Farmboy91 Posted June 26, 2020 Author Report Share Posted June 26, 2020 2 hours ago, Zapp said: I've been trying to find the pics from when I got a bad one on my ankle just forward of my Achilles tendon. I picked it up walking the dogs on a sunny day wearing trainers and no socks. I didn't realise I had been got until I came home, by which time it was bleeding because of my shoe rubbing it. At work the next day I was getting stabbing pains in my ankle which soon progressed into my calf. I did the biro thing in the morning and by lunchtime it was spreading quickly so I went to the doctors for antibiotics. These halted the spread and it began to heal, but there had already been enough damage to cause the tissue at the centre of the bite to die off. I didnt realise this until the scab came off and I had a hole I could have put the end of a pencil into. Its healed now all but for a slight dimple. I still remember the itching though as it healed, it was enough to drive you loopy. Dont take any chances if it keeps spreading. 1 hour ago, Vince Green said: You are right to be concerned about the possibility that it might be a tick bite with the risk of Iyme Disease always a worry. More so because you got it at grass level and ticks lie in the grass. I would get it checked ASAP if you have any doubts. I definitely won't be taking any chances with it, it's not itchy at the moment, I soaked the white bit of a plaster with TCP and stuck it in, I've drawn the circle and it doesn't seem to be spreading, if it gets any worse I'll call the doctors straight away though. I'm now thinking I might have actually picked it up at home, I went out in the morning in the same boots, came home and was barefoot till the evening when we went out, so same boots but fresh socks. Maybe covering it up was what agitated it. Quote Link to comment Share on other sites More sharing options...
treetree Posted June 26, 2020 Report Share Posted June 26, 2020 2 hours ago, old'un said: Well apart from DUNKS asking if the OP has made a will, we have the following recommended cures for horsefly bites, scolded with a red hot spoon, a pungent smelling liquid that makes you smell like a skunk, being electrocuted with an high voltage spark and finally the removal of the infected limb, any more recommendations before the OP decides to end it all. So what you're saying is that we need a 'Medical Advice' sub-forum to allow us to share the wealth of medical knowledge this particular post has demonstrated is out there. Mods - please make this happen. Quote Link to comment Share on other sites More sharing options...
old'un Posted June 26, 2020 Report Share Posted June 26, 2020 1 hour ago, treetree said: So what you're saying is that we need a 'Medical Advice' sub-forum to allow us to share the wealth of medical knowledge this particular post has demonstrated is out there. Mods - please make this happen. That’s a good idea, can I book an appointment as I have this nasty rash I would like to talk to someone about. Quote Link to comment Share on other sites More sharing options...
harrycatcat1 Posted June 26, 2020 Report Share Posted June 26, 2020 3 hours ago, old'un said: Well apart from DUNKS asking if the OP has made a will, we have the following recommended cures for horsefly bites, scolded with a red hot spoon, a pungent smelling liquid that makes you smell like a skunk, being electrocuted with an high voltage spark and finally the removal of the infected limb, any more recommendations before the OP decides to end it all. That about sums it all up 👍 Not going off topic too much does anyone use one of those "ultrasonic" things that they advertise for keeping bugs, mosquitos etc away? They "claim" they will keep you free of them if you wear this watch type thing 🤔🤔 Quote Link to comment Share on other sites More sharing options...
hawkeye Posted June 26, 2020 Report Share Posted June 26, 2020 Years ago when i used to fly fish for seatrout on the river Weir near Bishop Auckland one pool was hell for mosquitoes, i used to soak the peak of my fishing cap with old spice after shave never got bothered at all.. Good thing about it i used to have this particular pool all to myself no body else would fish it because of the mosquitoes Quote Link to comment Share on other sites More sharing options...
discobob Posted June 26, 2020 Report Share Posted June 26, 2020 I used to get bit like hell by Mossies when I arrived in Cyprus and no amount of burners etc.. could save me - then somebody told me to drink Schweppes Limon as it has Quinine in it - it worked bloody wonders Quote Link to comment Share on other sites More sharing options...
old'un Posted June 26, 2020 Report Share Posted June 26, 2020 14 minutes ago, hawkeye said: Years ago when i used to fly fish for seatrout on the river Weir near Bishop Auckland one pool was hell for mosquitoes, i used to soak the peak of my fishing cap with old spice after shave never got bothered at all.. Good thing about it i used to have this particular pool all to myself no body else would fish it because of the mosquitoes I found it had the same effect on woman. Quote Link to comment Share on other sites More sharing options...
harkom Posted June 26, 2020 Report Share Posted June 26, 2020 10 hours ago, washerboy said: Open a can of man up 😊😊 🤣 Quote Link to comment Share on other sites More sharing options...
