General Medical issues thread

[Quickstatus]

S9 drugs

S9. There is an S9 schedule but you meant S8?.

The authorities are casting a more critical eye over prescribing of S8 and S4D.
The Japanese are also non S8 prescribing. When MrsQS broke her tibia/fibula all she got was paracetamol. No S8.

Trivia: S7 includes coughnic and cyanide

heated operating tables

No heated tables per se but “active patient heating”. There is a thing called a “Bair Hugger” which is a Unit blowing air at 37-40deg via a thick hose connected to a disposable blanket with tiny holes to let the air through. The blanket covers the patient (except for the bit that is operated on). There is a danger of overheating if temperature is not monitored.
Similarly all intravenous fluids are also warmed to 40deg as part of active warming.
And any postop patient with temp under 35 basically causes the generation of a “please explain” to the anaesthetist.

A cold patient increases the chance of bad outcomes.

Trivia: They used the same unit and connected extension hoses to keep Stuart Diver alive and warm during the Thredbo landslide. He didn’t have the benefit of the blanket but in the confined spaces the hose was enough to keep him alive

 

[TheRealTMA]

Been reading some interesting reports of a significant increase in diabetes after COVID infections.

 

[drron]

And any postop patient with temp under 35 basically causes the generation of a “please explain” to the anaesthetist.

In my student days the Professor of surgery asked that question. The Anaesthetist replied. "He's been dead for half an hour but I thought you needed the practice.
Well known for his practical jokes and ability to tell any one off.

 

[drron]

Been reading some interesting reports of a significant increase in diabetes after COVID infections.

Not surprising. The same happens after the Flu.

Pandemic influenza and subsequent risk of type 1 diabetes: a nationwide cohort study

Case reports have linked influenza infections to the development of type 1 diabetes. We investigated whether pandemic and seasonal influenza infections were associated with subsequent increased risk of type 1 diabetes.In this population-based registry ...

www.ncbi.nlm.nih.gov

 

[prozac]

Not sure what you are asking but

Irbersartan can be protective to kidneys in setting of hypertension or diabetes

Rosuvastatin ok for kidneys too. (Unless it causes rhabdomyolysis which can damage kidneys.

Yes, this is exactly what I am asking. If per drron's comments if Rosuvastatin or Irbesaten cause any of the problems he mentioned. You have answered that.

No heated tables per se but “active patient heating”. There is a thing called a “Bair Hugger” which is a Unit blowing air at 37-40deg via a thick hose connected to a disposable blanket with tiny holes to let the air through. The blanket covers the patient (except for the bit that is operated on). There is a danger of overheating if temperature is not monitored.
Similarly all intravenous fluids are also warmed to 40deg as part of active warming.
And any postop patient with temp under 35 basically causes the generation of a “please explain” to the anaesthetist.

A cold patient increases the chance of bad outcomes.

Trivia: They used the same unit and connected extension hoses to keep Stuart Diver alive and warm during the Thredbo landslide. He didn’t have the benefit of the blanket but in the confined spaces the hose was enough to keep him alive

During my 8 heart procedures I had a heavy warmed top blanket. Toasty warm thanks.

 

[CaptainCurtis]

Yes, this is exactly what I am asking. If per drron's comments if Rosuvastatin or Irbesaten cause any of the problems he mentioned. You have answered that.

During my 8 heart procedures I had a heavy warmed top blanket. Toasty warm thanks.

The last thing I remember before the anaesthetic for my cardiac ablation was the coldness in the lab. They had to cover me in a good few blankets to stop my shivering. Thankfully I went to sleep soon after.

When I woke up in the CCU, they had me covered in a blanket connected to some sort of heater/fan. It was sooo toasty.. I want one for home

 

[prozac]

...

When I woke up in the CCU, they had me covered in a blanket connected to some sort of heater/fan. It was sooo toasty.. I want one for home

When I woke up in ICU I lasted about 2m before I launched into unconsciousness due to a compressed nerve. O2 dropped to 30%, they had me on Ketamine for the pain. When they woke me 8 hrs later the second thing they said was "What did you see?"

 

[CaptainCurtis]

When I woke up in ICU I lasted about 2m before I launched into unconsciousness due to a compressed nerve. O2 dropped to 30%, they had me on Ketamine for the pain. When they woke me 8 hrs later the second thing they said was "What did you see?"

Funny story - the electrophysiologist had told me that my procedure would likely only take about an hour. Turns out my my case was a little more complicated - the accessory pathway was left-sided, which meant a transseptal puncture was needed.

Anyway, the procedure ended up taking four hours. Now this was all during the peak of COVID last year, so the hospital wasn't allowing any visitors. I found out later that a couple of hours into the procedure, my parents were inconsolable and frantically trying to get hold of the hospital for an update. After four hours, my parents finally got an update from the hospital, but it wasn't the news they were hoping for - "there were some complications, and he is in the ICU". Well, the "complications" were nausea that I was complaining of immediately after waking up, and the "ICU" was a combined ICU/CCU (i.e. standard practice after the procedure I had). I felt very bad when they told me the story the next morning.

 

[Quickstatus]

Well known for his practical jokes

Actually a real story. The RPAH department of anaesthesia had some characters.

 

[Quickstatus]

diabetes after COVID infections

Hard to say.
The initial study was a retrospective observational study of older white US veterans where the incidence of hypertension and obesity were high and at risk of Type 2 diabetes.

No evidence in younger people or evidence that Covid is causing Type 1 diabetes.

