From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: rec.pets.cats,sci.med
Subject: Re: Cat Bite Danger!!!
Date: 2 Jul 1998 05:25:11 GMT

In <359AA5B0.D76D7C35@concentric.net> David Voth <drv1@concentric.net>
writes:

>Then I cleaned my finger as well as I could using hydrogen peroxide and
>Betadine. I know that deep punctures can't be cleaned well with first aid
>techniques, but figured I'd simply go to the doctor if it seemed to get
>unduly infected. 12 hours later the finger was severely swollen and
>throbbing with pain. I put it on ice and tried to sleep, bit kept waking
>up shivering with my bedding soaked in perspiration. First thing Monday I
>began seeking medical attention. Due to various screwups and needless
>delays [more on that in alt.slack later!] I finally got some antibiotics
>(ticaracillin intravenous) in a hospital emergency room around 3 pm.


Comment:

   Your finger is swollen and throbbing with pain after a bite, and you
decide to ICE it, and not seek medical attention, if not immediately,
at least early the next morning?  Christ, what DO they teach people in
high school health these days?  Has condom use entirely replaced first
aid?

   Infected fingers need heat, not ice, and bites of any kind need
broad spectrum antibiotics from the word go (we call the drug Augmentin
"Dogmentin" sometimes).  Oral antibiotics are sometimes enough, if
started within hours.  Slacking got you a huge hospital bill which it's
a shame doesn't come out of your own pocket.

                                        Steve Harris, M.D.





>  By then the pain
>was so bad [and I was complaining so much] they gave me some morphine
>(also IV), which didn't stop the pain but helped my attitude
>immeasurably.
>
>I got IV antibiotics every 4 hours and all the oral painkillers I wanted
>for 2 nights in the hospital. I was released to my home midday today with
>an IV catheter in place, and I'll be giving myself antibiotics for about
>8 more days. The good news is my finger was saved and won't require
>surgery. The infection is well under control.
>
>I will pay someone to bathe at least _that_ cat from now on.  (Bathing
>them helps with flea control.)  Fortunately it's 1998 and I have
>generous health insurance.  And my cats have been vaccinated for
>rabies.  Please don't underestimate the infection risk from cat bites.
>
>You could easily lose a limb from the infection!

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Cat Bite Danger!!!
Date: 2 Jul 1998 21:08:19 GMT

In <359BAC20.4DFEF430@concentric.net> David Voth <drv1@concentric.net>
writes:

>It appears that you didn't spend more than a few seconds reading my
>original post, because you missed some key sentences.

Which ones were those?  You STILL have not made it clear what you did,
and what your medical care people did, and when.  I figure that when
people do that, they usually are admitting some responsibility.
Perhaps you are as blameless as a lamb.  In which case, as I said,
apologies.


> Do you have time
>to see patients lately?

    Not as much as I used to before internet addiction set in.  But I
learn things about medicine, patient attitutes, and alternative
medicine here that I can learn nowhere else.


>And BTW "up yours" for insulting me in public
>like that.

    Well, you really should have learned this in highschool.  If you
find that insulting, well, too bad.

    Don't give me the sorry old me routine, either.  I have limited
tolerance for it.  I have feisty patients who, when they're not getting
seen for what they feel is urgent, make a hell of a stink, and start
seeing ERs, strange doctors, money be damned.  If you can afford a
computer or a TV, you can afford an ER visit.

>  You are getting more arrogant and hostile every day.  Did
>you learn your "bedside manner" in a boxing gymnasium?

   Bedside manner has nothing to do with it.  You're not my patient.
Did you notice that?

    Probably I am getting more crusty.  Each insult from a psychotic or
a nut or an axe-grinder who is partly to blame, puts a layer on.

   Anyway, now you learned something.  Pain is educational, and
education is painful.  Experience is a poor teacher, for she gives the
test first, and the lesson after.   Experience also keeps a dear
[expensive] school, but a fool will learn in no other.

