Medical Questions I'd Like Answered...

[Username17]

If the muscles don't want to cooperate, shouldn't that be a call for physical therapy so that they do?

Not really? The muscles aren't allowing the hip replacement to fall out of the socket because they aren't strong enough, they are usually doing it because the fibers aren't lining up properly. The muscles are always strong enough to hold the femur up or you wouldn't be able to take a step.

Exercise and hypertrophy of the muscles helps some. But it's not usually a solution for a really unstable hip. It's generally a solution only when the hip is only very slightly unstable. If it mostly stays in place already, getting your muscles conditioned can get it into "pretty much stays in place" territory. And if it mostly falls out then that won't do the trick.

-Username17

[Count Arioch the 28th]

Her insurance doesn't cover physical therapy anyway. Honestly I'm more concerned over the ambulance rides, they're expensive (several thousand dollars above and beyond what insurance covers), and the EMTs here are privatized which means they will in fact sue you (that's what got me in my financial predicament previously, ambulance rides. Wonder if there's a medic alert bracelet that says "don't call an ambulance if I'm unconscious"...)

[virgil]

The last day or two, I've been getting pulses of pain in my left ear, in the lower part of the antitragus. I can scratch, flick, pinch, and do other stuff to it without any pain or reaction (compared to normal); so it's not tender. There's no reddness or other signs of inflammation. This morning, for a couple hours, my tongue was getting a lesser version of this, just deep pulses of pain from within.

[K]

The last day or two, I've been getting pulses of pain in my left ear, in the lower part of the antitragus. I can scratch, flick, pinch, and do other stuff to it without any pain or reaction (compared to normal); so it's not tender. There's no reddness or other signs of inflammation. This morning, for a couple hours, my tongue was getting a lesser version of this, just deep pulses of pain from within.

I once had a bad tooth that manifested as only ear pain. If an eyes/nose/throat guy can't find anything, check the teeth.

[Username17]

If it feels like a portion of your outer ear is in pain but it's not actually tender, that's usually referred pain from elsewhere in the skull. The ears, nose, and throat are all pretty connected through the sinuses, and inflammation in any of those places can manifest as pain in any of the others. Sinus infections, inner ear infections, tooth infections and so on can all feel like the pain is in your outer ear or tongue.

-Username17

[deaddmwalking]

The human body is fuckin' weird, man

[Count Arioch the 28th]

Regarding ear pain: I clench my teeth with I'm irritated or stressed, also I have a nasty bone spur in my jaw due to me breaking it when I was a kid and not telling anyone. Typically that manifests as piercing ear pain. I recommend having someone who knows what they're looking at make sure that it's not something else.

My own question: I've been healthy enough to start a weight training regimen. However, I'm pushing 40 and have been obese my entire life. Other than having good technique and making sure everything I do is low-impact, is there anything else I should keep in mind for joint health? I haven't had any hip, knee or ankle problems, and I would prefer to keep it that way.

[Josh_Kablack]

My own question: I've been healthy enough to start a weight training regimen. However, I'm pushing 40 and have been obese my entire life. Other than having good technique and making sure everything I do is low-impact, is there anything else I should keep in mind for joint health? I haven't had any hip, knee or ankle problems, and I would prefer to keep it that way.

General advice:

1. Accept your age. For men the tendency is to overexert in the early workouts. This risks injury. Start lighter, slower and easier than your maximum effort. Your goal for the first couple weeks should be to establish the habits, not to push your limits. It's more important to avoid missing any workouts for the first three weeks than it is to worry at all about improving any specific workout numbers in that timeframe.

2. Accept your age. Let go of your ego -- you should not compete with others notably younger or notably more experienced than yourself. If you must compete, then compete with the person you were last month, not the person you were 10 years ago, nor the person next to you at the gym.

3. Make sure to warm up and cool down. Do not start with the hard stuff, do not finish with the hard stuff.

4. Make sure to use both strength training and cardio. In general, men tend towards too much strength training at the expense of needed cardio and women tend towards too much cardio at the expense of needed strength training.

[Count Arioch the 28th]

Believe me, after being mostly bedridden for over a year I don't feel embarrassed about being the guy using the 5 pound dumbbells, I'm just happy to not be dying. I've been working on getting my endurance up as it is currently in the toilet (again, long period of illness will do that to you), but I have been going consecutively. There's a gym where I work now, since I'm there every day anyway I hit the gym after my shift.

[Josh_Kablack]

One more kinda obvious piece of advice: If financially/insurance-wise possible, try to consult with a physical therapist or a sports medicine professional for specific exercises/training program recommendations and concerns about your body's particular issues.

