General Medical issues thread

[Flashback]

There are always going to be people critical of any diet.

I love ham. I want to eat things I enjoy not eat something I don't like. 60-80gm of ham per day is ok. Keep in mind this diet has been approved by 2 dieticians. And I can keep this going even after stopping the diet.

As I said so far so good. ~7-8kgs weight loss after 4 weeks is acceptable.

Oh don't worry, I agree - I am just stating the facts! I also enjoy ham in my diet Although, I try not to make it too regular.

Good job on the loss so far, may it continue!

 

[love_the_life]

I visited my friend with oesophageal cancer today (saw him a co'uple of weeks ago as well). He has had 2 rounds of chemo now and whilst it's palliative, the tumour seems to have shrunk and he is now able to eat. His daughter was there when I called in (funnily I taught her over 15 years ago!) and they were hoeing into Maccas chicken nuggets. He said he just felt like it. . I took him chocolates as he loved them before and now he can eat it might be a bit of a treat. He certainly looks much better than he did about 8 weeks ago. I said to MrLtL at the time that if he didn't get onto the chemo soon, I reckoned about 2 - 3 months if he was lucky but things are looking up. Hopefully he will be able to put on a bit of weight.

 

[blackcat20]

Second round of steroi_ injections for the baby today. For some reason they make my legs really sore.

 

[Flying mermaid]

Second round of steroi_ injections for the baby today. For some reason they make my legs really sore.

nearly over!

 

[Hvr]

nearly over!

Actually Winston Churchill had an applicable quote:
"Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning."

 

[love_the_life]

Second round of steroi_ injections for the baby today. For some reason they make my legs really sore.

More injections to come or is that the last?

 

[blackcat20]

More injections to come or is that the last?

That's all. They just want to make sure the lungs are ready.

 

[love_the_life]

So it sounds like you’re on ‘final approach’ now.

 

[scubabe]

Oh no! @blackcat20 I've missed something - if you're getting shots then you're expecting an early arrival - I hope you guys are all okay!

 

[blackcat20]

Oh no! @blackcat20 I've missed something - if you're getting shots then you're expecting an early arrival - I hope you guys are all okay!

Bub was showing signs of growth restriction so they elect for an earlier delivery.

 

[scubabe]

Sorry to hear that, but I'm so pleased they were on top of it and caught it early. Good luck for what must be happening in a day or two now I guess! Yay for the pitter patter of new feet in your gorgeous new house

 

[love_the_life]

Sorry to hear that, but I'm so pleased they were on top of it and caught it early. Good luck for what must be happening in a day or two now I guess! Yay for the pitter patter of new feet in your gorgeous new house

And the pitter patter ain’t a new puppy!

 

[blackcat20]

Sorry to hear that, but I'm so pleased they were on top of it and caught it early. Good luck for what must be happening in a day or two now I guess! Yay for the pitter patter of new feet in your gorgeous new house

My OB has been fantastic, extra scans and monitoring to make sure we act as soon as required.

 

[Pushka]

And the pitter patter ain’t a new puppy!

But at least puppies are house trained quickly.....

 

[Flying mermaid]

But at least puppies are house trained quickly.....

That’s true but given relative life spans you probably still get more out of a Bub than a puppy

 

[tgh]

thread has gone all clucky again….

 

[Flying mermaid]

thread has gone all clucky again….

It’s babies - we can’t help it

 

[Quickstatus]

Iron is a big subject in Medicine - too much to be able to explain here.

But here is a little insight into Iron in the human body:

Iron is an important trace element in the human body
The human body contains only about 3-4 grams of Iron - males about 4, females about 3.5
So about the same amount of iron in 2x 5cm iron nails.
75% is in hemoglobin in the red blood cells.
10% is in the protein ferritin - mostly sitting in all our cells
Rest in the transferrin, myoglobin and other more esoteric compounds.

The human body does not have an active mechanism for excreting iron. And all iron is obtained through diet.
However iron is lost in a few recognised ways - bleeding (menstruation), getting stabbed, and the losing of cells from your skin, and also from mucosal surfaces - inside of oral cavity and the gastrointestinal tract

Dietary iron in most people compensates for this. Iron is absorbed in the intestines. Obviously our bodies cannot make iron. We only absorb about 5-10% of the iron we eat.

