Htn urgency icd

42 M Area of concern? The organ formerly known as my appendix
I had my appendix removed two months ago, and the pathology report was just uploaded into mychart. I tried to look up what this all meant, but it was very much beyond my understanding. Can someone translate this into layman's terms? When I saw "periappendicitis" and the first thing Dr Google shows is "difficult diagnosis and high morbidity" it makes me wonder why there wasn't more urgency at the ED to get me with a surgeon.

FINAL DIAGNOSIS:
Appendix: Acute appendicitis and periappendicitis.
CLINICAL INFORMATION: Appendicitis. ICD code(s): K35.80.
GROSS DESCRIPTION:
A: Specimen: Received in formalin labeled with patient's name and "A. Appendix" Size & Integrity: Intact and 10.5 cm long by 1.2 cm in diameter
Appearance: Serosa = pink-tan, dull with mild scattered adhesions; lumen-diffusely dilated, up to 1.0 cm; wall-pink-tan, 0.1-0.2 cm and unremarkable
Perforation: Absent
Additional findings: None
Summary of sections: A1. Representative sections with inked margin en face and bisected tip.(rla VR)
MICROSCOPIC DESCRIPTION: Sections examined.

It's not my text,this one is from my doctor-
Burning in the urethra for 2 years, there is a constant desire to urinate, treated with doxycycline - without effect. Cystoscopy in the anamnesis - trigonitis. LPL denies. Consumes little water per day, but a lot of herbal teas. She also notes that the condition improved in the spring and summer. Consulted Dr. urologist on an outpatient basis, recommended cystoscopy, biopsies. Mirabegron was also prescribed - without effect. Urine cultures are sterile. Denies other diseases, medicinal allergies.
The tests were performed on an outpatient basis - within normal limits, there are no contraindications for surgical treatment. Urine culture: No bacteria. Histological examination answer: diagnosis: reactive urothelial hyperplasia. The fragments are covered with thickened urothelium without showing atypia, there are no mitoses. In the post-epithelial layer, fibrosis and slight infiltration by lymphocytes. ICD: N30.9
THEY DIDNT FOUND ANYTHING,AND NOT SUGGESTING ME ANYTHING TO IM 18 YEARS OLD FEMALE WITH EVERYDAY REALLY BAD URGENCY AND BURNING TO PEE,NEVER HAD PAIN ONLY URGENCY FOR 2 YEARS AND TERIGONITIS DIAGNOSE,I FEEL WORSE THAN BEFORE PLS HELP...
ALSO IF YOU ARE INTERESTED MY URINE CULTURE TEST ANSWER-
Automated urine test, 2023.10.24 Glucose in urine: Not found, mmol/l 0 - 0 Bilirubin in urine: Not found, mmol/l 0 - 0 Ketone in urine: Not found, mmol/l 0 - 0 Ratio volume: 1.027, 1.010 - 1.030 Urine pH: 5.5, 4 - 8 White urine: Not found, g/l < 0.10 Urob. urine: 16, mmol/l 0 - 17 Nitr. in urine: Not found, 0 - 0 Erythr.in urine: Not found, erythr./mkl 0 - 0 Leukoc.in urine: Not found, leuk./mkl 0 - 0 Urine color: Yellow, YELLOW (Yellow) Urine clarity: Clear, Clear Urine sediment microscopy (pathology), 2023.10.24 Flat epit. from: 0, points 0 - 3 Transitional epit.: 0, points 0 - 2 Renal canal: 0, r.l. 0 - 0 Leukocyte sediment: 3-4-5, r.l. 0 - 5 Erit. (unchanged): 0, r.l. 0 - 2 Erit.(changed): 0, r.l. 0 - 0 Erit.(akantoci): 0, r.l. 0 - 0 Hyal.cil.: 0, r.l. 0 - 2 Bacter. dep.: 0, points 0 - 0 Mucus sediment.: 3, points 0 - 0 Grain cil.: 0, r.l. 0 - 0 Waxk.cil.: 0, r.l. 0 - 0 Fat cyl.: 0, r.l. 0 - 0 Leukoc.cil.: 0, r.l. 0 - 0 Erythroc.cil.: 0, r.l. 0 - 0 Bacter.cil.: 0, r.l. 0 - 0 Other cyl.: 0, r.l. 0 - 0 Yeast fungi: Not found, Not found Oval fat body: Not found, Not found Spermatosis: Not found, Not found Macrophages: 0, r.l. 0 - 0 Crystals from: Oxalates-2, points 0 - 3 Atypical. cells: Not found, Not found Determination of glucose concentration in serum (plasma).

