General Medical issues thread

[cove]

One of my heart medications just dropped from $85 to $38 today. It is like a lotto win.

 

[JohnK]

Wife battling viral and bacterial infection. High fever a few days ago and better this morning but now high fever again.

Mum still in hospital. Hoping out today but now maybe tomorrow.

 

[whatmeworry]

Bit of a Measles outbreak in Melbourne. I think the original case stemmed from a JQ pax coming from DPS.

People who may have visited the same places as those infected also need to be alert:

• September 20: Melbourne International Airport, Jetstar flight JQ 36, arriving from Denpasar.
• September 20-22: Trains that passed through North Richmond, Southern Cross, Murrumbeena and South Yarra stations.
• September 22: The Australian Ballet's Alice's Adventures in Wonderland at the State Theatre.
• September 23: MCG – AFL preliminary final (Gate 5, Level 4); Greville Street, Prahran; Chapel Street, Windsor; Maribyrnong Boathouse, The Boulevard, Moonee Ponds.
• September 24: Melbourne International Airport, Qantas Club Lounge (8-10am); Qantas flight QF 29 to Hong Kong; Kmart Moonee Ponds; DFO Essendon.

Measles outbreak: Eight of 11 cases linked to Docklands workplace

 

[RooFlyer]

In a rural Tas town, with minor ailment, made an appointment to see local doc (there are 2) rather than hard-to-see GP in Hobart.

"Would you mind starting off with a medical student?" was the question.

No problem! but then:

Medical student A I thought was very inexperienced. Lots of questions, faffed around a bit, balked at hands on (face) ... that's OK, gotta learn and I wasn't in any serious discomfort or concern.

Medical Student B appears. Obviously a bit more experienced; a bit more assertive. Medical Student A recounted my situation .. except inaccurately, so I went through it all with B. Again, not concerned too much ... they gotta learn.

B told me what he thought the problem was ... now I respect Doctors opinions, and I don't see a doctor to have my own diagnosis confirmed, but what he said I thought as very unlikely (he was putting too much weight on what Student A had said, innacurately). Meanwhile Doc student A was at the computer live Googling (or Drs equivalent) ... and announced that what she was reading didn't seem to accord with what Doc B was saying. They both looked at the screen.

At that point I got a bit concerned, wondering when the 'real' doctor would appear.

The answer was, almost immediately. We went through it all; she assertive and explained what she thought and why she thought it to the students (and, for what its worth, I thought what she said was reasonable ).

Good result from my point of view - I went away with a prescription if the condition got worse (it hasn't) and students got a bit of experience. If only some-one could tell them not to use Google (or Drs equivalent) in front of the patient .

 

[whatmeworry]

I have seen a few junior docs consult google.

 

[drron]

Yes it really is a problem.I often get a comment along the lines of-I am glad you talk to me rather than a computer.
However If you see me in an outpatients clinic there will be med students.They actually like the fact I don't just repeat a didactic recitation of the diseases but give them practical advice on history taking and disease treatment.
So already here there are 3 med students on medical term-1 for each unit.But today I have 3 of them with me on my rounds.One of the reasons I still love doing the job I do.
And the first thing I tell them-talk to the patient,not the computer.

 

[JohnK]

Mum is out of hospital and feeling better.

Wife feels better but still battling flu/cold. Last antibiotic was 3 days ago. How long should we wait to test ESR again and if "old" infection still around whether viral or bacterial?

 

[rogerkambah]

WMW Just wondering how your dad is getting on with his drugs - side effects? and whether they are providing sufficient pain relief for him.

 

[love_the_life]

Feeling a bit bleh. Had coffee with a friend who said she was a little breathless at gym the other week. Followed up as thought she may have had a heart problem. Turns out it is idiopathic pulmonary fibrosis. Waiting to see respiratory specialist to get the full picture. Out of left field.

 

[whatmeworry]

WMW Just wondering how your dad is getting on with his drugs - side effects? and whether they are providing sufficient pain relief for him.

For the cancer they first started him off with Bicalutamide. The pain got worse and he became immobile so we had to call the ambulance about a 5 weeks ago, to get him admitted to hospital.

So once in Hospital they started him off with Goserelin Acetate (implant) along with Bicalutamide, another drug to help shrink the cancers by stopping the production of testosterone to hopefully get his PSA levels down.

He was meant to get some radiation treatment on his hips to target some bone metastases about 4 weeks ago but he started coughing up dry blood. So of course this was a delay and made all the docs nervous because of his recent "small" heart attack (He had in June) they were hesitant sticking a tube down his mouth. So went in after the second time of couching up dry blood, they went in and found no ulcers and started him on nexium. Of course they needed consent to put a tube in. He also received blood transfusions.

