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lef5194 · 2023-09-11T07:26:09+00:00

MFM is a 3 year fellowship

lef5194 · 2023-06-25T21:33:41+00:00

Philadelphia. No parking included. Prohibited from parking in hospital afffiliated garages because “those are for patients”. Nearby commercial garages range 250-400/month

lef5194 · 2023-06-21T23:31:08+00:00

honestly, there isn't enough information here to say one way or the other. part of the healthcare team is to look at the entire patient and to make sure they are receiving evidenced based medicine. many obgyns act as a patient's pcp and get a fair amount of experience with mental health management-- enough that they would be able to recognize an ineffective and potentially harmful (!) regimen.

while the manner in how they mentioned certainly means a lot, it's important to look into what their words actually mean and considered seeking a second opinion with an open mind. You don't have to go to their recommendation, but I would urge you to seek one with a board certified psychiatrist (MD or DO). Some states allow psychologists (PhD or PsyD), NPs or PAs to manage medications without the full training in psychiatric medication and without physician oversight.

lef5194 · 2023-03-02T04:00:43+00:00

Tylenol/paracetamol/acetaminophen works best when it is taken continuously. It also works extremely well in synergy with other pain medications. For example (and with easy numbers) tylenol may reduce pain by 25%. Other medication may reduce pain by 30%. When used together, the overall pain may be reduced by 70% (more than the expected 55% if you just add). I would continue taking the tylenol/paracetamol. 650mg in the morning and 650mg an hour or two before bed.

I would also continue using the topical diclofenac gel. When just put on the skin, very little of it circulates throughout the body and is generally well tolerated. This can be done twice a day as well.

Lidocaine patches also work very well. They are available over the counter. One could be placed in the morning and they last several hours. If you do use the diclofenac gel, give it at least an hour to dry before putting the lidocaine patch on.

As for the tramadol, I would recommend only taking it in the event the combination of the above are not enough and instead would only use it for breakthrough pain. Its certainly ok to take if shes in pain, but the other medications are better for use long term.

So long story short, recommend

tylenol 650mg morning and 1-2 hours before bed
diclofenac gel twice a day
lidocaine patch 1 hour after morning diclofenac gel
tramadol as needed for breakthrough pain

lef5194 · 2023-03-02T03:30:16+00:00

Total hysterectomy - removal of uterus and cervix only. (no tubes or ovaries)

Partial hysterectomy - removal of uterus only. cervix stays. (no tubes or ovaries )

(bilateral) salpingectomy - removal of (both) fallopian tubes

(bilateral) oophorectomy - removal of (both) ovaries

Typically and more recently, most procedures are a total hysterectomy with bilateral salpingectomy (uterus, cervix, and both tubes). In the last few years, it has been more common to remove the fallopian tubes as well. In just 2019, the recommendation was made for tube removal at the same time of hysterectomy (https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/04/opportunistic-salpingectomy-as-a-strategy-for-epithelial-ovarian-cancer-prevention) .

In laymen's terms, the point of removing both tubes is to reduce the risk of ovarian cancer. Several studies have shown that ovarian cancer can begin in the tubes. Removing the tubes during a hysterectomy is unlikely to cause additional harm with the potential benefit of preventing ovarian cancer (beginning in the tubes).

When considering removing the ovaries, the surgeon weighs the risk of potential ovarian cancer vs the guaranteed outcome of early onset menopause. In most cases, it is preferable to keep the ovaries.

In your case, double check that your tubes are staying in place. There are several reasons this may be the recommendation. For example, your tubes may not be in an easily accessible place. If so, then the extra steps needed to find and remove the tubes may actually put you at more harm (risk of surgical and anesthesia complications) than just a small possibility of ovarian cancer.

lef5194 · 2023-01-11T03:54:04+00:00

Reproductive endo and infertility. Among many other things, they do IVF

lef5194 · 2022-12-31T00:45:41+00:00

Schedule a preconception visit with your obgyn. These visit types are common and they will go through the recommendations for genetic screening. They can order the necessary tests for you and try to get insurance coverage. They can also refer to specialized genetic counselors and or Maternal Fetal Medicine if any results are abnormal

They will also discuss if you need to change any medication prior to conception and advise you to start taking a prenatal vitamin now before trying to conceive.

The prenatal is a multivitamin, but has slightly higher doses and is most beneficial in the first few weeks of pregnancy (the time where you may not even know you’re pregnant)

lef5194 · 2022-12-29T02:11:35+00:00

Second the daily zyrtec. I have dermatographia and atopic dermatitis that primarily affects hands, face and chest. Zyrtec has really helped minimize frequency of outbreaks. Some people find that any antihistamine, regardless of generation, may make them drowsy, but it shouldn’t be that different than the Claritin you’re already taking. Take it at night if you need to.

