An update for my friends who visit me here (instead of at the Big Bald Guy's Place... oops, I mean the BBG's Community) --Anyway -- just the gist about The Road Trip. As a testament to my laziness, this is a copy-and-paste from the aforementioned Big Bald Guy's Place.
Oh, ummm, the Church Lady. Let's just say it is a reference to a woman who has decided that Fred might just be... available. She is a very former friend, becoming more former every week. She fairly lusts after him at these purportedly innocent Wednesday Church Suppers. We all know it really is an Eat-Along During Devil Worship.
Anyway, she likes to bring desserts -- and not your Granny's Impregnated-With-Stuff Molded Jellos -- no, she likes to bring... Chocolate Mousse.
Chocolate Mousse: one of two dishes in my gastronomic experience that resulted in food poisoning. It was a rainy afternoon in Paris, I was drenched and sick with a bad cold, the Important Person with whom I had rendezvous failed to show up... and I needed chocolate. So at the end of a delicious Vietnamese lunch, I ordered up that Vietnamese specialty, the Mousse au chocolat. A little runny, but hey! Two hours later... runny had truly become the descriptor.
I remember being in bed the next morning, trying to hug the wall, ignoring the knocks on the door, wishing I could just die, promising never again to eat Mousse au chocolat.
[Just for the record, the other food that brought me lower than low was a "Garlic White (Stuffed à la Chicago Style) Pizza" that was scarfed down in Berkeley Town, prior to hoofing it with My Boy -- my oft cheating paramour -- to see El Norte at an Oakland discount theatre. It says something about our relationship -- what *exactly*, I am not sure -- that we both ate the garlic pizza! But get this: I got sick; Famous Writer did not. Ah, but I have seen him humbled by bleeding hemorrhoids. That's something.]
################################################################################## ROAD TRIP REPORT:
Youse Guys crack me up! (My friends had been leaving me online advice about dealing with Church Lady)
Okay, let's call Church Lady... The Mousse! Yesterday, Fred had a bunch of unexpected dental surgery, so he emailed The Gang at The Church to say he wouldn't make it to the Famed Wednesday Supper. About 10 pm, the phone rings, and it's The Mousse. Seeing her name on caller ID, I basically threw the phone at The Fredster.
What a conversation, judging from the one side I heard.
He sounded like he had just had a heart bypass or something:
"No, no... {sigh} I'm okay... No, thanks, Mousse, I don't need anything..."
Grrrrrrrrrrrrrrrrrr. Don't mind me, the woman running a fever, in 8+/10 pain, going back and forth in my wheelchair, bringing My Darling specialty coffees and scrumptuous soups, various cats, and all the remote controls. Don't mind me, The Gimp! Grrrrrrrrrrrrrrrrr.
((Oh, shut up! So what? Yeah, so... if I *had* shoulders, they *might* have chips on them... Grrrrrrrrrrrrrr.))
The poor endlessly suffering boy.
Anyway, I am trying to treat The Mousse as a bit of nothing. As a *speck* on a bit of nothing.
So... our roadtrip! Fred is incredibly accurate. We were to be there at 1 pm, and darned if we didn't pull up at 12:55. They were definitely aware of why I was there -- I felt like a very minor celebrity, emphasis on minor.
Okay, let's call Church Lady... The Mousse! Yesterday, Fred had a bunch of unexpected dental surgery, so he emailed The Gang at The Church to say he wouldn't make it to the Famed Wednesday Supper. About 10 pm, the phone rings, and it's The Mousse. Seeing her name on caller ID, I basically threw the phone at The Fredster.
What a conversation, judging from the one side I heard.
He sounded like he had just had a heart bypass or something:
"No, no... {sigh} I'm okay... No, thanks, Mousse, I don't need anything..."
Grrrrrrrrrrrrrrrrrr. Don't mind me, the woman running a fever, in 8+/10 pain, going back and forth in my wheelchair, bringing My Darling specialty coffees and scrumptuous soups, various cats, and all the remote controls. Don't mind me, The Gimp! Grrrrrrrrrrrrrrrrr.
((Oh, shut up! So what? Yeah, so... if I *had* shoulders, they *might* have chips on them... Grrrrrrrrrrrrrr.))
The poor endlessly suffering boy.
Anyway, I am trying to treat The Mousse as a bit of nothing. As a *speck* on a bit of nothing.
