Monday, August 22, 2011

For All My Readers:

This blog is for you, a potential patient, a patient advocate, or possibly you are related to a patient.  I would love for you to leave your comments at the bottom of any of the posts, or tell me what to change so that this site is more friendly, or welcoming for you.  Tell me what you want to read about or are curious about.

Thanks for reading!

Sunday, August 21, 2011

The Future of Medicine is Now!

Advances in medical care are coming at us at a furious rate.  Just within this past month we’re heard about an exciting treatment program for chronic lymphocytic leukemia by using genetically engineered T cells to attack the cancerous leukemia cells.  Not only did it treat the disease in the 3 individuals who received it, but it possibly might have even cured them! 
            The world of oncology has never been able to speak of ‘cure’ when it comes to cancer therapy, and now they are on the cusp of potentially being able to say that!
            Additionally every few months now we are hearing of another monoclonal antibody that has been approved by the FDA to treat another chronic disease.  Just this month it was an antibody against Hodgkin’s lymphoma.   Currently there are 16 (and growing) approved monoclonal antibodies which are being used against various chronic diseases, which includes many rheumatology disorders, inflammatory bowel diseases, psoriasis, asthma as well as macular degeneration. 
            The world of medicine has changed from being a place where treatment was broad ranged (systemic antibiotics being used for a local sinus infection, systemic steroids being used for local inflammation due to a brown recluse spider bite, etc) to a world of cell directed therapy (monoclonal antibodies which react only with the inflammatory cell they have an antibody against, gene therapy for pediatric patients with SCID, etc). 
            With the change in the approach to treating medical conditions so has the side effects of being treated changed.  Patients will no longer have the chance of acquiring diabetes from receiving too many doses of steroids, or end up with a yeast infection from their antibiotics.  Instead they will have problems with cell mediated treatment such as flu like symptoms and/or fever. 
            With such advances being made in medicine, patients can now have increasing hope that the conditions they have, the chronic diseases they have to deal with on a daily basis may indeed become a thing of the past.  Based on all of the new advances, just in the past few years, who’s to know what will become available to us providers in the ever so near future?  Now is an exciting time to be a medical provider!

Wednesday, August 17, 2011

A Single Mom with a Genetic Disorder

 I hadn’t been working in the GI practice for long when I went into see a new patient.  Her name was Sandy, a divorcee who was 31 years old, and had two young kids in elementary school.   She was being seen for an auto-immune disease, called Crohn’s.
“Hi, I’m Sharon, I’m a physician assistant.  You’re new to our practice and I see from your medical records that you have a diagnosis of Crohn’s.  How long have you had it?”
                Sandy with her long blond curly hair replied, “I was diagnosed with it as a teen-ager, I think I was about 14.”
                “Okay, so what medications are you on now for it?”
                “I’m on Asacol and Prilosec.  They seem to be working for me right now.”
“Mmm, glad to hear that. When was the last time you had a scope procedure done to check for evidence of your disease?”
                “More than three years ago.  I think the last one was when I was in Nebraska and married.”
                “Okay, well seeing that you’re now 15 years plus into your disease we will need to get your scheduled for an upper and a lower scope of your GI tract.  I would assume you’re familiar with the routine, nothing but fluids the day before, and you swallow a half gallon of go-lytely to clean out your bowels.”
                “Yeah, I know the routine.”

Crohn’s disease is a T cell mediated disease which can affect any portion of the gastrointestinal tract from the mouth all the way through to the anus.  In the upper portions of the gastrointestinal tract (GI) patients can have aphthous ulcers, then in the intestinal tract they can have ‘skip lesions.’
                Skip lesions are areas of involvement followed by areas of the GI tract that are normal.  As opposed to patients who have ulcerative colitis, Crohn’s patients have involvement throughout all 3 layers of their GI tract, in otherwords it is transmural.  It is for this reason that Crohn’s patients can end up having fistula formations, or strictures which necessitates surgery. 
                Patients typically present with symptoms of abdominal pain, increase stools, fevers, weight loss, sometimes even nausea/vomiting. 
                A typical work-up for a patient suspected of Crohn’s disease is to inquire as to whether they have any family members with Crohn’s disease or ulcerative colitis, seeing that both of these diseases typically follow a family lineage.  Patients also get a upper GI with small bowel follow-through, an endoscopy and a colonoscopy.  They have blood drawn to assess for anemia, and liver function tests to look for any hepatic involvmenet.  Patients are then diagnosed based on their pathology findings from their scope procedure and radiographic findings.

