5 ms·

> I’m sure you’re here to rub your reflex hammer in our ignorant little pig faces. I do realize there are a lot of crappy doctors out there, but about the pers

> I’m sure you’re here to rub your reflex hammer in our ignorant little pig faces. I do realize there are a lot of crappy doctors out there, but about the person putting a reflex hammer in your face -- are you sure that was an actual doctor? To your other point, while I often realize the futility of responding to the direct commenter, this is a public forum so maybe others can get some information or entertainment, whatever might be.

Pigalowda 4y ago
haldujai 4y ago
As a physician I am in complete agreement with danachow’s statements. A hemoglobin of 4 must be corrected irrespective of the underlying etiology. Furthermore, I am also in complete agreement that such a patient without obvious source for anemia requires a hematology consultation. That may be the only error that happened here. I would greatly welcome your rationale as to how we can safely discharge a symptomatic patient with a Hgb of 4 as this directly contradicts all of my medical training. In fact, I would lose my license if I ever did that. If you happen to know information about anemia I do not, please provide your rationale.
- com2kid 4y ago
  I've gone into the doctor with a BP of 160/90 and a headache that had been with me for 3 days. After asking some scary questions and ruling out that I wasn't going to die then and there, I was sent on my way and told good luck. I figured out myself that the problem was a potassium deficiency. I hadn't eaten any leafy greens in a week or two (lots of veggies, just none that had significant levels of potassium) and I don't normally eat any processed food. A couple handfuls of baby spinach later and my headache was gone. A lack of effort in diagnosis is the norm, not the exception. I have plenty of other stories! As does damn nearly every one else. Computer techs don't bother diagnosing PC problems and just prescribe a reboot. Many Doctors seem to have the same attitude, but for the patient things are a bit more personal.
  - danachow 4y ago
    How did you confirm the potassium deficiency? How low was it?
    - com2kid 4y ago
      At the time I carefully tracked everything I ate and realized I hadn't consumed any potassium for a couple weeks, but had a high salt intake. Lots of sodium, no potassium, things get out of wack quickly.
      - danachow 4y ago
        Ah, ok, so it was just bullshit. It’s virtually impossible to become hypokalemic from dietary insufficiency alone if maintaining caloric needs unless you’re puking or shitting your guts out or have certain endocrine or renal chronic illnesses - not over 2 weeks. And a headache is entirely non-specific - it may have completely resolved on its own as they usually do. We have to meet a certain rigor - we can’t just say oh headache it must have been some dietary indiscretions and low potassium with no evidence - that’s not how any of this works. If you were critically and symptomatically hypokalemic a couple handfuls of baby spinach would not have corrected that deficit. > Lots of sodium, no potassium, things get out of wack quickly If you don’t have an endocrine or renal disorder or taking certain medications - no, they really don’t. Sitting in the position of the doctor - there’s no way to counter this. You immediately jump to the conclusion you’re symptomatically having headaches because of hypokalemia based on no evidence whatsoever and just a coincidental diet pattern but with no concept of potassium homeostasis - there’s really not much I can do to convince you otherwise if you are inclined to jump to conclusions that quickly. It isn’t supported by basic biology and a practitioner actually has to show some consideration in their diagnosis. You’re going to chalk it up as being ignored. And there we are. When somebody generally healthy comes in with an episode of a non alarming headache - conservative management is the evidence based standard of care. Come in for follow-up make sure the BP was a transient thing. Maybe have you do some home monitoring. Perhaps your diet is shit, but the potassium would likely not be the problem. If you really think you’re chronically hypokalemic - maybe get a basic blood test (you can order them yourselves these days - take it when you think It’s low) and take it to a doctor if it’s low. I’m sure it’ll be normal though - and you will have no further diagnosed your headache - just like your doctor. Also 160/90 is not a great blood pressure to be living with day to day - but it is not "dangerously" high - or what we would call urgent or emergent. BP can be transiently elevated in pain or stress states and 160/90 isn't going to kill you. If you keep coming in with that or better yet you have multiple readings at home like that, we'll talk about lifestyle changes and then maybe talk about a chronic BP medication. But there is no reflex reason to do any lab workup just because a BP is 160/90. What is considered safe blood pressure and how we should control it both chronically and acutely is something that has undergone a stupendous amount of thought and research since hypertension became a major health concern 75-80 years ago. Not immediately doing every lab test and imaging study in the book for a one time BP reading that high is not based on some capriciousness - it's based on some of the most basic and well-trodden evidence based medicine. It's not as cavalier as the assumption of many here.