[Thaluikhain]

1. Accept your age. For men the tendency is to overexert in the early workouts. This risks injury. Start lighter, slower and easier than your maximum effort. Your goal for the first couple weeks should be to establish the habits, not to push your limits. It's more important to avoid missing any workouts for the first three weeks than it is to worry at all about improving any specific workout numbers in that timeframe.

Hardly an expert, but I second that. Better to do next to nothing and keep at it, than try too hard and then give up and do actually nothing from then on.

[tussock]

Six weeks first up, just get basic fitness, go do stuff. Like, your blood pressure will come way down as you build more red cells and can move oxygen easier, lets you do a whole lot more, a lot safer, a lot less pain, after that.

It's basically whatever is a bit of effort and at least sometimes fun. Don't go long sessions, don't do heavy weights, just find something that makes you work a bit and do it until you're happy with what you've done and stop. Total rest minimum one day a week, activity other days can be as small as you like, 5 minute walk, a single flight of stairs before getting on the elevator, free throws and chasing the stupid ball that won't go in the stupid hoop, try to hit a baseball, anything. Just don't be a total slacker all the time, it gets easier so do a bit more now and then. If you go hard and it hurts the next day, have a few days off, it's all good.

If it hurts when you start something, just stop and rest it, do something else the next day, or the day after. If you miss days, don't sweat it, just go do something instead of beating yourself up about it later.

Then you can get into targeting stuff, measuring your efforts, setting goals, and beating them. 2-3 days a week you can go really hard, push yourself, but get a bit fit first.

[ACOS]

This one is probably best aimed at Frank .....
I need to know if this is normal protocol, or if I should take strong action:
Bottom line is this -- an xray found a 18mm "suspicious mass" on my left kidney. I was referred to the urologist (took a whole month) who said "come back in 6months for another CT". Full stop, that's it.
I was expecting a PET, or a biopsy, or something.

I showed up at the er for mild upper-left abd pain that increases with palpation and with eating (long story short, I seriously suspect pancreas, even though I had gallbladder removed 4+ years ago). They took 3 vials of blood, a urine sample, an xray, and a ct w/contrast. Supposedly all that came back was a slightly elevated wbc (14000), and said kidney mass (btw, I'm 42).

5 weeks later, the abd pain is still there (despite a 100hr fast immediately prior to the er visit), sometimes it flares up when I eat, usually not now that I've radically improved my diet, and pain in my back (left side) but only when there is pressure on it (like laying down or resting against a chair cushion). The urologist dismissed the back pain as muscular-skeletal, but I've plenty of experience with that and this is different (I can now only sleep in my right side, otherwise I wake up in pain).

I realize these are different, unrelated conditions, ..... but are they really?

Unfortunately, my current situation dictates that I'm stuck using the V.A., so that sucks.
So, should I just go with the flow, or do I need to jump up and down with my hair on fire to get some more movement in this?

Thanks.

[Username17]

Without access to the scans I couldn't tell you whether that's reasonable or not.

Kidney cysts are extremely common and rather uninteresting. Benign tumors of the kidney aren't usually worth chasing after because the kidney's really vascularized and nephro-biopsies are surprisingly dangerous. Obviously, if it's suspicious for malignancy, that's a whole different ball game. But I don't know what they were suspicious of. Also, when you say the mass is "on" your kidney, do you mean that it's in your adrenal gland that is literally on your kidney, or do you mean that there is a mass inside the kidney? It's also really important whether they thought it was solid, liquid filled, or loculated.

The three bottles of blood almost certainly were a full blood count, a urea and electrolytes, and a coagulation screen. The U&E part contains a pretty accurate kidney function test, and if one or both of your kidneys is acutely not working properly it should come back with a spike in creatinine. If they tell you that it did not, that indicates that your kidneys as a whole are still functioning reasonably well.

The bottom line is that they want to see a baseline on whether the mass is growing, shrinking, or staying the same. And unfortunately, that takes time.

-Username17

[virgil]

I have pseudotumour cerebri, which my opthaneurologist has me come in every three months or so (sometimes four) to do a visual field test. Recently (as in a year ago), he started doing a macular-related test (makes me move my eyes while they examine the electrical charge). Should I be worried this test has been added to my regimen, or even that he has me come in every three months?

Semi-unrelated note: I get my symptoms listed in some of insurance paperwork after every visit, and they always include headache in the list. I very rarely get headaches, and they've always been clearly due to sinus issues or stress.

