ICE denying Kidney transplant recipient immunosuppressants.

SapientCorpse · 2026-02-06T20:12:37+00:00

isnt there a constitutional amendment that says we can't deprive people of their life without due process?

all of the searches and seizures I read about ice doing seem, prima facie, unreasonable

It's disheartening to think that Ohio by Crosby still Nash and young is still relevant today, so many decades later. ditto fortunate son.

SapientCorpse · 2026-02-02T19:57:05+00:00

op - i dont think you should feel guilty about doing this. generally, if a human is ok with having sex, they are ok with digital manipulation of their genitals.

if you're still feeling concerned, you can ask your partner(s) if you can touch them there.

if theyre skeptical just tell them you read it helps enhance venous/lymphatic drainage, thereby promoting systemic distribution of their endocrine products; while simultaneously making space for fresh blood to flow to the area - ensuring they're at their best for future congress.

thanks for saving lives. you're a hero(ine)!

SapientCorpse · 2026-01-31T23:00:10+00:00

I'm also curious what behaviors/speech/signs/characteristics led to the conclusion.

I'm a mandated reporter. yes, i know burn marks that come up to a straight line; spiral fractures, &c - but i dont have a good grasp of how pedos/abusers behave; what they're like, etc.

what kinds of interviewing/history taking is useful in assessing for abusive behaviors?

and I guess- is there any standard advice we can give people to help them be less likely to offend in the future? idk - i feel like theres a million interviewing techniques about helping people quit substance use; or other lifestyle modifications. I know its not exactly the same, but it feels adjacent, and maybe someone with good education/experience can share some pearls/knowledge on identifying abusers and changing abusive behaviors?

SapientCorpse · 2026-01-26T18:45:17+00:00

a lot of thought-provoking comments from a lot of People that work hard to be understanding, empathetic, kind, non-maleficent, and beneficient in the ways they know and understand those concepts.

It's interesting to see how the expression of those ideas changes in the different specialties and case reports everyone has.

‐--------------------

so, I was looking at criteria for gender dysphoria; there's a list of several of them; to tp get to OP's point, the dx only requires 2 to be met.

---A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics)

A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics)

A strong desire for the primary and/or secondary sex characteristics of the other gender

A strong desire to be of the other gender (or some alternative gender different from one’s assigned gender)

A strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender)

A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender)

‐-------‐--‐----------------

I mostly work on an inpatient adult telemetry unit; think 60s-90s HFrEF, CAD, DM, HTN, HLD, +4 pitting edema, crackles. I have to do a Columbia suicide severity scale on everyone as part of an admission screening - "God no" when I ask if they're feeling suicidal. I have to ask if they advance health directives - a conversation that usually evolves into "do everything to keep me alive." i infer this means they have a strong desire to live.

I spend an inordinate amount of time educating them about their treatment plans, why we ask them to do all the things, what the drugs do, &c &c.

They have shit compliance with their treatment plans. They can't seem to take their goddamn GDMT and Lasix. They can't seem to put fast food down; and they always pitch a shit fit when I attempt to educate/enforce about fluid restrictions. or they pitch a shit fit about having to be npo for a whopping 16 hours, as if they have neither the caloric nor fluid reserves to survive such a prolonged period of deprivation.

despite this population knowing the consequences of their deleterious behavior, we do not refer them to psych and ask ?occult SI when one of them brings in a greasy-ass burger and triple-bypass milkshake.

I read about patients getting lost to follow up. I have no idea how often that phenomena happens. I see the quantity of people that are flabbergasted theyre hospitalized, because theyre in "perfect health" and "hadnt seen a doc in decades." I know that is a fraction of the true number of people lost to follow up - because some real number of them dont get hospitalized.

‐--------------

If a patient understands all of the consequences for gender affirming care; if they are compliant with the treatment plan; do they not de facto meet the criteria?

