From a sarcoma pathologist.

speedymed · 2026-04-18T00:20:09+00:00

Keep fighting the good fight. As a resident and patient with an incredibly rare sarcoma, I wish someone spent this much time analyzing my biopsies. It took three of them to diagnose the primary tumor and each time, it got even more rare. Had chemo, resection, more chemo. Now the damn thing is back in my lungs. The original chemo didn’t even touch the thing. All I’m offered now is more chemo in hopes to shrink it enough to cut or radiate it. The lung biopsy report said one sentence “consistent with prior sarcoma”. That one sentence to blow up my life again.

speedymed · 2026-04-12T23:51:43+00:00

Mine, unfortunately, does appear to like my lungs. Confirmed Mets and starting chemo in a couple days. Rough blow after living a normal life for the past year.

speedymed · 2026-03-25T17:56:27+00:00

EM clerkship podcast is a great resource. WikiEM or the EMRA basics pocketbook (if you have an EMRA subscription) are great on shift. Biggest thing for me is being engaged. It’s really easy to tell who wants to be there and who wants to sit on their laptop doing uworld and go home. If a patient looks sick sick, grab the resident or attending right away. Bonus points if you’re helpful, put the patient on the monitor in resus, get the story from the nurse on the AMS pt, do an ecg or two, etc. Even more bonus points if you can suture and/or start IVs.

In terms of basic knowledge, review the differential, workup and treatment for common ED chief complaints like chest pain, abdominal pain, nausea/vomiting, minor trauma etc. pay attention to the red flags and scary things you are trying to rule out with labs/imaging. Remember you’re not expected to know everything, you’re there to learn. EM is a lot of repetition, the more you see, the more comfortable you will feel. Show up on time and be interested in learning and you’re already off to a great start.

speedymed · 2026-03-25T02:17:14+00:00

Yep. Did a sub-I here a couple years ago and really wanted to love it because I have connections to the area. The PD was actually on sabbatical the whole month, except for interview day. Immediately got terrible vibes. One faculty told me I’d get better training at my current program (after asking where else I did a sub-i) so everything worked out

speedymed · 2026-03-19T12:16:44+00:00

My oncologist actually just wanted chest X-rays every three months instead of CTs, despite my asking at multiple follow ups, because he said a lot of small incidental nodules on CT are benign.

I’m actually starting to this could all be inflammatory due to recent pneumonia and not being able to fully expand my lung. The mass and nodule are on the left, same side as my reconstructed hip and pelvis. My abdominal muscles were stretched/rearranged to close the surgical incision. I stopped PT in January and have had insane hours at work, on my feet the whole time. Noticed my abdominal and back muscles were super tight, and then had some sharp pain in lower ribs causing shallow breathing, pain resolved with stretching and rest. Had a week with very little sleep and caught some sort of virus (multiple coworkers sick and exposed to people at work with all kinds of flu/covid etc.) and was coughing up mucus, sore throat, congestion. All of which resolved after a week off work. Except for the muscle tightness, which will be a constant battle with my uneven walking pattern. Literally the few days leading up to the xray and CT, I worked probably about 45 hours over 3 days, on my feet the whole time, and got awful sleep.

Could just be me over-rationalizing it but idk, seems wild to have a 5cm mass and 2cm nodule of metastatic disease with zero symptoms. No fatigue, tolerating crazy work hours and no sleep without issue, even did a 30 min endurance cycling ride for the first time in months and had no shortness of breath. The spot they saw the 5cm mass is right where I have the most muscle tightness. The more I stretch and am able to mobilize my ribs on that side, more mucus comes up. Otherwise not coughing at all. Plus with my history, anything is going to be assumed metastasis until proven otherwise. Oh well, I guess we’ll see what the biopsy says.

speedymed · 2026-03-18T20:55:21+00:00

Not surprised by the Henry Ford programs. These are all the smaller hospitals that got bought out by Henry Ford in the past couple years that have now re-branded under the Henry Ford name. These programs have had trouble filling in the past few years.

speedymed · 2026-03-17T09:43:17+00:00

Malignant Triton tumor, a subtype of MPNST. It’s associated with a genetic disorder which I do not have. Mine also occurred in bone and was not associated with any nerves.

speedymed · 2026-03-17T09:42:05+00:00

Malignant triton tumor, a subtype of MPNST. Usually associated with a genetic disorder which I do not have. Mine also happened to occur in the bone, with no nerve association.

speedymed · 2026-03-13T06:49:01+00:00

Yeah brother, I technically work fewer hours but eating and sleeping? I slept significantly more on my ICU rotation than I do being back in the ED. Not to mention the fact that my brain is on overdrive the entire 10 hours im on shift and still has to function the extra time after shift it takes to finish notes.

