MD STAT: Talk to a doctor.

How would you like to be able to simply ask a physician a question? To actually speak with a doctor regarding your medical and surgical questions? We bet you can't do that anymore. We physicians simply do not have time these days to pick up the phone and talk to you. So why not ask us? All contributors here are board-certified in the United States and we have some fantastic retired docs too. You may read their profiles on our left sidebar. We intend for this to be informative and fun. Welcome.

Tuesday, September 18, 2012

Low Potassium after Gastric Bypass

Please list any medication allergies that you have : : Penicillin, morphine
Please list any medications you are currently taking (and dosage if known) :: Saphris 10mg sublingual at night, xanax 2mg twice a day as needed, lunesta 3mg every night, vyvanse 40 mg once a day and aderall 15mg once a day and all the vitamins I listed above
When was your last menstrual cycle?: 4 weeks ago
Are you currently using or do you have a history of tobacco use?: Yes
Are you currently using or do you have a history of illegal drug use?: No
Please describe your alcohol consumption :: Never

HOW QUICKLY DO YOU NEED THIS TO BE ANSWERED?: As soon as possible
How fast potassium can drop. And should I wait to make yet another app with my Doc or go to ER

Sunday, September 16, 2012

Abdominal Pain? Back Pain?

I AGREE TO USE MD STAT FOR EDUCATIONAL PURPOSES ONLY, THAT NO DOCTOR PATIENT RELATIONSHIP IS FORMED BY MY PARTICIPATION IN THIS EXCHANGE, AND I UNDERSTAND THAT MY QUESTION AND ANSWER(S) WILL BE POSTED ON THE WEBSITE AND WILL BE VIEWABLE BY VISITORS TO THE SITE.: Yes, I agree.

MD STAT is an educational service. We do not prescribe medication. We do not enter into a doctor-patient relationship with you. We explain, educate, clarify, and suggest possible solutions to your medical questions. Thank you for your interest.

Gender: Female
How tall are you (feet and inches)?: 5'6"
What is your weight in pounds?: 171
How old are you?: 65
How long has this been going on?: More than a year

Describe associated symptoms not listed above: Quite a few years ago I began to have a slight twinge in the area of my solar plexis. Went through all kinds of tests by a gastroenterologist and finally it was chalked up to IBF. It has gotten progressively worse but the next time I went back he came up come up with the same diagnosis because he couldn't find anything else. But that was still quite a few years ago. Now it's really pronounced and the twinge radiates down my legs and I can feel it in my ankles. Some sort of nerve thing???? It happens at night in bed mostly. Any idea what this might be?

Please include tests and relevant studies here. Endoscopy, colonoscopy, MRI (or catscan) of my abdomen. Again all quite a few years ago.

Please list any chronic medical problems and also list any prior surgery (lacerations don't count!): Used to have chronic fatigue - but it has been under control for quite awhile.

Complete hysterectomy, hip replacement, carpel tunnel, many trigger fingers, orthoscopic knee ( 2 surgeries), stent for May Thurner syndrome in iliac vein.

Check all conditions present in your immediate family... : Stroke

Please list any medication allergies that you have : : MRI Contrast - hives

Please list any medications you are currently taking (and dosage if known) :: levothyroxine .088 mg 1/daily
imitrex 5mg as needed for migraine

When was your last menstrual cycle?: I no longer have a menstrual cycle
Are you currently using or do you have a history of tobacco use?: Yes
Are you currently using or do you have a history of illegal drug use?: No
Please describe your alcohol consumption :: Occasionally

HOW QUICKLY DO YOU NEED THIS TO BE ANSWERED?: As soon as possible

I'd like to know what this is since it's getting progressively more intense. Or what type of physician I should see and what to tell them. When I try to describe it no one seems to have any idea what it might be and tests don't find anything. But the feeling is like the fright/flight internal shock.
May we send you a satisfaction survey after your question is answered? It takes a minut to fill out.: Yes

Friday, August 10, 2012

Abdominal Complaints in a Healthy Young Male

I am a 24 year old male smoker with a clean bill of health, no known allergies, and no family history of cancer or illness.

For last 6 months I have had general weakness and ongoing discomfort in my lower/middle left abdomen area: sometimes its enough to wake me up; I feel better after a bowel movement and or urination.

I also have...
-joint pain
-slight numbness in my left leg, left testicle and lower back.
-when I urinate I have a burning sensation on the tip of my penis that comes and goes
- when I push hard on certain area on my lower left abdomen I have a quick sharp pain that I can feel in my anus
- frequent loose stools
- frequent diarrhea
- I've also lost ten pounds recently but I have had a more active life style and I've been going to the gym

My GP can't seem to figure out what is wrong. I've already had...
-full blood and urine work
-an MRI of my spine
-a three day stool study
-an ultrasound of my left testicle and lower left abdomen

I forced them to schedule me for a colonoscopy next week..

