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@crabcom
the concept bringing a grandfather clock into campus accommodation is killing me. like technically there's no one around to stop me. we don't have an RA or anything. but it would be a fundamentally unacceptable thing to do. imagine you're living in a dorm and one night you just wake up to a grandfather clock gonging. would you think you were going insane.
it's kind of crazy climate change has occurred at such a remarkable pace that I and everyone else around my age can remember a completely different climate in our childhoods. I truly watched winter gradually disappear in my life.
"You're too young to remember this, but there used to be so many insects outside that you would have to clean them off the windshield after a long car ride" is the kind of sentence that would have been in a cheesy scifi short story earlier in my life, perhaps submitted to a literary magazine and accepted to show support for its environmentalist message - now it's something I've said in earnest.
nothing makes you feel like more of a flop than not getting a phishing scam in your inbox even though the problem is apparently so prevalent that tumblr had to put out a site wide warning on everyone's dashboard
Florida Governor Ron DeSantis had the state pave over the memorial for the 49 Pulse Nightclub massacre victims.
Members of the community responded
🌈💙❤️💛🩷💜🩵💚💛🏳️🌈🏳️⚧️✌🏻🤟🏻
Orlando Resident here. The chalk was later replaced by paint by more proud citizens, but the state came through AGAIN last night and painted over it AGAIN, and everyone has re-chalked it rainbow again as of 5 hours ago. A bucket of chalk now sits by the crosswalk. Orlando will not lose this fight. We are not letting this go.
How’s it going today? Did they erase it again?
They painted it again, and it has been rechalked again as of about 2 hours ago. They can keep repainting that shit till it builds a speed bump we are not letting them have this
I wanna address this tag I got on this. I get it, I’m furious too. But it is extremely important to know that this is NOT the city of Orlando doing this. This is NOT the city government’s decision. This is ENTIRELY the actions and choices of the state of Florida highway department, not only operating without the city government’s permission but without their knowledge. The original repainting was done in secret, without warning, in the middle of the night. The city was not informed. Our eternal goat, Buddy Dyer (🎶hello this is Orlando mayor buddy dyer🎶), the mayor of Orlando, spoke out against this immediately after it happened. Orlando is not a perfect city but the city government is actually just as pissed about this as we all are. They didn’t even know it was happening. This is DeSantis bullshit, all the way down. Direct your rage to the world’s most cartoonishly evil governor. The city government isn’t any happier about this than the rest of us.
I had a patient come in the other day because she wanted her IUD replaced. It was at the end of it's life and she loved having her IUD, this was her second one. My MA let me know that the patient was very anxious about getting the IUD replaced, she'd had painful experiences in the past with her other replacements and was dreading this visit for that reason.
I spoke with the patient and she was literally shaking with anxiety. I asked her to describe her prior experiences as well as what she liked about her IUD and what she didn't like. She said that she wished she didn't have to get it replaced so often, so I recommended we place a Mirena instead of just inserting a new Kyleena IUD. She was nervous about this because she didn't want an IUD that was big. I explained that the Mirena and Kyleena are essentially the same size but the Mirena lasts 3 years longer and would likely bridge her to menopause given her age whereas with the Kyleena she'd probably need another replacement to get there. She was okay with trying the Mirena.
I then talked to her about pain control during the procedure as this was what she was most worried about. I asked about her prior experiences and then laid out what I wanted to do to try and improve her experience during this procedure. I told her I planned to give her prescription strength ibuprofen, a heating pad, and a very dense anesthetic block in her cervix to hopefully make it a better experience. If she had had someone to drive her home I would've also given her an ativan because we have studies that show patients who report higher rates of anxiety surrounding a procedure also report higher rates of pain associated with it.
She was down for this plan. I gave her a very dense block, she only felt three small injections and then nothing else. She was shocked when I told her that her old IUD was out and the new one was in. She didn't believe me when I told her it was over.
I don't tell this story because I wanna brag about how amazing of a doctor I am because I'm not. I tell this story because this is the way IUD insertions SHOULD go and I want people to know that IUD insertions do not need to be traumatic. And I want other providers who may insert IUDs to know that a paracervical block should be your standard when it comes to IUD insertions.
When people find out I'm an OBGYN, complete strangers, acquaintances, etc. , the two things they like to tell me immediately are their horrible birth trauma story and their terrible IUD insertion story and I'm trying to at least make the latter one a little less common.
