Tribulations

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This patient's patience is sorely tried

A comedy of errors, in two acts

Act One, Scene One, late April 2016

You turn 80 in splendid health, then you go to the local GP for a test so the RTA knows you can still be trusted with a horseless carriage.

(After my subsequent tribulations, I can only hope Tesla or GM bring their driverless carriages to Australia A.S.A.P.)

But lets begin with the test, done in late April. The GP avers that I am healthy, can see properly, and he ticks a multitude of other criteria, then compliments me on my astonishing health and looks – for my age.

Never mind, I say, it's because I tend to stay away from doctors... (our son used to be a GP, which somehow taints my observations. He's since morphed into a health policy adviser at a respected U.S. University hospital. But who are we to criticise the Americans!)

So, after the test, the good GP suggests his visiting hospital nurse take blood from me for a test. Why not, I've shunned such tests in past years, because they seem to be more for the benefit of the doctor, and the laboratories.

But I have to make amends somehow for addressing the good man in Arabic with a phrase I learned some 60 years ago, “May Allah give you strength” - turns out the guy is an Arab Christian! Sorry, my bad... (But is he? In view of later developments, including me seeing a sign advising non-Medicare patients to make cheques payable to a fund with an Arabic name, I have begun to have doubts...)

So the nurse takes blood from my arm and squirts it into two ampoules that go to the laboratory. Shukram.

I later learn that the two samples were to assess my vitamin B 12 status, one shows it slightly high, the other slightly low. We'll have to do another test in a few months' time in order to be sure...

Scene Two, early May 2016

I develop a set of nasty pustules on my behind, my wife takes a snap on the mobile and I show the image to a pharmacist in town. He immediately tells me it's a Golden Staph (Staphylococcus aureus) infection, and I can take drops (Chloramphenicol, 5mg/1 mL) as well as an ointment (Chlorsig, 10 mg/g or 1 per cent), both developed for bacterial eye infections, to treat the excrescences on my posterior.

The pustules disappear. (Entr'acte May – September: the GP fears glaucoma...optometrists and ophthalmologist 'treat' my right eye LOL)

Scene Three, September 2016

By now, lots of skin eruptions appear all over my body. They itch like hell. I attack them with honey, eucalyptus essence, cider vinegar and lemongrass essence before eventually throwing the towel and booking another appointment with the local GP.

I am given an appointment two weeks hence, Monday September 26, the start of the NSW school holidays. When I front up, the receptionist cheerfully informs me that the good doctor is away for two weeks. I could book an appointment with a colleague, who attends in the afternoon, she advises, then traipses off across the wooden floors on high heels and with a very short skirt... Don't know why I noticed, I was so angry with such treatment that I just rushed out...

I immediately rang a practice in town, where a short-tempered foreign medico (“let me finish”, he said whenever I tried to get a word in) had many years ago looked at some BCCs for me.

I was given an appointment for the Wednesday September 28, rushed into town again and was told, upon visual inspection, that I had scabies. A swab was taken on my left arm, where a very bad-looking set of pustules invited inspection, and I was sent home with a prescription for Lyclear, two large tubes of Aristocort lotion, a box of Phenergan 25mg anti-histamine tablets for helping me sleep – as well as a box of Keflex antibiotics tablets (20, no repeats). Some $50 poorer, I returned home.

The treatment required that we take off all bedding and put it in the wash, have a warm shower and apply the Lyclear to the entire body, from the neck down. I should admit that I cut out the Aristocort after a few applications (my body should be capable of dealing with the itching itself) as well as the antihistamine tablets (ditto). I also did not open the cephalexin stuff, because why would I use antibiotics for scabies? The GP hadn't told me any reasons...

When I next passed the surgery on my way through town, I thought to check on the swab results. The good doctor had taken four weeks' holiday, the receptionist told me – but she said my swab results were clear... whatever that meant.

Scene Four, October 2016

With itching and possible new infestations of scabies (?!?) reappearing – and my GP in town still on holiday – I sought out my original local GP again. I advised him of the diagnosis of his colleague in town, he prescribed a different anti-scabies washing lotion (Benzemul), and he noticed a strange pustule over my right eye. He took a swab and said to treat that spot also with the scabies wash, but be careful not to get it into the eyes.

I should ring him five days after beginning treatment to advise of progress.

We started Saturday October 8, so I rang him on Wednesday October 12.

Answering machine. I left a message and requested a call back. Nothing. Same next day. So on Friday I went to the surgery and was greeted by the ambulant nurse. I repeated my quest for swab results and advice re the scabies treatment. She assured me that their locum would call me back that afternoon. My GP did not work Fridays or Mondays, she said.

I was not called as promised. By now I was getting worried: I had cheerfully mentioned to the good GP that I was fine until the two blood sample needles, in April, so having picked up my infection at that time was a possibility.

No calls Monday or Tuesday, so today Wednesday October 26 I fronted up in the local surgery again. The receptionist asked if I had an appointment, I replied that I didn't need one, just the results of the swab and advice on whether to continue treatment.

