Guest guest Posted March 1, 2012 Report Share Posted March 1, 2012 Hi All, I admit I haven't researched current AGA guidelines- if any even exist- but this has been on my mind re- urgency of workup for true melena. In a 30-60 y/o w/no PMHx, meds, fam Hx or other red flags (wt loss, pain, anemia), how much BRB PR do we tolerate before insisting on a colonoscopy? 2/3rds of my pts have no insurance, so a GI referral is a big deal to them. Thought, please? "We will bankrupt ourselves in the vain search for absolute security." -Dwight D. Eisenhower zell, DO, MPH. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 1, 2012 Report Share Posted March 1, 2012 " True melena " actually means black, tarry stools, typically with a very foul odor: I would have no tolerance for that whatsoever, but remember that iron supplements and pepto bismol both also give black stools (not tarry, though). hematochezia (bright red blood per rectum) is different. I'd say: - Higher risk for something significant: on NSAIDs, h/o heavy ETOH use, older age - Lower risk: known history of hemorrhoids and/or hard stools, minimal volume that's consistent with wiping a bleeding hemorrhoid, recent history of diarrhea that might have exacerbated a hemorrhoid, etc. - Intermediate risk: known history of diverticulosis - Absolute risk: impossible to say. We can only make recommendations and inform our patients of the facts as we understand them. " Low risk " people can bleed to death and " high risk " people can be totally fine. Ken ------ > Hi All, > > I admit I haven't researched current AGA guidelines- if any even exist- but > this has been on my mind re- urgency of workup for true melena. In a 30-60 > y/o w/no PMHx, meds, fam Hx or other red flags (wt loss, pain, anemia), how > much BRB PR do we tolerate before insisting on a colonoscopy? > > 2/3rds of my pts have no insurance, so a GI referral is a big deal to them. > Thought, please? > > > > > > " We will bankrupt ourselves in the vain search for absolute security. " > -Dwight D. Eisenhower > > > > > zell, DO, MPH. > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 6, 2012 Report Share Posted March 6, 2012 I was taught that by the time a pt has true melena, they have lost a couple pints of blood already. As far of black stools goes- I have seen them all- melena is more of a very dark dark red. Pepto bismaol is a dark dark grey and Iron stools is a very dark brown. You have to take a very close look.... " True melena " actually means black, tarry stools, typically with a very foul odor: I would have no tolerance for that whatsoever, but remember that iron supplements and pepto bismol both also give black stools (not tarry, though). hematochezia (bright red blood per rectum) is different. I'd say: - Higher risk for something significant: on NSAIDs, h/o heavy ETOH use, older age - Lower risk: known history of hemorrhoids and/or hard stools, minimal volume that's consistent with wiping a bleeding hemorrhoid, recent history of diarrhea that might have exacerbated a hemorrhoid, etc. - Intermediate risk: known history of diverticulosis - Absolute risk: impossible to say. We can only make recommendations and inform our patients of the facts as we understand them. " Low risk " people can bleed to death and " high risk " people can be totally fine. Ken ------ > Hi All, > > I admit I haven't researched current AGA guidelines- if any even exist- but > this has been on my mind re- urgency of workup for true melena. In a 30-60 > y/o w/no PMHx, meds, fam Hx or other red flags (wt loss, pain, anemia), how > much BRB PR do we tolerate before insisting on a colonoscopy? > > 2/3rds of my pts have no insurance, so a GI referral is a big deal to them. > Thought, please? > > > > > > " We will bankrupt ourselves in the vain search for absolute security. " > -Dwight D. Eisenhower > > > > > zell, DO, MPH. > > > > > -- M.D.www.elainemd.comOffice: Go in the directions of your dreams and live the life you've imagined. This email transmission may contain protected and privileged, highly confidential medical, Personal and Health Information (PHI) and/or legal information. The information is intended only for the use of the individual or entity named above. If you are not the intended recipient of this material, you may not use, publish, discuss, disseminate or otherwise distribute it. If you are not the intended recipient, or if you have received this transmission in error, please notify the sender immediately and confidentially destroy the information that email in error. