The Good Doctor and The Ugly Spot

Not all I have to say about American medicine is bad.

I used to have a doctor, a GP, I really liked. One of those rare gems, good bedside manner, sharp as a tack, a no bullshit guy. He's the one who referred me to the neurologist who finally solved the riddle of my left arm (diagnosed as tendonitis back in high school, but unresponsive to therapies for that; it turned out to be Thoracic Outlet Syndrome). He's the one I went to when I first exhibited signs of REM Behavior Disturbance, and to this day I think I've met only one other doctor who's even familiar with that (the aforementioned neurologist—she's a sharp cookie, too, pity she only does grown-ups).

The sleep study for the REM Behavior Disturbance led to my being diagnosed with sleep apnea. And while a CPAP is far from a sexy device, I wouldn't go back to feeling like hell every morning and nodding off all day for anything. And without the Good Doctor's persuasion I wouldn't have tried it.

So then about nine or ten years ago, the company I was working for switched insurance to an HMO run by cave trolls (Blue Cross & Blue Shield of Kansas City). It was actually very good insurance from a premium and copay standpoint, but my doctor wasn't on it.

That, and BCBSKC was fond of refusing to pay any and all claims regarding Mo. An ear infection, a stomach bug, an ER visit for a burn, they'd send EOBs out explaining that it wasn't covered because autism related services were contractually excluded. And we'd have to call them and tell them, no she wasn't being seen for autism, she was being seen for a huge gash in her foot or whatever.

There were other incidents with BCBSKC. Such as when they decided to approve therapy for Mo, and then after she'd been going for a couple months decided to retroactively change their minds and attempt to collect from us. Because even though they'd already paid, the pre-authorization explicitly states in the small print that it is not a guarantee of payment.

Then there was the second level appeal joke. I'm ranting, sorry. I really hate Blue Cross & Blue Shield of Kansas City. It's better than no insurance, but you should have to commit a crime or maybe be an executive at GMAC Mortgage to deserve that kind of treatment.

But that's not what I came here to talk about, as Arlo Guthrie would say. The Good Doctor is on the insurance I have with my present job, and I had occasion to make an appointment and go see him. This is not something I'd normally be happy about, but it was such a relief not to have to subject myself to The Clown Doctor.

The appellation 'Clown Doctor' was coined by the artist formerly known as Frau Lobster. In the darkest days of our dissolving marriage, in our bitterest conflict, we were at least united on this: the primary care guy Blue Advantage HMO stuck us with is a quack. I don't know what tropical island he mail-ordered his diploma from, but when I feared I had ass cancer (turned out to be hemorrhoids) it really was a debate as to whether to have my butt checked out or take my chances with fate.

Today's ailment was really no big deal. It was my Ugly Spot.

The Ugly Spot is a red area at the belt line, front and center. It's come and gone over the years, mainly come. All the over the counter ointments, hydrocortisone, etc., didn't do much to it. And occasionally it would get wildly inflamed and spread. It was diagnosed by doctor after doctor as a fungal infection, basically jock itch. And it responded to anti-fungal creams and prescription steroids.

The Clown Doctor told me to keep treating it with anti-fungal for six months to really lick the fungus for good. Which didn't work. In fairness to the quack, every other doctor I've had in my adult life has seen the Ugly Spot at some point. It's been there for at least twenty years in some form or another.

I was out of the prescription steroid cream I had managed to get form the Clown Doctor by promising to use the Lotrimin AF for six months. The combination worked, but I think it was mainly the steroid cream.

I tried following the Clown's advice, but figured maybe the fungus was resistant to this anti-fungal. So I tried another. Then another. Every active ingredient I could find on the jock itch/athlete's foot front. Terbinafine, Clotrimazole, Tolnaftate, I've used them all. For at least as long as their packages recommend, yet the Ugly Spot persists.

This is probably the first time I've shown the Ugly Spot to a doctor in it's least inflamed state. It's there, but only a little bigger than a quarter.

The Good Doctor took one look and said, 'Piece of cake. That's a nickel allergy.' He explained that the fungal infections are opportunistic, and they just hit because the skin is already irritated by the metal.

For twenty years I've been using steroid creams and anti-fungals to treat this. I mean there's scar tissue for crying out loud. And all I needed was a non-metallic belt buckle???