Rx for Readers: Given the runaround

If someone with cellulitis used the same bathtub as someone who doesn’t have it, will the bacteria spread?

Stethoscope [Illustrative] (photo credit: Courtesy of alaasafei)
Stethoscope [Illustrative]
(photo credit: Courtesy of alaasafei)
I have several chronic illnesses. As I take medications daily, I am upset that I have to go back to my health fund’s main pharmacy every month to pick them up; some are not subsidized if I purchase them at a private pharmacy or my local health fund pharmacy.

If it were possible to get a three- or six-month supply, there would be less waiting time, lower transportation costs and less need for staff pharmacists at the central branch.

For example, I will be taking a thyroid drug for the rest of my life – and every month I have to wait on a long queue and, when I get my turn, wait while a pharmacist counts 30 tablets out by hand. The tablets come in bottles of 100 – perfect for a three-month supply.

There is even more red tape. My family doctor monitors my blood levels and ensures that I take the correct dosage, but because the drug is not in the basket of medical technologies, I also have to go to an endocrinologist every six months for a letter stating that I need the medication and a form with basically the same information. These two papers are then faxed to my health fund. Someone approves the medication and sends me a letter that it’s been approved. One would think that a single letter and form would be sufficient. It is such a waste of time.

– R.Z., Jerusalem
Health Ministry deputy director-general Dr. Yoel Lipschitz, who is in charge of health fund supervision, comments:
There are instructions to all the health funds to provide medications to people with chronic illnesses for at least three months at a time.
There are insurers who agree to six months at a time or even more. The problem with allowing long-term purchase of medications is abuse by people who go abroad for long periods and take the medications abroad at the health funds’ expense. The health funds do not cover medications taken abroad.
The policy is also motivated by the fact that it’s important for the family physician or specialist to see the patient periodically to check his health and the effects of the medications.
My mother is recovering from cellulitis in both legs. The bacteria entered her skin through dry, cracked heels and caused red, swollen lower limbs. She is being treated with antibiotics. I want to know whether someone who has athlete’s foot is at risk for cellulitis.

Also, if someone with cellulitis used the same bathtub as someone who doesn’t have it, will the bacteria spread? How can a person who has been infected prevent recurrence?
– E.N., Givat Shmuel.
Veteran Jerusalem dermatologist Dr. Julian Schamroth, replies:
Cellulitis of the foot, ankle or lower leg is an extremely common condition. It is a bacterial infection, often due to the bacteria Streptococcus, and presents as redness, tenderness and swelling. Without treatment, the condition usually resolves spontaneously after several weeks. However, for most patients the severe pain and resultant difficulty in walking requires medical therapy. The condition is not really contagious to others, but in people with weak immune systems, the infection can spread via the bloodstream to other organs. This is uncommon.
There are several predisposing factors that may make people susceptible to cellulitis. These include diabetes, previous leg trauma and varicose veins. Many patients who have undergone cardiac bypass surgery develop cellulitis at the vein donor site on the leg. Other patients who develop cellulitis often have a port of entry – a break in the skin whereby the bacteria enter its lower layer. The port of entry is often minor; it can be an insect bite, fungal infections of the toenails, fungal infections between the toes or dermatitis on the feet. In some patients the cause is unknown.
Cellulitis is treated by antibiotics: oral therapy if mild, intravenous therapy if severe. It is also essential to treat any predisposing conditions. Your dermatologist can readily tell if there are any disorders that require therapy and will prescribe appropriate therapy for cracked skin, fungal infections and so on.
Unfortunately, many patients develop recurrences of their cellulitis. To prevent this, longterm use of elastic stockings may help. Your physician might also prescribe long-term oral antibiotics, although it is not certain that such therapy will prevent recurrences. For diabetics, it is imperative to see a podiatrist regularly.
Once the acute phase of cellulitis is over, there is often residual pigmentation, redness and swelling that may take six months or longer to resolve. In some patients, the swelling and pigmentation persists. If you’ve had cellulitis, it is a good idea to visit your family physician or dermatologist once a year. It is also vital for cellulitis patients with dry skin on their feet and legs to moisturize it nightly with an emollient cream to prevent pathogens from entering the body through the cracks.
Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 91000, fax your question to Judy Siegel-Itzkovich at (02) 538- 9527, or e-mail it to [email protected], giving your initials, age and place of residence.