26 November, 2009

Peritonsillar Abcess

On Monday night, while I was showering I began to feel dizzy and nauseous, so I reached for the wall of the tub to steady myself and instead abruptly found myself face-first on the floor outside the tub with no recollection of falling. So I picked myself up from my elbows and forehead and tried to figure out why I still had the shower in my hand. Logically the best thing to do was to get out of the shower and lie down somewhere with more padding as I was still rather dizzy and was entirely unsure of where my feet were. So I rinsed off the suds, turned the water off, reached for my towel, and promptly found the floor on the other side of it. Somehow this got me angry enough to stop feeling dizzy and I managed to make it into my room to dry off and put on pajamas. I set my alarm to wake me up in 1.5h and kept doing so throughout the night as a concussion watch. It didn't feel like a concussion so much as a bruise, but I wasn't going to take any chances.

Ordinarily, this kind of thing would prompt one to go see a doctor the next day. Not so much for me. I had lost my voice and was having great difficulty swallowing food and liquids 1.5d before, so I figured by that point that I was rather dehydrated and as such the hot shower steam simply got to me. No, it took another night where I couldn't tell the fever sweats from the drool and not even being able to comfortably drink water around the bellicose pin cushion that had taken up residence at the back of my throat to get me to seek medical attention.

By this point I could barely even manage a hoarse whisper, so after I'd managed to phone in an appointment at the student/staff clinic that afternoon I tried to legibly write down the timecourse that symptoms had emerged on. It helped. The doctor at the clinic looked into my throat and saw the same thing I had for the past few days, the right side of my throat swollen so much that my tonsils were stuck to it. I had attributed it to weird strep throat and expected it to start improving any time, maybe I'd leave with cyclosporin antibiotics and an analgesic gargle. She recognized it as a peritonsillar abcess, which is basically a very acute infection in a very limited site that gets massive neutrophilic infiltration and subsequent inflammation (pain and pus) and that if it was left untreated it could wind up occluding my trachea. So I was sent off to the ER at the university's hospital, trying to figure out how they were going to drain an abcess at the back of my throat.

I've had an abcess before. I developed a topical abcess on my chest one season where I was playing cello for Bach's "Double Violin Concerto in D Minor - Vivace" and practiced so much that the contact point for the cello on my chest developed into an abcess. But they're easy to deal with on the skin surface, even if it did open back up after draining right as I arrived at my stats class.

I arrived at the ER and was fairly quickly seen, and within about 1.5h they determined that I could have IV fluids, a dose of antiinflammatories, a round of cyclosporins, and morphine. They pushed all of these at once and the nurse wrapped me in warm blankets and suddenly I was a sublime cloud. The clot of burrs at the back of my throat was gone, and I was simply at absolute peace in a way that I have not been since last I saw Prime. I sat somewhere between wakefulness and dozing and I have no idea how much time passed in this state.

Then a resident walked me (I denied the use of a wheelchair because I wanted to see what it would be like to try to walk on morphine [not easy]) up to the otolaryngology clinic and sat me in a procedures room. A nurse bustled about and laid out far more surgical instruments than could possibly, POSSIBLY, be used at once, right? Once I realized that there was absolutely no way topographically that all of those pointy and sharp objects could be applied to the back of my throat simultaneously, I was greatly reassured.

Eventually, one doctor did the procedure and I got to help. First he sprayed the back of my throat with Lidocaine, which does not taste good but thankfully numbs that which tastes and followed it up with an injection of Lidocaine into the abcess. Next came a 10ml evacuation syringe, which drew out about 7ml of pus. Then there was a tiny little scalpel blade to widen the incision and another evacuation of a similar volume, and then I sat there dutifully holding the suction hose drawing away the remaining blood and pus into a bucket on the wall (no appreciable further volume). I'm now on a course of major cyclosporin antibiotics (more than 1.0g/d!), a course of antiinflammatory steroids, and some painkillers, and there will be a follow-up appointment to make sure the abcess hasn't reconsolidated and needs further drainage. It was also mentioned that there is a risk for repetitive abcesses here now and that I should consider getting my tonsils out to stop them from happening. On the last point, I'm not yet sure.

Abcess pus. Pic taken while doctor wasn't looking. I could make several inappropriate and disgusting Thanksgiving food references here, but I shall refrain for your sake.

UPDATE: Culture of above pus showed that the cause of the peritonsillar abcess was clindamycin-sensitive Fusobacterium necrophorum, which is apparently a normal microbial resident of the mouth (no satisfactory reference found for this yet save one that cites isolation of it from canker sores), but apparently it causes a hoof disease in sheep called scald and it survives in the soil of sheep pastures for years.


Tea said...

I'm glad I already wasn't planning on eating the turkey.

And have a good recovery, I suppose. I'm not precisely certain what the polite response to an abcess is.

Genomic Repairman said...

Hope you feel better man I heard that kind of asbcess is miserable until its drained.

Cath@VWXYNot? said...

Nice pic - I <3 scientists! Hope you feel better soon

Juniper Shoemaker said...

Holy yikes! Though I do have to applaud you for the picture. I hope you continue to feel better.

LostMarbles said...

Now, I feel like a wimp for leaving the lab early because too much fluorescence gave me a headache.

Hope you get better quickly!

Eppendork said...

Manky Manky Manky - might I say that is an impressive amount of pus you have got there me boy! I went through a phase of watching people opening up boils on youtube there are some nasty nasty things growing in people. This one for instance http://www.youtube.com/watch?v=RSQIRSR0RyU


Anonymous said...

Great, now I am completely freaked out since I also have a paritonsillar abcess and will probably have to have it drained in the very near future.

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Anonymous said...

I have just had my PTA drained on friday, when the absess got so big just about ut off all air supply. The pain was so great that I was bed ridden and dibilitated, and thats from a fellow that broke to ribs on a sturday night and went to work on the conatruction site that very next monday. Absess is gone got stwriods and anti bodies and man the pain has gone from searing agony to a deep pounding ache of bruised tonsils from being drained. Cant wait till my ear feels like it aint ruptureing and I can eat a normal meal again. Hope you get well as anyone who has experienced this knows all to well of the nightmare you have been through.