Father In Law: I've got this rash on my belly
Happy: Let me see
Father in law. It's nothing. The nurse at the plant said it looked like a spider bite
Happy: How long have you had it for
Father in Law: About a week
Happy: Let me see it
shows me the rash
Happy: That's shingles. Step away from the pregnant woman. Mrs Happy, let's go.
Father in Law: It's just a spider bit
Happy: No it's not. That's classic shingles. Step away from the pregnant woman Next day
Text from Mrs Happy: Dad went to see the doctor. It's shingles. He said you were right. They gave him two pills.
I didn't have any doubt I wasn't right. It looked like classic shingles. Shingles has a very defined look to it. It usually just affects a single or regional dermatome area. As a general rule of thumb, draw a line down the middle of your body. If the rash crosses the midline and affects both sides of your body, it's not shingles. I had a patient I picked up from one of my partners that was being treated for shingles of the face. The rash crossed the midline. I discontinued the antivirals. It's not shingles. I don't treat shingles every day, but antivirals are usually of some benefit only if given within the first 48 hours of the onset of the visible rash. I'm not sure what pills he received from the doctor for seven day old shingles. Perhaps they wrote for antivirals and steroids anyway. I'm not even sure there is any evidence based medicine that says any pills are indicated for shingles one week after the fact. But who cares. As a patient yelled at me last week for suggesting that a generic metformin ($4 a month a Walmart) would work just as well as the trade brand Fortamet ($160 a month on drugstoreDOTcom)
Happy: Let me see
Father in law. It's nothing. The nurse at the plant said it looked like a spider bite
Happy: How long have you had it for
Father in Law: About a week
Happy: Let me see it
shows me the rash
Happy: That's shingles. Step away from the pregnant woman. Mrs Happy, let's go.
Father in Law: It's just a spider bit
Happy: No it's not. That's classic shingles. Step away from the pregnant woman Next day
Text from Mrs Happy: Dad went to see the doctor. It's shingles. He said you were right. They gave him two pills.
I didn't have any doubt I wasn't right. It looked like classic shingles. Shingles has a very defined look to it. It usually just affects a single or regional dermatome area. As a general rule of thumb, draw a line down the middle of your body. If the rash crosses the midline and affects both sides of your body, it's not shingles. I had a patient I picked up from one of my partners that was being treated for shingles of the face. The rash crossed the midline. I discontinued the antivirals. It's not shingles. I don't treat shingles every day, but antivirals are usually of some benefit only if given within the first 48 hours of the onset of the visible rash. I'm not sure what pills he received from the doctor for seven day old shingles. Perhaps they wrote for antivirals and steroids anyway. I'm not even sure there is any evidence based medicine that says any pills are indicated for shingles one week after the fact. But who cares. As a patient yelled at me last week for suggesting that a generic metformin ($4 a month a Walmart) would work just as well as the trade brand Fortamet ($160 a month on drugstoreDOTcom)
I don't care what it costs. My insurance is paying for it. And who are you to barge in here to tell me that I don't need the real stuff. Get OUT of my room.