It's not my text,this one is from my doctor-
Burning in the urethra for 2 years, there is a constant desire to urinate, treated with doxycycline - without effect. Cystoscopy in the anamnesis - trigonitis. LPL denies. Consumes little water per day, but a lot of herbal teas. She also notes that the condition improved in the spring and summer. Consulted Dr. urologist on an outpatient basis, recommended cystoscopy, biopsies. Mirabegron was also prescribed - without effect. Urine cultures are sterile. Denies other diseases, medicinal allergies.
The tests were performed on an outpatient basis - within normal limits, there are no contraindications for surgical treatment. Urine culture: No bacteria. Histological examination answer: diagnosis: reactive urothelial hyperplasia. The fragments are covered with thickened urothelium without showing atypia, there are no mitoses. In the post-epithelial layer, fibrosis and slight infiltration by lymphocytes. ICD: N30.9 THEY DIDNT FOUND ANYTHING,AND NOT SUGGESTING ME ANYTHING TO IM 18 YEARS OLD FEMALE WITH EVERYDAY REALLY BAD URGENCY AND BURNING TO PEE,NEVER HAD PAIN ONLY URGENCY FOR 2 YEARS AND TERIGONITIS DIAGNOSE,I FEEL WORSE THAN BEFORE PLS HELP...
ALSO IF YOU ARE INTERESTED MY URINE CULTURE TEST ANSWER-
Automated urine test, 2023.10.24 Glucose in urine: Not found, mmol/l 0 - 0 Bilirubin in urine: Not found, mmol/l 0 - 0 Ketone in urine: Not found, mmol/l 0 - 0 Ratio volume: 1.027, 1.010 - 1.030 Urine pH: 5.5, 4 - 8 White urine: Not found, g/l < 0.10 Urob. urine: 16, mmol/l 0 - 17 Nitr. in urine: Not found, 0 - 0 Erythr.in urine: Not found, erythr./mkl 0 - 0 Leukoc.in urine: Not found, leuk./mkl 0 - 0 Urine color: Yellow, YELLOW (Yellow) Urine clarity: Clear, Clear Urine sediment microscopy (pathology), 2023.10.24 Flat epit. from: 0, points 0 - 3 Transitional epit.: 0, points 0 - 2 Renal canal: 0, r.l. 0 - 0 Leukocyte sediment: 3-4-5, r.l. 0 - 5 Erit. (unchanged): 0, r.l. 0 - 2 Erit.(changed): 0, r.l. 0 - 0 Erit.(akantoci): 0, r.l. 0 - 0 Hyal.cil.: 0, r.l. 0 - 2 Bacter. dep.: 0, points 0 - 0 Mucus sediment.: 3, points 0 - 0 Grain cil.: 0, r.l. 0 - 0 Waxk.cil.: 0, r.l. 0 - 0 Fat cyl.: 0, r.l. 0 - 0 Leukoc.cil.: 0, r.l. 0 - 0 Erythroc.cil.: 0, r.l. 0 - 0 Bacter.cil.: 0, r.l. 0 - 0 Other cyl.: 0, r.l. 0 - 0 Yeast fungi: Not found, Not found Oval fat body: Not found, Not found Spermatosis: Not found, Not found Macrophages: 0, r.l. 0 - 0 Crystals from: Oxalates-2, points 0 - 3 Atypical. cells: Not found, Not found Determination of glucose concentration in serum (plasma).

Hey good people! PGY-2 FM
Had a patient having some unilateral blurry vision, did a Snellen and he was about 20/40 on affected eye, neuro exam otherwise normal. Placed order for screening fundus photography, significant for bilateral proliferative diabetic retinopathy and bilateral macular edema. Report did not comment on degree of severity.
DM2 and HTN are now well-controlled from LOV 3 months ago. Placed stat referral for ophtho.
​
I feel strongly about not sending patients to ED for things that should be managed outpatient, but I'm not familiar with ophthalmologic urgencies vs emergencies, just wondering if should call pt to proceed to emergency room. Or when it would be reasonable to (say, he can't get appointment for months).
Any advice on this and general advice on true ophthalmologic emergencies vs urgencies would be greatly appreciated!

Hello. Question regarding my wife’s recent condition
32 y/o female, type 1 DM that’s well managed, recent diagnosis of hypertension, taking losartan 100mg daily and fairly controlled now 3 weeks ago had an endometrial ablation with no complications
1 week ago had urinary urgency, was given Rx for Bactrim
4 days ago began having severe LLQ pain and dark urine. Went to local clinic and urine was cola colored. That was so concerning we went to ER, we were concerned to hx of DM and HTN there could have been some kind of kidney injury
Thankfully in ER her creatinine was fine (0.89). UA showed 105 wbc, +1 Leuko, no nitrite, 2000+ rbc, and negative culture.
CT scan also negative, no stone, no hydronephrosis, no acute abnormality
Urine cleared up with fluid and placed on keflex for mild uti
Still today having LLQ pain now like radiating into suprapubic area and occasionally to L flank, straw to amber colored urine
We plan on calling a urologist for appointment tomorrow
Any ideas? the symptoms sound like a kidney stone or UTI with hematuria. But seeking ideas making sure I’m not missing anything major or obvious or common
Thanks in advance

Just wondering how many 911 services have a hypertensive Crisis/Urgency protocol. I get a lot of new hires who are surprised to see that we do indeed have a protocol for HTN. If so what’s your criteria to treat and what meds do you give?

Posting here kind of in desperation as I live in the US but my mom lives in Sri Lanka and I am trying to figure out if I should bring her here for possible repeat MV surgery. It's a difficult decision because due to my mom's language and health literacy barriers (we're from low-income background), there are gaps in info re: her health. Would love to hear what you think as I try to piece it together and come up with next steps. I'm in healthcare so will use some medical abbreviations for ease.
She's a 63yo F, weight 120 lbs, 4'0" with possible asthma dx (more on that below) and hx of MR. No smoking, drinking, or drug use. 10y ago she was dxed in the US with MR 2/2 rheumatic valve disease, during an ER trip for SOB. She also may have asthma, unclear because never received formal dx but her SOB is alleviated at least in part by Advair. Anyways, 10y ago she had MV repair via annuloplasty, then 3y later she moved back to Sri Lanka and has seen a cardiologist q6mo there. Cards there has said each time that she's going between MR grade 2 and 3, but never pushed for surgery; instead they put her on ASA 81mg, atorva, lasix, and spironolactone which to me suggests that perhaps she has CHF, but she never got a formal dx. No s/s CHF except DOE, reportedly improved with the Advair. EKG in Jan this year was NSR, and echo mentioned LA and mild RA dilation, mild pHTN, normal LV fx with EF in the 70s%.
However, she went in a week ago and was found to be in afib with HR to 130-140s, and hypotensive 70s/50s but somehow she tells me she's asymptomatic (baseline BP is 90-100s/60-70s). Echo shows MR grade 2, mild pHTN, and I believe shows an EF of 69% and LV EDD of 38mm. Cards put her on xarelto, digoxin, and amiodarone.
My question is, I wonder how urgent it is for her to be considered for surgery now that she's progressed to being dxed with afib. From the literature I'm reading, looks like postoperative outcomes and M&M is much better if surgery is not delayed until the pt becomes symptomatic or develops LV dysfunction. Mom would ideally like to stay in Sri Lanka for another 6 months and forego surgery until then, but I'm not sure if delaying surgery that's too big of a risk in her case. Do you have any thoughts on the urgency of surgical eval for her if our goal is to assure a longer (she always says it'd be great to live until 75yo), more high-quality of life for the remainder of her life?
It's hard because she's not here in the US to get a consult from a US cardiologist, so any input you have is greatly appreciated. TIA!

