would I be a tool if I went to the ER with this CC?

stoic · May 20, 2004

Because Juddson asked, I'm going to as well.

So I've been sick since Monday. Yesterday I went to my PCP and she thinks I've got mono and strep. My tonsils are HUGE (kissing, even). Swallowing right now is seriously the *MOST* painful thing I've ever experienced. On top of that 102 degree fever, aches, etc. I'm taking lortab 5/500 and ibu 600 every 4-6 hours and this really hasn't scratched the surface of my pain.

So the reason I'm thinking of going to the ER is that I cannot get fluid down. It hurts too much to even sip ice water. I'm getting really dehydrated and am sure a saline drip would do me good. I also think that a shot of cortisone might ebb the swelling in my tonsils.

So is this legit? Or would going in for this make me a tool?

Thanks,
Dave

Febrifuge · May 20, 2004

I'm no doctor (although curiously enough, I am qualified to play one on television), but I can say this:

a) If you're still concerned whether you look like a tool, then it's your call. The ED is (ideally) for when you just don't care anymore if your underwear is clean or you're "sick enough."

-HOWEVER-

b) While plenty of people who come in are considered tools, no one is more of a tool than the one you hear about on the news, who was found dead of something treatable. The one who comes in acutely sick, who would have been easier to treat two days ago, is slightly less of a tool than that. There is tooldom to be earned in not getting treated, is the thing.

and c) It's not every day you see tonsils bugging out and slapping each other like saloon doors. Go to a teaching hospital, and let a room full of students gawk at you on rounds. That'll relieve you of any lingering worries about you inconveniencing them.

and it should go without saying that d) Medical advice on the Internet is a little suspect. I mean, my traditional magnetic Swedish elk-spleen vitality tonic is good medicine, but there are some weirdos out there.

DrMom · May 20, 2004

Since it is daytime, how about you call your PCP first & see what they suggest you do.

margaritaboy · May 20, 2004

I agree with Dr. Mom. Although you may not be a tool, you may find that a call to you PCP will get you seen sooner and with greater attention to your complaint than would otherwise be possible at a busy ER. Just make them understand how serious you think it is, and many times they'll squeeze you in that same day or the next day. If steroids or other drugs are indicated, she should be able to hook you up.

Robz · May 20, 2004

Febrifuge said:
b) While plenty of people who come in are considered tools, no one is more of a tool than the one you hear about on the news, who was found dead of something treatable. The one who comes in acutely sick, who would have been easier to treat two days ago, is slightly less of a tool than that. There is tooldom to be earned in not getting treated, is the thing.

how come my mind just screams jim henson when I read this.

southerndoc · May 20, 2004

I'm guessing you do actually have strep and not some abscess? (Sorry, just had to ask.)

stoic · May 20, 2004

southerdoc - I definately have strep (postive rapid strep). the mono is likely, but not for sure. Mono spot was neg., but wbc's are elevated and i've got like 8 differentiated lymphocytes. My PCP is of the opinion that I haven't had mono long enough to test positive... so retest next week.

I was thinking of the ER 'cause my PCP is at my universities health services, which was not open early this morning. In any case, I did call my PCP and she suggested I try taking 10mg hydrocodone/1000 acetomenophen and see if I coud drink once it kicked in. In fact, I coud... though there was only a brief window between when I was able to drink and when I fell asleep. Luckily my time in college has taught me how to "chug" and I was able to get down nearly a liter of water in that time.

Have you guys ever seen streptococcal tonsilitis? (probably the answer is yes, since this is a resident forum). I mean it's crazy. Looks like I have giant cotten balls in the back of my throat. If they weren't so damned painful, I'd find them pretty interesting.

Anyway, thanks for the info. I feel that my road to tooldom has been averted, at least for now.

Dave

edinOH · May 20, 2004

What am I missing here?

sore throat
fever of 102
exudative pharyngitis
rapid strep test +

I'll go out on a limb and bet there is alittle lymphadenopathy there as well.

How about some IM bicillin or PO PenVK and a steroid to cool the tonsils?

Not that I'm giving medical advice or anything.

