General Medical issues thread

[Pushka]

Yes thank you. I got about 15 hours sleep last night (not uninterrupted!) which was exactly what I needed.

I think we underestimate the importance of sleep.

 

[JohnK]

One thing that's bothering me JohnK is that your supposed recovery due to antibiotics might just be because your own immune system has finally got on top of the virus in question.

I'd be surprised if my own immune system would be able to fight bacterial/viral infections that quickly. My immune system does fight in some way and general colds don't last very long at all.

Since starting influenza vaccine shots in 1999, I have have had the flu maybe 4 times in that time. Previously used to get the flu at least 3 times/year. I don't take any medication for flus. Tonsilitis/laryngitis/pharyngitis infections are a different story. The infections are mostly very severe and can be extremely uncomfortable. If I miss the initial symptoms for a few days this can spell trouble.

This is now the second serious infection this year. The February/March infection was very severe. I went through 4 courses of antibiotics and that may well have been a viral infection but 6+ weeks is a long time to be suffering. I had 3-4 severe panic/anxiety attacks that I believe were directly related to the infection. Felt like I was going to die.

I'll worry about overuse of antibiotics later.

 

[love_the_life]

Totally agree with that. JohnK and I are both on immunosuppressant treatment. This is my first Winter on it and have had the worst colds ever. Previously I would get one every 18 months or so. And no need for antibiotics. I've now had 2 hackers in 3 months plus two UTI's. But lupus/APS more under control. Hmmm. Fix up one thing and create another.

Wore my mittens here in Warnemunde Germany as fingers were going bloodless again. At least this time my nails weren't painted red - that makes them look really vampirish!

Ouch I can feel for you.
Been cold to give you the white fingers or something else you think?

Yes thank you. I got about 15 hours sleep last night (not uninterrupted!) which was exactly what I needed.

That's good to hear. Sleep is a wonderful thing.

 

[Pushka]

Ouch I can feel for you.
Been cold to give you the white fingers or something else you think?


That's good to hear. Sleep is a wonderful thing.

Cold and wet. Then a breeze - it's all good now. And going to be 29 in Amsterdam in a couple of days! Hot.

 

[Quickstatus]

Confirmation bias = if it resolves while on antibiotics it must be the antibiotics.
I would still get swab especially when it does not seem to work.

 

[Pushka]

Confirmation bias = if it resolves while on antibiotics it must be the antibiotics.
I would still get swab especially when it does not seem to work.

Maybe. But if an individual's experience has been it deteriorated previously when not on antibiotics then this adds a bit of context.

 

[suze2000]

I would still get swab especially when it does not seem to work.

The problem is that you must take the swab before you start the antibiotics.

JohnK I forgot you are immunosuppressed and I do remember your panic attacks, which must be greatly distressing. I'm not a wowser when it comes to antibiotics by any means (a UTI has me heading straight to the doctor for antibiotics), I am more concerned at the possibility of mis-diagnosis, which will delay your recovery.

 

[Quickstatus]

Assumption that immunosuppression = must be bacterial = must take antibiotics is misdiagnosis 101.
Could still be viral - infact it still most probably is
Or is bacterial could be the wrong type of antibiotic. Maybe it's a bacteria resistant to the antibiotic. How would you know?

Where to from here?. Continue antibiotic? - another course?. On what basis?
Change antibiotic ? To what?. And on what basis?.
UTI completely different kettle of fish - almost always bacterial.

Lets start with the assumption that it's bacterial. Maybe that assumption is incorrect.
That it has "worked" in the past does not make the assumption correct.

 

[Milboo]

I think we underestimate the importance of sleep.

For sure. I had a bit of a sleep deficit from the week too.

After being awake for about 40 minutes around 10am (but reading iPad in bed) I decided to nap further - and woke after 2.30! I was expecting maybe an hour at most...not 3.5 hours!

 

[donovan301]

For sure. I had a bit of a sleep deficit from the week too.

After being awake for about 40 minutes around 10am (but reading iPad in bed) I decided to nap further - and woke after 2.30! I was expecting maybe an hour at most...not 3.5 hours!

Interesting, was talking to better half today.

She was saying she gets the sleepiness when reading from a device, but if she decides to go to bed she can't nod off?

