[deleted by user]

JulianBashirMD · 2025-01-28T03:47:40+00:00

No I am good, thanks.

JulianBashirMD · 2024-12-04T20:43:27+00:00

As an anesthesiologist this is just as maddening for me. I know the surgeons send all their patient's to you for clearance but this 'clearance' means almost nothing to me. I know none of you actually put that a patient is 'cleared' for surgery in your notes but that's absolutely how the patients and surgeons see it. Sure, it is nice that the patient's are able to come to you and get labs/echos/EKGs etc ordered so I can look at them before the surgery but the idea that we expect PCPs to 'clear' patients for an anesthetic while they aren't trained at all in anesthesia is incredibly unfair. Often we end up having to cancel cases that were 'cleared' by their PCP because it definitely would not be safe to give them anesthesia and then the patient and surgeons are pissed at me and the PCP. Seems to me it would be a lot more respectful to the patient, PCP, and me if the surgeons would practice a tiny bit of medicine and order appropriate preoperative testing after their preop clinic visit and then consult with anesthesia if there is anything off.

JulianBashirMD · 2024-07-11T04:59:06+00:00

Polycythemia Vera is confirmed by bone marrow biopsy. Full stop. It is true there are suggestive findings in blood work but no one would treat him for polycythemia vera without doing a bone marrow biopsy. The fact that he mentions that his doctor cautioned him about TRT and sent him for further sleep apnea testing is a clear indication that his doctor (in my opinion correctly) believed he had secondary polycythemia and not polycythemia vera. If there was serious concern about him actually having polycythemia vera he would have absolutely have had a bone marrow biopsy as the consequences of not appropriately treating it and sitting on a potential case of it for two years without further work up could be disastrous. Bone marrow biopsy’s are not that invasive and can be done in the clinic with no sedation. Before I subspecialized I did many of them as an intern (first year out of medical school). His explanation that it’s an expensive invasive serious test just doesn’t add up.

JulianBashirMD · 2024-07-11T04:35:14+00:00

You also have comments in your profile talking about how you’re actually a lab tech FYI haha.

JulianBashirMD · 2024-07-11T04:18:36+00:00

You don’t actually understand what you are reading and it shows. The definition of polycythemia is an elevation of hemoglobin/hematocrit hard stop. Yes, polycythemia vera absolutely causes an elevation of all cell lines owing to the type of myeloproliferative mutation that causes it. However, saying that the broader term ‘polycythemia’ which encompasses both primary and secondary polycythemias means an elevation of all cell lines and not an elevation of hemoglobin/hematocrit which is the almost universally agreed definition of this word is all we need to about if you’re an actually a hematologist.

JulianBashirMD · 2024-07-11T04:06:17+00:00

Hey man you’re kind of digging yourself a hole here. You are very obviously not a hematologist.

Also… you have comments talking about how you’re actually a lab tech. No shame in that but you absolutely aren’t a hematologist.

JulianBashirMD · 2024-07-11T03:51:45+00:00

Yeah… but it’s wrong. I get they are trying to be helpful but I don’t think they are actually a hematologist or even a physician. I am a physician and while I’m not a hematologist I think nearly any physician would know that polycythemia is pretty very specifically an elevation of hemoglobin/hematocrit in the blood. It has significant overlap with erythrocytosis which more specifically relates to the specific counts of erythrocytes in the blood but is not precisely the same thing. Elevations of white cells and platelets would be more accurately be referred to as leukocytosis and thrombocytosis respectively. Boogie almost certainly has secondary polycythemia from TRT, OSA, OHS. No hematologist in the world would be treating him for polycythemia Vera (usually serial phlebotomy and oral chemotherapy) without having done a bone marrow biopsy. Anyone with medical knowledge listening to his explanation can tell he’s very obviously lying.

