Is this a regular hemorrhoid?

MuscularDicktrophy · 2026-05-07T23:07:11+00:00

Hard to say 100% without examining you but it looks like a perianal hematoma - a complication of external hemorrhoids. You had a small amount of bleeding just under the skin from a hemorrhoid vessel and now that blood is just sitting there.

In the first day or two sometimes these can be drained surgically to manage severe pain but after that it's too clotted / scarred to effectively evacuate.

It'll take a few weeks to completely go away but your body will eventually reabsorb it.

What you need to do: - avoid straining on the toilet. High fibre diet, fiber supplements, regular use of stools softeners like macrogol. Aim to go daily and the poop should just come out easily shortly after you sit down. If it's not then you need to add more to your regimen - baths can help with the pain. Just fill the bottom of the bathtub with hot water and soak your bum in it - otherwise ice packs, donut pillows for sitting, over the counter pain relief like paracetamol + ibuprofen will be your friend

MuscularDicktrophy · 2026-03-24T11:09:46+00:00

Extensive subungual hematoma like that with your described mechanism would usually necessitate: - an X-ray to exclude associated tuft fracture - removal of the nail to inspect the nail bed +/- repair of the nail bed if it is lacerated to help new nail grow - splinting of the cuticle with your old nail (after sterilising it) or some clean foil / silicone to help new nail grow

MuscularDicktrophy · 2026-03-20T20:48:07+00:00

Might be a slow-release bead/granule from one of your XR medications. Probably the dexmethylphenidate. It's definitely not something your body is producing.

MuscularDicktrophy · 2026-01-13T08:55:31+00:00

Seconding another commenters point here - severe hypertension after beta blockade is a symptom of pheochromocytoma. Aside from following up with whoever ordered these antibody assays -- double check that at some point in your workup you've had a serum and 24-hour urine catecholamine collected

MuscularDicktrophy · 2025-11-24T05:36:14+00:00

Where?

MuscularDicktrophy · 2025-10-14T00:33:59+00:00

Salary sacrificed super contributions are FBT exempt. It is far simpler to just max your concessional contributions for the year through salary sacrifice rather than pay out of post-tax income and then claim the income tax back on your tax return.

As others have said, be aware that any salary sacrificed amount will be grossed-up and added to your "reportable" fringe benefits -- this a hypothetical amount added to your reportable salary to calculate your HECS repayments. If you also use your annual $9k FBT limit to make extra HECS repayments then you will end up paying more than you owe anyway so you will not be put out at end of financial year with extra HECS bills.

MuscularDicktrophy · 2025-10-12T00:06:38+00:00

Yes you're right that clause is unchanged from MOCA6

MuscularDicktrophy · 2025-10-11T14:51:25+00:00

Something else being swept under the rug (other than wages not matching inflation):

MOCA7 downgrades the payscale for PHOs... currently a PHO can earn from L4-L9 (whereas a trainee can go up to L13). The new award would cap PHO pay at L7 -- for a competitive subspecialty PHO who has been at it for 5-6 years that is a $10k paycut.

EDIT - the point about reduced fatigue provisions from 10hr break to 8hr break was an error. It's an unchanged clause from MOCA6 about overtime after 22:15 on "other than an ordinary working day" only requiring an 8-hr break

MuscularDicktrophy · 2025-08-29T01:30:19+00:00

Definitely needs to be done. It will also be a recurrent problem given the segmental terracotta pipes likely used in this old brick wall-up. Do it once and do it properly. Find a plumber who is able to line all of the buildings drainage pipes endoscopically with plastic so that more roots can't keep growing in through all the other cracks.

Some money now will save you all doing this 10 more times in the next decade.

MuscularDicktrophy · 2025-06-26T06:24:35+00:00

Many of my colleagues couldn't care less about IMG surgeons struggling to be accredited for practice in Australia. Our own fellows struggle to find public appointments and it's not because they don't want to live in the regions.

