General Medical issues thread

[drron]

FM in your situation now steroi_s are not essential.I must say when you descibed your symptoms initially they just screamed PMR and had it been me I would have definitely taken a short course of steroi_s-<3 weeks.
At that point it is essential to talk to the patient and let them decide whether to continue long term steroi_s or not.But there must be a discussion on the long term side effects of steroi_s versus the risk of blindness from an associated arteritis which is a devasstating side effect.However also the patient should be told that if their body is under stress (flu or severe accident) that they must have an increase in steroi_ dose if they are on >5mg a day as they may have an Addisonian crisis which may cause death.

So steroi_s really are not necessary to treat long term symptoms of PMR but to prevent blindeness.I always offer a third option of continuing low dose steroi_s-<5 mg a day.Risk of steroi_ side effects very low.Whether it is enough to prevent the blindness is not known as there are very few trials related to this.A couple of trials have found low dose steroi_s as effective as treating according to the CRP result where the doses are even higher.Some suggest using methotexate to lower the dose but again you are using a drug with potential severe long term side effects.

So FM I think your approach now is reasonable.But do take notice of the rheumatologist's opinion.

 

[rogerkambah]

@drron I wish you were practising in CBR,
you explain medical situations so well.
Although I'm sure you would never have wanted to as the temperature overnight reached a low of -2.5 at my house last night, and it isn't even winter yet.

 

[JohnK]

There is a difference to what most people think what is a cause of a disease and what Medicine considers a cause.

Wish there was a simple solution to every problem.

For close to 2 weeks now I've been struggling for a deep breath. No chest pain but chest feels tight. Conscious of my breathing so some sort of anxiety or panic disorder. I've been taking Xanax daily but my usual dose is not helping. I've even increased dose some days without effect.

My diagnosis is evil eye or some sort of voodoo. I've experienced this before. Unable to relax causing more stress and in turn more anxiety. I'm not mentioning to GP as all he'll recommend is psychiatrist/psychologist and I have no interest in visiting either.

Anything that I may have missed?

 

[JohnM]

Your own penultimate sentence, perhaps...?

 

[Flying mermaid]

FM in your situation now steroi_s are not essential.I must say when you descibed your symptoms initially they just screamed PMR and had it been me I would have definitely taken a short course of steroi_s-<3 weeks.
At that point it is essential to talk to the patient and let them decide whether to continue long term steroi_s or not.But there must be a discussion on the long term side effects of steroi_s versus the risk of blindness from an associated arteritis which is a devasstating side effect.However also the patient should be told that if their body is under stress (flu or severe accident) that they must have an increase in steroi_ dose if they are on >5mg a day as they may have an Addisonian crisis which may cause death.

So steroi_s really are not necessary to treat long term symptoms of PMR but to prevent blindeness.I always offer a third option of continuing low dose steroi_s-<5 mg a day.Risk of steroi_ side effects very low.Whether it is enough to prevent the blindness is not known as there are very few trials related to this.A couple of trials have found low dose steroi_s as effective as treating according to the CRP result where the doses are even higher.Some suggest using methotexate to lower the dose but again you are using a drug with potential severe long term side effects.

So FM I think your approach now is reasonable.But do take notice of the rheumatologist's opinion.

GCA only affects about 15% of people with PMR doesn’t it? And generally there are warnings such as Jaw pain and headaches? I would certainly be racing to my doctor and demanding steroi_s if I had any of those indications! Your way does seem a bit safer as no second guessing, just preventative for everyone.

If PMR had been diagnosed in March I would have happily taken steroi_s as the pain was severe, but everyone seemed to segue off on things like myasthenia gravis and the like, probably because of the double vision I have had for some years (which now seems to have pretty much cleared up). I guess we would have got to this point at Easter if we hadn’t gone to America.

I have an appointment with a Rheumatologist for late July and will of course listen to her!

My ESR was 83 and CRP was 48 - are these fairly mild or bad or what?

 

[drron]

They are elevated.The problem is they just measure inflammation.So if you now have a cold or sinus problems those might be the major cause of those levels.
The incidence of GCA varies between studies but that is roughly the average.Some suggestion it may be more prominent in Australia and NZ.

 

[JohnK]

Your own penultimate sentence, perhaps...?

Psychiatrist/psychologist?

Doctor referred me to a psychiatrist 25 years ago when panic/anxiety attacks were first diagnosed. Psychiatrist asked me where I saw myself in 5 years time. I said doing exactly what I'm doing today. He said I can't help you and I didn't want to waste my time.

Stress can be difficult to manage. Drastic changes trying to control stress could in themselves cause further stress.

