A Doctor, a Patient, a Rash, and Google
Don’t you hate it when you can’t get your doctor to agree with your own assessment of your symptoms? Never mind that she’s been to medical school and has years of experience. It’s MY body, and so I would like that fact to have as much weight in the diagnostic process. Alas, it does not.
I think I have shingles; my doctor thinks it’s poison oak. Either way, it’s annoying, itchy, and even painful. And I guess time will tell who is right; if I get better in a week or so with no further symptoms, I’ll give her the diagnostic credit. If the pain gets worse than the itch, and if my other symptoms don’t abate (nausea and headache), then I’m sticking with my shingles verdict.
Let me back up a bit and tell you how this whole debate started:
Two days before my son’s wedding, I fell while I was running in a grassy meadow near my house. This is my normal running route, and usually in that section I walk because it gets quite muddy from the Oregon rain; when it dries up the ground is rutted and uneven. With the upcoming trip, my mind must have been elsewhere, and I fell into a crevice and broke my ankle. It was a stable fracture, and so I didn’t need surgery or a cast, just a boot and crutches (which I jettisoned for my walk down the aisle and for the occasional dance).
While we were at the rehearsal dinner, a barbeque held in a St. Louis park, many of the guests remarked on the beautiful weather and how lucky we were that the mosquitos weren’t bothering us. But I had two bites on my arm, I pointed out, and so it appeared that some were flying about and they found me. Over the next couple of days, the festivities continued, and these apparent bites seemed to spread. By the time we left on Sunday my ankle was swollen from too much activity, and my arm now had an actual rash.
We’ve been back for a week now. My ankle has simmered down and is on the mend. The rash has spread in a semi-circular band on my upper arm. Another patch of skin is also beginning to hurt and itch right above the ankle injury. With the nausea and headache, I just don’t feel like myself, hence the visit to the doctor.
But first I googled everything about shingles and other skin rashes, including poison oak. I know what shingles feels like because I’ve had it before, when I was only in my 20s. I know that it’s possible, though rare, to get it twice. And I remember that it started out for me, years ago, as merely itchy, and then blossomed into a full blown, quite painful, rash that lasted for months, accompanied by flu-like symptoms.
When you’re lying in bed at night, scratching instead of sleeping, the mind draws interesting connections. This morning I decided that maybe my ankle break was somehow related to the rash! If I indeed have poison oak, then the correlation is obvious. I must have tumbled into some leaves when I fell. But if it’s not poison oak, is it possible that the shock of the break precipitated a shingles outbreak, I wondered?
And so I turned to the internet again (a dangerous thing for an amateur), and sure enough I found a study that linked physical trauma to shingles. My doctor, as you might imagine, rolled her eyes at my findings, though I found the article persuasive. It’s known that emotional stress can cause shingles, and now this study confirmed my suspicion that the physical shock my body endured when I broke my ankle could have affected my immune system such that it sparked the dormant herpes-zoster virus into action.
Trying to get the doctor to agree with me was impossible. She said the rash’s pattern did not present in a typical shingles way, despite its semi-circular pattern. And that poison oak could also cause the nerve pain I was feeling. And that the nausea and headache could be due to lingering pain from the ankle or from the poison oak. All true enough, I suppose, and I do like her diagnosis much better because poison oak will go away sooner, without the after effects that shingles can cause.
My skepticism remains though because I have a keen sense of my bodily sensations (at least I think I do), whereas the doctor can’t tell how I’m feeling. She’s evaluating me according to a conventional understanding of how a disease typically manifests itself as well as her vast experience of seeing hundreds, if not thousands, of rashes. So, I guess I have to concede that she’s likely right. And if she is, I’ll happily eat these words, which will be easy to do because the upset stomach (probably completely unrelated to any of this) will hopefully have disappeared by then. No matter the outcome, I remain a firm believer in patients having a particular authority when it comes to their own symptoms and an admirer of physicians who take their patients’ opinions and google searches seriously.
Update: Turns out the doctor was right. Poison oak, headache, nausea, all gone. My ankle still hurts a bit, but mostly from jumping to the worst case medical conclusion.
Elizabeth Reis is a professor of gender and bioethics at the Macaulay Honors College at the City University of New York. She is the author of Bodies in Doubt: An American History of Intersex, which was recently published in a 2nd edition, and Damned Women: Sinners and Witches in Puritan New England. She is also the editor of American Sexual Histories: A Social and Cultural History Reader.
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