General Medical issues thread

[love_the_life]

.......
First thing I’ll be packing.

In the hand luggage!

 

[k_sheep]

While you are at it ... If an anaesthetic will be used? ( When procedure nowhere near the gut, no fasting?). Types of anaesthesia?

Depends on the procedure. If it's a simple skin excision with local anaesthesia, then no fasting needed. If any sedation is being used (such as with bone marrow biopsies, endoscopies, simple gynaecological procedures) then 8 hours of fasting again (with sips of water okay).

 

[mrs.dr.ron]

After our trip to NZ in Feb I have had some problems with my lungs, with pneumonia and a pleural effusion and now a persistent cough. My GP referred me to a respiratory physician - but the first one wouldnt see me and only sees sleep apnoea problems now !! So the referral goes to the second one & they phone me and offer me an appt at the end of May. I say I am going OS on the 5/5 and wont be back till 27/6. The secretary says you live at 4 xx_ St I say yes, she says I used to live at 6 xx_ St - we talk about her parents, and I get an appt for 3/5 FINALLY = TKWIA !!!

 

[Flashback]

After our trip to NZ in Feb I have had some problems with my lungs, with pneumonia and a pleural effusion and now a persistent cough. My GP referred me to a respiratory physician - but the first one wouldnt see me and only sees sleep apnoea problems now !! So the referral goes to the second one & they phone me and offer me an appt at the end of May. I say I am going OS on the 5/5 and wont be back till 27/6. The secretary says you live at 4 xx_ St I say yes, she says I used to live at 6 xx_ St - we talk about her parents, and I get an appt for 3/5 FINALLY = TKWIA !!!

If only you knew a reliable Dr

 

[love_the_life]

Which reminds me, have you recovered now Flashback?

 

[Flashback]

Which reminds me, have you recovered now Flashback?

I'm about 90% now, had vertigo again kn the weekend but seems to have settled again. Getting day long headaches but that's more likely stress related. I've been handed a screaming child to settle as it were .... my reputation is built on being the fixer, so is an interesting but in this case very stressful challenge. 12 hour plus days don't help I suppose... at least Monday is a bank holiday. Thanks for asking!

 

[drron]

If only you knew a reliable Dr

She does know an unreliable one very well.you just never know where and when he will turn up for work.

 

[Denali]

Anyone heard of cherry juice to help with gout?

Is it ok for diabetics?

thanks,

 

[cove]

I am now on Forixiga which my cardiologist prescribed to get my blood sugar down. I have had blood sugar readings between 6.2 and 7 but he wants to lower it with this prescription medication due to my artery history.
The stated side effects possible haven't happened.

 

[RooFlyer]

Anyone heard of cherry juice to help with gout?

I understand that cherry juice is alkaline and I have heard that it can assist with gout. I think it was on 'Trust me I'm a doctor' a few weeks ago but they had a caveat on it, which I can't recall. May have been the amount of sugar added to some juices. Sticking to unsweetened or 'tart' cherry juice would be the go.

 

[RooFlyer]

For anyone who doesn't watch the BBC's Trust me, I'm a doctor may care to browse here: BBC Two - Trust Me, I'm a Doctor - The BIG experiments including the links down the bottom of that page, for other aspects covered.

What do our medicos think about the program (as broadcast, which is a bit different from the web site) ?

PS looks like I was wrong about the 'cherry juice' story on that show.

 

[Quickstatus]

@RooFlyer

"Surgery that will require fasting" includes any surgery that involve the administration of any mind altering drugs.

but apologies I could have been clearer

.....

Depends on the procedure. If it's a simple skin excision with local anaesthesia, then no fasting needed. If any sedation is being used (such as with bone marrow biopsies, endoscopies, simple gynaecological procedures) then 8 hours of fasting again (with sips of water okay).

Im assuming you meant 6 hrs

 

[Quickstatus]

Now some of you would be old enough to require colonoscopy after a positive Poo Test

Have you heard of the "White Diet" which is now the common preparatory diet before a colonoscopy?

......

Anyone heard of cherry juice to help with gout?

Is it ok for diabetics?

thanks,

Don't know much about Cherry Juice and the associated claims, but in general diabetic suitability would depend on sugar content. Anything that is marketed as a "Juice" is suspect in my view.

 

[Quickstatus]

For anyone who doesn't watch the BBC's Trust me, I'm a doctor may care to browse here: BBC Two - Trust Me, I'm a Doctor - The BIG experiments including the links down the bottom of that page, for other aspects covered.

What do our medicos think about the program (as broadcast, which is a bit different from the web site) ?

