Brief Answer:
Muddied waters in this partially treated patient

Detailed Answer:
Good evening. My name is Dr. Saghafi and I'm an adult neurologist. I'd like to give you a few bits of information that I hope you find helpful.

First, let's clarify that the isolated fact of your kissing or being in intimate contact with someone who is suffering from meningitis (or any other infectious/contagious disease) and not coming down with the same symptoms does not by itself constitute any guarantee that the person you are with doesn't have a contagious illness. So you need to remember that for future reference. Having said that, however, I would say that even if we were to have meningitis (bacterial or viral) that he's been under the treatment now with so much ANTI-meningitic types of medications that at the very least the waters are muddied as to the actual diagnosis. Therefore, UNFORTUNATELY, I believe the doctors are justified in their concern.

There are many other signs, however, of fulminant meningitis that you've failed to mention in your fiance and so I wonder just how likely it is that he really had it to begin with but again, we're dealing with a muddled picture clinically due to the medications he's already been getting. Therefore, I guess I would run the logic like this:

1. Assuming he does not have a high WBC (and you said that really his liver enzymes are highly elevated..but that the rest of his labs look good?), no neck stiffness, no lateralizing severe pain, weakness, double vision, nausea/vomiting, decreased and decreasing mental alertness that even IF HE HAD meningitis that so long as they keep giving him the antibiotics and Acyclovir (or whatever they're using for the viral contingency) keep giving fluids and keeping nutrition up then, he's well protected and should resolve.

2. Of course, it would be very nice to get an LP to verify things (though by now with so much antibiotic in his system...I have no doubt that the culture results would come out clean) but if they don't have the personnel (and that's a story in itself) and they don't want to send him to fluoroscopy for a guided LP then, they should just keep giving him the meds until they finish the course. I'd recommend they use something broad spectrum to cover both for Gram (+) as well as Gram (-) bugs including keeping the antivirals going for the standard course of time then, he can be released.

If he would submit to an LP then, I would ask that either it be done by radiology under fluoroscopic guidance or by a neurologist or neurosurgeon.

3. Just remember you're in a hospital...NOT A PRISON...he can leave at any time although they will make you feel criminal somehow and try to make him stay (partly that's because ALL DOCTORS want you to stay in the hospital...in THEIR hospital...if you've got a condition that truly believe is contagious). They don't want him to walk out and then, for something to happen and then, have the liability of being told, "You never told me this could happen to me..."etc. etc.

Therefore, they will try their best to convince you that he MUST stay. But the truth is he can leave ANY TIME as long as he's not unconscious or not making any sense and then, that's a different ballgame, right? But all he needs to do is to agree to the risks of leaving as they will tell him what they are...and he can go....right after you've read this note in fact. It's THAT SIMPLE.

BUT-- truthfully, I think that would be a mistake. Unfortunately, this is not a black and white case of "Is it or Isn't it meningitis?" So, as an alternative if you guys aren't happy with the way he's being treated you can ask for a hospital transfer and I'm sure they'll arrange something for you. You may try and find the nearest Academic Hospital since they tend to have the highest levels of care in complex situations and I think this case is potentially complex because it's not clear exactly what's going on.

4. Also, do be sure he is drinking PLENTY OF WATER or other fluids. If he is on Acyclovir or any of its cousins for the viral form of meningitis then, if he doesn't drink plenty of fluids to flush his kidneys he may develop kidney stones...very painful...

I hope this answer satisfactorily addresses your question and if so I'd appreciate the favor of a HIGH STAR RATING with some written feedback.

Also, in case there are no further comments or questions may I ask that you CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary? You may always stay in touch directly with me by writing future questions to:

bit.ly/drdariushsaghafi

Please keep me informed as to the outcome of your situation. All the best.

The query has required a total of 37 minutes of physician specific time to read, research, and compile a return envoy to the patient.

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Brief Answer:
Not unexpected reaction given the number of drugs he's getting

Detailed Answer:
Hope he's not having an allergic reaction....which of course, would not be unexpected if they are using that many different types of medications.

Not sure why they're switching everything up based on what you've said so far. I think 1 broad spectrum is good enough and the Acyclovir (antiviral)....I'm kind of +/- on since you said the CT is negative. You said there were fevers/chills but I'm assuming that's calmed down now since he's been in the hospital.

But anyways, good that they're doing the fluoroscopy. Now, be AWARE.....radiologists are NOT NEUROLOGISTS when they do these taps. The neurologist or doctor in charge should ask that no less than 4 cc. per TUBE be collected in the spinal tap. Typically, 4 tubes are collected so they should get about 16cc. of fluid. If they are going to do PCR testing for herpes or anything else...they will need a fair amount of fluid...In fact, that last tube maybe should go all the way to the top if possible. That way they can look for more than just Herpes. There's West Nile Virus that could be looked for as well.

They should also send some fluid for AFP staining as well as XXXXXXX Ink (Acid Fast Bacilli) which is to look for fungal infections. If you've got a neurologist on the case then, he should order these things automatically.

All the best....I'd love to hear the outcome.

I hope this answer satisfactorily addresses your question and if so I'd appreciate the receiving a HIGH FIVE STAR RATING with some written feedback.

Also, in case there are no further comments or questions may I ask that you CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary? I'd love for you to stay in touch directly with me by writing future questions to:

bit.ly/drdariushsaghafi

All the best.

The query has required a total of 49 minutes of physician specific time to read, research, and compile a return envoy to the patient.

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Brief Answer:
Glad the decision was made to stay in the hospital

Detailed Answer:
Despite what you guys have gone through I'm glad the final decision was to stay in the hospital and get the tap done. I think it is unlikely that they will find any bacterial form of meningitis given the amount of antibiotic he's been on for so long but there still may be a chance of finding fingerprints of a herpetic viral infection (If it was there in the first place). If a neurologist is going to be on the case then, he should be in good hands.

Feel free to give me an update on his condition once more is known otherwise, if you have no other questions or comments at this time would you do me the favor of CLOSING THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary?

Also, a HIGH STAR RATING for the answers I've given thus-far would also be appreciated if appropriate.

Stay in touch directly with me by writing future questions to:

bit.ly/drdariushsaghafi

All the best.

The query has required a total of 55 minutes of physician specific time to read, research, and compile a return envoy to the patient.

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Brief Answer:
Fiance hospitalized

Detailed Answer:
You are very welcome and all the best for a speedy recovery of your fiance.

BTW, I want to thank you for allowing me to be part of your fiance's care and also for the very kind words that I saw posted recently from your end on the quality of the service.

Don't forget to simply close this particular query out at this time so my responses can be transacted, archived, and made available to colleagues as necessary to aid in their cases and patients. If you'd like to open another query at a future date to update or question me on other things I'm most happy and available for duty!

Cheers!

The query has required a total of 61 minutes of physician specific time to read, research, and compile a return envoy to the patient.

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