General Medical issues thread

[ellen10]

Mine charges $93 and Medicare benefit is $42.85.

That is what my GP charges and the rebate I receive.

 

[Pushka]

I had to look up ganglion to see it wasn’t the clap. Once I knew that it was a cyst I felt around my hands and yes there are a couple that exist that were not there 25 years ago. Just part of the fun of getting older.

I had a ganglion cyst in my upper wrist many years ago. So not an old people thing. It grew really large. A remedy used to be to hit it with the family bible. Mine started impededing wrist movement so it was removed surgically 20 years ago.

 

[blackcat20]

Were lucky that our local GPs are all bulk billed.
Popped in yesterday for scan results for my foot lump, they were inconclusive. But recommended surgical removal and pathology.

 

[Quickstatus]

it needs to be proven that the people were not simply drinking a poisoned drink and not necessarily under the influence

There is no direct test for methanol or ethanol. Measurement relies on the sample undergoing controlled chemical reactions.

 

[Pushka]

There is no direct test for methanol or ethanol. Measurement relies on the sample undergoing controlled chemical reactions.

Yes, understand that. The thing that needs to be proven for a denial of claim is the level of alcohol intoxication - ie how many alcohol drinks did they consume, ie were they drunk.

 

[Quickstatus]

how many alcohol drinks did they consume, ie were they drunk

Sprry i thought you were referring to something else.

Should be easy enough to prove one way or another. Just a blood alcohol test will do or in the absence of that ofher evidence such as a bar tab and/witness statements

The TI I usually use specifies a BAC of 0.19 which is nearly 4x the usual 0.05

A positive BAC wont affect a methanol poisoning diagnosis. I suspect in some/many of these cases there will also be other substances other than methanol including ethanol, illegal drugs etc. standard management include testing for all sorts of substances one would typically find in a cohort of patients like these

What might be problematic would be a BAC > 0.19 + methanol poisoning. Interestingly when using ethanol infusion to treat methanol poisoning the target BAC is 0.15. So being drunk is protective but it only buys time - need stomach pumped, then dialysis, maybe 4MP infusion etc etc

 

[mrsterryn]

We followed our GP . Definitely worth it. Also about $95 a visit with $42 back.
He has moved surgeries a couple of times but I think he has children in high school in local area

 

[k_sheep]

Whilst I have a GP, I can easily go 2+ years with zero need to visit them as have no ongoing health issues that need continuous treatment.

So I guess I have to be ok with an autopsy if I drop off this mortal coil before deteriorating to the stage I need to be at the GP every 2-3 months like my parents.

Coroners very rarely request autopsies in my experience. They try to go the low effort route if at all possible. Any medication? Any investigation for blood pressure or cholesterol in the last 20 years? Boom, heart attack, signs the certificate.

There is no direct test for methanol or ethanol. Measurement relies on the sample undergoing controlled chemical reactions.

Actually we (and I imagine all larger laboratories) do measure it directly by GC-MS. I always got phone calls about this at 4pm Friday as a chemical pathology trainee.

 

[Quickstatus]

Actually we (and I imagine all larger laboratories) do measure it directly by GC-MS.

You are absolutely correct. Do most hospital labs have them?

 

[k_sheep]

You are absolutely correct. Do most hospital labs have them?

All the large referral labs will; very common analyser for therapeutic drug monitoring, volatile measurement, lots of metabolics.

Your regional centres are unlikely to have one but all the centrals ones will.

For the regional labs, you can have a guess based on the anion gap ... remember the MUDPILES acronym from med school! For the non medical, the anion gap is calculated based on a bunch of very commonly measured blood parameters. If there's a big gap, it means there is something in the blood that isn't being measured - this could be methanol (amongst others).

 

[MARTINE]

All the large referral labs will; very common analyser for therapeutic drug monitoring, volatile measurement, lots of metabolics.

Your regional centres are unlikely to have one but all the centrals ones will.

For the regional labs, you can have a guess based on the anion gap ... remember the MUDPILES acronym from med school! For the non medical, the anion gap is calculated based on a bunch of very commonly measured blood parameters. If there's a big gap, it means there is something in the blood that isn't being measured - this could be methanol (amongst others).

I think I slept through MUDPILES in med school but your explanation resulted in some creaky turning of a few cogs in my brain @k_sheep !

 

[Pushka]

All the large referral labs will; very common analyser for therapeutic drug monitoring, volatile measurement, lots of metabolics.

