General Medical issues thread

[JohnK]

I'm not sure I've mentioned before.

I have an old ulcer/wound half way up the left shin that has never healed. It occasionally opens up and I'm almost certain this is how cellulitis starts in my left leg.

I saw dermatologist in October and asked them to consider a procedure to cut and graft skin there. Boy you'd think I asked them to give me their life savings.

Both the trainee and the professor were grilling me. They gave me 101 excuses of why it's not a good idea to try and fix this chronic ulcer and that it's in my best interests to keep suffering from cellulitis infections.

Should I seek a second opinion? Where would you go, plastic surgeon? I was hoping to get it done in the public system and not be out of pocket.

 

[RooFlyer]

Should I seek a second opinion?

Would you listen to it if it wasn’t what you wanted to hear? I suspect not, so the answer would be no.

 

[tgh]

I guess there is entertainment value in all this Brouhaha.. but I feel that I am watching a slow motion train wreck and find it all very depressing

 

[drron]

But not all Penicillin allergy is truly penicillin allergy.

https://www.cdc.gov/antibiotic-use/community/pdfs/penicillin-factsheet.pdf

 

[prozac]

But not all Penicillin allergy is truly penicillin allergy.

https://www.cdc.gov/antibiotic-use/community/pdfs/penicillin-factsheet.pdf

I read a report not so long ago they said most people grow out of it. I have it. Was in hospital getting infused last Friday and must have been asked 8-10 times.

 

[Lynda2475]

But not all Penicillin allergy is truly penicillin allergy.

https://www.cdc.gov/antibiotic-use/community/pdfs/penicillin-factsheet.pdf

Well my grandfather was in his late 40s when a reaction to penicillin nearly killed him (he never worked again, my Dad had to drop out of school and support the family); and having been hospitalized myself Im not prepared to gamble and try it again, not when there are plenty of other options. that have always worked for me.

A penicillin allergy is not a a food intolerance, the consequences can be very serious and even deadly.

I once had a dentist try to prescribe penicillin after a root canal in his opinion I had probably grown out of it, I said can you guarantee it, of course he couldn't so I tore up the script and insisted on a new one for something I knew i could take safely.

 

[drron]

Well my grandfather was in his late 40s when a reaction to penicillin nearly killed him (he never worked again, my Dad had to drop out of school and support the family); and having been hospitalized myself Im not prepared to gamble and try it again, not when there are plenty of other options. that have always worked for me.

A penicillin allergy is not a a food intolerance, the consequences can be very serious and even deadly.

I once had a dentist try to prescribe penicillin after a root canal in his opinion I had probably grown out of it, I said can you guarantee it, of course he couldn't so I tore up the script and insisted on a new one for something I knew i could take safely.

You really should have a test for penicillin allergy.
please read the whole link i posted.

 

[Lynda2475]

You really should have a test for penicillin allergy.
please read the whole link i posted.

I did read it and in addition to being hospitalized due to reactions as a baby, I have previously tested positive to skin test as an adult, so I see no need to repeat the test again. Further I would never agree to take amoxicillin as suggested in that link even under medical supervision as that was the the specific drug that sent me to hospital in the first place.

My younger sister was prescribed amoxicillin a few times, my parents would put the fear of the devil into me to make sure I didnt touch it in the fridge.

It may be convenient for some to say I should suck it up and try again because the alternative antibiotics are slightly more expensive but I've only needed antibiotics a handful of times in my entire life so Im hardly a burden on the health care system.

It is frustrating to be disbelieved that I have a genuine allergy, probably because too many people who don't like things these days say they are allergic, rather than admit they are fussy eaters.

 

[drron]

I have had several patients who have well documented ana phylactic reactions to Penicillin who on testing have no evidence og IGe mediated penicillin allergy and who have then taken penicillin without any problems.
As you say it is frustrating to be disbelieved when you are presenting up to date genuine medical advice.

 

[Pushka]

But not all Penicillin allergy is truly penicillin allergy.

https://www.cdc.gov/antibiotic-use/community/pdfs/penicillin-factsheet.pdf

It's understand though the reluctance if the first dose gave you the anaphylactic response that would be terrifying AND there were alternatives. This was back in the fifties I guess. He wore a medic alert bracelet. Its not like peanuts that are everywhere and can't be avoided. And you like peanut satay

 

[Quickstatus]

I don't think Augmentin will help you. Keflex is the drug of choice for cellulutis

