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No but we will look into that with his dr

Would you mind updating us if this gets diagnosed or if a future treatment works well? I gave you my best impression but this is not like anything Ive ever seen outside of textbooks, and I want to learn from this in case I ever have the chance to help a patient like your husband.QOut of curiosity, I am NAD, but could this be caused from an insect or spider? The reason I ask is I have friend who was bit by a spider while in Afghanistan and he still suffers complications from the wound site. While not near as extreme as what OPs husband is going through, but is it possible that OP is suffering from some sort of parasite or long term degeneration from venom? Would that turn up on any clinical tests? And do you think it would be prudent for OP to contact medical professionals in the country where OP was originally exposed?Has he had biposies of the lesions?QYes he has had biopsies several in fact alot of them come back as a burn but that's not the proble. This is not a burn.The fact that biopsy reports give the wrong answer and he's seen multiple specialists possibly suggests that you're dealing with a new, hitherto undocumented entity. What treatments has he had for this if any? Response to certain drugs could tell us what sort of disease process this is.

My husband is fighting for his disability because this is so debilitating he cant work. But without a diagnosis the disability people keep denying himHire a VA disability appeals attorney. It cost me 2 grand twice, the first time got me from 30% to 90% and the second time got me from 90% to 100% total and permanent. I personally have far less severe injuries than what your husband has and was suffering the same issue.There are also attorneys for SSI/SSDI benefits, though I havent personally used them as applying for SSDI as a 51 year old is relatively easy. As a 27 year old though it is damn hard and you likely will need a lawyer or a few years of trying, and a lawyer works out cheaper in the long term.

Need more history, things like past medical problems, medications, drug use, etc. Differential as I see it includes infectious, autoimmune, vasculitis, drug use, medication, environmental (especially considering the burn pit). It's very odd that it would take years after that exposure that these ulcers would start, but not impossible. Why has he lost countless jobs? What did previous skin biopsies show? What have his labs shown?

He has no other medical problems, he isnt one any medications, no drug use in fact he quit smoking 5 months ago. He started having small ulcers as soon as he came home but now they are way worse. Hes lost jobs because he has to be off so long and they let him go

And the skin biopsies? And the labs?Qsome have came back as a burn which they are not and others show nothingAnsNeed the actual reports, which are always available through either a patient portal website or though a medical records department. Also need the lab reports.

Does This Really Sound Like Dermatomyositis?BackgroundAge, sex: 31Mheight: 5 11race: whiteprimary complaint: purplish skin along with tachycardia and extreme fatigue/tirednessduration: I have experienced skin discoloration since I was a kid, but this progressively got worse once I was an adult. The tachycardia started when I was about 24 and has progressively gotten worse.Medications: My rheumatologist has me on hydroxychloroquine (200 mg), prednisone (started at 50 mg, but now taking only 5 mg), and pantoprozole (40 mg). An ER doctor started me on meclizine (25 mg) as needed for dizziness that started about a month ago. I have also been on Adderall XR since 2019. I currently take 25 mg, up to two in the morning. I do not drink, smoke, or use any recreational drugs.Other medical conditions: ADHD. Morphea (I developed this when I was 8, and it has never gotten any bigger). Splenomegaly. In July 2021, I had encephalitis due to reactivation of varicella-zoster virus.I apologize in advance for the length of this post. I just want to be sure I include anything that might be relevant.Starting in 2014, my heart rate would randomly jump up to 120-140 bpm, and I would experience tingling in my extremities. The purplish skin started when I was a child, but it has gotten worse over the last few years. Between 2014 and 2021, I had multiple echocardiograms done to check for any abnormalities of the heart, but doctors never found any. I also wore a holster for a month, and that came back mostly normal.A couple of months after I had encephalitis, a rheumatologist diagnosed me with dermatomyositis based on the redness and scaliness on my knuckles and redness around my fingernails. Lab tests showed that my muscle enzymes (CK, aldolase), liver enzymes, and IgM all were elevated, but additional diagnostic testing has not shown anything to confirm dermatomyositis. Ive had an MRI of my legs, hands, abdomen, lungs, and heart. The abdominal ultrasound showed that I have a slightly enlarged spleen. Everything else looked normal. I have never experienced muscle weakness or the characteristic rash that DM patients usually have. I did see a dermatologist after I started treatment. She said it looked like it could be DM, but there wasnt anything on my skin for her to biopsy.Since my rheumatologist started treating me for DM, my heart rate tends to stay around 80-90 bpm, and the palpitations are much less severe when I do experience them. My most recent blood tests came back normal except for my IgM. However, my skin still turns purplish, and it sometimes feels like there is a rubber band around my arms.I dont know if there is any connection between the encephalitis, tachycardia, and DM, but it makes me wonder if there is something more serious than DM going on. My doctor does not think its necessary to explore other possible causes. She says that the treatment she has me on will treat any rheumatological disease. I really like and respect her. Shes the first one Ive seen who acts like she cares about my health. I just want some kind of confirmation that shes right.I appreciate any feedback, insight, suggestions, etc. Also, I can submit my full CBC report if that would help at all.

Please include one of preferably more of the pictures in your post as an imgur.com link. It makes it easier to help with something when it can be examined visually. Additionally, share the values of your ANA, ENA, CK, aldolase

Thank you for your response. My apologies for not getting back to you sooner.I am not sure about the ENA. I did a Google search and think I found what test results to include. Let me know if these results are not what you need.Below are the results of lab tests from September 22. These tests were done before I started treatment for DM.CK - 1,063 units/literAldolase - 26.3 units/literANA - Negative (<1:80)RNP/Sm - < 12 unit(s)Anti-Smith - < 12 unit(s)C3c - 107.0 mg/dLC4c - 20.0 mg/dLKappa FLC - 12.7 mg/LLambda FLC - 17.5 mg/LFLC - 0.73 ratioIgG Card - < 9 GPL-Units/mLIgM Card - 16 MPL-units/millileterI'm not sure if ALT and AST help with diagnosing DM, but they came back abnormal. This isn't unusual for me (they've been as high as 240 on tests I've had done over the last 10 years), but I thought I'd include them, just in case:ALT - 56 units/literAST - 44 units/literBelow are the changes in some of these values when I had the lab tests performed again on November 4. These tests were done after I had already started prednisone and hydroxychloroquine.CK - 83 units/literAldolase - 9.2 units/literIgM Card - 23 MPL-units/millileterALT - 15 units/literAST - 14 units/literHere are the best images I have of the skin discoloration. Because the discoloration on my knees is usually worse while I'm in the shower and right after I get out, I took the photos and video of my knees in the shower. There is nothing graphic in these images, but I wanted to explain why I took them in the shower.Right hand - https://imgur.com/icyYOPQKnuckle, right hand - https://imgur.com/fD48uK0Left arm - https://imgur.com/JVPth2XBoth knees - https://imgur.com/bszpHWgRight knee - https://imgur.com/cjdn4zVBlanching (Video) - https://imgur.com/3KszJT7

No mention of the most important test - skin biopsy results. Everything you present is less important.

She said that there was nothing for her to biopsy. This is the note that she included in her report:Physical exam: dilated nailfold capillary loops of fingernails, L>R. Mild erythema of proximal nail folds of fingernails. Ragged cuticles. No evident Gottron's papules, heliotrope sign, shawl sign, holster sign, or other stigmata of DM. Scalp clear with no erythema or scale-prior labs including myositis panel, CK (elevated), and aldolase (elevated) reviewed. Negative myositis panel noted.-findings on exam today support prior diagnosis of DM (esp in context of markedly elevated CPK and aldolase), although unfortunately there is not a high-yield spot to biopsy to provide additional support of this diagnosis. Suspect that pt's cutaneous findings have improved with plaquenil + prednisone therapy

Spots change over time. Right hand knuckle that you show could be a Gottron's papule. Lupus can look like this as well, as can many other conditions.

3.5f with mystery illness 4 childrens hospitals and 14 specialists cant diagnoseThis is going to be so, so, so long and Im so sorry. But we dont know what else to do. Ive tried to compress it the best I could. 3f with medical mystery.First year of life: -couldnt latch until 2 months old -refused all food, in all forms. -up every 20 minutes every single night, wouldnt nap longer than 30. -had newborn shakes that stuck around a year old. -consistently has BM 60-70% mucus, and majority of time was green.February 2017(1 year old): -staring spells began -CT at hospital was clean, sent us to neuro. -EEG performed, no episodes happened, clean. -lost all of the words she had and remained non verbal, despite starting speech therapy at 18 months, until over 2.Eventually they went away after a few months. Doc said absence seizures are harmless and not to be concerned. Released us from his care.June 2017: 16 months old. -woke up and couldnt walk. Screamed when weight put on leg. Took to urgent care. Urgent care ran labs and found a sed rate of 44. Referred us to an orthopedic surgeon. Orthopedic surgeon did treatment for transient synovitis. When it became clear that wasnt the cause, sent us to rheumatology.August 2017: -diagnosed with Oligoarticular JIA (right knee only at this point). -started on naproxen.November 2017: -first steroid injection. Kenalog into right knee. -two days later, woke up screaming and manically itching legs. Hives sprouted. Face swelled, eyes became black, hives all over neck and face. Started wheezing and gagging, rushed her to the ER. ER said it was an anxiety attack from the itching, not anaphylaxis. -steroid injection worked for about two months.Spring 2018 (2 years old): -staring spells started creeping back. -swelling in both knees was coming and going. She was in extreme pain and couldnt walk more than a few feet. Rheumatologist said it wasnt arthritis, it was growing pains. Referred to PT. -we werent super worried about the staring spells, and wanted to wait until the arthritis was sorted out to see neuro. The staring spells were coming more frequently. Her speech therapist asked us if wed ever had her evaluated for epilepsy, as she sees several kids with it, and our daughters episodes were scaring her. -We decided to get her in with neuro. It would be a two month wait.May 2018: -second opinion rheumatologist said there was obvious arthritis and sent her for a second round of steroid injections. Allergy had deemed the first reaction as a coincidence, not from the injections. -had an allergic reaction to the injections again. -she begins collapsing and falling pretty much non stop. To the point where PT and Speech therapists were suggesting a helmet because she wasnt catching herself when she fell.June 2018: -steroid injections failed -our first appointment with PT. PT noticed several left side deficits, severe balance issues (that were worsening), and wrote a letter to neuro suggesting an MRI be done. -woke up soaking wet, dripping in urine, and her urine was brown. Took her to the ER, ER noted it was brown but testing was normal, and she was well hydrated. -had an episode where myself and her speech therapist were present. Eyes glazed over and she started walking around like she was drunk. She became delirious. Then that turned into manic aggression (totally out of character). It lasted 20 minutes start to finish, ended with several staring spells. Speech therapist wanted to call an ambulance. 4-5 minutes later, she was completely back to normal. Took her to the ER where they said it was behavioral. I insisted they call neuro, who said it sounded like worsening seizure activity and scheduled an EEG for the next month. -pediatrician urged us to go to a different childrens hospital and demand an MRI. CT showed a small arachnoid cyst, MRI was clean. Her left side reflexes were slow, and she had a positive babinski reflex on left foot. -lost gross motor skills like squatting or standing up without using hands. Could no longer identify letters, though she had been able to since before 2. -discharged after a negative EEG, but nothing happened while she was hooked up. Told us to get video. -balance continued to deteriorate, along with left side deficits. -got videos of staring spells, neurologist said that it could be seizures or it could be sensory. She passed sensory tests with flying colors, OT said it was highly unlikely to be sensory. Neuro told us to go to a different hospital. -things calmed down for about 3 weeks.July 2018: -PT started noticing balance issues worsening again, she wouldnt catch herself when she fell or even try to. Began falling 2-3 dozen times a day. -she began dropping. Like a robot running and then its power source dying. My husband and I would have to sprint and throw pillows or our hands under her head to keep it from hitting the floor. We couldnt be more than a few feet from her. She would collapse, lay there for 10-20 seconds in a haze, and then sit up. -July 19th she told us her head hurt. A few minutes later, she looked out of it. I pulled out my phone because it mimicked the look when she had the episode of delirium. She began stumbling, so I pulled her onto my lap. She began aggressively rubbing her face and making weird faces. Her body then began to jerk/shake. Lasted 20 seconds. When it stopped, she continued to lay down, still, with her eyes glossed over. Her urine was brown again. -pediatrician sent us to ER. Admitting doctor said it was a tonic clonic seizure based on the video. Was attached to a vEEG for 9 hours, nothing happened. EEG was clear. Doctors said it was behavioral and released her from further neurological care. said there was nothing wrong with her. They called her speech therapist who was livid, as she had been watching her deteriorate right along with us. I needed backup since the doctors were blowing me off. Doctors told speech therapist it was behavioral and from sleep deprivation. But she slept 14 hours a night. -as month goes on, shes dropping and having staring spells non stop. -PT says nothing about daughters exam makes sense. Her balance is awful and deteriorating when walking, standing, crawling, kneeling, but she can jump. Shes developmentally advanced so it doesnt seem lime it could be a developmental issue. Shes also watching my daughter turn into a shell of herself and is begging doctors to do something. -MRI of knees and hips was ordered by new rheumy after worsening gait issues. MRI showed a healing stress fracture in the knee, along with bone marrow edema (with no trauma to explain it) -went limp on a ride at six flags and her eyes rolled to the back of her head for a full 2 minutes. -went to playground and she was climbing one of those coils. Body went limp and she fell 5 feet. I caught her and set her down while her arms twitched and she was unresponsive. Slept for several hours after, and took several minutes of shaking to wake up.August 2018: -basically everything continued with no answers from anyone.October 2018: -a 3 day inpatient EEG was scheduled and nothing happened. I mentioned to the doctors that it looked like a mass was growing on her legs and they didnt look. Sent us home. -pediatrician saw the masses and sent us to orthopedic surgeon. -the muscles in her left knee began to atrophy, despite her being crazy 24/7. She never sits still and is always jumping/climbing/running. Orthopedic surgeon said it was definitely neurological, sent us to a new neuro. The atrophy was so bad we were approaching loss of mobility. She still cant walk for more than 1-2 minutes at this point. -atrophy worsens until November. Other symptoms start to go away.November 2018: -started methotrexate injections for the JIA.January 2019: 3 years old. -urine began to darken again. -symptoms started popping up mildly. -had episodes where shed scream and rub her legs manically saying bees were attacking her. She did it both while we were there, and when we werent. I watched her do it on the baby monitor in the middle of the night. -neuro ordered MRI of spine. Normal. -on jan 16th, I heard noises in her room. I looked on monitor and she was sitting and swaying in her bed. I got to her bed to put her back down and by then, she was jerking. I tried to get her attention but she was unresponsive and eyes were glazed over. -I pulled her onto my lap, where she remained out of it. Her body was jerking, and her right leg started convulsing like it was on a washing machine. Once the jerking slowed, I asked her to point out her nose and mouth. She failed but thought she did it. I put her back to sleep, where she remained restless. Her urine was normal again 2 days later. -urine brown again on Jan 25th. Had a staring spell at a birthday party and was unresponsive for 30 seconds. Fell asleep in the car 10 minutes later, slept for 45 minutes, and then woke up screaming. Continued to scream for almost an hour. Urine was clear again a few days later. -Neuro tested for porphyria. Corproporphyria level was 2.5x adults high normal but said it wasnt high enough to be porphyria. No pediatric reference ranges exist.February 2019: -fingers started severely pruning and turning white in just a few minutes, while her sisters hands (who was 1.5) were completely normal. -throughout all of this, little bite/pimple like bumps showed up on face/neck/joints. They come and go. In February, they got bad. No fleas, no bugs, always accompanied other symptoms.March 2019: -GI said that while shes tall, shes short based on how tall she should be since Im 510 and husband is 64. Wanted to run tests. Thinks theres a larger autoimmune disease at play. -genetics said that something is definitely wrong, doctors needs to coordinate. Said porphyria test could have been deteriorated because it sample taken at home and exposed to light in the car. Said hes concerned by the progression and created a team of doctors to evaluate her case. Was afraid it was possibly life threatening. -testing was planned for summer when she began showing symptoms again. She remained asymptomatic.September 2019: -things remained calm, arthritis was under control. -began flaring in both knees and both ankles. -staring spells, balance issues, and not catching herself came back.October 2019: -things are worsening again. -left ankle is atrophying. Neuro wont call me back. -PT is concerned she wont be able to walk soon because the stuff that atrophied last year has never come back. She still cant walk more than a few minutes without collapsing. Sleeping 13 hours a night. Is complaining of pain and isnt eating. -preschool teachers reporting odd behavior and lots of collapsing. -most recently broke her wrist because she fell down the stairs and didnt try to catch herself. She landed on face and chest, with her arm against her chest. -ETA: her urine was brown again this morning for the first time since spring.Any ideas? Weve been to four childrens hospitals and will be pursuing new ones when we move in February. Im so scared for my daughter and still cant understand the lack of concern by the doctors weve seen. I dont want my daughter to suffer anymore and I dont know what else I can do.Thank you so much.

