General Medical issues thread

[love_the_life]

The lady I went to lunch with yesterday has Lynch. She didn't know this until she was 60, because while her mother died in her fifties it was presumed to be lifestyle. She only found out when her 30 year old son was diagnosed with very advanced bowel cancer that had metastised into bladder. He had significant chemo before they could even attempt surgery. Six months later he had a 12 hour surgery that took so much bowel and bladder. He also experienced nerve damage in his arm leaving it paralysed because of the surgical process where he was suspended, to operate.

It's been three years now. He goes into hospital several times a year for issues of kidney function, infections, stent repairs, etc etc. He married a few months later (engaged before the discovery) and they were successful in having a child through IVF. Every embryo is screened. They had a boy and are trying for a second. However last round (last week) four of the 6 potential embryos had Lynch syndrome. Along with the cost of IVF it costs them $800 per embryo to be screened.

Genetic testing of my friends family found that only she, in a family of four siblings, and her son, in a total of around 10 cousins, had the syndrome.

My friend now has had a preventive hysterectomy and has constant colonoscopies and breast scans.

It's a devasting one. And Covid has been awful for them. So much so that even though I had no symptoms and no known contacts, I did a RAT before meeting them. And we ate outside. Masks worn inside when ordering.

I remember you talking about this friend. It is so lovely they have a little boy but it must be heartbreaking for them to learn their embryos have the syndrome - so hard for them. You did the right thing with the RAT and outside dining - hope the weather was warm though.

 

[Pushka]

I remember you talking about this friend. It is so lovely they have a little boy but it must be heartbreaking for them to learn their embryos have the syndrome - so hard for them. You did the right thing with the RAT and outside dining - hope the weather was warm though.

Lovely weather here. MrP about to land in Canberra tonight too. But it's raining? Yes, I mentioned it on here it must be four years ago now. Their little boy is about 18 months. But it's costing them so much money to have a second one. Damn genes.

 

[love_the_life]

Lovely weather here. MrP about to land in Canberra tonight too. But it's raining? Yes, I mentioned it on here it must be four years ago now. Their little boy is about 18 months. But it's costing them so much money to have a second one. Damn genes.

Mr P will find it a tad chilly here - it's drizzled off and on most of the day and quite a cold wind. Hope he has his thermals. Pity you didn't accompany him - could have caught up.

 

[Pushka]

Mr P will find it a tad chilly here - it's drizzled off and on most of the day and quite a cold wind. Hope he has his thermals. Pity you didn't accompany him - could have caught up.

Indeed. I’m limiting my travels right now as need to babysit grandson whilst DIL has an important scan on Weds in the city. Even MrP knows he has to have an oral RAT on arrival here before I will let him inside the apartment.

 

[Hvr]

So, had the wax sucked out of my ears today. I can hear better and was amazed at how much the nurse removed.

I used to wear ear plugs at a noisy workplace, now I've finished there hopefully I won't need to wear them until I flying long haul again.

 

[andye]

So, had the wax sucked out of my ears today. I can hear better and was amazed at how much the nurse removed.

I used to wear ear plugs at a noisy workplace, now I've finished there hopefully I won't need to wear them until I flying long haul again.

When I was an Intern, I initiated a syringing round of my elderly patients. Most thanks I had that year
(Obviously younger patients can benefit too @Hvr)

 

[Hvr]

Had a potential skin cancer cut out today with a student doctor present. She got to see it close up and engage with me as the treating physician under instruction. The nurse who was present watched to ensure everything was done properly so that the sample was not compromised as it was prepared to go to pathology.

Student doctor got the benefit of my 'wisdom'; always treat the nurses with respect. I could see the nurse smiling behind her mask. Then the nurse administered my flu shot, as is usual for her I barely felt it.

 

[Quickstatus]

The Rona thread got me thinking about some of the greatest and often most heroic Randomised control trials in medicine that have made immense changes to medical practice:

1) Bernard Fisher’s 1985 RCT which showed a lumpectomy followed by radiotherapy rather than total mastectomy gave better long term survival in breast cancer - this eventually led to many women not having the terrible disfiguring surgery of a total mastectomy. It was also heroic because it went against the accepted thinking at the time that in order to tackle the cancer you had to remove all the breast tissue.

