cranquis mail

Cranquis Mail: I want to get high...

(name withheld) asked:

Hello. Im taking venlafaxine 150mg with prolonged release and lamotrigine 100mg at day and night. i want to get high on buphedrone. any lower high on stimulant or chance to die xD? p.s no moralizing plz

Dammit Jim, I’m a doctor not a chemist.

And as a doctor, “moralizing” is not what I’m doing when I point out that:

  • (a) taking illegal drugs to hopefully attain a temporary high is dangerous, no matter what your friends say
  • (b) taking any chemicals (including venlafaxine and lamotrigine – and those are “approved” well-studied drugs!) comes with significant potential for side effects, so mixing in a non-pharmaceutical drug like buphedrone, which certainly has not been tested for drug-drug interactions with those medications, is dangerous
  • © asking a doctor (albeit online and anonymously) to give you advice on getting high is like asking a police officer how to speed without getting caught – your question violates common rules of decency, implying that “just because I’m anonymous” in this realm of interaction that I would be willing to ignore my professional and personal code of ethics, put aside my vow to “First Do No Harm”, and jeopardize my DEA license to prescribe controlled substances, just so I can guess-timate your chances of surviving your proposed experiment. 

So, good luck with whatever you decide, Dammit Jim.

PS: It’s been years since I’ve posted anything about street/illicit drug use, and the last time it led to weeks of cranky half-illegible messages from people defending their chemicals of choice. This time around, I’ve learned my lesson – THERE WILL BE NO REPLIES OR ACKNOWLEDGMENTS TO ANY COMPLAINTS OR ATTACKS RE: THIS POST.

anonymous asked:

Hi! I'm currently a medical student, but will be leaving in short because the cost (emotionally, financially, and investment of my time) isn't worth the benefit. I'm starting to explore the options of mid-level practitioners because I don't want to give up the health field completely. What made you decide to go the PA route rather than all of the other options open to you?

Excellent question. For me choosing PA had much to do with investment of time and my desire to have a more meaningful impact on the lives of patients. Prior to PA school I was a 26 year old married x-ray tech who desired a more challenging career and wanted to start a family soon. When I considered my options for advancement the choices were hospital administration, PA school, or medical school. Now I am not particularly skilled at politics or small talk so hospital administration was quickly crossed off my list. The real debate in my mind was PA vs. MD. The table below demonstrates my findings after some research.

In short, I found that a career as a PA will provide me with the mental challenge and job satisfaction I desire while still allowing me to practice before I turn 30. This table is certainly not all inclusive but I found it helpful and maybe you will as well.

Here are some other resources that may help answer this question. 

 I wish you the absolute best of luck no matter what you decide. I am sure that your awesomeness will succeed no matter which path you take.  

Cranquis Mail: What do you think about lab techs?

@beta-hydroxybutyrate asked:

I’m sure you get thousands of messages and I doubt you will see this, but when will your ask box be open again?! I’m a Medical Technologist at a local hospital (I work in Chemistry and Hematology) and I’d love to hear your opinion on med techs and the lab… in addition to the unspoken “battle” between nurses/lab techs/doctors (ie: when we call to cancel a test due to not enough sample/hemolysis/incorrect specimen collected, etc). I once had an outpatient doctor who refused to take a critical result from a “lab rat” and it made me very sad to hear he thought of us in that way.

Med techs! Clinical lab specialists!

“Oh ye tireless workers, blessed with the mental and emotional fortitude to perform a wide array of ridiculously complex, perfection-requiring tasks OVER AND OVER with little acknowledgment from the people who depend on their work (except when those people feel a test took too long or didn’t come out right). Ye who do a job which I personally would hate to do, but for whom I am so grateful that you are willing and able to do it!”

Look, I’ve said something similar to this before: in any profession, there are jerks – and it is usually the way that the jerks from one profession interact with another profession that determine the reputations each profession carries around. So listen – I want to apologize for the doctor jerks who have forgotten that lab techs (JUST LIKE DOCTORS) are human, capable of making mistakes, and possess emotions which can be battered and broken by harsh words and actions. Those doctor-jerks have lost sight of the main reason that they themselves endured toil and abuse by superiors and self-deprivation in order to become doctors: “Solving problems and helping people”. Instead, by behaving like spoiled brats when a lab tech “dares” to approach them with an issue, they are CREATING problems and HURTING people!

