Health Problems

Oblio

Utah
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I got through the night, feeling much better. A bit soar but I think that is exacerbated by how tired I am. Fuck kidney stones!
 

Oblio

Utah
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I got through the night, feeling much better. A bit soar but I think that is exacerbated by how tired I am. Fuck kidney stones!
Just passed another and I was able to capture it this time. Took a picture next to a quarter for scale/size reference.

P_20180628_195602.jpg
 

Vanderhoof

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So...so...absolutely ignorantly wrong.


On an unrelated note. For all the medical folks on this board. We had a patient come in via code 3, sepsis alert. IVs placed, sepsis bundle protocol initiated. Patient was pretty much GCS ~11. Responsive to sound, unable to open eyes, barely able to move extremities. Pale as a motherfuck. Perfusion was almost nonexistent. Cap refill >10 seconds, lips were cyanotic. OK... Place a foley in him to see if he's having any output. Out comes 1200mL of clear yellow urine. We are freaking out at this point that the full bladder was tamponading a bleed and sure enough. Yes.

Patient began seizing. EKG showed inferior acute MI. Patient by this point was unresponsive. We got him to CT scan and I call lab for stat H/H. His hemoglobin was 2.1 and hematocrit was 7.8. Intubated, we started the level 1 rapid infuser and poured 8 units of PRBCs, 4 bags of platelets, and 4 bags of plasma.

A 4 hour code. I was drained. My bladder was full. I wanted to drink myself to death. Got him stabilized and sent him to ICU.

That's too much for me. I had to spend 20 minutes explaining over and over why me giving him lorazepam is not an appropriate way to prevent him from arguing with his wife when he gets home from work; I was ready to to home after that.

Insurance is frustrating. I billed out like 750k last year and the hospital has only collected like 220k from patients and insurance.
 

Kuriin

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Just passed another and I was able to capture it this time. Took a picture next to a quarter for scale/size reference.

View attachment 169137

We had a patient come in with flank pain and CT and US showed that he had a 6mm kidney stone. Physician told the patient it's a tiny one and the wife of the patient is also a physician had a wide eye stare (as did I) when our ED MD said that. It may seem small, but, jesus, I'm sure they hurt! Biggest one I saw was a 12mm one. OUCH!
 

sleevedraw

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The utilization management nurse in me is currently shaking his head and preparing to refer the use of CT for kidney stone to physician review for possible denial of claim.
Unless the US was negative, patient was over the age of 50, or uro wanted a better look for a lithotripsy.
 

alavaz

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This might fit better in the depression thread, but since it's dead I'm jumping in here. For some reason like 3 months ago, I started having my heart just jump up from my normal resting rate at like 60bpm to 90-110bpm and beat super hard. This usually happened at night when I was relaxing (or trying to) so I started stressing about it a bit and went to see the doctor. Of course they want to make sure it's not some sort of afib thing so I went through all the tests - holter for a month, treadmill, ekgs several times and an echo. After all that, they deduce that my heart is in awesome shape probably just anxiety and offer me SSRIs and benzos.

I figure great, I'm healthy now I can stop worrying and this will go away. I don't need meds. Nope, instead I trade out heart palps for extreme insomnia. It's not even that I couldn't fall asleep, I usually fell asleep just fine, it's just that I would wake up 1-3 hours later and then sort of fall into this nod and jolt back awake pattern like I'm sleeping on an airplane or something. This happens for at least a month and the weird thing was I never really felt fatigued. It was almost like my body was kicking into high gear but my brain wasn't ready. I've lost like 15 pounds during all this, which is fine since I was like 30 overweight anyway, but worrisome that I wasn't trying to.

