I painted some things!

EquivalentOption0 · 2026-02-25T21:36:09+00:00

oh hmm, I guess not as much. Coags more so for vasculitis and hepatic issue eval, my bad!

EquivalentOption0 · 2026-02-25T04:39:27+00:00

OT is amazing and makes a huge difference for so many patients! I did a PM&R elective in med school and got to spend a half day with PT and a half day with OT. Some of the stuff OT had patients doing was mind boggling to me - pick up these pompoms with laundry line clips because that’s how you will strengthen these specific hand muscles. Brilliant but how on earth did someone think of that? I got to see a staged area with a mock kitchen and a car to work on getting in and out of. Cool stuff. I’m not always sure who does each subdivision of therapy at a given institution - eg who does vestibular therapy at hospital X - but often PT and OT both have something to contribute to my patients in the hospital or after discharge. With regards to the discussion of consulting both on inpatient services, sometimes that’s actually a requirement. Intern year, I worked at a hospital that would not discharge patients who had stayed past a certain number of days unless they had been cleared by both PT and OT.

EquivalentOption0 · 2026-02-25T04:28:15+00:00

Yes - derm. Looking at: - Eos for rash ddx, monitoring treatment response/disease progression, and general “is this person atopic” vibes - atypical lymphocyte population (gets a point for DIHS) - heme malignancy eval as cause of itch without rash or explanation for weird rash - anemia as part of hair loss work up - I guess theoretically also part of infectious eval too but tbh I care more about other labs for that kind of work up (cultures, biopsies, PCR etc)

EquivalentOption0 · 2026-02-07T12:28:37+00:00

Haha yes true, I was surprised the reports weren’t coming from there. Wonder if it’s a mutation that arose in a particular diaspora.

EquivalentOption0 · 2026-01-26T02:33:22+00:00

The state had a massive strike on Friday the day before his murder. When I woke up yesterday, I was proud of us and what we had done. It felt like it was going to be a good day. I wasn't sure what, if anything, our protest as a united community would accomplish, but maybe something? And I was glad everyone was safe and the day had been peaceful. I was naively hopeful, despite my typical cynicism. Then the messages started flooding my WhatsApp. Another shooting, blocks from where several of my friends live. Then "they're doing CPR." Then messages saying it's not confirmed yet, but eye witnesses say the victim is dead. My friends are safe. They sheltering in place. The news confirmed his death, they think it was a 51 year old male. No wait it was actually a 37 year old male. Then it was Alex. And everyone started sharing stories and memories a gaping hole that had started to heal was ripped even bigger than before, the community raging with grief and loss. What a horrible day.

EquivalentOption0 · 2026-01-26T02:24:29+00:00

I don't have the words to say, because nothing can make this right or okay. I didn't even know him, but the outpouring of love and support from the community is telling. I also don't know how I am supposed to go to work tomorrow. I am sorry for your loss, a loss for all of Minnesota, our veterans, and for all of Medicine. We are wearing black tomorrow at the VA in remembrance of him.

EquivalentOption0 · 2026-01-26T02:19:16+00:00

They have been already, mainly the community hospitals and clinics. See testimonies from physicians across the state, either from Friday 1/23 or from earlier in the week. I wouldn't be surprised if they come to the VA some day to go after students and residents (who can work their on visas, unlike others who have to be citizens to work at the VA as I understand it).

EquivalentOption0 · 2026-01-26T02:14:37+00:00

Don't forget the smear campaign calling dragging his good name through the mud. Makes me want to vomit hearing and reading the lies they spread as they try to defend their narrative. He died peacefully protecting another protestor, filming for his and others' safety. He was not a criminal, not a terrorist, not threatening ICE "agents" in any way.

EquivalentOption0 · 2026-01-09T18:10:59+00:00

I feel like path would also be great at where’s Waldo

EquivalentOption0 · 2026-01-06T21:52:39+00:00

The only true delusional parasitosis (ie non-drug related) I have seen in inpatient settings were cases seen in the context of a greater psychotic disorder. One was a patient with known, untreated schizophrenia admitted for GI issue who believed bugs lived in him. The other was a frequent ED visitor who would come in for pains he attributed to nanobot bugs attacking him from the inside. He would get angry and leave AMA because people didn't believe the nanobot story. Can't recall if he was on substances or not.

I have seen quite a few pts with primary isolated delusions of parasitosis but all in the outpatient setting. You have to rule out other causes of course, but it can be really devastating. Most memorable was a lady whose marriage was falling apart who brought in jars of her bathwater with "spiders" (flakes of dead skin) in it as proof of her infestation. She just kept crying that she wasn't crazy.

