Early poll results for the free tetanus shot
Wednesday ain’t here yet, but you guys are doing good. I’m on a number of blogrolls, so folks have my e-mail, and I’ve heard from a lot of folks with excellent thoughts on the case.
After years of dealing with patients I anticipated the insight. I was surprised how timid everyone was though.
I don’t know why ’cause everyone is guessing pretty good. Irene and the English Professor are figuring carcinoid, and is Ms. Susan. Everyone comes at it from a different perspective, but given her background as a romance writer, Susan tended to trust the intuition of the daughter in Tennessee.
mschili went with a literary analysis, and opted for appendicitis or carcinoid. She also had some intuitive notions and was afraid to go against Irenes’ gut in an abdominal case. Irene and the English Professor have studied Bibey speak even a few months longer than mrschili, (the English Teacher) so chili feared ignoring their insight.
Ms. Pande is getting warm, and I don’t know how up there in the Icelandic frozen tundra she writes from. She said her cousin had a similar clinical course, so better take out the lady’s appendix, and don’t wait a day.
Ms. Ruby said she was tired of hearing about belly aches, and was listening to bluegrass music today.
I can’t print all of what banjobilly said, ’cause this is a PG-rated site, but he concluded with something like “unless that there lady has done s#&* her a camera, she’s got a blockage somewheres.”
Dr. Bob was excluded from the competition, but being an old pro at this business, he called my hand. “Not enough history son, go back and ask the patient a few more questions and report back to me in an hour.” I guess it was the professor coming out in him, but he was right- you don’t have enough data to know for sure, so it wasn’t a fair question.
Here’s what I want to leave you with for now, though. As a writer, I am figuring out how to learn from my readers. As a doc, I have always learned from my patients. There is an old saying in medicine. “If you listen to your patient they’ll tell you what is wrong.”
I always tell my folks I want to hear what they have to say, ’cause 90% of the time what they think turns out to be the right answer. They come by their conclusions via a personal life perspective. Just because it is from a different genre than I came up in makes it no less legitimate. I love bluegrass but that don’t mean I can’t dig jazz.
I tell my people what they pay me for is to try to figure out the other ten percent. Unfortunately, I only get another eight or nine. Only the Good Lord knows all the answers. I’m just gonna do the best I can and hope people will forgive me what I can’t get right, cause it is the best I can do.
Well come Wednesday we’ll find out the diagnosis, and who won the free tetanus shot. Hey, if you get a bad cut between now and then go get one anyway, and I’ll give you the free one later. Tetanus is a bad actor, and I don’t any of my readers to ever come down with that malady. It’s as rough style as rabies was on “Old Yeller,” and about as hard to treat, so if you ain’t caught up on your tetanus shots (you need one every ten years even if you are not injured) go get one sometime soon.
Talk to you Wednesday.
Dr. B
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February 10, 2008 at 2:48 pm
Doc, set me straight on the tetanus thing: I’ve been told that I need to get one every ten years, injured or not (just like you said). I’ve ALSO been told that REGARDLESS of whether you’ve had a booster or not, you’re going to get one if you come in injured anyway, ESPECIALLY if the docs treating you don’t have ABSOLUTE PROOF that you’ve been updated, so don’t bother with the booster. What’s the answer?!
February 10, 2008 at 4:24 pm
If I am sure of the immunization status, and the wound is not too bad, if there has been one within five, I let it go at that. The books say if the wound is minor, and one has had the full series, and the last one within ten, then NTW. (bluegrass for not to worry) I admit I always fear a dose might not have taken, and tend to err on the side of giving one if it is more than five, but the experts would say that is too cautious in a clean wound.
In the nasty wounds, (tetanus prone ones) I give one if the last was more than five, and this is consistent with official policy. Often these are seen by the ER docs, and I think they are afraid the history might not be accurate, and get even more conservative than we do- if that is possible! (For us everyone is family, for the poor ER Doc, many if not most are strangers.) The difficulty in following immunization status is another reason to eventually get comprehensive Electronic Medical Records going.
In nasty wounds and when the immunization status is up in the air, there are special booster shots (Tetanus immune globulin) that can jump start the process. In a captive group like my little practice the idea would be you hardly ever need that, though. Ie, they SHOULD be up-to-date on their immunizations.
Finally, in situations where the history is one of partial completion there are all kind of catch up schedule recommendations for every combination and permutation known to man. (Here we are talking routine, non injured situations.) To be honest, on these I often have to consult the web sites for the CDC or AAFP.
Another reason to get the routine ten year booster is unfortunately docs are human and sometimes in a wild ER, or office too for that matter, the shot gets overlooked. One (of many) reasons I dictate on the same day is every few years, I’ll realize I forgot one, and we double check the nursing and computer record. If it was left off, we call the patient back in. (Sometimes I find Lynn or Myrd already took care of it.) In the case of the ER, I know they try to offer that kind of personal touch but I find that an impossible standard with all the traffic they have, so when the patient comes back to office we try to check. So, to answer your question about the every ten year routine dose, I think it is a good idea to get them anyway.
Like the old Boy Scout motto says, “Be Prepared.” Of course, this blog is written by a cat whose idea of taking wild chances is to hit a 6-iron across the lake instead of a 7 if there is a slight breexe in the face, or play a pentatonic scale break on “Little Cabin Home On The Hill” in a group of traditional bluegrassers. (Too much like rock ‘n roll for those guys.)
If in doubt it is best to err on the side of overdoing it- can’t hurt folks anyway. (O.K. I realize there are rare case reports of unexpected things, but I am one to play the odds to my patient’s best advantage whenever I can.) One year I was due and had Lynn O’Carroll give mine. I was busy and forgot to mark it off my to-do-list and had Myrd give me a second a month later in the middle of the day. Myrd was upset when she looked at the chart and realized it, but it was my fault, ’cause I ordered the thing. (Nowadays the State Board prefers we not order our own, and we have a Corporate employee nurse who keeps up with it for all the offices in the group and comes by to give them).
My point of course is it didn’t do any harm, although I do not recommend such a lassiz faire attitude towards immunizations!
And last but not least, one needs to be sure to get caught up on the Tdap business that came out in the last few years. Doesn’t change anything for Tetanus, but does for adult pertussis and diptheria odds.
Well that was a long answer to a short question. Sorry, but I hope that covered at least the basics.
Dr. B
February 11, 2008 at 11:01 am
Hey, I will let you know when I get warm. I’m not yet. I won’t be until mid-July, when the temps are in the 90s with a 110% humidex rating. (That’s a hint as to where I am!)
I just had a tetanus shot during my annual physical, and the injection site was itchy and sore for two weeks! Is that normal? Anyway, I won’t need one of those, but I’ll take a raincheck on a flu shot for next year.
February 11, 2008 at 1:03 pm
Hey Ms. Pande.
Yes, the contest rules allow for a substitution for any shot of lesser or equal value as they say in the marketing world. The flu shot is a good’un too, although I think this year was not a 100% effective one.
I tell folks if the soreness doesn’t go away in a week or ten days to let me look, but it is probably still O.K. If it deosn’t resolve soon I might let ’em take a peek.
Dr. B