Diver One Posted June 26, 2020 Report Share Posted June 26, 2020 EMERGENCY UPDATE....... dont use ACTIPEN it's for activating superglue! instead use AFTERBITE........whoops apologies to anyone who has glued parts of themselves to other parts/people/animals etc 4 hours ago, discobob said: I used to get bit like hell by Mossies when I arrived in Cyprus and no amount of burners etc.. could save me - then somebody told me to drink Schweppes Limon as it has Quinine in it - it worked bloody wonders Right, that's one on the list for the next trip! Quote Link to comment Share on other sites More sharing options...
discobob Posted June 26, 2020 Report Share Posted June 26, 2020 1 hour ago, Diver One said: EMERGENCY UPDATE....... dont use ACTIPEN it's for activating superglue! instead use AFTERBITE........whoops apologies to anyone who has glued parts of themselves to other parts/people/animals etc Right, that's one on the list for the next trip! Get drinking it before you go - get it in your system Quote Link to comment Share on other sites More sharing options...
7daysinaweek Posted June 26, 2020 Report Share Posted June 26, 2020 (edited) 14 hours ago, Farmboy91 said: I was bitten by something the other night, and it's nothing like any bite I've had before. We was walking round one of the ponds on a perm late evening. Not quite sure how whatever did bite me got there as I was wearing thick socks and laced up boots. I did check my socks and boots after I noticed the bite but couldn't find a culprit. Anyway, the first picture is what it looks like this morning and the second is Wednesday after it happened. Any ideas? Don't really want to have to go down the doctors unless I have too. That could be a bite from many types of 'Beastie.' The redness is from the localised inflammatory response from the bite , draw a pen around it. If the redness (erythema) spreads more than 5cm seek review. It is not an apparent Erythema Migrans sign from a tick bite (see my post in a recent thread on ticks) however not all tick bite result in a Migrans sign. From the picture there is no evidence from what we would refer to as tracking, there is no cellulitis and this appears to be a localised inflammatory response which is common with insect bites given the history if you think think is the most likely cause. If you are feeling well otherwise in the absence of the following "red flag" symptoms then it appears satisfactory at present for self management of over the counter (otc) antihistamines/steroid cream (see at the bottom of thread) Bite area rash does not blanch when you press on it, rash covers round circumference of lower part or upper part of leg (circumfrencial), headache, neck stiffness and eyes sensitive to light (menigism symptoms) not passed urine despite fluids in last 12 hours, severe muscle pains /aches genralised to all of body (sepsis symptoms) have no ability to weight bear, total loss of sensation, anaphylaxis symtoms such palpitations/fast heart rate, extensive itch (urticaria itch) extensive rash (urticaria) swelling of lip tongue or throat, difficulty breathing, difficulty swallowing, loss f consciousness or severe pain. Pain can be difficult to describe and assess and is of multi factorial, assess, use of a visual analogue scale from 0-10, severe pain 7/10 and feel that it is the worst pain you have ever suffered. Warmth is expected over the site as part of increased vascularisation however a hot site can be an indication of developing infection. These aforementioned symptoms singular or multiple symptoms are red flag symptoms which would require timely review without any delay. If I were consulting your 'presenting complaint' from the limited information you have given with the only symptoms being presumed a mild discomfort and mild localised itch and nil other additional symptoms and medical conditions this would be the consultation and advice. Pt introduction pt consents to verbal and physical examination PC (presenting complaint) ? Insect bite HPC (History of presenting complaint) 1/7 ago ? insect bite to right lower leg (Patients own words) was out walking around local ponds/grass area, has since developed discomfort and swelling at ? bite site. Did not see what bit him. nil news meds or hygiene products or occupational exposure chemical/irritants history No anyphylaxis symptoms, nil urticaria, nil chest tightness, nil sob, nil angiodema can clear fluids nil aspiration nil