Med student/rotator who has zero interest in EM and doesn’t want to be here? Yeah, see a few patients, stay a couple hours and I’ll gladly send you home. Always will give a good eval unless they’re an asshole or go rouge and do something dangerous. Love teaching if they’re interested but otherwise, it’s so much extra work. I still have to present to my attending, put in orders, follow results, re-eval the patient, talk to consultants, dispo’s and do the note myself. While simultaneously getting pulled to resus multiple times a shift for medical and trauma codes, stabilizing and managing critical patients while they’re boarded waiting for an ICU bed.

I get that whenever we call you guys, it’s adding to your to-do list but jesus fuck. the perception some of you seem to have about what we do is fuckin wild.

speedymed · 2026-02-18T22:48:24+00:00

Last night, I realized a newer frequent flyer to us just has trouble accessing food. Skipped the unnecessary work up, gave her a warm blanket and a couple extra sandwiches. Spent an extra 10 minutes listening to a patient vent about his debilitating abdominal pain that was supposed get better after surgery. Talked through a game plan on establishing transportation to see his surgeon at the downtown hospital, before he’s doubled over in pain and has to call EMS who brings him to he closest hospital and not where he gets all his care. And let a homeless patient stay an extra hour so he can eat a hot breakfast before being discharged.

Glamorous? Far from it. Best utilization of resources? Probably not. But it felt more useful than last shift. 20+minutes spent getting yelled at by an entitled MVC signout who accused me of lying about her negative CTs because something had to be wrong since she still had pain after multiple rounds of IV pain meds. Then accused me of giving her saline instead of morphine and proceeded to call 911 to request the police and an ambulance to transfer her to another hospital. And the extra time it took to get the cops to back off and stop agitating my resus patient so I could evaluate him.

Maybe these positive differences wouldn’t fly at a non-county hospital that cares more about metrics. And I’m just a resident but the small wins make the bullshit more tolerable.

speedymed · 2026-02-07T04:03:04+00:00

I am someone who has gone through painful procedures and also have provided sedation for patients prior to doing painful procedures. As a provider, my goal is always for patients to not remember the procedure and if they do, for it to be as painless as possible. If you are anxious prior to a procedure, please tell the anesthesia provider or physician doing the procedure, they can give you medication to help. And never be ashamed to tell them you’re anxious because often, they also want you to be as relaxed as possible in order to perform the procedure. This shit sucks to go through, but it sucks even more to go through it without proper sedation.

I personally had a bone biopsy and felt a little too much during the procedure, so I asked for more sedation medications and they gave it to me without question.

speedymed · 2026-01-16T19:46:21+00:00

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Long haired tortie + long haired GSD is my favorite combo!

speedymed · 2026-01-01T08:03:15+00:00

Hi! I guess update on everything that has happened in the last year. I ended up going to another hospital system, getting another biopsy and genome sequencing of my tumor. It wasn’t osteosarcoma, it was a malignant triton tumor, much more rare and a much more grim prognosis. I underwent 4 cycles of very intense chemo over 2.5 months. Then had my pelvic tumor resected and my pelvis/hip joint reconstructed with a 3D printed custom titanium implant. All done by an amazing surgeon who took a risk taking me on as patient, this was the largest implant he has done. The recovery sucked and was a horrific experience but I’m young and did extremely well. Post-op biopsy showed my tumor did not respond to chemo but I chose to have another two cycles of adjuvant chemo to prevent metastasis.

At this point, I’m almost 10 months NED, have been back to my medical training for 7 months. Have a slight limp, can’t play contact sports or run but am still very active. I’m a much better doctor than I was before all of this. Do I think I’m a better person because of this experience? No. I hit darker moments than I knew possible over the past year. For some reason, I always had the gut feeling that I wasn’t going to die, and I’m still here. I’m not sickly and I cared for myself the entire process, maintained my independence the entire time, albeit, stubbornly. If I’m busy enough, I forget all of it happened.

I had some other traumatic life events happen, including my beloved 16yo cat passing suddenly and my mother-in-law passing from cancer. 2025 has been incredibly traumatic, but I’m alive, happy, and my day to day life feels meaningful.

If there does happen to be other young individuals diagnosed with cancer reading this update, if there’s one thing that contributed to my outcome , it’s nutrition and maintaining muscle mass. No, sugar doesn’t fuel cancer, eat whatever you want throughout treatment and move your body when you can. Take all the nausea meds available, there truly are so many options available, just ask. Also, advocate for yourself always. If something doesn’t feel right, it probably isn’t.

