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Nivash
(04-21-2017, 04:23 PM)
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Originally Posted by Maxim726X

Very low. My attending said it was only the second time he'd seen it in his life... But after the first, it's something he would always keep in his pocket as a differential. Assuming the patient fit the profile, of course.

And I don't even remember learning about Miller-Fisher syndrome. I need to brush up on weird ass illnesses as my recert is coming in a year or two.

Can't say I heard about it before I saw it either. All I knew was that it looked like Guillain-Barre except weird. The neurologist was the one who said it was Miller-Fisher. Then again, I never got a chance to follow up on it so I don't know if it was actually Miller-Fisher in the end or not. It was a weird time anyway, we had half a dozen Gullain-Barre patients present all at once, so who knows. Filled up half the neuro ward. We even got a call from the Swedish CDC asking what the hell was going on. It got chalked up to a statistical anomaly in the end.

Originally Posted by Reynx

My first patient as a fresh medical student starting a neuro rotation had Miller-Fisher and the next had CJD. My consultant told me it would most likely be the last one I encountered throughout my medical career. Weird how these super rare things tend to crop up as a student.

Haha, yeah. Everyone I shadowed as a student kept complaining to me that it was their worst days ever and that I was attracting weird shit. Once I became a doctor myself it stopped - except when I have students, then it's back to being House MD again. I swear, students are bad luck or something.
Last edited by Nivash; 04-21-2017 at 04:27 PM.
Mighty Chin
Member
(04-21-2017, 04:24 PM)
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Originally Posted by Shogmaster

4 different meds! that's a new hypertension treatment record. What are your BP readings now?

Usually 115/68
Shogmaster
Not genuinely interested in rational debate.
(04-21-2017, 04:25 PM)
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Originally Posted by Mighty Chin

Usually 115/68

Wow. that combo definitely works. ^_^
Class_A_Ninja
Member
(04-21-2017, 04:30 PM)
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Excercise a little. Maybe work on that anger.
Turnip Truck
Member
(04-21-2017, 04:30 PM)
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Sorry you're having these issues, OP. I'm a couple of years older than you and have been fighting kidney disease for the last dozen with its associated BP concerns. Just a couple of thoughts here:

1. I agree with those who advocate keeping your own records. Get a home blood pressure monitor (the arm ones are better than the wrist types) and check/log it daily. Try to also note things like if you've had a stressful day, general info on your diet (salad or pizza for lunch for example), how much sleep you got, whether you exercised that day/previous day. See if you can notice any trends. My BP often reflects what I ate the previous day. Bring these records when you visit the doctor. Quantitative information like this is incredibly useful.

2. Definitely look for a new doctor. But if you're not getting the attention you need from a full on primary care physician, you might consider working with a nurse practitioner or a physician's assistant. Both of these have at least a master's degree of training, often focus on chronic conditions, and most important, can give you more time than an MD. I prefer a PA or NP because they'll sit and discuss my concerns for 30 minutes to an hour if needed. I'm lucky to see my primary care physician for two minutes a year. They work with MDs and can present a much more comprehensive picture of what's going on with the patient to the rest of the care team since they took that time with you. My wife also visits a PA and loves the time and attention they are able to give.
Mighty Chin
Member
(04-21-2017, 04:33 PM)
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Originally Posted by Shogmaster

Wow. that combo definitely works. ^_^

Just decided to take my BP. I rarely do it anymore unless I'm feeling very fatigued.

Haven't taken my morning Meds yet.

130/90. Been 12hrs since my last dose.

I found at the start that my BP woulld rise a lot in the late afternoon. I started spreading out my Meds to 3 times a day. It use to be morning and night. Now I take 2 of them in the afternoon and I never feel out of sorts.
numble
Member
(04-21-2017, 04:33 PM)
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Originally Posted by Shogmaster

How about we use actual body fat percentage instead? When Lambert Adolphe Jacques Quetelet concocted BMI formula back in 19th century, there were no reliable ways to measure actual body fat percentage. Now we do in 21 century. He squared height to come up with a formula that fit his collected numbers. Its 19th century mathematical hack. It's nonsense.

It has been adjusted for things like race and is still recognized as a good rule of thumb for the general populace. What is your body fat percentage?
Elfotografoalocado
Junior Member
(04-21-2017, 04:37 PM)
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I visit a speciallist practicioner for my allergies, which causa asthma.
The summer a couple of years ago, I started building up green phleghm and having a bad cough, as well as losing lung capacity. But since it was not associated with the sharp pain of an asthma crisis, I assumed it was an infection and went to my general doctor, who prescribed me antibiotics. These did nothing, and my doctor's substitute prescribed me even more antibiotics, again with no results. I spent a shitty summer, gained weight, had to lower my workouts and went from having the 120% of the expected lung volume based on my body parameters to having the 80%.
Then my specialist saw me and called both me and those "stupid general practicioners" a bunch of idiots, prescribed me my regular ass medication for clearing up the lungs (Seretide 50/250) and in a couple weeks I was back to normal.
Edit: This is in Spain, so not all of this may apply to the US.
Aruarian Reflection
Chauffeur de la gdlk
(04-21-2017, 04:41 PM)
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Originally Posted by Nivash

Pheochromocytoma? That's rare to the point that I've seen even endocrinologists call it a "textbook disease" because it practically doesn't exist in the real world.