I applied for a job and was asked to take a coding skills assessment. One of the questions listed diagnoses and a set of ICD-10-CM codes and asked if the codes were correct.
Diagnoses

• CAD with prior MI Atherosclerotic heart disease of native coronary artery with angina pectoris. Currently stable.
• History of DVT, stable
• HTN
• CKD

Codes: I25.119, I25.2, Z86.718, I12.9, N18.9
I selected "No" because I thought a code from I13 (specifically I13.1) should be used due to the CAD instead of a code from I12. However, the correct answer was "Yes" indicating the listed codes were correct.
Can anyone shed some light on this for me? Thanks in advance!

I (23F) have had numerous bladder issues since July 2022. I went to a walk-in clinic first because I thought it was a UTI, but they did a urine test and said it came back negative. I went back two weeks later because I still felt like I had a UTI, but alas, it was negative again. They referred me to a Urologist, who I've been seeing since August 2022.
I told the Urologist my symptoms. I constantly feel like I have to pee, even if I just went. I'll sit down and push and it stings, almost like my bladder is full but there's nothing inside. They had me pee in a cup for a urinalysis, and then did a sonogram after. It showed that my bladder was completely empty even though it still felt like I had the urgency to go.
They said it must just be Overactive Bladder, and started me on Oxybutynin 5mg which didn't do much, so they put me on 10mg a few weeks later. The 10mg was sorta helping, but I still felt that urgency to go even though my bladder was empty - just not as bad. The doctor put me on the Oxybutynin for 6 months until my next follow up. I'd say at month 4.5, I started really feeling the pain again, but I had a busy schedule and figured I could just wait until my appointment.
My appointment was on March 21st, and I told them I was having pain and urgency again. They ran another useless sonogram and urinalysis, and put me on 15mg of Oxybutynin.
After a week, the 15mg was helping a bit (again, not making the pain entirely disappear, just relieving it a little) but I felt myself getting extremely tired throughout the day where I almost thought I was going to fall asleep while in public or class or work, and had extreme mind fog. I called the doctor and he said to just go back on 10mg until I met back with him on April 21st, and then we'd go from there.
On April 21st, he decided to take me off of the Oxybutynin and put me on Myrbetriq 25mg, and also to get an ultrasound done of my kidneys and bladder since they spotted microscopic hematuria - blood in my urine.
I got my ultrasound done this past Tuesday (April 25th), and the next day I got results back that said:
Adjacent to the right bladder base, a 1.9 x 1.7 x 1.1cm nodular echogenic focus is demonstrated, demonstrating a twinkle artifact.
The same day I got my results (Wed., April 26th), I spent the entire day crying my eyes out from how much pain I was in. I kept feeling like I desperately needed to pee, even though every time I'd go sit on the toilet, it would sting really bad like I was going to pee, but there was nothing coming out. I kept running to the bathroom and sitting in there for 10 minutes pushing and pushing for some relief, but I had no urine in my bladder and I just kept crying from the pain. I figured it was because I came off of the Oxybutynin and was waiting for the Myrbetriq to kick in the next few days.
I called the Urologist office and told them I was in so much pain and couldn't wait until next week to see the doctor, and asked if there was something OTC that I could take to relieve this pain, but they told me to come in first thing tomorrow.
I went in on Thursday (4/27) and he told me that he looked over the ultrasound and it looked like it could possibly be a stone, but he thinks it might be a lesion. He seemed really uneasy when he said that, but I didn't really think anything of it. He told me to get a CT scan as soon as I can, and to meet back with him right after. The CT scan script says:
CT Urogram w/wo Cont
ICD 10: Lesion of bladder (N32.9)
Prompts:
Clinical Indication: bladder lesion vs stone
Lasix: 10 mg Lasix IV push X 1 unless contraindicated (default)
He also prescribed me Solifenacin Succinate 5mg to help ease the pain in the meantime.
Yesterday (Fri., 4/28), I was at work and was in so much pain that I kept running to the bathroom to cry hysterically, pushing for some bladder relief. It was the most painful thing I've ever experienced and felt like there was something definitely wrong, so I went to the Emergency Room. They ran urine and blood tests, and told me to drink the large bottle of contrast (so gross!) so they could run at CT scan. Then one of the PA Urologists came by to talk to me and said I looked really comfortable (implying that I wasn't in any pain) and I guess told them that I should just wait until Tuesday for my scheduled CT scan and to just go home.
They said they did find a UTI which might be the reason why I've been in so much pain the past few days, and gave me antibiotics and probiotics to help me fight that the next few days.
Overall...

1. I clearly have something growing in my bladder, which is making me worried. If it was a stone, it would've been blocking my urine from leaving the bladder, and it also would've passed last summer.
2. The urinalysis from yesterday shows that my WBC is >50, RBC is 10-20, and protein seems a little high (100mg). Is this normal for a UTI, or should I be worried?
3. The UTI is recent since they're always doing urinalysis, so that can't be the reason for me going to the Urologist the past several months.
4. I've been doing research (of course the worst thing to do when you have medical issues) and they said that a large majority (like 95%) of lesions in the bladder are malignant.
5. I know that most people with bladder cancer are 55+ men who are heavy smokers, and that I'm very unlikely to get it, yet all of the symptoms are pointing towards it.
6. I don't know much medical information, so I'm doing my best to research but the internet is sooooo dramatic sometimes.

