General Medical issues thread

[tgh]

But @tgh we are all different

Of course ; my comments reflect a "one rat" study, and were not offered as a universal panacea.
I do commend you for your efforts and hope you can continue, some ibuprofen is a good recovery tool….

 

[JohnK]

Osteoarthritis in left hip for past 6-7 years, then osteoarthritis in right hip, then osteoarthritis in both knees with the left one worse and I gave up 2 years ago when I found out there's osteoarthritis in left foot after 1st cellulitis infection.

I can push through pain better than most but fighting through the hip pain causes issues in pelvis, in knees and lower back and from lower back come the neck issues.

I have no idea what it is but the left knee locks up regularly. It's just above the knee. It started off occurring while I was sitting. If I pushed down on thigh I could get up with some further pain. Now pain is excruciating. When knee locks the only way to unlock is to put it through more pain. Knee could lock up a dozen or more times in succession. Sometimes it occurs in middle of night and I wake up stressed and in panic.

I don't know what to do. Just put up with it but obviously this is causing issues. Struggle to walk up and down stairs. It doesn't get better with more walking although some days are better than others. I became my dad but 20 years earlier.

 

[tgh]

I don't know what to do

How is the weight loss coming along ?

 

[JohnK]

I don't know what to do

How is the weight loss coming along ?

Lost 3-4 kg easily and the rest is uphill battle. Body is trying very hard to maintain current weight.

 

[tgh]

As ye sow et al...
Body mass and joint function are very closely linked.
IF.. you had managed some discipline over all those self indulgent years stacking it on, the health and well being outcome later in life would have been much different.
You are probably now locked onto the ever steepening slippery slide with the outcome shining brightly just ahead...

 

[drron]

But @tgh we are all different

Of course ; my comments reflect a "one rat" study, and were not offered as a universal panacea.
I do commend you for your efforts and hope you can continue, some ibuprofen is a good recovery tool….

Unfortunately I will not risk any of the NSAIDS when on an anticoagulant.

 

[RooFlyer]

Unfortunately I will not risk any of the NSAIDS when on an anticoagulant.

I saw a similar comment of yours before. Is that a personal situation, or while you were practicing, would you also not prescribe NSAIDs for those on blood thinners? I'm on 20mg Xarelto daily but my GP has no problem with short courses (up to 5 days) of up to 200mg Celecoxib, with food.

Not sure if Nurafen is a NSAID but he also is OK with longer course of that (once daily only).

Do you think I might query him about this?

 

[Pushka]

Unfortunately I will not risk any of the NSAIDS when on an anticoagulant.

So ibuprofen (Nurofen) and such like? Coz that helps with the PMR stuff. On X 20mg. I do have a blood clotting issue so maybe that's different than preventive use of anticoagulants. I still can't get off the steroi_s grrr.

 

[prozac]

... I still can't get off the steroi_s grrr.

As in you cannot kick taking them?

 

[Pushka]

As in you cannot kick taking them?

Every time I lower the dose the PMR literally creeps back in. The rheumatologist isn't concerned about me being on it, nor is the GP, but I am. Just concerned about osteoporosis. Rheumatologist is considering methotrexate as a sparing agent but

 

[tgh]

Post stenosis, I was prescribed Clopidogrel and received no drug interaction caution from hospital, cardiologist Gp or Pharmacist.
My meloxicam scrip remained available through my year on thinners although I do not use it.
I only heard about the nasaid /anticoagulant caution from earlier posts here……
I have, for many years used one Nurofen capsule post heavy stress exercise to assist recovery as opposed to simple pain relief
Many drugs offer a choice in terms of the help/harm balance and I guess the buck stops with the user.

 

[QF WP]

Great text message from my BFF yesterday - "Cancer free is me!"

She had a few moles/skin bits cut out a few weeks ago, and the one on her tummy tested positive as melanoma. So back to cut more out last week. Really relived the pathology came back so quickly and she wasn't stressing all week waiting for the result.

From my experience as well, getting the pathology from the re-excision that the margins are clear is always a relief.

 

[drron]

I saw a similar comment of yours before. Is that a personal situation, or while you were practicing, would you also not prescribe NSAIDs for those on blood thinners? I'm on 20mg Xarelto daily but my GP has no problem with short courses (up to 5 days) of up to 200mg Celecoxib, with food.

Not sure if Nurafen is a NSAID but he also is OK with longer course of that (once daily only).

Do you think I might query him about this?

Because I saw a few patients on both with brain bleeds. now could have just been the anticoagulant as it is a known side effect.

However way back in the past -80s- we had been using heparin after a heart attack. The reason officially was that we were preventing blood clots because we also insisted on bed rest after a heart attack. But when 2 of my first 10 patients that weren't given heparin died of blood clots I went back to using heparin. A few years later the results of the Monica study were released - a WHO study comparing results of treating heart attacks in a CCU between rural and teaching hospital. My hospital was rural and turned out to have statistically significant less mortality and heart failure than the teaching hospital despite the fact that they limited CCU treatment to people under 65 whilst I treated all ages.

