General Medical issues thread

[bosox76]

My wife has rushed to visit a good friend in Prince Charles Hospital (next to a hospital that I now know well), she had chest pains 2 days ago and has been diagnosed not with a heart attack (as she thought), but a tear in an artery leading to the heart. Don't have full details, but will be interesting to hear how she sustained that injury. She has lost a lot of weight in recent month, but mainly to do with smarter eating and smaller portions, rather than exercise related.

Edit: My wife just rang. Seems to be a fairly common thing according to the doctors - no idea how she did it. Will be on low dose aspirin for the rest of her life and other drugs, but no surgery - as they think it will heal itself.

Coronary artery dissection - rare
Manifests just let me heart attack - can lead to heart attack.

Heart attack, myocardial infarction is due to interruption of blood supply to heart muscle whether by blockage (classic) or spasm of artery (rare) or dissection (rare)

Agree that a spontaneous coronary dissection (SCAD) is rare but certainly more common in women. Some that get it have an underlying condition known as FMD which makes you more prone to artery dissections esp cardiac and cerebral. Depending on age and risk factors her renal +\- cerebral arteries may need to be screened.

(Assuming it is SCAD and not an aortic dissection)

 

[Milboo]

Apropos of the itching, I had terrible itchy skin so much that I wanted to run a serrated bread knife over it. I couldn't figure it out and then I thought about the calcium that I had taken a bit more of recently. I looked at the ingredients and it said fish. So I rang Blackmores and they said it was actually ground up exoskeletons from shellfish. To which I have a mild allergy. I remonstrated with them about that saying that shellfish allergy was actually quite common. And they said that was all the TGA required them to do.

I've cut back the calcium by 50% which did not affect my levels, nor the vitamin D levels.

Interesting as Crustacea and Fish are two different declared allergens.

Calcium supplements would be a complementary medicine regulated by the TGA (there should be an L number on the label). You should contact the TGA and report any adverse reactions to a medicine. It gets recorded in the ADRS initially and will be reviewed and the report would go to the Quality person at the company for review too.

Declaration of allergens is one of the areas that they have included within the new medicine labelling standards that came into force a couple of months ago (but with a 4 year transition period).

So I would be reporting it.

 

[JohnK]

Extreme pain from what appears to be sciatica. Starts off from lower spine (where surgery was performed ~10 years ago) intensifying at the left buttock and then left calf.

Tylanol not helping. Nurofen Zavance helps a little but not much. Breastfeeding so Tramadol out of the equation. No other codeine based products and I am not sure these are good idea anyway. Would Naprosyn be ok in this situation?

Will more than likely go and see doctor in hospital in Pattaya tomorrow but diagnosis could be a long time coming and we only have a few more days here before going to Sydney.

Is Panadeine Forte, Panadeine Extra, Nurofen Plus not recommended while breastfeeding?

P.S. I am suffering from safe condition but just ignore the pain as much as possible.

 

[Quickstatus]

Extreme pain from what appears to be sciatica. Starts off from lower spine (where surgery was performed ~10 years ago) intensifying at the left buttock and then left calf.

Tylanol not helping. Nurofen Zavance helps a little but not much. Breastfeeding so Tramadol out of the equation. No other codeine based products and I am not sure these are good idea anyway. Would Naprosyn be ok in this situation?

Will more than likely go and see doctor in hospital in Pattaya tomorrow but diagnosis could be a long time coming and we only have a few more days here before going to Sydney.

Is Panadeine Forte, Panadeine Extra, Nurofen Plus not recommended while breastfeeding?

P.S. I am suffering from safe condition but just ignore the pain as much as possible.

Yes could be sciatica as diagnosis number 1,2,3,4,5 but after wife had all that birth related surgery - as a rare possibility - 'psoas abscess' causing pressure on sciatic nerve resulting in similar presentation. Is it on same side as damaged ureter?

Paracetamol, nurofen safe for breastfeeding.

Edit: scratch codeine.

