General Medical issues thread

[Freq Flier 2013]

I needed an x-ray of my hand recently. I had one 10 years previously (image on a big film) and knowing that radiologists like to have something to compare a scan to, I took it to my appointment. It was waved away by the receptionist.

Naturally, the radiologist's new report started "There is no previous imagery to compare ..."

I still have about 6 big x-ray films and will keep 'em.

Medicare receptionists are the worst. I’m my opinion less educated but feel far superior. Bad attitude and seem to know better than the actual doctor / specialist.

 

[Brissy1]

Disturbing article in the Australian today about a report (by interstate authors) into the Qld Prince Charles Hospital heart transplant unit. Some of the issues...
- only performs ½ the transplants it should,
- 12 month post operative mortally rate 150% of international benchmark (including from fungal infections from mould in the hospital room),
- ½ of all donor hearts are sent interstate,
- categorises patients as not medically suitable, who nevertheless then have successful transplants interstate.

When reviewed, waiting list was "surprisingly(sic) small", just 10 suitable persons on the list. So KPIs met .

$5.9M pa allocated to fix the problem. Meanwhile, permanent 50cent bus subsidies in Brisbane area is a $350M continuing cost (in 2024 $) every year.

 

[andye]

Disturbing article in the Australian today about a report (by interstate authors) into the Qld Prince Charles Hospital heart transplant unit. Some of the issues...
- only performs ½ the transplants it should,
- 12 month post operative mortally rate 150% of international benchmark (including from fungal infections from mould in the hospital room),
- ½ of all donor hearts are sent interstate,
- categorises patients as not medically suitable, who nevertheless then have successful transplants interstate.

When reviewed, waiting list was "surprisingly(sic) small", just 10 suitable persons on the list. So KPIs met .

$5.9M pa allocated to fix the problem. Meanwhile, permanent 50cent bus subsidies in Brisbane area is a $350M continuing cost (in 2024 $) every year.

There was a not dissimilar situation in Bristol, UK. Took whistleblowers to uncover and a major scandal. I havent read this report but, on the face of it, mortality should be lower if you reject high-risk patients.

 

[Brissy1]

There was a not dissimilar situation in Bristol, UK. Took whistleblowers to uncover and a major scandal. I havent read this report but, on the face of it, mortality should be lower if you reject high-risk patients.

Interesting, so I looked up 12 month survival rates for St. Vincent Sydney. Non-frail 95%, frail 74%. Send me there. Prince Charles (with their "medically suitable" restrictions so presumably non-frail) 79%. Don't send me there. I see why an administrator wouldn't want frail patients messing up their rates.
I'm old enough to remember the 1st heart transplant (South Africa?) and now we have up to 95% survival. Amazing.

 

[Pushka]

Two things I've noticed after the laser treatment post cataract. I said the second night that the television must have updated its transmission as the picture was so clear. Next morning I realised my sunglasses didn't need cleaning. I'd be cleaning them obsessively. Then I realised it was the result of the laser. Doh. I was still able to read without glasses - yeah - prior to the laser but realise now the clarity wasn't there.

I think I have MrP interested now. He's talking of possible dates . He's a bit jealous and keeps telling me I'm showing off. I'm not. He just keeps asking me what is written.

 

[Himeno]

Broke my elbow a little over 2 weeks ago now. Saw a GP to get the last bit of paperwork workers comp wanted during the week.
GP agreed with fracture clinic about not going back to work in a retail environment until 6 weeks after injury.

Sometimes I feel no pain in the arm, at other times there is a lot and not centered around the area of the break with pain extending down from the elbow and around the wrist.
The pain meds the hospital said to take (just basic paracetamol and ibuprofen) has been doing little to nothing. Is it worth going to a walk in clinic or hospital to see about getting something stronger?

 

[lakeman]

Broke my elbow a little over 2 weeks ago now. Saw a GP to get the last bit of paperwork workers comp wanted during the week.
GP agreed with fracture clinic about not going back to work in a retail environment until 6 weeks after injury.

Sometimes I feel no pain in the arm, at other times there is a lot and not centered around the area of the break with pain extending down from the elbow and around the wrist.
The pain meds the hospital said to take (just basic paracetamol and ibuprofen) has been doing little to nothing. Is it worth going to a walk in clinic or hospital to see about getting something stronger?

Sometimes pain is a sign you have been overdoing things

 

[Quickstatus]

The pain meds the hospital said to take (just basic paracetamol and ibuprofen) has been doing little to nothing.

