Tuesday, 17 October 2017

09:39 – It was 33.6F (1C) when I took Colin out at 0645, mostly clear, chilly, and breezy. Our first real frost of the season is forecast for Wednesday.

It seems that I have some sort of lung infection. Before I went to the doctor yesterday, Barbara said she suspected walking pneumonia, which is the old term for an atypical pneumonia (one not caused by the usual suspects).

Barbara called Alleghany Family Practice and got me an 11:15 appointment, with Dr. Ambler. We signed up with the practice a year or so ago and both of us were assigned to him. I’d never seen him, and Barbara had seen him only a couple of times. She said he struck her as a good doctor.

He’s young. Mid-thirties, I’d guess. He and his wife, also an MD, moved here last year. They’d been practicing on an Indian reservation out in the Pacific Northwest, but decided that wasn’t where they wanted to raise a family. They were looking for a small-town, rural environment, which they found here.

Dr. Ambler seemed in no hurry at all. He spent probably 20 minutes asking me questions and checking me over. I weighed 181.4 pounds. My blood pressure was 130/80, which he said was fine given how I was feeling and where I was sitting. My pulse-ox was 97. (As he was using the clamp-on pulse-ox meter, Barbara said we needed one. I told her I’d get one on order.)

After he listened to my lungs, he said there was definitely something going on and he couldn’t be completely sure what it was without running CBC and Chem-7 panels and getting PA and lateral chest x-rays. He set those up while we talked, and then said he wanted to start me on antibiotics. The conversation went something like this:

Him: “Have you had any problems with your joints or tendons?

Me: “Oh, boy. I hope that doesn’t mean you’re going to give me Cipro or some other fluoroquinolone.”

Him: “I was going to prescribe Levaquin. Is there something else you’d prefer?”

So we talked about that for a while. I suggested doxycycline. He said that ordinarily that’d be fine, but there was quite a bit of resistance to it in this area. I asked if amoxicillin/clavulanate would suffice. He said he’d use it in cases of aspiration pneumonia (upper lobe), but what I had was lower lobe. He suggested azithromycin, which I agreed to. He also wanted to co-dose with a 3rd-generation cephalosporin. So I ended up with six 250-mg tabs of azithromycin, two to be taken the first day and then one per day for four more days, and 14 200-mg tabs of cefpodoxime, to be taken bid for seven days.

On our way out of his office, they drew blood to run the panels and then we headed across the street to the hospital. He’d set up the chest x-rays, which I got. While we were signing in for those at the front desk, I noticed a stack of those multi-color drug discount cards. Why not? I grabbed one for each of us and asked Barbara to try using it at Walgreens when we picked up my prescriptions. It worked, at least for the cefpodoxime. With just our insurance, that one would have been $84. With the discount card, it was half that. Still pretty outrageous at $3/tablet, but a lot better than $6/tablet.

As I expected, the effect was immediate. By yesterday evening, I was breathing a lot more freely, and wasn’t nodding off every few minutes. I probably should have just taken the levofloxacin, but the side effects scare me, in particular because they can be delayed weeks after one finishes the course of treatment.