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 6, 2012 Report Share Posted March 6, 2012 Elaine, can we just send our stool samples to you to interpret? (you seem to have the knack ! You have the scoop on the poop.... You are cool with stool..... You are a hit with the........) I was taught that by the time a pt has true melena, they have lost a couple pints of blood already. As far of black stools goes- I have seen them all- melena is more of a very dark dark red. Pepto bismaol is a dark dark grey and Iron stools is a very dark brown. You have to take a very close look.... " True melena " actually means black, tarry stools, typically with a very foul odor: I would have no tolerance for that whatsoever, but remember that iron supplements and pepto bismol both also give black stools (not tarry, though). hematochezia (bright red blood per rectum) is different. I'd say: - Higher risk for something significant: on NSAIDs, h/o heavy ETOH use, older age - Lower risk: known history of hemorrhoids and/or hard stools, minimal volume that's consistent with wiping a bleeding hemorrhoid, recent history of diarrhea that might have exacerbated a hemorrhoid, etc. - Intermediate risk: known history of diverticulosis - Absolute risk: impossible to say. We can only make recommendations and inform our patients of the facts as we understand them. " Low risk " people can bleed to death and " high risk " people can be totally fine. Ken ------ > Hi All, > > I admit I haven't researched current AGA guidelines- if any even exist- but > this has been on my mind re- urgency of workup for true melena. In a 30-60 > y/o w/no PMHx, meds, fam Hx or other red flags (wt loss, pain, anemia), how > much BRB PR do we tolerate before insisting on a colonoscopy? > > 2/3rds of my pts have no insurance, so a GI referral is a big deal to them. > Thought, please? > > > > > > " We will bankrupt ourselves in the vain search for absolute security. " > -Dwight D. Eisenhower > > > > > zell, DO, MPH. > > > > > -- M.D.www.elainemd.comOffice: Go in the directions of your dreams and live the life you've imagined. This email transmission may contain protected and privileged, highly confidential medical, Personal and Health Information (PHI) and/or legal information. The information is intended only for the use of the individual or entity named above. If you are not the intended recipient of this material, you may not use, publish, discuss, disseminate or otherwise distribute it. If you are not the intended recipient, or if you have received this transmission in error, please notify the sender immediately and confidentially destroy the information that email in error. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 6, 2012 Report Share Posted March 6, 2012 Sent from my iPod Elaine, can we just send our stool samples to you to interpret? (you seem to have the knack ! You have the scoop on the poop.... You are cool with stool..... You are a hit with the........) I was taught that by the time a pt has true melena, they have lost a couple pints of blood already. As far of black stools goes- I have seen them all- melena is more of a very dark dark red. Pepto bismaol is a dark dark grey and Iron stools is a very dark brown. You have to take a very close look.... "True melena" actually means black, tarry stools, typically with a very foul odor: I would have no tolerance for that whatsoever, but remember that iron supplements and pepto bismol both also give black stools (not tarry, though). hematochezia (bright red blood per rectum) is different. I'd say: - Higher risk for something significant: on NSAIDs, h/o heavy ETOH use, older age - Lower risk: known history of hemorrhoids and/or hard stools, minimal volume that's consistent with wiping a bleeding hemorrhoid, recent history of diarrhea that might have exacerbated a hemorrhoid, etc. - Intermediate risk: known history of diverticulosis - Absolute risk: impossible to say. We can only make recommendations and inform our patients of the facts as we understand them. "Low risk" people can bleed to death and "high risk" people can be totally fine. Ken ------ > Hi All, > > I admit I haven't researched current AGA guidelines- if any even exist- but > this has been on my mind re- urgency of workup for true melena. In a 30-60 > y/o w/no PMHx, meds, fam Hx or other red flags (wt loss, pain, anemia), how > much BRB PR do we tolerate before insisting on a colonoscopy? > > 2/3rds of my pts have no insurance, so a GI referral is a big deal to them. > Thought, please? > > > > > > "We will bankrupt ourselves in the vain search for absolute security." > -Dwight