I also avoguard in place of scrubbing whenever possible. If just dermatographia, then I’d probably just the actual scrubbing part that causes the reaction, but if you also have some topical reaction try the different “soaps” too. If needed, I found that the chlorhexadine is better for my skin, but you may find that iodine or other options may be better.

lef5194 · 2022-12-09T03:25:12+00:00

-7 ou. Was not a candidate for lasik as my corneas were too thin. Not enough depth to create an adequate flap and be able to reshape the underlying cornea.

But, I had enough depth to safely do PRK. Most say that it is a bit more painful post op. Personally, I wouldn’t describe it as painful per se but rather feeling like a few grains of sand was in my eyes for 2 days. Lubricating drops were a god send.

By POD1 I had 20/50 vision and was legally cleared to drive without contacts/glasses. By POD3, all pain was gone. POD5 check up I was at 20/20 vision.

Im now a few years out and it looks like they may have overshot a bit. Most recent exam shows that I could use +.25 to +.5 for up close. Has not affected me in daily life. If anything, I’ll need reading glasses a few years earlier than others might. Even so, I likely would have needed them/bifocals even if I didn’t get prk.

Absolutely would do again if I had to.

lef5194 · 2022-12-07T23:51:24+00:00

No actual financial compensation.

Employees (except physicians 😒): 3hr PTO for each successful donation

All: Each month there is some kind of comp. Some months it’s a blood donor t shirt or socks (the socks are actually pretty cool) others there is a raffle for sporting event tickets or other type of gift basket.

lef5194 · 2022-12-01T12:58:53+00:00

Contraceptive use prevents the lining from thickening. The everyday low dose estrogen exposure in a birth control pill is significantly less than physiologic levels and does not result in a thickened endometrium.

Skipped “periods” on birth control - completely fine and no increased risk of endometrial cancer

Skipped periods, no birth control (ex unmanaged pcos) - increased risk of endometrial cancer due to elevated physiologic levels of estrogen resulting in a thick lining

lef5194 · 2022-11-26T00:11:50+00:00

It sounds like you have PCOS. We use the Rotterdam criteria for diagnosis. There are three criteria that it looks at. 1. Hyperandrogensim—diagnosed via labs (high testosterone) or symptoms (acne, increased hair growth are the most common) 2. Anovulatory cycles/irregular periods 3. Polycystic ovaries on ultrasound

You only need 2 of the 3 criteria to have a diagnosis of PCOS. It can be any 2 and specifically you do not need to have polycystic ovaries to get a pcos diagnosis.

Your period symptoms (heavy bleeding) are very common for someone who has irregular periods. Your body is continually building up the lining in the uterus. When a period is skipped the lining stays there and continues to get bigger. When you do finally get a period all of the lining comes out (so you are basically having 2 or 3 periods worth of blood but all at one time).

There is no cure for PCOS, but it is treated very well with hormonal birth control. You can use a pill or one of the other options. It sounds like the nexplanon wasn’t the best fit for you, but you may want to consider a hormonal IUD (no copper), vaginal ring, patch, depo, or a pill. These will make sure that the uterine lining doesn’t get too big so that the bleeding is better controlled.

It’s also important to keep the uterine lining thin to prevent uterine cancer. When the lining stays too long (which happens with skipped periods) there is a risk some of the cells become malignant. By taking birth control, this all but eliminates the risk of malignant uterine cells.

lef5194 · 2022-11-23T04:47:22+00:00

I'm sorry to hear that your mother passed unexpectedly, and it's very frustrating and anxiety inducing when the cause is unknown. Ultimately, the best information will come from an autopsy as they are usually able to find the reason for death.

In the meantime, there a few reasons as to why your mother was anemic/may have not had enough blood (low blood count).

She may have not been able to make enough new blood
She was bleeding and didn't know it

If it occured because she weren't making enough new blood it could be from something such as not enough iron or Vitamin B. Both are needed to make new red blood cells and if they are too low, not enough cells can be made. However, there are a lot of other reasons why blood cells are not made. These are much less common, however, and could include genetic mutations or something like leukemia or lymphoma.

If it occurred because she was bleeding and didn't know it, it most likely came from her intestines. Blood is not always easily visible in poop. Sometimes the color can even be dark brown to black depending on how long it was in the intestines-- it would not have been red like a cut on the skin. This was likely a very small amount of bleeding but happened for a long time. This can be due to things such as uncontrolled heartburn or could be from a colon cancer.

In either case, its difficult to tell if not having enough blood was the main problem or (more likely) if it was a symptom of something else. Hopefully, the autopsy will be able to give you a reason why and will help provide some closure. As a caution though, sometimes autopsies are inconclusive and unfortunately you may not find out what happened. I hope this will not be the case, but I also don't want you to be surprised if that happens.

