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Jag, Have A Med Question. Bump When Around
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Date: September 9th, 2024 2:29 PM Author: Splenetic background story (http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2...id#48066743) |
Date: September 10th, 2024 5:57 PM Author: jag (http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2...id#48071425) |
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Date: September 10th, 2024 6:03 PM Author: ...,,..;...,,..,..,...,,,;.., had annual physical and bloodwork. HGB was 13.7 (range is 14-18), and WBC is 4.1 (4.5-11). gp then said he's ordering a vitamin test. vitamin text shows serum iron at 60 (65-175) and % saturation at 17% (20-50).
he said i'm slightly anemic and should do a colonoscopy to rule out internal blood loss.
is he right or, or is this CYA defensive medicine?
fwiw, i don't eat much red meat (once every 2 weeks). i told him this and he said only a true vegan diet would make you anemic. |
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Date: September 11th, 2024 6:48 PM Author: jag this is an incomplete iron study. I'd need to see a TIBC and a ferritin to distinguish whether you have iron deficiency or anemia of chronic disease. if your ferritin is below 30, then you definitely are iron deficient. but let's assume you do have iron deficiency anemia. it's very very unlikely to get this from diet alone, regardless of red meat intake. if you drink an abnormal amount of tea, perhaps this could explain it (it can reduce iron absorption). and i'm supposing that you don't have celiac or gastritis or whatever that can readily explain iron deficiency.
so for someone who is otherwise healthy and has no obvious cause of iron deficiency, i would agree with a referral to a GI. i wouldn't call this CYA, it's basically standard of care |
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Date: September 11th, 2024 6:54 PM Author: ...,,..;...,,..,..,...,,,;.., here's the complete iron data:
serum iron 60 (65-175) [low] TIBC 361 (165-502) % saturation 17% (20-50) [low] ferritin 194.7 (21.8-274.7) folate level 8.8 (7-31.4) B12 354 (213-816)
didnt know you needed all that. pls proceed, doc. tyia... |
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Date: September 11th, 2024 8:06 PM Author: jag do you have an MCV available as well?
this is actually somewhat interesting. your ferritin levels are not what i would expect for iron deficiency. this is an inconclusive result. it could very well be iron deficiency with a confounding elevated ferritin in the setting of chronic inflammation. you could ask for a "soluble transferrin receptor" lab test, which would elucidate if you truly have iron deficiency anemia. or it could be that you have both iron deficiency anemia *and* anemia of chronic disease/inflammation. you might see this in the setting of occult bleeding and inflammation from inflammatory bowel disease or colon cancer. there is no lab test that can easily determine this scenario, but a serum hepcidin level may help. alternatively, you could opt for a therapeutic trial of iron supplementation -- if iron studies improve, then it was just iron deficiency and nothing else is going on hematologically.
but this won't change management for you. if you have iron deficiency, you need to figure out why, and you'll still end up with an endoscopy.
excuse all the jargon. in short, we can wax poetic about your iron studies all we want, but all roads seem to end in a probe up your ass. |
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Date: September 11th, 2024 8:18 PM Author: ...,,..;...,,..,..,...,,,;.., MCV is 83.9 … does that change anything?
Ty for this. Is a stool test not accurate compared to a colonoscopy? I asked why I can’t just do that and do for said it’s not as comprehensive. |
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Date: September 11th, 2024 8:26 PM Author: jag no it doesn't change anything
yeah it's flame
pick a good GI doc, not just someone who rushes through the exam to stack more procedure fees in a day |
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Date: September 11th, 2024 8:28 PM Author: ...,,..;...,,..,..,...,,,;.., my jew GP recommended two, one a jew boomer and other a fat white woman. jew boomers are the ideal. how do i really know if he's good?
are there risks with a colonoscopy? can they tear your colon?
