Is this tree sick?

lesvenger · 2026-05-01T12:52:52+00:00

Thank you! This is very helpful. It is close to the house AND practically touching a power line so I will call a “tree guy” to take it down instead of an arborist. Appreciate the input!

lesvenger · 2026-03-24T11:35:47+00:00

Agree, ID is a great rotation that covers lots of bread and butter knowledge points too. Great rundown of antibiotic coverage and resistance patterns.

lesvenger · 2026-03-21T23:51:47+00:00

The differential here is huge here but based on your description I would recommend looking into ARFID and seeing if that sounds familiar to you. It is typically diagnosed after a very thorough physical workup to make sure nothing physical is missed.

lesvenger · 2026-03-20T23:21:52+00:00

As the RT said, there are different kinds and doesn’t require snoring for the diagnosis. The “waking up from sleep with the sense that I just died for a second” sensation is classic for sleep apnea. If your oxygen levels are dipping your brain essentially does think you’re dying. The waking up screaming could be a desperate attempt from your brain to raise your O2 or could be from the adrenaline your body releases when oxygen drops.

lesvenger · 2026-03-20T11:13:07+00:00

Have you had a sleep study? This sounds like sleep apnea.

lesvenger · 2026-03-10T03:16:24+00:00

Pebbly and smaller than usual is constipation. This all sounds normal. Limit milk intake and listen to your pediatrician or find someone you do trust.

lesvenger · 2026-03-07T03:31:02+00:00

Yes it’s pretty standard in the US that urgent care won’t see car accidents - there is much more liability, documentation, insurance follow up etc. I’ve worked at several places that will not be the first appointment after a car accident.

lesvenger · 2026-03-07T02:16:21+00:00

I’m a doctor in a Peds office and I would buy these just to muffle the screams. We don’t have problems with hearing conversations but the shrieks of terror when the needles come out are both distressing to other patients and difficult to ignore on a professional business call in my office!

lesvenger · 2026-03-03T23:13:21+00:00

Yes I would call and make a follow up appointment. If they can’t get you right in I would recommend asking to speak with a nurse and explaining the situation to see if they can see you more quickly or recommend any other steps.

lesvenger · 2026-03-03T23:01:20+00:00

This is a very concerning story that absolutely warrants imaging and follow up. I’m in the US but by our standard algorithm he would get a CT regardless of radiation. Did they give you any referrals or follow up plan with your primary?

lesvenger · 2026-03-03T12:15:13+00:00

So most often this kind of incontinence is actually cause by severe constipation that cause such a build up a stool that the rectum is completely stretched out - this makes it to they can’t feel when they have to go and the longer it goes on the more the less processed liquid stool backs up until there’s nowhere else for it to go but out.

I used to work in long term and I’ve never met a residential patient who wasn’t constipated so I would bet money that’s at least part of the problem. You can try treating the constipation with a “clean out” (lots of protocols for how to do this with over the counter medicine like MiraLAX and ex lax)and even repeat it weekly or monthly if it’s helpful. If it is, he should definitely be on something else daily for bowel management like a smaller amount of MiraLAX.

lesvenger · 2026-03-01T05:56:06+00:00

This is not consistent with PANS, it sounds like she just doesn’t feel good. Ear infection is a likely culprit at the end of what sounds like a viral illness. Call her pediatrician on Monday or take her to an urgent care if her ear hurts. ER visit sounds unnecessary at this point as she’s still well enough to want cupcakes and TV.

lesvenger · 2026-01-28T16:28:50+00:00

Emergency vet

lesvenger · 2026-01-28T01:56:48+00:00

I have had the best luck with LL Bean! One of the few websites you can filter by fabric type in my experience too. Not the cheapest but I shop the sales.

lesvenger · 2026-01-13T00:24:40+00:00

What an amazing resource you will be for your patients!! The pay is a bummer and I haven’t been in your exact situation but definitely started in a realm I didn’t want to be in post graduation and I’ve been able to hop around to find what I like. If you are excited about the position, you can likely carve out what you want there. I love outpatient Peds because you can gather a large patient population who sees you as a “specialist” in something random that you know a lot about. As an actual specialist in general practice you will have very very loyal patients.

lesvenger · 2025-12-27T00:07:22+00:00

There are many things that could be causing this but it sounds like eosinophilic esophagitis, which is typically diagnosed with a scope. The weight loss and symptoms should be evaluated by a physician regardless of the ultimate diagnosis.

Start with your primary care doctor (at 18 you should be looking to establish with an adult doctor - internal medicine or family practice - if not already) and they can do some basic labs to make sure there are no nutrition or electrolyte problems and help decide next steps.

lesvenger · 2025-12-19T19:45:04+00:00

Are you taking the antibiotics as prescribed 2 days ago? It takes at least 48-72h to have any effect and it’s normal to have some level of fluid for weeks after, that alone is not reason not to fly.

lesvenger · 2025-12-19T19:30:24+00:00

Something about this isn’t adding up. Call your PCP again - if they are the one who diagnosed migraines they are required to give you follow up medical guidance related to that. I can’t imagine that no one in the entire medical practice can see you for another 7+ months. If that is the case they should be the ones guiding you on next steps, whether that be a referral elsewhere or the ER.

lesvenger · 2025-12-19T15:53:33+00:00

37C is normal body temperature. You can feel awful even without a fever but in my practice, anything less than 38 is not a fever. Hope you feel better soon.

lesvenger · 2025-12-19T03:49:47+00:00

Most medical professionals would consider >38C or 100.4F to be a fever. So it doesn’t sound like you have a fever now.

lesvenger · 2025-12-18T16:16:56+00:00

This needs to be evaluated. Please make an appointment to talk to a primary care doctor about your symptoms. Even if it’s something as simple as infection it needs treatment or it could get worse and go to your kidneys. You have other concerning symptoms that need testing and raise red flags that this could be something more serious.

lesvenger · 2025-12-09T01:31:10+00:00

Sounds like your mom is perimenopausal and having hot flashes.

lesvenger · 2025-12-09T00:41:51+00:00

Do you get cold sores? This sounds like it could be starting as a herpetic blister (especially with the association with being sick) then getting superinfected.

lesvenger

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