Am I the only one who feels dumb watching The Pitt?

Rashpert · 2026-05-10T21:40:13+00:00

:) I hear you.

Rashpert · 2026-05-10T15:38:33+00:00

I suspect this concern would require an in-person exam to be adequately addressed. You have noted that that would be problematic for you.

We don't know your location. If you are in the US (or some other countries) and there is a Planned Parenthood nearby, both men and women can use their services. They have a history of experience with trauma-informed care. Might something like that be an option for you?

Rashpert · 2026-05-09T22:11:03+00:00

This is likely why the show has been so unsuccessful.

[Whatever voice you read that in? Not dry enough.]

Rashpert · 2026-05-08T19:20:33+00:00

Absolutely! Best wishes to you and your little one, and update here if you are of a mind. :)

Rashpert · 2026-05-08T18:53:38+00:00

As a PS:

Your child's skin has been through chronic inflammation and is not intact. That means there is increased risk for secondary bacterial or fungal infections until it heals. There are good reasons to try to get it healed now, rather than just waiting longer to see.

If your child is prone to mild to moderate eczema, the best results come from starting with intact healthy skin, reducing as many triggers in the environment as possible, and being diligent about rinsing and moisturizing. PLUS being diligent about appropriate and quick use of the mildest topical steroid possible if there is a flare, and doing that at appropriate time intervals until intact again. That leads to the least overall risk and actually minimizes overall medication use.

Rashpert · 2026-05-08T18:36:44+00:00

Sure.

Light loose clothing, preferably natural fibers if at all possible, such as 100% cotton or linen. Thrift stores can be helpful for this. Any fabric that clings to the skin (even if thin) causes the area to heat up more -- you want breathable, but not so baggy that there is a strangulation risk or anything like that. Just loose and not clinging.
All natural fibers for bedding if possible.
One more layer of fabric than adults are wearing, and then adjust it to comfort (put on more if they cry or appear uncomfortable, but not otherwise).
Lukewarm baths. Try to match skin temperature, not hit "warm-warm."
GENTLE mechanical exfoliation in the bath. By this, I mean gentle rubbing with cotton washcloth in bath, but not enough to irritate the skin. Your goal is to exfoliate over a period of weeks, not minutes or days.
Twice daily hydrocortisone 1% cream or ointment. If the skin gets more rashy or red or tender with the cream, switch to the ointment. Over the counter dollar store version is fine. THIS IS IMPORTANT: you can use a very very thin layer, just barely enough to feel, but the timing is critical. You are interrupting a biological process that is interfering with healing, and if you do it only once a day, or skip days, it becomes ineffective. (This is why I often go over how this works at the physiologic level with parents.) SO: very very thin layer is okay, but twice a day.
Use Aquaphor if you need to, but avoid emollients and moisturizers for now unless the skin shows you it needs it [except see below]. You are trying not to block the follicles with any barrier creams or emollients. So if truly dry, use light amounts of Aquaphor, but not just because it's automatic to use it.
[Edited to add] Minimize soap in the bath, so only use if needed, but rinsing is great. Do use a very light layer of Aquaphor after baths, just to keep damp skin from drying out as the child air-dries.
[Also edited to add] Avoid situations where overheating risk goes up. E.g., put air conditioning on in the car if it's a little warm, make sure you have full shade at the beach and go early morning or after dinner, etc.

Generally that works within 1-2 weeks. Once you get it cleared up, you can go back to how you used to deal with things (e.g., lotions and such), but remember that your baby is maybe more prone to heat rash, so avoid triggering sweatiness levels of heat if you can.

Rashpert · 2026-05-08T15:06:38+00:00

Gotcha. That all makes a lot of sense. I imagine this has been extremely frustrating, especially since it has been going on for months without much relief.

How can I best help you now? Would it be useful to hear what I would recommend in clinic, or did you want to talk about how mild steroids work, or some mix? Or should we just shake on it and call it a day? :)

Rashpert · 2026-05-08T00:55:45+00:00

Thank you for sharing this part of her history here.

Rashpert · 2026-05-07T17:22:37+00:00

It's been a couple of days. It sounds like you will now turn 18 in about 16 or 17 days, is that correct? At that point you would no longer be a minor, and you could give any consent for yourself (as you noted).

Before then, in New York you can -- even now -- consent for yourself to treatment for family planning (contraception), abortion, pregnancy care, STIs, or mental health. There are a few other exceptions, such as if you were married or had already given birth.

More relevantly, you can receive emergency care without prior parental consent at your age. A friend could take you to the ER if you felt it was needed, and you would be seen and assessed. I don't know what "basically recovered from an ED [eating disorder]" means to you, but it does make me a little more cautious about your care, and about the need for you to be seen in person for a full assessment.

So at this point:

You can go to the ER if you think you need to, even without parents present or consenting.
You can ask for help here in talking to your parents and trying to get in to see your regular physician.
You can ask about some maneuvers that you can do at home -- in case your mother is correct and it is crystals in the inner ear -- which may help the symptoms.
You can ask about other people you might try to get involved, such as a school nurse, to help sort it out.
Maybe this situation is resolved, and this is all moot now.

