putting things in order

[Mark Tarver]

I still have a debilitating racking cough and weakness and a deterioration

last week.   There is a viral condition attacking my lungs and lymphatic.

The UK has a serious flu going round here too.  I've missed that so far.

I think nothing can be assumed in these conditions. I'm placing the passwords 

to the site with Bruno and Neal to manage affairs if I am inconvenienced.   Just

a precaution, I'm sure I'll pull through. There is a mass of unpublished work in various pieces that probably amounts to 500 pages and something needs to be done there too.

M.

 

[nha...@gmail.com]

Sorry to hear it's getting worse. Have you got screened to make sure it isn't a bacterial lung infection?

[Mark Tarver]

The NHS is pretty much non-functional now.  During my pneumonia of 2022, I couldn't get to my GP.

Being treated takes months and my experience is that they seem incapable of effective medicine.

The whole system is just overworked and overstaffed with admin and PPP contractors who siphon

off the money.

So early C21, you really have to be your own doctor and diagnose and prescribe for yourself.   I

think I have the handle on this.  But arranging for continuity of my intellectual legacy is important

and so I'm makine arrangements publically now so that people know the score.

M.

[nha...@gmail.com]

If your breathing gets noticeably bad I think you can just walk into the hospital urgent care and they aren't allowed to turn you away. 

I've done it about 10 times now with my infant. They basically said if the breathing gets past a certain breaths per minute or his asthma inhaler doesn't last 4 hours you automatically have to take him in.

Obviously they prioritise babies over adults, but you can still walk in as an adult. Being over 65 might get you a bit of extra priority too.

I walked in with a cut on my eyeball a few months ago, and they didn't try to turn me away. They made me queue for 8 hours, but it's still faster than dealing with the GP who just sends you to someone else anyway.  

I actually got admitted to the hospital urgent care yesterday without even wanting to. We came there for a scheduled outpatient follow up, and asked the receptionist where to go for it, and the receptionist just printed an armband and automatically admitted us to the urgent care without paying attention. When I said no we don't need to go to urgent care, one of the other NHS workers stepped in and said just go in there and talk to them. So we go in there and the nurse says to have a seat in the waiting room, and I tell her we're not supposed to be here, and show her the appointment. She just complained that the receptionists were idiots, and that it costs the NHS money to even admit someone into urgent care, and told us how to get to the right ward. 

They probably should just strip down the NHS and have it only deal with very serious medical issues and emergencies, and have the private sector deal with everything else. The government can always just give a type of medical insurance to low income families for use in the private sector anyway. There really seems to be a huge amount of misc "support" people who talk to you, but don't actually do anything remotely useful.

[Mark Tarver]

I did enter A&E and was told that it was more dangerous to have a bed with a lung infection

in hospital rather than stay at home.  More chance of catching something.   So I'll continue

to self-prescribe and do my own thing.    But I do need to sort out some mechanism if things

go south.  I'll think on it.

M.

[nha...@gmail.com]

"I did enter A&E and was told that it was more dangerous to have a bed with a lung infection in hospital rather than stay at home.  More chance of catching something."

Is that really true though? Sometimes they just say things to scare the patient so they opt out of treatments. 

When I had a head injury and wanted an MRI done in Sweden, the doctor was trying to say they shouldn't do it because radiation blah blah blah. I had a student doctor friend of mine with me and she said "So you can be sure he doesn't have a brain bleed then?". Of course he can't say so without a scan, and if something were to happen there was another witness there, and he doesn't want to end up under a malpractice review, so he sorted out the scan right away with no fuss.

[Raffaele Granato]

Hello all. I'm a worse-than-average med student and sometimes lurk around in various programming languages mailing lists and groups, including Shen's. Dr. Tarver, I've read your posts about your recent health issues and since I've got the impression that the previous communication you've had with some health providers could be improved, I temporarily joined the Shen group just to reply to this thread.

Here's some of the general principles physicians follow with pneumonia:
- Appropriate treatment depends on the both the type and the severity of pneumonia. To tell the type and severity of pneumonia you need clinical data, imaging and labs.
- Antibiotics are given:
  - For bacterial pneumonia, even if mild: because the risk of it worsening is high.
  - When in doubt if bacterial or viral: because we don't take risks, and also because they are not mutually exclusive.
- When oxygenation is needed, you give oxygenation.
- When IV fluids are needed, you give IV fluids.
- When ICU admission is needed, you admit in ICU.
- With appropriate treatment pneumonia is expected to get better. If it fails to improve you must do additional tests and reevaluate the type of pneumonia, severity and treatment. If it was viral, considering a secondary bacterial cause is just due diligence, given how common it is.
- All patients who develop worsening acuity of illness require further evaluation and management.

> I did enter A&E and was told that it was more dangerous to have a bed with a lung infection in hospital rather than stay at home.  More chance of catching something.

Physicians working in hospitals have to weight the risks associated with admission against the risks associated with non-admission. In the case of pneumonia it's done considering the suspected cause, the medical history and the severity indices. If they decided to treat you as an outpatient the first time it was probably because the the type of pneumonia was known, it was acute, and the severity was mild. However, the fact that some time has passed since your first visit and now you are starting to feel worse means that all of these may have changed. For these reasons I think a reevaluation is highly suggested.

If I were in you I'd telephone my GP and tell them: "I've got COVID x weeks ago and now I'm starting to get worse. In particular what has gotten worse are x y z. And it has worsened so much that it started to worry me. What would you suggest me to do? Self-medicate, come and see you in person or go to the hospital?". I'm not familiar with how the health system works where you live, but if it's similar to how it is here it should also be possible to schedule a telephone call with your GP just to clarify any doubts that may be cause of worrying. Physicians are not just for writing prescriptions, and bidirectional communication is key to reach the outcomes. If however talking with my GP wasn't possible I'd go straight to the hospital.

In case you are curious about the how clinicians approach pneumonia, the following videos cover the general principles:

- [youtube] Strong Medicine - Community Acquired Pneumonia
- [youtube] Lecturio - Pneumonia: Types, Classification, Symptoms & Management

Finally, I'm not qualified to offer medical advice in place of real physicians, but if you have any trivial medical questions you want to ask I can either try and google it up at the best of my knowledge, if I'm able to, or give-up and redirect you to your GP.

I hope you get well soon,
Raffaele Granato.

[Mark Tarver]

Wow; the only medical thread in the group.  Seriously I'll pull through this.   But I need to sort some 

stuff out.  I'll phone the GP.   Thx a lot for all the advice.   

Back to computing ...

M.