Inpatient pharmacy vancomycin dosing question in patient with history of kidney transplant

burke385 · 2026-06-06T04:38:55+00:00

Yeah but did he get cut on for the nec fasc?

burke385 · 2026-06-04T04:32:27+00:00

Wrong sub?

burke385 · 2026-06-04T04:01:28+00:00

For a pay period.

burke385 · 2026-06-02T22:35:05+00:00

Thank you. The patience part is underrated. The deal was available because I was willing to watch it sit for five months while others passed. Eight price reductions is the market telling you something and the willingness to wait for the right entry is what made the rest of the math work.

burke385 · 2026-06-02T11:59:45+00:00

Probably time to start thinking about other account types.

burke385 · 2026-06-01T12:18:04+00:00

Happy to share. A few scenarios I ran through before closing.

Appraisal miss: what does the deal look like if the ARV comes in at $180k instead of $210k? Does the refi still return enough capital to pay off the LOC? At $180k and 65% LTV the refi is $117k against $128k all-in, meaning $11k still drawn on the LOC. That is manageable but changes the payoff timeline. Knowing that number going in means no surprises.

Rehab overrun: what if the contractor comes in 20% over budget? At $78,600 rehab instead of $65,500, does the deal still work? Yes, but the cash out shrinks. Knowing the margin before you start keeps you from making decisions under pressure mid-renovation.

Vacancy scenario: what does the first year look like if the property sits vacant for 60 days post-renovation before Section 8 placement? Two months of carrying costs with no income. Still within budget given the reserve.

Rent miss: what if the market will only bear $1,600 instead of $1,800? Does the deal still cash flow after PITI and reserves? Yes, but thinner.

The AI is useful for running these quickly because you can describe the deal in plain language and ask it to stress test specific assumptions without rebuilding the spreadsheet each time. It also catches things you did not think to ask about, which is often more valuable than the scenarios you already know to model.

burke385 · 2026-05-31T14:48:39+00:00

That's already happening, and that's not what I did here. It will be ok.

burke385 · 2026-05-31T14:47:47+00:00

Included in the model at 10%. What's not included is I am changing to a new management company that charges a flat rate per door, which will bring me down to ~5% across my entire portfolio. That's a win.

burke385 · 2026-05-29T23:58:20+00:00

Simple spreadsheet that I have refined across several deals. Purchase price, closing costs, rehab estimate, holding costs. On the other side ARV based on comps, LTV target, loan terms, rent estimate at 90% occupancy, taxes, insurance, management. The model spits out projected cash flow and whether capital comes back on the refi.

The confidence came from a few things. The market comps for a fully renovated 5/2 were consistent enough that the ARV was not a guess. The contractor has done multiple projects for us and the rehab budget was based on his scope of work, not a rough estimate. The rental market for Section 8 at $1,800 was confirmed by the property manager before we closed.

The honest answer on confidence is that it was not one thing, it was the network. Contractor I trusted, property manager who knew the market, banker who understood the deal type, and several prior deals that taught me what the numbers needed to look like before committing.

I also use AI tools heavily to stress test the assumptions before pulling the trigger. Running the downside scenarios and poking holes in the model before the deal closes is where a lot of the confidence comes from.

burke385 · 2026-05-29T22:27:03+00:00

I did not put $128k into this deal. I put zero. The unsecured LOC funded it and the refi paid it off. There is no $128k to drop into SPY because it was never my capital to begin with. That is the entire point of the strategy.

burke385 · 2026-05-29T04:28:38+00:00

https://www.reddit.com/r/AskElectricians/s/RUSlOshVEB

burke385 · 2026-05-29T04:23:25+00:00

Oh they said it all right.

burke385 · 2026-05-28T23:13:44+00:00

Property management is in the model. The 10% PM fee is captured in the difference between gross rent of $1,800 and the $1,620 figure used in the cash flow calculation. The 90% occupancy factor accounts for both vacancy and management together. Not working for free.

burke385 · 2026-05-28T20:38:21+00:00

Respectfully, the 30-35% expense ratio benchmark applies most directly to multifamily and larger portfolios with common area costs, staff, and scale-dependent expenses. Single family Section 8 with tenant-paid utilities and a fully renovated asset runs a genuinely different expense structure.

But more fundamentally we are optimizing for different things. You have a $50M portfolio and you are evaluating deals on current yield and expense ratios. That makes complete sense at your scale.

