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TheGermDoctor
TheGermDoctor, Doctor
Category: Medical
Satisfied Customers: 1549
Experience:  17 years as a physician, Board Certified in both Internal Medicine and Infectious Diseases
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I had a right big toe fusion with a metal plate & screw on

Customer Question

I had a right big toe fusion with a metal plate & screw on 9/29/09 and then 2 weeks after surgery the sutures were removed, steri strips and a drying salve applied for yellowish drainage and placed on Cipro 500mg po bid and Doxycycline 100mg po bid for 1 week and drainage continued with increasing erythema and edema for the next 3 weeks when a local ARNP RX Bactrim DS i po bid for 10 days who did C&S on drainage with results Staph Coag Negative. Then I had a check-up with surgeon on 11/13 who recommended I&D with C&S. I requested an infectious disease doctor on the team. Then I was given Vancomycin 1 gram IVPB q12h and Cefepime 1 gram IVPB q12h for 3 days after 2nd surgery. C&S negative 24-72 hours postop. Then dismissed from hospital on Vibramycin 100mg po bid for 2 weeks. I will finish this medication on Friday am at 6:00. This evening I changed my sterile dressing and noticed dark yellowish drainage from my foot. The foot is starting to have erythema, edema, pain. Sutures out 10days
Submitted: 4 years ago.
Category: Medical
Expert:  FamilyMD replied 4 years ago.

Dear Sherrym1:

 

You need to see your surgeon right away. If it is painful and draining, it probably needs to be redrained. There is something that is preventing the healing--do you have diabetes? Thank you.

 

Dr. P.

Customer: replied 4 years ago.
No-I do not have diabetes. I had a Staph epi infection but not infection inside my foot. It is not swollen to the point it needs to be opened and drained. I think what I need is an expert in infectious disease who will treat this infection with IV antibiotics. I do not want to see my surgeon because he said quote "I think I over-reacted referring to my 2nd surgery which showed no growth from the C&S after 72 hours.
Expert:  FamilyMD replied 4 years ago.

Hi Sherrym:

 

Let me see if there is an ID specialist I can refer you to on JustAnswer. Good luck!

 

Dr. P.

Customer: replied 4 years ago.
Thankyou for referring me to an ID specialist.
Expert:  FamilyMD replied 4 years ago.

I referred you toCustomer who is an ID specialist. Please wait for his response. Thanks.

 

 

Customer: replied 4 years ago.
The Bug Doctor?! I assume you mean someone who is a specialist in infectious diseases.
Expert:  TheGermDoctor replied 4 years ago.

Hi Sherry-

 

When the surgeon did the I and D- is it fair to assume that he left the screw and plate in?

 

Is the drainage you have now increasing from the time of your last surgery?

 

Do you know if additional blood work has been done- a white cell count? ESR or C-reactive protein?

 

Why did your surgeon decline your request for an ID consult when he did the second surgery? And have all the antibiotic choices so far been done just through his office ( and his NP)

Expert:  FamilyMD replied 4 years ago.

He is a specialist. Thank you.

 

Dr. P

Customer: replied 4 years ago.
The plate & screw were left in. My WBC was 3.7 prior to 2nd surgery, dropped to 2.5 next day and then day prior to dismissal 3.6. My surgeon did agree with my request for an infectious disease doctor or I would have never agreed to the 2nd surgery. I have not had a ESR or CRP test. The surgeon's ARNP in Wasjhington, DC prescribed the Cipro and Doxycycline which I have since learned that Cipro increases risk for Staph infections. Bactrim DS prescribed by an ARNP locally in my Kansas hometown. The infectious disease doctor prescribed the Vancomycin and Cefepime IVPB meds and Vibramycin po post 2nd surgery.
Customer: replied 4 years ago.

Yes, the drainage is increasing since the 2nd surgery-it is a dark yellow but is negligible in amount, but my toe and surrounding area is becoming edematous and erythematous.

I am a Registered Nurse with a wide range of experience. And I long to have this health problem resolved.

Expert:  FamilyMD replied 4 years ago.

Dear Sherrym1:

 

I apologize---but I did not "Release lock" which means that you may have to wait 2 hours for THEGERMDOCTOR to respond to you. He just explained this function of JustAnswer to me. Sorry, please wait for your response. Thanks!


Dr. P

Expert:  TheGermDoctor replied 4 years ago.

The question has now been opened for me to answer ...

