General Medical issues thread

[Quickstatus]

Proper physio after surgery is the best predictor of recovery.

Actually "prehab" is a better predictor

 

[Seat0B]

Actually "prehab" is a better predictor

Oh yes, I did that too.

 

[MARTINE]

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.
.

Wow
It is wonderful to hear you are doing so well @Seat0B and - may you continue to enjoy wonderful well deserved experiences with your circle of support

 

[Flyfrequently]

Just on a year ago

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.
.

And I feel you can take some of that "thanks" also, @Seat0B for sharing your journey with such honesty and positivity at a very personal time.
So good to hear that you are embracing travel again - stay well.

 

[RooFlyer]

How to ruin a quick trip to Brisbane. Woke up with tachycardia then in atrial flutter and so a visit to Greenslopes private ED.

given a beta blocker to slow things down, there for 2.5 hrs, and I’ll be seeing my own cardiologist back in Hobart this week.

So I saw my cardio an hour after I arrived back in Hobart on Monday (sometimes living in a small place has its advantages ). Yes, still in flutter. Technician will arrange a cardioversion - call you tomorrow.

Unfortunately, due to an anaesthetist shortage (flip side of living in a small place) can't get me in until following Monday. Gulp.

So during last week I tried to go about business as usual, but not feeling great. Worst, Apple watch showed heart was up and down like the Assyrian Empire (to coin a phrase) - down to 36 bpm for periods of 10 mins or so while sleeping, up to 100 while sitting. I know I shouldn't look often, but hard not to.

Finally, last Thurs night after dinner started feeling really bad - hot, a bit trembly, heart rate up while sitting until it went into tachycardia at about 114 bpm. Out of tachy, then back in. Almost certainly being driven by feedback loop of stress; I'm by myself in a small rural town. I didn't want to take a beta blocker (to slow heart rate down) due to observed low heart rates already.

Bugger it, dialled 000 for the first time ever and got an overnight bag ready if going to hospital. Local ambulance vollies turned up at 11pm (geez - lighting the place up, with 360degrees side floodlights etc. What will the neighbours think!!) Did some basic stuff, saw I wasn't too serious physically. Then state service ambo turned up with paramedics. Did thorough assessment then announced they thought I should go to Hobart (+1 hour away) for observation. I was OK with that.

First ever ride in ambulance . Had a good chat to the lovely young lady paramedic.

Taken to Hobart Private ED, arrived abt 1am, taken to bed, blood taken, assessed and hooked up. Spent very uncomfortable night; virtually no sleep. It was all great there except for the noise! I think a well known feature, and they obviously can't keep quiet when admitting/treating others but much of the noise this night was easily avoidable. Won't go into it, as of course I was grateful to be there but certainly patient sleep and comfort isn't a priority. Nurses were fantastic, especially the lady on night shift. Oh, just remembered. the night shift Dr was very average - very heavily accented, not always understandable, but worst, had a bad cough. Had surgical (not N95) mask on, but didn't cover mouth while coughing!!

Next morning, told the cardioversion would be done that day (hooray!). So admitted, paid $500 health fund excess and $300 for ED. Taken up to private room, then my cardiologist appeared in casuals (it was obviously his day off - made me feel even more cough). Then aestheticist arrived, went through the usual stuff very business like, then everyone there, in goes the good stuff. Wake up, heart back to normal rhythm, discharged a couple of hours later.

In retrospect, this was a useful experience. I'm always worried about 'what if' when I'm travelling, esp to places like Antarctica. Cardio previously assured me that I was OK to be in flutter, just a matter of feeling bad, maybe. No need for evacuation. But to experience it over a number of days was a new experience. Travelling these days I'm usually in populated places and/or with a group so I wouldn't be so stressed

 

[prozac]

So I saw my cardio an hour after I arrived back in Hobart on Monday (sometimes living in a small place has its advantages ). Yes, still in flutter. Technician will arrange a cardioversion - call you tomorrow.

Unfortunately, due to an anaesthetist shortage (flip side of living in a small place) can't get me in until following Monday. Gulp.

So during last week I tried to go about business as usual, but not feeling great. Worst, Apple watch showed heart was up and down like the Assyrian Empire (to coin a phrase) - down to 36 bpm for periods of 10 mins or so while sleeping, up to 100 while sitting. I know I shouldn't look often, but hard not to.