DrQuinn · May 20, 2004

edinOH said:
What am I missing here?

sore throat
fever of 102
exudative pharyngitis
rapid strep test +

I'll go out on a limb and bet there is alittle lymphadenopathy there as well.

How about some IM bicillin or PO PenVK and a steroid to cool the tonsils?

Not that I'm giving medical advice or anything.

he's a chronic strep carrier, and forgot to mention his massive penile discharge.

Q, DO

A little elf · May 21, 2004

Go to the ER. 3/4 of the people that I see on any one shift are less sick than you. Go get some bicillin, steroids.

stoic · May 21, 2004

QuinnNSU said:
he's a chronic strep carrier, and forgot to mention his massive penile discharge.

Q, DO

Quinn - Don't think I'm a chronic carrier. I've tested negative a couple times in the past. And about the penile discharge, well, there hasn't been any of that since a got that shot a few months ago...

edinOH - You were right on with the lymphadenopathy.

***update*** my tonsils are no longer kissing.

. They hurt a little less: now I can eat exciting and tasteful foods such banana's. When I'm really high on hydrocodone, I can eve get some Macaroni down!

I really really want a pizza.

docB · May 21, 2004

margaritaboy said:
I agree with Dr. Mom. Although you may not be a tool, you may find that a call to you PCP will get you seen sooner and with greater attention to your complaint than would otherwise be possible at a busy ER. Just make them understand how serious you think it is, and many times they'll squeeze you in that same day or the next day. If steroids or other drugs are indicated, she should be able to hook you up.

This is exactly what he should be able to do. However in the medical third world (America) he will be told by the receptionist "We can see you in October of 2018. Oh, you're really sick? Then go to the ER. We'll call the ER for you and they'll get you right in."

Sessamoid · May 21, 2004

Sounds like you should be on a short course of prednisone. Much more effective than opioids for pain from Strep throat.

stoic · May 21, 2004

Sessamoid said:
Sounds like you should be on a short course of prednisone. Much more effective than opioids for pain from Strep throat.

See, this is the kind of information the wanna-be-doc's down at student health services should have. First she just gives me a Z-pack and Lortab and recommends to keep taking ibuprofen. After discovering the lortab/advil cocktail did essentially nothing for the pain, I talk to her on the phone - even asking about the possibility of steroids - and she said she felt they weren't indicated. Meanwhile, I'm over here learning to understand what Ralph Wiggum meant when he said "it taste like burning."

ERMudPhud · May 24, 2004

Show her this

: Acad Emerg Med. 1998 Jun;5(6):567-72.
Related Articles, Links

Comment in:
Acad Emerg Med. 1998 Jun;5(6):557-9.

Acad Emerg Med. 1998 Jun;5(6):559-61.

The role of betamethasone in the treatment of acute exudative pharyngitis.

Marvez-Valls EG, Ernst AA, Gray J, Johnson WD.

Department of Medicine, Louisiana State University, New Orleans, USA. [email protected]

OBJECTIVE: To compare betamethasone with placebo as an adjuvant to antibiotic therapy in the treatment of acute exudative pharyngitis. METHODS: The study was a randomized, doubled-blind, placebo-controlled, single-center, parallel, outpatient clinical trial. After consent was obtained, each patient was asked to rate his or her pain on a 10-cm numbered visual analog scale (VAS; 0-10). All of the patients received injectable benzathine penicillin. If allergic to penicillin, they were started on a 10-day course of polyenteric-coated erythromycin (PCE). Each patient was randomized to receive either i.m. betamethasone or i.m. placebo. All patients were contacted by telephone at 24 and 48 hours by one of the study investigators and asked to rate their pain based on another VAS. If their pain was not resolved by 48 hours, they were called again daily between the third and seventh days after the initial visit to determine the time of pain resolution. RESULTS: A total of 92 patients were enrolled in the study, with 46 randomized to receive placebo and 46 to receive betamethasone. Eight patients were excluded from the statistical analysis because of inability to obtain follow-up. Demographic comparison showed that gender distributions, ages, mean initial pain scores, mean times to the first and second follow-up calls, and treatment regimens were similar in the 2 groups. There were significantly better pain scores for the betamethasone group at first follow-up (p = 0.0005), at second follow-up (p = 0.004), and in number of hours until relief of pain (p = 0.004). When only those patients with a positive culture for a streptococcus species were analyzed, there also were significant reductions in pain score at the first (p = 0.006) and second (p = 0.02) follow-up visits. CONCLUSION: Pain relief was greater and more rapid in patients treated with betamethasone as an adjuvant therapy in acute exudative pharyngitis.

