Biopsis Interruptus

Not one single biopsy!

I got down to Cedars, where the Great Doc resides. The journey from the parking lot to the doc's office is a long and arduous one. Going there on my scooter really hit home to me that I had decided against more appointments with this doc simply because I couldn't get in there very well.

So, I gleefully - smugly - oh, contentedly! - scootered my way to the office and the waiting room. My scooter can easily hold both my canes, my purse, and my laptop. I wanted to show off my pix from the 10/19/06 leg infection.

When I first met this doc around a year ago, I had laid out photos of Poor Mr. Foot, showing the progress of the 2004 infection and abscess. I did this after surfing the doc's name showed not only his fine qualifications as a dermatology MD/scientist, he'd also published at least one article on MRSA.

I read his article. He made some good observations, including the striking comparison between the often less than dramatic appearance of the infection, and its extreme pain.

That first visit, I'd laid out the series of 2004 pix on the countertop in the exam room. He walked in the door and immediately gravitated toward those pix, and spent some time reviewing them. The 2004 photos, now, they are dramatic. It's the sort of thing that can help one's medicos take one's case seriously.

To my surprise, he recalled that first visit and the pix quite clearly.

This time, as he trooped in followed by a couple med students and a nurse, I had the laptop open and the Friday-Saturday-Sunday leg pix up on the screen. All three docs had a fine time looking.

Next, of course, we came to the purpose of the visit: the arm.

I noticed that both med students were doing Giant Step Backwards on me. The male student doc never came near, deliberately hiding behind one of the other docs the whole time. Thinking he was invisible? Definitely skittish. Showing the whites of his eyes any time I glanced his way.

The female student doc was hesitant too, but she determinedly gloved up and examined my arm. She was the one who kindly wrote down the name of my elbow thing for me.

To the Great Doc, it looked like it was a MRSA infection in four lymph nodes and possibly the vessel too. He also thought it had gone to more areas of my arm than I'd identified. This made sense, because when I posted the pix of the arm, I realized the rest of the forearm had reddish patches more visible to the camera than to my eyes. He spotted those exact same areas.

It looks like it's traveled up the back of my arm too, past the elbow toward the shoulder. Laying my right arm down on the worksurface is often when I feel these things first.

With the infection in such a state, he refused to do a biopsy. Cutting into that stuff can send loose germs running around in one's bloodstream and lymphatics and such, and he refused to do a procedure he considered unsafe. Good.

He put me on a month of minocycline, and also mupirocin cream to try to decolonize me. I said we'd tried that over and over again, but I'd try 18 million times if there was a chance it might work.

He was puzzled about why the ID doc didn't already have me on antibiotics, too.

See, she thought the first big red lump in my arm wasn't anything at all. And that, my friends, was where she and I first disagreed on Monday. The lack of antibiotics was another.

Before that? While the 10 days of minocycline appears to have killed off the primary infection in the left leg, still, MRSA's well known to hang around long after a *normal* course of antibiotics. So we also disagreed about that. I didn't say so at the time. Now I'll ask her more about it. It could very well be she's trying to keep me from sensitizing to more antibiotics. But me, I think leaving unkilled germs behind is worse.

So I feel much safer being on a whole month of minocycline.

There was no wound or other entry point for the arm infection. From some things kdad explained to me, I'm guessing this may have started from germs circulating around, unkilled after the leg infection, and setting up camp in that lymph node for reasons they'll never disclose. Once they settle into one lymph node, they often travel up the lymphatic vessel and infect other nodes on the way. It's what happened with my very first cellulitis in September, 2001. That was also in my right arm.

But not having any biopsy, no way to prove what I believe about this infection? ARGH!

I did get a little more info on other lumps:
-The watery bubbly bump on the end of the elbow is called *olecranon bursitis.* An excellent addition to The Collection of Stuff Gone Wrong.
-The big hard lump a couple inches from the elbow is probably just a calcified lump of inflammation.
-The other lumps they thought were from mycobacteria could also just be due to inflammation, from more of the autoimmune process that's eating me alive.

Now: Remember when I sicced the CIC doc on the cardiac surgeon to make sure Walter stayed put for his surgery?

Docs can get into serious pissing contests. When this happens, if you're the patient sitting in the middle, best thing to do is duck.

They're not shooting at you. They're shooting at each other. No point getting caught in the crossfire.

So when I called the ID doc's to say there was no biopsy, and there was a month of minocycline, I was expecting smoke signals.

I got 'em too.

Her medical assistant called back and left a message: Dr. C wants to see you Friday, the 8th; call the office for an appointment time.

Ha!

Okay. 10:30.

This will be interesting.

Good thing I used to work for the government, huh? I really did learn how to duck.