                The GI attending in clinic confirmed my assessment and plan, so Sandy was scheduled for an upper and lower scope procedure.  They showed she had some evidence of disease in her esophagus as well as her transverse colon and terminal ileum.  I explained this to Sandy when she returned to the clinic for her appointment.  Dr. Silver decided to put her on prednisone and begin Imuran.  Over the next year she did relatively well on her imuran dosing with prilosec which dealt with her acid reflux. 
With Sandy’s next clinic appointment, I walked in to find an unhappy patient.  “What’s going on?”
I’m in pain, my meds are not working like they should.   I’ve started having abdominal pain again, especially over this part (putting her hand over her right lower quadrant).“  As she touched her abdomen, she winched. 
                “I see.   Let me first do the physical exam and then I’ll have the GI attending in the clinic this morning come in and see you, after which he’s probably going to want to change your meds until we can get your scoped again“
                With that I finished taking my medical history and then did a focused physical exam.  Her abdomen was somewhat tender right over the terminal ileum, a common area for Crohn’s involvement.
                “I’ll be back in with Dr. Silver shortly, Sandy” I spoke as I exited the exam room.
                I went to go find Dr. Silver and presented Sandy to him.  After I was finished, we both walked back into the exam room to see Sandy together. 
                “Hi, Sandy, Dr. Silver stated.  Sharon has presented your case to me.  She told me that you’re having some abdominal pain.  So it sounds like your Crohn’s is acting up again.  With that in mind, let’s switch your medications over to include some prednisone that you take once a day, in addition to what you’re currently taking.  But I don’t want you to start taking the prednisone until after your colonoscopy is done.  So I want to get your procedure done as soon as possible.   I’ll send in the scheduling nurse after I leave.  I want to see you back right after your procedure is done. “
                After answering her brief questions, and giving her a prescription for the steroids to start after her procedure, we sent in the scheduling nurse for her colonoscopy, who got her scheduled for it in two days.   She was also given a lab slip to get her blood drawn.    
                I didn’t see Sandy again until 4 weeks later in clinic.  I looked over the her colonoscopy results as well as her pathology report before I went in to go see her.
                “Hi, Sandy, how are you doing?”
                “Much better.  The prednisone has helped.  My pain is gone. “
                “Well your colonoscopy showed that you have quite a bit of involvement with your Crohn’s.  Your large colon showed involvement basically all throughout it.  And the area that you were complaining of over your right lower quadrant which correlates to your terminal ileum showed that you have quite a bit of inflammation.  So I’m glad that you are on prednisone and that it is working for you. “
                “So am I.”
                After I answered her questions, and did her focused physical exam, I excused myself by saying,
“Well, let me go find Dr. Silver and have him come in and see you.”
                I found Dr. Silver and presented her case and showed him the results of her endoscopy and colonoscopy.  I told him that the 20 mgs of prednisone was working, and she had stayed on her Imuran, Prilosec and Asacol. 
                “Good.  Now based on Sandy’s scope results and knowing how much meds she is on, we need to switch her over to Remicade.  I think she’ll do much better on that IV medication and her disease will respond and she should stay in remission.”
                “Okay, I’ll get her set up in the infusion center for her Remicade.”

                Crohn’s disease is a relapsing/remitting disease.  Patients will times where the disease is quiescent and other times where it is active. 
                Medications that are used for this disease include: mesalamine (either Asacol or Pentasa), steroids (prednisone), imuran, budesonide, methotrexate, and the newer ones out: monoclonal antibodies, Remicade and Humira. 
                Patients are treated with medications based on the severity of their disease, some patients have mild to moderate involvement, others have severe involvement.  Patients are also treated based on their response to medications.  If they don’t respond to one medication, then they can be given a combination of medications or be stepped up to long term immunosuppression with using Imuran, or by giving them the monoclonal antibodies, Remicade or Humira. 
                Patients can also have numerous manifestations of their disease outside of the GI tract.  These include problems with their liver, joints, eye or skin.
                All patients are endoscoped on a regular basis.  This is due to the fact that patients with Crohn’s disease are at a higher risk of colon cancer than the general population. 

