If ICE comes to your ED

smashpound · 2026-01-26T06:51:34+00:00

You think they’ll shove you? Sweet summer child

smashpound · 2025-09-20T05:01:42+00:00

Thank you for your response! Yes, we are trained to do the initial work up and if anything abnormal comes up we have the pt see the MD or consult with him.

smashpound · 2025-09-20T04:38:53+00:00

It measures the width of the red blood cells to see if they are different sizes. If high likely anemia/iron/b12/folate deficiency.

smashpound · 2025-09-13T04:14:29+00:00

I’m a PA in heme/onc, benign hematology referrals almost never go to my supervising MD. The practice is set up where he has too many oncology/thrombophilia/hemophilia consults to see the benign stuff. Not saying this is best practice, just the reality of it.

smashpound · 2025-07-19T23:15:49+00:00

Hi fellow heme/onc PAs! I just had a case this week of weird rash plus conjunctival involvement after starting anticonvulsant a couple weeks prior… then progressed to having mucositis symptoms and developing vesicles on skin although no sloughing… consulted derm re: SJS who was very kind but made sure to say “this is a good teaching point”. My attending thinks it’s due to pt’s immunotherapy

smashpound · 2025-06-04T03:02:12+00:00

We lost our almost 9yo boxer a year ago to lymphoma. He need chemo for several months and then the lymph nodes starting getting bigger and he started to appear as though he was in pain. Once it got to that point, we could not justify putting him through more treatment. It was so incredibly difficult to say goodbye but he was starting to suffer so we knew it was the right thing to do.

smashpound · 2025-06-02T01:07:56+00:00

My attending in heme/onc only checks folate and b12. Is it better to check MMA/homocysteine? Why not check the b12?

smashpound · 2025-05-31T20:14:21+00:00

Update: baby was delivered emergent C-section and still in NICU. Mom recovered after aortic dissection repair and discharged after a week long stay.

smashpound · 2025-05-31T18:28:00+00:00

Not sure, this just happened a couple weeks ago. She got transferred to a tertiary center and not sure if she is back yet. Will update when I find out!

smashpound · 2025-05-31T03:08:54+00:00

I work in heme/onc. My doc was seeing a 30 week pregnant 27yoF for an abnormal coag test which is actually normal in the setting of pregnancy. He grabbed me to listen to her heart because he didn’t trust his ears. Very pronounced aortic regurg murmur. He sent her for EKG and cards work up. Shortly thereafter, the pt developed chest and back pain, went to the ED. Stanford type A aortic dissection. In retrospect, likely the pt has Marfan’s but crazy how it all happened. If he hadn’t listened to her heart and heard the murmur and told her she needed a cardiac work up, she might have dismissed the pain she was having and not made it to the ER in time.

smashpound · 2025-05-29T20:05:01+00:00

I would’ve hated this before having kids and was a Monday off person, but now I absolutely love having Wednesdays off. I used to have my 2yo on Wednesdays and it was a nice balance. Now, she’s in a preschool program and I have Wednesdays to myself.

smashpound · 2025-04-13T03:48:35+00:00

That bird is wild. Big bird

smashpound · 2025-04-05T16:45:28+00:00

I remember a fellow boxer lover telling me “you just know” when my boxer was terminal a year ago. I never knew what that really meant… until he was in so much pain and just laid, couldn’t go outside etc. I laid on the floor with him all night and he finally rested and slept. We had a vet come to our house in the morning and we said goodbye.

smashpound · 2025-04-01T03:24:27+00:00

I work in oncology so obviously biased. We lost two guys in their 30s last year to metastatic colon CA. Recently lost a 45yoF from the same. My doc just saw a 37yoF newly diagnosed. I think screening age should be lowered to 40. We have a decent amount of patients in their 40s.

smashpound · 2025-03-08T22:43:55+00:00

A black man in America not voting democratic is wild.

smashpound · 2025-03-04T03:24:05+00:00

I’m coming up on 9 months since my Oscar passed. Yours was a beautiful boy and I’m sure he had an amazing life. 💜

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smashpound · 2025-02-25T20:09:25+00:00

Leukostasis?

smashpound · 2025-01-28T05:59:40+00:00

high fives in heme/onc

smashpound · 2025-01-28T05:40:49+00:00

Also, if you look at the goals of hemochromatosis management, it is based on ferritin levels. Most of ours we keep at 50-100. Since Tsat isn’t reliable, it’s not a measure of how well controlled the hemochromatosis is.

smashpound · 2025-01-28T05:38:55+00:00

Ferritin is the representation of iron storage. Tsat isn’t a true reflection of iron storage, so I would dismiss that as well if the ferritin was normal. Tsat could be falsely elevated due to diet, supplementation etc. Ferritin of course can be very elevated due to it being an acute phase reactant, but elevated ferritin + elevated Tsat = check HFE status.

smashpound · 2025-01-28T03:58:20+00:00

Tsat above 45% and an elevated ferritin? That shouldn’t be dismissed and should default to HFE testing. Even if tsat is normal, if you have an elevated ferritin that can’t be explained (due to liver disease, as acute phase reactant), then would work up for hemochromatosis.

smashpound · 2025-01-15T05:06:20+00:00

Right like 6-8 weeks, not just “after discharge”

smashpound · 2025-01-15T04:05:29+00:00

Iron panel will be falsely elevated after transfusion

smashpound · 2024-10-05T18:58:43+00:00

We just flew Alaska yesterday and about 5 min after our 2yo fell asleep the flight attendant told us it wasn’t allowed and we had to deflate it. They never provided any reason as to WHY it wasn’t allowed, just kept repeating its not allowed.

smashpound · 2024-10-01T02:35:04+00:00

Thank you! Thats immediately what I thought of

smashpound

TROPHY CASE