Mystery Disease: Doctor Takes Best Guess, Brings Out Big Guns

I chose Sand Point Internists because my wife had a good experience there. My regular clinic was too far from my house, and Sand Point was just 5 minutes away. I had worked myself up into so much anxiety about the cough that I thought driving any further with little sleep and a cough that caused violent spasms would lead to a five-car pileup.

The doctor put on a mask when she started her exam, which is never a good sign. (Note that I’m not naming the individuals in this piece because I went into the clinic as a patient, not a reporter.)

She told me that she didn’t think I was contagious but that she just was especially susceptible to getting sick. She checked my temperature, my blood pressure, my lungs.

She immediately ruled out bronchitis.

“You’re not wheezing the way you would if you had bronchitis,” she said.

She asked me about the symptoms other people in my house had had. A little bit of coughing. A little bit of stuffiness. Nothing like what I was experiencing.

She told me about a recent bout of sickness that she had suffered and how bad her cough was and how very little over the counter worked for her, too.

“So you think it’s just a common cold gone bad?” I asked.

 “It could be. But I think it’s whooping cough,” she said. “Have you had the Tdap vaccine?”

That’s short for tetanus, diphtheria and pertussis. I told her I had, most recently in 2012.

“You can still get it because the immunity isn’t 100%,” she said.

“But wouldn’t my kids have it, too?” I asked.

“Not necessarily. They may have been protected by their vaccines, but you got it for whatever reason.”

She wanted to be sure, naturally. So she asked me if I wanted to be tested for it. How polite! Sometimes in a medical setting you feel as if your blood, phlegm and anything else in your body is just free for the taking. Like you’re a gas pump, and doctors and nurses can just squeeze whatever they want out of you on a whim.

“Is there a reason I shouldn’t be tested?” I asked.

“Well, I have to put this swab up your nose,” she said, holding up what looked like a 10-inch needle with a little ball on top.

“Sure, what’s the worse that could happen?” I asked.

“You have a deviated septum, so I’m going to try to pass the swab through. Usually I’m able to tell if I’m running into anything and I will stop.”

“Usually?”

She explained that if she wasn’t careful, she could tear up the inside of my nose. Now, the reason I have a deviated septum is because, like a lot of boys growing up in Montana, I used to get into fights on occasion. I wish I could say I always won. My nose isn’t Picasso off-kilter, but it does go a little wayward compared to a lot of teen-agers in the San Fernando Valley. Did I want to inflict more damage on it or – the mind starts to wander – my eyes, ears, or brain?

“If we don’t know what it is, how are you going to treat it?”

“I’m going to treat it as if it were pertussis,” she said. “But if we treat it and you don’t get any better, this will help us decide what to do next. We should know by next week.”

"And should I worry about taking a bunch of antibiotics and steroids even if I don't have pertussis?" I asked.

"No. Because what I'm going to prescribe is going to wipe out so much in your system that it probably will get rid of anything else that might be causing it, too. And it's going to get rid of a lot of good bacteria, so you will want to take some probiotics."

OK. Bring on the nasal swab. (And if you want to see how it works, the CDC provides a helpful video.)

That was July 12. She prescribed antibiotics so powerful that she also prescribed probiotics to counteract what they were going to do to my gut. She prescribed a ‘rescue inhaler’ for serious coughing fits like the one I had suffered two nights prior. And she prescribed a regular steroid inhaler just to keep the mystery bug at bay. Total bill at the drugstore: $182 out of pocket.

August arrived, and, after taking a full course of antibiotics and inhaling steroids twice a day for weeks, I still didn’t know what was burning me up inside. I felt better, but, perhaps naively, I wanted certainty.

Next: When begged for an answer, testing labs say, ‘Take a number.’

Image by Army Medicine via Flickr