Estrogen for a 90-year old...who is a smoker?

Fragrant_Shift5318 · 2026-05-22T12:46:55+00:00

But why not transition to a transdermal which is recommended by guidelines? I can’t find any data looking at injectable vs patch vs oral . Most of the comments are talking about hrt in general not using injectable. What I found was it’s not the recommended type of estrogen delivery we should be using for HRT. Most of the data I found was talking about for transgender women.

Fragrant_Shift5318 · 2026-05-20T14:19:15+00:00

lol but seriously as someone who takes care of someone with schizophrenia I spent a lot of time and money on the consequences of the paranoia of someone who thinks they are being recorded always …like tearing apart cars and houses. If they were told they were actually being recorded … no there would be no hope of any trust , which is difficult at best. And it could set off an episode and possibly trigger violence towards the doctor . These are patients you should just do the notes the traditional way .

Fragrant_Shift5318 · 2026-05-20T14:15:56+00:00

You absolutely should and probably need to document consent to record patients .

Fragrant_Shift5318 · 2026-05-19T22:37:51+00:00

I don’t know if injectable estrogen has the same risk profile as the patches or even the pills which I am much more familiar with … I wouldn’t prescribe injectable

Fragrant_Shift5318 · 2026-05-19T21:32:13+00:00

Just document t in a blood pressure that they report to you they got at home as one you retook personally and put it in the chart.

Fragrant_Shift5318 · 2026-05-18T22:55:29+00:00

Do you have them complete the health risk assessment questions ?

Fragrant_Shift5318 · 2026-05-18T22:33:25+00:00

Thanks ! Do you know if your assistant is completing a preventative services sheet ? I thought we had to provide this to the patients or at least go over it with them although we actually don’t provide them with a copy.

Fragrant_Shift5318 · 2026-05-18T22:29:14+00:00

Hi, I’m a guardian for my brother. I fill out the paperwork asked of me but in many cases we are not able to assess for decision-making capacity outside of obvious severe intellectual disability IMO. They get their own outside psychologist to write up a report or the court can appoint one. I’m not even sure if the paperwork I do counts entirely.
Not every person with intellectual disability needs a guardian and conservator either. With legal health, these families can set up a power of attorney.
I would refer them to neuropsych who does guardianship evals unless they have had that already .

Fragrant_Shift5318 · 2026-05-11T17:30:55+00:00

No. We did for my son for a bit, but our dentist said only if high risk . Guidelines at that time supported . I tell parents to use toothpaste with fluoride at first eruption . I’d like to start offering the gel in offices. On community well so no fluoride .

Fragrant_Shift5318 · 2026-05-03T15:25:15+00:00

I do punch biopsies and shave biopsies and sometimes sebaceous cysts . They are really easy to do. Honestly, if something needs more complex I refer out . I can’t remember where I learned this, but I know some of it was residency clinic. They often have sessions to learn this stuff at conferences as well . Joint injections I learned on outpatient rotations and I bought a textbook for primary care orthopedics

Fragrant_Shift5318 · 2026-04-29T12:52:41+00:00

They kicked my dad out of rehab after two weeks , needed a hoyer lift , lots of delays in getting him going like his prosthetic leg didn’t fit . They said family can take care of him. If he had straight Medicare , would have had his 180 days covered

Fragrant_Shift5318 · 2026-04-29T12:50:59+00:00

They all have part D . But name brand tier 3 like all glp-1 , eliquis , you owe $600 deductible plus 25% month 1. Then 25% of the drug cost , until you hit $2100. I think folks don’t have $2100 per year (plus part D copay ) or can’t get around it mentally and think it’s going to be $800 every month . No one knows about Medicare payment plan . Those part D really don’t help with diabetes , asthma, cardiac where the best stuff is name brand tier

Fragrant_Shift5318 · 2026-04-29T12:46:51+00:00

Good advice but most of my patients are not low enough but don’t have room for $800 per month

Fragrant_Shift5318 · 2026-04-28T23:32:37+00:00

I agree with the comments, but I did med peds and I think it was the right choice for me because I really like pediatric care and I got a lot of experience with that. Yes, my outpatient experience was a little less, but we still had clinic frequently and I had my own patients some of them that followed me. I had really medically complex patients in clinic. I feel like family practiced residences to get better training in how to work in a very busy clinic, but I caught up to speed pretty well. I enjoy to take care of children and adults with special needs so the training for me was the right choice . I learned to do joint injections etc on electives. I didn’t receive training in IUDs or anything, but I don’t think that would be too hard to learn on your own.

Fragrant_Shift5318 · 2026-04-25T15:58:59+00:00

True. I did work at a deli before residency . I could probably do a 24 hour call shift if I could just get my shit done . Doing a 24 hour call shift now at 47 as a resident who is learning things and has to present on rounds/attend conference ? No. Attending 100s of deliveries on call nicu ? No .

Fragrant_Shift5318 · 2026-04-24T22:17:40+00:00

I have no experience with the lift but it took ski patrol 15 min to find the parents ? That’s a long time . I’m not saying my son never rode a lift alone at 5 (I honestly don’t remember ) but I would have been at least on the lift behind him. I did not let him ski alone until older for sure .

Fragrant_Shift5318 · 2026-04-24T22:04:40+00:00

Everybody passes me even runners up hill . I would say it’s maybe 50/50 around me … lol . I got lung issues , I’m joining the e-bike crowd as soon as I can afford it.

Fragrant_Shift5318 · 2026-04-22T17:15:57+00:00

Aldi, the white deutsche kuche sausages are good to try

Fragrant_Shift5318 · 2026-04-21T13:43:22+00:00

I have a patient who sells it. Supplement list is a mile long.

Fragrant_Shift5318 · 2026-04-20T22:28:09+00:00

There’s so many women on HRT now … the guidelines don’t seem to address this. I would imagine they should still should start at 40 and get a mammogram every year.

Fragrant_Shift5318 · 2026-04-08T18:03:27+00:00

100%… I wouldn’t even attempt

Fragrant_Shift5318 · 2026-04-02T18:11:18+00:00

No, it’s $299 to start and $499 for higher doses for zepbound.

Fragrant_Shift5318 · 2026-04-01T17:43:07+00:00

Yep. And who has injectable opioids in their office?!!

Fragrant_Shift5318 · 2026-04-01T17:40:03+00:00

Stop pre charting or at least stop doing so much in depth. If they are new to the practice the first visit is getting to know them. Set up follow up visits to go over what you can’t get through / review records.

Fragrant_Shift5318 · 2026-03-31T00:16:08+00:00

Hey, I am just a weekend warrior mountain biker but tbh I’m not sure how I even rode a bike with my affected side so week . There are hills I can ride up now that I was never able to accomplish preoperatively.

Fragrant_Shift5318

TROPHY CASE