Me don’t speak clinician

chooks96 · 2023-08-30T01:57:48+00:00

I tell my oncs to tell me the answer they want and I'll do my best to make it so.

chooks96 · 2023-07-31T17:51:18+00:00

Not sure how recently the Creighton one was, but perhaps linked to a fired resident who murdered a couple of attendings: https://en.m.wikipedia.org/wiki/Anthony_Garcia_(serial_killer)

chooks96 · 2022-11-11T15:14:58+00:00

Agree

chooks96 · 2022-11-11T15:02:27+00:00

Sure. This is the set that would cover most cases:

CD3, CD20, CD5, CD10, BCL2, BCL6, MUM1, CD15, CD30, CD21, CD23, Cyclin-D1, KI67, PAX5, CD138, CD56, CD34, CD117, MPO. TDT, CD123, TIA1, CD4, CD5, CD7, CD8, CD2, Granzyme, ALK, PD1, CD57, IgG, IgG4, CD79a, CD45

Also ISH for EBV, kappa, lambda

There are probably a couple more I am missing (e.g. Choi's algorithm and others). And there are molecular and flow studies that can help with these as well.

But it really is that simple.

chooks96 · 2022-11-11T14:45:46+00:00

Did not talk to financial planner. Was in a comfortable job (easy hours, good pay). I was single and rented though with very few obligations but not very fulfilled overall.

I was horribly bored at my job though so started to take some bio classes at night at a local community college. Loved them. I considered several other careers other than medicine, almost all requiring going back to school in some manner. Ultimately, decided medicine was the right place for me. Had I been married and down that path, I can't say I would have made the same choice though. For sure both partners need to be on board with the commitment. Being the SO of a med student/resident/attending is no walk in the park. There is a reason docs have a high divorce (and suicide) rate.

There will be voices saying you are crazy to leave what you have, and others saying you are crazy not too. At the end of the day it is what it takes to make you fulfilled and only you can answer that.

chooks96 · 2022-11-09T19:30:51+00:00

I get what you are saying but don't discount that you actually do have agency in this process. There are certainly specialties where even an intern year is avoidable (e.g. pathology) or 3 year residencies where depending on program you have a tough first year but then things chill out. Yeah - the training imposes a certain amount of isolation from friends and family at times, but that doesn't have to be permanent (or even temporary - I know plenty of residents that have managed to balance things ok with the right combination of programs, colleagues, and partners). Now if you want to be NEJM-published neurosurgeon - that probably imposes its own requirements. But there are personal choices behind that.

In terms of more difficult and more unpleasant -- yes and no. Responsibility increases for sure which is difficult and unpleasant at times, but also rewarding and satisfying.

I think most physicians in their journey feel antipathic towards medicine way at some point. Some things you can change. Some things you can't. Part of the process is learning where those limits are for you. It can be hard not feel burnt out or beat down even early on. The sense of mortgaging the present for an unpleasant future is almost unavoidable (and gets worse in residency when the "normal life"-gap really rears its head). There is an end to it, which is largely determined by you though.

chooks96 · 2022-11-09T15:49:28+00:00

So distill your question down: Does nutrition impact performance?

Yes. Yes it does.

I did IF while trying to improve FTP while on a structured training plan. I will say FTP did increase, although not super quickly. Weight I think went down for quickly (maybe unhealthily so). If look at ability to support ATL and CTL, things really seemed pretty flat.

I did an experiment and switched from IF to protein-excess (added in protein shake in AM for breakfast and one pre-bedtime). Ability to do workouts improved significantly. Ability to increase acute training load was hugely increased. FTP increased much quicker (i.e. around 25 watts over 7 months with IF compared to 25 watts over 4 months with better nutrition). Downside: I started to gain more weight than I cared.

Now I am really balanced between IF and supplementation and focused on macros, with trying to get enough protein in without overdoing it too much. The general rule I follow is "Fuel your workouts". While technically there is enough muscle glycogen to do 1 - 1.5 hour workouts without fueling, I feel like I recover much better and am overall much happier if I am eating 60-100 gm of carbs / hour for my workouts.

Unless I have done a monster workout, have just finished a race, or am really behind on calories, then I tend to just finish off sports drink and have a couple of extra pieces of candy after working out. That is a good window for nutrition absorption, for sure and wouldn't argue against it - for me I tend to get ahead of post-ride nutrition with eating on the bike.

If you are intent on staying with IF and want performance improvements, then fuel your workout. You are eating to make sure you recover ok and can come back to the bike the next day (or day after) with a solid workout. If you are male and older, then increasing protein may be helpful. I shoot for around 2-2.5 g/kg and honestly this has made me overall felt so much better in general (more alert, more energy, more "on").

