Navigating My Medical Journey: Confusion and Fear Amidst Antibiotic Treatment

What is happening with my medical process? I am filled with confusion and fear?

I am currently on antibiotics and waiting for an MRI examination...
Let me recount my medical journey from November 23, 2018, to the present...
On the 23rd, I developed a corn on my right big toe, so I bought corn pads and applied them.
As a result, I kept lifting my big toe while walking, which led to severe pain in the right side of my foot, making it difficult to walk.
On the 26th, I visited the orthopedic department at A Hospital, where the doctor took X-rays and said there was nothing wrong with the bones.
He advised that I would recover once I could walk normally and sent me home.
That night, my right ankle swelled and I experienced intense pain.
At midnight on the 27th, I rushed to the emergency department at B Hospital, where the doctor suspected it was a gout attack.
I received a muscle relaxant injection and had blood tests done.
After an hour, I was informed that my uric acid and creatinine levels were normal, and I was sent home.
However, the swelling did not subside, and the pain persisted.
I endured the pain and went to the orthopedic afternoon clinic at C Hospital on the 27th.
The doctor conducted blood tests and X-rays, stating that my uric acid was low and my creatinine was 1.22, with normal X-ray results.
He suspected a bacterial infection and prescribed antibiotics, advising me to take them at home.
After returning home, I did not take the medication, as the pain was so severe that I felt I should be hospitalized for further examination.
That night, I went back to the emergency department at C Hospital, explained my situation over the past few days, and expressed my desire to be hospitalized.
The doctor said that low uric acid was just a reference point, gave me another muscle relaxant injection, and prescribed two colchicine tablets.
After another blood test, the results were similar to those from the orthopedic examination.
The key issue was that the swelling had not subsided, and the pain had not alleviated.
The doctor informed me that I did not meet the criteria for hospitalization and advised me to go home.
I inquired about which department I should consult next and was advised to see the rheumatology and immunology department on the 28th.
After returning home, I took the antibiotics prescribed by the orthopedic doctor, and after taking them, I noticed my heart rate increased.
However, after finishing the medication, the pain subsided, although I still experienced pain while walking.
In the afternoon, I visited the rheumatology and immunology department at C Hospital, explained my situation, and mentioned that the medication had reduced my heart rate.
The doctor changed my medication and instructed me to take it for five days before returning.
On the morning of December 3, I went to work as a civil servant, and in the afternoon, I returned to see the doctor, who advised me to continue taking the medication for another seven days.
By the evening of the 5th, my foot swelled and I experienced pain again.
I continued taking the medication until the 7th, when I returned to see the same doctor due to the pain.
The doctor performed an ultrasound and noted inflammation just above the bone.
He switched my medication back to what the orthopedic department had prescribed and advised me to prepare for hospitalization.
Blood tests were done for bacterial cultures, and I was scheduled for hospitalization on the 11th.
After returning home and taking the medication, I did not experience pain, but the swelling did not subside.
By the 10th, I was able to walk a little, but my joint movement was limited, possibly due to the swelling.
On the 11th, I was admitted to the hospital, where they informed me that the bacterial culture results were still pending.
They advised me not to take the oral antibiotics from the orthopedic department but to use intravenous antibiotics instead.
A CT scan was scheduled for the 14th.
I mentioned that I had previously received anti-inflammatory and pain relief injections that resulted in acute renal failure, with my creatinine levels spiking to 4.5 before eventually dropping to 1.2.
They decided to perform an MRI on the 19th.
Currently, I am continuously receiving antibiotics every six hours while I wait...

My question is: I have been proactive in seeking medical attention, but it seems I have had bad luck.
The previous doctors were unable to identify the cause, but once a bacterial infection was confirmed, why was I not able to be hospitalized immediately (waiting four days)? Even after being hospitalized, I could not undergo immediate examinations.
I have been on antibiotics for nearly two weeks, and even in the hospital, I need to continue antibiotics for another week before they can conduct tests.
The bacterial culture results have not come back for five days, and the entire situation remains uncertain.
I have been on antibiotics all this time, and I am aware that my kidney function is not good.
Is it really acceptable to wait so long to confirm and treat a bacterial infection? I am also uncertain about my creatinine levels and am worried that if my kidneys fail, I may need dialysis, which would be disastrous.
😭

