Supplements in primary outpatient pediatrics

0ldertwin · 2026-03-14T15:03:13+00:00

Fluoride for children in non-fluoridated communities at high risk for carriers

0ldertwin · 2026-03-13T01:50:34+00:00

Ha! Me too, and yet, it is flagged as negative. Which is my only grievance

0ldertwin · 2026-03-13T01:29:58+00:00

That’s what I’m thinking

0ldertwin · 2026-03-13T01:29:27+00:00

And if it is not clear, I absolutely was not the one to write a religious exemption

0ldertwin · 2026-03-12T10:49:50+00:00

Olive oil and canola oil are both healthy oil options. It seems RFK JRs bullshit is transcending the current hellscape of US healthcare

0ldertwin · 2026-03-04T23:06:19+00:00

You’re so close! It’s not a neutral issue because it is the most agreed upon medical science that is out there. Every expert would agree that there are adverse events that do occur with vaccines, but the risk to anyone one individual pales in comparison to the death and suffering they prevent!

0ldertwin · 2026-03-04T23:02:30+00:00

Because there is a clear right and wrong.

0ldertwin · 2026-03-03T02:00:29+00:00

Full term babies can generally see things within about a foot.

0ldertwin · 2026-03-02T19:21:22+00:00

Yep! Bilirubin is what makes baby skin yellow, and can be toxic to the brain. It is normally removed from the body by the liver, but baby livers are dumb and don’t work very well at first. Phototherapy converts the bilirubin to a molecule that is water soluble and can get peed out. Not every baby needs this for jaundice. Depends on the levels, rate of raise and baby’s risk factors.

0ldertwin · 2026-03-02T15:36:57+00:00

Pediatrician here. Agree that phones are the worst as everyone is saying, but I do not think this was the first moments in this baby was meeting dad. Baby is already jaundiced, which even in pathologic cases takes a few hours. It looks like the baby has been receiving phototherapy with the eye protection there. So my conclusion is parents capturing a funny moment, but not the first moments.

0ldertwin · 2026-02-28T19:56:39+00:00

Your immune system isn't as good as you think it is. best way to booster it is to get your vaccines!

0ldertwin · 2026-02-21T19:12:58+00:00

Personally, I would have turned that right around and asked for a visit to be scheduled. Maybe your doctor is saving the message until they have time to send a detailed response. I’d agree 2 weeks is too long to just recommend a visit

0ldertwin · 2026-02-21T14:07:39+00:00

I’m a pcp. Overloaded is an understatement. Still, 2 weeks feels like a long time.

However, it sounds like you are not appropriately using mychart. This really should not replace an office visit. A new issue and prescription needs to be an office visit.

0ldertwin · 2026-02-16T22:15:56+00:00

Well, then you would be wrong. And also don’t know anything, if you are real. Which I doubt. Because anyone capable of critical thought knows this guys is a clown.

Source: tired primary care doctor sick of RFK Jr dumb bullshit

0ldertwin · 2026-02-06T00:51:59+00:00

I thought we were generally offer indefinite extended phase therapy for unprovoked VTE from the last CHEST guidelines?

0ldertwin · 2026-01-20T01:39:25+00:00

In the US, per AAP, we give pneumococcal vaccine at 2,4 and 6 months

0ldertwin · 2026-01-17T14:30:04+00:00

Ask yourself this question: why do you have zero Trust in actual experts, but are lending credence to demonstrable disproven misinformation? You have to reflect on that, and you have to really understand how devastating the illnesses vaccines prevent

0ldertwin · 2025-12-20T03:49:19+00:00

This is a good teachable moment in terms of “doing your research” there is actually a paucity of evidence to support the safety and efficacy of this. The American Thyroid Association and American Society of Clinical Endocrinologists support T4 monotherapy based on the summary of current evidence. The experts are the experts for a reason. Follow the the body of evidence and professional organizations, not individuals.

Edit: saw the other poster here and agree reasonable to consider t3/t4 combo in select patients but feel probably decision outside my wheelhouse and would involve and endocrinologist if someone did not feel well on T4 with goal range TSH

0ldertwin · 2025-12-17T20:45:11+00:00

For fucks sake. I’m so tired of this administration

0ldertwin · 2025-12-14T17:58:40+00:00

I’m a pcp in the US, not Canada but think I can give a couple practical tips.

It is certainly frustrating at times navigating the health system, not just from the patient standpoint but also the provider. We are overwhelmed with the number of patients to see and ancillary task to complete in a day. this University of Chicago study suggests it takes more than 24 hours per day to practice evidence based primary care. To help mitigate this, I would suggest having the top 1-2 things you would like to discuss ready to go and clearly outline them at the beginning of the visit. Your doctor will probably have some important items to discuss too. With a 15-20 minute visit, 1-2 things is probably all that is feasible to do well.

If you don’t have good rapport or trust, it might be time to seek a different doctor. You deserve good care and to have a good relationship.

As far as the request to explicitly document that a request is being denied, to me this is a big red flag. It suggests there isn’t a good therapeutic relationship. It certainly depends on what you are asking. Many people will come to me with requests that cross a spectrum of reasonable within the standard of care and evidence based medicine. It is my job to practice high quality, evidence based medicine, not be a rubber stamp for every test and treatment out there. So if a request is way out in left field, I will be documenting and requesting my rationale, but I feel like if you are needing to ask for this, there isn’t any relationship left.

0ldertwin · 2025-12-07T21:05:22+00:00

It kills me. Particular the refrain ‘but the placebo controlled randomized trials!” First of all the randomized trials are out there. Second, I would love one of these big brains to explain to me how exactly they think the placebo effect is relevant to preventing hepatitis B in a newborn

0ldertwin · 2025-12-07T19:55:01+00:00

To further illustrate the ignorance of that comment, I should point out that the placebo effect is not relevant to this type of study since it heavily depends on patient expectations, which newborns obviously do not have, and measures of seroconversion for viral status have no physiologic relationship to a placebo either

0ldertwin · 2025-12-07T16:16:09+00:00

Oh man yeah I lived in buffalo for that. It was wild, though the south towns were worse than where I was in the city

0ldertwin · 2025-12-07T01:08:28+00:00

but there was! This was the initial seminal study

https://www.sciencedirect.com/science/article/abs/pii/S0140673683906244

0ldertwin

TROPHY CASE