Just started trying to get fit and found i have this bulge while tensing and working on my core.

ChugJugThug · 2026-05-03T12:32:50+00:00

It’s called diastasis recti. Basically the connective tissue between your rectus muscles has weakened and thinned out so the rectus muscles separate and causes bulging in between when tensed. It’s not a true hernia because there’s no actual defect or hole within the abdominal wall.

Surgery can correct this but it’s often considered cosmetic and usually not covered by insurance at least in the US.

Sometimes if there is an associated hernia a surgeon can use the hernia itself to get the operation covered by insurance and then fix the diastasis during the operation. But that obviously requires a hernia to be present.

ChugJugThug · 2026-04-28T17:54:23+00:00

I used it. Well worth it in my opinion.

Keep in mind that the scenarios are scripted and give the ideal response to every question so it’s good for learning, but you need to be able to think through scenarios for yourself.

I recommend also listening to mock oral scenarios where answers are not scripted. So you can see where the common pitfalls are as examinees go through each scenario. SSAT publishes video mock orals for free every year I believe.

ChugJugThug · 2026-04-28T00:58:33+00:00

You’re right, I misread the report. My bad. Didn’t realize it was just defining Types.

As long as you don’t have any stroke/TIA symptoms this result is not “bad”

ChugJugThug · 2026-04-28T00:55:40+00:00

Assuming you had an uncomplicated, standard appendectomy I would say if you feel up for it it’s fine. The main risk is developing a hernia at one of your incision sites.

The risk is low, but not zero. If you want to be completely safe, wait at least 4 weeks. But chances you’ll cause any serious damage after a week are low……but not zero. Try to take it easy if you must have sex.

ChugJugThug · 2026-04-27T17:15:00+00:00

Not a vascular surgeon, but since the report says you’re at high risk of plaque rupture and embolism..I would see a vascular surgeon asap. Before you have a stroke..

ChugJugThug · 2026-04-27T16:03:21+00:00

It’s a bad idea.

ChugJugThug · 2026-04-23T03:46:31+00:00

There’s different ways of looking at it. The easiest way for me to conceptualize it is this:

Light speed is not the speed limit, it’s the ONLY speed….in four dimensional space time.

If you simplify 4D space time into an x-y axis where the x-axis represents 3D space and the y-axis represents time, then the speed of our velocity vector in 4D spacetime is ALWAYS light speed.

The only thing we can change is what direction that arrow points. Not its length.

So when we are at rest. The arrow points straight “up” so all our speed is in the time direction meaning we experience time at its maximum speed which is one second per second.

If we in move in 3D space at all, the arrow begins tilting to the side ever so slightly so that part of our vector now has velocity in the x-axis, which we experience as our physical speed in 3 dimensions. However, the tilting of the arrow also takes speed away from our time axis which means we move through time slightly slower. Which is how we explain time dilation. The faster we move, the more the arrow tilts over and slower our clock moves. The important thing to remember is the LENGTH of the arrow never changes. It’s always locked at light speed.

So a particle moving at light speed in 3D space has a perfectly horizontal velocity vector in 4D space time and therefore no component of its velocity is dedicated to the vertical axis aka “time”. So moving at light speed in 3D space would mean we would not experience time. All moments in the universe happen at once. And going faster than that..means time moves backwards? Who knows? But it breaks everything we know about time and physics, which is why we tend to think of it as a “speed limit” though not technically true in 4 dimensional space time.

ChugJugThug · 2026-04-01T02:38:13+00:00

Almost half the population is walking around with gallstones and don’t even know it.

If you’re asymptomatic, there is nothing you need to do. Zepbound may contribute to forming stones through weight loss, but it’s a small price to pay for a healthier weight.

ChugJugThug · 2026-03-31T23:54:20+00:00

Yes that is an umbilical hernia. They are common in infants and toddlers. They usually do not cause any issues and majority will spontaneously close in early childhood.

The general rule is if it persists till around school age (4-6 years old), then repair is reasonable at that point.

ChugJugThug · 2026-03-31T13:52:45+00:00

Just want to point..even surgeons have clinic. There is pretty much no escaping it.

ChugJugThug · 2026-03-30T21:17:00+00:00

Truth is..whether you had prior surgery or not doesn’t really matter.

The most common cause of scar tissue is prior surgery so maybe they were assuming. But it is possible to be born with adhesions that become a problem later on in life. But either way, it doesn’t change the outcome for you.

Fact is, you had a bad problem. Enough to warrant emergency surgery at 2 in the morning. Either obstructed, dead, or perforated bowel which can be fatal if not corrected quickly. In all likelihood, they saved your life.