 

[love_the_life]

Psychiatrist/psychologist?

Doctor referred me to a psychiatrist 25 years ago when panic/anxiety attacks were first diagnosed. Psychiatrist asked me where I saw myself in 5 years time. I said doing exactly what I'm doing today. He said I can't help you and I didn't want to waste my time.

Stress can be difficult to manage. Drastic changes trying to control stress could in themselves cause further stress.

A pity you did not persist as both psychiatrist and psychologist could have helped. Son with multiple issues has found that his psychs are of enormous benefit.

 

[love_the_life]

Spent the afternoon with my friend - reminiscing and talking about her time with Dave. A happy time but I needed quite a few drinks tonight somehow. So unfair and now I'm angry and sad.

 

[Flying mermaid]

A pity you did not persist as both psychiatrist and psychologist could have helped. Son with multiple issues has found that his psychs are of enormous benefit.

I agree. My son went through a bad patch with panic attacks and depression and finally (more to keep me happy than anything else), he did a session with a psychologist I had found for him.

She was amazingly helpful in helping him see what things he could do to reduce stress in his life. He didn’t solve his problems entirely - that took a lot more time and change in circumstances, but she definitely set him on the path to recovery.

I think sometimes you have to try a few until you find someone with whom you have trust and rapport.

 

[suze2000]

Psychiatrist asked me where I saw myself in 5 years time. I said doing exactly what I'm doing today. He said I can't help you and I didn't want to waste my time.

Guy should have his license revoked. I had talk treatment for three years for situational depression that was focussed on giving me strategies to deal with situations that I was unable to change. I know you are a busy man, but I wonder how different you would feel if you took the time to seek treatment for your issues. And yes, as mentioned above, you sometimes have to see more than one shrink before you find one that you are comfortable with.

Don't underestimated how emotional stress can manifest in the body as well. All the best to you.

 

[Milboo]

Don’t forget he said 25 years ago. Psych treatment then is somewhat different to more modern thinking.

 

[Pushka]

I agree. My son went through a bad patch with panic attacks and depression and finally (more to keep me happy than anything else), he did a session with a psychologist I had found for him.

She was amazingly helpful in helping him see what things he could do to reduce stress in his life. He didn’t solve his problems entirely - that took a lot more time and change in circumstances, but she definitely set him on the path to recovery.

I think sometimes you have to try a few until you find someone with whom you have trust and rapport.

And sometimes it’s not a Psychiatrist or Psychologist but a Counsellor who has an unusual spin on things. Of course there are those who just think that depression is simply a ‘snap out of it’ moment. Clearly having never experienced clinical depression nor seen a loved family member having those battles.

 

[get me outta here]

Cognitive behaviour modification therapy is prob best carried out by a psychologist and can be very helpful to those experiencing anxiety etc. A psychiatrist is qualified after many years of medical specialist training and can prescribe and monitor medications.
A psychologist cannot prescribe.

An experience 25 years ago that is interpreted as not being helpful or successful should not deter one from trying again, esp if self medicating, which is not working anyway.

 

[Flashback]

This is one very close to my heart, so all I can say @JohnK is just give it another try and be open to it, go in without any expectations.

 

[suze2000]

Don’t forget he said 25 years ago. Psych treatment then is somewhat different to more modern thinking.

My experience was almost 20 years ago. I had been depressed about a year. It took about several months before I felt noticeably better and a year before the depression fully lifted and I continued to see her for another two (less often), and only stopped therapy because she had to give up her practice because of her own health situation. I consider that time spent with her the most valuable health dollars I have ever spent.

 

[JohnK]

A pity you did not persist as both psychiatrist and psychologist could have helped. Son with multiple issues has found that his psychs are of enormous benefit.

Possibly but we'll never know. Not sure I'd seek help now. My biggest problem is my mind never stops. And I do too much. I need to spend time doing nothing again and learn to relax.

And for what it's worth I did try Aurorix for 6 months ~20 years ago at the request of my GP. Never again. I hated what it did to me. I hated the person I had become so I went off the drugs.

Chronic depression is a difficult one. The hardest thing is going to bed happy and waking up with feelings the world around you has collapsed. Not easy to deal with that situation.

 

[Flashback]

My biggest problem is my mind never stops. And I do too much. I need to spend time doing nothing again and learn to relax.

Tick, tick, tick and tick ....... that all describes me

 

[love_the_life]

Tick, tick, tick and tick ....... that all describes me

You should concentrate on other things. I know too well from personal experience the tick tick tick mindset. It can be challenging.

 

[Quickstatus]

...Anything that I may have missed?

Hard to know. Very nonspecific.
What about a GP visit?