 

[Quickstatus]

I want one for home

Surprisingly a domestic version has never been developed AFAIK.

The hospital version just pumps hot air at 37-40deg. No timer.
A domestic version needs to have a remote timer/temp adjuster. It also needs to be quieter. And a special dooner with a opening at one end that accepts the hose.
Not hard to develop

 

[drron]

Actually a real story. The RPAH department of anaesthesia had some characters.

Indeed I was a student doing my anaesthetic term and I was standing beside the anaethetist when he said it.
On another occasion I was told to give the anaesthesia. Fortunately I was warned about his trick of leaving the student with about 5-10 minutes of the Oxygen cylinder running out - this was the 60s. So I knew what to do. Obviously I was being observed and the anaethetist burst back into the theatre uttering those famous lines -"Never fear,mafeking is relieved.'

 

[Quickstatus]

10 minutes of the Oxygen cylinder running out - this was the 60s

That trick persisted through the generations. In the newer machines with piped O2, the trick was to disconnect the piped O2 so the machine was on the backup cylinder.

 

[RooFlyer]

That trick persisted through the generations. In the newer machines with piped O2, the trick was to disconnect the piped O2 so the machine was on the backup cylinder.

I'll bet the patients concerned were in stitches (boom-tish!) over the little pranks being played around them.

 

[Quickstatus]

patients concerned were in stitches

Literally they would be - eventually, but if you mean figuratively in stitches that would be a fail as they would be awake during surgery

There were other characters. One Dr Michael B used to say the the young residents he was the smartest in the department because he got his fellowship without having to study for it. Basically everyone was “darling you’re useless”. Eventually the hospital made him go and see a psychiatrist but apparently the psychiatrist said there was nothing he could do. .

But there were some stars. They had a paraplegic anaesthetist and the Dept in the 70s made it possible for him to work in a wheelchair and continue his trade. I observed his colleagues helping him put on theatre scrubs in the change room.

There was also a Chinese immigrant gardener on the RPAH grounds but he was supported to study medicine and eventually became a very respected plastic surgeon. Not many can boast a CV that includes Gardener RPAH…..Plastic and reconstructive surgeon RPAH.

 

[samh004]

Been a while since I ventured to this thread and simply seeking some free advice on whether I should shop around.

For several years I have had varying neutrophil levels and been monitored by a haematologist once a year. In 2016 the levels stayed low for long enough that I experienced the joy of bone marrow collection. But it was all clear.



Late last year I again had my yearly check-up, but I had moved house and misplaced the blood test form. As nothing had really changed for me and years of monitoring producing no results I wasn't in a rush to find the form before the appointment. My doctor didn't seem concerned and sent me to have one immediately afterwards. I figured he'd have contacted me if there was anything to be worried about. And that was the last I heard of it, until yesterday when I was absentmindedly flicking through MyHealthRecord and found the report from last year.



So back to my question, should I talk to my GP about getting a second opinion from a different haematologist? Or is this about par for the course and nothing to be worried about.

Scare me or put my mind at ease

 

[prozac]

Been a while since I ventured to this thread and simply seeking some free advice on whether I should shop around.

OT, like your signature and had a laugh at the vehicles. Land Rover Defender to get you anywhere ... Suzuki Vitara for when you want to get back home.

 

[Quickstatus]

should I talk to my GP about getting a second opinion from a different haematologist?

Sounds like you have chronic neutropenia.
I can’t see an issue in getting a 2-O
Rule of thumb- if you need to ask, get it

Basically just be aware your bacteria fighting ability is lowered
Make sure you are up to date with jabs
Importantly keep regular dental appointments
Report fevers (say above 38deg) promptly and say you are neutropaenic
Wash hands
Food hygiene
Cuts and scrapes - apart from usual first aid, dab with betadine

 

[drron]

Talk it over with your Haematologist. There is a condition called Cyclic Neutropenia which is often inherited. It is caused by a dominant gene so one of your parents would have to have had it.It is though quite rare.
At present do as @Quickstatus said. but do talk to your haematologist.

 

[drron]

Another article from the past that signals that all is not well in Medical Research.

The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness. As one participant put it, “poor methods get results”. The Academy of Medical Sciences, Medical Research Council, and Biotechnology and Biological Sciences Research Council have now put their reputational weight behind an investigation into these questionable research practices. The apparent endemicity of bad research behaviour is alarming. In their quest for telling a compelling story, scientists too often sculpt data to fit their preferred theory of the world. Or they retrofit hypotheses to fit their data. Journal editors deserve their fair share of criticism too. We aid and abet the worst behaviours. Our acquiescence to the impact factor fuels an unhealthy competition to win a place in a select few journals. Our love of “significance” pollutes the literature with many a statistical fairy-tale. We reject important confirmations. Journals are not the only miscreants. Universities are in a perpetual struggle for money and talent, endpoints that foster reductive metrics, such as high-impact publication. National assessment procedures, such as the Research Excellence Framework, incentivise bad practices. And individual scientists, including their most senior leaders, do little to alter a research culture that occasionally veers close to misconduct.

DEFINE_ME

But finally something may happen to improve the situation.

Ninth international congress on peer review and scientific publication—call for abstracts

Share your important work on peer review, publication, and the conduct of scientific research In 2019, before the covid-19 pandemic, we highlighted the unprecedented promise and peril surrounding the quantity, quality, and integrity of scientific research.1 The pandemic has been a crash test...

www.bmj.com