 

Sherry-

Since you already saw the ID doctor once- why don't you schedule a follow up appointment with him now? You should not need your surgeon's approval for that,

 

Did the ID doc think you did not need a longer course of therapy when he saw you? What specifically did he say?

Customer: replied 4 years ago.
The ID doctor said that I would be dismissed that Friday on oral Vibramycin 100mg po bid. He never looked at my foot after surgery, but he did see me. He said based on the fact that the C&S had not grown anything since performed, he thought I could go home on oral antibiotics. I also told him that as long as I was in the hospital my insurance would pay the bill, but I could not be dismissed on IV antibiotics for home care with labs or my insurance would not pay. All I have is hospital insurance and 2 doctor visit a a year. Now, I am wondering if this had an affect on his decision to send me home on oral antibiotics to hold down cost. I suggested to the floor RN that I have an additonal dose of each IV antibiotic prior to dismissal, but she said I was the last patient in that area of the hospital and they planned to close the unit down at 6:00 pm at the time of my dismissal.
Customer: replied 4 years ago.
Also I would have to fly back to Washington, DC and I live in Kansas.
Customer: replied 4 years ago.
I will look at response in the am. It's after 11:00 pm now. Thankyou.
Expert:  TheGermDoctor replied 4 years ago.

Well , the honest truth is it sounds like you did not respond to oral therapy and likely do need iv therapy.

I probably would at least give you Vancomycin, but may add a second drug- Sometimes cultures may not be fully sensitive and may be falsely negative, especially with retained foreign bodies.

Without seeing you it is hard for me to say what I would do. But I would check an ESR and CRP, and repeat cultures from the drainage. And I'd likely start you on iv therapy.

 

But the other important thing is that not uncommonly the response to antibiotics is poor with a foreign body infection ( your plates/ screws). Infection does not respond sometimes unless it is removed, if the infection has extended down to the foreign body. Plus this requires a much longer course of iv therapy- longer than you received- like even up to 4-6 weeks.

 

Always ask if you need clarification/more information.


POSITIVE feedback & a BONUS are warmly appreciated.
Please note that answers are for information only, do not take the place of an assessment by your doctor,
and does not establish a patient-physician relationship.

 

Customer: replied 4 years ago.
Sir:Where are you located and do you see patients.Would you consider seeing me
Customer: replied 4 years ago.

If you get online again, please respond ASAP and then I will gratefully pay you. God richly bless you during this holiday season and if you are a believer in the Lord Jesus Christ-Please pray that the Lord God would heal my foot-I need a miracle. By having the 2nd surgery and if the infection was obvious on the outside of my foot -because according to the surgeon he over-reacted- that was his comment on the post-op appointment could the infection have spread internally inside my foot by doing the second surgery-I&D,C&S. I know my skin was prepped with betadine-but will betadine kill staph epi?

Customer: replied 4 years ago.
I still have not heard back from you-please answer ASAP! then I will make a payment for your services and I hope to meet you personally if I continue to have problems after my appointment with the ARNP tomorrow.
Expert:  TheGermDoctor replied 4 years ago.

Sherry-

Sorry for the delay in responding again.

( I actually see patients in real life, and was busy in the hospital and office all day.)

 

As can be seen in my profile I am based in Chicago, but the JA policy is not to provide personal contact information offline. This is to protect everyone involved.

 

I am quite positive you should be able to find many very well qualified and excellent clinical infectious diseases physicians in most large hospitals- If you are not satisfied by the opinion you received from the one you already saw- you absolutely SHOULD seek another opinion from another ID doctor offline.

 

My concern, as noted is if there is indeed residual infection deep in your wound- I cannot be certain without more investigations and a proper assessment, but that would be the concern that needs to be addressed.

Betadine does lower bacterial counts before surgery and is commonly used- but having said that, Staph. epi remains the commonest bacteria that infects foreign bodies after surgery- So clearly effectiveness is far from 100%.

 

Good luck and let me know how it goes.

 

Always ask if you need clarification/more information.


POSITIVE feedback & a BONUS are warmly appreciated.
Please note that answers are for information only, do not take the place of an assessment by your doctor,
and does not establish a patient-physician relationship.

 

TheGermDoctor, Doctor
Category: Medical
Satisfied Customers: 1549
Experience: 17 years as a physician, Board Certified in both Internal Medicine and Infectious Diseases
TheGermDoctor and 4 other Medical Specialists are ready to help you

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