DrQuinn · May 24, 2004

docB said:
This is exactly what he should be able to do. However in the medical third world (America) he will be told by the receptionist "We can see you in October of 2018. Oh, you're really sick? Then go to the ER. We'll call the ER for you and they'll get you right in."

I like it when the patient comes in and says "Yeah I called DocWagner's office, they told me to come to the ER and that he'll see me here, he said I wouldn't have to wait if I said that."

I have yet to see an FP attending in my ED. Granted, I'm only 11 months into my residency...

muhahahahahaahahahah.

Q, DO

daveswaf · May 24, 2004

ERMudPhud said:
Show her this

: Acad Emerg Med. 1998 Jun;5(6):567-72.
Related Articles, Links

Comment in:
Acad Emerg Med. 1998 Jun;5(6):557-9.

Acad Emerg Med. 1998 Jun;5(6):559-61.

The role of betamethasone in the treatment of acute exudative pharyngitis.

Marvez-Valls EG, Ernst AA, Gray J, Johnson WD.

Department of Medicine, Louisiana State University, New Orleans, USA. [email protected]

OBJECTIVE: To compare betamethasone with placebo as an adjuvant to antibiotic therapy in the treatment of acute exudative pharyngitis. METHODS: The study was a randomized, doubled-blind, placebo-controlled, single-center, parallel, outpatient clinical trial. After consent was obtained, each patient was asked to rate his or her pain on a 10-cm numbered visual analog scale (VAS; 0-10). All of the patients received injectable benzathine penicillin. If allergic to penicillin, they were started on a 10-day course of polyenteric-coated erythromycin (PCE). Each patient was randomized to receive either i.m. betamethasone or i.m. placebo. All patients were contacted by telephone at 24 and 48 hours by one of the study investigators and asked to rate their pain based on another VAS. If their pain was not resolved by 48 hours, they were called again daily between the third and seventh days after the initial visit to determine the time of pain resolution. RESULTS: A total of 92 patients were enrolled in the study, with 46 randomized to receive placebo and 46 to receive betamethasone. Eight patients were excluded from the statistical analysis because of inability to obtain follow-up. Demographic comparison showed that gender distributions, ages, mean initial pain scores, mean times to the first and second follow-up calls, and treatment regimens were similar in the 2 groups. There were significantly better pain scores for the betamethasone group at first follow-up (p = 0.0005), at second follow-up (p = 0.004), and in number of hours until relief of pain (p = 0.004). When only those patients with a positive culture for a streptococcus species were analyzed, there also were significant reductions in pain score at the first (p = 0.006) and second (p = 0.02) follow-up visits. CONCLUSION: Pain relief was greater and more rapid in patients treated with betamethasone as an adjuvant therapy in acute exudative pharyngitis.

So now the question is, would I be a tool if I sent the MD who treated me a copy of this abstract?

I guess you get what you pay for... and keep in mind the student health center is free.

juddson · May 25, 2004

I hope you go to the ER. I was a TOTAL TOOL, and misery likes company.

I'm just kidding. If it's day time (or anytime before 9pm in most cities) I would try an urgent care center if you can't get into your PCP.

I used to get strep twice a year all through college. My tonsels got all puss-covered and would meet in the center of my throat.

A course of Augmentin always did the trick (made my urine smell though - what's that all about?) Ahh. . .good times. . .good times.

judd

would I be a tool if I went to the ER with this CC?

stoic

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Febrifuge

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DrMom

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margaritaboy

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Robz

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stoic

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edinOH

Can I get a work excuse?

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A little elf

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stoic

"Time you enjoy wasting, was not wasted"

docB

Chronically painful

Sessamoid

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stoic

"Time you enjoy wasting, was not wasted"

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DrQuinn

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daveswaf

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juddson

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