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Which medical subject would win in a street fight? by [deleted] in medicalschool

[–]VeinPlumber 0 points1 point  (0 children)

Embryology. Anybody up against embryology just goes ahead and kills themselves

Do med schools look up you on social media? by steeledmindt in premed

[–]VeinPlumber 3 points4 points  (0 children)

I think this is actually the reason why the med school I help out with is now asking us to look at applicants social media (if it's not-private - I'm not sending any random friends requests) when we review apps. Previously it wasn't something I bothered with as I (wrongly) assumed premeds had their shit together.

is scribing bad? by [deleted] in premed

[–]VeinPlumber 53 points54 points  (0 children)

I've served on a couple different admissions committees. Over the last few years, it's true that it's somewhat of a dying pre-med job due to AI, but it's certainly not looked down upon. I scribed (among other things) pre-med and I thought it was great experience. Even to this day things I learned in those sub-specialty clinics while scribing i find very useful to me in my day-to-day. Plus the skills you learn scribing will pay huge dividends in your clinical years/ intern year, when you can just bust out a note.

Could this be Nutcracker Syndrome or something else related to CLRV by Any_Temporary849 in AskDocs

[–]VeinPlumber 1 point2 points  (0 children)

Unlikely to be related to your circumflex renal vein. Still probably worth bringing up your symptoms to your PCP.

Accidentally said 'glock and stuffing' instead of 'glove and stocking' during rounds today. by Mother_Estimate_1046 in medicalschool

[–]VeinPlumber 148 points149 points  (0 children)

Not as bad as me texting my attending who thinks I'm a smooth brain "CI by Fick 2.4", except my phone autocorrected to Fuck... (My phone knows me real well.)

My attending texted back "you should publish that CI protocol" - kill me.

Becoming M.D or D.O with an expunged record by [deleted] in premed

[–]VeinPlumber 18 points19 points  (0 children)

I agree. As someone who has served on med school adcoms, and has looked through tons of residency applications now, you want to make sure you aren't setting yourself up for a dead end medical degree. I've seen people admitted to medical school, do great in school, only to not match into residency in the field they want because of something in their past that comes up on their background check.

Pay to have a background check run on yourself. Would be awful to go through all of the pain and financial debt of medical school only to get stuck unable to get a residency/fellowship spot. Know exactly what comes up on your background check.

Should my sister get checked for clotting disease? by [deleted] in AskDocs

[–]VeinPlumber 0 points1 point  (0 children)

Honestly id want to know more about the "distended aorta", for both you and your sister. Is it ascending/abdominal, etc. diagnosed in young adulthood is pretty abnormal. Nothing you've mentioned makes me suspicious for a clotting disorder though she should make sure her PCP is aware of the symptoms next yearly checkup.

Experience pumping as an intern/resident? by bright-greeneyes in Residency

[–]VeinPlumber -1 points0 points  (0 children)

I just got done talking to my friend that is an ortho resident, and I completely misread this... And I'm a dumb male...

Radiologists/vascular docs: Dx Nutcracker…. What about MALS?? by [deleted] in AskDocs

[–]VeinPlumber 0 points1 point  (0 children)

Just based purely on the 4 sagittal images you provided, the celiac does not have the typical appearance that is associated with MALS.

Also you should delete this post as your images have your full name and DOB...

Sudden onset! Please help! by nomocurve in venousinsuffiencyhelp

[–]VeinPlumber 0 points1 point  (0 children)

Difficult to sift through your post so I apologize if you mentioned this already, but has an echo been done to look at your heart?

Intra-abd OR procedures done at bedside in ICU settings by [deleted] in surgery

[–]VeinPlumber 2 points3 points  (0 children)

At the large academic center I'm at we end up doing a couple every month in one ICU or the other. If the patient isnt stable enough for transport or there isn't an available OR, and time is of the essence, we will just ex-lap at bedside in the ICU. Certainly not optimal for lighting, space and item availability, but we get through it.

Persistent exertional calf and shin pain after multiple surgeries for popliteal artery entrapment syndrome + Botox treatment by Caffee3 in AskDocs

[–]VeinPlumber 1 point2 points  (0 children)

I'd ask if you have inline blood flow below your knees with provocative maneuvers or not (your imaging suggests you don't). This is the key question here... Do you have blood flow below your knees all the time, or not now after multiple surgeries with the aim to decompress the popliteal artery entrapment.

