rather freaked out

[gosling]

Chip was just diagnosed with cellulitis in the side of his face and ear, with no apparent injury beforehand. (I could also see serious redness spreading down his neck and shoulder by the time he went in.) It's the no apparent injury that worries me. This is the third time this has happened in less than nine years. The first two were in a leg known to have lymph circulation problems, where the foot had been swelling for a while before the first infection. This one there was nothing apparently wrong until the infection.

The doctor had no explanation of *why* this was happening, and the impression I got was the followup appointment on Tuesday (I believe with the NP) was just to make sure the infection was subsiding. (He has a prescription for antibiotics he is on his way to fill, which will hopefully treat the infection throughly. I always get scared of antibiotic resistance with this, but I know the odds are that won't be a problem.)

There are questions I want answered, though (which I imagine Chip would have asked if he wasn't feeling so horrid). Foremost of these is whether there is any chance of neurological damage to the ear, or the brain or any of the other rather critical organs right in that area. If there was a subtle injury, how would he know? What should we be looking for? Also, *why*, for the third time, has he gotten cellulitis with no apparent injury and what can he do to prevent there being a fourth time?

What else would you be asking in his position?

Comments

[browngirl.livejournal.com]

Also ask about facial nerve damage.

Also, breathe.

*hugs you both sustainingly*

[gosling.livejournal.com]

Thank you

[hammercock.livejournal.com]

Yikes! :(

Maybe ask if they have cultured the pathogen to identify just which one it is, and then ask whether a longer-term treatment is warranted to really kill it off? I'm thinking of the long-term vancomycin regimen that Aries had been on when he had MRSA.

[teddywolf.livejournal.com]

It might also be worthwhile to see if it is two or more different strains, in addition to looking for long-term damage.

All my best. This does not sound good.

[gosling.livejournal.com]

I think as long as the antibiotics work they don't usually culture something like this.

[redheadedmuse.livejournal.com]

I don't have any insight into what questions you should ask. Just wanted to say I'm thinking of you. Let me know if we can help at all.

[moominmolly.livejournal.com]

Yeah, this. Same here. Anything we can do, I'll do.

[gosling.livejournal.com]

thank you

[gosling.livejournal.com]

thank you

[juliansinger.livejournal.com]

I was told (when I was hospitalized for cellulitis in my leg (well, actually an abcess, but anyway)) that frequent infections do degrade tissue and make it more susceptible to further infection.

I would think that should then affect things that had previously been infected (legs, say), but... Could be wrong.

[gosling.livejournal.com]

That doesn't explain the facial infection, however. Part of what worries me is that it is an entirely new part of the body.

[juliansinger.livejournal.com]

Yeah, exactly. Going by that, that shouldn't mean random bits of him should start getting infected. *baffles*

[bercilakslady.livejournal.com]

No advice, but I'm keeping him in my thoughts.

*hugs*

[gosling.livejournal.com]

thank you

[rmd.livejournal.com]

Aaah! Hopefully he will heal quickly, completely, and well.

[gosling.livejournal.com]

thank you

[bikergeek.livejournal.com]

Good luck and healing vibes, etc., to Chip.

[gosling.livejournal.com]

thank you

[entrope.livejournal.com]

This sounds incredibly stressful! I know someone who gets cellulitis from eczema gone wild, but by the time cellulitis sets in, it's really clear what happened.

Let me know if you'd like to come over after bedtime sometime this weekend to drink tea and freak out a little. It sounds like that might be helpful.

[gosling.livejournal.com]

I could totally use the support. thank you. it's pretty stressful emotionally these days. Late nights don't work so well though, because I usually am asleep (or wish I could be) earlier than the kids.

[fangirl715.livejournal.com]

I could almost see it happening in the leg again, but his face? WTF? Definitely ask about the potential for nerve damage & anything else in that area, and definitely ask about getting it cultured. He (and you) shouldn't have to keep dealing w/this over and over again, damn it.

*hugs* to all of you...

[gosling.livejournal.com]

yeah, I really wonder what is up with that.

[achinhibitor.livejournal.com]

Certainly I'd ask those questions. But it may be that nobody knows the answers. As to the "sequelae" (what further damage has happened), it's likely that the MDs say, "Do you see any damage?" For a lot of problems, the most effective way to discover whether there is a problem is to see whether a problem shows up.

The most useful thing would be to know why he's getting repeated cellulitis and what can be done to prevent it from happening again. But I'd be surprised if there is an answer to that, unfortunately.

Gaah... Get well soon, and have a healthy immune system!

[docorion.livejournal.com]

Cellulitis is not particularly likely to damage things in the way you're concerned about. (Abscesses can, but even then often do not). So achinhibitor's answer is what I would have said.

As regards why he's getting them-well, if you find the answer. let me know. My boss (one of them) is struggling with the same issue-recurrent cellulitis, no known reason why she should be getting it. Your choices include but are not limited to:

Diabetes mellitus (probably not, unless you kno something you haven't shared with the class)
Peripheral arterial disease with ischemia (Nope)
HIV infection (unlikely)
Cirrhosis (dunno-but also not likely)
Nephrotic syndrome (Nope)
Hemoglobinopathy (these are caught from birth. Nope)
Inflammatory bowel disease (Perhaps, but again, can't tell from here)
Neurologic disease (nope)
Autoimmune disease (could be a winner...should be worked up at least a bit)
Splenectomy (Does Chip still have his spleen? Yes? Then this isn't it)
Malignancy (Would be weird in the face; occult hematologic malignancy is an easy workup, and should probably be pursued)
The below are likely not in the running, again assuming no facts not in evidence)
Radiation therapy
Immunosuppressive agents, such as glucocorticoids and others
Immunomodulatory agents, such as rituximab, etanercept, and others

(Above list courtesy of Up To Date)

In the lower extremity, prior cellulitis predisposes to future cellulitis, so recurrence there is basically not a surprise. The face is a surprise, though, and should prompt at least some workup. Hope this helps some.

My sense of humor

[drwex]

occult hematologic malignancy is an easy workup

And a kick-ass punk band name! Or maybe the name for a seasonal house of horrors.

On a more serious note: *hugs* and hope everything clears up soon

Re: My sense of humor

[gosling.livejournal.com]

it really would make an excellent name, wouldn't it?

[gosling.livejournal.com]

This is totally helpful. Now I feel like I at least have some clue of what to ask about. Thank you!

[ceo]

Yeah, nope on all of these. I've never had any autoimmune issues that I know of, but that's probably worth looking into. Many, many thanks for looking these up.

[mizarchivist]

Good luck :(

[gosling.livejournal.com]

thank you.

[koshmom.livejournal.com]

After a quick readup on what cellulitis is, it seems to sometimes start with a scratch. Facial case + male might equal an investigation into shaving? I don't know the current status of his facial hair, but if he trims he might have scraped. If he has longer facial hairs, there might be irritation or infected ingrown hairs. Investigate sleeping pillow fillings/pillowcases? How does he bathe his face (soap irritation or allergy)? Could be a mild allergy to some over-the-head clothing, or a change in washing detergent. If he scratches his face, even a rub a la Rodin's "The Thinker" may irritate skin.

Good luck.

[gosling.livejournal.com]

maybe. there was no obvious broken skin though.

[ceo]

Thank you all very much. I'm not as freaked out as gosling is, but it is rather disturbing nonetheless. I have my annual physical coming up next month and will pursue these questions then.