So although the official teaching now is that you can take both it wasn't initially when the newer anticoagulants were introduced.

 

[Flashback]

Because I saw a few patients on both with brain bleeds. now could have just been the anticoagulant as it is a known side effect.

However way back in the past -80s- we had been using heparin after a heart attack. The reason officially was that we were preventing blood clots because we also insisted on bed rest after a heart attack. But when 2 of my first 10 patients that weren't given heparin died of blood clots I went back to using heparin. A few years later the results of the Monica study were released - a WHO study comparing results of treating heart attacks in a CCU between rural and teaching hospital. My hospital was rural and turned out to have statistically significant less mortality and heart failure than the teaching hospital despite the fact that they limited CCU treatment to people under 65 whilst I treated all ages.

So although the official teaching now is that you can take both it wasn't initially when the newer anticoagulants were introduced.

Mrs FB still won't touch ibuprofen since her stroke 12.5 years ago. She also had a bleed on the brain too. Initially due to medical advice (I.e., told not to) and the tablets she was on after, and now... actually I'm not sure she's ever been told it is OK to use them again, so she doesn't. It must have done her some real damage, she married me 2 months after the event

 

[Pushka]

Because I saw a few patients on both with brain bleeds. now could have just been the anticoagulant as it is a known side effect.

However way back in the past -80s- we had been using heparin after a heart attack. The reason officially was that we were preventing blood clots because we also insisted on bed rest after a heart attack. But when 2 of my first 10 patients that weren't given heparin died of blood clots I went back to using heparin. A few years later the results of the Monica study were released - a WHO study comparing results of treating heart attacks in a CCU between rural and teaching hospital. My hospital was rural and turned out to have statistically significant less mortality and heart failure than the teaching hospital despite the fact that they limited CCU treatment to people under 65 whilst I treated all ages.

So although the official teaching now is that you can take both it wasn't initially when the newer anticoagulants were introduced.

May I ask how you can tell the difference between a brain bleed and a stroke for someone who is on warfarin and with correct INR and not having taken any ibuprofen etc? As in my mum who succumbed and at her age no autopsy. Which may of course be complicated by the fact that she may well have had undiagnosed APS as well?

 

[Seat0B]

Every time I lower the dose the PMR literally creeps back in. The rheumatologist isn't concerned about me being on it, nor is the GP, but I am. Just concerned about osteoporosis. Rheumatologist is considering methotrexate as a sparing agent but

This happens to my mum too. She is stuck at 5mg dose and cannot get it lower without awful return of PMR symptoms.

 

[Pushka]

This happens to my mum too. She is stuck at 5mg dose and cannot get it lower without awful return of PMR symptoms.

That's interesting. 5mg is where the natural cortisol production is supposed to kick back in. Clearly it doesn't. I've been having issues with shoulder blade, just one side. Thought it was a pinched nerve, muscle strain and so on. I'd got down to 2mg when it started, as I didn't get shoulder pain when first diagnosed I didn't attach it to PMR. Increased the dosage to 3 because muscle pain in other arm, then up to 4 and now 5. Shoulder pain gone. Dr Google says PMR. Anyway guess the rheumatologist will be happy as it shows she was right and her patient was being stubborn, and wrong.

 

[Quickstatus]

I'd be surprised if there isn't something a plastic surgeon couldn't do?

A hand surgeon might be able to replace the joint

Not sure if Nurafen is a NSAID

Yes


The issue of NSAID and anticoagulants is a complex subject.

They all increase the risk of coronary thrombosis in people with heart disease , and/or those with coronary stents. On the other hand they also increase the risk of bleeding especially in people on anticoagulants.

Whats that you say - Thrombosis AND bleeding?. Yes - it can increase the risk of heart attack from thrombosis of the coronaries, and risk of bleeding in people with antiplatelet medicines like aspirin and clopidogrel. The association with thrombotic stroke is less clear.

Then there are NSAIDS and there are NSAIDS. Some, the "COX2" NSAIDS have lower risk of bleeding. These include Celecoxib and Meloxicam. But the increase in risk of coronary thrombosis appears to be higher across all NSAIDS (though some studies suggest there is ethnic variability so it is actually more complex -(for example a Korean study suggests celecoxib and meloxicam is OK in heart disease)

So:
Use NSAIDS at the lowest dose and for the shortest period of time. Consider a COX2 like Celecoxib and Meloxicam if you are worried about bleeding.
But if you have coronary disease, no.

 

[tgh]

But if you have coronary disease, no.

…..Oh…

 

[Quickstatus]

…..Oh…

Unless you are Korean according to one study