General Medical issues thread

[Quickstatus]

Back in Sydney today

Welcome to Sydney. I wondered why the weather changed to Hobart.

I too had eye test today for prescription renewal. No change in 2.5 years since previous prescription. Apparentlt also no AMD

 

[pagingjoan]

really? Why? Besides the obvious.

Following a diagnosis of malignant glaucoma more than ten years ago and umpteen surgical procedures, I have been having a set of those tests also. Declining frequency now, but was originally multiple times a year. Down to annual testing the past couple of years.

 

[RooFlyer]

@VPS - why would you have the test every year if you don’t have any symptoms? ( Poor dark adaptation in an eye)

 

[VPS]

@VPS - why would you have the test every year if you don’t have any symptoms? ( Poor dark adaptation in an eye)

monitoring to see what the changes are - occasionally they get concerned and I'll have to have a repeat in 6 months

 

[tgh]

Anyone know what is the difference between an everyday field test and Rooflyers procedure ?

 

[Quickstatus]

Anyone know what is the difference between an everyday field test and Rooflyers procedure ?

Viaion is made up of a combination of central vision and peripheral vision.

The tests for each are different.

Dark adaptation is a test for central vision specifically the ability of the Rods in the macula to recover sensitivity in the dark after exposure to bright light.

Rods are the retinal cells in the macular which enable low light vision and Cones are the retinal cells in fhe macular which enable colour vision

 

[RooFlyer]

Dark adaptation is a test for central vision specifically the ability of the Rods in the macula to recover sensitivity in the dark after exposure to bright light.

That doesn't really describe the nature of the test I had (didn't seem to test central vision) . But I also thought the DA test was poorly controlled and I'm not optimistic that the results will make much sense. Not impressed with the Sydney Eye Hospital in general. Disorganised, messages not passed on, rushed sometimes, long delays other times ... I had to almost force someone to sit down so I could tell them the reason why I was there - what my symptoms are, so they can relate the report to me, not just something in the ether.

 

[Quickstatus]

test central vision

Its all part of the central vision. Thats what the macula is for

You become just another number undortunately when you are at a quaternary referral centre.

 

[prozac]

Back to the skin specialist yesterday. Very happy with the way the crater in my scalp is healing and the other cancers around it. Should be after 2 x 30 day Efudex treatments and another 14 day. Zapped one solar keritosis that looked like it might be trying to happen again, iced a patch each side of my face (side-burns), top of ear, a number of warty things that have appeared since chemo in a semi-circle between collarbones each side, and a 10c sized sun spot on side of my neck. Instructions to Efudex below each cheek bone for 14 days. I love a sunburnt country ...

Dragged MrsProzac along to GP today after no-one seems to be on top of her vertigo. Another referral to a neurologist at St Leonards. We get home and I say, 'right give me the referral and I'll make an appointment for you'. It's no-where to be found. Finally after 15 minutes searching I call the surgery and ask if perhaps she left it behind? Sure enough it is still on GP's desk. Did I mention she has become very forgetful this year? A brain scan earlier this year indicated some brain ischemia. I don't know if this means she has had a stroke, we have had an enormous amount of stress past couple of years which resulted in us moving homes. Perhaps that is it. I started her on blood pressure tablets last week. Why did I "start her". Because I found the script amongst paperwork dated March 24. So now I hand her the tablet every night. Good news, her BP down from 156 to 130/80 this morning. GP told her she really needs to keep taking the tablets.

 

[Himeno]

Got sent home from work today after the problem from Wednesday flared up again. It was bearable yesterday, maybe due to the nurofen I had yesterday.
Boss wants me fine for tomorrow.

Headed to the hospital. They changed the SPC early, took clean samples with the new tube, then gave 2 types of IV antibiotics for the UTI. Most of the discomfort now gone. Sent home with a 7 day course of more antibiotics.

 

[mrsterryn]

Curious when do people start seeing a geriatrician? Does the geriatrician take over from your GP? Reason behind asking, for a few maternal generations dementia has been an issue . Knowing there are some excellent "slow down " drugs out there just curious about what and when to consider ?

 

[Quickstatus]

Curious when do people start seeing a geriatrician?

See post #10454 onwards

And here

Your GP is not replaced as a Geriatrician still requires a referral. Given the family history it is worth exploring with your GP and with a referral to a geriatrician

 

[andye]

The new Alzheimer drugs are not approved yet here. It's not just a cost (though the drug and necessary investigations are not cheap) or bureaucracy thing as there are some very significant side-effects.

Although there is some evidence in the mild cognitive impairment group (the group between mild memory problems and definite dementia affecting ability to carry out activities),I suspect any license here would start with people with established early dementia.