PS looks like I was wrong about the 'cherry juice' story on that show.

Mostly these "experiments" would not survive proper the usual rigorous statistical analysis applied to any study.
So while it is an interesting concept and the value might be to engage the viewer to think a bit more about issues of health, it has as much authority as New (No) Idea telling you what the latest superfood is.

Specifically (looking at the big BP study)
Experiment/study number far too low - usually hundreds are required
the study didn't go for long enough - usually months are required
The subjects are not necessarily ramdomised.
The subjects are not blinded -they know what they are eating
The investigators are not blinded - they know what each subject is eating
The subjects are not controlled in each study arm - such that differences in the subject between each study arms are minimised/controlled

 

[Quickstatus]

I am now on Forixiga which my cardiologist prescribed to get my blood sugar down. I have had blood sugar readings between 6.2 and 7 but he wants to lower it with this prescription medication due to my artery history.
The stated side effects possible haven't happened.

Farxiga the brand name of a medicine of the "Gliflozin" family. In this case Farxiga = Dapagliflozin

The Gliflozins are SGLT-2 inhibitors.

Diabetes is the excess glucose in the bloodstream. The treatment is to reduce bloodstream glucose by getting it out of the blood

Ways of getting glucose out of the bloodstream (simplistically)
1)Put less glucose into blood - by eating less glucose or substances that convert to glucose (diet)
2)Put less glucose into blood - by making the liver reduce its production of glucose (oral hypoglycaemics such as metformin)
3)Take glucose out of the blood - by forcing glucose to go from blood into cells (insulin)
4) Take glucose of the the blood - by making cells more sensitive to insulin (oral hypoglycaemics)
5)Take glucose out of the blood - by getting rid of glucose in the kidney (SGLT-2)

Up until a few years ago method 5 was not available.


Enter SGLT-2
These are sodium-glucose cotransporter inhibitor.

SGLT-2 is a protein in the kidneys that is involved with over 90% of the reabsorption of glucose from the urine within the kidney back into the body. Very efficient except that in diabetics with very high blood sugar this mechanism can be overwhelmed so a urine test of diabetics can often show excess glucose in the urine.
SGLT-1 is resposible for the other 10%. This is a protective mechanism because glucose is the body's fuel and losing fuel is not good from a evolutionary sense. But in diabetes it makes sense

So if you want to inhibit glucose reabsorption in kidneys you would sensibly target SGLT-2.

So now, we have a way of increasing glucose loss from the bloodstream by method 5 that does not rely on insulin. In fact as the body detects the lowering of glucose in the body, it shifts its metabolism toward lipolysis (the breakdown of fat) to counteract the loss of glucose (fuel);. So you can get a double whammy - reducing glucose and potentially reducing fat.

 

[drron]

A warning for anyone taking SGLT-2 inhibitors.These can be associated with Diabetic Keto Acidosis.However unlike the classic cases the sugar may only be slightly elevated so if the doctors are unaware of this side effect treatment might be delayed.If you are really feeling in ask the doctor to do a test for ketones which will give the answer.

SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin): risk of diabetic ketoacidosis

Test for raised ketones in patients with acidosis symptoms, even if plasma glucose levels are near-normal.

www.gov.uk

 

[Quickstatus]

I think the SGLT-2 are very powerful drugs which mimic what a Type 1 diabetic suffers but without the associated high blood glucose.

Can be especially dangerous when fasting or well physiologically stressed

Type 1 diabetics = poor insulin production by pancreas. Glucose builds up and is lost in urine despite the efforts of SGLT-2 mechanism. Liver also goes ketogenic in effort to produce more glucose because cells not getting enough glucose. and then a vicious cycles ensues.
With SGLT-2 inhibition this also happens but not because of high blood glucose. And in a fasting state, the liver can sometimes go into overdrive by breaking down fat trying to make glucose and in the process makes too much ketones.

 

[tgh]

Diabetes is the excess glucose in the bloodstream. The treatment is to reduce bloodstream glucose by getting it out of the blood

Qik_s , in a very informative post, left out the most important way to lower blood sugar.. and that is to burn it.
Exercise is the very best diabetes medicine on all levels and , (IMnsHO) ...should be compulsory before drugs are administered.
Of course there will be exceptions, but in the main .. exercise is the key

 

[Quickstatus]

Correct @tgh
Prescriptions should include exercise.
The more exercise the more the cells need glucose and insulin sensitivity (the ability of insulin to increase glucose transport into cells) increase as well.

 

[tgh]

the main problem is getting the excess sugar into the cells where it can be burnt off

Can you please expand this .. or point me to some research ?