Cellulitis treatment tends to be empirical (treatment based on experience) The antibiotics are usually Dicloxacillin/cephalosporin//penicillin/Clindamycin/Augmentin
If there is an open wound that is associated with it then a swab is important
Cellulitis tends to be either Staph or Strep
I tend to start with Keflex which covers both, if no better then Dicloxacillin for the Staph. Good old penicillin for the Strep. Or Clindamycin if unable to take keflex or Dicloxacillin. Augmentin if Hemophilus suspected for Cellulitis around the eyelids. If there is an open wound or boil then Dicloxacillin

But irrespective of the antibiotic - Rest, ice, elevation is the other important treatment that should not be ignored

And the other treatment (and likely more important in the long run) is the management of risk factors of cellulitis including swelling in the leg, venous insufficiency (varicose veins), diabetes, heart failure, peripheral vascular disease, dermatitis, obesity etc etc

 

[JohnK]

Cellulitis treatment tends to be empirical (treatment based on experience) The antibiotics are usually Dicloxacillin/cephalosporin//penicillin/Clindamycin/Augmentin
If there is an open wound that is associated with it then a swab is important
Cellulitis tends to be either Staph or Strep
I tend to start with Keflex which covers both, if no better then Dicloxacillin for the Staph. Good old penicillin for the Strep. Or Clindamycin if unable to take keflex or Dicloxacillin. Augmentin if Hemophilus suspected for Cellulitis around the eyelids. If there is an open wound or boil then Dicloxacillin

LOL. Why are you so nice?

Doctor got scared I have covid. No doc. Pain in ankle, swelling, warm to the touch, discomfort under the skin. Felt like a flu on Friday but definitely not flu. And definitely not covid either.

Doctor prescribed dicloxaccilin. 2nd day now. Still have swelling, acute pain but no redness or discomfort under the skin.

The wound on my leg does not look open but I think it does open up occasionally. If it's not the wound in leg then I have no idea how I get cellulitis in left shin/ankle each time.

 

[drron]

Oh. So just suffer until Monday and risk sepsis so I can wait for doctor to prescribe me antibiotics that PBS covers. Or go to hospital and wait and wait and wait and wait in the hope that I am seen and they get the right diagnosis?

@drron if you knew me well enough you'd know that I don't just take antibiotics at the drop of a hat. I knew my wife was suffering and we went to medical centre where it took 3 days for the results to come through but "doctor" was more concerned that my wife had covid with 2 episodes 1 week apart and doctor didn't want to catch covid. LOL. No. Wife is complaining of kidney pain. Wife has fever and chills. It is not covid. Same symptoms 1 week apart. It is more than likely UTI but we've it left too long. Hospital 24 hours later in serious condition.

@Pushka I know exactly what I'm buying in Thailand. I'm buying from reputable pharmacies. These are reputable antibiotics.

As for daughter seeing a doctor. We saw our doctor. He said let her get over it naturally. Went to medical centre and she prescribed puffer/inhaler. FFS that's not going to help with a severe infection that being going 3-4 weeks. She had 11 infections last year. Too many in my book. One of them lasted 6-8 weeks. This year shes had 2 already.

@drron I don't need to change because I'm not doing anything wrong. My GP of many years who knew how I'd suffered for many years said "John, you need to self medicate. Don't wait to see a doctor."

I was getting throat infections 3-4 times a year. I could not breathe. I could not swallow. Some were in Thailand. Run around trying to find a doctor that speaks English or go to hospital and tell them what's wrong like I did when I had cellulitis. Some were here on a weekend. I know they were serious. Any doctor would know they were serious. There was no way I'd wait to see if my body would fight these infections. It's torture. I don't need to prove Im tough. In 2019 I had 2 serious infections that lasted between 6-8 weeks each. That was torture. Antibiotic the only way to go.

So please be critical if I've done something wrong otherwise tell me I've done well to get to infection quickly.

I’ve been thinking about this for some time but now I think I need to be blunt. I know that you are going to self treat no matter what any one says. I also know you have very little understanding of medical science. You demonstrate that constantly.
However it worries me that you also treat your daughter. It’s well known that for young children at least 70% of acute respiratory tract infections are caused by viruses. Antibiotics do nothing for viral infections but do Expose you to antibiotic side effects as well as increase the risk of developing antibiotic resistance.
So the doctor who said she will get over it naturally was almost certainly right. The doctor who prescribed a puffer again is almost certainly right as one of the commonest things that precipitates asthma. So a puffer can help reduce the breathlessness that she experiences with her viral infections. Antibiotics on the other hand will not reduce the amount or severity of viral infections but are useless in treating the symptoms of those infections.
Your princess deserves better.

