Things that make me go hmmm

[ventana]

patient I am seeing in follow up for COVID admission

not vaccinated

given antivirals in ER, then everything short of vent in hospital for a number of days

 

B ring up that she dodged a bullet by not DYING with covid and she really should be vaccinated NOW

 

Her response

 

"I don't need that vaccine, my body did what it should have done, I will be fine"

 

I sat there with out a comment........  as I was told early in my career by a very astute older attending "there is no cure for stupid"

[ANESMCR]

So what brings you in today? 
 

“I’m having 2-3 soft bowel movements a day”

[Boatswain2PA]

On 12/21/2021 at 3:28 PM, ventana said:

patient I am seeing in follow up for COVID admission

not vaccinated

given antivirals in ER, then everything short of vent in hospital for a number of days

 

B ring up that she dodged a bullet by not DYING with covid and she really should be vaccinated NOW

 

Her response

 

"I don't need that vaccine, my body did what it should have done, I will be fine"

 

I sat there with out a comment........  as I was told early in my career by a very astute older attending "there is no cure for stupid"

And she is probably right.

 

What does the vaccine do?  Make the body create an immune response and antibodies to the virus.

She just did this naturally.

 

 

 

[ohiovolffemtp]

7 hours ago, ANESMCR said:

So what brings you in today? 
 

“I’m having 2-3 soft bowel movements a day”

Sounds like they need a referral to a opiate pill mill.

[EMEDPA]

15 hours ago, Boatswain2PA said:

And she is probably right.

What does the vaccine do?  Make the body create an immune response and antibodies to the virus.

She just did this naturally.

except for the part that without full court press in the ED she would have died. Maybe that was what was supposed to happen naturally. I have no problem with someone not getting vaccinated as long as they don't infect others or expect science to save their ass once they get sick. They should stick to their moral stand and use echinacea at home for their 72% o2 saturation. 

and yes, I agree with places that require smokers to pay more for their care or tax unvaccinated folks who get really sick and require major ICU expenses( of course I would not apply these to folks legitimately allergic to the vaccine, etc). 

[ventana]

18 hours ago, Boatswain2PA said:

And she is probably right.

 

What does the vaccine do?  Make the body create an immune response and antibodies to the virus.

She just did this naturally.

 

 

 

no she is dead wrong but not dead

 

had she not accessed an amazing level of care she would be dead....  

[EMEDPA]

6 minutes ago, ventana said:

no she is dead wrong but not dead

 

had she not accessed an amazing level of care she would be dead....  

Yup. I don't want to be vaccinated because Bill Gates will know where I am, but I do want regeneron, bipap, intubation, and proning in the ICU for 2 weeks( FFS) . Also, I don't want anyone to give me a hard time for going to thanksgiving while infected and killing my 84 year old grandma who was on chemotherapy. . 

[Boatswain2PA]

6 hours ago, EMEDPA said:

Yup. I don't want to be vaccinated because Bill Gates will know where I am, but I do want regeneron, bipap, intubation, and proning in the ICU for 2 weeks( FFS) .

One who thinks this way is about as ignorant as one who thinks that she needs vaccinated soon after a proven infection.

[ventana]

6 minutes ago, Boatswain2PA said:

One who thinks this way is about as ignorant as one who thinks that she needs vaccinated soon after a proven infection.

When do you think someone should get vaccinated after Covid (with out Antibody treatment given?)

[Boatswain2PA]

Not enough information to give anyone advice on this yet.  Certainly not enough data to disparage those who choose not to.

8 hours ago, EMEDPA said:

I have no problem with someone not getting vaccinated as long as they don't infect others

I missed this earlier.  You do realize that the vaccine clearly doesn't prevent spread.  There was recently a covid outbreak in Antarctica among fully vaccinated people.  

[EMEDPA]

1 hour ago, Boatswain2PA said:

Not enough information to give anyone advice on this yet.  Certainly not enough data to disparage those who choose not to.

I missed this earlier.  You do realize that the vaccine clearly doesn't prevent spread.  There was recently a covid outbreak in Antarctica among fully vaccinated people.  

well aware, but it prevents the vast majority of ICU admits and deaths. 

[Boatswain2PA]

23 minutes ago, EMEDPA said:

well aware, but it prevents the vast majority of ICU admits and deaths. 

Concur, but let's not accuse the unvaccinated of spreading the disease, when the vaccinated apparently do it as well.

And since it doesn't prevent disease, and doesn't prevent transmission, then we should look at it as a risk/benefit decision for the individual.  Obviously Ventana's patient whom he hates so much was high risk for getting severe disease, so the best advice for her WAS to encourage her to get vaccinated.

But can we say the same thing for kids?  If they are vaccinated they will still get the disease, and spread the disease.  But since kids are at virtually zero risk of severe disease....is it reasonable for them to forego being vaccinated for a disease that they will still get & spread but won't get severely ill?