D. Eisenhower > > > > > zell, DO, MPH. > > > > > -- M.D.www.elainemd.comOffice: Go in the directions of your dreams and live the life you've imagined. This email transmission may contain protected and privileged, highly confidential medical, Personal and Health Information (PHI) and/or legal information. The information is intended only for the use of the individual or entity named above. If you are not the intended recipient of this material, you may not use, publish, discuss, disseminate or otherwise distribute it. If you are not the intended recipient, or if you have received this transmission in error, please notify the sender immediately and confidentially destroy the information that email in error. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 6, 2012 Report Share Posted March 6, 2012 Poetry?Adolfo E. Teran,M.D. Sent from my iPod Elaine, can we just send our stool samples to you to interpret? (you seem to have the knack ! You have the scoop on the poop.... You are cool with stool..... You are a hit with the........) I was taught that by the time a pt has true melena, they have lost a couple pints of blood already. As far of black stools goes- I have seen them all- melena is more of a very dark dark red. Pepto bismaol is a dark dark grey and Iron stools is a very dark brown. You have to take a very close look.... "True melena" actually means black, tarry stools, typically with a very foul odor: I would have no tolerance for that whatsoever, but remember that iron supplements and pepto bismol both also give black stools (not tarry, though). hematochezia (bright red blood per rectum) is different. I'd say: - Higher risk for something significant: on NSAIDs, h/o heavy ETOH use, older age - Lower risk: known history of hemorrhoids and/or hard stools, minimal volume that's consistent with wiping a bleeding hemorrhoid, recent history of diarrhea that might have exacerbated a hemorrhoid, etc. - Intermediate risk: known history of diverticulosis - Absolute risk: impossible to say. We can only make recommendations and inform our patients of the facts as we understand them. "Low risk" people can bleed to death and "high risk" people can be totally fine. Ken ------ > Hi All, > > I admit I haven't researched current AGA guidelines- if any even exist- but > this has been on my mind re- urgency of workup for true melena. In a 30-60 > y/o w/no PMHx, meds, fam Hx or other red flags (wt loss, pain, anemia), how > much BRB PR do we tolerate before insisting on a colonoscopy? > > 2/3rds of my pts have no insurance, so a GI referral is a big deal to them. > Thought, please? > > > > > > "We will bankrupt ourselves in the vain search for absolute security." > -Dwight D. Eisenhower > > > > > zell, DO, MPH. > > > > > -- M.D.www.elainemd.comOffice: Go in the directions of your dreams and live the life you've imagined. This email transmission may contain protected and privileged, highly confidential medical, Personal and Health Information (PHI) and/or legal information. The information is intended only for the use of the individual or entity named above. If you are not the intended recipient of this material, you may not use, publish, discuss, disseminate or otherwise distribute it. If you are not the intended recipient, or if you have received this transmission in error, please notify the sender immediately and confidentially destroy the information that email in error. = Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 6, 2012 Report Share Posted March 6, 2012 thank you Ron! Jean Elaine, can we just send our stool samples to you to interpret? (you seem to have the knack ! You have the scoop on the poop.... You are cool with stool..... You are a hit with the........) I was taught that by the time a pt has true melena, they have lost a couple pints of blood already. As far of black stools goes- I have seen them all- melena is more of a very dark dark red. Pepto bismaol is a dark dark grey and Iron stools is a very dark brown. You have to take a very close look.... " True melena " actually means black, tarry stools, typically with a very foul odor: I would have no tolerance for that whatsoever, but remember that iron supplements and pepto bismol both also give black stools (not tarry, though). hematochezia (bright red blood per rectum) is different. I'd say: - Higher risk for something significant: on NSAIDs, h/o heavy ETOH use, older age - Lower risk: known history of hemorrhoids and/or hard stools, minimal volume that's consistent with wiping a bleeding hemorrhoid, recent history of diarrhea that might have exacerbated a