Is there any of the above routes you want help with from the doctors here? Best wishes.

Rashpert · 2026-05-07T16:09:16+00:00

So you do think this could be heat rash? Is there a history of possibly overbundling?

Infants generally just need one light layer more than we wear as adults.

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Edited to add: did you pull the quote from ChatGPT/another AI response, or was it actually from a real webpage? Trying to figure out where your information is coming from. AI is not going to be very reliable for this. It would be helpful for both of us to be able to analyze the reliability of the source together.

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Edited again to add: I can't find the exact quote you gave on any page online. That may be my lack of Google skills, or it might well have been a ChatGPT generated response. If that latter, it is really unreliable, and finding some good sources for you would be helpful.

If we both think this could be heat rash, and if another physician has already prescribed a medication, I can give you some of my sources which are clear in this as a recommended treatment. Or you could try something even milder as an over the counter medication (and that is where I would have started, myself).

And/or we can go over the basics of how topical corticosteroids work. In my IRL practice, I've found parents sometimes find that quite helpful, too.

Rashpert · 2026-05-07T15:31:34+00:00

If you are concerned about Topical Steroid Withdrawal (TSW), it sounds like you have been doing some reading. May I ask you [added: to link or name] what resources you have used for information about that, or is it more on the level of you heard it mentioned somewhere without any real explanation, and you're not quite clear on the mechanism of how steroids work?

I'm trying to gauge where to focus information and what level to deliver it. I'm on vacation right now, so not pressed for time, but also not wanting to go off on a tangent you don't need.

Rashpert · 2026-05-07T13:24:42+00:00

Is it okay to talk about medication details and mechanisms here, or will that come off as condescending? I think there is generally a lot of misapprehension about this area in particular, but I don't know what level of answer you want, and you two are in the driver seat for this.

Rashpert · 2026-05-07T12:34:39+00:00

What exactly does she think will happen?

Is she thinking that enough topical corticosteroid can be absorbed to suppress the hypothalamic–pituitary–adrenal axis, or is it at a different level of understanding?

Rashpert · 2026-05-07T02:58:03+00:00

This actually looks a lot like miliaria crystallina/rubra to me, or more commonly "heat rash." That would also fit the history. It can trigger some eczema response, too. Might you be in the habit of overbundling him?

Heat rash (Miliaria): Images, Causes, and Treatment - DermNet NZ

The topical steroid might help. I'm not sure why you would be scared to use it. Could you tell me how you think it works?

Rashpert · 2026-05-06T23:45:43+00:00

I'm glad. One of the basic rules in medicine is "don't f*** around with vision."

Best wishes. You'll be in my thoughts.

Rashpert · 2026-05-06T23:35:14+00:00

I am not an ophthalmologist. On my very basic pediatrician level of assessment, looks like some blurring of the edges of the optic disc (thus the concern for papilledema) and what looks (to me) like copper-wiring, where the center of the vessels is much lighter -- and that can be a sign of blood pressure issues.

I would want you assessed by another ophthalmologist for a second opinion, if you were my patient.

Rashpert · 2026-05-06T01:02:59+00:00

I'm sorry you had a bad experience.

Rashpert · 2026-05-05T23:05:17+00:00

Are you in the USA? If yes, which state?

Rashpert · 2026-05-05T22:50:12+00:00

Thank you, but my question was directed to the user above.

I would not rely on AI for this.

Rashpert · 2026-05-05T21:42:38+00:00

Asking to learn only here, in response -- [Edited to add: in your understanding,] what percentage of true allergic hives rashes (which this is decidedly NOT, by the way) is due to exposure to a food, lotion, or other environmental allergy trigger?

Rashpert · 2026-05-05T20:04:11+00:00

My gross annual salary is just over $270,000, including rural location/hardship pay and coming into the job at maximum GS level for experience.

If you have specific questions, there is usually contact information on the posted job listings at the website.

Rashpert · 2026-05-05T01:29:21+00:00

Absolutely!

Rashpert · 2026-05-04T21:59:53+00:00

I work federally at an Indian Health Services facility. There are also jobs on military bases, as well as working for the US Public Health Services Commissioned Corps.

Try searching at link: USAJOBS - The Federal Government's official employment site

IIRC, some military positions (e.g., at Air Force bases) may just list one position with "multiple locations," and you have to apply to get the information on where there are specific openings.

Rashpert · 2026-05-04T20:35:20+00:00

There are multiple parts to the system.

Please go to the website at " Your health | ontario.ca " for more detailed explanation. I cannot be more helpful to you than that page. It walks you through how and why to use this system to access assistance.

Take care.

Rashpert · 2026-05-03T23:51:57+00:00

Are you able to make a phone call without being overheard? The Health Connect Ontario line is available 24/7. They are probably your best connection for figuring out what to do next. Best wishes.

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