is it really worth the risk? |
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Date: September 11th, 2024 8:32 PM Author: jag you won't really ever know unless you talk to the people he works with like the GI tech, nurses, and anesthesia i agree that jew boomer sounds like the better choice here, but i know a couple boomer jew GIs who spend the least amount of time in the colon they can get away with unfortunately most GI docs cease higher level brain activity as soon as they hit fellowship and just become procedure monkeys. but this is fine as long as they are thorough. |
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Date: September 11th, 2024 8:35 PM Author: ...,,..;...,,..,..,...,,,;.., is the issue that a shitty GI doc is more likely to injure you, or more likely to miss stuff because they're rushing? shouldn't there be a recording of what's inside to make sure everything is covered? (http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2...id#48078578) |
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Date: September 11th, 2024 8:38 PM Author: jag the latter you could ask for a recording but i think they only take pictures you could ask to remain awake for the exam (which is the standard in Europe where anesthesia is in restricted supply), but i dunno if that would make them more thorough or just freak them out |
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Date: September 11th, 2024 8:43 PM Author: ...,,..;...,,..,..,...,,,;.., how painful is it to stay awake for the exam? i'd rather not have some WOC CRNA put me down (http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2...id#48078614) |
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Date: September 11th, 2024 8:53 PM Author: jag https://pubmed.ncbi.nlm.nih.gov/10228252/ this seems to suggest 95% of people don't need sedation for a colonoscopy it would certainly be a more pleasant experience with sedation/anesthesia, but if you're not anxious about it and can tolerate some discomfort, it can be done |
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Date: September 11th, 2024 9:00 PM Author: ...,,..;...,,..,..,...,,,;.., ty. googing this. wonder if i'd be a freak to ask for it. (http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2...id#48078668) |
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Date: September 11th, 2024 8:37 PM Author: jag there is a risk of perforation but for a screening colonoscopy it's exceedingly low. 1 in 1000-10000 as to whether it's worth the risk, i dunno... i would personally just get it done if i were in your shoes because i've noticed an increased incidence of colorectal malignancies in younger people (see brother luis). you could also have a jewish gut disease like celiac or gastritis that they could find but this would be unlikely without any GI symptoms |
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Date: September 11th, 2024 8:46 PM Author: ...,,..;...,,..,..,...,,,;.., i've had some sort of jewish gut disease at times. like 8 yrs ago, i had incredible stomach pains and eventually a specialist thought it was stomach ulcers and gave me carafate and it made it better. at 2 other times since when i had similar severe stomach pains.
is stomach ulcers = gastritis?
could this be causing the labs? |
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Date: September 11th, 2024 9:01 PM Author: jag gastritis is an inflammatory process that can lead to ulcers. but not all ulcers are from gastritis and yes, it could be causing the labs
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Date: September 11th, 2024 9:17 PM Author: ...,,..;...,,..,..,...,,,;.., should i ask the GP to retest my labs before i do the colonoscopy? (http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2...id#48078717) |
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Date: September 11th, 2024 9:35 PM Author: jag yeah you can ask for a soluble transferrin receptor test. if the value is increased, then hie to GI (it means you do have iron deficiency) if he asks you why you want it, say that the normal ferritin value doesn't make sense with iron deficiency |
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Date: September 11th, 2024 9:02 PM Author: sure, bud, sure Impressive that you remember all this stuff as an ortho. (http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2...id#48078676) |
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Date: September 11th, 2024 9:05 PM Author: jag my step score was 265, this is all prime step 1 content ask me about managing this stuff and i'll get lost pretty quickly |
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Date: September 11th, 2024 9:18 PM Author: ...,,..;...,,..,..,...,,,;.., what's a 265 mean? (http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2...id#48078723) |
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Date: September 11th, 2024 9:26 PM Author: jag equivalent to 175+ on LSAT (http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2...id#48078751) |
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Date: September 11th, 2024 9:27 PM Author: ...,,..;...,,..,..,...,,,;.., wow. what was your mcat and approx med school rank? (http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2...id#48078755) |
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Date: September 11th, 2024 9:38 PM Author: jag i think rank was #2 but they don't make this public knowledge. i do remember finding out somehow mcat i honestly forget. maybe 38 but i can't be sure |
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Date: September 11th, 2024 9:37 PM Author: ;;;..........;.;.;.;.;.;.;.,,;.;.,,,;.;. wow (http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2...id#48078783) |
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Date: September 11th, 2024 11:00 PM Author: sure, bud, sure I think a 265 is closer to 179+. (http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2...id#48079067) |
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Date: September 11th, 2024 9:24 PM Author: ...,,..;...,,..,..,...,,,;.., wife is reading this thread. she's WET for jag. she's impressed and said she has a "clit boner" for his medical intellect. (http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2...id#48078742) |
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Date: September 11th, 2024 9:36 PM Author: ;;;..........;.;.;.;.;.;.;.,,;.;.,,,;.;. Jag, I need help too
My mom passed out in her bathroom for some unknown reason and broke c4 c5 vertebrae with "stable" fractures. After a helicopter flight to a hospital they sent home after 24 hours with a neck brace and a 3 week follow up.
She's 60 years old. This was the 3rd time she has had these fainting episodes in the last couple months and she never had then before. What should we be doing.
Ty bro |
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Date: September 11th, 2024 9:46 PM Author: jag man syncope and "dizziness" workups were the bane of my existence i'd need a LOT more info about her to give a focused answer to this but basically you need to find out if she's passing out because of her heart, her brain, vasovagal, metabolic (blood glucose etc), or orthostatic hypotension i can't imagine they didn't thoroughly investigate this stuff, and you don't always uncover an etiology what kind of doctors was she seen by (other than ortho) |
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Date: September 11th, 2024 9:49 PM Author: ;;;..........;.;.;.;.;.;.;.,,;.;.,,,;.;. Should we be worried any more about the neck fractures? Should I get a second opinion?
