@boilercat @Gur_36547
When your meds are about to expire or have expired, IRCC sends them for reassessment to the Regional Medical Officer, who makes a determination on whether to extend them to ask for re-meds. If you were asked for re-meds, then get them done and send the upfront sheet back via webform if your do not have a space in your MyCIC account to upload them.
If you received 4 updates, it could be that you have 4 family members and it could be for each. If not, then it is a system glitch.
As regards IELTS, your documents have to be valid as on the date you submit your application. However, IRCC can ask for a new IELTS score, but very rare. For most they will not.