I know I won't have any clear answers until I get my CT scan done on Tuesday and get the results the day after, but I'm just really worried and don't know what to expect from here.
​
General Info:
Female, 23
5'7" - 173lbs
Ongoing for 9 months, but been treated
Current medications as of today:
Myrbetriq 25mg
Solifenacin Succinate 5mg
Bacid with Lactospore - 1 billion cell capsule
Cefdinir 300mg

300: Get waken up in the middle of the night by a phone call. It is an after-hours call from the clinic. Patient is asking if it is ok to take 500mg of tylenol for fever. Their temperature is 98 degrees Fahrenheit.
0530: Wakeup
0545: Brush my teeth with the tears from the previous day.
05:48: Another after hours phone call from clinic. The previous patient is requesting a prescription for tylenol.
6:02: I have eaten rejected prior auth forms for breakfast. A nutritious meal.
6:11: Prepare to sit in mind numbing traffic due to having to cover 8 different residency clinics and 3 hospitals. I fucking love my fucking residency program.
6:32: Violate carpool lane. I tell myself I am the foundation of the american medical system after all. My patients need me.
7:00: Arrive at the hospital. My medical students are nowhere to be found.
7:30: Start prerounds, only 13 patients are waiting on dispo placement this morning. A good start.
746: My attending has forgotten to include 3 additional admits on our list. He requests to start rounding at 8:15. He has to get his Tesla serviced.
8:00: Seeing my final patient before rounds. They were a transfer from the internal medicine team. Someone forgot to restart Miralax. Patient is constipated.
8:10: Get a page from the ED for what is presumed a new admit. Washing machine sounds are heard over the phone. Ah, pancreatitis. An excellent learning opportunity for the med students who I am sure will show up soon.
8:25: Rush to do the new admit prior to rounds.
8:36: Get to workroom for rounds. Attending not present.
8:44: Get a page from nursing our 90 year old female with CHF, HTN, CAD, COPD, CKD, DVT, DMII is constipated for the last 8 days. Requesting order for miralax. Miralax PRN has been ordered since admission.
9:30: Rounds begin. Attending does not want to talk about sodium or aldosterone today. He has an appointment for his Tesla. Med students still nowhere to be found.
10:02 Attending realizes he forgot to plug in his Tesla. He ends rounds early. Before leaving tells the team to contact case management for 13 patients awaiting disposition.
10:03: Call case management. Voicemail on the other line. They will be at lunch from 10-3.
10:18: Page from the ED. It is an NP. She wants to admit a patient for pneumonia. Azithromycin has been started. On chart review, D-dimer is positive, patient has recent cancer treatment, and also reporting hemoptysis and tachycardia. Afebrile. Tell NP to do CTA stat. She says LOL it is not PE. I put in STAT CTA order anyways.
11:06: Work on notes. Call CM again. They are still at lunch
11:26: Receive call from a different attending at the SNF: the FM resident on SNF rotation called out sick and the attending needs me to do the admit for a new SNF patient.
11:33: Walk across the street to the SNF. Patient is a 56 yo M admitted for wound care management for cellulitis and lymphedema. Gentleman is very pleasant. The stack of paper discharge notes he came with is less pleasant.
12:08: Receive call from one of the residency clinics. Patient from the middle of the night called the office very irate and asking why the pharmacy doesn't have his tylenol order. It was determined the patient ended up going to the wrong pharmacy.
12:15: Grab free food from the cafeteria. It is tuna melt sandwich, which statistically gives a 64.8% chance of diarrhea after ingestion. Don't care, that is for future fluffbuzz to worry about.
12:26: Finish the sandwich. Need to head over to one of the residency clinics for half-day of clinic. It is 35 min to the south. Pass by the IM team in the cafeteria still doing table rounds. The IM senior is discussing hyponatremia.
12:35: Get phone call from my intern. STAT CT scan finally came back. It is PE. We start Heparin. I stop Azithromycin. An ID attending sheds a tear somewhere.
12:40: Use the carpool lane to clinic.
13:00: Arrive to clinic.
13:15: First patient scheduled for 1300 still has not showed up. Try to finish up remaining hospital notes from the morning
13:56: New patient visit. Has not seen a doctor in 15 years. I spend more time putting in EPIC orders than making eye contact with the patient.
14:22: The 1300 shows up and demands to be seen. Clinic manager and clinic attending have no backbone and tell me to see the patient. Now running behind in clinic. Patient needing FMLA forms filled
14:54: MA can't find the FMLA form the patient dropped off a few days ago. Patient screams racist slurs at me, is escorted out of the room and clinic by security. I expect her to leave me and clinic glowing reviews on google.
15:15: 1500 Telemed Zoom patient has not logged in. Finally, my first no-show. Need to count the small victories.
15:20: Receive phone call from clinic manager. The 1500 Zoom patient could not figure out zoom, demanding to be seen by telephone instead. The reason for the visit is a referral to PT for sciatica. Proceeds to talk for 25 min about her young children and their school grades.
16:51: Post hospital followup visit. Need to look through scanned hospital notes one by one on epic. Radiology read for a CXR finds a 9 cm lung mass, mentions to correlate clinically. I appreciate their recs.
17:18: Last patient seen. Luckily no patients needed to be sent to ED today for hypertensive urgency.
17:12: MA nowhere to be seen. She left for the day. I proceed to check out the patient myself.
17:15: Leave clinic. It is a 55 minute drive back. It is Southern California rush hour. Not even the carpool lane will save me this time.
18:05: Get home. Start working on clinic notes. The attending requested I finish all noted before 8pm.
18:55: 5 minutes before night shift takes over, I receive a page from nursing that our 90 year old female with CHF, HTN, CAD, COPD, CKD, DVT, DMII is coding. She is fullcode, as per daughter the patient is a fighter. I tell nursing to get CCU team, and intern is already there. Intern requests my presence there. I return to the hospital.
19:20: No traffic. Speed limits were violated. Doesn't matter. I am the backbone of the American healthcare system. Patient resuscitated before I got there. Is in ICU now. One less patient on our census. Need to count the small victories.
20:00: Return home. Skip dinner. As a resident I am less than human. I do not deserve to eat anyways.
20:01: Log into the EMR for one of my other residency clinics. 24 inbox messages are present.
21:05: Receive angry text from clinic attending asking why my clinic notes have not been finished before 8PM. Oops, completely forgot about the last few notes. I apologize profusely and offer my future firstborn as tribute. The attending deems this as satisfactory compensation for my transgression.
22:59: Finish inbox messages. 2 patients were asking about Ozempic as they saw TikTok influencers mentioning it.
23:11: Head to bed. Tomorrow is another day. I am the forefront of medicine.
23:59: Wake up, need to have diarrhea. Life is beautiful.

