#US medicine

[dinovia-grant]

Two things about caesarians:

First, in the US, it may depend on the hospital whether they offer elective caesarians. Also, some insurance companies may not cover an elective caesarian, which may make you liable for the full $50k+ bill. Check with your OB early on.

Second, caesarians are still major surgeries and have their own complications. Wound infection, incision dehiscence (where your stitches tear and the incision reopens), and post-surgical pneumonia are not uncommon for mothers. Surgical injuries (i.e. the surgeon accidentally cuts baby or supporting organs during the operation) and increased trauma response are not uncommon for babies.

Plus, caesarians do not mitigate the changes to the mother's brain or bone density, but they do interfere with the usual hormonal cascade of natural birth, which promotes, among other things, mother-baby bonding, baby's temperature regulation, and lactation. Higher incidences of a complete lack of mother-baby bonding are reported after caesarians, and a lack of mother-baby bonding increases the risk for post-partum depression and post-partum psychosis.

The bottom line is pregnancy and birth are major events in any woman's life and can result in major medical issues and outcomes. The legal option to opt out of an unwanted or non-viable pregnancy should be every woman's right. Period.

In addition, in the US, the risk of maternal death during delivery for Black women is four to five times higher than for white women, and the reason for that is systemic racism and misogyny in (US) medicine.

giving birth sucks tbh. not only do you and the baby you’re birthing almost die, usually you shit yourself and often you tear your taint. then you have to push an organ out of your body (placenta) and if even a little of that remains in your body, you can hemorrhage to death or develop an infection that essentially rots your body from the inside out. even if you had a relatively “easy birth”, you bleed for weeks on end. even after that stops, your body and brain is changed for the rest of your life, the pregnancy leeched minerals from your bones, that can cause osteoporosis later. minor urinary incontinence is not uncommon, brain scans of people who gave birth show permanent changes in their brain, you’re never quite the same.

I say all of this not to say giving birth is disgusting but it is a harrowing and visceral experience. society downplays how fucking awful it is and makes it out to be a ~magical~ experience but it isn’t a magical transformative experience for everyone. it can be an extremely traumatic experience for someone who wanted to carry a pregnancy to term, much more so for someone who did not want to be pregnant in the first place or someone who knows their baby won’t survive the birth. anyway, abortion is a right. pregnancy and birth aren’t just inconvenient, it’s fucking awful.

[politijohn]

Source

[reasonsforhope]

Sorry I'm kind of dissociated and my vocab crashes during that can you explain the Biden drug thing in just. Shorter simple sentences.

Sure! You're not the only one who's mentioned being unclear on what it means either, and I'm happy to help

(Context for anyone else: US Sets Policy to Seize Patents of Government-Funded Drugs if Price Deemed Too High, via Good News Network, December 11, 2023)

From the very basics:

When drug companies create new drugs, they get a legal protection called a "patent." The patent means no one else can make or sell the same drug for whatever number of years.

Usually, this is about 10 years after the drug starts being sold to the public.

So, for those years, that one drug company is the only source of whatever medication. And since people need their medication, drug companies can charge however much money they want.

Meaning a lot of drugs that people need to live cost way too much money to buy.

So, with this, Biden told drug companies "Fuck you, if you keep making medicine too $$$ for people to afford, I'm giving your competition the right to make and sell those drugs too."

The US has never done anything like this before.

This is a huge threat to the whole (awful) drug industry in the US. It will save people thousands of dollars. If he does this, it will save lives.

--

Edit 12/17/23: Quick note, as people have said in the notes, this only applies to drugs made in part using taxpayer money. Which is! Literally all of them!

[zenosanalytic]

just to be clear, the above is both a joke and true.

Like: USians, bereft of decent healthcare, get by through self-medicating the pain, and drug companies fight against public healthcare so they can continue to profit from selling us this stuff in huge quantities.

wait americans can just. buy massive bottles of ibuprofen what the fuck

[tombraiderrocker]

If they claim they can cure your condition that you have been told is incurable, run. If they claim they cured themselves, run. If they claim they have cured everything from cancer to lupus holistically, run. If they claim you have to buy only supplements from them, run. If they claim they that only thing that will cure is x but x costs tons of money, run. If they refuse to run tests or address your diagnosed conditions before insisting you do an expensive treatment not covered by insurence, run. If they offer a one size fits all treatment/cure, run.

