#consults

PSA: when you work in an academic institution and you receive a call from a community provider, it is so important to remember that you are colleagues; take opportunities to educate, not crucify. This is especially important when you are so lucky to be in a tertiary centre with ALL the resources--many of the centres that are calling you for help, advice, or transfer to your centre do NOT have access to these things (hence why they are calling you!). It really grinds my gears when I hear colleagues making comments like, “I can’t believe they did ___, what were they thinking? Obviously they should have done ___.” ...well, no, it was probably not obvious to that provider at the time they saw the patient and with the information and resources they had at the time. By the time you get the call, you’ll probably have had the benefit of some time, and hindsight is 20/20.

Sometimes I find myself talking from the “ivory tower”, and when I catch myself I feel so terrible about it! Our colleagues transferring patients to us are doing the best they can with what they’ve got--the least we can do is meet them halfway. Talking down to or about other providers does not help our patients. And sometimes we find ourselves in the sticky situation of having patients question what other providers did, and usually I find the best answer is, “Unfortunately, I cannot comment on what the other provider saw or thought at that time. They didn’t have the benefit of all this information I have now, since you last saw them. So with this additional information, my impression is ___ and my plan is ___.” 

1. Don’t non-urgently consult a service at 3am for a patient who is clinically brain dead.

2. What a clinically brain dead person looks like.

3. Don’t operate on patients that haven’t stopped their Plavix. I see red in my dreams.

The Young Turks Jul 7, 2020 

You Won't Believe How Much Federal Stimulus Money Kanye West Took

The right-wing is full of hypocrites. Cenk Uygur and Ana Kasparian discuss on The Young Turks. 

Read more here: https://www.hollywoodreporter.com/new... 

Kanye West's Yeezy company received more than $2 million through the Paycheck Protection Program, the Small Business Administration disclosed on Monday. Yeezy, an LLC formed by the musician and clothing designer, received a loan between $2 million and $5 million, according to the SBA. The company disclosed that it saved 106 jobs because of the program, meant to help businesses struggling during the novel coronavirus pandemic." 

The Young Turks Jul 7, 2020 

Republican Insiders: It's OVER For Trump

Republican insiders are not hopeful about the 2020 election. Cenk Uygur and Ana Kasparian discuss on The Young Turks. 

Read more here: https://www.rollingstone.com/politics... 

"Shooting rubber bullet grenades at protesting priests. Catastrophically botching the pandemic response, resulting in a public health and economic calamity. Tweeting “white power” memes. Ranting in front of empty arenas about how he navigated a “slippery ramp.” Being MIA while his Russian benefactors put out a hit on American soldiers in Afghanistan. The last 3 months have been a political dumpster fire for President Trump, and the flames have engulfed Republicans up and down the ballot. But while pockets of Republican resistance have roasted Dear Leader, elected officials in D.C. and their svengalis in the consultant class have remained steadfast."

The Young Turks Jul 7, 2020

Tucker Carlson Attack BACKFIRES

Tucker Carlson is a right-wing hack. Cenk Uygur and Ana Kasparian discuss on The Young Turks. 

Read more here: https://www.usatoday.com/story/news/p... 

"WASHINGTON — Sen. Tammy Duckworth, D-Ill., who lost both legs in a 2004 helicopter crash during the Iraq War, hit back at Fox News host Tucker Carlson by asking if he wanted to "walk a mile in my legs" after he suggested she and other Democratic leaders "hate America." "You're not supposed to criticize Tammy Duckworth in any way because she served in the military," Carlson said in the opening monologue of his Monday show. "Most people just ignore her. But when Duckworth does speak in public, you're reminded of what a deeply silly and unimpressive person she is." "These people actually hate America," he said, adding later in the show that Democratic leaders "despise this country."

The Young Turks Jul 7, 2020 

HORRIFIC Trump Family Stories in New Book From Niece Mary Trump

More unbelievable stories from Mary Trump's new book about the Trump family. Cenk Uygur and Ana Kasparian discuss on The Young Turks. 

Read more here: https://www.politico.com/news/2020/07... 

