Let’s Treat Some Patients (continued)
5) Your other grandson (again with no vaccinations) has broken out with a fever, runny nose, and rash, which consists of small fluid-filled blisters on bright red spots on his skin. They itch and when one area gets better another bunch crop up elsewhere.
Diagnostic features: fluid-filled blisters on red skin occurring in crops, non-vaccinated.
Diagnosis: Chickenpox
Treatment: Viral illness- no cure. Supportive care with spontaneous resolution without complication in 99% of kids (80% of adults).
6) Your third grandson (again with no vaccinations) has headache, vomiting, muscle aches, a fever of 104.2, and weakness of his left leg muscles. Ten days ago you chastised him for drinking untreated water from a creek. He didn’t know, but it was downstream from a big FEMA refugee camp.
Diagnostic features: CNS signs (headache, vomiting, muscle weakness), high fever, water contaminated with human waste, non-vaccinated.
Diagnosis: Polio
Treatment: Viral illness- no cure. Illness will either progress to death (2-5%), or he will recover with a permanent weakness of the muscles of the affected nerve pathway.
7) Your neighbor’s wife has a fever, abdominal pain, and vaginal drainage. You know she was raped on a trip to the farmers market one week ago.
Diagnostic features: Sexual trauma, unknown pathogen, pain, fever, drainage.
Diagnosis: Pelvic Inflammatory Disease
Treatment: Doxycycline plus (Clindamycin or Metronidazole)
8) A farmhand seemed okay yesterday but woke with a fever to 102.9, chills, coughing, body aches, runny nose, and a headache. His nasal drainage is yellow-green.
Diagnostic features: Rapid onset, fever, coughing, body aches.
Diagnosis: Influenza
Treatment: Viral illness- no cure. Supportive care leads to complete resolution without complications in 80%. If symptoms persist past seven days, consider treating for pneumonia.
9) Your teenaged daughter has not been drinking enough since you ran out of “flavor enhancers” for your water. Now, she has a fever of 101.5, painful urination, urinary frequency, and urinary urgency. Her urine smells “strong”.
Diagnostic features: Inadequate fluid intake. Pain with urination, urgency, frequency. Fever.
Diagnosis: UTI
Treatment: Bactrim or Cipro
10) Your prepper neighbor (who has a special filter to remove the fluoride from his city water) has been struggling with a toothache for a few days, but now he can barely open his mouth. He has a fever of 102.3, jaw pain, and swelling on the right side of his face. He says he can taste a foul drainage from the base of the tooth. He took some penicillin he had stocked, and it seemed to help a little but then his symptoms got worse.
Diagnostic features: toothache that progressed. Facial swelling. Fever, puss, failure to respond to penicillin.
Diagnosis: Dental Abscess
Treatment: I&D plus Clindamycin or Metronidazole
11) Your neighbor ran out of food a while ago and has been shooting and eating prairie dogs out of desperation. He was okay yesterday but woke in the middle of the night with fever and now has fever to 103.7, headache, chills, muscle aches, and diarrhea. He also says his “glands” are swollen in his neck, armpit, and groin. (plague)
Diagnostic features: prairie dog exposure, rapid onset, swollen armpit and groin lymph nodes.
Diagnosis: Bubonic Plague (Yersinia pestis)
Treatment: Doxycycline or Cipro. Even with antibiotics, there is an 8-10% mortality rate.
12) Another neighbor was out hunting when he drank untreated water from a creek. Upstream he found a beaver pond. He presents with four days of abdominal pain, copious (8-10 stools daily), watery (non bloody) diarrhea, and a fever to 102.2.
Diagnostic features: Water contaminated with mammal feces, abdominal pain, frequent watery diarrhea
Diagnosis: Giardia
Treatment: Metronidazole (or supportive care; without treatment will resolve spontaneously in up to six weeks)
13) A boy from down the road was caught looting a house and was hit in the abdomen with three rounds of 00 buckshot as he ran away. This was two days ago. He presents with a swollen painful abdomen that is rock hard and fever to 105.6. He is incoherent and having hallucinations. The buckshot is still in his body. His father begs you to save him, and he says he will give you his cherry 1965 Mustang fastback if you do. (If he hadn’t spent so much time and money on that car he might have been able to get some preps of his own and wouldn’t have had to resort to looting houses for food.)
Diagnostic features: penetrating abdominal trauma, rigid abdomen, fever
Diagnosis: Peritonitis
Treatment: Cipro or Metronidazole (Regardless of treatment, this child is likely to die. The holes in his intestines will constantly be spilling bacteria into his abdominal cavity; without surgical closure of the intestinal perforations, it is only a matter of time before he dies. Might want to save your antibiotics to use on someone who has a greater chance of recovery. Look up “Triage- Black tag”.)
