Medical Questions I'd Like Answered...

Username17 · Post by **Username17** » Mon Jan 05, 2015 12:43 pm

Prak wrote:Ok, I know I've fucking asked this before, but I can't fucking find the posts, so

Frank- how much water is a person supposed to drink per day, and does anything with a high water content (tea, coffee) count, or should it be just water?

You probably need about 2.5 liters of water. But that's total, and milk, juice, and even cola contribute towards that.

Shatner · Post by **Shatner** » Mon Jan 05, 2015 6:03 pm

My wife started having joint pain in one of her knees about two months ago, then recently she started having stiffness in the joints of one of her fingers on one hand (worse when she first woke up). She visited the doctor, they did some lab work, and she showed as having slightly elevated ANA levels. Oh, and the finger thing is apparently called Trigger Finger. The doctor didn't seemed concerned and told her to pick back up the yoga she'd dropped during her pregnancy.

So, my mother-in-law has, among other issues, lupus and arthritis. Really, she's got a lot of health problems but many of them boil down to "has had lupus for decades". When my wife spoke with her recently she learned that her auto-immune disorder manifested as knee pain and trigger finger when she was in her early thirties, shortly after giving birth. My wife is 30 and gave birth to our son 10 months ago. My wife also learned that her paternal grandmother suffered from rheumatoid arthritis, which is also auto-immune related.

She went to the doctor again to mention that some of the trigger finger symptoms were now manifesting on an adjacent finger and to pass on all this additional, worrisome family history. The doctor wasn't concerned, saying these sorts of things could be lingering pregnancy symptoms (stuff readjusting after the hormones have subsided and the ligaments are trying to tighten back up) and the ANA test could be a false positive. If my wife was really concerned, she should go see a joint specialist.

I have a couple of questions. Is trigger finger and knee pain 9+ months after giving birth plausibly a pregnancy side effect? Is her family history (lupus'd mom, arthritic grandma) relevant or just a red herring? What should we be looking for to confirm or deny the onset of lupus? If it is lupus, or another auto-immune disorder, is there anything we can do early on to mitigate it?

Username17 · Post by **Username17** » Mon Jan 05, 2015 7:24 pm

Auto-immune disorders are common, especially in women and even more common in women who have recently given birth. Something about carrying a parasite with different but similar DNA to your own for 40 weeks makes you vulnerable to that sort of thing. Sometimes these things go away on their own, and sometimes they don't.

Auto-immune joint conditions can be really annoying, but even if they are incapacitating they are a lot less dangerous than a lot of other auto-immune conditions like diabetes or vasculitis.

There generally isn't a whole lot that can be done about auto-immune conditions. Treatments get to be one of: dangerous, expensive as fuck, or limited effectiveness. For the most part, you just end up taking ibuprofen and hoping the swelling goes away. You can suppress your immune system and make the symptoms stop by taking a bunch of corticosteroids, but you probably don't want to do that.

-Username17

Prak · Post by **Prak** » Tue Jan 06, 2015 12:54 am

FrankTrollman wrote:
Prak wrote:Ok, I know I've fucking asked this before, but I can't fucking find the posts, so

Frank- how much water is a person supposed to drink per day, and does anything with a high water content (tea, coffee) count, or should it be just water?
You probably need about 2.5 liters of water. But that's total, and milk, juice, and even cola contribute towards that.

How much does that change depending on one's weight, and optimum vrs minimum?

erik · Post by **erik** » Tue Jan 06, 2015 1:33 am

Prak wrote:
FrankTrollman wrote:
Prak wrote:Ok, I know I've fucking asked this before, but I can't fucking find the posts, so

Frank- how much water is a person supposed to drink per day, and does anything with a high water content (tea, coffee) count, or should it be just water?
You probably need about 2.5 liters of water. But that's total, and milk, juice, and even cola contribute towards that.
How much does that change depending on one's weight, and optimum vrs minimum?

