General Medical issues thread

[Quickstatus]

Interesting though i do not see it offered on local hospital cardiac websites.

Not mainstream yet and as I i understand, it is a niche offering. only some patients are suitable - if you can find a cardiologist that offers it.

 

[prozac]

Not mainstream yet and as I i understand, it is a niche offering. only some patients are suitable - if you can find a cardiologist that offers it.

It seems it is a last ditch effort procedure. I would have thought you'd have pieces of plaque flying through the blood to give you a quick stroke somewhere. The explanation says not and pieces very small. Just wanting to stay informed.

 

[Quickstatus]

Not a topic I suspect I can broach successfully.

The Sestamibi heart scan and other investigations is only to determine medical suitability for surgery and anaesthetic.

Surgery only puts a new knee joint in, but the outcome of a TKR is not that a new joint is put in. It is what happens to the knee function after a new knee joint is put in. When a knee deteriorates, the muscles that move the knee get used less so they atrophy. Once a new knee is put in the muscles don't magically go back to normal. Anything that can be done to improve the muscles before hand only improves the TKR outcomes.

It is also well known that High BMI is associated with poorer outcomes after a TKR.
Its hard enough to be back on your feet the day of or day after a TKR (which is the immediate goal after a TKR) let alone while carrying extra 40-50kg on your back doing so.

Therefore "Prehab" is as important as Rehab.
Outcomes can be quite positive and life changing but there is a lot to do between now and March to get there. At least there is some time.
Father needs to get his leg muscles as strong as possible and optimise his medical issues, lose weight prior to surgery in order to gain the best outcome possible.

 

[drron]

Not a topic I suspect I can broach successfully.

Which is sad because it is the most effective way of getting a better result from surgery. In fact in some cases the outcome is surgery is no longer needed.

Just wondering if there has been any advancements in angioplasty procedures past few years. Someone suggested to me recently that arterial plaque could be physically removed. I was skeptical (very).

When angioplasty was first done stents had not been invented and it was balloon angioplasty. In 1992 I had the privilege of looking after the first ever proceedure done in 1962 at St. Vincents hospital Sydney in 1962. He obviously survived and had no cardiac events since. He had a negative sestamibi test. his Cardiologist though had died.

 

[tgh]

Rotational coronary arthrectomy.. is the reason I am still here...

 

[prozac]

Rotational coronary arthrectomy.. is the reason I am still here...

Heart or limb? Did they stent afterwards?

 

[andye]

It seems it is a last ditch effort procedure. I would have thought you'd have pieces of plaque flying through the blood to give you a quick stroke somewhere. The explanation says not and pieces very small. Just wanting to stay informed.

Its been knocking around for about 20 years but yes uncommon probably as need high technical skill level. Stroke risk shouldn't be higher than other interventions unless the lesion is at origin of coronary artery. Main complication issues are dissection or perforation of coronary artery

Here is an (oldish) European overview

European expert consensus on rotational atherectomy

European expert consensus on a standardized protocol for performing rotational atherectomy to treat heavily calcified coronary lesions.

eurointervention.pcronline.com

 

[tgh]

Heart or limb? Did they stent afterwards?

Heavily calcified lad , all in one spot….. rotablator + stent
No heart attack , just raised bp that sent me to seek help , back to normal bp and fit as a mallee bull to boot…..

 

[Quickstatus]

you'd have pieces of plaque flying through the blood to give you a quick stroke somewhere.

worst is a dissection (split in the coronary wall causing a collapse and blockage). The bits of drilled material is very small

 

[tgh]

worst is a dissection

..leads to..
Opine that rotablation should take place in the best full service cardiac facility one can find.
Yes the procedure has stellar results but if the excreta hits the revolving object.. open heart surgery may be moments away….
I might say that all this wisdom comes from hindsight and I did not really have a clue in the heat of the moment.

 

[Quickstatus]

rotablation

And stenting for that matter, though so think the risk would be lower (but not zero) for standard stenting

 

[tgh]

Interesting that such complex procedure has such a stellar success rate, who remembers the first heart transplant ?

The first human heart transplant and further advances in cardiac transplantation at Groote Schuur Hospital and the University of Cape Town - PMC

 

[prozac]

worst is a dissection (split in the coronary wall causing a collapse and blockage).

I've had a dissected LAD and can vouch for discomfort level.

The bits of drilled material is very small

Understood this when I read up on it. My comment was my preconception that bits might travel.