fever nil nausea passing urine nil menigism nil loc passed urine last 12 hrs mild itch not hot over site no loss sensation Not been elevating mild discomfort pain 2/10 taking regular paracetamol 1g qds and managing discomfort nil antihistamines taken can fully weight bear otherwise nil concerns from patient PMH (previous medical history) Nil known medical /nil immunosupression Nil anaphylaxis nil atopy nil asthma nil, cardiac/respiratory thoracic/MsK/neuro/diabetes nil eczema nil medications rx/otc/illicit Allergies nil known imms up to date Tetanus status ? FH (Family history) no anaphylaxis/allergy/atopy nil other SH (social history) lives alone non smoker Employed as.... Examination pt walked in unaided nil antalgic gait alert Nil cyanosis nil lip swelling Oral hard and soft palate patient, nil lesions or swelling nil stridor/talking full sentences nil urticarial rash rr 18 bp 124/77mmhg pulse 77 regualr sa02 97% O/A Left lower leg 1 inch proximal of left lateral malleolus apparent insect bite site approx 1x1 cm superficial epidermal, nil open wound, nil peri bite site erythema, nil tracking, nil cellulitis, nil oedema, fully blanchable, sensation intact, CRT under 2 seconds. Nil hot site or bony tender of MSK to lateral malleolus/ base of tib&fib Full ROM, pedal dorsalis and posterior tibial foot pulses intact. Impression: Insect bite non cellulitic/non septic arthritic ICE of patient (Ideas , concerns, expectations of patient) Plan/patient advice: Advised impression of insect bite and nil immediate concerns/nil antibiotic strategy/low clinical suspicion of Lyme borreliosis Take regular paracetamol or ibuprofen for discomfort management otc as per box dose instruction Elevate whenever possible Apply cold ice pack in towel several times daily Take otc antihisatmine non sedating next 7 days, if not improving itch in 2/7 stop oral antihistamine and switch to topical otc steroid cream 1% to area twice daily for a maximum of 5 days. Non improving seek review. Advised inflammatory response from soft tissue envenimation inflammatory response can last up to 7 days. Any ongoing concerns seek review. Draw around area or take picture and if have onset of spreading erythema greater than 5cm or tracking line of eryhtema spreading out from site seek review. At present if non worsening but no improvement at 7 days seek review. Red flags below discussed and pt to seek urgent review without any delay. Bite area rash does not blanch when you press on it, rash covers round circumference of lower part or upper part of leg (circumfrencial)tracking ,headache, neck stiffness and eyes sensitive to light (menigism symptoms) not passed urine despite fluids in last 12 hours, severe muscle pains /aches genralised to all of body (sepsis symptoms) have no ability to weight bear, total loss of sensation, anaphylaxis symtoms such palpitations/fast heart rate, extensive itch (urticaria itch) extensive rash (urticaria) swelling of lip tongue or throat, difficulty breathing, difficulty swallowing, loss f consciousness or severe pain. Pain can be difficult to describe and assess and is of multi factorial, assess, use of a visual analogue scale from 0-10, severe pain 7/10 and feel that it is the worst pain you have ever suffered. Warmth is expected over the site as part of increased vascularisation however a hot site can be an indication of developing infection. These aforementioned symptoms singular or multiple symptoms are red flag symptoms which would require timely review without any delay. Seek review with onset of the following symptoms: Erythema migrans sign (patient shown picture) headache,fever and sweats, swollen glands, malaise, muscle aches,lethargy, joint pain and swelling,neck stiffness,difficulty concentrating symptoms at any time of onset from short weeks to months to in rare circumstances short years for exclusion/differential diagnosis Lyme Borreliosis From the limited information you have given in the absence of any of the red flags and no significant immunosuppression this would be the current advice. Any concerns overnights nhs111, nhs choices on Google, Out of hours gp. 👍 On the whole these things are in most circumstances self limiting and fully resolve with no concerns in a short period and usually nothing significant to worry about but as said if ongoing get reviewed. atb 7diaw Edited June 26, 2020 by 7daysinaweek Quote Link to comment Share on other sites More sharing options...
