scuba-sass
Wreckmaniac Extrordinaire
This is completely non-diving related, so if the Mod's think it should be moved to the non-diving forum, feel free...
My partner and I had an experience this week, that I'd like some medical opinions on. We live in Connecticut, USA, and have not been diving since last summer (long story - we really miss it), so this really is not dive-related.
Sorry, it's a rather lengthy tale...
On Sunday, June 15th we went for a 4-hour hike in the woods with our dog. Bug spray was applied, and no ticks were found on any of us. On Wednesday, June 18th my partner (Lydia) began to feel ill. Fever, headache, neck and back pain, joint pain throughout her body, especially in her jaw. She failed to mention any of this to me until the weekend. She was taking Tylenol regularly to reduce the fever, but symptoms continued to get worse. We attempted to go to a walk-in clinic on Sunday (6/22) morning, but were turned away. Her insurance would require her to change her PCP, which couldn't be done until Monday. She decided to hold off for her own PCP on Monday.
That evening, only 3.5 hours since the last dose of Tylenol, her temp was 102.0F, and she agreed to go to the Emergency Dept. at a large nationally-known teaching hospital in our area. The choice of facility may have been our first big mistake. Upon check-in, her temp was 101.7F - I had given her more Tylenol before deciding to leave home. We were at this facility for 7 hours, only the first 15 minutes in the waiting room (pretty impressive - I expected a longer wait for treatment). Lyd was asked about bites or rashes, she had none. They took urine and blood samples, chest x-rays and lumbar puncture(s). This last was, understandably, the worst. I was not allowed in the treatment room for the procedures. The first attempt was sitting up on the side of the stretcher, and Lyd nearly passed out. She was given a bag of fluids, and allowed to rest for about an hour or so, before the second attempt, which they did with Lyd laying on her side. According to her - they "poked" her 6 or 8 times. The first LP was done by a very nice Physician's Assistant, and the second by a 3rd year Resident - the only Doctor we saw all night. The conversations Lyd overheard during the LP's were not very confidence-inspiring, I won't go into the details.
After all this, they were able to rule out meningitis, but couldn't reach any other conclusions. Lyd was sent home with a prescription for 600 mg Ibuprofen every 6 hours for the pain, and advised to take Tylenol every 6 hours (alternating by 3 hours) for the fever. Also "If it gets worse, come back. If not better in a few days, call your MD".
There was no improvement, and possibly her fever cycle was worse - the Tylenol was not lasting as long. On Tuesday, we saw an MD at her regular practice. Her first comment was "Wow, they really did a number on your back!" This was, ofcourse, about the LP. This doc made the assumption we were dealing with Lyme's disease, in an early stage which might not yet show up in blood work. On the "it can't hurt" theory, she prescribed Doxycycline (sp?) every 12 hours, blood tests and continue with the Ibuprofen / Tylenol cycle. She indicated that if it is Lyme's, Lyd will feel better after the 2nd or 3rd pill. Miracle of Miracles, by Wednesday evening there was an amazing turn around. Still achey and a little feverish, but nothing like before.
Now for my questions:
1. Given the symptoms presented at the ED (the same presented to the PCP), why couldn't they consider Lyme's, and begin treatment for it? If not caught and treated early, Lyme's can have some serious long-term health effects.
2. Should PA's be able to perform LP's???
3. Given the options of a large teaching hospital, or a variety of sizes of community hospitals, did we make the right choice? In other words - was the LP performed as someone's "practice", or would any of you Doc's have performed it in this case? (I realize you can't give a deffinitive answer here...)
Any way, thanks for listening. This has been a very taxing week, the worst being the lack of any known cause for a high fever lasting more than 5 days. The relief of even a possible diagnosis (Lyme's), was significant. When the treatment began to be effective, we were nearly ecstatic!
Thanks!
Scuba-sass
My partner and I had an experience this week, that I'd like some medical opinions on. We live in Connecticut, USA, and have not been diving since last summer (long story - we really miss it), so this really is not dive-related.
Sorry, it's a rather lengthy tale...
On Sunday, June 15th we went for a 4-hour hike in the woods with our dog. Bug spray was applied, and no ticks were found on any of us. On Wednesday, June 18th my partner (Lydia) began to feel ill. Fever, headache, neck and back pain, joint pain throughout her body, especially in her jaw. She failed to mention any of this to me until the weekend. She was taking Tylenol regularly to reduce the fever, but symptoms continued to get worse. We attempted to go to a walk-in clinic on Sunday (6/22) morning, but were turned away. Her insurance would require her to change her PCP, which couldn't be done until Monday. She decided to hold off for her own PCP on Monday.
That evening, only 3.5 hours since the last dose of Tylenol, her temp was 102.0F, and she agreed to go to the Emergency Dept. at a large nationally-known teaching hospital in our area. The choice of facility may have been our first big mistake. Upon check-in, her temp was 101.7F - I had given her more Tylenol before deciding to leave home. We were at this facility for 7 hours, only the first 15 minutes in the waiting room (pretty impressive - I expected a longer wait for treatment). Lyd was asked about bites or rashes, she had none. They took urine and blood samples, chest x-rays and lumbar puncture(s). This last was, understandably, the worst. I was not allowed in the treatment room for the procedures. The first attempt was sitting up on the side of the stretcher, and Lyd nearly passed out. She was given a bag of fluids, and allowed to rest for about an hour or so, before the second attempt, which they did with Lyd laying on her side. According to her - they "poked" her 6 or 8 times. The first LP was done by a very nice Physician's Assistant, and the second by a 3rd year Resident - the only Doctor we saw all night. The conversations Lyd overheard during the LP's were not very confidence-inspiring, I won't go into the details.
After all this, they were able to rule out meningitis, but couldn't reach any other conclusions. Lyd was sent home with a prescription for 600 mg Ibuprofen every 6 hours for the pain, and advised to take Tylenol every 6 hours (alternating by 3 hours) for the fever. Also "If it gets worse, come back. If not better in a few days, call your MD".
There was no improvement, and possibly her fever cycle was worse - the Tylenol was not lasting as long. On Tuesday, we saw an MD at her regular practice. Her first comment was "Wow, they really did a number on your back!" This was, ofcourse, about the LP. This doc made the assumption we were dealing with Lyme's disease, in an early stage which might not yet show up in blood work. On the "it can't hurt" theory, she prescribed Doxycycline (sp?) every 12 hours, blood tests and continue with the Ibuprofen / Tylenol cycle. She indicated that if it is Lyme's, Lyd will feel better after the 2nd or 3rd pill. Miracle of Miracles, by Wednesday evening there was an amazing turn around. Still achey and a little feverish, but nothing like before.
Now for my questions:
1. Given the symptoms presented at the ED (the same presented to the PCP), why couldn't they consider Lyme's, and begin treatment for it? If not caught and treated early, Lyme's can have some serious long-term health effects.
2. Should PA's be able to perform LP's???
3. Given the options of a large teaching hospital, or a variety of sizes of community hospitals, did we make the right choice? In other words - was the LP performed as someone's "practice", or would any of you Doc's have performed it in this case? (I realize you can't give a deffinitive answer here...)
Any way, thanks for listening. This has been a very taxing week, the worst being the lack of any known cause for a high fever lasting more than 5 days. The relief of even a possible diagnosis (Lyme's), was significant. When the treatment began to be effective, we were nearly ecstatic!
Thanks!
Scuba-sass