I go back to the doctor tell him about it. He still thinks anxiety but wants to make sure it's not a thyroid thing. So they test that, it's within normal range but the number leans more towards hyperthyroidism than the other direction. Says we'll keep an eye on it but it shouldn't be causing much effect at this point. I just needed some sleep at that point, so I took the Ativan and actually got some great sleep. I'm at the point now where I can usually sleep without it but I wonder if I should give the SSRI a go. My doctor claims it will reset my brain chemistry or whatever and I don't have to stay on it for more than a few months. This is Cymbalta he's pushing by the way. I dunno though, I'm worried about doing all that and really fucking myself for sleep. Seems like from I read it's 50/50 on whether it helps people sleep or wires them up. I definitely don't need the latter.
 

sleevedraw

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This might fit better in the depression thread, but since it's dead I'm jumping in here. For some reason like 3 months ago, I started having my heart just jump up from my normal resting rate at like 60bpm to 90-110bpm and beat super hard. This usually happened at night when I was relaxing (or trying to) so I started stressing about it a bit and went to see the doctor. Of course they want to make sure it's not some sort of afib thing so I went through all the tests - holter for a month, treadmill, ekgs several times and an echo. After all that, they deduce that my heart is in awesome shape probably just anxiety and offer me SSRIs and benzos.

I figure great, I'm healthy now I can stop worrying and this will go away. I don't need meds. Nope, instead I trade out heart palps for extreme insomnia. It's not even that I couldn't fall asleep, I usually fell asleep just fine, it's just that I would wake up 1-3 hours later and then sort of fall into this nod and jolt back awake pattern like I'm sleeping on an airplane or something. This happens for at least a month and the weird thing was I never really felt fatigued. It was almost like my body was kicking into high gear but my brain wasn't ready. I've lost like 15 pounds during all this, which is fine since I was like 30 overweight anyway, but worrisome that I wasn't trying to.

I go back to the doctor tell him about it. He still thinks anxiety but wants to make sure it's not a thyroid thing. So they test that, it's within normal range but the number leans more towards hyperthyroidism than the other direction. Says we'll keep an eye on it but it shouldn't be causing much effect at this point. I just needed some sleep at that point, so I took the Ativan and actually got some great sleep. I'm at the point now where I can usually sleep without it but I wonder if I should give the SSRI a go. My doctor claims it will reset my brain chemistry or whatever and I don't have to stay on it for more than a few months. This is Cymbalta he's pushing by the way. I dunno though, I'm worried about doing all that and really fucking myself for sleep. Seems like from I read it's 50/50 on whether it helps people sleep or wires them up. I definitely don't need the latter.

Benzos are OK for very short term insomnia, but they are not something you want to be taking for extended periods of time, because they are a) addictive and b) even though they are sedating, they ruin your sleep architecture (so while you might feel asleep, your brain is not really getting rest).

People respond to SSRIs very differently. Some people get energized, some people get sedated. In post-release surveillance of Cymbalta, about 10% of people get insomnia, and another 10% get sedated. SSRIs are generally well-tolerated, but they have a couple nasty side effects that docs are not always forthcoming with: erectile dysfunction and weight gain. The ED is very, very common (>20%) and in some cases is irreversible even after the drug is discontinued.

Are you practicing good sleep hygiene otherwise?
 

3301

Wake Up Man
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This might fit better in the depression thread, but since it's dead I'm jumping in here. For some reason like 3 months ago, I started having my heart just jump up from my normal resting rate at like 60bpm to 90-110bpm and beat super hard. This usually happened at night when I was relaxing (or trying to) so I started stressing about it a bit and went to see the doctor. Of course they want to make sure it's not some sort of afib thing so I went through all the tests - holter for a month, treadmill, ekgs several times and an echo. After all that, they deduce that my heart is in awesome shape probably just anxiety and offer me SSRIs and benzos.

I figure great, I'm healthy now I can stop worrying and this will go away. I don't need meds. Nope, instead I trade out heart palps for extreme insomnia. It's not even that I couldn't fall asleep, I usually fell asleep just fine, it's just that I would wake up 1-3 hours later and then sort of fall into this nod and jolt back awake pattern like I'm sleeping on an airplane or something. This happens for at least a month and the weird thing was I never really felt fatigued. It was almost like my body was kicking into high gear but my brain wasn't ready. I've lost like 15 pounds during all this, which is fine since I was like 30 overweight anyway, but worrisome that I wasn't trying to.

