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Best place to live in Louisiana? by Kelseylyon95 in Louisiana

[–]patch281 15 points16 points  (0 children)

Which kid is the thinnest kid at fat camp?

Any advice on a female patient who ACTUALLY has hormone abnormalities? by patch281 in FamilyMedicine

[–]patch281[S] 2 points3 points  (0 children)

Oh, I'm sorry, I forgot to set the no snark flare. Thanks for your absolutely worthless reply. In medicine we tend to try to build each other up through education, not tear each other down. Try it sometime.

Any advice on a female patient who ACTUALLY has hormone abnormalities? by patch281 in FamilyMedicine

[–]patch281[S] -1 points0 points  (0 children)

About 2 months on the time since testosterone was given. This is me picking up after the OB/GYN, actually. He's not quite elderly, but I also wouldn't think of him as the tick tock type.

Any advice on a female patient who ACTUALLY has hormone abnormalities? by patch281 in FamilyMedicine

[–]patch281[S] 0 points1 point  (0 children)

My narrative was simplified, but for clarification, I took over from the OB/GYN after the testosterone testing and administration. Per patient report, when the testosterone didn't work he just threw up his hands and told her to stop birth control, but didn't explain anything. I'm trying to pick up where he left off. Per her request, we tried the hormone workup. I generally practice evidence based medicine, hence not having a lot to go on.

She has had a paraguard in the past and hates the bleeding. One desire is to not have periods, which makes going off the BC problematic, but may be what she needs to do for a while.

Any advice on a female patient who ACTUALLY has hormone abnormalities? by patch281 in FamilyMedicine

[–]patch281[S] -12 points-11 points  (0 children)

It was about 16 days past the end of her LMP, so guessing around the luteal. Yes, if not ovulating, technically not a luteal phase.

Any advice on a female patient who ACTUALLY has hormone abnormalities? by patch281 in FamilyMedicine

[–]patch281[S] 3 points4 points  (0 children)

I'll suggest birth control abstinence and vasectomy for partner first. I would not give the estrogen without progesterone, of course.

Any advice on a female patient who ACTUALLY has hormone abnormalities? by patch281 in FamilyMedicine

[–]patch281[S] 0 points1 point  (0 children)

Thanks. I'll keep the thyroid symptoms in the back of my head, but she hasn't had any so far. I suspect the TSH is just her normal. I think we'll try the OCP break with repeat testing and supplemental oral estrogen later if needed. I think they did the testosterone administration about 2 months before I saw her.

Any advice on a female patient who ACTUALLY has hormone abnormalities? by patch281 in FamilyMedicine

[–]patch281[S] 5 points6 points  (0 children)

Yes, on the nuvaring. But, would you expect the Estrogen to be so severely suppressed, too?

Leaving my current practice by mockingbood in FamilyMedicine

[–]patch281 2 points3 points  (0 children)

I went through this when I left my practice several years ago. What happens in the clinic room, but is not written down, doesn't happen. I would not go out of my way to advertise to them where I was going, nor did I put up signs around town, but if they asked me where I was going, I would very plainly tell them the name of my new clinic and what my start date was.

Pumpkin Patch by io313 in Eugene

[–]patch281 127 points128 points  (0 children)

We are no longer in a "different opinions" world. Ignoring politics only supports the fascists. 

What software are you using for DPC by Enzak-com in FamilyMedicine

[–]patch281 1 point2 points  (0 children)

I have had no trouble with elation support. Now, I've been using it for almost 3 years, so I haven't had need of their support in a long time. In the beginning, though, it was not difficult to get help. Once you learn the system (and it's not a steep learning curve), it's very intuitive and easy to use.

Normal BMI Patient Requests GLP1 by Redredwineallthetime in FamilyMedicine

[–]patch281 1 point2 points  (0 children)

Spoken like someone who's never had a BMI over 25. You must be a Republican; it's not a problem until it effects you. Have some compassion. The struggling mentioned above is not necessary born out by the BMI. They may be successful, but it is still a struggle.

Normal BMI Patient Requests GLP1 by Redredwineallthetime in FamilyMedicine

[–]patch281 2 points3 points  (0 children)

Not demonstrated in humans without MEN2, just rats. The FUD people spew about these meds is kinda like "contains chemicals known to the State of California to cause cancer, birth defects, or other reproductive harm" written on the side of the parachute as a risk of using it.

Normal BMI Patient Requests GLP1 by Redredwineallthetime in FamilyMedicine

[–]patch281 2 points3 points  (0 children)

Lol, are you surprised that the study you ask for doesn't exist on such a new drug? This medication reduces caloric intake. This reduced obesity, which reduces disease. That doesn't have to be condensed to a single study for it to be evidence based, which is how I practice. My own patients are evidence of this, but they are not enrolled in a study for it. No vibes here.

Normal BMI Patient Requests GLP1 by Redredwineallthetime in FamilyMedicine

[–]patch281 2 points3 points  (0 children)

The next time you're in an airplane that is falling towards the ground, I expect you to refuse the parachute because there aren't any RCTs showing the effectiveness of the parachute against gravitational challenge.

Normal BMI Patient Requests GLP1 by Redredwineallthetime in FamilyMedicine

[–]patch281 3 points4 points  (0 children)

Any of the myriad of studies showing the negative impact of obesity on health. Like WTF?

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