Biopsied!

YESSSSSSSSSSSSSSSSSSSSSSSS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

I GOT it!

Today was my one-month return visit to the Great Skin Doc down in Miami.

Yesterday I talked to Dr. C, my ID (Infectious Disease) doc. I told her I was scheduled for this followup Tuesday but ran out of antibiotics Sunday night. I did not 'fess up that I'd stayed on the Minocycline for the full month. I did 'fess up that I went to the ER over New Year's and they gave me Clindamycin. She said, --That's not so good on MRSA any more. I'll call in some Minocycline for you.

So, at least I had antibiotics by late Monday afternoon. By which time the lymph nodes were already growing again, growing by leaps and bounds.

I told Dr. C: --I want so very much to get a biopsy. I would love to get this thing cultured so we can find out for sure what it really is and maybe even do a sensitivity test on it, see which antibiotics kill it the best. He refused to do it last time, but I'll try very hard to get him to do it this time. Is there anything else you can think of for him to do? Anything else that might help?

She said, --A biopsy would be very good. A very good thing.

Okay.

That was my assignment for today: get that biopsy. Git 'er done. Get it get it get it.

Sometimes I still get to put on my Master Negotiator hat.

When I arrived I discovered that my new Medicare insurance plan - which had faxed in a referral and EVERYTHING - didn't allow me to see docs in Dade County as opposed to Broward.

Now, this one is the nice saleslady's fault. The Great Skin Doc was one of the docs I carefully vetted with her before I switched plans.

OTOH: this woman is very good and very adept. Intelligent. Forthright.

She instantly figured out what happened, and apologized. She tried to clear it as a one-time special with her boss, to give us a little breathing room to do whatever repairs to the plan we need to do, but that didn't fly.

So she thought for a bit, discussed, called back, and said: Here's what we can do. We can make the new insurance effective 2/1/07 instead of 1/1/07 and put you back on Health Options for January. That way you can still see this guy today, and we'll have time to set things up better.

Okay. I like it. Another minor flurry of faxes and phone calls and we're done.

It did mean I had to pay a $25 copay for today. The new plan is $0 copay for anyone in the plan, which means almost all the same docs I already have. Generic meds are free too, if you get them through their mail order pharmacy. Otherwise they're maximum $5 for generics, and not much more for call brands. Cheap plan. I'll be spending a good $150 a month less than with Health Options M&M. That's a lot of money just now.

Also, January is refill month on a lot of my prescriptions. This way I can get 90-day supplies and make HO M&M pay for 'em, with very low copays on my part. That'll give me time to learn the new mail order bit, plus a tiny taste of monetary revenge against the Scooter Stealers for a chaser.

This minor scene from HMO Hell took about an hour and a half to complete. Since the one who caused it apologized, then diligently - and successfully - worked to solve it, I didn't really mind.

As long as it was resolved before the doc went home for the day...

Which, finally, it was.

I scootered into the exam room. This time there was only one student doc. A beautiful, tiny, very good Asian lady. Down to earth, and impressive at the same time. She looks to become a superb doctor.

She displayed the added quality of being TOTALLY unafraid of me.

Oh, I liked that.

We had a nice long talk. I told her all about my various MRSA woes, the disseminated cold sore thing, the maybe mycobacteria that never cultured, the tenosynovitis in the right hand that maybe was inspired by the myco but also never cultured. They tried to grow it and nothing grew, either time.

Okay. She clearly likes all this stuff, likes her specialty. She checks out many of my scars, the purple bruising and staining, asks good observant questions. When she ran her hand down the long string of big red lumps on my forearm she carefully, but unobtrusively, watched my face. I'm wearing my Master Negotiator hat, remember. So my face records none of what she's making me feel. I am more poker-faced than this Asian lady today. And she's good.

--Doesn't this hurt?

--Sure. Very much.

--On a scale of one to ten?...

I close my eyes and allow the feelings into my brain.

--Eight.

She stopped and thought.

Then she left.

And soon the Great Doc came in, trailing the student doc behind him.

--How's it look?

I hold up my arm. It looks pretty rabid. Walter drew a couple outlines on it Sunday night, when it wasn't even red but just really lumpy, and now the red is a good half inch past the lines. When I scrubbed this morning I worked hard to leave those pen lines intact.

