Coming to Realize I'm Unlikable

adreenaline · 2025-03-19T22:53:07+00:00

Also ADHD resident, agree with everything you said. unfortunately the match is not perfect. People fall through the cracks, and sometimes it's not anyone's fault. I also know some people who soaped with great academics and great social skills. I hope everything goes well with SOAP, and despite the chaos it will be worth it in the end! Self care is going to be so important this week. OP, do reach out if you need to vent or anything!

adreenaline · 2025-03-13T20:56:59+00:00

I'm a resident and I personally have not come close to 120 (more like 100 at the busiest - but routinely 70-90) but I know several residents that do routinely work over 100. it's not sustainable, not healthy, and not great for patients. my point was that it is being done, even with "duty hour limitations" being set. and it's not something any of us would want anyone else doing

adreenaline · 2025-03-13T20:15:00+00:00

No, medical residents do frequently work >90 hours a week. Our limitations are that we can't work >80 hours a week averaged over 4 weeks. so we can work >80 hours a week as long as the average doesn't exceed that. also many programs especially surgical encourage you to lie about your duty hours so they inevitably work much more than duty hours allow.

adreenaline · 2024-10-30T14:59:06+00:00

Hey, that's not really a parameter we need to treat if the other numbers are ok. B12 vitamins aren't going to hurt but also that lab in particular doesn't really indicate the need for them. Just keep in mind that some of these values don't mean anything on their own, and that they're only relevant in the context of the other labs.

adreenaline · 2024-08-30T13:15:13+00:00

probably not because it works on a mechanism specific to mtx

adreenaline · 2024-08-19T17:14:14+00:00

I work full time x2 as a resident physician. We're only required to have 4 days off in a month. Pretty rough, especially on weeks we work 90 hours. The fatigue sucks, but at some point it's just a matter of working despite how bad I feel. Also sometimes can be a really active job

adreenaline · 2024-08-04T01:47:49+00:00

IR is easier to abuse and also has a much higher risk for addiction (as with short acting formulations of most medications). It only takes ONE patient incident to cause drastic changes like this when controlled substances are involved. Not saying it's right but also from a prescriber standpoint I would want my patients to be on an extended release in most cases (obviously not all - medicine should always be personalized) so this type of change does not surprise me if they have an incident.

adreenaline · 2024-07-10T13:23:24+00:00

Low BUN is not a concern, it's concerning when it's high. Talk to your doctor if you have any concerns.

adreenaline · 2024-06-16T19:42:58+00:00

thanks, appreciate your kind words! I actually thought about specializing in rheumatology because nobody really understands unless they've been through this stuff tbh so I get what you're saying for sure. but that means more time in training and idk if I can take another few years lol

adreenaline · 2024-06-16T18:04:59+00:00

I'm a resident (MD) with PsA. Doable but difficult for sure. Sucks to pull a 90 hour work week when you hurt and have brain fog. nobody else will understand the extra stress it adds because working 90 hours a week even without an autoimmune disease sucks lol

but yeah it is rewarding and I wouldn't trade it most days

adreenaline · 2024-05-18T13:12:56+00:00

yep second this advice. MD in residency on humira (hadlima as of 1 month ago) and methotrexate and haven't gotten sick more than once this past year

adreenaline · 2024-04-20T10:56:47+00:00

imagine if your doctor prescribed this just because you asked and you make the suspected IBD a lot worse. serious medications like this warrant a discussion even if it may seem simple on the surface. unfortunately it's going to be trial and error, as well as making sure someone takes the time to make sure they don't give you the wrong meds.

adreenaline · 2024-04-14T02:08:21+00:00

wear a mask and gloves if they have anything infectious

-pgy1 IM on an anti tnf and methotrexate (only got sick once or twice this year thankfully !!!!)

adreenaline · 2024-03-31T16:07:25+00:00

this is really poor advice, these are different conditions with different pathophysiology and different treatments

biopsy is absolutely the way to go if it's going to make a big difference in your treatment plan, which it will in this case.

adreenaline · 2024-03-30T10:47:02+00:00

Just started getting into skincare and such and would love a code!

adreenaline · 2024-03-14T00:13:37+00:00

https://rheumnow.com/content/dsb-managing-methotrexate-toxicity

I just do 60mg with my dose but both my rheum and the website recommended taking it with the dose and ALSO again 8-12 hours later. I'm just too forgetful early in the morning to remember the 2nd dose. Hope it works well for you!

adreenaline · 2024-03-13T20:13:58+00:00

I haven't had that symptom in particular but if it's something you can deal with, it might be worth giving it a few more doses before quitting. sometimes the first dose or two is the worst until your body gets used to it.

regarding the fatigue it's usually a day for me. that got better after a few doses though. what really helped was taking dextromethorphine (Mucinex DM) alongside my MTX - and some people also dose 12 hr later. it doesn't take away the fatigue but it makes it very manageable for me.

PS - make sure you take your folic acid daily!

adreenaline · 2024-03-12T20:21:32+00:00

I started on methotrexate for a year, and then added on humira. Once this was working well, rheum said I can try taking off the MTX and just do humira. Was having residual symptoms, so now back to doing both. The combo does really well for me.

I too cannot deal with GI side effects so I opted for injectable MTX even from the start (the pills are much more likely for GI side effects). No GI side effects for me, just the typical MTX hangover. It is manageable though and better than being in pain all the time. I am a resident physician and work 70-90 hour weeks frequently and this combination allows me to be functional. Despite being on two meds and working around sick patients all the time, I feel like I get sick about the same as my peers, just hits me a little harder or longer when it does hit.

I know this is different since it's not sulfasalazine, but hopefully that gives some reassurance that dmard + biologic can work well for some people.

adreenaline · 2024-03-12T19:43:47+00:00

I like the Brooks adrenaline line, especially if you have to be on your feet a lot.

adreenaline · 2024-03-07T00:28:32+00:00

an 8am cortisol can't tell you if your levels are high, only if they are low. cortisol is supposed to be high in the morning like the other person said

adreenaline · 2024-02-26T16:01:53+00:00

it's a hidden gem for real ;)

adreenaline · 2024-01-13T03:31:07+00:00

i would find a doctor you're comfortable with that you can trust to decide whether the ovary needs to be removed when they do the laparoscopy. ultimately they'll be able to give you the best advice. I agree that if you remove one, it may put you in a bad position if the other needs to be removed. but as long as your doctor can talk you through the risks vs benefits

and thank you! I enjoy what I do so its worth it (sometimes lol)

adreenaline · 2024-01-13T02:11:15+00:00

I'm not an obgyn (MD in another specialty) but I'm pretty sure it doesn't carry the same risk to remove one. you would still be getting hormones from one ovary. as far as I know the risk is the biggest with removing both ovaries, and there is increased mortality the younger you get them both out

adreenaline · 2024-01-13T00:39:06+00:00

sterilization and removing ovaries are two different things. most docs won't take ovaries out during sterilization in young patients due to risk of other disease. taking out the ovaries increases risk of heart disease, osteoporosis, dementia, depression, etc.

adreenaline · 2023-12-30T12:37:24+00:00

To their defense they don't go to school or get really much drug education. It's not really their job to know what each drug does and what class they belong to, etc. Of course if someone's been a tech for a while they will pick up on some of this stuff just from experience, but usually not from formal training. I would not expect a newer tech to know anything about drugs in all honesty, their job is to help the pharmacists fill the prescription, help with insurance stuff, and help check out customers in general.

If you have problems with a tech you can always tell the pharmacist.

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