By Tedler D. Depaynos, MD
The lady patient is almost twenty years beyond her first senior year but still active taking care of her grandchildren and still could help in the simple farm work despite the joint and back pains she experienced from time to time. Actually she migrated to the lowlands where her son acquired a farm land when he made good processing the rare expensive metal they dug behind their houses in their mountainous crowded community. It was a fortunate opportunity because the government became suddenly strict in prohibiting them from their usual livelihood to protect the environment.
Before the patient migrated, she has always been complaining of on and off dry coughing which may last for weeks. Difficulty of breathing may be experienced and sometimes accompanied with wheezing respiration. During her attacks, her difficulty of climbing their steps was doubled which she attributed as part of her ageing. She consulted several MDs on several occasions because she never had permanent relief. She even got tired of taking several medicines. She was eventually diagnosed to have “allergic coughing” and had been prescribed different antihistamines, bronchodilators and “anti-asthma” medications by the different MD’s. Recurrence, however, had always been a rule. Actually, one of the MDs advised her to take the anti-allergy meds continuously for at least 3 weeks but then she wanted immediate relief. Eventually she was prescribed the steroid “prednisone” which gave her fast relief. Since then this was her medication.
It was surmised that she probably became sensitive to the “chemicals” used in processing the evasive metal which caused her allergy together with the “cold weather” which sometimes becomes severe when their mountainous environment became windy. She grew up in that environment and never had any problem. She admitted that she had once an attack of skin allergy with crabs but she never tasted it for more than a decade already. One of her MDs who prescribed the “prednisone” explained that she became sensitive because of her age. Actually, this was the main reason she migrated down to the warmer place leaving the community she grew up in together with her late husband.
It was just incidental that she came over to visit her other children and “apos” when the Covid quarantine was imposed. There were no chemicals she was exposed to but because of the coming rainy season characterized by rains every late afternoon with cold winds, she began coughing again. She was not allowed by her children to go out and they tried buying her medicines specially the “prednisone” she demanded but the local drug stores refused to sell it to them. A helpful salesgirl advised them to text their MD so he could send his prescription thru E-mail or just thru the “messenger” which they could show at the counter. This they did.
The contacted MD was surprised to receive the request for he had not seen the patient for quite some time. He even had a hard time remembering her if not for her children advising him that she is a distant relative. He understood the difficulty and risk of bringing the patient to the hospital because even he has not opened his clinic for the past months due to the quarantine. Being almost senior himself, he was afraid of the Covid infection which may probably be present in the hospital where his clinic is located
The patient completely recovered from her chronic cough when she was in the warm lowlands. It was only during this cold rainy season that she started coughing. It was initially with no phlegm but after more than a week of coughing she started spitting yellowish and sometimes greenish and dark phlegm. Wheezing however was never noticed. Sometimes she appeared to be having slight fever at night. The MD was worried that the patient may have the Covid 19 but the informant argued that she never left their house throughout.
It was a revelation that he could send his prescriptions thru E-mail or just thru the messenger which could be honored by a drug store. He avoided giving prescriptions to patients he have not seen or even talked to but this case seems to be an exception. Because of the darkened phlegm, the patient may already have a super imposed bacterial infection so that together with the steroid, he also prescribed antibiotics. It was barely a week after when the one who contacted him sent a message that their mother has improved a lot. The MD was with all smiles because treatment can now be thru cell phones.**
