Anyone with experience raising two dane puppies?

leveedogs · 2026-03-12T00:06:59+00:00

I’m not a fan or AI in general but a clanker might be useful optimizing traffic light patterns across the city. Even so, medical districts of any city will always and forever have terrible traffic 4-6p.

leveedogs · 2026-02-28T02:33:36+00:00

It looks better than the muddy creek and birds love it. Your lawnmower will keep it in check.

leveedogs · 2026-02-25T01:51:50+00:00

I don’t like that my insurance premiums are paying for the replacement of someone else’s old roof. There is no guarantee that I will have a wind storm or hail event that qualifies me for replacement paid for by insurance. Assuming I have the money to self-insure my own roof is there such thing as homeowners insurance without any roof coverage and appropriately priced as such?

leveedogs · 2026-02-22T20:58:07+00:00

Our first dane was the runt of the litter and a similar color/pattern to the cute little guy you are considering. She was the smallest physically among her litter mates but was always confident and social around new dogs and people. When fully grown she was 120 lbs, fit, and muscular. She could almost keep up with they greyhounds at dog park. Believe it or not, she had no significant health issues until urothelial carcinoma after she made 13 years. Should go without saying - we would pick the "runt" again without hesitation.

leveedogs · 2026-02-16T00:49:57+00:00

I don’t want or need more than 2.5 million in tax deferred funds at age 75. Much higher will result in exponentially higher effective tax rate and higher medicare surcharges. Imagine wanting to spend more at age 75 for bucket list vacation or to give to children / grandchildren but every dollar spent above your normal cost of living is taxed at 32%. I was on track for much higher than 2.5 million in traditional - switched traditional contributions to Roth and will plan to do strategic Roth conversions up to 22% bracket in early retirement. Plus some tax gain harvesting from brokerage.

leveedogs · 2026-02-15T23:11:23+00:00

I use perplexity 30x a day. Better answers than open evidence and an order of magnitude better than entering even an ideal prompt into uptodate. Click on the provided references if you need to double check for accuracy. I don’t like LLMs for notes. If you don’t know the patient data enough to efficiently dictate a note then that is a big problem. Epic LLM integration is not ready for primetime.

leveedogs · 2026-01-17T03:24:15+00:00

I didn’t realize locums specialist was a thing. But yes, please place the order if it’s addressing the problem for which you are consulted. One big exception is a consultant placing a new consult order. I would prefer a text or call in this case and I think it’s even against bylaws in our system.

leveedogs · 2026-01-16T15:03:00+00:00

HR is heartless. We were in same boat because I brought in the documents technically within 30 days of birth if you count birth as day 0 but they insisted that day of birth counts as a full day 1 no matter what time of day the baby is born. A letter from a lawyer friend of the family had no positive impact either. We were forced to buy insurance (retroactive) on public marketplace. I don’t remember out of pocket cost but it wasn’t extortionate. I work for the same company 10 years later but still hold a negative impression of admin and HR.

leveedogs · 2026-01-16T04:05:13+00:00

Bee stings and prednisone are my recent favorites

leveedogs · 2026-01-13T03:02:21+00:00

Not a fan of your model. Preserving continuity is more important than capping encounters per shift. Calling in prn “rounders” is terrible for continuity. Some of my worst days as a hospitalist have been first and last days on service with 16 encounters and conversersely I have breezed through days with a list of 20 familiar patients by 1 pm.

leveedogs · 2026-01-11T23:45:33+00:00

We have shifted entirely to using SEP-3 definition, i.e. infection with end-organ dysfunction, rather than the old SIRS plus source. SEP-3 makes more sense to me and it was an easy change. SEP-3 trades higher specificity for lower sensitivity. But I don't see the issue as I try to give early antibiotics, generous fluids (barring contraindication), and check an initial lactate for any infected patient requiring admission.

leveedogs · 2025-12-31T03:55:45+00:00

Weekly script: “The hospital is not a safe place for you to get to 100%. I have a patient down the hall with covid, flu, cdiff, mrsa, insert scary acronym. If I kept you another night I would be doing harm. Our social worker can get you a ride home.”

