What To Do When You Encounter a Pain in the Butt

What To Do When You Encounter a Pain in the Butt

October 8, 2008 0 Comments

I interrupt our normally serious blog posts with this breaking story, based upon the principal that if you cannot at least laugh in the middle of a crisis you need to get a life.

The lead article in the current issue of the New England Journal of Medicine is titled “Management of Skin and Soft-Tissue Infection — Polling Results.” The article reports the results of a poll taken among readers who are medical professionals (i.e., they didn’t include me) about the best way to treat the case of a college athlete with a skin and soft-tissue infection.  The patient was a healthy 20-year-old college basketball player who presented with a tender erythematous area on the right buttock (a pain in the butt). He reported that there was no direct trauma to the area. (Oh good, I was really worried.) He noted having subjective low-grade fevers the night before presentation and had a temperature of 37.7°C at presentation. The area of erythema was 5 by 3 cm and had a firm central area 2 cm in diameter. Although he reported that he does not like taking medications, he also expressed concern about being ready to play in his next basketball game in 1 week. (He is all about the team.)

There is a nifty graphic showing the votes cast by continent and country. Note that North America is the ONLY place where a majority of voters chose the MRSA therapy. MRSA is the deadly disease you catch in hospitals where the professionals do not follow strict hygiene protocols.

Of the three management options proposed, the most popular — receiving 4585 votes (41% of the 11,205 votes cast) — was incision and drainage plus an oral antimicrobial agent active against methicillin-resistant Staphylococcus aureus (MRSA). The second-most popular option, incision and drainage alone, received 3508 votes (31% of the votes cast). A close third, with 3112 votes (28% of the votes cast), was incision and drainage plus an oral antimicrobial agent active against methicillin-susceptible S. aureus (MSSA).

And there you have it.


John Rutledge


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