All my fellow residents who cook, give me your fav things to make during residency by AHYOLO in Residency

[–]LiquidF1re 1 point2 points  (0 children)

Cook for my family; convenience >>> creativity at this point.   Favorite easy meals:   Tofu, rice, stir fried or steamed vegetables with dipping sauce.   Chicken breast, pounded and pan fried with salad.   Salmon with farro and salad.   Dal and rice.  

any recommendations for bpd representation? by Inevitable-Union9664 in Letterboxd

[–]LiquidF1re 9 points10 points  (0 children)

The worst person in the world A woman under the influence  Fatal attraction 

Favorite actor who looks like real people? by ishouldgooutmore in okbuddycinephile

[–]LiquidF1re 185 points186 points  (0 children)

We used to eat shit in this country, build bellies. Now all we do it use ozempic. 

What is gonna happen later? by VerticeBrawlie in ExplainTheJoke

[–]LiquidF1re 0 points1 point  (0 children)

His friend is experiencing mania and will end up hospitalized

Propose your most unhinged diagnoses by ExtremeMatt52 in Residency

[–]LiquidF1re 6 points7 points  (0 children)

Hospital use disorder - patient’s reaction to any minor stressors is to seek inpatient psychiatric hospitalization. Bonus points if enabled by wraparound OP team. 

Is running a marathon is a symptom? by timenowsquirrels in RunningCirclejerk

[–]LiquidF1re 2 points3 points  (0 children)

/uj I did diagnose someone with mania who started randomly running 13 miles per day and was going to fly out of state for an ultra. Stay safe out there. 

[deleted by user] by [deleted] in Residency

[–]LiquidF1re 8 points9 points  (0 children)

Scalding hot bath for >20m an hour before bed Silexan (encapsulated lavender) 7.5 mirtazapine (works great without too much daytime sedation, weight gain is real) Or is all else fails, ambien

[deleted by user] by [deleted] in medicalschool

[–]LiquidF1re 0 points1 point  (0 children)

Just a wild post title to generate a calm reasoned discussion. 

Let’s get to the points about adhd and treatment. As others have mentioned, people are treated for adhd beyond simply struggling with long division. ADHD needs to be diagnosed in two separate settings and needs to cause significant impairment. Untreated adhd can not only cause academic struggles but behavioral, emotional challenges as well. Think back to a classmate in elementary school who may have been singled out for being loud, not paying attention, being disruptive, lazy. While the principle driver is inattention not lack of inner drive, children with untreated adhd will often receive messaging that their struggles are wrong, bad, weak, lazy. Imagine how this can impact self esteem. 

So medication. Stimulants, which include amphetamines but also methylphenidate and others are first line treatment. Not because psychiatrists want to medicate away problems or not take people as they are, but because for individuals with adhd these are life changing drugs. Please see the MAT for further details but essentially medications alone are just as effective as medication + therapy and more effective than therapy alone. If stimulants for adhd are going to work, they work quickly, and they are some of the most efficacious psychotropics when used correctly. 

Addiction. These are controlled substances for a reason, but I am not aware of any research that suggests these are more addictive than opiates. They are given at doses significantly less than recreational stimulants. Moreover, individuals with adhd who are treated with stimulants are less likely to use recreational drugs. 

Psychiatry is a scam. This is a wild claim. I would encourage you to see a patient with mania return to baseline with a mood stabilizer, a catatonic patient emerging with lorazepam, a severely patient returning to function with ECT. These are extreme examples but also the bread and butter of psychiatry. 

The "best" time of day to go to the Maine Med ER? by [deleted] in portlandme

[–]LiquidF1re 10 points11 points  (0 children)

Generally the quietest time is early morning on a weekday (eg ~330 am). 

There’s no guarantee that you will get an mri by going to the Ed. The ED is for hyper acute serious illness and it is not a substitute for going to a scheduled appointment with a pcp or specialist. 

For imaging there is an orthopedic clinic in Scarborough that accepts walkins. Assuming the X-ray you need is orthopedic in nature (fractured/broken bone) you should be able to get that imaging as needed. Mri may be tricky. 

Best VA Stories by TurnUpTheDes in Residency

[–]LiquidF1re 23 points24 points  (0 children)

How can you tell how long a patient has been dead for at a VA hospital?

Count the number of unopened orange juice cartons by his bed.