I have been scammed by "holistic" and "naturalistic" people before as a chronically ill person. In fact it was an actual doctor who went to medical school who scammed me for years. So watch out. If it seems too good to be true it probably is.

[vaxxman]

Could I request Medic having The Mom Grip on Scout’s shoulder after the speedy moron almost let a mercenary secret slip while they weee getting groceries?

Three Europeans and two Americans walk into a grocery store in New Mexico.

I hope this is the right meme.

More silliness below.

This comic is the antithesis of the "wtf is a kilometre" joke.

The faces they make when they can't quite identify the type of brown bread in the bread aisle.

You don't know how [insert nationality here] you are until you go overseas and things are different.

Spy obviously has no problems with pretending to know how much a gallon of milk is, he just peeks into his conversion chart notes, pretending it's his shopping list.

I want to think Heavy is completely fine with having to readjust to a new unit system, he just eyeballs most practical things anyways by holding them up and mumbling about how they approximately weigh like a chicken or his kettle bell etc. He's always been living in practical ignorant bliss.

Medic has a peer reviewed meltdown the first time he realises there's no uniformity in "a cup of ____" because every object has different densities. He's diligent about memorising the conversion rates for ounces, pounds, the most common things etc., and recovers ok. He goes through the same stages of grief rage when he finds out about distances and lengths.

Just remember four inches are 10.16 cm and pray no one asks you to specify anything bigger than inches.

Everyone does a mental victory lap when they manage to guess how much Celsius the weather is because they keep forgetting it's Celsius*5/9+32=Fahrenheit, Engineer reminds them patiently.

The true victories are the correct temperature guesses we've made along the way.

One time, a friend asked me if I actually knew how much a tablespoon of flour was in gramms to convince me that metric users also make use of volume based units without thinking about them. But little did she know a heaped spoonful of 405 flour is about 15g and a level tablespoon is 10g.

They claim Oolong just tastes better when it's boiled to 80°C exactly with a Bunsen burner.

You only asked for one scene but somehow I came up with a bunch of other things. This post was drawn across 2 months so the artstyle is all over the place. Thanks for your ask!

[taibhsearachd]

Very cool that in the US I have a problem with my ankle that's been ongoing for a year... on real bad days I can feel something in my foot grinding or clicking over something... and I gotta clear this with my insurance before I can get a test that will diagnose this problem I've been having for a year. Extra cool that I have to wait for the time of year when you're allowed to switch insurance providers, bc I want to negotiate with the new insurance providers vs the old ones about whether they should X-Ray my ankle that doesn't work.

[gayerthanliberachi]

The AMA has broadly reversed course on limiting residency positions. You'll notice that of the links above one is a heavily biased paper, one is from a conservative think tank, and one is over a decade old. None of those are good sources you should trust.

Here's a blog post from Harvard that contains a ton of more useful references noting that the AMA has reversed course on limiting residencies, a position they held when there was a forecasted mass excess of doctors. The post also brings up that the AMA is lobbying heavily for "scope of practice" laws which limit what physicians vs non-physicians are allowed to do. Scope of practice isn't necessarily a bad thing, so read with a grain of salt and draw your own conclusion.

I get the impression that surgery has a reputation for having a very toxic culture and surgeons have a reputation for yelling at their coworkers all the time and being generally abusive. I also get the impression that surgeons often go very long periods without sleep and routinely work while highly sleep deprived. If true, there is literally no way these things aren't directly related.

[bluismie]

sibling banter 🍂

[professional-writher]

*comes out of the new Crane Wives album shaking, covered in blood, and changed as a person* anyway-!

[medicinepocketarchive]

Weibo Arts

From Medicine Pocket's designer on weibo.

