General Medical issues thread

[QF WP]

Thanks. There is no pain in the chest other than when I cough and even then the pain is not there with every cough. I actually feel well other than the stress and the cough. Played the best golf I've played here the past couple of years.

By the way I'm not trying to ignore it. I just don't think I'll get any answers in the few days left in Thailand.

@JohnK it sounds like the virus I had 6 weeks ago and my wife had last week. Similar symptoms, sputum and expectoration. Not COVID. Cough is damn annoying. We started with pain relief for coughing (diaphragm/lungs), a dry/wet cough decongestant and throat lozenges. It’s a waiting game. Coughing takes 3-4 weeks to reduce in severity and time

 

[QF WP]

Then my 17 yo daughter had day surgery today. Had a hysteroscopy, D&C and an IV iron infusion. Mirena put in (levonorgestrel 20 micrograms every 24 hours). She’s been having horrible pain on the first day of her periods. Hoping the report shows the issue. Only on oral drospirone and Panamax. Young people bounce back quickly. But my wife and I are being hard task masters and sending her back to bed. She needs to rest

 

[RooFlyer]

Found out that I had high LDL (4.9) so onto statins.

Just one test showing that? They didn’t want to see how you went next time?

 

[QF WP]

Finally, asking for an extended family member. He’s 89 and until a month ago, working in his garden and shed (has all kinds of tools, as he was a sheet metal worker and welder).

He had a turn (breathless and disoriented) and went to hospital. Was there for a week whilst they organized various tests. Report given to me below seems to be the main issue is the left ventricle.

I get the main concern but would love some simple English - I didn’t go to hospital as I had my own issues at the time. We know it’s heart failure (life limiting).









What should so be researching to inform the relevant people?

 

[QF WP]

Just one test showing that? They didn’t want to see how you went next time?

Well up from the last one that I’d had a couple of years ago. Given familial similar diagnosis perhaps?

 

[Pushka]

@JohnK it sounds like the virus I had 6 weeks ago and my wife had last week. Similar symptoms, sputum and expectoration. Not COVID. Cough is damn annoying. We started with pain relief for coughing (diaphragm/lungs), a dry/wet cough decongestant and throat lozenges. It’s a waiting game. Coughing takes 3-4 weeks to reduce in severity and time

6 weeks post RSV. Mid May. Coughing just stopped two days ago. Nothing stopped it.

 

[Quickstatus]

We know it’s heart failure (life limiting).

TL;DR version is severe heart failure
The "turn" likely caused by a small heart attack - trop (troponin) 400-500

 

[lakeman]

Finally, asking for an extended family member. He’s 89 and until a month ago, working in his garden and shed (has all kinds of tools, as he was a sheet metal worker and welder).

He had a turn (breathless and disoriented) and went to hospital. Was there for a week whilst they organized various tests. Report given to me below seems to be the main issue is the left ventricle.

I get the main concern but would love some simple English - I didn’t go to hospital as I had my own issues at the time. We know it’s heart failure (life limiting).

View attachment 393701

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What should so be researching to inform the relevant people?

That test is 2 months old !
Has he seen the cardiologist?

 

[Katie]

Then my 17 yo daughter had day surgery today. Had a hysteroscopy, D&C and an IV iron infusion. Mirena put in (levonorgestrel 20 micrograms every 24 hours). She’s been having horrible pain on the first day of her periods. Hoping the report shows the issue. Only on oral drospirone and Panamax. Young people bounce back quickly. But my wife and I are being hard task masters and sending her back to bed. She needs to rest

Have some similar, but not identical issues. Teen had her first iron infusion in Nov/Dec and now looking at some other things, but not intending to poke around much even though I asked about checking for endo. I frequently have to pick up the Teen from school in the first days of her period.
Getting another blood test this week to see if her iron needs a top up.
She is trying the Lula warming patches with her recent period, and they seem a bit more portable and longer lasting than a heat pack.

It’s apparently common that neurospicy girls have more painful periods, but there’s limited recs for better pain meds or management.

 

[drron]

Finally, asking for an extended family member. He’s 89 and until a month ago, working in his garden and shed (has all kinds of tools, as he was a sheet metal worker and welder).

He had a turn (breathless and disoriented) and went to hospital. Was there for a week whilst they organized various tests. Report given to me below seems to be the main issue is the left ventricle.

I get the main concern but would love some simple English - I didn’t go to hospital as I had my own issues at the time. We know it’s heart failure (life limiting).

View attachment 393701

View attachment 393702

View attachment 393703

View attachment 393704

What should so be researching to inform the relevant people?

Have they organised any follow up? Should see a cardiologist. Even though he is 89 an angiogram could be done. An akinetic area of the left ventricule is usually because of a heart attack. He also needs treatment fot left Ventricular failure. Heart failure in other words.

 

[SuePa]

6 weeks post RSV. Mid May. Coughing just stopped two days ago. Nothing stopped it.

Oh no! Two weeks of RSV, 10 days later I'm still coughing like a 50-year chain smoker.
I'm flying to Mongolia next Tuesday and was hoping the cough would be gone, but you're not giving me much hope.

