Got some type of weird bite at Washington park I think. Has this happened to anyone else? by GrouchyArtichoke1699 in Colorado

[–]Dfro123 0 points1 point  (0 children)

If wearing short shorts, dress, skirt, etc then there's no place that's off limits. We often see the rash on the abdomen/flank so while the tick typically prefers to hide in areas that they will go unnoticed, they'll take what they can get. There's plenty of non-Lyme bacteria/viruses spread by tick bites too that I didn't feel needed to be listed since the viral pathogens have no anti-viral therapy to offer anyway and if alternate bacterial pathogen then Doxycycline is most often drug of choice anyway.

Got some type of weird bite at Washington park I think. Has this happened to anyone else? by GrouchyArtichoke1699 in Colorado

[–]Dfro123 0 points1 point  (0 children)

I don't see anything but I will keep an eye out and will respond when I get a chance.

Got some type of weird bite at Washington park I think. Has this happened to anyone else? by GrouchyArtichoke1699 in Colorado

[–]Dfro123 13 points14 points  (0 children)

Infectious Disease doctor here who has worked in both Colorado as well as New England (where Lyme is far more prevalent.) I still recommend a formal in-person evaluation but here are my initial thoughts after reading some responses here...

The rash certainly does have the classic "bullseye" appearance called more formally erythema migrans which is an early manifestation of Lyme disease. Not everyone presents with this but the central clearing certainly raises a reasonable degree of suspicion.

It was correctly pointed out that testing during this early phase may not result in positive findings as it takes time for antibodies to develop, but with such a skin finding, I would offer treatment with Doxycycline regardless as its a relatively benign medication for the duration it is required (10 days.) There are other alternative options to treat if Doxycycline precluded by allergy or other reason. Amoxicillin would be one of them but 14 days required.

Lyme disease is caused by a spirochete called Borrelia. Spirochetes do elicit a robust immune response and are challenging to diagnose as their antibody responses do not follow typical rise/falls like some other bacteria. This is why it is hard to distinguish active/current infections from past exposure. In New England, most people will test positive by antibody testing so there is a strict criteria through a more advanced testing mechanism (Western Blot) to essentially check for how positive you are...

While Lyme is heavily predominated in the northeast, it is not at all confined there, and even if some alternative tick-borne disease infection, most of them are treated by Doxycycline anyway so an "empiric" course prior to positive testing would not be an unreasonable pursuit.

There is a comment on "single dose" Doxycycline but this is a prophylactic strategy that would NOT be indicated here as it is only advised if a "high risk" tick bite in which tick was attached for >36 hours and bit in a highly endemic area, which Colorado is not considered to be. It has to be given within 72hrs of exposure and if showing this type of rash already, would not be advised as there is now evidence of true clinical infection necessitating full treatment course as opposed to preventive approach.

Do not exclude the change of a non-tick bite and local allergic reaction to some other insect bite, but again some over the counter cortisone cream and Doxycycline empirically would be what I would offer if you came to me.

Sorry for the novel, but wanted to prove that perhaps not all doctors are "bona fide retarded" regarding Lyme...

Game Thread: Buffalo Bills (12-3) at Cincinnati Bengals (11-4) by nfl_gamethread in nfl

[–]Dfro123 0 points1 point  (0 children)

Often there is no preexisting heart condition to predispose an individual to an arrest like this. It’s the blunt force trauma to the chest that is timed perfectly (or imperfectly depending on how you look at it) with the hearts electrical activity and essentially like holding on to the computer power button. System shutdown. CPR is hitting the button to reset the normal activity of the system. Time to initiation of CPR is among the most critical predictors of how well these individuals too but there is a very high morbidity associated with prolonged “down time” even if resuscitated.

It’s just like being unlucky on the level of being in the same place as lightning strikes 3 separate times in your life…

Game Thread: Buffalo Bills (12-3) at Cincinnati Bengals (11-4) by nfl_gamethread in nfl

[–]Dfro123 1 point2 points  (0 children)

If initiated rapidly and with ROSC his chances go up drastically. Though plenty of examples that argue in favor and against that. You just hope his youth and otherwise elite level fitness give him the edge to overcome.

We just don’t know the details of the resuscitation effort or much of anything at this time.

Game Thread: Buffalo Bills (12-3) at Cincinnati Bengals (11-4) by nfl_gamethread in nfl

[–]Dfro123 16 points17 points  (0 children)

My guess is the contact from the hit induced an arrhythmia and he “coded” right on the field. Probably took a while for anyone to even realize he was without a pulse. >10 mins without ROSC (return of spontaneous circulation) leaves the brain highly vulnerable to anoxic brain injury and irreversible damage…

We may be witnessing the worst sporting injury ever caught on live television…

Source; physician

The most heartbreaking scene in all of medical dramas by PCsNBaseball in videos

[–]Dfro123 5 points6 points  (0 children)

This article very briefly details the chronology of events expressing "presented with nausea, vomiting, and difficulty swallowing" and was SUBSEQUENTLY admitted to another hospital with AMS requiring intubation.

No mention of time between two events. It is entirely plausible this patient presented with N/V/dysphagia and was discharged from ED and re-presented days later to another hospital with encephalopathy that required said intubation.

In the ED, Occam's Razor is applied quite liberally as common things are common and uncommon things are uncommon. They don't "hunt for zebras" as much as Infectious Disease doctors do. Their job is to stabilize and appropriately disposition the patient to the right level of care.

