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coolhandluke
They're treating you with medications that the organism already has a resistance too, thats why they need to find out if the mecA gene or others are part of this particular bacterium's plasmid. It's only going to cost you more money on co-pays and meds if you delay the PCR test, one thing i'm sure they'll label you community acquired MRSA if they do determine it is a particular strand of S. aureus that has the particular genes for resistance. It's your penis, i'd recommend stern and direct body language, skip the family doc, and see an internal medicine physician or walk into your local emergency room and have them admit you. If they admit you, PCR will be standard especially if its a teaching hospital. If you start experiencing fever, chills, weakness or become hypotensive, you need to walk into your local ER. Topical application of Clindamycin, or Bactrim DS, Linezolid or Rifadin orally may treat your condition as well. Be stern and direct and demand these options. But after you're done with the antibiotic dose, immediately start a 30 day min. probiotic regiment. There are recommendations i can make for effective strains of probiotic organisms if you are interested. MRSA already has a known resistance to Vancomycin, but the admitting hospital with probably start on an IV with that. Silver nitrate...I'm only familiar with silver sulfadiazine for burns, I had a second degree oil burn some years ago and the silver sulfa cream provided tons of relief in the healing process. At this point, your last photo of your testicles looks like a chemical burn, keep it dry. If the purpose of the silver nitrate was to close the wound, it seems overly done, and blistering of your skin has occured, this melting of the skin appearance is a clinical sign of chemical burns. Keep it dry, an epson salt bath won't hurt but may facilitate in the healing. I'm sorry you are experiencing a level of distress, take the recommendations i've already made, and if any clinician wants to pour silver nitrate on your penis/testis say you have an allergic reaction to the compound. You actually might, the very least you are extremely sensitive to it upon topical exposure.
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Restoration
I'm not sure what could be biopsied at this point.  The  yellow escar from the silver nitrate?  That's about all there is to biopsy, but it's very fragile there now. The nodule is in a tissue block at the pathologists office, but do you think there's a chance of it having bacteria embedded in it? Swabs and cultures don't generally allow biofilm detection...that's one thing Lemperle said too.  It would need to be a biopsy with PCR, but I don't know where the biopsy would be taken from. Since I am asymptomatic for infection, they have been resistant to doing a biopsy.  MRSA presentation is usually pretty obvious, right?  Everyone I've asked says it's not really done, unless you have a massive infection and are in a wound care clinic.  I went to the wound care doctor (ass hole) who didn't address the bacteria issue and just burned my penis and balls...but he was supposed to do a biofilm biopsy. Instead...he had other ideas.

Part 1:  The first year - recovering 1/2" girth lost to Peyronie's Disease (Round 1 & 2 Metacrill PMMA)
Part 2:  Things starting to go bad (I had nodules removed and excisions wouldn't heal)  (After Round 3)
Part 3: Resolving Round 3 problems caused entirely by USA doctors.
Part 4: All PMMA (from all 3 rounds) hardened 6-12 months after round 3.

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coolhandluke
There is an innate problem when a patient sees too many clinicians, everybody is providing suggestions, and the primary objective becomes a dilute-less direct approach (let things play out per say), this approach often results in the clinician just billing your insurance company while your condition may get worse. I would swab the site of infection and take a small tissue sample, culture the swab and run the PCR on the tissue biopsy (something that can easily be done at any major teaching hospital). PCR is such an easy assay to run, have the necessary primers, and in a few hours your results should be made available. New qPCR assay technology may even allow for sooner results. In the meantime, bleach bath & eugenol, and next time you visit your primary Bactrim DS & topical clindamycin, then after the 30 days a probiotic to replenish your intestinal flora. Keep the site of infection dry, and always wear clean underwear.
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Restoration
Thanks CHL.  I will see my prior derm soon.

Quote:
 this approach often results in the clinician just billing your insurance company while your condition may get worse


lol yep.

Part 1:  The first year - recovering 1/2" girth lost to Peyronie's Disease (Round 1 & 2 Metacrill PMMA)
Part 2:  Things starting to go bad (I had nodules removed and excisions wouldn't heal)  (After Round 3)
Part 3: Resolving Round 3 problems caused entirely by USA doctors.
Part 4: All PMMA (from all 3 rounds) hardened 6-12 months after round 3.

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Restoration
I can order clove oil on amazon.  I guess the one thing I don't really understand is how I can have MRSA or an infection like that without any pain, redness, heat, discharge, etc... and why all the other excisions closed without any issue if that area (or the pmma) is colonized.  And, it hasn't changed in 2 months (no worsening, I mean).  Is that the clinical presentation of a biofilm infection?

I was expecting that wound care doctor to culture / biopsy it...now I've been set back two week since he decided to chemically burn it like a lunatic. 

Is this what you had in mind?
http://www.amazon.com/NOW-Foods-Clove-Oil-ounce/dp/B002N0H36O/ref=cm_cr_pr_product_top?ie=UTF8

I'll have to wait for another Dr. appt to ask about the others. I have clindamycin for acne topically, though it has benoyl peroxide in it.  What do you think?  It's called acanya (brand name)

Part 1:  The first year - recovering 1/2" girth lost to Peyronie's Disease (Round 1 & 2 Metacrill PMMA)
Part 2:  Things starting to go bad (I had nodules removed and excisions wouldn't heal)  (After Round 3)
Part 3: Resolving Round 3 problems caused entirely by USA doctors.
Part 4: All PMMA (from all 3 rounds) hardened 6-12 months after round 3.