Finally, last Thurs night after dinner started feeling really bad - hot, a bit trembly, heart rate up while sitting until it went into tachycardia at about 114 bpm. Out of tachy, then back in. Almost certainly being driven by feedback loop of stress; I'm by myself in a small rural town. I didn't want to take a beta blocker (to slow heart rate down) due to observed low heart rates already.

Bugger it, dialled 000 for the first time ever and got an overnight bag ready if going to hospital. Local ambulance vollies turned up at 11pm (geez - lighting the place up, with 360degrees side floodlights etc. What will the neighbours think!!) Did some basic stuff, saw I wasn't too serious physically. Then state service ambo turned up with paramedics. Did thorough assessment then announced they thought I should go to Hobart (+1 hour away) for observation. I was OK with that.

First ever ride in ambulance . Had a good chat to the lovely young lady paramedic.

Taken to Hobart Private ED, arrived abt 1am, taken to bed, blood taken, assessed and hooked up. Spent very uncomfortable night; virtually no sleep. It was all great there except for the noise! I think a well known feature, and they obviously can't keep quiet when admitting/treating others but much of the noise this night was easily avoidable. Won't go into it, as of course I was grateful to be there but certainly patient sleep and comfort isn't a priority. Nurses were fantastic, especially the lady on night shift. Oh, just remembered. the night shift Dr was very average - very heavily accented, not always understandable, but worst, had a bad cough. Had surgical (not N95) mask on, but didn't cover mouth while coughing!!

Next morning, told the cardioversion would be done that day (hooray!). So admitted, paid $500 health fund excess and $300 for ED. Taken up to private room, then my cardiologist appeared in casuals (it was obviously his day off - made me feel even more cough). Then aestheticist arrived, went through the usual stuff very business like, then everyone there, in goes the good stuff. Wake up, heart back to normal rhythm, discharged a couple of hours later.

In retrospect, this was a useful experience. I'm always worried about 'what if' when I'm travelling, esp to paces like Antarctica. Cardio previously assured me that I was OK to be in flutter, just a matter of feeling bad, maybe. No need for evacuation. But to experience it over a number of days was a new experience. Travelling these days I'm usually in populated places and/or with a group so I wouldn't be so stressed

After my pacemaker was installed in 2015 I had PMT, pacemaker mediated tachycardia. It took 3 months of weekly electro-cardiologist visits to work out why and start the process of correcting it. The point of this post is to tell you when it was first noticed by my cardiologist he attempted to stop it by placing his fingers over the carotid arteries in the neck to stem the flow of blood. It did not work in my case because the pacemaker was overriding the attempt (and so I had to drive the 20km to my electro-cardio's office to have him make an adjustment) but it would seem it might be possible in the absence of medical care to do this yourself.

NOTE: Warning from @Steamrollersam following.

 

[Pushka]

So I saw my cardio an hour after I arrived back in Hobart on Monday (sometimes living in a small place has its advantages ). Yes, still in flutter. Technician will arrange a cardioversion - call you tomorrow.

Unfortunately, due to an anaesthetist shortage (flip side of living in a small place) can't get me in until following Monday. Gulp.

So during last week I tried to go about business as usual, but not feeling great. Worst, Apple watch showed heart was up and down like the Assyrian Empire (to coin a phrase) - down to 36 bpm for periods of 10 mins or so while sleeping, up to 100 while sitting. I know I shouldn't look often, but hard not to.

Finally, last Thurs night after dinner started feeling really bad - hot, a bit trembly, heart rate up while sitting until it went into tachycardia at about 114 bpm. Out of tachy, then back in. Almost certainly being driven by feedback loop of stress; I'm by myself in a small rural town. I didn't want to take a beta blocker (to slow heart rate down) due to observed low heart rates already.

Bugger it, dialled 000 for the first time ever and got an overnight bag ready if going to hospital. Local ambulance vollies turned up at 11pm (geez - lighting the place up, with 360degrees side floodlights etc. What will the neighbours think!!) Did some basic stuff, saw I wasn't too serious physically. Then state service ambo turned up with paramedics. Did thorough assessment then announced they thought I should go to Hobart (+1 hour away) for observation. I was OK with that.

First ever ride in ambulance . Had a good chat to the lovely young lady paramedic.