                After we went in to go see Sandy together, I gave her the orders for her Remicade as well as her lab request to get her blood counts, liver function testing done.  We advised her to return to clinic and see us again in 4 weeks, which would then be after her first two infusions of Remicade.  I advised her that she could stop her Imuran and mesalamine after her first Remicade infusion.  After her second infusion, I advised her she could taper her prednisone, so that by the time she came back to see us she would have just been on the IV med. 
                Sandy ended up making an appointment to be seen in my hepatology clinic instead of the main GI clinic.  So she ended up just seeing me.  But she was doing well, had tapered off of her prednisone and was just on the Remicade.
                During her third infusion of Remicade, which was at 8 weeks into her new therapy, I was called urgently to the infusion center.   I hurried down there and walked into the center to find Sandy sitting in one of the chairs. 
                Her nurse immediately told me, “Sandy is itching, and her skin has turned red and her ankles are swelling up.  What do you want me to do?”
                “Did you give her the pre-meds of Benadryl and Tylenol prior to her infusion?”
                “Yes, she got them.”
                “Okay, well this is probably serum sickness to the mouse antibody in the Remicade.  So we have to stop the infusion.  Give Sandy another 25 mgs of Benadryl. “
                Turning to Sandy I asked her whether she still had any of her prednisone with her.
                “Yes, I have a few pills left in my purse, why?”
                “I need you to take one of the 20 mgs tablets now.  Then I need you to take one of them tomorrow and then again two days from now.  After that I need you to taper down so that you’re off of them in 10 days.  Do you have enough to do that with?”
                “I think so.”
                “Alright, well we will have to switch you over to Humira instead, which I will have to show you how to do your own injections in the clinic.  So I’ll have to get a pre-authorization done for you to receive this medication, it will take a few weeks.  So hang tight.”
                Over the next couple of weeks I proceeded to get her the medication authorization needed for her to receive the Humira injections at home.  During this time she started having problems again.  She called up and told me that she had doubled up on her Prilosec due to increasing problems with acid reflux and not being able to get her food down.  With this information I scheduled her for the GI clinic where Dr. Silver would be seeing patients. 
                Sandy came into the clinic within two weeks to be seen. 
                “Okay Sandy, tell me exactly what’s going on with your swallowing problems.”
                “I started noticing that I was having problems with my acid reflux again when I was on the prednisone.  I know steroids increase my acid reflux, so I somewhat expected that, but then once I was off, my symptoms didn’t resolve.   In fact they actually started getting worse.  So I doubled up on my Prilosec.  That helped a little bit.  But I was still having problems getting food to stay down, it always felt like it was stuck right here in the middle of my chest.”
                “Alright.  So what are you able to eat now and get down?”
                “Mostly just liquids, some pieces of bread/cereal if I drink a lot of liquid with it.”
                “Well, Sandy it looks as though you’re going to have to get another upper endoscopy done so we can figure out what’s going on.  I’ll finish doing my focused physical exam on you and then I’ll go get Dr. Silver.”
                After doing what I needed to do, I left the exam room to present her to Dr. Silver.  He came back into the exam room and advised Sandy that he wanted to set her up with an esophageal mannometry  (a test where a patient has their muscular tension vs. relaxation of a group of specific muscles assessed).   He told her that he suspected that she was having problems with increased pressure at the gastroesophageal (GE) junction, which was not allowing food to pass through to the stomach.  Sandy came back to clinic after that test was done and saw Dr. Silver again.
                Her test result showed that she had evidence of a ‘nutcracker esophagus.’  This means that she had increased pressure readings at the GE junction and hence her esophagus was not relaxing enough to allow food to pass through to her stomach.  Dr. Silver explained this to her and had her scheduled for a repeat endoscopy.  Only this time they would be injecting botox into her GE junction sphincter which would paralyze the muscles and allow relaxation for food passage.

                There are side effects to the medications patients are put on for their Crohn’s.  In addition there can be complications to their disease manifestations.  These include the complication of having ‘nutcracker esophagus’ which is related to this patient having long-standing acid reflux. 
                One of the side effects of a patient being on Remicade is fever, chills, and serum sickness, which is related to their receiving a mouse related antibody.  So when patients have serum sickness they are  switched over to Humira, which is the same monoclonal antibody only it is derived from human antibody and thereforeit  circumvents the problem with the foreign mouse antibody.  