[macgyvermedical]

Harm Reduction Ideas for Substance Use Disorder

Recently I have been listening to a podcast called The Curbsiders Addiction Medicine. If you are a clinician that works even sometimes with people who use substances (every clinician ever), it is a fantastic look at all the harm reduction practices you can use to make these individuals safer. Plus, you get free CME.

I’m hardly going to do the podcast itself justice with this post, but I wanted to share some things I learned from it:

If the dangers of using substances (social and legal consequences, time commitment, health problems, money problems, etc…) was a deterrent, people wouldn’t be doing it. But it’s not. Because uncontrolled substance use is a chronic disease that generally does not get better without treatment. When people are treated, not only do they generally use less, but they have a much lower chance of death and a much higher chance of a happy, productive life- whatever that means for the patient.

Previously (even a few years ago) we hung such treatment on the requirement that people be abstinent from substances in order to receive help. This works for some people, but far from everyone.

The evidence shows that best thing we can do for many individuals is to make their use safer and less of a burden on their life and health. This is called harm reduction, and it WORKS.

Here are some evidence-based ideas for how to help your patients:

Create a space where you are working together with your patient and following your patient’s lead. Do they want to become abstinent? Great! Do they want to use less or use in a more controlled way? Also great! Do they want to continue use in a safer way? You guessed it, also great! Support them in whatever their goal is

Provide or prescribe safe, clean tools of use. Things like clean needles, Pyrex pipes, and straws. This decreases rates of infection and abscesses

Prescribe medications that reduce cravings or reduce/eliminate withdrawal (methadone, buprenorphine, topiramate, bupropion, naltrexone) without requiring abstinence

Teach people safer use practices and safer routes, such as rectal (booty bumping) or oral (parachuting) instead of injection drug use

Prescribe PrEP if people are at risk of HIV without requiring abstinence

Test for and treat the consequences of substance use (such as HIV and Hep C) without requiring abstinence

Provide fentanyl and xylazine test strips so people know what is in the substances they are using and can adjust doses/use pattern accordingly

Recommend Never Use Alone hotlines to prevent overdose death or better yet, take turns using with a buddy

Prescribe naloxone to anyone who uses any substance- nearly all street drugs are contaminated with synthetic opioids and naloxone is an effective way to prevent deaths

People use substances for a reason, especially early in their journey- pain, coping with depression/other mental illness, ADHD, and social issues like being unhoused. Treat the problem if you can find it, and you can help people significantly decrease use or use in a more controlled way

Be aware that return to use (or return to uncontrolled use) is a thing you can plan for with the patient and manage before it even happens

It’s hard sometimes to change the idea of addiction/substance use disorder as something that can only be treated as a reward for staying sober. But thats why so few people seek treatment for it. The evidence does not equivocate. Harm reduction WORKS.

[metamatar]

November 11, 2023—Hospitals in Gaza have been under relentless bombardment over the past 24 hours. Al-Shifa Hospital complex, the biggest health facility where staff for Doctors Without Borders/Médecins Sans Frontiéres (MSF) are still working, has been hit several times, including the maternity and outpatient departments, resulting in multiple deaths and injuries.

The hostilities around the hospital have not stopped. MSF teams and hundreds of patients are still inside Al-Shifa Hospital. MSF urgently reiterates its calls to stop the attacks against hospitals, for an immediate ceasefire, and for the protection of medical facilities, medical staff, and patients.

“We are being killed here, please do something," texted one of MSF's nurses from the basement of Al-Shifa Hospital this morning, where he and his family were sheltering from the incessant bombing. “Four or five families are sheltering now in the basement, the shelling is so close, my kids are crying and screaming in fear.”

"The situation in Al-Shifa is truly catastrophic," said Ann Taylor, MSF's Head of Mission in Palestine. "We call on the Israeli government to cease this unrelenting assault on Gaza’s health system. Our staff and patients are inside Al-Shifa Hospital, where the heavy bombing has not stopped since yesterday.” [...]

MSF denounces this death warrant on civilians currently trapped in Al-Shifa Hospital signed by the Israeli military. There needs to be an urgent and unconditional ceasefire between all warring parties; humanitarian aid must be supplied to the entirety of Gaza now.