I posted this before but Frank ninja'd me so I deleted it. Now methinks it relevant.

You should probably aim to get your urine to be clear or at least light yellow. That's a good minimum indicator that you are cleaning things out. Within reason make this a goal, you probably will achieve it by following Frank's recommendation. If you have to drink gallons to get that, don't.

Weight isn't the only indicator though more mass does typically mean needing more water. Everybody is a bit different so you're probably best off starting in the 2.5 liter range and seeing if you need to increase a slight bit to 3 liters maybe or if you can even take it back to 2 liters.

Maj · Post by **Maj** » Tue Jan 06, 2015 1:38 am

The urine color thing is a good test. You can teach a kid to work with that one.

Occluded Sun · Post by **Occluded Sun** » Tue Jan 06, 2015 3:45 am

Within fairly forgiving limits, drinking more water than you need isn't particularly harmful. Not getting enough water has subtle but real impairments. So just drink enough that the body doesn't need to try to conserve water by concentrating urine and you're probably fine.

Count Arioch the 28th · Tue Jan 06, 2015 10:06 pm

Random question, how easy is it to OD on Vitamins? Assuming that I don't take supplements on a regular basis (only a fiber supplement if I need to do some spring cleaning...), and I eat normal servings of leafy green veggies once a day, nearly every day (Love me some green. Chard, spinach, kale, etc).

Nachtigallerator · Post by **Nachtigallerator** » Tue Jan 06, 2015 11:15 pm

If you do take supplements: Possible but not that likely.

If you don't: Pretty hard. Vitamins E, D, K, and A are fat-soluble and can accumulate in the body when consumed in excess (usually with supplements), whereas an excess of every other vitamin would be excreted via urine. Vitamin overdose from one serving of vegetables a day is something I would confidently rule out unless something is really wrong with your kidneys, in which case you have other problems.

Re: Water, I am sympathetic to the recommendation that you should drink when you're thirsty and the only beverage that can result in net water loss is alcohol. If you do feel you are still dehydrated, around two litres total is the usual recommendation.

Re: Autoimmune, the specialist you're looking for if you want it worked up with regards to Lupus/RA is an internist specialising in rheumatology. Depending on the condition in question, you'll want it controlled with steroids or even expensive-as-fuck biologicals despite the side effects (on your body or on your wallet). Lupus in particular can be nasty.
Rheumatoid arthritis that significantly affects internal organs is unusual, but it's an atherosclerotic risk factor so you may want to know if it's really that or not.

I should point out that I live in a communist hellhole where society usually pays for all the cruel and unusual diagnostic procedures in rheumatology, so I can't really estimate how much of a hurdle it would be in the US.

tussock · Post by **tussock** » Fri Jan 30, 2015 12:54 pm

Shatner wrote:Is trigger finger and knee pain 9+ months after giving birth plausibly a pregnancy side effect?

A sister of mine got knee pain a long while after giving birth, eventually hip and back and so on, turned out to be one side of the pelvis didn't re-close fully after birth, leaving one leg just barely out of orientation, which lead to gradual muscle atrophy, and then pain as you get ever more twisted up to compensate.

Took about four years to find someone who knew that could happen, and they fixed it with a towel in a couple minutes (plus a bunch of home-rehab to strengthen various muscles). Don't know about trigger finger, but fucking up a leg because it's not quite on strait any more can totally happen after giving birth. IIRC the most obvious change was an atrophied gluteus on the sore side, though that took a long time to happen.

Count Arioch the 28th · Sat Jan 31, 2015 12:12 pm

How long should I wait until seeing a doctor for a chest cold?

On one hand, this has lasted since I got back from the cruise (4-5 days). On the other hand, there's currently a flu epidemic in my area and the urgent care center is likely to be packed with flu sufferers and I might just be safer staying inside away from them.

fectin · Post by **fectin** » Sat Jan 31, 2015 3:14 pm

Maj wrote:The urine color thing is a good test. You can teach a kid to work with that one.

