General Medical issues thread

[JohnK]

Thanks. Need to check if they did the CRP as well.

Wife is back in village. Not easy to get to doctor/hospital and would need someone to come along to look after daughter.

I'll see how she's feeling in a few days. Think headaches and dizziness gone now with the last lot of antibiotics. Hope she's finally infection free.

 

[bosox76]

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 .

Reminds me of my time as a med student in Scottsdale, Tassie. Spent six weeks there and learnt heaps. Always amazes me how much a rural GP is able to do relative to their city cousins. Thank you Rooflyer for being so patient with the students. It's an invaluable time of learning.

 

[Cynicor]

It's more that rural GPs HAVE to do it, more than being able to do it. In the city you may get thrown to the coroner if something goes wrong when you could have handballed, in rural areas you gave it your best shot. I have lately been working in towns of 200-600 people and when you have to fly someone 2 hours and 2 nights accommodation for even an xray, you definitely make sure you do everything you can before you send them.

 

[cove]

I was pleased to see my friend who had walked to the pool to buy a newspaper. He had a perforated colon from diverticulitis and the surgery took out a big piece. It wasn’t key hole surgery seeing the surgery cut was about 400 mm long. He has a journey ahead as tests revealed cancerous tissue.
He was smiling and free of pain and he has dropped 10 kgs.

 

[drron]

It's more that rural GPs HAVE to do it, more than being able to do it. In the city you may get thrown to the coroner if something goes wrong when you could have handballed, in rural areas you gave it your best shot. I have lately been working in towns of 200-600 people and when you have to fly someone 2 hours and 2 nights accommodation for even an xray, you definitely make sure you do everything you can before you send them.

It is truly amazing what the previous generations of rural docs could do.I used to do MSOAP visits to the North Burnett.Two of the towns had docs about 70 as they would not retire until they got a full time replacement.One visit one of these docs looked exhausted.I asked what had happened.He said he had to do a bit of surgery.Later at the hospital I found out the full story.There had been a high speed head on.The first patient clinically had a subdural/extradural bleed-burr hole was performed.They did have an Xray machine so the second patient was found to have a large left pleural collection.Also an acute abdomen.The doc had induced anaesthesia,removed the ruptured spleen and drained his haemothorax.Both patients survived.They probably wouldn't have survived an emergency evacuation.

 

[bosox76]

It's more that rural GPs HAVE to do it, more than being able to do it. In the city you may get thrown to the coroner if something goes wrong when you could have handballed, in rural areas you gave it your best shot. I have lately been working in towns of 200-600 people and when you have to fly someone 2 hours and 2 nights accommodation for even an xray, you definitely make sure you do everything you can before you send them.

True. I probably should have worded it better. As drron states the previous generation of rural GP's were amazing but the newer GP's that I deal with in Mildura (mostly IMG's) just don't have that skill set anymore. But that's probably true of any specialty. I feel we're de-skilling doctors at every level in every field.

 

[rogerkambah]

Sad to hear this sorry tale WMW. Unfortunately bone breakage in hospital seems to occur in the elderly, just to compound his already serious position. He doesn't need that extra pain now..
Lets hope his bone metastases respond to the radiation he is now having and the other drugs manage to get his PSA levels down.
I guess ATM you are just taking it a day at a time to see how the various cancer sites respond and what improvement can be made to his overall condition.
Hope your mum is improved by now too. .

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

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.




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]

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.

The rheumatologist tests ESR regularly. Mind you the tests they order sound like the Greek Alphabet. Kappas. Alphas. Betas. Vipers. A whole new world of tests.

 

[Quickstatus]

The rheumatologist tests ESR regularly. Mind you the tests they order sound like the Greek Alphabet. Kappas. Alphas. Betas. Vipers. A whole new world of tests.

That’s right - has utility in vasculitic diseases.

 

[Pushka]

That’s right - has utility in vasculitic diseases.

Ah. Just googled that. Makes sense.

 

[Pushka]

Because extracting the blood test results is like extracting teeth I decided to pay for some. Not cheap but worthwhile. So am retesting all the thyroid tests, thyroid antibodies, ANA again, the DRVVT and coealiac. The DRVVT can be influenced by taking Anticoagulants so have widened the window on these tests. ANA has been positive three times now but different ‘patterns’ each time which may represent different presentations.

 

[Cynicor]

Your doc won't just give you a printout and explanation??

 

[Pushka]

Your doc won't just give you a printout and explanation??

