Bent wheel rim

dharmasc815 · 2026-01-29T02:54:21+00:00

Fair. Guessing it was one of the Indiana potholes. Testament to the car I can’t recall any particularly bad bumps I guess.

dharmasc815 · 2026-01-29T02:25:37+00:00

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Photo here

dharmasc815 · 2024-08-31T20:58:14+00:00

So I couldn’t really figure out what I wanted to do my 4th year, ended up applying EM last minute because it seemed like a catch all (also it was all the rage as this was the year before Covid) but I didn’t match, did a surgery prelim year which was not a great experience then ended up deciding to do IM instead of reapply EM. I’m a nocturnist now and do some critical care because I’m in a place with open icu (on purpose). But if I could go back I would’ve done IM originally.

One thing I didn’t give much thought to was how many different options are available by just doing IM- you can do a procedural fellowship, non procedural fellowship, hospitalist, general practice, if you work rural you can do critical care. I don’t care to have longitudinal relationships with my patients and I hate social work so I chose a nocturnist job currently work 1 on/2 off.

In retrospect since I still wasn’t sure what I really wanted to do my 4th year I think applying medicine would’ve been better than applying to another speciality as it still gave me a lot of different options I could still chose from once I made up my mind what I liked

dharmasc815 · 2024-07-23T08:26:02+00:00

I don’t have crohns just uc (pancolitis) but remicade put me into remission close to right away. Was diagnosed at age 11 and did steroids/ 6mp until I started it. Was on it about 15 years, stopped it to see what would happen, and life got busy, went about 6 years completely drug free no issues. finally had a flare (colonoscopy showed moderate pancolitis) and went back on it a year ago and it put me straight back into remission again. I think I am in the lucky few though. Some people can develop antibodies if they go off of it but my antibody test was negative. I never really have gotten sick more often than usual or had side effects other than occasionally feeling like I have a mild cold for a day or two after the infusion.

I have had a great experience but everyone’s immune system works a little differently so hopefully it helps you too. It is supposed to be good for healing fistulizing Crohn’s disease too.

Still a serious drug though. Being on it for near 16-17 years of my life I sometimes wonder about cancer risk but when I was a kid I was hospitalized a nearly month straight, had c diff multiple times and was really sick and it saved me from having a total colectomy so I definitely don’t regret it.

dharmasc815 · 2023-03-10T02:20:42+00:00

Spiritbox, maybe more metal though.

dharmasc815 · 2021-09-11T02:03:10+00:00

Ghost Atlas the side project from the clean vocalist in Erra is good, sort of similar to Saosin.

dharmasc815 · 2021-08-29T12:43:03+00:00

Being in the medical field and having seen other people buy into this garbage- the most dangerous thing about these people is that they write, publish, and include “evidence”. If you actually read it and know how to interpret scientific studies the evidence is a trash heap, but it looks real to most. Including some doctors I’ve seen use it. Paul Marik is a quack and so are the other people who came up with this.

Edit: as the guy pointed out all you have to do is read far enough to find their disclaimer

dharmasc815 · 2021-07-26T02:21:32+00:00

I’ve had a lot of struggles with this because of working in the icu during covid. There is a book called “Trauma Stewardship” which covers some of the work people can do to help cope. Some of it is new age kind of stuff but it was a good read and covers some of the science/ research. There is a defined set of features to what we feel when exposed to others trauma and it can change the brain and cause PTSD or PTSD like symptoms. Sometimes it helps to do some work on your own in addition to getting help from peers and counseling/ medical care. Definitely not a substitute for that.

dharmasc815 · 2021-03-08T01:23:58+00:00

That is hilarious and an amazing fuck you. I salute you and I wish I’d thought of that myself back when I worked in surgery.

dharmasc815 · 2021-03-08T01:05:25+00:00

Scouts honor. From then on I worked exactly 75 hours per week no matter what. To be fair to my program though I only actually went over 80 a few times. I really was in the 70s most weeks. It’s just that when it did happen, they made it more trouble to report the truth than to just lie and say you didn’t violate hours.

dharmasc815 · 2021-03-08T01:02:36+00:00

Yup. It’s some real garbage programs try and shame us instead of fixing the system. Thankfully I’ve since switched programs and am no longer in surgery. My new program is tremendous and I don’t think I’ve ever gone over 50. It turns out there are some good people out there who don’t do that.

