General Medical issues thread

[Quickstatus]

health system is groaning at the seams.

It always has been

 

[Quickstatus]

Where do the folks in the big houses on the harbour go??

Don’t forget that Packer the senior who lives in a very big house got treated mostly at RPAH. When his heart stopped they took him to a public ED. Money made no difference but as his heart stopped, his triage category was higher than a busted toe.

 

[prozac]

Pre-covid that hospital had one of the state's best ED performance metrics (you can argue the quality of the field).
Whole health system is struggling with demand, staffing and a need to catch up with postponed surgeries.
Unfortunately the lower triage categories are the most likely to be inconvenienced-sorry @prozac

Don't apologise, the press indicates it is across the city. I think your points valid, I also think the politicians see population growth as great economics but fail to build and staff infrastructure first.
I am also responsible for one day of postponed surgeries at NBH when my LAD was dissected mid op and this pushed the day's schedule back.

 

[MEL_Traveller]

Don’t forget that Packer the senior who lives in a very big house got treated mostly at RPAH. When his heart stopped they took him to a public ED. Money made no difference but as his heart stopped, his triage category was higher than a busted toe.

For something life threatening I’d be going to a public ER, no questions. Hospitals like the Alfred in Melbourne are some of the best in the world for trauma and emergencies.

But it’s the other issues, for example something like AF, where you could wait 12 hours in a public ER, or 30 minutes in a private one, to have corrective treatment.

 

[coriander]

Rooflyer said
I spent 2 nights in hospital - first night was a given, second night I told them I wasn't going anywhere until the intense pain was managed. (Sorry @coriander , I didn't mention this before ).

I've been fairly quiet about my op as I didn't want to "mozz" myself plus the above post gave me no joy. I had my surgery on Monday 01/08. Trepidation about perioperative pain discussed with my anaesthetist. Woke up after surgery feeling really good - asked nurse why - she said "hah, wait till local wears off". Back into the ward by 9:30pm, given 2 panadols and a Palexia tablet. Woken at midnight for a heparin shot.

Next morning woke after great sleep...... didn't want to move in case it hurt. Sat up slowly..... nothing hurts. WTF? But, but, @RooFlyer said ........ Got out of bed and groin area felt as if someone was trying to pull sticky bandage off my skin - very superficial medium grade pain. Took a couple of panadols, got dressed.... aaah. ouch ... can't bend down to put socks on. MrsC gets my socks and runners on. Home and off to bed took a Palexia before bed, slept like a baby.

T+2 got up, no pain from surgical area, can actually bend to touch as far as medium calf. Pottered around home - only 2500 steps, but no pain at all.

T+3 - hooray I can get socks and shoes on, twinges a bit as I do up laces. Walked, well ambled 5000 steps. Get very tired easily. Mrs C injecting Heparin every morning giving me small purple spots to mark previous injections.

T+4 ambled my 10,000 steps. Just a bit of leg-meets-groin discomfort. Still very tired which puzzles me as I wasn't that tired after my heart surgery seventeen years ago.

T+7 - off for another round of bloods as WCC and folate have fallen, my haematologist wants to check that all is ok.

Wednesday (T+9), my birthday! Annabel rings. "How nice to ring me on my birthday", I think.
She actually sounded concerned. "Your neutrophils have dropped more but your haemoglobin has fallen off a cliff and your platelet count is 28. I want you to have a bone marrow biopsy first thing tomorrow." Umm, the last time my platelet count dropped under 50 was during my stem cell transplant (I think it dropped to 3) and they immediately gave me a platelet transfusion.

I discuss briefly with her: where has my Hgb gone? Did I bleed out on the table or something? No, my total protein is normal, my paraprotein is zero (whew!) - that's why we need a BMB.
So I had my BMB on Thursday and now await results. BMB didn't hurt at all apart from the initial local anaesthetic (it seems counter-intuitive that local anaesthetics hurt on injection). The registrar doing the biopsy said the smears looked ok but of course doesn't mean much until a pathologist has a squizz.

Hmm. Apart from my dangly bits turning black for 48 hours after the surgery, there's no evidence of bruising anywhere. My heparin-induced spots are fading, my urine is mildly yellow (I'dve thought much more or reddish even if Hgb is being broken down to bilirubin/biliverdin as I see in in my patients).

Since last blood test, the only thing that's changed is the surgery. As for meds I've had midazolam, morphine, propofol, panadol, hydromorphone, clexane before....... but never ever had heparin.

I wonder........ HIT?

Hopefully we get some answers Monday. We leave for EU in 23 days.

 

[k_sheep]

HIT would fit the timing and platelet count but you don't need a bone marrow biopsy for that. But I guess given your history it's probably prudent to check out what's happening in the marrow.

 

[Quickstatus]

where has my Hgb gone?

Hard to know what falling off cliff means without pre and post

HIT

Possibly.
But need more criteria
Theombocytopaenia (low platelets) while exposed to heparin
Resolution of same after cessation of heparin
Evidence of thrombosis
Presence of heparin dependant platelet antibodies
Serotonin release assay

 

[coriander]

My brain sort of faded when she said "platelets 28" (lots of unhappy memories) so I confess forgot the Hgb pre/post figure. (She's not given to hyperbole, always very matter-of-fact, fantastic doc, so perhaps it was the platelets that fell off a cliff.) My very first question, though, was "what's the paraprotein?"

EDIT: I'd guess there'll be another blood test request come Monday. Otherwise I'm feeling fine, tiring a bit after 10,000 ambles.