If a second opinion is needed on this comment, I 100% agree with this. OP is free to try and ask the reddit community out of pure desperation, but be careful of lay comments, even from physicians who aren't experts in OP's child's care.

In my opinion Rasmussen would've shown up on an EEG or Scan, as the episodes are lasting a while and the activity of the inflammation would probably have been detected, though it's not impossible. I don't see how this goes in line with the arthritis, the stress fracture indicates that the loss of function and pain should not be purely neurological, maybe there are 2 problems going on simultaneously.I feel that you're a bit lost with doctors who don't do anything. So I'll suggest things to do by yourself:start a detailed diary, try to recall everything, every doctor's visit, result, try and collect the imaging done, lab results. But also start recording symptoms like ataxia, seizures, pain, atrophy. Every day. Also note any environmental changes that might occur shortly before episodes. This should include nutrition, but also stress, long exposure to sun, noise, physical activity. Get videos if you can.buy urine test strips, check her urine when it's normal 2-3 times, then when it gets dark. Check for blood, proteins, sugar. If you can, contact urine when it's brown in a clean jar and have your doctor send it to lab.if you have access to it and feel comfortable, also check blood sugar in normal and episode conditions. Again, note it done carefullyconsider to get psychological evaluation and counselling. Not only are you going through a very difficult situation, you will also avoid people saying that's only behaviour, and you're not willing to accept it. I'm not saying it is, but by acknowledging it a possibility, you rule out one more thing.consider changes in nutrition. Observe if anything changes. Might work, might not. Changes may include protein level, fat level, sugar level, etc.Then, what to do while relying on doctors:I agree with getting a second MRI. One usually isn't enough. It needs 2 to notice changes.did you get a check of the peripheral nerve system? I'd ask the neuro to check that. If they don't call back, they're probably out of ideas. Hey a new one.Get a general ultrasound of the organs.get blood test of porphyrines in normal and episode conditions.get liver and kidney blood test in normal and episode conditionsreach out to get metabolic diseases checked, like fatty acid issues, glycogen issues. Try also getting genetical analysis. I don't know about your financial situation, if you're located in usa and they don't do those, consider a visit in a different country. We have a whole ward here for diagnosis. Try reaching out to mayo or Cleveland.consider reaching out to help groups for genetic or rare diseases. They often have valuable contacts and ideas. https://www.globalrarediseasecommission.com/Report/tracks/track-1.htmlI wish you all the best!

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I would strongly recommend rainbow over ccf for pediatrics.

So to make sure that I have the situation in a nutshell: 3.5 y/o female with progressive weakness, intermittent episodes of loss of tone that are not accompanied by EEG changes, intermittent episodes of darker urine in the morning, and a diagnosis of oligoarticular JIA. Please correct anything that I got incorrect and I have some clarifying questions.-what is the state of her motor function now? Can she run, climb a ladder on the playground, fatigue quickly like walking around a store?-do the weakness episodes seem intermittent, like lasting for a few hours to days, or are they every single day.-does she have unsteadiness when reaching for objects? Having her hand seem to stumble past a cup or fork for example?-does she have any drooping of her eyelids? It would be to the point where the black of the pupil is obscured by the lid or she has to lean her head back to look at you.-following steroid injections did any of her other symptoms seem to get better? the weakness and seizure like episodes.-any family history of children passing away or having major medical issues. Do you, your spouse, or the child's siblings have any medical issues?-any issues during the pregnancy or delivery? Did she have to go to the NICU for any reason?

According to what I found online, Mount Sinai has the only genetic test for porphyria. Trust me, I had a couple hundred dollars ready to spend on the genetic testing but everyone I spoke to who was versed in this stuff said it wouldnt make a difference

TF is going on in here? What is wrong with all of you people? None of you are physicians, I doubt even medical professionals, and even the "best" "written" comments in here are absolute drivel. You are NOT being helpful. You are torturing someone while stoking a House, MD type fantasy.Dear OP, I sympathize with you. Dealing with a sick kid is trying and tough and this awful thread is NOT useful to your mind state NOR your health.A problem I have noticed in my short career has been clear communications to patients. I highly doubt after 4 hospitals, 14 specialists, and however many other physicians and staff that no one has come up with a diagnosis. What does this mean? I bet at minimum you had multiple different teams with multiple different personnel working on your daughter's case. It's possible the primary team wasn't doing their damn job of synthesizing all of the specialists information into easy to understand information and presenting that information to you. Even when we don't "know" what's going on, I can still call something idiopathic (as in I don't know) or I can throw out a variety of possible causes in what we call a differential diagnosis.To everyone saying "gEt GEnEtIC tEsTiNG". That's not even how any of this works. Even if we were to use "genetic testing" this would only confirm the diagnosis, NOT LEAD US TO THE DIAGNOSIS. Even then it is absolutely unnecessary for treatment in this case. Genetic testing is useful when we are performing family planning or working on research on illnesses. To my knowledge, and I'm open to any updates, bread and butter medicine does not YET have the tools to use genetic testing in the fashion many of you seem to think exists.

Thats been our understanding. Genetic testing is like the final puzzle piece once all of the other testing is done, and narrows down the list of possible causes. The geneticist said there was a list about 30 things long that he thinks it could be, but wanted further testing before divulging them, which I get.We have seen 4 childrens hospitals but the specialists span. Weve seen 1 endocrinologist, 1 allergist, 4 neurologists, 3 rheumatologists (our new rheumy actually suggested another opinion since she was out of ideas too), 1 GI, 2 geneticists, 1 orthopedic surgeon, and 1 ophthalmologist. They were supposed to be coordinating on a team that diagnosis rare diseases, but when she remained asymptomatic, we held off. We didnt want to put her through anything more if the tests would be inconclusive, under the direction of the team. But red flags have been popping up over the past few months, and theres been a lack of response or a shrug. The atrophy was so bad in the knee last year that she could barely walk. The muscle/tissues/whatever it was never grew back, and she cant walk more than a few minutes. PT is concerned that with the loss of knee support, the ankle atrophy is going to be detrimental. Which is how I ended up here. Her pediatrician finally got neuro to call us and shell now be getting ultrasounds of both legs.I wanted to take a list to her doctor and say could it be any of these?Shes spent most of her life in constant pain, in doctors offices, and its just killing us. I want her to have a normal life, and if she cant, I just want to make it as pain free as possible.

The most important thing I can recommend is finding a good PCP to make sure you have a medical home. That doctor should keep track of everything and keep the puzzle pieces together for you. I'm hoping that's already your pediatrician. From what you write, it seems like each specialist is stumped and is each trying to treat symptoms as they see it. Let's say we can't find what is going on, this is what we would be doing anyway. I say if things have been continuing to worsen, you may try another hospital system. I'm partial to Mayo, CHOP, and Children's National. On the other hand, you may have to consider that there isn't much to do but keep her comfortable. Palliative doctor's role are just that, keep people with chronic disease comfortable. That may include working with PTs, pain specialists, and whatever other tricks they have up there sleeves.

'm not a doctor. Along with a suggestion, I just want to say how sorry I am to hear about your family going through this. I know how terrible I feel when our daughter just has a cold.Because I'm not a doctor, I don't have a diagnosis to suggest, but instead I want to suggest that you start collecting data, lots of data, then find your most analytical friend(s) and get them looking at it. They don't have to be a doctor; they're more likely to work in science, technology, engineering, business or law.What I'm suggesting you collect is literally everything your daughter eats, drinks, does and where she goes, including basic nutritional information what she's eating and drinking - carbohydrates, fats, etc. The same stuff that they put in big letters on most food packages.Along with that, put in what symptoms she had and how bad they were; devise a rating for her day if nothing else, where "5" is "it was a terrible day" to "1" is "she barely had any symptoms at all."This is going to be a complete pain in the ass.If it's a metabolic problem, there's a chance you'll see something like "when she has a high-carb, low-fat diet, she has a bad day" or "when she has a lot of fat, she does great" or some other permutation.If it's somehow an environmental problem, then maybe you'll see that "when she stays at grandma's house she's better than when she sleeps at home" or "if she doesn't go to school, she's better" or "she played in the basement today and she's a wreck."The doctors are clearly missing something, and maybe with some analysis you can find some clues to point them in the right direction. You may have the problem that they've already made up their mind about her and there's no changing it; in that case, you also need new doctors.Best wishes.

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Rash EVERYWHERE? Please helpHello, so a little background. I am a 23yo F. I suffer from an ED and weigh approximately 80lbs and am 51. I was diagnosed with MCTD, scleroderma, dermatomyositis, and a grocery list of other things, but I feel those are most prevalent to the issues I am having. I also use marijuana regularly as well as vape. So. I moved to MI from MO last summer. Ever since about.. November 2021 I have been having skin issues. The skin is incredibly dry, most spots opened and scabbed and now they hurt and itch. No lotion I have tried (10+) seem to help. I have it on my legs, arms, chest, hip, back, face, behind/in my ears. Ive never had my skin look like this while living in MO. I have seen my PC and I have a rheumatology appointment end of April. I dont even want to imagine how much more this will progress. Does anyone know what this is? Or how I can manage it to minimize symptoms? Im at a loss. Please help! Skin rash

Images do not allow us to see the extent and appearance of the eruption. A diagnosis is not possible. You are medically complex and you need dermatology care. I work closely with many rheumatologists and we have mutual respect. I would not count on a rheumatologist to manage your skin.

What does high glucose in a CSF mean?28, Female, T1D 14 years, 59 165 lbs. I have upper extremity weakness in my legs and arms, worsening over the last year. Cant walk up stairs, all my tests come back inconclusive including genetic testing and nerve (I mean literally I have had an ENTIRE work up- MRIs, X-rays, blood work, neurology, spine clinic, rheumatology) so Im left with getting a triple muscle biopsy and had a spinal tap today. The only result that came from that was high glucose CSF and I cant find anything about what that signifies versus the low glucose.ETA: additional test results just came back showing high wbc and rbc in the fluid.

Generally we're looking for low glucose in the CSF, as that's a sign that bacteria may be in there. There's usually a ratio between CSF and serum glucose (CSF is about 60% of serum), so I'd wonder if your serum glucose was just on the higher end when you got the LP done due to your T1DM.

Good to know. Im sure Ill hear back Monday, but additionally seeing the high WBC + RBC in the fluid made me nervous.

How high for each?Reply Wbc 13, rbc 16

My Arms Are Turning Blue, Please HelpTL;DR: I removed lab values, as they are no longer the most recent. I have normal skin underneath, to my knowledge, my skin just sheds blue - unaware as to why. I have neurologic and gastric issues, like already stated in edit one, so no need to retouch on that, just briefed about a new procedure I didnt know was going to be requested. I will update about the (dead) blue skin, the literal reason for the post in the first place, if ever discovered.No confirmed, or believed hematologic issues. I only shed blue skin? My skin recently came off, and its pink underneath like it used to be, for some reason it just comes off in blue heaps (random dead skin, I assume, but unsure as to why the color is blue). The veins are extremely bright, but thats about it underneath, I believe. I already have eczema/atopic dermatitis, I know that, but this still confuses me because it doesnt appear to be that. I plan on seeing my derm soon just in case.I thought Id add this information, only to discuss how thorough Ive tried to be, but none of which is the cause for it either. I have a whole host of neurological issues, migraines and OC as listed below, among other newly diagnosed issues, like tremors and possible nocturnal seizures (Im epileptic). Im going to be getting a VEEG done, as ordered by the newly epileptologist I just began seeing. My medications are being readjusted, and a hospital is the only safe way to do so.I also have gastric issues, like I said below.Bottom line, thank you all. If I ever figure out why Im shedding blue skin, Ill make sure to share.TL;DR: I took all suggestions as best I could. I was denied by hematology, rheumatology found no issue despite only slightly abnormal values (mainly NOT severe muscular degeneration that Ive now been made aware of, it didnt alarm him like I said), EKG and EEG requested are both normal. There have been newly diagnosed neurologic issues, but easily fixed with botox.Edit: Thank you to everyone who suggested various things that it could possibly be, and please know that I took your advice, both from this post, and the follow-up one I made awhile back, that Ive since deleted. Here is the in-depth follow-up that some had asked me to provide.Hematology: I was denied by two different hospitals, even though I had a thorough PCP referral, as both places said my issues werent possibly blood related. There were no other hematologic options in my area, so I decided I needed to move on from hematology completely, because I wasnt getting anywhere. Ive not been tested for any hemoglobinopathy as suggested on this post, or any other blood-related issue due to this.Rheumatology: This was the major one recommended on my other post, and I actually just went there a couple days ago after a successful (and surprisingly quick) referral. Despite my leg pain, color-changes and other various issues discussed below, the doctor doesnt believe its anything rheumatology related, either. A physician on the other post I had made, suggested getting a work-up and asking about APS (antiphospholipid syndrome), but I was only tested for possible muscle diseases to my knowledge. I havent received those results yet, but Im sure theyll be normal. Well see.Ive also recently had a redo of my heart echocardiogram done (which came out normal) because the last one was poorly imaged. My most recent (required) EEG was completely normal, but Ive been put on yet another epilepsy medication, unfortunately.The only thing Ive been diagnosed with, since when this was originally posted, has been migraines and occipital neuralgia, which I now receive injections for.Original Post:25F, 185lbs, white, non-smoker, non-drinker.TL;DR: major breathing difficulty, chest discomfort/pressure, (mainly) left leg heaviness/throbbing, odd blood consistency and possibly abnormal values.Hello, Im in quite a predicament. Ive now been labeled a zebra by a vein specialist, because no one can figure out the reasoning behind my current issues.For context, this is now seems to be a somewhat progressive issue, as different symptoms have arisen as time has gone on. I began not being able to breathe well sometime last year, but every time medical professionals take my O2 stats, it never goes below 98. However, its becoming increasingly harder within these last few months, especially taking deep breaths. After having some bad reflux episodes, I was told I had GERD, and then given some medication. However, Ive now been hospitalized twice for my severe breathing issues, both occasions in September, after my GERD diagnosis (and its well controlled/no reflux episodes), so I have a feeling its definitely a separate issue. My chest also feels as if theres a crushing force on it very frequently.I started getting severe leg pain, that made my (especially my left) calves feel heavy one minute, almost like carrying around tree trunks, and then pulsing/throbbing the next. I was scanned for blood clots in my left leg while at the ER, and everything came back normal. The same day I was scanned, a nurse noticed my left arm being a vibrant blue. The ER doctor then pointed out the fact hed noticed that it was also on my right arm at that point, as well. Ultrasounds have recently been done on both my arms, but those results also came back normal.My blood is now starting to be impacted as well I believe, as its appearing to have trouble stopping or clotting quickly. Im not sure if this issue is related to the color-changing or not. My blood will borderline gush out after blood draws/IV site wounds. My RBC has also been consistently high for awhile now, and my MCH and MCV are now dropping again. The values being abnormal arent by much or extremely significant, but Im not sure the reason for the abnormality either (again, reiterating the fact that Im not sure if its connected to the color-changing or not).

Except for the bleeding, you're pretty much describing a sickle cell disease crisis. Did you ever have a hemoglobin electrophoresis test?EDIT: I saw the conversation further below. Some common traits for hemoglobinopathies are indeed low hemoglobin, high RBC and low MCV. I'd say you could catch about 80% based on these values (but then, electrophoresis is still required for final diagnosis, or DNA testing for alpha thalassemias). Anemias can be compensated for with high RBC counts. MCV, as in sickle cell anemia, may be normal since the sickeling occurs in the microcirculation at low PO2s.EDIT2:I'll give a short summary of things written below (including personal interpretation of what was written) for any physicians currently tuning in;Summary28F, non smoker, non drinker, not on birth controlFatigueSevere leg pain (excruciating), pulsing, throbbingSevere pain 'everywhere', especially shoulder bladesBlue discoloration in armsOxygenation is fineBoth arms and legs were scanned but no clots were foundNo history for excessive bleeding during surgery or tooth extractionsPeriods were heavy in the past, but no longerPictures could be interpreted as deep-tissue bleeding/bruising, but no discoloration has been described (cave too recent)No weight loss, fevers, infectionsLiver and spleen are normalLabNo full lab results on hemostasis (e.g. PT, APTT, Fibrinogen)Initially high RGB, normal MCV, hemoglobin. Now all three are decliningNormal d-dimer, normal plateletsNo hemoglobin electrophoresis was donePossibilities (in no particular order)(Acquired) Bleeding disorderThrombosisSickle-Hb C diseaseAnxiety...?

I have not, I dont even know what that is.

