Doctors of VN

#551
#551
utchs81 said:
not sure why she should be required to have those instruments at all. Especially as a psych np. But if they are I would go low end for sure as she will likely not be using them in the future. They do come in a combo kit with interchangeable heads.
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Well, I was wrong about it being for clinical, I asked the same question. It's for her physical assessment class that she has to do on video (online program). Cheap it is now.

Thanks.
 
#552
#552
jhamilton1208 said:
My wife is going to start her clinicals (psych nurse practitioner) in a couple of quarters, and we are required to get an opthalmoscope and otoscope. I've looked around and seen them anywhere from 30 to 550 bucks. I'm not familiar with using these instruments, so I really don't even know what to look for.

In other words any suggestions on a combo kit reasonable, but good?
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If it's something she will actually ever need, you can't beat the Welch Allyn Macroview otoscope. It has both magnification and focus adjustment. The Lithium ion rechargable handle is lightweight and easy to carry. As far as ophthalmoscopes, the old-school type have a VERY steep learning curve. The newer Panoptic is MUCH MUCH easier to use and get a clear view of the fundus.

All that being said, these are not cheap models. I'm just giving you the skinny on what actually works!
 
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#553
#553
kiddiedoc said:
If it's something she will actually ever need, you can't beat the Welch Allyn Macroview otoscope. It has both magnification and focus adjustment. The Lithium ion rechargable handle is lightweight and easy to carry. As far as ophthalmoscopes, the old-school type have a VERY steep learning curve. The newer Panoptic is MUCH MUCH easier to use and get a clear view of the fundus.

All that being said, these are not cheap models. I'm just giving you the skinny on what actually works!
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Thank you very much. I appreciate the input. I've played around with them some, but have no idea what the intricacies are in what makes one a decent piece of equipment. I'm guessing she won't need them as she goes on matter, but if she does, at least I/we will have an idea.
 
#554
#554
ok my turn to 'ask the doc'. I recently had a bout with diverticulitis that resulted in a very tiny perforation of the large intestine. No surgery just heavy antibiotics. After 6 days in the hospital I'm home but of course not out of the woods yet. Will probably have a resection down the road to removed weakened area but that's after I recover. One thing I was told was if you have diverticulitis once, you got it. Question for the docs are is there actually any dietary restrictions I need to impose for the future. I've seen/heard no popcorn, corn, anything with small seeds, nuts. But on the other hand I was told by the internalist I just need to add fiber to my diet which could include something like Metamucial. I was wondering if other drs have opinions on it
 
#555
#555
GreveHaller said:
ok my turn to 'ask the doc'. I recently had a bout with diverticulitis that resulted in a very tiny perforation of the large intestine. No surgery just heavy antibiotics. After 6 days in the hospital I'm home but of course not out of the woods yet. Will probably have a resection down the road to removed weakened area but that's after I recover. One thing I was told was if you have diverticulitis once, you got it. Question for the docs are is there actually any dietary restrictions I need to impose for the future. I've seen/heard no popcorn, corn, anything with small seeds, nuts. But on the other hand I was told by the internalist I just need to add fiber to my diet which could include something like Metamucial. I was wondering if other drs have opinions on it
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Yes, a high fiber diet can reduce the chance for another bout of diverticulitis. Although it had been recommended for years, there is actually no evidence that avoiding nuts, seeds, or corn is beneficial.
 
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#558
#558
GreveHaller said:
ok my turn to 'ask the doc'. I recently had a bout with diverticulitis that resulted in a very tiny perforation of the large intestine. No surgery just heavy antibiotics. After 6 days in the hospital I'm home but of course not out of the woods yet. Will probably have a resection down the road to removed weakened area but that's after I recover. One thing I was told was if you have diverticulitis once, you got it. Question for the docs are is there actually any dietary restrictions I need to impose for the future. I've seen/heard no popcorn, corn, anything with small seeds, nuts. But on the other hand I was told by the internalist I just need to add fiber to my diet which could include something like Metamucial. I was wondering if other drs have opinions on it
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What your physician meant, most likely, is that you have diverticular disease which never goes away. Diverticulitis however is an acute event which can recur from time to time.
 
#560
#560
? Since starting on propranolol two years ago, I have gained 25 lbs. Is there any evidence that this medication causes weight gain?
 
