General Medical issues thread

Can attest to that
Had one bloke (think MAMIL>50yrs) fall off his bike and landed on hs face. In the process he # the jaw and bit his tongue. He was on warfarin for the AF

In Emergency, suddenly he became very agitated.
Code Blue
His tongue stuck out of his mouth which it didn't before and started asphyxiating and trashing about. Telling him that we needed to cut the front of his neck didn't seem to alleviate his agitation.

My first and last emergency tracheostomy. I was a registrar then. INR at the time was not overly high but elevated cant remember number, so it was a very bloody tracheostomy (think making a large 10cm slash).
I seriously think MAMILS on bikes should refrain from bikes if they are on Warfarin/Xarelto/etc etc
Geez. Glad I didn’t know that yesterday morning. No wonder they reacted the way they did. The number of randoms wanting a look as a ‘never seen anything like it before’ should have alerted me.

Interesting at the critical care unit once I said what I’d done at triage immediately said ‘are you on blood thinners’. Risk versus benefit.

I took photos. 😂. MrP was quite umm, nursing his delicate stomach 🤣
 
refrain from bikes if they are on Warfarin/Xarelto

Indeed..'cept that I was sent home with 0 input about the practical reality of living with blood thinners.
One might have hoped that someone had a duty of care to explain but it appears not...
In the end I was counting down the hours to ditch day and have a much sympathy for those souls stuck with them permanently...
 
One might have hoped that someone had a duty of care to explain but it appears not...

Dont start anticoags risk of something bad
Stop the anticoags risk of something bad
Dont stop the anticoags risk of something bad

Cardiologists love the anticoags, but the gastroenterologists/radiologists then sort out the other side of the coin because there is an increased incidence of GI bleed. The RBR is in favour of the cardiologists but the gastroenterologists/radiologists have to come in at midnight to stop a GI bleeder
 
Dont start anticoags risk of something bad
Stop the anticoags risk of something bad
Dont stop the anticoags risk of something bad

Cardiologists love the anticoags, but the gastroenterologists/radiologists then sort out the other side of the coin because there is an increased incidence of GI bleed. The RBR is in favour of the cardiologists but the gastroenterologists/radiologists have to come in at midnight to stop a GI bleeder
And taking Xarelto or similar usually requires PPI although I was already on those prior. Rheumatologist said that a Dr taking me off X would be an idiot. 😂. She's pretty blunt like that. Sadly my now 38 year old niece has followed my path and is on Warfarin. She developed her DVT in her abdomen, but already had the high markers so was on aspirin at the time. Whatever I get, she follows. We share the same rheumatologist. But - nothing stops her. She's just been awarded South Australia's Young Tall Poppy and will go on to the National Competion later this year.
 
Stop the anticoags risk of something bad

Lots of drugs that are promoted by medicine seem to have major downsides upon exit.
One might hope that medicine would spell this out instead of just selling the relief spin to everyday folks.
I had a recent experience (unrelated to blood thinners) where my body had to make a huge reset without a drug
The problem being treated returned but all the side effects vanished.
It was an on balance call , reinforced by another ugly truth.. humans adapt to drugs and for many, the headline efficacy
falls steadily or even sometimes rapidly.
 
Can attest to that
Had one bloke (think MAMIL>50yrs) fall off his bike and landed on hs face. In the process he # the jaw and bit his tongue. He was on warfarin for the AF

In Emergency, suddenly he became very agitated.
Code Blue
His tongue stuck out of his mouth which it didn't before and started asphyxiating and trashing about. Telling him that we needed to cut the front of his neck didn't seem to alleviate his agitation.

My first and last emergency tracheostomy. I was a registrar then. INR at the time was not overly high but elevated cant remember number, so it was a very bloody tracheostomy (think making a large 10cm slash).
I seriously think MAMILS on bikes should refrain from bikes if they are on Warfarin/Xarelto/etc etc
When I developed a large clot in axilary and branchial viens the vascular surgeon, on telling me I would be on Xarelto asked if I did any motorsports. I said I rode a bike (motorcycle). His response was "Don't". At the time there was no reversal drug for xeralto.
 
Lots of drugs that are promoted by medicine
Always worth having a discussion re coming off pills. The discussion is about the RBR - risk benefit ratio. Just like a coin has 2 sides so does any pill.

Just because your cholesterol is high should not mean you should take an anticholesterol pill
 
Physio happy that my knee is in no immediate danger, kneecap has settled back into place. Got some exercises to help it and was sent off to my usual reformer pilates class today to give it a good workout.
My son as a 10 year old kept throwing out his shoulder when tossing a basketball. He was banned from playing for a year or so but physio fixed it. He blamed it on us when we may have swung him round as a child. Was rather interested to see him doing likewise with his own.
 
My son as a 10 year old kept throwing out his shoulder when tossing a basketball. He was banned from playing for a year or so but physio fixed it. He blamed it on us when we may have swung him round as a child. Was rather interested to see him doing likewise with his own.
I'm so conscious of making sure no one picks the kids up by their arms, far too many horror stories of kids popping elbows and shoulder.
 
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I found the letter I was sent about this test in Sydney. For some reason it was sent to the spam folder. The email account I give out to government/random companies seems to be rather odd with the spam filtering lately.

They want to do a retrograde urethrogram, trying to work out why there is apparent inflammation closing the urethra. (last xmas, closed completely. anti-inflammatories (started in Feb) reopened it by April, then started closing again in June. anti-inflammatories opened it again, only to start closing again 2 weeks ago, which anti-inflammatories again reopened late last week)

Have been trying to sort out travel up to Sydney for the test.
I had been expecting this to happen at Nepean, but they've booked it in at Royal Prince Alfred.

