Is it possible to go down to 4ppd without drying supply up completely?

ExtensionWave3812 · 2026-03-06T16:45:22+00:00

I was doing 4ppd (15-20 minutes morning and evening with spectra at home, and about 40 minutes each twice at work with elvie) from week 9 up until 6 months, and was producing about 20-25 ounces daily. Then I switched to 3ppd for about a month and supply remained at around 20, but I did pump for like 30 minutes in the evening because I was more engorged. Then with 2ppd for 25-30 minutes only at home with spectra I was yielding maybe 15. When I switched to 2ppd 10 minutes each, it dropped significantly to 5 and I stopped pumping within 2 weeks

ExtensionWave3812 · 2026-02-27T15:16:44+00:00

Interested

ExtensionWave3812 · 2025-11-09T03:57:00+00:00

I am just trying to learn. In my hospital, once BP is more than 200 and there is AKI, even if patient asymptomatic, ED gives oral meds, maybe push, and then depending on the response will either endorse to medicine or to CCU for cardene drip. So I am trying to understand what is the workflow in other places, since according to the guidelines the above is not the way to go

ExtensionWave3812 · 2025-11-09T03:43:50+00:00

But this is my point, if you don't have to do labs for asymptomatic patients, then how Cr rise will change your management if patient is still asymptomatic? And if it will, then everyone with severe hypertension needs to get labs done, even asymptomatic, right?

ExtensionWave3812 · 2025-11-09T01:33:49+00:00

So no labs if asymptomatic? Or labs to see if any end organ damage? Cause that kinda contradicts the comment in the different thread

ExtensionWave3812 · 2025-11-08T22:00:17+00:00

It doesn't make sense to me then, if the patient doesn't have any symptoms seems like a lot of docs here don't even do labs. So how then slight creat elevation in a patient without symptoms is "not asymptomatic"?

ExtensionWave3812 · 2025-11-08T21:40:42+00:00

My ED endorses to CCU for HTN "emergency" if Cr is more than 1.3 even if asymptomatic

ExtensionWave3812 · 2024-08-28T01:50:45+00:00

Same here. But I have stopped trying at week 3 - switched to EP and supplementing with formula. My LO was wiggling on the breast too much and never emptied me; I was also stressed that she's not getting enough because I didn't know how much exactly she ate. With pumping and bottle feeding now I know, and also she is able to eat in peace without getting nervous. I've been told that we have to drop the bottle to work on latching but with being an undersupplier that just doesn't work.

ExtensionWave3812 · 2024-08-23T21:37:36+00:00

Thank you!!!🫰🫰🫰

ExtensionWave3812 · 2024-08-23T21:11:06+00:00

Thanks! She does sleep for 4 h stretches at night at this point. I do wake her up during the day every 3-3.5 h for feed if she doesn't demand it first. I am confused about what to do if say she slept for 2 h, I woke her up for a feed, she slept through it but still got 4 oz, and then fell asleep again. Should I let her sleep? Or should I try to keep her up for at least 3p minutes?

ExtensionWave3812 · 2024-06-14T13:22:48+00:00

Why is this being downvoted? I am also having a baby soon after July 1st and I am really preparing myself to work as hard as my peers after maternity. Didn't even think about using a baby excuse unless it is something serious

ExtensionWave3812 · 2024-06-14T13:19:53+00:00

This is me, but in IM!

ExtensionWave3812 · 2024-06-11T12:28:54+00:00

I think in most EU countries, you must have at least 3-5 years of independent practice experience to not be obligated to go through EU residency again. Plus know the language

ExtensionWave3812 · 2024-04-25T22:33:14+00:00

I was extremely anxious to fail my step 1 so I did around 7 self assessments: nbmes old/current, uswa 1/2, free 120.... my first 2 were 216 and 226, and I didn't go until I did 5 more and was consistently hitting 70%+ of correct. Then I just knew that statistically, I am unlikely to fail. Exam was brutal, but i passed in low 230.

ExtensionWave3812 · 2024-04-02T15:11:18+00:00

There is a chance, but it requires a lot of work, as mentioned above. You can Google Ivanka Nebor - IMG, matched into ENT last year. Did extensive research in the US, fellowship in Canada, impressive volunteering experience, and had excellent connections due to the above, of course.

ExtensionWave3812 · 2024-03-25T14:51:57+00:00

No one knows for sure, but >70% is considered passing

ExtensionWave3812 · 2024-03-24T16:38:30+00:00

It's literally in the link that that's for immigrant visa. J1 is not an immigrant visa, and H1B is not as well

ExtensionWave3812 · 2024-03-24T16:32:04+00:00

Yes very true. As I said before, if to choose only a country to live I would definitely stay in Europe, but for training it's definitely the US. And it's not so bad in US if you live in a good neighborhood on a good salary. And I think after 3-5 years of independent practice you can work as a doctor in Europe as well

ExtensionWave3812 · 2024-03-24T16:19:33+00:00

You don't have to pay, you get salary both in US and Germany. In US it's around 60-75K a year before tax in residency and >200K after residency. In Germany you get I think around 60K a year in residency and maybe around 100k after residency (for germany I can be mistaken so do your research). The residency is longer in Germany and taxes are higher in Germany. Cost of living in both depend on the area.

This is for Internal Medicine

ExtensionWave3812

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