So the next time some jumped-up jerk-king with a long white coat feels snooty enough to royally degrade you and your profession, just remember: without your tireless toil down in the lab dungeons, the entire healthcare castle would grind to a halt.
Thank you for what you do!

(OH, and re: my stubbornly-closed Ask Box – see my explanation here.)
Cranquis Mail: Early Early Decisions about Medical Specialties

pikagirl25 asked:

Hi cranquis! First i wanna say i love your blog its so interesting. Second i wanted your opinion. Im 16 years old and a junior high school i know i want to go into the medical field but i have no idea what specifically i should do, which makes it really hard to choose a college because i dont know what to look for. What is a good way to help get an idea of what field i should go into it? Im really into blood and organs and stuff, just incase that would help.

I’m going to have to lead off my reply with a well-meaning reassurance/reminder which I think more high-schoolers need to hear: SLOW IT ON DOWN!

You are still in high school, friend, so you have tons of time (TONS) before you have to pick your medical specialty. In fact, if we assume that you’re in the US educational system, you still have a minimum of 8 years before you would even need to narrow down your specialty to a COUPLE options (in order to narrow down the types of residencies to apply to in the Residency Match program, during the 4th year of med school) – and some med students actually don’t pick a specific specialty because they can’t make up their minds, so they apply broadly to various residencies and let the Match process “decide their future”!

Speaking from personal experience, I didn’t even know I wanted to go to med school until my junior year of COLLEGE (4 years later than you are now), and at that time I thought I would be a child psychiatrist. Then I hated child psychiatry during 3rd year of med school (7 years from where you are now), so I explored pediatrics, briefly considered ENT or urology surgical subspecialties (but couldn’t bear the idea of doing a surgical residency), and finally ended up doing family medicine instead!

This “meandering journey of self-discovery” is very common in medicine. Many people either have (a) no idea or (b) the wrong idea of what specialty they think will interest and engage them. You can’t really know until you’ve encountered (and suffered through) a bunch of clinical rotations in med school.

The closest you can come right now to even BEGINNING to explore your medical-specialty options is to start shadowing in the medical world. Here, read my posts about #shadowing.

But honestly, don’t sweat this very-future detail right now. The college you attend will only make a difference for strengthening your application to med school, NOT to residency (which is where the actual specialty training takes place). You mentioned “blood and organs and stuff”, which could include any of the surgical specialties, pathology, emergency medicine, OB-GYN, radiology – see what I mean? You’ve got plenty of options and plenty of time to decide about those options. So enjoy your education, enjoy your youth, take time to do things because you LIKE to do them and not just because “they might look good on your application to med school” – and you’re going to be fine.

Cranquis Mail: The MCAT keeps defeating me

(name withheld) asked:

Hello Dr C
I really enjoy your blog. I am hoping to someday be a doctor but getting in has proven quite challenging. I did very well in school, have hospital/ER experience, volunteer at retirement home playing music and did independent biochemistry research. However, I feel I have been defeated by the MCATs. I have taken them twice now and the best I can do is a pathetic 26. I have no idea how to study for them. I tried notes and note cards. I took a class and I did practice questions, but being a full time worker at the hospital has made studying hard. Do you have any advice? How can I get all that information to stick? I am great at problem solving and diagnostics ( or at least the rudimentary diagnostics we did in physiology) but its the shear volium of information I am finding so defeating. Sorry to assault you with this wall of Text. Thanks for taking the time

Greetings, Gargling Gluestick (your CranquisNym™) –

First off, my standard disclaimer re: MCAT-related advice: It has now been… 18 (18?!) years since I took the MCAT. Plus, my preparation for the MCAT was rather, um, atypical.  So please realize, I am in no way an expert on anything MCAT related. Seriously, you’d be better off asking Kim Kardashian for her tips on memorizing the Krebs Cycle Cycle.

But for lots of tips on how to study, you should wade through (more information for you to absorb, sorry) my #study tips tag. Or here, this particular post summarizes a lot of my usual “studying under a deluge of info” advice.