#561
#561
Alright Vol Docs I've got a problem. I'm a 23 year old male, perfectly healthy most my life. When I was 12, had a camping accident and lacerated my spleen (spleen healed and wasn't taken out), and 3 left knee surgeries, but other than that perfectly healthy. I've been having a problem since my teen years. Major Digestive issues. My problems have been consistent, having to urgently go to the bathroom too much and too soon after eating. When I was 19, I went to a Gastroenterologist and he tested me for Celiacs and Chrohns, neither came up. I had a family history of bad gallbladders, so he said that he really thought it was my gallbladder causing this so he sent me to a general surgeon. I had my gallbladder removed, when they cut it open there were a bunch of little stones, no big ones yet but in a year would have been a big problem. I'm nearing 4 years post op and am still having the same problems as I was having before, but probably worst. I've went to the GI doc since my gallbladder and he just said that some people have chronic diarrhea after gallbladder removal and just kinda shrugged it off and prescribed me something to slow my digestion down a little bit. This did help, but almost a little to well. The only reason I'm concerned is because its not necessarily diarrhea. It's not complete liquid. I rarely ever have a solid stool, like ever. There seems to be a lot of what looks to be mucus or bile in it. Like I said, its not liquid but really really soft. Any explanations or should I even be concerned? Thanks guys.
 
#562
#562
overseasorange2 said:
? Since starting on propranolol two years ago, I have gained 25 lbs. Is there any evidence that this medication causes weight gain?
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Weight gain is well known with the older beta blockers. Not knowing your age or medical history I would only be guessing as to what is the causative reason. Not sure why a gain of 25 pounds but fluid retention, lack of exercise and lowering metabolism could all be playing a role. If it is due to just the propranolol maybe a change could be helpful, Ask your Doc.
 
#563
#563
Grudenator said:
Alright Vol Docs I've got a problem. I'm a 23 year old male, perfectly healthy most my life. When I was 12, had a camping accident and lacerated my spleen (spleen healed and wasn't taken out), and 3 left knee surgeries, but other than that perfectly healthy. I've been having a problem since my teen years. Major Digestive issues. My problems have been consistent, having to urgently go to the bathroom too much and too soon after eating. When I was 19, I went to a Gastroenterologist and he tested me for Celiacs and Chrohns, neither came up. I had a family history of bad gallbladders, so he said that he really thought it was my gallbladder causing this so he sent me to a general surgeon. I had my gallbladder removed, when they cut it open there were a bunch of little stones, no big ones yet but in a year would have been a big problem. I'm nearing 4 years post op and am still having the same problems as I was having before, but probably worst. I've went to the GI doc since my gallbladder and he just said that some people have chronic diarrhea after gallbladder removal and just kinda shrugged it off and prescribed me something to slow my digestion down a little bit. This did help, but almost a little to well. The only reason I'm concerned is because its not necessarily diarrhea. It's not complete liquid. I rarely ever have a solid stool, like ever. There seems to be a lot of what looks to be mucus or bile in it. Like I said, its not liquid but really really soft. Any explanations or should I even be concerned? Thanks guys.
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Did your GI do a colonoscopy? If not that might be of benefit. Do you have any blood in your stool? I would still be concerned about possibility of Inflammatory bowel disease i.e. Crohns and Ulcerative colitis. Another possibility is collagenous colitis which is diagnosed by biopsy. If you have a high fat diet I recommend lowering that immediately could help.
 
#564
#564
utchs81 said:
Did your GI do a colonoscopy? If not that might be of benefit. Do you have any blood in your stool? I would still be concerned about possibility of Inflammatory bowel disease i.e. Crohns and Ulcerative colitis. Another possibility is collagenous colitis which is diagnosed by biopsy. If you have a high fat diet I recommend lowering that immediately could help.
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Forgot to mention that. I had a colonoscopy 1 year post op and they said my colon was really inflamed and that they couldn’t even get into parts of it, but other than that it looked normal. No blood in the stool. The dr said he thought it could potentially be chrohns. I’ve had both a negative and a positive test. He said since chrohns is auto immune and I’m so young that it sometimes can be hard to diagnose. Is this true?
 
#565
#565
Grudenator said:
Forgot to mention that. I had a colonoscopy 1 year post op and they said my colon was really inflamed and that they couldn’t even get into parts of it, but other than that it looked normal. No blood in the stool. The dr said he thought it could potentially be chrohns. I’ve had both a negative and a positive test. He said since chrohns is auto immune and I’m so young that it sometimes can be hard to diagnose. Is this true?
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I would think that a biopsy would have been done during that procedure and a diagnosis made from that. Crohns and ulcerative colitis should be diagnosable with that much inflammation I would think. However I am only an old retired ER doc I only know a little about everything and not a whole lot about anything
 
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#566
#566
@kiddiedoc do you know anything on this subject -
cortisol levels -- I guess mine is high and is causing glucose readings of around 185 and a A1C test I just had was 10.1 --- not sure what to do I didnt eat alot of sugary or high carb foods, but at the same time not much exercise and alot of stress
 
#567
#567
508mikey said:
@kiddiedoc do you know anything on this subject -
cortisol levels -- I guess mine is high and is causing glucose readings of around 185 and a A1C test I just had was 10.1 --- not sure what to do I didnt eat alot of sugary or high carb foods, but at the same time not much exercise and alot of stress
Click to expand...

