General Medical issues thread

[Pushka]

1st medical appointment
Although my cataract surgery was 9 months ago and new glasses 8 months ago, vision hasn't been all that good, especially reading.
Several visits back to my optometrist and we finally settled on a new prescription.

Picked my new lens up just now, no double vision and she gave me a considerable discount.
Have been going there for over 25 years.

2nd appointment today will be dentist
And tomorrow, specialist for my SCC

It's just weird how some cataract surgery provides complete vision whilst not in all cases then.

I was looking through all the tests I've done over the last 15 years or so in the health portal. February seems to be my month of "discovery". 10 years ago today it was the discovery of the fist dvt.

 

[Seat0B]

For the last 3 months I have been using chatgpt for understanding my health condition. and at the end it has a list of questions to ask your doctor.

Me too and it has been very helpful.

 

[Pushka]

Me too and it has been very helpful.

It's brilliant isn't it. I have a list of questions now too.

 

[hydrabyss]

Me too and it has been very helpful.

I had used it previously for other things but never more than a few questions at a time. Now realising how in depth you can get on subjects it has sped up what would have taken me hours before can be done in ten minutes.
The only downside is I feel you need some knowledge of the subject and ask for links so you can verify what it is saying. I can see some getting into trouble but also many that would benefit.

 

[Hvr]

 

[Pushka]

I had used it previously for other things but never more than a few questions at a time. Now realising how in depth you can get on subjects it has sped up what would have taken me hours before can be done in ten minutes.
The only downside is I feel you need some knowledge of the subject and ask for links so you can verify what it is saying. I can see some getting into trouble but also many that would benefit.

Mine provide source links for several of the points it is giving me.

 

[RooFlyer]

Should you ask it for links to other points of view or things not discussed by it?

 

[OZDUCK]

For a few weeks I have been suspicious about 'happenings' in my right hand. Cramp in the hand when driving more than 20 minutes or so and odd pains. Then last Friday I went for a bike ride and a few hours later the symptoms really jumped up - pains when twisting the wrist, 'electric' shocks if fingers are strained at odd angles, some tingling in the fingers, pain in the wrist and lower arm when sleeping etc. I had a successful 'nerve decompression' operation on my left wrist for carpal tunnel about 5 years ago so these symptoms were all too familiar. An ultrasound on Tuesday confirmed my suspicions.

I am going to have a steroi_ injection into the wrist tomorrow to see if it provides relief if not then straight off to the surgeon. I can't really complain about the time frames - Doctor on Monday, Ultrasound on Tuesday, Doctor revisit for results on Wednesday and injection on Thursday - and all 'free' so far. If I have to go to the surgeon I know that the time frame and costs will all be entirely different.

 

[Flyfrequently]

There is now a plan after visiting the Dermatologist yesterday re SCC on right hand/finger near MCP joint.
Will have Moh's surgery and hopefully will only need to have a small flap rather than requiring a skin graft.
Had Moh's before so know what to expect, pity I am right handed.
Now waiting for this to be co ordinated as Moh's and subsequent repair done at two different hospitals, hopefully can be done on the same day depending on their theatre schedules

 

[prozac]

We haven't heard from @JohnK for a while? RUOK?

 

[Flashback]

We haven't heard from @JohnK for a while? RUOK?

PM sent.

 

[prozac]

Where to start. As you all know I had a pacemaker box replacement 3 weeks ago. I was not particularly well leaving hospital, walking to St Leonards station and catching the train half a dozen stops. When I alighted the train I was not able to walk up the station stairs and needed to take the lift. OK, I had just left hospital. In the intervening time I have had nightly, at rest angina episodes in the early morning. This morning I had 4 between 0330 and 0730, each time requiring nitrolingual to settle. This despite taking a calcium channel blocker.
So today was the follow up with the surgeon. Talking with the pacemaker rep I discover that my unique setting were not hard-copied across to the new pacemaker. My file no longer notes that the pacemaker setting are never to be changed. The original pacemaker took 5 months of weekly visits to get set up properly and none of these settings were copied to the new pacemaker. I have been tired, easily fatigued, breathless etc since the procedure and now I know why. The pacemaker rep said the settings had not been changed so I quized her and discovered I had a standard calibration and then quizzed her the settings. They were not MY settings. I have fired off a stern email to the pacemaker manufacturer asking for confirmation they will ensure proper processes are in place in future to prevent such a catastrophe happening to other patients. My surgeon was apologetic (it was not his job to calibrate the pacemaker). I asked him how he would feel if he sent his Maserati in for a service and it came back with the performance chip disabled?

