Coris USA, a travel insurer, sent me to see a 35 year-old Argentinean lady with diarrhea at a Beverly Hills Hotel.
Arriving, I learned that her illness was entering its sixth day: too long to be the ordinary stomach virus. She felt weak and feverish, and she mentioned that she had recently taken antibiotics. I wondered this was Clostridium difficile colitis, a rare consequence of the avalanche of unnecessary antibiotics consumed by humans everywhere including readers of this column.
Every antibiotic you swallow kills trillions of harmless germs living in your bowel. They are immediately replaced by other germs that can grow in the presence of that antibiotic. Most bowels don’t harbor C. difficile, but if yours is an exception, antibiotics may convert a small population into a large one, and it produces an irritating toxin that causes a severe, occasionally fatal diarrhea.
Diagnosing Clostridium requires more than suspicion, and there were other possibilities. She needed a thorough evaluation.
Fortunately, Coris USA is a good travel insurer: meaning that it (a) pays promptly and (b) takes my advice. These sound unrelated, but I’ve found that good travel insurers do both, bad ones do neither.
I phoned Coris’s Miami office with the news and the name of the doctor I recommended. The dispatcher contacted the main office in Buenos Aires for authorization; it appeared within the hour, and the patient went off. If I were dealing with a bad insurer, authorization would be denied or remain pending indefinitely. I often send patients off, warning that they would have to pay up front and try for reimbursement later.
Tests turned up Clostridium difficile, and she began improving after a few days of treatment.
About Mike Oppenheim
Doctor Oppenheim has been a hotel doctor in Los Angeles for thirty years. He has made about 15,000 visits. Authors contact:
Mike Oppenheim
Email: michaeloppen@yahoo.com