hemorrhoid, etc. - Intermediate risk: known history of diverticulosis - Absolute risk: impossible to say. We can only make recommendations and inform our patients of the facts as we understand them. " Low risk " people can bleed to death and " high risk " people can be totally fine. Ken ------ > Hi All, > > I admit I haven't researched current AGA guidelines- if any even exist- but > this has been on my mind re- urgency of workup for true melena. In a 30-60 > y/o w/no PMHx, meds, fam Hx or other red flags (wt loss, pain, anemia), how > much BRB PR do we tolerate before insisting on a colonoscopy? > > 2/3rds of my pts have no insurance, so a GI referral is a big deal to them. > Thought, please? > > > > > > " We will bankrupt ourselves in the vain search for absolute security. " > -Dwight D. Eisenhower > > > > > zell, DO, MPH. > > > > > -- M.D.www.elainemd.comOffice: Go in the directions of your dreams and live the life you've imagined. This email transmission may contain protected and privileged, highly confidential medical, Personal and Health Information (PHI) and/or legal information. The information is intended only for the use of the individual or entity named above. If you are not the intended recipient of this material, you may not use, publish, discuss, disseminate or otherwise distribute it. If you are not the intended recipient, or if you have received this transmission in error, please notify the sender immediately and confidentially destroy the information that email in error. -- MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 6, 2012 Report Share Posted March 6, 2012 Ron, have you been hanging out with Marty? From: [mailto: ] On Behalf Of Jean Antonucci Sent: Tuesday, March 06, 2012 6:07 AM To: Subject: Re: re- ifob/hemoccult thank you Ron! Jean Elaine, can we just send our stool samples to you to interpret? (you seem to have the knack ! You have the scoop on the poop.... You are cool with stool..... You are a hit with the........) On Mon, Mar 5, 2012 at 9:56 PM, wrote: I was taught that by the time a pt has true melena, they have lost a couple pints of blood already. As far of black stools goes- I have seen them all- melena is more of a very dark dark red. Pepto bismaol is a dark dark grey and Iron stools is a very dark brown. You have to take a very close look.... On Thu, Mar 1, 2012 at 12:22 PM, Ken Stone wrote: " True melena " actually means black, tarry stools, typically with a very foul odor: I would have no tolerance for that whatsoever, but remember that iron supplements and pepto bismol both also give black stools (not tarry, though). hematochezia (bright red blood per rectum) is different. I'd say: - Higher risk for something significant: on NSAIDs, h/o heavy ETOH use, older age - Lower risk: known history of hemorrhoids and/or hard stools, minimal volume that's consistent with wiping a bleeding hemorrhoid, recent history of diarrhea that might have exacerbated a hemorrhoid, etc. - Intermediate risk: known history of diverticulosis - Absolute risk: impossible to say. We can only make recommendations and inform our patients of the facts as we understand them. " Low risk " people can bleed to death and " high risk " people can be totally fine. Ken ------ > Hi All, > > I admit I haven't researched current AGA guidelines- if any even exist- but > this has been on my mind re- urgency of workup for true melena. In a 30-60 > y/o w/no PMHx, meds, fam Hx or other red flags (wt loss, pain, anemia), how > much BRB PR do we tolerate before insisting on a colonoscopy? > > 2/3rds of my pts have no insurance, so a GI referral is a big deal to them. > Thought, please? > > > > > > " We will bankrupt ourselves in the vain search for absolute security. " > -Dwight D. Eisenhower > > > > > zell, DO, MPH. > > > > > -- M.D. www.elainemd.com Office: Go in the directions of your dreams and live the life you've imagined. This email transmission may contain protected and privileged, highly confidential medical, Personal and Health Information (PHI) and/or legal information. The information is intended only for the use of the individual or entity named above. If you are not the intended recipient of this material, you may not use, publish, discuss, disseminate or otherwise distribute it. If you are not the intended recipient, or if you have received this transmission in error, please notify the sender immediately and confidentially destroy the information that email in error. -- MD ph fax Quote Link to comment Share on other sites More sharing options...
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