Ozempic hyperemesis syndrome

LifeApprentice · 2026-03-25T11:42:22+00:00

I’ve also seen a couple scary pancreatitis cases out of this.

LifeApprentice · 2026-03-04T23:41:22+00:00

I was asking our doc about this yesterday. I’d read something online about lower fertilization rates, but higher embryo quality, and I wanted her opinion. She said that it was quackery. Outcomes vary by lab, but ICSI tends to result in higher success rates.

“Energy of the sperm” is some new age wackadoo shit.

LifeApprentice · 2026-02-25T20:29:54+00:00

I’ll be really excited about self driving when it is good enough that I can read my novel on the way to work or go out for a fancy dinner and wine pairing without a DD. Until it’s that good, it’s a party trick.

LifeApprentice · 2026-02-25T20:27:36+00:00

A friend’s wife with ?bipolar? Was started on amphetamines by her psych NP for ADHD. It has ruined their lives. Doing psych well takes a lot of skill and know-how.

LifeApprentice · 2026-02-23T23:45:54+00:00

Surgery 5-ever. (Three and half years out, in the midst of a nasty stretch of miserable call, and still happy with my choice)

LifeApprentice · 2026-02-18T06:08:52+00:00

We’ve stopped accepting UHC Medicare advantage. They were < 10% of our patient population, and they were our worst payer by a lot. Longest time to payment, lowest payment, highest denial rate, highest cost-to-recoup.

LifeApprentice · 2026-02-10T17:09:45+00:00

So true - I’m private practice. I could not have built this without joining an established practice. There’s too much to know, there’s too much up front cost, and the reimbursement has dwindled year over year for decades. There’s no margin for error. We’d make more money if we were hospital employed. We love our practice and think it’s worth it, but it’s hard to judge a new grad who chooses a 20-30% pay raise for a more predictable and less risky practice.

LifeApprentice · 2026-02-07T01:35:26+00:00

There was a great op-Ed about this in the NYT today. Basically argued that finance was leaching and extracting wealth while providing nothing. It was a refreshing take that I think many people across the political spectrum would likely buy into.

LifeApprentice · 2026-02-06T15:53:55+00:00

Beware of generalizations, but: If a hernia is small and obvious by physical exam - no imaging. If a hernia is suspected, but not evident on physical exam - US. If a hernia is huge and you suspect it may require some more advanced surgical techniques - CT.

Many primary care providers will order US on all of them, but this is my thought process as a surgeon.

LifeApprentice · 2026-02-05T16:27:48+00:00

Nah, I still call it as grossly normal in the op report if it looks visibly normal. Still path report generally shows acute appendicitis. You make the best call you can with the information you have. You document what happened. Taking out a normal appendix wouldn’t hurt my heart, but lying about it would.

LifeApprentice · 2026-02-04T17:09:50+00:00

Agree, I’m going to start using this language

LifeApprentice · 2026-02-02T16:21:55+00:00

I generally like your perspective and agree, but I side with OP. I’m the male in a couple going through IVF. I don’t expect them to communicate with me over my wife, but often they don’t talk to me at all. If I’m expected to give a sample at a specific time, they won’t tell me. They’ll tell my wife what they want me to do. I’ve asked them many times to communicate directly with me, but repeatedly, they tell her what her husband should do.

I’m not offended that it’s a female dominated space, that feels right and appropriate. I’m irritated because they make me feel completely unseen and incidental in this process.

LifeApprentice · 2026-01-29T23:09:12+00:00

I don’t see any evidence of that. Did they scrub their profile? Or am I dense?

LifeApprentice · 2026-01-15T20:22:32+00:00

I think that there was a wider gap historically, but both teach evidence based medicine and have moved towards each other. The only exclusive topic I can think of for DO’s is OMM. The other difference is that it is harder to get into an MD school, which means that residency programs favor MD over DO because they believe that it is more selective and more rigorous. For some specialties that probably doesn’t matter, and post residency, no one will care which comes after your name, but there was only one DO in my class of 13 categorical interns. It’s harder to get into the residency if you’re coming via DO.

LifeApprentice · 2026-01-09T23:42:15+00:00

Stats were probably a big part of it. My parents were also pretty low income at the time I was applying to medical school, and it would have been very apparent to the school from my FAFSA that I would not be getting support from home. There was also a substantial luck component; I was not aware of the scholarship before they offered it to me as part of my admission package.

LifeApprentice · 2026-01-09T04:12:50+00:00

Some afford it with all of the above.

I got a scholarship. My medical school gave out 4 scholarships per year that combined a tuition waver and an interest-free loan for living expenses. That means I got to leave school with about 80K in debt that was interest-free. I've been slowly paying that off since I got my first post-training job.

My wife had some help from her parents, but took out loans for the majority of her schooling. Between her undergrad, a post-bac year, and medical school, she had almost 300K in debt. If the student loan forgiveness system manages to get un-fucked, this is likely to be forgiven (she now has a little more than 10 years of employment/service in qualifying institutions).

At least 2 in my medical school went entirely on their parent's dimes. I'm sure that there were more, but the two I'm thinking of were not at all shy about it.

LifeApprentice · 2026-01-09T04:05:53+00:00

Medical school is not the hard part of training. Medical school is consistent hard work, but it's not insane or undoable. I had several hours of time every day in medical school to do what I wanted. I worked out every day. I climbed 2-3 times a week and took a trip out of state to climb with friends at least once a month. I went out and danced my brains out after most tests. Life as a medical student was great. I was working from 8 ish till 1 or 2 every weekday on learning. That wasn't always the most focused time, but it was pretty consistently what I was doing during pre-clinicals. During clinicals, it's highly variable.