Taken to Hobart Private ED, arrived abt 1am, taken to bed, blood taken, assessed and hooked up. Spent very uncomfortable night; virtually no sleep. It was all great there except for the noise! I think a well known feature, and they obviously can't keep quiet when admitting/treating others but much of the noise this night was easily avoidable. Won't go into it, as of course I was grateful to be there but certainly patient sleep and comfort isn't a priority. Nurses were fantastic, especially the lady on night shift. Oh, just remembered. the night shift Dr was very average - very heavily accented, not always understandable, but worst, had a bad cough. Had surgical (not N95) mask on, but didn't cover mouth while coughing!!

Next morning, told the cardioversion would be done that day (hooray!). So admitted, paid $500 health fund excess and $300 for ED. Taken up to private room, then my cardiologist appeared in casuals (it was obviously his day off - made me feel even more cough). Then aestheticist arrived, went through the usual stuff very business like, then everyone there, in goes the good stuff. Wake up, heart back to normal rhythm, discharged a couple of hours later.

In retrospect, this was a useful experience. I'm always worried about 'what if' when I'm travelling, esp to paces like Antarctica. Cardio previously assured me that I was OK to be in flutter, just a matter of feeling bad, maybe. No need for evacuation. But to experience it over a number of days was a new experience. Travelling these days I'm usually in populated places and/or with a group so I wouldn't be so stressed

So the both of us had our first ambulance rides this week. Sounds like you are really on the mend.

 

[Steamrollersam]

Carotid sinus massage will only work to revert supraventricular tachycardia (and not all SVTs, just the two common ones). It will not work for pacemaker-mediated tachycardia. A toroid magnet on the pacemaker will stop the tachycardia in an emergency until proper pacemaker setting changes are instituted. Modern pacemakers have PMT algorithms that automatically detect and treat PMT but may need fine-tuning.

Carotid sinus massage may slow atrial flutter down momentarily but will not break the circuit, so the tachycardia will resume once CSM stops. I generally don’t recommend carotid sinus massage in over 50s because if you have any plaque in your carotids, this can dislodge and lead to a stroke. If flutter has a “typical” appearance, success rates of flutter ablation is ~95% with a low complication and recurrence rate.

 

[drron]

Also when doing Carotid Sinus Massage it is important to do only 1 side.
I well remember a prominent Sydney cardiologist massaging both sides of a Knight of the Realm when I was in my second year residency and a term in the Coronary Care Unit of RPAH. The monitor went to a flat line and the cardiologist took his right hand off the carotid swung it in a full circle and finishing with an almighty thump to the chest. It worked the tachycardia was gone and normal heart rhythm commenced immediately after the thump.

Though some times that can be very useful. I have related my experience in Maitland Hospital in the late 70s. The CCU was used as a waiting room for prisoners waiting to be transferred to Long Bay hospital. One day a very large but fit prisoner had overpowered the guard,taken his handcuffs off and was heading for the Nurses station when I walked in right behind him. was just one of those immediate reactions. From behind i did bilateral CSM and the fellow slumped to the ground. fortunately the guard had awakened and saw what happened and immediately cuffed him again with hands behind the back.
He asked how I did it so I said haven't you heard of the sleeper hold.

I haven't related the follow up though. As the only Physician in Maitland at the time i occasionally did house calls to the gaol. One day it was the same guard that escorted me to the cell. The fellow as most of them in Maitland had a history of violence. The guard said to the prisoner now don't even think of having a go at the doc. I have seem him flatten xx_ with just one blow to the head.

 

[Himeno]

Heading off to Sydney shortly for the test tomorrow morning (8am test).
I got an email from RPAH late last week saying that the blood tests (FBC, Creatinine, eGFR and INR) weren't compulsory (got them done anyway as they had already been booked to happen when I saw the email). When they called this morning to confirm the test, they asked about the blood tests anyway.

 

[andye]

Curiosity at this point as an MRI is yet to be done……..does a CT scan always show cause of TIA? A friend on the weekend was reaching for a high shelf in the bathroom when her right arm went completely limp. She couldn’t move it and says it felt like rubber. She called her son and the words were garbled. 5 minutes later all was fine. In the ED they did CT scan and other tests but nothing showed up. MRI is next week.

I had a little panic after seeing this post, as I had seen someone who had very similar symptoms (but without me eliciting any speech disurbance) recently and diagnosed no TIA but a neck problem.
Glad to report, it wasn't her and the MRI spine went along with my original thoughts. She is on good preventative drugs for TIA in any case.