Everyone tells me its just stress/anxiety but I just don't feel like myself anymore and I think something is wrong.
Can all of these symptoms be explained by something benign... ie gas, ibs, stress, pinched nerve, etc

All these tests are depleting my savings...
What should I do? Whats wrong with me? Are there any other tests you would recommend.

Gender: Male
How tall are you (feet and inches)?: 6'1''
What is your weight in pounds?: 172
How old are you?: 24
How long has this been going on?: More than a month

Check all symptoms you are currently experiencing:
Abdominal Pain
Palpitations
Diarrhea
Musculoskeletal Pain

Please list any medication allergies that you have : : none

When was your last menstrual cycle?: I'm a man, baby!
Are you currently using or do you have a history of tobacco use?: Yes
Are you currently using or do you have a history of illegal drug use?: No
Please describe your alcohol consumption :: Daily

Can all of these symptoms be explained by something benign... ie gas, ibs, stress, pinched nerve, etc?

what should I do?

______________________________________________________

Wow, tough one. First of all, when you get your colonoscopy, which I'm glad you are getting. Ask the GI physician if he would recommend anything further. The one miss that I see is that you have not had a CT of your abdomen and pelvis, but, honestly, your symptoms wouldn't prompt me to order that test right away. Certainly this could be something benign and it most probably is. The worrisome symptoms you mention is the abdominal pain which is produced with pressure on your left lower quadrant of your abdomen. Make sure the GI doc knows about this. So far I think your GP has done a great job ruling out the bad things that can happen to a 24 year old who is otherwise healthy. Testicular cancer, lower spine issues like nerve impingement from a mass or tumor, and there's other things, no doubt that have been ruled out. I do wonder if stool studies have been sent, not just looking for blood, but looking for infection like Giardia Lamblia... a pretty common parasitic infection of the colon that is picked up by drinking stream or creek or lake water in many parts of the US. Make sure to ask the GI doc about this as well. I think you are being well taken care of. I know this is late in coming, so please do write and tell us what is going on. You can do this in the comment section. Thank you for the question and sorry for the delay.

Wednesday, July 25, 2012

Supraventricular Tachycardia

I AGREE TO USE MD STAT FOR EDUCATIONAL PURPOSES ONLY, THAT NO DOCTOR PATIENT RELATIONSHIP IS FORMED BY MY PARTICIPATION IN THIS EXCHANGE, AND I UNDERSTAND THAT MY QUESTION AND ANSWER(S) WILL BE POSTED ON THE WEBSITE AND WILL BE VIEWABLE BY VISITORS TO THE SITE.: Yes, I agree.
Seriously.. please take me seriously!

For over ten years I have had 'attacks' of SVT. Throughout my childhood and teen years, I would experience periods of arrhythmia, had pneumonia several times and was often sickly. No one ever took me seriously about my heart. I'm now 29 and my SVT lasts about 3 hours at 250-300 bmp. I have been informed that I am "Too young..." and a hypochondriac.

An episode was at last caught on an EKG after ten years of being dismissed. AV Nodal re entrant SVT.

More tests ensued, MRI, MRA, Echo, Doppler. Told I have a common carotid malformation, no neck rubbing. Shipped out of the ED with a rx for Metroprolol and no idea what to do. I just stated a new job, in a new area. No benefits until October. More than slightly worried.

History of illegal drug use in teen years. Cocaine overdose at 17. No drug abuse since.
Gender: Female
How tall are you (feet and inches)?: 5'6"
What is your weight in pounds?: 180
How old are you?: 29
How long has this been going on?: More than a year
Check all symptoms you are currently experiencing:
Bruising or Bleeding
Describe associated symptoms not listed above: Bruise ridiculously easy. Iron and potassium always deficient on blood work.
What have you done so far to remedy this condition? Please include tests and relevant studies here.

I have not begun the beta blocker. I take fluxetine and xanax for severe anxiety and read there could be an interaction.

Please list any chronic medical problems and also list any prior surgery (lacerations don't count!): Anxiety, ADHD, Psoriatic Arthritis, Migraines
Two C-Sections
Cholecystectomy

Check all conditions present in your immediate family... :
Asthma / Lung Problems
Cancer
History of Back Pain
Please list any medication allergies that you have : : Latex

Please list any medications you are currently taking (and dosage if known) :: fluxetine 60mg po in a.m.
Xanax 1mg - 5x a day
When was your last menstrual cycle?: 2 weeks ago
Are you currently using or do you have a history of tobacco use?: Yes
Are you currently using or do you have a history of illegal drug use?: Yes
Please describe your alcohol consumption :: Rarely

HOW QUICKLY DO YOU NEED THIS TO BE ANSWERED?: As soon as possible

This is something that has been getting more severe over time. Can it wait a few more months?
__________________________________________

I'm confused by your question ma'am. It seems that you have problems with anxiety that can mimick an attack of SVT, but now you have an EKG which proves that you do have it.