So... our roadtrip! Fred is incredibly accurate. We were to be there at 1 pm, and darned if we didn't pull up at 12:55. They were definitely aware of why I was there -- I felt like a very minor celebrity, emphasis on minor.
But no matter who you are, there is always a huge pile of redundant paper work -- and it always starts with signing away your rights... especially at a teaching facility. "We have the right to allow untrained students to mess around with your one and only body, and furthermore, we have the right to publish and just plain gossip about your case..."
"We also intend to charge you an arm and a leg for the privilege..."
Anyway, I did manage to hurt Fred's feelings -- he started to gather his things to go back with me to the exam room -- and asked, just as a matter of course, "Want me to go back with you?"
"We also intend to charge you an arm and a leg for the privilege..."
Anyway, I did manage to hurt Fred's feelings -- he started to gather his things to go back with me to the exam room -- and asked, just as a matter of course, "Want me to go back with you?"
-- already standing up, tossing his backpack over his shoulder.
"Nope," said I, and motored off.
I don't know why. It probably wasn't smart, because some doctors will open up more if there is a 3rd, "responsible" party in with the patient. They tend to spend more time explaining... Oh, well. I think I managed to get the drift.
Actual time with the doctor? 8 minutes.
Time the doctor had spent in consultation with my orthopedic surgeon here and the famous Dr. Go-To-Guy? Unknown, but apparently more important -- because at least 3 minutes of the aforementioned 8 minutes were wasted on niceties, and questions like "Are you sure your shoulders hurt more than, say, your hips or knees?" He asked that 3 times. Obviously a crucial question. WTF?!
So... he thinks that the spacer on the left side, which is the second spacer since last December, must be taken out, and soon. He claims that the hand-fashioned antibiotic-laced head of the spacer (the round part at the top of your humerus) is fractured into 3 pieces.
Okay, folks. {Sigh. BIG sigh.} I *assumed* that he must have seen this on one of the x-rays that I brought him. I had not looked at them, because... I can't read x-rays! But when we got home, I took out all the films and eyeballed them. Know what? There was only ONE sent of that shoulder since the 2nd spacer got put in -- on April 27, 2009. And it was very clear, very clean: There were no "pieces" of spacer, or fractures. None, as in NOT THREE.
Anyway, it is exceedingly painful, as you kind people understand, and he thinks it needs to come out. Pronto.
When he finally turned to the issue of infection, I was again pretty surprised.
"I spoke with Dr. ShoulderMan and Dr. Go-To-Guy, extensively. I think we are dealing with a very common bacteria by which your immune system is being compromised. It usually is considered a culture *contaminant* -- propionibacterium acnes. It is notorious for infecting shoulder prostheses."
I was excited at that point, but posed a question. Turns out he doesn't like to be interrupted. Tough titties, I say! He even employed one of those weird-out moves: The Two-Handed Hand Hold Pat-Pat and Dip. Ha! Foiled again...
"What leads you to think it is P. Acnes as opposed to all the other possibilities, Super Smart Guy?"
"Well, Former Prof, it takes a very long time to grow in cultures. At least 19-21 days, in fact. Hospitals only keep cultures 5-7 days. So your cultures weren't given enough time to grow."
I didn't want to burst his Super Smart Guy Bubble... but I was being treated by one of the region's best infectious disease doctors... and he had ordered the hospital lab to KEEP my cultures, week after week. Once I know he kept a set of them incubated a month. NOTHING grew -- not P. Acnes, not a contaminant, not nothin'!
I figured he hadn't read the ID doctor's notes yet, and, come to think of it, the ID guy was the one doc with whom he did not chat on the phone in advance of my arrival.
Seeing that this was his Big Finish, I just kept silent.
"If it is P. acnes, how do we treat it?" I wondered, out loud (keeping silent).
"Well, Former Prof, it is actually an easy one to treat!" He never said what antibiotics are typically effective, so I let that go, too. I mean, give the guy a break -- he just had three hundred pages or so of notes to go through.
By the time we got home, I was in horrible pain, and had developed some Serious Attitude about driving all that time just to spend 8 minutes with someone who already had his mind made up before I got there.
I have heard rumors about some exciting new technologies out in the larger world -- things like computers and telephones, oh -- and teleconferences! Gawd! I can't think of a situation that better lent itself to teleconferencing than this one! His physical exam consisted of a few half-hearted palpations of my shoulder, evincing nothing but bared teeth and growls.