As an outpatient doc who hates the bloat of most SOAP notes these days with the blown in diagnoses, ICD codes, and medications. I was toying with the idea of combining subjective and assessment/plan so I can quickly keep the flow of my thinking in one place. For example:
----------------------------------------------------------
#HTN
Subjective:
- pt denies any symptoms
- Measures BP at home with x results
- Adherent to medications, blah blah blah
A/P:
"Medical decision making"
- continue x med
- bmp and Urine protein today
- counseled on blah blah
----------------------------------------------------------
Then put all objective below.
I know APSO notes are another way of writing notes but still require talking about the same problem twice which I was hoping to just keep in one spot.
Thoughts?

See my Citations and supplementary material here
The Rise of Transphobia in the U.S.A and the Effects it Brought
______________________________________________________________________________________________________First I would like to preface this by stating my biases. I support the rights of transgender people
I also feel the need to mention that I myself am a Trans woman. Meaning I support Trans rights_____________________________________________________________________________________________________
In recent years there has been a noticeable rise in anti-LGBTQIA+ legislation and hate crimes, particularly targeting educators, health care providers, trans-youth, and transwomen of color. Though harmful, this legislation and these attacks are only the surface of the deeper issues within our society. We as a people have a fear of the unknown. This fear has historically been weaponized by those seeking to gain or maintain a level of control. By demonizing people they don’t understand, politicians, religious leaders, and “activists'' are able to gain an audience and turn a group into a problem rather than a people.
I want to explore this and show the corrupting nature of these actions tracing them back to the source. In my research, I discovered many activist groups, businesses, and political organizations have disguised their close-minded views and hateful rhetoric as beliefs grounded in scientific study and the harmful actions they take as well-intentioned actions taken to defend the defenseless. They claim to be informing the public when they are both denying scientific studies and attacking the defenseless for their own personal gain. To more effectively combat this we need to understand when and who set these events into motion.
My analysis starts in 2015. The House had just passed the Mariage Equality Act, anti-LGBTQ+ groups were airing homophobic advertisements more than they ever had before, and Barack Obama's second term was about to end. This was a year of both celebration and protest. It is my belief that during this year due to homophobia becoming less socially acceptable, anti-LGBTQIA+ groups began to lean harder into opposing the right of transgender and non-binary people to live as the gender they identify as. Because of this, these groups began introducing new policies dubbed “Bathroom Bills” ' meant to restrict transgender and non-binary peoples' usage of public facilities such as restrooms and locker rooms.
These “Bathroom Bills” on the surface appear to be only a minor inconvenience but in areas where they were signed into law proved to be detrimental to the physical and mental well-being of transgender and non-binary students in the area.
These bills had a multitude of negative effects, the most prevalent of these is increased stress, anxiety, and depression due to the uncertainty of finding a restroom they are legally allowed to use and the abuse they may face when using the restroom corresponding with the sex they were assigned at birth. Another effect was an increase in UTIs due to transgender individuals “holding it” due to a lack of or inconvenient location of appropriate facilities. These claims are corroborated by an American Medical Association report which can be found here.
Another type of bill that saw an increase in recent years is the banning of trans women from women's sports. For more information on the topic see the TUE Physican Guidlines as presented by The World Anti-Doping Agency. As I am not qualified to speak on this I will only be speaking on the effects these bills had on LGBTQIA+ individuals. Banning Trans athletes from competing in sports aligned with their gender identity harms the mental health and safety of transgender athletes. For many, these bans can be dehumanizing, and isolating, also putting those who swap teams in danger. These bans can make people feel isolated because they separate friends from each other and lower the visibility of transgender athletes thus making it harder for transgender individuals to find other athletes they can relate to. These bans can also put transgender athletes who decide to stay in sports by joining a team not congruent with their gender identity in danger due to a raised risk of bullying, harassment, and assault as shown by this study from the American Psychology Association
More recently the U.S. has seen an increased push for a total ban on gender-affirming care for transgender minors. This push has been mainly made by Conservatives, Religious Organisations, and Politicians of the Republican Party. A common claim by these groups and individuals is that “Most children who think they are the opposite sex will grow out of this delusion before adulthood” stating “By mutilating children with these chemicals and surgeries you will be ruining their lives” citing this outdated and heavily contested study.
Another common claim made that focuses on gay youth is that “Most trans kids aren't trans and just suffer from confusion or internalized homophobia.” Another is that ”Kids with Autism aren’t mentally capable of making such a drastic and irreversible decision.” This claim disregards the autonomy and mental capabilities of neurodivergent people. They also tend to cite the heightened risk of suicide in trans youth. To back this up they don't normally cite any specific studies but many of the statistics they use and claims they make come from these studies.
Most studies that back their claims up are old, outdated, rescinded, or debunked. Even when the studies don’t line up with their claims they bend the truth, misinterpreted the data, and use it out of context. An example of this is one study from Sweden.
This study focused on the results of Swedish citizens post-SRS over the course of 10 years. It does show a heightened mortality rate for transgender individuals. The main problem with this study is a lack of a control group containing individuals suffering from gender dysphoria. This study also lacks vital context involving environmental factors such as transphobia, financial hardship, discrimination, and political discourse and is mainly used to attribute the increased risk of suicide directly to transitioning rather than the social stigmas around it.
