The Middle Finger

Quick update on my finger, because there’s been alot of emails, texts, and questions.  But first – thanks for the support.  Dan, Rachel, Mom, and Tess – you’ve been awesome.  I really appreciate it.  Readers and friends too – thanks for the info, the comments, texts, and the emails.

No pictures on this one, the finger is pretty gross.

Self Diagnosis

I’ve been holed up in a hotel not too far from the hospital here in Panama City.  I came into town last Wednesday, with the intentions of spending a single night, buying some supplies, and heading back to the boat.  I’m still here.  I have laundry at the cleaners in Puerto Lindo, my dinghy is still at the dinghy dock, food is rotting onboard, and I only brought one change of clothes.

When it came time to leave Panama City on Thursday, my finger was very painful and inflamed.  That night that I had trouble sleeping due to the pain, so I self-diagnosed a staff infection (cellulitis).  Fairly logical conclusion, given the symptoms.

From there I found an antibiotic that treated that condition and was locally available.  From what I read, in 24 hours it should have stopped spreading, in 48 hours it would start reacting.  Not the case.  In fact it was more painful, the skin had broken, and it was noticeably more inflamed/red by Friday afternoon.

New Diagnosis

At this point I’d done enough research to find out about mycobacterium marinarum infections (fish-handler’s-disease).  That made more sense, considering I’d pricked myself scaling a fish in San Blas (just a minor fin-prick) and I’d handled many fish, crab, and lobster.  The downside is that this is a slow-growing and slow-reacting disease.  Which means that I could be in for months of antibiotic treatment.  And I also needed different antibiotics.

All that said, I wasn’t totally convinced that it was myco. It could still be cellulitis or MRSA.  So I went to the ER in Panama City.  I can say that it was (at least) cheap.  It cost $2 to be seen, and $13 for IV antibiotics and an X-Ray of the finger in question.  But it wasn’t easy – nobody spoke English, and I was having trouble figuring out where to go, who to see, and what to tell them.

When I finally got in front of a doctor, I showed them the finger, explained stuff, and even showed them a couple of pages on myco from the web (translated, of course).  When I broke out the iPad to show the doc, though, they laughed.  My idea that it might be myco was dismissed – they insisted it was cellulitis. So they hooked me up to IV antibiotics, and told me to come back Monday.

I wasn’t convinced about cellulitis, so I texted a couple of friends and got some recommendations from an infectious disease specialist, and from a small-town doctor my Mom knew.  Their advice was to add another antibiotic to my regimen, one that has been prescribed for myco. In theory, I’d covered all my bases.

No Improvement

Saturday was painful.  Sunday was worse, and the redness had grown again.  At this point I was pretty sure it was myco – other than MRSA, it’s the only thing that wouldn’t have reacted to the plethora of antibiotics I was on.  The thing with myco is that it can keep growing, even when being treated.  It’s very slow to react to treatment.

The other thing about myco is that it’s very hard to identify.  Mostly because it to culture it takes 6 weeks, and a negative result doesn’t necessarily mean that it isn’t myco.  I have no idea where I’ll be in six weeks, and I can hardly wait around to see if it’s myco before I treat it. Finally myco responds best to anti-TB drugs.

So I went in search of a couple of the anti-TB drugs. But, as I suspected, they’re tightly controlled and not in a typical pharmacy.  But I need them.  So my buddy got a couple weeks supply and stuck them in the mail.

The Hospital, Again

Since things hadn’t improved much I went to the hospital on Monday (today).  It was an outpatient consult.  What I didn’t realize is they’d sent me to orthopedics (?) and not an infectious disease specialist.  When I inquired about the infectious disease specialist, the doc told me that they’d have to check me into the hospital for a few days in order to see this specialist.  So I showed him a ton of info on myco, including the need to treat with anti-TB drugs – then I asked for a prescription for them.  The doc said he can’t prescribe them.  The only way I could get the drugs was through the infectious-disease specialist, and the only way I could see this specialist was if I stayed in the hospital for a week or so.

The doctor also made it pretty clear that he didn’t believe it was myco.  He said it was too rare.  I told him I’d had IV antibiotics and a variety of oral antibiotics, and there had been plenty of time for them take effect.  I also told him that I’d been handling fish, lobster, and crab.  He wasn’t really sure about anything, except that I was wrong.  I did, however, convince him to write me a couple of scripts – one for an alternative to the TB drug (for treatment of myco).

No Hospital

The hospital stay wasn’t really an option today.  I’ve been wearing the same clothes for almost a week already, haven’t shaved, my dinghy is still at the dock, and there is food rotting in my fridge on S/V NOMAD.  So I found another drug that was easier to get, that also had positive results with myco.  The plan, now, is to head back to Puerto Lindo and give this other drug two weeks.  As long as there isn’t any major complication (if it’s myco, there shouldn’t be).  I don’t have a fever, I don’t have chills, there aren’t any streaks running out of the wound, and the pain is (somewhat) controlled by Advil.

I’ll get a mail-shipment of anti-TB drugs from a doc in the States, shortly.  Of course, if it gets noticeably worse I’m heading back to the hospital for a fairly long stay.  Or maybe straight to the States.  That’s a bridge I’ll cross when I come to it.

Big picture:  I’m alive, and I think I’ve got it under control (but I’ve said that before)…

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