Tri-County Infectious Diseases
 

When am I going to stop beating my head against the walls of incompetent medical offices in The Villages. I recently returned from a cruise with a broken toe and an infection from the break that had doubled the size of right leg up to the knee. I immediately went to my PCP - Dr. Allen Schwartz (one of the few practitioners in he Villages that has your back covered). He said this was very dangerous and could lead to sepsis - an infection that can cause blood clots and organ failure. He sent me to the first Infectious Disease practice that had an opening - Tri-County Infectious Diseases. He also faxed to them my medical records and a copy of an x-ray he had taken.

With my arrival, the front desk staff appeared to have just sucked on a lemon. When I was taken to an exam room a doctor - Dr Sheila Gillikin, rushed in, and read the top page of Dr Schwartz notes. Turned to me and asked, "What was wrong." She obviously had a problem seeing my elephant sized right leg. I explained the issues and concluded with "I also have a broken toe." She took my toe and wiggled it around and asked if it hurt. I said, "No." "Then you don't have a broken toe." She finally looked at my records and the X-ray and said, "Oh. You do have a broken toe." I had been taking Levaquin (a general antibiotic) that in two weeks had done nothing. She said "I can't make a diagnosis until I have an MRI. Keep taking the Levaquin; here is a prescription for an MRI. I will see you in two weeks." I asked her, "What about my broken toe?" Her parting words were "That's not my specialty." I felt she had as much interest in me as she would looking at an amoeba under a microscope.

I immediately returned to Dr. Schwartz. Explained what happened. I told him I would travel to any COMPETENT Infectious disease doctors south of the north pole. He sent me to Ocala Infectious Disease Center in Ocala. They were so concerned that I am now starting a 2 hour a day, 10 day therapy. The therapy calls for two powerful antibiotics administered through an IV.

I think there is a large alumni association among the doctors in The Villages - Voodoo U.

That is so scary and am sorry you had to travel to Ocala to have it taken care of.

Sorry for your situation but sometimes less is better, sometimes getting more data before deciding on therapy is better. Obviously bedside manner makes a difference and it was lacking locally. But you had two weeks on a very powerful oral antibiotic. It was not unreasonable to consider imaging to get further information on why your leg was so swollen before changing your therapy. I am writing in generalities, not knowing how your leg looked, what your temperature might be, swollen glands, underlying disorders or a host of other considerations in your specific situation. I just wish to say that the most aggressive treatment is not always, or even not often, the best treatment. Speedy recovery..

I remember reading a similar article to this just a week ago about people having problems with Levaquin. Definitely worth reading. Levaquin (Levofloxacin) Side Effects Leave Long-Lasting Disabilities - The People's Pharmacy

For whatever reason Ocala medical community does exceedingly well. By virtue of the fact of Ocala's immediate and specific protocols speaks to the danger you were in. sepsis is serious business

I have dealt with Dr. Gillikin twice and was very pleased both times. She does have a quirky sense of humor however.

Just goes to show have patients have very different perceptions of the same doctor.

First of all, I feel sorry for the OP and hope he/she gets better quickly. But with the limited information posted, I have about a million comments I could make

Staff attitude and bedside manner aside, do you think it is unreasonable to get either a MRI or bone scan in a patient with a fracture and unresolved cellulitis who failed 2 weeks of a flouroquinolone antibiotic in order to exclude osteomyelitis? Because Dr. Gillikin was 100% correct to order one of them. The implication that she was "incompetent" is truly outrageous, unless the OP has gone to 4 years of medical school, 3 years of Internal Medicine residency and 2 years of Infectious Disease fellowship as well.

And now for something much more important and deadly serious----did the Ocala physicians get an MRI or bone scan? The OP mentioned 10 days of "2 hour a day" therapy. The 2 hours has nothing to do with severity, it simply that it takes an hour each IV bag of antibiotic to be infused. However, while 10 days IV therapy followed by more oral antibiotics is appropriate for cellulitis, it is TOTALLY INADEQUATE for osteomyelitis, which requires 6 weeks of IV therapy. So what is Ocala treating, cellulitis or osteomyelitis? Do they realize that if an osteomyelitis is inadequately treated the patient could lose their leg, or worse? Without a specific diagnosis, would you like to know who I think is "incompetent"

So, again with limited info, I would be asking the ID specialist in Ocala if I have osteomyelitis, and how do they know if I do or don't.

Dr Gillikin
 

As a HHC RN I have followed hundreds of Dr Gillikin's patients over the past 5 years and have not found one who was not pleased with her. She is an exceptional infectious disease physician, her patients recover remarkably well. And I would advise you to RE-READ AND HEED Golfing Eagles advice...... he is telling it like it is..... you are taking a very dangerous path.

