Specifically, I tested positive for C. difficile, but not the really nasty variant, and will be taking antibiotics.

The lab results took a few days, but the various tests are positive for C. difficile, negative for giardia, and "consistent with" Crohn's disease and ulcerative colitis. The doctor I talked to this afternoon said that C. diff. or other infections can produce false positives for those other things, and they'll want to retest after I recover.

The antibiotic is Dificid (fidaxomicin), twice a day for two weeks. I also have a telemedicine appointment with Carmen Monday. She's on vacation this week, so I asked the receptionist to have someone else look at the test results and call me back. The covering doctor looked at the test results, called in a prescription, and then called me back. I missed her call, and we played a bit of phone tag because she specifically said she wanted to talk to me, but didn't wait until she talked to me to call the pharmacy.

She asked me a couple of questions about symptoms, including whether I had been "able to maintain my weight" over the past weeks of illness. She also told me that C. diff can be the result of taking another antibiotic, sometimes months earlier

The only warning I found about this antibiotic when I looked it up at a few places like WebMD, was not to take it for anything except a C. difficile infection.

This is going to be expensive, because for some reason it's in my insurance company's formulary for 2025, but not 2024. I thought of getting them to send a new prescription, seven days with one refill instead of 14 days, but I do NOT want to risk a gap partway through this course of antibiotics.

Cattitude picked the prescription up this evening, and I took the first dose when he got home with it. I have made a little chart to write down each dose, with 15 rows for days, and columns for a.m. and p.m., rather than relying on memory while sleep-deprived and generally worn out.
I called my doctor's office on Monday, asking if I needed a follow-up appointment for my cough: three weeks ago, Carmen had prescribed an albuterol inhaler to use for two weeks, in the hope that it would interrupt the (hypothesized) cycle of coughing --> irritated lungs --> more coughing... It had helped quite a bit, but I was still coughing a little, and then it felt like it was getting a bit worse.

They gave me a telemedicine appointment for the following day, at which Carmen told me to get a chest X-ray and basic bloodwork; she said it could wait until the next day rather than exposing me to a very hot day with smoky air.

So, yesterday I went to Arlington, where they took two X-rays of my chest, and then I went next door, waited three quarters of an hour, and had blood drawn. The phlebotomist had a bit of trouble finding a vein, but succeeded the second time she tried my right elbow (usually the best place, for me). From there I went to [personal profile] adrian_turtle's; I'd been at Adrian's for a couple of hours when my doctor's office called.

This time I talked to a different nurse practitioner, Michelle. She said that the X-ray showed one cloudy area in my right lunch, which wasn't typical of pneumonia but suggested an infection, and prescribed axithromycin, in the five-day "Z pack" where the first day's dose is two pills. I asked if I could wait until today to start taking the pills, and she said yes, so I had her send it to Capsule for delivery by one of their couriers. (If she'd wanted me to start it right away, I'd have had her send it to one of the pharmacies near Adrian's apartment.)

I am now back in Belmon, and the axithromycin arrived right after lunch. I opened the package, and saw that it contained three Z-packs instead of one. They charged me for one, and the pharmacy label on the outside of the box said I was getting one five-day supply, but someone seems to have grabbed the drug manufacturer's box without noticing that it contained three of the neatly organized packages of axythromycin. I

I am going to drink my tea and then ask the pharmacy whether they want to send someone to pick up the excess medicine.

ETA: I got the results of the bloodwork this afternoon. The levels of a few things are elevated in a way that also suggests infection. I have sent Carmen a message, asking if, based on that, I need to do, or not do, anything other than what Michelle told me yesterday.
redbird: tea being poured into a cup (cup of tea)
( Oct. 8th, 2013 10:20 am)
The last few years, there's been a lot of encouragement to cough into your elbow instead of covering your mouth with your hand or a tissue. It sounds good, but does it help?

A team in Edmonton compared different "cough etiquette" maneuvers to see whether they would prevent the spread of viruses. Covering your mouth with both hands, a tissue, a clothed elbow, or the usual , including covering your mouth with both hands, a tissue, a clothed elbow, or a surgical mask are all equally ineffective.

The basic problem is that aerosol drops are too small to be blocked by any of those things.

So that leaves us with vaccination, hand-washing, and staying home when sick, which of course many people can't afford to do. (And that person on the bus who is coughing or sneezing might be reacting to an allergy, which is not contagious.)

As a side note, you have read every scientific study that supports coughing into your elbow. Really. There aren't any.

After noting the problem, the authors encourage research to find evidence-based procedures that do block the transmission of respiratory disease. In the meantime, I think I'm going to start carrying hand sanitizer. If you're in the Northern Hemisphere and haven't already gotten a flu vaccine, they're widely available in the U.S. and Canada (I haven't checked on other countries). If you're in the U.S. and have health insurance, it's probably covered. If you're in Canada, the categories of people who can get it free vary by province.

Conclusions

All the assessed cough etiquette maneuvers, performed as recommended, do not block droplets expelled as aerosol when coughing. This aerosol can penetrate profound levels of the respiratory system. Practicing these assessed primary respiratory hygiene/cough etiquette maneuvers would still permit direct, indirect, and/or airborne transmission and spread of IRD, such as influenza and Tuberculosis. All the assessed cough etiquette maneuvers, as recommended, do not fully interrupt the chain of transmission of IRD. This knowledge urges us all to critically review recommended CE and to search for new evidence-based procedures that effectively disrupt the transmission of respiratory pathogens. Interrupting the chain of transmission of IRD will optimize the protection of first responders, paramedics, nurses, and doctors working in triage sites, emergency rooms, intensive care units, and the general public against cough-droplet-spread diseases.


[Via the Science-Based Medicine blog, tucked in near the end of a piece about osteopathic manipulation.]
Last month, I read Lisa Sanders's Every Patient Tells a Story. Sanders is talking about diagnosis, how it can be difficult, and how the process has changed over the last 20-30 years. The "annual physical" is a thing of the past, and many doctors doubt that a physical exam is ever worth doing, given modern medical testing (from blood tests to MRIs). Other doctors regret the loss of the physical exam, but suspect it's too late to save it: you can't teach skills you never learned. Sanders falls somewhere in the middle: not that everyone should have an annual physical, but that there are things the doctor will learn from talking to the patient, watching them walk, and so on, and that these are things worth doing if the diagnosis isn't obvious.

cut for length; this review also discusses Bernard Groopman's *How Doctors Think* )
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