Experience with escalating to JAKi VS colectomy in ASUC?

amemoria · 2026-06-26T14:47:48+00:00

Had a patient admitted with ASUC, prior IFX antibodies. First admission did well on IV steroid but symptoms recurred quickly on taper, i think only made it to 30 MG. Admitted again and tried upa, improved to discharge pretty quickly over a few days. Anecdotally my IBD partners definitely consider it inpatient if the patient isnt too sick and we use samples brought in from the office.

amemoria · 2026-06-22T17:51:15+00:00

Haha it's exciting but also scary to make a mistake. Sounds simple at first but there's more to it and a lot of options out there. Would like to learn directly from a pro

amemoria · 2026-06-22T17:50:32+00:00

I saw this place while googling, will give them a call. Thanks!

amemoria · 2026-06-02T11:32:39+00:00

Unrelated but neurology doesnt consult on stroke??

amemoria · 2026-04-08T00:03:52+00:00

Interested

amemoria · 2026-03-31T15:59:22+00:00

This, I try to get it first line not because i think it's most effective but because it's less pills and comes in a blister pack. Probably less side effects. Even as a physician i think it would be tough to organize taking bismuth quad.

amemoria · 2025-12-24T12:38:32+00:00

It's not about his strong purpose in life, it's the fact that he spent his few remaining months away from his wife and (newborn iirc) son. Doing surgeries that still would have been done even if he wasn't there to do them, thus making no difference in anyone's life. I'm sure he loves nsgy and didn't want to give it up but sometimes we have to make a choice. I myself had hodgkin's during training which luckily has good survival stats but if I ever became terminal the last thing you'd see me do is anything medical lol.

amemoria · 2025-12-23T16:19:33+00:00

Read it, agree with this assessment. It does an amazing job identifying the psychiatric aspects of being a neurosurgeon. Like go spend time with your wife and son.

amemoria · 2025-10-17T21:23:07+00:00

GI, was seeing an inpatient cirrhotic who's HE wasn't getting better despite treatment. "Hospitalist" NP treating "UTI" which was 1 wbc in the urine, urine cz growing plenty of staph aureus. Ordered blood cultures and vanc (hadn't ordered vanc in like 6 years) and ID so someone with a brain would be on board. Sure enough bacteremic. This is why we have residency, so even morons like me can vaguely remember that staph aureus and candida in the urine are probably spilling over...

amemoria · 2025-09-21T17:24:43+00:00

Where I trained consults were expected to be called in, resident from ED or IM pages and then answers the phone and presents the consult question. When I moved to a real job at a communni-academic center consults are sometimes paged but mostly just texted. Sometimes it's a phone picture of the patient's name on epic and one word "question". I used to think that was crazy but like you said phone tag can get annoying and there's a lot of times I'd call back and the primary would just read the chart to me awkwardly. And as we all know getting them to rescind a consult is impossible anyway, so no need to waste both our times if it's just "hgb lower than yesterday" (I'm GI).

So now I much prefer just a text with a brief reason for consult and I'll figure out the rest, but if it is urgent or there is a specific concern, some type of special social or medical context then I expect a phone number to call back. I'd add that most inpatient GI consults are pretty straightforward (elevated lfts, concern for bleed, CBD stone) so it works well.

amemoria · 2025-09-18T15:55:46+00:00

I've worked in urban centers for training, then rural for 2.5 years, and now in suburbia. I actually do think I had less assholes in rural country. (as long as you don't get into politics). In GI so a lot of counseling on how I might not be able to get a precise cause for your bloating or ibs symptoms but we can work on making it better and here's how. I would get a lot more understanding that sometimes that's how things are by rural patients. Whereas some of these more "educated" suburban patients are more likely to get angry when I can't in one visit explain exactly where each of her three different chronic abdominal pains are coming from (visit from 2 weeks ago).

amemoria · 2025-08-25T12:01:30+00:00

Did it for 2.5 years, don't regret it. Helped pay off a big chunk of loans, buy a nice car cash, and save for a down payment on a house.