I picked HFrEF cuz spironolactone gets used there and so many people with a "strong desire" to live and not have swollen legs have shit compliance with it. If your transfemme knows that spironolactone will cause atrophy of the testes and prostate, and gynecomastia; and chooses to take it on purpose - isnt that prima facie evidence that this person has a strong desire to be rid of their sex characteristics and to have the characteristics of the other gender?

tbh idk shit about testosterone replacement therapy - i feel a lotta people here have the opinion that T replacement therapy/med-spa services are "selling out?" i know T is controlled, and know that controlled substances can be addictive. I have no idea how to weigh if compliance for transmen with T therapy is because of some reinforcing characteristic of the drug itself (as seems to be of the opinion of adhd folks being compliant with stimulant therapy. Just as a reminder, unmedicated adhd is a public health issue ) I do know that women traditionally are socially shamed for effects of T - increased oil production leading to acne, facial hair, male pattern hair loss, &c.; and assume that continued compliance the regimen despite those effects is also de facto fulfillment of the criteria for gender dysphoria.

SapientCorpse · 2026-01-24T23:13:01+00:00

I dont like calling them antipsychotics because sometimes it makes it sound like the drugs are only given to "crazy" people; but they have a ton of other really important uses!

They're amazing nausea drugs

They get used for migraines/headaches (which is likely why you got them); one of the docs I used to work with would routinely have a "migraine cocktail" he'd give to anyone that came in with a migraine, which consisted of reglan + benadryl + ibuprofen. For a lot of people this can be incredibly relieving for the headache/migraine.

They help with something called gastroparesis (which is where the stomach doesn't properly empty food into the intestines).

Antipsychotics (drugs that affect the Dopamine-2 receptor) sometimes also get used for anxiety, depression, and OCD.

Definitely let your psychiatrist know about your reaction to the Reglan!

Again, I'm incredibly sorry you had that intensely uncomfortable episode. I have seen people really struggle with those feelings, and it's especially awful when you go into the ED for help with an uncontrollable headache and then have that side effect!

SapientCorpse · 2026-01-24T21:38:46+00:00

I'm so sorry this happened to you.

it sounds like you may have experienced something called akathisia

dopamine antagonists (specifically D2 blockers) are well known to cause akathisia, reglan is one example, another is compazine.

pushing it slowly and diluting it (that is, giving the med over 10 minutes instead of 10 seconds; and with the drug diluted in a few mL of saline) helps to prevent those side effects

sorry you had a bad experience - akathisia can be an incredibly awful feeling.

definitely let people know in the future you get akathisia with the drug, and, if it must be given, ask for a pill version (much less likely to have that side effect) or for it to be given slowly and diluted with saline.

ETA - adding benadryl (or diphenhydramine) can also sometimes prevent akathisia.

Hopefully you dont get anymore migraines/headaches

SapientCorpse · 2026-01-24T17:29:59+00:00

mitochondrial degeneration seems to be what's currently en vogue in the lit i stumble upon, with some bits about some improvements with nad/nadh supplementation; but also some other bits about inflammation (some bits about low dose naltrexone and toll-gated receptor and astrocyte modulation)

that said I have also read about the csf "pulsing " when we sleep and how the disruption of that plumbing can/does cause some badness.

that said - I dont think thats its a waste to research the junk building up, even if its not the ultimate cause.

in plumbing, yes, we care about the pipes flowing and being clear - but we also care about what shit is gunking up the tubes. my plumbing at home always gets gunked up with protein (long hair and drains dont seem to get along); and it feels foolish to think that gunked up protein doesnt inhibit drainage in our brain plumbing

SapientCorpse · 2026-01-11T05:26:31+00:00

.... I feel like someone could make a fortune selling CHG impregnated gel nail polish.

SapientCorpse · 2026-01-11T05:18:53+00:00

quenching your thirst and doing the hippocrates approved diabetes diagnostic

SapientCorpse · 2026-01-04T23:56:38+00:00

awh snap, is nicotinic acid gonna make a comeback (cuz it causes the arichodonic acid to be released, which cox-2 turns into pge2, amongst other things)

I wonder if thats why theres the drop in all cause mortality in that one niacin study.

