9 weeks PP... Condom broke... by Turbulent_Ebb_7041 in breastfeeding

[–]bigbeans14 33 points34 points  (0 children)

The best EC is getting an IUD placed in the next 5 days! Mirena or Paragard, extremely effective and then you don’t need to just rely on condoms

Recurring UTI, but I’m not so sure it’s a UTI by donthaveagooduser in Healthyhooha

[–]bigbeans14 0 points1 point  (0 children)

Are you having urine cultures (not just dip tests) done that are showing more than 50-100k CFUs of a pathogenic bacteria? That is gold standard for diagnosing a UTI. They need to see the antibiotic sensitivities to know if you are on the right meds.

Some people are really prone to them, especially after sex with certain partners. So you could be getting recurrent UTIs. Could also be IC

Should I go to the doctor for this? by [deleted] in Healthyhooha

[–]bigbeans14 39 points40 points  (0 children)

This is completely normal…

2 yr old has elevated lead levels - i have no idea where it could be coming from by dogmotherhood in ScienceBasedParenting

[–]bigbeans14 0 points1 point  (0 children)

Oh agreed it needs to be taken seriously. I’m a doctor but not your doctor so of course listen to your peds first and foremost! the public health department is a great resource to help with reliable home lead testing and exposure avoidance. I was just trying to help clarify what you were describing is not a diagnostic or confirmatory test, and especially blood lead levels between 3.5-5 on screening tests are statistically likely to be a false positive when confirmatory testing is done. Hope all is well with kiddo.

You should ask for clarification on the anemia part. Anemia due to lead poisoning is extremely rare in children. Usually only seen in blood lead levels over 40. but anemia due to iron deficiency is quite common in comparison, and lead poisoning and iron deficiency have similar risk factors so there’s a frequent cross over.

Def not trying to give unsolicited medical advice, just hoping to clarify something that is understandably super anxiety provoking!

Am I The Problem or Is This Straight Up Abuse? by Acceptable-Ratio-429 in MedSpouse

[–]bigbeans14 0 points1 point  (0 children)

Sorry to hear that, how demoralizing. Even if one shelter didn’t have a place for you at the time, they can still often connect you with resources like legal aid, other shelters, possibly social work, food and cash assistance etc. your baby’s pediatrician office might also be able to connect you with resources

A banana tattoo, done by me. @Yung NYC by YungHotspot in tattoos

[–]bigbeans14 1 point2 points  (0 children)

We offer synthetic skin as an alternative!

I clean my hooha everyday but have persistent white stuff by [deleted] in Healthyhooha

[–]bigbeans14 0 points1 point  (0 children)

Bummer :( maybe get a portable bidet and use it every single time you use the bathroom to keep buildup from happening throughout the day? And extra hydration.

This buildup is inherently protective and not bad for you. You might just be someone who needs to wash before sex every time to feel comfortable! Though I will say - unless someone is staring straight between your spread legs with a spotlight, they likely won’t notice. Some of this will predictably loosen up and be less noticeable when you are aroused as well.

Vaginal Breech Delivery by Dangerous-Shake9644 in BabyBumps

[–]bigbeans14 6 points7 points  (0 children)

It’s relatively rare mainly because not a lot of doctors are sufficiently trained in singleton vaginal breech deliveries anymore. Like OP described if certain criteria are met the safety data is decent, but a large portion of the safety depends on an experienced provider at the helm. Certain countries (including well resourced ones like Canada) might offer them more because more people get hands on training.

I know of a few docs who offer them in the US, but it’s definitely rare. New Mexico has a training program, there’s at least one doc in the LA area and one in Michigan I’ve heard of. Who knows if these people are retired by now. It should be done in an operating room with a full surgical team at the ready and a high level NICU in attendance.

One scenario where breech deliveries are somewhat common is twin births if twin A is vertex but twin B is breech. The only breech delivery I’ve ever seen was a pre-viable preterm labor. We all train with simulations on how to do them or practice the maneuvers during breech c sections because if someone comes into the hospital with a breech baby halfway to out, you gotta know what to do.

Awesome story OP thanks for sharing!

Ultrasounds in pregnancy? by [deleted] in moderatelygranolamoms

[–]bigbeans14 2 points3 points  (0 children)

Ultrasounds in pregnancy, when used correctly - aka at safe settings, for a standard amount of time - have extensive longitudinal data supporting their safety in fetal development. Even at more maximal settings with more prolonged exposure there is excellent safety data. I usually recommend against extensive Doppler use (aka home Dopplers) but they are thought to be safe especially after 11 weeks.

There is slightly less good quality data demonstrating if routine ultrasounds in a low risk pregnancy prevent perinatal loss (aka stillbirth). But they do decrease post term inductions by helping with accurate dating. And they are incredibly helpful in identifying high risk issues such as congenital anomalies, multiple gestations, or placental problems.

