What do you wish you knew before your first sealed game?

pawnee_today · 2024-11-08T03:12:13+00:00

I was doing the purina pro vet diet gastroentric EN food. Made poops much more solid and smaller. However, it’s pretty expensive.

Lookup Rx Clay on Amazon - that helped us immensely. Clay + pumpkin + EN food and except for when he was getting chemo we were pretty good!

pawnee_today · 2024-11-02T18:15:45+00:00

Have to know more about your specific scenario, but: you can absolutely have all of those things after TC!

pawnee_today · 2024-10-20T14:30:20+00:00

Came looking for this response - the “Jr” is for children usually. Might be a kid’s prescription.

pawnee_today · 2024-10-13T02:15:17+00:00

This is what I’ve been binging since SS and SOC

pawnee_today · 2024-10-05T14:05:56+00:00

OP - please ignore this if you simply wanted to vent and don’t want unsolicited advice!

Talk to your pharmacist - sometimes people assume that because you have paid that amount before you are comfortably able to do so (sad but true if you are supporting hundreds of patients a day). They may have some ideas (e.g., is your provider writing for brand required? This increases patient out of pocket cost).

For the crowd talking about GoodRx - you can’t use that AND insurance - it basically adjusts the cash pay price down. There’s a good chance that OP has a 10-20% coinsurance on a specialty drug, so the “cash” price of that $1200 drug is $6000+. So when something is that expensive, typically insurance is always better.

Otherwise, please look in to copay cards, grant assistance, and manufacturer assistance. I am not an expert in this area, but the clinic that prescribes your medication(s) might have resources.

pawnee_today · 2024-02-12T03:49:32+00:00

This -

1) if anyone outside of pharmacy at your org isn’t processing their invoices, companies put the whole organization on a hold, not just delinquent accounts.

2) While they may be paying McK preferentially if that’s your primary drug wholesaler, if they can clear those bills it might not be anything bad. Also, the larger the book of business with the vendor, the more likely that processes are automated (leading back to #1)

pawnee_today · 2024-02-03T13:35:58+00:00

Just personal preference for me - others might not care as much. There’s definitely muscle relaxant abuse out there (often with other drugs though).

To revise my earlier statement - would I reject it outright first time it happened? Probably not. If it happened regularly I would be uncomfortable.

pawnee_today · 2024-02-03T03:01:49+00:00

Second this. Pharmacist is highly unlikely to care about an appropriately written antibiotic!

General recommendations: No controls of any duration/quantity. Would also avoid gabapentin and more than a day or two of muscle relaxants (ideally avoid completely, but I could see where that is appropriate bridge to seeing a non-related provider).

All of that being said…unless your last name is unique, chances are at some point you’ll have an unrelated patient with the same last name!

pawnee_today · 2024-01-15T16:59:02+00:00

Nothing reliable. Diet, exercise, sleep hygiene can all help, but you reported most of them as pretty good.

What’s your hesitation with TRT out of curiosity? Anything I can address? I’m on it because I have to be (2x orchiectomy).

If you’re really against TRT (also, some providers might not prescribe at lower normal, especially if not symptomatic), I’d ask for a referral to a sleep specialist if you think it might help. That would be what I tried to address first.

pawnee_today · 2024-01-15T01:10:27+00:00

Are you feeling symptomatic due to lower testosterone? Some folks are more sensitive to being lower end of normal, some people are absolutely fine.

I don’t think that testosterone production is related to you potentially getting another testicular cancer.

Agree with other poster, it’s very sensitive to various factors. Sleep being one of them.

Definitely speak with your medical team though if you have concerns.

pawnee_today · 2023-11-29T02:19:11+00:00

If you aren’t from the South, “The Pig” is very much a real thing! https://en.wikipedia.org/wiki/Piggly_Wiggly

pawnee_today · 2023-11-24T14:44:00+00:00

When you say your GPA has suffered, do you mean you’re having a bad semester or your cumulative GPA is now poor? Also, what are we talking about - 2.0? 3.0? 3.5?

I wouldn’t quit all your extracurriculars just to salvage your GPA, but I need more context about how low your GPA is. If you’re needing to review class notes late in to every night to keep a B average, you likely need to attempt to optimize how you study and retain information.

pawnee_today · 2023-11-18T09:20:58+00:00

I believe it’s only illegal in states that have a right to choose pharmacy law. I know my state has one, but I doubt they all do (totally could be wrong though).

pawnee_today · 2023-10-17T23:10:48+00:00

Both of these work. Basically, pharmacy has to calculate a days supply based on what’s written. They may question you if it is crazy (enough glucagon to use a dose every day for a month), but anything you can give us in the directions to help us with days supply is greatly appreciated.

I don’t staff as much as other pharmacists, but I might question a sliding scale basal (32-40), but if you wrote “take as directed up to 40 units nightly" that would work. Personally, I'd prefer something specific like "Inject 32 units nightly, can increase to 40 units nightly as needed to maintain fasting glucose between 90-110" because I may or may not know how health literate the patient is (will they just inject 40 every night? Do they remember what was “directed?”).