No problem. Would you mind posting your history of values? Mainly hemoglobin, RBC, MCV

Sure! Im going to hit the hay first since its 6 AM here and I havent slept yet, but when I get up, Ill get my bloodwork out.How do you want me to write it out on here? Like the reference ranges, and then my results?

Screenshots are fine too btw.Otherwise, maybe like so? Dates aren't crucial, just give an indication of how far apart (e.g. months between or hours). If there's a missing value in one of the labs, just put a '-' so the values stay aligned vertically.RBC [ref], x, x, x, x MCV [ref], x, x, -, xI'd update your original post, and we'll go from there.

I updated it! I just separated it by the blood test, and it looks kind of chaotic I know, but I tried my best.Ill have to grab ahold of more of my bloodwork at my primarys office soon, so that theres not just three

Hmm, these results neither confirm nor refute my first thought. But on seeing the photos they remind me more of deep-tissue bruises.Do they ever go away or change color at all? Was a tourniquet placed on your upper-right arm?Could you perhaps elaborate a bit on your bleeding history? Ever had any surgery or tooth extractions? Nose bleeds? How are your periods?Personally really looking forward to the comments of the hematologist.

Can alpha thalassemias present with normal hemoglobin, but chronically low ferritin? My hematologist suggested my hemoglobin was normal because I burn through ferritin so quickly. Like OP, my specialists have all but thrown in the towel after four years of treatments (for a diagnosis that has now been thrown out - Von Willebrands 2M).I have had high RBC and low MCV, normal HCT and HGB, low B12 and D (take weekly injection of the former, high dose oral supplement of the latter). Ive had two iron transfusions ~4 years ago. I can provide complete blood work for the last four years if that would help.

Hemoglobinopathies (like thalassemias) produce red-cells that have a shorter life-span than regular 'normal' red cells. So yes, there is a high turnover and therefore higher demand of nutrients. However, there are other explanations as well. If you like further exploration I would suggest you make a new thread? Results from the last 4 years would give a tremendous head start.

I updated D-dimer and platelet results now that Im home to see my bloodwork. I apologize I keep replying, but since you made the list, I thought Id let you know, in case you end up not seeing it.

Do you have a picture of your blue arms? Is it al over? Are the blue areas painful or itchy?

Theres a small sliver, same area on both sides, that is my pale skin. The rest of my arms are completely blue. Im currently trying to link photos, but I still am in the process of deleting photos, so that my already filled up iCloud storage will allow me to actually create a link lol.

Would be really useful to see a picture! (Once youve had some sleep)

Dont link through your iCloud to avoid being doxxed or anyone with nefarious intentions causing you more trouble.Edit: create an Imgur account (takes 2 seconds) and link

Are you on any medications, otc stuff, supplements? Lots of exogenous substances can cause blue pigmentation (colloidal silver, amiodarone, minocycline to name a few).

I put the data in that I was asked for, but I can totally do the whole thing, if you think itd be helpful! Quite a bit of my results are online, though, so Ill probably take some screenshots. Ill add it in the post too, once I do.

Screenshots would be fine (and probably easier) as long as its readable.

I put it in my post! Theres a lot of screenshots lol, so beware, but its every test result Ive received most recently (September 11th).

Is it just your arms that are blue? And the right started before the left?QYes, just my arms. The left one started turning blue before the right one, its the blood oddity that started in the right. My lips used to also occasionally turn blue months and months ago, but now its strictly my arms.Sorry it took so long to get back to you things have been crazy on my end with covid. Ive been thinking a lot about your case over the last few days. I think its really strange that its only your upper extremities that are changing color. Please keep an eye out for color changes on your legs or other body parts. Typically when there is some form of differential cyanosis (one part is blue and others arent) we think of cardiac defects and if its one specific limb poor perfusion. But given your age and normal echo a cardiac defect causing your symptoms is unlikely. My next best guess would be something like pernicious anemia/B12 deficiency. This could explain your developing anemia and some of your pain symptoms. The blue coloring could be due to easy bruising related to it. However given that you have microcytic anemia (small red blood cells) and we typically see a macrocytic anemia (big red blood cells) with pernicious anemia/B12 deficiency. But that doesnt necessarily rule out that as a cause for you symptoms. To evaluate this you would start by checking b12, folate levels. Like other have mentioned you could have a hemoglobinopathy causing the cyanosis and anemia which would be more consistent with your microcytosis. However I would have expected this to show up before now, have some known family history of anemia or bleeding disorders, and/or have cyanosis or bruising on more of your body than just your arms. My best guess would be some kind of vasculitis causing vasospasm in your arms giving them a cyanotic appearance. The vasculitis could also be causing the pain you experience in your legs. Your developing microcytic anemia could be early anemia of chronic disease with maybe a pinch of iron deficiency thrown in. Id recommend asking for a ferritin and iron level to evaluate the anemia more. In terms of vasculitis workup, its a bit out of my wheelhouse so Id recommend considering seeing a rheumatologist for further evaluation. Those docs typically (or at least the ones I have worked with) are more of the safari guides than other docs and specialize in zebras.Tl;dr: Possibly a vasculitis, consider rheumatology. Also could be B12 deficiency/pernicious anemia or hemoglobinopathy but less likely due to nerd stuff as above.*edit: Like to add that you should probably also consider seeing a hematologist as well if you havent.

Thank you! I appreciate all this information greatly, and I will definitely take the advice. Im sorry things are bad with COVID right now, honestly I couldnt imagine what its like to be a doctor during this pandemic. Ive already had it myself, and my mother almost died from it. Its nasty stuff. Im praying for all of you.I went to the doctor today (my primary), and Ive been given a referral to hematology and cardiology, as most of my previous heart echo was suboptimally imaged and apparently the cardiologist remarked several times that he couldnt see hardly anything. Were making 100% sure its not my heart first, and then were going to hematology because Im having extreme bleeding issues again. I had blood drawn today for a new PT and PTT also and the tubes were filled up within seconds. The phlebotomist even remarked on the situation, and my blood appears to be almost the consistency of water. I was born at the hospital Im going to for hematology, so maybe there can be some connection if possible. Also, apparently on my last echo, it was remarked as me having trivial to mild mitral valve regurgitation but Im not quite positive what that is anyways, or if it is even something to question.Ill definitely be hitting up rheumatology next, especially if these dont pan out.

Mitral valve is valve on the left side of your heart. The regurgitation means it leaks a little allowing some blood to flow backwards. I wouldnt think much about trivial to mild mitral regurgitation especially if it was a bad echo. I hope you find your answer. Please feel free to DM me at anytime if you have questions or concerns. Always happy to help

Rheumatology- [49][female] Methotrexate and ColdMy mom is a patient of La county hospitals but does/t have a PCP only a specialty clinic doctor that she sees every 3 months so Im hoping to get some advice. She recently got a cold this past weekend, she tested for covid and had a negative result. She has a cough and is taking Acetaminophen from OTC. She is due to take Methotrexate today due to her Lupus treatment for her flare. Her doctor recently increased her dose to 10 pills weekly which I understand to be an immunosuppressant. How does this affect her if she has a cold? Should she skip until she gets better?

That's a spectacular question,I wouldn't panic, I don't think it's radically dangerous but this does merit a phone call to the doctor's office. It's important and should be answered by someone who understands her particular history with lupus quite well.I say don't panic because it is not radically uncommon for people to take immunosuppressive drugs when they are in fact sick with an infection, that is the whole basis of taking steroids(the most iconic immunosuppressive drugs) when you have covid, it's looked at like a double-edged sword. So that's good with bad. In theory it could make her cold much more intense and last much longer than it would in a normal person .I don't know how bad her lupus flare is and if that's going to hurt her more withholding the drugs; or how bad her cold is, and if she's really going to fall apart, so I will refrain for making an explicit recommendation.I recommend you get this specialist to give the recommendation, but either way giving it or holding it, she will probably be okay for the meanwhile.

Thank you! I feel much less panicked now. Ive tried getting a hold of her doctor but have not able to. Ill continue trying. On the lupus thread, Ive also seen that others have been told by their doctors to skip methotrexate when they had a cold. Ill let her know to skip and take it next week, when shes hopefully back to her normal self.

I think that's probably an OK decision. Not my decision. I don't know her.

Chest/Neck CT/PET in preparation for lymph node biopsy for neurological/rheumatologic(?) symptoms, also showed lung nodule?Hello everyone! I just had a chest CT and neck CT with contrast to evaluate lymphadenopathy of the neck as well as potential lymph node activity of the chest, and to move towards a lymph node biopsy.This is what was found so far (also had an ER ultrasound showing multiple mildly enlarged lymph nodes in parotid, submandibular, levels 1 and 2 no fatty hilum)-Multiple nonenlarged reactive appearing cervical chain lymph nodes bilaterally. Asymmetric 0.9 cm left level 5 and 4/5 nodes, with preservation of the fatty hilum, likely reactive. Subcentimeter right retropharyngeal node similar to the recent cervical spine MR, with an elongated reactive appearance.My ENT, advised by the rheumatologist I am seeing, was somewhat hesitant on doing the biopsy before having a PET scan done because she stated a biopsy would interfere with a PET/CT for 12 weeks afterwards. The PET scan was recommended by the rheumatologist, as we do not have solid leads for the issues I am having and per his words can collect more sensitive data. I have symptoms progressing by the day, and would like to go ahead with the biopsy and forgo the PET scan also because of the high radiation dose. My questions are, does a biopsy really impact PET results for so long, and would it make sense to perform? Can I request the biopsy first instead? Also, would an excisional biopsy really be needed over a core needle biopsy?The CT also found a 4 mm right lower lobe nodule adjacent to pleura image versus subpleural atelectasis. Should i be concerned about this nodule or its location, and could it represent a rheumatologic disease process?I appreciate any advice! I am a mystery case to all the doctors I have seen and feel completely utterly hopeless.28F, 57, 172 lbs, Asian, No drug use or smoking of any kind, Current Medications include Levothyroxine, estrogen, and progesteronePrimary Issue- Multi system wide involvement including neurological, dermatologic, possible rheumatologist, endocrinologic- Severe neurological presentation of symptoms beginning as constant left-sided facial pain, progressing to tingling and cold, then constant numbness and deadness of sensation in peri orbital area, decreased corneal reflex, whole cheek, down to jaw, and through lips, combined with massive headaches in occipital temple and behind the eye, feels like face is falling off face and sagging. Loss of muscle in face and body as well as muscle twitching/pulsing in top and bottom eyelids (right and left) constant muscle twitching/aches/pain in random muscles throughout body. Recently spread of pain in parotid, submandibular, occipital, ear canal, left neck, supraclavicular areas with associated mildly enlarged and reactive lymph nodes, mostly on left but also bilaterally. Very recently tightness, compression, and loss of sensation in left front of foot and back of left calf which is still present.Many other non-neurological symptoms, have seen 60+ doctors.Duration: 2 years of worsening symptoms.

Reactive lymph nodes are usually from some infection or inflammation and biopsy will likely not be helpful. Id say go for the PET first. The lung nodule does not seem worrisome. PET once again may be helpful to see if it is metabolically active

Positive ANA test 1:1280, whats next?Hello im F 24 i weigh 110lbs and am 51 Ive been on a four month journey of trying to figure out whats wrong with me, had an oncology appointment recently as my physicians were suspicious for a lymphoma or leukemia. Had an ANA test along with a myriad of others and it came back positive 1:1280 speckled pattern. im being sent to a rheumatologistIm wondering what are the different things that can come from this positive test? and are petechiae something that happens with autoimmune diseases?ive had widespread lymph node swelling, with some hard immovable ones in my neck and underarmsdaily feversnight sweatsweight loss 10lbs in four monthspetechiae and bruisingred bumps in areas of lymph swellingfacial flushingburning sensation on skin face, neck, shoulders, armswidespread intense itchinessextreme fatigue, weaknessdizzinessupper abdominal pain & hip/lowback painand migrating pain that feels like growing pains in my bones throughout my body

Could be lupus, maybe Sjogrens. Both can look like lymphoma and cause most of the symptoms youve listed. Rheum will test a battery of inflammatory markers, immunoglobulins and antibodies for a specific connective tissue disease (CTD). Many CTDs can cause petechiae and purpura due to vascular fragility and small vessel vasculitis. It can take some time to make these diagnoses.

Should I see a Rheumatologist?Hi I am 26F, 150lbs, currently only taking hormonal birth control (sprintec). I have been dealing with recurring hand and arm pain for the past four months or so. I'd estimate since the end of January 2023. It started as a sort of tingly feeling in my fingers with some pain around the proximal interphalangeal joint in all 10 of them. I wouldn't describe the tingling as numbness exactly, as it's not the pins and needles that others use to describe it, but it is constant. The pain is in both hands, but my right hand is worse as that is my dominant hand. As there is no specific moment I can remember when this started, I thought this might have been carpal tunnel or some other overuse injury from spending time knitting & crocheting as well as being on the computer 8-10 hours a day for my job/fun. I stopped knitting as much and when it didn't get better around a month in I stopped knitting completely. The pain does get worse when I use the computer and my phone so I am trying to limit the use of both and I have already switched to using a vertical mouse which didn't seem to make a difference. Specifically when I click the mouse with my right pointer finger I feel a pinch between my ring and pinky fingersI went to an orthopedic hand surgeon who said that he didn't think it was carpal tunnel as those are unusual symptoms for it and even more unusual to be experiencing the pain in both hands. He took X-rays that he said looked normal, and he ordered a bunch of blood tests for me including one for Rheumatoid factor. He also prescribed me physical therapy after I complained about still being in pain. The physical therapist did a bunch of intake tests that showed my grip strength and other strengths were on the low end, but normal and he seemed stumped on how to help me. After 3 sessions of in office physical therapy I did not seem to get better and if anything it's worse. As I now feel regular pain up my arms around my forearm and triceps (feels kind of like a tight stretching) in addition to the pain I described earlier. Also in the last couple of weeks I've experienced actual numbness in both of my pinkys, on seperate occasions. For the record I wasn't as diligent with the PT as I could have been, ie sometimes I would do exercises only once or twice a day instead of the recommended 2-3 times. I was diligent about the heat he recommended though.My blood tests came back all negative so the doctor said that he's at a loss, suggested I maybe make an appointment with a rheumatologist and prescribed me a 4mg medrol dose pack as a last ditch effort. During and after the prednisone I didn't really notice a change in pain levels. That coupled with the negative Rheumatoid Factor suggests to me that maybe there is no inflammation causing this? But I know that seronegative rheumatoid factor exists, hence why I'm now asking on reddit. Does it seem like this could be RA? Would it be worth it to go to the Rheumatologist for this? Was my doctor just wrong and it is some kind of overuse injury and I should just try a new orthopedic doctor? Maybe someone less specialized in the hands because the physical therapist suggested it might be a spinal issue since the pain is traveling up my arms. Should I just give up on doctors and try to be more diligent about the physical therapy on my own?For the record here are all the blood tests I got:CBC W/PLAT AUTOMATED DIFF - Only showed I have a slightly low red blood cell countANA PANELSEDIMENTATION RATEC-REACTIVE PROTEINRHEUMATOID FACTORURIC ACIDHLA-B27 ANTIGENCYCLIC CITRUL PEPTIDE ABSANACHOICE(R) SPECIFIC ANTIBODIES W/RFLX TO DSDNA

Picture does not sound rheumatologic to me. In addition to the negative labs and imaging, most patients have relief with steroids on initial diagnosis of a rheumatologic condition. This tells me what is going on is unlikely autoimmune or inflammatory.Some ideas and thoughts on things that can cause pain/tingling/weakness in the arms and hands that I do have are have you ever had any neck trauma or whiplash? Has your B12 and thyroid been checked? Do you have any history of migraines?

No neck trauma or whiplash and I'm not sure my B12 has ever been checked. I went to an endocrinologist last year because I found out I had a high level of thyroid peroxidase antibodies (166 iu/ml) after testing for a seperate concern, but my T3, T4, TSH were all normal so she said to come back in a year. I hadn't thought about it because the endo seemed very unconcerned, but do you think that could cause this?Also no real history of migraines, I remember I had 2 around when I started puberty and haven't had one since. My (older) siblings do occasionally have them though, not sure if that would matter.

Hypothyroid can certainly cause some real muscle pain, joint pains and parasthesias (tingling in hands/feet). As a matter of fact, carpal tunnel syndrome is a common neuro symptom of hypothyroidism and is often reversible with thyroid hormone therapy.Get your thyroid checked. Id still also check B12.