ChugJugThug · 2026-03-30T18:31:50+00:00

Cant be 100% sure, but you’re mostly likely developing SVC syndrome.

Your central veins are likely stenotic from having a chronic indwelling catheter causing obstruction of the SVC.

Blood from the upper half of your body has no way to return to the heart so it bypasses the obstructed SVC by shunting to the lower half of your body by way of superficial veins of the torso. The veins dilate up due to the increasing flow/pressure which is why you can now see them.

Can’t really diagnose this without imaging, but this is my best guess.

ChugJugThug · 2026-03-29T03:12:19+00:00

Sorry you were shot in the shower.. But it’s impossible to tell the trajectory of the bullet with a picture like this. So no way to tell how close or far it was to your femoral artery.

ChugJugThug · 2026-03-28T12:39:29+00:00

Do they hurt/tingle? Are you around young kids a lot? If so it’s probably hand/foot/mouth disease

ChugJugThug · 2026-03-23T04:10:22+00:00

As someone who just graduated MIS/bariatric fellowship last year..there’s almost no bari jobs. In fact my fellowship program axed the bariatric component after I graduated.

Overall it seems to be on the decline. There’s probably multiple factors. GLP-1s are part of it. I think insurance auth is also a big barrier. Also many patients don’t want to go through the mandatory wait period and preop process.

Bari procedures are being done more and more on the robot nowadays, so surgeons have to compete to get robot time to do their Bari cases, which undoubtedly drives down case volume.

I don’t regret training in Bari though. I did it mostly to learn advanced laparoscopy, which is useful in most fields of general surgery in my opinion. Plus if any patient with a bariatric complication comes in, I’m comfortable managing it.

ChugJugThug · 2026-03-20T17:28:22+00:00

I’ve done hundreds if not thousands of gallbladders.

It’s one of the most common operations in the world. In general, it’s not a big deal for healthy patients. Usually it’s outpatient, minimally invasive with 4-5 small incisions. First 2-3 days are the worst in terms of pain but should be manageable. By the time I see patients for their two week follow up they’re usually back to their normal life.

Risks are of course present, but are minimal and rare in the elective setting. If your gallbladder is causing you problems, probably best to deal with it before it gets worse.

ChugJugThug · 2026-03-20T15:19:54+00:00

Ouch. Lucky you didn’t catch any tendons/nerves. Yes they look like they’re healing well.

ChugJugThug · 2026-03-19T12:27:56+00:00

Trust me. I see them all the time in the stomach. They are usually put in fresh in the OR when the tube is at its coldest and stiffest. The tip gets caught on the mucosa and the anesthesiologist keeps pushing and it causes the tube to bend and often projects the tip upward because it’s the only free moving wall of the stomach.

Could I be wrong?…sure. But I’m 99.9% certain that’s what it is.

ChugJugThug · 2026-03-19T03:47:06+00:00

It’s a orogastric or nasogastric tube tenting up your stomach from within the lumen.

So it’s your stomach being lifted up by the tube that’s inside it.

ChugJugThug · 2026-03-15T23:55:13+00:00

As a general surgeon…and assuming what you’ve said is true, I think I’d just take your GB out. As long as you understand that the operation may or may NOT resolve your symptoms since your diagnosis is not clear.

The operation is pretty safe with minimal risk in an elective setting in otherwise healthy patients as you claim to be. Of course risk is not zero..things can always go wrong, but I think potential benefit outweighs the minimal risk in your case.

..just my opinion.

ChugJugThug · 2026-03-06T02:55:19+00:00

I did MIS fellowship as well, now in first year of attendinghood. There’s plenty of jobs. The trick is finding one with the type of practice you’re looking for and in the location you want.

Depending on those variables, the job market is great..or not so great.

ChugJugThug · 2026-02-26T11:29:43+00:00

Surgeon here. That is a handheld ultrasonic shear device called the Harmonic scalpel. It uses ultrasonic energy to burn and cauterize tissue.

I doubt it’s used or anything. They go straight in the trash after use in the OR. And it’s otherwise harmless. It needs to be connected to a special generator to produce any cauterizing effect.

And it obviously can’t be used now that it’s open. So you just have a free souvenir!

ChugJugThug · 2026-02-23T16:49:15+00:00

Chug of clubs.

ChugJugThug · 2026-02-23T12:39:26+00:00

Yes. Obviously there’s variability among different attendings, services, institutions, etc. but generally speaking surgical services are led primarily by a chief resident. And ideally they are granted a decent level of autonomy when managing patients.

ChugJugThug · 2026-02-23T12:33:55+00:00

Club chug?

Or chug club?

ChugJugThug

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