Magnesium for leg cramps…just as good as placebo?

Clinical question: does magnesium work for leg cramps?

Findings 1: Cochrane review, 2012

Both magnesium & placebo reduce the frequency of leg cramps with a non-significant difference between the two groups.  The Cochrane review analysed four RCTs (n=322), two of which were deemed to have a high risk of bias and the remaining two trials had a combined total of 86 participants – better quality evidence needed.

Findings 2: Roguin Moar et al. JAMA, 2017

Continue reading “Magnesium for leg cramps…just as good as placebo?”

A 62-year-old Male with Dreadful Dysuria

This case has been inspired by events in the Torres Straits and details have been changed to ensure patient anonymity.

History

A 62-year-old Male trudged into the Emergency Department on a Friday night. There was a downpour of rain outside as the wind was whistling through the windows and doors. This weather came as no surprise to anyone – it was after all the wet season. He complained of dysuria, urinary frequency and hesitancy for over two months. There was no blood or pus in his urine, no bowel symptoms, no abdominal or flank pain and no fevers. He had visited his GP a few weeks ago who diagnosed a urinary tract infection and given him a course of Trimethoprim.  Urine cultures at that time grew sensitive E. Coli. But his symptoms never seemed to have resolved and in fact now were worse. “Just fix the problem doc!!” were his words.

His had diabetes (on metformin and gliclazide); hypertension (on ramipril) and hypercholesterolaemia (on a statin). He was a ex-smoker, non-drinker, not currently working and enjoyed gardening.

Continue reading “A 62-year-old Male with Dreadful Dysuria”

Incidental Eosinophilia

As we improve our preventative health screening practices in Remote Indigenous Health we inevitably encounter incidental abnormalities in routine pathology.  Given our limited resources and developing recall systems, what do we do about them?  Over the next few weeks we will address a handful of common queries and a sensible approach to management.

Eosinophilia is a common finding in this region. Continue reading “Incidental Eosinophilia”

Urinary incontinence

Island Docs are generalists.  We strive to maintain a breadth of knowledge rather than focus on a particular specialty field.  In our efforts to provide high quality patient care, we work hard to keep up to date with the latest evidence and guidelines.  We are lucky to receive regular visiting specialists, who continue to teach us and support us.  In this section, we go back to basics and present approaches to common conditions seen in rural general practice.  We’ll also try to include any hot tips and tricks from our visiting specialists.

GP Summary: Urinary Incontinence
FROGS Outreach Teaching 13/03/2018

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A 25-year-old Female with a Mysterious Myalgia

This case has been inspired by events in the Torres Straits and details have been changed to ensure patient anonymity.

History

A 25-year old previously well female presented to the remote area nurse on an outer island somewhere in the Torres after being carried into the clinic by her family. She had woken that morning with severe muscle pains in her neck, back, abdomen and hips. She described the pain as ‘just like a cramp’ and denied joint pains, nausea, vomiting, fevers and bowel or bladder symptoms.

The patient had been Crayfish diving the day prior but can’t remember being stung by anything in the water. She ate cooked boxfish the night before – a regular meal in her family. She didn’t drink alcohol and denied drug use. Continue reading “A 25-year-old Female with a Mysterious Myalgia”

Week 5.1 – Non Invasive Ventilation

CPAP and BIPAP can be daunting to commence if you’re not familiar with your emergency department equipment. This week we get started with our NIV machine – the Oxylog 3000. Having a dedicated BIPAP machine is somewhat of a pipe dream for our ED, but on the bright side it means that you only need to learn how one ventilator works!

First we cover what CPAP and BIPAP are. We then discuss who might benefit from each and what the contraindications are. Next we work on how to titrate NIV to effect and when to wean. After that, it’s time to put theory into practice and commence NIV on your friendly SMO.

Here are some useful links for review for this week:

Non-Invasive Ventilation (NIV)

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Week 4.1 – Chest Pain Emergencies

This week we explore the variety of chest pain emergencies that present to our Emergency Department via ambulance, dinghy, helicopter or even sometimes by bicycle.

Taking a targeted chest pain history and performing an efficient examination is a skill that develops over time. This skill is essential, particularly in chest pain emergencies, where time is of the essence.

Chest Pain: What is the Value of a Good History?

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Professional Burn Out – Am I Enough?

Behind every committed professional is the quietly disconcerting question “Am I enough?”

Our profession is full of them; harm avoidant, reward dependent, goal orientated individuals.  However in remote practice, these effective traits can lead to frustration and burn out.  Supporting systems are still in development, recruitment and retention is difficult and workforce shortages restrict ideal models of care.  Shifting roles and responsibilities with unclear expectations and excessive workload are risk factors and common challenges in remote medicine.  The usual response is to try harder.  We work longer hours, take on more responsibility, fill the gaps, often at great personal cost.

https://www.racgp.org.au/Education/Curriculum/Doctors’-health

We work in challenging environments with multiple risk factors for professional burn out.  Acceptance of our limitations within such environments is an important protective exercise, and yes colleagues: You are enough.

A 40-year-old Male with a Serpiginous Foot Rash

This case has been inspired by events in the Torres Straits and details have been changed to ensure patient anonymity.

History

A 40-year-old male presented to his primary health care practice during the wet season somewhere in the Torres during the wet season. He had an intensely itchy rash to his right ankle for the past five days. It started out as a small but painful raised erythematous lesion then began to migrate around his ankle. The rash was found nowhere else on his body. He didn’t have a fever, abdominal pain, diarrhoea or cough. He had recently been doing some gardening barefoot around a flooded creek and described the water to be quite muddy and contaminated. He is an otherwise well male with no past medial history, regular medications or allergies. Continue reading “A 40-year-old Male with a Serpiginous Foot Rash”