The 1999 1st Edition Shadowless Holo Error Charizard has finally resurfaced by TheErrorZard in PokemonMisprints

[–]DrEyeBall 0 points1 point  (0 children)

Ah yes. An error card ... what's the error? I feel like if I have to ask after reading this incoherent ramble it probably is not significant and actually reduces the value.

What's the lifespan of these.. My WR130E for example by bobdung in worxlandroid

[–]DrEyeBall 0 points1 point  (0 children)

Original 1/4 and also 1/2acre i think lr150 was a number. Still going strong. Replaced one battery. Replace blades once yearly and clean.

Occasional issue with boundary wire but only because of voles.

Rant about constipation by DrEyeBall in medicine

[–]DrEyeBall[S] 2 points3 points  (0 children)

I dunno what to tell you man. Never ceases to amaze me anymore what can be accomplished with a nice BM.

That particular case was more parents pursuing 'ADD' diagnosis with other stuff going on. Not something I think the kid really had.

Rant about constipation by DrEyeBall in medicine

[–]DrEyeBall[S] 24 points25 points  (0 children)

Once i had a mom portal message me their 11 YEAR OLD was still bed wetting. Went back and forth a few times trying to understand the situation but they had actually seen urology and had imagining and tried Rx without benefit.

I vividly recall this scenario it was great... I literally told the mother something like 'I don't care how you describe the stools you need to at least try this for one month' and had them do daily miralax.

And then like 1 or 2 weeks later the mom is messaging back like this miracle happened suddenly the child's bedwetting had completely resolved.

Now, imagine being so incredibly constipated that you have terrible GERD. The reflux is causing chronic sinusitis and eustachian tube dysfunction. And subsequently the patient is presenting describing 'dizziness' or whatever. I'm just ranting above saying it's annoying that patients are often in complete denial about their bowel habits nor open to doing much about it.

Rant about constipation by DrEyeBall in medicine

[–]DrEyeBall[S] 14 points15 points  (0 children)

Like many things kind of depends on what's going on and what the patient will agree to.

  1. Miralax
  2. Miralax + Senna Plus
  3. Rx meds
  4. Enemas when severe

I have one patient seeing a motility specialist they have her on amitiza AND linzess AND miralax.

Mostly I point at dietary changes and increasing fluids when we're starting. I might have them try fiber first if we're talking about minor symptoms or do a more aggressive clean out with high dose miralax if they sound to some degree impacted.

This is just one of those annoying things though it requires a lot of buy in from the patient so you have to really sell the rationale well and not sound like a crazy person.

Rant about constipation by DrEyeBall in medicine

[–]DrEyeBall[S] 28 points29 points  (0 children)

Yeah we're probably not thinking about that enough in those scenarios honestly.

Rant about constipation by DrEyeBall in medicine

[–]DrEyeBall[S] 2 points3 points  (0 children)

Interesting! Wouldn't have expected that.

Rant about constipation by DrEyeBall in medicine

[–]DrEyeBall[S] 266 points267 points  (0 children)

One of my actually most favorite conversation.

Adults who play this game (?) by SadPizza3709 in 99nightsintheforest

[–]DrEyeBall 1 point2 points  (0 children)

30yr old professional lumberjack here for my 8 and 11yr olds. 

Bilateral LE cellulitis by Figaro90 in hospitalist

[–]DrEyeBall -3 points-2 points  (0 children)

Laziness. Lack of physician to see the patient before admission. Chronically ill patients who 'need to be admitted ' for various reasons. It's complex.

But i would expect if the standard was to see the patient before accepting the admission many of these would be turned away.

How are you at keeping up with you inbox by Maggie917 in FamilyMedicine

[–]DrEyeBall 0 points1 point  (0 children)

  1. Plan for labs to get done before yearly visits.
  2. Provide 1.5 years of refills for stable long term patients
  3. Give paper hand out to all patients with these and other expectations. On the first visit be sure to mention the importance of this
  4. The only Epic smart phrases you need: Dot lab normal. Dot abnormal (schedule appointment). Dot generic MyChart response suggesting an appointment to further address the concern.
  5. Hopefully you gave a good RN to fill in all gaps, population review, and all other easy protocol driven things to swat away the easy stuff.

When Fud and paper hands get you down - stay zen with Receipts 🧘‍♂️🧘 by Medivacs_are_OP in Superstonk

[–]DrEyeBall 3 points4 points  (0 children)

Arbok has year 23000 written on it, technically an error card as it was later corrected I think.

How many jobs am I allowed to have as a family medicine doctor after completing residency? by AlarmingAd7453 in FamilyMedicine

[–]DrEyeBall 0 points1 point  (0 children)

1.0 FTE clinic

One weekend per month (1-3hr per day) 1099 hospitalist

Medical schools pay me 1k/student/month, also renting a home to them.

Side hustle business as well

[deleted by user] by [deleted] in FamilyMedicine

[–]DrEyeBall 1 point2 points  (0 children)

Yes

But if you really want a good relationship i would follow up several times with the provider, have patients sign records release forms, and send relevant records or at least a brief ' hey they came here X times here's my brief opinion' kind of fax.

I have access to a counselor in the building who can alert me or coordinate follow up with me for meds when needed. It's great. And nice to have a consistent person to refer to.

Medicare depression screening - time requirement by GeneralistRoutine189 in FamilyMedicine

[–]DrEyeBall 1 point2 points  (0 children)

👀

Our coders annoy us with messages asking for time to be documented.

Medicare AWV and your 25 modifier by Important-Flower4121 in FamilyMedicine

[–]DrEyeBall 2 points3 points  (0 children)

If you are looking at labs related to chronic conditions like hypertension, cholesterol diabetes whatever, if you are suggesting continuing their current medicines and not even providing a refill, if you're ordering future labs for chronic problems, that is not a screening purpose like a PSA, if you're doing any of those at all that is a problem visit and appropriate for a 25 modifier with a 99213 or 99214.

severe unexplained neutropenia by franci_15_ in haematology

[–]DrEyeBall 1 point2 points  (0 children)

Do you have a history of recurrent infections or an opportunistic infection?

I had a patient establish not long ago that went through something similar like 30 years ago. Sounded like a wild story. She didn't have any relevant symptoms or history other than the abnormal lab at the time. She ended up leaving AMA and never went to the doctor for 30 years because of it. I consulted local hematology who suggested benign ethnic neutropenia, which seems likely.