69M - prostate cancer? - what to expect?Hello, this is concerning my father (69M). He's 6'3" and about 15st. Anatomically this concerns this prostate, and geographically we're in the United Kingdom.He is a moderate regular drinker (2-3 small glasses wine most nights) but has never taken recreational drugs. He used to smoke but quit about 35 years ago.He has mild asthma and chronic sinus issues caused by nasal polyps that cause total nasal obstruction. He is awaiting followups for a cauterising surgery, but this seems unrelated.As part of routine bloods, my dad got a psa test about a month ago, which came back at 13.3, which is obviously elevated.His GP hasn't seen him in person and hasn't carried out a rectal exam, but instead referred him to urology. His urology referral was a telephone consult to tell him that he was being booked in for an MRI.He had the MRI (with contrast) last week and today was told that there was something suspicious on the left side of his prostate, and that he would need a biopsy. He hasn't had the biopsy yet.I understand that this is all geared towards a prostate cancer diagnosis, and I understand that at this stage, prostatitis is unlikely. All the clinicians with whom my dad has spoken have been very reticent when he has asked about cancer, but simultaneously tell him he might need a bone scan based on the outcome of the biopsy.I'm under no illusions that prostate cancer is high on the differential, but could benign prostatic hyperplasia still be on the cards? I understand that both conditions are diagnoses histologically, but it would be helpful to know whether PC and BPH look distinct on images?For background info - he has no urinary symptoms but has been losing weight steadily for about 3 years (maybe 4st in 3 years?). Assumption has been that he hasn't been eating much because his nasal polyps have robbed him of his sense of last largely. He also lost his wife (my mum) to breast cancer six months ago. He can't cook and eats rubbish, and also likely has depression.Any insight here would be useful in terms of differentials, outlook (based on the vagaries I've provided) and generally what to expect. I definitely feel that no clinical has been forthright with my father thus far. That's no criticism of the docs, but it hasn't helped him and has compounded his stress as he's gone straight to Google and catastrophised.

Urologist. Impossible to provide much advice since he hasn't actually been diagnosed with prostate cancer and there are many nuances depending on what type / grade / stage of prostate cancer we are talking about. Certainly a chance you can have an elevated PSA and no prostate cancer even with an MRI. Only way to find out is biopsy. Results of that would determine what needs to be done.If he does have prostate cancer it is almost certainly localized to the prostate. Options would then be surgical prostate removal, radiation, or surveillance and waiting. Obviously I don't want to go into these with out a proper diagnosis. Biopsy happens in the office, takes about 15 min. Results take a week or two to come back.

[Urology] 27M, Pee drops "leaks" after peeing. Embarrassed to visit a doctor.As the post says, I am 27M. After peeing few drops of pee leak out after peeing.As a "solution", i "rub" my penis to move any pee in the canal outside. I do it even from behind the testicles. However recently, it seems even that doesn't work out. As i still get few drops of pee afterward, especially when i sit down.I wanted to go to a doctor, however i am extremely embarrassed. And I am not even sure if there is anything that can be done at this point.The thing is: the reason i believe this is happening, is because when i was a kid, i inserted a thermometer in my urethra, it was deep enough that i felt it penetrating something and pee came out.However if i recall correctly nothing really changed after that incident and this leaking issue started happening about 5 to 8 years ago.

To put your mind at ease, there is a VERY low likelihood that these issues are secondary to your "self-exploration" event that you journeyed on when you were younger. Additionally, there's absolutely no reason to be embarrassed about this. This is what us physicians do on a daily basis, and we do what we do because we love to help people (most of us, that is). And I promise, for every "embarrassing" event you think you might be bringing to the table, I guarantee all of us have seen much, much worse. But again, there's absolutely zero shame in what you're going through whatsoever. Get a referral to a urologist from your PCP; all they focus on is genitourinary tract issues, and they should hopefully be able to help you find an answer to what's going on.

Piggybacking... had this start happing to an extent sometime in my 30s or 40s, and figured this was just attributable to aging... Would a urologist visit typically be warranted if there's no other symptoms or related trauma that could have caused it?

It's true that many men will develop these types of symptoms later in life due to something called BPH (benign prostatic hyperplasia), which is essentially when the prostate grows too large and starts "pinching" the urethra closed, which subsequently may lead to symptoms such as difficulty starting a stream or completely emptying when they go. However, your 30's is way too early for this to begin occurring. I would start with going to your PCP first so they can do a physical exam and ask more questions, and then they can help decide whether or not a urology consult is appropriate for you.

Cystocele76 old woman. Her nurse practitioner diagnosed her with cystocele. What kind of doctor would be the right doctor for cystocele? Would gynecologist be better option than an urologist since the patient is a woman?

Luckily you don't have to choose: there are urogynaecologists out there, which are gynaecologists who specialize on urological and proctological issues in women. I'd go to one of those.

Does OB/gynecologist fit that category? Medicare physician finder doesn't even have the doctors category of urogynecologist on their web portal.

Ah, I see. Sorry, I'm not in the united states. It's the right type of doctor, yes, but it doesn't tell you their sub-specialisation. Maybe look the ones you find via the portal up on the internet or call their office?

27m - Urology/Andrology Question - successful Penile vein ligation and shockwave treatment contra indication? What happens to ligated veins ?Hello to all,I have been diagnosed with severe organic erectile dysfunction and am using PDE5I, injectable PGE1 (Alprostadil) and sometimes alpha-1-antagonists (doxazosin).I am suffering from organic erectile dysfunction and had a successful dorsal vein ligation (3 years ago - superfical and deep dorsal vein as well as two ectopic veins (which helped me to get erections with medication).Even though shock wave treatment might not be very promising I still want to try it and as I happen to live in a country where it is comparatively cheap I am about to do 10 sessions in 5 weeks.But I fear that it might "unblock" the vein ligation ?Hypothethically speaking - if the ligated veins where freed from their suture would they pop open again ? Or is there scar tissue built up which will continue to block the vein ?I fear the shockwaves might damage the "suture". Since I cannot happen to find information about that online maybe someone can help me out.Thank you and best,

The suture themselves dissolve after a while. So 3 years later the veins are closed by scar tissue. Also, when a blood vessel is surgically closed, a longer segment of the vein eventually becomes "clogged". Sounds very unlikely that anything could break them open again, even if they should deliberately try.So I don't think you should worry about this specific complication. There's probably a lot of other possible complications though, I don't know much about this specific shock wave procedure. Sounds very experimental though. Do you know how it's supposed to help for ED?

Constant 9/10 flank pain Female 31Hello fellow people of reddit. I hope you are all doing better than I am currently.Overview: I had my first set of kidney stones in may of 2022. I had another set in July of 2022. In December of 2022 I started having constant pain in my flanks. Ive been to the emergency room several times since then. Ive seen urology, Ive seen my pcp, Ive seen the pain clinic, Ive seen a nephrologist. I have bloods done frequently as well as UAs. Ive been ignored and sent home every time when I seek help. Otc meds dont work and the narcotics just make me sick. I feel like Im going insane. Im Im so much pain on a constant basis. My mental health is starting to tank because of this. Any advice would be appreciated.I do have hypercalcemia, and hyperparathyroidism, and my nephrologist believes I could also have necrosis in my kidneys.I am 31, obese, 5 foot 3 inches tall. I have never smoked, dont drink, dont do drugs other than weed in gummy form every now and then.Current Meds are:Concerta, Propranolol, Losartian, Amlodipine, Nebulizer, Quvar, Alb inhalerHere are my most recent labs.UA:https://gyazo.com/d5f6f1fc96058f29dd17ea6d2e3126f9https://gyazo.com/fca06118e1b739c171942f1b3050492fCBC with Auto Differential:https://gyazo.com/940243c0ec3bb61963388832f51c2bd0CMP:https://gyazo.com/2586ac67b7574917dcb76db00ddf78ae

The fact there is calcium oxalate in your urine, plus blood +++ indicates there may be a stone in the process of breaking up, and this is what is causing the pain for you (especially if you have a history of kidney stones). Looks like a slight UTI too, which isn't going to help.

Thats what I said, but the only stone they can see is, according to them, no bigger than a grain of sand. The doctor I saw last night also said that I didn't have a UTI. I've had the crystals and blood in my urine every single UA since December.

You don't have a raging UTI and your culture is negative from what I can see. But there are white blood cells in your urine, and bacteria (though no leucocytes/nitrates, which tend to be the classic uti markers). Plus, a high number of epithelial (skin) cells, which indicates sample contamination. So, not anything that warrants treating.And yes, kidney stones can literally be a grain of sand size and cause utter havoc.

Man, I wish the doctors here would understand that. Because every time Ive gone to the ER (which is a lot unfortunately because I cant deal with the pain and otc meds don't work on it) they just tell me Im being dramatic and to go home.

I'm sorry to hear that. When I come across patients with pyelonephritis/renal colic etc, they tend to benefit somewhat from hot water bottles.

My heating pad does help to a degree. Sometimes, it helps enough that I can sleep or do whatever it is I need to. And sometimes it does nothing.

Do you have any imaging? Does the pain come and go? Where is it located? Is it the same as when you had kidney stones? What therapies have you tried, what did urologist say about the pain?

Nephrology says it's probable stones and/or renal papillary necrosis.s.ne. There's a constant dull ache and then like a colicky pain that gets really bad really fast. It feels very similar to past kidney stones. The pain is on both flanks and spreads to my side right above my hip.I've had a couple of CTs. The last one showed at least one itty bitty stone. There's a constant dull ache and then a colicky pain that gets really bad really fast. It feels very similar to past kidney stones.I've done heat, cold, narcotics, NSAIDS (which the nephrologist said to stop) Ive done physical therapy, exercise, and stretching.The urologist says he didn't see anything and that I'm being dramatic.My PCP says there is something wrong and to see urology.Nephrology says its probable stones and/or renal papillary necrosis.The pain clinic says Im being dramatic

I agree that NSAIDS and opiates are not the way to manage this, and I believe your pain you are not "dramatic".How high is your calcium? Your hyperparathyroidism is possibly the most crucial thing to get under control. Chronic hypercalcemia obviously predisposes to stones, but also to a disease called nephrocalcinosis which can be painless but sometimes causes marked pain as small rocks of calcium get lodged in the draining portion of the kidney.The other not mutually exclusive possibility is you are having ureteral spasms, which are associated with hyperparathyroidism and hypercalcemia but no stones.So it is crucial to get your hyperparathyroidism under control. Even with "normal" calcium this can cause kidney problems and with hypercalcemia can cause kidney failure. If this is already under control then possibly it will get better once the ongoing calcium deposition improves. Dietary changes can also decrease calcium deposition, your nephrologist can advise on these.There are several medications available that are somewhat helpful for ureteral spasms including oxybutynin and tamsulosin but would focus on the underlying cause.

My calcium bounces between 11.5 and 13.5. I have surgery to remove the overactive parathyroid glands at the end of next month. It was supposed to be this month but the hospital broke a needed machine the day before it.I will have to looked into the nephrocalcinosis, I haven't heard of it before.

Holy smoking gun batman.Yes I suspect this surgery will help tremendously with your pain. If it was delayed long you should have been on a calcium lowering agent, though likely a little late to start now.

Fun fact my endocrinologist told me to take calcium and vit d.Im really hoping the surgery helps because I might just loose my mind if it doesnt. My calcium has been like this for about three years but I was always told it was fine until recently.

I don't know the details so I can't really assess what is going on here, but in general we wouldn't let someone be that high for that long. Surgery is usually done fairly early and if not medical therapy offered, targeted at lowering not raising the calcium.

Unfortunately, I had a pcp that seemed to believe that everything was either due to menstruation, things I was doing, or that it was due to my low mental health or that I was lying. But he was the only one my insurance would cover. As soon as I switched doctors I got referrals and scans and procedures but that only happened in November of last year.The Ed always said it wasnt that high and it wasnt something to worry about.

The ED is never going to treat hypercalcemia or really any chronic problems. It isn't acutely life threatening unless very high so not on their radar.They aren't mini-PCPS.Unfortunately people have poor access and get stuck in the ED visit spin cycle with care never moving forward. I think you are on a goodish path now though.

The case of the constant invisible urine flood: neuro? Psych? Other?This is a bizarre one, so Im hoping for any ideas here.Pt (family member) is an 80 year old female residing in an assisted living facility with hx of benign essential tremor and recent dx of possible Parkinsonism (tremor, left side more than right. A&Ox4; No signs of dementia; MOCA 7.1 score 28/30. More hx and meds below) About three months ago, pt c/o urine constantly running down my legs. She reports that her clothing, shoes and socks get soaked with urine, to the extent that she leaves wet footprints when walking, and smells urine strongly in her room and on her clothing. She has been wearing adult incontinence briefs, but reports that the urine bypasses these briefs.Heres the problem. Family, caregivers, physicians, nurses, and therapists cannot see, smell, nor feel the urine. When pt says her pants are soaked, they appear and feel dry to the touch. Incontinence briefs also feel dry, and there is no sign of urine on pts bedclothes or clothing. She recently spent two weeks in an acute care hospital and another two weeks in a rehab hospital, and in that time, only one instance of urinary incontinence was noted and that was on admittance when it had been some time before she could be seen.She has seen a neurologist who prescribed Sinemet (carbidopa/levodopa) for her tremors. The neurologist mentioned that Sinemet can exacerbate incontinence, but didnt really address pts insistence that she is constantly having urine flow that soaks her legs and shoes but somehow bypasses the incontinence briefs leaving them dry.She has seen a urologist, who prescribed a bladder training regimen and voiding journal, but a bladder scan showed she is emptying her bladder just fine. Labs show no sign of UTI or other infectious or inflammatory process. Urology suggested this was more likely a sensory issue than a urology issue and referred back to the neurologist.Pt insists that her fellow assisted-living residents can also see and smell the urine, and has reported that she believes the caregivers are lying about not seeing it in order to be polite.Complicating this is that pt has a history of anxiety disorder, depression, sometimes exaggerating physical symptoms and deciding she has a grave condition of some sort until tests are done to rule it out. A psychologist has suggested she may have a personality disorder with emotional dysregulation and attention-seeking features as well.The fact is, though, this pt is miserable and 100% insistent that she is experiencing a constant flow of urine and sitting in wet clothes all the time. We cant get her in to the psychiatrist until late April.Are there ANY ideas of what we may be missing to explain this from a neurological/sensory standpoint or another place to look? I have been really trying to advocate for this pt but its very difficult when the problem seems to be invisible for everyone but her. On the chance this is not psychosomatic, Id really like to make sure weve considered all options and are not just blowing her off because of her mental health issues.No alcohol, no drugs other than prescribed, no marijuana, no tobacco/nicotine use.Meds: Sinemet 25/100 2 tabs tid (Parkinsonism) Bupropion 75mg qam (depression) Liothyronine 5mcg tid (hypothyroid) Levothyroxine 50mcg qam (hypothyroid) Trazodone 50mg qpm (sleep) Buspirone 5mg bid (anxiety) Alprazolam 0.5mg qpm (anxiety/sleep) Ibandronate 150mg q30day (osteoporosis)Surgical/other hx: Hysterectomy/bilateral oophorectomy ~40 years ago Pregnancy: G2P2 ~50 years ago Melanoma removal, L knee, ~5 years agoLabs:CBC shows minor anemia beginning the day after starting Sinemet but seems to be resolving.BMP normal except for elevated AST (last values from Jan 2023 to Mar 2023 were 88, 71, 144, 156, 162, 91, 101 in chronological order.)Imaging:MRI Lumbar spine w and w/o contrast 2/1/2023: they didnt think it had anything that would explain constant urine flow but I can post the report if needed.CT head 1/30/2023: impression was: 1. No acute intracranial abnormality.2. Atherosclerosis.

I would guess these are vivid hallucinaties, resultibg in a delusion. These can be caused by her combination of meds ( levodopa, bupropion and trazodone can cause agitatie and confusion in eldery patients). Did it start after starting levodopa? Parkiinson itself can cause vivid hallucinations too,but often parkinsons is more advanced then. And it could also be caused by depression. Older people often have these kind of delusions when they have psychotic depression.I would go back to the neurologist or psychiatrist for an evaluation. Probably stopping some meds should be tried, or antipsychotics compatible with parkinsons like clozapine added. But ask her doctors first what and how.

