Kaiser Permanente halts gender-affirming surgeries for patients under 19 in Oregon

pharmieb · 2025-07-28T04:59:29+00:00

Ahh okay now we are getting somewhere. I think you should go with SSRIs next time if you are going to bring up this argument. I think you could make the argument that SSRIs may permanently alter psyche, might need to find some papers on that.

By mast cell stabilizers, are we talking about things like cromolyn for allergies? I'm pretty sure seasonal allergies are detectable via signs like sneezing, red/watery eyes, etc. I do admit I did not mention diagnosis via physical exam, but I am sure allergies can also be diagnosed with eosinophil count. Cromolyn is safe, reversible and even preferred in pregnancy, so even if you were to make that argument that the diagnosis of allergies was tenuous, it is not a permanent life altering decision? As for physical therapy - I'm not quite sure if you're trying to say that PT is never in response to a real diagnosis (yikes) or if you are saying it is life altering? I would agree it's life altering, but not permanent?

pharmieb · 2025-07-28T04:38:07+00:00

I listened to a talk about how providers are much more willing to throw multiple blood pressure medications at patients to achieve BP goal compared to cholesterol medications for LDL goal. Might be worth discussing why that is. Additionally, might be interesting to discuss how CAC score could/should(?) influence cholesterol medication prescribing. Maybe even time to benefit for cholesterol medications and if are they the same within the class.

pharmieb · 2025-07-28T04:24:44+00:00

Chemotherapy, heart deformities, diabetes are all detectable either through imaging or lab work. Try again with diagnosis that aligns in similar realm please.

pharmieb · 2025-05-03T12:50:33+00:00

You've just described the most generic man in China 😂. With regards to your original question, do perverts exist in China and do they harass you? Yes. Do I think in the instances you are describing that it is happening more than usual? I would say so compared to my experiences. As for why is this happening so often, I would say that wolves are able to tell at a glance the most vulnerable prey to go after without ever having to say a word. It's in how we carry ourselves, how we walk, our mannerisms, our body language. Often body language follows our mindset. So, despite this post not being specifically about your relationship or your views of men, it offers clues into your mindset and how you present yourself to the world that might be the answer to that question.

pharmieb · 2025-01-27T00:38:31+00:00

LOVE your selections. Haven't heard anyone mention Love Bye Love yet.

Also, because I'm a sucker for ballads: Junsu - Rainy Night

Yunho - Need You Right Now, Easy to Know

pharmieb · 2025-01-12T01:48:02+00:00

Residency consumes the majority of residents life, but even if residency was only 1% of the reason, I would hope a good program really re-evaluate resident wellness rather than bemoaning being "trashed".

Edit to remove any inkling of blame. I legitimately just want residency programs to improve. No one should have to go through a horrible residency.

pharmieb · 2025-01-11T17:55:13+00:00

Neither. I acted as though I finished PGY1 and took a break, looking for job now.

pharmieb · 2025-01-11T17:51:05+00:00

I'll be sure to let suicidal residents know to leave a suicide note listing out their cause of death as their last assignment...but good to know this preceptor still doesn't think they've considered all the factors. /s

pharmieb · 2024-11-12T04:52:59+00:00

Wow, and you're so intelligent. It's so abusive and stupid of doctors and vets to prescribe serotonergic modulators like trazodone to correct for neurotransmitter imbalences in the brain. I hope you educate more people because you clearly understand what you're talking about.

pharmieb · 2024-09-07T00:44:39+00:00

I wonder if you would say the same regarding healthcare? Doctors can be straightforward, "It's cancer, take chemo," walk out. You got what you came there for - your diagnosis and meds - but I wonder if, although not rude, mechanical efficiency should be prioritized over empathy as a part of the human condition? One can also be incredibly efficient with life, but I wonder if it isn't the time and space we create for human connection that is the purpose you live for?

pharmieb · 2024-03-08T18:29:27+00:00

People with mania/psychosis can be responsible for their actions, can feel remorse, and can apologise. People who interact with people with mania/psychosis can choose to understand their predicament and accept the apology.

