Sunday, March 2, 2008

Pathogen Party in my Pharynx (or why I'm very bad at being sick)

So I finally, FINALLY, had a full two consecutive days off work (no call, no emerg, no second call, nada). It was nice except I spent most of it moaning about my strep pharyngitis.

Most GP's use the strep score to estimate risk of a sore throat being due to a streptococcal infection. You get a point each for: temperature > 38 degrees celsius, absence of a cough, swollen and tender anterior cervical lymph nodes, tonsillar exudate or swelling, and for being between the ages of 3 and 14 years. You get zero points for being between 15 and 44 years old. You get minus 1 point for being 45 years or older.

My score is 3, given that I haven't really had a documented fever. The recommendation is to treat with antibiotics if the score is 4 or more, and to treat a score of 2 or 3 only if there is a positive Rapid Antigen Test or positive swab culture. But look at that exudate on my tonsils, will ya?

That exudate, coupled with my hot potato voice, and my inability to swallow without feeling like I'm trying to Houdini a couple of razor blades leads me to believe that I do indeed have a strep throat. Time (and my properly collected pharyngeal swab) will tell. However, antibiotics it is for me. It should be noted that antibiotics for strep throat are used not only to speed resolution of symptoms, but to limit the period of transmissibility and to prevent post-streptococcal infection complications (like rheumatic fever).

I feel like I can usually tell just by looking at the pharynx whether I'm dealing with a true strep throat vs. a viral URTI with a sore throat. However, I do usually do a swab, and I can say that I've been fooled more than a couple of times (nasty looking throats that are culture negative, or vice versa). So I'll be interested to see what my swab actually grows.

The other thing I've discovered this weekend is that I'm a very, very pathetic sick person. My difficulty with swallowing my own saliva, and the GI distress from my antibiotic did nothing to make me a more pleasant individual to be around (sorry Dr. J!) However, I think it's not a bad thing for physicians to get a little sick themselves on occasion, as I feel it makes us more compassionate towards our patients. It's not fun to feel unwell, whether it's a small thing like a sore throat, or something more severe like abdominal pain or bad shortness of breath. I hope I'll remember how I'm feeling right now the next time I'm on emerg and seeing my 14th "sore throat x 3/7" in a row.


Xavier Emmanuelle said...

Youch! Doesn't look like much fun at all! Hope you feel better soon :)

Martina said...

I had strep pharyngitis twice in the past two years, and was taken aback by how painful it was. I wanted narcotics!

I'm more sympathetic towards patients now. The ones with strep throat, that is, not the narcotic-seekers.


JeanMac said...

The picture makes my throat sore - just looking at it. Razor blades is a good description.

Liana said...

holy moly, look at thos eexudates.

Liana said...

holy moly, look at thos eexudates.

Cin said...

"My difficulty with swallowing my own saliva."

Ugh, I can so relate to that feeling. I had pytlism (sp?) with my last pregnancy (I had hyperemesis gravidarum). My advice: don't swallow it. Spit it into a tissue discreetly.

Get well soon!

Sage said...

Thanks for the diagnosis, I had that about 5 weeks ago, had penicillin prescribed but 3 days after finishing the dose it returned with a vengeance so back to the docs and given twice the dosage... finally cleared up completely after a month but it was so painful trying to swallow or drink/eat anything too hot or cold...

Glad it is now subsiding nicely.