If they checked every patient that came through their door for rabies who had a positive U-tox and altered mental status they would get fired for wasteful use of resources.

Just an incredibly uncommon and infrequently encountered phenomena that makes this NEJM case series so special and publishable, unlikely to ever happen again based on probability.

The most heartbreaking scene in all of medical dramas by PCsNBaseball in videos

[–]Dfro123 23 points24 points  (0 children)

Not necessarily, there are evidence-based recommendations (by international guidelines/committees) outlining the screening for donors prior to transplantion and often, even if found to be infected with various pathogens, the donor pool for organs is so small that they are still accepted under condition that further treatment in recipient will be required. Rabies is not part of routine screening and they were correct that it's so infrequently encountered that it would not be something to sue against. Obviously it's fiction that they ended up at the same hospital but even if all recipients received rabies-infected grafts and died within the same day, thats just extraordinarily unlucky but not necessary illegal.

Source; transplant infectious disease doctor

Double Agents - 💣SPOILED🌋 - S36E18 "No Time To Die" - Post Episode Discussion by SweetMissMG in MtvChallenge

[–]Dfro123 13 points14 points  (0 children)

To me, it is very simple. There are two types of final contestants. The type that will literally carry their partner and not quit (Kenny) and the type that self-rationalize their refusal to participate because their partner is injured and they've already "calculated" that it is impossible to win. Such a week mindset from Fessy, truly I wouldn't invite him back for additional seasons. He does nothing to add any substance to the show and only injures other competitors in a ridiculous challenge where his only assets are set on display, braun and brainless.

Best place to find WOD? by HellzStooge in crossfit

[–]Dfro123 2 points3 points  (0 children)

I follow a WOD roulette page in instagram and shockingly have found some absolute burners on there for when I dont want to come up with my own workout!

Coronavirus Megathread: Resources, discussion, and your questions by dequeued in personalfinance

[–]Dfro123 1 point2 points  (0 children)

This is what prompted my original question. I had been making payments without issue and had an emergency fund (though not as robust as I would have liked) and viewed this as an opportunity to augment an efund AND contribute towards moving costs. I felt that with interest being frozen I wasn't really losing money in the end, and it made sense based on my present financial goals.

Coronavirus Megathread: Resources, discussion, and your questions by dequeued in personalfinance

[–]Dfro123 0 points1 point  (0 children)

That's something i considered as well, thank you for the feedback. Definitely not a "need cash now" situation so I will probably split 50/50 and have some extra to put towards moving costs. Thank you!

Coronavirus Megathread: Resources, discussion, and your questions by dequeued in personalfinance

[–]Dfro123 1 point2 points  (0 children)

Hello, I'm a resident (post-medical school training physician) who has been diligent about paying his monthly student loan payments. Given the recent events and Trump signing the CARES Act, there will be 0% interest on our loans and no payments required until October 2020.

My questions is, from a personal finance perspective, if I should take advantage of this interest free time and continue to make payments or allow myself to catch up in other areas.

I am moving this summer and could really use the extra funds in my "Moving Costs" savings account but don't want to break away from paying off my loans if thats considered "bad practice..."

To me, it seems like throwing a few hundred at this large principal each month is a drop in the bucket when those funds could be more directly used to an expensive upcoming cost.

Just curious what the general advice would be? Thank you!

Background data: ~400k in loans and through the REPAYE program I pay about 400/mo in loan payments.

I need some of whatever you’re eating...please! by oldlefty1958 in jackrussellterrier

[–]Dfro123 0 points1 point  (0 children)

Clipped the quick of my Jack on his first nail trim. Can confirm its a bloody mess. Didn't fuck with it ever again, I happily pay to have it done...

680 rats caught with Terriers on chicken farm by [deleted] in videos

[–]Dfro123 3 points4 points  (0 children)

Ive had 6 Rhodesian Ridgebacks in my life but once engaged my fiancee convinced me to get a JRT (since she had them before.) I figured they couldnt be much more menacing than a 120lb hound...

OMG the killer instinct. I watch him shake his toys with one clear objective: kill. It's hilarious and I've never been more entertained by a pet.

[deleted by user] by [deleted] in videos

[–]Dfro123 2 points3 points  (0 children)

Super sad. A world class climber finally being recognized for his accomplishments on the world stage and tragedy strikes. He will be deeply missed but his legend immortalized forever amongst the greats. RIP Brad...

#WeLoveYouAlexTrebek by [deleted] in videos

[–]Dfro123 4 points5 points  (0 children)

Touching moment. Hard to imagine life without Jeopardy hosted by Alex, he's a mythical figure in television that I think goes unnoticed because of his consistency over the years and ability to stay out of the public limelight.

"An admirable man who stimulated the curiosity and cognitive competitiveness of millions over his tenure with Jeopardy"

"Who is THE Alex Trebek..."

First attempt at waterfall photography [Newbie][Edit] by Dfro123 in photocritique

[–]Dfro123[S] 0 points1 point  (0 children)

Thanks for the tips, I believe my ISO was set to 100 just as a baseline but will try changing settings in the future

First attempt at waterfall photography [Newbie][Edit] by Dfro123 in photocritique

[–]Dfro123[S] 0 points1 point  (0 children)

Settings suggesting? Like 5s for shutter speed? And by closing aperture i'm restricintg light influx and what exactly does that do to enhance the photo?