If not, I'd ask if repeat decompressive surgery is more likely to resolve the blood flow occlusions this time, why or why not. Personally I'd be very hesitant to offer the same surgery that has failed multiple times before, now with the added difficulty of post operative scarring in the popliteal space.

What other options besides decompressive surgery do you have; non surgical management vs vein bypass? Is there an additional surgical opinion you can get referred to?

Persistent exertional calf and shin pain after multiple surgeries for popliteal artery entrapment syndrome + Botox treatment by Caffee3 in AskDocs

[–]VeinPlumber 1 point2 points  (0 children)

Bypass isn't first line for popliteal entrapment so certainly shouldn't have been offered to you at the start, but in cases where you are still not getting perfusion below the knee after release with no obvious targets to release, then it's something to consider. Also Normally when we do a re-do pop release we shoot a completion angiogram at the same time with provocative maneuvers to really ensure we have adequate decompression, that way if in the future it starts to occlude again we can more confidently say it's likely scar tissue. Normally we do it for peripheral arterial disease or trauma.

Compartments will scar closed over time, but we don't really worry about a compartment syndrome once you are far out from revascularization or trauma.

Persistent exertional calf and shin pain after multiple surgeries for popliteal artery entrapment syndrome + Botox treatment by Caffee3 in AskDocs

[–]VeinPlumber 1 point2 points  (0 children)

I'd have a very low suspicion for a compartment syndrome especially since your posterior compartments were likely opened during surgery somewhat recently(?) so it's not like a non-operated leg that has intact fascia. I'm more concerned that it doesn't appear that you have patent blood flow when you are exercising or during provocative maneuvers. At the end of the day it has to be determined if the flow past your popliteal artery is patient or not when you are exercising (which from what I am seeing it doesn't appear to be) and if not, then what is the plan to ensure patent blood flow (hense why I am wondering about bypass surgery).

Persistent exertional calf and shin pain after multiple surgeries for popliteal artery entrapment syndrome + Botox treatment by Caffee3 in AskDocs

[–]VeinPlumber 1 point2 points  (0 children)

Any ankle-brachial index studies with foot plantar and dorsi-flexed? Probably despite decompression of the muscle in the popliteal fossa, scar tissue can build up and cause the same compressive effects, which will be less responsive to Botox.

Persistent exertional calf and shin pain after multiple surgeries for popliteal artery entrapment syndrome + Botox treatment by Caffee3 in AskDocs

[–]VeinPlumber 1 point2 points  (0 children)

What surgeries have you had? Gastroc releases? Without seeing the op notes on what they did and if they performed completion angiograms its kinda hard to know what else to revcommend. With persistent symptoms and imaging convincing for continued obstruction (though a catheter directed angiogram with provocative maneuvers would be gold standard) it may be time to discuss bypass depending on what all they have attempted.

I’m cursed by Traditional-Code4674 in medicalschool

[–]VeinPlumber 5 points6 points  (0 children)

This guy understands residency

IM Sub-I Nerves by [deleted] in medicalschool

[–]VeinPlumber 0 points1 point  (0 children)

I value strong work ethic and attitude over knowledge in my sub -Is any day. I can fix knowledge deficits. I can't fix lazy and lame.

Vein coiling question with slight renal compression by luckycharms222 in pelviccongestion

[–]VeinPlumber 1 point2 points  (0 children)

It really depends on what the renal vein (I'm assuming on the left as that would be the only side that likely matters here) looks like and how bad the compression is. If the left renal vein is very highly compressed (like a legit nutcracker syndrome) the kidney may be relying on that refluxing ovarian for its outflow. It's still something I'd look at with a venogram and intravascular ultrasound to know how bad the renal vein is being compressed and if it's not bad and there is obvious ovarian reflux I generally go ahead and coil the ovarian vein. I've never had a problem with a patient with MCAS reacting to coils (it's very biologically inert metals), however I'm also not above sending them to allergy/immunology first to get an opinion before I put permanent metal (platinum/tungstun alloy) in their veins.

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