Oh, I forgot to answer your question: No, this started quite awhile before she started levodopa and buspar.She had been taking bupropion, trazodone, and alprazolam for years, but spent a few weeks in an inpatient psychiatric facility specifically focusing on elderly patients (edit: for depression/SI) about 9 months ago, and the psychiatrist there doubled her bupropion from 75mg qd to 150mg qd.The urinary problem started about three or four months after that. Two months ago, she was hospitalized for increasing tremor and weakness, at which time a consulting psychiatrist said to titrate her off the bupropion as he felt it was contributing to her anxiety levels. At that time, her bupropion dosage was cut in half to the 75mg she is currently on.The increasing tremor and weakness were determined to have been simple deconditioning due to self-isolating, turning away physical therapists, and not moving around much at all. She went from acute care to an intensive inpatient rehab facility and very quickly (about 2 weeks) regained much of her strength and a decrease in tremors.Thank you so much! We are trying to wean her off bupropion for that exact reason (not hallucinations specifically, but because it can exacerbate anxiety), so thats good to know. We just saw the neurologist yesterday but he sort of waved it away and suggested we discuss med interactions with the pharmacist.Further complicating matters is that shes tried pretty much every SSRI and SSNRI for depression and has had bad reactions to all of them, so bupropion at the time was thought to be a sort of last-ditch effort and seemed to be working for her. Since it also works on dopamine, the neurologist was completely unconcerned about it, but admitted that comprehensive med review was not in his wheelhouse.We did specifically ask the neurologist if this could be related to the Parkinsonism and he said he didnt think so because of the rest of how her condition appears.So, it sounds like I should continue trying to get her into the psychiatrist sooner? So far her other doctors dont seem to think theres a problem that they can speak to.

For depression with psychotic symptoms, like these hallucinations/delusion, often tricyclic antidepressants are used, so probably meds she has not tried yet or maybe a few decades ago when they were more common.Personally i would try to get an appointment as soon as possible, because something is clearly not right and she is suffering probably.That could be a psychiatrist specialised in the eldery or (another?) neurologist. Consulting a pharmacist with an interest in psychopharmacology however also a good idea in the meantime.Armchair diagnosis is easy, but i could be very wrong and there is something else going on. This is just some thoughts that came to mind

Child urology: Double kidney, megaurether, uretheroceleFemale, 10 months old, 70 cm, 7.5 kgHi all,I am searching for second opinions and experiences for my 10 months old daughter.She was born with a double kidney whose upper part is polycystic and thus not working properly. The urether of this part became a megaureter, probably because it ends in an ureterocele in the bladder.Her first surgery was when she was 1 month old. They cut into the ureterocele so the urine can flow into the bladder. However, at this point they thought she had only one urether for both systems and thus there had been enough urine to guarantee sufficient flow. When she had a persistent infection with Klebsiella pneumonia, we were referred to specialists who saw the second urether and, 2 weeks later, her second surgery was done to make a urostoma, so the basically standing urine from the megaureter could flow directly outside. The ureter is smaller now and except that she receives prophylactic treatment with antibiotics, everything is normal. But the stoma has to be closed of course. Now there are 2 options:connect the ureter from the dysplastic part of the double system with the healthy ureter from the healthy partcut out the dysplastic part of the double system and part of its ureter, leaving the other part and the ureterocele where they are, as there is no refluxOur doctors recommend option 1), as the surgery is shorter (90 minutes vs 3 hrs) and less invasive (opening up the existing hole from the stoma a bit more vs making an additional cut close to the lungs) and the healthy kidney part is not damaged (vs certain loss of at least 7% function). The only risk is that the connection of the two ureters leaks, which is rare and easily fixed they say.These are all compelling arguments, but we were also told that option 2) is the more common one. Does anyone have experience with similar cases? What's her best option in your opinion?Thank you very much for any feedback!

!redditsilver

Is it normal for a Urology PA to try to prescribe antidepressants/SSRIs?(Posting this again to fix some things that I needed to fix in this) Age: 24Sex: FemaleHeight: 5'1"Weight: 100Race: CaucasianDuration of complaint: urinary issues for about a year, suspected interstitial cystitis. Appointment was todayLocation on body: urethra/bladderCurrent medications: N/ANo recreational drugs, non-smoker, non-drinkerI had a very uncomfortable urology appointment today and while one of my doctors confirmed this was really weird I kind of would like to hear from other doctors unrelated to the situation.I went in because my gyno suspects that I have interstitial cystitis.I'd like to mention he's very very specific with me about what will happen. He knows that I rely on a really precise description of what the plan is (I have really bad anxiety and sensory issues). So it was weird to me when I went in and the PA immediately scoffed and said "it's never interstitial cystitis. They just claim that and send you off our way". Then she insisted on pelvic floor massage which I am unable to do and I said no to because my gyno and I went over all the options and he didn't think that was even on the board of necessary ideas. She pushed and said that "I injured my shoulder and got pelvic massage therapy and it fixed my shoulder".She claimed she had read all of my charts and medical background and asked if I was taking anything for the pain. I thought she meant Tylenol and said no because it doesn't work. She then started listing off amitriptyline and two other antidepressants/SSRIs. Then cymbalta. I got confused and told her I'm already taking savella and she asked me "what for? What does that do?"Shouldn't she know what that does? It just sent off a really red flag for me because those are usually meds that you need to involve a psychiatrist for. And if she had read my file and is messing with those kinds of meds why would she mess with my antidepressant that is package insert for pain and depression? She also would've seen that I'm prescribed tramadol.She also got really snotty when she asked if I had been surgically diagnosed when I said I had endometriosis which also would have been in my file/medical history. It also seems like any message from my gyno she just threw in the trash pile and came in with her mind made up that he was full of it.I guess I just need to know what to do. If this is normal and she just was kind of awful then okay but it really didn't feel normal. Do I tell someone about this? Who do I tell? She told me "then just go back to your gyno and see what he says" and (as I expected he would) he's sending me to another urologist, I imagine he's wondering why there was a problem.Edit: she also asked me about a bunch of food and drinks, I answered honestly that I just drink water with an occasional soda and about my food habits. Then she sent me home with a list of food to stop eating and all of it is stuff I point blank told her I don't eat. I'm just really upset because I had to drive a long way to get there, do things that will set me back anxiety-wise for days and she didn't even listen to that.Edit 2: There's also the unfortunate fact that the more stressed I got by her ignoring me and getting really pushy the more I started to stim. And she decided the best thing to do was start IGNORING me (I was still speaking to her, just no eye contact and moving my fingers) and only speak to my mother. I was then completely invisible.

That sounds like a mix of multiple bad things. Theres a strong whiff of functional medicine (read: quackery) in massage for everything and weird food restrictions. Theres stigma against psychiatric treatment and mental illness. And theres ignorance.Theres nothing wrong with a urology PA managing antidepressants if he or she actually has expertise in those medications, but that isnt what happened here. This PA might be right about it not being interstitial cystitis, but even if so behaved so badly that youd want a second opinion anyway.

Definitely getting a second opinion, hopefully with someone that actually is interested in sitting down and talking things out instead of whatever this whole mess was.Thank you for letting me know that it's not unusual for urology PAs to work with those meds in general

I think it actually is unusual. Its not unprofessional or absolutely a bad thing, but its unusual.Its not only psychiatrists who manage psychiatric medications, but most of the other doctors (and PAs and NPs) who do it are generalists, so probably family our internal medicine primary care doctors and the occasional gynecologist who does primary care.

Yeah the savella is for my fibromyalgia and depression, I've cycled through stuff like elavil (ultimately dismissed as an option when I was 14ish) and cymbalta (horrible reaction) so I don't find that so weird. I guess maybe it put me on edge because I've had bad experiences with a lot of those? I'm very touchy about messing with those when I'm settled in one because it's hard physically and mentally and I really don't feel safe unless my psychiatrist is involvedI've gotten the "what's it for" question a lot it was more the "what is that" that got me because I thought it was a pretty well known med

Sorry this is short. No signal. Speed read the issue. Only have to say.... Cymbalta is a powerful antidepressant which has use in resistant stress incontinence , that is leaking on exercise usually later in life.Amitriptyline has a big role in bladder control mostly for nocturia, peeing at night. It is used at doses much less than when used 50 years ago as an antidepressant but I like to correct people who complain theyve been put on an antidepressant when the dose is 50mg instead of the 300mg it was then. It was a poor antidepressant but people said that their bladders were better

That's interesting. But also odd because I told her I'm not having incontinence

Precisely. It doesnt really make sense so maybe another opinion

My (72M) father was sent off for a number of urology tests, are these standard procedure?72M, 160 lb. He has had frequent urinary urgency for years now, untreated. Recently has gotten much worse, and the need to urinate has been waking him up 5+ times each night. When he does urinate, he has trouble emptying his bladder.I scheduled an appointment for him with a urologist and the urologist prescribed Flomax to him. This was today. The urologist sent off for a number of tests:PSACreatinineUrinalysisAlso, these procedures:Transurethral cystoscopyRenal ultrasound and ultrasound of the urinary tractI'm wondering about the cystoscopy - as this is what my father is most fearful of. I spoke with the urologist and he said this is to see if there are issues that need to be addressed by surgery that the Flomax can't help cure. I'm still not sure what this is done for and if this is standard procedure? Would it be better to just see how he responds to the Flomax and perform the procedure if he doesn't? Or is there value in doing this anyways?

Flomax was given as due to the likelihood of benign prostatic hyperplasia, and pretty much every guy has an already enlarging prostate when they're above 60 anyway.The cystoscopy is to look into the urinary bladder for any issues that may not be due to the prostate (prostate would still be the number one source of problems in this age group regardless). All these tests should cover all the bases for the probable urinary tract issues for his age.

I did an in home vinegar test yesterday and the area he was referring to did NOT react. I did have a single spot react, but not the one he was referring too. The vinegar test has a high false positive rate so I'll talk to him about that, but still, the visible areas he could have been talking about DID NOT react.I want this guy to be sure i have HPV before he charges me to cut shit that's been there forever. I can take care of a skin tag for under $5 at home. And while I know it's incredibly common to have hpv I want him to be sure if I'm going to have to disclose that with future partners. Maybe I should see a dermatologist?What are some questions I can ask to make sure he's right?

Easiest and cheapest way is to post a picture here and Ill check it for you. Its a clinical diagnosis and honestly not that difficult to determine.Edit. Also, if you have had unprotected sex with > 1 partner, chances are you have been exposed to the virus.

http://imgur.com/a/lhCk8a4Again, its been there my entire life, including the skin bridge. I always assumed they were caused by the same shitty circumcision.To your edit: I've never had unprotected sex. That includes oral (not fun).

Doesnt look like a wart and your history doesnt really support that diagnosis either.

Bleeding vs. clotting risk - When is heparin bridging appropriate?Hi all, I am just a simple-minded EMT, trying to understand this concept for a family member who recently underwent surgery.The family member has chronic a-fib, which has been well managed with warfarin. He needed a trans-urethral resection of a bladder tumor (TURBT). His cardiologist said he should not be off warfarin for more than 72 hours, and his urology surgeon said to stop the warfarin 48 hours in advance of the surgery (meaning the plan was to resume the warfarin 24 hours after surgery). After the surgery, the surgeon said he was not able to cauterize all of the 'wound' (I am not sure the correct term here), so my family member had a good amount of hematuria, though the surgeon said it was not a life-threatening amount.He was supposed to take aspirin after being discharged, but they ended up admitting him due to a good amount of clotting in the bladder, which required daily irrigation. I am not sure if the nurses ever ended up giving him aspirin or heparin while he was off the warfarin. The surgeon seemed very concerned about the bleeding, and said that my family member could not go back on his blood thinners for another 48 hours after the initially planned resumption (which would result in a total of 5 days off the blood thinners).Now my question is, isn't it easier to fix a bit of bleeding than a blood clot (which could cause CVA, AMI, or PE)? Wouldn't it be better to keep him on blood thinners and handle the bleeding, than to risk a deadly clot?We would ask his surgeon, but it's sort of a foregone conclusion at this point as my family member has already been discharged. So, this is just for my personal education. Thanks for your insight.

isn't it easier to fix a bit of bleedingGeneral surgeon here. No, it's not always easier. Sometimes the tissues are just oozy, and you can't just throw a simple suture in or cauterize it and make it stop. Sometimes, the more you cauterize something thats oozy and inflamed, the more it oozes and bleeds on you. Sometimes, you just need to let the body do its thing and form a clot. So either you stop blood thinners for as small a window as possible, and accept the risk of developing a clot elsewhere, or you keep them on blood thinners and just let them ooze and ooze and ooze, potentially requiring blood transfusions, which then opens them up to other risks. Others may have other viewpoints, but this is from a surgical view.

Thank you.Do you always do a heparin bridge or is this contraindicated under certain situations?Does a patient history of a-fib affect the outcome of the risk calculus?

When considering the decisions here, you need to weigh the benefits and risks of anticoagulation.His stroke risk from afib can be estimated with the CHADS2-VASC score. Look this calculator up online. Most people stand an annualized risk of 2-11% of experiencing stroke. On a day to day basis, that risk is super small. Like 0.001% chance of having a stroke every day he's off anticoagulation, and even that is probably an overestimate of his stroke risk.The risks of bleeding are obvious. He's bleeding into his GU tract. This could occlude his bladder. He could bleed into the wound bed in ways that make his recovery worse. The chance of bleeding while anticoagulated is 100%.The last nail in the coffin is that we have multiple large and well-designed trials (BRIDGE and PERIOP2) that show no benefit to bridging pre or postoperatively in any population we've looked at this far, including mechanical valves in the post-op setting.At this point the only cases where bridging might be worth it is acute DVT/PE within 3 months of surgery, and maybe mechanical mitral valve.

What monitoring is usually needed when taking a patient off anti-coagulation therapy for surgery? e.g. CT scan, d-dimer?For reference, this family member's CHADS2-VASC score is 4.Thank you for your help. The CHADS2-VASC calculator definitely improved my understanding.

No monitoring is needed. The idea now is to resume anticoagulation once appropriate from a surgical standpoint. Not uncommon to wait anywhere from 5-14 days post-op to resume anticoagulation depending on how bloody the procedure was.

I (f25) recently was referred to the one stop urology specialist clinic for tests, but the specialist I saw refused to do any of the tests I was booked in for based on my age.Hi there! I am F25, around 8st (I don't weigh myself due to history of anorexia nervosa), don't drink, smoke cigarettes (have cut down, do not smoke heavily), don't use recreational drugs, and live in England. Previous diagnosis fibromyalgia ~5 years ago, ASD, c-PTSD, juvenile arthritis (age 14). I am prescribed quetiapine XL 200mg once p/day, naproxen as and when needed, promethazine hydrochloride as and when needed, cocodamol as and when needed. I also take a probiotic, vitamin D, iron, vitamin c, and a multivitamin all as supplements once p/day.I have recently been having a lot of medical issues, which my GP is trying to have investigated. I have petechiae all over both arms after sun exposure, internal pain in the chest, and incontinence with internal pain in the kidney area. Also, a year or so ago I had blood tests done which indicated my kidney function was lower than normal. I also have a lot of other symptoms, but these are presumably to do with fibromyalgia, so I won't list them. The incontinence gets worse in the evening and at night, where I am needing to urinate every 10-15 minutes. Pretty much every time I drink anything, I need to urinate straight after. GP sent a urine sample away for lab analysis, which showed microscopic blood in the sample, and protein. I was referred for an emergency CT scan due to the intense pain, which flares up and is not constant, but the hospital declined to do one (due to not having space, I think). I was then referred to the urology clinic for a four hour appointment.When I arrived at my appointment, I was told I would have an ultrasound, a flexible cystoscopy, blood tests, urine test, and flow rate test. After going back into the waiting room, I was shortly called back into the doctor's office. He told me that he would no longer be performing any of the tests I had been booked in for, except for an ultrasound. He did a stick test of my urine sample and told me I had no blood in it, but the blood from my previous sample was microscopic and was only found in the lab analysis, NOT in the initial stick test. I was told that, because of my age, I could not possibly have any health issues, and that he had people with possible bladder cancer who he could be seeing but wasn't able to as I was "taking up [his] time, when others need it more," despite my time being booked in. He explained that the only issue I could have was kidney stones, and also dismissed my pain further when he found out I have fibromyalgia.I then went in for my ultrasound, which came back as no kidney stones. I was then called in and, to the doctor's surprise, told that I don't have stones (which I already knew and had tried to explain - I have had kidney stones in the past, and my recent issues have not been consistent with my previous experience). He said "I'm a surgeon, I look for problems to treat. You don't have stones, so I can't treat you." I asked why I am having incontinence issues, and he said "probably because you are a woman. It's common in women," and when I asked what I'm supposed to do about the awful pain for which painkillers barely touch the side, his best advice was "get pregnant. Pregnancy often cures all sorts of illnesses." I was almost in tears at this point. My response was "I just had a miscarriage in December. I've had two miscarriages," and he said "try again." I said "I don't want to," but he insisted this was the best idea. I also explained that my GP had said there could possibly be an inflammatory issue, and he said it wasn't possible to have inflammation without kidney stones or an infection. He also implied that my fibromyalgia is not real because he "prefers not to label patients if [he has] no real evidence." He also stated that the only reason he was going to do any other tests in the first place was because if he didn't it would be "sod's law" and I'd actually have something wrong.I feel at such a loss. I was so devastated after my appointment, and still ended up being in there for 3.5 hours even though he refused to do any of the tests. Fortunately I had my partner with me, who was able to support me whilst I was sobbing in the waiting room. It's been such a long journey to find a GP who takes my complaints seriously, and have had years of doctors being dismissive. I genuinely thought I might begin to have some answers after the appointment, but I now feel like I'm just five steps back.Is it normal to be refused tests based on age and gender? Is anything he said to me actually true, as I feel like it was all completely dismissive? Should I request to see someone else, or will the same thing happen again? I'm honestly devastated, and concerned for my health. Any advice is welcome, I just want to know what the best way to proceed is, and if there is anything specific that I should be emphasising with doctors in the future to be taken more seriously. I tend to mask and come across as very polite, but maybe it would benefit me better if I acted less positive and worked harder on getting across the severity of the pain? Also, am I able to request any specific blood tests? If so, what would be recommended?Thank you so much for reading, apologies for the long post.

