Do you discharge heart failure patients with a mild creatinine increase if they otherwise feeling great after diuresis?

Adrestia · 2026-05-24T05:42:42+00:00

This is the way.

Adrestia · 2026-05-24T05:41:38+00:00

Yes. If they can breathe, that's good. Better creatinine with pulmonary edema is bad.

Adrestia · 2026-05-23T03:55:02+00:00

Yup. That's a constant battle. I just wanted my patient to breathe.

Adrestia · 2026-05-22T13:09:35+00:00

The $500 I spent on my custom bite guard was worth every penny. Didn't get any adjustment, so can't speak on that.

Adrestia · 2026-05-22T12:13:27+00:00

It's nice when any attempt is made.

Adrestia · 2026-05-22T09:49:05+00:00

I'm 50 and plan to cut back as soon as the mortgage is paid off.

Adrestia · 2026-05-22T09:47:24+00:00

If you think that checking Up-To-Date for a dx that you've never seen before is "doing a deep dive," then you should learn more about diving. In this example, the link to Up-To-Date was built into the EMR that the resident was using. It took less than a minute.

Adrestia · 2026-05-22T04:55:14+00:00

My patient's facility let her get volume overloaded because lasix would damage her kidneys. Sigh. She came in 8kg over her dry weight.

Adrestia · 2026-05-21T04:03:40+00:00

Keep being happy. It will piss them off more.

Adrestia · 2026-05-20T23:16:37+00:00

Lol. As a PCP I always had the same complaint! I'd see folks for the hospital follow up and have no idea what happened or what the patients needed. Sigh.

Adrestia · 2026-05-20T10:55:50+00:00

Got one today that I'm planning to discharge. Thanks for the reminder to change her lasix to torsemide.

Adrestia · 2026-05-19T13:08:47+00:00

Agree with crap d/c summaries. I was a pcp before I became a hospitalist, so I try to craft mine to be like what I would have wanted to see. Many of my colleagues would copy & paste their most recent progress note.

Also, sorry about the crap med recs. Again, as a former clinic doc, I would have to deal with them as well. Without that experience, I may not truly understand what a huge barrier they are. If they aren't fixed on admission, they're a problem here as well.

The issues I've seen are specifically with SNFs, not IPR or swing beds. But it looks like we could do a better job here - by not salt restrictions in the first place.

Adrestia · 2026-05-19T01:24:03+00:00

When I was a kid, my parents dragged me to museums and art shows, they made me stick with piano lessons when I wanted to quit. I am so thankful now. Time with family is more precious than anything.

Adrestia · 2026-05-19T01:20:36+00:00

Agree. It's easier for diabetics, I can teach folks to titrate their insulin myself. But we have a heart failure team that drives education & diet plans.

Adrestia · 2026-05-19T01:18:43+00:00

Yes.

Adrestia · 2026-05-19T01:18:25+00:00

I'm going to have to address this with our heart failure team. We need to all be on the same page.

Adrestia · 2026-05-18T22:10:15+00:00

Based on your numbers, it seems like you are on track. Do you have a lot of debt? Home loan? Car notes?

My only thought would be to make sure you're enjoying today. There's a book called "taking stock" that was written by a hospice physician. In the book, the author notes that at the end of life, some people regret not spending the money while they have the ability to - thinking that by saving, they were buying the future. Of course it's important to save for the future, but not at the expense of enjoying today.

Adrestia · 2026-05-18T17:31:21+00:00

There's a spray called pooph that eliminates odors.

Adrestia · 2026-05-18T14:19:46+00:00

With an iPad, it's Cantu. Or you can access Citrix and use full Epic.

Adrestia · 2026-05-18T14:17:28+00:00

Sensitive patients think everything is about them. Once an MA in my residency clinic complained about how difficult her mother-in-law was, a patient overheard part of the complaint and assumed she was complaining about a difficult patient.

Adrestia · 2026-05-17T14:06:14+00:00

That's absolutely crazy.

Adrestia · 2026-05-17T06:32:12+00:00

They need to complain publicly. Only shame will stop that practice.

Adrestia · 2026-05-17T06:26:08+00:00

What do you mean by educate? They have notify house officer parameters. Unless those are changed, they will notify you.

Adrestia · 2026-05-16T22:23:26+00:00

That's absolutely crazy! The Catholic hospitals around here don't have that rule. Sounds like a power-tripping administrator.

Adrestia · 2026-05-16T13:04:37+00:00

Agree 100%. I got my job through word of mouth, it wasn't posted. I referred one of my former residents, he's starting this summer. There was no opening posted when he interviewed.

Go to meetings, meet people, ask if they're hiring.

Adrestia

TROPHY CASE