Re: foods,heat edema and rosacea

[Guest guest]

Stacey, based on what you described here, I have a different take on

the care you received. Streptococcal infections, very commonly in the

throat ( " strep throat " ) are *very* important to treat early on

because failure to do so can result in a post-streptococcal infection

several weeks later that can affect the kidneys.

The problem is, diagnosizing strep throat is not very

straightforward. Physicians look for a constellation of signs and

symptoms -- and as important, lack of other signs and symptoms -- to

make the diagnosis. Throat cultures aren't even close to 100%.

Without a way to definitely diagnose, doctors will tend to treat

everyone with antibiotics unless they're certain it isn't strep

throat, since missing a subtle or unusual case can be potentially

damaging. So to your doctors who say it looked like strep throat, it

was certainly appropriate to treat you with penicillin and, when that

failed, it was equally appropriate to try a second antibiotic, and

even a third trial isn't unreasonable at all.

But now you have a recurrent/persistent sore throat, and that's

managed differently than a new sore throat. I can't know, but I

suspect your GP would probably have provided you with approximately

the same care you already received. But with continued signs and

symptoms after two or three full courses of antibiotics, we're now

talking a sore throat that need to be investigated, usually with

blood work to rule out systemic causes of a persistent sore throat,

and an exam by an ENT specialist who can look down your throat and

see if there are problems outside the visual range of a typical

exam.

As an emergency physician I don't do throat swabs/cultures, but many

physicians do. I'm not sure why you put such importance on the throat

swab results. I assume it wasn't explained that, since you've been on

antibiotics (even just two or three doses) the test would certainly

turn negative even if you had strep throat; that was probably

the " false negative " the doctor was referring to, although even an

untreated strep throat can give a false negative result, for a number

of technical and lab reasons. So after treatment has begun a negative

test means nothing, but it sounds like your doctors felt a positive

test might be helpful.

Your GP knows you, and knows how you like to be cared for. That's at

the heart of a good patient-doctor relationship: he's doing the right

thing by you, and doing it in the way you like. You may be surprised

to learn that most patients don't want to know all the details of

what a doctor is doing/thinking, they just want treatment (and

information about that treatment). Knowing that, most doctors assume

that if a patient doesn't ask, they aren't interested. Unfortunately,

there are also health professionals who aren't very good at patient

education, even when asked.

Thanks for the kind words.

Marjorie

Marjorie Lazoff, MD

>

> In a message dated 5/5/02 11:33:34 PM, filter@r... writes:

>

> << I recently said to my doctor that I am sure food is one of the

biggest

> influences on my skin.

> >

> > Now I know I don't have any food allergies, but, after eating my

face

> bloats. The doctor dismissed this and said that it's almost

impossible for

> food to effect rosacea so quickly.

> >>

>

> remember --

> you know your self better than anyone else does!

>

> i've had some bad experiences with doctors that have made me

extremely

> skeptical

> i used to have absolute faith in any doctor --

> stupidly assumed that because they went to medical school

> and were in the business of helping

> that they knew what they were doing.

>

> i found out the hard way that there are as many lousy doctors as

there are

> lousy makeup artists ...

>

> if you see an effect in your own body

> you know it's there

> even if your doctor says

> " it's impossible "

> trust yourself above all...

>

> especially if your doctor doesn't have the same condition

> (ie rosacea)

> that you have

>

> side note to marjorie md

> that you are eager to ask for information

> share information

> interested in learning new things

> makes you much more trustworthy as a doctor --

> why is it that so many doctors refuse to admit they don't know

> everything?

>

> i have a recurring throat infection

> i went to the doctor (at a highly reputable walk-in clinic)

> she said: it looks like strep here take this penicillin

> i did

> of course the pen v made me really ill but

> and then the throat infection came back

> i went back to clinic

> saw another doctor

> he prescribed ceftin for strepthroat

> and did a throat swab

> with eventually came back negative

> the throat infection came back

> i went back

> saw a different doctor

> she said : it's clearly strep throat

> i said: i don't think it is. the last throat swab came back negative

> and it just keeps coming back.

> she said: well, it was obviously a false negative. it's clearly

strep throat

> here take these antibiotics.

> i said: i'm waiting for the results of the throat swab.

> she said: it's clearly strep throat so you should take the

antibiotics

>

> anyway

> the swab came back negative

> the symptoms lessened in a few days.

>

> and then it came back again!

> so i went back to the clinic

> this time fortunately it was on a day that my regular gp was in

> i told him the story

> he said:

> i'll make an appointment with an ENT for you

> instead of trying to convince me i had strep throat ...

>

> if he's unsure of something, he'll be the first to admit it

> which is why i feel like i can trust him completely ....

>

> hey guys have a beautiful day!

> the magnolia trees are in bloom ...

>

> stacey