Now, in case you wanted some feedback on your efforts so far: 

Keep reading

Ask Me Anything: Kids vs Adults

forcedinspiration asked:

Dr. Cranquis, as someone who works with both pediatric and adult patients, what would you say are the pros and cons of specializing in pediatrics vs. family/adult medicine?

Ok, let’s clarify some terms first:  Pediatrics = kids only (usually up to age 18, sometimes longer depending on the medical condition) Adult Medicine ONLY = Usually “Internal Medicine”, ages 18 and up. Family Medicine = ALL THE PATIENTS – cradle to the grave, often (but not always) including basic OB-Gyn management too. (PS: This is my area of training.) So, let’s consider all 3 categories (to keep it simple, we will assume “just primary care” for each of them – none of that hospitalist/specialist jibber-jabber):

Oh, you want a gif to represent each category? Ok!


Internal Medicine:

Family Medicine:

There, glad we could clear that up.

Cranquis Mail: Is there life after 1st year of med school?

(name withheld) asked:

I am a first year med student about to go into my second semester and I was wondering, does it ever get better? I feel like I’ll always be over-worked and tired with little time for family or relaxation.

IT GETS BETTER. So much better.

Don’t try to imagine the future right now, because your world is just a clutter of too much info and not enough time– and that taints your imagination, painting the future with a black paintbrush of late nights and no social life.

But I, a full-fledged doctor, can sit here in my present (which is also your future) and call back through the years to tell you IT GETS BETTER.

Some things get better by 2nd year, some things by 4th year, some by graduation, some after intern year of residency, some after residency… it really does get better.

There will be “worse” moments coming at you too, but if you can get past your MS1 year with your integrity and tenacity intact, you will conquer those future frustrating times too.

And in enough time, you too will look back on your Medical Journey and mainly see the Better instead of the Worse.

Good luck, my future colleague.

(For more words of hope on a variety of topics related to med school and beyond, check out my “encouraging posts for discouraged med students” tag #lasix for the soul.)

Cranquis Mail x3: Changing your mind about pursuing med school

Three different readers (names withheld) asked similar questions about having a change of heart regarding their aspirations for med school. Their questions each have unique situations, and are laid out below the jump. But here’s my reply for all 3 of them:

Friend: You do you. Becoming a physician is not inherently “better” than becoming a physical therapist, an interpreter/psychologist for the deaf, or even completely leaving the world of healthcare and doing something else! Your desire and fascination for a particular job/career is what makes THAT a better choice for YOU. A “loss of interest” must always trump a “prior fascination” with a potential life-long career that has rigorous entrance requirements. There is absolutely no reason to slog on through the hell of medical education (studying, exams, rotations, residency… and all the financial/emotional debt involved!) just because of a Aspiration Inertia lingering from your past. And you are NOT a failure (to yourself or your family) for changing your mind – Life is change! Circumstances shift, interests shifts, and your personal evolution can cause you to eventually become “a better fit” for something different then what you were pursuing before.

Good luck to all of you.

Keep reading

Behind the Medic: Zpak Alternatives

Been working on a Cranquis Mail reply about antibiotic overuse. Just had a great idea for some alternatives to the Zpak (azithromycin, an antibiotic often demanded by patients) – I need to patent these ASAP:

  • See?Pak – 6 combo tabs of azithromycin + a powerful laxative, designed to emphasize my warning that “antibiotics can have many side effects, including diarrhea.”
  • Zpak 90x – A homeopathic 90x dilution of azithromycin, for people who actually NEED an antibiotic but refuse to take anything that “isn’t natural.” (Note: dosing requires 180 tabs the first day, 90 tabs each day after, for a total of 90 days.)
  • Zpatch – Adhesive patch impregnated with topical azithromycin, to apply directly over the chest of people with viral chest colds. (“Studies proved Zpatch has equal efficacy as oral Zpak for people with your illness!”)
  • PlaZbo – Sugar pills packaged in old Zpak containers.
Cranquis Mail: Assumptions about pregnancy in female patients
silverstars87 asked (and gave permission for posting):

Dr. Cranquis, I’m respectfully responding to your reply to Easter Elephant. Why do all male MDs automatically assume a lady of child bearing age is pregnant? Most women I have talked to (including myself) find this highly disrespectful, especially if there are no other signs of pregnancy.