Anyway, sleep was denied Tuesday night, so I did what everyone here would do -- I got online to learn about P. acnes bacteria. I have never had acne or been treated with antibiotics for acne -- Super Smart Guy said that we all have the bacteria on our skin and in our mouths. It is now believed to be very common in shoulder hardware -- why the shoulder and not the hip, for example? No one knows. Also -- infection by it is almost exclusively limited to males!
Unfortunately, the antibiotics used to treat it? I've already been on them -- by i.v. -- for extended periods of time.
I know it sounds like I am refusing to accept the first answer anyone has dared to propose... but it makes NO SENSE.
"Nope," said I, and motored off.
I don't know why. It probably wasn't smart, because some doctors will open up more if there is a 3rd, "responsible" party in with the patient. They tend to spend more time explaining... Oh, well. I think I managed to get the drift.
Actual time with the doctor? 8 minutes.
Time the doctor had spent in consultation with my orthopedic surgeon here and the famous Dr. Go-To-Guy? Unknown, but apparently more important -- because at least 3 minutes of the aforementioned 8 minutes were wasted on niceties, and questions like "Are you sure your shoulders hurt more than, say, your hips or knees?" He asked that 3 times. Obviously a crucial question. WTF?!
So... he thinks that the spacer on the left side, which is the second spacer since last December, must be taken out, and soon. He claims that the hand-fashioned antibiotic-laced head of the spacer (the round part at the top of your humerus) is fractured into 3 pieces.
Okay, folks. {Sigh. BIG sigh.} I *assumed* that he must have seen this on one of the x-rays that I brought him. I had not looked at them, because... I can't read x-rays! But when we got home, I took out all the films and eyeballed them. Know what? There was only ONE sent of that shoulder since the 2nd spacer got put in -- on April 27, 2009. And it was very clear, very clean: There were no "pieces" of spacer, or fractures. None, as in NOT THREE.
Anyway, it is exceedingly painful, as you kind people understand, and he thinks it needs to come out. Pronto.
When he finally turned to the issue of infection, I was again pretty surprised.
"I spoke with Dr. ShoulderMan and Dr. Go-To-Guy, extensively. I think we are dealing with a very common bacteria by which your immune system is being compromised. It usually is considered a culture *contaminant* -- propionibacterium acnes. It is notorious for infecting shoulder prostheses."
I was excited at that point, but posed a question. Turns out he doesn't like to be interrupted. Tough titties, I say! He even employed one of those weird-out moves: The Two-Handed Hand Hold Pat-Pat and Dip. Ha! Foiled again...
"What leads you to think it is P. Acnes as opposed to all the other possibilities, Super Smart Guy?"
"Well, Former Prof, it takes a very long time to grow in cultures. At least 19-21 days, in fact. Hospitals only keep cultures 5-7 days. So your cultures weren't given enough time to grow."
I didn't want to burst his Super Smart Guy Bubble... but I was being treated by one of the region's best infectious disease doctors... and he had ordered the hospital lab to KEEP my cultures, week after week. Once I know he kept a set of them incubated a month. NOTHING grew -- not P. Acnes, not a contaminant, not nothin'!
I figured he hadn't read the ID doctor's notes yet, and, come to think of it, the ID guy was the one doc with whom he did not chat on the phone in advance of my arrival.
Seeing that this was his Big Finish, I just kept silent.
"If it is P. acnes, how do we treat it?" I wondered, out loud (keeping silent).
"Well, Former Prof, it is actually an easy one to treat!" He never said what antibiotics are typically effective, so I let that go, too. I mean, give the guy a break -- he just had three hundred pages or so of notes to go through.
By the time we got home, I was in horrible pain, and had developed some Serious Attitude about driving all that time just to spend 8 minutes with someone who already had his mind made up before I got there.
I have heard rumors about some exciting new technologies out in the larger world -- things like computers and telephones, oh -- and teleconferences! Gawd! I can't think of a situation that better lent itself to teleconferencing than this one! His physical exam consisted of a few half-hearted palpations of my shoulder, evincing nothing but bared teeth and growls.
Anyway, sleep was denied Tuesday night, so I did what everyone here would do -- I got online to learn about P. acnes bacteria. I have never had acne or been treated with antibiotics for acne -- Super Smart Guy said that we all have the bacteria on our skin and in our mouths. It is now believed to be very common in shoulder hardware -- why the shoulder and not the hip, for example? No one knows. Also -- infection by it is almost exclusively limited to males!
