General Medical issues thread

[Solid]

Called up the OT driving people. They want $1500 for the assessment and say it will be at least annually! Everyone has their hands in our pockets. The neuropsychology consult was $1960 with no medicare rebate. The neurologist costs a bucket too. Says come back in 5 months and in the same breath says there is no cure.
She scored a few wronguns on the mini mental state examination with questions like what is the date today? I couldn't readily answer that one myself because I have no reason the check dates.
MrsP going to think about it but likely will hand in her license.

I know it feels like a loss of independence but $1500 would cover a lot of Ubers in a year.

 

[Quickstatus]

If it ain't broke don't fix it?....

Yes But what is your definition of broke?.

 

[Flyfrequently]

I'm only early stages of cataracts.

As long as you have your eyes checked and cataracts monitored, the decision remains yours until you or your health practitioner feel it is time @JohnK

I was reading that cataract surgery was 98%-99% successful. With my luck I'm thinking what happens to the 1%-2% that are not successful.

With any procedure there is always a risk

If it ain't broke don't fix it?....

There will come a time, as I suggest, maintain regular check ups.

 

[RooFlyer]

If it ain't broke don't fix it?....

My ophthalmologist explained it in terms of risk. If the risk of the op is more than then problem at hand - don't have it done. If the problem becomes large in comparison to the risk - get it done. But the doctor assesses this - they know the risks and they also know your eye's performance. But I'm guessing you'd want t be the judge, not them?

 

[JohnK]

Yes But what is your definition of broke?.

I can still see using glasses and any condition is not life threatening.

Something unrelated but it would appear that right knee is now bone on bone. Very painful. Ive seen/heard horror knee/hip/shoulder replacement stories.

Thats a tough one.

With any procedure there is always a risk

There will come a time, as I suggest, maintain regular check ups.

I have eye check-ups every 6-9 months. I'm 61 and we've only just recently noticed cataracts. No rush for any surgery.

 

[drron]

And I have a very good story of a knee replacement. I was walking normally with a better than average flexion in my knee. Driving in the second week without permission.
And now 10 years since it was done now the only major joint that doesn't give me pain.

I have spinal canal stenosis and have had sciatica in both my legs.
Next compression fracture of L2. happened as I walked into the IC Sydney and had to walk past the red bandana guy. I blame him.
15 years of a sensory motor peripheral neuropathy with bilateral foot drop worse on left side. That causes a tendonitis in front of the ankle. Tendonitis of the left hip.
Bursitis of the right hip.
Decreased movent right shoulder after dislocations.
Then gout or pseudo gout can occur in any joint.

Walking this year has been a real problem but i know that with my loss of muscle mass I need to keep walking. Some days that means most of my day is walking slowly with short rests to settle the pain. However in the last 3 weeks I realised 2 things. First some of the pain in my left ankle and left hip was actually sciatica. Doubled up my medication and it settled and after 5 days going back on my usual dose it returned. So I am continuing on the double dose. My GP knows.

As well thought that the foot drop on my left side may be the partial cause of the tendonitis. I could get my left shoe modified through the podiatrist at a fairly substantial cost for each shoe. but I thought that a sliding motion of my left foot when walking might help. It has helped a lot and so think I will be able to do some walks on our next trip starting on Monday.

So John have your knee looked at by your GP and then Orthopaedic surgeon. If they think you should have a knee replacement then get it done. But follow the post operative instructions they give and only make a change to those instructions if you are progressing faster than they thought.

 

[prozac]

I have spinal canal stenosis and have had sciatica in both my legs.
Next compression fracture of L2. happened as I walked into the IC Sydney and had to walk past the red bandana guy. I blame him.
...

Could have been worse. Might have been double trouble.

 

[mrsterryn]

And so the two yearly medical tests start again lol for husband
I don't mind his maintenance various appointments just don't need to have to have new specialists for him (I hope )

 

[Flashback]

Another GP visit and another.... batted away result. So hard to get any help in the UK unless you're rich and can afford to go private (yes, even for GPs!).

 

[JohnK]

So John have your knee looked at by your GP and then Orthopaedic surgeon. If they think you should have a knee replacement then get it done. But follow the post operative instructions they give and only make a change to those instructions if you are progressing faster than they thought.