                During her work-up for her problems with swallowing and eventually getting her botox injections, she ended up scheduling herself back to my hepatology clinic where I saw her again.  She had  received her first several doses of Humira from the pharmaceutical company’s patient assistance program and needed to be shown how to inject herself.  So I went through how to use the self-injector and advised her that she would have to do one every other week at home.  I set her up for a blood draw and for her to be seen back in clinic in 2 months.  Thankfully the botox ended up working and she was able to swallow once more.
                Over the next several months Sandy did very well on her Humira.  She enjoyed the freedom of being able to do the injections at home which did not interfere with her taking care of her two kids and working.  She came into the clinic to be seen every 3 months and to also get her blood work done. 

Thursday, August 11, 2011

School Aged Vaccine Requirements Have Gone Overboard!

I have always had a problem with the amount of vaccines that are required of kids to attend school.  Now don’t get me wrong, I’m a firm believer in vaccines.  But I believe we need to focus our attention on what vaccines we are giving to our children as well as when we are giving them. 

First off, I don’t believe that State Board of Education committees should be REQUIRING school aged children to be receiving ALL of the vaccines the CDC only RECOMMENDS.  I don’t believe that the various deciding committees associated with the State Board of Educations truly understand what diseases are truly communicable within the school buildings and what ones are not. 

When was the last time you or I heard of a hepatitis A or B outbreak in a school (K-12) ?  Can you name one?  I can’t.  I can’t even name one prior to either of these vaccines becoming available.  When was the last time you heard of a meningitis case in an adolescent aged 11-17 that could have been prevented by the meningitis vaccine required of children age 11-12?  I bet you can’t name one of these episodes either, seeing that the CDC doesn’t have the data to show that this vaccine has made any difference so far in this age group. 

Yes, I agree once the child reaches the age of 18 and leaves for college that the incidence of meningitis goes up, especially if they live in the residence halls.  So, yes I believe they should be vaccinated then.  But not at age 11-12 for a almost non-existant chance of acquiring meningitis, and if they do acquire it, the vaccine does not cover the bacterial serotype they have come down with. 

And yet, the CDC does recommend children under the age of 5 receive a pneumococcal vaccine to prevent meningitis.  This has shown itself to be effective in preventing infections.  So why don’t the various State Board of Educations require this vaccine prior to children starting school? 

I believe that the School Boards have overstepped their boundaries.  Yes, I do believe there should be a certain amount of vaccines required for children to be in school.  Those that are communicable within the school boundaries, such as varicella, Tdap, MMR, and polio.  But those diseases which are not directly communicable between kids such as hepatitis A/B, HPV, and the almost non-existent meningitis in adolescents 11-17 should be left up to the parent and the pediatrician to decide on what is best for the child. 

Yes, I do believe kids should be receiving the hepatitis A vaccine from their pediatrician if they are in an area where hepatitis A is prevalent.  This typically means in South Texas, where there are a lot of Hispanics emigrants who bring the disease with them from Mexico.  Or in the case of hepatitis B, kids should receive this vaccine if they live in a household with a chronic hepatitis B carrier, an Asian household (due to the high prevalence of hepatitis B in this community) or if they decide to enter a healthcare career when they are going off to college. 

I’m tired of seeing kids come into my acute clinic with tears in their eyes, afraid of being seen by me because they believe I’m going to give them yet another vaccine.  We need to learn to balance what is best for each of our individual children with what is best for our community. 

Wednesday, August 3, 2011

Kids and Their Fascination with Foreign Objects!