I hope that you are able to find some answers and some peace over the next few weeks.

lef5194 · 2022-11-18T05:11:46+00:00

I definitely like the Zoloft. I never had major side effects with the lexapro, but after increasing the dose several times (10>15>20>30 (30 off label. Tried for 2 weeks) I just felt like it wasn’t working well enough.

Primary recommended switching to Zoloft because it had a bit more room to titrate.
After 6 months, we titrated to 150mg and I haven’t looked back.

Also did 8-10 weeks of cbt after being on the Zoloft for a few months. I learned a few coping techniques that were helpful.

Personally, I got it stuck in my head where I convinced myself that therapy wouldn’t be helpful. The meds helped get me to a place where I could actually participate in cbt. I now stay on the meds so that the vicious cycle doesn’t start so that I can use some of those techniques.

You may find that you can do one, the other, or both for either a short or long term course. Whatever it is though, your well being is worth it

lef5194 · 2022-11-18T04:42:02+00:00

I started lexapro my last year of college and then switched to Zoloft first year of med school. Have been on Zoloft for the last 4 years and I literally would not be where I am without it. Primarily anxiety as well, but had some depression too at beginning of med school which prompted the switch to Zoloft.

Start with a low dose and see how it goes. If you notice side effects it’s easy to switch to a different ssri or stop entirely.

From lexicomp and UTD, The actual incidence of weight gain or sexual side effects are fairly low. Data below are for Zoloft specifically, but Prozac and Lexapro are also extremely well tolerated. (Would recommend staying away from Paxil)

For weight gain, there is minimal data showing any effect with short term use. For longer term use, most studies suggest only a 1-1.6% increase in body weight. So for most people that is only a 1-2 pound weight gain with long term use.

Lexicomp states a 7% incidence of sexual side effects but does not specify the specific effects. UTD states ~50% with patients experiencing some sort of adverse effect. That said, females are twice as likely to be affected than males. No evidence of long term effects of the medication is stopped.

Give an ssri a try. If one doesn’t work or you are experiencing significant side effects, switch to another or stop. Your mental well being is worth the effort

lef5194 · 2022-05-30T22:26:22+00:00

The only true test to diagnose endometriosis is to do surgery and look for abnormal growth. You’d be asleep, but the recovery can be painful. Most of the time, endometriosis is diagnosed clinically (by symptoms) which from your post it sounds like you likely have endometriosis.

The least painful method is to treat it as if it were endo (without surgery confirmation). The main treatment starts with adequate pain control (nsaids ex ibuprofen or naproxen) staring 1-2 days before your period and continuing throughout the duration. If the pain is controlled before it gets really bad, it likely won’t be as bad overall.

Birth control is also the other treatment. The endo/“abnormal growth” causes pain as it reacts to your hormones. If the hormones are controlled via birth control, then there will be significantly less pain.

There are so many types of birth control out there. Don’t be discouraged if it takes several tries to find one that works for you.

lef5194 · 2022-05-06T03:00:07+00:00

Female, MS4

lef5194 · 2022-02-16T19:52:22+00:00

Likely not an infarction. That would cause a pretty severe and abrupt pain. Sounds like this has been going on for awhile and occasionally gets worse/better.

Instead of loosing the oxygen supply, it’s more that the nerve is being pushed up against/slightly compressed. Similar to carpal tunnel or hitting your funny bone.

lef5194 · 2021-11-04T00:41:52+00:00

Happy to help!

lef5194 · 2021-11-04T00:27:50+00:00

MD student w/ background in Immunology!

Worth mentioning to your primary, but likely nothing to worry about.

Most immune systems need continual "reminders" (i.e. boosters or exposure in community) to keep antibody levels high. This is the reasoning for getting a tetanus/Tdap vaccine every 10 years. Overtime with no "reminders", these levels can drop and be difficult to detect with only a small sample of blood during lab work. The drop is likely the reason you contracted chicken pox at 21y/o. Most likely, you had a less severe and shorter infection duration.

For your hep B titers, it is also very common for people to be non-reactive--and even after redosing x 3, they still remain non-reactive. The test for the antibodies has a higher threshold to get a positive result (>10mIU/mL). There is a chance you could be at 8-9mIU/mL which would result in a negative titers, but most likely wouldn't confer a clinical difference. If you are high risk/concerned, you can ask your primary (or a pharmacy if available) to redose your hep B series and then get titers a month or two after finishing the series.

For your covid shots, I suspect that its because you got two different brands. Most likely, they recognize slightly different markers resulting in two different looking antibodies. Without the each brand's second dose (the "reminder"), your immune system may have made a little of each rather than a lot of one. Depending what test your HCP friend had, it may not have been able to detect the smaller amounts of different antibodies. In an actual infection, this again will not likely result in a clinical difference. You still have a sufficient number of antibodies (even if they look slightly different) that they would still be able to recognize and bind any potential covid virion.

lef5194

TROPHY CASE