When things turn to cough it always happens to me but not to others. At least that is my experience.

 

[RooFlyer]

I’m on Mounjaro, which people may know slows the emptying of your stomach to make you feel fuller to encourage weight loss. It also slows the uptake of fluids when you’re drinking, which is what I’ve been told by Dr and is also my experience.

I had a bladder ultrasound requiring a full bladder on arrival a few months ago and realising what the effect would be, I started drinking water much earlier than their recommended one hour beforehand. This worked and I arrived with a full bladder which I was able to empty and the ultrasound was good.

So now I’m in for a kidney ultrasound. The instructions were to drink a litre of water between one hour and 30 minutes before arriving. That’s all. I started a bit earlier but on arrival was asked - do you have a full bladder? I said no; I’ve drank the water as required but no one mentioned anything about the bladder for a kidney ultrasound.

I would’ve thought Ozempic and Mounjaro use was wide enough now for them to realise to ask that question when giving advice on needing to have a high water uptake before arriving.

At the moment, I’m just sitting in reception waiting for nature to slowly take its course.

 

[RooFlyer]

At the moment, I’m just sitting in reception waiting for nature to slowly take its course.

To conclude. The sonographer was very flexible and did my ultrasound two patients later when I was ready to ‘go’. Results given orally were good.

Then I had to dash straight off to see a specialist on something somewhat related, but the u/s wasn’t requested by them, but I knew they would be very interested in the results.

By the time I saw the specialist, 30 minutes later, the report from the radiologist was already on his system. He was very pleased - he was going to order these tests anyway so now the issue is seen to be resolved. I don’t have to see him again.

30 minutes to get a radiologist report, how good is that? And all the imagery is on their app on my phone.

 

[ellen10]

Mr Ellen10 has had some ongoing heart problems. Basically Its called Mitral Valve regurgitation and it has escalated since he had pneumonia late last year.

He is very active and has kept a good deal of day to day fitness. But after some tests and day surgery investigations, we had a call from a heart surgeon and an appointment this afternoon.
So he is not overly happy about it all but has been booked into hospital for mitral valve repairs, which can be open heart surgery or there is a less invasive procedure via the side and ribs. Apparently this less invasive procedure is not covered by medicare, rather than cracking open his chest, which has a longer recuperation time.

This is what a google search shows:

"Mitral valve regurgitation (MR) is a heart condition where the mitral valve fails to close properly, causing blood to flow backward into the left atrium during contraction, reducing forward flow to the body. It causes fatigue, shortness of breath, palpitations, and swollen ankles. Treatment ranges from monitoring to surgical repair or valve replacement."

Does anyone have any prior experience with this procedure or knowledge?

 

[Quickstatus]

Does anyone have any prior experience with this procedure or knowledge?

2 types of treatment for mitral valve disease (whether stenosis or regurgitation)
-Replacement
-Repair

Replacement is the replacement of the diseased valve with a pig or metal valve
Repair is the repair if the diseased valve without replacing it

Access to the mitral valve is via:
(a) Open heart surgery
Sternotomy is a large incision in front of the chest and splitting the chest bone open and using a heart lung machine while the heart is stopped during surgery

(b)Minimally invasive surgery:
-Minithoracotomy is a cut through the right side of the chest going in between the ribs. Increasingly robot assisted
-Transcatheter. is a tube via the groin

Open heart surgery is used for replacement of the mitral valve, not for repair
Minimally invasive approach is used for repair and increasingly replacement of the mitral valve

The vast majority of Mitral valve disease these days is treated via minimally invasive techniques. Maybe 4 in 5 cases. However, it is important to select the best treatment for the individual patient as replacement may have a better outcome in some cases.

