Hey it is Kathy here with another post for “The Medical Connection.”

Yesterday I saw another one of my favorite patients. He was returning for a follow up from last week. Mr. C, was complaining last week of an itchy rash along his right ankle and slightly on the left. He had tried multiple “over the counter” cremes with no improvement.

Mr. C about 4 weeks ago had a bout of C. difficile colititis, due to the antibiotic he was given to treat an upper respiratory infection. This type of colon inflammation is induced by your common broad spectrum antibiotics. You see, C. difficile is a normal anaerobic (doesn’t like oxygen) bacteria in your colon in small numbers.
When your Doctor gives you a broad spectrum antibiotic like Amoxicillin, Levaquin, Augmentin, etc. the treatment effects not only at the site of your infection, but also the normal flora in your large intestine. So when you are taking your broad spectrum antiobiotic it will decrease the normal good bacteria in your colon and allow the C. difficile to multiply and gain strength. When that happens you have the colitis symptoms which will begin to develop like abdominal cramping, nausea, uncontrolled diarrhea,…………Yes, I know this is TMI, but people need to understand this. This is why you never take antibiotics on your own. Healthy people have lost colons because of this problem.

Prevention Hint** Eat yogurt 3x/day while on Antibiotics or take a good Probiotic while on your antibiotic and for at least 7 days after completing your antibiotic.

Now back to Mr. C.

So when I saw Mr. C last week with the rash on his right ankle, I recommended an antibiotic creme and not an oral antibiotic.
The last thing he needed was another antibiotic. People that get C. difficile tend to be frequent flyers with enhanced recurrence if you are not careful.

I scheduled Mr. C for a follow up visit in 5 days because cellulitis can worsen quickly, lead to blood clots, sepsis (infection in the blood) if you are not careful.
Mr. C, presented yesterday with with a major improvement of his ankle rash. When I looked closely he did have a significant change, but I noticed the rash was only where his socks covered.
Upon noticing this, I recommended to the patient he may want to not wear socks throughout the day, maybe even wear flip flops to allow air to help heal his rash. I recommended he may even have an allergic response to his socks he was wearing.

Mr. C  looked up at me very concerned and said, “But, I can’t stop wearing these socks. When my wife died I started wearing these socks to keep my feet warm at night. No way, can I stop wearing these socks.” He smiled at me and I said nothing because I knew he had more to say. “Anyway, I can’t give up my holey socks. I wear these to church.”
Mr. C proceeded to take off his shoes and illustrate very proudly his toes protruding from holes in his socks.
He smiled even bigger, causing his lines around his eyes to wink at me. ” Twenty years ago, my wife bought me these socks and I can never let them go.”

Just keeping it real.

Kathy Marshall

The “Medical Connection”

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November 6, 2009

Hello to you all. It is a beautiful friday afternoon in Friendswood, Texas. I have a great story to share today.

 During this journey of creating my home based business dynasty I do still work as a Physician Assistant. I really enjoy what I do as a health care provider. You just never know when the patient or a family member comes back to say thank you for helping them.

Back in time, about 2 weeks ago a nice man stopped at my desk where I work in a retail clinic. I could tell he really didn’t want to be speaking with me and probably was not a frequent flyer with his primary care physician.  He held out his right hand to me and showed  a swollen red thumb that was really hurting him. He did have a minor scratch on the thumb, which he said was done while working on his boat.

I asked him to roll up his arm sleeve and yes, I saw the hint of a small linear red streak going up his lower right arm. He did not have a fever and other than the pain on his right hand he did not really feel very bad. He told me he was presenting to our clinic for antibiotics because he was a busy man and did not have time to wait for his primary MD in his clinic.

So, as I spoke with him he was sort of nervous and I could tell he wanted to split because the whole medical thing was just overwhelming to him.  I next sat down and asked him to do the same. I removed the stethoscope around my neck and gave him a smile.

His wife had showed up by then. My reply was to the both of them, that the patient would need emergent care and referred him to the closest emergency room for evaluation, probable IV antibiotics and hospitalization. 

The patient kept saying but “It is only a small scratch?”

Similar scenes occurred while I was a student at Baylor College of Medicine, during our student training in the ER.  I promise to not get graphic but we saw numerous patients losing limbs, getting bacteria in their blood or chronic heart problems because they thought “It is only a small scratch”.

I slowed the patient down, the busy man and shared a few stories of my memories.  Speaking slow and sure I told him he needed to take care of himself now and go to the ER immediately. He listened , thanked me and left on a mission to visit the ER.

Today his wife stopped at the desk to thank me for helping with her husband.  He actually was not a regular patient with his MD and often would not follow medical advice.  His wife told me he was hospitalized for 3 days, was treated with  3 different IV antibiotics.  He recovered quite nicely with full function of his right hand and arm. He was told upon admission his recovery was good because he listened and followed instructions. Because he took immediate action his outcome yielded awesome results.

This story should speak to all of us that are getting training for our online and offline adventures.  Not following good instruction, getting mislead or not listening can yield poor and often devastating results.  Listening to your heart, following instructions and doing the right things can lead to success.  But where do you go for such knowledge with so much being sold and marketed to the thousands of visionary people.  Like in medicine if we take the time to explain and educate, patients can have great outcomes.  Your future and business can be successful and we would like to help you get to that point.

But first and most important action is required.

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October 29, 2009
Simple day in the clinic. The hype and scare of the H1N1 illness has people running around with the “deer in the headlights look”.  You really can’t blame them with so many cases of Swine Flu being reported.  I decided to not take the vaccine, since I am not surrounded by multiple sickly patients, thus I will not be a huge threat to spread the virus. Also, in my work environment, I see others that were in higher need to be vaccinated.

You can always tell the patients with serious anxiety disorder. They walk up to the desk and can’t quit moving. They play with the business cards, the scanner to pay, they smell like cigarettes and they can’t look you straight in the eye.
I understand these people and let them run themselves to the point of exhaustion. Some just won’t stop. My focus is to help them leave with a tool to help them. I find laughter is the key with most of these patients.
Now, dealing with the angry patient is my favorite. Yes, I love working with hard cases. My goal is to take the angry ones and have them leaving the clinic laughing their ………..off. Laughter is seriously the best medicine.  Often as they leave I say a secret prayer for them.

Another day of keeping it real as a health care provider that cares.
Kathy