Your regional centres are unlikely to have one but all the centrals ones will.

For the regional labs, you can have a guess based on the anion gap ... remember the MUDPILES acronym from med school! For the non medical, the anion gap is calculated based on a bunch of very commonly measured blood parameters. If there's a big gap, it means there is something in the blood that isn't being measured - this could be methanol (amongst others).

I have multiple blood tests done each month and a whole new ones every 12 months and have always wondered what the anion gap was. Now I know what it is but I don't understand what it is. Progress methinks.

 

[Pushka]

I have multiple blood tests done each month and a whole new ones every 12 months and have always wondered what the anion gap was. Now I know what it is but I don't understand what it is. Progress methinks.

And watching one of those medico programmes on Netflix they just doscussed the anion gap. What are the chances of that after 8 years of blood tests and never doscussed the anion gap before.

 

[andye]

All the large referral labs will; very common analyser for therapeutic drug monitoring, volatile measurement, lots of metabolics.

Your regional centres are unlikely to have one but all the centrals ones will.

For the regional labs, you can have a guess based on the anion gap ... remember the MUDPILES acronym from med school! For the non medical, the anion gap is calculated based on a bunch of very commonly measured blood parameters. If there's a big gap, it means there is something in the blood that isn't being measured - this could be methanol (amongst others).

I thought it was the osmolar gap for methanol...or is it both?

 

[prozac]

My good news, my LDH numbers are going down. After the last PET scan did not indicate any tumour activity I suggested perhaps the Efudix cream I was using over repeated courses was the cause. I stopped the last course a few weeks ago. At my Friday pre-infusion meeting with my specialist she agreed that could be the answer.

 

[Quickstatus]

osmolar gap for methanol.

If bothanion and osmolar gap elevated then it's alcohol poisoning - ethanol/methanol or antifreeze poisoning. Metabolic acidosis generally also occurs which is part of the anion gap so it's also suspected - in these cases it's going to be bad.


However if anion gap alone, then suspect methanol but never forget diabetic ketoacidosis or (other metabolic acidosis)

Anion gap calculator.
Change units from mEq/L to mol/L
The menu at top lists the differentials including MUDPILERS and HARDUPS etc

 

[ellen10]

I’ve been enrolled in a clinical medical trial for RSV respiratory syncytial virus and hMPV human metapneumovirus . My first 3 hour appointment starts on Tuesday. They do interviews, check your medical history, ECG etc.
Then the following visit, you are injected with either vaccine. You have to stay there for 5 hours to be monitored.

There are 4 short 30 min visits after the injection. There will be a further 8 visits over the next 6 months

I had RVS last year and I was really quite sick, so originally thought a good idea of the trail and vaccines.

Anyone else had any experience with these trials or vaccines? I haven’t told my GP. Maybe I should? Maybe having second thoughts?

 

[RooFlyer]

Anyone else had any experience with these trials or vaccines?

I got the RSV vax 'Arexvy' about 3 weeks ago. Usual sore red area for a few days.

If the trial clinic didn't write to your GP, I'd be surprised; but I'd mention it to him/her anyway. Does it appear on your Medicare vax history statement?

 

[ellen10]

I got the RSV vax 'Arexvy' about 3 weeks ago. Usual sore red area for a few days.

If the trial clinic didn't write to your GP, I'd be surprised; but I'd mention it to him/her anyway. Does it appear on your Medicare vax history statement?

Good questions @RooFlyer . I have had a couple of phone calls from receptionists, but I can’t recall them asking my GPs name.

They did ask me to bring a full medical history.
We had been crazy busy at home with house painters and we are now away for a few days. So I have been distracted and hadn’t thought too much about it until they phoned earlier this week with the appointment times on Tuesday.

 

[Pushka]

Good questions @RooFlyer . I have had a couple of phone calls from receptionists, but I can’t recall them asking my GPs name.

They did ask me to bring a full medical history.
We had been crazy busy at home with house painters and we are now away for a few days. So I have been distracted and hadn’t thought too much about it until they phoned earlier this week with the appointment times on Tuesday.

If they have your Medicare number they will know everything.

I'm due for the second shingrix now. But have heard anecdotal experience that the second one can have a poor reaction. My first one gave me a dead arm for a few days but it's the same arm that is my sentinel area for a pmr flare. And my immune system is rubbish. Im either getting it done immediately before the family stuff kicks in or waiting until after Christmas