The letter is very vague. It seems like a general letter used for any test. Lots of "You need to do/bring this, but maybe not".

The test is currently booked for next Tuesday, but might be delayed because the Urologist wants to see me after, but isn't available on Tuesday. Waiting to see if they can do a phone consult afterwards (like when the Urologist first spoke to me) or if I need to see them. Trying to avoid extra trips to Sydney. If I do have to see them in person, then we might have to delay the test until November.
 
At the time there was no reversal drug for xeralto.
Still isn't in general use. Its the one downfall. But seriously if it can get bad biting your tongue then maybe being a biker isn't so risky 🤷‍♀️
 
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Just on a year ago I left hospital after a 5 day intensive inpatient course of cladribine infusions to treat hairy cell leukaemia. It is not an experience I am keen to repeat.

That said, as I enjoy my remission from the HCL, today I want to give my thanks to everyone involved. Thanks to the researchers who found this targeted immunotherapy and all the patients who went in clinical trials to find out that it was safe and effective. Thanks to the drug companies for making it. Thanks to the TGA for approving it for use in Australia, and the Government for making it available on the PBS and DVA schedules. Thanks to DVA for paying my costs. Thanks to Dr Pati, my wonderful haematologist and Dr Malik, my GP for taking care of me so well. Thanks to all the blood collection technicians, and the pathologists and lab staff who tested my blood samples - sometimes as often as twice a day. Thanks to the ACT government for the wonderful myDHR app so I got my results in table and graph format within 3 hrs or less, every single time. Thanks to the absolutely kind and compassionate chemo nurses who made it a bit less scary and a bit more tolerable. Thanks to the general nurses, even if many of them overdid the chemo precautions 🤭. Thanks to the hospital kitchen staff for making soft foods for me when the whole roof of my mouth peeled off after less than 2 hrs on treatment. Thanks to Mr Seat 0A for looking after me when I was very low, and for isolating with me so I did not get any infections, keeping me company and cheering me up, cooking, cleaning, shopping and everything else. Thanks to my mum, daughter and granddaughter for isolation busting phone calls and video calls to boost morale. Thanks to my darling PT Pip (RIP) who made a special exercise through chemo program for me, and broke all the isolation rules to pop past the hospital with coconut mango sago pudding. Thanks to all my kind friends who brought me food (that I mainly could not eat) and books and gave me podcast and TV recommendations to help pass the time, and stood outside my windows and talked to me. thanks to Covid for teaching us all these things to cope with isolation. Thanks to family far away for What’s App messages and phone and video calls despite weird time zones, especially Seat Son and my two fantastic sisters-in-law and various nieces. Thanks to all the kind people on here who cheered me on my way. Thanks to anyone I forgot to thank.

Yes, it takes a lot of people to get one cancer patient into remission, and I appreciate you all.
.
 
Just on a year ago I left hospital after a 5 day intensive inpatient course of cladribine infusions to treat hairy cell leukaemia. It is not an experience I am keen to repeat.

That said, as I enjoy my remission from the HCL, today I want to give my thanks to everyone involved. Thanks to the researchers who found this targeted immunotherapy and all the patients who went in clinical trials to find out that it was safe and effective. Thanks to the drug companies for making it. Thanks to the TGA for approving it for use in Australia, and the Government for making it available on the PBS and DVA schedules. Thanks to DVA for paying my costs. Thanks to Dr Pati, my wonderful haematologist and Dr Malik, my GP for taking care of me so well. Thanks to all the blood collection technicians, and the pathologists and lab staff who tested my blood samples - sometimes as often as twice a day. Thanks to the ACT government for the wonderful myDHR app so I got my results in table and graph format within 3 hrs or less, every single time. Thanks to the absolutely kind and compassionate chemo nurses who made it a bit less scary and a bit more tolerable. Thanks to the general nurses, even if many of them overdid the chemo precautions 🤭. Thanks to the hospital kitchen staff for making soft foods for me when the whole roof of my mouth peeled off after less than 2 hrs on treatment. Thanks to Mr Seat 0A for looking after me when I was very low, and for isolating with me so I did not get any infections, keeping me company and cheering me up, cooking, cleaning, shopping and everything else. Thanks to my mum, daughter and granddaughter for isolation busting phone calls and video calls to boost morale. Thanks to my darling PT Pip (RIP) who made a special exercise through chemo program for me, and broke all the isolation rules to pop past the hospital with coconut mango sago pudding. Thanks to all my kind friends who brought me food (that I mainly could not eat) and books and gave me podcast and TV recommendations to help pass the time, and stood outside my windows and talked to me. thanks to Covid for teaching us all these things to cope with isolation. Thanks to family far away for What’s App messages and phone and video calls despite weird time zones, especially Seat Son and my two fantastic sisters-in-law and various nieces. Thanks to all the kind people on here who cheered me on my way. Thanks to anyone I forgot to thank.

Yes, it takes a lot of people to get one cancer patient into remission, and I appreciate you all.
.
Congratulations @Seat0B . Despite all the help and wonderfully clever people who invent the treatment we also make our own luck. Thank you for sharing your journey and for offering support.
 
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Proper physio after surgery is the best predictor of recovery.
I second this after 2 knee replacements and a shoulder reconstruction. Surgeon gets you up to the starting gate. Physio makes it possible for you to get normal motion - or near normal. Personal trainer/gym program helps you maintain that. The only way I know to get a good result is to do all three.
 

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