Let me begin by answering your question with a question: Why did you assume the anonymous Easter Elephant is a female, just because I teasingly asked about pregnancy? ;) Go back and read that post – nowhere is the Anon’s gender mentioned or hinted at, except in my teasing comment about “sensitive sense of smell can occur in pregnancy” at the end. Anyways, it’s not just male docs who assume that female of child-bearing age is pregnant until proven otherwise – ALL docs are taught to assume that, so that if anything along the course of evaluation/treatment may affect an underlying as-yet-undiagnosed pregnancy (especially an early pregnancy, where the pt herself may not have any reason to suspect being pregnant but the fetus would be so much more susceptible to radiation, drugs, etc), the doctor then will remember to check for pregnancy before proceeding. It’s all about Do No Harm – not only to the female patient you can see, but for the somewhat-hypothetical unborn “patient” that you cannot see. So tl;dr: we assume because we care – care about not harming anyone (including ourselves, with the inevitable lawsuit if we didn’t consider pregnancy and then the fetus has a bad outcome) – not because we give a flying fetus one way or the other about your choices re: sexual activity, contraception, child-bearing, etc etc etc. silverstars87 followed up with:

When inquiring about pregnancy, do it tactfully, non-judgmentally and without teasing. A good provider-patient relationship is important, and being a jerk when inquiring about pregnancy is a surefire way for your patient to lose trust and confidence in you as a provider. I’m sure you were joking but an acutely ill or distressed person is not going to take it that way. Some providers may not even realize the tone or words they are using sound judgmental or condescending. It certainly is an important discussion to have as I will be an APRN soon and understand the importance of the question, but it’s all about how the provider goes about asking.

I TOTALLY AGREE WITH THIS. Words and “innocent” questions can hurt if delivered in the wrong way or timing. Thank you, my future colleague, for reminding all of us current/future healthcare providers about this important issue – and for doing so in such a tactful and way-more-mature-than-usually-encountered-online way. :)

Cranquis Mail: Why vaccinate, when you can medicate? ;)

@simonbitdiddle submitted:

Has there been any statistical research between anti-vaxxers and parents who insist on antibiotics for their children?

HA! I see what you did there!

I don’t know of any studies in this topic – but I gotta admit, it makes my dark twisted heart quiver with sardonic glee to imagine research demonstrating a high statistical overlap between the groups of “parents who refuse to vaccinate their children against dangerous-but-preventable illnesses” and “parents who demand antibiotics to treat symptoms of a viral illness that will go away on its own”…

PS: Don’t bother sending me hate mail about vaccines – I’ll just refer you to my colleague aspiringdoctors for a second opinion.

Cranquis Mail: "Patient doesn't like being touched, Doctor needs to do a physical exam"

I don’t think this is medical advice, so I’m asking it here. It’s more about how to best communicate with doctors. I have autism and I’m tactile defensive (don’t like to be touched). I understand that touch is an important part of a doctor’s exam, but I can’t help flinching when touched. There are things doctors could do to help, like announcing what they’re going to do before they do it. But, when I tell this to doctors, they don’t understand. They think I’m worried about germs. Sometimes they start asking me questions about a history of abuse. Very few of them seem to know the term “tactile defensive”. How can I explain this so doctors understand? – name withheld by request

Hi there, and thanks for your terrific question (and for giving me permission to publish it on here!).