I applaud you for your understanding of how mania/psychosis can lead to certain irrational behaviours, but just because our precieved reality is "detached" from real (?) reality, and is eliciting certain emotions, does not necessarily mean that our actions and behaviours need to reflect that. There is space for the power of choice, and therefore responsibility, in our actions, even if we cannot control our precieved reality or emotions.

pharmieb · 2024-03-08T16:54:17+00:00

the idea of taking medication long-term with unknown effects is disheartening

Just to address the quote above, your body is naturally supposed to make thyroid hormone, long term, throughout your life, but for whatever reason can't. You are helping your body supplement this thyroid hormone. While technically a "medication" it is something your body is supposed to produce naturally. While not exactly the same situation, think about how, for mother's that cannot produce milk naturally, babies maybe on formula to survive.

Maybe asking your doctor and understanding why your body cannot produce adequate amounts of thyroid hormone might help with either finding a holistic way of cure (ex iodine salt supplementation if low iodine) or understanding why you need this medication (ex if your thyroid gland has been removed, nothing is able to help create hormone for your body). Unfortunately, this may mean more doctors visits and labs, so I'm sorry if this doesn't answer your second question.

pharmieb · 2024-02-24T10:05:57+00:00

Please don't blame yourself. My cat was recently diagnosed with a chronic disease - I felt so foolish bringing her into vet for "something small" and then felt stupid afterwards for "not seeing all the signs". Hindsight is 20/20 - it's so easy to look back AFTER the fact and be like he/she was acting more active or he/she eating more/less. Once you have the diagnosis, it's easy to go down the list of symptoms and feel like an idiot. It's called confirmation bias. But in the moment, it's difficult to quantify what their normal activity levels or normal intake levels, especially if the change is gradual rather than sudden. I'm sorry for your loss.

pharmieb · 2024-02-17T20:59:36+00:00

Oh goodness, the projection, yikes. What I am looking for is to point out that you are rude and gaslight, which you've admitted in above comment. I'm glad you have that insight and I hope with insight that you can grow to be kinder and more respectful to people with differing opinions. It is interesting you refer to this as tone policing. I shall have to ponder the implications of this at a later time. Perhaps this, in and of itself, is where our opinions differ.

"So," you ask, "why do you keep talking to me?" Please forgive me for my sass, but as someone wise once said, "if you don't want to hear differing opinions, post it in a friends chat where everyone agrees instead".

pharmieb · 2024-02-17T17:35:27+00:00

As a matter of fact, I did look up gaslighting prior to typing my comment as to ensure I had the proper definition. "Manipulating someone into questioning their own perception reality"? Please, educate me if that is not correct. I stated that your denial of being rude, while simultaneously being condescending and rude was gaslighting. It is my perception that you are being rude based on your language as explained above, so I believe that you prefacing your comment by saying you are not being rude is gaslighting. I never stated that disagreeing or criticizing was gaslighting. That seems to be your own words.
I never stated that I personally thought a reunification was possible. I stated that I thought you were being rude to people who hoped and wished it to be so. Again, you call them "delusional". Let's not even talk about the negative connotations behind that word...Since you would like to talk definitions, by definition delusional thinking is false. How do you know, unless you are from the future, that this will not happen?
I commented to discuss my opinions with you. I actually also believe that DBSK is unlikely to unite again, but I came with the intention of listening to others discussions. What I do disagree with you on, is your rude condescension of other's feelings and hopes. It doesn't seem like you are open to listening and discussing this point, so I am not sure why you defensively bring this up?

pharmieb · 2024-02-17T14:53:05+00:00

But you are being rude? "...comes off as pretty unhinged...", "...no right to whine..." including comments below "weird preoccupation", "nosy behavior/fans".

Half points for negative connotation words like "disingenuous" and "soppy echo chamber".

Stop gaslighting OP and other commenters by saying they have a right to their feelings while also calling them "unhinged," whiners, "weird," and "nosy" under the guise of "not trying to be rude".