From the ER you would have been advised to seek the care of a cardiologist. In particular, you need to see an electrophysiologist. They can, usually, cure, permanently, your SVT with something called a 'cardiac ablation procedure'.

I have no idea what to make of the comments that you are 'too young' and 'a hypochondriac'.

As to the metoprolol I do not understand why you are not taking it. The interaction is that while being on the other medicine you are on the dose you need may be lower than that for most, but metoprolol can prevent the episodes of SVT. Smoking, of course, is a risk factor for heart attack and you should stop.

It is time, now, to call and make an appointment with a cardiologist. While your SVT is likely okay to follow over time, a one time capture of the rhythm in the ER is lucky, but is also crying out for expert intervention at this time, namely that of a cardiologist. And one very important thing, when you go see the cardiologist, take a copy of the EKG. Scan it, make ten copies, don't ever lose that EKG... it is very important indeed.

That is where you should turn. Can you wait? Sure, Will anything bad happen? Probably not, especially if you take your metoprolol, but you absolutely need a physician to supervise your medicines and get to the bottom of this. The ER is the worst possible place to go in a case like yours, because while SVT is something we see routinely, we can not fix it. And now that we know what you have it's time to get to the doctor that can fix it.

Friday, July 20, 2012

Chronic Abdominal Pain

This is a really hard question for an online discussion. It is possible that your wife has a post cholecystectomy syndrome. This is a very difficult diagnosis and somewhat controversial. She needs to be seen by a very good GI doc and her surgeon should also know that she is having these problems. The thing is, it seems from what you are saying that she has had a VERY thorough workup since this started. The problem here is that her pain is so suggestive of pain originating in the area of the gall bladder that it's hard to think of another cause, especially with the tests she has had and the results obtained. I wish I had a 'magic bullet' solution for you but I simply do not. You said the tests have been 'mostly normal'... can you tell me what tests have not been normal? Please respond in the comment section.

Wednesday, July 18, 2012

Hypokalemia of Unclear Cause

I AGREE TO USE MD STAT FOR EDUCATIONAL PURPOSES ONLY, THAT NO DOCTOR PATIENT RELATIONSHIP IS FORMED BY MY PARTICIPATION IN THIS EXCHANGE, AND I UNDERSTAND THAT MY QUESTION AND ANSWER(S) WILL BE POSTED ON THE WEBSITE AND WILL BE VIEWABLE BY VISITORS TO THE SITE.: Yes, I agree.

I am a 32 year old female and have never had a problem with my potassium until the last three months. I was put in the hospital once because my potassium was 2.3, I got potassium by iv and it was painful! They sent me home taking 80 MEQ a day then when my blood work came back normal they told me I didn't have to take the potassium anymore

Then a month and a half later my legs started hurting really bad so I went to have blood work in the morning and the doctor called that evening and told me to go to the er because my potassium was 2.3 again. When I got there the doctor told me he though they made a mistake because he didn't think it could be that low so he checked my blood again and it had already dropped down to 1.6 So they admitted me and three bags of potassium and A LOT of potassium pills later they finally got it up to 3.1 The doctor in the hospital said that I was losing blood (my count was going down) but couldn't find a reason for it other than a mild anemia. My co2 levels are also so low they said it was dangerous for me to go home with them that low.

I was told to go to my doctor every other day for blood work but I never could get any answers from the doctor on how to treat it so that I am not in the hospital every other month not to mention the pain in my legs when it gets so low I can barely walk.

Gender: Female
How tall are you (feet and inches)?: 5'6
What is your weight in pounds?: 175
How old are you?: 32
How long has this been going on?: More than a month
Check all symptoms you are currently experiencing:
Difficulty Breathing
Describe associated symptoms not listed above: Major leg pain, hurts so bad I can barely walk
What have you done so far to remedy this condition? Please include tests and relevant studies here.
: So far all that has been done is treating me in the hospital with potassium by iv and a lot of potassium pills. This last visit they added a daily vitamin. Once my potassium goes up they take me off the potassium.
I had blood work where my co2 and potassium were extremely low.

