General Medical issues thread

[ellen10]

I had my second one 5 weeks ago. Yes sore red arm for almost a week.
Maybe wait until after Christmas @Pushka

 

[SuePa]

I turn 65 in Feb and I'm going to book in for my shangrix straight away.
I've had shingles once and I never want them again ! (Ha, ha, auto correct keeps changing shingrix to shangri-la. )

 

[cove]

Shangri-La hotels are very nice and shingles is the opposite of that.
My mother got shingles around her eyes and it was nasty. We paid for our two shots in Los Angeles several years ago. I think it cost $280 USD per person and I cannot remember if the second shot was a further $280 USD 6 months later.

 

[SuePa]

Shangri-La hotels are very nice and shingles is the opposite of that.
My mother got shingles around her eyes and it was nasty. We paid for our two shots in Los Angeles several years ago. I think it cost $280 USD per person and I cannot remember if the second shot was a further $280 USD 6 months later.

It's truly awful and the pain recurs for months. Well mine did.
I was lucky and got the antivirals early, but I'd hate to have a full-blown dose.

 

[drron]

And watching one of those medico programmes on Netflix they just doscussed the anion gap. What are the chances of that after 8 years of blood tests and never doscussed the anion gap before.

Actually very high chance with most people walking around that have many blood tests will never have a discussion re the Anion Gap as usually it is "normal".
Here is a discussion of it. And note it has CATMUDPILES which we learnt doing Respiratory Medicine.

Biochemistry, Anion Gap - StatPearls - NCBI Bookshelf

 

[Pushka]

Actually very high chance with most people walking around that have many blood tests will never have a discussion re the Anion Gap as usually it is "normal".
Here is a discussion of it. And note it has CATMUDPILES which we learnt doing Respiratory Medicine.

Biochemistry, Anion Gap - StatPearls - NCBI Bookshelf

Thanks. Mine seems to range between 15 and 17 over the last 18 months of monthly tests. 17 being 'upper limit'.

 

[VPS]

If bothanion and osmolar gap elevated then it's alcohol poisoning - ethanol/methanol or antifreeze poisoning. Metabolic acidosis generally also occurs which is part of the anion gap so it's also suspected - in these cases it's going to be bad.


However if anion gap alone, then suspect methanol but never forget diabetic ketoacidosis or (other metabolic acidosis)

Anion gap calculator.
Change units from mEq/L to mol/L
The menu at top lists the differentials including MUDPILERS and HARDUPS etc

Never seen albumin used in Anion Gap - normally Na K Cl HCO3

 

[Quickstatus]

Never seen albumin used in Anion Gap - normally Na K Cl HCO3

K often not used but Albumin is definitely used as a correcting factor under some circumstances

Albumin is the greatest "source" of un- measured anions in the blood under normal conditions. Most of the normal AG is due to albumin. There is a correcting formula for it. Observed AG needs to be corrected especially in cases of abnormal albumin.

But yes in an otherwise healthy person who comes into emergency with symptoms of poisoning, albumin correction would be irrelevant. Where it makes a difference is a patient who is in ICU with low albumin due to illness/malnutrition who has a "normal AG" but once corrected for low albumin actually has a high anion gap.

Edit you can see how albumin is used in the "evidence" section of the MDCalc

 

[Quickstatus]

What is the evidence for yearly /recurrent vaccinations for respiratory illnesses?

 

[Major]

I had my second one 5 weeks ago. Yes sore red arm for almost a week.
Maybe wait until after Christmas @Pushka

I had my 2nd one earlier this year. Sore for 24 hours. No big deal

 

[k_sheep]

I think I slept through MUDPILES in med school but your explanation resulted in some creaky turning of a few cogs in my brain @k_sheep !

You and me both ... I had regrets when I sat my fellowship exams and had to learn it all for that!!

Actually very high chance with most people walking around that have many blood tests will never have a discussion re the Anion Gap as usually it is "normal".
Here is a discussion of it. And note it has CATMUDPILES which we learnt doing Respiratory Medicine.

Biochemistry, Anion Gap - StatPearls - NCBI Bookshelf

Man there's 3 more since I was a trainee? I'm too old for this!

(straight off the bat of sitting an exam today for a post fellowship scope of practice extension....)

I find medicine is often like that.... you never think about something or see it, then you see it 3 times in a week. This week is apparently anion gap week.

 

[prozac]

What is the evidence for yearly /recurrent vaccinations for respiratory illnesses?

My specialist is surprised I have not had any illness or infections throughout my cancer journey. It hasn't been without complications but I haven't been otherwise sick.

 

[Quickstatus]

This week is apparently anion gap week.

The week just gone has been Ozempic/Wegovy Week.
Latest recommendation is to stop these meds including Mounjaro for minimum 3 weeks to 4weeks before any elective surgery.

Lots of patients not telling us they are on Ozempic etc unless you ask specifically.

 

[love_the_life]

Son has only just been able to fill his Ozempic script again as chemists in the area were out of stock and couldn't say when they would get more. His doctor changed him onto another drug to complement the one he has as well as Ozemic and then when the chemist rang this week he is back on the O again. Was about 2-3 weeks.

 

[Pushka]

Son has only just been able to fill his Ozempic script again as chemists in the area were out of stock and couldn't say when they would get more. His doctor changed him onto another drug to complement the one he has as well as Ozemic and then when the chemist rang this week he is back on the O again. Was about 2-3 weeks.

That is extremely disappointing wrong that people who require it medically are facing issues with supplies. Same thing happened to hydroxychloroquine supplies during Covid even for those who'd been using it for years for systemic auto immune issues, thanks to someone in the US and our own idiot in Australia who bought all the supplies.

 

[Flashback]

Shangri-La hotels are very nice and shingles is the opposite of that.
My mother got shingles around her eyes and it was nasty. We paid for our two shots in Los Angeles several years ago. I think it cost $280 USD per person and I cannot remember if the second shot was a further $280 USD 6 months later.

Sorry @cove, laughed at the first line, not the latter.

 

[cove]

Well @Flashback you only need shingles shots if you had chicken pox. Our two sons do not have to bother.
The Shangri-La hotels are very nice.

 

[Flashback]

Well @Flashback you only need shingles shots if you had chicken pox. Our two sons do not have to bother.
The Shangri-La hotels are very nice.

I had it when I was 7 (in grade 2). I remember that I got it on the last day of school term.......... and then through the school holidays. So, no time off. All of my mates parents wanted their kids to have it too, so I was rather popular back then. Lots of play dates.

I think I had 1 day off throughout my whole primary school career.

 

[Freq Flier 2013]

The week just gone has been Ozempic/Wegovy Week.
Latest recommendation is to stop these meds including Mounjaro for minimum 3 weeks to 4weeks before any elective surgery.

Lots of patients not telling us they are on Ozempic etc unless you ask specifically.

What is the reason for stopping them for 4 weeks prior?

 

[Quickstatus]

What is the reason for stopping them for 4 weeks prior?

They have a nasty side effect of reducing gastric emptying which makes the "fast for 6hrs prior to an Op" questionable.

As they are dosed 1/week, they hang around a long time - the effect lingers for up to 4 times that. Currently no one knows what the real answer is, so the recommendations are likely to change as these drugs are better understood.

Another recommendation is to fast from solid food for 2 days but can drink water or clear fluids - sort of like the colonoscopy prep period without the bowel prep.