 

[Flashback]

Yes could be sciatica as diagnosis number 1,2,3,4,5 but after wife had all that birth related surgery - as a rare possibility - 'psoas abscess' causing pressure on sciatic nerve resulting in similar presentation. Is it on same side as damaged ureter?

Paracetamol, codeine, nurofen safe for breastfeeding.

When you say nurofen I assume you mean ibuprofen?

 

[Quickstatus]

Yes.

Nurofen and nurofen zavance are same drug but zavance is in a more absorbable salt form - so acts much quicker due to much faster absorption.

There is really no reason to take nurofen as its old technology. Zavance is much better.

 

[JohnK]

Paracetamol, codeine, nurofen safe for breastfeeding.

Opposite side.

Is it ok to give her 2 Nurofen Zavance, with 1 Panadeine Extra and 1 Panadol Osteo to try and get through tonight? I think 15mg Codeine enough. Don't want load her with 30mg codeine.

Naprosyn not ok?

 

[Quickstatus]

I prefer Voltaren (diclofenac) to Naprosyn. Voltaren technically less risk of gastric ulcer as a complication.
Short term (<5 days) antiinflammatories (whatever type) in breastfeeding is OK.
Dont take 2 types of antiinflammatories at same time under any circumstances.

Max dose of paracetamol in 24 hours = 15mg/kg in 4 doses = 60mg/kg/24hr. Ceiling dose 4000mg/day if weight above 67kg. Same for daughter.
Nurofen for daughter max 10mg/kg 3 times per day. Ceiling dose 400mg/dose if weight above 40kg - usually for adults

Panadol osteo is just a longer acting panadol formulation - 3 times per day instead of usual 4 times per day which is why its 665mg per tab instead of 500mg

 

[Princess Fiona]

Extreme pain from what appears to be sciatica. Starts off from lower spine (where surgery was performed ~10 years ago) intensifying at the left buttock and then left calf.

Tylanol not helping. Nurofen Zavance helps a little but not much. Breastfeeding so Tramadol out of the equation. No other codeine based products and I am not sure these are good idea anyway. Would Naprosyn be ok in this situation?

Will more than likely go and see doctor in hospital in Pattaya tomorrow but diagnosis could be a long time coming and we only have a few more days here before going to Sydney.

Is Panadeine Forte, Panadeine Extra, Nurofen Plus not recommended while breastfeeding?

P.S. I am suffering from safe condition but just ignore the pain as much as possible.

Sciatica is very difficult to treat adequately to achieve good pain control initially. Best to avoid any medicines containing codeine whilst breastfeeding. Stick to simple analgesics, and advise your wife to keep moving.

EDIT: as per previous replies from others, seek medical attention if doesn't improve.

 

[Quickstatus]

On reflection, PF, I think you are correct with the codeine issue. We have moved away from codeine as an analgesic in paediatrics. Ultra fast metabolisers more common than previously thought. Though painstop (panadol+codeine) is still available as over the counter elixir for kids.

Ive corrected my earlier post in interest of safety

https://www.ncbi.nlm.nih.gov/pubmed/25809057

 

[JohnK]

On reflection, PF, I think you are correct with the codeine issue. We have moved away from codeine as an analgesic in paediatrics. Ultra fast metabolisers more common than previously thought. Though painstop (panadol+codeine) is still available as over the counter elixir for kids.

I understand re codeine use but I am curious about her pain so gave her 1 Panadol Osteo and 1 Panadeine extra and it has helped her more than Nurofen Zavance and at least she is sleeping now and not in too much discomfort.

Voltaren did nothing for me over the years. Naprosyn can be quite effective for short term inflammation but as you mention I try to avoid it for long term use but do use it as a last resort especially if I have had 2-3 golf games in a row. Panafcort can be quite good too but it's such a strong drug with long term side effects. Mum has been taking sparingly as needed for severe inflammation for many years.

I may continue with one dose of Panadol Osteo tomorrow and try massage tomorrow evening after golf.

P.S. on second thought Tramadol could be a good idea if daughter will sleep more. Could do with a break from some of the screams.