2) Daryl Francis’s 2018 RCT showing that coronary angioplasty in severe coronary stenosis did not improve exercise time compared with placebo - going against the orthodoxy at the time.

3)Womens Health Initiative 2002 RCT into HRT for menopausal women finding that HRT increased the risk of heart disease and breast cancer

 

[drron]

1) BHAT trial, Began 1977,ended 1981,reported 1982.

Significant decrease in all cause mortality with Propranolol compared to Placebo.
But also found in those with existing Heart failure the decrease in mortality was greater compared to those with no heart failure. eg 47% decrease in sudden death v 13% in those without heart failure.
This then led eventually to B-Blockers becoming the mainstay in treatment of heart failure. I worked through the before and after B-blocker age and believe me it was life changing.

Beta-Blocker Heart Attack Trial (BHAT) - Full Text View - ClinicalTrials.gov

Beta-Blocker Heart Attack Trial (BHAT) - Full Text View.

clinicaltrials.gov

 

[Quickstatus]

I think the CAST study 1990? also U turned the prevailing medical practice of suppressing cardiac arrhythmias after a heart attack with anti arrhythmic meds - there meds were effective except that more people died

 

[drron]

Yes it certainly did change treatment but it was known prior to the CAST trial being published.
I changed my practice after CAPS - the pilot study pre CAST. Interim results of CAST were being released regularly as well.

 

[Quickstatus]

BHAT

BHAT was a very compelling study . Luckily for me I came later. It must have been sobering to be there before and after BHAT

 

[Quickstatus]

NICE-SUGAR showing higher blood sugar of 8-10 in ICU has better overall mortality than tightly controlling blood sugar in the normal range of 4-6. Message: “Normal is not necessarily best and Sweeter is better in ICU

 

[ethernet]

I read something about heated operating tables, rather than ice cold slabs of steel having improved outcomes. Nursing homes that 'saved energy' by cranking down the thermostats also had higher mortality. Higher Vit D levels. As did one very big Victorian hospital. I await the UK blind Ivermectin study that is having political interference applied. Thinking about my S9 drugs during covid, heh another voting irk to consider. After 3 nights at presenting at A&E because the medical centre does not prescribe dd (even if you are in howling pain) because the doctor was too timid/frightened, they made a call, and no problems after that. Each time I told A&E I was referred to them by Ginanderra MC because they have a 'strict no dd prescription policy'. I understand at $300 a pop for A&E, was an expensive disaster for unreasonable dd tightening (MRI in hand after X-ray anomoly). Thankfully I have 80% of the tablets unused for the next episodic event. Never got to see the neurosurgeon, before the event resolved itself. Stop bullying GP's and let them make the calls.

 

[drron]

BHAT was a very compelling study . Luckily for me I came later. It must have been sobering to be there before and after BHAT

Yes. In some studies pre B Blockers the mortality rate was ~ 50% in 12 months. Now many live for years and die of something else often renal failure.

 

[prozac]

Yes. In some studies pre B Blockers the mortality rate was ~ 50% in 12 months. Now many live for years and die of something else often renal failure.

Renal failure drron?

 

[drron]

Yes. A lot of the factors that can cause heart failure can also cause kidney problems. Then some of the drugs we use don't help the kidneys. So not that unusual in those that live many years with their heart failure develop severe problems with their kidneys. Their co morbidities and age usually mean they are not considered for a renal transplant and many decide they don't want continuing dialysis.

 

[cove]

Mrscove's mother crashed to the floor in her bedroom and acquired lots of large bruises but no broken bones. Her GP thinks Prolia has strengthened her bones.

 

[prozac]

Yes. A lot of the factors that can cause heart failure can also cause kidney problems. Then some of the drugs we use don't help the kidneys. So not that unusual in those that live many years with their heart failure develop severe problems with their kidneys. Their co morbidities and age usually mean they are not considered for a renal transplant and many decide they don't want continuing dialysis.

How about the usual rosuvastatin and irbesarten?

 

[Quickstatus]

rosuvastatin and irbesarten

Not sure what you are asking but

Irbersartan can be protective to kidneys in setting of hypertension or diabetes

Rosuvastatin ok for kidneys too. (Unless it causes rhabdomyolysis which can damage kidneys.