--Oh, that doesn't look better.

--Nope.

--Hmmm.

He strokes his chin like he has a goatee. Flips through my chart.

I wait in perfect self-contained silence.

--I hear you want a culture? Didn't we do a culture before? Two of them?

--Yeah, but they were for TOTALLY different things. One was the cold sore thing, the other came back as some sort of myco, but it was from a totally different kind of lump. Not red, not warm, not tender. Little bitty pea-size things. Completely different.

he's looking at me...looking in my chart...

--Same arm. Both cultures.

--Yup. Problem arm, there. All kinds of different stuff going on.

I shut up again and sit perfectly still.

he does NOT want to do this biopsy. Danger danger danger. He's right to be cautious but not having good data is more dangerous than poking me.

--What happened with the Minocycline you were on?

--At first it helped. Then after three weeks it started getting worse again. I had to take my husband to the ER, he just had a triple bypass, and it was New Year's weekend so I figured it'd be hard to get an appointment so I went to the ER for myself too. They gave me Clindamycin. When I took that with the last of the Minocycline it improved again. When I ran out of Minocycline and took only Clindamycin it got worse again. Then yesterday I ran out of Clindamycin. And the lymph nodes grew and grew. I got more Minocycline from Dr. C and started it up around 6 PM yesterday. I feel it working some but I'm still sick as a dog. I'm not sure it's all that effective any more. So if we could culture the germ up and see exactly what it is and maybe do a sensitivity test...

--How did we know it was MRSA a month ago? Or did we?

--We did NOT know. I haven't had any of these cultured for two years now. All my culture results are old. I mean, it could be anything, really. Anything at all.

say yes say yes say yes PLEASE say yes...

--Okay. All right. We'll do a culture. I think we pretty much have to at this point.

YESSSSSSSSSSSSSSSSSSSSSSSS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

He's done. The real work is performed by the students, that's why they're there. To practice. He confers with the student doc briefly...okay, a six millimeter punch then split it in two...mutter mutter...and he leaves.

I tell her I have fibromyalgia and she instantly knows. --Oh, okay, we'll put in lots of extra Lidocaine.

The nurse and the student are conferring. I stay quiet, let them work. They're filling out the papers for the culture: --okay, what do we want done? *rule out*...okay, rule out MRSA, rule out...student doc rattles off several other things, the nurse throws one in too...student doc tosses in some obscure dermatological lymph node thingie I have NO idea what the hell they're talking about and could NOT care less just now, I am walking on air dizzy sick with fever and happiness and relief and the pride of success.

Ha! Looks like they're having fun. Good. Everyone should enjoy their work. IMO.

All right. Tool tray. Lots of rubbing alcohol. She jabs me with the Lidocaine a good ten times or so.

--I'm sorry, I must be hurting you.

--Nah, I mean sure, but it's okay, I really appreciate the numbing stuff. Some people hate the needles worse. Not me.

--You don't show it.

I grin at her. --I got rheumatoid arthritis when I was eight. I've had a lot of time to practice.

Usually I watch but it's in an awkward place, I'm reclining in this exam chair with my right arm next to me at a right angle. Hurts my bad shoulder. When I know she's done cutting I slowly turn my head and look. Blood everywhere, a big ol' mess.

She says, Yup. Got a hole there now. You've confirmed it.

She grins at me. I suddenly think: We could be friends, she and I. I almost never think that.

I tell her I like to watch. She's a little surprised. As she stitched me up I told her about the time in the hospital, watching Dr. M open up and debride my huge foot abscess in my hospital bed, no operating rooms available, no general anesthetic. How I found out much later that he was worried he'd have to amputate with the patient watching. She's efficient, not slow, but goes more for precision than flashy stitching speed. Good work.

Two fancy stitches. Take them out in two weeks.

See the Great Doc in three weeks.

Ha!

I know who gets to take my stitches out.

And just before driving away I call Dr. C's medical assistant *D,* who I also really like, and leave a message about my good news. Wake up Walter with it too.

The insurance snafu delay means I hit our infamous rush hour traffic, but I don't care. A couple accidents, a couple traffic cop stops, loads of road debris flying around, a couple kids throwing big rocks off the overpasses. Same oId same old. I made it safely home.

And into bed.