Two notes on this:
One, some drugs affect urine color (looking at you, Phenazopyridine).
Two, some things you don't think of as drugs affect kidney function. Specifically booze and caffeine. Booze makes your kidneys less good at retaining water, so your urine will be much clearer for the same level of hydration (pretend 'level of hydration' is a thing). Caffeine pushes more fluid through those filters, so if you drink quite a lot of coffee it can mess with your usual urine-color instincts.
Hopefully neither applies to kids.

RobbyPants · Post by **RobbyPants** » Wed Mar 04, 2015 7:36 pm

I've had this odd issue with my lower back for about two months that doesn't seem to be going away.

I feel it on or near my spine somewhere between the bottom third and half of my back. It might be best described as "discomfort" and is in no way painful. I only feel it when my back is somewhat bent and I am leaning it against something (typically a chair). Sometimes, the best way to describe it is like it feels like my shirt is bunched up in the area or that I'm otherwise leaning on something.

I can't physically feel anything through the skin when I touch my back. It isn't painful when I touch the area in question. I don't seem to notice it in any way when doing exercise or otherwise moving about.

Any idea what this might be and what type of doctor I should contact?

Kaelik · Post by **Kaelik** » Wed Mar 04, 2015 11:20 pm

So spinal something something infarction/spinal stroke. It is a thing. What level of recovery can someone expect from lost functions? Does it matter if they are younger or older? What if the damage is getting worse for several days?

Starmaker · Post by **Starmaker** » Thu Mar 05, 2015 6:18 pm

First, my thanks to everyone, especially Frank, for helping me to get rid of the chest alien.

About two weeks ago, I had a cycling marathon scheduled, and I started getting really nervous about it.

In the daily life, I'm relatively calm. I don't get sadface over current events, I don't get heartbroken, I don't get upset by monetary issues other than all my savings being stolen, and I'm not afraid (as in phobias: heights, darkness, assault, etc) of anything except slugs (but it takes an actual live slug on my skin to scare me, I'm not checking under the bed for the Vlodblad or anything). In fact, from early childhood up to 2009 when I was fired after a workplace argument, I was being blamed and punished for random shit because I didn't look or sound upset enough.

Sometimes, I have headaches that I try to medicate with over-the-counter painkillers. They don't always work, but since morphine went prescription-only I've been unable to get a prescription, being constantly brushed off with "ah you're just overstressed".

(Doctors who aren't personally getting direct financial benefits from extra visits really love the stress excuse. One neurologist hack even ascribed the chest alien to "lol, stress", despite an endoscopy result with pretty scary stuff in it. This January, the atmospheric pressure hit 980 hPa and a kid committed suicide because of migraines, no meds, and drug abuse accusations, and the parents blamed it on comic books. I remember that weekend, I spent it eating over-the-counter painkillers like candy and throwing up.)

However, before a big event (such as a university exam), I get a bit lightheaded, have trouble holding food down in the morning, plus a mild case of the shits. I also had mild to severe stuttering bouts at the exams, which probably helped more than hindered (otherwise, I don't stutter at all). One time, my handwriting changed from the normal messy curvy script to angular paper-shredding fucknuttery. But I'm long since done with exams for good, and for years any nervousness I occasionally felt hadn't exceeded the level of normal, pleasant, contextually appropriate excitement.

In the autumn of 2013, I took up marathon cycling. The first two marathons were "big events" and I had the same lightheadedness and the shits. The following year I had to ride like every weekend, and over the summer the nervousness almost entirely disappeared. Twice, I needed to get shitfaced on some cheapass berry beer in order to sleep during the day, and I had a weeklong case of the shakes before a 400 km event I wasn't even registered for (retroactively justified by signing up at the last moment and winning the thing).