An aside: holy moly this doctor has a lot of minions. He started his own private practice about five years ago (been seeing him for about a decade) and I seriously see at least a score of people in black scrubs working for him for any particular visit.

[ACOS]

Thank you very much. That was infinitely more informative than was the urologist, who wouldn't speculate out loud on any of the physical characteristics (hell, I couldn't pry much of any kind of answers/explanations out of her with a crowbar and dynamite).
Also, it's more "in", and at the bottom end, with no further complications.
(as a humorous aside: obviously it's growing, because it used to be 0.00mm, and now it's 18mm. That's 18mm of growth in 4 years. Just saying) (4yrs happens to be my last xray/ct, for something unrelated)

This lets me be a little less paranoid. And it actually gives me some actual questions to ask at my next appointment (I did ask for a second opinion, the f/u is next month ..... this week's appointment was with only a urology p.a., next month's appointment is with an actual m.d., fwiw)

Again, thank you.

[Zaranthan]

(as a humorous aside: obviously it's growing, because it used to be 0.00mm, and now it's 18mm. That's 18mm of growth in 4 years. Just saying)

For the sake of being pedantic, it might not be growing anymore. It could have ballooned up over the course of the last 12 months, and has now been arrested by an ordinary inflammatory response, so it'll be 18mm for the next ten years.

That said, definitely get that second opinion. Stuff like this can be absolutely nothing, and your abdominal pain unrelated, or it could be killing you. Totally worth another pair of eyes on the scans.

[Prak]

TMI question under the spoiler:

I've been dealing with stomach pain, diarrhea and frequent defecation for a week and two days now (since last Monday). Seems I have to go about every two hours or so. It has not cleared up, and I'm experiencing no other symptoms.

I have not eaten anything in the last week that I ate prior to this (ie, no leftovers or anything), my overall diet habits have been consistent, and there have been no recent changes in diet, habits, or the like.

I'm currently hypothesizing 4 possibilities:
1) Meds side effects. No change in meds, no recent refills, but nausea and diarrhea are potential side effects of my antiandrogen. I had my dosage upped in April, and I'm wondering if it's either a build up thing, or the fact that I was spotty about taking my meds before this and have basically resorted to taking them whenever I remember just so I've taken the damned things. So either build up, or the inconsistent schedule as cause.
2) Some major bug that lasts longer than a few days, but only causes diarrhea and stomach pain
3) Something relating to my overall dietary habits. It occurred to me that it'd been a bit since I'd last had much in the way of real vegetables, and my go to veg when cooking are onions and garlic, which apparently can cause diarrhea
4) Something environmental, possibly water, but my roommate drinks more of the local tap than I do, and is not having issues to my knowledge.

So, anyone able to give me a better idea of what the hell I'm dealing with, or evaluate my hypotheses?

[Iduno]

TMI question

I have not eaten anything in the last week that I ate prior to this (ie, no leftovers or anything), my overall diet habits have been consistent, and there have been no recent changes in diet, habits, or the like.

So, anyone able to give me a better idea of what the hell I'm dealing with, or evaluate my hypotheses?

That sounds pretty similar to the time I suddenly became lactose intolerant. It's possible your body now hates you as well, and will not let you enjoy your favorite foods. Also, lactose and various lactates are in way too many foods and medicines.

It's possible you've gotten some other type of food allergy or sensitivity instead.

[ACOS]

Last time, Frank. I promise. (as long as you don't mind, of course). Please.
(if there happens to be anybody in the peanut gallery who knows what they're reading, feel free as well)

goddammit - I sent away for my lab/rad reports, because I was seriously second-guessing what I was told by my dr .... just received them in the mail, and my suspicions may have been warranted. And my next appointment is still a month away -- need to know if i need to go back before then.

here's what I got (will only note the abnormal) *reminder - original complaint was ULQ abd pain, some bloating, irregularity, so other symptoms*
Labs:
blood
- WBC 14.9 (3.5-10.6)
-- neutrophils 10.64 (1.5-8)
-- monocytes 1.02 (.2-1.0)
-RBC 6.0 (4.4-5.9)

urine
- ketones 5 (neg)

plasma
- ALT 46 (10-35)
- GAMMA-GTP 53 (0-50)
also, seem to be using an apparently outdated method of Anion Gap - 12.0 (9-18). not sure if that's a red flag or not.

