Way OT - bat bite

[True North]

Perhaps a little OT from original thrust of this thread, but I’ve wondered why baited immunization programs to decrease wild animal rate of rabies seems to be less used than previous? Decades ago, planes here would ‘bomb’ wilderness areas surrounding human population centers with immunization bait. Seemed to work to decrease skunk and racoon rabies rates locally in the past. Had an obviously rabid racoon in my own backyard last summer. Don't know of any method to decrease bat carriage rates.

 

[Gordon Heaton]

Probably didn't really help. You still have to have the animal for testing or get the shots anyway.

 

[eKretz]

It sounds to me like OPs doctor could use a link to this thread...

 

[challenger]

Odd thing about the testing is that the results take 10 dsys according to the info from the ER staff. So the shots have to be administered regardless of the test results.

 

[Bill D]

I saw, years ago, folks using old gigantic tires from excavators to make bat caves. Dig a trench, put tires standing in operating position in a line like a pack of lifesavers. Bury the tires and leave a small gap at one end. instant bat cave. Almost free legal way to dispose of hazardous waste.
BilL D

 

[Donkey Hotey]

I agree with almost everything you said except for the very last statement. I would modify it focusing on the rabies question by saying that as a certified family practice physician I know from 40 years of practice experience...

And that right there is where you lost me. Yes, doctors are fallible, even with 40 years experience and they absolutely need to be questioned. Medicine is every bit as flawed as any other profession. For every trash mechanic who screws up a car, there is a board certified MD who isn't qualified to even change oil.

I have enough completely separate stories of grossly misdiagnosed or mistreated medical conditions that I could fill a book. They were all me or my immediate family.

I personally got up and crutched out of an operating room pre-op area because my orthopedic couldn't read an x-ray and I was having to explain to him how many pieces my ankle was in (knowing how to read a drawing turns out to be useful with x-rays too).

My father had a torn aorta that an entire team of doctors from a major Los Angeles hospital couldn't diagnose for six months. In the process, that team of circus freaks killed one of his kidneys completely and damaged the other badly enough that he spent a year on weekly dialysis. Read the charts? Hospital pharmacy cross check to see what they're pumping into him (in the hospital!)? Nah, they're doctors with "40 years of practice experience."

Had those drooling morons caught the textbook-case injury before the aneurysm spread, he would have lived a full life. Instead, it spread 19" from the arch to his pelvis. He had to be flown to Texas where a team who actually knew what they were doing tried to save him. The repair lasted maybe six months before it failed and he bled-out internally.

Or the dipshit doctor that wanted to give me a colostomy over a pinched nerve in my lower back? Yeah, you doctors don't get a pass for anything. You can absofuckinglutely bet you're getting questioned. The second you pull that "40 years experience" bullshit on me, I walk out.

 

[eKretz]

And that right there is where you lost me. Yes, doctors are fallible, even with 40 years experience and they absolutely need to be questioned. Medicine is every bit as flawed as any other profession. For every trash mechanic who screws up a car, there is a board certified MD who isn't qualified to even change oil.

I have enough completely separate stories of grossly misdiagnosed or mistreated medical conditions that I could fill a book. They were all me or my immediate family.

I personally got up and crutched out of an operating room pre-op area because my orthopedic couldn't read an x-ray and I was having to explain to him how many pieces my ankle was in (knowing how to read a drawing turns out to be useful with x-rays too).

My father had a torn aorta that an entire team of doctors from a major Los Angeles hospital couldn't diagnose for six months. In the process, that team of circus freaks killed one of his kidneys completely and damaged the other badly enough that he spent a year on weekly dialysis. Read the charts? Hospital pharmacy cross check to see what they're pumping into him (in the hospital!)? Nah, they're doctors with "40 years of practice experience."

Had those drooling morons caught the textbook-case injury before the aneurysm spread, he would have lived a full life. Instead, it spread 19" from the arch to his pelvis. He had to be flown to Texas where a team who actually knew what they were doing tried to save him. The repair lasted maybe six months before it failed and he bled-out internally.

Or the dipshit doctor that wanted to give me a colostomy over a pinched nerve in my lower back? Yeah, you doctors don't get a pass for anything. You can absofuckinglutely bet you're getting questioned. The second you pull that "40 years experience" bullshit on me, I walk out.

While I agree completely with your assessment, having seen too many "experts" in my life that couldn't find their ass with both hands, it's not fair to tar everyone who uses that statement with the same brush. I do also agree that such blanket "trust me" statements aren't very useful though.

 

[dgfoster]

And that right there is where you lost me. Yes, doctors are fallible, even with 40 years experience and they absolutely need to be questioned.

I wonder if you actually read what I wrote. I did not say that in general doctors are, in general, right 99% of the time. I was responding directly to the statement suggesting doctors are across the board clueless concerning rabies specifically. And I do know that is not the case. Pretty simple statement. And pretty clearly correct to me.

The average non-infectious disease doc would not know from memory the exact PEP regimen I suspect. But they will know that bat exposure warrants careful investigation and they would usually know to refer the person to the health department.

Finally, what we do not know about this particular case is whether the OP actually talked to the doc or left a message with the assistant and exactly what the assistant said to the doc. So, before I even tar that specific doc, I would need to know more info.

Of course physicians are all fallible. But all being fallible and and all being clueless are not the same by a long shot.

I stand by what I really said which was replaced by … in the Donkeys post.

Denis

 

[gustafson]

Doctors are well educated mechanics.
You wouldn't let a Toyota mechanic work on your Ferrari, or, your Ferrari mechanic work on your Toyota, or either of them work on your RX7.
Half of doctors are below average.

 

[snowman]

I agree with almost everything you said except for the very last statement.

