Q fever and long term survival

I heard the name on the phone

 From a nurse who spoke with a moan

 Of prescriptions too plenty.

After years more than twenty

I remembered the fever unknown.

 I take call Christmas and Easter, I have for a very long time. None of my partners have ever objected to working on my holidays.

Working Christmas several years ago, I attended a patient who arrived with a high intermittent fever with no apparent source. Investigating fever of unknown origin, I initiated a thorough work up while she was in the hospital. Perhaps the work up was a little too thorough; I got CT scans of the abdomen, chest, and pelvis. The patient ended up with two unusual diagnoses: a rickettsiosis and a very early cancer.

Rickettsioses are so unusual  it doesn’t feel fair to mention them. They include Rocky Mountain Spotted Fever and typhus, all transmitted by the bite of a flea, tick or mosquito, with the exception of Q fever

The early cancer showed at a curable but would have progressed quickly to fatality.

I hadn’t heard from the patient for a long time. I know the patient regarded me with great respect into the 1990’s, but sometimes people change their point of view. And sometimes their insurance makes them change doctors.

Today I got a call from a nursing home about that patient, who had been admitted there for rehab following major surgery. Doctor A, who doesn’t go to the nursing home, has been providing medical care in the office, Dr. B was the hospitalist (which I didn’t understand because Dr. A is perfectly capable of taking care of the patient in the hospital), Dr. C was the surgeon and removed a different cancer. Our practice, the nurse told me, will providing care for the patient during the nursing home stay, but the responsibility for the patient’s care will return to Dr. A after the patient leaves the nursing home.

I asked about medicines. To my concern, I found Coumadin on the list, along with two drugs that interact with it. The nurse noted that the patient’s nausea got much worse after taking a pain pill, in this case, a narcotic, noting the patient didn’t have much pain.

We were using Coumadin before 1950 and we’re still using it now, and you can’t say that about very many drugs. A blood thinner, it offers little difference between enough to therapeutically thin the blood and enough to kill. The pill you give today doesn’t get to full effect for a week. Diet changes the effect dramatically. It interacts with a lot of other medications. All in all, it wouldn’t take much competition to drive it from the market, and good riddance when it goes.

I had the nurse change the narcotic to tramadol, a weaker narcotic pain reliever. I asked for tests to check the interaction between the medications. The patient, whom I shepherded through her two most hazardous illnesses, will see Dr. A after leaving the nursing home, and I will get no reimbursement for the care I’ve given by phone, and, ironically, I don’t mind. Dr. A is a good doctor and will take good care of the patient in my year’s absence.


Tags: , , ,

One Response to “Q fever and long term survival”

  1. Alveo Says:

    Thank You For This Blog, was added to my bookmarks.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s

%d bloggers like this: