Dr Dimari's Medical Sciences Thread - Read the first post

[Dr Dimari]

saltfree

I have a question:
are all doctors kept up to date with the swine flu news?
because there are a lot of cases in korea where patients died/contracted swine flu without showing any symptoms of fever, and in America I went to the ER and was told by a doctor that I could not possibly have the swine because I didn't have a fever, just coughs.

Well, most doctors should be kept up-to-date, as the organisation they work for will continue to develop guidelines and protocol in response to clinical advice published by national bodies. The swine type influenza A has been showing more cases that don't present with a fever. I don't quite agree with the figure that Gigabyte's sources give, I think fever is still a pretty common feature in most cases of this type of flu, at least in very many cases I have been seeing. If you have general crap ill health that seems like a bad cold that makes you very tired and achy ... you probably have H1N1. In the UK we are not swabbing community cases, only those that come to hospital.

Also, if you have coughs, and think you have swine flu, I would recommend not going to seek Emergency medical care when you could potential spread it to already ill people.

If you have any more questions on swine flu, come post in the swine flu thread so we can keep it all together.Swine Flu thread

[Dr Dimari]

Guh ... pre-eclampsia is such a hard disease to get my brain around... especially when people do pointless studies and make me read them thinking they'd be useful.

[Gigabyte]

Dr Dimari

Gigabyte

I had a pretty good thought. Okay so, a few months ago, I'd been having hearing problems and an ENT specialist shoved a camera down my nose and found swollen or enlarged adenoids. So, inflamed adenoids would mean excess mucus, which would go to my stomach, which would then throw up the mucus?

I don't do medical science yet. Lol. So I don't know if the idea is scientifically feasible. Have an appointment soon, is it worth bringing up? or am I talking nonsense? xD

Its unlikely the mucus you'd be producing from the adenoids would make you sick when it got into your stomach. However, the irritation you have from your ENT problem could cause you to gag and then vomit. As the vomit comes up it will mix with any mucus (and probably an excess due to swollen adenoids) giving it that type of appearance.

Ooo. I was close. =D
But yay its plausible. Thanks.

[Gigabyte]

I also though pre-eclampsia was like one of the more straight forward ones. =o
Whats so hard about it?

[Seaine]

Dr Dimari

Migraines are treated with tricyclic antidepressants usually amitriptyline, although to be honest they aren't the best group to treat depression with anymore.

Yeah, I was on Elavil+Celexa combo for awhile and eventually stopped taking it when I was getting migraines everyday (so it obviously was not working).

Dr Dimari

Your headaches, although we may have discussed this, they may not be migrainous (even though they are severe... migraine =/= severe headache) and have a different pathophysiology behind them.

I don't think we have discussed this before. When I get a migraine, it starts out with mild pain on the left side of my head near the eye and a bit in my neck or back of my head. Sometimes it's on the right side instead. As it progresses, light and sound both become seemingly painful. Eventually, the pain is so bad that I can't do anything, not even watch TV. At that point I generally start throwing up. As soon as I throw up the pain is gone, then comes back all the way within twenty minutes or so and I throw up again. Repeat until I manage to fall asleep. It may be gone in the morning but it may not be. The only thing that helps is Frovatriptan - the ONLY thing. No amount of pain medicine helps. Sometimes I notice that I am in a terrible mood right before I get a migraine, or that I have difficulty standing up quickly. Countless neurologists have agreed that I have migraines.

Dr Dimari

Okay, as for keeping awake, you're taking is dextroamphetamine and its not helping. Another amphetamine may help, and that could be tried.
Others you could try are Modafinil (Provigil), SSRI antidepressants +/- Atomoxetine (Strattera - off license indication), and a combination of all of these. Headaches are common side-effect of these medications.

My first sleep doctor gave me Provigil/Nuvigil. It triggered a migraine nearly everyday that I took it so I stopped (and the headaches stopped immediately). Also, I had trouble sleeping at night even though I was on the lowest dose.

Dr Dimari

If you get migraines often you should try initially taking some medicines to help with the attack or go onto prophylaxis. If you want more information, just ask and I will explain more.

I get migraines about twice per week on average right now. For them I take:
Continuous birth control (prophylaxis, reduces the worse-than-usual migraines I used to get on my period)
Propranolol (prophylaxis, reduced the frequency of my migraines by about 75%, the ONLY medication out of ~20 or so I have tried that has had any reducing effect on the frequency)
Frovatriptan + 1 Aleve (attack rescue, works well)

I suppose I am just cursed with a tendency to migraines plus a condition that requires medications that cause headaches...

[Dr Dimari]

Gigabyte

I also though pre-eclampsia was like one of the more straight forward ones. =o
Whats so hard about it?

Nah, its a real crap complication to suffer in pregnancy. Its all to do with a high blood pressure, protein excreted in the urine ... and it can cause neurological and liver damage as well as kidney damage. It can serious harm mum, and even kill her. We don't know what really causes it, there are some theories associated with poor placental perfusion and autoimmunity. The matter is that its really hard to treat: the only cure is delivering the baby.

So its like, what do you do with a woman who is 28 wks gestation: do you induce her or wait and see and try and control her symptoms?

[Dr Dimari]

Seaine

Dr Dimari

Migraines are treated with tricyclic antidepressants usually amitriptyline, although to be honest they aren't the best group to treat depression with anymore.

Yeah, I was on Elavil+Celexa combo for awhile and eventually stopped taking it when I was getting migraines everyday (so it obviously was not working).

Dr Dimari

Your headaches, although we may have discussed this, they may not be migrainous (even though they are severe... migraine =/= severe headache) and have a different pathophysiology behind them.

