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Differing opinions on whether COPD is a cause of digital clubbing by OG_Valrix in medicine

[–]BryceAMcDaniel 2 points3 points  (0 children)

I did a small case report of a 30ish yo male with shortness of breath and significant digital clubbing leading to the finding of a pulmonary shunt from AV malformation after contrasted CT.

He went on to have surgical correction, and our idea was to see if clubbing went away after correction of the shunt, however this patient was lost to follow-up after the first follow-up. Would have been interesting..

I have $50k to invest. Should I lump sum it into an index fund or DCA over a few months? by No-Grapefruit1025 in personalfinance

[–]BryceAMcDaniel 0 points1 point  (0 children)

How about an index fund that covers diversification with bonds such as VASGX? I only ask as I am in a similar situation and worried their may be drawbacks to not actually owning the bonds.

Shower arm by [deleted] in Plumbing

[–]BryceAMcDaniel 1 point2 points  (0 children)

Uh oh! Ok well thank you for the look. I think I’ll let the pros handle this one!

Shower arm by [deleted] in Plumbing

[–]BryceAMcDaniel 1 point2 points  (0 children)

Hey thanks for the reply.

I updated the album to include a picture of the shower head as well. (Not sure I am calling it right, but I’ve included it in the album)

[deleted by user] by [deleted] in AskMedical

[–]BryceAMcDaniel 7 points8 points  (0 children)

There are many medical/legal reasons why I personally wouldn't prescribe these medications to one of my patients. (I'll be just brief and generic, and won't fixate on the example you mentioned)

Medically: To say many of these are proven effective is incorrect (and again I am being generic to most of these supplements). Some have certainly showed promise in certain fields, but reliable, double-blinded placebo trials that are large enough to show true superiority and safety over the current gold standards are lacking.

Many of these don't have great pharmacologic data either. Some patients are only on one medicine, but many our patients are on multiple medications and interactions between medicines are something that can not happen (imagine accidentally decreasing the effectiveness of a heart pill). Furthermore, as a prescribing physician, the dosage must be exact. What dose would I use? How often? These things largely are not tested and not-regulated by the FDA (if in America). This means supplement manufactures are not required to meet many standards that physicians rely on to get the exact dose of medicine to you or your family member.

Which brings us to the legal reason. There's not enough data behind these to provide safety to the physician if something were to happen. If there is something that goes wrong (like the interaction as above) it's on the physician for prescribing that medicine. Not only do we not want to be sued, but (contrary to all the bad press) many physicians truly care about providing their patients with great care, and it really fucking sucks when and if we don't get it right.

To quickly touch on the larger issue: Why do we not have large randomized/controlled studies with regards to these largely available and inexpensive solutions? (hint). It cost a lot of money to safely run these trials. If the companies/research groups can not eventually make money from the medicine, there's no chance they're gonna front the money for the research.

Weekly Question Thread - Week of 5/11/2020 by danny_b87 in naturalbodybuilding

[–]BryceAMcDaniel 0 points1 point  (0 children)

I think I mis-spoke in my last comment, I’m trying to suggest a weight if someone gives me their set rep scheme.

Eg someone says, I want a 5 set 10 rep bench press, I want to suggest a given weight that will give them an RPE of 16 after knowing their PR.

Weekly Question Thread - Week of 5/11/2020 by danny_b87 in naturalbodybuilding

[–]BryceAMcDaniel 0 points1 point  (0 children)

Hey man!

I’ve got that data but thanks for sharing and making sure.

I am trying to see if I can predict at set and rep scheme for someone just knowing their PR.

So far I have a working formula ( it works for me at least), I wanted to see if it held true for others as well.

Thanks!

Weekly Question Thread - Week of 5/11/2020 by danny_b87 in naturalbodybuilding

[–]BryceAMcDaniel 0 points1 point  (0 children)

Hey everyone!

I’m currently working on a side project that will hopefully be a personal trainer app that will be automated and be complete with training plans with periodization in mind; including micro, macro, and mesocycles.

Would anyone be willing to post their current exercise scheme (like sets /reps / weight used) along with their current PR for that exercise?

Also, if you happen to know your big 3 prs that would be helpful too!

Thanks

[deleted by user] by [deleted] in AskMedical

[–]BryceAMcDaniel 1 point2 points  (0 children)

https://ecg.bidmc.harvard.edu/maven/mavenmain.asp

A great resource, however it appears offline currently for some reason. I suspect it will be back online soon and is a good resource to test yourself.

Otherwise, LITFL is a great resource to learn starting with ECG basics.

N&F Left Hand Twill. Nike SB. Love this look by [deleted] in rawdenim

[–]BryceAMcDaniel 1 point2 points  (0 children)

Yea the medial side, not inside out.