When making their push to ban Gender Affirming Care for Minors they also appeal to a sense of urgency and responsibility in their arguments claiming “Gender-affirming care for minors is child abuse.” In many cases, these arguments have convinced a large enough number of people to support such bans. Since 2015, a number of states have banned gender-affirming care for transgender minors such as Alabama, Arkansas, Texas, and Florida while Arizona has enstated a ban on any gender-affirming surgery for transgender minors. Recently Michigan *among others, have begun their fight to ban Gender Affirming Care for transgender minors as well
These bans and claims are harmful and go against The World Health Organisations' recommended treatment plan for gender dysphoria. In the states where these bans have been enstated courts were able to temporarily block investigations of families supportive of their transgender child. But many living in these states still feel as though a dark cloud is looming overhead, and that it’s only a matter of time before these bans take full effect. This feeling is echoed in these quotes. As shown by multiple studies, withholding access to gender-affirming care from gender-diverse youth has a long-lasting detrimental effect on their mental and physical well-being.
These individuals see increased rates of anxiety, depression, feelings of hopelessness, fear, stress, self-harm, and attempted suicide. This can be caused by a multitude of factors. Gender-diverse youth who are denied gender-affirming care are a majority of the time forced to watch their bodies change and morph into something that ‘on a deeper level’ feels wrong while knowing these changes could have most likely been prevented. Due to these changes, they are also more likely to be bullied for physical characteristics not typical of their gender identity. They may also feel hopeless as though they may never gain access to gender-affirming care. Most of all, gender-affirming care has been proven to be an effective treatment of gender dysphoria so without gender-affirming care it is left for the most part untreated.
These consequences are primarily why I find it important to understand why and how these events take place. The rights and Lives of LGBTQIA+ Children, Teens, and Adults all over the U.S. and The World are at stake. The best way to combat hate is through knowledge and in the knowledge we find truth, I urge you if this topic interests you look into it further and speak out.
______________________________________________________________________________________________________Paper written and researched by: Stella Cox
For questions and inquiries contact me at [TheMagicFolf@aol.com](mailto:TheMagicFolf@aol.com)________________________________________________________________________________
Testimonials
Parental Testimonials on The Fear of Anti-Trans Legislation ______________________________________________________________________________________________________
“It would mean that my son would go back to hating himself every month when he began to menstruate again. The thoughts of hurting himself would return.”
(Mother of a transgender son from Illinois) Source ______________________________________________________________________________________________________
Without hormones and surgery, my teen would probably have committed suicide.
(Mother of a transgender son from Connecticut) Source ______________________________________________________________________________________________________
“My daughter tried to harm herself at an early age due to her misery of having male parts. She only got hopeful when her doctor told her she wouldn’t go through male puberty. Male puberty would kill my daughter.”
(Mother of a transgender daughter from Ohio) Source______________________________________________________________________________________________________
“If she had been younger, and been told that she couldn’t get the hormones, the medicine that would help her overcome this problem, she would have been devastated. The message would have been that she is so very wrong, disordered, hopeless that she isn’t even worth treatment. And that leads to profound mental health issues and suicide.“
(Mother of a transgender daughter from Ohio) Source______________________________________________________________________________________________________
“Even if they don’t pass, just the news cycle letting him know that people hate him, despise him, and have no larger concerns than to dispose of his very existence is a very trying experience.“
(Father of a transgender son from South Dakota) Source______________________________________________________________________________________________________
“The very existence of these laws, regardless that they are in other states, renders my child less safe. They encourage and legitimize hate. The idea that the government can raise children better than the parents is absurd. “
(Mother of a transgender daughter from New Jersey) Source
Testimonials From Gender-Diverse People on The Fear of Anti-Trans Legislation
______________________________________________________________________________________________________
“Kids, or just people supportive of trans youth, see the news reports and understand some of the content, and think that if this passes the restrictions will immediately go into place. They’re going to immediately close up, stop talking to counselors, etc. That’s where the harm begins — where the unhappiness begins.” “My main question to people trying to pass this bill is: How can you make decisions for trans people when you don’t even know us? We live in communities everywhere — as students, coworkers, friends, family — and deserve to be heard just like anyone else.”
(Jeremiah - age 17 from Alabama) Source
______________________________________________________________________________________________________
“The issues they’re making laws to protect against don’t exist; instead, they’re creating problems where there are none. These bills will have a really bad effect on kids like me everywhere and are just going to hurt people if passed.”
“It’s hard enough being a trans kid, not knowing if you’ll be bullied at school, but to have politicians who supposedly have the good of the people at heart do this is so upsetting.”
“Know that we’re here for you, I’m here for you — I hope everyone finds that person who will always listen to and believe in you no matter what.”
(Adam - 8th grade from Tennessee) Source
______________________________________________________________________________________________________
“I’ve met so many of my close friends by playing basketball and they’ve really become a support system for me throughout middle school.”
“To all the parents out there, my main advice is to listen to your kids. When we share something with you, it’s because we want to be seen and heard. It’s important for trans people, and
especially trans kids, to have our stories heard so that others can get to know us for who we are.”
(Daniel From Arizona)Source

I think this is same in most hospital; “75 y/o male with T2DM and HTN, coming in pelvic fx, ortho will take OR in the AM, admit to medicine.” Why? Just have medicine as consultant, he is not going to DKA nor HTN urgency; just give him home meds, if struggle managing, consult medicine. I just don’t understand why Medicine needs to admit this patient, nothing active going on from medicine stand-point.
Edit: After reading through comments, now this practice makes sense to me.

