General Medical issues thread

[Lost Redditor]

Strangulated hernia: an incarcerated hernia that becomes a medical emergency because the blood supply to the herniated tissue is being cut off.

I might change my phone consult with my GP for tomorrow to an in-person visit then.

 

[Quickstatus]

I might change my phone consult with my GP for tomorrow to an in-person visit then.

If it can be pushed back in, by definition it is a reducible hernia not strangulated.

 

[prozac]

Monday morning is my annual cardiologist visit. I am hoping I can get a change of medication as Amlodipine, the calcium channel blocker I take, makes my ankles swell excessively. Sometime I will have a few days / week where walking is difficult when soft tissue is pinching and it feels like a soft tissue injury. I need the Amlodipine to keep cardiac spasm angina in check. I no-longer get woken through the night with crushing chest pain but I still get it when wake at 0500-0600 for a bathroom break. By the time I return to bed the spasm has started and I need the angina spray to settle the spasm. My reaction to the pain sometimes wakes MrsP. Hoping a change of medication is the answer as, for reasons noted above, I don't want to increase the dose. I suspect Dr will suggest an angiogram just to make sure I don't have more blockage. This time last year was 95+% and I was told I certainly know when to return to base.

 

[drron]

Amlodipine isn’’ The only Ca channel blocker but usually the worst for ankle swelling. Maybe just a change of blocker.

 

[prozac]

Amlodipine isn’’ The only Ca channel blocker but usually the worst for ankle swelling. Maybe just a change of blocker.

Yes, that was thinking. I contemplated reducing to half a tablet (cardiologist did say I could play around with dose) but when I was on half I was getting the 2/3/4am angina attacks. Have to say I was feeling a bit gun shy, but perhaps my reaction might be different if I halved the dose now. The ultimate aim is to eliminate the morning angina as well.

 

[drron]

I was around for quite a while before Ca channel blockers were around such as diltiazem and amlodipine. So I used verapamil. Now when the new ones came out Verapamil was forgotten but I kept using it because it worked. And I got proof when the Monica study-

https://www.aihw.gov.au/reports/heart-stroke-vascular-diseases/who-monica-study-australia-1984-1993/summary

The study was initially to ascertain the difference in survival between a teaching hospital coronary care unit and a regional hospitals coronary care unit. Newcastle was one of 2 Australian study centres with Newcastle's John Hunter hospital and Maitland hospital. I was the director of the Maitland Hospitals coronary care unit. It was the only centre where the regional hospital had a statistically significant better survival rate than the teaching hospital after a heart attack plus a statistically significant reduction in heart failure despite having no age restriction on admission to the coronary unit.

I had 2 significant differences in treatment. first at the time of study I continued use of heparin when the official line wasn't needed. Secondly I had a higher use of Ca blocking agents and for me it was verapamil. At tte time it was used in Scandinavia for heart faiulre with good results. Subsequently it was shown to be effective in what was then called diastolic heart failure subsequently called HFPEF.
My colleagues in Newcastle refused to acknowledge me because I used too much verapamil.

 

[prozac]

No angiogram for me at this time. Doc satisfied the angina is not blockage related and is vasospasm related. We debated the change in Ca blocker as Verapamil is also a beta blocker reducing the heart rate...but wait I have a pacemaker so it will not be an issue, unless something goes wrong with it. Otherwise I've got a bit of valve leakage commensurate with age and a lazy spot from when I had a heart attack cycling to the Superbike races in Assen in 2015.
Cholesterol is 2.9, LDL 1.1.
Plan is to switch to Verapamil and if I am still getting angina pain stop nebilet. I see him again in December at which time I'll likely start a diabetes drug (I don't have diabetes) that lowers glucose and has been discovered can also give the heart a little pep in it's step. I think it is empagliflozin.
Hopefully it'll be running like a Swiss watch when I make my first trip in a decade next year.

Meanwhile I had to negotiate the worst carpark in Sydney with it's narrow up/down ramps, tight corners and short car spaces that some new cars are too long for. I parked on level 6 and pointed out to MrsP on the way down that the down ramps have more coloured paint scrapes than the up ramps. I think drivers are simply too fed-up by the time they are leaving. @Quickstatus, you'll know what I'm talking about.

