Time for another round in the series designed to help you get to know me better!
Kaci’s Currents are (usually) mini recap posts designed to give you a glimpse into what’s flowing through my life at the present time and the impact it’s having…
**This months Kaci’s Currents is a bit different than usual. Instead of going into detail about what’s going on in all the various areas of my life, I thought I would share a more in-depth experience I had this month, the lessons it brought me, and the best strategy I have found for coping with negative situations.**
So, you wanna know what’s making waves in my world, see what’s splashing around in my head, and read what’s rockin’ my boat right now? You’ve come to the right place!
Grab your snorkel, and let’s dive in!
I’ll start with photos, because a picture is worth 1,000 words, right?
It started just along the navel the first week. Somewhat itchy and started to spread up and around the second week.
By the middle of the second week it had spread around to my back/whole trunk, up to my neck and scalp, and started going down both legs and arms. It never went past my knees or elbows. At the worst it was almost like hives, but they didn’t go away once they come up like hives typically do.
Very thankful that this ridiculously itchy situation has almost completely resolved. Yes, that is me. Lovely, right? I know you’re curious as to what it was… Allergic reaction? Fungal infection? Food sensitivity? Inflammatory response? Contagious illness? Mite infestation? Plant dermatitis?
Well, after about two weeks of a slowly progressing, itchy, hive-like rash, I’m thankful to know that it ended up being what I suspected at the beginning—pityriasis rosea You can read more here and here). Compare the pictures of me above to this photo from Up To Date:
Ok, now for the story… After being fairly certain that I was being misdiagnosed by the urgent care doctor I went to see the first week that all this started (his diagnosis was scabies—despite my husband not having any symptoms and me not having any of the classic scabies lesions), I opted not to use the prescription he wrote, and tough it out until I could get in with a specialist. To his credit, he did not see me in the full-blown phase of the lesions, but I do feel as though I had enough signs that this was not scabies for him to have crossed it off his list. If it tells you anything, even one of his staff members sided with my thoughts on his diagnosis accuracy!
By the time my appointment rolled around with the skin/allergy specialist, things had started to take a turn for the better (thanks to a kindhearted colleague and a Medrol dose pack). Long story short, I can rest at ease knowing I am not allergic to eggs or peanuts as I had feared, and I don’t have some horrendous contagious illness… Or scabies!!
Of course, being in the medical field, when it first started I was hoping to determine what it was myself. That way I’d know if I could manage/treat it myself at home, or if I needed to go see someone to manage it. I just wasn’t sure though. There were several things that made the course of my symptoms very difficult to figure out, as I had almost all of the possible predictors/exposures/history red flags for the various differential diagnoses.
- I had the flu a couple of weeks before this started, so I thought it could have been some kind of post viral eruption (aka pityriasis rosea).
- My husband and I had stayed out of town at hotel, and since I was still recovering from the flu and still potentially contagious, we used the opportunity to enjoy our own separate queen size beds. Thus, I could not initially rule out bedbugs.
- I had laid out to get some sun in our yard the weekend before everything started, and thought I possibly got into poison ivy or poison oak. I’ve never had a response to either that I know of though.
- Even though I’ve never had any allergies to food, I was not certain that I was not having a hypersensitivity reaction/allergy response to something I had re-introduced after completing the Whole 30. I had recently taken the PinnerTest, and while this the test is designed to give you insights into food sensitivities, rather than true allergies, I had a positive response to eggs (+1/3) and peanuts (+3/3), as well as soy and pinto beans (both +1/3)! I started to wonder if my skin reaction was a response to not having exposed myself to peanuts for a full 30 days, and then re-introducing them. I knew it wasn’t the eggs, soy, or pinto beans. I had eaten eggs the entire whole 30, and I had not re-introduced soy or pintos at that stage. I had, however, started consuming PB2 and peanuts almost daily right before all of this started (before the PinnerTest results).
At this point I started to get worried, and questioned my initial self diagnosis of post-flu pityriasis. While it is uncommon to have an anaphylactic reaction once you are several hours or days into an allergic or hyper–sensitivity reaction, I was at wits end and confused enough that I started to worry more and more as the rash started to spread. Even if I wasn’t having a severe response initially, there is always a small possibility that repeat exposure can trigger an increasingly more severe reaction. At that point even Benadryl wasn’t helping, things kept spreading and getting more and more itchy, and I was getting more unnerved. At that point, I called into work and went to the urgent care as I mentioned above. I was hoping to get some insight on to whether this could be a post-viral sequel as I suspected, or if it was a response to re-introducing foods. Enter the scabies diagnosis and more frustration. This was the point at which I proceeded to schedule the specialist appointment and manage my symptoms until then. The soonest they could see me was a week from that day. Luckily, I got the Rx for the Medrol dose pack the next day. With the combo of the steroid pack, Claritin, and saying a lot prayers, I finally saw some improvement in the itching the following day. Then each day, the lesions slowly started to get better. I still kept my appointment with the allergist and, as I stated above, she agreed that it was Pityriasis.