I go back to the doctor tell him about it. He still thinks anxiety but wants to make sure it's not a thyroid thing. So they test that, it's within normal range but the number leans more towards hyperthyroidism than the other direction. Says we'll keep an eye on it but it shouldn't be causing much effect at this point. I just needed some sleep at that point, so I took the Ativan and actually got some great sleep. I'm at the point now where I can usually sleep without it but I wonder if I should give the SSRI a go. My doctor claims it will reset my brain chemistry or whatever and I don't have to stay on it for more than a few months. This is Cymbalta he's pushing by the way. I dunno though, I'm worried about doing all that and really fucking myself for sleep. Seems like from I read it's 50/50 on whether it helps people sleep or wires them up. I definitely don't need the latter.

Do not take Cymbalta. The withdrawal is horrific. If that were my doc, I’d find a new doc.
 

TomServo

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your doc is pushing the drug angle far to hard. drugs are not a magic cure all. you probably need to speak to a therapist.
 

Gamma Rays

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I would concur with the cause being a stress / anxiety problem. I have had similar problems and at its worst I went through a period of trying to relax in bed and feeling my heart pounding, plus I'd get a similar thing of jolting awake when I was nearly fully asleep. For me I was getting a nausea / acid stomach rush that would jolt me awake. Once woken by it, then the stomach feeling wasn't too bad, I'd just lay there annoyed with it all. But it would take a long time to get relaxed again.

It was a work situation, which I was able to find better ways to deal with it during the day, once the cause was more controlled, then the issues I had at night got better.

Not sure how helpful this is, as each case is different. You probably just need to find what works best for you to deal with it.
 
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3301

Wake Up Man
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I remember my heart pounding off and on several years ago, and a weird head/ear pressure thing if I drank a lot of water. Ever since I started doing epsom salt baths to raise my magnesium level, it has gone away.
 

Frenzied Wombat

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I figure great, I'm healthy now I can stop worrying and this will go away. I don't need meds. Nope, instead I trade out heart palps for extreme insomnia. It's not even that I couldn't fall asleep, I usually fell asleep just fine, it's just that I would wake up 1-3 hours later and then sort of fall into this nod and jolt back awake pattern like I'm sleeping on an airplane or something. This happens for at least a month and the weird thing was I never really felt fatigued. It was almost like my body was kicking into high gear but my brain wasn't ready. I've lost like 15 pounds during all this, which is fine since I was like 30 overweight anyway, but worrisome that I wasn't trying to.

.

Welcome to the last 10 years of my life. I used to sleep ten glorious peaceful hours per night, and could never get enough-- now I'm lucky to get 6 disturbed hours of sleep. Like you, despite the lack of sleep, I don't feel tired anymore. One doc says it's "just getting old" and recommended all sorts of sleep hygiene techniques that didn't work. The 2nd doc tried sleeping pills (didn't work, 'cause my problem isn't falling asleep, it's staying asleep), then Xanax (which did work, but couldn't take long term). Basically he concluded it was low level anxiety combined with being a light sleeper and recommended a psychologist. Basically, as you get older and life's burdens accumulate (parents die, mortgage, job, etc) some people just develop a low level anxiety which affects their sleep. For instance, I used to be able to watch horror movies, surgery documentaries, or some human spider climbing a skyscraper without feeling anything. Nowadays, for whatever reason, all these things literally give me physical anxiety (horror/surgery-- stomach churning feeling, human spider--vertigo). I never saw the shrink, but ultimately smoking weed before bed turned out to be the best treatment-- it suppresses those anxiety ridden dreams that wake you (even if you don't remember them). Might want to give it a shot.
 
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TomServo

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Wombat is right. Therapy worked for me, not advocating it works for everyone but, the drugs like weed just suppress it and it will eventually make itself known. My doctor had me on a max dose of lexapro. That did help me sleep for a while but over time just made the underlying anxiety worse.
 

alavaz

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I think I will skip the cymbalta then. My doctor is a cool guy. He's not trying to make me take it, it's just what he feels works best for anxiety in my case. I'm not averse to therapy and I might consider it. It just seems to me that the root of my anxiety is my health and since that seems to be good, I figured it would go away. I mean the heart stuff has stopped, just the insomnia that lingers. Like I said though, I really only use the ativan maybe a night or two a week at this point so I'm hoping to be done with it altogether soon.

edit: my sleep hygiene is also very good (I think). My wife and I don't want tv in bed or anything and keep a cool room. I don't know how well sleep hygiene works for not being able to stay asleep. It seems it's all more geared towards going to sleep but still I tried to make sure it was as good as I can get it.
 