radiology: (non-relevant findings excluded; the rest is roughly verbatim)
- stomach: small sliding hiatal hernia
- kidneys: heterogeneously enhancing mass left renal lower pole 19mm. left interpolar region partially exophytic 7mm hypoattenuating nodule. no hydronephrosis. no renal calculi. Highly suspicious for renal cell carcinoma.
bladder: moderate circumferential bladder wall thickening. recommend clinical correlation with urinalysis to evaluate for cystisis. underlying malignancy cannot be excluded.
- bowel: diverticulosis w/o surrounding inflammation.
there was some other stuff, but not relevant to present concerns. (also note cholesystectomy in '14 -- seems possibly relevant to blood work)

question(s)
I understand the need to wait-and-see for the kidney, especially with no compromise of unine flow. I'm concerned about the bladder, and the fact that nobody mentioned it.
I'm also concerned about my labs. The ketones can easily be explained by the ~4day fast immediately prior to the test. But from my research, the other abnormal results seem to indicate some sort of damage or infection of the liver (possibly the bile duct). yet i was told i was "fine". what gives? The original complaint has slowly improved, but still slightly present. Most of the persistent pain has gone since I started doing this several times per day; but still feel ULQ pressure when I lay on my left side and still some point-tenderness.
(also note history: up until visit, consumed excessive energy drinks - 4-6 per day - which are loaded to the gills with b vitamins -- basically, I was certainly consuming toxic levels of some of them. 100% abstinence since then)

yes, yes -- i know, understand, and appreciate the limits of what you can determine from across the internet. initial impression is all i am hoping for (feel free to PM me a paypal # if you genuinely feel the need).
I'll leave you alone after this; at which point I'll just grit it out.
Thank you.

[Username17]

The elevated White Cell Count is in range for you having an infection of some kind. Not really a big deal if you have access to some antibiotics or just drink some water and eat some soup and rest for a few days. The body is generally pretty good at fighting infections and you don't need to do much.

The elevated Liver Function Tests are indicative that some kind of liver irritation or previous damage has happened. Someone stabbed you in the gallbladder a few years back, so it's likely that those levels are permanently slightly elevated. I am extremely unconcerned about that.

The radiological findings are obviously very concerning. Thickening of the bladder is reasonably common, and in the context of having a presumed infection there's a reasonable and uninteresting explanation well at hand. But in the context of a potential renal carcinoma it could be related and indicate spread. Less likely than being related to a bladder infection, but it's a possibility.

They are still going to want to wait and do a time interval scan. But if there's more evidence implying that it's RCC, you're probably going to lose the kidney. You don't normally cut out partial kidneys for a host of reasons. It's important to note that there are a lot of nodules you can have in a kidney that aren't cancer, but if a radiologist says it's suspicious for cancer you gotta take them at their word and do the appropriate tests.

-Username17

[ACOS]

The elevated Liver Function Tests are indicative that some kind of liver irritation or previous damage has happened. Someone stabbed you in the gallbladder a few years back, so it's likely that those levels are permanently slightly elevated. I am extremely unconcerned about that.

Good to know.
Also, been sober for 18 years; but before then, I was REALLY bad (was actually hospitalized for alcohol poisoning twice) -- figured that would have healed by now.

The radiological findings are obviously very concerning. Thickening of the bladder is reasonably common, and in the context of having a presumed infection there's a reasonable and uninteresting explanation well at hand. But in the context of a potential renal carcinoma it could be related and indicate spread. Less likely than being related to a bladder infection, but it's a possibility.

Again, good to know.

, you're probably going to lose the kidney. You don't normally cut out partial kidneys for a host of reasons.

I've already come to terms with that. I guess I'm hoping I can get away with a partial, but understand maybe not. Just don't want it in my lymph nodes->and on to elsewhere.

Thank you sir - you're a scholar and a gentleman.
I'll leave it the locals now.

[Prak]

This seems like a weird question to me, but I figured it's worth a shot.

Let's say that I have a weekly standing therapy session Tuesday nights, and that it's on record as such at work.

If work basically says "we need someone to work this night, and that's you. Sorry." would I have some legal standing to require them to compensate me for missing my therapy that well? As in, would I have legal standing to say "I want time and a half if you make me work a Tuesday night"?

[erik]

Sounds more like an FMLA question. As in if your employer participates in FMLA (if it's a small enough operation they can be exempted), then you have some standing to say "No, I cannot work since I take medical leave for therapy session."

Trying to negotiate extra pay... seems like a good way to demonstrate that you can reschedule it without interfering with work and then lose your standing that you have to take that particular day off.

[Prak]

Interesting... Basically, I just want there to be a cost to my employer if they try to make me miss it, so they are disincentivized to do so.