 

[Flyfrequently]

Cellulitis treatment tends to be empirical (treatment based on experience) The antibiotics are usually Dicloxacillin/cephalosporin//penicillin/Clindamycin/Augmentin
If there is an open wound that is associated with it then a swab is important
Cellulitis tends to be either Staph or Strep
I tend to start with Keflex which covers both, if no better then Dicloxacillin for the Staph. Good old penicillin for the Strep. Or Clindamycin if unable to take keflex or Dicloxacillin. Augmentin if Hemophilus suspected for Cellulitis around the eyelids. If there is an open wound or boil then Dicloxacillin

But irrespective of the antibiotic - Rest, ice, elevation is the other important treatment that should not be ignored

And the other treatment (and likely more important in the long run) is the management of risk factors of cellulitis including swelling in the leg, venous insufficiency (varicose veins), diabetes, heart failure, peripheral vascular disease, dermatitis, obesity etc etc

You are very generous and gentle with your explanations @Quickstatus as is @drron with his comment.

 

[prozac]

Cellulitis tends to be either Staph or Strep

Mine was/is staph. Prof Clem Boughton suggested it is likely residing in scar tissue within my leg. It was a work accident.

The wound on my leg does not look open but I think it does open up occasionally. If it's not the wound in leg then I have no idea how I get cellulitis in left shin/ankle each time.

You have many tiny scratches on your leg that are not visible to the naked eye. The bug that causes the cellulitis is tiny and only needs a tiny hole to enter your leg, ankle etc. Washing with a surgical wash when you shower will reduce your chances of infection. Initially I was advised to scrub head to toe with 747. There may be better options available now.

 

[JohnK]

Your princess deserves better.

Daughter did not have any breathing issues. Puffer was and continues to be total waste of time.

We use cough syrups and liquid paracetamol. Next time she's sick for 4-6 weeks with same infection I'll consult GP.

I'm not entirely as useless as you make me out to be. I care about all 3 women in my life and do not want them to suffer.

 

[andye]

I not a fan of keflex for cellulitis but it's probably a cognitive bias as it is commonly prescribed by GPs and I often see people in hospital who haven't responded to initial treatment.
I usually use flucloxacillin as first line (oral or IV).
Though I sometimes use augmentin orally instead, I probably should go with dicloxacillin as it's likely better to prevent resistance.
For more serious (or not improving) infections I use iv cefazolin. If I'm worried about MRSA (penicillin-resistant staph) I use vancomycin or clindamycin.
When I was a young doc I tended to think of cellulitis as one of the more trivial conditions that get admitted to hospital but I respect it more and more as I've aged.

 

[mrsterryn]

Ahh hope everyone else's coloscopies went well
I am out to five years between that delightful prep having to be ingested again

 

[JohnK]

You have many tiny scratches on your leg that are not visible to the naked eye. The bug that causes the cellulitis is tiny and only needs a tiny hole to enter your leg, ankle etc. Washing with a surgical wash when you shower will reduce your chances of infection. Initially I was advised to scrub head to toe with 747. There may be better options available now.

You're a genius. This is why it's always good to be pleasant and not put people down and offer useful thoughts.

I was just video chatting mum in Sydney so she can see her gorgeous granddaughter blossoming more and more each day when I showed mum my legs.

The left ankle/leg still swollen and the right ankle/leg is fine but a nice bloody 2 inch scratch on the shin just above ankle. I haven't noticed it but it's from the socks and is obviously caused by my legs swelling all the time. There's a faint line on the left leg and I'm guessing it's one these scratches that cause cellulitis last week.

The elastic on these socks is not tight but my legs/feet do swell more than normal and may cut into the skin. Need to keep an eye on this but I'm not sure there's an easy answer. I don't like wearing socks without some elastic but need to look for alternatives.

 

[prozac]

You're a genius. This is why it's always good to be pleasant and not put people down and offer useful thoughts.

I was just video chatting mum in Sydney so she can see her gorgeous granddaughter blossoming more and more each day when I showed mum my legs.

The left ankle/leg still swollen and the right ankle/leg is fine but a nice bloody 2 inch scratch on the shin just above ankle. I haven't noticed it but it's from the socks and is obviously caused by my legs swelling all the time. There's a faint line on the left leg and I'm guessing it's one these scratches that cause cellulitis last week.

The elastic on these socks is not tight but my legs/feet do swell more than normal and may cut into the skin. Need to keep an eye on this but I'm not sure there's an easy answer. I don't like wearing socks without some elastic but need to look for alternatives.

You should wear whenever possible a German or similar heavy denier medical compression stocking to reduce the oedema. make sure your toes only just protrude from the end of the stocking (if it is a toe-less design). Don't waste our time with a stocking that finishes at the ankle.
In the first few years I had cellulitis this is what I wore and I was advised by the leading authority on infectious diseases in Australia, Prof Clem Boughton. 23 years later it still flares up from time to time.