She took notes, went into the doctor's rooms and – nothing. She came out saying he was too busy, but would ring me in the afternoon. No call by 7:30 p.m.

The plot thickens. Are they shunning me because they fear a case of ca-MRSA raising its ugly head?

Tomorrow I'll try the short-tempered foreigner again for his swab results, if any. The wound on my left upper arm is still looking nasty 5 months or so after the first appearance.

Depending on what I learn, I'll drive to Taree Friday to present in Emergency. After all, clinically-acquired methicillin-resistent Staphylococcus aureus is no laughing matter...

ACT TWO Scene One

At the skin cancer clinic I am given an appointment for November 1 to learn the results of my initial swab by the good Vietnamese doctor.

I scour the Internet for government-issued information on what looks to me like a persistent staph infection. On one page I find a decision tree-like chart spread across the bottom, listing alert levels from one to five. At level Five, with the conditions I feel cover my case, I am advised to go to a local Emergency facility A.S.A.P. and have a swab taken and analysed as it were on the spot. Apparently the tests can be performed by machine these days...

So I dash off to Taree on a 120 km round trip as planned. I arrive at the hospital's emergency department at around 11:30.

After registering and seeing a triage nurse, I am indeed seen by a young resident doctor, who patiently listens to my rambling yarn, examines the evidence and concurs that it appears to be a staph infection.

She spends a good half hour or more going through all the symptoms with me, stating that she will prescribe an oral anti-biotic, a topical anti-biotic and a special wash, explains the procedures to me and asks that I inform her after completing the course of medication over 5-7 days.

I apologise profusely several times for taking up her time, then race back to my home town pharmacy. I hand over the emergency doctor's prescription, and am asked Do you want both? This later struck me as odd, since I was expecting three medicines... but I wasn't thinking too clearly by then.

I received a 24-capsule pack of Staphylex 500 (Flucloxacillin 500 mg each), to take once capsule every six hours (the pharmacist begged to differ but I followed doctor's instructions to the letter, even setting up an alarm to wake me at three a.m.!).

I was also given a bottle of PHisohex wash which I also had at home during my recent endeavour to prevent spreading infection. Interestingly, I had also just come across U.K. research that asserted the wash was no more efficient than soap and water! And how was I going to prevent it from getting into my eyes - expressly discouraged - when I was supposed to lather the entire body from the head down before washing it off?

I had been booked in to see the other skin doctor on November 1, Melbourne Cup day, to learn what the 'clear' swab results mean. But by now I had decided to cancel because I patently did not have scabies.

Today, November 2, I have used most of the Staphylex and I see not much difference in my skin lesions - even though I'd treated several, particularly the pustule over my right eye, also with a smear of Chlorsig 1%!

When I've finished the course tomorrow afternoon at 3 p.m., I'll try to ring the Taree hospital doctor to let her know the result...

What next? Perhaps she'll tell me - or I may have to see a dermatologist. For whom I'll need a referral...

(Meanwhile the Emergency doctor is not on again until next week. The duty nurse promises to find out by Friday when she's next on duty...)

I finished the last Flucloxacillin capsule on Thursday afternoon. A couple of hours before I had run into town again with Bianca, who'd made an urgent appointment for me with a large medical practice.

ACT TWO Scene Two

I was seen by another young foreigner who diagnosed folliculitis upon visual inspection of my pustules. I wanted to be sure – after the two previous off-hand misdiagnoses. So he said he'd get me to have a 'punch biopsy' and give me precise results based thereon.

The biopsy was to be made today, but I demurred, having read the drastic description of the sampling method on the Internet...

Instead I drove into town for the third time this week, explained to my new doctor that I had full confidence in his diagnosis – whereupon he promptly gave me a prescription for another course of 24 Staphylex capsules.

Started these on 4/11 and took the last capsule on 9/11. Initially symptoms alleviated, but towards the weekend I am suffering biting/itching sores again – all in the old spots!

What the hell is going on? Bianca thinks I have very bad mouth odour: in fact she wants me to book an appointment with a local dentist A.S.A.P. And I do feel some pain in a filled upper left molar occasionally, as well as in a upper right molar and in a broken second lower right molar...

Checking with the Forster medical practice right now on a: whether the elusive GP has given them my swab results and b: what the other medico will do now.

I immediately got an appointment for 2:30 p.m. today Monday 14/11.

This time the good doctor looked again at my thigh and calves lesions, declared I was suffering from dermatitis, prescribed a cortisone cream (Novasone 0.1 % = Mometasone) for these, glanced at my staph pustules on my back and arms and prescribed a moisturising lotion, Cetaphil, declaring my skin was too dry...

And no, the strange original GP had NOT shared his purported swab results with my new GP.

But he must have shared something with my second GP, for after the latter had amended his erstwhile diagnosis, he put my consultation on Medicare ('free' to me) and said: “You are welcome to come back – but not too often”. WTF?!

