Comments on: On the list of things I expected to hear today, this was not near the top http://onthepharm.net/2007/11/diagnosis-dropping.html Life on the pharm Fri, 21 Nov 2008 03:47:57 +0000 http://wordpress.org/?v=2.6.3 By: On panic disorder and benzodiazepine use :: OnThePharm http://onthepharm.net/2007/11/diagnosis-dropping.html#comment-180098 On panic disorder and benzodiazepine use :: OnThePharm Wed, 02 Apr 2008 02:27:34 +0000 http://onthepharm.net/2007/11/diagnosis-dropping.html#comment-180098 [...] This week’s topic is panic disorder and relapse in patients with and without a history of substance abuse. Fun topic, really, and one close to my heart. [...] [...] This week's topic is panic disorder and relapse in patients with and without a history of substance abuse. Fun topic, really, and one close to my heart. [...]

]]> By: RJS http://onthepharm.net/2007/11/diagnosis-dropping.html#comment-178295 RJS Thu, 22 Nov 2007 18:19:13 +0000 http://onthepharm.net/2007/11/diagnosis-dropping.html#comment-178295 I have Crohn's disease localized (right now) to my terminal ileum. (End of my small intestine just before the colon.) Crohn's can flare anywhere from the mouth to the anus, and because this flare felt different than the others, it seemed prudent to check my upper GI tract, particularly because I've been having some reflux and slower gastric emptying than normal. I will be completely unconscious during the procedure. I could probably write a haiku about propofol. ...Maybe I will. My GI doc is the bomb. He lets me decide what I want to do (or not do) with his guidance. I'd hang out with him outside work he's just that cool. I have Crohn's disease localized (right now) to my terminal ileum. (End of my small intestine just before the colon.) Crohn's can flare anywhere from the mouth to the anus, and because this flare felt different than the others, it seemed prudent to check my upper GI tract, particularly because I've been having some reflux and slower gastric emptying than normal.

I will be completely unconscious during the procedure. I could probably write a haiku about propofol. …Maybe I will.

My GI doc is the bomb. He lets me decide what I want to do (or not do) with his guidance. I'd hang out with him outside work he's just that cool.

]]> By: DP http://onthepharm.net/2007/11/diagnosis-dropping.html#comment-178293 DP Thu, 22 Nov 2007 15:23:31 +0000 http://onthepharm.net/2007/11/diagnosis-dropping.html#comment-178293 Please get checked out for GERD. PVCs caused problems for my husband and his three siblings (all in their 40's) and it turned out to be GERD. Once you're on Prilosec you'll be AMAZED at the number of symptoms that go away. That night-time or early-AM asthma? GERD! Google around and check it out... Do you need to get actually scoped for GERD? That's up for debate, most people just get vast symptomatic improvement with the PPI treatment, but GI docs *LOVE* to do upper GI scoping. It's apparently a very profitable procedure (great reimbursement), relatively benign and low-risk - but dang it's uncomfortable. I'll let you & your GI doc decide. Ask him if he's funding a new wing in his clinic or remodeling his house when he whole-heartedly suggests getting an upper GI.... Please get checked out for GERD. PVCs caused problems for my husband and his three siblings (all in their 40's) and it turned out to be GERD.

Once you're on Prilosec you'll be AMAZED at the number of symptoms that go away.

That night-time or early-AM asthma? GERD! Google around and check it out…

Do you need to get actually scoped for GERD? That's up for debate, most people just get vast symptomatic improvement with the PPI treatment, but GI docs *LOVE* to do upper GI scoping. It's apparently a very profitable procedure (great reimbursement), relatively benign and low-risk - but dang it's uncomfortable.

I'll let you & your GI doc decide. Ask him if he's funding a new wing in his clinic or remodeling his house when he whole-heartedly suggests getting an upper GI….

