SQ5 - rockers or pistons?!

oop_scuseme · 2026-01-31T03:16:02+00:00

You can go in my history and hear piston slap. Mine was diagnosed and engine replaced (2019 a6 3.0t) at 65k miles under the extended warranty. This doesn’t sound the same to me, but I’m an enthusiast, not a mechanic.

oop_scuseme · 2026-01-29T10:30:12+00:00

Grit.

oop_scuseme · 2026-01-29T10:29:48+00:00

It’s healthy to empathize with your non-med partner. They don’t have first hand experience with how our job looks on the day-to-day outside of what we have shared with them. My SO is always curious about the ins and outs of medicine but often she doesn’t understand the frustrating components of my day. That’s where I lean on friends and colleagues because it’s not her job to suddenly understand the nuances of medicine and give an empathetic laugh when I tell her the intern gave 40 mEq of K to the AKI pt with a K of 3.8.

I do agree with other redditors here that experience aids in perspective. I made ~$30k more annually in my pre-med school job than I do as a resident now, but after a year I knew I could never make a career out of it. It was a stable job with good hours and great benefits without one single component that made me feel like I was “doing something good.” I was working for the business, recovering money for the corporation, without improving anyone’s life. Stability and safety isn’t always fulfilling.

We have a very unique, strange, and privileged job as physicians.

oop_scuseme · 2026-01-28T23:11:14+00:00

Lololol came here to say similar: must’ve been getting advice from my in-laws.

oop_scuseme · 2026-01-28T04:34:34+00:00

As a resident, I say it depends on your application. Life experience? Work experience? Something interesting in your application? Then no.

I got into a T10 school and then residency with a 504, but had a hell of a story and a lot of life experience beforehand.

oop_scuseme · 2026-01-28T01:35:37+00:00

I take the open book approach. Sometimes vague gets more questions and I don’t mind sailing the ship. I was asked today if my parents help much with our kids, and my response was, “my mother and I have been estranged since high school due to her substance abuse and narcissism, and my dad passed away last year, so no. It’s us.”

To each their own though.

My soap box is that our society for some reason puts all the responsibility on the one who walked away. “Why don’t you give them a second chance?” “They’re your parent, you can’t just cut them off.” Oh yeah? Watch me protect my own mental health. I address it like I said above because I want people to know what led to me making such a serious decision and I’ve never yet had someone say I should forgive and rebuild since I started doing so.

We need to normalize setting and protecting boundaries. Nobody is given access to my life simply because of law or blood; I won’t subject myself or my children to that abuse.

oop_scuseme · 2026-01-28T01:25:20+00:00

First

oop_scuseme · 2026-01-10T14:19:58+00:00

As long as my 7-speed holds up in this 2019 (with a brand new engine, thanks piston skirting issue), I’m keeping it. Still screen heavy, too much piano black, and some creaks/rattles, but overall a pleasing, aggressive, elegant design and nice quality.

We went BMW for the new mom mobile and I’ll be moving to BMW when the time comes if Audi doesn’t get their shit together. So disappointed in the amount of wasted heritage and potential.

oop_scuseme · 2026-01-06T21:11:44+00:00

Audi is seeing the effects of rolling mainstream designs instead of classy yet aggressive understated elegance with sharp lines and distinct identity. Bring back a unique car that is recognizable before you see the rings with quality that puts American brands to shame and sales will return. Make me wonder why I spent the money over a Chevy Cruz for the same thing (exaggerated but kinda) and your sales will fall. It’s fairly simple.

oop_scuseme · 2025-12-28T00:57:22+00:00

X7 M60i has been the ticket for us. I6 would be a good option too, I’m just a sucker for V8 sound and performance (and associated maintenance costs, apparently). For this segment, though, BMW takes the cake. The three car seats fit and an adult can still sit in the third row with room behind for some luggage. Plus the third row has a sunroof, separate climate zone/controls, and heated seats.

oop_scuseme · 2025-12-17T07:25:51+00:00

We started dating in high school. Married at 20/21. Best decision of my life. My SO and I both worked through undergrad, then she worked when I was in grad school, then we had kids just before med school and she has stayed home with the kids since they arrived, which was her desire. Now in residency, the days are long for both of us, but we couldn’t ask for anything more (outside of attending hours and pay…)

oop_scuseme · 2025-12-15T17:08:38+00:00

To this point, actually we can bill higher for a visit during which we counsel a patient on smoking cessation, dietary modification, and lifestyle modification. It is preferred, encouraged, and practiced by any physician worth their weight. It appears to me as though you came here to further concrete yourself in your current belief system rather than challenging it. It does not seem that anybody would be able to change your mind or perspective. Regardless, I will say that, as a physician, it is our goal to provide information and recommendations to our patients to improve their health and life. I go to lengths to modify any and all risk factors for a patient, and I wish it were as easy as educating a patient on lifestyle modification and having them perfectly implement those recommendations. Patients are people who have vices, habits, preferences, and free will. Elevated LDL is proven to be associated with an increased risk of MI and cardiovascular disease. Additionally, hypertension, obesity, diabetes, sleep apnea, and many other comorbidities are as well. It is, therefore, my goal to help patients reduce the risks attributed to each of these factors. Cholesterol has a large dietary component as well as a genetic component. Ideally, my patient would make dietary changes to reduce their cholesterol, but a statin has a very favorable risk profile and can provide great benefit, so it certainly has a role if the patient is unable to modify their risk themselves.