I'm a new grad working in an ER and I face this question almost daily: if patients in hypertensive urgency want to leave, should I discharge them or make them sign an AMA form?
The story usually goes like this:

• Pt with chronic uncontrolled HTN comes to ED for one reason or another. (many times the BP is incidental to their complaint; today it was a headache, so the BP is obviously more relevant here)
• BP is 240/110, but past records over many years suggest this is baseline. They live in stroke territory and don't care.
• That BP is the only reason to keep them: labs/imaging are normal, HPI/PE suggest no sign of end organ damage, etc. (in my headache case today it's very reasonable to assume the HA was HTN-related, but CT/labs were normal and he had no other complaints)
• BP meds don't make a dent in the PT and eventually the Pt wants to leave. Nothing I say changes their mind--they want to go and think I'm crazy for insisting they take more meds.

Am I safe discharging them with thorough documentation? Or do I make them sign an AMA?

I'm a newly graduated PA working in an ER and I face this question almost daily: if patients in hypertensive urgency want to leave, should I discharge them or make them sign an AMA form?
The story usually goes something like this:

• Pt with chronic uncontrolled HTN comes to ED for one reason or another. Today it was a headache.
• BP is 240/110, but all past records over many years suggest this is baseline. They live in stroke territory.
• Nothing in labs/imaging suggests a reason to keep them: head CT is negative, labs normal (other than labs related to their current UTI or whatever)
• Nothing in HPI/PE suggests a reason to keep them: no sign of end-organ damage, you'd never know their BP was through the roof.
• I give BP meds but it barely makes a dent (my headache Pt was mad at me because he thought the BP meds made it worse)
• And finally the Pt wants to go home. They're not concerned in the slightest about their BP.

Am I safe discharging them with thorough documentation? Or do I make them sign an AMA?

Hello. I bought cracktorio about a week or 2 ago and have logged 179.8 hours at the time of writing this.
I thought I'd share my design for a quickly deployable wall with you all. I'd appreciate any advice on how to improve the design. This is Mk2 and have spent an embarrassing amount of time designing it.
I put a lot of thought into making it useful in any situation. Keep in mind, I haven't actually launched a rocket yet and haven't entered the true endgame so idk if this design stands strong when things presumably get even harder.
Here's the string:
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

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2799548
*ASA classification = American Society of Anesthesiologists (ASA) physical status classification [level 1 = healthy person ~ level 6 = brain-dead, organ donor] *ASA emergency status does not appear on official ASA documentation.
“Although COVID-19 primarily affects the pulmonary system, it is also known to cause endothelial dysfunction, vascular inflammation, and sweeping changes in the coagulation cascade, all of which are thought to result in higher rates of deep vein thrombosis (DVT), pulmonary embolus (PE), and cerebrovascular accident (CVA).[4] Furthermore, regional inflammation and cytokine release have been linked with pulmonary complications, myocardial injury, and acute kidney injury (AKI).[5] Taken together, these associations present a substantial potential mortality risk for surgical patients, who experience additional inflammatory activation as a result of their operation.
[...] The primary objective of the analysis was to examine the association between the time interval from COVID-19 diagnosis to surgery and a composite outcome of DVT, PE, CVA, myocardial injury, AKI, or death within 30 days after surgery using multivariable logistic regression.
[...] We included all adult patients (aged ≥18 years) with a history of confirmed COVID-19, as documented by a positive polymerase chain reaction (PCR) test result, who were undergoing surgery at VUMC between January 1, 2020, and December 6, 2021. [...] We identified 3997 eligible patients (2223 [55.6%]; median age, 51.3 years [IQR, 35.1-64.4 years]; 667 [16.7%] African American or Black; 2990 [74.8%] White; and 340 [8.5%] other race) who underwent surgery between January 1, 2020, and December 6, 2021, with a positive SARS-CoV-2 PCR test result prior to surgery (eAppendix in Supplement 1). The median time from COVID-19 diagnosis to surgery was 98 days (IQR, 30-225 days), and 1394 patients (34.9%) underwent surgery within 7 weeks of a confirmed COVID-19 diagnosis.
[...] In our cohort, we identified 61 patients (1.5%) who developed DVT, 16 (0.4%) who met criteria for PE, 29 (0.7%) with CVA, 116 (2.9%) with myocardial injury, and 363 (9.1%) with AKI within 30 days of surgery (Table 1). In addition, 79 patients (2.0%) died within 30 days after surgery. The overall incidence of the primary composite outcome was 12.1% (n = 485).
[...] From the results of the multivariable logistic regression model, we found that increasing time from positive SARS-CoV-2 test result to surgery was associated with a decreasing rate of the primary composite outcome (adjusted OR [aOR], 0.99 [per 10 days]; P = .006). [...] Similar associations between the time from positive SARS-CoV-2 test result to surgery and primary composite outcome were detected from analyses of the individual outcomes of myocardial injury (aOR, 0.97 [per 10 days]; P = .004) (eTable 1 in Supplement 1), AKI (aOR, 0.99 [per 10 days]; P = .04) (eTable 2 in Supplement 1), and 30-day mortality (aOR, 0.96 [per 10 days]; P = .007) (eTable 3 in Supplement 1).
[...] At the time of testing, 2350 patients (58.8%) had symptomatic infections, and 1539 (38.5%) had asymptomatic infections; the remaining 108 cases (2.7%) did not have structured data on whether they were symptomatic. Consistent with the primary analysis, increasing duration of time from a positive SARS-CoV-2 test result to surgery was found to be associated with a decreasing incidence of the composite outcome (aOR, 0.98 [per 10 days]; P = .009) for the symptomatic subgroup (eTable 6 in Supplement 1). Increasing time interval from a positive SARS-CoV-2 test result to surgery showed a tendency toward decreasing risk of the composite outcome for the asymptomatic subgroup (aOR, 0.98 [per 10 days]; P = .06 (eTable 7 in Supplement 1), although this finding did not reach the threshold for statistical significance.
[...] No substantial change was observed in the estimates of association between the subgroup receiving at least 1 dose of a vaccine (1552 patients; aOR, 0.98 [per 10 days]; 95% CI, 0.97-1.00; P = .04) (eTable 8 in Supplement 1) and the unvaccinated subgroup (2445 cases; aOR, 0.98 [per 10 days]; 95% CI, 0.97-1.00; P = .02) (eTable 9 in Supplement 1).
[...] Recent publications have cited general guidelines for specific postoperative complications such as major adverse cardiac events, DVT, and bleeding.[25, 26] Most recommend delaying surgery for at least 7 weeks after COVID-19 infection. This recommendation, however, is based on very limited evidence and it remains unclear how patient vaccination status or specific COVID-19 strains may be associated with these risks.[27] Our findings provide a more granular exploration of the time-dependent association between COVID-19 infection and outcomes after surgery, estimating a 1% reduction in the risk of our composite outcome for every 10 days after diagnosis.
[...] First, because this is a retrospective study, we cannot assume causation, only association. In addition, the virus, care, and recommendations during this pandemic have been dynamic. As more treatments are available and variants in the virus become evident, an infection in 2020 is most likely different than an infection in 2022. [...] Capturing postoperative DVT and PE through ICD-10 codes had the potential for inaccuracies, based on the unreliable nature of clinicians recording data in the medical record and the large variety of ICD-10 codes for acute embolus. This limitation was mitigated by requiring both ICD-10 codes and imaging study for DVT and PE, as well as extensive manual review and validation. Our definition of CVA—patients with a neurology consultation and stroke imaging performed—did not include confirmed stroke.
[...] There were also several limitations resulting from the rapidly changing nature of care during this recent pandemic. We lacked the data to stratify patients based on partial vs full vaccination course or type of vaccine received. We were not able to investigate different strains of the virus as our hospital does not perform variant testing and we were not sufficiently powered to study temporal trends in our data set. [...] We were unable to ascertain the severity of COVID-19 infection from our data, and future studies may add value by addressing long-term implications of more severe infections. [...] We were also unable to perform a case-by-case analysis of the urgency of each surgical procedure, although we did include ASA emergency status and surgical case acuity as covariates to try to account for urgency. Finally, patients in our study population often have preoperative comorbidities that place them at higher risk for individual outcomes that were used in the composite postoperative outcomes.”

