- "In thirty years as a specialist in infectious
disease, I have seen only one other case of this. It's
very uncommon. A primary care physician might never come
across it."
--Ian Smith, M.D.
An English woman finds relief from a physician in Iowa
through an internet search.
For the past six years, Margaret couldn't figure out why
an unusual sore was spreading across the side of her face.
Neither could anyone else.
It wasn't until earlier this year when she came across
Ian Smith, M.D., emeritus professor of internal medicine at
University of Iowa Hospitals and Clinics, that she was
properly diagnosed and received an appropriate treatment
plan.
Margaret's story (she prefers to keep her last name
confidential) might not sound that unusual except for the
fact that she and Smith have never met face-to-face; not to
mention that the eastern half of the United States and the
Atlantic Ocean separate them.
Her difficulties began seven years ago when an abnormal
spot developed on her chin. Over time, the spot became an
open wound traveling along the side of her face toward her
ear. As the spot moved, it healed the area it had left,
forming a scar.
As her condition developed and subsequently worsened,
Margaret visited a series of physicians in England,
including her general practitioner, a dermatologist, and a
plastic surgeon. She took several different medications, but
none of them gave her any improvement. Eventually, her
doctors performed a biopsy, which also came back negative.
"It was very depressing," said Margaret. "Nobody seemed
to know what it was."
Just when it looked as though there was very little hope,
Margaret's son, Steve, looked to the Internet for help. In
his search, he came across Smith, whose series of articles,
"Aging Begins at 30," regularly appear on Virtual
Hospital®, University of Iowa Health Care's digital
library. His articles receive about 150,000 hits per month.
With nothing to lose, Margaret wrote Smith a brief letter
describing her situation and asking for any possible
answers. Her letter, addressed to "Dr. Ian M. Smith,
University of Iowa Hospitals and Clinics, USA," managed to
find its way into Smith's hands.
Smith quickly recognized what he believed to be the cause
of Margaret's abscess: an uncommon organism known as
bacteroides, a bacterium usually found in the intestine that
assists in the breakdown of food products. In rare cases,
the bacterium may find its way out of the intestine and form
an abscess on the skin, like the one Margaret had on her
cheek. The bacterium is unusual in that it is hard to grow
because oxygen destroys it, and it also requires special
antibiotics for treatment.
Smith had a feeling this rarity might be why Margaret was
unable to find answers in her previous attempts. "In thirty
years as a specialist in infectious disease, I have seen
only one other case of this," said Smith. "It's very
uncommon. A primary care physician might never come across
it."
Smith noted how he had diagnosed and treated his previous
patient with the help of the microbiology lab and shared
this information in a letter back to Margaret to give to her
physician. She again visited her general practitioner who
elected to place her directly on the medication.
Shortly after starting the medication, Margaret began to
see some improvement. "It was brilliant," she said. "It
stopped spreading, and then slowly started healing."
Since the initial correspondence, Margaret and Smith have
been communicating through e-mail. "It was good of him to
take an interest," Margaret said. "You don't find many
people like that."
Margaret's son, Steve, has also been pleased with the
help Smith has offered. "We were surprised and very grateful
that Dr. Smith took the time and effort to help, and his
recommended treatment has made a great improvement on her
condition," he wrote in an e-mail.
Smith had a feeling his advice might help Margaret and
didn't hesitate to answer her. "It seemed as if she could do
with a reply," he said.
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