 22, 2012

Doc-O-Matic 2012 Report

Wow, it was like I knew the symptoms already or something: dx sinus infection, rx Amoxicillin twice a day for ten days.

Back home now and back in bed, after a short nap on the couch to prepare for the tricky assault on the East face of my bedroom.

(Just for Able, with great affection:

Entering the examining room pale as Death, stark naked and glistening with what I supposed to be animal fat, her iron-gray hair in direly snake-like dreadlocks and with a chicken bone through her nose, my fiftyish physician shrieked nonsense syllables, then ceremoniously twisted up and burned the nurse's intake report on a small brass altar inset in the side wall. She licked the still-hot ashes from the brazier, took up some of the resulting paste on her fingertips and traced lines down her face. She then turned to face me, shaking a curious bundle I recognized as a stethoscope, wound and braided with dark ivy in full leaf. Leaping straight up into the air, she hawked and spat a nasty gray blob of ash, sputum and mucus right at my feet before murmuring, "Probably sinus. Amoxicillin, well-tolerated, usually effective, if you're not better in five days, come back."

With that, she turned off the lights and left the room, never to be seen again. Awed, whispering nurses edged in a few minutes later and led me to the outer sanctum, where, with many a grandiloquent flourish, I was presented with a prescription and a bill.

--That's how we've always done it here, of course, but rarely so well.)

17 comments:

Tango Juliet said...

Get well soon!

Drang said...

So, no tower work for you any time soon...?

Able said...

Sorry to be a pain (but it's the only thing I do well) but how did doc-in-a-box diagnose this? (I'm only doing this coz I'm a 'caring professional' honest!)

Why? It's just that whilst you know yourself, and as such probably do have another sinus infection, some of your symptoms are anything but sinus related (joint pains, weakness, tinnitus, off food and especially dizzyness).

It's not the first sinus episode is it? as such I'd expect at least a CT and labs to confirm that limited selection of symptoms and then a prescription of a fluoroquinolone (ie. Cipro) at least (not another penicillin) for what is effectively a chronic sinusitis (if you're sure).

Alternatives could be a concurrent Otitis Media or Labyrinthitis I suggested or, sounding more likely, something like Nasopharyngitis (with the tinnitus even Fibromyalgia is a better symptom fit).

Hope it all resolves but doc-in-a-box just got demoted, in my book, to 'don't bother except when you want a script signed' after you've self-diagnosed.

Get well soon!

K U said...

I feel your pain... or felt it. When I flew to the UK for an Air Force stint, I flew with a "sinus issue". Woke up the day after arrival and couldn't even stand up. No balance whatsoever. I was admitted to the base hospital, saw the doctor once and was flat on my back for three days.

On the morning of the fourth day, I asked when I'd see the doc again. About two hours later the nurse told me (rather sheepishly) that he had transferred back to the states the day after I arrived and they forgot to assign another doctor to me.

I asked for my clothes and haven't gone near a hospital since! And that was in 1975!

K U said...

I feel your pain... or felt it. When I flew to the UK for an Air Force stint, I flew with a "sinus issue". Woke up the day after arrival and couldn't even stand up. No balance whatsoever. I was admitted to the base hospital, saw the doctor once and was flat on my back for three days.

On the morning of the fourth day, I asked when I'd see the doc again. About two hours later the nurse told me (rather sheepishly) that he had transferred back to the states the day after I arrived and they forgot to assign another doctor to me.

I asked for my clothes and haven't gone near a hospital since! And that was in 1975!

K U said...

I feel your pain... or felt it. When I flew to the UK for an Air Force stint, I flew with a "sinus issue". Woke up the day after arrival and couldn't even stand up. No balance whatsoever. I was admitted to the base hospital, saw the doctor once and was flat on my back for three days.

On the morning of the fourth day, I asked when I'd see the doc again. About two hours later the nurse told me (rather sheepishly) that he had transferred back to the states the day after I arrived and they forgot to assign another doctor to me.

I asked for my clothes and haven't gone near a hospital since! And that was in 1975!

K U said...

I feel your pain... or felt it. When I flew to the UK for an Air Force stint, I flew with a "sinus issue". Woke up the day after arrival and couldn't even stand up. No balance whatsoever. I was admitted to the base hospital, saw the doctor once and was flat on my back for three days.

On the morning of the fourth day, I asked when I'd see the doc again. About two hours later the nurse told me (rather sheepishly) that he had transferred back to the states the day after I arrived and they forgot to assign another doctor to me.

I asked for my clothes and haven't gone near a hospital since! And that was in 1975!

K U said...

I feel your pain... or felt it. When I flew to the UK for an Air Force stint, I flew with a "sinus issue". Woke up the day after arrival and couldn't even stand up. No balance whatsoever. I was admitted to the base hospital, saw the doctor once and was flat on my back for three days.

On the morning of the fourth day, I asked when I'd see the doc again. About two hours later the nurse told me (rather sheepishly) that he had transferred back to the states the day after I arrived and they forgot to assign another doctor to me.

