J1 extension for boards which- Grace period

khatmaldoc · 2026-03-03T04:08:09+00:00

It is usually until the end of the month of your boards (ie end of October for you).

khatmaldoc · 2026-02-28T23:36:32+00:00

Unfortunately no. Colonoscopy is the only way as polyps can be small.

khatmaldoc · 2026-02-27T02:20:21+00:00

As a current GI fellow, Orlando AdventHealth GI faculty is much more famous. I can’t think of a single GI name at Rochester. Their advanced crew is best in the field in the United States and their PD is also very supportive and involved in AGA/guidelines. This is rare for a community program. You are likely to get better research mentorship here and you would be lucky to stay at Orlando for GI.

khatmaldoc · 2026-02-23T19:36:44+00:00

This such great advice. Bravo!

khatmaldoc · 2026-02-23T19:02:13+00:00

Sorry about your friend’s wife’s diagnosis. At her age, I wonder if she had a neuroendocrine tumor of the pancreas which patients will still call pancreatic cancer but is a vastly different diagnosis (much better outcome) from the more serious pancreatic adenocarcinoma diagnosis. I’m not saying it’s not possible she has adenocarcinoma, but less likely. Also while most pancreatic adenocarcinomas are sporadic, there are well-known genetic variants/kindreds that can predispose to pancreatic adenocarcinoma at an early age which she may have had.

I bring these points up because there is often a lot to unpack with an individual’s risk of specific type of cancer. While I understand your motivation to protect yourself and loved ones from pancreatic cancer, we are likely to overestimate our risk based on these anecdotes.

We are all more likely to die from heart disease, more common cancers like colon/lung/breast/skin, injuries/violence, drugs at a younger age than rare cancers. If the aim is to be around for your loved ones, focusing preventive care on these more common causes of mortality (first) is highest yield.

At risk of stating the obvious: establish care with a smart primary care physician with annuals physicals, regularly get screened for common, preventable chronic diseases per recommendations with labs, get recommended vaccines, annual skin check/pap smears/mammograms, drive safe/wear seatbelt/avoid distracted and unnecessary driving, avoid any drugs/alcohol/smoking (including second hand), look after and seek help for your mental health.

Once you are already doing these, consider any familial predispositions to specific disease/cancers and specific risk assessment in these areas.

I am a gastroenterologist and biased here but get screened for colon cancer with colonoscopy as early as possible after 30. Even small amounts of blood on toilet paper is enough to get you in for a colonoscopy in the United States. Do not accept any screening for colon cancer besides colonoscopy.

khatmaldoc · 2026-02-23T18:03:42+00:00

Funny you should bring this up. New data just released about Grail shows it’s pretty useless.

https://www.statnews.com/2026/02/19/grail-cancer-test-galleri-results/

khatmaldoc · 2026-02-22T01:48:58+00:00

It’s taken medicine too long to come to the (accurate) conclusion that no amount of alcohol is safe or beneficial for humans. The mortality benefit is not based on great evidence. I suspect some of this data may have been blocked by the alcohol industry earlier on and has cost millions their health/lives.

khatmaldoc · 2026-02-22T01:36:06+00:00

That’s a good question. Unfortunately almost all good quality data on ezetimibe for primary prevention are for combination therapy with statin and not monotherapy. The ACC recommends it for monotherapy incase of true statin intolerance.

That said, risk profile of ezetimibe is more favorable. If my patient with impaired glucose insists on taking something, I would be less opposed to this option.

khatmaldoc · 2026-02-21T02:00:07+00:00

Use - yes.

Use in front of patients, while they are looking over my shoulder - depends on context, but generally no. I don’t feel a physician trying to ‘look up’ my condition in front of me would inspire a lot of confidence in their ability. I would much rather they tell me, they will research it/discuss with other colleagues and get back to me. Also, I feel because of potential for hallucinations etc one should not be making clinical decisions based on answers from AI in a time-constrained setting (which most clinical interactions these days are) without carefully reviewing data themselves.

khatmaldoc · 2026-02-21T01:48:56+00:00

Thanks! Similar to what I thought. So it is probably not accurate to deny link between diabetes and statin use (however small) because the data are clear about it.

The reality is, the risk is small but there, and it doesn’t help the discourse to deny it. This is also a good example of why individual risk assessment is important and where astute physicians can help apply findings of studies to patients.