I want to be very clear about a few things. First, I do not mean to completely discredit the intelligence of the physician who originally saw me at the urgent care and diagnosed me with scabies. Where I think the failure came in was not the misdiagnosis itself, but rather the approach he took when he was clearly not certain of a diagnosis (which he gave clear indication of, but never openly stated). He made it seem as if that was it—that there was no other possibility of it being something else, and didn’t even mention to follow up if I didn’t improve. Perhaps he intended to and forgot.
Second, so that you understand my thought process better, I am of the opinion that being straightforward is best, even when it isn’t what the patient hopes to hear. (Doesn’t everyone appreciate honesty?) When it comes to dermatological complaints, it can be very difficult to sort through all of the possibilities together with the patient’s history in order to determine exactly what is going on. Patients tend to present fairly early with skin symptoms, as opposed to other complaints, usually because they are worried about something being contagious to others, or the potential aesthetic repercussions that may occur if things continue to progress. I’ve had my fair share of patients present to me with very early symptoms which could not necessarily be linked to one absolute etiology. In this case, what I find the best thing to do is to explain to the patient that this is common, especially when it comes to dermatologic complaints. I then do my best to reassure them that I have a plan, and with trial and time, we can tease out exactly what’s going on. What I don’t do, however, is act as if I know exactly what’s going on, unless I truly do. I find that most of the time, patients are completely OK when I tell them I don’t know exactly what it is, but I think it’s either X, Y, or Z and here is how we are going to start treating you. Based on the response, we will know what to do next.
I’ve also had my fair share of patients who have come to me after being “incorrectly diagnosed” (according to them) by other providers, and who then credit me with the ability to correctly diagnose them. I make it abundantly clear that I had the benefit of time, trial, and the subsequent outcome of the failed treatment that the previous clinicians did not. Instead of allowing them to assume that I know more than what their previous clinicians did, I tell them that I probably would have done the same thing had they ended up seeing me initially. I respect that we all have days where we intend to counsel patients and then end up getting distracted and failing to follow through. I always, always choose to give the benefit of the doubt until proven otherwise. We are human after all.
Ok, now back to it…
So why on earth am I sharing all this? ‘Cause you know it is not for the very unflattering photo op!
I am a firm believer that whatever I’ve been through, good or bad, is an opportunity to learn and grow. In this circumstance I think it gave me fresh perspective on the patient experience, which will ultimately result in the opportunity to become a better medical provider. I try very hard to make sure my patients understand what is going on and why things are being done. I try to relieve the discomfort and vulnerability as best as I can for them, but no matter how hard I try, sometimes I forget what it is like to be on the other side of things. I know patients appreciate it when we are able to show empathy.
It was a humbling experience to say the least… Being in the patient’s role. It was a very good reminder as to how overwhelming it can be when you don’t know what’s going on. I am grateful for the fresh perspective that this experience gave me. It was something I already knew to be the case, but the business of the medical field necessitates frequent reminders to slow down and connect with the patient on the level that they need—whatever that might happen to be.
This whole ordeal served as a lesson that, more than anything, a patient needs reassurance. They need this even more than they need a diagnosis. They need this more than the guarantee of immediate improvement once treatment has started. They need to know that someone is in this process with them. That the person on the inside of the white coat is, well, a person. Someone with emotions and compassion and the willingness to be just as vulnerable as they are with the process of their health. When they recognize that we are willing to do this, they are actually more willing to trust us.
It also served to remind me that no matter how bad things get, we need to appreciate that it could always be worse. I know that sounds negative, but really do mean this in a positive way! Having perspective on things is important. When you have a weird looking rash all over you and know that people can see it and are wondering “what the heck is wrong with her,” it makes the days of a small blemish or not-so-perfect hair seem much more trivial.
If you have stuck with me through this longer than usual post, bravo and thank you! Your reward is, as promised, my #1 tool for handling negative situations.
When in the midst of things that make me feel like coming unglued or seem to have no good in them, here’s what I have found to be the best way to cope: gratitude. Seriously. Stop focusing on the negative and everything that is going wrong, and find at least 3 things that you are grateful for. Even if it seems like something silly or small. You can certainly find 3 things to pull out of what is going on that may be potentially good within the experience and/or which may result at the outcome. For me, in the above experience, I made a list and emailed it to my mom.
The things I was grateful for in the midst of the ordeal:
1/ That my husband not only made it clear that he didn’t find me repulsive, but even looked at me as if I was beautiful, and was so kind, considerate, and sensitive about how gross I felt.
2/ That the rash, although it was almost everywhere else, was at least not on my face.
3/ That I had been given the opportunity to remember what it is like to be the patient, and that it would improve my sensitivity to patients in the future.
4/ That I have co-workers who cared about what was going on and who were kind enough to help with writing an Rx until I could get in with the specialist.
5/ I was reminded that things other than beauty are important and that the internal growth will outlast external circumstance.
Gratitude is a powerful tool to keep your mindset and perspective set on positive. The great thing is that it is a tool you can use anytime and anywhere. Hopefully you’ll give it a try the next time you find yourself feeling stuck in a situation which seems to have no good in it.
1/ What is your best tip for managing negative situations?
2/ Do you practice gratitude / keep a gratitude journal?