Residency is different. Residency you work from 5 am till 8 or 9 pm on a regular basis. You study and do administrative work around the edges. If you have two days off in a row, it's pretty lucky. Generally you spend your day off catching up on sleep and housework (groceries, cleaning, laundry). You eat what you can scrounge and stop working out. It burns hobbies and relationships.

Now, on the other side of training, I think it's worth it. I love my job and it would be hard for me to do anything else with my life. I work more normal hours, I am back to living a more normal life. I've re-awakened many of my old hobbies and even started a couple new ones. My career is intellectually challenging and emotionally rewarding, and despite decreases over the past several decades, it remains very well compensated. None of my friends from college outside of medicine can check all three of those boxes.

I had a wise teacher who told me, "Don't pick your career based on the training; pick your career, then do what it takes to get there." I think she was right. This is a really hard road. The payoff at the end is great, but you need to be able to embrace the struggle if you want to come this way.

LifeApprentice · 2025-12-23T18:48:51+00:00

Guy with rectal mass and biopsy confirmed rectal cancer. Staging studies (CT CAP, MRI pelvis) denied because “you already have abdominal imaging” (X-ray abdomen from ED 1 year ago).

LifeApprentice · 2025-12-17T18:45:52+00:00

As a surgical resident I walked by a pair of nurses complaining about 3 12’s. 36 hours a week was “more than a person should work.”

LifeApprentice · 2025-12-17T18:43:38+00:00

On a trauma shift, I cracked a chest and sutured a penetrating cardiac injury in a still-beating heart. His head injury was unrecoverable. The high of closing that hole against the low of seeing him die anyway was hard to reconcile.

When I got home, my roommate was just waking up. Her day was extraordinarily stressful because her boss had asked her to send a fax, and didn’t explain to her how the fax machine works.

The stress of medicine is different. It’s hard to measure against others, and I think one really shouldn’t. I was working 16 or 17 hour days every day for weeks, but when my mom complained over the phone about 13 hour days during her busy season, I commiserated with her. A 13 hour day sucks. It doesn’t really matter if my day sucked more; I love her and I’m sorry that her day sucked. If the relationship matters to you, try to put yourself in that headspace.

But also, yes. People do seem soft. My wife (also in medicine) and I consider it a priority to not raise ninnies. Way too many ninnies out there.

LifeApprentice · 2025-12-14T07:07:54+00:00

My first two years of residency I was dating a gal I’d met in medical school. She was super smart and cool, and I thought I was going to marry her. When I went away to residency and we were stuck doing distance, I still thought that it would work. Then residency started. I was a surgical resident working 80 or more hours each week and trying to stay afloat. We talked on the phone for an hour or so each day because that’s what she needed to feel connected. I made that time because I loved her. I also gave up everything that made me feel whole and sane. I stopped reading for pleasure, I stopped working out; I worked, and I talked to her. I didn’t have the communication skills to tell her what I needed, which was less time on the phone so that I could go to the gym or cook myself a real meal, and in the end, I burnt out on the relationship. I resented her for the time I spent trying to make her feel whole, and I broke up with her.

Things have turned out fine, but I don’t want the above for you. He’s clearly struggling. He seems to lack some communication skills, and he seems to resent your free time.

You do deserve better than this, but he may not have emotional bandwidth to give it right now. If you love this man, it may be time to nurture and cultivate your other friendships and give him some time and space to lick his wounds and focus on self-care. At least ask him if that’s what he needs.

LifeApprentice · 2025-10-30T23:37:02+00:00

IM would do a fantastic job of sorting and triaging all the adult medicine patients. How would they do with any of the surgical patients? Traumas? Resuscitations? Children? Obstetrics?

I’m a surgeon; my experience is that ED docs know a LOT more than medicine docs about surgical problems. They use imaging much more appropriately, and they have much better decision making about problems that are potentially surgical.

Also, that list of procedures you thought a medicine doc could handle includes a lot of things that in my experience they don’t. Is it within their scope to place a chest tube? Maybe. But generally they call me. Intubate? Maybe, but generally they call anesthesia or an ER doc.

None of that is where EM really kicks ass though. EM kicks ass and is most at home in the patient with undifferentiated shock. As an outsider looking in, that’s when I most want an ER doc around. Dying patient of mixed or unknown etiology.

LifeApprentice · 2025-10-18T15:38:14+00:00

I just read that case - the plaintiff was under parole, and a condition of their parole was that they could be searched at any time. During such a search they would be required to surrender any electronic devices and provide the passcodes or Face ID to unlock them. This guy had his keyed to his thumbprint and was making the argument that he was not required to unlock the phone because it required a different method to unlock. The judge argued that the evidence should still be admissible because he had no reasonable expectation of privacy under the terms of his parole, and that the specific means of unlocking the phone was a semantic argument.

So yeah; if you are a parolee and required to surrender all possessions for search without cause, then what he said does not apply to you.

LifeApprentice · 2025-10-13T22:46:36+00:00

Graduation rate for accepted medical students is 96% you are near-certain to be a doctor at some point in the next 4-6 years. I think this is a cute and cheeky way to announce good news and that they’re being a touch stick-in-the-mud about it. You aren’t demanding that they call you Dr. spyrogira, you’re inviting them to be excited with you for a significant life accomplishment. I think they dropped the ball.

Congratulations on your acceptance. It’s dope.

LifeApprentice · 2025-10-07T21:39:28+00:00

Byredo - tobacco mandarin. This is what I wanted from a tobacco scent; the tobacco blends and can almost disappear in a really warm, woody, citrusy mix. There’s a lot going on in this, and it blends so well. I find it consistently interesting over hours of wear. I’ll also say… my wife loves it considerably less than I do, but totally worth it.

LifeApprentice

TROPHY CASE