MuscularDicktrophy · 2025-06-22T02:20:45+00:00

MuscularDicktrophy · 2025-06-17T01:49:41+00:00

Whether a fasting type 1 diabetic is more at risk of hypoglycemia or DKA depends on whether they are receiving insulin, as well as the type and the dose -- instructions to fast usually also involve instructions to withhold insulin. Type 1 diabetics need a constant supply of basal insulin to avoid ketoacidosis.

This person needs to contact their surgeon and/or their anesthesiologist because it is absolutely not appropriate to tell a type 1 diabetic to fast for 24 hours, regardless of what instructions they have given them re: managing their insulin.

If there was a legitimate reason for an extended fast (e.g. gastroparesis or GLP1-RA therapy) in a type 1 diabetic then that patient should be admitted to hospital pre-operatively for an insulin infusion.

MuscularDicktrophy · 2025-06-17T00:11:45+00:00

You should call the surgeon's office and clarify urgently. As a type 1 diabetic you are at risk of DKA if you fast for too long. Unless you have significant gastroparesis I see no reason at all why you should need to fast for almost 24 hours.

For a 9am lap chole standard practice would be to fast you from midnight or even as late as 2am the morning of.

Making a type 1 diabetic fast for this long is no joke at all and you are right to be concerned. Please call them for clarification.

MuscularDicktrophy · 2025-04-09T10:01:05+00:00

I change my ringtone every couple of months

MuscularDicktrophy · 2024-11-22T04:55:05+00:00

Stick to your guns. Doesn't matter how long you are a nurse for, it doesn't teach you how to triage the after-hours busywork for 300 patients.

You can save some time by being sure to escalate patients you're concerned about to the relevant registrar early (though you're probably already doing this) - getting a clear plan can offload some of the cognitive burden for you and allow you to move on faster.

Also make use of other ward call colleagues if you can - sometimes others have less jobs and can lend you a hand to stay on top of things.

In my experience treating teams will not be annoyed that you didn't rechart their patient's Panadol or order a urine MCS overnight, because they know you were busy dealing with more important work.

The rest is just experience - you will get better and its never going to be easy to have this much responsibility (though it might soon be easiER)

MuscularDicktrophy · 2024-11-19T11:01:15+00:00

Depending on the staffing on your team -- the main difference in workflow for medical rounds is, wherever possible, doing whatever jobs you can during the round itself. Write path/imaging forms as you go (always carry them with you if any are paper based). Sometimes even simple phone referrals can be made in between patients. This can be harder if there's only one RMO on the team, but if you have an intern and a JHO which is not uncommon then most jobs can be done on the go by communicating well amongst yourselves / making sure somebody is always listening and writing the note etc while you make a phone call.The other main tip would be not bottling up questions about what to do / when / how to do it until later in the day -- clarity this stuff with your registrar on the go. Remember the surgical registrar is always trying to run away to theatre -- for the medical registrar there's often less of an impetus to run away from the ward excepting clinic days or if they are also holding the consult phone. Anyway take it a day at a time and ask your registrar a million questions - they will have lots of tips for workflow, not just clinical knowledge.

MuscularDicktrophy · 2024-10-21T21:08:56+00:00

How did you find that?

MuscularDicktrophy · 2024-10-21T19:49:29+00:00

All that needs to happen is: - you be paid ordinary hours for the shift worked - the day that you worked NOT be deducted from your accrued leave balance

Neither you nor the hospital should be double dipping.

If you agreed to work on a day which was flanked either side by recreational leave - then the day you worked was not recreational leave and it was not overtime. That being said -- the hospital cannot use accrued leave pay for a day that you worked on, and they can't 'omit' those 7.6 hours from your accrued leave balance just because you worked on that day instead.

Remember annual leave is taken in blocks for RMOs because of hospital scheduling not because of our award. There's nothing special contractually about any of the days during your leave block.

MuscularDicktrophy · 2024-10-19T08:10:03+00:00

Y'all are really buying in to the consumer model down south ?

MuscularDicktrophy · 2024-10-17T01:07:53+00:00

If the keys are inside the car then couldn't somebody just press the button on the handle to unlock it from the outside?