]]> By: RJS http://onthepharm.net/2007/11/diagnosis-dropping.html#comment-178287 RJS Thu, 22 Nov 2007 04:42:22 +0000 http://onthepharm.net/2007/11/diagnosis-dropping.html#comment-178287 A word with a specific meaning, then. Thanks. :) I wonder what my problem will end up being. :rolleyes: A word with a specific meaning, then. Thanks. :) I wonder what my problem will end up being. :rolleyes:

]]> By: #1 Dinosaur http://onthepharm.net/2007/11/diagnosis-dropping.html#comment-178286 #1 Dinosaur Thu, 22 Nov 2007 04:22:28 +0000 http://onthepharm.net/2007/11/diagnosis-dropping.html#comment-178286 Nope: a murmur is a murmur. Other "sound abnormalities" are called "clicks" and "snaps" and "venous hums." "Extra heartbeats" have the same sound qualities as "regular" ones. If a valve is leaking, it doesn't matter where the electric impulse that stimulated the beat originated (sinus node vs. elsewhere); it'll still leak -- and give off the same murmur -- with each beat. Nope: a murmur is a murmur. Other "sound abnormalities" are called "clicks" and "snaps" and "venous hums."

"Extra heartbeats" have the same sound qualities as "regular" ones. If a valve is leaking, it doesn't matter where the electric impulse that stimulated the beat originated (sinus node vs. elsewhere); it'll still leak — and give off the same murmur — with each beat.

]]> By: RJS http://onthepharm.net/2007/11/diagnosis-dropping.html#comment-178285 RJS Thu, 22 Nov 2007 04:07:57 +0000 http://onthepharm.net/2007/11/diagnosis-dropping.html#comment-178285 Now that I think about it, the nurse said "murmur" and the doctor said extra heartbeats. Probably PVCs. Is "murmur" used in a more colloquial sense to mean "sound abnormality"? Regardless, that'll have to be sorted out, I expect. Now that I think about it, the nurse said "murmur" and the doctor said extra heartbeats. Probably PVCs.

Is "murmur" used in a more colloquial sense to mean "sound abnormality"? Regardless, that'll have to be sorted out, I expect.

]]> By: RJS http://onthepharm.net/2007/11/diagnosis-dropping.html#comment-178284 RJS Thu, 22 Nov 2007 04:02:17 +0000 http://onthepharm.net/2007/11/diagnosis-dropping.html#comment-178284 Thanks for the explanation. I probably would have paid closer attention in physio and patho had I known I would have had this problem. Cardio was so boring back then. Now I want to know everything about everything. How things have changed in 2.5 years. Thanks for the explanation. I probably would have paid closer attention in physio and patho had I known I would have had this problem. Cardio was so boring back then.

Now I want to know everything about everything. How things have changed in 2.5 years.

]]> By: #1 Dinosaur http://onthepharm.net/2007/11/diagnosis-dropping.html#comment-178283 #1 Dinosaur Thu, 22 Nov 2007 03:39:08 +0000 http://onthepharm.net/2007/11/diagnosis-dropping.html#comment-178283 Murmurs and arrhythmias are apples and oranges. The only thing they have in common is that they involve the heart. Here's how I talk about it to patients: The heart has three separate systems: mechanical (valves which can leak or not open wide enough); plumbing (coronary arteries, blockages of which cause MIs); and electrical, which is the source of arrhythmias. Murmurs are mechanical issues. Your murmur is probably innocent, but if a good cardiologist can't tell for sure by listening, then the test you need is an echocardiogram. That exercise intolerance history and arrhythmia stuff is a little more concerning. I just had a relatively young patient who needed a pacemaker for chronotropic incompetence: her heart couldn't speed up to meet myocardial demand when she exercised. The money test there is a treadmill stress test, though they're looking more at rate and rhythm with exertion than for ischemic changes. Good luck. Murmurs and arrhythmias are apples and oranges. The only thing they have in common is that they involve the heart.

Here's how I talk about it to patients:

The heart has three separate systems: mechanical (valves which can leak or not open wide enough); plumbing (coronary arteries, blockages of which cause MIs); and electrical, which is the source of arrhythmias. Murmurs are mechanical issues.

Your murmur is probably innocent, but if a good cardiologist can't tell for sure by listening, then the test you need is an echocardiogram.

That exercise intolerance history and arrhythmia stuff is a little more concerning. I just had a relatively young patient who needed a pacemaker for chronotropic incompetence: her heart couldn't speed up to meet myocardial demand when she exercised. The money test there is a treadmill stress test, though they're looking more at rate and rhythm with exertion than for ischemic changes.

Good luck.

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