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Forum Name: eyrie.private-mail
Topic ID: 644
#0, Pseudomonas (warning, gross description)
Posted by Terminus Est on Jun-28-15 at 05:01 AM
I was diagnosed this week with a pseudomonas infection of the lower legs (yes, both of them, and no, I'm not sure which strain). I've been put on ciprofloxacin oral and gentamicin sulfate ointment, alongside tramadol for pain. During the initial visit I was given a shot and a prescription for sulfamethoxazole-tmp (bactrim), which I was told to stop taking two days later via phone because it was ineffective against the culture they took.

The infected area (primarily the left calf) is covered with small bumps that resemble blisters, and one large ulcer that has been described as a shallow split in the skin approximately an inch and a half to two inches in length, and I wasn't told how wide. The right leg is much less visibly affected, and much less painful as well - I suspect that it was infected via contact with the original area during sleep.

Since I started taking the antibiotic (two days ago), the pain has not reduced by any appreciable amount - it still feels like someone's driving a red-hot poker through the back of my leg, and it's still draining pretty heavily. I can't very well look at it to see if it's improving or not, meaning I have to rely on someone else's opinion... but to be perfectly honest I'm not sure they're being entirely candid with me. Parents are like that. I'm also having trouble with leg cramps, which you can imagine just makes the whole thing feel GREAT, but that's somewhat beside the point.

My questions are: Is hospitalization likely? What kind of prognosis can I expect, given that I am on medication that cultures suggest should be effective? And how the hell can I reduce the pain without aggravating the infection, because holy fuggin' OW.


#1, RE: Pseudomonas (warning, gross description)
Posted by Gryphon on Jun-28-15 at 01:43 PM
In response to message #0
I am in no way qualified to answer any of your questions, but, yikes, best of luck with that. About the only thing I can suggest in good conscience is that increased hydration may help you with the leg cramps part - and maybe potassium, but check with a pharmacist or something to make sure that won't interact with your meds in some way.

Yikes.

--G.
-><-
Benjamin D. Hutchins, Co-Founder, Editor-in-Chief, & Forum Mod
Eyrie Productions, Unlimited http://www.eyrie-productions.com/
zgryphon at that email service Google has
Ceterum censeo Carthaginem esse delendam.


#2, RE: Pseudomonas (warning, gross description)
Posted by Terminus Est on Jun-28-15 at 05:05 PM
In response to message #1
I'm already on potassium (chloride, not citrate - not sure what the difference is, honestly, but I know I've seen both), and hydration is something I'm working on. I'm going back in to talk to the doc on Tuesday (would go tomorrow but I have no way to get there) so should know more then.

#3, RE: Pseudomonas (warning, gross description)
Posted by Tabasco on Jun-29-15 at 12:08 PM
In response to message #2
LAST EDITED ON Jun-29-15 AT 12:14 PM (EDT)
 
With the caveat that my area of practice is nursing homes and long term care pharmacy, so you're a bit outside my usual demographic, here's what I think.

NSAIDs like ibuprofen or naproxen do have a chance of interaction with Cipro, so Tylenol would be a better pick for the pain assuming it works for you. The only difference between the potassiums is the amount of elemental potassium each one contains, you might also try a magnesium supplement as well. Hydration is definitely a good idea, Pedialyte or a half strength mix of Gatorade works well for that and might help with the cramps as well.

As for the infection itself I'm reluctant to guess without knowing more, but the duration of therapy for a major skin infection can be up to two weeks. Two days might not be enough time to see huge improvements.


#4, RE: Pseudomonas (warning, gross description)
Posted by Terminus Est on Jun-29-15 at 02:30 PM
In response to message #3
I do have a question you may be able to answer. The gentamicin ointment - they gave me a tiny tube, like 15 grams, and no refills, and told me I'm supposed to use it every time I change the bandages. The nurse told me I'm supposed to do that three to four times daily. How the heck am I supposed to make that tiny little tube of ointment stretch through three bandage changes a day for two weeks?

#5, RE: Pseudomonas (warning, gross description)
Posted by Tabasco on Jun-29-15 at 04:44 PM
In response to message #4
>I do have a question you may be able to answer. The gentamicin
>ointment - they gave me a tiny tube, like 15 grams, and no refills,
>and told me I'm supposed to use it every time I change the bandages.
>The nurse told me I'm supposed to do that three to four times daily.
>How the heck am I supposed to make that tiny little tube of ointment
>stretch through three bandage changes a day for two weeks?

Well, the short answer is that you don't! :) Most likely they just meant to give you enough to make it until your primary doc could follow up.

You are only supposed to use a thin smear of it at each change though, as I'm sure they said. Laying it on thick doesn't help it work.


#6, RE: Pseudomonas (warning, gross description)
Posted by Terminus Est on Jun-30-15 at 02:10 AM
In response to message #5
Problem is, this WAS my primary doc. Same one that won't give me pain meds because, and I quote, 'You fit a demographic that's known to abuse them.'

Only reason I can think of they did it this way was because the ointment and second antibiotic were actually prescribed after I had left and the cultures came back. I was supposed to go back early this week, but... well, money. I can't go in til Wednesday.

The nurse did give me something to think about though - 'What's more important - keeping your legs or an overdraft charge?'


