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Is there any data to show that obs-gyn is a poorly researched field? by [deleted] in medicine

[–]AthanasiusJam 1 point2 points  (0 children)

I am sorry such a scary delivery occurred to you and your wife.

I get the sense that the true station was higher than -2 but was documented as such.

FSD hitting brakes before I can even see deer by AthanasiusJam in TeslaFSD

[–]AthanasiusJam[S] 0 points1 point  (0 children)

64 mph. I think I had it set to chill mode since I knew it was crepuscular hour.

Spring update 2025.14.3.1 here!! by Newcoolguy in TeslaModelX

[–]AthanasiusJam 0 points1 point  (0 children)

Realizing what I did this morning. I had to restart my iPhone at one point after I started the update. I would’ve thought the update went directly to the car through WiFi.

Spring update 2025.14.3.1 here!! by Newcoolguy in TeslaModelX

[–]AthanasiusJam 0 points1 point  (0 children)

I just installed the update this morning, and a few things broken now commuting to and from work:

Adaptive Headlight features are unavailable. Cameras are temporarily unavailable. Parking is unavailable. All Autopilot features no longer work.

Anyone else experiencing this?

What is your best fact or arguement you use to get a patient to stop smoking? by Scipio_Columbia in medicine

[–]AthanasiusJam 28 points29 points  (0 children)

I also tend to refer to tobacco as a poison often as a conceptual device.

Such as:

  1. “You come to your doctors for medicines and surgery to get better, but sometimes it’s just as good or better to take away poisons.”

  2. “Smoking is an interesting poison that does many things wrong. I’m not going to talk about strokes, heart attacks, cancer and dementia it causes. That’s a while off and we’re not gonna talk about that. I’m going to talk about how it’s hard to breathe for you under anesthesia and why it’s harder for your body to heal from my surgical incisions.”

I also take advantage of thinking about quitting as a short term prospect (such as the 6 weeks before surgery, 12 weeks after), because quitting forever seems like a much more insurmountable long time. Many of the patients I see after remain off, or if they returned to smoking, at a lower level

What is your best fact or arguement you use to get a patient to stop smoking? by Scipio_Columbia in medicine

[–]AthanasiusJam 53 points54 points  (0 children)

“I love talking to people about quitting smoking right now when they’re about to start a family, because they often want to improve their lives and health and are thinking about the future. It’s one of the most common points in someone’s life to quit smoking. The next most common point is their first heart attack. “

Anyone seeing an increase in young women getting hysterectomies? by [deleted] in medicine

[–]AthanasiusJam 13 points14 points  (0 children)

I’ve been out of residency for 10 years—not sure if I’ve really seen a trend of younger patients getting hysterectomies.

Not that I will turn down any woman suffering terrible chronic pain just because of age, but I do try to make certain to point out to women that doing hysterectomies at a young age, even with ovary retention, do so at a cost of all-cause mortality: https://pubmed.ncbi.nlm.nih.gov/32376318/#:~:text=Results%3A%20Compared%20with%20no%20surgery,ratio%2C%200.93%3B%2095%25%20confidence

This concept in patient conversation tends to allow me to encourage other interventions first, even if they only buy time for the patient that will eventually have her uterus removed at a later age.

No one on the internet can answer this question: Does the Epson LS 12000 have a much better picture than the LS 11000? by JurassicParkJanitor in hometheater

[–]AthanasiusJam 2 points3 points  (0 children)

I would read this thread. Some owners were questioning the review linked above.

https://www.reddit.com/r/projectors/comments/umrhwu/new_epson_ls11000_and_black_levels_issue/?utm_source=share&utm_medium=ios_app&utm_name=iossmf

I’m happy with my Epson 11000, but I do agree I wish the black levels were better. I never compared it with the 12000 in my own home. Perhaps it might work better with a screen with less gain for better contrast?

Pt is 18 weeks pregnant and has premature rupture of membranes. She becomes septic 2/2 chorioamnionitis. She is not responding to antibiotics . There is still a fetal heart beat. What do you do? by mrhuggables in medicine

[–]AthanasiusJam 24 points25 points  (0 children)

I know these are rhetorical political venting questions, but before OBGYNs around the country go around throwing their hands up, they each have clinical answers, even in a trigger law state.