[EMEDPA]

healthy Kids under 12 are worth talking about. sick (cancer, dm, etc) kids should get vaccinated. 

I don't have a study to back this, but it follows that someone who has an active case and is sick with fever and every known sx (vaccinated or not) will likely have a higher viral load than an asymptomatic pt and therefore more likely to spread it. Someone coughing and sneezing like there is no tomorrow will infect more people than someone with zero sx. Put another way, if it spread through the vaccinated population and everyone was asymptomatic, our society would be in a better place than it is right now( and yes, I know vaccinated folks can get full blown disease, but it is very uncommon). 

[MediMike]

Vaccination reduces viral load and the incidence of transmission. Yes you can be vaccinated and still contract and transmit the virus. You can impregnate someone while wearing a condom but it sure as hell reduces the chances of that happening. 

https://www.nejm.org/doi/full/10.1056/nejmc2106757

https://www.nejm.org/doi/full/10.1056/NEJMoa2116597

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00648-4/fulltext

 

 

 

[EMEDPA]

1 hour ago, MediMike said:

Vaccination reduces viral load and the incidence of transmission. Yes you can be vaccinated and still contract and transmit the virus. You can impregnate someone while wearing a condom but it sure as hell reduces the chances of that happening. 

 

 

 

 

This just reminded me of the meme going around in response to "both vaccinated and unvaccinated people can transmit covid". The responses are great:

Both Serena Williams and I play tennis.

Both Mario Andretti and I drive cars.

Both Sean Connery and I can do a Scottish accent.

etc, etc

 

[MediMike]

2 hours ago, EMEDPA said:

This just reminded me of the meme going around in response to "both vaccinated and unvaccinated people can transmit covid". The responses are great:

Both Serena Williams and I play tennis.

Both Mario Andretti and I drive cars.

Both Sean Connery and I can do a Scottish accent.

etc, etc

 

The problem with that analogy is: https://www.onepoll.us/40-percent-of-americans-think-they-could-compete-in-the-olympics/

[ventana]

14 hours ago, Boatswain2PA said:

Not enough information to give anyone advice on this yet.  Certainly not enough data to disparage those who choose not to.

I missed this earlier.  You do realize that the vaccine clearly doesn't prevent spread.  There was recently a covid outbreak in Antarctica among fully vaccinated people.  

So you are saying even though CDC has come out in favor of vaccination after acute illness is done you believe there is not enough evidence??(as long as not monoclonal antibody given)

 

((last time I checked CDC was the leading body of knowledge experts.  Also I just read another physician loose their license in Maine for purposefully spreading misinformation about Covid. ))
 

so just to be clear.  You as a singular PA have decided, against the world wide experts, that there is not enough evidence.  
 

back to initial post.  The patient was hospitalized before omicron made an appearance.   Now it is >95% of cases.  Prior infection does not prevent reinfection as well. 

 

 

 

please provide some supporting evidence to your claim as I want to learn.  

[ventana]

12 hours ago, Boatswain2PA said:

Concur, but let's not accuse the unvaccinated of spreading the disease, when the vaccinated apparently do it as well.

 
 
 Please provide any evidence you have to support this statement. 

12 hours ago, Boatswain2PA said:

And since it doesn't prevent disease, and doesn't prevent transmission, then we should look at it as a risk/benefit decision for the individual. 
 

no.  Society has the right to protect itself the best way it can.  Personal liberty does not trump public health in pandemic 

12 hours ago, Boatswain2PA said:

 

Obviously Ventana's patient whom he hates so much

 

how can you know my feelings towards my patient??  Wow, just wow   I think the only thing you like to do is argue and inflame as evidenced by such ludicrous statements  

 

12 hours ago, Boatswain2PA said:

 

 

 

12 hours ago, Boatswain2PA said:

 

was high risk for getting severe disease, so the best advice for her WAS to encourage her to get vaccinated.

But can we say the same thing for kids?  If they are vaccinated they will still get the disease, and spread the disease.  But since kids are at virtually zero risk of severe disease....is it reasonable for them to forego being vaccinated for a disease that they will still get & spread but won't get severely ill?

 

Ugh such misinformation. 

[Colorado]

FIT tests are great when they’re negative. If it’s positive and a clear reason for it is discovered then I repeat it. Something like 5% of FITs are false positives and 50% of follow-up colonoscopies reveal no malignancy.

[ANESMCR]

3 hours ago, Colorado said:

FIT tests are great when they’re negative. If it’s positive and a clear reason for it is discovered then I repeat it. Something like 5% of FITs are false positives and 50% of follow-up colonoscopies reveal no malignancy.