If you place IUDs and aren't doing a cervical block, you need to start. This should be the standard but over 90% of OBGYNs in the US aren't doing them and it's unacceptable. We are traumatizing people and it's entirely avoidable. We are scaring people away from one of the most effective and long lasting forms of birth control in a time when people are losing their ability to end unwanted pregnancies all for no justifiable reason.
"It takes too long:" No it doesn't, that visit took me 20 minutes with a highly anxious patient from start to finish.
"It's not worth it for such a short/small procedure." It's worth it for the patient.
"It's too expensive." You can do a paracervical block with just normal saline. You don't even need lidocaine if you use a generous amount of volume. And if you place Nexplanons I know you stock lidocaine in your office, stop being fucking cheap at the expense of women's pain.
"Patient's don't need it, they'll get over it." I'm telling you they do need it and they aren't getting over it as evidenced by literally everyone wanting to tell me about their terrible IUD insertion experience as soon as they find out I'm an OBGYN.
We should do better. The cervix has nerve endings, stop acting like it doesn't.
Make cervical blocks your standard of care, there's no excuse not to.
My buddy does EMLA before the cervical block, that seems to help reduce pain even further.
I do 20% benzocaine and my patients almost never feel any of the 5 shots ( I do tenac site and then 2, 4, 8, 10.) Buffering the lidocaine and warming it to body temperature makes it work super fast and not hurt at all during infiltration.
Also a block makes insertion easier. No reason not to.
It's wild to me how some providers accept levels of pain for things involving the cervix that would never be remotely tolerated with other things, like, say, dental work.
I have had people freak out and act like it was crazy that I once let a dentist give me a (very shallow) filling without novacaine. Yet it was less painful than itching a bad mosquito bite. The norm in dentistry is to give local anaesthetic before anything that might cause much pain, and use a numbing agent before the injection.
Rarely a dentist might offer to do something without anaesthetic like that one filling, but only if they really know what they're doing and think it's highly unlikely to be painful. And even then if you yell out, they'll stop and numb you if you want. 100% of the time.
I want this to be the norm for basic gynecological care too.
I have broken several bones, some of which required surgical intervention and have had a hysterectomy, and yet the most medically traumatizing things to ever happen to me were a colposcopy done when I was 21 with no warning or real explanation, and a uterine lining biopsy done with no drugs at all by an intern who was trying her best but sucked at it royally.
We can do better.
oh yeah no that’s the edible of ‘inescapable plastic smell and feeling hot all over’ feel free to try one
when you cook for everyone and they tell you how much they like the food
Source
"these researchers published a paper on something that literally any of us could have told you 🙄" ok well my supervisors wont let me write something in my thesis unless I can back it up with a citation so maybe it's a good thing that they're amplifying your voice to the scientific community in a way that prevents people from writing off your experiences as annecdotal evidence
cant stop thinking about this this was sooo crazyyyyy
i’m the best kind of girlfriend bc i love both dogs and cats… we can have both
this stupidass post is almost a decade old AND it was a lie. don’t bring a dog into my house.
Before getting wine drunk you MUST consider if you have a man you can feel up. If not, you must seriously consider if you are ready to be wine drunk without having a man to feel up and do not overestimate your mental fortitude
I love when you go on a date with someone and you’re like. well that was neither wonderful nor horrendous. You seem Fine. I’m sure if this was the 18th century and we were gentry arranged married to secure our fathers respective land interests we would care for each other in our way. you would buy me nice horses that I really had no interest in but would admire how gentle you were with them and when I died in labor during my third pregnancy you would tell our surviving heirs that their mother was a handsome woman who never drank too much and embarrassed herself in company
Part of getting older is realizing how absolutely insane it is that basically every form of media is constantly trying to convince us that the most interesting moments of the lived human experience are happening in HIGH SCHOOL…… girl who gives a flying fuck what 16 year olds are doing.
the first law of tragedies: the end is already written and inevitable. the second law of tragedies: your actions are all your own and you can choose to get off this ride whenever you want. the third law of tragedies: we both know that you are never going to do that.
idk thinking about how sometimes you have to show up for people you aren't that close to, because sometimes you're just the person who's there. sometimes you invite a new friend to a party and end up having to sit with them through a panic attack. sometimes you run into an acquaintance on their worst day and they need to talk about what happened. sometimes someone is crying in a stairwell and you're the only one around to ask if they're okay. and none of this is "trauma dumping" or whatever the fuck it's just being there for people because you're the one in the room with them.