She’s 64f, 5’0”, varies between about 180-200 lbs. Former longtime smoker but quit maybe 10 years ago. No alcohol or illicit drugs. Medical history:
CAD w/ double CABG and many stents, HTN-sometimes controlled, HFpEF, COPD-not on O2, Hypothyroidism, CKD stage II, One kidney stone, Crohn’s with partial colectomy, Fibro and poly arthritis, And she’s had two bouts of AKI on CKD leading to metabolic encephalopathy
Meds that I can remember: Plavix, Atorvastatin, Lasix (which she generally refuses to take), Cymbalta, Lyrica, Oxycodone, Synthroid, Humira, Metoprolol, Ditropan, Hydroxyzine, Protonix
She had one UTI years and years ago and then another maybe five or so years back. That one presented only with confusion. Then last year she was diagnosed with Crohn’s, had emergency partial colectomy due to severe stricture and bowel bleed necessitating transfusion. A couple months later she had an ileostomy reversal. This was a year ago (almost to the day). Since then she’s had probably five or six UTIs, two requiring a PICC line, one of which she was also septic. Many times she gets urinary urgency as the only symptom, if that.
Well, she was back at the ER on 10/29 with general body aches and saying it was kind of the way she felt with the last UTI (the PICC line and sepsis one). The trip offered these urinalysis and urine culture results:
pH 5.5 Specific gravity 1.027 Color yellow Clarity turbid Leukocytes trace Nitrites negative Glucose negative Bilirubin negative Ketones negative Uribilinogrn 0.2 (range 1.0, 0.2 mg/dL Blood negative Protein 30 RBC negative WBC 6-10 (range 0-5) Squamous epithelial 31-40 (range 0-5) Bacteria negative Hyaline casts 31-40 (range none seen) WBC casts few (range none seen) Clean catch culture 75,000-100,000 klebsiella pneumoniae CRE
She had initially been told things looked okay and was discharged from the ER. Culture came back a couple days later but we got it from her electronic chart. ER never contacted her. She called her PCP and they wanted to do another urine, we assumed with culture, but so far there are only urinalysis results from 11/1:
pH 5.5 Specific gravity 1.021 Color yellow Clarity clear Leukocytes negative Nitrites negative Glucose negative Bilirubin negative Ketones negative Uribilinogrn 0.2 Blood negative Protein 30 RBC 0-2 WBC 0-5 Squamous epithelial 11-20 (range 0-5) Bacteria negative Hyaline casts 16-30 (range none seen) WBC casts rare (range none seen)
I think the UA results don’t seem all that bad, but coupled with the culture and her history, would you rx abx or am I overthinking this?
Sorry for formatting. I copied and pasted lists but it smooshed everything together.

50F, 5'6", 218lb, caucasian. Sudden onset of new sole of foot numbness, bilateral but worse on left. Feels like I'm stepping on very large rocks. Left foot is entire ball of foot. Right foot is smaller random areas. Not diabetic. Currently Covid +, no hypoxia, primarily upper respiratory symptoms with it. Tylenol, sudafed prn. Both feet normal temperature, full movement of all toes, normal color. Maybe some tingling, area feels "tight" when I try to stretch it.
PMH: HTN (diazide and lisinopril) insomia (trazodone prn) depression (zoloft 50mg) anxiety (ativan 1mg prn- rarely used, mostly manifests as insomnia for which the trazodone is effective) Currently under care for plantars wart on left ball of foot, Cantharidin applied by podiatry 2-3 weeks ago.
PSH none
never smoked, never any recreational drugs, very rare social drinking
Other pertinent: Maybe 9 months ago had some random "hot foot" episodes. Foot would sporadically feel like it was on fire, both, but I think more the right foot. Those episodes were rare and went away on own.
Any ideas? Urgency? hate to ask for an urgent appointment when I'm covid+