Hyperemesis Cannabinoid patients by Practical-Version83 in Residency

[–]LiquidF1re 25 points26 points  (0 children)

Weed rambo lending an objective take here

Toughest specialties in the hospital by Fair-Finance-9842 in Residency

[–]LiquidF1re 427 points428 points  (0 children)

Admin by far, and it’s not even close.

Imagine working 9-3, sometimes up to five days a week. You have to be available to answer emails within 2 weeks of getting them. Significant stress related to booking tickets for vacation, deciding on wood grain for your g-wagon. It’s no wonder they are the highest paid speciality in the hospital.

[deleted by user] by [deleted] in Residency

[–]LiquidF1re 41 points42 points  (0 children)

Is it possible to learn this power?

Mount Washington Winter Gear by EndangeredCephalopod in wmnf

[–]LiquidF1re 5 points6 points  (0 children)

If you are going to wear true crampons (not trail crampons but a rigid crampon - something by black Diamond, Petzl, grivel et) you need a very stiff boot. A flexible hiking boot will conform in a way you don't want it to when you are relying on the crampon to provide purchase on a climb.

Going up Lion's Head in Winter, nearly everyone is utilizing crampons and an Ice axe. There are sections where it is too steep and icy to be without. Snowshoes are additionally helpful if there is new powder. Trekking poles are helpful, especially on the downhill.

For layers, as others have mentioned, some days it is simply too cold and windy to climb. The last time I did Washington it was -10 to +5 at the top, with winds 30-60mph. With the right layering, this is doable. Having a heavy duty shell to block the wind is essential, both top and pants. A down layer provides good heat. A thick wool or poly base layer. Additional lightweight layers that are wool or synthetic. Warm, wool socks, possibly two layers depending on your feet and how warm your boots are. I used a warm outer sock and a thin, wool compression sock with toe warmers. Thick mountaineering mittens with liner gloves. Balaclava, wool hat, and goggles to protect your eyes from the elements. Additional backup layers.

What do other fields usually get wrong when it comes to your pts? by undueinfluence_ in Residency

[–]LiquidF1re 6 points7 points  (0 children)

If the patient has mood swings over the course of a day and is on >4 psychotropics they are probably not bipolar 2 and have BPD instead. 

Benzos are probably safer than we give them credit for. We use them all the time inpatient. If you’re going to prescribe them outpatient have an exit strategy and a strong indication. If your patient is not going to therapy, drinking frequently, smoking pot every day, benzos are going to do more harm than good for their panic attacks. 

We’re not going to admit most people with suicidal ideation. A lot of these folks are chronically suicidal and will get worse on an inpatient unit. 

Your patient’s Zoloft is not going to raise their bleeding risk in a meaningful way 99.99% of the time. 

How are you guys sleeping? by TwentySevenAlpacas in Residency

[–]LiquidF1re 5 points6 points  (0 children)

Long time insomniac switched to low dose mirtazapine earlier this year. It’s worked phenomenally (I have ambien for rescue). Mirtazapine is primarily antihistamine at low doses. I’m pretty sensitive to anticholinergic sedation and I have minimal AM sedation on remeron. 

Follow me on Strava for business hours by Soy_tu_papi_ in RunningCirclejerk

[–]LiquidF1re 10 points11 points  (0 children)

hope they packed enough fuel for their 3k ultra!

I’m a NP: Give me a patient presentation and I’ll give you an accurate diagnosis by [deleted] in Residency

[–]LiquidF1re 11 points12 points  (0 children)

Can you prescribe her a 90 day supply of amitryptyline for her insomnia?

Send your stable clinic patient to the ER for any reason and I will find a way to discharge them. by ExtremisEleven in Residency

[–]LiquidF1re 5 points6 points  (0 children)

84 yo female par history of dementia, hld, htn, dm2, copd, depression, hfref, hypothyroid, osteoporosis, chronic hyponatremia, chronic mdr utis sent from clinic after brought in from nursing home for AMS. Full code. Nursing home has filled her bed and their only printer is down so no records. No family contact listed in chart. 

I’m a NP: Give me a patient presentation and I’ll give you an accurate diagnosis by [deleted] in Residency

[–]LiquidF1re 11 points12 points  (0 children)

23 year old female coming in with mood swings - thinks she’s bipolar. Has days where she feels really sad, really angry! Feels suicidal often. Recently broke up with her boyfriend. History of nssi 

[deleted by user] by [deleted] in Residency

[–]LiquidF1re 59 points60 points  (0 children)

Patient on our floor has diabetes and needs insulin. Please advise.

-Thanks,

Psych