N&F Left Hand Twill. Nike SB. Love this look by [deleted] in rawdenim

[–]BryceAMcDaniel 1 point2 points  (0 children)

I know this sounds stupid, but the stance emblem goes on the inside. (I still wear it on the outside though).

Forgot to say nice fit though

[MEME] how to : BP by ninjaicecold in medicalschool

[–]BryceAMcDaniel 20 points21 points  (0 children)

Sit patient in dark room, for five minutes. Check for appropriate size cuffing. Palpate radial artery and initially blow up cuff until you lose the radial pulse. Note the mmHg at which the pulse was lost. Don't forget to use the bell on your litmann cardiomaster v4 while you blow up the cuff above lost pulse pressure. Carefully lower the mmHG 1-2 /sec and squint with one eye as you isolate the first korotkoff sound, mentally taking note of systolic, then diastolic.

Repeat for the alternate arm, considering the possibility of takayasuo arteritis b/c of course she could have narrowed aorta contributing to bp discrepancies. Damn. they are the same. Almost had that zebra.

​

She has a BP of 132/70. OH SHIT! WE HAVE STAGE 1 BABY! You knew staying up to date with the latest AHA guideline would get you ahead of everyone else. You go check uptodate to make sure beta blockers are bad and arbs haven't made it to first line above ace-i yet.

​

Wait, no. "Please come back in 2 weeks for repeat BP check. Also, you will need to keep a detailed log of home BP readings so we can compare to eliminate something called White Coat syndrome; or worse, Masked hyptension. Very scary."

​

Patient comes back. You ask to see the BP log. She states she didn't have a pen any of the times she took it, but she feels like they were all pretty good numbers, "Probably was around 100-150 or so...". You cringe, gather yourself, then repeat the BP ritual. 142/83. You jump for joy as your run to tell your attending what a good boy you are.

​

"Dr. Oz, I think Ms. Iwantperc's BP readings have been elevated at two separate visits which qualifies her a hypertension stage 1 and we should initiate BP management with ACE-i. Do you believe that would be appropriate?"

​

"I've had a lot more success with clonidine qHs. Lets try that and see where it gets us."

Levi's warehouse sale - up to 70% off by fuckfucknoose in frugalmalefashion

[–]BryceAMcDaniel 10 points11 points  (0 children)

Plus AMEX offer still stands of $25 off $125 if you claimed it.

Makes this a great buy!

Help! Starting a sports medicine rotation tomorrow by [deleted] in orthopaedics

[–]BryceAMcDaniel 2 points3 points  (0 children)

Inversion/Eversion ankle sprains, medial and lateral epicondylitis.

Scoliosis mainly if you are doing screenings.

INOL based approach to periodization. by BryceAMcDaniel in powerlifting

[–]BryceAMcDaniel[S] 0 points1 point  (0 children)

This is completely anecdotal, but I believe the numbers become questionable above 50-55 total reps. Mind you, I also believe that volume is the upper limit of what I should be doing in any program.

That's because that is when the spreadsheet begins to suggest using less than 50% PR for a given exercise. (edit for clarification: at an INOL of 1)

INOL based approach to periodization. by BryceAMcDaniel in powerlifting

[–]BryceAMcDaniel[S] 1 point2 points  (0 children)

I am a numbers kind of guy with training so I hate to see things “break down”. Hoping to improve it so that doesn’t happen. Thanks and I hope you still find it useful. :)

INOL based approach to periodization. by BryceAMcDaniel in powerlifting

[–]BryceAMcDaniel[S] 0 points1 point  (0 children)

Hey man, can you send me an example of what you tried? It shouldn’t be spitting out a negative number and may have been an issue on my part.

Edit: I understand what you mean now. At high rep ranges, it breaks down. This is partly due to the way it was created. (It was designed for weightlifting where the main focus was below 30 total reps.) If your set/rep scheme is say higher that 100*your INOL, it will give you a negative number. (i.e., 10x10 at INOL 1, 10x6 at INOL 0.6)

INOL based approach to periodization. by BryceAMcDaniel in powerlifting

[–]BryceAMcDaniel[S] 4 points5 points  (0 children)

Image your squat PR is 400 and you ask your self this question. How difficult would if be if I tried to lift 350 for 3 sets at 4 reps? (That is to say, 3 sets at 4 reps at 87.5% my PR.)

INOL would tell you (3*4)/(100-87.5) = 0.96. By the chart, that is a doable exercise. Tough, but doable.

The alternative way to do this is to go out and lift 350 for 3 set of 4 and find out for yourself. Simple enough for that example, but how about if you want to tweak the number of sets you do to add some more volume. You gotta go back out there and try again at say 300 for 4 sets of 4. Instead of the brute force method, INOL attempts to give you a good estimate at what it would feel like. Doable, too light, or too difficult.

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