I’m not a doctor but I’d say the last line sums up the rest of it. And I’m not saying that judgmentally. It’s just that stress and exercise play a big role in that. The fact you try to limit sugar is definitely a positive tho.
 
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#568
#568
wildnkrazykat said:
I’m not a doctor but I’d say the last line sums up the rest of it. And I’m not saying that judgmentally. It’s just that stress and exercise play a big role in that. The fact you try to limit sugar is definitely a positive tho.
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yes, Im going to start doing more exercise and hope it cuts down the stress - my daughter is having a difficult pregnancy and since July Ive done nothing but worry about it. I also worry about things I cant control --
 
#569
#569
508mikey said:
@kiddiedoc do you know anything on this subject -
cortisol levels -- I guess mine is high and is causing glucose readings of around 185 and a A1C test I just had was 10.1 --- not sure what to do I didnt eat alot of sugary or high carb foods, but at the same time not much exercise and alot of stress
Click to expand...

Not really my area of expertise, but I would question whether a high cortisol level would be the cause of that hyperglycemia. I would definitely investigate that A1C level.
 
#570
#570
kiddiedoc said:
Not really my area of expertise, but I would question whether a high cortisol level would be the cause of that hyperglycemia. I would definitely investigate that A1C level.
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I expected it to be a bit high maybe 8.0 because of the lack of exercise so I dont know what to think right now - guess I will just check it everyday for a few weeks and see if it comes down - the Dr upped a dosage of glimepiride from 2 to 4 a day taken along with the metformin of 1000 twice a day -- Thanks for your reply
 
#571
#571
508mikey said:
@kiddiedoc do you know anything on this subject -
cortisol levels -- I guess mine is high and is causing glucose readings of around 185 and a A1C test I just had was 10.1 --- not sure what to do I didnt eat alot of sugary or high carb foods, but at the same time not much exercise and alot of stress
Click to expand...

I’m not a doctor but I’d say the last line sums up the rest of it. And I’m not saying that judgmentally. It’s just that stress and exercise play a big role in that. The fact you try to limit sugar is definitely a positive tho.
508mikey said:
yes, Im going to start doing more exercise and hope it cuts down the stress - my daughter is having a difficult pregnancy and since July Ive done nothing but worry about it. I also worry about things I cant control --
Click to expand...

Adding exercise should help. Even if it’s just walking. Also make sure you are watching your food labels for hidden sugar, your drinks and even fruit. Some people say no fruit but I don’t think you have to be that strict, but like all things, in moderation.
 
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#572
#572
508mikey said:
I expected it to be a bit high maybe 8.0 because of the lack of exercise so I dont know what to think right now - guess I will just check it everyday for a few weeks and see if it comes down - the Dr upped a dosage of glimepiride from 2 to 4 a day taken along with the metformin of 1000 twice a day -- Thanks for your reply
Click to expand...
It appears to me that your diabetes is not yet adequately treated. That does involve your activity level and diet das well. It may be time to start thinking about injectables such as insulin or the newer meds.
 
#573
#573
utchs81 said:
It appears to me that your diabetes is not yet adequately treated. That does involve your activity level and diet das well. It may be time to start thinking about injectables such as insulin or the newer meds.
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I finally got normal readings back today -- motivation and will power will beat it -- also need to stress less -- I am also planning to see a dietitian since my ins plan covers it -- websites are not very accurate for instance, when I see several that claim bananas are good then some say bad -- also 'sugar free' foods like ice cream and chocolate are misleading imo
 
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#574
#574
Grudenator said:
Forgot to mention that. I had a colonoscopy 1 year post op and they said my colon was really inflamed and that they couldn’t even get into parts of it, but other than that it looked normal. No blood in the stool. The dr said he thought it could potentially be chrohns. I’ve had both a negative and a positive test. He said since chrohns is auto immune and I’m so young that it sometimes can be hard to diagnose. Is this true?
Click to expand...
Sounds like chrohns.... my brother in law had it..... my sister has it..... and your symptoms sound exactly like theirs
 
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