Please list any chronic medical problems and also list any prior surgery (lacerations don't count!): As far as medical problems I have only really been sick once about 3 years ago. I got up with a sore back and the next day I had to call 911 because I couldn't walk. I had meningitis, endocarditis, and internal MRSA. As I was being treated for those my blood stopped producing hemoglobins so they had to give me a blood transfusion. I was in the hospital for a little over a month and had a PICC line to keep taking medicine for another two months after I got out of the hospital.

Check all conditions present in your immediate family... : none
Please list any medication allergies that you have : : none
Please list any medications you are currently taking (and dosage if known) :: potassium 30 MEQ, daily vitamin
When was your last menstrual cycle?: 4 weeks ago
Are you currently using or do you have a history of tobacco use?: Yes
Are you currently using or do you have a history of illegal drug use?: No
Please describe your alcohol consumption :: Occasionally

I want to know what is wrong with me and why would it come on suddenly?
Is the medicine I am what i need to get my body on the right track or do I need to look for another doctor?
_____________________________________________

Ma'am, you have a complex medical problem. You have had diseases and conditions that would have killed most people. It is possible that after your bacterial endocarditis that your kidneys are permanently damaged. As to why you can't keep your postassium levels up, if your current doctor can not tell you, then you need to see a nephrologist.

A GOOD DESCRIPTION OF THE EFFECTS AND CAUSES OF HYPOKALEMIA (LOW POTASSIUM) CAN BE FOUND HERE.

To be frank, you have a life threatening condition that has not been fully explained, or, if it has, it has not been fully explained to you. Please do contact or see a Nephrologist (kidney specialist) as soon as possible and do not hesitate to go to the ER if you have worsening symptoms.

To summarize from the above link....

Causes

The most common cause of excessive potassium loss is the use of prescription diuretics — water or fluid pills. Causes of potassium loss leading to low potassium include:

Chronic kidney failure
Diabetic ketoacidosis
Diarrhea
Excessive sweating
Excessive use of laxatives
Prescription diuretic (water or fluid pills) use
Primary aldosteronism
Vomiting

When to see a doctor

In most cases, low potassium is more commonly found by a blood test, before it gets so low that it causes symptoms.

Low potassium symptoms may include:

Weakness
Fatigue
Muscle cramps
Constipation

Abnormal heart rhythms (arrhythmias) are the most worrisome complication of very low potassium levels, particularly in patients with underlying heart disease.

Talk to your doctor about what your results mean. You may need to change a medication that's affecting your potassium level, or you may need to treat another medical condition that's causing your low potassium level. Treatment of low potassium is directed at the underlying cause and may include potassium supplements. Don't start taking potassium supplements without talking to your doctor first.

Causes

Low potassium (hypokalemia) has many causes. The most common cause of low potassium is excessive potassium loss in urine or from the digestive tract. Only rarely is low potassium due to not getting enough potassium in your diet.
The most common cause of excessive potassium loss is the use of prescription diuretics — water or fluid pills. Causes of potassium loss leading to low potassium include:

Chronic kidney failure
Diabetic ketoacidosis
Diarrhea
Excessive sweating
Excessive use of laxatives
Prescription diuretic (water or fluid pills) use
Primary aldosteronism
Vomiting

When to see a doctor

In most cases, low potassium is more commonly found by a blood test, before it gets so low that it causes symptoms.
Low potassium symptoms may include:

Weakness
Fatigue
Muscle cramps
Constipation

Abnormal heart rhythms (arrhythmias) are the most worrisome complication of very low potassium levels, particularly in patients with underlying heart disease.
Talk to your doctor about what your results mean. You may need to change a medication that's affecting your potassium level, or you may need to treat another medical condition that's causing your low potassium level. Treatment of low potassium is directed at the underlying cause and may include potassium supplements. Don't start taking potassium supplements without talking to your doctor first. "

If you have questions please ask them in the comment section.

Monday, July 9, 2012

Chronic Abdominal Pain

Gender: Male
How tall are you (feet and inches)?: 5' 8.5"
What is your weight in pounds?: 194
How old are you?: 65
How long has this been going on?: A week or two
Check all symptoms you are currently experiencing:
Difficulty Breathing
Chest Pain
Palpitations
Respiratory

What have you done so far to remedy this condition?

I have just taken pain relievers ( otc ) for the pain.

Please list any chronic medical problems and also list any prior surgery: In 2004 i had two stints put in after a heart attack.

Please list any medication allergies that you have : : none that i know of
Please list any medications you are currently taking (and dosage if known) :: sotolol 80mg twice daily
lisinopril 20mg once a day
asprin once a day
When was your last menstrual cycle?: Now
Are you currently using or do you have a history of tobacco use?: No
Are you currently using or do you have a history of illegal drug use?: No
Please describe your alcohol consumption :: Never