                                      Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Cat Bite Danger!!!
Date: 2 Jul 1998 21:00:38 GMT

In <359BA782.853BD205@concentric.net> David Voth <drv1@concentric.net>
writes:

Lots of stuff about his dumb HMO.  If your HMO is really so bad as to
make you wait 7 hours for an emergency condition, then it deserves to
pay for your hospital bill, not you.  Appologies.

However, with an HMO you get what you pay for.  There "blame" if we can
use the word in a "blameless" way for bad medical care, is not entirely
resting on employers and HMOs.  Employees settle for something they pay
less for, and don't regard medical benefits in the same light as
salaries at the negociating table.  That leaves you in the lurch, when
the crunch comes.

>Ahem!  I DID seek attention the next morning as soon as my "primary care
>physician's" office opened.  But due to the EXTREMELY STUPID,
>RIDICULOUSLY INEFFICIENT SYSTEM we have, which cares more about
>following the rules and protocols set up by insurance company
>bean--counters, IT TOOK MORE THAN SEVEN HOURS BEFORE I GOT ANY FUCKING
>MEDICAL TREATMENT.  IF THE SYSTEM WORKED I COULD HAVE BEEN GETING
>TTREATMENT IN LESS THAN 24 HRS.  The system strongly discourages people
>from going straight to an ER unless death appears imminent.


    This is one that should have been called to the emergency triage
nurse, however.  If it was and she blew you off--- HMOs fault.  If you
didn't call, your fault.

>Now you've done it, Steve.  The topic shall now shift to "The fucked
up health--care system in the USA.  And perhaps "Why does Steve spend
so much time arguing with psychotics on sci.med<


   It is in the interest of education for the non-psychotics who get
taken in by the psychotics.  It doesn't do any good for the psychotics.

>No first aid class I've had ever mentioned that.  Nice to know.
>
>And the opinion of the surgeon who treatred me was to aim treatment at
>anaerobic bacteria, specifically Pasteurella.

   Correct: Pasturella and Staph are your main targets.  Augmentin gets
them both.  Otherwise you have to treat with two separate pills,
something like dicloxicillin and penicillin VK.   Basically,
Augmentin's an oral analogue of Timentin, the drug combo you DID get IV
(if you only got Ticarcillin, they could have chosen better).

   In a world with good medical care, you should have gone staight to
the ER for your first dose of Augmentin, or even IV Unisyn or Timentin.
If you were my patient, you would have paged me from bed on the
emergency number, and from bed I would have ordered that first dose,
sight unseen, for you from a 24 hour pharmacy, and told you to stick
the finger in warm water until I saw you pronto at 9 AM.  But I don't
work for an HMO.  I hate them.

   In the lab where I do research and act as medical consulting staff,
one of our research staff members recently got his hand bitten CLEAR
through in the palm area by a dog (he was trying to break up a
dog-fight in a kennel).  He got 1.5 grams of Unisyn IV within minutes,
then started on Augmentin.  X-ray at the lab showed no broken bones, so
he never had to see the folks his insurance demands.  He never had a
trace of infection, and healed perfectly in days (and that area's a
really nasty one for infection).


                                        Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.health.alternative
Subject: Re: Help!!!! Dog Bite Remedy?????
Date: 23 Jan 1998 05:12:55 GMT

In <19980123024901.VAA18548@ladder01.news.aol.com> apmodeler@aol.com
(APMODELER) writes:

