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Wait so is the mandate of heaven and the divine right of kings the same kind of concept, or have I massively misunderstood one or the other?

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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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Breaking: The prettiest girl you know is FORCED to wake up and go to work instead of lounging around in bed and being paid to look cute. Life's cruelties win again...

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Now a new study looking at 400,000 youths from 88 countries around the world suggests such bans are making a difference in reducing youth violence. It marks the first systematic assessment of whether an association exists between a ban on corporal punishment and the frequency in which adolescents get into fights. 

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roommates don't like my new weapon

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New flow props. I am reclaiming liturgical dance for the gays.

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a niche ship had me deleting all my filters on ao3 and just raw dogging it in there. discovered that I’m even more of a freak than I previously believed and also that sometimes you gotta give that tag you hate a try

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Listen to me if that robot you've been chatting up reveals that they used to be a human, they do NOT want to hear you start talking about "from the moment I know the weakness of the flesh" or whatever, that's a personal and important thing to reveal about their past

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The other night husband and I were watching a documentary about the yeti where they were doing DNA analysis of samples of supposed yeti fur, and every one of them came back as bears.

Anyway, the next night we watched a thing about some pig man who is supposed to live in Vermont. People said it had claws and a pig nose but walked upright like a man. Now, I happen to know that sideshows used to shave bears and present them as pig men. So every piece of evidence they gave of this monster sounds to me like a bear with mange.

So now the running joke in our house is that everything is bears. Aliens? Bears. Loch Ness monster? Bear. Every cryptozoological mystery is just a very crafty bear.

Bears. They’re everywhere. Be wary. Anyone or anything could be a bear.

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i wish i could see this picture for the first time again

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the turkey swiss on rye incident

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so luigi mangione is framed by the media as the killer, the assassin, the terrorist, etc, and the feds enforce his guilt through sensationalist bait, but a literal assassin we have video evidence of entering the houses of the people he was killing is still only a suspect

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the tiktok itself is funny but i’m deeply obsessed with this dog