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.

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48071460)

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

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48078095)

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...

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48078130)

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.

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48078434)

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.

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48078484)

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

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48078530)

are there risks with a colonoscopy? can they tear your colon?

is it really worth the risk?

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48078542)

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.

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48078567)

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

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48078593)

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

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48078650)

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

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48078587)

is stomach ulcers = gastritis?

could this be causing the labs?

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48078632)

and yes, it could be causing the labs

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48078675)

if he asks you why you want it, say that the normal ferritin value doesn't make sense with iron deficiency

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48078777)

ask me about managing this stuff and i'll get lost pretty quickly

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48078691)

mcat i honestly forget. maybe 38 but i can't be sure

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48078784)

he said he's happy to do the colonoscopy if i want, either now or after the stool and repeat bloodwork, but he knows nobody wants them. he said i can do it for peace of mind, but doing it for peace of mind doesn't mean there's a necessary clinical reason to do so.

i told him that my GP said that even one low result from the bloodwork would be concerning and worth testing even if the bloodwork is normal later on -- where it's unexplained why that low result happened. he didn't seem concerned.

he's an old-school boomer solo. i guess he's not under pressure from a big group to crank out procedures.

you think he's wrong? i don't see why he'd be full of shit. seems like he doesn't practice defensive medicine like the rest of them.

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48106314)

would have been trivial for him to just push a colonoscopy on you to cover his ass

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48111987)

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

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48078781)

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)

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48078817)

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.

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48078823)

can you at least tell me what kind of fracture? compression, spinous process avulsion, transverse process, etc?

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48078839)

I'm reading from the hospital records

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48078858)

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

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48078908)

It was a level 1 trauma center

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48078911)

https://ibb.co/HtRTZcr

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48078836)

No other medications

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48078861)

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

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48078863)

How serious is this scale of 1 to 10?

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48078864)

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

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48078925)

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

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48078946)

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

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48078960)

HGB 13.8

ferritin 101

iron total 67

TIBC 350

saturation 19% (low)

GI doc said: the ferritin is normal. the iron is low but normal, and the saturation % is a bit of a red herring because i'm a little high on the TIBC and a little low on iron, which gives a saturation ratio that is abnormal and if my TIBC were lower that ratio would be fine.

he said he doesnt see evidence of iron deficiency, and said the issue is how much more do we chase this for a 40 year old to look for something that may not be there, and he said anything else we do at this point is peace of mind, and he just doesnt think im anemic.

he asked then my next trip to the primary is, and i said in august, and he said just to redo the labs with him in 3-6 months because he wouldnt go a year seeing if there's a problem.

jag what do you think.

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48263908)

now you're not even anemic anymore, so the original result was either just noise or a lab error

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48289601)

yeah, high 13s is likely normal for you. the reference ranges are population averages but for an ashkenazi jew, it's unlikely to be true anemia

moreover your iron studies look better

i would go with whatever your GI doc says really

(http://www.autoadmit.com/thread.php?thread_id=5591377&forum_id=2\u0026mark_id=5310864",#48289655)