I was working in a rural clinic and went into see my next patient.  She was the 7 year old daughter of my medical assistant.  He had been called by his daughter’s school nurse during her lunch time due to her having suddenly started to wheeze.  He had just arrived back with her and needed me to see her urgently.
            Little Melissa was noticeably wheezing and was in acute discomfort sitting on the exam table.  I turned to my medical assistant and asked him her medical history which was not significant.  He then said, “they told me at school that she was playing around with a quarter, showing off to a friend when all of the sudden the quarter disappeared and she started having problems with her breathing.”
            “Okay, Melissa did you swallow the quarter?”
            Painfully she turned her head from side to side giving me a negative response.
            “Where does it hurt, Melissa?”
            She pointed to just below her neck area at the top of her chest. 
            “Hmm, okay, well Melissa, let me take a look at you.”  I quickly examed her throat, nose and felt her cervical lymph nodes (in the neck).  Nothing was out of the ordinary.  I then listened to her chest with my stethoscope.  She was wheezing everywhere with inspiratory stridor (a sign of a foreign object blocking the airways) heard over the upper midline. Her cardiac sounds were fast, with a pulse of 120.
            With the idea in mind that she could have potentially swallowed the quarter and it was stuck in her trachea (airway) or her esophagus (swallowing tube) I sent her across the street to the county hospital to get a plain film of her chest done.  I expected to see her back rather quickly, knowing it would only take about 30-45 minutes or so to get it done.
            When an hour and a half had gone by, as I had continued to see patients, and she hadn’t showed back up I was really beginning to wonder.  I called the county hospital radiology desk to find out that she had been seen, her x-ray had been taken and she had been sent back over to the clinic more 30 minutes ago.    
            I walked into the front reception desk area of the clinic to find the receptionist gone.  She was Melissa’s mom.  So now, the clinic didn’t have any staff but me, her father, the clinic’s medical assistant had taken her over for the x-ray, and now her mom was gone. 
            “Great, my patient has gone who knows where, and I have no staff to help me see patients.”
            Just then, one of the medical assistants from next door, which housed the family practice clinic of my two supervising physicians walked in the back door of the rural health clinic.
            “Dr. Spencer sent me over to help you out with the patients needing to be seen.”
            “Okay, thanks for the help.  But where is Melissa and her parents?”
            “They’re next door, Dr. Spencer is trying to figure out how to get the quarter out of her esophagus.  It’s sideways, about right here as she pointed to the upper midline of her chest.”
            “I see. Well can you check this next patient in, get their vital signs and I’m going to go next door and see what’s going on, seeing that she was my patient.”
            I quickly walked next door, went in the back entrance and walked towards the commotion.  Dr. Spencer was leaning over a squirming Melissa on the procedure exam table.   Her parents were unsuccessfully trying to hold her down, in an attempt to keep her motionless. 
            “Melissa,” Dr. Spencer sternly spoke, “stay still.  I’m going to try to have you swallow the end of this tube and if you can do that I might be able to wiggle the quarter back up.”
            I could hear her wheezing and trouble getting her breath.  Melissa was also crying and more than likely scared. 
            “Dr. Spencer could we try to have her swallow a small amount of olive oil?  That will make the quarter slippery and then you’ll probably be able to joggle it lose and back up if it’s oily, in other words slippery.”
            “Good idea, someone go get a small amount of olive oil out of the kitchen for her to swallow.”
            I knew by now that the patient who was checking in over at the rural clinic was most likely ready to be seen, so I left Melissa in Dr. Spencer’s hands.  I walked back to my clinic and continued seeing patients the rest of the afternoon.  About an hour later my medical assistant walked in.  His wife, the clinic’s receptionist had put Melissa in the car and was driving home. 
            “Okay, fill me in on what happened with Melissa?”
            “Well, after Melissa swallowed the oil, Dr. Spencer had her swallow the foley catheter tip and with the oil helping to get it to slide down, he then nudged it past the wedged quarter, inflated the balloon on it and started gently tugging on the catheter.  I think the oil made it a little bit slippy because it came lose quickly and with the balloon tip pushing it upwards, Dr. Spencer was finally able to get it back into her mouth, where she spit it out.  Melissa was still pretty upset, but her wheezing quit almost immediately and my wife thought it was best to take her home for the rest of the day.”
            “Okay, well thanks for telling me what happened.  Now it’s back to work for the two of us.”

            Kids will swallow or poke up their noses, or into their ears the strangest things.  I remember during my student days at a well known medical college I was doing a rotation in pediatrics when a 6 year old came into see us.  I went in to take the history and her mom told me that her daughter had a very pungent odor to her, which she couldn’t get rid of. 
            I examined the patient and noticed that she was having some sinus congestion.  The odor seemed to be coming from her mouth or nose, that was for sure.  But I couldn’t figure out exactly where or why. I went into the pediatric attending, presented the patient to her and she went into the exam room and asked this little patient, “okay, Annie, what did you do this time, did you stick something up your nose?” 
            I remember Annie looking rather coy and finally admitting she had stuck an eraser up her nose so that she could know what it felt like. 
            “How long ago did you do that, Annie?”
            “A week ago.”
            “Okay, well then the attending stated, you have a chore to do every day for the next two weeks.  You’re going to have to blow your nose several times a day and blow hard.  You’re going to have to blow out that rubber eraser you sniffed up your nose.  Understood?”
            Annie nodded ‘yes.’