He was moved from Oncology to a Geriatric rehab ward.

They were going to discharge him about two weeks ago and do the scans and radiation as an outpatient. But about two weekends ago he had a fall going to the toilet and bumped his head and subsequently was found to have fractured his pelvis. So again this delayed his radiation treatment.

I also mentioned to his social worker and his team I thought they were negligent for not constantly providing him a urine bottle, as he has an enlarged prostate which causes him urinary difficulty, which means he would have been holding his manhood with one hand and the other hand using a cane, which I believe caused him to lose balance.

They gave him some analgesics for the extra pain of a fractured pelvis, which caused him to hallucinate. He receives Endone at night and paracetamol during the day, he also has been told to ask for pain relief when he requires. But of course he is a bit holistic or stubborn and hates taking tablets.

He had a scan last week and finally received radiation today. They want to kick him out next Friday.

Meanwhile my Mum suffered a case of Gastritis two weeks ago and was in hospital for about 6 days. They had her stop using mobic and Ramipril.

She saw a Surgeon this week for her severe OA in her knee and will have an MRI next week to also rule out any problems in her hips and back.

Back to my Dad, the ultimate goal is to get him onto LuPSMA 177 Radionuclide therapy if his cancers becomes resistant to hormonal therapies (or preemptive strike) either via the trial at Peter Mac or privately.

The private option would be about 10k per cycle and currently I think is only available in Perth and Brisbane with Sydney coming soon.

This therapy currently is about 70-80% effective with some peoples cancers going into complete remission for at least 6 months after two cycles with some requiring follow up cycles down the track.

On heavy medication to cope with bone pain, he spent most of the day asleep. With his PSA, the blood marker for prostate cancer, having rocketed to 967 he felt weak and without hope.

Then an offer came along to join the first Australian trial of an experimental treatment for men with advanced prostate cancer who had exhausted all their options. It was for a disruptive technology in the field of nuclear medicine.

Findlay, 78, happened to be a perfect candidate. In October and November he had two cycles of the treatment and, as the second scan shows, his cancer temporarily vanished and his PSA dropped to seven, almost within the normal range for his age.

He was back with the living. His wife Robyn, a former oncology nurse at Melbourne's Peter MacCallum Cancer Centre, said she'd never seen anything work like this before.


"Within a week he was up and cleaning the garage, without painkillers."

According to the trial protocol. Findlay was supposed to have another two cycles before six months was up, but he didn't seem to need them. So treatment was halted while his doctors kept watch.

So our dilemma is if we can't get into the trial, do we travel interstate and pay 10k a cycle with no guarantees of it working, or wait till the treatment becomes the gold standard and is available publicly with less caveats?

More places available for 'game-changing' nuclear treatment for prostate cancer

Radioisotope therapy

 

[Pushka]

Feeling a bit bleh. Had coffee with a friend who said she was a little breathless at gym the other week. Followed up as thought she may have had a heart problem. Turns out it is idiopathic pulmonary fibrosis. Waiting to see respiratory specialist to get the full picture. Out of left field.

Not good. I guess the positive is that she didn’t dismiss the symptom and will get prompt treatment.

 

[love_the_life]

For the cancer they first started him off with Bicalutamide. The pain got worse and he became immobile so we had to call the ambulance about a 5 weeks ago, to get him admitted to hospital.

So once in Hospital they started him off with Goserelin Acetate (implant) along with Bicalutamide, another drug to help shrink the cancers by stopping the production of testosterone to hopefully get his PSA levels down.

He was meant to get some radiation treatment on his hips to target some bone metastases about 4 weeks ago but he started coughing up dry blood. So of course this was a delay and made all the docs nervous because of his recent "small" heart attack (He had in June) they were hesitant sticking a tube down his mouth. So went in after the second time of couching up dry blood, they went in and found no ulcers and started him on nexium. Of they needed consent to put a tube in. He also received blood transfusions.

He was moved from Oncology to a Geriatric rehab ward.

They were going to discharge him about two weeks ago and do the scans and radiation as an outpatient. But about two weekends ago he had a fall going to the toilet and bumped his head and subsequently was found to have fractured his pelvis. So again this delayed his radiation treatment.

I also mentioned to his social worker and his team I thought they were negligent for not constantly providing him a urine bottle, as he has an enlarged prostate which causes him urinary difficulty, which means he would have been holding his manhood with one hand and the other hand using a cane, which I believe caused him to lose balance.