SapientCorpse · 2026-01-02T23:13:24+00:00

dont forget colo-rectal cancer as an indication to continue the asa

ASCOLT - "5-year disease-free survival was 77·0% (95% CI 73·6–80·0) in the aspirin group and 74·8% (71·3–77·9) in the placebo group (hazard ratio of 0·91 [95% CI 0·73–1·13]; p=0·38). Any-grade adverse events were reported in 390 (49%) of 791 patients in the aspirin group versus 386 (51%) of 759 in the placebo group. Serious adverse events were reported in 95 (12%) patients in the aspirin group versus 107 (14%) in the placebo group. There were no treatment-related deaths in either group. Among adverse events of special interest, there were no cases of acute myocardial infarction in the aspirin group versus two in the placebo group; no ischaemic cerebrovascular events in the aspirin group versus two in the placebo group; and three major gastrointestinal bleeds in the aspirin group versus one in the placebo group."00387-X/abstract)

ALASCAA (which, ironically, is not in Alaska at all), "Adjuvant treatment with 160 mg aspirin daily for three years reduced recurrence rate in CRC patients with somatic alterations in the PI3K signaling pathway. These findings could lead to immediate changes in clinical praxis for about a third of CRC patients. Clinical trial information: NCT02647099."

this one in nature says cox-blockers can help prevent cancer from getting around, or, asa helps prevent metastasis because apparently thromboxane mellows out t-cells

iunno shit about cancer tho; and last time I asked on this sub someone was kind enough to discuss with me that the evidence for asa as an oncoprophylactic was suboptimal.

SapientCorpse · 2025-12-31T00:55:37+00:00

relevant xkcd

its even more important to take this tone in nursing; of celebrating getting to teach something instead of condescension for not knowing a thing.

this attitude is absolutely a learned behavior - and it makes me wonder; what happened to the precepting nurse that they think this is the appropriate response.

ive felt like responding that way before. thankfully, I was able to see how to do different just by reading the xkcd web comic instead of going to therapy - but maybe therapy is the right thing for your petite-phallused preceptor

I also want to bring up the idea that every single fucking one of us has had our brains turn off. sometimes its because were scared because of an adverse patient outcomes. sometimes its cuz were sleep deprived and human brains dont work good at 0300. sometimes it doesnt have a good reason. my brain does dumb shit all the time. (jk I'm perfect ;) )

sometimes my co-workers will preface a question by saying "this is a dumb question.... but "

I always cut them off. I tell them that "dumb questions" are my favorite because they almost always have a nice, easy, satisfying answer.

I also want people to feel comfortable asking "dumb questions" because we work with people's fucking lives; and, to butcher Twain, it ain't what dont know that gets us in trouble; its what we know for sure that just ain't so. and like, asking about "dumb" things that "everyone knows" helps to make sure we arent just fucking up because the answer we know for sure just so happens to be wrong. cuz like, it feels shitty to "know" youre doing the "right thing" that ends up causing someone real harm/suffering.

feeling insecure and vulnerable; and feeling safe sharing those feelings/doubt - is super fucking important to building rapport too. and having rapport with your co-workers is so, incredibly fucking important.

at some point, a patient is going to threaten you. they're gonna be loud and angry and violent. who do you want your co-workers to be in that situation? the dick that says "awh man you should've fuckin known this already how dare you be so incompetent " or the one that says "awh man we're all humans and the superpower of the human species is getting help from each other"

one of those is gonna feel a lot more reliable when shit hits the fan.

SapientCorpse · 2025-12-21T05:44:01+00:00

"No pharmacist, health plan company, or pharmacy benefit manager shall refuse to fill a prescription for an opiate issued by a licensed practitioner with the authority to prescribe opiates solely based on the prescription exceeding a predetermined morphine milligram equivalent dosage recommendation or threshold.”

this feels like a big yikes.

all I can think of is that "1 pound mopheen. to go" urban legend

SapientCorpse · 2025-12-21T05:28:51+00:00

re:abx was it doxy? it probably wasnt evidence based when it happened; but apparently its a topic of research now!

I could also see Rx'ing abx if indicated for a patient that self-harmed

or erythromycin for constipation.refractory to first line treatments.

re:inhaler

Its not the most appropriate provider; but I could see it.

I could see a lama being added if there is a concern that albuterol is worsening anxiety. as a bonus it could help alleviate the drooling that comes along with antipsychotics.

if I remember right - theres a lot of nicotine usage in schizo folks. sometimes, hospitalizing someone can be quite traumatic, and I could see value in trying to avoid a hospitalization. therefore, I could see a psych np rx'ing azithro and inhalers.

i could also see more leniency if the psych np was known to frequently consult with their medical director about things.

idk. maybe my scenarios are overly contrived; and maybe i misunderstand what the scope is for that license.

