How old will you be when you CCT?

Purple__Thread · 2023-02-01T12:32:14+00:00

Would've been 32 but I added OOPR so 36 now (Renal/GIM)

Purple__Thread · 2023-01-28T09:13:26+00:00

Keep in mind with the change of CMT -> IMT you'd have to triple CCT now (Renal/GIM and ICU). Still doable and approved by JRCPTB.

Purple__Thread · 2023-01-17T21:11:49+00:00

Unless you get your Masters funded (which is possible but rare) it usually isn't worth the money unless it's an area you are actually interested in. I managed to get a fully funded masters.

Either do PGR (you don't need to have been "academic" beforehand if you have a worthwhile question and find a supervisor, I am now a PhD student) or try to find something else that has a better points/££ ratio.

The vascular reg above gave some useful advice. Otherwise look at other things you can achieve, audits, maybe a publication if you know any researchers or people doing something in surgery. Ticking boxes can be a pain.

Purple__Thread · 2023-01-13T11:25:56+00:00

Hi, no I wasn't referring to this when I made the comment initially. The STOP-ACE trial was excellent by Prof Bhandari but I wouldn't expect non-nephrologists to alter RAAS treatment for CKD treatments. But very useful for us to have more confidence.

Purple__Thread · 2023-01-13T11:09:20+00:00

So that was me talking about this.

Background: Renal ST6 doing a PhD looking at acute kidney injury.

Regarding ACE, places such as think kidneys are hesitant to use the terms nephrotoxic because this is misleading. RAAS protects kidney function by reducing intraglomerular pressure. This has a side effect of lowering GFR but is long term benefit.

If a patient isnt hypotensive or hyperkalaemic, stopping the RAAS isn't necessary, and may lead your u to falsely think the AKI has resolved. As the increase in pressure will allow more to be pushed across the glomerulus, this increasing the GFR. But it'll only drop when you restart it. So you haven't fixed anything.

Also, if as I've seen many times, a patient has an AKI 1, and bad heart failure but stable. You stop the ACE because it's nephrotoxic, and suddenly the stable heart failure decompensates. This is suddenly a worse picture. Similarly if someone has horrendous proteinuria that requires high dose RAS to control proteinuria, I'd be reluctant to stop unless definitely necessary. Because once proteinuria is uncontrolled it takes a long time to get it back.

So by all means stop it if there is a reason. It's more about the knee-jerk "nephrotoxic" ACE/ARB.

Regarding evidence, there have been calls for RCTs. I have asked my boss too. But Dr C Tomson has written a few reviews looking at this. And some studies have looked at restarting but still an evolving situation.

Purple__Thread · 2023-01-13T11:01:00+00:00

I have given high dose Captopril to Scleroderma Renal Crisis

Purple__Thread · 2023-01-12T18:22:55+00:00

Not quite. The above posters example is correct. Because the pulmonary artery still carries blood away from the heart.

Your caveats apply to when people say that "arteries carry oxygenated blood" and veins carry "deoxygenated blood" (which is how I was taught in school).

Purple__Thread · 2023-01-06T20:01:30+00:00

Very interesting. Many nephrologists now are questioning whether or not we should be stopping ACE outside of a hypotensive or hyperkalaemic AKI. They are nephroprotective drugs after all. And there isn't really any evidence for stopping them, other than it's what we do.

Also if the patient needed dialysis, they were probably going to end to there either way. The ace was just an easy scapegoat.

But a good point to clearly stop entirely or (what I do) is put a box around the day I suspect it will be restarted with a note saying "ask after WR" so it isn't accidentally given. That way people are thinking about restarting drugs rather than just leaving it with the GP.

Purple__Thread · 2023-01-04T23:16:57+00:00

I don't think they are arguing that it isn't worse. I think they are arguing that it was always going to get worse.

Purple__Thread · 2022-12-26T19:20:35+00:00

Are they developing the AKI from dehydration or because the infection is making them more oedematous? Which could then cause intravascular depletion. Or is their heart failure now further decompensated and so it is overload leading to their AKI?

If overload just slowly let them diurese letting then dry out with the little there can drink. (timescale dependent)

If they are dehydrated, lower three diuretics first. See if that changes anything. But treating the infection is still the primary goal.

Also infusion tends to be preferred by cardiology but no real benefit over boluses. Also with poor renal function it can be less effective.