“A new book by Donald Trump’s niece Mary Trump describes the president as a person likely afflicted by multiple psychological disorders who is profoundly unsuited to be president. Mary Trump is the daughter of the president’s older brother, Fred Trump Jr., an airline pilot who suffered from alcoholism and died of a heart attack at 42. She is a clinical psychologist who holds a Ph.D. from Adelphi University in New York.

The Young Turks Jul 7, 2020 

Trump: All Statues Matter! Vows To "Protect" A Religious Statue...That's In BRAZIL!

Trump vows to "protect" a statue of Jesus that IS NOT IN THE U.S.A. Cenk Uygur and Ana Kasparian discuss on The Young Turks. 

Read more here: https://www.thedailybeast.com/trump-c... 

+ from a different anon:

I really, really want to get top surgery but have been unable to schedule even a consultation due to being paralyzed with anxiety. Do you have any idea what I should expect, going into a first appointment? Will I need to take my shirt off? Should I be prepared to be touched? Drawn on? Photographed? Really any information would be greatly appreciated.

It depends on 1) where you are 2) what your medical history is like 3) your surgeon and 4) what kind of consultation it is.

If what you’re having is a pre-screening appointment with a GP, which are uncommon but becoming more common, you will likely just talk to the GP about your expectations for surgery and your medical history. They will ask you questions about any history of dysphoria related to your chest—e.g. “how did you feel when you went through puberty and your breasts started developing?”. They will ask you questions about your mental health, particularly if you’ve ever been suicidal, because surgery can be a psychological and physical stressor and they want to make sure you have an appropriate care plan in place. They will likely measure your height and weight, ask you to list what medications you’re on, and review your medical records to see if you have a condition or risk factor that would require extra consultation or special monitoring. (For example: I was considered a sleep apnea risk, and while I wasn’t asked to do a sleep study I did have to schedule an additional consult with an anaesthesiologist to talk about my family medical history.)

If what you’re having is a first consult directly with your surgeon, they should ask you the same kinds of questions, particularly about what you hope for out of surgery. They’ll also:

Talk to you about methods that they use, healing time, what you can expect out of nipple grafts if you’re getting those, and where they perform surgery (e.g. private clinic vs hospital).

Ask you to take your shirt off so that they can physically examine your breasts; this is because they approach their techniques differently depending on how full vs hanging your breasts are, their spacing, “sideboob”, etc.

This involves touching, which can be weird to experience but should be done professionally; they may ask you to stand with your arms hanging loose or turn from side to side, and use a measuring tape to go under your breasts, over your nipples both horizontally and vertically, and above your breasts.

They may also lift your breasts to measure from your nipple to the mammary fold, where your breast meets your chest.

They usually don’t draw on you for a first consult, though they do immediately prior to surgery as reference marks. They use a Sharpie for this, which really threw me at the time.

They may take photographs of your chest at the initial consult. I’m not sure how common this actually is, versus taking photographs in the pre-operative room, but either way they will take photos at some point before surgery. These are for the surgeon’s reference, and usually they take photos from the front, both sides, and at angles both before and after your surgery (immediately and ~6 months post-op) so that they can see how their techniques heal over time.

Your surgeon shouldn’t be brusque about this at any point. It’s completely normal to be nervous or anxious, and even if you’re the most chill person on Earth it’s still a little weird to have someone picking up one of your breasts to put a measuring tape against it. They’re aware of how weird this is for you as the patient, and should generally tell you what they’re doing before they do it. Don’t be afraid to ask questions—not only should they be able to answer your questions, but actively participating in your care can help you feel less anxious and more in control of the situation. Honestly, one of the weirdest parts of the whole consultation process is how not big of a deal it is to the surgeon—they do this a lot, and for them it’s their work, while for us it’s a huge event.

Read more: http://bit.ly/2ZTvcZO

Patient Formally Diagnosed as Acute on Chronic Hot Mess

https://gomerblog.com/wp-content/uploads/2017/10/31021855_m.jpg

SANTA FE, NM – After a battery of laboratory tests, radiographic imaging, and subspecialty consultations, a team of health care ...

Read more on https://gomerblog.com/2019/09/acute-chronic-hot-mess/?utm_source=TR&utm_campaign=DIRECT