14) Your neighbor’s son presents with fever, fatigue, headaches, vomiting, and diarrhea, and has been unable to sleep. Dad hoped it was just a virus and would pass, but this morning he had a seizure and the father brings him to you. Two months ago the child found a bat in their grass in the middle of the day. He picked it up and got bit, but the wound seemed to heal without complication.
Diagnostic features: bite from mammal acting oddly, CNS signs (headache, vomiting, seizure), long incubation time
Diagnosis: Rabies
Treatment: Viral illness- no cure. Supportive care until child dies. 99.9% fatal (only a handful of documented cases of recovery in the history of mankind, and these all required days in the ICU and drugs you don’t have).
15) Your aged mother has had a sore throat, low grade fever of 100.6, and stuffy nose for four days. There are white patches on her tonsils. It hurts a little to eat or drink.
Diagnostic features: runny nose and cough. Exudate (white patches). Brief duration.
Diagnosis: Viral URI (likely Rhinovirus)
Treatment: Viral illness- no cure. Supportive care. If symptoms persist out beyond 12-14 days, consider examining/treating for sinus infection or pneumonia.
16) A farmer from down the road (whom you don’t like very well) tells you he has been trading food for sexual favors from the desperate unprepared women of the nearby town. He says there is an ulcer on the head of his penis. Otherwise he feels fine. It does not hurt, but he is worried he might have “picked something up from one of those whores!”
Diagnostic features: Painless chancre in sexual active adult.
Diagnosis: Syphilis
Treatment: Doxycycline. In the modern world, we would try to track sexual partners and treat them too.
17) A coworker has shown up for help. You had talked to him about prepping, and he was on the path when the balloon went up. He presents with bloating, watery diarrhea that has streaks of blood in it, abdominal pain, and a fever to 104.7. He says the diarrhea smells like horse manure. He also says he recently had a suspected strep throat and took Clindamycin for it (its the only antibiotic he had. While the throat got better, the diarrhea (which he suspected to be from the antibiotic) has been present for nine days now and is getting worse.
Diagnostic features: bloody diarrhea, abdominal pain, high fever, recent broad spectrum antibiotic use, long duration
Diagnosis: C. diff colitis
Treatment: Metronidazole
18) A neighbor’s child has been struggling with an illness for a few days but over the last 24 hours has worsened significantly. She awoke this morning with a very stiff neck, high fever, severe headache, and severe nausea. She also has broken out with a blotchy purplish rash on her lower extremities that does not go pale (blanch) when you push on it. Father is here begging for help.
Diagnostic features: stiff neck, high fever, severe headache, purpuric rash
Diagnosis: Meningitis (purpuric rash is classic for Neisseria meningitis)
Treatment: Cipro and Ampicillin (even with treatment with IV antibiotics there is about a 6-8% mortality rate, and even with recovery between 30-50% will have permanent neurological complications with deafness being the most common). In approximate order of greatest CNS penetration to least CNS penetration for your antibiotics: Metronidazole–>Cipro–>Ampicillin–>TMP-SMX–>Doxycycline–>Clindamycin –>Penicillin–>Amoxicillin–>Keflex.
19) A neighbor has been ill for about five days. Started with two days of non-bloody vomiting and then evolved into watery non-bloody diarrhea. Had a fever of 101.3 at the beginning of the illness but does not have one now.
Diagnostic features: non-bloody vomiting evolving into non-bloody diarrhea, short duration, no fever
Diagnosis: viral gastroenteritis (common causes include Norovirus, Enterovirus, Rotavirus, Astrovirus, and Adenovirus)
Treatment: Viral illness- no cure. Supportive care including fluids to avoid dehydration. Imodium okay as long as the diarrhea is not bloody.
20) A neighbor ran out of food a few weeks ago and has been out foraging in the forest. He has pulled a lot of ticks off his body. He presents with fever to 102.5, muscle aches, a headache, and a rash on his thigh that looks like a bullseye with concentric rings of redness.
Diagnostic features: Bullseye or target lesion, tick exposure, fever, body aches.
Diagnosis: Lyme disease
Treatment: Doxycycline or Amoxicillin
So now you are the hero (except to that one family). You have provided sound medical advice and treated 19 of your 20 patients. Your understanding of the causes of illness and how to treat them using nothing more than pet antibiotics gives you a real skill that can be used in the world you now live in after the TEOTWAWKI event. Whether you use this skill to help just your family of an entire neighborhood is up to you. Also up to you will be how you “bill” for your services. Your skill and your antibiotics are an incredibly valuable bartering commodity.
Good luck.