>>Please help. I was bitten in several places by a dog, last nite. The
>>emergency room staff irradated the wounds and bandaged them. I received
>>a tetanus shot and some antibiotic shot. My prescription is for
>>Augmentin, an antibiotic. I don't have the money nor desire to buy this
>>drug, but am concerned about infection. I'm drinking Goldenseal tea and
>>will have some Echinacea/goldenseas tincture delivered in a few minutes.
>>Is there anything else I can take to prevent a serious infection? Please
>>e-mail me asap.......i'll be checking my mail often for an answer.
>>Thanks so much,
>> Angelo Guadagnoli
>>angelo@bga.com
>
>It's foolish to avoid the prescription in this case for a few reasons: -
>amoxicillin, the generic equivalent, probably costs less than what
>quality goldenseal is going for these days (in sufficient amounts to have
>much systemic effect), and is less risky. Part of the reason goldenseal
>is so expensive is that it is being _far_ overused - (I did recommended
>it to someone on this NG just a few days ago for a unique case, but I
>seldom use or prescribe it). There are a number of other herbs with
>significant effect against specific pathogens _if_ they are already
>identified, or by specific signs of the pattern of the persons response,
>- this requires professional diagnosis (which is seldom cheap). I would
>gather that the hospital ruled out rabies as a concern, or you would have
>gotten gamma globulin or antiserum. You could take homeopathic Arnica for
>the trauma (low potency repeated, or 30 or above once only), and bath the
>wounds with Calendula tincture in water. The biggest problem with
>refusing the prescription is that if anything develops over the next few
>days, you could easily miss the signs and wind up back in the high-priced
>route of the emergency room and/or other doctors (mainstream or
>alternative).
>
>Joe Reid, O.M.D.


   Amoxicillin is NOT the generic equivalent of Augmentin (also known
in the trade as Dogmentin, because it's so useful for covering both
Staph and Pasturella, the major pathogens involved in dogbite).
Amoxicillin without clavulinate won't kill Staph (99% resistance now),
and it's not great against anaerobes.  You might be able to get by with
a cheaper mix of generic Dicloxicillin and Pen VK.   You can also get
by with Augmentin 250 only twice a day if you supplement with extra
cheap amoxicillion or Pen VK every 6 hours.  But don't d*&^ around with
a dogbite.  It's a good way to end up in surgery with drains in your
hand, and a $10,000 hospital bill.

   And watch what advice you get here on the internet, too.  There are
ignorant people here, some with degrees, already to give advice.  But
you paid for good advice at the ER.  I suggest you take it.

                                       Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Cat Bite Danger!!!
Date: 6 Jul 1998 07:50:35 GMT

In <35A05A36.4ECF6B42@interlog.com> Happy Dog <happydog@interlog.com>
writes:

>I suffered a deep cat nip on my thumb joint. I washed the wound and went
>directly to emerg. I was given an oral antibi (ampi500 I think). The
>wound became infected (entire thumb and part of my palm) and I returned
>to emerg 14 hrs later. A nurse told me to go home and continue on the
>medication. Six or eight hours later, the infection was spreading up my
>arms at a rate of 1 or 2 cm/hr.


    Geez.  Ampicillin for a bite in 1998 is about as likely to be
effective as drinking lemonade.  And the lemonade tastes better.

     It would have worked in 1950, though.  Maybe.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Cat Bite Danger!!!
Date: 7 Jul 1998 00:51:10 GMT

In <slrn6q1cdk.54q.hillary@manx.misty.com> hillary@hillary.net (Hillary
Gorman) writes:

>Working in veterinary medicine, I've had a lot of experience with cat
>bites and associated ER visits. My first trip to the ER with a cat bite
>was in 1987, and I was prescribed Augmentin (amoxi + clavulanic acid,
>same as the veterinary prep Clavamox). My most recent trip (wasn't for
>me, I was accompanying a co-worker) - the patient was prescribed
>Augmentin. Maybe happydog was confused? I've never *not* seen an rx for
>Augmentin given after catbite!
>
>--
>	hillary gorman 	http://www.hillary.net	info@hillary.net
>             "uber vaccae in quattuor partes divisum est."
>                 upenn school of vet med class of 2000



    Either confused or malpracticed on, one or the other.  Augmentin is
God.  The only thing better orally for bites is Augmentin plus a big
dose of Bacampacillin (Spectrobid) to give you IV levels on an oral
drug.  I've tried to convince the the people who make Spectrobid (a
rare and off patent drug) to make a new patentable formulation with it
plus some other beta lactamase inhibitor, but they've ignored me (it's
worse, since they're actually also the Timentin people).  Too bad.  Yet
another of my underappreciated ideas.

                                        Steve Harris, M.D.