General Medical issues thread

[QF WP]

Further update - as weekly on Tuesdays is my day to head back to surgeon & his nurse to review my two sites. Opted for afternoon appointment so I could go straight home.

Had needed Cephalexin Mon on Tuesday to Thursday night inclusive due to the constant stinging that tearing out all the hairs in my donor site last week had caused.

The main site looked really good yesterday after a good clean up, nice amount of pink skin growing from the inside out. Surgeon was really happy. New dressing and antiseptic cream put on then normal dressing.

The donor site was again the issue. Even after 2 saline tubes and waiting 10 mins. the middle of the wound wouldn’t release the dressing, so it bled again as it was taken off. Nurse really apologetic as she tore it off.

Antibacterial cream and dressing re-applied. Back to the constant stinging last night and fell asleep after taking another Cephalexin Mon. Much better today but back to wearing shorts and working from home - can see the blood under the Opsite dressing.

Until next week…

 

[Quickstatus]

middle of the wound wouldn’t release the dressing

Maybe ask then to try Mepilex

 

[JohnK]

This is basically week 9 of my chronic cough and is the first week I am not coughing uncontrollably. 10 days of Augmentin Forte may have helped.

Chest x-ray is clear although still sensitive near collarbone but the discomfort there has been improving.

Platelet count 147 which is the highest I've seen it in a long time.

Both ALK Phosphotase and ALT are slightly elevated.

C-reactive protein is the highest I've seen at 3.2 but still below 5.0!

D-dimer is 0.70 where it should be <0.55!

Doctor called this morning. The above suggest I may have had a clot recently or may be susceptible to clot. Asked about my breathing. Asked about shortness of breath. I'm not experiencing either. If any get worse then to rush to emergency with these blood results.

I'm not a doctor (obviously) but to me the last 3-4 weeks I've felt inflammation is out of control. Lot of discomfort. A lot more than usual. My body has also been fighting off some sort of infection as elevated ALP and ALT suggest possible inflammation/infection or even autoimmune issues/diabetes? Now on Keflex for possible urethritis. Not fun.

 

[Pushka]

This is basically week 9 of my chronic cough and is the first week I am not coughing uncontrollably. 10 days of Augmentin Forte may have helped.

Chest x-ray is clear although still sensitive near collarbone but the discomfort there has been improving.

Platelet count 147 which is the highest I've seen it in a long time.

Both ALK Phosphotase and ALT are slightly elevated.

C-reactive protein is the highest I've seen at 3.2 but still below 5.0!

D-dimer is 0.70 where it should be <0.55!

Doctor called this morning. The above suggest I may have had a clot recently or may be susceptible to clot. Asked about my breathing. Asked about shortness of breath. I'm not experiencing either. If any get worse then to rush to emergency with these blood results.

I'm not a doctor (obviously) but to me the last 3-4 weeks I've felt inflammation is out of control. Lot of discomfort. A lot more than usual. My body has also been fighting off some sort of infection as elevated ALP and ALT suggest possible inflammation/infection or even autoimmune issues/diabetes? Now on Keflex for possible urethritis. Not fun.

This cough RSV thing produced my worst set of figures for inflammation markers in the last 7 years or so. So I'd be quite pleased to have your inflammation markers.

C- reactive was 15 (<8) and ESR was 78 (<20) . Platelet count of 500.

I trust they are down again now for next test.

Isn't ALP/ALT liver issue? Never heard it discussed with rheumatologist (auto immune stuff)

 

[JohnK]

Isn't ALP/ALT liver issue? Never heard it discussed with rheumatologist (auto immune stuff)

Yes, slightly elevated liver function.

 

[prozac]

Yes, slightly elevated liver function.

Take Betavit brand vitamin B1. Check with medico first but that is what I was started on in hospital when my liver function was high.

Had a biopsy (s) taken today and now nursing a sore breast.

 

[andye]

Take Betavit brand vitamin B1. Check with medico first but that is what I was started on in hospital when my liver function was high.

Had a biopsy (s) taken today and now nursing a sore breast.