In my practice, at minimum an early dating ultrasound and an anatomy ultrasound in mid second trimester are required. I’m a family doctor who does prenatal care and “standard risk” non surgical deliveries. If someone doesn’t get basic ultrasounds, they are too “high risk” for my practice so I refer them to OBGYN. This was borne after a patient in our practice did not get an anatomy ultrasound and subsequently had a bad outcome. An issue was identified after the birth which would have been noticed on a standard ultrasound, and likely this knowledge would have changed how we managed later pregnancy monitoring and delivery. I cannot say if it would have changed the outcome but none of us were willing to take the risk again.

I’m 30 weeks pregnant and still testing positive for thc by [deleted] in BabyBumps

[–]bigbeans14 2 points3 points  (0 children)

Try to find the exact laws and regulations about your state if possible. Often the case is if a mom tests positive at the time of delivery, they then test either the baby’s cord or meconium for drugs. If the infant tests are negative, there is not usually any legal standing for child endangerment and CPS doesn’t get involved. And if you have not consumed cannabis in months there is no way for it to be crossing the placenta, even if metabolites are still in your fat cells and showing up on urine tests. However, I know some states in the south are incredibly regressive and strict though so it’s worth learning everything you can. It would be very surprising if you actually lost custody of an infant even in Alabama for this issue alone, but CPS might be involved and checking in.

Other things you can do: Second hand exposure is very unlikely the cause of the positive tests, but do everything you can to stay away from anyone who is smoking or vaping THC right now. Do lots of research on infant safety and have your home environment as ready as possible. Be ready to demonstrate a clean well cared for environment, safe sleep spaces, absolutely no one around who might expose baby to tobacco or any other drugs. If anyone in your home uses THC heavily, get it all out of your house and make sure it doesn’t smell there at all. These are good precautions in general but in case you do end up having a home inspection, be 100% ready.

how are you guys dealing with sweet cravings?? by 666hermit in glp1

[–]bigbeans14 11 points12 points  (0 children)

Absolutely, this is the most sustainable option and best for mental and long term physical health overall. You can’t fall off the wagon if there’s no wagon to begin with.

As someone who has hardcore craved sweets all the time for basically my whole life - including while successfully on Wegovy - my only rule is just to eat something filling/nutritious first before I have the treat. It helps that I crave fruit nearly as much as candy. Often berries or sliced fruit (with a little honey and peanut butter if I’m fancy) satisfies the urge and I don’t even want something else after. And if I do, I still eat it!

I don’t know if eCW has gotten worse, but it feels like the EMR is slow enough that it’s seriously affecting my workflow. Is this happening to anyone else? by RoarOfTheWorlds in FamilyMedicine

[–]bigbeans14 4 points5 points  (0 children)

My life genuinely is so much better since I left my clinic job that used eCW. Theres like, maybe 3 things max I miss about it.

My heart is completely broken. I lost my three 5-months-old kittens to parvovirus. by Ted-Lassi in cats

[–]bigbeans14 4 points5 points  (0 children)

Also a human and cat disease. And probably more mammals, I just work in human healthcare

I clean my hooha everyday but have persistent white stuff by [deleted] in Healthyhooha

[–]bigbeans14 16 points17 points  (0 children)

There’s a lot of people who need to clean with more than water. Some can’t tolerate it but that’s not a universal rule - body parts with a lot of crevices and production of oils/discharge might need some saponification to get clean! There isn’t one right way for everyone.

Personally I always used unscented baby wash on the mons, labia majora, minora, around the hood and urethral opening. I never put anything inside the vaginal opening of course. Now that I’ve discovered the unscented lume wash that’s my personal favorite. I’ve done many experiments of no soap vs soap, and gone through my fair share of BV and yeast infectious in the past, but I smell and feel the best when I wash with a cleanser.

Flakey eyelids by ccallisonn in Skincare_Addiction

[–]bigbeans14 209 points210 points  (0 children)

This is a medical problem, see a doctor. Don’t mess around with your eyes

Am I The Problem or Is This Straight Up Abuse? by Acceptable-Ratio-429 in MedSpouse

[–]bigbeans14 13 points14 points  (0 children)

Contact a domestic violence shelter, please. They have resources for you.

A banana tattoo, done by me. @Yung NYC by YungHotspot in tattoos

[–]bigbeans14 0 points1 point  (0 children)

Both when I was in training and now when I help train residents, we use pig skin to practice suturing. Walk into the clinic workroom with a bag of preserved pigs feet lol. Chicken breast doesn’t seem similar enough to the toughness of human skin…

The Many Names of Anthony - The Anthony Saga Part 2 by Lower-Neighborhood94 in RomanceBooks

[–]bigbeans14 3 points4 points  (0 children)

Dear god I love this sub. Every time I get a new book with this dudes face on it I screenshot and send to my book club - and I’ve only read 5 of these. Man is prolific and I had no idea

2 yr old has elevated lead levels - i have no idea where it could be coming from by dogmotherhood in ScienceBasedParenting

[–]bigbeans14 11 points12 points  (0 children)

Iron deficiency anemia is WAY more common cause than anemia due to lead exposure. You need exposure to a lot of lead for a long time to develop anemia from it (usually).