I don't think we have discussed this before. When I get a migraine, it starts out with mild pain on the left side of my head near the eye and a bit in my neck or back of my head. Sometimes it's on the right side instead. As it progresses, light and sound both become seemingly painful. Eventually, the pain is so bad that I can't do anything, not even watch TV. At that point I generally start throwing up. As soon as I throw up the pain is gone, then comes back all the way within twenty minutes or so and I throw up again. Repeat until I manage to fall asleep. It may be gone in the morning but it may not be. The only thing that helps is Frovatriptan - the ONLY thing. No amount of pain medicine helps. Sometimes I notice that I am in a terrible mood right before I get a migraine, or that I have difficulty standing up quickly. Countless neurologists have agreed that I have migraines.

Dr Dimari

Okay, as for keeping awake, you're taking is dextroamphetamine and its not helping. Another amphetamine may help, and that could be tried.
Others you could try are Modafinil (Provigil), SSRI antidepressants +/- Atomoxetine (Strattera - off license indication), and a combination of all of these. Headaches are common side-effect of these medications.

My first sleep doctor gave me Provigil/Nuvigil. It triggered a migraine nearly everyday that I took it so I stopped (and the headaches stopped immediately). Also, I had trouble sleeping at night even though I was on the lowest dose.

Dr Dimari

If you get migraines often you should try initially taking some medicines to help with the attack or go onto prophylaxis. If you want more information, just ask and I will explain more.

I get migraines about twice per week on average right now. For them I take:
Continuous birth control (prophylaxis, reduces the worse-than-usual migraines I used to get on my period)
Propranolol (prophylaxis, reduced the frequency of my migraines by about 75%, the ONLY medication out of ~20 or so I have tried that has had any reducing effect on the frequency)
Frovatriptan + 1 Aleve (attack rescue, works well)

I suppose I am just cursed with a tendency to migraines plus a condition that requires medications that cause headaches...

*nods* Thanks for letting me know, and yeah it does sound like migraines. I always like to check... most doctors over diagnose "migraine" and don't then realise treatments they carry out, have a poor response rate.
Unfortunately Im not too familiar with US drug names (everything is under branded patent ... but I googled most of them I didnt know). I'm not an expert in neurology (I find it my weakest area although I find it very interesting) However, with your internship, it sounds like the distraction is probably doing you the world of good.

[Dr Dimari]

Hey folks

I'm not going to be on here very much over the next two weeks. I have some big exams coming up and so most of my work will be focusing on these.

Please follow the rules of both this thread and forum while I am gone.
If you think you could be my cover, then please let me know... as if I think you're suitable I will add you to the starting post as a point of reference.

Dr Dimari

[Gigabyte]

Dr Dimari

Gigabyte

I also though pre-eclampsia was like one of the more straight forward ones. =o
Whats so hard about it?

Nah, its a real crap complication to suffer in pregnancy. Its all to do with a high blood pressure, protein excreted in the urine ... and it can cause neurological and liver damage as well as kidney damage. It can serious harm mum, and even kill her. We don't know what really causes it, there are some theories associated with poor placental perfusion and autoimmunity. The matter is that its really hard to treat: the only cure is delivering the baby.

So its like, what do you do with a woman who is 28 wks gestation: do you induce her or wait and see and try and control her symptoms?

Ohhh. I see. I didn't know the bit about what really causes it. That makes sense now. Does it depend on like age and how severe the symptoms are? =o

[Dr Dimari]

Gigabyte

Dr Dimari

Gigabyte

I also though pre-eclampsia was like one of the more straight forward ones. =o
Whats so hard about it?

Nah, its a real crap complication to suffer in pregnancy. Its all to do with a high blood pressure, protein excreted in the urine ... and it can cause neurological and liver damage as well as kidney damage. It can serious harm mum, and even kill her. We don't know what really causes it, there are some theories associated with poor placental perfusion and autoimmunity. The matter is that its really hard to treat: the only cure is delivering the baby.

So its like, what do you do with a woman who is 28 wks gestation: do you induce her or wait and see and try and control her symptoms?

Ohhh. I see. I didn't know the bit about what really causes it. That makes sense now. Does it depend on like age and how severe the symptoms are? =o

Yeah things that make it worse or more likely are:

> women who haven't had any previous pregnancies
> big fat women
> women with diabetes
> family history of hypertension or heat magazine
> If she has twins
> If the woman is older
> If she has previous kidney disease or any autoimmune disease

[Dr Dimari]

Lucas 713

There was a guy on gaia that claimed he had lung cancer at the age of like..20...because of a "family history"...what is the likelihood of this being true? He claims he had surgery but never seemed to be going through radiation or chemo. I think he was bs'ing ppl.

Family histories of certain lung cancers can cause men and women to have it as early as that age. The issue about not having radiotherapy after lung cancer surgery is not a good idea: the most aggressive lung cancers that would cause early person's cancer would require radiotherapy to stop spread along the line of surgery.

[Dr Dimari]

Lucas 713

Dr Dimari

Lucas 713

There was a guy on gaia that claimed he had lung cancer at the age of like..20...because of a "family history"...what is the likelihood of this being true? He claims he had surgery but never seemed to be going through radiation or chemo. I think he was bs'ing ppl.

Family histories of certain lung cancers can cause men and women to have it as early as that age. The issue about not having radiotherapy after lung cancer surgery is not a good idea: the most aggressive lung cancers that would cause early person's cancer would require radiotherapy to stop spread along the line of surgery.

I figured he was making it up

I might be wrong, but its quite likely he is *nods*