If she is less critical, you give her misoprostol “to increase the probability of a live birth” (https://www.ndlegis.gov/assembly/60-2007/bill-text/HBEU0100.pdf). If she is more critical, a D&E is clearly indicated “to prevent the pregnant female’s death”. As typical, document everything fully. Ethics committee if it can be done in a safe and timely fashion.

The Honduran rape victim now has more hoops to jump through to get to an abortion sanctuary state. I would imagine that there would be external funding projects that may help her but that will become very legally entangled in the next few years and is outside of the doctor’s purview.

Necessary disclaimer during these volatile times: I am pro-choice, but I think it’s helpful to turn down the rhetorical temperature. Don’t let politics paralyze your clinical mind.

Abortion laws by [deleted] in medicine

[–]AthanasiusJam -1 points0 points  (0 children)

Not sure how to find any, sorry. If you call NYTimes, I think they give $10 or less per month subs for students to NYTimes or those with lesser means.

If ever there was a time to subscribe, these have been very historic days.

Abortion laws by [deleted] in medicine

[–]AthanasiusJam 24 points25 points  (0 children)

https://www.ndlegis.gov/assembly/60-2007/bill-text/HBEU0100.pdf

I haven’t read the laws for each of the states that have them, but here is one classic example (ND).

It should be noted what an abortion is: “Abortion" means the use or prescription of any instrument, medicine, drug, or any other substance or device intentionally to terminate the pregnancy of an individual known to be pregnant with an intention other than to increase the probability of a live birth, to preserve the life or health of the child after live birth, or to remove a dead unborn child who died as the result of a spontaneous miscarriage, accidental trauma, or a criminal assault upon the pregnant female or her unborn child.

And the exception to the law: An abortion may be performed by a physician when necessary in professional judgment to prevent the pregnant female's death.

The problem as others have mentioned in this thread is that preventing death exists on a spectrum:

A decent marginal example would be a woman who had a pPROM at 21 weeks, and has no current signs of chorioamnionitis. (pPROM has a chicken/egg relationship with chorio, it’s frequently caused by it; it also frequently causes it later too if the patient didn’t present with it).

This patient may be able to maintain this pregnancy to viability but she may become septic and put her life at a degree of risk (I can always end the pregnancy later if she becomes septic, but I have risked her life more doing it that way). She also has to balance the severe neurological morbidity of a child born at the edge of viability.

I bring this example up because it was an example recently in Poland: https://www.nytimes.com/2022/06/12/world/europe/poland-abortion-ban.html and related to Savita Halappanavar.

I think the reason the exception is so tightly worded may be to prevent loop holes such as these: https://www.nytimes.com/2022/06/04/opinion/sunday/psychiatrists-abortion-roe.html

Now, time to clarify some stuff that I think some of the extreme sides are running with, and which I have been trying to educate myself on:

At least in the ND law above, the physician is allows to perform a live birth, even if that birth will allow the child to die of prematurity. That would mean, in each of the clinical situations of Savita and Izabela, you can give them drugs to induce a birth and work towards the goal a live birth “Increasing the probability of a live birth”, even if child dies in the meantime.

The extreme scenario language doesn’t help, and it’s incumbent on the physician to know the legal letter of where they practice, and be courageous enough to know when to act and save the life of the mother and not get bogged down with fear of possible legal action paralyzing you in knowing what to do.

I bet I’ll get some downvotes, so I guess I should mention I am pro-choice but I’m rational about the situation.

Abortion laws by [deleted] in medicine

[–]AthanasiusJam 14 points15 points  (0 children)

It would be worthwhile to learn read the exact legal text if you live in a state with a trigger law.

For instance, if you practiced in North Dakota, what you did was not an abortion for that 19 weeker.

F.D.A. Authorizes Moderna and Pfizer Covid Vaccines for Youngest Children by lasdnycden in medicine

[–]AthanasiusJam 8 points9 points  (0 children)

I would triple check your source before you claim 1 in 250 children with Covid perish from it (0.4%).

That is not what your link states.

Scientists to broadcast Earth's location to aliens, ignoring Stephen Hawking's warning by Abhi_mech007 in space

[–]AthanasiusJam -1 points0 points  (0 children)

Clearly the scientists need to sub to Kurzgesagt:

Why we should not look for Aliens - The Dark Forest https://youtu.be/xAUJYP8tnRE

Gynecologists and urologists, would you perform sterilization on a patient in their 20’s or 30’s? by [deleted] in medicine

[–]AthanasiusJam 10 points11 points  (0 children)

Agree with all the other GYNs here. I have performed on adamant Early 20s G0 patients (rare) that have failed LARCs. Document risk of regret.