Umm... I'm an endocrinologist. It's rare, sure, but I would not say it "practically doesn't exist in the real world" and I am surprised any endo would say that
Emerson
May contain jokes =>
(04-21-2017, 04:47 PM)
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It's not at all routine to start patients on 50-100 of metoprolol and automatically titrate them up to ~400mg. I've actually never seen a patient taking that high of a dose.

You are on 4 hypertension meds and your BP is still uncontrolled. Perhaps you need to be seeing a cardiologist for this at this point?
BlackBanditSho
Member
(04-21-2017, 04:49 PM)
145/85 as of this morning. Haven't taken meds yet. Still breathing out of one nostril. Still...those numbers are better.
Nivash
(04-21-2017, 05:01 PM)
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Originally Posted by Aruarian Reflection

Umm... I'm an endocrinologist. It's rare, sure, but I would not say it "practically doesn't exist in the real world" and I am surprised any endo would say that

It was during a hospital lecture on secondary hypertension, actually. He made a point of not going into pheo and basically told us to just keep an eye out for the attack-like symptoms he (correctly) assumed we would already know from med school - pheo being the exam favourite it is - and just give him a call if we ever actually suspected it. He thought our time was better spent learning about the more common causes.

He had a point, in a way. We're a regional hospital serving 70 000 people a year. We'd get one case every ten years on average and would just end up transferring the patient to the university hospital we're partnered with as soon as we ever got one. The odds of any one of us front-line docs encountering it and having to manage it on our own is just negligible.
Last edited by Nivash; 04-21-2017 at 05:04 PM.
darscot
Member
(04-21-2017, 05:05 PM)
Man it drive me nuts when people shit all over Doctors. 210, 5.9 and high blood pressure, I wonder why. At 6'1 when I hit 205 the alarm bell of fuck you need to take better care of yourself goes off. The way I see it anything a Doctor can do to help someone is a blessing, no one forces you to go them.
AbortedWalrusFetus
Member
(04-21-2017, 05:19 PM)
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This thread reminded me to check my blood pressure. I was pre-hypertensive about a year or so ago, but I've lost a significant amount of bodyfat and become much more active, going to the gym 3 times a week, doing weight training as it's supposed to help with BP. I should check and see if I'm still pre-hypertensive or if I'm lucky enough to have gotten back into the regular BP range.
sooperkool
Member
(04-21-2017, 05:21 PM)
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Originally Posted by Shogmaster

Nobody figured out the cause of the hypertension. They called it "intractable hypertension" and said about 5% of population has this type that they can't pin down the cause.

The medication combo was figured out by current doctor, but that's because I kept record of all the meds I tried and so he simply noticed that I didn't try any beta blockers. Nothing amazeballs. If anything, that doctor I saw after hospital stay was a totally useless chump. He has 4 months to find me something. Got me down to 170/110. Useless.

Ofc your regular doctor was better equipped, that's why we have regular doctors... So they can get familiar with us. And your also supposed to keep track of your meds, your not a child anymore, that's what adults are supposed to do.
Nivash
(04-21-2017, 05:25 PM)
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Posted in the wrong thread. Stupid iPad.
Shogmaster
Not genuinely interested in rational debate.
(04-21-2017, 05:26 PM)
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Originally Posted by sooperkool

Ofc your regular doctor was better equipped, that's why we have regular doctors... So they can get familiar with us. And your also supposed to keep track of your meds, your not a child anymore, that's what adults are supposed to do.

I did my part. He didn't. I told him several times he is repeating combos that didn't work. What the fuck is that stupid chart he is looking at for if he isn't writing the prescriptions down and referring back to them. Don't try to defend him. He had 4 months/9 visits and got me nothing. My current doctor got it in 2 tries because I kept track of meds and he fucking read them before prescribing.
Shogmaster
Not genuinely interested in rational debate.
(04-21-2017, 05:28 PM)
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Originally Posted by Emerson

It's not at all routine to start patients on 50-100 of metoprolol and automatically titrate them up to ~400mg. I've actually never seen a patient taking that high of a dose.

You are on 4 hypertension meds and your BP is still uncontrolled. Perhaps you need to be seeing a cardiologist for this at this point?

What are you talking about? I'm not on 400mg. I'm on 200mg. And it's now controlled (116/82).
hockeypuck
Member
(04-21-2017, 06:15 PM)

Originally Posted by Miker

This post sucks. The guy said he's working in the ICU, where most patients are literally on their deathbed. As for emergency care, I'm an ED doc and this isn't true at all. Some people aren't grateful no matter what you do for them, including saving their lives.

Read Rhaegar's post again and tell me it's not melodramatic. A stranger vents on a public forum, some guy he's never personally treated, and his response is to include mention of his sacrifice, his loans, and concludes with a statement of regret? Even if sarcastic, please.