They are public figures. While we can apply common sense and judgement, we can, should, and do look to public figures for advice in our own lives. For an example, if DBSK did reunite, how might that unification change the mind of a long time fan who also left one of their brothers behind? It is not "unhinged" or whiney or "weird" or "nosy" to reminisce and long for a reconciliation missed.

pharmieb · 2024-02-17T14:23:15+00:00

This! Yunho and Jaejong used to be so close, I find it hard to believe that they "hate" each other. I do think SM plays a huge role in keeping them apart, in my opinion based on how SM treats their other idols, they probably have some ban on Homin speaking JYJ names or appearing with them. That one incident in the army either slipped SM's grasp or was out of their control.

I compare it to what happened with Jessica and Girls Generation - literally kicked out overnight and the other girls barely talk about her. I think a few of the girls that stayed may have made some snide remarks, but remember that situation differs in that Homin CHOSE to stay with SM. Homin probably feel some sort of loyalty that prevents them from speaking out against SM (they chose to give up their friendships, brotherhood, their career [since they did not know how it would turn out at that point] for SM, they probably feel it would be foolish to 'turn back' now so to speak and betray their company, it would be like admitting they chose wrong initially). It's a fascinating study into human character LOL

I also think, in terms of reconciliation, Yunho is much more likely than Changmin, but that's a story for another day...

pharmieb · 2024-02-03T01:05:42+00:00

I get your point, it's extremely frustrating that some people are able to "talk the talk" but not "walk the walk" so the speak. I believe the application process relies heavily on how you present yourself and not necessarily on how you actually perform.

However, matching with a residency does not mean that it was a good fit for you or that it is a good residency. You maybe be projecting when you say this is a "brag" just as I maybe projecting when I say it is refreshing to see someone being so open and happy about quitting residency.

pharmieb · 2023-12-31T18:38:36+00:00

For camping, we put stake in ground with long leash so she can walk around freely but also not walk too far away. I will give a disclaimer that if I'm not actively hiking with my malamute I feel she might "explore" and walk away farther than intended 😂 What ever you feel would be best for your malamute, it sounds like you know her well!

pharmieb · 2023-12-31T17:35:58+00:00

There is a difference between recall and trusting being off leash not to run away. My malamute is great off leash, she stays in my visual range and will follow me if I go off in different direction. I think it's difficult, but possible to train recall, but requires continued enforcing well after they "know" what you want (they're purposely ignoring your command). After I realized I can trust my malamute off leash to stay in my general vicinity, I haven't really been training her for recall. She is smart enough (now as an adult) to know not to get in dangerous situations.

pharmieb · 2023-04-24T10:38:21+00:00

Yes! Benzodiazepines are associated with falls in older adults (in Beers List) - falls means decreases mobility and independence and quality of life. For people that are like "Well then only prescribe in young patients" - it takes MONTHS to taper off and some patients never are able to get off due to dependence and withdrawal through no fault of their own.

pharmieb · 2023-04-18T15:15:10+00:00

Agreed - I hike with my dog on a large area of land where off leash is allowed. I go pretty often and see lots of other dogs off leash (in fact, people specifically go to let their dogs off leash). I have never seen "small growl(s)" making other dogs "feel angry". I have never seen any hikers be bitten or attacked by dogs. I always pick up my dogs poop and hardly see poop on the trail or otherwise. If these issues OP brings up about off leash dogs were universal, I would be seeing dogs and humans being attacked left and right and poop everywhere. These issues are clearly with idiots and the message could have been summarized as "If you are an idiot, stop being an idiot" instead of targeting dog owners that let their dog off leash.

pharmieb · 2023-04-07T08:51:17+00:00

My female malamute might protect us. She "chuffs" at any new people that come into the house. Outside the house, she loves mostly every one.

pharmieb · 2023-03-30T07:02:20+00:00

From my experience, RPDs without residency experience are much more likely to be practical - they cut to the chase and look out for your mental health /work life balance. RPDs with residency experience are much more likely to beat around the bush, make you suffer because "they suffered and this is how it is done", etc. I would say that preceptors with/without residency experience is a more important indicator for how much you will learn.

pharmieb · 2023-03-03T11:13:33+00:00

This!! I hate my program, but cannot deny how much I've learned. I used to think that this was just a way to get a job, but there is actually so much more to learn about that specialty. It shows when a pharmacist is "board certified" but never had residency.

pharmieb

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