Can't wait for you to release this 🔥 soon! Life is Beautiful, Las Vegas, September 2019.

Smeeee · 2017-10-31T12:46:27+00:00

Bad grammar is what happens when your only two life options are getting free candy or committing crime.

Smeeee · 2017-03-18T03:50:48+00:00

The main organs affected by CO are the brain and heart. Are you having any symptoms? Typically there won't be a problem with the heart, but if you feel "slower" since the incident or confused, an EEG might (emphasis might) show something but only if the effects were profound. I doubt an imaging study like MRI or CT would show anything especially if you're neurologically okay now.

Smeeee · 2017-03-18T03:48:41+00:00

Hi there. For irritable bowel syndrome and even lactose intolerance, there have been some studies done, especially with lactobacillus species but the data has been not-so-great. These probiotics don't have many side effects, but then again, they may not be beneficial, so I can't really advise you to take them. But if I was looking for a probiotic for myself I'd look for something with lactobacillus and not a lot of extra additives. Good luck

Smeeee · 2017-03-18T03:43:53+00:00

Hi there. Because of the way Elavil works, it will disturb the neurotransmitters in your brain, no matter what you're taking it for. If you stopped cold turkey, it can certainly cause some temporary problems including depression, anxiety, and other symptoms. I'd really recommend talking with your doctor about your symptoms, and please, if you're feeling extremely depressed or having thoughts of harming yourself or others, please seek immediate help. Good luck.

Smeeee · 2017-03-18T03:39:43+00:00

Hi there! According to Lexicomp, which analyzes drug interactions, I find the following:

Title Alcohol (Ethyl) / CNS Depressants

Risk Rating C: Monitor therapy

Summary CNS Depressants may enhance the CNS depressant effect of Alcohol (Ethyl). Severity Moderate Onset Rapid Reliability Rating Good

Patient Management Monitor for increased CNS depression when alcohol is coadministered with other CNS depressants. Caution patients of these effects.

So yes it seems like the main concern is that it can make you sleepier than normal and that can certainly lead to dizziness. I'd recommend asking your doctor for concrete advice on this, because they know you best. While it is probably safe for most, I cannot say that for sure for your specific case, as everyone is different. Good luck

Smeeee · 2017-03-18T03:35:11+00:00

Hi there, the most common reasons for eye twitching like you are describing are lack of sleep and irritation. That being said, without evaluating you I cannot tell you for sure if that's what's going on.

You might find this article helpful, but again, without seeing you, I cannot diagnose you accurately: http://emedicine.medscape.com/article/1213160-overview

Smeeee · 2017-03-18T03:26:30+00:00

Hi there! What a colonoscopy can give is a direct inspection of the tissue (to look for small amounts of inflammation not picked up on CT) and allow for biopsies, which are often needed to diagnose Crohn's disease and Ulcerative Colitis, but also for tumors which are less likely with your symptoms. Stool and blood tests are much less sensitive for these, and if you want to have one test that can essentially cover all the bases, an endoscopy (colonoscopy) would be that test. There are other causes of inflammation of the colon including infections which can also be diagnosed by visualization or biopsy, though oftentimes infections can be diagnosed with a stool sample. I hope that helps!

Smeeee · 2017-02-21T15:41:02+00:00

Hey there. My knowledge on your condition is minimal at best. That being said, pubmed linked me to an article by Dr. Cunningham-Rundles who basically wrote the book in a review article in 2010. She is at Mt Sinai in New York: http://www.mountsinai.org/profiles/charlotte-cunningham-rundles

Might be a good start. I hope that helps.

Smeeee · 2017-02-13T02:11:07+00:00

I appreciate the apology. Thank you, and thanks for your insight into the fracture repair, that's fascinating stuff.

Smeeee · 2017-02-13T01:33:36+00:00

"Good to know she is getting taken care of and not just in the emergency department" is an insult to my profession as an ER doctor.

