I saw another doctor, who I will be calling Doctor Knowslittle, at UAB on Monday morning. He said that whatever was causing my symptoms after 9 days of clindamycin couldn’t be strep because and I quote, “strep is a weak little bug.”12 He also said that I wasn’t feverish because my temperature had yet to hit the 100.4 °F that some doctors still believe is the norm for fever in adults. Fever isn’t supposed to be defined so rigidly anymore.3
Anyway, he thought that I had mononucleosis or “some other virus” now and that that was what was causing my symptoms to worsen. To prove this, he ordered six blood tests: a CBC, blood smear, CMP, EBV, CMV, and a sed rate.4 The results came in this morning–or, at least, he saw them this morning and called me with them. No mono. No Epstein-Barr or cytomegalovirus. But I did have a high lymphocyte count.5 He told me that it “must just be another virus” because, again, he doesn’t believe that strep throat can continue after so long.6
As my symptoms are continuing to get worse,7 I will be going tomorrow to get checked out by a different doctor. Maybe they’ll have a solution to this whole mess. Maybe they’ll listen and not be dismissive.
But this doctor? I pity anyone who sees him8 and doesn’t get their condition properly treated. If he does this on strep and it’s complications and drug-resistance are so well known, then people with lesser-known issues are totally screwed.
In related news, because it was part of the blood count stuff, my anemia is coming back. Doctor Knowslittle didn’t notice it, but I did. My mean corpuscular hemoglobin concentration (MCHC), which is the amount of hemoglobin relative to the size of the cell (hemoglobin concentration) per red blood cell,9 is low. It’s almost as low as it was in September/October 2012, which was after the small iron infusions, but before the big one. It’s the first time it’s been below normal at that clinic since then. My MCH, which is the amount of hemoglobin per red blood cell, was close (0.7 picograms/cell) to being in the low-range.
Another big clue is that my platelet is headed back up. If it hits 400, it will actually be too high, and that will probably happen because it’s a known sign of iron-deficiency anemia. It won’t get super-high, but it will continue to go up until the anemia is treated. Then it will drop off again.
As iron deficiency anemia is one of my primary diagnoses at UAB, it seems like Doctor Knowslittle would have been interested in why my MCHC was low. And that he would have compared the CBC levels from the past few years, but he didn’t.10 And it shouldn’t surprise me that he didn’t, since he’s so well-versed in streptococcus and how it works–and, like I said, that’s well-known shit.11 But a second year resident should be paying attention to this sort of thing. If he doesn’t now, he won’t notice it when he’s in practice on his own, and that could lead to badness.
Anyway, I will not be seeing DK again and I hope that whoever I see tomorrow (or at any other visit) is a bit more knowledgeable. At the very least, I hope they willing to do the research/get a consultation with their resident to make sure they’re not wrong. It’s better to be a doctor who admits they’re not completely sure than to be one who makes a bad call due to an inflated ego. If people are placing their lives and their health in your hands, you need to know what you are talking about.
Also, from the Concise Reviews of Pediatric Infectious Diseases article “Macrolide-Inducible Resistance to Clindamycin and the D-Test” by Charles R. Woods, MD, MS:
Clindamycin resistance is common among health care-associated MRSA strains. Most CA-MRSA remain susceptible to date, but resistance rates vary by region. Pneumococcal resistance to clindamycin may exceed 30% in some areas of the US, while about 4% of group A streptococcal isolates are resistant.
The Mayo Clinic says this about fever: “You have a fever when your temperature rises above its normal range. What’s normal for you may be a little higher or lower than the average normal temperature of 98.6 °F (37 °C).” ↩
But not a blood culture, which could have been used to look for bacterial infections, including strep. ↩
It is higher than it’s been the whole time that I’ve been going there. ↩
Lymphocyte counts also go up for bacterial infections. ↩
A few hours after coming home from the doctor on Monday, my temperature was at 100.5 °F. It took multiple ice packs, several doses of Tylenol, and at least 96 oz. of ice water to get it down into the 99.0-99.9 °F range. Sleep is getting it to 98.1-98.6 °F, but, about an hour later, it’s back in the hot and sweaty range. ↩
And my dad is assigned to his care, so I’m definitely worried about him. ↩
This is a pet peeve I have with a lot of doctors. If you order a test on someone that has had this test before, then you need to compare the test to the past tests to see how a person’s condition is progressing or declining. If you’re not going to check back, you either shouldn’t be a doctor or you should archive all of their old test results. And if you want to do the last thing because you’re too lazy to actually care about your patient’s history, then you should probably do the former suggestion. ↩
Okay, I didn’t call it shit, but that works, right? ↩