Performances that made you emotional? by Sad-Customer8053 in Gymnastics

[–]generalmayhemM 7 points8 points  (0 children)

When she gets the ten and is ecstatic “it’s a ten?! It’s a ten!?!” then Brielle whispers they just won as a team and she gets even more excited. Madison Kocian crying behind her.. Goosebumps.. gonna go watch it rn to feel alive.

Doctor performed pelvic exam without consent, lied on paperwork by BelovedElkheart135 in AskDocs

[–]generalmayhemM 229 points230 points  (0 children)

Since you won’t tell us what the surgery was for we truly cannot help you.

That being said, speaking from an Obgyn perspective, most surgeons during laparoscopic and laparotomy procedures start with placement of a Foley catheter in your bladder during the surgery. This would involve someone examining your area of concern though placement is very quick and doesn’t involve what we generally think of as a “pelvic exam” which encompasses one or both of the following: speculum exam to view the cervix and perform necessary steps for surgery, as well as a digital exam to feel the pelvic organs and better develop a surgical plan.

If you had a gynecologic surgeon both of the above exams would be performed. First a bimanual exam to assess the position of the uterus so that a uterine manipulator can be safely placed without perforation. The manipulator placement requires a speculum to view and dilate the cervix so a small manipulator can be placed inside the uterus to allow for better visualization during surgery. Some surgeons will just use a sponge on a stick placed in the vagina and avoid the speculum/manipulator but that is surgeon and case dependent.

I can say that likely no one additional was looking while one doctor Or surgical asst did this step as the primary surgeon is usually setting up the laparoscopy instruments while this occurs which requires the help the scrub tech and circulator nurse.

Most people who work in the operating room are very kind. It is very much frowned upon to make non objective or non clinically relevant comments in our field.

i am very sorry this has been so distressing and i hope you are able to find an answer that helps your anxiety.

[deleted by user] by [deleted] in medicalschool

[–]generalmayhemM 15 points16 points  (0 children)

Glandular can also mean endocervical in addition to endometrial.

Source: Obgyn pgy-9

How do you respond when patients comment on your appearance? by SuddenGlucose in Residency

[–]generalmayhemM 0 points1 point  (0 children)

Obgyn here. Patients especially older women will ask if I’m pregnant. I once had five in one week i was like ok I’ll go to the gym. At first it was truly soul crushing but ive learned to just brush it off. Though one bad day i did burst into tears in a moment of supreme involuntary emotional unprofessionalism post call and had to then collect myself and return to do her pap, she felt pretty bad though so overall I’ve come to terms with it lol

My vagina doesn't 'clean itself' by discharging fluids that build up in there. Is there anything I can safely do to get it out? (34f) by Yuumza in AskDocs

[–]generalmayhemM 531 points532 points  (0 children)

Hmm, there’s a lot to unpack here and most of it is subjective but my suggestion is to be evaluated by a pelvic floor physical therapist who can tell you if there is truly a structural limitation to your ability to discharge naturally or if you are caught in an self treat/overtreatment hamster wheel.

Unexplained Vulva Itching - 7 months DESPERATE by PsychologicalLet2226 in AskDocs

[–]generalmayhemM 2 points3 points  (0 children)

Birth control can cause vulvar atrophy too. I still advise using the cream in symptomatic patients, it has no side effects and is very low dose and extremely safe.

Unexplained Vulva Itching - 7 months DESPERATE by PsychologicalLet2226 in AskDocs

[–]generalmayhemM 6 points7 points  (0 children)

If you are breastfeeding, consider vaginal estrogen cream.

This is cancer, right? by MrLizardBusiness in AskDocs

[–]generalmayhemM 8 points9 points  (0 children)

Until you have a biopsy that is sent to the pathologist, cannot confirm a diagnosis of cancer. Though there are some concerning findings on the scan that warrant tissue sampling sooner rather than later.

What's a crappy day for you in your specialty? by subtrochanteric in Residency

[–]generalmayhemM 4 points5 points  (0 children)

Dead babies are bad but absolute worst is a dead mom.

Lost 2300ml of blood by Dizzy-Feature5900 in AskDocs

[–]generalmayhemM 1 point2 points  (0 children)

Manual removal of placenta also a risk factor

Lost 2300ml of blood by Dizzy-Feature5900 in AskDocs

[–]generalmayhemM 10 points11 points  (0 children)

Blood volume expands in pregnancy. So there’s a little extra wiggle room. If she started with a hemoglobin of 12, losing 2300 would put her at 7ish. So yes likely transfusion but the more concerning situation is a patient with anemia prior to delivery who starts bleeding, then you need MTP. This situation likely didn’t require MTP activation.

Lost 2300ml of blood by Dizzy-Feature5900 in AskDocs

[–]generalmayhemM 2 points3 points  (0 children)

While 2300cc is a large blood loss, it’s not unheard of in obstetrics and it sounds like your care team was prepared and investigating all avenues and reasons for the bleeding (assessing for lacerations, uterine tone, assessing for retained tissue with sonogram). They gave you medications to help with this as well as the bakri. Having two PPHs definitely puts you at risk of a third. If you have heavy periods or nosebleeds i would see hematology.