Farmboy91 Posted June 27, 2020 Author Report Share Posted June 27, 2020 10 hours ago, 7daysinaweek said: That could be a bite from many types of 'Beastie.' The redness is from the localised inflammatory response from the bite , draw a pen around it. If the redness (erythema) spreads more than 5cm seek review. It is not an apparent Erythema Migrans sign from a tick bite (see my post in a recent thread on ticks) however not all tick bite result in a Migrans sign. From the picture there is no evidence from what we would refer to as tracking, there is no cellulitis and this appears to be a localised inflammatory response which is common with insect bites given the history if you think think is the most likely cause. If you are feeling well otherwise in the absence of the following "red flag" symptoms then it appears satisfactory at present for self management of over the counter (otc) antihistamines/steroid cream (see at the bottom of thread) Bite area rash does not blanch when you press on it, rash covers round circumference of lower part or upper part of leg (circumfrencial), headache, neck stiffness and eyes sensitive to light (menigism symptoms) not passed urine despite fluids in last 12 hours, severe muscle pains /aches genralised to all of body (sepsis symptoms) have no ability to weight bear, total loss of sensation, anaphylaxis symtoms such palpitations/fast heart rate, extensive itch (urticaria itch) extensive rash (urticaria) swelling of lip tongue or throat, difficulty breathing, difficulty swallowing, loss f consciousness or severe pain. Pain can be difficult to describe and assess and is of multi factorial, assess, use of a visual analogue scale from 0-10, severe pain 7/10 and feel that it is the worst pain you have ever suffered. Warmth is expected over the site as part of increased vascularisation however a hot site can be an indication of developing infection. These aforementioned symptoms singular or multiple symptoms are red flag symptoms which would require timely review without any delay. If I were consulting your 'presenting complaint' from the limited information you have given with the only symptoms being presumed a mild discomfort and mild localised itch and nil other additional symptoms and medical conditions this would be the consultation and advice. Pt introduction pt consents to verbal and physical examination PC (presenting complaint) ? Insect bite HPC (History of presenting complaint) 1/7 ago ? insect bite to right lower leg (Patients own words) was out walking around local ponds/grass area, has since developed discomfort and swelling at ? bite site. Did not see what bit him. nil news meds or hygiene products or occupational exposure chemical/irritants history No anyphylaxis symptoms, nil urticaria, nil chest tightness, nil sob, nil angiodema can clear fluids nil aspiration nil fever nil nausea passing urine nil menigism nil loc passed urine last 12 hrs mild itch not hot over site no loss sensation Not been elevating mild discomfort pain 2/10 taking regular paracetamol 1g qds and managing discomfort nil antihistamines taken can fully weight bear otherwise nil concerns from patient PMH (previous medical history) Nil known medical /nil immunosupression Nil anaphylaxis nil atopy nil asthma nil, cardiac/respiratory thoracic/MsK/neuro/diabetes nil eczema nil medications rx/otc/illicit Allergies nil known imms up to date Tetanus status ? FH (Family history) no anaphylaxis/allergy/atopy nil other SH (social history) lives alone non smoker Employed as.... Examination pt walked in unaided nil antalgic gait alert Nil cyanosis nil lip swelling Oral hard and soft palate patient, nil lesions or swelling nil stridor/talking full sentences nil urticarial rash rr 18 bp 124/77mmhg pulse 77 regualr sa02 97% O/A Left lower leg 1 inch proximal of left lateral malleolus apparent insect bite site approx 1x1 cm superficial epidermal, nil open wound, nil peri bite site erythema, nil tracking, nil cellulitis, nil oedema, fully blanchable, sensation intact, CRT under 2 seconds. Nil hot site or bony tender of MSK to lateral malleolus/ base of tib&fib Full ROM, pedal dorsalis and posterior tibial foot pulses intact. Impression: Insect bite non cellulitic/non septic arthritic ICE of patient (Ideas , concerns, expectations of patient) Plan/patient advice: Advised impression of insect bite and nil immediate concerns/nil antibiotic strategy/low clinical suspicion of Lyme borreliosis Take regular paracetamol or ibuprofen for discomfort management otc as per box dose instruction Elevate whenever possible Apply cold ice pack in towel several times daily Take otc antihisatmine non sedating next 7 days, if not improving itch in 2/7 stop oral antihistamine and switch to topical otc steroid cream 1% to area twice daily for a maximum of 5 days. Non improving seek review. Advised inflammatory response from soft tissue envenimation inflammatory response can last up to 7 days. Any ongoing concerns seek review. Draw around area or take