Wednesday, January 2, 2013/lk
Everybody’s got their own problems, so you might wonder why I’d think you’d all want to listen to mine. But amazingly, here you are reading my monthly column again (you should know better by now!) and guess what I’m going to talk about.
But really, I think it is only fair.
As a health care provider, I spend an awful lot of time listening to other people’s problems. In fact, I’m so good at it that people actually pay me just for the opportunity to gripe to me for 20 minutes. I hear about all kinds of problems: sore throats and aching backs and twisted ankles and really, really bad headaches.
This time of year I get to hear a lot about congestion. You would not believe the multitude of colors that snot and phlegm come in! I could paint a rainbow! I get to hear about coughs and earaches and heart disease. I hear about wheezing and blurred vision and tingling fingers.
I hear A LOT about depression and anxiety. Man! You think you’ve got problems? Try living through a panic attack. You’re fine one minute and then, wham, you get dizzy and you can’t breathe and your heart is going a million miles an hour and you’re absolutely sure you’re dying. Somehow you get yourself to the emergency room only to be told that you must be crazy because there’s nothing wrong with you. “Go home.”
Then two weeks later you get a bill for $2,600.
That WOULD make you crazy.
Some people’s problems are more serious than others, but at my clinic I charge everyone the same no matter what. It’s hard to compare a wart on a finger to a debilitating migraine to finding blood where one shouldn’t, but I don’t discriminate.
Now, I promised I was going to tell you about MY problem, and I want you to listen carefully because I need to share this with you.
When I listen to patients tell me about their headaches, my head doesn’t automatically start throbbing. When a patient tells me about their depression, I don’t go home and put my head in the oven. But goodness gracious, start telling me about an itchy rash and instantly I start feeling it!
Some itches are worse than others. A couple summers ago, Stacey and I went bushwhacking up a creek in far Eastern Oregon. As we made our way through the brush in our shorts and T-shirts she pointed to the oak-shaped leaves and said, “Doesn’t this look like poison oak?”
“Naw…” I said.
The rash of poison oak generally takes a few days to develop, particularly if you’ve never had it before. It is essentially a chemical burn that causes an eruption of big, fluid-filled blisters that ooze and weep and itch like crazy. It took a month and a half for us to get better. And Stacey still hasn’t gotten over her lack of trust in my botany-identification skills.
But when I see a patient with a poison oak rash — which can absolutely drive a person nuts with itch —it isn’t the kind of rash that triggers my sympathetic response. For one thing, it’s not contagious, so I don’t start worrying about catching it myself, and then it is usually confined to the areas exposed to the poison oak oils, so I don’t start feeling it spreading over my entire body.
Scabies is different. Scabies gets me every time, probably even more so because I know a little bit about it. So let me share my burden:
Scabies is an itchy rash caused by an infestation of the tiny Sarcoptes scabiei, a whitish-brown mite with eight legs that looks a little like a turtle. A very small turtle. It measures 0.4 x 0.3 millimeters, which is just at the border of visibility without a microscope.
This is what Up-to-Date, my online medical resource, has to say:
“When fertilized, the female burrows quickly into the epidermis … where it extends its burrow by approximately 2 mm each day, lays two or three eggs at a time to a total of 10 to 25, and dies in place after one to two months. Larvae hatch in three to four days, molt three times, leave the burrow for the surface, copulate, and continue the cycle.”
Doesn’t that sound special?
Typically, the mite likes to burrow down in particular areas. People usually start itching around the wrists and in the webs between the fingers, then it spreads to other places such as the arm pits, around the waist and between the thighs.
The rash itself is not remarkable — unless you’re just crawling with the little buggers — with just tiny little bumps and the occasional small streak of inflammation caused by the burrowing. The itching is caused by a hypersensitivity reaction to the mite, its eggs and its feces.
You can have the mites for weeks without even being aware that there might be a dozen or more eight-legged turtleoid creepy-crawlies laying eggs and pooping and dying under your skin. And you can’t even see them!
In fact, you might even have them right now. Aren’t you kind of feeling it? Don’t your wrists kind of itch right now? Geeze, what if they were in your hair? Can you just imagine one of these little suckers crawling across your back, right where you can’t possibly reach without dislocating your shoulder? Doesn’t that just make your skin crawl?
Feeling better already
I know that it’s part of the job; one can’t treat the sick without exposing oneself to illness, and without empathy one can’t fully understand the suffering of the inflicted. It is the constant burden of the health care provider… and I want to sincerely thank you for allowing me to share some of that burden with you.
Are you feeling better? I know I am!
Happy New Year!
Craig Danner is a novelist and physician assistant living in Hood River with his wife and two teenage sons.