So, two weeks earlier, I readied the bike and the equipment, ran around town doing random important stuff and expected to have a good night's sleep and wake up in the early morning feeling like a prospective winner. Instead, at about 10 pm, I started getting the shakes and my heart was pounding so hard that it felt like it was literally jumping up and down in my chest. The only booze I had at home was some stinking cooking cognac and I didn't want to lose my supper, so after an hour or so, I loaded up on (over-the-counter) phenobarbital drops instead (30 drops, the maximum recommended dose). That helped for about 20 minutes -- unfortunately, I didn't manage to fall asleep before the heart started hammering again. I had some jam and tea and tried to sleep. Lol nope. So I took twice the recommended dose of phenobarbital (for 3x total in the span of an hour) and waited for it to kick in. When it did, the crazy hammering receded, but I suddenly felt COLD -- so cold I couldn't find the willpower to get out of bed and find a warmer blanket. I stuck a hand out, grabbed some clothes and threw them on top of me, lay for 20 minutes berating myself for dumbassery, and then as I started to feel the warmth BADUM BADUM BADUM BADUM FUCK NO NOT AGAIN for the rest of the night.

I got up when the alarm rang, couldn't eat, stuttered at registration, was 13 minutes late for the first checkpoint (mostly because of the wind, although the lack of solid food didn't exactly help either), loaded up on sports gels gifted by the refs and won.

"'sup guys, where's my welcoming committee?"

Except for a slight headache this week, I've been feeling awesome since. However, I have another marathon the day after tomorrow. I'll just say no to drugs and get preventatively liquored up instead. Still, this shit is scary.

- What the fuck is this?
- What do I do if I get it in the wild?
- What type of doctor should I go to?
- What should I say to minimize the chance of getting dismissed with "don't be so stressed over it" / "quit your job" / "don't do anything exciting ever again"?

Username17 · Post by **Username17** » Thu Mar 05, 2015 7:56 pm

What you're describing is indeed "stress" in the actual rather than colloquial sense. You are having overactive supplies of sympathetic nervous activity, causing you to become hyper aroused, get a pounding pulse, and have your gut give up on any holding actions it might have committed itself to.

What you want to do is to tell a doctor that you've been having palpitations at irregular intervals. Tell them that for about an hour at a time you've had these spells where your heart felt like it was pounding in your chest and you felt a little dizzy and your ears hurt. Tell them that you measured your blood pressure at home during one of these things and it was 180/110. Then they'll give you Nebivet or Biprol or something.

Then, when you have something big coming up that is making you stress to the point of discomfort, you pop some betablockers and the palpitations will go away.

-Username17

name_here · Post by **name_here** » Thu Mar 05, 2015 8:12 pm

That actually does sound like anxiety; it can cause lightheadedness, headaches, significantly increased heart rate, and nausea. Particularly since you only get it before competitive/graded things I presume you want to do well in. I'm actually sensitive to noise and get similar symptoms when I know there's a fire drill scheduled.

I would suggest seeing a pyschiatrist who remembers that his job actually includes helping people with problems. You may get prescription medication, you may get suggestions for over-the-counter medication, or you may get advice for handling stress which is actually helpful.

Username17 · Post by **Username17** » Thu Mar 05, 2015 9:25 pm

Kaelik wrote:So spinal something something infarction/spinal stroke. It is a thing. What level of recovery can someone expect from lost functions? Does it matter if they are younger or older? What if the damage is getting worse for several days?

Spinal infarcts are pretty rare. The spine is much smaller across than the brain and has a lot of anastomoses. But of course, they are real. Actually demonstrating the injury and estimating prognosis would require an MRI.

If it's an ischemic stroke, prompt blood thinning and clot busting can help. If it's several days in, it might be a bit late for that. But if it's getting worse, you might need to go in on the clot busting to prevent additional clotting.

A lot of people recover from spinal infarcts in a few months. Lingering problems with bowel control or sensation in the feet or the like are not uncommon even in people who recover.