X-ray already done earlier today. Will see GP next few days. My guess is osteoarthritis. I can't see an easy solution.l

Knee replacement for someone with osteoarthritis in both hips, ankles and feet is major surgery and recovery depends on being somewhat fit. I struggle to walk. I will struggle with any exercise plan. I cannot afford not to be able to drive for 4-6 weeks. Recovery for me may take more than 6 months.

This is a tough one. I'm not ready but need to look for alternatives.

 

[Seat0B]

When I ruptured my quad I became convinced of the superiority of tapentadol (Palexia) over oxy. Got off as soon as I could but has changed my practice with my own patients

I really can't take Endone as it just turns me into a total zombie who would sleep for 23 hours a day left to my own devices. So I managed a total knee replacement in 2015 on Panadeine Forte. Imagine my joy and delight to be given Palexia for some hand surgery in 2021! It worked very well to alleviate pain for me, and I was not a zombie!

 

[Seat0B]

Ive seen/heard horror knee/hip/shoulder replacement stories.

Just want to encourage you @JohnK.

I have both my knees replaced - one in 2003 at the age of 43, the other in 2015 at the age of 55, both due to very severe osteo arthritis.

The relief from the arthritic pain (which was bad) was almost instant from the moment I woke up from the surgery. Sure, I had surgical pain, but that felt different, and actually less than the arthritic pain. As I just mentioned above, I did my 2015 knee replacement on Panadeine Forte, which was prescribed, so not hard to get.

Then I did a week of residential rehab - game changer - followed by an 8 week outpatient rehab program and regular physio for a further 3 months. Yes a lot of this was painful and caused swelling at the time, but I just kept on doing the work, on icing my knee and taking Panadeine Forte and later on, Panadol Osteo.

And now, my knees are fantastic. I am a 65 year old woman and I can deadlift 80kg, squat 85kg and ski the pants off many younger people.

I don't know why people always want to over- exaggerate surgical stuff. It's not kind or helpful. Just like those women who delight in telling the newly pregnant their horror birth stories.

A positive attitude will win out every time. It's only as bad as you let it feel.

 

[Seat0B]

I have newly diagnosed osteopenia .

I happily toddled in for my DEXA scan the other day, knowing that at my last scan in 2018 I was nicely above the age relevant line on the chart. I do a lot of weight bearing exercise (as noted in previous my post), and lead a quite active life. But pride goes before a fall (boy I must watch out for falls now) and I am now below the line for my age (65). T score femoral head is -1.2, and lumbar spine is -1.5.

I confess to feeling a bit bummed out about this, even though I know it is very mild. Just not what I was expecting given previous better results.

Any advice?

 

[TheRealTMA]

I have newly diagnosed osteopenia .

I happily toddled in for my DEXA scan the other day, knowing that at my last scan in 2018 I was nicely above the age relevant line on the chart. I do a lot of weight bearing exercise (as noted in previous my post), and lead a quite active life. But pride goes before a fall (boy I must watch out for falls now) and I am now below the line for my age (65). T score femoral head is -1.2, and lumbar spine is -1.5.

I confess to feeling a bit bummed out about this, even though I know it is very mild. Just not what I was expecting given previous better results.

Any advice?

Prolia injection.

 

[Quickstatus]

Panadol Osteo.

It's weird. There are no technical reasons why Panadol Osteo should be better than bog standard Panadol. The 24hr paracetamol dose is the same but many patients swear osteo is better

Drug manufacturers love it cos they can charge more $/gram of paracetamol

T score femoral head is -1.2, and lumbar spine is -1.5.

Great numbers TBH
Biphosphonates/antiresorptives only PBS when T < -2.5.
No PBS subsidy for < -1.5 unless on steroi_s

Skeletal health optimisation:
Excercise
Alcohol consider minimising
Smoking stop
Post menopausal hormonal replacement - yes yes yes

Calcium - there are some which have better "available" calcium than others
Vit D

IV biphosphonates like Aclasta often only need once a year.