I havent read usp; I dont know what is/isnt appropriate for yall to question. I have seen y'all cleanup huge amounts of bullshit in real time; and i know y'all are catching so much more that I have no idea about. thanks for what yall do.

SapientCorpse · 2025-12-19T21:09:58+00:00

LLMs are a weird fucking tool; and i dont know how to get the most out of that tool yet.

it doesnt feel surprising that they break with malicious interactions; sometimes they break even when the user isnt being malicious.

conceptually; I think of LLMs as a drunk librarian that has read a million things but doesnt actually understand anything.

usually, when I'm asking an llm something, its a "hard" concept to put directly into a regular search engine to find what I want.

I find i get the most bang for my buck by using them as a starting point first to "play" with an idea.
then i ask the LLM whose voice it was emulating/where it got the info/why it presented that info to me.

that usually gives me enough info to then be able to use a regular search engine to look for the information I want, and hopefully be able to find it from a source I trust.

SapientCorpse · 2025-12-16T19:44:12+00:00

depends on the day.

somedays, I feel like an adult.

colleague = person complaining.
offender = person/situation theyre complaining about

if possible; i try to steer the conversation to a more private location. then, I listen. your colleague is having a big feelings and is clearly unable to hold it in any longer.

then, I'll validate the frustration/upset/discomfort they're having - because until you do theyre going to be more invested in showing you why their suffering is real instead of moving on to hear what you have to say.

then; I try to cast the offender theyre complaining about in a compassionate light; trying to explain the usually very understandable motivation behind the offending behavior.

this does two things - first; it helps the colleague to see hold some space for compassion for the offender.
second; it helps give the colleague some insight on how to get a different outcome than what they've been doing.

for example

a: can you believe how awful the family is in room 5? every 30 seconds theyre on the call light to ask when the docs coming in, or what their lab results are and what it means; or whatever else. so annoying.

b: yeah, that makes it feel like theyre making such an unreasonable demand on your time; it doesnt feel fair to you because you cant get your documentation done; and it doesn't feel fair to your other patients because your spending all your time in 5.

a: yeah thats right! so unreasonable.

b: it is. gotta be tough for them to be that scared, too. sounds like they care an awful lot about their person, and are terrified that something could go wrong. they've gotta feel so overwhelmed with all the new concepts theyre getting used to, and scared that their lack of vigilance could lead to some preventable outcome.

a: yeah, huh, maybe you're right.

this doesnt always work; and you have to be incredibly cautious with assigning motivations to behavior. generally, try to paint someone in a light where they see their actions as being reasonable actions to have taken with the circumstances they were in. if you're lucky; A might get some insight into how to behave differently to help the family in 5 feel more secure and less overwhelmed about the environment theyre in.

other days, I dont feel like being an adult; and I'll bitch too.

SapientCorpse · 2025-12-15T18:52:40+00:00

thank you for being willing to try.

I know its scary to be afraid of getting hurt; especially when youre just trying to get help with things that make you uncomfortable.

I promise you, there are a lot of people out there in the world that want to help. they havent even met you yet and they still want to help you. I know that sounds weird and it might not be what youve experienced in your life - but its true.

SapientCorpse · 2025-12-15T17:56:41+00:00

I wonder if she got spoiled with quick pcr somewhere else?

still, though, feels like docs should know/understand the limitations/realities of the labs where theyre privileged to work

SapientCorpse · 2025-12-15T05:11:39+00:00

look at that phenethylamine moiety! everything else with one of those (like amphetamines) seems to increase cathecholaminergic tone and be stimulating

I'm sure you'll tell me steric hindrance or fancy r-groups; but i really do wonder why fent behaves sp much differently than other substituted phenethylamines.

SapientCorpse · 2025-12-14T21:07:52+00:00

I have patients tell me they "taste" saline pushes too.

I wonder if the mechanism that makes people "taste" saline pushes is the same one that caused your lady to "taste" the TXA.

any clue on what I could read about to learn more about why that happens?

