Coris USA, a travel insurer, sent me to see an Argentinean lady with diarrhea at the Beverly Hills Hotel. Diarrhea is usually an easy visit.
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 had recently taken antibiotics, so I wondered this was
Clostridium difficile colitis, an occasional consequence of the avalanche of
antibiotics consumed by humans everywhere.
Every antibiotic you swallow kills trillions of germs,
mostly harmless, 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 does, 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 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 will
have to pay up front and try for reimbursement later.
Tests were positive, and she began improving after a
few days of treatment: an antibiotic but one different from the one that caused
the problem.
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