-Username17

Kaelik · Post by **Kaelik** » Thu Mar 05, 2015 9:31 pm

FrankTrollman wrote:A lot of people recover from spinal infarcts in a few months. Lingering problems with bowel control or sensation in the feet or the like are not uncommon even in people who recover.

This is literally infinity times better than what I have been told, by actual doctors and everything. So I have no idea what the difference is, but I'm going to take the word of the people have seen the MRIs and shit, and just assume this is something different, and I missed the actual diagnosis through a game of telephone.

Username17 · Post by **Username17** » Thu Mar 05, 2015 9:52 pm

Kaelik wrote:
FrankTrollman wrote:A lot of people recover from spinal infarcts in a few months. Lingering problems with bowel control or sensation in the feet or the like are not uncommon even in people who recover.
This is literally infinity times better than what I have been told, by actual doctors and everything. So I have no idea what the difference is, but I'm going to take the word of the people have seen the MRIs and shit, and just assume this is something different, and I missed the actual diagnosis through a game of telephone.

The key issue is whether it's been severed or turned dormant through ischemia. Severed spinal tracts basically don't grow back, but impinged spinal tracts do. If someone who has seen your MRI says that you'll never feel your penis again, they are sadly probably right.

However, it would be really weird to get the spine severed straight though. More likely you'll have a core that dies off and a periphery of the lesion that recovers. So in half a year or so, you could have some sensation and motor function back, with some other spinal functions never recovering.

-Username17

DSMatticus · Post by **DSMatticus** » Thu Mar 05, 2015 9:55 pm

I dunno, between the lines that sounds a lot like the prospects of a regular stroke. "A lot of people recover from strokes in a few months. Lingering problems as a result of having dead brain parts are not uncommon even in people who recover." It seems to boil down to how you define recovery. If you mean "will I ever be the same," no. If you mean "will I ever get some of the lost functionality back," sometimes yes and sometimes no. Both the severity and recovery are going to be unique to the circumstances and to some extent random. The people who have seen the MRI's are probably in the best position to be making guesses, but there's always room for optimism, particularly in the young and healthy.

Or what Frank just said.

Kaelik · Post by **Kaelik** » Thu Mar 05, 2015 10:04 pm

I mostly just want to know if my brother will be walking again for most of the next 60 years.

DSMatticus · Post by **DSMatticus** » Thu Mar 05, 2015 10:50 pm

Kaelik wrote:I mostly just want to know if my brother will be walking again for most of the next 60 years.

Your brother's doctors have seen the extent of the damage and can give a much better prognosis than a doctor on the internet telling you about spinal infarctions generally (no offense, obviously) and some dude telling you "it varies." Doctors can be wrong, but not as often as you'd like after hearing something like that. I do know that with regular strokes and other nervous system damage, most recovery happens early or not at all, and google says spinal infarctions are pretty much the same way. Whatever functionality your brother has by September is probably the functionality he'll have the rest of his life.

Plan around whatever the doctors say. Tentatively hope for somewhat better than that. You'll know for sure by the end of summer. That's all you can do.

Stahlseele · Post by **Stahlseele** » Thu Mar 05, 2015 11:10 pm

This might be relevant to the topic at hand:
http://www.healthline.com/health-news/e ... egs-040814

Kaelik · Post by **Kaelik** » Thu Mar 05, 2015 11:57 pm

DSMatticus wrote:Your brother's doctors have seen the extent of the damage and can give a much better prognosis than a doctor on the internet telling you about spinal infarctions generally (no offense, obviously) and some dude telling you "it varies."

I realize this, but I don't have a direct line to my brother's doctors, and I don't want to call my brother and pump him for information about his possible paralysis if he doesn't want to talk about it.

EDIT: for what it is worth, the new new new diagnosis for KaeBro is (possibly the same cause) the reason he is losing function is because blood is pouring into his spinal column, so once they fix that he should get (most) function back. So yay for KaeBro.