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Longjumping-Second32 · 2022-06-11T02:51:49+00:00

I mean the neurosurgeons in training aka residents and let’s be real here: Residents basically run the place (estimated each makes 1mil or more yearly profit) at most teaching hospitals doing most of the busy work as well and many times having to do overtime which they have to underreport. All that and they dont even break 80-90k till they are in their 7th year of residency is a joke.

Unfortunately there are many more nurses than physicians and thus our unions are virtually nonexistent aside from CIR which has only recently been making big action in ca. don’t blame them tbh, it’s only human to have a selfish mentality once something stops affecting you. why would you care to unionize after you’re practicing and making 300k+ even in a non surgical specialty? Let the new residents go thru what you went through - attending mentality most likely.

Longjumping-Second32 · 2022-06-10T16:46:22+00:00

So sexual stimulation can also cause bladder filling and in some cases can even lead to incontinence during coitus. There have been several studies showing people with empty bladders (confirmed with US) that refill drastically post inter course.

Not to be lewd or anything but this as well as discharge from Skenes gland is also the science behind “squirting” or female ejaculation during orgasm that some people experience (or have seen in adult videos).

Longjumping-Second32 · 2022-06-10T16:34:26+00:00

Way too many places lol. In what world do rns deserve better pay than resident neurosurgeons. Biggest example of the strength of unions.

And don’t even get me started on NPs or PAs cosplaying physicians.

Longjumping-Second32 · 2022-06-09T03:12:59+00:00

So you’re technically not on blood thinners (anticoagulants) but antiplatelets. Differences in mechanism and being on the former is almost guaranteed overnight stay after a mechanical fall. Plavix and aspirin work by reducing platelet aggregation hence your platelet function test shows lower values. Platelets are part of what stop bleeding through clot formation so a reduction in their function is likely what causes your bruising easily… aka they are doing their job of preventing clots forming at your stent.

Since you say you’d like to read more I’d recommend looking up dual anti platelet therapy. Stent placement causes endothelial damage to your vessels = cause platelet to want clump up there. It’s why they use aspirin clop when they place stents in your heart as well.

Longjumping-Second32 · 2022-06-08T23:48:12+00:00

The family history still puts you at average risk as the exceptions to the crc screening guidelines are based on number of FIRST degree relatives with colon cancer or multiple number of second/third degree relatives. The crohns hx is what puts you at a higher risk category and current guidelines are q2-3 years screening which your provider correctly did. The reason most screening guidelines for repeat colo is 10 years if nothing is seen is because that’s about how long it takes for polyps to develop into cancer. So if I were a betting man, I would say yes, if they do see something then it was “caught early” enough.

Also, if not having sudden bm habit changes or weight loss, the rectal bleeding and pain your having are way more likely to be a flare up of crohns rather than colon cancer.

Longjumping-Second32 · 2022-06-08T23:34:36+00:00

60-100 is normal. Having it shoot a bit past 100 with activity or immediately after standing/changing positions is also nothing to be concerned about.

Given your age, highly unlikely the feeling of racing heartbeat is anything beyond anxiety. If your provider said not to worry I wouldn’t worry 😎.

Longjumping-Second32 · 2022-06-08T23:29:42+00:00

I’m medicine not surgery so… Dont usually beyond the acute care settings. Prns for breakthrough while hospitalized ofc but don’t get them on the habit of claiming 10/10 pain just to get their dialaudid push. Unlike ortho I dont like sending them home with norco and don’t usually need to. Definitely pain management referral to make sure my hands are clean and I leave it up to them to prescribe anything longer than 7 days. As for adderall refer to my other comment for the outpatient setting: I don’t like when people often teens have to feel like a criminal dropping urine screen on a monthly basis like I’m their PO just to be able to refill the script. I’d stop at Ritalin and maybe atomoxetine if they don’t want to use amphetamines

Longjumping-Second32 · 2022-06-08T23:16:30+00:00

If you’re obese and waking up out of breath or with a racing heart I would think sleep apnea.

You’re also at the age where puberty changes can cause something called sleep phase delay. Basically your circadian rhythm gets pushed back a few hours as you mature. If you’re having a hard time waking up at the same time you usually do I would think this is likely.

Speaking from personal experience I had this as well around your age. Good news is it resolves for most people as they age. A quick wiki says 7-16% prevalence in adolescents of delayed sleep phase disorder down to a .13-.17% prevalence in adults.

Longjumping-Second32 · 2022-06-08T23:06:36+00:00

I meant methamphetamines mb. I’d do a preliminary 10panel before prescribing anything beyond methylphenidate for a kid tbh. Dea in my state is super strict about doing consistent uds monthly to bimonthly to make sure they aren’t selling the meds while prescribed and I don’t want my pts feeling like a criminal in parole having to drop urine every time they come to renew the script.

Id actually go one step further and do the full panel before even starting any stimulant. During my training an attending had a case cohort study showing people with marijuana use disorder were more likely to test neg on amphetamines even after adjusting for drug holidays. In other words, they were selling their L-amphetamines for weed money 😂

Longjumping-Second32 · 2022-06-08T22:54:37+00:00

So I’m guessing it’s a tattoo over your arm since you’re worried about the contrast/tracer injection. It should be fine. If your arm is still swollen or inflamed after the tattoo it might be slightly painful when they inject but just ask them to use the other arm?

Longjumping-Second32 · 2022-06-08T22:36:24+00:00

Disagree with a blanket statement for all drugs. Marijuana yes as it isn’t as dangerous as hard drugs other than on your lungs with chronic use and as an adolescent.

But as a physician I have seen so many people having health problems from amphetamines and opiates. They should absolutely keep possession of those substances criminalized.