They gave him some analgesics for the extra pain of a fractured pelvis, which caused him to hallucinated. He receives Endone at night and paracetamol during the day, he also has been told to ask for pain relief when he requires. But of course he is a bit holistic or stubborn and hates taking tablets.

He had a scan last week and finally received radiation today. They want to kick him out next Friday.

Meanwhile my Mum suffered a case of Gastritis two weeks ago and was in hospital for about 6 days. They had her stop using mobic and Ramipril.

She saw a Surgeon this week for her severe OA in her knee and will have an MRI next week to also rule out any problems in her hips and back.

Back to my Dad, the ultimate goal is to get him onto LuPSMA 177 Radionuclide therapy if his cancers becomes resistant to hormonal therapies (or preemptive strike) either via the trial at Peter Mac or privately.

The private option would be about 10k per cycle and currently I think is only available in Perth and Brisbane with Sydney coming soon.

This therapy currently is about 70-80% effective with some peoples cancers going into complete remission for at least 6 months after two cycles with some requiring follow up cycles down the track.




So our dilemma is if we can't get into the trial, do we travel interstate and pay 10k a cycle with no guarantees of it working, or wait till the treatment becomes the gold standard and is available publicly with less caveats?

More places available for 'game-changing' nuclear treatment for prostate cancer

Radioisotope therapy

Certainly concerning for you WMW, especially as your mum was ill as well. It's a really hard thing to know what to do. Hopefully you won't have to make the choice and he is accepted into the trial.

 

[love_the_life]

Not good. I guess the positive is that she didn’t dismiss the symptom and will get prompt treatment.

She's had a bit of a bad trot lately as one of her sons announced a month or so back that he was separating from his wife which was a shock. After the scan results on her lungs came back she did a bit of DrGoogling and was quite shaken but luckily then found the Lung Foundation site and there was quite a lot of good information for her there. She is waiting to see the specialist to find out exactly the extent of the fibrosis and what if any treatment is suggested. Although it's a worry she is hopeful that it can be kept in check for a period of time.

 

[JohnK]

Wife feels better but still battling flu/cold. Last antibiotic was 3 days ago. How long should we wait to test ESR again and if "old" infection still around whether viral or bacterial?

Any clues as to how long before we can test ESR again?

I'm back at the liver clinic next week and need to see GP as well. Don't want to leave it too long.

 

[Quickstatus]

Any clues as to how long before we can test ESR again?

I'm back at the liver clinic next week and need to see GP as well. Don't want to leave it too long.

You can test ESR anytime you want but what do you want to measure and how the ESR is going to guide management.
Sort of like blood pressure- is there any clinical utility measuring blood pressure every hour or just once when visiting dr for a checkup

ESR is a very nonspecific indicator of inflammation. The only proven disease where repeated ESR is of any utility is the management of temporal arteritis.

 

[JohnK]

You can test ESR anytime you want but what do you want to measure and how the ESR is going to guide management.

It's like a catch 22. I'm trying to assist in getting my wife better and free of bacterial/viral infections.

In Sydney in August ESR = 400 and viral infection confirmed in urine.

In Thailand last week ESR = 100 and bacterial infection confirmed via same blood test.

She was on antibiotics for 5 days and that stopped 6 days ago. When should we test ESR and signs of any infection again? The tests are not cheap in Thailand either.

 

[Quickstatus]

I suggest don’t do them. There is little utility.
I have not ordered an ESR for several years. I only order them for managing temporal arteritis.

 

[QF WP]

A friend of ours died the night before last and it appears to have been from the flue.

Sad news indeed. Better news was that it wasn't you

 

[JohnK]

I suggest don’t do them. There is little utility.
I have not ordered an ESR for several years. I only order them for managing temporal arteritis.

How do we know my wife's infection is now clear? It has been over a month and body has not been able to shake infection(s).

 

[Quickstatus]

It's like a catch 22. I'm trying to assist in getting my wife better and free of bacterial/viral infections.

In Sydney in August ESR = 400 and viral infection confirmed in urine.

In Thailand last week ESR = 100 and bacterial infection confirmed via same blood test.

She was on antibiotics for 5 days and that stopped 6 days ago. When should we test ESR and signs of any infection again? The tests are not cheap in Thailand either.

I’d rather do CRP as an inflammatory marker as it more closely follows the inflammatory process. An ESR takes a bit of time to rise to an inflammation and can persist even after the inflammation has subsided. Whereas the CRP follows the inflammation more closely.
So When inflammation starts CRP quickly rises but ESR lags behind. Then after inflammation subsides CRP falls but ESR persists. Both tests are inexpensive when part of a blood test work up.