            Another small tyke of 3 years came into the emergency room while I was doing my rotation there and his mom said that he had swallowed his pet baby turtle.  We asked how big the turtle was and the mom said it was about 2 inches in diameter.  The 3 year was acting fine, we did an x-ray of his abdomen and there was the turtle in his stomach.  This 3 year was sent to surgery to have the turtle removed due to the concern that the turtle could perforate the child’s stomach with his paws. 

            When you work in pediatrics you have to be prepared for many things.  You have to be inventive in retrieving foreign objects out of a child’s nose, ear canal, airway and esophagus (swallowing tube). 
            Thankfully, Dr. Spencer had the ingenuity to try using a small foley catheter with a balloon tip and it worked.  Otherwise she would have ended up being emergently sent to Houston, a hour’s drive away for a pediatric gastroenterologist (kid’s GI physician) to see her and scope her to remove the quarter. 
            Kids really will do the darn-est things!


Monday, August 1, 2011

Sore Throat, skin rash, yet another strep infection

I saw a lot of patients in the urgent care clinic setting.  Generally they were the acutely ill with an upper respiratory infection or an urinary tract infection.  Today was no exception. 
            I knocked on the exam door and walked in.  “Hi, I’m Sharon, I’m a physician assistant, how can I help you?”
            The patient was 15 years old, a typical looking teen-age male, whom I’ll call Drew. 
            “I’m having a bad sore throat, it hurts to swallow, my nose is dripping, I have this bad headache and I don’t want to eat.  I’m also all sweaty.”
            “Okay, Drew, how about any cough?”
            “Some, not bad.”
            “When did you symptoms start?”
            “About two days ago.”
            “Strep is going around the community, have you been around any small kids who have had it?”
            “No, not that I know of.”
            I went ahead and took his medical history, family history and then did his physical exam. 
            “Your throat and tonsils are just plain nasty red, Drew and you have the typical white exudates on your enlarged tonsils.  Are your glands here in the neck tender to touch?”
            “Yeah, especially on the left side.”
            “How long have you had this rash?”
            Drew looked at his skin and it dawned on him that his skin was redder than normal.  “I don’t know, I didn’t notice my skin until just now.”
            “Well Drew this fine red rash you have which blanches, as well as the linear red lines on the inside of your elbows is a sign of strep.  It’s called a scarlet fever rash.”
            Drew had the scarlet fever rash over both arms, chest, neck and face.  His temperature in the clinic was also 101.5. 
            “Okay, Drew you have strep throat with the typical skin rash which goes along with it.  I’m going to start you on an antibiotic called amoxil, which you will have to take for 10 days, three times a day, okay?”
            “You’re going to be infectious towards others for the next 24 hours, so no kissing of your girlfriend or coughing on anyone, understood?”
            “Okay, well here’s your antibiotic prescription, you can go home after you pick up the amoxil and make sure to drink plenty of fluids so you stay hydrated and you can take some Tylenol or motrin for your fevers.”
            Drew got up and left the clinic exam room with his script in hand. 

            Years ago when patients used to get strep infections they could end up with scarlet fever (which is strep throat with the skin rash), or just strep throat.  Even as late as the 1950s patients who came down with either of these forms of strep would need to recuperate at home for as long as six weeks.  They didn’t have the antibiotic armamentarium we have now to treat infectious agents.  Patients who had strep as a child (as late as the early 1950s) and were not treated for it with the appropriate antibiotics could then end up with post-streptococcal complications which included inflammatory arthritis (joint swelling/pain), cardiac (heart) valve scarring which over time would lead to the patient needing to have the heart valve replaced via open heart surgery.
            Nowadays patients are treated up front with a penicillin based antibiotic and they no longer suffer the long term sequalae of strep infections.  Thankfully we have antibiotics for strep, because even today this is a favorite of the young kids to spread among themselves and their older siblings.
            The fact that we don’t have the long term consequences of strep that we used to have just goes to show how much medicine has progressed and preventing illness’ that used to be common place just a mere 60 years ago. 
            So if you have a sore throat, and it feels as though you are ‘swallowing razor blades’ or you have been around someone with strep and all the sudden come down with a bad sore throat yourself, check in with your physician.  You may have acquired this common bacteria and need antibiotics yourself.