Nope. It’s a clinic that doesn’t really indulge in extras. The GP says it’s too hard for him to print out as each kind of test is in a different ‘page’ on his computer screen and each visit I have maybe 15 different types of tests done. He did print out the thyroid ones for me but none of the other specialist ones.
I should add that he has said my case is one of the most complicated ones he’s seen and he’s a bit like a deer in headlights. Yet I’m quite well most of the time then for a period it goes down the toilet but then it comes good again. I’ve learnt the meaning of ‘flares’ and they last about 3 months. So far Feb - April 2 years in a row and I’m starting to associate that with extra sun which is a known factor in SLE.

I’ve signed up for the Health Records on myGov and a year ago signed the consent form in the Drs practice but no one has ever entered any data so that’s a goddam waste of Government spend. Plus the rheumatologist is the first one to test T3 even though I’ve been hyp for many years and testing for TPO antibodies just isn’t done so a few years ago I went to a specialist hormone clinic for that. That came back hugely positive (>1600, <100 range) and realised the rheumatologist hadn’t seen that so she was very interested in that but that test was done in 2002.

 

[Cynicor]

That's cough from your GP. Anyone could:
Select all of the tests and click print.
Open word and copy/paste each one.
Have the tests CC'd to you.

If that GP is private billing, you are being screwed. If bulk billing, find a better GP! I can understand the time constraints of a BB GP, but if I charged $80 a consult and said I couldn't give someone their results I'd be sat around with no one to see.

 

[drron]

Ask the pathology practice to send you a copy.most will but some insist on the doctor putting your name down to receive copy.
I used to have quite a few patients who wanted copies of all their results and this always worked.

 

[Cynicor]

I think the pathology companies aren't meant to do this without it being in writing from the doc. And I'd be very annoyed if the phleb was doing this. But I give the results willingly anyway, so...

 

[Pushka]

That's cough from your GP. Anyone could:
Select all of the tests and click print.
Open word and copy/paste each one.
Have the tests CC'd to you.

If that GP is private billing, you are being screwed. If bulk billing, find a better GP! I can understand the time constraints of a BB GP, but if I charged $80 a consult and said I couldn't give someone their results I'd be sat around with no one to see.

Agree.
Bulk billing but now they have all my records and think this is their practice standard. If the gov site worked it wouldn’t be an issue.

Ask the pathology practice to send you a copy.most will but some insist on the doctor putting your name down to receive copy.
I used to have quite a few patients who wanted copies of all their results and this always worked.

Will try this next time.

I think the pathology companies aren't meant to do this without it being in writing from the doc. And I'd be very annoyed if the phleb was doing this. But I give the results willingly anyway, so...

Well, I guess it’s only those patients who want the results that would do this and after all, it is the patients right surely?

The myGov website locks all results for 2 weeks in anticipation that people will get the results from the Doctor in that period. Would save me trips to the dr if I could check results then attend if I needed a script review etc.

 

[casanovawa]

I think the pathology companies aren't meant to do this without it being in writing from the doc. And I'd be very annoyed if the phleb was doing this. But I give the results willingly anyway, so...

How come you'd be annoyed Cynicor?? I guess you're the the doc is the one ordering etc but it is the patients own results after all?? Its not like they could get someone else's sent to them..

I get regular blood tests done and i used to be able to ask the lady to put my name down to get a copy of the results but then she said that they don't do that anymore without the doctor having written it in, even though when i have the tests done i will often tell them the name of a couple of my other doctors that should get a copy of the results, i just can't add myself seemingly...

But my doc is ok with adding my name on to the referral... ( he joked one time that if the patients got the results the doc's might be out of a job.. )

 

[Quickstatus]

Here is a reasonable summary of the issues surrounding MyHR.
Great in theory but poor implementation and integration, and lack of industry consultation.

In the end the MyHR website itself says MyHR is not comprehensive and cannot replace official medical records. So effectively no one can really rely on it. And if patients control it and are able to edit it then it can present a risk to the Dr.

Back to the drawing board.....

 

[Pushka]

Here is a reasonable summary of the issues surrounding MyHR.
Great in theory but poor implementation and integration, and lack of industry consultation.

In the end the MyHR website itself says MyHR is not comprehensive and cannot replace official medical records. So effectively no one can really rely on it. And if patients control it and are able to edit it then it can present a risk to the Dr.

Back to the drawing board.....

KWM | My Health Record: the resuscitation of e-health, or a data placebo?

Well I know my GP practice is registered, I have given consent, and still nada. What a disgusting waste of money.