picture and if have onset of spreading erythema greater than 5cm or tracking line of eryhtema spreading out from site seek review. At present if non worsening but no improvement at 7 days seek review. Red flags below discussed and pt to seek urgent review without any delay. Bite area rash does not blanch when you press on it, rash covers round circumference of lower part or upper part of leg (circumfrencial)tracking ,headache, neck stiffness and eyes sensitive to light (menigism symptoms) not passed urine despite fluids in last 12 hours, severe muscle pains /aches genralised to all of body (sepsis symptoms) have no ability to weight bear, total loss of sensation, anaphylaxis symtoms such palpitations/fast heart rate, extensive itch (urticaria itch) extensive rash (urticaria) swelling of lip tongue or throat, difficulty breathing, difficulty swallowing, loss f consciousness or severe pain. Pain can be difficult to describe and assess and is of multi factorial, assess, use of a visual analogue scale from 0-10, severe pain 7/10 and feel that it is the worst pain you have ever suffered. Warmth is expected over the site as part of increased vascularisation however a hot site can be an indication of developing infection. These aforementioned symptoms singular or multiple symptoms are red flag symptoms which would require timely review without any delay. Seek review with onset of the following symptoms: Erythema migrans sign (patient shown picture) headache,fever and sweats, swollen glands, malaise, muscle aches,lethargy, joint pain and swelling,neck stiffness,difficulty concentrating symptoms at any time of onset from short weeks to months to in rare circumstances short years for exclusion/differential diagnosis Lyme Borreliosis From the limited information you have given in the absence of any of the red flags and no significant immunosuppression this would be the current advice. Any concerns overnights nhs111, nhs choices on Google, Out of hours gp. 👍 On the whole these things are in most circumstances self limiting and fully resolve with no concerns in a short period and usually nothing significant to worry about but as said if ongoing get reviewed. atb 7diaw Thank you for posting such a detailed response 👍 really appreciate that. I've just checked it this morning, the ring I drew is still visible and it hasn't grown at all and I feel fine otherwise. Thanks again 👍 Quote Link to comment Share on other sites More sharing options...
7daysinaweek Posted June 27, 2020 Report Share Posted June 27, 2020 14 minutes ago, Farmboy91 said: Thank you for posting such a detailed response 👍 really appreciate that. I've just checked it this morning, the ring I drew is still visible and it hasn't grown at all and I feel fine otherwise. Thanks again 👍 Great stuff! No concerns. atb 7diaw Quote Link to comment Share on other sites More sharing options...
ditchman Posted June 27, 2020 Report Share Posted June 27, 2020 On 26/06/2020 at 14:21, treetree said: So what you're saying is that we need a 'Medical Advice' sub-forum to allow us to share the wealth of medical knowledge this particular post has demonstrated is out there. Mods - please make this happen. terrible idea.............................some one will suggest using wd40 on yer farmer giles..............and old wives tales...............could get the admin into an awful lot of bover........ 8 hours ago, Farmboy91 said: Thank you for posting such a detailed response 👍 really appreciate that. I've just checked it this morning, the ring I drew is still visible and it hasn't grown at all and I feel fine otherwise. Thanks again 👍 im glad you can still see your ring. Quote Link to comment Share on other sites More sharing options...
Farmboy91 Posted June 27, 2020 Author Report Share Posted June 27, 2020 42 minutes ago, ditchman said: im glad you can still see your ring. That hasn't always been the case, Tell you what though, the warmth and concern of the PW collective is wonderful. 😂 Quote Link to comment Share on other sites More sharing options...
7daysinaweek Posted June 27, 2020 Report Share Posted June 27, 2020 35 minutes ago, ditchman said: terrible idea.............................some one will suggest using wd40 on yer farmer giles..............and old wives tales...............could get the admin into an awful lot of bover........ im glad you can still see your ring. But the question is Ditchy. "DOES IT WORK!?" 😣 Quote Link to comment Share on other sites More sharing options...
ditchman Posted June 27, 2020 Report Share Posted June 27, 2020 Just now, 7daysinaweek said: But the question is Ditchy. "DOES IT WORK!?" 😣 there was a post on here about 6 or 7 years ago about using wd40 on your piles.........not sure if it was a wind up...........im easily led........... im still trying to get HARNSER to show me the USAF ww2 bunker with all the goodies in it which he found.......cracking write up it was...well worth the read Quote Link to comment Share on other sites More sharing options...
