General Medical issues thread

[Flying mermaid]

So update on the Miss FM saga. Rheumatologist got back to Miss FM today and yelled at her for saying the marks were new......They were new to her -it was only after her appointment she discussed it with her fiancé and he said no she had had them for 5 years. Given the whole of her lower back is covered in patches of brown skin, I don't know why she hadn't noticed before, but then I guess you don't normally twist around to look at your back..... There were two patches on her stomach as well! But she thought it was some sort of eczema... Rheumatologist has now decided there isn't a need to go onto Methotrexate.

I have also also yelled at Miss FM and told her she has to take notice of everything that happens to her and mention it.

this whole thing has been a fiasco from the beginning. Miss FM saw her Rheumatologist for 5 years after her ANA and RF detected and nothing seemed to be happening. She also had 3 knee operations in this period on her left knee and the right leg started looking wasted. She spoke to her orthopedic surgeon a few times, but he said no problem (presumably just looking at the knee he operated on). I wasn't happy so sent her to our GP, he said no problem. Leg got thinner and thinner and so I sent her to a physio. Physio takes one look at leg and sends her back to GP with a note. GP apologises and he said he was looking at left leg and sends her to Rheumatologist. Rheumatologist looks at leg, but never examines rest of her so never sees all the lesions on body. Sends her to Neurologist, who does all sorts of biopsies and tests and ascertains nerve and muscle is dead, for no reason. Sends her back to Rheumatologist, who tries steriods just to see if that helps the elevated CK. Finally Miss FM mentions marks and we have a diagnosis -around 5 years after I notice leg wasting. Hopefully this doesn't come back again, but at least if it does we will know what it is.

I will probably drive Miss FM bonkers for the rest of her life asking if there are any new lesions .

 

[JohnK]

I'm currently losing weight and don't really need to. Stress does that.

You want to swap? I'm trying to lose weight and getting there slowly after September's highs.

 

[love_the_life]

What a saga FM. That tunnel vision of some medical professionals means that they miss important symptoms that can point to an issue and then lead to a proper and timely diagnosis/treatment regime. Hopefully there will not be a repeat and things will remain stable.

 

[Pushka]

Goodness FM. A saga. My rheumatologist does a full exam every time I see her. Her initial appt is an hour and follow up appointments are 25-30 minutes. She asks about issues already documented and looks for new ones. I think she is an information seeker rather than someone who looks for the obvious.

But good ones are hard to find and hard to get into. I think I would be searching for another one. Do you have any medical contacts? My SIL found mine by asking at the Hospital she works at.

You want to swap? I'm trying to lose weight and getting there slowly after September's highs.

Well, my stomach shuts down when I'm stressed. Family stuff and all that.

 

[Hvr]

Saw my GP today. There's a possibility that the nose is broken but can't really tell until the swelling goes down. So back in a fortnight.

It's still sore but no internal bleeding which is good.

Problem du jour is that my Medicare card expired in September and they never sent me a new one. This meant I had to pay upfront rather than be bulk billed. Credit card surcharge $2 so had to pay cash.

Off to the Medicare office to deal with them and they denied having my address. So go through that cough and get a temporary card.

 

[love_the_life]

The doesn't sound too good Hvr, Hope things come out OK.

 

[Flying mermaid]

Goodness FM. A saga. My rheumatologist does a full exam every time I see her. Her initial appt is an hour and follow up appointments are 25-30 minutes. She asks about issues already documented and looks for new ones. I think she is an information seeker rather than someone who looks for the obvious.

But good ones are hard to find and hard to get into. I think I would be searching for another one. Do you have any medical contacts? My SIL found mine by asking at the Hospital she works at.



Well, my stomach shuts down when I'm stressed. Family stuff and all that.

I did wonder about that - I just wasn't sure if a full exam was the norm - Miss FM's Rheumatologist seems to rely on blood tests, which is how this all slipped through. Anyway not blaming anyone - it has just been a list of compounding things. Probably by the time we noticed the leg starting to waste it was too late anyway, although she had been seeing the Rheumatologist for years before that. No idea when the Morphea actually started, as the only one who seems to have noticed anything is the fiance and he only came on the scene 5 years ago

Last week I asked Dr FM to find someone in Sydney. One of the guys who went through med school with her is a Rheumatology Reg and he works with someone who is a Scleroderma expert - does heaps of research, so I figure that is as good as you get. Going to send Miss FM to him. Her Rheumatologist in Canberra is one of the best in Canberra, but I am thinking for a rare disease we need the big smoke. This may never come back again, but also it may. It shouldn't progress to systemic scleroderma but it might - I think we need some more expertise...

Sorry to hear you are stressed - hope it gets sorted out and you have a good Christmas. I appreciate the advice you have been giving.

 

[Flying mermaid]

Saw my GP today. There's a possibility that the nose is broken but can't really tell until the swelling goes down. So back in a fortnight.

It's still sore but no internal bleeding which is good.

Problem du jour is that my Medicare card expired in September and they never sent me a new one. This meant I had to pay upfront rather than be bulk billed. Credit card surcharge $2 so had to pay cash.

Off to the Medicare office to deal with them and they denied having my address. So go through that cough and get a temporary card.

Poor thing - last thing you need is bureaucracy.

 

[Pushka]

I was surprised at the follow up she did FM. I expected a 5 min consult which is the norm for specialists. Its interesting the relationship between symptoms and physical evidence from blood tests. So far it's just an ANA and high lupus anticoagulant but the latter can't be diagnosed without a specific clinical event (PE/DVT). You can carry all these antibodies around but they might not 'convert' to symptoms. So a watch and wait game.