So, I am now essentially without a GP. I try to keep up my thalassotherapy and go to the beach once or twice a week to immerse myself briefly in the 20 C water, and it seems to bring some relief.

I also tried to book an appointment online with a woman doctor at the second GP's practice, who described herself as particularly interested in skin disorders.

But since the bookings software insisted on me filling out a field for mobile phone number, I gave up – what if someone does NOT possess this little pocket scourge?

Will try to book an appointment with her after the Christmas break – perhaps I can even confer with her in German, looking at her name...

Mal sehn...

Instead of booking online, I went to the practice after the Christmas break to arrange a booking in person. When I fronted up at the reception asking for the GP with a specialty in dermatology, the receptionist brusquely said “All our doctors are dermatologists”, or words to that effect...

I turned on my heel and left.

Next I e-mailed the dermatologist suggested to me by Dr. Google. No reply. I assumed the mail might have ended up in the SPAM folder, I e-mailed the practice once again – from my Gmail address.

This time I got a reply – yes, the receptionist had retrieved my original e-mail from the trash – and was advised that I needed my GP's referral.

So I went looking for a new GP. Found a practice in Forster and asked for an appointment. Not today, the receptionist told me, come back tomorrow. So I drove home and drove back into town the next day.

The GP who saw me shared my abhorrence for President Tweet. He examined me from head to toe and diagnosed the pustules as secondary staph infections upon wounds caused by the Human Megalo Virus (HMV). This rare infection was, unfortunately, not really treatable, he warned me.

To be certain, he asked me to come back in a week's time for biopsies.

The punch biopsies I had feared were done by another medico in the practice, and I had to wait another week for the lab results.

Last Friday (24/2/17) I was told the lab results showed NO bacteria or virus presence and no sign of cancers or anything untoward. It basically was, the GP enlightened me, a long Latin name for a 'scratchy itch' or unspecified dermatological condition.

Did I want to try a scabies treatment? I had to laugh: after THREE courses of scabies treatments prescribed by two doctors I didn't think we needed to go there again!

The good biopsy doctor suggested I might want to try tea tree oil, or whatever I thought might help heal those pesky pustules...

In the meantime, he communicated the lab results to the Taree dermatologist, who, I was told by a message on her phone that her first available appointment would be sometime in July!

Speriamo!

Post-script: Saw the specialist in Taree yesterday (11/5) late afternoon. She seemed particularly interested in my large lesions on the left, and similar smaller ones on the right calves.

This, she enthused, was the rare – and perhaps persistent – affliction known as nummular dermatitis. And she prescribed a corticoid lotion of the type that MAY have caused just this particular skin rash in the first place (Aristocort cream).

She did not dwell on the persistent pustular protuberances on my arms and upper body, some of which have been around for half a year or more.

Some others strangely disappeared, or almost vanished after many months. This included the pustule over my right eye – using onion juice scared that one almost into disappearance LOL

She also suggested I undergo a series of at least 30 UV-B illuminations in a sarcophagic cylinder of which I was shown a type in her rooms.

I considered all these options, and decided none of them made much sense for a healthy 80-y-o. Sorry!

So I began my 81^st year determined to let my body look after itself for a while.

It did alright during the first 80 years, give or take a few pustules...

Post-script II

I booked a quick appointment with my new GP to appraise him of the findings of his dermatologist colleague in Taree, but he was already aware of them.

Remembering his colleague who'd performed two punch biopsies on my arms and back for the pustules, I mentioned some BCCs behind my right ear that another Forster GP (“Isn't he a great surgeon,” enthused a female colleague in the practice at the time) had excised against previous advice from my skin cancer specialist, who had just put a watching brief on them...

But my new GP merely said “excision” and booked another appointment with his resident punch biopsies colleague.

Fronted up in mid-September with a clean and smooth skin where those old BCCs had been excised 10 years ago, and which had given up their occasional minor skin eruptions under my regimen of apple cider vinegar, 3 p.c. salt water solution and 265 MGO Manuka honey applications.

No need for any excisions here, I told the good doctor, I'll just keep watching this space! Oh no, quoth the punch proponent, we'll do a punch biopsy first.

The results came back – not that I was shown the lab report – and the punch man said the BCCs needed to be excised in a wide strip behind my ear.

I held up my hand and said 'over my dead body' or words to that effect. The new GP suggested to burn the blighters off with an Interferon-based cream. But again I demurred. I'll keep watching them – and will consult you when I think it might be necessary...

Oh, said the good doctor, in some cases they could disappear by themselves...

That's the spirit! My body will take car of the matter in its own good time.

Salute a noi!

NB: Names/places have been generally deleted to preserve anonymity in case this treatise falls into the wrong hands...

(An oldie, as you can see, but I thought it ought to be preserved in the interests of science LOL. It should also be copied to the AMA for study, and to the Medicare people for examining how the profession appears to bill/bilk the elderly willy-nilly - at a great cost to the public purse. And, come to think of it: do I have a case to complain to the Obudsman about seemingly wide-spread ageism?)