7daysinaweek Posted June 27, 2020 Report Share Posted June 27, 2020 8 minutes ago, ditchman said: there was a post on here about 6 or 7 years ago about using wd40 on your piles.........not sure if it was a wind up...........im easily led........... im still trying to get HARNSER to show me the USAF ww2 bunker with all the goodies in it which he found.......cracking write up it was...well worth the read Zikes! That certainly is "Quackery of the very highest order" and best avoided at all costs. I would think that all the chewing gum the Americans used would have kept them regular to a greater extent, all that Sorbitol in the gum which has a laxative effect in high doses. Evidence based medicine is most certainly the best course of advice in relation to the appropriate "Sphincter tincture!" Quote Link to comment Share on other sites More sharing options...
Mice! Posted June 27, 2020 Report Share Posted June 27, 2020 24 minutes ago, 7daysinaweek said: would think that all the chewing gum the Americans used would have kept them regular to a greater extent, all that Sorbitol in the gum which has a laxative effect in high doses And I've always thought people constantly chewing gum were full of it, obviously not. 1 hour ago, ditchman said: im glad you can still see your ring. A wing mirror would work Ditchy 😉 I'm guessing you or Sarah don't have a selfie stick. Quote Link to comment Share on other sites More sharing options...
mel b3 Posted June 28, 2020 Report Share Posted June 28, 2020 11 hours ago, 7daysinaweek said: Zikes! That certainly is "Quackery of the very highest order" and best avoided at all costs. I would think that all the chewing gum the Americans used would have kept them regular to a greater extent, all that Sorbitol in the gum which has a laxative effect in high doses. Evidence based medicine is most certainly the best course of advice in relation to the appropriate "Sphincter tincture!" Ah yes , but as a medical professional , can you provide evidence to prove that wd40 doesn't work on your farmer giles ?. I know several mechanics , and I've never heard any of them complain of the affliction, so I'm saying it definitely works 😆. I'd wager my left testicle that someone on pw actually tried it . They're either reading this red faced with a sore ring because it didn't work , or they're reading this with a smug grin because it did 😅. Quote Link to comment Share on other sites More sharing options...
amateur Posted June 28, 2020 Report Share Posted June 28, 2020 52 minutes ago, mel b3 said: .......They're either reading this red faced with a sore ring because it didn't work , or they're reading this with a smug grin because it did 😅. Or, more likely, they are now undergoing treatment for anal cancer. Quote Link to comment Share on other sites More sharing options...
eddoakley Posted June 28, 2020 Report Share Posted June 28, 2020 On 26/06/2020 at 23:01, 7daysinaweek said: That could be a bite from many types of 'Beastie.' The redness is from the localised inflammatory response from the bite , draw a pen around it. If the redness (erythema) spreads more than 5cm seek review. It is not an apparent Erythema Migrans sign from a tick bite (see my post in a recent thread on ticks) however not all tick bite result in a Migrans sign. From the picture there is no evidence from what we would refer to as tracking, there is no cellulitis and this appears to be a localised inflammatory response which is common with insect bites given the history if you think think is the most likely cause. If you are feeling well otherwise in the absence of the following "red flag" symptoms then it appears satisfactory at present for self management of over the counter (otc) antihistamines/steroid cream (see at the bottom of thread) Bite area rash does not blanch when you press on it, rash covers round circumference of lower part or upper part of leg (circumfrencial), headache, neck stiffness and eyes sensitive to light (menigism symptoms) not passed urine despite fluids in last 12 hours, severe muscle pains /aches genralised to all of body (sepsis symptoms) have no ability to weight bear, total loss of sensation, anaphylaxis symtoms such palpitations/fast heart rate, extensive itch (urticaria itch) extensive rash (urticaria) swelling of lip tongue or throat, difficulty breathing, difficulty swallowing, loss f consciousness or severe pain. Pain can be difficult to describe and assess and is of multi factorial, assess, use of a visual analogue scale from 0-10, severe pain 7/10 and feel that it is the worst pain you have ever suffered. Warmth is expected over the site as part of increased vascularisation however a hot site can be an indication of developing infection. These aforementioned symptoms singular or multiple symptoms are red flag symptoms which would require timely review without any delay. If I were consulting your 'presenting complaint' from the limited information you have given with the only symptoms being presumed a mild discomfort and mild localised itch and nil other additional symptoms and medical conditions