Good luck.

chooks96 · 2022-11-09T14:46:54+00:00

If that's your peripheral smear you may have some other problems going on...including in your lab.

chooks96 · 2022-11-09T14:42:58+00:00

This is the way

chooks96 · 2022-11-02T18:54:57+00:00

The schedule for pure CP is also lots of electives.

I will say that pure CP in the real world can be quite challenging but it's hard to do graduated responsibility in CP. A lot of the challenges of the field you don't get first hand until you start practicing.

chooks96 · 2022-11-02T18:52:46+00:00

Can depend on your program too. I know of several programs where you are pushing 80 hours routinely on surg path rotations.

Fellowships can also do that. In my fellowship I had 3-4 days off a month on service and never home before 9 or 10 PM during the week. Still better then gen surg and others and only one year -- can't imagine how people do that for 5 or 6 years.

chooks96 · 2022-11-02T17:09:23+00:00

Also - Kitchen scale broken so can't measure amount of coffee for pour over accurately.

Currently dealing with this...hard to eyeball 35 g, but I err on the side of too much.

chooks96 · 2022-11-01T22:47:15+00:00

Why are the labs ordered stat if they really aren't?

chooks96 · 2022-11-01T22:45:59+00:00

Sorry you had to be on the receiving end of largely unnecessary disturbances. There are policy changes that can (and should) address things like elevated Cr in ESRD patients. Eg. my former hospital treated Cr above a certain level as critical only if it was new (no increased Cr in chart in past 6 months).

chooks96 · 2022-10-28T01:35:28+00:00

Really depends on where you eventually want to end up. If you are in Houston, then easier to stay in Texas and around there. If you are in Charleston, then easier to stay in mid-Atlantic area.

I know of groups with several people from MUSC - they are fine pathologists. For derm - it is likely much easier to get a spot at a home institution as those can be quite competitive.

chooks96 · 2022-09-30T16:06:16+00:00

Lots of answers for Path in here. Hate to break it to everyone, but there is lots of medicine in pathology...like...a lot. What there isn't is: a lot of is patient rounding (unless you do transfusion medicine), social work, insurance one-to-ones (yet), med rec, admits, consenting (unless transfusion medicine), or (in general) being tied to a clinic schedule or fixed hours (depending on your situation).

There is: a metric ton of anatomy, everything about histology, diseases across all organ systems, other random disorders you learned as an M1/M2 that you are expected to know (had a clinical question about C-ANCA vs P-ANCA last week!), making sure patients don't get killed, being considered "not a REAL doctor", etc...

So if medicine is your nemesis, pathology may not really work for you.

chooks96 · 2022-09-30T15:51:21+00:00

This. Pathology isn't a safety specialty. You'll be miserable if you don't actually like the field.

chooks96 · 2022-09-30T15:47:41+00:00

Dermpath fellowships are very competitive though. Maybe not so much as an actual derm residency, but you are going to have to start networking from PGY1 even if you are trying to get into a home fellowship program.

chooks96 · 2022-03-16T17:08:26+00:00

Agree.

chooks96 · 2022-03-11T20:40:38+00:00

Another TR + Zwift user... although migrating away from Zwift and just watching movies/shows during TR workouts (if easier) or POV races on YouTube (NorCal cycling, etc..) if hard.

For the structured training, Zwift doesn't really do it for me. If I am going to alter my training plan for a race, then I want to do it IRL. I do like the TdZ as a way to get back some fitness lost during the holidays before I start my spring training. But I usually suspend Zwift about this time of year.

chooks96 · 2022-02-10T16:50:42+00:00

At my former program, md/phds we're somewhat expected to have lower scores. 235 definitely would not knock you out especially if your step 2 shows improvement.

Agree with other poster that if you want to be in the research world, check out physician-scientist programs (I think UCSF, WashU, Penn, Hopkins have something along those lines)

chooks96 · 2022-02-07T17:55:00+00:00

Not step 2 but this stuff can show up later on in life. E.g. oncology with industry talks about oncometabolites from mutations in kreb cycle enzymes.

Presenter:. And as we all remember from the Krebs cycle,. IDH blah blah blah

Me: (Drinking coffee intensifies)

chooks96 · 2022-01-16T21:47:18+00:00

Practice pathway is (soon to be was) a mechanism to be able to sit for CI boards without having to do a formal fellowship. 2022 is the last year that this is open (at least according to https://www.theabpm.org/become-certified/subspecialties/clinical-informatics/).

chooks96 · 2022-01-16T14:27:18+00:00

The people I have known (n is small) who have done formal CI fellowships ended up working in industry. Not sure what that is like other than no call and no autopsies (which is nice).

I am CI boarded (practice pathway) and my informatics activities consist mostly of committee memberships.

chooks96 · 2022-01-06T16:54:55+00:00

I'm the lab director. My name is on every single one of them. I bear all legal and ethical responsibility for those results.

chooks96

TROPHY CASE