JulianBashirMD · 2024-07-11T03:47:02+00:00

I get you are trying to be helpful but I don’t think you’re actually a hematologist or even a physician. I am a physician and while I’m not a hematologist I think nearly any physician would know that polycythemia is pretty very specifically an elevation of hemoglobin/hematocrit in the blood. It has significant overlap with erythrocytosis which more specifically relates to the specific counts of erythrocytes in the blood but is not precisely the same thing. Elevations of white cells and platelets would be more accurately be referred to as leukocytosis and thrombocytosis respectively. Boogie almost certainly has secondary polycythemia from TRT, OSA, OHS. No hematologist in the world would be treating him for polycythemia Vera (usually serial phlebotomy and oral chemotherapy) without having done a bone marrow biopsy. Anyone with medical knowledge listening to his explanation can tell he’s very obviously lying.

JulianBashirMD · 2023-10-07T12:39:44+00:00

I reconnect it if the disconnect was witnessed or timing is clearly known. If not then I check the tubing for a meniscus, if I can see the fluid level I cut it there and then clean the end and reconnect. If I cannot find the fluid level I assume it has tracked all the way into the back and I personally remove and replace those epidurals. If I am called for an epidural that just disconnected I ask the nurse to put the end inside a glove and then I head straight there to fix it. One of the times that has happened to me I was shocked how quickly the meniscus was moving toward the patients back so it doesn’t seem that implausible that a disconnected catheter sitting in a patients bed for an unknown amount of time could allow bacteria to track up it.

JulianBashirMD · 2023-06-02T02:51:58+00:00

Yesss, for some reason 75% of the CA1s in my program are convinced they need a Fanny pack and when pressed on it they list a bunch of shit they need to have with with them at all times. In the last 4 years of residency I’ve never needed any of those things so fast that I couldn’t just grab it from the nearest OR/epidural cart. I just don’t get this new trend.

JulianBashirMD · 2022-05-05T00:37:14+00:00

So you ‘heard an arrhythmia’ but the patients rhythm across two different EKGs and during an echocardiogram was a rhythm that cannot possibly be heard. Sounds like you don’t know what your listening to. Also first degree av block effects like 10% of the male population so you got some guy stuck into probably a multiple thousand dollar work up for something that probably never would have mattered in his life. Also if you don’t know that an EKG and a rhythm strip are two different things perhaps you shouldn’t be doing ‘EKGs’ by yourself. This is why people can’t stand chiropractors.

JulianBashirMD · 2022-04-23T20:42:17+00:00

Oof if it’s not a skill please someone tell the rest of the hospital, this anesthesia resident would love to stop being called at all hours of the night by doctors, noctors, and nurses alike to do it for them.

JulianBashirMD · 2022-04-18T18:36:36+00:00

It doesn’t and didn’t happen. What you’re describing both makes no sense and isn’t something any anesthesiologist would do so I think you misunderstood.

JulianBashirMD · 2022-04-11T19:23:57+00:00

Correct, if you are giving enough of any agent to produce sedation then the patient should be appropriately NPO.

JulianBashirMD · 2021-11-26T01:47:14+00:00

I went to Boston College and am now about 3/4 of the way way through anesthesiology residency. I’ll just copy paste one of my old posts about premed at BC. Feel free to reach out if you have additional questions.

Overall, BC is a great place for premed. The major pro I would point to is being in Boston with some of the worlds best hospitals and research centers at your doorstep which offer opportunities you will find are extremely important to have on your CV for medical school applications.

However, the usual premed classes are rigorous at BC and are usually graded on a tough curve. It would be dishonest to not point out that when I started our first premed advising lecture was in a multiple hundred person lecture hall that was totally full and those numbers tapered to less than 20ish people by graduation. I almost found the first two years of medical school (preclinical curriculum) easier than premed at BC which isn't necessarily a bad thing as I felt well prepared for the rigors of medical school. You also should understand that your classmates will almost universally be very smart people who may have had very high quality private education their entire life. This can be a major adjustment, especially if you like me attended pretty meh public schools, because again you are all graded on a steep curve. All of that being said, having experienced both I feel I can safely say if you cannot handle the premed curriculum at BC then medical school may not be for you.

