Jump to content
RemedySpot.com

re- ifob/hemoccult

Rate this topic


Guest guest

Recommended Posts

Guest guest

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.

Link to comment
Share on other sites

Guest guest

" 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.

>

>

>

>

>

Link to comment
Share on other sites

Guest guest

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.

Link to comment
Share on other sites

Guest guest

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.

Link to comment
Share on other sites

Guest guest

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.

Link to comment
Share on other sites

Guest guest

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.

=

Link to comment
Share on other sites

Guest guest

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

Link to comment
Share on other sites

Guest guest

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

Link to comment
Share on other sites

Join the conversation

You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

Loading...
×
×
  • Create New...