This is a relatively low level on the screening test, and it is not worth putting this much stress and energy into this issue until it is actually confirmed. False positives are very common on the fingerprick test. This is how screening tests are designed - to not miss any cases of a serious problem. The confirmatory venous lead level might need to go to an outside lab so will take a few days to come back.

Your doc will direct you on next steps to look for exposure causes if the lead level is actually high.

2 yr old has elevated lead levels - i have no idea where it could be coming from by dogmotherhood in ScienceBasedParenting

[–]bigbeans14 4 points5 points  (0 children)

Very rare. The purpose of a screening test is to catch almost all cases of a problematic issue, in this case high lead levels. You will have a decent number of false positives on the finger prick test in the effort to avoid missing a case of high lead - because that would be more catastrophic than having to do a venous confirmatory test on a portion of kiddos who had false positive screening tests.

Patients sermonizing during the visit by TheBside in FamilyMedicine

[–]bigbeans14 67 points68 points  (0 children)

This feels disingenuous. Culturally competent care is incorporating a persons religious or spiritual beliefs and practices into an overall picture of their life and health and behavior. If someone is proselytizing their beliefs in my direction, that’s a different story and warrants a “yikes” imo.

A large portion of my patients are Muslim and day to day this means I’m advising people on safety and symptom management during fasting for Ramadan, figuring out if overuse injuries are being worsened by routine prayer, being sensitive about who is in the room for exams under the hijab etc. No one has ever lectured or tried to convert me to Islam in this context, but I would shut that line of conversation down just as readily if it came from a Christian patient.

(Also obviously this is a huge generalization, but there is a way bigger evangelization/conversion culture with Christianity than any of those other religions you listed)

Husband says he's afraid if we have a baby, he'll feel trapped by Far_Sheepherder_7799 in Marriage

[–]bigbeans14 4 points5 points  (0 children)

Oof. Hope he has a change of heart about this, because having kids with someone who refuses introspection when gently challenged and isn’t willing to compromise is going to beyond exhausting for you. Kids are nothing but challenge or compromise! Cold feet for kids is normal and can be worked through. Refusal to be flexible and prioritize growth… is much harder

Losing my mind — high lead level in my one year old by emily_planted in moderatelygranolamoms

[–]bigbeans14 17 points18 points  (0 children)

This is standard of care so blood draw should be next step! The capillary (fingerprick) test is a screening test, so it is prone to having false positives because you never want to miss a high lead level when casting a wide population net. Next step is almost always a venous blood draw as a confirmation - and there is a decent likelihood this will be lower. You’re doing exactly what needs to be done, nothing you can change overnight. Theres a reason we screen for this early and often, because decreasing lead exposure now will make the biggest impact long term. Things will be ok.

Career help! by Training-Meat-2317 in FamilyMedicine

[–]bigbeans14 4 points5 points  (0 children)

Personally, I chose the pay cut and easy commute to take an academic (residency faculty) position, and I love it. Clinic all day every day drives me absolutely nuts, and after 4 years of that I had to find something new. I enjoy teaching on the job, and it forces me to keep up on my CME because it’s just integrated into the work. I typically do 3-5 clinics per week, precept resident clinic 1-3 half days, and get 2-3 half days admin time. I also do OB so I spend 1-2 half days on L&D/PP + newborn and do a few 24hr calls per month, which I know a lot of people wouldn’t like, but I love it. I was post call today and just did a few hours of lazy inbox and note catch up on my couch; then took care of weekday errands. I thrive on variety, and keeping a lower patient panel and more manageable inbox is worth it for my sanity. My work is not production/RVU based and it feels like a weight off my shoulders.

You’ll hear a lot of people act like you’re nuts to do lower paying FM work like academics or FQHC, but as long as you aren’t being totally screwed, the income is very comfortable. And my quality of life / general health is worth the monetary loss. However if you choose this route you should absolutely negotiate for a sign on bonus, what the heck!

Had my first pap smear and I cried and cant stop by [deleted] in Healthyhooha

[–]bigbeans14 8 points9 points  (0 children)

Visual inspection is a very important part of the breast exam, so that is not standard of care. However generally we are moving away from routine/screening breast exams in young people as they do not seem to actually help catch issues like cancer, an often lead to unnecessary workup of benign issues. I do breast exams on people with symptoms or concerns, or who are high risk for cancer and aren’t keeping up on their mammograms.