So, for starters, I gotta be honest – I had never heard of the term “tactile defensive” before you educated me about it just now. I probably could have figured out what it referred to, but I would have been guessing. Certainly, if a patient (or more likely, a nurse who had just talked to a patient I was about to see) informed me that the patient was “tactile defensive” or “wants to avoid physical contact if possible”, I would initially wonder if the this was a clue to an underlying phobia or abuse history, or perhaps related to the patient’s cultural background – but if the patient explicitly stated that it was “associated to my autism”, then at least for *this* doctor, that would be sufficient explanation. Here’s the tricky thing about doctors, though – we often deal with patients who have a “hidden” or underlying reason for a particular behavior, and we have been trained to be curious people. So, if a doctor were to ask you a few “nosy” questions about possible germ-phobia or a history of abuse, I think it would be more of a sign that the doctor was trying to understand you + trying to avoid “overlooking” some diagnostic significance to your dislike of physical contact. Please don’t take that as a demeaning insult or attack or accusation of dishonesty. The average primary care physician is more likely to encounter someone with an anxiety disorder or a history of abuse than someone with autistic tactile defensiveness. You have a relatively “unique” finding, and doctors always like to poke at unique findings a bit before moving on. But, here’s the thing about tricky doctors – if the doctor can’t abide by your request to be warned before being touched during the exam, scoffs at it, or makes a game out of it and intentionally DOESN’T warn you “just to see what will happen”, then all the power is in YOUR court. You now have the right to (a) firmly (but calmly) state, “I already asked you to not do that” or “Could you please talk me through as you do the exam?” – or (b) you could ask for a nurse to be present during the exam, which is usually enough to remind a doctor of the importance of working within the patient’s special needs, rather than being a obstinate pighead trolling for giggles. And if those nice reminders don’t work, well – I’m not trying to stir up trouble for all the good doctors out there, but technically, “laying hands on a patient when the patient has stated that he/she doesn’t want to be touched” fits the legal definition of “battery” or “physical assault” and can be grounds for a lawsuit. Usually, the patient’s implied consent for a routine physical exam is assumed when the patient presents to a doctor’s office, and usually the doctor would only ask for specific permission before doing an “intimate” exam (such as a pelvic or rectal exam) or a procedure. But a doctor who has been requested to “go ahead with the normal physical exam, but please inform me before you actually touch me, due to my medical/psychological condition” should hopefully be extra careful about following that request – especially in the presence of a witnessing nurse or family member. I hope that helps somehow. Feel free to let me know about your future medical experiences with this issue! And perhaps other readers with similar conditions will add their own advice in the comments.
Cranquis Mail: How to NOT be (too) emotionally attached to your patients
(name withheld) asked…

Hello I’m a medical student and I just want to ask how do you not get so emotionally attached to your patients?

Hi there! Sorry it took me so long to reply to your question. It’s a fascinating question, very unique – I’ve been asked before: “How do you HOLD ON TO empathy for your patients” – but never “How do you tone down your emotional sensitivity around patients?”!

But your question is important. It’s important for a doctor (or other healthcare provider) to be able to disengage emotionally from their patients, when necessary, for the sake of properly evaluating and addressing their medical condition. Patients need a doctor who can step back from all the emotional/social/cultural/spiritual factors of a particular medical situation and SOLVE THE PROBLEM at hand, without getting so mired into the emotions that they become useless as a trained-and-paid clinician. The short/sardonic/kinda-true answer to your question is: Go to med school and residency – for most people, that in and of itself is enough to shrivel up your empathy glands (located just under the xiphoid process, I believe? Ha!) and leave you permanently handicapped at detecting your patient’s emotional state and replying accordingly.

But I think the better answer is (as I mentioned in that prior post about empathy): Learn to put the patient’s emotions (and your own, as well) into proper perspective and priority. This takes much practice, but the goal is to (1) detect the emotions involved in the medical situation (patient’s frustration, your fatigue, family member’s apathy, etc), and then (2) prioritize them into “important” and “not important”. The “important” emotions get acknowledged right up front (in a visible and verbal way, if they are emotions of the patient/family/etc; internally and without disrupting the encounter, if they are your own personal emotions), and then set aside to focus on the medical issues. The “not important” emotions are ignored, or can be discussed later (if they happen to become more important/relevant to managing the situation). By acknowledging the emotions, you keep your humanity intact – but by then putting them into the metaphorical “back seat”, you exercise your inner strength and medical training to move past the emotions in a way which will ultimately benefit the patient/family/etc. I hope this answers your question – thanks for asking it!
Cranquis Mail: Childbirth in America, Y U So Expensive?

(name withheld) asked:

Okay, so I have a question. I saw a post earlier that was asking about how you essentially have to pay money to push a child from your body in America. Do other countries not pay money or something for this ? Or is it just not as obscenely expensive?

This article really gives a terrific overview of the situation, but in short: YES, America is the most expensive place to give birth in a hospital (vaginal or C-section). Sadly, America also has the highest rate of complications around childbirth, which seems counter-intuitive. The article examines that issue too.