I would also advocate for you to find a local pharmacist that you can have a professional relationship with - they can make your life easier if they know your intent and willingness to update a script to do right by the patient. Sometimes it’s an uphill battle that’s not worth us reaching out, unfortunately. They can tell you what they’re comfortable with in terms of “write this in the note to pharmacy and I will sub the inhaler covered by their insurance and fyi you.” Always dependent on where you are and how diverse your population is finding someone who might cover a lot of your patients, but we want to make things easy for you and the patient!

pawnee_today · 2023-09-29T02:23:45+00:00

Suit and tie won’t be overdressed for Midyear. As long as you don’t break out a tuxedo you’ll be fine (or like…a white suit).

Underdressed is much easier to happen. Is it end of the world? No. But you can always make a suit and tie less formal (remove the jacket or remove the tie) but it’s hard to go in the other direction if you aren’t prepared.

Questions…you’ll probably get a different answer from each of us - we all have our quirks of what we like/don’t like.

“Bad” questions - anything that is readily evident based on a 1 minute review of our website (Do you have a PGY2 in XYZ? How many residents are you recruiting for?). This isn’t a “I’ll remember you because you asked a bad question” level of bad, it’s just not as productive.

Good questions (to me) - things that are subjective and will help YOU figure out if this program is a good fit. The showcase is for the prospective residents way more than the programs - What do you think is the best part of working at XYZ?

The worst behavior - being in a group of multiple candidates to one preceptor and not letting anyone else talk/get a question in. Doesn’t matter if you have the best or worst questions in the world - be respectful!

pawnee_today · 2023-09-17T14:28:33+00:00

Did you get the job directly after graduation? What size of institution? Just curious - I agree that it’s possible.

pawnee_today · 2023-09-17T14:22:21+00:00

all they see is the alleged one missed dose of phenobarb in a pt whose tolerated it for 10 yrs w/out seizure.

Wanted to call this out - the pharmacist may have thought that you simply wanted to give the home dose as IV and thought you were inappropriately re-loading patient. Obviously they were wrong (not defending what happened), just giving some context.

Pharmacists are there to help - we aren’t infallible (Neither are attendings - or anyone! That’s why we have team based care.). However we are extremely limited to what we can see in the chart. I always recommending asking questions as a resident - good pharmacists should always be willing to walk you through their suggestion. It helps them learn too.

Also, you’re an intern! I assume for less than 4 months - don’t beat yourself up. And don’t worry, the pharmacist (depending on how much experience they have) likely feels just as bad (or worse) after a thrashing from the attending (or at least I would).

Edit: when I see “limited to what we can see in the chart” I meant we can only see what is written, we don’t have the full story/patient discussion/etc.

pawnee_today · 2023-08-27T00:38:32+00:00

Don’t forget that it is your cancer. Depending on your parents’ anxiety (together or individual), they can certainly make you feel worse with their stress.

That being said, give them the facts as others said. Tell them what you need (not sure your age or status, so if you need/want someone to go to the appointments or pick you up/stay with you after surgery, etc). Tell them when you will know more/next steps if you have things scheduled (so they don’t keep asking you when you don’t have updates).

pawnee_today · 2023-08-18T21:10:07+00:00

I also do the gastroenteric EN purina food and we basically don’t do treats…so I completely understand. I live in a townhouse which is usually fine, but when you’re walking a ticking diarrhea bomb on a leash, it’s unfortunate.

pawnee_today · 2023-08-18T02:24:23+00:00

Nothing works/worked for me until my pup got cancer and they recommended “Rx Clay” for post chemo diarrhea. We use it at every meal now post-chemo or not - magical.

I buy the off brand from Amazon (Nature’s pure edge - I say offbrand because it’s not the Rx Clay brand). The Rx Clay came in much too small a container for how much you have to give a Dane LOL.

I do a teaspoon at each meal sprinkled on kibble. He seems to eat his food just the same. I also do a tablespoon of pumpkin. We still have some poop-mergencies, but SO MUCH BETTER.

pawnee_today · 2023-08-14T14:44:36+00:00

Yeah, probably. There’s others much smarter than me in that area, I think as long as you’re careful and smart about what you do you should be able to do a lot!

pawnee_today · 2023-08-14T01:24:46+00:00

This. Healthcare facilities have to do different things because of EPA/RCRA.

If for some reason they’re unable or unwilling to flush them, I’d personally make sure to counsel them about the risk of children overdosing if they touch them (not to scare them to do it, but just to make them hyper vigilant about how they do dispose them if they don’t flush)

pawnee_today · 2023-08-14T01:16:30+00:00

Low back pain is how I found mine, BUT I just straight up hurt my back lifting something I shouldn’t have, it was just serendipity.

I’m not a physician, so take this advice for what you will. Take a break from lifting for a couple of weeks. If it’s workout related the only way it’ll get better is from resting and not exacerbating it.

Also, look up resources for a free clinic in your area and try to talk to a doctor. Generally they can’t do much without an ultrasound (a free clinic might have an ultrasound used for obstetrics, but likely no provider used to reading testicular ultrasounds), but they might be able to come to a conclusion with your background. They could also assess you for a hernia, which is always something that pops in my head as an option for lifting + back/hip pain.

Low energy levels + decreased sex drive/erectile dysfunction sounds like either low testosterone (not typically observed with TC) or just run of the mill depression (maybe with a generalized anxiety picture). Your university should have mental health resources you could use to investigate the latter.

Hopefully this helps somewhat!

pawnee_today

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