I asked for my clothes and haven't gone near a hospital since! And that was in 1975!

K U said...

Yer blogs not broke!

I thought the "prove you're not a robot" toy was telling me to take a hike.

What it was really telling me was that after 12+ hours pen testing, I have no business going anywhere near a keyboard!

My apologies.

rickn8or said...

Get well soon Roberta.

Meanwhile, play the Sympathy Card for all it's worth.

Frank W. James said...

Get Well Soon Kid, but my personal experience with amoxicillin for sinus infections is it is about as effective as aspirin.

Hope it works for you. I always ask for at least a Z-Pack...

All The Best,
Frank W. James

Roberta X said...

Able: This particular M.D. views the doc-in-a-box gig as something like veterinary work; she does not give patient-reported symptoms nearly as much weight as her own observations as interpreted though her own experience and knowledge.

In a practical sense, how would treatment differ other than, perhaps, choice of antibiotic? I figure Amoxicillin is a good start...unless it's viral, in which case time, adequate nutrition and sleep will probably do.

Able said...

"how would treatment differ"?

Hmm, well it's more along the lines of 'diagnosing a cause' (something reputable physicians occasionally attempt to do) as opposed to picking only one of a multifarious bunch of symptoms and saying 'Ahah! That'll do - hand over the cash.'

It more than likely is a sinus bacterial infection but, as you'll be aware, what caused that could be one of a three page list of ailments (primary cause is usually a viral URTI causes swelling, obstruction, and then... bacteria set up a rave party). Then there's the differences in which sinus is effected (symptoms vary). A CT would show the why (perhaps structural?), labs? to differentiate between obstructive and infection (cells in exudate), and to specify what organism for a targeted response to actually clear, as opposed to reduce, the infection. Why a fluoroquinolone, because repeat prescriptions of any limited spectrum antibiotic, like Amox, do develop resistance and become rapidly ineffective. Just sayin'.

The main concerns are the other symptoms (tinnitus, joint aches, dizzyness), they point to a completely unrelated cause. I'm definitely no expert but the only thing which would fit 'All' the symptoms as a single cause is something like fibromyalgia. They in themselves are as serious as the pain of a blocked sinus, if not more so. Don't worry too much though as multiple, separate opportunistic infections taking advantage of a 'run-down' super-lady are not unusual.

Like I said, I hope it all does resolve with the Amox! Just watch the other symptoms too.

Get well soon!

(Oh and I am now going to seek urgent ENT assistance myself since I appear to have aspirated the barley-saugar I was sucking when reading your description of the consultation - It may have been the image of you 'throat-singing'! I think I need a donut )

Able said...

I know it's probably a silly question but have you ever suffered a traumatic injury to head (specifically jaw) or neck (ie whiplash type injury)?

Why? You became an anonymous topic of conversation at the Infirmary here and we considered TMJ disorder and Barre-Lieou Syndrome as probable diagnosis. Just a thought, and resolvable with chiropractic input. (Google them and compare)

Sorry, I'm a bit OCD on this type of thing. I shall return to my lurking lair - until Disease calls to be resisted yet again! (yes, I do have a disease-fighters outfit - scrubs, mask and non-latex gloves [purple if you must know], I think the tactical tongue-depressor pouches are a nice touch).

Robin said...

I get the same thing at Kaiser, but the doc wears clothes.

Otherwise - identical.

Roberta X said...

Able, the trouble with Barre-Lieou Syndrome, at least in the States, is that it's a bit of a catch-all and not well-regarded -- q.v., "...obsolete eponym."

But to shortcut a lot of back and forth, I do have some nasty issues of the cervical spine, especially around C4/C5, some whaddayacallit-ridiculopathy and a bit of displacement; but it's in a place where spinal manipulation is more likely to do me great harm than good, especially considering things would not sit right if they were forced back into place. The never-pinching usually announces itself with hand trouble, and has not done so since the last round of PT and shots into the spine some years back, the latter a terrifying experience I have been though twice and would as soon avoid.

Able said...

"obsolete eponym"

Ah yes, we medical types are real suckers for following what's fashionable, believe me. What it really means is that someone in a position of authority, usually educational, disagrees with an hypothesis (usually having published an alternative) and so all the next few 'bright young medics' get turned out having this meme implanted (I could mention smoking as an example of medical science choosing to ignore evidence in favour of opinion but I get a bit worked up on that one).

I worked in a specialist diagnostic centre in London (St. Thomas') with two Consultants - we ran a sweapstake on whose favourite eponymous syndromes would be in or out each month.

Thank you for allowing me to switch of my overheated grey-matter by giving the real mechanism possibly causing those other problems. My sympathy about your PT experiences, there always seems to be a lot of 'dust in the air' whenever I go for my regular knee appointments (the Marquis de Sade has nothing on my physio). You could get an unofficial opinion from a Chiro as their approach is often very different than traditional physio.

I still think a CT and Cipro though!(climbing of soap-box and quietly sulking in corner) ;-)