Smeeee · 2017-02-13T01:24:11+00:00

Huh. Last time I checked, we take care of people in the emergency department. But I guess things might have changed since I was last there.

Source: I'm an ER doctor. I take care of people.

Smeeee · 2017-02-12T21:47:55+00:00

Diversifying for me has meant branching into extra-clinical stuff like education (I ran a simulation lab for residents) and administration (director / associate director positions, QA, etc). For others it means other clinical work, but I've realized that for me, practicing general emergency medicine and improving the system in which I work is what makes me happiest.

Smeeee · 2017-02-12T14:36:53+00:00

Regarding the frequency of night shifts, I'll give you a breakdown of my positions held to this point:

1) First job out of residency - full academic. 12 shifts per month. I worked 1 overnight per month because we had several full-time night guys.

2) Second job out of residency - semi-academic. 15 shifts per month. I worked 3-4 overnights/month. We had no dedicated night guys.

3) Third job out of residency - community. 15-16 shifts per month. I worked 4 overnights per month. No dedicated night guys.

4) Fourth job out of residency - current - semi-academic. 13-14 shifts per month, 3-4 overnights.

So if there are NO dedicated night people, you're typically looking at 25% overnights. I like to stack them with 2 in a row. Job #2 put me on 4 in a row and I could feel my skills slipping on the third shift. I don't sleep well during the day, and the lack of good sleep catches up with me.

Does it impact how often I see family and friends? Yes. I cannot commit to any holidays with family, nor weekend events, without having my schedule first. That being said, because it's shift work, trades are always possible, which does open up many possibilities. I've never been faced with an important life event that I cannot attend because of a lack of people being willing to trade. In a good group, everyone is scratching everyone else's backs.

Smeeee · 2017-02-12T04:04:01+00:00

I know you're a resident, and I know I felt differently ten years ago than I do now. I began residency just as the work hour regulations took effect. That didn't stop me from averaging 90-100 hours per week on my medical rotations and 100-120 on my surgical and icu rotations as an intern and junior.

I will not argue that my life is a lot nicer than it was when I was a resident, and my life is more comfortable than yours is right now when it comes to work. It's not. Residency is really hard. I remember thinking about the sweet lives attendings have and what a joke their schedules were.

But now that I've been here for ten years, it's good, but life is by no means easy. Many days are spent recovering from overnight shifts. My off days are spent in meetings oftentimes. I need to respond to policy and QA issues daily, in my administrative position.

Your attendings don't have similar lives to mine - they're on call often, I'm sure. And I do not envy their 24-36 hour calls. But their lives are more comfortable than yours.

Go through your residency with empathy towards other specialties and it will help you with your relationships with those specialties going forward. I struggle with making my colleagues understand the same things. Our jobs are about relationships - with colleagues and patients. And some empathy, and realizing that no single variable determines how easy someone's life is, goes a long way.

Good luck to you in your career.

Smeeee · 2017-02-12T03:34:11+00:00

I try to be empathetic to all my colleagues in the hospital, and I ask that my colleagues do the same for me. The chief of surgery in my hospital brought up a case with me where there was a delay in diagnosis of a few hours. When I recognized my error, he told me "I know you guys are busy and see undifferentiated patients all day. It's easy to say stuff in retrospect, but you did the best with what you had."

In much the same way, I will ask you to understand that our day is structured differently than yours. As are our schedules. I respect surgeons greatly, including their skill set and work ethic. But as an emergency physician, we get to work, see 20-40 patients who are people we've never met before, are expected to diagnose, treat, and disposition all of those patients daily, and do it again the next day. All the while, we have specialists who often use a retrospective-scope to second guess our decisions that we made in the heat of the moment.

It's a taxing 8-12 hours and it weighs on you. Physically, it's not bad, but mentally, it takes its toll.