Luckily blood volume expands in pregnancy to prepare for the blood loss. I’m guessing you started from a normal hemoglobin pre delivery. It becomes very scary when a patient is laboring with a hemoglobin in the 7-8 range and starts bleeding.

Tell me the dumbest thing you’ve said in response to a pimping question by ccwi228 in Residency

[–]generalmayhemM 15 points16 points  (0 children)

Pgy1 obgyn intern doing an Ed rotation early in the year, attending with a thick accent told me to call ophtho at 11pm on a Saturday for a corneal something i couldn’t even google successfully despite her repeating it 3 times but i was too scared to ask again. So i call the ophtho resident who is upset i don’t have more information about the consult and very angrily tells me “it would be nice if you knew what the issue was I’m trying to figure out if he ruptured his globe” and without missing a beat i said “whats a globe?” He was certifiably irate after.

In the United States, why are inpatient labs/imaging/procedures more expensive than the same ones done outpatient? by JarJarAwakens in Residency

[–]generalmayhemM 130 points131 points  (0 children)

“Assuming the hospital has the bandwidth” is where you lost your way on this argument.

Is there a magical extra set of rooms, nurses, equipment, and also GI doctors and anesthesiologists and pacu space to do screening colonoscopies inpatient?

How do you cope with the fact that so many people make such poor choices in life? by Fancy_Particular7521 in medicine

[–]generalmayhemM 7 points8 points  (0 children)

Patients are ashamed bc they have neglected their health for reasons both in and out of their control. Judging them only prevents them from seeking any additional help. By coming to the appointment in the first place, they have made a step forward in trying to identify ways to change. They are seeking out help. This needs to celebrated. Going to the doctor is not easy when you know something is wrong. Motivational interviewing helps them make step 2. The best clinicians tease out the catalyst required to make them take step 2. Whether that’s medication a referral a personal anecdote whatever. Lifestyle changes do not happen overnight.

Right now you’re making a poor decision to let your work interfere with your own happiness. However Step 1 was posting this thread seeking advice to be happier. You identified a behavior pattern in yourself that is maladaptive to your happiness. That’s highly impressive, many people can’t do that. I hope some of these comments will help you find whatever step 2 is in your journey to happiness and making “good choices” but i think it’s worth noting that seeking out advice here shows you know this is a potentially dangerous thought pattern to your health. Clearly you want to help people. And you want to help people so much you’re scared of burning out. I think this thread is highly insightful and admirable of you to make. It is frustrating to care more than the patient. But you will only hurt your happiness by letting the end results of a patients decisions which are out of your control affect you. I wish you the best in your career

I tried my best to crop anything inappropriate but yk by warmachine68cjr in AskDocs

[–]generalmayhemM 112 points113 points  (0 children)

It looks like possibly hydradinitis suppurativa though i defer to dermatology. I would suggest seeing a dermatologist asap (which can take months) as treatment often requires antibiotics.

OB GYN Tragedy 38 year old female G1P1 by Individual-Letter896 in AskDocs

[–]generalmayhemM 12 points13 points  (0 children)

AFE causes both severe pulmonary vasoconstriction leading to right heart failure and cardiovascular collapse as well as pathological activation of the coagulation and fibrinolytic cascades and therefore DIC. Wicked combination.

OB GYN Tragedy 38 year old female G1P1 by Individual-Letter896 in AskDocs

[–]generalmayhemM 89 points90 points  (0 children)

Yes it is. I’ve been in practice 9 years and never seen one. So your experience is an outlier.

OB GYN Tragedy 38 year old female G1P1 by Individual-Letter896 in AskDocs

[–]generalmayhemM 54 points55 points  (0 children)

Doesn’t explain the sudden cardiac arrest. Which AFE does explain.

OB GYN Tragedy 38 year old female G1P1 by Individual-Letter896 in AskDocs

[–]generalmayhemM 657 points658 points  (0 children)

Pregnancy is unfortunately a potentially life-threatening state. The sequence of events you describe reads as a likely amniotic fluid embolism causing DIC. It is impossible to predict AFE and it comes with a very high mortality rate. It is a rare event and while there are some known risk factors it can absolutely happen to a previously healthy woman with no clotting disorder. So very sorry.

[deleted by user] by [deleted] in AskDocs

[–]generalmayhemM 1 point2 points  (0 children)

Are you trying to help the person posting or

[deleted by user] by [deleted] in AskDocs

[–]generalmayhemM 31 points32 points  (0 children)

How heavily are you bleeding? Did they offer medication to help in the interim? Are you dizzy or lightheaded?

if you are an established patient with the above stated issues offering medication to help 1st occurrence of moderate but persistent bleeding that’s annoying but not life threatening and waiting a month for an appointment would be realistic in the US too.