But if she stays on device, she wakes up later on with device in hand.

Do you experience similar, or did you successfully put device down and then sleep well?

 

[Milboo]

I put it down and snuggled down into bed - it was a brisker morning here. Kitty came back to bed and curled in and off to sleep we went.

 

[Quickstatus]

Unfortunately for many of us we wake up when the alarm goes off and not when we finish sleeping

 

[Pushka]

Assumption that immunosuppression = must be bacterial = must take antibiotics is misdiagnosis 101.
Could still be viral - infact it still most probably is
Or is bacterial could be the wrong type of antibiotic. Maybe it's a bacteria resistant to the antibiotic. How would you know?

Where to from here?. Continue antibiotic? - another course?. On what basis?
Change antibiotic ? To what?. And on what basis?.
UTI completely different kettle of fish - almost always bacterial.

Lets start with the assumption that it's bacterial. Maybe that assumption is incorrect.
That it has "worked" in the past does not make the assumption correct.

Except that isn't our assumption at all.

Immunosuppressant medication renders people vulnerable to both bacterial and viral infections. What does happen though is that viral infections can quickly become more significant and lead to secondary bacterial infections as the immune system becomes overwhelmed.

 

[Quickstatus]

Except that isn't our assumption at all.

Immunosuppressant medication renders people vulnerable to both bacterial and viral infections. What does happen though is that viral infections can quickly become more significant and lead to secondary bacterial infections as the immune system becomes overwhelmed.

Here is the rub: starting on a course of antibiotics when there is no bacterial infection does not prevent a secondary bacterial infection. All you are doing is adding to the risk that bacterial will over time develop resistance to that antibiotic especially when using a broad spectrum antibiotic - such as the erythromycins.

The secondary bacterial infection story more or less has most evidence in the influenza-pneumonia story. The significant mortality during influenza pandemics was often caused by a bacteria called streptococcus. This is usually best treated by the veteran penicillin WHEN the pneumonia is confirmed. Outside of influenza-pneumonia not a lot. Pharyngitis secondary bacterial infections?. I don't think I've seeen it.

Here is another aspect: we often have people in intensive care units. These patients often are immunocompromised to a greater extent than those in the community. But we don't usually start antibiotics to prevent secondary bacterial infections.

Why is flu vaccine recommended for the immunocompromised and not combined with penicillin?.

The use of broad spectrum antibiotics in an empirical manner is causing rampant bacterial resistance. And this problem most affects the immunocompromised.

 

[JohnK]

Lets start with the assumption that it's bacterial. Maybe that assumption is incorrect.
That it has "worked" in the past does not make the assumption correct.

I totally respect your advice and expertise. There are some things to consider here and history is the most important factor for me to consider.

I get a lot of infections and inflammation. The first major infection from memory was 1987 around the time of me first taking immunosuppresants in 1986. I spent around 10 days in Lidcombe hospital getting daily antibiotic injections. Not long after, perhaps 1987, I had severe pneumonia. Not sure whether that was viral or bacterial but GP gave me prescription for 5 injections which he administered daily. By the way went to medical centre on Saturday night and they were not able to diagnose the pneumonia and by Sunday morning I was in real trouble. It was this episode that put me right off medical centres.

During the early 90's I started having stomach infections and one of these was quite severe helicobacter pylori in 1994 that required 2 courses of triple therapy and all up I was in a bad way for around 6-8 weeks. I also started having more and more cases of influenza to the point where I was knocked about at least 3 times a year which is when I decided to have the influenza vaccine.

Throat infections were not occurring that often in the 90's but once influenza was under control late 90's early 00's the throat infections started occurring. I cannot tell you if these were viral or bacterial but can say with great certainty in the majority of cases the infection had responded quite well on the 2nd-3rd day of taking antibiotics. I guess in my mind and the GP at the time was these were bacterial. There was one time where 3-4 courses of penicillin including Augmentin forte did not assist and GP prescribed flucoxacilin which at a guess means that was staphylococcal bacteria?

A side effect of taking antibiotics was then fungal mouth/throat infections which are worse than bacterial infections. I used to scrape the tongue until it was bleeding and I was in extreme pain. These are not fun at all and for a time I used to take fungilin lozenges with each antibiotic tablet and that kept it under control.