Is Elbow # in a cast from armpit to wrist

 

[Himeno]

Is Elbow # in a cast from armpit to wrist

no cast, just sling.
fracture clinic said I can stop using it in another 2 weeks.

 

[Seat0B]

So after 17 years with a very severe chronic cough, my current specialist (an ENT in Sydney, the 9th specialist I have seen, plus 2 specialised speech pathologists) has been doing botox shots bilaterally to the superior laryngeal nerve every 3 months since February. This has helped by almost eliminating the laryngospasms (an almost daily occurrence, and terrifying), but has not addressed the coughing at all. I still cough more than 100 times each day, sometimes until I vomit. He ordered an MRI of my brain because he was surprised that the botox was not reducing the cough.

The MRI report notes "left PICA contacts the anterior aspect of the left vagus nerve. No nerve deviation." ENT said this suggests I may have hemi-larnygopharyngeal spasm (HeLPS) and/or VANCOUVER syndrome. He has suggested a neuro-surgical consult to investigate surgical decompression of the nerve.

Along the way, I have been treated with various medications - gabapentin, amytriptaline, dom peridone, anti-histamines, asthma puffers, codeine, reflux medications..., none of which worked. I guess not that surprising if there is a physical issue like a nerve compression?

I've made the "mistake" of googling all this, and feel like the descriptions of symptoms related to HeLPS in particular, are very indicatie of what I have suffered - cough, stridor, vomiting, nausea, headaches, feeling faint/almost blacking out, losing weight (from inability to eat without coughing until I vomit - lucky I was overweight to start with), reflux (which my Gastroenterologist blamed on chemo), fatigue and brain fog (which I blamed on chemo). So perhaps they are FINALLY onto something.

However, I feel a bit daunted by the cough choice of live with the dreadful coughing, that episodically and increasing really makes my life very very miserable, or have brain surgery.

I would welcome comments from anyone who knows anything about this, and particularly advice on what questions I should ask the neurosurgeon to help me make this hard decision.

 

[Quickstatus]

I would welcome comments from anyone who knows anything about this

Never heard of it.
Though trigeminal neuralgia can be due to an cerebellar artery contacting the V cranial nerve (trigeminal nerve)

The Vagus nerve is the X cranial nerve which control the muscles of vocal cords and muscles involved in swallowing

So in a way it makes sense that an artery can compress another cranial nerve.

If trigeminal neuralgia is caused by an artery compressing the V nerve the neurosurgical procedure is to insert a small piece of Teflon material between the artery and nerve = so called microvascular decompression

The access to X nerve and PICA would be from behind the ear

 

[Seat0B]

 

[Beano]

Broke my elbow a little over 2 weeks ago now. Saw a GP to get the last bit of paperwork workers comp wanted during the week.
GP agreed with fracture clinic about not going back to work in a retail environment until 6 weeks after injury.

Sometimes I feel no pain in the arm, at other times there is a lot and not centered around the area of the break with pain extending down from the elbow and around the wrist.
The pain meds the hospital said to take (just basic paracetamol and ibuprofen) has been doing little to nothing. Is it worth going to a walk in clinic or hospital to see about getting something stronger?

I fell heavily on my left elbow and didn't think much of it at the time except some bruising but then later it became very sore. If I twisted my arm it got better. Had an x-ray and eventually ultra-sound. Found a lump on a bone, some voids and small pieces of bone floating around and was suggested an orthopaedic consult with possible surgery. After 4 months it seems to have gotten better so declined. I take diclofenac (aka Voltaran) for a long standing rotator cuff injury. and seems to work with paracetamol. I've also had knee surgery (TKR) and been through most painkillers up to codeine and Tramadol which didn't seem to work. After paracetamol and ibuprufen you would need a prescription. Brufen works for me (very strong ibuprufen) but I can usually get away with the paracetamol and diclofenac. (tried Celocoxib too). As you see, there is plenty of choice, but you should discuss with your medical professional to get the correct product for you.

 

[prozac]

So after 17 years with a very severe chronic cough, my current specialist (an ENT in Sydney, the 9th specialist I have seen, plus 2 specialised speech pathologists) has been doing botox shots bilaterally to the superior laryngeal nerve every 3 months since February. This has helped by almost eliminating the laryngospasms (an almost daily occurrence, and terrifying), but has not addressed the coughing at all. I still cough more than 100 times each day, sometimes until I vomit. He ordered an MRI of my brain because he was surprised that the botox was not reducing the cough.