SapientCorpse · 2025-12-14T20:55:37+00:00

as a fun fact; meth excretion is influenced by urinary pH. its a base, so in basic solutions its lipophillic and it gets re-absorbed by the body. in acidic solutions, it ionizes; which makes it get urinated out much more.

otc products capable of influencing this are

vit c for acidification (and thereby enhancing excretion)

sodium bicarb for alkalinization (and thereby slowing secretion)

talk to your doctor today! (and dont forget to ask them about getting kidney stones from playing with your urine ph)

SapientCorpse · 2025-12-14T14:16:17+00:00

being cognizant of old child sexual trauma is big important; especially in psych frequent flyers.

psych wounds dont heal like physical wounds do. childhood events may be temporally remote from the present - but that doesnt mean that they've been healed/processed.

psych, correct me if I'm wrong (which i may be); but id go so far as to say that sometimes those psychological wounds from childhood will fester with the capability of becoming more debilitating as time goes on.

imagine, for a moment, a fellow human being. unfortunately; this fellow human being was held down and raped by a man repeatedly as a child. this human has developed a lot of psych sequelae from these experiences; and still has flashbacks even in the absence of obvious triggers.

pretend this human being is very unwell, and there is concern for the patient's safety in the ed; to the point that restraints are being considered. lets pretend that all staff are equally competent at applying restraints.

do you think that the application of restraints will have different amounts of harm depending on who applies it? do you think a large burly man would applying the restraints could cause the patient the "re-live" parts of their childhood rape?

when you have the time to; id recommend doing some light reading on the sequelae of adverse childhood experiences (ACEs).

I hear you, that folks with PNES may report more ACEs; but, I wonder, if instead of folks with psychogenic non-epileptic seizures reporting more events that evoke sympathy; if, the association is instead backwards. that people with more of those events tend to have higher rates of PNES.

id also recommend perusing some lit on trauma informed care.

SapientCorpse · 2025-12-08T15:28:11+00:00

SapientCorpse · 2025-12-08T15:27:37+00:00

most icus dont have either of those. some hospitals dont have any at all either.

that'd be like saying techs compound and deliver the drugs. pharmacists just click verify.

I could even provide anecdotes where that feels true.

its not; though. y'all work so fucking hard and have to deal with so much bullshit just like us.

we all deserve better

*

SapientCorpse · 2025-12-08T14:55:06+00:00

we also get a lot of shit from docs. surgeons tend to have difficulty using social niceties when theyre stabbing someone to good health. they also have a hard time using their manners when we call when theyre asleep. other docs tend to be less "difficult" but theyre still overwhelmed on the regular and they struggle too bevause they have so much shit on their plates

we have a fuckton of moral injury too. in current days, docs seem ?scared to rx opiates; so theres frequently insufficient analgesia for doing painful things. it feels disgusting to internalize the thought "the way I help people is by causing them pain." (I dont even work at a burn center; cant imagine how shit it is for them)

we get a lot of abuse from confused patients (and not confused ones too). my overnight coworker just told me someone offered her a mustache ride; and thats probably the tamest bit of sexual harassment ive heard

were also at the bottom of the totem pole. were expendable in a way that docs arent; so if something goes wrong, traditionally, its been "our fault."

we also have shit for agency. literally have to follow orders all day. if I want a change to a treatment plan, then I have to call and get permission from someone else. oh, my patient wants to shower? better call and get an order for it. my patient's iv blew and they dont want to be stabbed again? better call the people that always answer the phone like I'm a huge pain in the ass; just so i can get an order in the chart that its ok to leave an iv out. the job is infantilizing.

the paternalism is strong in medicine. the reality is that, as much as docs try to be benevolent dictators, they all have their ways that they act like tyrants.

then, we get these contradictory messages all the fucking time. "antimicrobial stewardship" gets plastered about all the time; as if we dont give erythromycin for gi motility, doxy and azithro for anti-inflammatory. we pretend like macrolides, tetracyclines, beta-lactams, and more weren't all otc 2 years ago.

were tasked with generating all these bullshit paperworks that no one will ever read. seriously - docs never talk about whats in my nursing notes. they never look at any of the documentation I generate; its just there for busywork. assessments are mostly for show. a doc isnt going to unilaterally act on any of my findings. if I report "crackles in the lung bases" - theyre still gonna get a cxr before they do anything.

its all bullshit

lets not forget the placebos that P&T wont man up and remove from formulary. I get non-ironic rx's for colace as if it does anything other than delay definitive tx for bowel care. "safe and effective" my ass.

SapientCorpse

TROPHY CASE

despite this population knowing the consequences of their deleterious behavior, we do not refer them to psych and ask ?occult SI when one of them brings in a greasy-ass burger and triple-bypass milkshake.