If some benign complaint like the OP's is going to elicit a response like Rhaegar's, I wonder how he's going to respond to a lawsuit threat said face-to-face by a patient's family member. Now that's a discouraging feeling.

If Rhaegar truly regrets going into the medical field and the time sacrifice it requires, then perhaps he should quit whatever rotation he's in, whether this is residency or if he's still a student, and do something else. He can make 6 figures a year doing medical chart review from home. He can make a living doing workplace physical exams for insurance companies. No nights or weekends.

And in regards to your own experience as an ER doc, if the negative patient interactions are outweighing the positive ones, then perhaps you should look for other opportunities, if only for the sake of your mental health. And you could tone down the hyperbole yourself, since average ICU mortality is 10-29%, according to SCCM. Now you know.

Maybe I'm just lucky, I don't know. But I'm reminded every week why I went into this field. My interactions at work far greatly outweigh the negatives.
GiJoccin
Member
(04-21-2017, 06:16 PM)
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Originally Posted by Shogmaster

What are you talking about? I'm not on 400mg. I'm on 200mg. And it's now controlled (116/82).

dude, you said you looked on medscape or some other site, and that website told you that you're supposed to start on the baby dose and then advance up to 400. do you even remember what you wrote?

also its controlled for now while you're self medicating, what about when it jumps again and you think it's a good idea to go up in metoprolol again? there are diminishing returns on most meds, and side effect risk goes up markedly.

just go see a cardiologist or try another GP, and ask a lot of questions, your posts show that you don't know a whole lot about your medical issues (that's NOT a knock on you, but you're in dire need of quality time spent one on one with a doctor)
Eppy Thatcher
Member
(04-21-2017, 07:05 PM)
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Worked with doctors my entire life and some of my favorite horror stories start with
"So I decided to look it up on the internet"

Be careful with that shit. Good luck to you...
ColdPizza
Member
(04-21-2017, 07:08 PM)
Dude, what are your height/weight stats and diet like?

I'm on lisinopril 20mg a day. Hoping to cut out caffeine, alcohol and sodium while losing 30 pounds.
Juan29.zapata
Member
(04-21-2017, 08:00 PM)
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Originally Posted by Shogmaster

Right... So if I went to my doctor the next day, knowing that I had difficulty finding combination of drugs that worked prior, he wouldn't have done the same damn thing?

With a systolic pressure at 220 along a crippling headache? No, he wouldn't have. There are limits to how much you can reduce arterial pressure in a certain timeframe without compromising brain perfusion.

I know you're frustrated, but what you did is pretty damn risky and you're pretty damn lucky nothing happened to you. I hope you have gotten another medical appointment. After all it's your life on the line.

Originally Posted by Nivash

Pheochromocytoma? That's rare to the point that I've seen even endocrinologists call it a "textbook disease" because it practically doesn't exist in the real world.

I've also seen one! But just that one time. It's still pretty rare.
DrMungo
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(04-21-2017, 08:55 PM)
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Hey OP

Sorry for what your going through. It's definitely no fun being a "medical mystery". My wife and I are both in the medical field. after we had our son she got really sick and the doctors weren't sure if she had a Blood clot in her lungs. It was terrifying even for us.

From what I've read so far ITT your case is pretty extreme and warrants looking for more rare causes. People mentioned pheochromo and hyperaldo which is a good start. They are rare but I have seen cases so they are not complete "unicorns". Also important because metoprolol can be deadly in the cases of a pheo. I'd also consider a renal artery stenosis work up as well since you are young. Family history is important too especially if there is evidence of bad hypertension in your family. Again there is a chance that it can all come back normal but it's good to rule things out.

In day to day routine I would reduce or eliminate salt and caffeine. Weight loss can help too but I would not start intense exercising right now.

I hope you find some answers and someone that can treat you. Hope you feel better.
Last edited by DrMungo; 04-21-2017 at 08:58 PM.
Shogmaster
Not genuinely interested in rational debate.
(04-21-2017, 10:49 PM)
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I appreciate all the professional medical advice in this thread. I will definitely look into those rare cause possibilities as well.
poppabk
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(04-22-2017, 03:07 AM)
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Originally Posted by Shogmaster

How about we use actual body fat percentage instead? When Lambert Adolphe Jacques Quetelet concocted BMI formula back in 19th century, there were no reliable ways to measure actual body fat percentage. Now we do in 21 century. He squared height to come up with a formula that fit his collected numbers. Its 19th century mathematical hack. It's nonsense.

It isn't nonsense, its just an overly simple approximation. Counting the seconds and dividing by 5 won't give you the exact distance that a storm is from you, and in some cases will be entirely wrong, but it is a good general rule of thumb approximation. And what collected numbers are you talking about, the square is just an approximation of how weight is expected to scale with height, he just chose a rough approximation that isn't quite accurate as you get away from the mean. It's all arbitrary anyway, if you said that over 20% bodyfat was overweight that would be an arbitrary distinction as well. The important thing is how well it correlates with disease risk, and for the average person it correlates quite well. You can incorporate waist measurements, but people are lousy at accurately measuring their waist, so a simple formula works best.

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