I would anticipate a significant delay between any TGA approval and it being approved for PBS subsidy. If widely available, there would also need to be infrastructure investment to administer infusions

 

[prozac]

Having ritux infusion today. I always see my wonderful haematologist prior. There is an increase in LDL (bloods) so I will be having another PET scan to confirm there is no lymphoma activity. The raised LDL combined with fatigue is a potential indicator the lymphoma might have returned. Good news is the local hospital has recently commissioned it's new machine so I don't have to travel far.

 

[lakeman]

Having ritux infusion today. I always see my wonderful haematologist prior. There is an increase in LDL (bloods) so I will be having another PET scan to confirm there is no lymphoma activity. The raised LDL combined with fatigue is a potential indicator the lymphoma might have returned. Good news is the local hospital has recently commissioned it's new machine so I don't have to travel far.

Do you mean LDH ?

 

[prozac]

Do you mean LDH ?

Oh, I don't know. It was the first 2 letters with another one.

EDIT: Just looked up the meaning. Yeah, not the cholesterol one.

 

[RooFlyer]

@RooFlyer
Time to see an electrophysiological cardiologist and get them to do a radiofrequency ablation of the source of the ectopics.

RFA - through the groin as a general anaesthetic. General easier than being awake because it can take a while to be on the table trying to stay perfectly still. . They insert wires and map for the source of the ectopics and then zap it with radiofrequency energy.

OK; that time has come. After my recent bout of flutter, my cardiologist has referred me to an electrophysiologist in a few weeks. I'm relieved.

I'm not worried (so far) but what are the dangers? I'm not keen on having a hole pierced through the septum between atria, notwithstanding my cardiologist said it "was very small" and X% of people have a hole there already.

 

[Quickstatus]

Risks:
Bleeding in groin requiring a vascular surgeon repair.
Cardiac tamponade - wire goes through to the outside of the heart causing the blood to restrict heart pumping efficiency. Need to insert a drain
Trans septal puncture not a big deal
They burn off a bit too much of the electrical pathways causing you to require a pacemaker
Your heart stops requiring a jumpstart
Risk of stroke/TIA
Blood clots in heart/lung

0.1 to 0.5% risk of each of above, probably kess

It does not work and you need a subsequent procedure or it works initially but the Flitter comes back or turns into atrial fibrillation. Success rate 90-95%

Other than that you are OK. In most cases the risk benefit strongly in favour of benefit

 

[Steamrollersam]

Risks:
Bleeding in groin requiring a vascular surgeon repair.
Cardiac tamponade - wire goes through to the outside of the heart causing the blood to restrict heart pumping efficiency. Need to insert a drain
Trans septal puncture not a big deal
They burn off a bit too much of the electrical pathways causing you to require a pacemaker
Your heart stops requiring a jumpstart
Risk of stroke/TIA
Blood clots in heart/lung

0.1 to 0.5% risk of each of above, probably kess

It does not work and you need a subsequent procedure or it works initially but the Flitter comes back or turns into atrial fibrillation. Success rate 90-95%

Other than that you are OK. In most cases the risk benefit strongly in favour of benefit

False aneurysms from vascular access treated with thrombin injection in radiology under CT or ultrasound guidance. Very rare to encounter enough vascular damage to need a vascular surgeon for open repair/stenting.
Transseptal puncture not needed for typical flutter (>98% of flutters sent for ablation) because it’s on the right side of the heart.
Need for permanent pacing non-existent, one isn’t ablating anywhere near the AV node/His. One might need temporary pacing via a catheter already inside the heart for sinus bradycardia, usually few minutes. This is something that’s happened once in 15 years for me.
Cardiac tamponade using irrigated ablation catheters almost unheard of, tends to happen due to heating of cardiac tissue and “steam pops” rather than catheter trauma.
Can’t have a stroke/TIA with a right-sided/typical flutter ablation unless there’s a congenital cardiac defect (patent foramen ovale, etc). Can have a PE I suppose but how unlucky can one be to have a lung clot when taking blood thinners around the time of the procedure and using heparinised irrigation fluid for the procedure.

 

[Quickstatus]

Very rare to need a vascular surgeon for open repair/stenting.

Rare and my vascular surgeon would disagree as he had to fix a few of these pseudoaneurysms . Ive seen a few myself. At my hospital they have stopped using AngioSeal and gone to PerClose.

Transseptal puncture not needed for typical flutter

Agree but i was responding to his comment that they mentioned a transeptal puncture. Any why i said it was not a big deal.

Need for permanent pacing non-existent,

Disagree. We dont exactly know what they are going to do. As a result we can only comnent generally about risk. The treating cardiologist will be able to clarify the risk in the individual case- and this encourages the patient to ask the question.

Cardiac tamponade using irrigated ablation catheters almost unheard of

Again same point as above. BTW ive seen one in flutter ablation. Never say never.

Can’t have a stroke/TIA with a right-sided/typical flutter ablation unless there’s a congenital cardiac defect (patent foramen ovale, etc).

Which is the point that was made about the incidence of a PFO by the treating cardiologist