 

[Quickstatus]

A friend...

Whatever @andye said + What age?. On Pill?

MRI is next week.

Might actually be an MRA - an angiogram but with MRI machine.

eGFR

Not a test but a calculation using creatinine, age and sex. The "e" is estimated, indicating the nature of the calculation to arrive at the number.

 

[MelMel]

Whatever @andye said + What age?. On Pill?

Might actually be an MRA - an angiogram but with MRI machine.


Not a test but a calculation using creatinine, age and sex. The "e" is estimated, indicating the nature of the calculation to arrive at the number.

47 years old, on HRT just come off Ozempic. Small thyroid nodule found during CT. Saw Endocrinologist today probable Hashimotos thyroid riddled with nodules. MRI (?) and stroke clinic on Wednesday.

 

[Quickstatus]

47 years old, on HRT

Many years ago had a patient in her 30s. Smoker and Pill. Bad combo. Had a couple of TIA. Stroke clinic sorted it out including changing to lower dose Pill and stopping smoking.

 

[MelMel]

Many years ago had a patient in her 30s. Smoker and Pill. Bad combo. Had a couple of TIA. Stroke clinic sorted it out including changing to lower dose Pill and stopping smoking.

Doesn’t smoke tobacco but does vape weed on an occasional basis

 

[Himeno]

Had the urethrogram yesterday. Was unconformable and messy.
Afterwards, I went to the urologists office nearby for a flow test. Took 2 attempts to get enough out for a good read because the urethrogram had completely emptied the bladder.

Had some unpleasantness in the car on the way out of Sydney due to the ~3L of water I drank in the 90 minutes after the urethrogram. (good thing I had expected some 'unpleasantness' and had a change of clothes.)

They think they found the stricture. Now waiting for the urologist to look at the images.
I felt fine (more or less) after the test. But this morning, it started to feel worse (compared to before the test). Increasing discomfort in that area when walking around. Constant feeling of needing to go, even when I know there is nothing in there, only when walking around (was intermittent before the test).
I wouldn't say it's painful (at least no more then it has been since I got the SPC put in).

Not sure if I should head to the hospital because of the discomfort.

 

[Pushka]

Finally managed to get my first Shingrix vaccination yesterday. Through a pharmac_ so not even a fee to the GP. Pharmacist explained that the paperwork needed to get stock is such that many just don't bother keeping it.

Goodness it does make for a sore upper arm though. How long does this last?

Post automatically merged: Sep 25, 2024

Had the urethrogram yesterday. Was unconformable and messy.
Afterwards, I went to the urologists office nearby for a flow test. Took 2 attempts to get enough out for a good read because the urethrogram had completely emptied the bladder.

Had some unpleasantness in the car on the way out of Sydney due to the ~3L of water I drank in the 90 minutes after the urethrogram. (good thing I had expected some 'unpleasantness' and had a change of clothes.)

They think they found the stricture. Now waiting for the urologist to look at the images.
I felt fine (more or less) after the test. But this morning, it started to feel worse (compared to before the test). Increasing discomfort in that area when walking around. Constant feeling of needing to go, even when I know there is nothing in there, only when walking around (was intermittent before the test).
I wouldn't say it's painful (at least no more then it has been since I got the SPC put in).

Not sure if I should head to the hospital because of the discomfort.

UTI maybe? Maybe everything is just irritated and needs to settle? Hope you get it sorted soon.

 

[prozac]

Finally managed to get my first Shingrix vaccination yesterday. Through a pharmac_ so not even a fee to the GP. Pharmacist explained that the paperwork needed to get stock is such that many just don't bother keeping it.

Goodness it does make for a sore upper arm though. How long does this last?

Post automatically merged: Sep 25, 2024

UTI maybe? Maybe everything is just irritated and needs to settle? Hope you get it sorted soon.

24hrs for me.

 

[Himeno]

UTI maybe? Maybe everything is just irritated and needs to settle? Hope you get it sorted soon.

The ED doctor thought UTI 2 weeks ago when I had blood coming out and gave me meds for that, then the culture came back.


I might deal with it, maybe try some basic pain meds, unless I get some other symptom.

 

[Quickstatus]

Not sure if I should head to the hospital because of the discomfort

Not unless urine flow completely blocked
Simple analgesics
Urine culture likely just colonisation.