#7, RE: Pseudomonas (warning, gross description)
Posted by Tabasco on Jun-30-15 at 09:06 PM
In response to message #6
Well when you put it that way...

#8, RE: Pseudomonas (warning, gross description)
Posted by Proginoskes on Jul-03-15 at 11:46 AM
In response to message #6
This immediate situation isn't the time for it, but I'd say that the refusal to give you pain meds would be a sign to start seeking out a new primary physician. It's not like they'd be giving you opiates; and anyway, demographic profiling is (if it's a physician doing it, I'd imagine quite literally!) criminal. Or inviting litigation, at the very least. "Refusal to provide appropriate care based on discrimination."

#9, RE: Pseudomonas (warning, gross description)
Posted by Terminus Est on Jul-04-15 at 10:35 AM
In response to message #8
I had to go to the ER day before yesterday for an unrelated condition (ridiculously bad gout flare, literally could not walk). They did more blood work, and put me on YET ANOTHER antibiotic, this one in addition to the cipro primary doc gave me. This after taking two blood cultures and a couple vials to test white count and uric acid count (both 11.4k) and utterly failing to hit a vein the first time while I sat there and hyperventilated while watching them dig around with the needle. Newly discovered phobia: Needles.

As for the pain meds, primary doc has me on tramadol. She said she can't put me on anything stronger because of me fitting the demographic - bearing in mind that anything much stronger actually IS starting to edge into opioid territory. Regardless, I will be bringing this up with her next time I actually get to speak with her for more than a minute at a time (she has the habit of poking her head into the room and telling a nurse to take care of whatever the obvious problem is, without ever really stopping to speak to me...)


#10, RE: Pseudomonas (warning, gross description)
Posted by Proginoskes on Jul-04-15 at 11:40 AM
In response to message #9
Oh, I had gotten the impression that your primary MD was refusing to give you prescription pain meds of any kind, not that what she prescribed was proving insufficient. That makes the issue significantly less WTF, although her explained reason still seems litigation-generating.

#11, RE: Pseudomonas (warning, gross description)
Posted by Gryphon on Jul-04-15 at 02:09 PM
In response to message #9
>Newly discovered phobia: Needles.

No, no. Phobias are unreasonable fears. For instance, being afraid to be in the MRI machine even though you've done before and you know that, since you're not a robot, it won't hurt you.

Fear of needles, particularly unskillfully/unluckily employed ones, is perfectly reasonable. (And I sympathize with it considerably. Boy howdy, have I had some fishing expeditions. One weird side benefit of losing a kidney: they're not allowed to give me MRI contrast any more, so I no longer have to combine my two least favorite medical activities, getting an MRI and having an IV line put in.)

--G.
-><-
Benjamin D. Hutchins, Co-Founder, Editor-in-Chief, & Forum Mod
Eyrie Productions, Unlimited http://www.eyrie-productions.com/
zgryphon at that email service Google has
Ceterum censeo Carthaginem esse delendam.


#12, Things I've Learned
Posted by Terminus Est on Jul-21-15 at 03:41 AM
In response to message #0
1: Aleve retards wound healing in a major way.
2: Having a uric acid level of 11.4 is considered alarming.
3: An improperly dressed wound hurts worse than not having it dressed at all.
4: Compression therapy works, but only if you can maintain it.
5: It's damnably hard to wrap your own leg under the best of circumstances.
6: It's impossible if you're overweight.
7: Apparently, your doctor has to exhaust conservative measures before they can hospitalize you, when you're on Medicaid.
8: A full course of antibiotics may not be enough to kill a persistent infection.
9: Medicaid will not refill a prescription within one month, regardless of whether it's an antibiotic necessary for wound treatment and regardless of whether it's one that was originally supposed to have been given as a much, MUCH larger package.
10: Medicaid DOES cover bandage materials. At least, certain versions of it do.
11: In-home care nurses are very, very candid.

#13, RE: Things I've Learned
Posted by Sofaspud on Jul-28-15 at 02:50 PM
In response to message #12
I realize I'm a bit behind the times here and hope by now it's cleared up, but speaking from experience (I've had two flareups, one severe enough that I *should* have been hospitalized, and one just a couple weeks ago that we caught early enough to stave off Bad Stuff), the course of antibiotics generally does nothing to stop the pain -- and the pain will continue for a while even after the infection itself has been cleared up, because the infection is destroying tissue.

The first time I encountered it I had *no* form of medical insurance whatsoever and couldn't afford to pay out of pocket. I ended up going to a community clinic and making arrangements to pay off the bill in small chunks, and they gave me 10 days of antibiotics and no pain meds. I needed a second round of antibiotics to finish clearing it up, and the leg still hurt (though not as bad) probably a full month afterwards, slowly easing up on the throbbing and the ow.

The second time around one batch of 10-day antibiotics (same ones you mention) cleared it up. I have insurance now, so they discussed pain meds, but my doc preferred I stay off them and use OTC ones if I absolutely could not stand the pain because (his words) I needed to know if it flared up, and the only way to tell is if it starts hurting more or in new areas.

I don't know that the demographic argument is a valid one, but I had to admit mine had a point with his :)


--sofaspud
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