Hospital Adventures: ER Visit #3, #4 in 2018 - Turns out to be Valley Fever

Even if you feel great take it easy for so me time if you can. You symptoms may be over but what happened was traumatic to your entire body. Your resistance to infections, your cardiovascular system etc may be temporarily compromised. Do not put it through any additional stress, take some rest.

 

Just read through her autopsy report. I highly doubt it, what killed her was her being an idiot and not wearing a seat belt.

Healthcare has changed vastly since her death, is possible she would have lived if the accident occurred again in Paris or NY today but wouldn't be surprised if she didn't.

I always find American healthcare a joke from what I can tell you've undergone alot of uncessary and expensive investigations for something that can be quite easily diagnosed. I believe this is due to a culture of fear of legal action against health professionals. It boogles the mind how much Americans spend on healthcare yet get little return on it, probably the most cost ineffective healthcare system in the world.

Hope you get better soon. Make sure you rest but if you can do light excecise such as walking will aid your recovery.

 

And be thankful it didn't involve a 911 ambulance call. It happened with my mother and the ambulance charge was $15K. Insurance paid 90%, still leaving $1.5K out of pocket. It's sad to think it could make people hesitate to use an ambulance even if they need it.

 

Yikes, that sucks. Please take a lot of rest even if you feel fine as others here have noted. Better to be safe than sorry. Get well soon!

 

Before reading all this I actually thought a trip to the lakes of Michigan might be fun. I guess I just need to make sure I don't get mixed up with any rednecks while I'm there, even ones that might be in-laws. Like that old Dave Chappelle routine, it's always your white friend(s) that are the craziest.

In all seriousness, thanks @purrin for sharing - you could have saved us some pain/hassle/death sharing your harrowing story. Some hard-earned, valuable lessons there! Also, hope you can take a few days off work and just recouperate.

 

Get well!

Interesting hearing your perspective on our healthcare system.

 

I agree the American dream is a powerful thing, over in England sadly our class system is too deeply imbeded in our culture to allow it.

The care you've received probably has been great but would sadly be a very different story if you could not afford it.

Even realtively wealthy people are at risk in the American health care system. All it takes is a long term health condition to rob you of your wealth, just look at what happened to the great musican Vic chesnutt.

I weridly would argue that the American health care system actually goes against the ideal of the American dream. As it only looks after the people who already have money. When the root of the American dream is that any person has potential. How can they achieve anything of value if their health bars them from doing so?

But anyhow get better and sorry about the reaction with the medication, yes I agree people should be more informed about side effects. I too commonly see problems persist because doctors and surgeons don't fully explain the risks

 

I'm always struck by how cemeteries here in the U.S. often have gravestones flat on the ground, invisible.

 

Purr1n's tale is sadly not uncommon, I find all too many health services are driven by protocols. This is not necessarily a bad thing - these protocols have been developed through evidence based studies and rapidly screening for a heart attack or vascular rupture will save a number of lives. Think of this along the lines of a building management system which buys cheap lightbulbs and systematically changes them out every 6 months - this is cheaper than paying for staff to be available with a storage unit of said bulbs who then have to be called, have to locate the defective bulb and replace it as needed. Perhaps not the best analogy but this is health care in America - some of it driven by risk of litigation, some driven by institutional statistics. I am not saying the ED physicians are not capable of thinking, some of the most astute diagnosticians I have met are emergency care providers but they run internal algorithms to rule out common things first.

The future of health care is actually incredibly exciting, not sure how much reading folk do around AI in health care but it is a megamillion dollar enterprise. I have seen examples of an AI system being able to diagnose carbon monoxide poisoning in an ED situation by doing a near instantaneous analysis of the symptoms, lab values, demographics and public health records to identify an at risk neighbourhood. Purr1n's story might have run - old geezer in good shape with fever and left shift on CBC, facebook antics suggest he tried to consume lake Michigan - most likely diagnosis is aspiration pneumonia.

Now we get to the cool part of the future, imagine that when he was but a pink blubbering babe in his mother's arms, his new born screening would include complete genomic analysis so we would know what drugs are likely to work best for his system and provide the least side effects. This aspect of personalized medicine is called pharmacogeneics , picture a Punnet square top left corner is a group of people who based on the genetics, will not benefit from therapy but have no side effects and thus are non the wiser, top right is where levaquin and Purr1n land - benefit from the drug but have side effects, bottom right - no effect but side effects , no one wants to be here, and the best place to be, bottom left get all the benefit and no side effect risks. And this is just the tip of the iceberg when it comes to precision / personalized medicine and health care. We have the ability to look at the genomic risks and even further in the future we will be looking at how his genomic fingerprint reacts to environmental exposure ( epigenomics ) and looking at his poop to assess his microbiome ( which represents greater cellular biomass than you can possibly imagine) ... fun times ahead.

