Friday Night No-Wine Non-Buzz. I'm on call. Ask me anything.

[Aristus]

Got to stay sober in case I get a call...

[cilla4progress]

1. If it's Friday night it's

ARISTUS!

How does Friday night look from the sober side?

Hahaha!

[Aristus]

2. Strange...

So this is what Friday night looks like!...

[dmoyer]

3. Thank you for your service!

[Aristus]

5. It's in my contract.

And I get extra scratch for it.

But I think I'd give it back in order to not have to lose a weekend like this.

Outpatient call is a big waste of time...

[cilla4progress]

4. Well, we're here for you,

buddy.

Here's a question for you: do you ever wonder if some day you'll be driving or strolling along and you'll pass right by or have a chance encounter with someone you only know online and are friendly with, without ever realizing it?

[Aristus]

8. Thank you.

Yes, I've thought about that before. The idea that our anonymity online means that IRL we could be right next to someone we know very well digitally, and not even know it. It's weird.

[California_Republic]

6. On call for what?

[Aristus]

23. Outpatient call.

An after-hours resource for patients who are too sick for home remedies, but not sick enough for the emergency room.

Usually, it's calls from patients who are either unable to figure out an effective home remedy for a nothing-illness, or are unable to figure out that they should have gone to the emergency room two hours ago.

It's a waste of time, but they pay me for it. So here I sit...

[TexasTowelie]

7. Since you're on call and sober I guess that medical questions are appropriate.

One of the outdoor cats bit me hard on the top side of my wrist on Wednesday night. I don't believe he has rabies, but I don't believe he was ever vaccinated either.

While it was sore on Thursday it was mostly affecting my grip. However, today and the skin between the two bites is red and sensitive and I had trouble holding any thing that weighs more than a few pounds today. When U was bit, I scrubbed it with alcohol and also put Neosporin on the wounds. I started taking ibuprofen this afternoon and plan on using an ice compact on the swollen area.

The major concerns are sepsis and rabies of course, so I've looked up the symptoms online. However, do you have any other recommendations?

[Aristus]

9. Yeah, the big risk is not rabies; it's Pasteurella, a common bacterium found in cat bites.

Go to your clinic, get the bite cultured, and get some oral antibiotics.

Anyone who has read my medical posts knows that I don't throw antibiotics at every problem that walks in the door. But this is a situation in which treating empirically is appropriate.

[TexasTowelie]

14. The good news is that I have some Bactrum here

so I'll add it to my regimen until I run out. I can make it to an ER if things do get worse. I recall reading about a man in West Texas dying after a cat bite so anything more than a surface level scratch gts my attention.

[Aristus]

15. Bactrim is broad-spectrum, so you should be all right.

However, I would caution you against keeping antibiotics handy to slam when you're feeling a little sick. I know some people who do that.

"Oh yeah, I started feeling better the last time, so I didn't finish my antibiotics. I just keep 'em around in case I need 'em."

Not a good idea...

[TexasTowelie]

20. I usually don't.

My physician was willing to write the prescription to ward off secondary infections after I had scabies because the skin around those sores was still pink. The sores healed and the danger of the secondary infections disappeared which is why I had a few pills remaining.

[Lithos]

10. So, if no wine

Being good all the way, or have you found something decadent? (Chocolate, ice cream, etc.)

L-

[Aristus]

11. No. I'm just powering through.

No relief until next Thursday...

[Lithos]

12. Ouch

No fun..

Do have a medical question - topical with Shkrelli. Besides the Epi-pen crap and Daraprim, what are some of the biggest pharmaceutical price gouging items that you're aware of.

L-

[Aristus]

13. Albuterol inhalers. Co-pays and out-of-pockets for those things are outrageous.

Hepatitis C treatment medication Harvoni originally cost in the neighborhood of $85,000 for 12 weeks of treatment.

Last I heard, it was down to $44,000. So, bonus, I guess...

[Lithos]

17. Such a deal

Just googled Harvoni and see an article where it costs $900 in Egypt. So, it's not a manufacturing cost issue. Insurers should pay for a trip to Egypt every 12 weeks. Would come out ahead cost wise.

Had heard the Albuterol inhalers were bad, but didn't know they were that bad.

L-

[Aristus]

19. In the medical circles I run in, the reported cost of Harvoni in Egypt is only $300.

Is there a Hepatitis C tourism industry shuttling people to Egypt?

There should be.

Except, there shouldn't be.

Our pharmaceutical manufacturers need to man up and stop gouging patients who need this medication.

[Lithos]

28. Agree on all points

Hell will freeze before the drug business does the right thing

[TexasTowelie]

16. I would have answered CVS.

It seems like they always have the highest prices when I shop around.

[Lithos]

18. Probably because they have a captive market

I know they have preferential deals with several insurance plans. (You are out of network if you go to Walgreens, etc.)

L-

[CaliforniaPeggy]

21. No questions, my dear Aristus...

I just want to thank you for being on call.

You stand ready to help and that is so important. I know, because back in my nursing days, I used to be on call...

And I was called in when they needed my help. Out of a sound sleep.

So, I'm proud of you.

[vercetti2021]

22. Question..

Go to the ER for depression or not?

[Aristus]

24. If it includes suicidal ideation, and making a plan to go through with it, yes.

Without a doubt.

I urge the patient to go to the emergency room, then call ahead to the hospital to alert their crisis response team.

[vercetti2021]

25. I probably should then

It's been bad today

[Aristus]

26. Are you all right?

If you're saying what I think you are, call a suicide hotline.

1-800-273-TALK.

1-800-273-8255.

I'm not trained in suicide counseling, but I'll stay right here if you need me to.

[vercetti2021]

30. I spent the night at the ER

Think I'm going to have to find a psychiatrist.

[Aristus]

31. Please do. And thank you for reaching out.

In a society like ours that touts 'rugged individualism' to a ridiculous degree, I think it takes exceptional courage to ask for help.

Get better soon...

[vercetti2021]

33. I don't care what others think

I need help and I'm not ashamed to admit it

[Skittles]

27. your opinion on this kind of article, seen yearly

every time I read one I think day shift folk have to be the most delicate things on the planet (I work 12 hour nights and very often go to work on 3 or 4 hours sleep)

https://www.telegraph.co.uk/health-fitness/mind/what-losing-an-hours-sleep-will-do-to-your-body/

[steve2470]

29. Did on-call go well?

I always hated being on-call.

[Aristus]

32. It's still going.

Until Friday morning.

A busy day of clinic will be followed by a busy night answering calls all week.