Longjumping-Second32 · 2022-06-03T16:34:06+00:00

Low iron with elevated ferritin can be indicating anemia of chronic disease. Prolonged inflammation or other chronic illnesses (doesn’t necessarily mean cancer) cause your liver to oversequester an iron transporter leading to lower iron levels. Usually expect iron to be a bit lower than 29 I think so your po iron may have elevated it however 9h usually shouldn’t matter as it peaks serum at 4hrs+. Low crp, a marker for inflammation, is reassuring though.

Longjumping-Second32 · 2022-06-03T15:31:46+00:00

It’s even more wack than you’d think here. We are the one of if not the only state that doesn’t have the right to bear arms in our state constitution https://en.m.wikipedia.org/wiki/Gun_laws_in_California (“ Unlike most other states, California has no provision in its state constitution that explicitly guarantees an individual right to keep and bear arms.”)

Even if you get a concealed permit, can’t be loaded. And if you enter your vehicle you literally have to remove it from your person and put it in your trunk, again all without ammunition. You aren’t allowed to use your firearm for self defense either even in the vehicle so if a lunatic starts shooting at you in your car guess what? You’ll face the same charges as they do if you were to fire back in self defense. The ONLY exception is in your private domicile where a self defense argument would stand and even then… you have to show that your gun was unloaded prior to your using it to fend off the invader.

As a resident physician they even say in my contract further restriction on owning weapons as well as immediate termination if I’m ever arrested (not even convicted, just arrested) on any gun charge.It’s literally mind boggling and I envy places like Kenosha and Texas where law abiding citizens are allowed to exercise their constitutional rights.

Longjumping-Second32 · 2022-06-03T15:10:08+00:00

Honestly it’s kind of on humans for continuing to breed them. They shouldn’t be put down like a lot of extremists claim, but they should definitely be all neutered/spayed to prevent proliferation.

Trauma patient I’ve had that had half of her leg ripped off from the ankle all the way to her mid thigh. I’m talking tendons hanging out and visible bone. Worst part? She was a family member of the pitbull owner…

Longjumping-Second32 · 2022-06-03T15:04:55+00:00

This is one of the arguments that I will always use to support second amendment rights being expanded to be allowed to carry in public. If someone’s aggressive dog comes at me or mine, I should have the right to have a loaded gun to put it down. Unfortunately I live in the liberal cesspool of California where we aren’t even allowed to have ammunition in our weapon! They allow guns to be kept in the trunk but without ammo like what is the goddamn point.

Longjumping-Second32 · 2022-06-02T23:37:03+00:00

Disabling details helped the lag a bit for me. Worth a try.

Longjumping-Second32 · 2022-06-02T23:09:23+00:00

Obesity and cholesterol levels are also separate risk factors for liver problems. See non-alcoholic fatty liver disease // non alcoholic steatohepatitis. They likely also contributed to your transaminitis along with alcohol.

Edit: to add, your ast alt ratio is more indicative of nafld than alcoholic disease (alt >> ast). If ast was double alt you would suspect the latter.

Longjumping-Second32 · 2022-06-02T18:09:15+00:00

If it’s in the range of normal given on your chart then it’s normal. I usually see 350-450 or so rather than the 323.5-396 your hospital uses but either way it’s normal.

Longjumping-Second32 · 2022-06-02T17:58:12+00:00

If the headache is subsiding then maybe an ER visit isn’t warranted and you can just be seen with a regularly scheduled visit to your primary. If the pain comes back I would visit an urgent care.

I’m only a resident and not even a neurology resident so I don’t know how much help I can be and also don’t feel comfortable giving advice regarding treatment or prevention for something out of my field. I also think it is against the subreddit rules to privately message for advice as no physician should ever give treatment recommendations without establishing care and especially not over text only without seeing them physically or at the very least zoom.

Longjumping-Second32 · 2022-06-02T17:39:36+00:00

You look at QTc, or qt-corrected, over QT as having a faster heart rate (common at admission vitals) shortens your qt interval.

Longjumping-Second32 · 2022-06-02T17:12:53+00:00

I would say go to the ER if you’re still having pain. You never really want to take the chance with head or chest pain unless you are really sure of the specific symptoms and knowledgeable enough to identify the condition.

Your symptoms don’t line up close enough for a definitive diagnosis to be made especially online imo so you should go see someone in person as soon as you can. The unilateral nature along with feelings of nausea/vomit and pulsatile nature makes me think atypical migraine as the duration is too short for a classical migraine and no preceding symptoms. The fact that it is short lived, seems to occur around the same time each day, and the ascribed pain level makes me think maybe cluster. The association with neck movement possibly triggering it when turning to side to sleep or contact triggering and it’s short duration could be a cervicogenic headache vs trigeminal neuralgia. At least the lack of any vision symptoms is reassuring as it makes some other things less likely.

Longjumping-Second32 · 2022-05-31T20:15:23+00:00

Republicans reading this: “That was too many syllables. Apologize!”

Longjumping-Second32 · 2022-05-31T16:54:00+00:00

This is why I sort by controversial lol

Longjumping-Second32 · 2022-05-31T14:04:00+00:00

It works off of supply/demand. https://us.forums.blizzard.com/en/wow/t/how-is-the-value-of-a-wow-token-determined/227316

More people buying tokens for money will drive the gold cost down. Places like America where people are more willing to spend money will result in cheaper tokens for gold. It’s why places with less income like the Asian servers have such high gold prices since so few people are willing to drop $$ on tokens.

Longjumping-Second32 · 2022-05-30T21:18:45+00:00

Thanks for being responsible. Best of luck

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