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coolhandluke
I've heard great things about Now Foods, they offer an OTC version of clove oil, but Walgreens also has a dental product known as Red Cross Toothache (85% eugenol and sesame oil). I know it would be odd buying a dental product as such, but clinically and abroad eugenol is a strong agent against mrsa infection. It's odd you aren't experiencing any pain, inflammation, tenderness or a fever. Lets consider the eugenol and bleach baths a prophylactic measure. I recommended Bactrim DS, since it doesn't irritate the stomach too much. Clindamycin phosphate topical lotion 1% was the second medication i'd recommend, the benzoyl peroxide is known to cause chemical burns (DO NOT use it on your genitals), when you get the Clindamycin phosphate lotion use sterile q-tips when applying to wound site. If it isn't a biofilm, the epson salt baths may help in closing the wound. Unless we have a small biopsy, we couldn't be 100% certain you have a mrsa biofilm. Quite honestly, we see these biofilms with surgical patients due to the hospital acquired mecA gene being rampant. 

If i were you, the patient, I would take the recommendations previous made until your treating physician writes you a prescription for the correct clindamycin lotion and bactrim ds. We've already done half the physicians work, this is why i'm a firm believer of telemedicine. University of Arizona is conducting some great pilot telemedicine programs with chronically ill patients. Don't worry everything should be fine, but if you do develop a fever, please admit yourself to your local emergency dept.
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Restoration
CHL - thank you so much.  

Yeah I totally agree about telemedicine.

I'm going in tomorrow so a dem can look to see if he maybe wants to biopsy the area (7 minute visit - $60 copay), but then - of course the biopsy will be weeks away.   I'll print some of your comments out for him as I agree those antibiotics are going to be the right ones.  He also gave me clindamycin lotion for acne way back in 2012 (it's expired) - and then after that, acanya (the benzoyl peroxide + clindy one) which works really well.

Doxy has been hard on my stomach unless I take it w/ food - but then supposedly it's less effective or absorbtion goes down (though this is debated...and then they mostly point to calcium).

I saw that tooth stuff yesterday!- And I was like, hmm...is this what CHL was talking about? haha.

My urologist only does procedures in the hospital (even excisions)...and he wants to do an excision with mattress or buried closure of PDS or Chromic - taking out this area (leaving a bigger scar) and one other nodule.  But, there are 3 probs... 1.  Infection is going on and 2.  hospital environment is even more contaminated (though less so in an OR).  3. Bigger scar.

I think I'd rather wait - and medically, it should be healthy tissue before a third attempt to close it is made, wouldn't you agree?  It's frustrating because only his PA saw me to schedule the procedure, and I couldn't explain any of this...and he charges a huge cancellation fee.  I could go and just ask him to take out the lower nodule... or wait and see.  

The way it looks - basically metacrill all stuck to my inner shaft, and linnea safe all stuck to my outer fascia.  So, he has to dissect it off dartos.  Metacrill is all bound to bucks and smooth.

Also, I'm having some pain in one of the nodules that had a partial excision. Scar is looking good but it is very sore.  


Part 1:  The first year - recovering 1/2" girth lost to Peyronie's Disease (Round 1 & 2 Metacrill PMMA)
Part 2:  Things starting to go bad (I had nodules removed and excisions wouldn't heal)  (After Round 3)
Part 3: Resolving Round 3 problems caused entirely by USA doctors.
Part 4: All PMMA (from all 3 rounds) hardened 6-12 months after round 3.

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Restoration
Here's the update:

Derm -- looked at wound & as it has recovered from silver nitrate - I watched it like a hawk & applied bactroban, neosporin, celacyn, etc... and he said he really doesn't see signs of a biofilm. He read Prof Lemperle's email, but he thinks that it might have been hard for Lemperle to know for sure, given that it was only on email. He thought systemic antibiotics didn't pay - and topicals were working fine.  He said NOT to have anymore surgery or excisions for at least 2-3 months on that site.  His office and pathologist cannot do PCR.

Uro -- He's the one at the major teaching hospital.  He hasn't seen me since he's booked up solid, but he saw the same pics Lemperle did.  He thinks that excision will take care of the problem, and the biofilm won't return if it is there (though he hasn't seen post silver-nitrate pics since I hate to bog him down with emails & it takes him a while to get back).   He didn't comment on my PCR question...but I checked with my insurance and the whole thing would be around $300 since I am at my out-of-pocket max already (good lord!  It's definitely not all penis related, but about half was). To cancel would be $250 and would also piss him off...and he's one of the best male urologists around so I don't want to do that.  I'm thinking he could do some excisions of the other nodules and address this in person.  I wish I could see him before the procedure, but it's just impossible with his schedule.

My urine drips again after I finish...which was happening when I had that base nodule pushing on my urethra that got kenalog + 5fu and shrunk.  It almost seems like it increased in size over the past 3 months.   Maybe he can take that out during the procedure...or the ventral nodule that also pushes on my urethra...so in a way, it's still worth doing.  I just hope these freaking incisions CLOSE.  Most of them did, but we didn't use the hyfrecator which can melt PMMA (after the first one didn't close).  Uro wants to use it...said he'll be very selective about just a few blood vessels...not just burn the whole area out... but that's easier said than done.

(Edit - I saw a wound care specialist who made things worse & then had the urologist do the excision.  The details are  continued here)

Part 1:  The first year - recovering 1/2" girth lost to Peyronie's Disease (Round 1 & 2 Metacrill PMMA)
Part 2:  Things starting to go bad (I had nodules removed and excisions wouldn't heal)  (After Round 3)
Part 3: Resolving Round 3 problems caused entirely by USA doctors.
Part 4: All PMMA (from all 3 rounds) hardened 6-12 months after round 3.

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