Subcutaneous Denosumab like Prolia 6montjly

Oral biohosphonates like Fosamax need to take frequently

In your case assuming no steroi_s, no minimal trauma fracture, just maintain healthy lifestyle, exercise, alcohol consideration, stop smoking.

Some people want to consider biphosphonates but it will be not PBS subsidised if T is not worse than -2.5. Speak with your local endocrinologist.

 

[Seat0B]

It's weird. There are no technical reasons who Panadol Patel should be better than bog standard Panadol. The 24hr paracetamol dose is the same but many patients swear osteo is better

Drug manufacturers love it cos they can charge more $/gram of paracetamol


Great numbers TBH
Antiresorptives only PBS when T < -2.5.
No PBS subsidy for < 1.5 unless on steroi_s

Skeletal health optimisation:
Excercise
Alcohol consider minimising
Smoking stop
Post menopausal hormonal replacement - yes yes yes

Calcium - there are some which have better "available" calcium than others
Vit D

IV biphosphonates like Aclasta often only need once a year.

Subcutaneous Denosumab like Prolia 6montjly

Oral biohosphonates like Fosamax need to take frequently

In your case assuming no steroi_s, no minimal trauma fracture, just maintain healthy lifestyle, exercise, alcohol consideration, stop smoking.

Some people want to consider biphosphonates but it will be not PBS subsidised if T is not worse than -2.5. Speak with your local endocrinologist.

Thanks a lot for all these things to discuss with my doc, @Quickstatus. I really appreciate the help steering me towards the things I need to ask for advice and info about - sometimes my GP is so busy I feel he doesn’t always have the time to just respond fully to a broad question like “what’s your advice?” Also good to hear that the numbers aren’t too bad in your opinion. I guess I was just a bit shocked by the graph - I was well above the average for age last time and this time, have fallen below average, despite not really changing my lifestyle except for the better! Unless the chemo had something to do with it?

I’ve had no fractures, never smoked, and haven’t been drinking at all since chemo went and spoiled the taste of wine! I have previously had low Vitamin D, but last blood test was normal. Might ask for that to be tested again.

When you say no steroi_s, would that include occasional use of Symbicort puffer - I don’t have asthma, but do have a diagnosed hyper-reactive upper airway that sometimes responds to Symbicort to prevent laryngospasm. I don’t take it every day, but some days use it 3 times. And I did have some HRT during the actual menopause years but not on it now - is that something that should be considered?

Thanks, send your bill!

 

[Quickstatus]

I feel he doesn’t always have the time to just respond fully to a broad question like “what’s your advice?”

I thought you might say that . Hence the last paragraph:

Speak with your local endocrinologist

Inhaled corticosteroids long term much less risk of OP than oral corticosteroids. I would check with gynae and endocrinologist re HRT question

Interestingly there is calcium and there is good calcium. A lot of calcium supplements (inorganic) are actually not good. There is evidence that suggest it just clogs up the arteries. Naturally sourced Calcium better. (I didn't know this)

Mrs QS is on this Calcium (recommended by her Endocrinologist who said don't take inorganic calcium): The other good calcium source is Almonds but calorie rich

 

[Seat0B]

I thought you might say that . Hence the last paragraph:



Inhaled corticosteroids long term much less risk of OP than oral corticosteroids. I would check with gynae and endocrinologist re HRT question

Interesting there is Calcium and there is good calcium. A lot of calcium supplements are actually not good. There is evidence that suggest it just clogs up the arteries. Naturally sourced Calcium better. (I didn't know this)

Mrs QS is on this Calcium (recommended by her Endocrinologist who said don't take inorganic calcium): The other good calcium source is Almonds but calorie rich

View attachment 442854

Thanks so much, this is very helpful info.

 

[Quickstatus]

With the biphosphonates I mentioned above it is recommended to have a treatment holiday - ie a few years without it after being on it for several years. Endocrinologist will have details

 

[RooFlyer]

The 24hr paracetamol dose is the same but many patients swear osteo is better

Being higher dose (665 vs 500mg and I think slower release) it means 3 doses a day 8 hrs apart to get 24 hr coverage rather than needing to take a 4th dose in the middle of the night to get 24 hr coverage. I take mine at 7am, 4pm and 10 +/-pm