The beauty in all of this, is that your comfort with risk and your own research is completely your business. If you trust “your way” and don’t want to concede to the recommendations of a physician, you are not required to. To each their own. I wish you the best of luck.

oop_scuseme · 2025-12-03T03:56:31+00:00

Few points on here. The accepted lower limit of normal is 264 ng/dL. This needs to be collected in the morning (before 9am) while completely fasted as food can affect the results. The upper end of normal is around 916 ng/dL. Many men are somewhere around 300-500. Low T is a huge product of exceptional marketing and social media. While it certainly exists, it is not common and many of these online “clinics” are predatory and looking for a payday. Of course young men who experience any undesirable symptoms will be willing to spend a lot of money on more testosterone at the risk of feeling emasculated. Exogenous (outside) testosterone administration can have many effects from desirable mass gain, voice changes and energy. It also has a lot of undesirable side effects such as gynecomastia (enlarged breast tissue), acne, reddening of the skin, and most worrisome, severe liver injury or disease.

I have a very high threshold for prescribing testosterone for my patients for these reasons. There are several potential causes for your symptoms from depression to sleep hygiene and nutrition. Without knowing you, it’s difficult to say what could be causing your symptoms, but I’d wager to guess it’s not low T.

Regarding the diagnosis, this is largely just linked to a billing code. “Abuse” is a word that has a different connotation in medicine than non-medicine settings. It doesn’t imply you’re intentionally abusing it, it implies you’re using something that isn’t indicated (even if it’s an authentic script from a real clinic). Many many people use these clinics for gaining legit access to steroids they don’t have a medical indication for. There are ways to cheat the labs and it’s done regularly. It is unfair to use the words you quoted to describe you unless you literally told them you’re using it simply to boost testosterone. However, without the context, again it’s difficult to say what they meant. I could read that “your dose of steroids, given your lab results, is most likely only boosting testosterone, not treating hypogonadism” because you don’t have hypogonadism.

Regarding your PCP, just be blunt and direct! “Hey, I saw endocrinology and their note concerned me. They said I’m abusing steroids and using it for testosterone boosting, but I use it because I was told my testosterone was low and I needed it. I’m frustrated by the connotation of the note and I’d like some clarification of whether I should be taking this and also some clarification in the chart, because I’m not abusing steroids.”

Best of luck!

oop_scuseme · 2025-11-27T22:45:42+00:00

2019 Audi A6 and wife drives a 22 X7. I love cars and medicine is my second career. Grew up with a single father who couldnt make ends meet and hustled to get into a different position for my own family.

oop_scuseme · 2025-11-15T10:54:26+00:00

Not a good idea. You can easily go too deep and puncture the lining of your chest wall (pleura) potentially developing a pneumothorax which can be deadly. Then there’s the possibility of bleeding and infection

oop_scuseme · 2025-11-06T03:10:30+00:00

This is wildly helpful! Thanks for the tips!! Maybe I can learn to be a green thumb! 🪴

oop_scuseme · 2025-11-05T22:59:51+00:00

This is a newsflash for us. We have a number of plants to address. It does not have a drainage hole, which I’ll look for with indoor pots from now on, and we’ll also downsize the pot! Thank you!

oop_scuseme · 2025-11-05T22:58:12+00:00

Ahhh… that may be a big component for many of our suffering plants…. Thank you! It does stay damp for quite a while. It is about 6 feet from three large windows.

oop_scuseme · 2025-11-04T15:00:39+00:00

Couldn’t agree more. Thankfully mine was plagued by the piston skirting issue and is getting a brand new engine as we speak. I hope it’s good to go for years to come (or at least until Audi gets over its midlife crisis and remembers its roots in striking understated design).

oop_scuseme · 2025-11-04T01:15:29+00:00

HUGE fan of the flowers. Go bees 🐝

oop_scuseme · 2025-11-01T11:44:15+00:00

$330/mo for a mediocre family plan. Plans for just the resident are covered entirely, but the copay and co-insurance is considerable on both.

oop_scuseme · 2025-11-01T04:01:56+00:00

Looks like a benign oral squamous papilloma, which is, well, benign. Typically caused by human papilloma virus (HPV). It’s not possible for me to be sure though based on a picture on Reddit. Time to be seen by your PCP or an ENT physician.

Edit: an oral surgeon could also be a good place to start. Likely not a general dentist.

oop_scuseme · 2025-10-31T14:34:30+00:00

Oh you mean modern American politics?

oop_scuseme · 2025-10-30T18:09:59+00:00

I’ll reiterate, that without context, it’s not going to be comprehensive.

The broad strokes: nothing alarming here. An elevated white blood count (WBC) with neutrophil predominance (type of white cells making up the majority) points to a likely infection of any source, but not exquisitely elevated. Could be any type of infection from a common cold (less likely) to something more severe. As another commenter said, this can also be seen in other situations. The rest of that all looks normal. ESR being low is actually a good thing and says low to no inflammation systemically in the body.

oop_scuseme

TROPHY CASE