And even better, using the power of genetic testing for other uses - why wait for a bacterial or viral or other organism to be cultured ( if it is even possible to culture some infectious agents) - there are companies who use fragmented DNA from these infectious agents which circulate in blood to provide conclusive diagnoses within 24 hours. To read more, one of the more popular companies is KariusDx

My recent soapbox has been patient centered care - allow people to carry their own health record in a cloud which has all their data in it - any test that has ever been run, all the "wearables" data etc etc - this way anyone can choose to go and get an opinion from any provider and they have access to all health records through simply sharing a link with them .... without the red tape of institutions hiding behind HIPAA and filtering what data actually gets shared.

Don't want to detract from @purr1n 's ordeal, it serves to highlight some realities of the world we live in. Thanks for sharing this with us..dB

 

Does anyone else want to rub Benedryl Cream on @purr1n 's back, poor fella...

 

The root of American dream is NOT that every person has potential. The root of American dream is that if you have potential, you will have an opportunity to build on your potential and have a good life, whatever it means to you.

And by the way can you imagine any planet in this solar system, or any other solar system, where your health, if it's poor, does not limit your potential? I spent many years riding really hard my road bike, cannot do it anymore because my heart rhythm is slightly fucked up. What does it have to do with the health care system?
And by the way I live in Canada but I spend few month each year in Florida where I have friends who are older than me, not rich but with ra reasonable insurance. They receive care I can only dream about in Canada.

 

Wow seems like you've been through a lot between the trip to Michigan and the visits to the hospital. Hope you are getting better! It really sucks that you reacted to Levaquin the way you did, but I think people should keep in mind that Marv's reaction is not typical. I just don't want people to read this and refuse Levaquin down the line, when it may be the best antibiotic for their particular pathology, because of anecdotal evidence. I agree that the best patient is a thoroughly informed patient, and I encourage everyone to ask questions, use the Internet, and question your physicians. After you've been thoroughly educated and informed, you can make an informed risk-benefit analysis. If the risk profile of an antibiotic is unreasonable to you, it's very reasonable to ask if there's an equivalent antibiotic in a different class for you; many times there is. Generally speaking, the first-line antibiotics we use today have low risk profiles. The old-school antibiotics, which are only reserved for special cases nowadays, can get you on dialysis in no time, but will save your life. Luckily, modern medicine has come a long way and we usually don't need to choose between your kidneys or your life.

Levofloxacin (generic for Levaquin) is on the World Health Organization list of essential medications, and I've personally seen it save many people's lives (no hyperbole); ventilator associated pneumonia and ARDS is no joke. It covers both gram positive and gram negative bacteria (including the notoriously pathogenic Pseuodomonas), has good lung tissue penetration, and is available in both oral and IV forms. One of its most attractive qualities is that it has equivalent bioavailability in oral and IV forms, meaning that taking it orally is just as effective as getting it IV. This means that if you're getting better in the hospital, you can quickly transition to the oral form and go home. Less days in the hospital is always better.

Oral azithromycin is a good antibiotic for low acuity, community acquired pneumonia (CAP), however the oral form has poor bioavailability compared to IV. Additionally, you've been in and out of the ER/hospital several times recently, which increases your risk of having a healthcare associated pneumonia (HCAP), which Azithromycin isn't great for. This is likely why they chose to switch you to Levaquin on discharge. Sometimes the only way to know what the bug is, is to do a bronchoscopy where a fiberoptic camera is inserted into your airway and lungs to get a sample of the secretions to send for culture. However, not only is this invasive, but it carries a separate set of risks because of the procedure itself and the anesthesia this is required to do the procedure. Many times these risks do not outweigh the benefit. In these cases, the pneumonia would be treated empirically, meaning, the most likely bacteria will be targeted, given your clinical picture, circumstances, and other objective data such as lab tests, radiographic imaging, etc.

Tendon rupture with levofloxacin is very rare (<1%, 5-10 out of 100,000), so much so that the benefits of it for a bad pneumonia generally far outweigh this risk. Rashes and hives are one of the most common side-effects of antibiotics, and while it can be a royal PITA, is generally considered a benign reaction. Usually, you can just change the antibiotic, but sometimes you're forced to continue the antibiotic because there isn't a reasonable alternative, and in that case you treat the symptoms of the rash and hives separately. Epinephrine is reserved for anaphylactic reactions (very low blood pressure, airway closing in); and in these cases you would definitely stop the antibiotic.

Medicine is a constant risk to benefit analysis. Unfortunately, this analysis is usually based off population level data, and if you're one of the 5 unlucky individuals, out of 100,000, you don't give a shit what the population level data showed. Medicine is shifting towards more individualized care, with genetics and genomics playing a larger role, like @dBel84 mentioned. I think we're still quite a ways off from this, but technology and science moves fast. Until we can reliably get that kind of data, we need to rely on the clinical trial. Generally speaking, a risk <1% is acceptable; however this can be different for everyone. So again, be informed, stay informed, and don't be afraid to ask questions.

 

Holy frick Marv. So was this likely related to the nasty river water exposure on vacation?

 

Damn. Good you are feeling better. I'm sure the family is relieved too, as we are here.

 

Glad to hear that it is finally figured out, keep on the mend..dB

 

Best wishes bro.