 

[Milboo]

I saw Ian Portek in Sydney and liked him.

 

[amaroo]

Hope wife seeks medical help sooner rather later.

I'm old fashioned, but sometimes life is pretty simple!

[video=youtube;E_n5xXYBiVY]https://www.youtube.com/watch?v=E_n5xXYBiVY[/video]

 

[Flying mermaid]

I was surprised at the follow up she did FM. I expected a 5 min consult which is the norm for specialists. Its interesting the relationship between symptoms and physical evidence from blood tests. So far it's just an ANA and high lupus anticoagulant but the latter can't be diagnosed without a specific clinical event (PE/DVT). You can carry all these antibodies around but they might not 'convert' to symptoms. So a watch and wait game.

She sounds wonderful! I think all the new tech we have is incredible (being a tech person from way back), MRIs, spectroscopy, all the pathology, but sometimes you can't beat a good old fashioned exam.

Our GP identified the high ANA and RF initially and sent Miss FM off to the Rheumatologist. She said it was pretty much just a wait and see until something developed. After 5 years she said she didn't need to see her anymore and just an annual blood test to keep an eye on things. We were already trying to track down what was going on with her leg, but didn't know there was any connection....The localised scleroderma must already have been active at the point she told her all was fine don't need to see you anymore!

Just hoping it never comes back - it doesn't seem to reoccur all that much, apart from the Coup de Sabre version, which seems more vicious. Honestly looking at some of the photos of localised scleroderma on the internet she seems to have got off quite lightly.

 

[bosox76]

I did wonder about that - I just wasn't sure if a full exam was the norm - Miss FM's Rheumatologist seems to rely on blood tests

Any decent physician/Rheum should definitely have done a full clinical exam at the first visit. Mine certainly did and for something much more basic than Miss FM's issues. Obviously if the patient notices any changes and points them out in subsequent visits that helps. Not as helpful given the SYD base, but If Miss FM is ever passing through MEL and or needs a second opinion I know a few great Rheumatologists. Waiting time can vary though.

 

[Flying mermaid]

Any decent physician/Rheum should definitely have done a full clinical exam at the first visit. Mine certainly did and for something much more basic than Miss FM's issues. Obviously if the patient notices any changes and points them out in subsequent visits that helps. Not as helpful given the SYD base, but If Miss FM is ever passing through MEL and or needs a second opinion I know a few great Rheumatologists. Waiting time can vary though.

Did an exam at the first visit, but no further ones in the next 9 years, not even when Miss FM came in with the leg problems! Anyway water under the bridge - Miss FM has to take responsibility for not mentioning skin changes. She might not have known about the ones on her back, but she certainly knew about the ones on her abdomen but didn't even tell me!

Thanks for the offer - actually Canberra based, but planning to send her to Sydney. Dr FM has suggested we see Prof Peter Youssef, who apparently is a bit of a scleroderma guru. Not sure we should be wasting his time on what appears to be a dormant issue, on the other hand given Miss FM's track record, it might be worthwhile just for reassurance.

 

[Pushka]

FM - my rheumy asks for new symptoms every time. Its how they diagnose as the disease unfolds. They want to know about them as it makes their job easier. Even what we think are seemingly unrelated as the autoimmune illness can impact on every single body system - bones, skin, brain, blood, hair, other organs - the works.

 

[bosox76]

Dr FM has suggested we see Prof Peter Youssef, who apparently is a bit of a scleroderma guru. Not sure we should be wasting his time on what appears to be a dormant issue, on the other hand given Miss FM's track record, it might be worthwhile just for reassurance.

FM - my rheumy asks for new symptoms every time. Its how they diagnose as the disease unfolds. They want to know about them as it makes their job easier. Even what we think are seemingly unrelated as the autoimmune illness can impact on every single body system - bones, skin, brain, blood, hair, other organs - the works.

Always worth getting a second opinion if unsure.

That's the tricky thing with a systemic condition. Anything can be involved or impacted. I always ask my patients to tell me everything. 99% of patients always try to tell me half a story then say "oh but that's not related to my condition". To which I usually reply "why don't you let me do my job and decide if it is or isn't". Well I assume that's why they've paid to see me. Always happy to chat though

 

[Pushka]

Always worth getting a second opinion if unsure.

That's the tricky thing with a systemic condition. Anything can be involved or impacted. I always ask my patients to tell me everything. 99% of patients always try to tell me half a story then say "oh but that's not related to my condition". To which I usually reply "why don't you let me do my job and decide if it is or isn't". Well I assume that's why they've paid to see me. Always happy to chat though

And that attitude is an indication of a professional.

 

[bosox76]

And that attitude is an indication of a professional.

Thanks Pushka. I'd like to think so but it's for my patients to judge.

 

[Flashback]

Have booked myself in to see the GP for some tests when I get back to London - have a few worrying symptoms that need to be checked. Hopefully it's nothing.

 

[drron]

It's not always easy on the doctor's side of the desk.I recall one amazing consultation with a fellow referred by his GP with chest pain-that was all the letter said.So the conversation went something like this-
"So where in the chest do you get the pain?"
"I don't have any pain."
"Do you get a tightness in the chest when you walk?"
"no."
"Do you get any pain anywhere in the body?"
"No."
"Do you get breathless?"
"No."
so after ansering in the negative for several other symptoms I asked-
"So why did your doctor send you to see me?"
"Because of the pain in my chest."