So not enough iron in the body could be due to:
Losing blood, pregnancy
Not absorbing enough iron due to intestinal disease - coeliac, crohns, and some other intestinal mucosal surface conditions.
Not enough intestine
Not enough dietary iron

Too much iron could be due to:
Increased iron absorption (and builds up because the body cannot actively get rid of excess iron)
blood transfusion
Certain types of anaemia (not enough blood) such as thalasemia due to the body inability to make proper blood cells and therefore not able to use up the iron stored in the body.
Liver disease - causes a reduction in the production of a special hormone that regulates the absorption of iron in the intestine
Doctor gave too much IV iron
Because we only absorb a very small amount of iron, eating too many steaks or drinking blood does not ordinarily cause iron overload

Transferrin is a protein that transports iron around the body - sort of like an Uber for iron to get around
Transferrin saturation - the amount of Ubers filled with iron.
If iron deficient - there usually is more transferrin, and if iron is adequate less transferrin floats about.
But the amount of transferrin in the body is not as simply characterised as just a supply demand equation

Serum Iron
The important thing to note is that when Drs talk about iron in the body they don't actually mean iron but what they are talking about is either hemoglobin or ferritin. The level of free/serum iron in the body is not a test that is in itself meaningful. Think of Free/serum iron as Millennial iron - just floating in the blood mindlessly, and doing absolutely nothing.

Ferritin is a little protein that stores iron (Think of it like an iron bag)
It exists mainly in cells. Thats why we lose iron when we slough off skin cells and mucosal cells
When your bone marrow needs iron to make red blood cells, it calls the Uber (transferrin) which comes around and picks up the iron bag (ferritin) and transports it to the bone marrow.
Please remember:
Low ferritin result = someone with iron deficiency will almost always have low ferritin, and someone who does not have iron overload almost always will not have low ferritin
High ferritin result = people with iron overload will almost always have high ferritin, but people without iron overload can also have high ferritin.


So someone with iron overload often needs tests other than just iron studies to confirm a diagnosis. Whereas someone with iron deficiency will only need an iron study test to make a diagnosis

Hemoglobin
This is where most of the body's iron is stored. Each Hemoglobin has 4 atoms of iron. It is the iron which is bind oxygen molecules on a 1:1 basis. The more oxygen bound to hemoglobin the redder it is because the oxygen causes the hemoglobin molecule to change shape causing more red light to be reflected while absorbing more blue-green light. Without oxygen the hemoglobin reflects more blue light. Thats why oxygenated blood is red (arteries) and blood without oxygen is more blue (veins)

Kapisch??

 

[Quickstatus]

Hemoglobin A1c (HbA1c)

The life of a red blood cell in the human body is about 120 days.
And because each red blood cell has a lifespan of 120 days, the hemoglobin it contains also has that lifespan.


Whats HbA1c? (Hemoglobin A1c)
Mostly human blood has 93% HbA0, 5% HbA1, maybe 2% HbA2. (a bit of HbF as well - foetal Hb but lets leave that out for the purposes of this post)

Think of HbA1c as hemoglobin with glucose barnacles.
New hemoglobin that sits in new red cells when they are produced do not have barnacles. As the hemoglobin circulates throughout the blood vessels and as it ages, it picks up barnacles.
The barnacles are molecules of glucose. The more glucose in the blood stream the more hemoglobin it binds to just like barnacles on a boat

It turns out that a subset of Hemoglobin seem to have glucose barnacles - HbA1. There is HbA1a,b,c but A1c seems to be in the greatest numbers - so blood tests look for the HbA1c because it is easier to measure when there are more HbA1c than HbA1a or b.

Therefore the amount of HbA1c is a really good way of checking the overall glucose level in the blood stream over the last 8 weeks. The more HbA1c the more glucose in the blood stream over the last 8 weeks.
Why 8 weeks?. The oldest red cell is 17 weeks the youngest is 0 weeks, so the average age of hemoglobin in the bloodstream at anytime is about 8 weeks.

The target of HbA1c is usually less than 7%
The 7% is the percentage of Hb in the blood that is actually HbA1c - in other words that have glucose barnacles on it.

Kapisch?

 

[tgh]

One "problem" with using HBa1c as the benchmark , is the damage done by post prandial peaks.
It's not hard to have sleek and shiny "average" blood tests and a happy GP.
For many diabetics, post prandial hyperglycaemia is doing a lot of damage.
It's my layman's spin that medicine will soon start to weight the importance of this issue in case management procedures
I run a permanent Google search and some of the research is quite chilling….