I have had decent luck in my own experiences, in that they have generally been pretty damn on the ball. However, when I was told that, we were also experiencing worldwide vaccine shortages, and people were being advised "you don't need that" when they very clearly did.

If you are interested, there's a great book by Bill Wasik called Rabid that goes in to the history of Rabies.

 

[challenger]

I have had decent luck in my own experiences, in that they have generally been pretty damn on the ball. However, when I was told that, we were also experiencing worldwide vaccine shortages, and people were being advised "you don't need that" when they very clearly did.

If you are interested, there's a great book by Bill Wasik called Rabid that goes in to the history of Rabies.

What vaccines are in short supply?

 

[GregSY]

I generally agree with the Toyota/Ferrari bit, but I also recognize that in the real world what I really want is a GOOD mechanic, not a 'Toyota' or 'Ferrari' mechanic. A good mechanic knows what to do and not do regardless of the make.

Back when we had the shop, it was very common for the local Chevrolet/Ford/Dodge dealer ASME technicians to come by and ask for help (not from me but from my friend)...they recognized, like it or not, he was a better mechanic and could resolve the problems they couldn't. He was the same guy who would disassemble, clean, repair, and rebuild a Mercedes trans when even the Mercedes dealer wouldn't touch it.

 

[michiganbuck]

If you die can I have your boots?
Oh , never mind, I checked and mine are still Ok.
Buck

 

[gustafson]

I generally agree with the Toyota/Ferrari bit, but I also recognize that in the real world what I really want is a GOOD mechanic, not a 'Toyota' or 'Ferrari' mechanic. A good mechanic knows what to do and not do regardless of the make.

Back when we had the shop, it was very common for the local Chevrolet/Ford/Dodge dealer ASME technicians to come by and ask for help (not from me but from my friend)...they recognized, like it or not, he was a better mechanic and could resolve the problems they couldn't. He was the same guy who would disassemble, clean, repair, and rebuild a Mercedes trans when even the Mercedes dealer wouldn't touch it.

Most doctors are 'good' doctors. When your life is in the balance, you do not want a 'good' doctor. You want the best available doctor, which is often not the one standing in front of you.
I have a buddy that wishes he knew your friend, many grand 3 transmissions into a Mercedes project

 

[dgfoster]

Most doctors are 'good' doctors. When your life is in the balance, you do not want a 'good' doctor. You want the best available doctor, which is often not the one standing in front of you.
I have a buddy that wishes he knew your friend, many grand 3 transmissions into a Mercedes project

What I think you want is a good doctor for the problem at hand. That means the doctor treating you should have training and experience for the medical problem being treated. For something like a sore throat, minor laceration, high blood pressure treatment, and similar everyday problems a good family practice doc is the physician of choice. You do not need a throat specialist for initial evaluation and treatment and may even get more practical care form the non-specialist. For unusual or somewhat uncommon problems or problems not responding as expected you may need a specialist in that area. A "good' doctor can not possibly know a wide range of problems in great depth. But a very good doctor knows, regardless of area of practice, when he is out of his depth and tells you so and knows whom to call. That to me is the key right there.

And there is more. There is the need for the patient to know and FEEL like they have gotten the best care especially if the outcome is going to be less than desirable. When I had the unpleasant task of diagnosing what I knew was a basically untreatable malignant condition, I advised the patient of the diagnosis and the difficulty expected in treating them. I knew for some things that was correct and essentially palliative care only was what I would want. But I also knew that they and their family would want to be certain that no stone had been left unturned. In those cases I referred them immediately to a specialist with expertise in the illness. And I also advised the patient to not hesitate and, in fact, encouraged them to get a second specialist opinion, perhaps at a university after their first specialist consultation. Very often they did get two or three consultations. All of the physicians involved were fine with the multiple opinions as they almost always lined up with only slight variations in treatment recommendations and everybody, and most importantly, the patient knew we were doing the best possible even if it was not as good as we wished could be done.

Denis

 

[Bill D]

It has been said here several times before you get injured know which doctor/hospital you will go to if you have a shop accident and need a hand doctor or eye doctor. If you are in danger of losing a hand or eye do not waste time going to your family doctor first. Go directly to the best surgeon in a reasonable distance.
Bill D

 

[dgfoster]

It has been said here several times before you get injured know which doctor/hospital you will go to if you have a shop accident and need a hand doctor or eye doctor. If you are in danger of losing a hand or eye do not waste time going to your family doctor first. Go directly to the best surgeon in a reasonable distance.
Bill D

To that list I would add chest pain, faintness, and shortness of breath come to mind. Call 911. By comparison to Emergency Rooms, urgent care facilities, and doctors' offices are relatively poorly equipped to deal with the complexity and demands of heart attacks, hypotension (bleeding? aneurysm dissection?) that such problems may and often do involve. One of my favorites was the guy who would walk in unannounced with "indigestion." Nearly always it was a heart attack in progress. So, that meant full stop on anything else going on and performing the chest pain protocol. About an hour later the patient was hopefully stabilized and was loaded into an ambulance and on the way to the hospital. We spent the rest of the day trying to get back on schedule and recovering from the stress. The ER has easily half a dozen folks that can swarm such a patient, has "crash carts," x-ray, CT lab and cath lab available plus cardiologists and anesthesia in house. Dealing with such a patient in the office with just your medical assistant to help can be taxing to say the least.

Denis

 

[challenger]

My boots? Did I forget to mention my boots shriveled up into a small rubber mass after the bat encounter?

I've found that the typical IM MD hates difficult cases. They generally have 10 minutes per patient and are always rushing to make the quota they have to comply with.

 

[henrya]

Are you foaming at the mouth yet?

 

[Glug]

Are you foaming at the mouth yet?

"That is not spittle. I have rabies."