 

[Quickstatus]

bits might travel

Too small to cause issues - apparently...

 

[JohnK]

Plus a determined effort at weight deduction before the knee replacement.

What do you call determined? 1-2 salads a day + vegetables or just starve?

Hospital food is the only way to lose weight.

 

[drron]

John I heard that many times over my career. As a mentor of mine once said The commonest cause of obesity is caloric amnesia.
Sorry I see your pictures on here about your bargain buys plus the pictures of them cooked. They certainly don't look like 1-2 salads a day.
One problem is in Australia the cheaper the meat the higher the fat content so the higher the caloric intake.

Another major problem people have when trying to lose weight is expecting the results in a short time when to be really successful it takes a long time so that behaviour is changed for the long term.

I can use my own example now. I retired on 1/3/22. I determined I needed to finally really do something about my weight. So I cut down the amount I ate. Not a diet. I still ate the foods I wanted to just less. I still had a large glass of red wine or a G&T in the evening but didn't have any more. The second part was that I increased my exercise. In my case it was walking and I tried to keep above 10000 steps per day. That has been hard at times as I have severe spinal canal stenosis at L3/4. I also have had a peripheral neuropathy for 14 years with a lot of muscle atrophy. There is basically not a time when I am pain free. There are times when I struggle to get to 4000 steps a day. So I have to make up for it when feeling a bit better.
It has not been helped by my developing Atrial Fibrillation and despite being on anticoagulation have had 2 brain stem emboli causing more trouble with balance and some right sided weakness.

When I began this journey I set a target of 81Kg from a starting weight mid February of 115Kg. It took me ~ 18 months to reach that target. Since then my weight varies from 78 - 81Kg. If I eat more or walk less my weight goes up so I cut back a bit more on food and increase steps to get back on track. So that is what I mean by determination.

 

[Himeno]

So for this UTI, they gave me a 7 day course of antibiotics with enough in the box for 7 days.

If the required course was in the one box, why does the script have a repeat?

 

[prozac]

John I heard that many times over my career. As a mentor of mine once said The commonest cause of obesity is caloric amnesia.
Sorry I see your pictures on here about your bargain buys plus the pictures of them cooked. They certainly don't look like 1-2 salads a day.
One problem is in Australia the cheaper the meat the higher the fat content so the higher the caloric intake.

Another major problem people have when trying to lose weight is expecting the results in a short time when to be really successful it takes a long time so that behaviour is changed for the long term.

I can use my own example now. I retired on 1/3/22. I determined I needed to finally really do something about my weight. So I cut down the amount I ate. Not a diet. I still ate the foods I wanted to just less. I still had a large glass of red wine or a G&T in the evening but didn't have any more. The second part was that I increased my exercise. In my case it was walking and I tried to keep above 10000 steps per day. That has been hard at times as I have severe spinal canal stenosis at L3/4. I also have had a peripheral neuropathy for 14 years with a lot of muscle atrophy. There is basically not a time when I am pain free. There are times when I struggle to get to 4000 steps a day. So I have to make up for it when feeling a bit better.
It has not been helped by my developing Atrial Fibrillation and despite being on anticoagulation have had 2 brain stem emboli causing more trouble with balance and some right sided weakness.

When I began this journey I set a target of 81Kg from a starting weight mid February of 115Kg. It took me ~ 18 months to reach that target. Since then my weight varies from 78 - 81Kg. If I eat more or walk less my weight goes up so I cut back a bit more on food and increase steps to get back on track. So that is what I mean by determination.

Great explanation @drron and congratulations on your determined success. I have cut back a bit but my exercise regime is difficult due angina. (more about that this afternoon). I do actually loose weight in hospital, usually 1kg per day and I eat well, ordering a lovely large mixed salad with steamed chicken breast. Last time their the nutritionist dropped in and observed I didn't have any carbs in my meals and I needed carbs to control the chemo induced (actually the preds) diabetes. Actually have wondered if the weight loss I experienced in hospital was muscle wastage.

 

[tgh]

Dr.Ron you are an ornament to longevity ambition .. long may you remind us that we are largely masters of our fate

 

[Pushka]

Dr.Ron you are an ornament to longevity ambition .. long may you remind us that we are largely masters of our fate

Yes but tell that to my immune system over which I have no control. It runs its own warfare on me. Don’t smoke never have. Don’t drink much these days. BMI 21. Nothing more I can do. But stuff still happens.