Pigalowda 4y ago

haldujai 4y ago

As a physician I am in complete agreement with danachow’s statements. A hemoglobin of 4 must be corrected irrespective of the underlying etiology. Furthermore, I am also in complete agreement that such a patient without obvious source for anemia requires a hematology consultation. That may be the only error that happened here. I would greatly welcome your rationale as to how we can safely discharge a symptomatic patient with a Hgb of 4 as this directly contradicts all of my medical training. In fact, I would lose my license if I ever did that. If you happen to know information about anemia I do not, please provide your rationale.

com2kid 4y ago
I've gone into the doctor with a BP of 160/90 and a headache that had been with me for 3 days. After asking some scary questions and ruling out that I wasn't going to die then and there, I was sent on my way and told good luck. I figured out myself that the problem was a potassium deficiency. I hadn't eaten any leafy greens in a week or two (lots of veggies, just none that had significant levels of potassium) and I don't normally eat any processed food. A couple handfuls of baby spinach later and my headache was gone. A lack of effort in diagnosis is the norm, not the exception. I have plenty of other stories! As does damn nearly every one else. Computer techs don't bother diagnosing PC problems and just prescribe a reboot. Many Doctors seem to have the same attitude, but for the patient things are a bit more personal.
- danachow 4y ago
  How did you confirm the potassium deficiency? How low was it?
  - com2kid 4y ago
    At the time I carefully tracked everything I ate and realized I hadn't consumed any potassium for a couple weeks, but had a high salt intake. Lots of sodium, no potassium, things get out of wack quickly.
    - danachow 4y ago
      Ah, ok, so it was just bullshit. It’s virtually impossible to become hypokalemic from dietary insufficiency alone if maintaining caloric needs unless you’re puking or shitting your guts out or have certain endocrine or renal chronic illnesses - not over 2 weeks. And a headache is entirely non-specific - it may have completely resolved on its own as they usually do. We have to meet a certain rigor - we can’t just say oh headache it must have been some dietary indiscretions and low potassium with no evidence - that’s not how any of this works. If you were critically and symptomatically hypokalemic a couple handfuls of baby spinach would not have corrected that deficit. > Lots of sodium, no potassium, things get out of wack quickly If you don’t have an endocrine or renal disorder or taking certain medications - no, they really don’t. Sitting in the position of the doctor - there’s no way to counter this. You immediately jump to the conclusion you’re symptomatically having headaches because of hypokalemia based on no evidence whatsoever and just a coincidental diet pattern but with no concept of potassium homeostasis - there’s really not much I can do to convince you otherwise if you are inclined to jump to conclusions that quickly. It isn’t supported by basic biology and a practitioner actually has to show some consideration in their diagnosis. You’re going to chalk it up as being ignored. And there we are. When somebody generally healthy comes in with an episode of a non alarming headache - conservative management is the evidence based standard of care. Come in for follow-up make sure the BP was a transient thing. Maybe have you do some home monitoring. Perhaps your diet is shit, but the potassium would likely not be the problem. If you really think you’re chronically hypokalemic - maybe get a basic blood test (you can order them yourselves these days - take it when you think It’s low) and take it to a doctor if it’s low. I’m sure it’ll be normal though - and you will have no further diagnosed your headache - just like your doctor. Also 160/90 is not a great blood pressure to be living with day to day - but it is not "dangerously" high - or what we would call urgent or emergent. BP can be transiently elevated in pain or stress states and 160/90 isn't going to kill you. If you keep coming in with that or better yet you have multiple readings at home like that, we'll talk about lifestyle changes and then maybe talk about a chronic BP medication. But there is no reflex reason to do any lab workup just because a BP is 160/90. What is considered safe blood pressure and how we should control it both chronically and acutely is something that has undergone a stupendous amount of thought and research since hypertension became a major health concern 75-80 years ago. Not immediately doing every lab test and imaging study in the book for a one time BP reading that high is not based on some capriciousness - it's based on some of the most basic and well-trodden evidence based medicine. It's not as cavalier as the assumption of many here.