aint-no-me-if-there-aint-no-youu

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some of you guys need to see this

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what annoys me about explaining evolution to people who don’t think it’s real is that everyone’s idea of how it works seems to be from this

Whereas the reality is far more like

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Sympathising with my mother but at the same time

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283,000 likes………giant meteor strike the earth rn holy shit. oh my god.

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Theyre called draculas because they drank u. La

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if you ask me, the guy who put the sword INTO the stone should be king, not the chucklefuck who got it out.

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“So how are the bodies prepared?”

(DM)“well for the funerary pyres they’re drained of most liquids, which are then replaced with waxes and oils for it to burn better, then pushed on the river.”

“Sounds like it stinks.”

(DM)“Not really, no, it’s fine if the bodies are fresh.”

(out of character) “wow DM sounds like you know a lot about this.”

(also OOC) “Yeah have you done this before??”

(DM) “Yeah I do bathtub embalming in my spare time”

[aint-no-me-if-there-aint-no-youu]

idk if i told the full story on here but i signed up for a research study where they were testing a new opioid, and it was supposed to be up to 5 injections increasing the dose to see what people could tolerate

i got the first dose and almost immediately fainted. they had to call in a whole medical team and it was a huge fucking deal

i was kicked out of the study and got a phone call later where they were supposed to tell me what the drug was, so i could avoid it in the future. they told me it was saline water. a placebo. i fainted from the placebo effect.

anyway, it's been a few months and i just got an email from the same department asking me to be a research participant in a new study: testing the effects of open-label placebo.

open label placebo is when the subjects and the researchers all know it's a placebo. they're testing the power of my mind. my power to imagine anything.

i like to think that they chose me for this specifically based on their past experience with me. "get the guy who fainted like a little bitch boy from saline water." anyway i just submitted all my info and i'm looking forward to getting started.

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I had a patient come in the other day because she wanted her IUD replaced. It was at the end of it's life and she loved having her IUD, this was her second one. My MA let me know that the patient was very anxious about getting the IUD replaced, she'd had painful experiences in the past with her other replacements and was dreading this visit for that reason.

I spoke with the patient and she was literally shaking with anxiety. I asked her to describe her prior experiences as well as what she liked about her IUD and what she didn't like. She said that she wished she didn't have to get it replaced so often, so I recommended we place a Mirena instead of just inserting a new Kyleena IUD. She was nervous about this because she didn't want an IUD that was big. I explained that the Mirena and Kyleena are essentially the same size but the Mirena lasts 3 years longer and would likely bridge her to menopause given her age whereas with the Kyleena she'd probably need another replacement to get there. She was okay with trying the Mirena.

I then talked to her about pain control during the procedure as this was what she was most worried about. I asked about her prior experiences and then laid out what I wanted to do to try and improve her experience during this procedure. I told her I planned to give her prescription strength ibuprofen, a heating pad, and a very dense anesthetic block in her cervix to hopefully make it a better experience. If she had had someone to drive her home I would've also given her an ativan because we have studies that show patients who report higher rates of anxiety surrounding a procedure also report higher rates of pain associated with it.

She was down for this plan. I gave her a very dense block, she only felt three small injections and then nothing else. She was shocked when I told her that her old IUD was out and the new one was in. She didn't believe me when I told her it was over.

I don't tell this story because I wanna brag about how amazing of a doctor I am because I'm not. I tell this story because this is the way IUD insertions SHOULD go and I want people to know that IUD insertions do not need to be traumatic. And I want other providers who may insert IUDs to know that a paracervical block should be your standard when it comes to IUD insertions.

When people find out I'm an OBGYN, complete strangers, acquaintances, etc. , the two things they like to tell me immediately are their horrible birth trauma story and their terrible IUD insertion story and I'm trying to at least make the latter one a little less common.

If you place IUDs and aren't doing a cervical block, you need to start. This should be the standard but over 90% of OBGYNs in the US aren't doing them and it's unacceptable. We are traumatizing people and it's entirely avoidable. We are scaring people away from one of the most effective and long lasting forms of birth control in a time when people are losing their ability to end unwanted pregnancies all for no justifiable reason.

"It takes too long:" No it doesn't, that visit took me 20 minutes with a highly anxious patient from start to finish.

"It's not worth it for such a short/small procedure." It's worth it for the patient.

"It's too expensive." You can do a paracervical block with just normal saline. You don't even need lidocaine if you use a generous amount of volume. And if you place Nexplanons I know you stock lidocaine in your office, stop being fucking cheap at the expense of women's pain.

"Patient's don't need it, they'll get over it." I'm telling you they do need it and they aren't getting over it as evidenced by literally everyone wanting to tell me about their terrible IUD insertion experience as soon as they find out I'm an OBGYN.

We should do better. The cervix has nerve endings, stop acting like it doesn't.

Make cervical blocks your standard of care, there's no excuse not to.

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an under-appreciated view.

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I am a grown ass adult and I still get nausea when I feel like I'm in trouble. They're gonna send me to the principals office and take away my toys for a week. Can you just fucking kill me instead of making me stew in my fucking anxiety

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i forgot to post this but which one of you lame ass nerds works at my dentists old office

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Arches National Park, Utah photo: Elliot McGucken