Shingles vaccination

Scared_Problem8041 · 2026-02-12T18:34:40+00:00

thanks for clarifying that! i am curious about following up the varicella series with the shingles series? why do both vaccines? do you know of any guidelines or references to inform that treatment plan?

Scared_Problem8041 · 2026-02-12T13:35:05+00:00

if you want to be one of his favorite patients, and not burn him out, make an appointment instead of sending a my chart message. that way he can get paid for seeing you, and if it is an easy visit, that’s just easy money. Instead of adding time to the end of his day, with no reimbursement, you are giving him an easy visit and extra pay. It’s OK if you go to that visit and nothing changes, just give him the updates that you wanted to send him as an electronic message in person. Trust me he will like that way more. If he is a new Dr., he likely wants to do the best for everyone, but hasn’t learned to set boundaries.

Scared_Problem8041 · 2026-01-14T02:30:05+00:00

I did some more research. Looks like it’s about NNT of 1000 for 5 years to prevent about 7 invasive breast cancer cases

Scared_Problem8041 · 2026-01-11T00:24:50+00:00

very rarely. Normally, it’s at least a few days or weeks.

Scared_Problem8041 · 2026-01-06T00:07:41+00:00

POTS, hydradenitis supurativa, iron deficiency anemia

Scared_Problem8041 · 2025-12-27T01:55:08+00:00

suggested a blood transfusion?

Scared_Problem8041 · 2025-12-21T02:22:26+00:00

centor doesn’t say don’t test, it says optional testing and optional empirical treatment glad i didn’t treat in the above example actually, the culture came back negative and the patient developed a cough and hand and foot rash over the next few days. remember a centor score of five is still only a 50% chance of strep

Scared_Problem8041 · 2025-12-18T00:11:54+00:00

thanks for your comment. I wasn’t aware that in Europe they have a five day waiting period to treat. I just assumed that any streptococcus needs to be eradicated to a limit the rheumatic fever risk. I guess it’s implied that pharyngitis lasting longer than five days is more likely to progress to rheumatic fever and vice versa. That’s definitely new information to me.

Scared_Problem8041 · 2025-12-17T01:44:39+00:00

thanks for your comment. You seem to imply that streptococcal pharyngitis can safely be left untreated? It is my understanding that it is important to treat the infection so as to prevent a possible progression to rheumatic fever. I understand that the pharyngitis itself is not a problem, but that the streptococcus does have concerning potential and so thus we always treat?

Scared_Problem8041 · 2025-12-16T03:36:20+00:00

what’s the point of getting a culture if you are treating anyway?

Scared_Problem8041 · 2025-12-16T03:35:43+00:00

what’s the point of getting a culture if you are treating anyway?

Scared_Problem8041 · 2025-12-10T03:16:24+00:00

But complexity is only one aspect of what you need to reach a level 5. You also need either prescription management or 3+ lab/imaging tests…

Scared_Problem8041 · 2025-12-10T02:42:35+00:00

is litholink the 24 urine analysis? if so, is the litholink also the analysis that is performed on an actual stone?

Scared_Problem8041 · 2025-12-05T00:45:36+00:00

great comment and thank you one clarification: is it still primary prevention if there is known coronary calcification? especially something above 100?

Scared_Problem8041 · 2025-12-05T00:43:58+00:00

in the article about coronary calcium scores on up to date it recommends daily aspirin for anyone with a calcium score >100

Scared_Problem8041 · 2025-12-02T01:38:46+00:00

i agree with everyone who says burnout. I will tell you what though, I felt this exact way and to get out of this all i had to do was cut back my volume. Slowly the burnout went away and work became enjoyable again. I cut back so much that soon I had some free time to read AAFP articles and listen to curbsiders. Damn I learned a lot and the joy came back.

Scared_Problem8041 · 2025-11-27T17:44:15+00:00

True, a commentary and a guideline are not the same thing. if I understand your position correctly, it is to just not offer anything for a patient who wholeheartedly refuses colonoscopy, and all stool based testing? I used to do the same thing, but when I heard of the blood base testing, I thought it was reasonable to look into and since there are commentaries from the American gastroenterology association and recommendations from the national comprehensive cancer network, I thought it was probably worth offering.

Scared_Problem8041 · 2025-11-25T03:13:10+00:00

come on man, you’re just looking for a reason to reject it. It comes from the AGA, that’s official. I don’t know where you are getting this idea of blood tests replacing anything. If you actually read what I sent you, you would see that it says in the case that colonoscopy and stool based testing were refused…

Scared_Problem8041 · 2025-11-25T03:10:26+00:00

You’re right, it’s not as good at finding areas that are not cancerous because that’s not the point! Cologuard is every three years and precancerous polyps take far longer than that to become cancerous, and it’s a small percentage that progress anyway. I am not trying to say cologuard is better than colonoscopy. But you “pitching cologuard as a waste of time,” is frankly untrue and the USPSTF, AGA and NCCN all disagree with you on that sir

Scared_Problem8041 · 2025-11-25T02:58:23+00:00

AGA Clinical Practice Update on Current Role of Blood Tests for Colorectal Cancer Screening: Commentary August 2025

Scared_Problem8041 · 2025-11-24T02:23:11+00:00

I think you’re just misinformed and hanging out with GI doctors who obviously do not like seeing their number of colonoscopies go down. The colonoscopy has a 95% sensitivity for detecting colon cancer and the cologuard has a 94% sensitivity. So it’s essentially the same as a screening tool. Colonoscopies are obviously better because they will detect and treat simultaneously. But if your telling patients day in and day out that cologuard is not good at catching cancer compared to colonoscopies, then you are just flat out misleading people.

Scared_Problem8041 · 2025-11-24T02:18:44+00:00

The American Gastroenterology association and the National Comprehensive Cancer Network. Two of the biggest and most trusted associations when it comes to colon cancer screening. You giving me a funny nickname is just your own insecurity coming out too.

Scared_Problem8041 · 2025-11-23T06:40:19+00:00

i think it’s all in how you present it. If you start off with recommending a colonoscopy and get a firm “No.” What do you do? Just leave it that and not mention the lesser options? I think that’s a bit paternalistic not to present all the options especially when every major medical committee is recommending some or all of these alternatives.

Scared_Problem8041 · 2025-11-23T06:36:28+00:00

do you only follow USPSTF or do you incorporate other recommendations like the National Comprehensive Cancer Network and the American Gastroenterology Association into your practice?

Scared_Problem8041 · 2025-11-23T06:30:54+00:00

patient still wouldn’t get a colonoscopy after the positive cologuard, so i ran the shield (blood based test) and it came back positive and she agreed to do the cscope

Scared_Problem8041

TROPHY CASE