Video about mitral valve regurgitation fundamentals

Questions to ask surgeon/cardiologist:
Please explain my treatment options including non surgery
What are the risk vs benefit of each
If minimally invasive what is the risk of the surgery having to be converted to open heart surgery
Do i need to be on lifelong anticoagulants after any of the above
How many of the recommended treatment have you done and is the hospital also similarly experienced
If something goes wrong, will i be transferred to another hospital or can that hospital deal with most/all complications.

 

[prozac]

...
Does anyone have any prior experience with this procedure or knowledge?

I can add from my experience, after open heart surgery significant scar tissue forms within the chest cavity. You don't expect anyone is ever going to poke around in there once you are fixed, but as in my case just 3 years later they were poking around in there again and the scarring made it difficult to see exactly where they were going and an artery was compromised. I know my heart surgeon doesn't want to go back and re-instate 2 by-passes because of the scar tissue.
I'd imagine if this is being done in public then surely they will offer the minimally invassive technique as it sounds less costly.

 

[Quickstatus]

I'd imagine if this is being done in public then surely they will offer the minimally invassive technique as it sounds less costly.

Both public and private
The public system just rations the number than can be done.
While cost is important to the overall health system, treatment outcomes are actually more important.
But the last question in my list is very important - sometimes these minimally invasive procedures are done in smaller private hospitals and if something goes wrong patients may have to be transferred to a larger private or public hospital.

 

[Aeryn]

So surely the solution is to be treated as a Private patient in a large public hospital or one next door i.e. St Vincents Private is next Door to St Vincents Public. Health insurance from birth means you can't be excluded from cover for pre-existing conditions and get the better procedure.

 

[ellen10]

2 types of treatment for mitral valve disease (whether stenosis or regurgitation)
-Replacement
-Repair

Replacement is the replacement of the diseased valve with a pig or metal valve
Repair is the repair if the diseased valve without replacing it

Access to the mitral valve is via:
(a) Open heart surgery
Sternotomy is a large incision in front of the chest and splitting the chest bone open and using a heart lung machine while the heart is stopped during surgery

(b)Minimally invasive surgery:
-Minithoracotomy is a cut through the right side of the chest going in between the ribs. Increasingly robot assisted
-Transcatheter. is a tube via the groin

Open heart surgery is used for replacement of the mitral valve, not for repair
Minimally invasive approach is used for repair and increasingly replacement of the mitral valve

The vast majority of Mitral valve disease these days is treated via minimally invasive techniques. Maybe 4 in 5 cases. However, it is important to select the best treatment for the individual patient as replacement may have a better outcome in some cases.

Video about mitral valve regurgitation fundamentals

Questions to ask surgeon/cardiologist:
Please explain my treatment options including non surgery
What are the risk vs benefit of each
If minimally invasive what is the risk of the surgery having to be converted to open heart surgery
Do i need to be on lifelong anticoagulants after any of the above
How many of the recommended treatment have you done and is the hospital also similarly experienced
If something goes wrong, will i be transferred to another hospital or can that hospital deal with most/all complications.

Wow @Quickstatus thank you for your comprehensive reply and excellent information.

Your questions you mentioned were mainly addressed by the surgeon at our appointment, he was very pleasant and explained things very well, he had a nice manner, but we will also ask about the anticoagulants. Husband is not on blood pressure tablets or blood thinners, at this stage.

The surgeon mention repairing the cords and strings and then placing a band? So I don't think it is a Mitral valve replacement.

The surgeon will get a CT scan prior to the operation, as husband has broken a few ribs over the years, mainly cycling. And he did mention that he will make a small incision to take a peak first. But we are hoping for the minimally invasive surgery. Less recovery time I think.

The operation will be done at Prince of Wales Private Hospital Sydney. (Which is not our local hospital). This surgeon has been at this hospital for 30 years and has done many of these procedures. We have checked out his profile So we are hoping/sure we are in good hands. They are saying he will be in hospital for a week.
We will be using our private health insurance, plus some residual not covered. We are happy to pay for the best care. Although the balance could have given me a nice holiday! Hopefully more travelling in the future.

Once again I appreciate all the valuable insight and suggestions from everyone.