It's not uncommon for liver function tests to increase with infection.
Raised LFTs are not always due to the liver at all. When I tore my quad, my bilirubin AST and ALT were all high but this was due to having a torn muscle and a leg full of blood (all back to normal now)

The d-dimer test is a tricky one.
It does go up with infection but its main purpose is to rule out deep venous thrombosis and pulmonary embolus. If d-dimer is normal and you don't have major symptoms, then it's very unlikely you have DVT+/-PE. If it's elevated it doesn't mean you have a clot, just that you can't rule it out. Many docs would say that if you order a d-dimer and it's high you are obliged to do a scan to rule out clots.

 

[Quickstatus]

In other words any tests have to be correlated with the clinical picture.

 

[JohnK]

Many docs would say that if you order a d-dimer and it's high you are obliged to do a scan to rule out clots.

Doctor did mention needing CT Scan with contrast but is not requesting one yet.

What do you call high d-dimer? Anything >.55 or some higher reading?

 

[andye]

Doctor did mention needing CT Scan with contrast but is not requesting one yet.

What do you call high d-dimer? Anything >.55 or some higher reading?

The standard teaching is anything above the cutoff for the lab.
As per @Quickstatus, I don't think your doctor is being unreasonable if he/she is entirely satisfied that your symptoms are explained by a respiratory infection. It's just that ordering the d-dimer has instead of the intention of reassuring him/her (had the test been normal) it has made things more complicated.

 

[Cossie]

So after a few weeks of applying Daivobet cream at night, things are looking so much better. Follow up appointment at the end of next week.

 

[Quickstatus]

It's just that ordering the d-dimer has instead of the intention of reassuring him/her (had the test been normal) it has made things more complicated.

@JohnKthis is correct.

D-Dimer has high predictive value for DVT where there is clinical suspicion of DVT

There are other causes of raised D-Dimer such as infection and inflammation. In this setting performing a D-Dimer has lower predictive value for DVT.

But once you do a test and it returns an unexpected value there is an obligation to follow it down the rabbit hole.

In your case they likely will do a CTPA.
(CT pulmonary angiogram) to look for blood clots in the lungs and maybe even a Doppler scan of the legs. I recall you had swollen legs.

 

[Quickstatus]

Other liver function test trivia:

= raised GGT

We can tell if you have been a naughty boy or girl.

 

[love_the_life]

View attachment 398961So after a few weeks of applying Daivobet cream at night, things are looking so much better. Follow up appointment at the end of next week.

Looking so much better.

 

[Quickstatus]

So after a few weeks of applying Daivobet cream at night, things are looking so much better

We're there any other recommendations ?

 

[Cossie]

We're there any other recommendations ?

No at this stage, lots of blood and urine tests to rule out viral things, hopefully more info next week.
Long term treatment? don’t know.

 

[JohnK]

@JohnKthis is correct.

D-Dimer has high predictive value for DVT where there is clinical suspicion of DVT

I suspect you are right but there's many things to consider.

I complained of coughing for 8+ weeks and pain up near the collarbone. No other pain. No sign of chest tightening.

The pain up near collarbone I've had for a long time. It comes and goes. I can feel severe inflammation there which can make it very uncomfortable.

I don't know why Doctor ordered d-dimer. Suspicion of DVT? We've had 4 CT scans in the past 2 years include Doppler checking for DVT and no sign of DVT. The Last CT scan for DVT was February this year. Legs do swell but I've had venous insufficiency for a long time.

I do suffer from severe chronic inflammation. Everywhere. This has been known for a long time. This shows up in the blood test but there's also signs of infection both in the lungs which has responded to antibiotics and signs of urethritis for which were taking antibiotics now.

We'll see where this leads and it will be interesting to see if the doctor does follow up. All he mentioned today was if lungs get worse or pain in collarbone gets worse to present to emergency.

I mentioned aspirin and he agreed so I'll take some aspirin daily. Hope nothing serious.

 

[RooFlyer]

We can tell if you have been a naughty boy or girl.

Yes, I tell my GP that that’s the snitch enzyme.

 

[Quickstatus]

snitch enzyme

Generally you can avoid self snitching by a few days of pre-test abstinence.

 

[prozac]

Generally you can avoid self snitching by a few days of pre-test abstinence.

And doesn't the B1 help the numbers too?