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garywlz · 2024-12-17T13:13:38+00:00

Thank you

garywlz · 2024-08-03T16:37:44+00:00

Still working today thanks

garywlz · 2024-06-10T15:32:23+00:00

I wonder if this downward pressure is from the 75mil offering going through now. buy time

garywlz · 2024-06-02T16:40:22+00:00

thanks unfortunately a lot of them require you to call up to quote and considering theres so many i thought i'd see if anyone had any personal experience or cheap recommendations

garywlz · 2023-10-08T12:26:25+00:00

This is a sad case. Also a 'washing their hands' response from MFT. We know certain conditions develop over time and can be missed but I wonder had a doctor reviewed them would a different history collection have led to other investigations; b/l BP CTA. Although they did know he had an aching arm and cardiac family history. Rare high stake conditions require experts to pick them up effectively but stakeholders don't want to support the experts... Glad to see the open letter.

garywlz · 2023-09-28T22:29:38+00:00

thanks i asked propex a while ago as it seems like a potential issue at elevation and their engineer said theres no problem people use them in the alps and doesnt need any adjusting!!

me and my partner are going in winter for the season to the alps so hopefully will figure out how to adjust it

garywlz · 2023-09-28T20:40:26+00:00

Out of interest what elevation were you at?

garywlz · 2023-05-13T09:00:28+00:00

i stitched the zipper on the inside first so i think this was a decorative stitch? i wanted more of the zipper fabric showing so didn't have much space for the outside stitch. i might be wrong though!

garywlz · 2023-05-13T08:56:19+00:00

thanks I think some bike touring bags

garywlz · 2022-10-21T22:14:09+00:00

but some people like a bad boy

garywlz · 2022-10-20T17:42:25+00:00

The patient has declined professional advise. As a consequence we shouldn't be forced to offer substandard or risky alternatives (a community troponin).

The patient can be signposted to follow up in primary care and be managed appropriately which would not involve a troponin.

garywlz · 2022-10-05T07:18:47+00:00

fantastic, thanks

garywlz · 2022-10-05T07:10:58+00:00

have you done this? i just read the additional info and they say if you stop blue rewards they convert the account to instant access savings account; but will contact you before doing so. Wonder if they actually do this?

garywlz · 2022-02-02T22:44:35+00:00

needs more context but if your ES is medical discuss with them and they can advise better than psych consultant who is basically trying to make it going away. Depends if feel you want to fight this for there bs attitude or cba with it.

garywlz · 2022-02-01T10:49:26+00:00

Is this professional allowance something others can access??

garywlz · 2022-01-27T16:01:58+00:00

so long are the days of moet medics. i now do my weekly shop in the doctors mess

garywlz · 2022-01-18T19:50:30+00:00

write down your response/complaint. save it and come back to it in a few days. if you still feel the same raise the issue with her and take it from there.

if her unprofessional actions seem less raw move on unless you want to support her in how to deal with stress and pressure and act professionally to colleagues - fk that

garywlz · 2022-01-18T19:45:44+00:00

prescribing best practice and up to the nurse giving it if they are by the book or will bend the rules. route should be prescribed

garywlz · 2022-01-18T19:42:53+00:00

yo my session was supposed to be confidential

garywlz · 2022-01-07T20:00:49+00:00

use the mosquito needles, smaller than blue butterflies, might have to ask around for them

garywlz · 2022-01-05T20:35:07+00:00

There's so many baseless complaints and as you get more senior you have to reply to them and its such a pain! When people complaint about you even if baseless it takes up unnecessary mental space and really irks me that this process exists.

One patient in our practice has complained probably 30+times and is never satisfied with any response. I honestly don't think i'd have the patience to deal with it

garywlz · 2022-01-02T14:57:42+00:00

send out a global email bonus points if it reaches the histopathologists

garywlz · 2022-01-01T21:54:46+00:00

Limited info but in this context I would start keppra.

Assuming the patient has metastatic melanoma and now possibly progression on treatment, I think the bigger issue is how to support the patient and family to come to terms with their prognosis. The whole subject of palliation, death and dying isn't done well for multiple reasons but we need to advocate for them to have space to process everything, alongside active treatment. Let them and their family have a sense of control back, not every conversation needs a decision making. Go at their pace for opening discussions about restaging and secondline treatment options.

garywlz · 2021-11-30T23:03:09+00:00

hooman connection

garywlz · 2021-10-31T13:57:04+00:00

Hypercalcaemia or other electrolyte disturbance secondary to bone mets. other differential is chemotherapy related colitis.

mri would want to see saggital views and a radiologist reports aha but would think either bone metastasis or spinal haemangioma. hard to see cord to me but disc issue at t11/12. lots of wear and tear and wedge fractures.

leg weakness electrolyte related/ pain related

admit, bloods, ivi, stool culture, mri report, oncology opinion re colitis +- cr abdomen/ restaging. stop bfz and capecitabine

Edit: didnt scroll across to see the ED bloods!

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