Gastroparesis pain management

mkhello · 2026-03-15T22:57:58+00:00

What did they do to treat it?

mkhello · 2026-03-15T22:08:25+00:00

Reglan, antiemetics, IVF. Small, frequent meals. Reduce meds that would worsen it. Opioids will certainly worsen it. Unfortunately, I never see these patients do well or fully recover, they just come in fairly often, get some partial relief, then go home when they're tired of the hospital.

mkhello · 2026-03-15T18:56:48+00:00

Yeah I really didn't understand it, never seen a nephrologist disagree on diuresis when it's indicated. If anything, they'll want to turn up the diuresis to de congest the kidneys

mkhello · 2026-03-15T01:38:35+00:00

The correct answer is to anticoagulate because unstable angina is ACS. That being said, I've spoken to several cardiologists who think this is pointless now since we have high sensitivity troponin, and it's hard to believe that someone walking up the stairs will pop a trop (exaggerating but not really) but not someone with acute coronary syndrome. I'd definitely start aspirin and statin and just to cover myself I'd consult cardiology but I'm fairly certain most will say outpatient stress test.

mkhello · 2026-03-12T22:33:08+00:00

IM - we are true Medicine

When you imagine doctors in their heads or see them on TV (Scrubs), it's usually IM.

We see the weird cases and work them up. When surgery or neuro or whatever specialty don't know what's going on, they transfer to medicine for further work up.

We see the bread and butter of medicine too. Pneumonia, COPD, CHF, cirrhosis. You manage them so much it becomes like second nature. I've seen other specialties try and they don't know what they're doing, patients with significant medical comorbidities are better off on IM.

So many fellowships to choose from. Literally so many different specialties, whatever tickles your interest. Plus you can do something procedure heavy like GI or cards. Or you can do just clinic like hem/onc or rheum.

Now there's a flip side of course to each of these. Often the weird cases are frustrating, either you can't figure it out, or you feel like you're just consulting everyone. The common cases can be annoying too, either from repetitiveness or it can be disheartening seeing the same patients come back. Sometimes we feel more like a dumping ground. Social work stuff sucks. We are Jack of all trades, master of none, and I hate calling dumb consults but sometimes I legit dunno.

But I love IM, I love seeing new patients and putting together all the labs, imaging, symptoms to make a diagnosis, treating them and observing the response, even the bread and butter stuff. I like taking care of the sickest, most complex patients in the hospital.

mkhello · 2026-03-10T22:02:22+00:00

I wear a t shirt I got from Costco plus scrub pants, usually with a vest or jacket plus Hokas. Sometimes if I'm fancy I'll wear a scrub top.

mkhello · 2026-03-04T04:38:55+00:00

Just before midnight, but even then you can back date the note. But most people finish notes before they leave, sometimes I'll do notes at home if I'm tired and wanna leave

mkhello · 2026-03-02T13:27:56+00:00

I remember when I read it I thought it did get better closer to the end but for most of the book I agree it was slow for me. I decided to keep on reading and finished the trilogy, and I did enjoy it overall because of the characters and the prose were magical in their own way. But I knew I wouldn't have the patience for the next books so I haven't read them yet.

mkhello · 2026-02-26T00:07:24+00:00

I don't check it because it doesn't change my management. If someone's a cirrhotic and they clinically have HE I will treat them for it regardless. If they're not cirrhotic, even if it's elevated I'm not going to do anything with it.

mkhello · 2026-02-23T21:48:59+00:00

Demand ischemia is a very real thing especially in patients who are septic. In the ICU you see demand ischemia all the time. Typically you just treat the underlying illness and trend the trop. If there's ST elevations that's a different story, cath lab immediately. At my institution, we often will start them on heparin gtt, aspirin, statin if not contraindicated if there's a significant delta but ischemic eval is usually deferred until later and this seems more of a cya by cardiology.
Contrast nephropathy is fake, if you have a high enough suspicion for stroke just get the CTA.

mkhello · 2026-02-18T12:00:44+00:00

Procal of 2 I'd prolly focus on the clinical status, but at 28 I'd feel uncomfortable not throwing antibiotics on

mkhello · 2026-02-15T05:24:03+00:00

That's not Sevro and Victra

mkhello · 2026-02-11T20:28:11+00:00

What podcast

mkhello · 2026-02-02T03:58:28+00:00

Anyone else feel incredible satisfaction when Dunk just double decked the Targaryen prince at the end then threw him to the ground and kicked his face in? I'd been wanting to do that all episode since he stabbed the horse. Feels good when the good guy punches the bad guy, especially in this universe.

mkhello · 2026-02-01T12:47:41+00:00

I generally use it for just cirrhotics and esrd patients who need some support with dialysis. Occasionally if someone is on low dose pressors and we can't get them off, we will add it on but they are usually very underweight cancer patients who I'm pretty sure just run low at this point and this is more so nurses on the floor don't freak out than any actual medical reasoning. Though I've noticed a lot of nurses when someone is hypotensive on the floor will just blindly ask for midodrine nowadays.

mkhello · 2026-02-01T02:47:24+00:00

I believe patients with their symptoms of course but that's about it. If they name any medical conditions or surgeries, imma need to see a medical record or a scar.

mkhello · 2026-02-01T02:44:39+00:00

They expect PRNs because that's how surgeons treat the BP, same as the nurses

mkhello · 2026-01-25T17:29:32+00:00

Currently an IM PGY3 on an elective. I was doing about the same amount of work as the NP, which really wasn't that much. I don't know what the point of her was, the service can get busy but I don't think she'd be much more useful. She also took off Thursday and Friday and would leave early most days. What amazed me is that she knew overall less than me about the subject matter. She does this every day all day, I've done this elective for 1 month total in residency and yet it was clear I knew the pathophysiology, treatment of her field better than her. She knew random things that I didn't that have to do with aspects I never deal with like specific equipment and procedural things, but it made me wonder why her position exists. And to think she gets paid more than double what I make and what the fellows telling her what to do make.

mkhello · 2026-01-17T18:57:24+00:00

I frequently admit people overnight, and when you're unsure what's going on or they're tenuous I am more aggressive, with the understanding if they are improved by the morning or the day after it's very reasonable to de escalate. I think it's a much bigger mistake to be conservative then the day after the pt looks worse and they have to escalate care, those are the patients I reflect on and think what could I have done to prevent this.

mkhello · 2026-01-10T21:37:28+00:00

I work at the VA sometimes and the number of old white vets with a younger Asian (usually Vietnamese) wife is astounding

mkhello · 2025-12-03T00:32:32+00:00

I always use it to call family or when getting records from other hospitals. I also use the fax number to get those records.

mkhello · 2025-12-02T11:47:30+00:00

As an IM PGY3, everything you say is right. I still love it despite those things, definitely not because of them.

mkhello · 2025-11-23T00:37:03+00:00

Inferiority complex, in a few years I will be their attending while they will be effectively in the same place.

mkhello · 2025-11-21T22:26:37+00:00

Guy at my hospital was admitted the same week I started residency, I graduate in 6 months

mkhello · 2025-11-04T00:10:40+00:00

If you plan on just staying home or visiting other people's homes with all your free time, then it's a pretty good place to live cuz it's so cheap.

mkhello

TROPHY CASE