Medically he may or may not have been justified in not doing all the initial tests - one-stop clinics usually book you in assuming youll need everything even if thats unlikely to be the case. And your urologist is probably a better judge of that than the GP.However, the way you were spoken to is bizarre and clearly inappropriate. Id suggest you contact the PALS service for the hospital you were at and ask your GP to re-refer you to urology - perhaps another urologists outpatient clinic. PALS may also be able to help with that.

[8 F] Higher WBC than RBC?My 8 year old daughter had labs and her WBC was 8.8 thousand and RBC 4.76. These are both in normal range, but is it actually ok if there are more WBC than red?We do have two doc appts this week for follow up, but my pediatrician did not notate anything about this in the system notes, only made a note for her to increase zinc intake based on her slightly low zinc.She has a variety of other health symptoms that we havent figure out also, but Im just curious if this is specifically alarming.Im sure Im over thinking it. I definitely have some medical anxiety since my mother passed last year, which I completely acknowledge. Thanks for any input!EDIT TO ADD: Conditions- bladder area pain (working with urology), abdominal pain, sometimes has protein in urine, burning feet/neuropathy (new symptom- one month), urine leakage during daytime, pale/flushed face, general malaise

The units on them are different - the red cells are in millions per cubic millimeter, the white cells are in thousands. Everyone has way more red cells than white. When it comes to the specific numbers on labs, we don't compare them like that.

What about having 57% lymphocytes? Is that ok too?

Yes, totally fine.

Urology or dermatologyAge: 28Sex: maleHeight: 170cm (5'7)Weight: 66kg (145 lb)Race: AsianDuration: several monthLocation: Singapore. Condition is on penisNo other health issueNo medicationMy husband has a little bump on his penis for several month. It's several mm wide, there's a hole in the middle, and can see some black stuff inside. The black stuff is shaped like a thin disk. It does not hurt or itch or anything.We are planning to see a doctor in Singapore to check it out, but I don't know if we should book a urology doctor or dermatology doctor. Any advice? We don't have a general doctor.Thanks in advance!

Both specialties would be a good choice.

Concerned over 'Spironolactone' Rx for acne as a maleHello, (30y/o male).I was recently seen by an NP at a Urology center and during my visit my acne was brought up. She just got done some time working in dermatology. I had stated I was not comfortable with something like Acutane since I am trying to have kids and honestly that medication seems very scary to me from a health standpoint. She Rx me something called 'spironolactone'. Coincidentally I was seeing a male health specialist (an NP) the next day and he also brought up my acne and suggested 'spironolactone' out of the blue..Before I picked this up from the Pharmacy I googled it, because I like to know about medications and nowhere does it say this medication is safe or FDA approved for men. It's apparently outstanding for female acne, but as an androgen blocker, is not intended for use in men, and in fact a clinical study showed 100mg of daily use for 3 months in a group of 18 men, 8 of them developed significant gynecomastia..I called and canceled my Rx for spironolactone. I wanted to get an MDs opinion on this. I am a lay person so maybe I was just dramatic here. I am quite confused why two entirely different NPs, practicing in different states, would both suggest spironolactone (100mg a day) for acne in men..Patient History:Pituitary tumor which impacts my testosterone levels (sub 100) so am on 100mg of T a week. I have cut this down and am weaning completely off of it because I am currently 0.00 10x6 for sperm. NP just started me on 5mg of 'finasteride' (for acne due to DHT conversion maybe?) and HCG (0.75mg a week) to try and get that up. Another NP started me on Clomid and suggested I finished off the HCG (*I know, its not ideal to have two providers dictating care for the same thing - but NP #1 didnt know I was at a 0 and wanted to determine if I needed something like Clomid after the analysis came back but I dont see her again for 2 months).*I will say the IM testosterone has changed my life. I cannot explain how much better I feel. Its so profound I almost want to cry. Its like seeing in color for the first time in 20 years. I am sad / nervous to get off of it, but its for a purpose so I can handle that.

I have never heard of spironolactone being used for men's acne. Without good evidence, I use it frequently in women.

Reoccurring UTIHi just looking for some advice and what to know looking forward. Before Christmas I had a UTI for approximately 2 weeks, during this time I tried one course of nitrofurantoin (100mg twice daily) which didnt help at all, then two courses of pivmecillinam (200mg three times a day, with a loading dose of 400mg both times) which also didnt help. Eventually I was referred to urology who did bloods (normal), urine dip (positive for protein and blood) and ultrasound of kidneys bladder and ovaries. Scans came back completely normal and the urologist then prescribed ciprofloxacin 500mg twice daily for a week. The cipro seemed to have worked and I was fine over Christmas, but potentially still had some dysuria/frequency though a lot less than before. In the past few days symptoms have come back to the extent that they were before the cipro.Im going to pick up a new prescription for ciprofloxacin in an hour or so and its a 5 day course. Should I be concerned and see a urologist? Or is this just a UTI that wasnt fully treated so has come back?21F, Mixed African-American/White, 60mg fluoxetine daily, 75mg desogesterel daily, 40mg propranolol up to three times daily

you should probably see your urologist again who may want to do a full urinalysis and culture/sensitivity test.

Coughing up blood after surgery29M, 150lbs, 57. No medication, no drug use, a drink 1-2x a week.Hello doctors, My husband had a minor urology surgery approximately 8 hours ago. He has been doing well, however, anytime he goes to lay down he begins to cough up bright red blood. It stops as soon as he sits back up. Is this from the intubation? He resident I called could not advise because he was not an anesthesiologist resident. Thanks for any insight.

Depends in part on the volume of blood. If it's a few specks of bright red blood that he's spitting out after coughing, sure. If it's frank bleeding that he's noting when he lays down, that's something else entirely. If it's the later, it would be atypical to have that happen and last 8 hours. I'd be concerned enough at that point to bring him into the ED.

Thank you so much! Also, please let me know if you need more details/clarity on his medical history.

I'm not a urologist, but I imagine the recommendation was for a transurethral resection of prostate (TURP). Relatively routine from my perspective.

Hello, 23f, 56, 48kg, venlafaxine 37.5mg. For the past few years Ive been having microscopic blood in my urine samples with a few clear ones here and there but nothing has ever been done. Another symptom Ive been having for a few years is on and off stinging when burning and multiple urinations during the night despite not drinking anything. I remember even as a little kid though I would pee throughout the night.I have now finally been referred to urology and have a cystoscopy next week and a CT scan at some point. My other symptoms arewaking up with a full bladder in the morning which is painful almost like a period pain which stays for a little while after I pee.Microscopic blood in urine.Cloudy urine sometimesSometimes burning when I peeBelly feels tight most of the time idk if this is what feeling bloated isHaving to stop and start peeing towards the end to empty bladderPain deep in pelvis during sex sometimes, like that tight period pain (dont know if relevant)On top of all this I have agoraphobia and havent left the house on 3 weeks and now I have to go half an hour away for horrible tests so no idea how Im going to get through this. I suffer from severe health anxiety and Ive convinced myself I have cancer and Im spiralling out of control with worry. I dont know if this is relevant but I also had chlamydia 3 times when I was 17 (6 years ago). Im just hoping for some reassurance that not might not be cancer

Could be stone issues, urethritis etc. Def not cancer. Go to your urologist appointments!

Thank you, could I ask why def not cancer? I will try my very hardest to go

Too long history, none of your symptoms are signs of cancer and cancer is virtually nonexistent in your age.

So signs of bladder cancer are: Pain in lower abdomen Pain when urinating Frequent urination during the night Blood in urineAll of these I have? But I do see what youre saying about it being too long history

But they are not specific to bladder cancer. In fact, they are some of the most common symptoms there is. Microhematuria for instance, is almost to the point where im more surprised when a random f23 surgical ER patient doesn't have it than when she does. (Macrohematuria is another matter altogether).Health anxiety is difficult, and all I can offer is my perspective that your presentation does not in any way signify cancer.

[32M] Lung Nodule Time!Age 32Sex MaleHeight 6'0Weight 190lbsRace WhiteDuration of complaint: Just startedLocation: Lower Right LungAny existing relevant medical issues: DepressionCurrent medications: WellbutrinHello, everyone. I know lung nodules are typically nothing, but I can't seem to find a whole lot. And I know wait on my pulmonologist appointment to go over the findings. So naturally I'm freaking out anyway.So last year I had gallbladder surgery so I had a CT scan done. I had another one today for something related to urology and a swollen lymph node (everything fine there) and that's when it was discovered.From my understanding, they compared it to the CT scan from January 2021 to the CT scan today, and it was 1cm then and now it's 2.7cm. I was diagnosed preliminary with a lung nodule that has grown into a cavitary lesion by the primary doctor and he's referring me to a pulmonologist. I currently don't have any symptoms.I know it could be dreaded cancer but is there anything else it could be at that size? Most of what I've found online is people talking about 10mm or less.Thanks for any input. I am just looking for possible alternatives so I can focus on that and can sleep until my appointment.I am 32M. 190 lbs and 6 feet tall. I currently take Wellbutrin for depression. I don't drink, I don't smoke, I don't do any recreational drugs. I had asthma from around age 5 until 21/22 when it went into remission. I had pneumonia once when I was 5.

A growing cavitary lesion is most likely to be inflammatory, infectious, or malignant (probably in that order of likelihood for you). There is a long list of possible causes. Something that big likely warrants further investigation, potentially with a biopsy. The pulmonologist will be able to further narrow what the possibilities may be (heavily dependent on where you live and in-depth past medical history).

Thank you. I'm in Alabama and the pulmonologist will have access to all my past records because I've stuck with the same facility pretty much my entire life. Tomorrow I will continue my good vibes going into this. Your answer helps alleviate a lot of the anxiety - I know how serious this is. I'll update once I know (pulmonary appointment hasn't been established yet)

Yea. I wouldnt be too stressed about it. Certainly something to get worked up further, but not something to lose sleep over or run to the ER about as long as youre feeling well.

Pregnant with kidney mass38 yo female 24 weeks pregnant (IVF) History of hydronephrosis (2017) 3.5 cm simple kidney cyst found while hospitalized for it as well as ovarian cystsI am currently 24 weeks pregnant, I had some pretty bad pain in the same kidney that I had hydronephrosis in years before. The pain only lasted for about an hour but I then had what felt like a UTI so I went to the doctor. My urine tests came back fine but my doc requested ultrasound of my kidneys given my history. I went and got it done and received a call the following morning to go straight to ER that I had an abscess so I did (4.7cm). My urine and cbc both came back ok and didnt indicate any infection so they sent me home with order for another kidney ultrasound in two days. I got that done and it came back complex mass 5.7cm with recommendation for MRI that I cannot get done while pregnant. I have been told that its ok to wait these 4 months but I cant help but be terrified in the meantime. I have an appointment with urologist in 2 weeks. What am I really looking at here? On a scale of 1-10 how concerned should I be that this is cancer? Google is really scaring me. I plan to have MRI while in the hospital after I deliver. What can I anticipate at the urology appt? Any insight is greatly appreciated. Thank you for reading.

Youll have to wait for the imaging study, but the wait shouldnt be a big deal. I prefer CT renal protocol over MRI, but maybe your urologist may feel differently. Based on the report its hard to say exactly whats going on. Theres no mention whether it is solid or not, which is critically important. Maybe just be a benign complex renal cyst. CT or MRI will clarify.Pelviectasis is minimal dilation of the renal pelvis. Based on your symptoms it sounds like you probably have a mild UPJ obstruction causing intermittent pain (Deidls crisis).Edit: spelling

Hello everyone;This is my first ever Reddit post and I am finally turning to the deep dark web for some feedback.I am a 40yr old woman who has some medical issues and I have been my own advocate since July 2019. I am still waiting for a family physician for my son and I here in Canada - it's been too long without support.A little back story...I had my son in 2009 and in 2013, I had the lovely pleasure of having a partial hysterectomy - As a lot of you know these two things can cause the uncomfortable issue of incontinence. Well in 2018, after two and a half years of very uncomfortable sexual activity and very embarrassing incontinence mishaps I finally decided to see a specialist.After all the testing, my only option really was: TVT - which is the procedure where you have your bladder lifted in a mesh/sling. Surgery was unable to be booked as at the time my family had some changes and we had to move away. Finally after a year. I received a phone call from a specialist in the new area, and yet again due to some unforeseen family issues - I had moved away yet again to another area. So in July 2019, I started hitting the ground on my own. From that day I was going to walk in clinics for UTI symptoms (blood in urine each time usually every other month until September) - got antibiotics monthly and went on my way. Finally in September 2021. I had to change my tactics. My life was completely upside down, the pain and the symptoms were increasing and I wasn't getting anywhere. So I started going to the Emergency room. And started asking for referrals. I was there twice a month until March 17. I was confirmed to finally see a specialist for my case in June. However; I was still in the emergency room three more times after.Finally I have a specialist!!! How exciting is that? Finally I can get fixed! After a cystoscopy, I remember three things he said to me;-- "You took that like a champ" (loved this made me laugh, I thought he was funny) -- "Unusual growths" -- "We'll fix you"Had a biopsy surgery on June 20th. And then... I had to wait 4 weeks for my next appointment. Let me tell you ya'll I didn't think I had cancer, I am ill tho I know that. I have no appetite, I don't sleep because of the pain. I am wearing adult diapers because I have no control, and the blood is only sporadic, I am tired, I am anxious, I am nauseated, and sick sometimes. I hold a low grade fever of 99.5-101 daily it will not break.Heading to my results appointment. I was ready for a few things...Not CancerDo the surgery to lift my bladder and while in there they will check others to make sure I am ok everywhere else.Meds to clear up whatever is causing these fake uti's - cause every culture would come back negative. The ONLY thing I didn't want to hear was; "I don't know what's going on, let's try these pills, and not do the surgery..."This is what I remember about the appointment...I told him since he likes to make jokes and laugh I had one for him before we started... He said ok shoot."After my biopsy surgery you tried to poison me". His reaction was inquisitive. I explained that I was prescribed Codeine pain meds and I am allergic and it's in file. He blamed it on one of his staff and then never replaced the medication either. (One reason I already lost trust)2. His exact words "Yay you don't have cancer".Kind of like the first meeting here is what I remember him saying...-- "I made a mistake, there weren't actually growth in your bladder. You have a beautiful bladder. It was just murky from this infection." (Lost trust for the second time - you mean I didn't even need a biopsy surgery?!?) -- "I did measurements of your bladder while you were in surgery because when you are under, your bladder is relaxed. And you don't need it lifted." -- I don't know what's wrong, but we are going to treat you with Overratve Bladder (OAB) with pills and a low grade antibiotic forever. If in 3 weeks there is no change we will increase your dosage. NEXT ONE'S THE KICKER!!!! -- "If that doesn't work I will refer you to someone SMARTER than me". (Lost all faith - he had a diagnosis from a specialist he was choosing to ignore to what put me on medication he didn't even know as going to help me?!?)So ya'll I am not going to lie. I was angry, frustrated, confused and couldn't speak. I took the script and left. After I left, I was beside myself and totally confused. How one specialist 5yrs ago said my only option when I had NO infections or other symptoms, said I had to have surgery... Now I am 9yrs after a hestorectomy, and this doctor hasn't done half the testing to see about a prolapse bladder (which again was diagnosed in 2018).I called my original specialist, he told me I would need to be referred back to him but he was concerned with the fact that he is over 2 hrs away from me now. He advised me to request a 3rd opinion with someone locally.I can say that has been requested... Now how long do I wait for this 3rd opinion?I am seriously in so much pain. I suffer from fibromyalgia and that is the only medication I am taking, so I am unable to manage. I haven't slept in 4 days. I feel like my right hip/leg are going to snap off me. I want to BIRTH something. I feel like I am in that last push pain of birthing... Everyday ... All day... I have been on medications for 5 days. The only thing that has changed, is that I no longer have blood in my urine. That's it.I am tired... Am I wrong for wanting to have a doctor to just please do an internal ultrasound to see if it's prolapsed? I mean seriously I feel like it's coming out. But they won't do that testing at the ER, and this specialist won't do it. How long do I need to wait?!?Thank you for listening...