It’s actually much higher. And false negative. For example, they only have a maximum sensitivity of 56% for advanced adenomas (>10mm). Much less for colorectal cancer with a false positive rate <10% (not 5). They’re not specific enough to determine a source, therefore typically a positive test requires EGD as well. If anemic then f/u capsule. What would be a clear reason to you without recent endoscopy? I see clear reasons in maybe 1/5 patients. How does a subsequent negative test rule anything out? Sure it helps, I guess. There are very select pts you could do this on such as healthy, average risk, normal labs, fairly recently scoped, etc. I encourage you listen to this (focuses on cologuard but similar concept) and change your practice. You will eventually do the above on the wrong pt and might come back to bite.
 

https://podcasts.apple.com/us/podcast/american-journal-of-gastroenterology-author-podcasts/id511125340?i=1000517791353

[Colorado]

Thank you for sharing that information and podcast. I’m always listening to them on the drive to and from work so this will be on the morning playlist. To answer some of your questions and to hopefully provide clarity that I’m not just a Wild West FIT slinging PA ..,

“There are very select pts you could do this on such as healthy, average risk, normal labs, fairly recently scoped, etc. “
^^^
 Pts in that group. Who refuse to be scoped again despite multiple attempts to convince them. I’ve done it twice in my practice (one finally agreed to rescope this year and the other continued annual FIT ) One had diverticulosis and felt like she was having a flare when she did her test (addressed on its own as well) and the other had bleeding hemorrhoids. Certainly not my usual practice to not go directly from a positive FIT to a referral to scope, but when you have those patients and they refuse the scope no matter what you or your colleague says, where does that leave you?

 Completely understand the concept that they don’t detect a lot of cancers which is why I always discuss colonoscopies first with everyone. I think the FIT tests are fine but rarely do I see a patient who actually keeps up to date with their annual FIT test. I so much prefer colonoscopy for pretty much everyone.

Again, thanks for the information share. Looking forward to the podcast this morning.

 

[CAAdmission]

On 1/15/2022 at 1:44 PM, EMEDPA said:

and yes, I agree with places that require smokers to pay more for their care or tax unvaccinated folks who get really sick and require major ICU expenses

I'd be interested to hear @rev ronin's take on the ethical implications of penalizing people for bad healthcare decisions. It seems like something that could impact probably 99% of the population. 

[rev ronin]

38 minutes ago, CAAdmission said:

I'd be interested to hear @rev ronin's take on the ethical implications of penalizing people for bad healthcare decisions. It seems like something that could impact probably 99% of the population. 

1. People are contrary. The current surge in popularity of the Anti-Vax movement demonstrates this, but it had been demonstrated in sociology of religion for decades: The more atypically you make someone act or dress, the higher their commitment to that faith. There are plenty of people who will sit in, for example, a mainline protestant church and not let their Sunday habits affect the rest of their lives, but you don't see that phenomenon among religious sects that exist at high tension with their surrounding society: from Amish to Jehovah's Witnesses, the weirder you are relative to the surrounding society, the stronger the adherence.

2. Who makes the rules? Whoever makes the rules gets to decide what society values. Maybe not just smoking, but what is the interaction between freedom to do avoidably dangerous things--skydiving, riding a motorcycle, having unprotected sex with a stranger, eating at Jack in the Box...--and rewarding or penalizing those things.

3. What role does agency play? We know the studies showing smoking is addictive as heroin, and as far as I know no one has refuted that. To the extent that human beings become habituated to harmful habits, what is the role of coercive monetary penalties in "helping" people?  Are we penalizing people for behaviors that are a natural outgrowth of environment/upbringing and genetic predisposition?

So, that's my 5 minute take on it.  Was that what you were looking for?

[EMEDPA]

As an aside, the WHO is in favor of higher taxes on alcohol, cigarettes, and soda. Why? Because every place that has instituted this has seen decreased rates of smoking, alcohol abuse, and obesity. New Zealand recently decided to ban smoking all together and phase it in over several years so folks currently under 14 will never be able to legally buy cigarettes: https://www.bbc.com/news/world-asia-59589775

medical and life insurance costs more if you are a smoker. There is a good reason for that.

[Aunt Val]

So getting back to the original topic . . .

Had a patient tell me that she ate a can of sardines and she must be allergic because it made her thyroid swell up so that she's having trouble breathing.  She explains this as she's sitting in the exam room playing on her phone and chatting away with absolutely no evidence of respiratory distress.  No thyromegaly or anything-in-the-neck-or-throat-megaly on exam.  And she's had thyroid labs run at least twice in the recent past by other providers with no abnormalities detected.  So I politely refused to order them again.  Told her to go to the ER if she has trouble breathing in the future.

SAME PATIENT, SAME VISIT . . . "I need an antibiotic shot, not pills, because antibiotic pills make my thyroid swell."

I try to be sympathetic and understanding, especially with people who may not know how to talk about things in logical medical ways, but sometimes I have to laugh.