Maarten Vasbinder lives in Isaan. His profession is general practitioner, a profession that he mainly practiced in Spain. On Thailandblog he answers questions from readers who live in Thailand and writes about medical facts.
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Dear Martin,
I am 70 years old and have a swollen left foot. Been to 2 hospitals and have been taking antibiotics for 42 days now. Tried three different types and nothing helped. Very painful and the conclusion is infection in foot without wound.
Now I do mention that about 3 times a year I get a kind of boil on my right buttock, the size of a beer mat and never opens and goes away later. The same pain is now in my left foot.
Would be happy again if I could get back in my shoe, but unfortunately this is not possible due to the intense pain.
Do you know a solution?
Regards,
E.
******
Dear E,
Did they take pictures of the foot? Echo? And from the right buttock? Do you have a fever? Fever when buttock is inflamed? Have they thought about gout?
I can't say much more. You have provided very little information.
Which antibiotics, other medication, any history.
It's something to take seriously.
Sincerely,
Martin Vasbinder
Hello Docter,
Thank you for responding quickly. No pictures taken. No echo. That boil on my right buttock has been bothering me for about 10 years, 3 to 4 times a year. Doesn't come up with a yellow dot, but the pain is high. Will go away after 3 weeks. I have no fever. Medications: Moxicillin-clavulanic 1 gr. after breakfast and dinner, had about 4 weeks. Dalacin-C Capsule 300mg. 3 times a day for a week or two
GraCE-Evit 50 mg. 3 times a day for 10 days. Been to several hospitals, PI hospital and Bangkok Pattaya hospital.
If it is slim for another day, toe wrinkles.
I don't have more information.
Regards,
E.
*******
Dear E,
They did their best with the antibiotics. First a fairly simple preparation, also called augnentine. Then two cannon shots of Dalacin and Sitafloxacin (GraCe-Evit 50). There is probably a resistant bacteria that is making your life miserable.
An internist specializing in infectious diseases might be able to find out what it is and where the source is. Probably in the buttock. There may be a fistula.
The picture of the foot resembles Erysipelas (wound rose) Didn't have a wound between the toes?
In my practice I had the luxury of a cardiologist who, in such a case, briefly examined the heart valves via an echocardiogram, in order to exclude vegetations (bacterial colonies) on the valves.
What to do now? Start with an ultrasound and/or an MRI of the soft tissues (buttocks), to see if there is a source there.
If so, puncture to get hold of the bacteria and culture it, to see which antibiotic still works.
They may also be able to find a fistula (in this case a connection to the intestine or skin).
I know it's not a nice story, but something has to happen before you get a real blood poisoning. The antibiotics have prevented that so far.
Have you ever had an intestinal infection or surgery in that area? The buttock problems can also be a result of injections long ago.
In other words, further research is required. Don't be put off by an antibiotic cannon.
If you develop serious intestinal complaints, a clostridium dificile infection should be considered. That's a side effect of so many antibiotics. Can still occur up to more than 3 months later.
Strength!
Yours faithfully,
Martin Vasbinder
Hello Docter,
I have had colon cancer and 3 heart attacks. Still get heart and cancer under control. an EKG and a scan every 6 months. Have had 6 bowel operations in 1 year. Constant intestinal leaks. Had a colostomy for a year and an ileostomy for 14 days. Could this have something to do with it?
Can I send your answer to my GP in Holland?
Regards,
E.
*****
Dear E,
That's what I mean by history. Indeed, your history may have something to do with it. That is even very likely.
In that case, it is better to contact a very experienced surgeon. A radiologist should be able to find a possible fistula.
The hypothesis of an abscess due to injections also stands.
The heart attacks could indicate a bad vascular system. Has a vessel from your leg been used for a bypass? If so, that could explain the erysipelas on the foot. Although it is readily admitted, using a leg vessel for bypass is one of the causes of erysipelas. The entrance of a hospital bacteria during the operation is then to blame for the infection.
In any case, I think it would be wise to examine the leg vessels. You will probably also need to start taking anticoagulants if you are not already on them.
Don't wait too long with these things.
Of course you can tell your general practitioner in the Netherlands. He has probably been thinking about this for a long time.
Yours faithfully,
Martin Vasbinder
Editors: When you ask Maarten a question, it is of course important to be as careful as possible and to state your history, existing illnesses, ailments and medication use. That saves a lot of e-mailing back and forth and Maarten can also give better advice.