Incontinence is s vast vast subject, i can't give you definitive answers online.For a tvt one of the most deciding factors if it will help or not is the Marshall Bonney test (you know the one with the urologist inserting 2 fingers in vagina and lifting motion to full bladder and telling you to cough)Has it been done and what was the result?A tvt or tob isn't always the answer, it doesn't work for any woman, there is a host of urodynamics tests and pelvic floor, abdominal pressure etc etc....that need to be done beforehand.The cystoscopy is also a must before the tvt for multiple reasons i cant describe them all (limited English and time) one of the reasons for the cystoscopy to be done and under anesthesia is to relax completely the abdominal muscles so the urologist can apply pressure to lower abdomen and with other hand to look at the roof and forward wall of bladder so not to miss anything. Without anesthesia he will not be able to see clearly and make a good assessment of the forward wall and roof.The biopsie isn't necessarily done only by suspected bladder cancer but also to outrule something called interstitial cystitis which is somehow similar symptoms to uti with clean uricults.Also not all urologists are the same, some like working exclusively in a practice, work fixed hours, ultrasound, diagnostics, cystoscopy, small stuff. And they know urodynamics and incontinence stuff (diagnostics) much better than me.Others like me work almost exclusively in the hospital performing multiple surgical procedures daily and also doing oncall shifts for EREven in hospitals, some do like 5-6 renoscopie procedures daily, others do kids daily, others the lucky ones do mostly DaVinci robot assisted surgeries, others kidney cancers, others tur-p tur-b holep etc... etc......That's why you can always get a second opinion. A urologist who is good with kidneys and works that daily and is concentrated on the malignancies in urology will not be a good fit compared to a urologist who knows his pelvic floor good and all types of incontinence and meds and bands. Also OAB represents similisr symptoms and can be treated with meds, if tjey don't work and marshall bonney test is negative, then botox injection in bladder is an option that works wonders for someIf you can provide me result of marshall bonney test i can give you a "guess" if tvt is right for you or not. A trustworthy diagnosis i cant provide online.Tvt done unnecessarly not only it will not help but can lead to complete shut close urethra and acute urin retention, so we don't want to do unnecessary procedures that will make matters worse. Also there is conservative approaches like pelvic floor exercises which in some patients do work well.Also TVT/TOB procedures aren't emergency and don't get priority so right now the waiting list at my workplace is about 3 months minimum and if another covid wave hits, it will be delayed further.Another Tip: gynecologists are more than capable of placing a tvt or tob. Its not a complicated procedure. Fairly straightforward but carries risks but rare when done by an expert. So if you can get a faster appointment with a gynecologist then do it.

[ Please Help ] CT Scan Abdomen and PelvisHi , i am male . the doctor at the Urology hospital asked me to do a CT scan of the Abdomen and Pelvis. will be done next week. My question is, will this CT scan show a testicle report if there is a problem with the testicles. or it is a different scan. because the Scan is for Abdomen and Pelvis

Nope. Testicles can't really be seen on this kind of CT.

Were my father's doctors negligent?My father was in hospital being treated for a suspicious catheter bleed and a UTI. As part of this the urologists had stopped all his anticoagulation/antiplatelet medication and presumably because of this he suffered a large ischaemic stroke. He was admitted on a Tuesday and I first noticed the stroke symptoms on the Thursday evening when I attempted to call my father on his mobile phone and when I finally managed to talk to him he had severe aphasia and cognitive decline. I immediately called the ward he was on and told the nurse that this was a very sudden and severe change in my father's condition (my sister had been to visit him that afternoon and he'd been absolutely fine - I had spoken to him earlier too and he was fine then) and the nurse said she would call for a doctor to review him overnight and he'd also be seen by his regular urology doctors in the morning and they would better understand the changes in him. I called the hospital a further two times that evening expressing my concerns about him and that I was concerned he might have had a stroke.On the Friday morning I call him and obviously he was still struggling to speak and still sounding very confused but he was however able to follow along with a conversation. I call the ward and the doctor has bumped my father up to IV antibiotics and fluids. I'm told later in the day that he was sleeping for most of the afternoon and didn't eat much through the day.Then Saturday morning my older sister spoke to the nurse looking after my father again expressing how concerned we are about this major change in him and we're told she will get the on call registrar to come and review him again. Later I am told he's being given stronger antibiotics. Saturday evening my father seems to be improving and is once again eating normally, also able to speak a little better.Sunday morning when I call the ward I am told by the nurse that my father isn't very good and he has been sent for a CT scan because he was really messed up that morning, exceptionally confused, unable to swallow and his aphasia has gotten worse. I called back a while later and spoke to a registrar who confirmed that the scan shows that my father has likely had a stroke. That afternoon he was moved to a specialist stroke ward.Over the last few weeks I've spoken regularly with the doctors on the stroke ward and they seem pretty mortified that it took 3 days for anyone to think to order a CT to check for a stroke. It seems obvious to my sister and I that when we have kicked up a fuss and he's been seen by a doctor they have just assumed that it was delirium brought on by the UTI but according to his notes no one had considered any alternatives. So I'd like to ask, would you consider this negligence?Relevant info81MUKWhite British79Kg5'11"Non smoker, no drugs or alcoholHistory - Alzheimer's, type 2 diabetes, metallic valve replacement and double bypass in 2011, diagnosed with kidney stone in late 2021, left side PCNL at beginning of February and recatheterised after a failed TWOC a few days after surgeryMeds - enoxaparin sodium 80mg twice a day, aspirin 75mg once a day, metformin 500mg two twice a day, gliclazide 80mg two twice a day, oxybutynin 2.5mg twice a day, linagliptin 5mg once a day, tamsulosin 400 micrograms once a day, donepezil hydrochloride 5mg once a day, colcalciferol 1,000 units once a day, bisoprolol 1.25mg once a day, atorvastatin 40mg once a day

Wait they took a guy with a prosthetic valve replacement off anticoagulation? How bad was the bleeding? Which valve was replaced? This is kind of concerning since mechanical valves need anticoagulation or else they clot and cause you guessed it, stroke.Were they giving the enoxaparin and aspirin in the hospital??Obviously hindsight is 20/20 and perhaps it wouldnt have changed anything, but it seems like an oversight that no one ordered even a CT.

I'm unsure on which valve was replaced, I've honestly never thought to enquire. The bleeding wasn't really all that significant, at least that I saw, my father wasn't complaining of being in any pain either and originally I was told that bleeding without pain shouldn't be a concern - it was only when I noticed he was passing clots into his catheter bag that I was told to get him to hospital.They 100% stopped the enoxaparin but I'm not totally sure about the aspirin.Edit: after checking with family we believe it was an aortic valve replacement

From a US standpoint I agree with everything here. Is it worth having a malpractice lawyer look at this? Yes. Is there a clear delay between stroke identification and likely onset? Yes, it sounds like it. Is there clear harm done? Not necessarily. Im so sorry all this happened, OP. Its hard even if there is no mistreatment.

This is very helpful, thank you. Regarding the improvement and them seeing anything on the CT - the report on the CT only identified a single stroke and described it as sub-acute so I was told it was likely to have happened a couple of days prior. I thought much the same as you originally, minor stroke on the Thursday and larger stroke sometime Saturday night into Sunday but I was told no.I have been intending on getting in touch with PALS for a while now and this should give me the push I need, at this point I'm not even sure what the situation with the bleed was by the time the stroke happened. It's not been an issue since he was moved to the stroke ward and they resumed anticoagulation (high dose aspirin originally and then unfractioned heparin infusion).

One thing worth noting is that inflammation after a stroke is worst ~72 hours afterward. The worsening symptoms a few days later may have been related to swelling and inflammation.

Leukocytes but no BacteriaAge: 34Sex : FemaleHeight: 511Weight: 170lbsDuration of complaint: 3 weeksLocation: USAny existing relevant medical issues: NoCurrent medications: None currently, just finished a round of macrobid.Hey guys, I posted something similar to this in a micro group but things have changed since then so Im just looking for further advice.Almost 3 weeks ago, during a routine exam i showed moderate leukocytes in urine with trace blood. Id had no regular uti symptoms at all other than some pressure after peeing like once. No burning, urgency etc. According to my blood work I was also dehydrated. My NP, who is also my boss & friend, gave me a prescription for Macrobid and sent off a culture. I took the antibiotics for 3 days then I got the call that my culture was negative and to stop the antibiotics. So I did. From there it was back and forth because although I was still asymptomatic I still had leukocytes in my urine. So another culture was sent off - same results 25 - 50k cfu mixed urogenital flora okay cool. So what do I do? NP tells me to just finish the antibiotics so I did. I did get a micro UA done as well and it showed 5-10 wbc with few bacteria, mucus and epithelial cells but none of my urine samples were clean catch.On Saturday after finishing my antibiotics completely I took one of those AZO uti strips after a shower and it had a small purple speck in the middle of the leukocyte pad after 2 minutes. I text my NP to let her know and she sent me in yet another prescription for antibiotics.My concern is that Im not one to take a lot of antibiotics. Actually, I havent taken antibiotics in several years so I feel uncomfortable just taking them with no identifiable bacteria present. I do have a referral to urology but its going to take some time and Im worried about getting a kidney infection. I also feel as though my concerns arent being addressed properly because of my NP being my friend, so she doesnt run the tests she would on a regular patient (IE I had to bug her for the culture and micro ua because she just immediately wanted to give me antibiotics and call it a day).Thanks in advance for any advice, I know its a long read.

Asymptomatic leukocytes in urine, with no growth on a culture, from a sample that isn't a clean catch, is not a UTI and does not need antibiotics.Stop getting medical "care" from this person. Sounds incompetent. Get an actual PCP, preferably a physician.Urology is gonna be scratching their head on why they have this referral.

Why are small kidney stones worse than my larger one?Female, 38yrs old, bilateral nephrocalcinosis, no other health concerns and only medications are acute pain relief (30mg codeine & 500mg paracetamol combined tablets at 2 per dose, Tramadol 100mg, Diclofenac suppository 100mg, Buscopan 10mg). Currently in absolute agony.8 weeks ago I passed a 4mm stone that was exceptionally painful. Worse than my unmedicated child birth. That pain started around 7am but by 5pm I had passed the stone. It was horrific, more intense pain than I currently have but at least over in less than 12hrs.I had a CT scan and a follow up call from a urology nurse informed me I only had very small stones, described as like gravel left. No treatment or management plan - just a follow CT in a year.Which would be fine but for the past 2 days I have been in agony in my right kidney. Im on maximum doses of all my home pain relief and Im getting breakthrough pain every 2.5-3hrs.I would love to understand why this is more drawn out than my bigger stone? Im drinking large amounts of water to flush it/them out but Im not passing much urine at a time and theres a lot of blood in there too. I think I could cope better if I knew why this was taking longer or if I could work out just how long this was going to go on for. Urology nurse was very terse and basically just said Theyll pass without intervention. Just take your pain relief.Grateful for any insight/ideas x

Not a urologist, but we deal with similar issues in the bile duct. When it's a single stone, it is very easy to pop out because there's nothing else obstructing or limiting its dislodgement. However, when the bile duct is full of sludge and copious amounts of smaller stones, it's like trying to pull out a tube full of thick gravel or sand and extraction becomes a lot more tedious and prolonged. My guess is that it's just difficult for the gunk to move through your ureters because it's somewhat clogged up.

Cant stop peeing blood! Help!Hi everyone! Please let me know if theres any other/better places to ask this but I didnt know where else to go. I am going through hell and feel so embarrassed talking about my bloody pee online but I have gotten blown off more times than I can count. I am 22F 59 with no prior history of UTIs and I have been peeing blood for TWO WEEKS with extreme pain! It started out full and just generally lower abdominal pain, but now Im starting to feel occasional sharp stabbing pain in my side/back which is making me think its my kidneys. Heres a timeline of how all of this has gone:1/2/22- notice blood on the tissue when I wipe for the first time, freak out, schedule an appointment with my GP1/3/22- I go to my doctors appointment, she tests my urine and finds high white blood cell count (infection) prescribes me 5 days of macrobid1/6/22- bleeding gets heavier and abdominal pain gets worse1/8/22- finished my antibiotics, still extremely ill, more pain more blood, I start running a low grade fever and throw up1/10/22- I go to an urgent care, blood found in urine but no signs of infection, gave me a shot of ciprofloxacin and sent pill form home with me, told me if it gets worse to go the emergency room1/12/22- after never noticing a difference in pain or blood I go to the emergency room. They test my blood multiple times, take urine sample, and do a CT scan. My blood work shows elevated white blood cells and elevated high lactic acid levels. They send me in for a CT scan (no contrast) and dont see anything. I get sent home because nothing is in my CT scan and get told if the pain gets worse come backI am in a lot of pain and I dont know what to do. I am STILL peeing blood and having awful pain. I have a urology appointment tomorrow but I dont know if I should wait or go back to the emergency room. My back keeps having these painful twitches and I cant stop shaking. The nurse who discharged me said she thinks its interstitial cystitis and it is an infection that is curable that you treat with antibiotics. I looked it up and thats flat out not true. Other nurses had said all night it seemed like I had a kidney infection, and thats honestly what it feels like. What should I do?

If they did basic blood work, urine tests, and you haven't had true fever, then you probably don't have a kidney infection.Did you original urine sample ever grow anything in the culture?Do you urine results show blood +? Do they say if they specifically see RBCs or not?Edit: include the actual lab info if you have it availableIt kind of upsets me that the CT A/P was done non con. I guess maybe they were looking for stones... But still. You cannot reliably comment on pyelonephritis on a non con CT.I'm sure they were hunting for stones. Shouldn't really need CT imaging to make pyelonephritis diagnosis.Posts by unflaired users that claim or strongly imply legitimacy by virtue of professional medical experience are not allowed. This includes medical students.

How urgent is urinary problem?40F, 5'7, 205 lbs, Caucasian.Primary complaint: blood in urine, lower abdominal painHx: Neurogenic bladder from fall in 2009, Intermittent catheterization. Hx of kidney stones, UTIs. Partial loss of feeling due to nerve damage in abdomen. OA/DDD with SCS implant.Painful cath 4 days ago with strange pinkish red tissue string in toilet.3 days ago Pain in right flank/lower back attributed to too much dancing the night before.Yesterday, orangish tinted urine, blood suspected.Today, bright red blood in urine and a strange feeling in my lower abdomen, which I would describe as pain-like.I moved states and have yet to fully establish care locally. I have not seen my primary or urology. I did see a resident yesterday for medication refills, who ordered blood work and a UA for my primary care appointment next month. The blood work is to be done in a week or two to get me back to full strength on my lithium.My question is: should I do the UA today and wait a few days for results or should I go to urgent care?Medical issues: Osteoarthritis, SI joint dysfunction, neurogenic bladder, Bipolar 1 Disorder, anxiety, PTSD, migraines, recurrent Varicella zoster, IBS-DMeds: Lithium 900mg daily Levothyroxine 50mcg ac am Metformin 500 mg bid (for weight loss) Prazosin 6mg nightly Trazodone 200mg nightly Tizanidine 4mg 1 tab am, 2 tabs qhs Alosetron 1mg bid Voltaren gel CannabisSmoke 1 pack/week, drink 1-2 drinks couple times a month (including the 2 heavy drinks night this began), No street drugs.Any light shed on the urgency of this issue would be awesome! Thank you all!

Sooner rather than later. Urgent care may not be that helpful unless you're pouring out blood or you're obstructed from a blood clot. You should do the UA soon. The only specific reason I'd go to urgent care is if you think it's a UTI which of course is possible given you intermittent cath.The bleeding could be trauma or a stone but the worst case scenario would be bladder cancer, especially since you have a smoking history. A work-up is definitely needed if the hematuria is persistent.