 

[Quickstatus]

Teen had her first iron infusion in Nov/Dec and now looking at some other things,

Other than menorrhagia, the main cause in this age group is lack of dietary iron

 

[QF WP]

That test is 2 months old !
Has he seen the cardiologist?

Have they organised any follow up? Should see a cardiologist. Even though he is 89 an angiogram could be done. An akinetic area of the left ventricule is usually because of a heart attack. He also needs treatment fot left Ventricular failure. Heart failure in other words.

Will go and find out. Dr Carroll is the Head of Medicine at Redcliffe Hospital, would have thought that it would have been done.

 

[Pushka]

Other than menorrhagia, the main cause in this age group is lack of dietary iron

Polyps.

Post automatically merged: Tuesday at 2:39 AM

Oh no! Two weeks of RSV, 10 days later I'm still coughing like a 50-year chain smoker.
I'm flying to Mongolia next Tuesday and was hoping the cough would be gone, but you're not giving me much hope.

I managed to travel to Europe 2 weeks ago. Just keep water on hand and hope for the best. The coughing spasms lessen in frequency. Drink soups on plane. Avoid spicy irritating foods. .

 

[Quickstatus]

Polyps

Not in "this age group"

 

[Pushka]

Not in "this age group"

I was in my early twenties.

 

[CaptainCurtis]

I've been getting my chest tightness again for the last few days, hoping it's not a return of the pericarditis from a few years ago. Contemplating running up to the hospital to get the tests done instead of waiting for my cardiologist.

 

[JohnK]

@JohnK it sounds like the virus I had 6 weeks ago and my wife had last week. Similar symptoms, sputum and expectoration. Not COVID. Cough is damn annoying. We started with pain relief for coughing (diaphragm/lungs), a dry/wet cough decongestant and throat lozenges. It’s a waiting game. Coughing takes 3-4 weeks to reduce in severity and time

I've not been taking anything except for the occasional strepsil.

The coughing drives me nuts. Cough once or twice and this triggers something in the throat and cannot stop coughing. I can feel the change in the throat. Thankfully not coughing often now but still annoying when it starts.

 

[andye]

Finally, asking for an extended family member. He’s 89 and until a month ago, working in his garden and shed (has all kinds of tools, as he was a sheet metal worker and welder).

He had a turn (breathless and disoriented) and went to hospital. Was there for a week whilst they organized various tests. Report given to me below seems to be the main issue is the left ventricle.

I get the main concern but would love some simple English - I didn’t go to hospital as I had my own issues at the time. We know it’s heart failure (life limiting).

View attachment 393701

View attachment 393702

View attachment 393703

View attachment 393704

What should so be researching to inform the relevant people?

You are right. Long post but hope it's helpful.

The major abnormality is impaired left ventricular function (should be >50%). This is sometimes called "left heart failure" or "cardiomyopathy", just "heart failure", or sometimes "HefRef" (heart failure with reduced ejection fraction)

There are some minor valve abnormalities but these are not likely to be clinically significant

The enlarged atria will give him a tendency to develop atrial fibrillation.

The regional areas of dyskinesia in the left ventricle point to the cause being reduced blood supply (ischaemia) almost always due to coronary artery disease.

The important thing about an ischaemic cause is that it may be partially reversible if the blood supply can be improved. On the other hand, the arteries could be already blocked and not reversible.

If he were a bit younger an angiogram would be pretty standard (especially with a raised troponin indicating acute cardiac ischaemia) with potential for stenting or bypass grafting if there were major narrowing of coronary arteries (stenosis). However at 89, with a delirious episode, the Cardiologists would need to assess his frailty and the pros/cons of an initial invasive procedure.
Alternatives might include looking for reversibility with a stress echocardiogram or nuclear medicine scan. A CT coronary angiogram may be used to screen for stenoses if he can tolerate lying flat and still for a prolonged period. However, they might decide that they wouldn't stent in any case and not do these tests if he is very frail

The other important thing about a reduced ejection fraction is that prognosis can definitely be improved with various medications; beta-blockers (drugs ending in -olol):, ACE or angiotensin receptor indicators (drugs ending in -pril or -sartan), spironolactone and entresto can all be tried. They all lower BP to some extent and this can be a limiting factor in their use.

Some very symptomatic patients with specific ECG findings benefit from a double-sided pacemaker but this would be unusual to do in an 89yo

If he has pulmonary oedema (fluid on lung) or peripheral oedema (fluid in extremities) he will usually be on a diuretic like frusemide (lasix). This doesn't improve prognosis in itself but improves symptoms. Ability to get rid of all fluid may be limited by low BP and/or kidney function


People with reduced ejection fraction do have limited life expectancy. The best predictor is exercise tolerance rather than the percentage ejection fraction but BP and kidney function are important too

One of the causes of death in people with heart failure is ventricular rhythm disturbances hence why some patients get implanted defibs. This can prevent you dying in your sleep which is sometimes the precise opposite of patients' wishes in their later decades

 

[QF WP]

Wow @andye that post is chock full of information that will take me a while to digest. Will copy and print out to give to him and his wife.