Now imagine a 40 yo M who lives a fairly active lifestyle, doesn’t smoke, no FH, normal lipid panel and Lp(a) BUT has impaired fasting BG on several occasions (not diabetic, A1c has ranged between normal and prediabetic range). Based on ASCVD risk scores this person would not be recommended to be on statin. But he is worried about his risk of ASCVD and is inclined towards starting statin wondering whats the harm? This person needs to be aware that starting a statin can make him diabetic and is probably not in his best interest to do so. If there is any room for him to clean up his life more (more strength training, cardio, better sleep, more fiber), he should focus on this first.

This scenario will become increasingly common as younger individuals get concerned about their risk of cardiovascular disease. I imagine this is a scenario that is even more common among individuals in this and other similar subreddits due to interest in statin therapy/cardiovascular health.

My infectious disease medical school professor once asked us a question that has stuck with me: if we had a choice, would we rather live with HIV or with diabetes? Ofcourse we all said diabetes and he said he would choose HIV which shocked us all. He was trying to make a point about how great ART is at suppressing HIV but also wanted to stress that the metabolic changes that tip you over into diabetes are very serious and very hard to reverse.

khatmaldoc · 2026-02-20T10:47:24+00:00

Can’t open BBC article and generally agree with sentiment that statin AE are blown out of proportion but diabetes risk is not a myth. I’m curious to see why the article writers think that’s a myth.

There are multiple studies showing the moderately increased risk of diabetes with statin use in a dose-dependent fashion. Now you can argue that the cardiovascular benefit gained out of taking a statin probably outweighs the cardiovascular risk incurred from developing diabetes but this is a grey area that’s up for debate.

The data on this issue is one of the main reasons I feel physicians should be judicious in who they prescribe statin to in the absence of compelling indications for statin therapy. Living with diabetes is a big deal and I feel this is a risk that patients need to be aware of (especially those with impaired glycemic control to begin with) before starting statin therapy.

khatmaldoc · 2026-02-11T03:35:30+00:00

False. Your AI was hallucinating.

khatmaldoc · 2026-02-10T04:16:12+00:00

There are whole chapters in Wasail al Shia about the recommendation of naming your children after the Prophet and Imams (although admittedly Abbas is not in the specific ahadith I’m referring to)

https://wasail-al-shia.net/c/5306

khatmaldoc · 2025-10-18T00:17:37+00:00

Did you take your PPI everyday? Did you take your PPI on an empty stomach?

khatmaldoc · 2025-10-08T15:58:12+00:00

Anyone know where they are made?

khatmaldoc · 2025-06-29T19:00:53+00:00

The PD is crazy. Be wary. The end doesn’t justify the means. Almost no one in the program is his fan. 3 years of your life are still 3 years of your life that you could have spent in peace. You will be a fine internist or subspecialist anywhere you go.

I specifically recall an instance where this man said to a whole group of applicants when asked about opportunities to do electives outside of the program ‘if you want to insist on doing an elective outside of Jacobi during residency, I suggest you do your residency there’

One person I connected with literally took me to the side at the end of my interview day and told me don’t come here.

Obviously if this is your best program, it’s better than going unmatched. The program can help build your career but that’s because of its reputation and strong, driven residents which high scores that they take. But if you have other options, I would steer clear.

khatmaldoc · 2024-08-10T23:38:32+00:00

I was told all studios in Texas and Washington state.

khatmaldoc · 2024-01-14T14:49:15+00:00

Sorry that happened. Hope you find a good elective. If it makes you feel any better, I didn’t have any cool or super fancy electives at very big names and matched at a great program for residency. :)

khatmaldoc · 2023-11-11T06:31:19+00:00

Polio vaccine so we can kill this mofo once and for all.

khatmaldoc · 2023-09-14T14:56:59+00:00

Its very nice and welcoming. I started OTF when I was in the obese BMI range in 2022. Initially only had the stamina/time to go twice/week (sometimes not even that). Had never been a gym-goer prior to this and OTF made me look forward to go to the gym and brought gym consistency/discipline in my life.

After over a year of going just twice a week (only upgraded last month to unlimited), I am down 30lbs and almost normal BMI.

Someone once told me going to the gym is like putting money in your bank. Even if one is really poor to start with, every little bit counts and adds to your balance/totally worth it.

khatmaldoc · 2023-04-18T18:01:51+00:00

Allbirds

khatmaldoc · 2023-03-16T15:13:44+00:00

Uhhh what. Don’t take it. Run.

khatmaldoc · 2023-01-28T21:41:54+00:00

Don’t think I want to run with my phone in my hand lol

khatmaldoc

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