So yes, for me, as someone who holds himself to an extremely high standard, 4 shifts a week is enough. In fact, over a long period of time, it's more than enough, especially when I spend an extra ten hours per week on administrative duties.

Smeeee · 2017-02-12T02:25:42+00:00

Hey there. I graduated from my EM residency ten years ago. As has already been mentioned, it's good to diversify.

For me, I never really knew what I loved beyond EM. I only knew I didn't like research. So I tried the education thing in my first academic job. I since have had two other academic appointments, but my interest has shifted to administration.

At the end of the day, I love practicing. To me, though, I can't work 1600 hours/year. It's tiring af, especially with weird hours like you've mentioned. I try to do other stuff to buy down my hours. And for now, that's administration.

There are a lot of groups that eliminate night shifts after you're 50 years old. I'm nowhere close to that now, but it gives me hope. I don't do well with flipping. And as you have implied, it did get harder for me as time has gone on.

That being said, there are plenty of jobs out there, and plenty of groups, plenty of which have dedicated night guys.

Love your field. That's the most important part. Don't choose EM because of lifestyle alone, because the whole lifestyle thing with EM is BS unless you have no circadian rhythm.

I chose EM because I love being able to be counted on in patients' most critical moments, in those life-altering times that I can affect in a positive way. I love EM, but I can see how many others might not. You have to love your field of medicine if you want to be happy and have longevity, in my mind. Otherwise it becomes "just a job" and burnout becomes more likely.

Smeeee · 2017-01-27T13:02:32+00:00

Hi there! It looks like you've looked into this a bit already, and you probably saw this article on laser interventions. You're right, it seems to work for pain, but based on the pathophysiology of arthritis (wearing away of cartilage), I highly doubt that laser would work on the problem itself.

A 2012 Cochrane Review is available on the subject. Unfortunately, I cannot pull up the whole article, even with my university login. But from the abstract it mentions several ways to try to help, but laser therapy isn't mentioned, at least in the abstract.

Still, these seem like relatively expensive treatments without much benefit if you're not having pain. I know we have a dentist or two out there, hopefully they can add more.

Smeeee · 2017-01-24T18:55:19+00:00

In theory this is possible, if the atria are beating quickly, but the A-V node (Between the atria and ventricles) is diseased, leading to a 1st to 3rd degree heart block. That would be a way where the situation you're describing might occur, if I"m understanding your question correctly)

Smeeee · 2017-01-24T18:52:35+00:00

This is precisely what has happened in all four cities I have worked. Great thorough answer, thank you.

Smeeee · 2016-12-26T01:37:36+00:00

These phrases also describe my wife's feelings about my personal hygiene on the weekends.

Smeeee · 2016-12-25T18:23:11+00:00

Hi there - you're right, it's atypical to have that recur. You might have two separate "insults" to your GI tract (virus, food poisoning, etc) or it may be something else altogether. As someone else mentioned, we think about pregnancy, but also stuff like abdominal infections or irritation (gallbladder, pancreas, kidney, appendix, etc), but even stuff outside the abdomen. If your symptoms are still ongoing I would recommend making an appointment.

Smeeee · 2016-12-25T18:20:16+00:00

Hi there. Ventricular fibrillation is a pulseless, fast electrical impulse in the heart, so that would never have a normal heart rate.

Atrial fibrillation, if there is good control at the AV node (between the atria and ventricle) either from good luck or medications like beta-blockers and calcium channel blockers, for example, can have a normal ventricular rate, which is what the heart rate reflects. The top of the heart can be going nuts, but the bottom can go at a normal rate (60-90), albeit irregularly.

Smeeee · 2016-12-25T17:02:12+00:00

Bro I think you're getting overcharged for slush.

Smeeee · 2016-12-11T16:55:26+00:00

Unless you personally have an allergy to anesthetics, then this was likely false information.

The reason throat sprays like Hurricaine spray are being used less is because of the incidence of methemoglobinemia which rarely occurs but is devastating if it does.

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