Kathryn - Black tonsils and abdominal pain?
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06:55 pm
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Black tonsils and abdominal pain?
(x-posted from ![[info]](http://p-stat.livejournal.com/img/community.gif) ask_a_nurse, hence the full history)
I've been running a low grade (~100.5) fever since Wednesday, along with a sore throat. Friday I went to my doctor, who told me I had strep based on a visual exam, even though my instant-read culture came back negative. He also said my right tonsil looked necrotic because it was black. He gave me a shot of penicillin in the butt, wrote me a prescription for Keflex, and told me to keep an eye on my fever.
All night Friday and all day Saturday, my fever continued to climb, reaching 102.6 despite ibuprofen and tylenol. By this time, the pain was fairly intense, and I was having trouble staying hydrated it hurt so bad to swallow. As of this morning, though, my fever has gone down to 99.6 or so and stayed there. But now BOTH my tonsils are huge and black, they're covered with white and grey goo, and so is the back of my throat. I had a bunch of episodes while sleeping last night where I dreamed I was drowning and woke up gasping for air. I don't have any trouble breathing while I'm awake, but I called the on-call doctor for my clinic to find out about the other black tonsil. She looked in the notes and discovered that my overnight strep culture was also negative. She was pretty damn concerned and sent me to Urgent Care.
The Urgent Care doctor looked in my mouth, said "hm," reacted to my abdominal pain symptoms with disinterest, and palpated my abdomen -- albeit not in the spot where it's actually hurting. (The pain is about 4" to the right of my navel, and quite sporadic, but goes up to a 6 or a 7.) He wrote me a scrip for prednisone to shrink my tonsils, confirmed that my repeat instant-read culture was negative, and told me it was "probably a virus" and to stop taking the Keflex.
I'll admit to some bias here based on past example. I saw this same doctor just about two years ago, when I was six weeks pregnant with my first child immediately after a miscarriage and having some bleeding and abdominal pain, and he flat out told me it was impossible for me to be pregnant so soon after a miscarriage, despite holding a positive pregnancy test, and refused to even touch me to check out my complaint. So I'm a little ticked off at him. But. . . what virus would cause pus-covered black tonsils? Isn't prednisone an immune suppressant as well as an anti-inflammatory? I really, REALLY don't want to discontinue the Keflex. . . can there be any harm from taking another dose before I see my doctor first thing tomorrow morning?
And finally, if I don't have strep, what in unholy blue blazes do I HAVE?!
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![[User Picture]](http://p-userpic.livejournal.com/1891173/503242) | | From: | ![[info]](http://p-stat.livejournal.com/img/userinfo.gif) loree |
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| Date: | April 21st, 2008 02:49 am (UTC) |
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It sounds like tonsillitis, which I've had about eleventy-nine times. It can be bacterial or viral in origin. Keep taking the cephalexin and the prednisone until you can get in to see your doctor. Unless you're on a hugeass dose of prednisone (like 100mg), you're not going to knock out your immune system in 24 hours. If it's bacterial after all, staying on the cephalexin will only help, and if it's viral another 24 hours isn't really going to make much difference.
In the meantime, gargling with warm salt water (1 tsp salt to 1 c water) can take the edge off the pain, relieve some swelling, and kill bacteria. And sleeping on your side will help with the apnea.
Edited at 2008-04-21 02:52 am (UTC)
| | From: | loree |
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| Date: | April 21st, 2008 03:18 am (UTC) |
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Regarding your abdominal pain -- what he was palpating was probably your appendix. If you have rebound tenderness (pain that increases sharply after you let go of the sore spot), it's the primary indicator of appendicitis, and you need to get your ass to the emergency room nownownow. But abdominal pain is a vague thing, and could be gas, constipation, acid reflux, cramping due to stress... Try some Pepto, maybe?
Far be it from me to be critical of your decisions, especially under the circumstances, but...dude... this UC doc sounds like a quack. WTF would you go back to him? I mean, damn. I had a similarly bad experience with a doc' back in high school. Came in with a legit' complaint and he kinda' half-assed his way through an exam and then spend the rest of the time alternating between accusing me of using drugs and lying about using drugs. I have not seen him since.
(fyi - do not watch any episodes of "House" in this condition; you'll drive yourself mad.)
![[User Picture]](http://p-userpic.livejournal.com/64108373/474148) | | From: | vixyish |
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| Date: | April 21st, 2008 05:11 am (UTC) |
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...it's not lupus.
I don't think he's the only doc at that particular Urgent Care facility, she's just had bad luck in running into him more than once.
Damn. Just because it's not strep doesn't mean it couldn't be some other bacteria, right? I'd definitely see someone else on Monday, maybe an ENT that would have seen a lot of messy tonsils?
PS - I didn't see the question in Ask a Nurse, curious to see what they say. Maybe they screen the posts first?
Never mind, none of the recents posts in Ask a Nurse show up, duh.
Back when I was living in CA I used to get tonsillitis every winter. The last time got pretty bad, though I don't think they ever turned black. As I recall it was always bacterial, and not strep. I don't remember the name of the bacterium in question. At that point I decided I'd had quite enough, thank you, and had my tonsils out. Which fixed the problem. But it also made it harder to close the gap between my soft palate and the back of my mouth, so if you consider that option I'd try to find a surgeon who deals with singers.
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