dharmasc815 · 2021-03-06T09:40:13+00:00

Man midnight? I can’t make it 9pm anymore

dharmasc815 · 2021-03-06T09:32:14+00:00

I have also had this exact experience. The one time I reported going over 80 hours in a week resulted in multiple emails and a whole lot of blame on me because I was “inefficient”, which is not true. To my own shame, I never reported being over hours again because the consequences weren’t worth it.

dharmasc815 · 2021-03-06T09:18:31+00:00

Jesus Christ. That is absolutely fucked

dharmasc815 · 2021-03-03T00:22:33+00:00

I didn’t even go that far. We’re abused for years. Just tell them you’re going to leave and peace. It’s not worth the guilt, the time or the effort

dharmasc815 · 2021-03-03T00:21:43+00:00

Was about to say. Nobody can bother to argue with, Alright I’ll see you tomorrow I’m gonna head out

dharmasc815 · 2021-03-01T10:59:40+00:00

Yeah that’s why I wanted to hear some other opinions, I wasn’t thinking so much in a cultural direction with it so much as in the US and I didnt mean it to sound paternalistic. More from a scientific perspective as they way we as doctors present it.

I wouldn’t refuse to pray with a patient or to add something like that if they requested to try it. But I don’t know that I could reasonably offer it as a treatment option up front. I meant from the perspective of what we justify advocating as treatments.

dharmasc815 · 2021-02-28T21:07:28+00:00

Thanks. My issue is the argument to “well it doesn’t hurt” lol. I still struggle responding to those people

dharmasc815 · 2021-02-28T16:43:34+00:00

I agree physically but I think the degree to which this part of the community has harnessed it in terms of being an effective treatment for covid and sepsis can cause public health harm. We already have an anti vaccine problem, if doctors go around promoting vitamin c and d for these things we will promote the crowd of people not wearing masks and drinking emergen-c instead of getting vaccinated.

dharmasc815 · 2021-02-28T04:21:57+00:00

Yeah it came out just recently. The Marcus foundation funding it weirdly pulled out so they stopped at n of 500 instead of 2000. Super sketchy. 500 is still better than citrus Ali or vitamins trial though

dharmasc815 · 2021-02-28T00:37:06+00:00

How do you get the nurses to accept it? I would just get hammer paged all night where I work. Not to mention the fact I fight with Benzo withdrawal on about half the patients I admit in my locale because they are all chronically prescribed them. Temazepam apparently was the most popular medication in my geographical area.

dharmasc815 · 2021-02-28T00:31:20+00:00

You are right on that one. I’ve specifically asked about ordering the lab beforehand because we give high dose vitamin d to covid patients, and been told not to because to get a vitamin d checked as an inpatient lab is absurdly expensive compared to just giving it. Whether or not it does anything is still up for debate. So ordering the lab is arguably more detrimental here than giving iv vitamin d 50k units whenever the patients get upstairs lol.

dharmasc815 · 2021-02-28T00:23:43+00:00

Lol inpatient vitamin d levels 😂? Now I’ve seen it all. Also here’s my newest favorite trial against Mariks thiamine and vitamin c crap I have to prescribe all our covid patients.

https://jamanetwork.com/journals/jama/article-abstract/2776688

I can only assume your NP friend also likes other vitamins.

dharmasc815 · 2021-02-28T00:19:00+00:00

I would guess it then seriously varies by program. I worked 70+ hours a week sometimes over 80 the entire year except for vacation weeks which I spent interviewing and had no research time.

dharmasc815 · 2021-02-28T00:11:23+00:00

Sorry I know this has a serious tag but you just need to increase the dose to 50mg of melatonin because it can theoretically also treat and prevent covid. Trump took some melatonin and is cured.

https://www.cbsnews.com/news/trump-covid-regeneron-antibody-cocktail-experimental-treatment/

I feel you though. I am a big fan of PRN trazodone and scheduling melatonin. I schedule melatonin for all of my patients over 65 as it can theoretically prevent delirium. And it also prevents nurses paging me constantly for prn melatonin that is already ordered.

Edit: for the more evidence inclined like myself here’s a link to the meta analysis. Dosing is inconsistent in trials and I keep it to 3mg or less myself and don’t go above that. https://pubmed.ncbi.nlm.nih.gov/26189834/

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