This is story on empagliflozin:

Drug used to reduce blood sugar levels in diabetic patients could also benefit hearts

A drug used to treat people living with Type 2 diabetes could also help improve their heart function, according to research we have funded at the University of Leeds.

www.bhf.org.uk

 

[Seat0B]

Well that seems like a pretty good outcome @prozac

 

[prozac]

Other news. In June I purchased a coffee machine and run a bit of coffee through it, typically 4 x 18g shots a day. This morning because of the cardio appointment I thought I better stick to one double shot. My BP was 126/71. I was worried it might push up my BP.
Another observation since I bought the coffee machine I no longer wake up through the night!

My game plan is if I keep buying stuff I have to keep going to get best value from it.

 

[MelMel]

No angiogram for me at this time. Doc satisfied the angina is not blockage related and is vasospasm related. We debated the change in Ca blocker as Verapamil is also a beta blocker reducing the heart rate...but wait I have a pacemaker so it will not be an issue, unless something goes wrong with it. Otherwise I've got a bit of valve leakage commensurate with age and a lazy spot from when I had a heart attack cycling to the Superbike races in Assen in 2015.
Cholesterol is 2.9, LDL 1.1.
Plan is to switch to Verapamil and if I am still getting angina pain stop nebilet. I see him again in December at which time I'll likely start a diabetes drug (I don't have diabetes) that lowers glucose and has been discovered can also give the heart a little pep in it's step. I think it is empagliflozin.
Hopefully it'll be running like a Swiss watch when I make my first trip in a decade next year.

Meanwhile I had to negotiate the worst carpark in Sydney with it's narrow up/down ramps, tight corners and short car spaces that some new cars are too long for. I parked on level 6 and pointed out to MrsP on the way down that the down ramps have more coloured paint scrapes than the up ramps. I think drivers are simply too fed-up by the time they are leaving. @Quickstatus, you'll know what I'm talking about.

This is story on empagliflozin:

Drug used to reduce blood sugar levels in diabetic patients could also benefit hearts

A drug used to treat people living with Type 2 diabetes could also help improve their heart function, according to research we have funded at the University of Leeds.

www.bhf.org.uk

My Mum has congestive heart failure and was put on Empagliflozen (Jardiance) two years ago. Her heart function has improved and her Cardiologist was so excited because with CHF there’s not always a lot that can be done. Good luck

 

[drron]

My Mum has congestive heart failure and was put on Empagliflozen (Jardiance) two years ago. Her heart function has improved and her Cardiologist was so excited because with CHF there’s not always a lot that can be done. Good luck

Compared to before 1990 there is a lot that can be done to improve CHF. Then it was a death sentence. In the early 90s beta blockers were introduced and for many had good results.
At that time I was basically a heart failure doctor as none of the cardiologists in town wanted to treat it. I had one patient who was wheelchair bound but a few months later was walking around with ejection fractions above 50.

The sad thing was that a paper in the late 50s reported that Inderal improved heart function but it was published in an Indian journal so was ignored by the western medical community.

 

[prozac]

Yesterday my cardiologist forgot to give me a script for verapamil. I called the rooms and asked if they would arrange for him to send an e-script which I received later in the day. My regular chemist is not far, only 3km or so but I don't go that direction much so when I do I update all my scripts. I got a grab-bag of medication renewals this afternoon and returned home. I won't likely go back for 2-3 weeks. I am not long home when the phone rings. The pharmacist is very apologetic because they did not dispense the verapamil. I am sensing this is a bad omen.

 

[andye]

Compared to before 1990 there is a lot that can be done to improve CHF. Then it was a death sentence. In the early 90s beta blockers were introduced and for many had good results.
At that time I was basically a heart failure doctor as none of the cardiologists in town wanted to treat it. I had one patient who was wheelchair bound but a few months later was walking around with ejection fractions above 50.

The sad thing was that a paper in the late 50s reported that Inderal improved heart function but it was published in an Indian journal so was ignored by the western medical community.

I am a few years behind you but still remember being taught in medical school that beta-blockers were contraindicated in heart failure.

There was a fair amount already being used in France, when I was involved in recruiting patients in Brighton (UK) to trials of carvedilol in 1996.

With ACE inhibitors, older patients with heart failure were still then being admitted to hospital for captopril challenges (in case they collapsed in a heap from what were very modest doses)