this would be the consultation and advice. Pt introduction pt consents to verbal and physical examination PC (presenting complaint) ? Insect bite HPC (History of presenting complaint) 1/7 ago ? insect bite to right lower leg (Patients own words) was out walking around local ponds/grass area, has since developed discomfort and swelling at ? bite site. Did not see what bit him. nil news meds or hygiene products or occupational exposure chemical/irritants history No anyphylaxis symptoms, nil urticaria, nil chest tightness, nil sob, nil angiodema can clear fluids nil aspiration nil fever nil nausea passing urine nil menigism nil loc passed urine last 12 hrs mild itch not hot over site no loss sensation Not been elevating mild discomfort pain 2/10 taking regular paracetamol 1g qds and managing discomfort nil antihistamines taken can fully weight bear otherwise nil concerns from patient PMH (previous medical history) Nil known medical /nil immunosupression Nil anaphylaxis nil atopy nil asthma nil, cardiac/respiratory thoracic/MsK/neuro/diabetes nil eczema nil medications rx/otc/illicit Allergies nil known imms up to date Tetanus status ? FH (Family history) no anaphylaxis/allergy/atopy nil other SH (social history) lives alone non smoker Employed as.... Examination pt walked in unaided nil antalgic gait alert Nil cyanosis nil lip swelling Oral hard and soft palate patient, nil lesions or swelling nil stridor/talking full sentences nil urticarial rash rr 18 bp 124/77mmhg pulse 77 regualr sa02 97% O/A Left lower leg 1 inch proximal of left lateral malleolus apparent insect bite site approx 1x1 cm superficial epidermal, nil open wound, nil peri bite site erythema, nil tracking, nil cellulitis, nil oedema, fully blanchable, sensation intact, CRT under 2 seconds. Nil hot site or bony tender of MSK to lateral malleolus/ base of tib&fib Full ROM, pedal dorsalis and posterior tibial foot pulses intact. Impression: Insect bite non cellulitic/non septic arthritic ICE of patient (Ideas , concerns, expectations of patient) Plan/patient advice: Advised impression of insect bite and nil immediate concerns/nil antibiotic strategy/low clinical suspicion of Lyme borreliosis Take regular paracetamol or ibuprofen for discomfort management otc as per box dose instruction Elevate whenever possible Apply cold ice pack in towel several times daily Take otc antihisatmine non sedating next 7 days, if not improving itch in 2/7 stop oral antihistamine and switch to topical otc steroid cream 1% to area twice daily for a maximum of 5 days. Non improving seek review. Advised inflammatory response from soft tissue envenimation inflammatory response can last up to 7 days. Any ongoing concerns seek review. Draw around area or take picture and if have onset of spreading erythema greater than 5cm or tracking line of eryhtema spreading out from site seek review. At present if non worsening but no improvement at 7 days seek review. Red flags below discussed and pt to seek urgent review without any delay. Bite area rash does not blanch when you press on it, rash covers round circumference of lower part or upper part of leg (circumfrencial)tracking ,headache, neck stiffness and eyes sensitive to light (menigism symptoms) not passed urine despite fluids in last 12 hours, severe muscle pains /aches genralised to all of body (sepsis symptoms) have no ability to weight bear, total loss of sensation, anaphylaxis symtoms such palpitations/fast heart rate, extensive itch (urticaria itch) extensive rash (urticaria) swelling of lip tongue or throat, difficulty breathing, difficulty swallowing, loss f consciousness or severe pain. Pain can be difficult to describe and assess and is of multi factorial, assess, use of a visual analogue scale from 0-10, severe pain 7/10 and feel that it is the worst pain you have ever suffered. Warmth is expected over the site as part of increased vascularisation however a hot site can be an indication of developing infection. These aforementioned symptoms singular or multiple symptoms are red flag symptoms which would require timely review without any delay. Seek review with onset of the following symptoms: Erythema migrans sign (patient shown picture) headache,fever and sweats, swollen glands, malaise, muscle aches,lethargy, joint pain and swelling,neck stiffness,difficulty concentrating symptoms at any time of onset from short weeks to months to in rare circumstances short years for exclusion/differential diagnosis Lyme Borreliosis From the limited information you have given in the absence of any of the red flags and no significant immunosuppression this would be the current advice. Any concerns overnights nhs111, nhs choices on Google, Out of hours gp. 👍 On the whole these things are in most circumstances self limiting and fully resolve with no concerns in a short period and usually nothing significant to worry about but as said if ongoing get reviewed. atb 7diaw All this half baked advice can't be good! 7diaw- I wish you would be more thorough. Edd Quote Link to comment Share on other sites More sharing options...
