u/Basic_Performer_6701

Our cardiology team orders these reflexively. I understand that much of the recommendation for SGLT2 inhibitors has been extrapolated from the earlier trials where dialysis patients were excluded from those studies.

I have not been able to find robust literature establishing a clear safety profile or meaningful clinical benefit specifically in the HD population. Same with spironolactone, I see it used frequently despite the obvious concerns regarding hyperkalemia. We had an anuric HD patient who was recently admitted for euglycemic DKA, and Jardiance was added per our cardiologists’s consult during previous admission.

Are there any cardiology pharmacists specialists who could provide better insight into how these medications are being justified and risk-stratified in HD patients?

I have to constantly babysit the entire workflow, having to ensure:
-the trough is drawn on time/appropriately
-sending reminders to order trough accurately
-dose isn’t hung before the trough/earlier than scheduled
-level is actually interpretable
-someone follows up on the result
-re-explaining for the 1000th time why re-dosing or holding is necessary
-monitoring trough with manually accessing pt profile a thousand times
-also ASP

I do recognize that it’s also a systems issue as much as an individual one. We do need effective, standardized communication and tighter protocols honestly work better. But we also need to hold the staffs (residents, nurses and phelbs) accountable as well — but alas, no repercussions made despite repeated failures in all fronts.

Rant over.

I’m obsessed with pimple extraction. After decades of performing it myself, I consider myself a back-alley dermatologist of the household. I’m grateful that I don’t get much acne myself, but my husband gets a ton of sebaceous filaments/clogged pores and I am exhilarated whenever he lets me go at them. Like I will be shaking with joy, barely can contain it.

Extracting a really good one that’s been “brewing” for weeks gives me an absurd amount of dopamine rush. I can literally sit there admiring the aftermath (the hole, the abyss). Meanwhile he’s annoyed and telling me to leave his face alone.

The pore remains so perfectly empty, so clean.. and the sensory stimulation when you roll the plug.. so satisfying! I presume this is what cleaning feels like for most people who enjoy the act.

Do you think this is ADHD related or am I just weird?

Eating lunch at work is honestly too taxing for me.

First of all, I’m come to terms about my inability to cook or prep lunch ahead of time before work, so my only option is usually ordering delivery. Most days I just skip lunch altogether for reasons I’ll get into later, but today I made the mistake of ordering through DoorDash and it was unbelievably stressful.

Having to constantly track the order while actively working, trying to time everything around an actual lunch break, making sure I didn’t miss the driver. My workflow was completely off-rhythm and I was so damn scatterbrained & that made me increasingly agitated.

After finally getting my food, I completely lost my appetite, ate anyway to be “good” so the food doesn’t go to wait, and afterwards I just felt thirsty, tired, and sluggish when that one hour is usually the only time I get to mentally decompress after my brain has been running nonstop for 4-5 hours straight since I tend to hyper-focus (the only way I know how to work). The thought of having to eat sometimes at work feels dreadful. If I’m not hungry, I’d honestly rather skip it.

But every once in a while my eating cycle gets thrown off and I suddenly get hungry at work, and then this whole disaster happens again. It’s so mentally taxing that after I got home, I ended up falling a sleep and just woke up now at 10:30 PM.

Am I the only one who feels like this? I enjoy eating but the processes involved in the end result of eating really sucks.