How to talk to my daughter's pediatrician about a concernUPDATE: The appointment went as expected. The pediatrician wasn't too concerned because she was still able to eat and "looked fine". So I took matters into my own hands and gave her a total of 6 doses of Miralax starting on Thursday. She had MAJOR success yesterday afternoon and finally ate a whole meal.Hi docs, I need advice on how to talk to my daughter's pediatrician about an ongoing kidney & bladder infection without sounding like a crazy mom. She's 12, 52 inches, and now weighs 87 lbs (from 98 lbs).She first became sick on Aug 25th, with fever and vomiting. The first dr visit was diagnosed with a stomach bug and period cramps. Ended up at the ER a few hours later with a temp of 103.7. ER ran tests for hours. Urine came back good, bloodwork showed an infection. After several tests, the conclusion was a kidney infection. Sent home because there were no available beds. This went on for 4 more days, in and out of the ER. After 8 days of yucky, she returned to school.On Sep 20th, I got a call from the nurse to come and get her. Temp was 102.7, BP 90/49, HR 125 and she was vomiting brown. Took her immediately to the ER. ER put her in PICU to treat the kidney and bladder infection. She was in the PICU for 6 days and step down for 3.Went to her pediatrician for the follow-up. She did bloodwork and ordered ultrasounds. Bloodwork wasn't so great. I picked up the ultrasound report and the report stated there was a fecal impaction. I asked the pediatrician, she told me to give her Metamucil and sent me off to a urologist.We had the 2nd urology appointment on Tuesday. The fecal impaction was brought up again when she was going over her (the urologists') ultrasounds and cystography. I asked more questions about this impaction and was told to give her FiberCon or Metamucil. She still has kidney and bladder infections. Urologists put her back on antibiotics.I have an appointment with the pediatrician this week. I really need to seriously discuss this fecal impaction. I have been giving her both Metamucil & FiberCon for about 22 days now. And have given her Milk of Magnesia a few times. She has not had a bowel movement (a small amount) since Wednesday.I have picked up all lab and radiology reports from 2 hospitals and 3 different doctors. The CTs on Sept 1 and Sept 20th note the impaction. Ultrasounds on Sep 22 and Oct 7 also mention the impaction. And now, the urologist mentioned it on Oct 26.She is still not feeling well and not eating much anymore. This morning her temp was 96.9, BP 103/53, HR was 65, and she said she was extremely tired. I logged in to the portal this morning and received Friday's blood and urine labs, neither are great news, but there is some improvement.How do I approach the pediatrician with all this information without sounding like a crazy paranoid mom? Or maybe I am and this is not a major concern or issue? I have asked about this and feel like I was brushed off. I feel kind of crazy as it is because I went to all these places and got the records and put it all together. Thank you.

First of all, don't ever worry about how you come across to a doctor when you're talking about literally the most important thing in your life - the health of your child. I have parents tell me all the time "OK, don't think I'm crazy." I never do. I go out of my way to tell them I don't think it's crazy and that the reason we're talking is to make sure we're all on the same page and we're both comfortable with the plan.Just express your concerns honestly and in a straightforward way. It is literally their job to help you navigate something that evokes a strong emotional response. If they can't do that, they aren't a good pediatrician. (But thankfully, most pediatrician, in my experience, are excellent at this).As far as the fecal impaction, Metamucil won't cut it. Rectal fecal impaction is a common cause of UTIs, especially in girls (who have shorter urethras than boys). I usually use the big guns - like a Miralax cleanout or a Mg citrate cleanout. Basically the same thing we would do before a scope. This usually helps you start over from ground zero and then you can work on keeping her poop soft with Metamucil or whatever else you think works for her on a daily basis (Miralax is still my favorite for this too).

Granma here, just wondering...no enemas, these days?

Enemas work great, but dont go too far up. Cleanouts from above take care of the whole problem at once.

Alcohol Flush Response. If not allergy, what could it be?44M WhiteAbout 3-4 years ago I developed an alcohol reaction. I can have a single drop of alcohol on my tongue and end up with a bright red, itchy and hot face, and I would sweat. I do not get chest pain. Often, if I ignored then the issue would disappear quickly (10 mins). Often, I could continue drinking and be fine.Sometimes the same alcohol would not do this another time (e.g. same drink one week vs next).I have been tested (23&me) GG for alcohol flush syndrome and am fine.I saw a GP after seeing a post on reddit where someone said something similar and everyone told him it was lymphoma. The GP checked me and said I was fine. I have no weight loss, no night sweats, no obvious lymph node issues.I spoke with an allergist and they said:"These reactions are unlikely to be an allergy as it does not occur every time alcohol is taken and also disappears after the first initial reaction.It might be due to the histamine in the alcohol, or even the presence of sulphites, but if this were the case then the reaction would be maintained throughout the period that alcohol is consumed.We do see people who have had reactions to alcohol, to rule an allergy out, but rarely is an allergy the cause."I am currently on betahistines for something else, and have no reaction, so I don't think it can be histamine allergy, and I have tried some drinks which say "includes sulphites" and have no effect.Last year I have had some urology issues (difficulty peeing). They did not get to the end of it and told me I had 'shy bladder' - I disagree, but I was told I had an enlarged spleen after ultra sound, but later told I did not.So, what could this be if not lymphoma or allergy? My GP is not being very helpful, but it is really affecting my mental health and I am worried a sign of something else.I do not drink any longer. I am currently dealing with a new thing, vestibular migraine, and this is all swirling around in my head.

A transient effect like this seems more likely to be an autonomic response, which would be very difficult to diagnose and there aren't any tests for it. This sort of thing usually goes away after a few minutes.You might still have an alcohol flush response, despite "normal" genetics from 23&me. There are more genes that have been described recently. The only way to know for sure is to do an acetaldehyde breath test, but this isn't very widely available.

Total loss of bladder controlWhat would cause a complete loss of bladder control in 17 year old with cerebral palsy. Yes he has cp and thats what his primary wants to relate it to, but hes been in control since age 8 and now suddenly, theres about a 2 second warning before he goes. Sometime he doesnt even know he went. Cp is non progressive. Last 2 months there has been 5 separate episodes of blood (not from urine) in his brief in the morning. After standing for sometime and then sits, he feels a slight pain in the groin area. Urine was cultured, no bacteria was found, only microscopic blood. Referred to nephrology and his kidneys are good but his compliment levels were low. Doc thinks from having COVID in November. Testing again in 2 months. Next step is urology. Thanks in advance for any insight....Edit: he is now being followed for increased hemoglobin and hematocrit in RBC

How severe is his cerebral palsy? Is he ambulatory? Is he bed bound? in children with significant skeletal deformities or minimal ambulation, kidney stones are very common. These can cause blood in the urine and the urinary incontinence that you are describing. You need to go see a pediatric urologist for evaluation. First step should be checking for a urine infection, but after that imaging with an ultrasound or CT scan is likely the next step.Moderate spastic cp, wheelchair yes, but can walk with a walker short distances. He did have kidney and bladder ultrasound that was unremarkable. He also had a urine culture that was clear of bacteria. Thank you for your repl

Can CT Scan without Contrast IV detect Pelvic/Abdominal Cancer22m, 220lbs, 5'6. No smoking or alcohol use.Got a CT scan from ER to look for kidney stones and they found none.Quote the patients case was ultimately discussed with urology who agreed with further evaluation with CT abdomen and pelvis to rule out renal and urethral calcinotic/renal pathology. The patient demonstrated no signs of acute intra-abdominal renal pathology. Urology advised to follow up with non-urgent cytoscopy"Im currently experiencing a lot of dull abdominal pain and worried about potentially having cancer in the pelvic region.For 3 months Ive had lower abdominal pain, frequency urinating, pain when urinating, urethral pain.I have no signs of kidney stones, leukocytes or blood in urine. Ive tested negative for bacterial STDs as well and even Hep B and C, Syphilis, HIV at 3 months.

To answer your question, a non-contrast CT scan does not rule out cancer in the abdomen/pelvis, barring a huge mass or obvious metastases. In fact, even a contrast enhanced CT scan is not very sensitive for several types of cancer.You should discuss with your physician whether or not additional imaging would be warranted. I don't know much about your history but in general, it is exceedingly rare for a 22 year old to suddenly develop some sort of intra-abdominal malignancy.

What would be used to rule out cancer then?

Again, I would recommend discussing this with your physician (either primary care or the urologist). We generally do not recommend blanket scanning everyone with CTs and MRIs for non-specific abdominal pain especially in young patients, unless the clinical history warrants further investigation (it's not because we mind the extra work; it would be comically easy to read a bunch of negative studies all day and charge for it).Laypeople and even people in the medical field tend to assume that imaging is a magic answer box, but it oftentimes is not and the potential benefits of imaging may not outweigh the risks/costs.

Urology - gross hematuria, pelvic pain, no UTI?33F, overweight, white, Canada. History of kidney stones (4 in the last 18 months). Not taking anything to prevent them but Ive reduced sodium and drink a lot of water.In the last 2 months or so Ive had 2 instances of long-ish periods of time where I have visible blood in my urine (sometimes enough that it resembles menstrual blood and other times the tissue is just pink when I wipe) along with abdominal pain and sometimes flank pain. Both times Ive been treated with antibiotics but Ive had negative urine culture. Urinalysis showed blood, mucus and bacteria a couple months ago but Im not sure what my most recent showed. Ive now had blood in my urine since June 26th and what feels like menstrual cramps. I pee fairly often and get up a couple times a night. My last 24 hour urine collection showed big improvements and my kidney ultrasound looked good.Is there anything else this could be besides a UTI? Im hoping my urologist follows up after she called in antibiotics on July 7th.

How were the urine samples collected? I really hope that they didn't just give you a cup to pee in.Macrohematuria in women can be caused by many things, the most common: hemorragical cystitis (infection) or urolithiasis (not just kidney stones but ureter stones or bladder stones) or an urothel carcinom of the bladder/ureter/renal pelvis, rarely but possible with RCC or a urethral caruncle

Yes I just peed in a cup both times. I forgot to mention that the bleeding last time was maybe a week after passing a stone so I assumed it was associated with that. The current bleeding hasnt been triggered by anything. How should urine be collected?Im also experiencing some edema in my feet. I thought this was because Im working a new desk job but its to the point that my one foot swells so much that it bruises from my shoe. Also just generally fatigued.

n a female coming with macrohematuria: this method of peeing in a cup is very wrong for me, its very inconclusive. A woman who says she urinates blood needs a small catheter inserted (transurethral or course) and then through the catheter the urine samples collected.I had many cases of women presenting such symptomatic and very common the urine in the bladder turns out to be super clear, so its becomes an Ob/Gyn issue.You mentioned stones so most likely that's the cause, even after passing a stone sometimes there is an acceptable degree of macrohematuria persisting upto two weeks(rosee urine and not like super dark red with clots) All urologist are more than capable in diagnosing such issues.

Complex Cystic Mass 8.5 cm x 5.9 cm x 5.0 cm - Left KidneyYesterday I had an ultrasound of my abdomen as I have had intermittent pain on my right hand side by my gallbladder and liver. I did not expect this result, but now it makes a bit of sense as it is probably pushing things over to the right which is causing my pain.I am a 38 year old female.Symptoms: Tired a lot, Full easily, Nauseous oftenLEFT KIDNEY: Normal size. Normal echogenicity with no hydronephrosis. In the left mid kidney there is a complex cystic mass with several septations and which have internal vascularity and areas of mural nodularity. This cyst measures approximately 8.5 x 5.9 x 5.0 cm.I am having difficulty getting a Urology appointment soon as everywhere is booked up until March or April. I have reached out to my primary doctors as well, but I am curios about what my next steps should be.What should I be eating? What should I be doing while I wait for my appointment? What should I not be doing?What tests should I have?I am assuming due to the size it may need to be surgically removed. Is that generally the outcome?Thank you.

Nothing really to do or not do in the meantime. You can expect that they'll want to do an MRI or multiphase CT to see if there are actually any nodular areas that enhance with intravenous contrast, because that would be suspicious for a cystic renal malignancy. If so, these things tend to be really slow-growing and amenable to just being surgically removed with curative intent.Regardless, I don't think the cyst is causing your abdominal pain and was probably just found incidentally.

Low right side front abdomen and right lower back pain (kidney?)Age 43 Hawaii Male UsaSo 3 or 4 months ago after a scan someone out in a Urology referral with no other notes other than hidden away positive for nephrolithiasis.Ive had this pain right where my kidney is. It becomes moderately painful after doing moderate work and takes a couple days to settle down.Is this still potentially a stone or would it have passed because of the time frame?

Stones that remain in the cavities of the kidney will grow and recede based on things like pH and ion concentration over time. They are relatively normal to find, particularly as we get up there in age. They almost never symptomatic, unless they break off and get lodged in the ureterat which point its very symptomatic. Its hard to say what the sensation that youre having is; sounds like its causing a pretty significant obstruction for you that would be worth seeing your PCP about to get it worked up.

Coughing up blood after surgeryHello doctors, My husband had a minor urology surgery approximately 8 hours ago. He has been doing well, however, anytime he goes to lay down he begins to cough up bright red blood. It stops as soon as he sits back up. Is this from the intubation? He resident I called could not advise because he was not an anesthesiologist resident. Thanks for any insight.

Depends in part on the volume of blood. If it's a few specks of bright red blood that he's spitting out after coughing, sure. If it's frank bleeding that he's noting when he lays down, that's something else entirely. If it's the later, it would be atypical to have that happen and last 8 hours. I'd be concerned enough at that point to bring him into the ED.

27Female unable to walk, urinary retention, gastroparesis27 year old female, weight:57kg, height164cm. Previously diagnosed with autism, pernicious anaemia, iron deficiency, epilepsy, POTS.Taking Wellbutrin, lamotrigine, clobozam, vitamin d, iron, vitamin b12 injection, pantoprozole, and now because of gastroparesis I am taking domperidone also gravol IVI have leg weakness and my legs feel heavy and like they will give out on me. I have diminished feeling in them but the EMG came back as completely normal.I had an MRI and an MRI with contrast and it showed a disk bulge effacing the anterior disk space and moderate to severe narrowing of both neural foremen on disk L5/S1Disk protrusion which is mildly protruding into the thecsl sac and causing mild stenosis and mild neural foramen narrowing on L4-5I have gastroparesis which was just diagnosed during this hospital stay. I was vomiting almost everything I ate (which wasnt much because I got full so quickly) and they did a gastric emptying study.I have urinary retention meaning that I am unable to start urinating and it caused me to retain over 2L of fluid. I am currently catheterized. A urologist wouldnt see me because they believed it was a neurological problem but neuro suggested I see urology.I have a lot of the symptoms of Ehlers danlos syndrome as well (hyper mobility type) such as hypermobile joints, hyper elastic skin, soft, easily bruised skin, dislocations and TMJ disorder (which have caused jaw to dislocate many times).I have not been diagnosed with this yet but could the leg weakness and other symptoms be caused by ehlers danlos or is there something else we (the doctors and I) should be looking at.I am doing Physio and am getting a bit better at walking but my weight is mostly in my arms and so my legs dont give out I have been using a chair for the majority of the time here and walking with Physio using a walker. Im really unsteady on my feet and have a hard time controlling where my feet go which is making it hard to walk so I can only do pivot transfers.I had an ultrasound done of my abdomen/pelvis and am not sure the results yetDoctor is referring me to an EDS clinic because no one here knows enough to diagnose me

Really depends on what the neurological exam shows.

Made an appointment with a urology office to discuss getting a vasectomy, was told that the initial consults are with a nurse practitioner and not the actual doctor performing the procedure. Is this common practice?I'm assuming I won't even be meeting the doctor until the day of the procedure, which I think is kind of strange and makes me even more nervous than I already am. I know doctors are spread thin and minor procedures like vasectomies are probably low on their list, but I would at least like a few minutes of facetime with the guy that's going to be working on my junk...

That's typical for many offices. If the doctor is meeting with everyone individually, then that's a lot fewer procedures they can do. Just the way healthcare works in the US.

21M URGENT UROLOGY HELPI was masturbating excessively yesterday and during / right before ejaculation I lost all hardness and my penis became flaccid, stretchy, and curved to the left. My left testicle is also much more lower now and the right one doesnt doesnt move as smoothly. I basically cant really feel my penis anymore and its hanging very loosely downwards, as are my testicles. I saw a urologist right after it happened and he dismissed any fracture since there was no pain upon inspection and said everything was normal. My penis doesnt look, feel, move the same and i can no longer get a hard erection, the most i can get is a semi erection very loose penis with a 60 degree bend to the left side. What should i do? Had to add that my penis has become much more fatter maybe swollen?, and much more veiny, and has its flaccid size has increased, also scrotum shape is very weird and wrinkly.

The only thing that sounds abnormal to me is the bend in the shaft of the penis. I'm not a urologist, but if you were unhappy with the urologist that you saw, I would recommend you seek a second opinion from another urologist.

Yes I just peed in a cup both times. I forgot to mention that the bleeding last time was maybe a week after passing a stone so I assumed it was associated with that. The current bleeding hasnt been triggered by anything. How should urine be collected?Im also experiencing some edema in my feet. I thought this was because Im working a new desk job but its to the point that my one foot swells so much that it bruises from my shoe. Also just generally fatigued.

In a female coming with macrohematuria: this method of peeing in a cup is very wrong for me, its very inconclusive. A woman who says she urinates blood needs a small catheter inserted (transurethral or course) and then through the catheter the urine samples collected.I had many cases of women presenting such symptomatic and very common the urine in the bladder turns out to be super clear, so its becomes an Ob/Gyn issue.You mentioned stones so most likely that's the cause, even after passing a stone sometimes there is an acceptable degree of macrohematuria persisting upto two weeks(rosee urine and not like super dark red with clots) All urologist are more than capable in diagnosing such issues.