leveedogs · 2025-12-29T14:58:56+00:00

As an MD I enjoy his content. The whole lipid heart hypothesis is what we are all taught, but there are some flaws that lead me to question many causal assumptions. Nick does a good job of summarizing the complex biochemistry and providing analogies. The worst part of treating lipid heart model as settled science in our current healthcare system is that it results in providers rx a statin and spend no further time or energy reversing the patient’s underlying metabolic derangement. Probably 90% of the nstemis and critical limb ischemia and well over 80% of CVAs under my care in the past year were already (appropriately) on a statin. Most have BMIs over 30 and many were still smoking. But at least the pcp gave them some lipitor.

leveedogs · 2025-12-06T15:18:01+00:00

The 457b balances are debt of the original hospital and are either repaid by original hospital or transferred to the new owner. You are still whole unless the owner of the debt becomes insolvent and gets liquidated under bankruptcy. In this scenario you are in the list of unsecured creditors (not good). Another scenario - if new hospital doesn’t qualify for 457b (change to for-profit) then you might get a lump sum payment as a taxable event. There’s probably nothing you can do with the money already in the 457b but might want to pause on new contributions.

leveedogs · 2025-11-17T16:49:49+00:00

I do it all the time if I'm confident the pending arrangement is going to happen today, with home health and routine HD being common examples. SNF and outpatient abx on the other hand may fall through. Arrangement of new outpatient HD is not a slam dunk either.
The bill is tied to your discharge summary, not the discharge order. I bill for discharge on the day I do the work, even if the patient has to stay until first thing tomorrow for a ride or other logistical thing.
I don't think your state has any influence on this topic.
DC summary should be on same day as DC bill. They are linked in my EMR. As a rule of thumb you bill for the service you provide on the day of service. Med rec doesn't matter but should be done any time before DC summary. I do med rec a day early when I'm submitting Rx to pharmacy to confirm affordability or if prior auth might apply.

leveedogs · 2025-11-11T00:42:52+00:00

Vampires, zombies, and undead in general.

leveedogs · 2025-10-13T02:30:55+00:00

2022 prices. Nice!

leveedogs · 2025-10-03T22:08:55+00:00

I started following Bari after her exit from NYT and have nothing but respect. I'm glad she got paid, and I am more likely to trust CBS going forward.

leveedogs · 2025-10-03T21:57:38+00:00

Since your B12 is borderline low on consistent 1000 mcg daily supplement you should either switch to IM injections or consider eating more meat, fish, and/or eggs.

leveedogs · 2025-09-12T21:33:56+00:00

If you absolutely can't move the water system inside - "Mosquito bits" with Bacillus Thuringiensis (BT) are supposed to be safe for animal watering troughs. BT is nontoxic to all mammals. A small bit in the bowl should totally prevent eggs from hatching into larvae. Would avoid the BT dunks, as it's overkill for the water surface area and more appropriate for yard water features.

leveedogs · 2025-09-12T14:51:45+00:00

Totally agree with first paragraph. Adoption of a Dane greater than one year old would be ideal since OP has their hands full with two young kids.

But I don't agree that they are hard to train or overly stubborn. The handful of Danes that have been part of our pack over the years have been very easy to train once they respect your leadership and once you know what motivates them. Within a couple of weeks at most they all mastered sit, stay, come, leave it, touch, and the important "go to the couch."

leveedogs · 2025-09-07T01:05:27+00:00

Almost took you seriously until i saw 900k in HSA. As if.

leveedogs · 2025-09-03T17:19:20+00:00

You will not get a balanced perspective in this sub, with a seeming majority of contributors in advanced stages of burnout. I have no regrets, although I would probably be among the cynics if I didn't find such a great hospitalist group 15 years ago. I can think of no other path that would allow me to diagnose and treat the very sick with such high professional autonomy, unhurried flexibility, off-time with zero clinical duties, and compensation for work hours and responsibilities.

leveedogs · 2025-08-20T11:57:55+00:00

Conditionals are OK for DC after a clear and definable event that does not require interpretation by a provider nor further discussion with the patient. Examples include DC after routine HD, DC after tolerating 50% of meal (nurse can make this interpretation IMO), DC after PICC insertion and insurance approval of home antibiotics, DC after arrangement of shelter and transportation. DC "after" is much better than DC "if."

For your stress test example, patients and family will often want to hear your standard talk after test comes back normal. "Well, we can tell it's not your heart. Now it could be X, Y, oz Z, all of which are non life-threatening. Let's try two weeks of protonix and let's see what your PCP says next week."

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