At Al-Quds Hospital, MSF has lost contact with a surgeon who is working and sheltering there with his family. Other health facilities, including Al Rantisi Hospital, which MSF has also supported in the past, were reportedly surrounded by Israeli tanks.

(emphasis mine)

[uncanny-tranny]

The interesting thing about medically transitioning is how you might just be treated with the wrong framework.

When I get my hormone levels checked, for instance, they check it against the wrong type of person, so everything is flagged. Did you know that testosterone encourages hemoglobin production? Well, my hemoglobin is perfectly in line with male levels, but my levels are checked for the wrong endocrine system. Before I realized this, I was really confused as to why my hemoglobin was two grams over the range given, and was confused as to why that happened, and worried about if I should be worried about that. But it was a normal consequence of my testosterone levels, which are also flagged though they are well-within the range that is typical for my age and health categories.

The way we treat and measure for trans people and trans patients will affect the treatment and education they receive. There are ways in which hormones especially can influence how one's body operates, and with that in mind, you also have to change the way you interact with a trans person. With my testosterone levels, if you were to measure them against the incorrect endocrine system, you would fail to treat me in reality - that being the way my body has changed and maintained homeostasis since being on T.

[reasonsforhope]

THANK FUCKING GOD

"The Supreme Court on Thursday [June 13, 2024] unanimously preserved access to a medication that was used in nearly two-thirds of all abortions in the U.S. last year, in the court’s first abortion decision since conservative justices overturned Roe v. Wade two years ago.

The nine justices ruled that abortion opponents lacked the legal right to sue over the federal Food and Drug Administration’s approval of the medication, mifepristone, and the FDA’s subsequent actions to ease access to it. The case had threatened to restrict access to mifepristone across the country, including in states where abortion remains legal.

Abortion is banned at all stages of pregnancy in 14 states, and after about six weeks of pregnancy in three others, often before women realize they’re pregnant.

Justice Brett Kavanaugh, who was part of the majority to overturn Roe, wrote for the court on Thursday that “federal courts are the wrong forum for addressing the plaintiffs’ concerns about FDA’s actions.”

The opinion underscored the stakes of the 2024 election and the possibility that an FDA commissioner appointed by Republican Donald Trump, if he wins the White House, could consider tightening access to mifepristone, including prohibiting sending it through the mail...

Kavanaugh’s opinion managed to unite a court deeply divided over abortion and many other divisive social issues by employing a minimalist approach that focused solely on the technical legal issue of standing and reached no judgment about the FDA’s actions...

While praising the decision, President Joe Biden signaled Democrats will continue to campaign heavily on abortion ahead of the November elections. “It does not change the fact that the right for a woman to get the treatment she needs is imperiled if not impossible in many states,” Biden said in a statement...

About two-thirds of U.S. adults oppose banning the use of mifepristone, or medication abortion, nationwide, according to a KFF poll conducted in February. About one-third would support a nationwide ban...

More than 6 million people [in the U.S.] have used mifepristone since 2000. Mifepristone blocks the hormone progesterone and primes the uterus to respond to the contraction-causing effect of a second drug, misoprostol. The two-drug regimen has been used to end a pregnancy through 10 weeks gestation...

Biden’s administration and drug manufacturers had warned that siding with abortion opponents in this case could [have] undermined the FDA’s drug approval process beyond the abortion context by inviting judges to second-guess the agency’s scientific judgments. The Democratic administration and New York-based Danco Laboratories, which makes mifepristone, argued that the drug is among the safest the FDA has ever approved."

-via AP, June 13, 2024

--

Note: A massive relief and a genuine victory - this will preserve access to the medication used in 2/3rds of abortions last year, for at least another 2 years. (Probably minimum time it will take Republicans to get their next attempt before the Supreme Court.)

Still, with this, a sword that has been hanging over our heads for the last two years is gone. There will be a new one soon, but we just bought ourselves probably at least 2 years. The fight isn't over, but this is absolutely worth celebrating.