 

[suze2000]

Paracetamol has been shown to be more effective with nerve pain than other painkillers, which might be why you are finding it better than nurofen? Certainly when my nerve pain flares up it works better.

Good that she's still got milk after so many traumas post-birth. Great for the baby but don't be afraid to feed her formula if she still seems to be hungry a lot.

Finally: interesting information about the calcium and the itch. I actually am allergic to fish, and believe this extends to shellfish (I've never tried enough shellfish to really test it out though, as I don't enjoy throwing up!). I wonder if my Caltrate has something to do with it. I've been taking it a long time, though I suspect slightly longer than the itch has been manifesting, and irregularly. But that also might explain why the itch comes and goes in terms of severity. I have noticed a vast improvement in suffering generally over the last year which also coincides with going off the Pill in expectation of menopause (which I look forward to, though friends have warned me not to!!).
ESR still in the 40s though, so wonder what's up with that? Expect a call from the allergy doc this week to discuss.

 

[Princess Fiona]

Paracetamol has been shown to be more effective with nerve pain than other painkillers, which might be why you are finding it better than nurofen? Certainly when my nerve pain flares up it works better.
.

Whilst this might be true for you, the evidence is very poor for Paracetamol particularly for low back pain and also in neuropathic (nerve) pain.
It has been shown in a systematic review to be efficacious when used with Ibuprofen for the relief of post-operative pain.

 

[suze2000]

PF, I don't doubt you, your qualifications being higher than mine

I was told that by a mate who's an ambo. My pain is definitely nerve in origin - can't remember what it was called, but a squeezing of the sciatic nerve by the spine on the left side. So yeah, what works would likely depend on the cause of the low back pain. But since she's complaining of sciatica (as I assumed mine was until I went to the doctor and had some scans), I thought it worth mentioning. I would definitely go to the doctor instead of writing it off as I did.

 

[Princess Fiona]

PF, I don't doubt you, your qualifications being higher than mine

I was told that by a mate who's an ambo. My pain is definitely nerve in origin - can't remember what it was called, but a squeezing of the sciatic nerve by the spine on the left side. So yeah, what works would likely depend on the cause of the low back pain. But since she's complaining of sciatica (as I assumed mine was until I went to the doctor and had some scans), I thought it worth mentioning.

Oh absolutely, not meant as a criticism of you at all. It's good to hear what works for different people. I only picked up on it because of the evidence part.
My own affliction is "OCD"

 

[JohnK]

Paracetamol has been shown to be more effective with nerve pain than other painkillers, which might be why you are finding it better than nurofen? Certainly when my nerve pain flares up it works better.

I have revised my diagnosis. Panadol Osteo and Nurofen Zavance had no effect this morning. Pain appears to be muscular (may still be due to sciatica) as it responds to manipulation. May try massage tonight.

Good that she's still got milk after so many traumas post-birth. Great for the baby but don't be afraid to feed her formula if she still seems to be hungry a lot.

Daughter very fussy. Prefers breast milk. At night she likes to suck the nipple even though breast milk has finished. She then falls asleep. If my wife moves daughter starts sucking again then falls asleep. Very funny to watch. Very spoilt. Need to somehow stop her doing that.

 

[marki]

Life again has its pluses and minuses ..... the pluses always win !

 

[cove]

OCD you say. Now where is my Qudos CC for a $10k daily ATO payment. I guess my life will get back 3 minutes each day around December1st or even a day earlier.
Now I will need to figure out how to use so much spare time.

 

[get me outta here]

Cove, would one of these be useful?

Https://www.amazon.com/Yosoo-Tracks...0d79fdf45cc223d135dfd&creativeASIN=B00D3D3L8Y

OCD you say. Now where is my Qudos CC for a $10k daily ATO payment. I guess my life will get back 3 minutes each day around December1st or even a day earlier.
Now I will need to figure out how to use so much spare time.

 

[whatmeworry]

What are the best/strongest OTC painkillers in Australia?