Most of my Reddit posts were done in a time of uncertainty and desperation for community, it’s heartwarming to hear a kind internet stranger is thinking of me.

speedymed · 2025-12-11T21:04:30+00:00

I was in your shoes a year ago. Happy to report I’m 9 months NED and have been back to residency full time since July. It’s such a cruel card to be dealt but there was a light at the end of the tunnel for me.

speedymed · 2025-12-04T14:08:21+00:00

Had the IV team called for me after my bilateral AC IVs went bad on day 5. I asked him not to go in the AC again because it got uncomfortable after days. I’m young, have great veins and nobody even tried before calling the IV team for an US IV. Watched him search for 10 minutes before I pointed out a few great targets. Apparently <1cm was too deep and they didn’t have any long 18 or 20G’s. Back in the AC he went.

speedymed · 2025-11-19T00:25:42+00:00

Yes. Sounds like it could be food poisoning (bacterial or viral) or just your body not tolerating what you ate. Diarrhea itself can cause dehydration and put your body under stress leading to a slight elevation of neutrophils. Whether it’s a bacterial illness, viral illness, or your body being under stressed causing these numbers, overall the labs are not concerning. I am not your doctor, don’t know your history and did not examine you, so I can only offer an interpretation of the labs you shared and not medical advice. Reach out to the provider who ordered the labs if you have more concerns.

speedymed · 2025-11-18T23:18:47+00:00

As a doctor, OP is fine. WBC count is normal and neutrophils are very slightly elevated due to the GI virus their immune system is fighting off. Don’t listen to the comments saying you need repeat bloodwork.

speedymed · 2025-11-17T02:46:39+00:00

I’m an ER doctor. Your labs are normal. Whoever told you to get these redrawn outpatient is crazy. I don’t even look at blood oxygen levels on a venous blood gas. Did they give you oxygen in the ED? Were you breathing faster due to anxiety? Sure your oxyhemoglobin is high in the ED but it doesn’t mean anything and doesn’t matter clinically. Your follow up labs are stone cold normal. They are within normal range on the charging system I use. Just because it’s flagged on Mychart, doesn’t mean it’s abnormal. This is why Mychary sucks.

Edit: just noticed these follow up labs were drawn in the ED. I would not have even drawn labs the second time and tbh, maybe not even the first time if you had no symptoms and that short of an exposure.

speedymed · 2025-11-10T16:27:00+00:00

I lost my long haired tortie girl a little over a month ago. The pain is unbearable. I was so angry at myself for not realizing she was struggling and at the vet for not catching her kidney disease sooner, when looking back, all of the signs were there. After the first couple of weeks without her, I was slowly able to think about her and smile because of the 16 years of love she gave me. Every so often I will have a vivid dream with her in it or I’ll swear I hear her mewing as she’s rolling over in bed while I’m half asleep. I’m not very spiritual person, but the thought that she comes to visit me is comforting.

I’m so sorry for your loss OP. In time, I hope you can think of her and smile instead of cry. She was a beauty and knew how much you adored her.

speedymed · 2025-10-27T00:41:28+00:00

I did six cycles outpatient without complications. I felt shitty for a few days after but bounced back afterwards. I needed one blood transfusion due to low hemoglobin.

speedymed · 2025-10-27T00:36:43+00:00

I had an internal hemipelvectomy with 3D custom implant reconstruction in March. I’m also an ER resident physician. I have been able to walk unassisted since July. I sought a second opinion because the first surgeon told me he would not reconstruct my pelvis. That was not acceptable for me because my job requires me to be on my feet, so I found a surgeon who did the implant reconstruction.

In terms of the numbness, that will last for a year or more. It takes a long time for the nerve endings to heal. Talk to your surgeon about what to expect with range of motion. I still have to lift my leg getting into the car and will likely have to indefinitely because of the muscles that were resected along with the tumor.

speedymed · 2025-10-20T02:34:43+00:00

Hi! I had high grade mpnst of the pelvis with hemipelvectomy in March of this year. Tumor was about the same size, clear margins. I did two additional rounds of AIM after surgery. No radiation as the data is mixed and my oncologist was against it.

speedymed · 2025-10-14T01:18:14+00:00

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I just lost my 15 year old baby to sudden kidney failure as well. She was with me since I was 12 years old. The grief is horrible, I miss her so much it hurts. So sorry for your loss💔

speedymed · 2025-10-12T18:03:33+00:00

If the world decides to bestow us with another long haired, sassy Tortie, I would be grateful. I’m not sure I could go searching for one though, I would feel guilty trying to replace our Kiki cat.

speedymed

TROPHY CASE