----------------------------------- Chapter 11 -----------------------------------

Laura left the exam room and tried to walk as normally as possible, hoping that no one would notice how painful each step was or how badly her backside was hurting.

Jo was seated at the nurse's station, and when she saw Laura approaching could not help but notice how gently and precise she was taking each step. "The doctor is in with a patient at the moment," the nurse said, "but should be finished in a just a couple of minutes, if you want to have seat over there and wait."

"Actually," Laura replied, "if it's all the same to you, I think I'll just stand."

The nurse returned a smile, but before a conversation could begin, the doctor appeared and escorted Laura to his office. He offered her a chair, which she graciously accepted, but reclined into very slowly.

"As you know," the doctor began, "we are treating you for multiple infections and the associated symptoms and problems they can cause. Even though we gave you a very powerful initial treatment today there are some things I need you to do over the next few days and weeks to prevent a possible relapse and ensure that we have a complete cure."

"OK," Laura said in agreement.

Doctor Sharp took a note pad and began writing instructions as he spoke, "we need to monitor your temperature closely for several days. Your fever breaking is a sign that the antibiotics are working and the infections are easing.

“So, as I told you earlier, I need you to keep a chart and record your rectal temperature at least two times a day - more if you want to and it's convenient, but at least twice a day. I prefer that one of the readings be first thing in the morning and one be at bedtime, and leave the thermometer in your rectum for at least five minutes each time. Lying on the bed, either on your side or on your tummy, would be a comfortable position to do it; and either of those positions would also allow the thermometer to go in easier and at the best angle. It needs to be placed as deep as possible in your rectum, so I want you to go by a pharmacy and get yourself one of the thermometers like we use here, they are a couple of inches longer than a standard thermometer and better for rectal temps on an adult. I'll write the product name on a note and you can show it to the drug store clerk. Also, get some water-based lubricant for insertion and don't use petroleum jelly. Any larger pharmacy will have these items and they are not at all expensive."

Laura did not respond, but nodded her head towards the doctor to indicate she understood his request. Silently she was thinking to herself that inserting a thermometer deeply into her butt twice a day wasn't a bad thing at all. So far, this was sounding like the next few days were going to be very enjoyable.

The doctor could not help but notice Laura frequently and gently change her position in the chair, and occasionally move her hands to her hips and give her bottom a rub, as he proceeded with his instructions. "Jo tells me that she did a digital rectal exam and noticed some buildup of fecal material in your rectum. You can begin using an oral laxative after the rectum is cleansed; but to insure a thorough cleaning I want you to take two disposable enemas tonight and one tomorrow. That should clean you out nicely, but if it doesn't you can use them for a couple of days; but no more than six enemas over a course of three days. The prefilled disposable ones are easy to use and you can get them in a package of three. I'll add that to your pharmacy list as well."

The doctor picked up a paper on his desk and looked it over as he continued, "Now, in going over your lab work, I notice that your red cell count is fairly low. In fact you are borderline anemic. I'm sure this is a temporary condition and is very likely because of the infections, and probably not eating well for a few days. However, with your body fighting the infections, we need to build your defenses as much as possible.

I considered giving you an iron shot today, but with all the other medicines, that would have just been too much. Hopefully the mega dose of B vitamins you received will kick start your red cell production without having to go the injectable iron route. Iron shots are very painful and they can occasionally leave a permanent stain on the skin. I don't want to put you through that unless we have to.

My preferred treatment would be to have you taking supplemental B12 injections every other day for about a month. Since coming to the office that often for Jo to give it to you is not convenient or practical at all, I'd very much like to have her train you, a family member, or even a friend to give them to you at home. I know that after today you probably never want to hear the word shots again; but the injectable route is the best way to get B12 in the system. So would you be willing to take those at home for a few weeks?"

Laura was really caught off guard by that question. As usual, from the treatment point of view the doctor's logic made perfect sense, so there seemed really no choice but to agree. But she also found the thought of doing the shots at home rather intriguing and exciting. After all, keeping a little soreness in her butt for a month or so could prove to be quite enjoyable. And she knew that Matt would be thrilled to help by sticking needles in her ass, and for a real legitimate medical reason at that. The more she thought about it, the more excited she got.

After a small hesitation, while her mind comprehended all the fun that this could entail, she answered the doctor, "sure, if that's what we need to do, I can learn to do it. I actually know people at the gym who use B12 regularly and say it really makes them feel good. I'm completely OK with doing that."

"Good," the doctor replied, "I'll write you a prescription for the B12 and all the injection supplies you will need. Since you had the large vitamin dose today, we'll give you a little break and start the B12 shots in two days. You can arrange with Jo when to come by for your first dose and also for your training to do them at home. It's not difficult to learn and won't take very long at all."

The doctor took his prescription pad and began writing as he continued his instructions, "I'm going to write you a prescription for an oral antibiotic that you will take for ten days and a steroid dose-pack that you will take for seven days - both starting tomorrow.

I'm going to write for some hydroxyzine tablets that you can use for nausea from the antibiotics, but only if you need them. These tablets will make you real sleepy, so don't use them if you plan to drive anywhere for a few hours after you take a tablet.

I'm also going to give you a fairly potent combination of cough suppressant and decongestant in a liquid. You can take two teaspoons at time, up to three times a day; but again, I only want you to use it if you need it.

Plus," the doctor said, "I'm going to write you a separate prescription for an oral contraceptive. You don't have to use it now, but when you decide to become sexually active, I strongly encourage you to get this filled and start using a method of birth control. Continue with your estrogen supplement for now, but if you decide to take the birth control pills, then discontinue taking your daily estrogen and use only the contraceptive."

Laura nodded her head as the doctor kept writing and speaking, "Then I also want you take two acetaminophen tablets every morning and evening for a week to keep that high fever under control until the antibiotics kick the infections. The analgesic in them will also help ease the pain of today's procedure over the next few days. If the tablets upset your stomach, or if you would just prefer the rectal route, you can get acetaminophen in suppositories, like we gave you here. They work just as well as tablets; in fact a lot of people say they work better than pills, and find it easier on their stomach to take the medication in the rectum. The suppositories are available over the counter at the pharmacy, if you decide to use them.

That large dose of penicillin we gave you will render your strep non-contagious in about twenty-four hours," the doctor stated. "Until then you should avoid any oral contact with other people. No kissing, sharing a drinking glass, or anything like that. I suspect the antibiotics will have you a bit lethargic for a few days, and I encourage you to limit strenuous activity and rest as much as you can for about a week. Drink lots of fluids so you stay well hydrated. And eat a good diet with protein and lots of veggies. Also, I want to see you back here in ten days for a re-check. When you come in, remember to bring the chart of your temperature readings."

The doctor handed Laura the notes he had written of all her instructions, as well as her prescriptions. "That's a lot of things I've asked you to do," the doctor said, "do you have any questions?"

"Not really," she responded, "I think you covered it pretty well."

"Great," the doctor said as he stood from his chair. "Quite honestly, you have a potentially significant illness," he continued. "I'm glad you came in when you did; If you had waited much longer, the infections would have been more difficult to treat and might well have required hospitalization. But the regimen we are following here should have you all fixed up real soon."