7daysinaweek Posted June 28, 2020 Report Share Posted June 28, 2020 4 hours ago, mel b3 said: Ah yes , but as a medical professional , can you provide evidence to prove that wd40 doesn't work on your farmer giles ?. I know several mechanics , and I've never heard any of them complain of the affliction, so I'm saying it definitely works 😆. I'd wager my left testicle that someone on pw actually tried it . They're either reading this red faced with a sore ring because it didn't work , or they're reading this with a smug grin because it did 😅. Mel "Quackery" comes in many forms and in some cases such as the WD40 are astonishing! Lots of these so called "good remedies" have been passed down through the ages and resurface every now and then. There are some aspects of high end quackery that is very lucrative in the ever burgeoning vanity market. I do understand to an extent how the relationships between "Quackery practitioners"and clients are formed and there are many unscrupulous quacks that are very convincing in their application of what they see as "good health". These practices carry risks both physical and psychological and can also drain the pocket of the individual which can at times result in the public purse picking up the tab in the form of medical, nursing and pharmacological management when non proven remedies go wrong and result in a poor outcome. Medicine in its many forms had some of it's roots in Quackery but has no place in modern evidence based medicine. This is one of the unsavory attributes of the the digital era and has hugely contributed to the spread of medical misinformation and governments must hold these powerful digital platforms to a increasing accountability if societal health is to be better optimised. The media are not immune to this also. I will adhere to prescribing Scheriproct among a few others for piles and certainly not WD. Quote Link to comment Share on other sites More sharing options...
Stonepark Posted June 28, 2020 Report Share Posted June 28, 2020 (edited) On 26/06/2020 at 10:14, treetree said: The best advice for horse fly bites I've used (may have even been from a thread here) is to put a spoon in boiling water for 30 seconds, then firmly press the back of the spoon onto the bite. Hold for as long as you can tolerate, then repeat a few more times. This does work, though would need to be done soon after being bitten, and stops the bite from progressing to the need to scratch symptom. Denatures (cooks) the histamine proteins. Loratidyne or cetrazine cream on it. If going into 'cleggy areas' I normally take 10mg loratidyne (non drowsey) in morning and if bitten another 10mg asap after the bite. Minimises the swelling effects. On 26/06/2020 at 15:36, harrycatcat1 said: That about sums it all up 👍 Not going off topic too much does anyone use one of those "ultrasonic" things that they advertise for keeping bugs, mosquitos etc away? They "claim" they will keep you free of them if you wear this watch type thing 🤔🤔 Look up Thermacell, ultrasonics are useless unless very powerful. Edited June 28, 2020 by Stonepark Quote Link to comment Share on other sites More sharing options...
ditchman Posted June 28, 2020 Report Share Posted June 28, 2020 33 minutes ago, 7daysinaweek said: Mel "Quackery" comes in many forms and in some cases such as the WD40 are astonishing! Lots of these so called "good remedies" have been passed down through the ages and resurface every now and then. There are some aspects of high end quackery that is very lucrative in the ever burgeoning vanity market. I do understand to an extent how the relationships between "Quackery practitioners"and clients are formed and there are many unscrupulous quacks that are very convincing in their application of what they see as "good health". These practices carry risks both physical and psychological and can also drain the pocket of the individual which can at times result in the public purse picking up the tab in the form of medical, nursing and pharmacological management when non proven remedies go wrong and result in a poor outcome. Medicine in its many forms had some of it's roots in Quackery but has no place in modern evidence based medicine. This is one of the unsavory attributes of the the digital era and has hugely contributed to the spread of medical misinformation and governments must hold these powerful digital platforms to a increasing accountability if societal health is to be better optimised. The media are not immune to this also. I will adhere to prescribing Scheriproct among a few others for piles and certainly not WD. Had anybody tried WD40.............does a study need to be done...........it certainainly stops squeaks...which could be useful in that area. Quote Link to comment Share on other sites More sharing options...
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