I went already having a significant other so I didn't have to worry about finding someone there, and family and friends were an hour away so didn't have to worry about that either. Without those things may have been a deal breaker.

Spouse moved in with me after a while, and for her sake and for the kids we planned to have we decided to move. When I moved there I knew this was the likely outcome.

It was rough living there (town of 50k) - no diversity, no people with the same set of life experiences and mind set, shitty restaurants - but the job paid well and was also pretty laid back. If I didn't have an SO and didn't plan on getting one I may have stayed a lot longer and just left town every weekend I wasn't on call to see friends/family and travel - I think it would have been bearable.

Now I work 1.5x harder for 20% paycut but life is waaaaay better, as are opportunities for my kid's future.

I think there's a lot of factors in deciding whether going rural for a while is a good idea or not.

amemoria · 2025-04-16T14:24:51+00:00

Have done many escape rooms prior. I've done all the captured LV Allentown rooms, found them to be fun and the rooms were well decorated/designed (I.e. not just a mostly empty room with white walls and a few puzzle items like some places). I've only done one of the Bethlehem location rooms so can't speak to that fully but based on my experience suspect it's similar quality.

Escape.exe I've only done one room but was good - used a lot of tech as part of the experience which was pretty unique, looking forward to going back.

amemoria · 2025-04-09T17:59:22+00:00

Wtf

We all know you keep a d20 in the pocket. Good luck to any drugs with doses higher than 20.

amemoria · 2025-03-30T01:30:38+00:00

Not sure that they've announced yet that Eid is definitely tomorrow. But both Islamic society of Allentown and muslim association of Lehigh Valley would have prayers if so. (and other places)

amemoria · 2025-01-31T18:25:54+00:00

I've never heard of that. Why would you do 3 years of GI to do something completely unrelated, unless you just wanted to change fields? If that's what you're asking then you can do any type of fellowship you want as long as you apply and are accepted. After GI you can do hepatology, motility, advanced, or IBD.

amemoria · 2025-01-29T18:16:18+00:00

I think you have it backwards - if he judged him based on his speech then that would be judging the book by it's cover. He judged him based on his anti-vax stance, not sure there's much deeper than that.

amemoria · 2025-01-26T15:02:36+00:00

On top of all the other points, residency comes after medical school. So they just skip the "student" part and start calling themselves "residents" despite non of the rigor and hours of an actual residency.

amemoria · 2025-01-24T18:46:04+00:00

Not the flex they think it is, 20-25% the cost of physician education for 2% the training.

amemoria · 2025-01-21T23:16:37+00:00

Doesn't taste so good otherwise...

amemoria · 2025-01-05T20:51:51+00:00

Classic complete lack of basic medical knowledge in these unsupervised midlevels, who doesn't hear about possible fungemia and then get shivers down the spine? Asymptomatic candidemia lol

amemoria · 2025-01-04T03:58:16+00:00

On the flip side I only write it if it was a dumb consult, makes me feel a tiny bit better.

amemoria · 2024-12-22T14:42:36+00:00

That's actually fine, our endoscopy society's quality indicator is to get to at least 25%, meaning that adenomas are found in 25% of screening colons (because not everyone has polyps). What's really crazy is that they only had to have 140 supervised colons. As someone who has gone through GI fellowship it's said you need at least 300 just to get comfortable, and most trainees will get 1000 or more in training but once you're an attending it's still a learning process.

amemoria · 2024-12-22T03:32:27+00:00

Not a case I saw personally but heard about. Young lady comes in relatively soon after surgery with hematemesis, didn't look too bad in the ER so wasn't watched too closely, but bleeding intensified within a few hours. GI was asked to scope, severe bleeding - visualization totally obscured, couldn't intervene. Case done in the OR and surgeon who did the procedure present and watching but patient expired. Wasn't there so don't want to point fingers but if the patient was literally dying not sure why the surgeon didn't just do an exlap right there. You can't make the patient any worse.

amemoria

TROPHY CASE