Towards mid to late 00's the GP at the time who I had been seeing for 20 odd years advised that I self prescribe antibiotics if I had throat infections. Call it the JohnK luck or whatever but a lot of my infections present on a Friday and are very severe by the time I see a GP on Monday morning.

The theory is prevention is just as good a cure? I don't know. Current GP does not quite agree. He is of the opinion that the throat infections could well be viral and we also need to vary the antibiotic used which is why he went for Roxythromycin last time.

Personally I will continue to self prescribe antibiotics when I feel I need them. As I get 2-3 infections a year, I don't think I am overusing antibiotics. I don't want to be suffering trying to decide if the infection is viral or bacterial before making a decision. I will try and go to GP tomorrow and out of curiosity ask him to do a swab to see what is causing this particular infection.

Apologies for lengthy post.

 

[Quickstatus]

Only you and your medicos know your history.
We here only talk in general terms. I totally respect where you are coming from.

One way is to get a swab and then start your usual antibiotics.
Its actually very easy to do: get your GP to give you the swabs - tubes with jelly in them and an included special long stem cotton bud. They can he stored at room temp. When you get sick just swab and get it to the pathology office with a pathology request request form precompleted by your GP

Have you ever had a swab or test which actually demonstrated a bacterial infection?. It's worth doing

Probably the swab will not show much because antibiotic already started

Prevention is better than cure. But here you are using a cure to prevent having to use a cure.
Using an antibiotic to prevent a bacterial infection will not stop a bacterial infection from occurring.

 

[JohnK]

Have you ever had a swab or test which actually demonstrated a bacterial infection?. It's worth doing

Probably the swab will not show much because antibiotic already started

Prevention is better than cure. But here you are using a cure to prevent having to use a cure.
Using an antibiotic to prevent a bacterial infection will not stop a bacterial infection from occurring.

Fungal infections confirmed via swab many times.

Sure an antibiotic will not stop the bacterial infection from occurring but it can assist by not allowing the infection to get worse? Called doctor today and he is away for another week or two. The replacement doctor is extremely busy so now have to wait until tomorrow or Wednesday for check up. If I didn't start course of Amoxyl I would be extremely uncomfortable for far too long.

And to make things worse daughter is not well at all. Fever at night the past 3 nights but ok during the day. Teething maybe but her body is very hot. Today crying non stop and not eating/drinking. Will be taking her to GP shortly. Managed to beg for emergency appointnent today.

 

[Flying mermaid]

Unfortunately for many of us we wake up when the alarm goes off and not when we finish sleeping

What's an alarm?

 

[Quickstatus]

Fungal infections confirmed via swab many times.

Sure an antibiotic will not stop the bacterial infection from occurring but it can assist by not allowing the infection to get worse? Called doctor today and he is away for another week or two. The replacement doctor is extremely busy so now have to wait until tomorrow or Wednesday for check up. If I didn't start course of Amoxyl I would be extremely uncomfortable for far too long.

And to make things worse daughter is not well at all. Fever at night the past 3 nights but ok during the day. Teething maybe but her body is very hot. Today crying non stop and not eating/drinking. Will be taking her to GP shortly. Managed to beg for emergency appointnent today.

I hear you JohnK!. In theory doctor stuff sounds like the logical way to go but in practice you gotta get to one first.
Maybe negotiate with Doc to get some throat swabs so you can do yourself.
In the past many rheumatic fever used to be one of the complications of a streptococcus pyogenes pharyngitis. Once penicillin came around the dates of RF dropped.
So yes treating a sore throat caused by streptococcus with penicillin can reduce RF and other complications of this bacterial infection. But only if the infection is caused by strep.

Dont forget a sore throat may not just be a sore throat.
(Speaking generally) the differential diagnosis is wide. I've seen a sore throat as a presenting symptom for myocardial infarction and cancer.

 

[JohnK]

Dont forget a sore throat may not just be a sore throat.
(Speaking generally) the differential diagnosis is wide. I've seen a sore throat as a presenting symptom for myocardial infarction and cancer.

Understood. Hope my throat infection is not that serious.

Think I need to consider having tonsils removed.