The MRI report notes "left PICA contacts the anterior aspect of the left vagus nerve. No nerve deviation." ENT said this suggests I may have hemi-larnygopharyngeal spasm (HeLPS) and/or VANCOUVER syndrome. He has suggested a neuro-surgical consult to investigate surgical decompression of the nerve.

Along the way, I have been treated with various medications - gabapentin, amytriptaline, dom peridone, anti-histamines, asthma puffers, codeine, reflux medications..., none of which worked. I guess not that surprising if there is a physical issue like a nerve compression?

I've made the "mistake" of googling all this, and feel like the descriptions of symptoms related to HeLPS in particular, are very indicatie of what I have suffered - cough, stridor, vomiting, nausea, headaches, feeling faint/almost blacking out, losing weight (from inability to eat without coughing until I vomit - lucky I was overweight to start with), reflux (which my Gastroenterologist blamed on chemo), fatigue and brain fog (which I blamed on chemo). So perhaps they are FINALLY onto something.

However, I feel a bit daunted by the cough choice of live with the dreadful coughing, that episodically and increasing really makes my life very very miserable, or have brain surgery.

I would welcome comments from anyone who knows anything about this, and particularly advice on what questions I should ask the neurosurgeon to help me make this hard decision.

I know what the cough is like. For six or so weeks before my cancer diagnosis I was coughing constantly due to the mass wrapped around the pulmonary artery and compressing the recurrent larangeal nerve. Also my voice would occassionally go haywire due to the nerve compression.
Hope you find the cause soon @Seat0B .

Edit: stupid question, what would I know. Some of these symptoms similar to my coughing etc which was an interaction between the left recurrent larangeal nerve and the pulmonary artery. Not in my case but reflux can cause the left larangeal nerve to cause the larynx to spasm causing some of the symptoms you mention.

 

[Seat0B]

I can understand why the range of symptoms is confusing g for doctors. But they are real and I have been repeatedly dismissed.

 

[Pushka]

Broke my elbow a little over 2 weeks ago now. Saw a GP to get the last bit of paperwork workers comp wanted during the week.
GP agreed with fracture clinic about not going back to work in a retail environment until 6 weeks after injury.

Sometimes I feel no pain in the arm, at other times there is a lot and not centered around the area of the break with pain extending down from the elbow and around the wrist.
The pain meds the hospital said to take (just basic paracetamol and ibuprofen) has been doing little to nothing. Is it worth going to a walk in clinic or hospital to see about getting something stronger?

Maybe nerve pain and might be worthwhile checking out? Many nerves running through elbow joint. And usual pain killers won't touch nerve pain.

 

[Beano]

I fell heavily on my left elbow and didn't think much of it at the time except some bruising but then later it became very sore. If I twisted my arm it got better. Had an x-ray and eventually ultra-sound. Found a lump on a bone, some voids and small pieces of bone floating around and was suggested an orthopaedic consult with possible surgery. After 4 months it seems to have gotten better so declined. I take diclofenac (aka Voltaran) for a long standing rotator cuff injury. and seems to work with paracetamol. I've also had knee surgery (TKR) and been through most painkillers up to codeine and Tramadol which didn't seem to work. After paracetamol and ibuprufen you would need a prescription. Brufen works for me (very strong ibuprufen) but I can usually get away with the paracetamol and diclofenac. (tried Celocoxib too). As you see, there is plenty of choice, but you should discuss with your medical professional to get the correct product for you.

PS, you can buy codeine over the counter at a pharmac_, at least you used to. It will be a lower dose than you can get on prescription.

 

[Quickstatus]

PS, you can buy codeine over the counter at a pharmac_, at least you used to.

All codeine products have required prescription since end of 2018. Over the counter S2/S3 codeine products were up scheduled to S4 or taken off the market

 

[Beano]

All codeine products have required prescription since end of 2018. Over the counter S2/S3 codeine products were up scheduled to S4 or taken off the market

I'm sure I could get Codeine but it could have been around that time. 5 mg/100 ml. I was told a script was required for anything stronger.

 

[Beano]

BTW, it didn't seem to work for me. I was on about 12 mg. My GP said that codeine was metabolised to morphine but some people couldn't do that so he gave me Tramadol which is more direct acting. In NZ it was 2020 after which you couldn't get codeine without a script.