Unfortunately, the antibiotics used to treat it? I've already been on them -- by i.v. -- for extended periods of time.
I know it sounds like I am refusing to accept the first answer anyone has dared to propose... but it makes NO SENSE.
[Don't forget the most disturbing detail of my situation -- these infections are recurring -- or never really going away in the first place. Even after being given what seems like appropriate antibiotic therapy, the infection remains/returns.]
In all of the studies and case reports, the longest time it took for P. acnes to grow in the culture dish was 11 days. There was no mention of 19-21 days! Most results came back in 5-7.
None of the studies/case reports dealt with patients whose samples refused to grow anything!
In summation (and please! put on your logic hats and tell me whether this makes sense to you.):
We're taking out this second antibiotic-laced spacer. He says it has broken into at least 3 pieces and is tearing up the joint space.
At the time of removal, he wants my surgeon to "reconstruct" the joint, and, I presume, to put in a different shaped spacer.
Take more [anaerobic] cultures, keep them at least 21 days.
As soon as something grows out -- determine antibiotic sensitivities, etcetera.
His money is on P. acnes.
The drugs that normally work? Penicillen and penicillen derivatives, cefepime.... ***vancomycin*** (yes, my eyes are rolling back in my head. yes, i just finished 6 weeks of i.v. vanco last sunday night).
So there you have it. If we buy into this, another surgery looms large, then about 3 weeks of waiting, followed by 6 weeks of [ineffective] i.v. antibiotics. Gee, I wonder if my WBCs and CRPs will still be way elevated, will I still be dripping with sweat from fevers, weak, bitchy and exhausted? Will my picture still figure next to the definition of "left shift"?
Do I do this -- another roughly 9-10 weeks of it -- or do I head for Baltimore?
Suddenly, I don't want to have to make the decision. I want my docs here to understand my doubts and concerns, and respond to them. I am sure that 10 weeks is not a long time to anyone else... I need to take a Patience Pill.
So... here is to patience! Wish I had some.
Thank you so much for following this ridiculous saga.
Prof
Just as a so-it-goes notice: I woke up this morning. [No, wait, there is more!] I woke up this morning, at the end of a 1 hour 15 minute nap, to find that I am developing a wicked chest cold to accompany this never-ending headache. Marmy and I sound much alike: *ack*-*ack*-*ack*-ing to beat the band. What say I get this out of my system before the next intubation, eh wot?
In all of the studies and case reports, the longest time it took for P. acnes to grow in the culture dish was 11 days. There was no mention of 19-21 days! Most results came back in 5-7.
None of the studies/case reports dealt with patients whose samples refused to grow anything!
In summation (and please! put on your logic hats and tell me whether this makes sense to you.):
We're taking out this second antibiotic-laced spacer. He says it has broken into at least 3 pieces and is tearing up the joint space.
At the time of removal, he wants my surgeon to "reconstruct" the joint, and, I presume, to put in a different shaped spacer.
Take more [anaerobic] cultures, keep them at least 21 days.
As soon as something grows out -- determine antibiotic sensitivities, etcetera.
His money is on P. acnes.
The drugs that normally work? Penicillen and penicillen derivatives, cefepime.... ***vancomycin*** (yes, my eyes are rolling back in my head. yes, i just finished 6 weeks of i.v. vanco last sunday night).
So there you have it. If we buy into this, another surgery looms large, then about 3 weeks of waiting, followed by 6 weeks of [ineffective] i.v. antibiotics. Gee, I wonder if my WBCs and CRPs will still be way elevated, will I still be dripping with sweat from fevers, weak, bitchy and exhausted? Will my picture still figure next to the definition of "left shift"?
Do I do this -- another roughly 9-10 weeks of it -- or do I head for Baltimore?
Suddenly, I don't want to have to make the decision. I want my docs here to understand my doubts and concerns, and respond to them. I am sure that 10 weeks is not a long time to anyone else... I need to take a Patience Pill.
So... here is to patience! Wish I had some.
Thank you so much for following this ridiculous saga.
Prof
Just as a so-it-goes notice: I woke up this morning. [No, wait, there is more!] I woke up this morning, at the end of a 1 hour 15 minute nap, to find that I am developing a wicked chest cold to accompany this never-ending headache. Marmy and I sound much alike: *ack*-*ack*-*ack*-ing to beat the band. What say I get this out of my system before the next intubation, eh wot?
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