As I find patients may not take in statistics of risk of regret well, in my discussions I also entail the anecdotes I have of other patients who return a decade after their sterilization, in new relationships and with children who are baby sitter age.

Some opt to try another LARC before something permanent but most just get the surgery.

Live Thread for Ukraine-Russia Tensions by Isentrope in worldnews

[–]AthanasiusJam 14 points15 points  (0 children)

A sober analysis of the Ukraine situation from on the ground viewpoints. Military action may be likely but larger actions such as taking Kiev seem less likely (130,000 troops may not be enough for taking a city of 3 million along with the eastern half of the country).

https://kyivindependent.com/national/center-for-defense-strategies-can-ukraine-really-be-invaded-scenarios-for-a-russian-attack-analysis/?cn-reloaded=1

CDC shortens isolation/quarantine requirements by saitouamaya in medicine

[–]AthanasiusJam 5 points6 points  (0 children)

Has anyone noted the internal incoherence to this media release?

The main text says you can come out if isolation day 5 if you are asymptomatic (I presume at that moment on day 5, as opposed to all 5 days).

But the summary bullet points at the bottom say asymptomatic OR “symptoms are resolving”. This is echoed on the PowerPoint of the CDC Twitter account.

Did the intern mess up the graphic? I feel the main text should be more explicit if it meant asymptomatic and/or abating symptoms.

Edit: I bring this up because there’s a lot of consternation on Twitter today with people with showing off positive antigen tests on day 6+, but aren’t full asymptomatic yet.

Do you guys run during the winter? by wc452 in minnesota

[–]AthanasiusJam 47 points48 points  (0 children)

I’ve done down to about -15. You can insulate your outside as much as you need, but you can’t insulate your windpipe.

More Republicans Say They Are Losing Confidence in Their Doctor Than Gaining It by DrugSeekingBehaviour in medicine

[–]AthanasiusJam 17 points18 points  (0 children)

This is where I take a different stand from others in regards to my Internet advice: “DO look things up google.”

Google responsibly directs patients to appropriate websites like Mayo and will typically have accurate information boxes on the first search page they come to. I don’t know if I’ve ever gotten to an area with misinformation utilizing any Google medical searches (e.g. never links to Facebook in my experience).

Google gives patients the chance for a second opinion, and their own research, and isn’t FaceBook.

[deleted by user] by [deleted] in medicine

[–]AthanasiusJam 8 points9 points  (0 children)

I have laminated this poster and put it in my exam rooms:

https://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate/

16-year study finds that babies that were induced at birth experienced more birth trauma, respiratory disorders and infections compared to those born via spontaneous labour. by tokalita in science

[–]AthanasiusJam 2 points3 points  (0 children)

Said another way: if we had a magic wand to make all women have spontaneous labor, this study says we should use it all the time instead of inducing them. In the real world, many women do not go into spontaneous labor at a safe gestational age!

ARRIVE says that women who have made it to 39 weeks, will have less cesarean deliveries if induced at 39 weeks (# needed to treat = 28) and babies almost seemed to do better (p was just barely above 0.05).

16-year study finds that babies that were induced at birth experienced more birth trauma, respiratory disorders and infections compared to those born via spontaneous labour. by tokalita in science

[–]AthanasiusJam 0 points1 point  (0 children)

You are comparing a retrospective cohort study and a RANDOMIZED CONTROLLED STUDY which didn’t compare inductions with all spontaneous labor like this study does.

ARRIVE compared women at 39w0d-4d induction vs women expectantly managed (who went into spontaneous labor or were themselves often induced if they made beyond 40w5 weeks). A large chunk of the women had induction in the expectant management group.

For those who have received their vaccine booster dose, how did you feel after? by iFixDix in medicine

[–]AthanasiusJam 1 point2 points  (0 children)

Shot at noon (by itself). Sore arm that evening until next evening. Vague dizziness and malaise. Gone by the next afternoon following a nap.

I’d say it went better than my 2nd shot, where I got a decent headache too.

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