I don't have any of the details because we're just now getting medical records, but what you are saying sounds good and reasonable. The tests from the hospital (MRI, blood work, ECG) were OK, but they did make a referral to a cardiologist. I'm taking her to that Friday.
Thanks again. |
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Date: September 11th, 2024 9:56 PM Author: jag the problem w discussing ortho is that i'm useless without looking at the imaging myself. need to look at bony anatomy and associated ligaments to determine stability can you at least tell me what kind of fracture? compression, spinous process avulsion, transverse process, etc? |
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Date: September 11th, 2024 9:58 PM Author: ;;;..........;.;.;.;.;.;.;.,,;.;.,,,;.;. "c4 c5 interior inferior teardrop fracture"
I'm reading from the hospital records |
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Date: September 11th, 2024 10:16 PM Author: jag impossible for me to comment on a teardrop without seeing imaging assuming it's an extension teardrop fracture, hard collar is the correct treatment the vast majority of the time but i can't rule out a flexion teardrop fracture, which is a serious injury and needs ortho/neurosurg evaluation. in fact, i can't imagine they wouldn't have been consulted for this |
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Date: September 11th, 2024 10:17 PM Author: ;;;..........;.;.;.;.;.;.;.,,;.;.,,,;.;. Ortho/neuro did review it and recommended no surgery
It was a level 1 trauma center |
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Date: September 11th, 2024 9:55 PM Author: ;;;..........;.;.;.;.;.;.;.,,;.;.,,,;.;. Does a "QTC calculation" of 491 mean anything to you? It was from the ekg
https://ibb.co/HtRTZcr |
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Date: September 11th, 2024 9:58 PM Author: jag yes that's prolonged. probably due to medications she's on and/or electrolyte derangements. this can be a cause of arrhythmia that can result in syncope (http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2...id#48078856) |
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Date: September 11th, 2024 10:00 PM Author: ;;;..........;.;.;.;.;.;.;.,,;.;.,,,;.;. she started taking tirzepatide but stopped, she started that before and if this started. Do you think that could be it? She has stopped completely, last dose was the day before she fell
No other medications |
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Date: September 11th, 2024 10:01 PM Author: jag nvm just saw the image you posted and it notes a bundle branch block qt interval is hard to evaluate in setting of bundle branch block still needs to see a cardiologist, it's an abnormal EKG and i'm kind of surprised they didn't admit her for workup |
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Date: September 11th, 2024 10:01 PM Author: ;;;..........;.;.;.;.;.;.;.,,;.;.,,,;.;. ty.
How serious is this scale of 1 to 10? |
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Date: September 11th, 2024 10:21 PM Author: jag bundle branch block in isolation doesn't mean anything to me necessarily bundle branch block plus syncope would have me searching for a electrophysiological (eg arrhythmia) or structural (eg valve stenosis) cardiac cause. absent signs suggestive of another noncardiac etiology of course |
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Date: September 11th, 2024 10:22 PM Author: ;;;..........;.;.;.;.;.;.;.,,;.;.,,,;.;. Ty so much brother. (http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2...id#48078931) |
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Date: September 11th, 2024 10:24 PM Author: jag i guess i didn't answer your question actually. i would say this is "serious" but that doesn't mean it's not readily treatable if they find a cause (http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2...id#48078939) |
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Date: September 11th, 2024 10:24 PM Author: ;;;..........;.;.;.;.;.;.;.,,;.;.,,,;.;. (http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2...id#48078941) |
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Date: September 11th, 2024 10:09 PM Author: ;;;..........;.;.;.;.;.;.;.,,;.;.,,,;.;. My mom said she is very grateful (http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2...id#48078880) |
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Date: September 11th, 2024 9:51 PM Author: ...,.;,.;,.;,,;,.;,.,;.;.;.; hey im 40 and havent been to the doctor in 20 years. how do i get a good primary care doctor and what 'tests' should i do. (http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2...id#48078828) |
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Date: September 11th, 2024 10:30 PM Author: jag good question, deserves thread of its own i don't have a good answer really. a good primary care is worth their weight in gold but they are diamonds in a rough. as a patient, all you can do is sort for someone who went to a good school/residency. not too recently graduated but not more than 5-10 years out of residency either.. at this point they're probably burnt out and no longer staying up to date |
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Date: September 11th, 2024 10:33 PM Author: jag probably just blood pressure and lipids. maybe diabetes screening if you're overweight colon cancer screening if you're 45 can't think of much else if you're otherwise healthy and don't smoke or drink too much |