I Need Some Viracillin, Cause I’m Illin’.

iStock_000000633147_MediumOne of the purposes of this blog is to educate and inform, and hopefully help you become a better consumer of your health care dollars. Knowledge is power, or something like that.

You’re sitting at work. Your throat is a little scratchy. You feel some drainage down the back of it. As you twist in your chair, you notice an ache in your back that wasn’t there when you woke up this morning. You push on through your day, mostly ignoring the gradual onset of malaise and fatigue. I’m just tired, you convince yourself. I slept wrong. You will yourself to health and wellness.

In bed early, Nyquil your evening nectar, you fall asleep easily. But, at 3:45, you awaken with chills so violent (we call them rigors – rhy-gors) that you’re certain your bone marrow suddenly became infused with liquid nitrogen. Your body shakes and shudders in an attempt to warm itself. You bury yourself beneath the covers. You have a fever. There’s no denying it now: you’re sick!

What’s the first thing we think when this hits us? “I don’t want to be sick. I didn’t ask to be sick. I want to be well. Well. That’s where I want to be. Who can help me to get back to well and away from sick? Who’s that person… went to school for a long time… practiced indentured servanthood for several years learning his craft… A DOCTOR!!! That’s who it is!!! That’s what they do. They get me from sick to well. And, they do so quickly!”

So, you make your way to see your friendly neighborhood medical professional, either at her office, or, if money is no object, you waltz up to the emergency department.

“May I help you?”

“Yes. I am here to be well. I’m sick, but that’s not what I want at all. Make me well.”

Now, here’s where things fall apart. There’s no debating that you’re sick. Clearly, you don’t feel well. Herein lies the rub: can we do anything about it? For the most part, the more ill you are, the more we can help. Like, if you’re really dying, we have some fancy interventions that involve tubes and plastic sheathes placed in various natural and man-made holes in your body. We can drip things into said tubes and paraphernalia and maybe make you better.

The real disconnect between what you want and what we can do comes when you feel horrible but you’re not that ill. This is when you start investing large amount of coin for little or no return. When you come see me in the emergency department, I’m going to do a few things. First, I will try to make certain you don’t have a life-threatening issue. I look at your vital signs, examine you, and, maybe, order some tests. (I don’t always need the tests.) Next, I’m going to try to figure out if this illness is something that can get better with antibiotics. More on this next. Lastly, I’ll try to see if I can at least help ease your suffering.

Viruses are not weakened by your silly little antibiotics. Bacterial illnesses (sometimes) get better with antibiotics. For a long time, we’ve over-prescribed these drugs, now to the point they’re expected for anything and everything. How do I determine if you have a virus or bacterial infection? Well, bacteria mostly cause what I call “focal” infections. Pneumonia, skin infection (cellulitis), urinary tract infections are often caused by bacteria and get better with antibiotics. Bronchitis, being the distant cousin of pneumonia, is an infection that doesn’t get better with antibiotics (the exception being if you’ve got bad lung disease from naughty habits like smoking). Think of bronchitis as a cold with a cough, and a disappointingly normal chest x-ray. Well, disappointing if you were hoping to get some antibiotics from me!

Does a cold get better with antibiotics? Nope. What about the flu? I mean the flu. Even though it can be fatal, it is still a virus. What about vomiting and diarrhea? Surely, you’ve got something to cure that, right? Well… um… no. These things are what we call “self-limited” illnesses. Meaning, your body has the capacity to deal with these on its own, it’s just not on the timeframe you’re looking for, like NOW.

Who needs to go see a doctor when they’re sick? Anyone who feels bad enough that they must be seen. I know that’s a cop out, but this blog really isn’t a substitute for an evaluation. I’m just trying to teach you what we look for. If you’re on chemo so your immune system is shot, you should be seen. If you’re extremely old or extremely young, err on the side of getting seen. If you’re delirious, have a severe headache, stiff neck, or your blood pressure is lower than where you want your IQ to be, by all means, go to the doctor!

On the other hand, if you’re a healthy adult and you want to try treating your symptoms and seeing how you do for a bit, that’s a good plan. Take some Tylenol and ibuprofen, assuming you’ve not been told you can’t have these. If you’re not doing better in a couple of days, or you ever feel you’re rapidly getting worse, make your way to a doctor.

My friend and fellow emergentologist, Dr. Edwin Leap, is a lyrical master in his poem that describes the woes of the dreaded virus sufferer. Please be aware that I’m not talking about the proverbial man cold here. Women are lucky to not be plagued by such catastrophic infirmary!

I always want you to be seen by a physician when you’re sick sick, but Zithromax won’t help if you have a virus. I could write you a script for Suck-It-Up-icillin, but you won’t find it very palatable. Instead, you can probably save yourself a little time and money if you try some remedies at home and reset your expectations of what we can do for you if you do decide to pay us a visit. For most things, we’re not going to be able to have you beckon our doors feeling like poo and leave feeling like a million bucks. We’re just not that good. Unless you’re dying. Then, we just might shine. But, let’s not find out.