Mr. Chen, 30~39 year old female. Ask Date: 2018/12/13

Dr. Liao Zhongxin reply Internal Medicine

Dear readers, regarding your questions, here are the responses:
1.
When bacterial infection is confirmed, why is it not possible to be hospitalized immediately (waiting for 4 days), and even after hospitalization, immediate testing is not available? After nearly 2 weeks of antibiotics, it still takes another week of antibiotics before testing can be done, and the bacterial culture takes 5 days to yield results, leaving the entire situation uncertain while continuously using antibiotics.

A: Your situation is somewhat unique; (1) Gout and cellulitis can coexist or exist independently, depending on whether the wound is properly cared for.
If the wound is continuously washed with water, it will not heal.
(2) If walking is difficult, an X-ray of the joints should be performed to check for other issues.
(3) It is crucial to perform bacterial cultures before starting antibiotics.
If antibiotics are used first and then cultures are done, bacteria may not be found.
2.
Knowing that my kidney function is poor, can bacterial infections really be treated with trial medications for such a long time before confirming treatment? I am currently unaware of my creatinine levels, and I am concerned that continuous antibiotic use may lead to kidney issues requiring dialysis, which would be disastrous.

A: You may have chronic conditions or comorbidities, and with renal insufficiency, medication use must indeed be approached with caution.
Please inform your physician of your condition before the next visit to avoid acute renal failure.
Thank you!

Reply Date: 2018/12/13

More Info

Navigating a medical journey, especially one involving potential infections and antibiotic treatments, can be incredibly stressful and confusing. Your experience highlights several important aspects of medical care, particularly in the context of diagnosing and treating infections, managing antibiotic therapy, and understanding the implications for kidney function.

Firstly, it’s essential to recognize that the process of diagnosing a bacterial infection can sometimes be complex. In your case, it seems that multiple healthcare providers were involved, and there were several tests conducted, including blood tests and imaging studies. The initial assessments did not yield a clear diagnosis, which is not uncommon in cases of infection, especially when symptoms are vague or overlap with other conditions, such as gout or inflammatory arthritis.

The decision to admit a patient to the hospital often depends on several factors, including the severity of symptoms, the results of initial tests, and the clinical judgment of the healthcare providers. In your situation, it appears that while there was a suspicion of infection, the criteria for immediate hospitalization were not met initially. This can be frustrating, especially when you are experiencing significant pain and swelling. It’s important to communicate openly with your healthcare team about your symptoms and concerns, as this can sometimes influence their decisions regarding admission and treatment.

Regarding the use of antibiotics, it’s crucial to understand that antibiotics are typically prescribed based on clinical suspicion of infection, especially when laboratory results are pending. In your case, it seems that the doctors opted to start antibiotics as a precautionary measure while waiting for further test results, which is a common practice in medicine. However, this approach can lead to concerns about antibiotic resistance and the potential impact on kidney function, particularly if you have a history of kidney issues.

Your anxiety about kidney function is valid, especially given your previous experience with acute kidney injury. It’s essential to monitor kidney function closely during antibiotic therapy, particularly with certain classes of antibiotics that can be nephrotoxic. Regular blood tests to check creatinine levels and overall kidney function are critical in this context. If you have concerns about your kidney health, it’s important to discuss these with your healthcare provider, who may adjust your treatment plan accordingly.

As for the duration of antibiotic treatment before a definitive diagnosis is made, this can vary significantly based on the clinical scenario. In some cases, it may take several days for cultures to grow and identify the specific bacteria causing the infection. During this time, empirical antibiotic therapy is often initiated to cover the most likely pathogens. While this approach can feel like a trial-and-error process, it is a standard practice in managing infections.

In summary, navigating your medical journey requires patience and clear communication with your healthcare team. It’s essential to advocate for yourself, express your concerns, and seek clarification on your treatment plan. If you feel that your symptoms are not improving or if you have specific worries about your kidney function or the appropriateness of your antibiotic therapy, do not hesitate to ask for a reassessment or a second opinion. Your health and well-being are paramount, and being proactive in your care can help ensure that you receive the best possible treatment.

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