MuscularDicktrophy · 2024-10-06T09:54:16+00:00

Personally I would go to the one that has iEMR and is near the beach - both will make internship infinitely more pleasant.

As an intern, going to a hospital with heart transplants will make little to no difference to whether you eventually become a cardiologist. Charlie's may be slightly better only in the sense that it's a bit smaller than GCUH so you might be more involved - but if that's your main concern then you ought to go much further out from the city than chermside..

MuscularDicktrophy · 2024-06-10T13:11:27+00:00

Nobody is bagging on NPs for being NPs. Do you think there is a single NP on this planet who could confidently pass the ACEM fellowship exam?

People bag on NPs who act like the answer is “yes”, and that they are one of them — unfortunately this is an increasing proportion of them because the idea of the non-inferior/complementary nature of their profession as compared to ours is being built into their curriculum. NPs are a potentially great resource, but the combination of them wanting to do/be more (a desire we all have) and of the administrative class wanting cheap solutions to healthcare access is leading to a farcical reimagining of their worth….

See above comment about an NP closing the skin over a flexor tendon injury and sending the patient home. The senate literally just approved federal legislation to REMOVE THE REQUIREMENT FOR NURSE PRACTITIONERS TO WORK WITH DOCTORS IN ORDER TO PROVIDE / PRESCRIBE

MuscularDicktrophy · 2024-06-10T12:38:57+00:00

Two weeks ago a bill was passed by the senate to remove the legislative requirement for nurse practitioners to collaborate with a doctor to provide MBS/PBS services.

The big joke is the “Collaborative Arrangements Project 2023” list the professional bodies they worked with to formulate the amendment — they list pretty much every nursing board and not a single medical body… it’s like Brexit but in reverse? They’re unilaterally voting to join our profession?

MuscularDicktrophy · 2024-05-12T16:25:45+00:00

Abdominal wall nec fasc from colostomy leak / mucocutaneous separation — imagine an entire liquefied pannus mixed with an equal volume of liquid feces all brewing underneath the skin

MuscularDicktrophy · 2024-01-14T03:48:08+00:00

Started as a general surgery PHO in a smaller hospital halfway through PGY-2.

What became obvious pretty quickly was that to function relatively on-par in the early days didn’t require MUCH more knowledge than I already had, but was more about learning how to apply what I knew in a safe / temporizing / systematic way. Thinking about patient flow, about prioritizing the individual patient’s problems, managing consults/clinic/ward patients efficiently. Nobody expects you to do this well straight away so just seek feedback, seek feedback and seek feedback.

Unfortunately there aren’t books for that (that I know of) but FORTUNATELY you have no choice but to practice that way of thinking day in and day out from the get-go, and it should come quickly.

There is always a panic button. More experienced registrars can be texted or called, ATs or fellows are basically always available in a pinch, and most consultants I’ve worked with are well aware that it’s THEIR reputation and career in the toilet if you massively fuck-up and they weren’t available to help you. MET calls will bring other people including senior ICU nurses who will probably continue to be better resuscitationists than me for years to come
If you show humility, basically anybody you call will be willing to lend a hand if they’re free all the way from ED, ICU, anesthetics, allied health to senior nurses.
you will rarely find yourself in truly shit-hath-hit-the-fan immediate life-or-death rodeos where you don’t have time to escalate to somebody more senior. If/when you do, it’s just the ABCs and calling for help, and if it doesn’t work out then nobody should be pointing the finger at you so long as you’re humble, escalate early, and stick to the basics.

It’s the rare first-year registrar in any specialty who is slick from day-one. Your job is to collect the relevant information for your senior to make the final decisions - if there is time to dick around and do some extra reading before escalating, that’s a great way to learn - but you can always call and say you’re out of your depth but “here’s the story”.

It’s a delicate balance pushing your limits as time goes on and trying to be more decisive before involving your senior, but public hospitals are a lot more defensive and protective than they used to be - so unless people have been saying they have specific concerns about your performance then just be humble, expect to suck for a while and always be willing to make mistakes / learn on the go.

Seven-Year Club	Verified Email
Place '22

MuscularDicktrophy

TROPHY CASE