Cranquis Mail: "Is hope a bad thing?"

thebeautyofmedicine asked:

Hi there! I’m just going to be ask it straight - is it a bad thing to be hopeful and somewhat confident that I will be accepted to medical school? The backstory is my first two years of undergrad were spent in anxiety ridden stress. It’s the summer before my junior year and I have this immense motivation and a much more detailed set of dreams for my career in medicine. In doing this, I’ve found I’m not questioning my capabilities in studying for the MCAT, or managing my applications, obtaining LORs, applying for the hpsp scholarship…I’m not forgetting about these things, but I’m just….more confident. It’s new for me. But I am a curious if placing my heart on my dreams is a something I should refrain from doing until I have a physical acceptance letter, a final GPA, and an MCAT score. Any thoughts?! Thanks for being awesome!

(Thanks for giving me permission to publicly post your Fan Mail question and my reply.)

Hey hey woah woah woah – are you really asking me for permission to feel optimism? To feel a measure of self-confidence? To feel a relieving sense of goal-driven motivation, especially after your former years of anxiety and stress and hopelessness? Dude. DUDE – listen to yourself! You are, right now, living the dream of any student! You know what you want to do. You feel qualified to pursue it and jump the hurdles that stand in your way. You feel the internal desire to push back against the stress that has previously knocked you down! You have a realistic awareness that the road ahead has many hazards, many obstacles, and surpassing those obstacles is only partially in your control –but you also now realize that YOU DO HAVE SOME CONTROL OVER YOUR FUTURE. And that is most definitely NOT something you should fear!

Keep reading

Cranquis Mails: Happy Updates

Cranquistador #1 wrote:

Hello Dr Cranquis!

Quite a while back I messaged you about some personal problems, that I felt like I wasn’t strong enough to be a med applicant because I was struggling with the death of a loved one and other things. You were so supportive and lovely to me, I felt like I was ready to face what I aspire to do again. I am ecstatic to inform you not only did I have an interview with one of the top medical schools in the UK but have received an offer to study there!
I’m so grateful for all the kind words you have given me to help me pursue my dream again - it’s now a case of knuckling down to get the grades required.
Thank you so much, God bless!

Cranquistador #2 wrote:

Hi Dr. Cranquis! I wrote you maybe 4 years ago as (redacted). I wanted to thank you for your kind words of encouragement! I had no other difficulties thru med school. Did well on my steps, did well in clerkships, got a ton of interviews, and ultimately am going into FM, matched into my #2 spot! I really appreciated your empathy and reached out to my underclassmen who were in similar position. Btw, I’m still following!

These kinds of updates really truly make me feel so proud of you folks: the fighters, the persevering ones, the tenacious, the battered but not beaten. I’m honored to have witnessed your struggles and eventual successes, and humbled when you allow me to provide the tiniest of encouraging nudges along your Medical Journeys!

Cranquis Mail: So you want to start a Medblr...

simplyyinspired asked:

What advice would you give to somebody who wants to start a medblr?

Some of the other Medblrs replied to your question already, and they had good advice. My own advice to a Budding Pre-Medblr would be

  1. Decide early on whether or not your blog will include HIPAA-compliant patient stories that you have witnessed first-hand. If so, consider strongly the benefits and costs of hiding your identity to better protect the patient (and yourself). I’ve written a whole post on my own process of obscuring my real identity here.
  2. Don’t worry about copying anybody else’s style or tone or voice. Write what you know and see, and let your personality shine through – that’s what attracts me to so many of the Medblr blogs!
  3. Don’t make up stories or plagiarize in order to make your blog/self seem cooler than you already are. That kind of stuff sticks out and people will notice you… for the wrong reasons. (Trust me, I’ve seen this happen a couple times on my years on Tumblr)
  4. Once your Medblr blog is up and running, feel free to message me about it and I’ll be glad to check it out (and possibly name-check it on my own blog if it meets my nebulous “#Cranquis Recommends” Criteria). FYI, I tend to only follow blogs that primarily feature original posts.

Good luck with your new adventure, and welcome! There’s always room for more at the Medblr Table here in the far corner of the Tumblr cafeteria…