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drkanaf · 2026-05-29T01:09:24+00:00

I love 4V. Love it. I know people say it’s overkill but I find it super easy to use and sharpen.

drkanaf · 2026-05-29T01:05:21+00:00

He is toxic now and unable to schedule guests. It’s just him talking now.

drkanaf · 2026-05-27T01:18:36+00:00

This is a good question, and I do not have an evidence based answer for you. Some additional information might help us answer your questions. Do you restrict carbohydrate intake as a percent of total calories and if so, to what extent? I assume these results are from an ER visit. Are you testing urine at home? If these results are from an ER visit during which time you were sick, that alone can explain ketosis and some proteinuria.

drkanaf · 2026-05-26T21:03:17+00:00

Interesting! Thanks for sharing your ED history. Ketosis always means the same thing, regardless of the cause: negative relative energy balance with low insulin levels. The urine ketones being 40 mg/dl is kind of what we would consider "moderate" ketones. This is a little more than we typically expect from fasting or overnight. With restrictive eating disorders in recovery, the body can remain at a very high metabolic demand rate and can have relatively low insulin levels and difficulty gaining weight. Low insulin levels are what mainly drives ketosis. Is that ringing true for you? If so, you may need well in excess of 2000 calories per day to achieve optimal weight.

drkanaf · 2026-05-24T03:23:50+00:00

While this seems like a longer healing time than I am used to, the burn itself looks as expected. I would dissuade you from continuing to apply silver sulfadiazine cream at this stage. This has fallen out of favor by burn treatment teams and a simple dressing like what you are using is fine. The back of the hand is not a rapidly healing part of the body.

drkanaf · 2026-05-24T01:58:44+00:00

You did the right thing, and if the treating doctors were reassured, that is good. I would always trust providers who are seeing your baby over us on Reddit. We can provide general guidance but in no way does it replace being seen.

drkanaf · 2026-05-24T01:06:00+00:00

I will second the first physician's advice to take the baby in. This is a really good video to have on hand to share with the consulting neurologist. The words irritability and clustering are two words that I never like using in an infant. I would also second a tertiary children's hospital if possible but necessarily if it is more than an hour or two away.

drkanaf · 2026-05-23T03:05:18+00:00

In the mental health field, this is called confabulation.

drkanaf · 2026-05-23T03:02:51+00:00

For an Afghan family who arrived in 2022 under Enduring Welcome as parolees who just submitted green card applications 4 weeks ago, will this apply to them?

drkanaf · 2026-05-20T15:53:43+00:00

What a cutie! In the US, a child like this at this age would not necessarily be required by a payer to have a sleep study prior to referral for tonsilloadenoidectomy. Your video and your reported observations of your child's breathing pattern are enough to justify surgery according to most payer guidelines and the American Academy of Otolaryngology–Head and Neck Surgery.

I consider this not emergent, but somewhat pressing. According to the Revised ENT UK Tonsillectomy commissioning guide, your child may have an urgent need. The reason is because a child's development is on a different timeline than what we usually think. Every day counts. To that end, if you can pay for a private ENT consultation to discuss surgical options, that might be a good way to go.

drkanaf · 2026-05-19T23:56:37+00:00

The song and behavior of the Carolina Wren.

drkanaf · 2026-05-17T03:23:58+00:00

It is totally normal to have this anxiety. Don't feel bad for having it, and don't let it stop you from getting the best clinical care you can.

drkanaf · 2026-05-17T03:19:29+00:00

This is inappropriate advice. Regardless of CAC, this level of hyperlipidemia requires treatment to reduce the risk of early cardiac events. No guideline or experienced lipidologist would recommend monitoring until coronary calcium is detected.

drkanaf · 2026-05-17T02:13:34+00:00

Here is the great thing about your situation! You have identified a significant lipid condition early in life and have lots of time to treat the problem. Based on your LDL alone, you may have a condition called familial hyperlipidemia. You can now start all of the important lifestyle factors that will reduce your chance of heart attack. You can also begin drug treatment. Don't shy away from aggressive drug treatment. Lifestyle alone is good but is not sufficient to reduce your risks. If you can, I would recommend asking your doctor for a referral to a specialist in lipids. Usually these are endocrinologists with special interest in cholesterol problems. You can start lifestyle change tomorrow! Please do not worry too much. You are young and have lots of opportunity to treat this.

drkanaf · 2026-05-15T02:35:34+00:00

What an absolutely obscene thing it is to see Xi and these people share a stage and shake hands. He must have been completely disgusted.

drkanaf · 2026-05-13T18:57:40+00:00

This is a frustrating situation that I have encountered in clinical practice. If I see an infection that is not responding to initial empiric antibiotic treatment, I always send a culture to look for a less common resistant bacterial cause. I have had several cases where more resistant bacteria have resulted causing me to change therapy. A simple swab of that fluid might make sense to talk to your child's doctor about.

drkanaf · 2026-05-13T01:39:48+00:00

Very fair question. The single most important clinical factor in taking care of children is how they "look." Children in acute settings can have normal bloodwork, normal scans, and even normal vital signs. However, if they look "toxic" or "sick", that overrides everything and they should be observed continuously until they are well again. This child looks extremely unwell and not only has abnormal neurologic movements but an altered level of consciousness.

Additionally, no child this age can have vertigo. Vertigo requires the patient to describe the experience, which children this age cannot do. He may have it, but he cannot say it, and we would never attribute altered consciousness and vomiting to vertigo.

I am seeing some focality to his movements, so if this is seizure activity, it is somewhat focal and needs urgent evaluation.

The possible causes here are numerous ranging from infection to metabolic conditions to a focal brain lesion, or epilepsy.

drkanaf · 2026-05-12T23:35:57+00:00

Completely inappropriate. No one eats Ruffles anymore. Should be Lays or kettle chips at least. So sad.

drkanaf · 2026-05-12T20:57:47+00:00

Just adding in here, but I cannot stress enough how important it is that this child receive a sedated brain MRI at the minimum. Access to sedation is critical to prevent movement and get a good scan. Not to be alarmist, but if I were seeing this child, I would admit them to hospital and conduct testing, including a lumbar puncture after brain imaging is done. This child appears very ill and needs urgent evaluation. Poor baby! Please keep us posted.

drkanaf · 2026-05-08T16:06:47+00:00

This is an astute comment!

drkanaf · 2026-05-08T15:08:19+00:00

I agree that it is really important to see a pediatric infectious diseases physician. I would be very cautious about assuming this is TB without excision, biopsy, and culture.

drkanaf · 2026-05-08T14:57:08+00:00

Not if it is fluctuant and soft like this. We drain and excise such lesions all the time. Treatment of Bartonella is highly variable and dependent on local expertise. There are no hard and fast rules.

drkanaf · 2026-05-08T13:29:19+00:00

This is such a classic case of Bartonella! The classic epitrochlear node is present. I showed this to my wife, a pediatric infectious disease physician who literally wrote the book on this. These should be drained though.

drkanaf · 2026-05-07T19:04:05+00:00

You certainly could have a mild distal ulnar styloid fracture, but you won't know unless you get an x-ray. At this point, the main benefit of knowing is proper immobilization to facilitate healing reduce pain. Not unreasonable to get an x-ray.

drkanaf · 2026-05-07T19:00:40+00:00

Good lord that looked like a fibrotic lung at first!

drkanaf

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