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sleevedraw

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Do you go to bed +/- 45 minutes of the same time every night, even on weekends?
Do you stop all electronics usage at least an hour before bed, not just TV (or if you're like me and can't, you at least use an extremely red-shifted blue light filter?)
Have you tried a bit of noise from either a fan or phone app (I prefer red noise myself instead of white noise, you may need to experiment).
 
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AladainAF

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This might fit better in the depression thread, but since it's dead I'm jumping in here. For some reason like 3 months ago, I started having my heart just jump up from my normal resting rate at like 60bpm to 90-110bpm and beat super hard. This usually happened at night when I was relaxing (or trying to) so I started stressing about it a bit and went to see the doctor. Of course they want to make sure it's not some sort of afib thing so I went through all the tests - holter for a month, treadmill, ekgs several times and an echo. After all that, they deduce that my heart is in awesome shape probably just anxiety and offer me SSRIs and benzos.

Stupid question, but do you have sleep apnea or snore heavily?

When I was a fat fuck, I had sleep apnea (It was originally not diagnosed properly) and I had the exact same problem. I would relax and have a really quick fade into sleep and then could not breathe and then my body would wake up in a panic obviously due to lack of oxygen, which causes my heart rate to lurch forward for a minute or two. You never really know you can't breathe. When it happens at first, you have no idea WTF is going on. I had a lot of these sleep fades because with sleep apnea, you're fucking tired all the time and never get a really good nights sleep.

I've never had that problem since losing all my excess weight.
 
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sleevedraw

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He did say that he was overweight at one point.

STOPBANG (preliminary screening) for sleep apnea is here. Only way to confirm 100% is with a sleep study, but it will at least stratify your risk.
 

alavaz

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Do you go to bed +/- 45 minutes of the same time every night, even on weekends?
Do you stop all electronics usage at least an hour before bed, not just TV (or if you're like me and can't, you at least use an extremely red-shifted blue light filter?)
Have you tried a bit of noise from either a fan or phone app (I prefer red noise myself instead of white noise, you may need to experiment).

I sleep with a fan and I read most nights for about an hour before I fall asleep. Can't say 100% yes to the electronics stuff, but I'd say greater than 60% of the time I haven't stared at any screens (aside from quick phone checks) for over an hour before I turn out the light to sleep. Bedtime is pretty religiously at 11pm. Weekends I do tend to sleep until 8 or 9 as opposed to the 6 I get up on weekdays. I swore off naps over ten years ago because they were messing me up, but that was a getting to sleep problem back then and not a staying asleep problem.

Dunno about sleep apnea. Anecdotally my wife says I never snore unless I'm drunk (I haven't drank much at all in over a year either and sleep quality was a big reason I gave it up). She also says she's never noticed me gasp for air or anything. I did bring up sleep apnea to the doctor but he doesn't seem to think it's a possibility due to my good blood pressure and overall health plus the circumstantial evidence from the wife. If this were getting worse I think I might push a sleep study at some point though.

I'm really just trying to stay positive and get to a point where I can sleep a whole week without meds. At this point I can usually make it 3-4 nights then have a real shit night. Which is way better than was it was a month ago.

edit: Yeah I don't really meet any of those STOP-BANG things. I'm overweight but only by about 15-20 lbs. When this all started I was like 30 lbs overweight but was starting to try and get that under control.
 

Woefully Inept

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So I have a very large (2-3cm) polyp deep down by my duodenum that needs removing. It's very deep and in a very difficult spot. Dana Farber has one guy that does all the crazy scope procedures so I'll have the best they've got working on it. However if he is unable to remove it via a scope procedure then I'll need to have it removed surgically. That would mean a Whipple procedure which would suck donkey balls because that means they'll have to remove a portion of my pancreas. So I'm going in with the expectation that he'll remove it during the scope procedure.