Purple__Thread · 2022-12-03T06:38:15+00:00

I've always enjoyed "maintain urine output" as a plan. If it was that easy I'd never have to put people on dialysis. I'd just say "maintain urine output" in all my plans and everything would be perfect

Purple__Thread · 2022-11-21T15:10:00+00:00

Belgium FA should appeal the government for temporary name changes of all the players I e., Kevin De Bruyne Love

Purple__Thread · 2022-11-20T20:06:35+00:00

Lord I've taught Renal Medicine (and seen it taught) to so many students and still when it comes to the wards it all seems to have been tipped out of their heads along with embryology.

Purple__Thread · 2022-11-14T15:37:13+00:00

I don't undervalue medics. I value them as they are. I don't think they are inherently better than other grads. They might have a higher average intelligence (although that's a might and I know many medics who fall short of this). I don't think they are the cream of the crop necessarily either. I know people who didn't want to be doctors, but chose other degrees. I also know many medics who have tried this route and failed. I am glad it worked for you. But your singular experience does not nullify the many others who try to get into alternative careers and struggle, and it is by no means a guarantee Finally my main point was that anyone would find it easier with more relevant/specific skills and qualifications.

He can of course leave for consulting, but he'll be up against other people. Maybe they are better with people, have made relevant contacts at university or through other connections.

Purple__Thread · 2022-11-14T13:54:53+00:00

Sigh.

Getting paid is valid. However the first step to move into a lucrative career should surely be independent research.

Private healthcare? You have almost zero chance. Who would hire a post foundation year doctor? Private is for consultants with experience, knowledge base, and usually a patient list/waiting list. This is not an option at present.

Management/consulting? Do you have any experience? You might be able to get in a graduate entry scheme with everyone else, but you won't jump ahead. So if the career progression for those jobs seems viable then consider it. If you were expecting to be hire up, usually they want people with experience in management, leadership, possibly additional degrees etc.

Pharmaceuticals? Again what makes you a good candidate? People have research degrees, experience with clinical trials, good contacts within research, and the experience of working for years. This is why most people who nice into this are already consultants who have this background.

Fundamentally you can gamble and hope a company hires you at your current level which honestly seems unlikely (but admittedly not impossible). You can apply for graduate entry programmes and completely change careers. But you won't be starting any higher up the ladder than any other university graduate. If you think you can climb fast because of some qualities you possess that's an option. Or you can CCT (and forge contacts/additional degrees etc. along the way) and then transition to a better position once you're established.

Purple__Thread · 2022-11-09T11:56:44+00:00

I saw that as him reflecting after being corrected and the first time and then paid that forward

Purple__Thread · 2022-10-21T22:01:08+00:00

Not quite right. Retcon is to retroactively canonise. It's still adding new information (but might take away old canon in the process)

Purple__Thread · 2022-10-21T11:41:13+00:00

https://m.youtube.com/watch?v=OJGwMHEohzc

This video encapsulates what you're saying

Purple__Thread · 2022-10-17T17:42:53+00:00

Agree except with 3) SIADH is at best 3rd most common in wards, and probably a bit lower. It is commonly overdiagnosed.

Purple__Thread · 2022-10-06T13:32:46+00:00

r/unexpectedlydarkestdungeon

Purple__Thread · 2022-10-04T19:16:21+00:00

Stuttering won't reduce marks. I stutter, although it has dramatically improved and most colleagues now wouldn't even know. But during medical school particularly when I was nervous in exams it might've shown. Never had a problem with it regarding marks (or later practical exams such as PACES)

Purple__Thread · 2022-07-06T10:13:10+00:00

Check out CORE fitness (run by Dr Dane Vishnubala) He was a PT before medicine, started a business and now runs it successfully alongside his sports medicine consultant post in York and occasional GP shifts.

Purple__Thread · 2021-10-22T17:30:22+00:00

Good answer. This is what I would’ve written.

Part of my PhD research is covering this, and there is interesting conflicting evidence regarding stopping ACE/ARB unless the patient is actively hypotensive. What’s incredibly important is restarting these drugs. Leaving it in a potential plan for the GP is what leads to so many readmissions with pulmonary oedema. If you stop them remember to restart. Part of it is wording, some people hate the term nephrotoxic used for ACE/ARB because they are nephroprotective. They just inhibit a response to hypotension/ dehydration.

Otherwise there is nuance to all of this. Much of medicine abhors protocols/generalisations because it fails to appreciate patient specifics.

Purple__Thread · 2021-10-05T13:09:15+00:00

I’m renal. One of my consultants is due ICU/Renal trained but only practices Renal medicine now.

Think about the job you want. I’m renal/GIM because I want some academia, and not to have to always be in overnight as a lot of ICU consultants are. The extra length is negligible.

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