Random Thoughts, Part VII

EROTIC STORY SITES ON THE WEB, ARE *NOT* GOOD SOURCES FOR ADVICE ON HOW TO LIVE YOUR LIFE.

A young lady came in to the clinic, and related that her visit today was occasioned by the fact that “My girlfriend’s boyfriend told her that he had (GC/chlamydia/herpes/syphilis/aids/hepatitis/the fuglies), and I slept with him, too.”

I was unclear on the timeline. “*After* you knew?”

She was not. “Yep!”

Sigh. Another round of “test for everything”, and pray that it all comes back negative.

LET’S FOCUS ON THE IMMEDIATE PROBLEM, SHALL WE?

So, TINS© (This Is No Shit), TIWFDASL© (There I Was, Fighting Disease And Saving Lives), and Jim Bob wandered in. In the course of his registration, as well as his rooming, he revealed difficulties voiding. Indeed, my MA related that, once she had requested that he provide a sample of urine so that I might use it to determine what sort of “urine problem” he had, he responded that “I can’t pee”.

In my clinic, there is no catheterization capability. In my not inconsiderable emergency experience, both as RN as well as provider, such a soul requires a catheter, both in order to obtain the urine sample that will guide further care, as well as to decompress the ailing soul’s urinary bladder, as such a condition can become very uncomfortable. Which ignores potential damage to one’s kidneys.

I told my MA that Mr. Cannotpee would have to go to emergency, where, indeed, they had both the ability to place a catheter, as well as labs and imaging to determine what might have caused this problem.

She returned moments later, reporting that he had considered the prospect of a urinary catheter, and thought that he might be maybe able to produce a little bit of urine, perhaps.

His sample was inconsistent with inability to urinate. My appraisal was that IDGAF about this guy’s pharmacologic mis-steps. His stupid life choices that might be revealed by a urine drug screen, a screen that I had no interest in performing let alone contemplating the results of, were his kharma and would impact his life.

And, good luck with that!

LIGHTING UP MY LIFE

Another day, another Child of Ghawd. Soul reports a rash, kinda-sorta itchy, started here, now here, and here, and here. No exposure to suspect plants, no new cosmetics/detergents/soaps/shampoos.

There is a thing, known as a “Wood’s Lamp”, which produces light in the near-UV portion of the spectrum, accompanied by some visible violet (surprising enough!) light. Some itchy rashes will fluoresce (glow, generally a pale yellow-green, occasionally a pale, “coral” red/pink) under illumination from a Wood’s Lamp, and in such cases, it is a dermatophyte that is causing your rash. Treatment is an antifungal, such as clotrimazole (you may recognize the brand as “Lotrimin AF”), or selenium sulfide (the active ingredient in the anti dandruff shampoo, “Selsun Blue”).

This individual described trying multiple creams, lotions, and sprays, none of which effected any improvement. I attempted to elicit a duration of use, and was told, “It just didn’t work!”

Alrighty, then!

For those in the studio audience who do not already know this, dermatophytes are slow growing organisms, and therefore they find themselves in that portion of their growth and reproductive cycle wherein they are vulnerable to treatment, at relative long intervals. For this reason, treatment is relatively prolonged compared with, for example, a boil or other skin infection from a bacterium like staph or strep.

Sigh. I directed my patient to employ Selsun Blue as a body wash, and to continue it for a couple of weeks.

This person looked me dead in the eye, and asked, “Aren’t you going to do anything for my rash? Shouldn’t I use a cream or something?”

Sigh, again. Repeat, verbatim, the care instructions I finished providing, oh, like TWO FREAKING MINUTES AGO. In English. To a native English speaking patient.

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