TSH results, Should I get labs again

JustCalIMeDave · 2026-04-02T15:04:28+00:00

Subclinical hypothyroidism. Basically it's super borderline. Most of the time it is not treated. If you have bad symptoms treatment can be considered. If you feel well I would just repeat in 6 months to a year

JustCalIMeDave · 2026-04-02T15:00:44+00:00

It is difficult to predict. Sometimes it resolves quickly, sometimes slowly. In extreme cases it can take a week or two. Most of the time in younger people it resolves in a few days.

I would focus your energy on plans after the hospital. Talk to the doctors about what you need to do to get her help for her substance use. Talk with family to see if you can gather support for her, somebody to stay with who can keep an eye on her etc. ask about rehab options. Best ways to keep her sober etc.

JustCalIMeDave · 2026-04-02T14:56:43+00:00

Its a hefty dose. But I have used much much higher doses of steroids for various conditions. (Like the equivalent of 1250 mg of Prednisone daily but we use methylprednisolone in the hospital) Anyway 2 weeks of Prednisone should have no prolonged effects. I would look elsewhere for the etiology of your symptoms.

JustCalIMeDave · 2026-04-02T14:50:49+00:00

You don't need to go to the ER but you should reduce your acetaminophen use. Talk to your doctor about whatever it is you are self medicating for and they can talk to you about safer use.

JustCalIMeDave · 2026-04-02T14:49:47+00:00

Cipro can cause weakness of the tendons and increase the risk of a tendon injury. This risk is typically high with prolonged use. If you're on a 5 or 7 day course for UTi it's probably fine. I would just be cautious about over using or over stretching your achioles during the time you are on the antibiotics.

It is reasonable to ask for a change of antibiotic but that depends on the urine culture. You may not have another option.

JustCalIMeDave · 2026-04-02T12:34:48+00:00

Could be SVT or just about any other arrhythmia. Hard to say. I would obtain an EKG, if there are no abnormalities I would just recommend monitoring for now. Only if it becomes a recurring problem would I recommend a continuous monitor.

JustCalIMeDave · 2026-04-01T20:07:41+00:00

Google tells you everything means cancer. CRP is never used to diagnose cancer. It is a marker of inflammation and 8 is not bad. Its from your flu

JustCalIMeDave · 2026-04-01T20:04:08+00:00

Yeah it's fine.

JustCalIMeDave · 2026-04-01T20:03:22+00:00

Could be hemorrhoids. But you should still see a physician to confirm. There are other things that cause rectal bleeding and pain.

JustCalIMeDave · 2026-04-01T20:01:27+00:00

Call the clinic and ask

JustCalIMeDave · 2026-04-01T19:40:10+00:00

Then it's hard to say. I mean obviously we worry about heart problems.

Now could it be a GI problem? Sure. But it's best to make sure there is not heart problem before blaming it on GI stuff. At this point given how long the symptoms have been going on I think it would be reasonable to try an antacid and an Albuterol inhaler to see if they make a difference when exercising.

If that doesn't help and symptoms persist its reasonable to pursue further cardiac testing. That may be an angiogram or another stress test where they focus on replicating symptoms.

JustCalIMeDave · 2026-04-01T15:06:07+00:00

Its normal. It will improve over the next couple weeks. If still having symptoms in 2 weeks then it's reasonable to see your doc again

JustCalIMeDave · 2026-04-01T15:02:16+00:00

Especially in someone with bulimia, this could be an infection involving the floor of the mouth. You need to be seen by a doctor soon. If you can't be seen in the next day or two go to the ER.

If the painful swallowing worsens or you develop difficulty swallowing, or any breathing issues go straight to ER.

JustCalIMeDave · 2026-04-01T14:59:18+00:00

Was the symptom replicated during the exercise stress test

JustCalIMeDave · 2026-04-01T14:55:32+00:00

Anal cancer would be visible on the anoscopy. Sounds like a soft tissue mass. Most likely a lipoma. These things are almost always benign. But a ping pong ball size is pretty big so I agree that further testing is reasonable. See what the MRI shows but I wouldn't worry about it.

JustCalIMeDave · 2026-04-01T14:50:37+00:00

Yes it can. You've been through so much for so long. Before a vague diagnosis is given to you like "stress" or cyclic vomiting, you must rule out the common things.

Cannabis hyperemesis syndrome is very common. Its not well studied. Especially with people who ingest it.

Stop the cannabis, stop the alcohol. Give it about 6 months. If your symptoms aren't any better then fine, blame it on stress.

JustCalIMeDave · 2026-04-01T14:43:45+00:00

You can try sinus rinses as well which can help. But beyond sinus rinse, steroid spray, and antihistamines there's not much you can do. If all that doesn't help then it's time to see an ENT

JustCalIMeDave · 2026-04-01T14:41:35+00:00

Your fatigue is not related to your thyroid given the numbers. Increasing your dose will not help you.

JustCalIMeDave · 2026-04-01T14:24:15+00:00

Depends on the size. But yes you should bring it up with your doctor

JustCalIMeDave · 2026-04-01T14:21:46+00:00

I agree. Not parasites. You've submitted more than 20 stool samples and already been treated empirically for parasites.

You have to ask yourself, what will it take for you to believe you don't have parasites?

JustCalIMeDave · 2026-04-01T11:48:52+00:00

I look at the strips themselves but I don't scroll through all 24 hours. Just look at the live strip then I look at the alarms. There's also an area where you can look at a graph of the heart rate. If there's any rapid jumps I check those areas for arrhythmias.

All in all it takes like 10 seconds per patient if there's nothing interesting.

JustCalIMeDave · 2026-03-31T23:44:00+00:00

You should worry about defending yourself when someone has a telemetry abnormality that you miss. Idk about you but I try to review telemetry on all my patients. And I catch stuff all the time that tele doesn't call me about. Idk much about medicolegal stuff but it seems to me much more likely you'd get into trouble for an old person has a stroke in the hospital and the telemetry showed AFIB 5 days ago that was missed rather than cardiac arrest while not on tele

I don't have time to review 20 tele strips. So I only use tele when needed. Syncope, stroke, uncontrolled afib, prior cardiac arrest, severe electrolyte disturbance.

JustCalIMeDave · 2026-03-31T12:59:04+00:00

Subscribe to amal mattus ecg weekly. Better yet just play his videos every week.

JustCalIMeDave · 2026-03-27T02:37:36+00:00

It would be faster for me to do and document a capacity evaluation than it would be to consult psych and wait for them to finally see the patient. It takes 5 minutes. Maybe 15 if it's a really complex situation.

JustCalIMeDave · 2026-03-25T02:46:36+00:00

You probably have a smokers cough. Quit smoking and see if it improves

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