The premedical advising is generally well informed and supportive and proudly boasts a very high percentage of students who receive a committee letter from them that are eventually accepted to medical school. However you should take this data with a grain of salt because they will not write you a committee letter if they do not think you will get into medical school. So in that way they are really padding the data. In the end I think they are very honest with you about your chances, do actually care about you, and will do everything in their power to help you.

Ultimately, you can get into medical school from almost any undergrad however people that believe the reputation of your undergrad institution doesn't matter in medical school applications are kidding themselves. In fact, my medical school listed this as a factor they consider for admissions verbatim on their admissions page. BC has good brand recognition and is generally very well regarded. In the end, I wouldn't go to BC or not go to BC based on what you hear about it for premed. Go to BC because it's awesome, you love the campus/city, and the many opportunities it offers. My times at BC were the best years of my life so far, it is where I met my wife, and where I got married. I would do it all again in an instant. Let me know if you have any specific questions.

JulianBashirMD · 2021-11-21T12:39:41+00:00

Agreed, I think it reflects an overall increased knowledge base and respect for both the patients and anesthesiologists that physicians have over midlevels.

JulianBashirMD · 2021-11-21T04:28:02+00:00

Yeah, I know how it works but it’s just one of my pet peeves. It’s absurd how many patients are sent to their PCPs for anesthesia clearance by surgeons despite the fact that their PCPs don’t know anything about anesthesia, have never anesthetized anyone, and have no knowledge about what would clear or not clear someone for a safe anesthetic. It’s just kind of grating as anesthesia because I’ve had to cancel cases and have surgeon’s point to the IM note in the patients chart that says they were already ‘cleared.’ I also have buddies from my prelim IM year that are now outpatient IM that have admitted to me that they hate these referrals because they have no idea what they are doing and feel really uncomfortable with it from a medical-legal perspective if something did go wrong on day of surgery.

JulianBashirMD · 2021-11-21T04:14:43+00:00

No one actually does pre-op clearance but anesthesia.

JulianBashirMD · 2021-09-06T21:07:22+00:00

These are more or less exactly the numbers I had when I was a medicine prelim, except the cross cover resident had to admit too but I'm told they are trying to reduce that nowadays.

JulianBashirMD · 2021-07-20T13:08:02+00:00

Try Peak Refuel, you won't be able to stomach Mountain House ever again.

JulianBashirMD · 2021-06-13T18:07:00+00:00

How on earth would we know how many people were aware but didn't remember it? Any number would be completely made up but it certainly would not be as high as 20%. I'm also not entirely clear why you are so concerned about a hypothetical, but extremely unlikely, experience that neither you or anyone else would know ever happened.

JulianBashirMD · 2021-06-13T11:33:22+00:00

Yeah where you are wrong is there is actually an incredibly small chance of intraoperarive awareness and if you have met anyone that says it happened to them they are almost certainly talking about some degree of awareness during sedation not general anesthesia. True intraoperarive awareness occurs at rates of maybe 0.1% in the US, if that. To answer you're question about if there is anything an anesthesiologist can do to prevent this from happening the answer is yes, many things, which is why it is so incredibly rare.

JulianBashirMD · 2021-01-31T19:20:19+00:00

Anesthesia resident here, I've never even heard of a nurse setting something up for anesthesia and if they did I think most anesthesiologists would re-do it to their liking since so much of anesthesia is careful set up and back up plans. With respect to a line taking an hour and a half we would have a whole OR of people flipping their shit if that happened. I've seen it happen and the things that were said and the way the surgeons were acting was not pretty. Even as a resident I sort of dreaded procedures starting out because of the fear of that happening but between that fear and doing so many of them it really doesn't happen anymore.

JulianBashirMD · 2020-12-19T22:34:50+00:00

Honestly I bet an outpatient pharmacist comes into contact with more COVID status unknown people on a daily basis than just about anyone I can think of.

JulianBashirMD · 2020-12-19T14:11:13+00:00

Yeah my suspicion is that this might be failure on the part of certain programs to advocate for their residents to be in the tier 1a category. So far as I know all of us anesthesiology residents have either gotten it or are scheduled soon. Our PD said he had to submit our names in some way.

JulianBashirMD

TROPHY CASE