 

[prozac]

My brain sort of faded when she said "platelets 28" (lots of unhappy memories) so I confess forgot the Hgb pre/post figure. (She's not given to hyperbole, always very matter-of-fact, fantastic doc, so perhaps it was the platelets that fell off a cliff.) My very first question, though, was "what's the paraprotein?"

EDIT: I'd guess there'll be another blood test request come Monday. Otherwise I'm feeling fine, tiring a bit after 10,000 ambles.

You have a determined attitude (all that walking and activity). All the best in your recovery.

 

[CaptainCurtis]

So a good few months ago my cardiologist gave me the all clear to start easing back in to exercise again, and recommended that I take guidance from an exercise physiologist. Well I started three weeks ago, and I just wanted to say that my body is feeling bloody brilliant. I was a little dubious about the whole exercise physiologist concept at first, but she has been amazing, setting up a training program for me that is perfectly aligned with my goals.

While I've been walking for the last couple of months, it has been a good 12 months since I did any resistance/weight training. My god, it's as if I had forgotten what the rush of endorphins felt like and not to mention the DOMS. Half marathon next year please god, a little late, but better late than never.

 

[coriander]

Latest bloods: Hg was 11, now 8.5, platelets were 28 now 24. BM biopsy no trace of myeloma, RBCs abnormal in size/appearance.
Now have been started on B12 i/m q7d. I run out of breath going up a flight of stairs, HR will jump from 60 to 100 at same time. Starting to get mildly concerned - only 15 days to departure.

 

[love_the_life]

Latest bloods: Hg was 11, now 8.5, platelets were 28 now 24. BM biopsy no trace of myeloma, RBCs abnormal in size/appearance.
Now have been started on B12 i/m q7d. I run out of breath going up a flight of stairs, HR will jump from 60 to 100 at same time. Starting to get mildly concerned - only 15 days to departure.

Good news that no trace of myeloma as that would be something hanging over your head. Hopefully can stabilise bloods and HR. Fingers crossed.

 

[prozac]

Latest bloods: Hg was 11, now 8.5, platelets were 28 now 24. BM biopsy no trace of myeloma, RBCs abnormal in size/appearance.
Now have been started on B12 i/m q7d. I run out of breath going up a flight of stairs, HR will jump from 60 to 100 at same time. Starting to get mildly concerned - only 15 days to departure.

Who are you using for travel insurance and what premium can be expected for declared conditions?
Everyone feel free to chip in.
I will need to declare heart conditions / pacemaker, diverticulitis, maybe recurrent cellulitis.

 

[RooFlyer]

Who are you using for travel insurance and what premium can be expected for declared conditions?
Everyone feel free to chip in.
I will need to declare heart conditions / pacemaker, diverticulitis, maybe recurrent cellulitis.

In my recent experience, such conditions will be refused coverage ( although I had some other complications). As mine was only a domestic trip I didn't worry but will have to look further next time.

I think most of the insurers use the same (3rd party) medical screening tool

 

[TheRealTMA]

Who are you using for travel insurance and what premium can be expected for declared conditions?
Everyone feel free to chip in.
I will need to declare heart conditions / pacemaker, diverticulitis, maybe recurrent cellulitis.

Most CC TI will not cover events resulting from any pre-existing medical conditions these days it seems, but most other TI policies will. Many TIs include a bunch of “standard” pre-existing conditions such as blood pressure, asthma, … You have to complete the pre-existing declaration and declare what you have and they may or may not you an extra fee. Insure&Go I used for upcoming trip like this but Covermore, Medibank and most others also work like this. One has to do comparisons between the various companies to find the best deal.

 

[MEL_Traveller]

Most CC TI will not cover events resulting from any pre-existing medical conditions these days it seems, but most other TI policies will. Many TIs include a bunch of “standard” pre-existing conditions such as blood pressure, asthma, … You have to complete the pre-existing declaration and declare what you have and they may or may not you an extra fee. Insure&Go I used for upcoming trip like this but Covermore, Medibank and most others also work like this. One has to do comparisons between the various companies to find the best deal.

ANZ platinum seems reasonable for covering at least some pre-existing conditions, with a possible further qualification of treatment. AF - post ablation - was included for no fee for USA and Europe travel. Hats off to them

Screening is free for ANZ CC, if they accept your pre-existing you can choose to pay the screening fee of $75 and be covered. No other premium. If they decline cover, no fee. You can also decline cover, also no fee.

 

[Pushka]

In my recent experience, such conditions will be refused coverage ( although I had some other complications). As mine was only a domestic trip I didn't worry but will have to look further next time.

I think most of the insurers use the same (3rd party) medical screening tool

Cruises even off Australia are not considered domestic travel eg if you need to have a retrieval flight to get you to hospital. Obviously on the mainland you are fine.

 

[RooFlyer]

Cruises even off Australia are not considered domestic travel eg if you need to have a retrieval flight to get you to hospital. Obviously on the mainland you are fine.

I took 'cruise cover'. I was assuming that covered things they refused cover for.

 

[love_the_life]

Cruises even off Australia are not considered domestic travel eg if you need to have a retrieval flight to get you to hospital. Obviously on the mainland you are fine.

And also if you need to visit the medical centre. No Medicare coverage once you are on the ship.

 

[prozac]

I suppose it makes no difference once you've paid your TI, but Australia has reciprocal medical care agreements with some some countries.

• Belgium
• Finland
• Italy
• Malta
• the Netherlands
• New Zealand
• Norway
• the Republic of Ireland
• Slovenia
• Sweden
• the United Kingdom

I've used this system once, it works. I recall someone, maybe on AFF, relate their care in Italy was excellent.