General Medical issues thread

[markis10]

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.

Good interview on the 612 Brisbane drive program yesterday at the 19min mark with a transplant survivor and his experience,

 

[Flyfrequently]

On a lighter note, today I'm a week post op from left calf SCC excision and graft with right thigh donor site.
To all the health professionals out there (am one - albeit retired now) who say
"Don't get the dressings wet, just shower with a plastic bag" - it isn't that easy

Think Mr Flyfrequently might just renovate our bathroom for our advancing years!

 

[hydrabyss]

Good interview on the 612 Brisbane drive program yesterday at the 19min mark with a transplant survivor and his experience,

Thanks for posting I found that very interesting. I know from my experience when it comes to what you take and what you do the more you ask and know the better off you will be. Although there are somethings especially those out of your control I would rather not have to think about as being told you need a transplant can be tough but also a second chance if your suitable.

 

[Quickstatus]

Tramadol which is more direct acting.

Tramadol is not direct acting for the opiate effect but is direct acting for the other effects.
It is like codeine - a prodrug. It has to be metabolised to the active drug for the opiate effect, though it is not metabolised to morphine.

So like codeine some people find it does not work and others find it too strong

Codeine is problematic because there is a small group of people called ultrafast metabolisers. This means they are extremely efficient in converting codeine to morphine. It is not recommended in paediatrics because there have been the very rare death because a small child turned out to be an ultrafast metaboliser. Luckily none in Australia but here is a TGA report

Tramadol is less problematic but same precautions apply.

 

[andye]

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

View attachment 479479

Its not something I'd specifically heard about. Seems to be quite recently described (great acronym) but plausible and similar surgeries are performed for trigeminal neuralgia and tinnitus. Neither are 100% succesful.
Any surgery would be next to the brain rather than in it. I'd be keen to ask how many procedures the surgeon has done previously

 

[Beano]

Tramadol is not direct acting for the opiate effect but is direct acting for the other effects.
It is like codeine - a prodrug. It has to be metabolised to the active drug for the opiate effect, though it is not metabolised to morphine.

So like codeine some people find it does not work and others find it too strong

Codeine is problematic because there is a small group of people called ultrafast metabolisers. This means they are extremely efficient in converting codeine to morphine. It is not recommended in paediatrics because there have been the very rare death because a small child turned out to be an ultrafast metaboliser. Luckily none in Australia but here is a TGA report

Tramadol is less problematic but same precautions apply.

and I was told Tramadol was directly accessible. Probably explains why Tramadol is great for me either. I'll stick to the paracetamol.

 

[Seat0B]

Thanks to all those who responded to my posts yesterday and to @Quickstatus and @andye for valuable input

 

[Beano]

and I was told Tramadol was directly accessible. Probably explains why Tramadol is'nt great for me either. I'll stick to the paracetamol.

*isn't

 

[Cossie]

So, visit today, he said basically nothing wrong with the mechanics of my knee, said the meniscus tear wasn't worth worrying about, I have a little bit of arthritis.
When I asked why I was in so much pain and could hardly walk, he put it down to overuse and carrying my camera bag. I really don't believe that as it was hurting weeks before I left and I nearly cancelled.
Oh well, he is meant to be one of the best, if not the best Knee/hip person in Canberra.
He suggested I go and do the GLAD programme and go to my GP if I am still having issues. Honestly, I feel like I wasted my time, I think I have a very high pain threshold, so I was surprised to be in agony even though I was taking anti inflammatories and panadol osteo.

 

[RooFlyer]

Oh well, he is meant to be one of the best, if not the best Knee/hip person in Canberra.

I’ll see my GP but Id ask for a referral for a second specialist for a second opinion.

Best - bah! It’s not his pain.

 

[Beano]

So, visit today, he said basically nothing wrong with the mechanics of my knee, said the meniscus tear wasn't worth worrying about, I have a little bit of arthritis.
When I asked why I was in so much pain and could hardly walk, he put it down to overuse and carrying my camera bag. I really don't believe that as it was hurting weeks before I left and I nearly cancelled.
Oh well, he is meant to be one of the best, if not the best Knee/hip person in Canberra.
He suggested I go and do the GLAD programme and go to my GP if I am still having issues. Honestly feel like I wasted my time, I think I have a very high pain threshold, so I was surprised to be in agony even though I was taking anti inflammatories and panadol osteo.

That's how it starts. An X-ray should identify the extent of the problem Mine must have escalated quickly to no cartilage between bones, and now have a TKR in right knee. All still good after 4 years. Left knee was identified then as having arthritis but hasn't developed significantly. Good luck. I still have some minor pain in both knees.

 

[Flyfrequently]

Surgical review this morning, pathology results as expected SCC (Bowen's) completely excised. - I would hope so!
Graft site redressed, donor site dressing to come down next week.
Not that I'm counting, but another 7 showers with a plastic bag

 

[tgh]

Cossie, your knee is likely quite saveable.
If the structure is largely intact , just rest and drugs are a path to more pain and a declining sedentary lifestyle.
You could try an exercise physio for some specific exercises with enough pain management support that you can and will do them.
Sadly the only way to maintain an active life is…activity

 

[Quickstatus]

suggested I go and do the GLAD programme

You could try an exercise physio for some specific exercises

Othewise known as GLAD - is good

If Glad not beneficial can try a Genicular nerve RFA

 

[VPS]

So, visit today, he said basically nothing wrong with the mechanics of my knee, said the meniscus tear wasn't worth worrying about, I have a little bit of arthritis.
When I asked why I was in so much pain and could hardly walk, he put it down to overuse and carrying my camera bag. I really don't believe that as it was hurting weeks before I left and I nearly cancelled.
Oh well, he is meant to be one of the best, if not the best Knee/hip person in Canberra.
He suggested I go and do the GLAD programme and go to my GP if I am still having issues. Honestly, I feel like I wasted my time, I think I have a very high pain threshold, so I was surprised to be in agony even though I was taking anti inflammatories and panadol osteo.

I did the GLAD program but if it was me I would be finding a really good physio and maybe a podiatrist to see if the way you are walking is irritating something. After seeing one practice for a few weeks with issues with my Achilles I went to someone at different practice last week and the advice is very different and I feel much more positive about the outcome

 

[prozac]

So, visit today, he said basically nothing wrong with the mechanics of my knee, said the meniscus tear wasn't worth worrying about, I have a little bit of arthritis.
When I asked why I was in so much pain and could hardly walk, he put it down to overuse and carrying my camera bag. I really don't believe that as it was hurting weeks before I left and I nearly cancelled.
Oh well, he is meant to be one of the best, if not the best Knee/hip person in Canberra.
He suggested I go and do the GLAD programme and go to my GP if I am still having issues. Honestly, I feel like I wasted my time, I think I have a very high pain threshold, so I was surprised to be in agony even though I was taking anti inflammatories and panadol osteo.

We'll start calling you George Costanza ...

 

[andye]

My experience of Orthopaedic Surgeons is that they really enjoy operating. If an experienced one says no, there is good evidence for non-surgical management strategies being helpful (and can conserve the cartilage for another day)