To fill in the facts that “golfing eagle” wants so that his “million” comments can be reduced to one – “dddave is right”:
First, Dr Gillikin did say an MRI was necessary, and yes, she said it was needed for her to diagnosis my situation. However, she never gave me a reason for it. Second, she never told me where to get it or when. Fourth, she never told me how to treat it in the interim, Fifth, she never told me physical restrictions, if any, that would be needed in the interim. Sixth, these questions were popping around in my mind, and she never gave me a chance to ask them. Finally, and most important – if, as you say, Osteomyelitis or Cellulitis are so very dangerous, why did she think it was okay to wait two weeks to see her again?
As for Ocala Infectious Diseases, Dr Schwartz arranged an appointment for me the next morning. Dr Haris Lambe was my treating doctor. He spent over half an hour questioning me on in the chronology and symptom changes. He concluded as you had said – cellulitis or osteomyelitis, with differentiation come as a result of an MRI. He immediately arranged for one that afternoon. When I arrived the next morning, the radiologist had already read the results, informed Dr Lambe, of a diagnose of cellulitis, and the10 day regiment was started.
By any standards, I challenge anyone to say that Dr Gillikin’s competence was anywhere near that of OID.
PS:” Staff attitude and bedside manner aside…?” Unfortunately, that is the mantra of too many physicians today, of which I assume, “golfing eagles” is one. I would remind everyone who has taken the Hippocratic Oath of the following sentence within that oath:
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

Blueash. Thank you again for your skilled opinion.

A couple of years ago a friend went into the water for a few minutes at a local river and had a small opening on her hand. That night it became seriously infected, enlarged, red and very painful and it was diagnosed as the aggressive bacteria that everyone fears(MRSA) She was hospitalized and after she was stable she received intravenous IV's for several weeks at the place that you didn't like. The recovery was slow and painful but it was a very serious bacteria. As Blueash pointed out, it is difficult to give the best treatment without all the information. In the case of this aggressive bacteria it must be cultured and identified before a treatment can be effective. If it were an aggressive bacteria, a broken toe was not at all as important. I am not ever concerned so much with a medical person's attitude as I am his/her skill. I am not a medical person. Just a mom who has seen a lot.

Well, first the good news: Dr. Lambe obtained the correct imaging procedure, started the correct treatment, and your leg will be getting better. I can tell from the tone of your post that you are already getting better. When I saw the abbreviated original post, my main concern was that Ocala ID may have just "shotgunned" your infection without excluding osteomyelitis, which would be a big mistake. When I referred to "staff attitude and bedside manner aside", I certainly was not condoning your encounter at Dr. Gillikin's office, IF that was what actually occurred, but simply putting your immediate medical problem at the top of the list.

Now, the bad news: dddave is neither right nor wrong, dddave is angry. Your 7 point rebuttal (which was actually 6 points since you skipped from second to fourth) acknowledges Dr. Gillikin's correct decision to get an MRI, then give 4 examples of poor communication. Your last point, however, is extremely valid. I'm sure Dr. Scwartz had the same question I did when I read the OP----why would anyone continue a treatment failure for another 2 weeks? It is likely she would have changed treatment when she got the MRI report, but that is speculation. I would have arranged for the second opinion as well. I probably would have called Dr. Gillikin and stated something like: Mr. Dddave is here and his leg looks pretty bad--do you think it warrants a change in treatment to IV while waiting for the MRI?" I'm pretty sure that would have occurred. Since you seemed to have an extraordinary zeal to go to anyone else "south of the north pole", Dr. Schwartz may have felt that phone call would be a waste of time. By the way, as far as where and when for the MRI, they arrange imaging procedures in TV differently than I did up north---they call the imaging center who in turn call you later that day to arrange a time and location---which you would have known had you seen through your anger to ask.

Next, don't EVER throw the Hippocratic Oath in my face. Even though I'm retired, it is hanging on the wall not 4 feet from this computer. It is right between my diploma from "Voo-doo Univ." and my state license to practice "voo-doo"

Finally, there's you statement regarding "incompetence", both concerning Dr. Gillikin and apparently many more local physicians. I really should invite you to our monthly meeting of "Voo-doo Univ." alumni. We discuss how to practice incompetent medicine, how to be rude to patients, and how to run a lousy office. But not for all patients, JUST for you. Read Inexes post. Looks like your opinion isn't shared by hundreds of her other patients. If you really want to know the truth about a doctor, ask the nurses---they know. As far as other local physicians go, the are two that are actively practicing in TV that I've worked with for 30 years. They are MY doctors--yes, I went out of my way to seek incompetent doctors for my own health care. Frankly, and pardon my bluntness, you do not have the education or experience to judge whether a physician is "incompetent" I know you THINK you do, but you don't.

Sorry for the harsh post, but when someone throws the word "incompetent" around, the need to be reeled back into reality.

:mademyday: Thank you so much for taking this person to task for his rotten attitude. Someone had to do it and I certainly do not have the medical knowledge.

We are yet another very satisfied patient of Dr. Gilliken. She treated my otherhalf, inserted his pic line, removed the pic line etc. etc. and we had no problems with her. He was in desperate need of help and she provided it.

It really angers me to hear people diss our medical providers in TV and if things are really so bad here you probably should think of going back where you came from .........................

And yet, my original intention was not to "take him to task", I had legitimate concern that he was throwing himself from the pot into the frying pan. The OP may, in fact be one of the nicest people around, other than he has a huge chip on his shoulder regarding physicians. I suspect he had other real or perceived bad experiences and now is just focusing on Dr. Gilliken and local physicians in general. Hopefully he can take a step back and see the forest for the trees.
(Sorry for the trite colloquialisms)