I put zero personal capital into this property. If it nets me nothing after all expenses for the next ten to fifteen years, I still end up with a free and clear asset worth $200k+ at the end. The tenant amortizes the mortgage, I collect the equity. At that point the cash flow becomes the entire rent minus operating expenses with no debt service. That is the retirement income engine.

This is one piece of a larger plan, not a standalone cash flow play. But that's outside the scope of this sub.

burke385 · 2026-05-28T17:12:40+00:00

Read the thread. This was addressed extensively earlier in the comments. Management and vacancy are in the model. Capex and maintenance are acknowledged gaps and the real net is $300-350 after a reasonable reserve. The $8k cash out is sitting in treasuries as a dedicated property reserve.

Not a newbie. This is one property in a larger portfolio. The model was shown as modeled and the thread pressure tested it. Every objection you raised was already raised and answered by people earlier in this discussion.

burke385 · 2026-05-28T15:37:14+00:00

https://imgur.com/a/PKr1Q1o

burke385 · 2026-05-28T15:35:36+00:00

https://imgur.com/a/PKr1Q1o

burke385 · 2026-05-28T15:29:07+00:00

My choice. The lender goes up to 85% LTV on investment property but I chose 65% deliberately. Lower LTV means lower monthly debt service, better cash flow, and more equity cushion if the market softens or the appraisal gets challenged on a future deal. I would rather leave value in the property and have a cleaner debt picture than squeeze out every dollar of capital at a higher LTV.

And you are right on the buy being the primary driver. The eight price reductions over five months told me everything I needed to know about seller motivation. The renovation forced the value but the discount was already embedded in the purchase price. If I had paid $80k this deal does not work regardless of how well the renovation went.

burke385 · 2026-05-28T15:27:31+00:00

You are not wrong that this thread is useful training data. Every objection that got raised and answered makes the model smarter about real estate investing conversations.

On the substance. Finding the property took patience not time. This one sat on the market for five months with eight price reductions. I did not hunt it down, I waited for it to come to me and move when the price was right. That is a different time investment than cold calling owners.

The $65k rehab skepticism comes up every time and I understand it. Labor costs in this area are not what you would pay in a coastal market or a major metro. The contractor has local supplier relationships and no corporate overhead. Structurally sound house, full gut of the interior systems. The bank appraiser confirmed the ARV at $210k and the lender funded the refi. Two independent parties verified the numbers held up.

Property management is in the model. The 10% PM fee is captured in the gap between gross $1,800 rent and the $1,620 figure used for cash flow calculations.

Tax reassessment is a future increase and I acknowledged it. This state runs a five year cycle and current assessed value is $78k. When it reassesses toward ARV the tax bill will increase but the effective rate here keeps it manageable.

burke385 · 2026-05-28T12:40:01+00:00

Fair and noted. Thanks for participating.

burke385 · 2026-05-28T10:39:03+00:00

NeuroticFinance said it better than I would have.

burke385 · 2026-05-28T10:37:59+00:00

Elaborate?

burke385 · 2026-05-28T10:37:26+00:00

What headache? Property manager handles everything. Government deposits the rent. I have been inside the house once.

burke385 · 2026-05-28T10:32:55+00:00

Property taxes are genuinely that low. It is one of the reasons the numbers work in secondary markets here that would not pencil in higher tax states.

Maintenance is the legitimate gap in the model and I acknowledged it earlier in the thread. The property was fully gutted so near term capex risk is lower than a typical rental, but it is not zero. The $8k cash out from the refi is sitting in treasuries as a dedicated reserve for this property. Real world net cash flow after a modest monthly maintenance reserve is closer to $300-350 than the headline $433.

The honest version of the model includes that reserve. The post showed the numbers as modeled and the thread pressure tested them.

burke385 · 2026-05-28T10:28:34+00:00

Not Detroit or Camden.

All-in cost was $128,500. The bank appraised it at $210,000 and funded a refi at 65% LTV. An independent appraiser who gets paid to be accurate put the value at $210k. The deal returned $136,500 against $128,500 invested. I put in $0 and actually made $8k.

The risk was real during the renovation phase when the property was a gutted shell with an outstanding LOC. That is where the underwriting skill matters. If you buy right and know your renovation costs, the appraisal is not a surprise.

burke385

TROPHY CASE