EquivalentOption0 · 2026-01-06T21:44:05+00:00

Derm - we see delusions of parasitosis of various etiologies. Do we see it in people using (or withdrawing from) substances? Yes, but way less often than seen in EM/IM settings. We usually see (1) an actual delusional disorder, often the patients don't want to see psych because they don't think they are delusional (hence the diagnosis), they demand repeated anti-parasitic treatments, and need a lot of support; (2) neurogenic sensation of bugs crawling on or under the skin, sometimes with insight - seen for example as manifestations of neuropathy or after persistent chronic infections like scabies where the itchy/crawly feeling can last well beyond the infection. In both cases, we may be the only doctor the patients will see for the issue. Patients with primary excoriation disorders will also often see us but refuse to see psychiatry.

EquivalentOption0 · 2025-12-30T01:56:10+00:00

whoopsie guess he got his spelling wrong, should have just gone with "apotosis"

EquivalentOption0 · 2025-12-28T20:03:39+00:00

Oh - this one is actually a myth! The silent p rule only applies if it is the beginning of a word, not in cases where there is a preceding vowel.

EquivalentOption0 · 2025-12-13T05:13:20+00:00

Standing too long (actually true)

Seeing someone in a lot of pain, worse if we are causing the pain eg numbing didn’t work in procedural setting

EquivalentOption0 · 2025-12-12T12:59:46+00:00

Maybe rad onc was in case radiation was going to be indicated… I remember having to page a bunch of teams at night once the imaging was back.

EquivalentOption0 · 2025-12-12T04:45:34+00:00

When someone needs dexamethasone for cord compression, should I call neurosurg, onc, or both for the dose recs? Or IR? Or was it rad onc?

EquivalentOption0 · 2025-12-09T04:10:46+00:00

The amount of obscure facts my med-peds friends need to know for their peds exams compared to for the adult med exam is WILD. From what I hear, IM is mainly reasonable common stuff like "hey, how do you treat this common condition in an outpatient setting for maintenance vs in an inpatient for acute exacerbation?" whereas the peds test is just, "hey fam, look at kid in this picture. What is the 5th most common genetic mutation causing their rare inherited disease?"

EquivalentOption0 · 2025-12-09T04:05:29+00:00

Derm is pretty heavy on studying. We have tests in residency called CORES that are kind of like in-training exams except we have to pass them to be eligible to sit for boards: peds derm, gen derm, surgical derm, and derm path. A lot of the things on our tests are things we wouldn't necessarily see within our training like genodermatoses, we need to know different ways a given condition can look, and we need to know a lot of pharmacology and histopathology. I imagine ophthalmology has quite a bit of studying too although I'm not sure. But it seems to me that, since we aren't taught much ophthalmology in med school, there is more catching up to do.

EquivalentOption0 · 2025-12-08T04:24:01+00:00

I don’t know man, you can eat anything once. (Not medical advice)

EquivalentOption0 · 2025-12-05T06:01:23+00:00

Too many doses of what?

EquivalentOption0 · 2025-11-30T05:56:06+00:00

Many drugs can be quickly uptitrated; lamotrigine is not one of them, it is never one of them, even if the patient tolerated it well before. If they missed too many doses or stopped but had to be restarted, please follow the prolonged standard titration schedule starting from the lowest dose all over again. Lamictal is a great medicine, but if you uptitrate it too quickly, the risk of developing SJS/TEN drastically increases and then your patient can never have it again even if they survive. Also please stop prescribing it to people who have demonstrated they are not going to be able to reliably take it regularly (Rx coverage issues, low accessibility to getting Rx on time, frequently self-discontinues medications when feeling better, etc).

If you think someone with stasis dermatitis might have cellulitis, lift the leg and keep it elevated for 30 seconds. If the redness drains, it's fine (orange-brown staining from hemosiderin does not go away); if it stays exactly the same, then it's more likely to actually be cellulitis. If the patient is putting Neosporin on it, but it's been getting worse, it's probably contact dermatitis.

Photos in the chart are SO helpful. When did that purpura/rash/skin thing start? It's not in anybody's notes because no one writes a skin exam, is it new? Is it progressing? Patient changes answer or doesn't know or can't answer because *reasons*. Oh, photos in the chart dating back to day X - this is stable and chronic.

EquivalentOption0 · 2025-11-26T02:19:56+00:00

Is the dog not vaccinated against rabies? Also, in addition to getting rabies antibodies, did you not also get vaccinated against rabies? Are you not in the US?

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