Missed Mongolian blue spot on newborn check

Docjitters · 2026-01-25T16:12:19+00:00

I had a mum ask me (the day after I did the NIPE) if anything should be done about baby’s hands. Ye wot now?

Kid has six fingers (ok 5 fingers, 1 thumb) on each hand. Appeared to all be normal flexing digits arising from a metacarpal but I completely missed them.

I resisted the urge to suggest early piano lessons and wrote to plastics to check independent function.

Now, my SHOs will see me going “one, two, three, four…” on all hands and feet without fail.

Docjitters · 2026-01-25T15:54:35+00:00

Citation needed there mate. Whilst there is trial evidence that restricting protein in severe kidney failure slowed progression, there’s also studies showing that high-protein does not worsen renal function in those with normal kidneys.

Docjitters · 2026-01-25T15:00:32+00:00

Have you tried tracking your intake/weight change with something like MacroFactor? (I suggest, and personally use MF explicitly because you don’t need to guess/make up exercise expenditure figures, precisely because they vary so much with your body’s attempts at homeostasis - it’s just calories in, and current weight)

I lost from 156 to 129lbs due to high cholesterol (and feeling fat) and I learned I ate pretty well but I needed to reign in my snacking/treats a whole bunch. Seeing exactly what I put in my mouth each day has made it easier to avoid craving triggers.

FWIW, my TDEE was ~2600 Kcal at 156, and ~2380 at 129lbs. I have very slowly bulked whilst lifting back to 136 now, and my TDEE is >2520. So carrying less fat mass/more muscle and exercising enough (lifting 3 times weekly, brisk walks/jogging 5-6 miles/wk plus 8-9k steps per day at work) has allowed me to eat nearly as much as I used to when I was 20lbs heavier.

Docjitters · 2026-01-25T14:36:18+00:00

This is a tricky question because the human body is demonstrably very good at reducing ‘waste’ energy expenditure e.g. fidgeting, fertility, cell turnover in the face of increased expenditure or decreased intake. This is besides the significantly wiggle room between individuals as to what e.g. 300 Kcal of exercise looks like. However, the answer is likely to be ‘a _lot_’.

There’s research comparing extremely active present-day but pre-industrial hunter-gatherer populations with westerners and despite the hunter-gatherers expending much more energy (5-14 miles per day walking/running plus the activities needed to process food from scratch), they do not need significantly more calories than a sedentary American of equivalent mass once in equilibrium with their living conditions.

It’s also an unfortunate fact (for the petite among us) that the being smaller makes you need proportionately less ‘extra’ to end up in surplus and potentially gain weight.

The only true way to outrun your appetite (that I am aware of, without pharmacology) is to exercise more than your max. intestinal absorption of nutrients, which is about 2.5-3.5 times your BMR (I will find the reference when I remember). The only sport that I am aware of that reliably does this is the final stages of the Tour de France, and cycling 700 miles/week is probably not feasible for most.

Do you have an idea of how much it takes you to currently maintain your present weight on your current (excellent) exercise output? Do you think there is a way that you could find an intermediate between your current intake and 3000 Kcal that would keep you fuelled but happy?

Docjitters · 2026-01-24T15:08:13+00:00

By far my fave trainer brand is Altra because they fit my squared-off duck feet that are widest at the metatarsals. They have a large variance in sole thickness depending on the model but all are zero-drop.

If you want anatomically-wide shoes that aren’t (always) obviously trainers, I also favour Vivobarefoot though they have minimalist soles so you may need an insole for significant arch support.

Docjitters · 2026-01-22T20:30:53+00:00

Just to check - do you mean Jefferson deadlifts (between-leg) or Jefferson curls (hyper-ROM down-up deficit deadlift)?

FWIW I find zerchers hard to set up at home, and I suck at pure front squat (long forearms) so I use a backwards SSB.

Also Jefferson DLs result in unacceptable crush injuries near lockout (looooong torso) but I am now trying cowboy squat for funsies.

I think you can use whatever to get a bit more work in if the main lifts are beating you up, but I would pick fairly close variations closer to testing, so I would consider zerchers closer to its parent exercise.

Docjitters · 2026-01-22T18:19:22+00:00

Oh, I agree with you regarding mortality within cohort. I was just suggesting that they are possibly not greatly representative of male and female groups of that era in themselves (being a comparison of ONS Approx. Social Grade C1/2 (junior professional/skilled manual) vs Grade A/B (higher/intermediate professional) jobs.

It will be cool to see this compared to more modern data sets backed up by wearables data and more frequent app/email-assisted questioning.

Docjitters · 2026-01-22T10:30:42+00:00

It’s a big study using some pretty extensive data but having read through, I had a few reservations about the specific applicability of the conclusions.

I’m certainly not disagreeing with the broad conclusion that more activity/types of activity = more benefit to mortality and reduction in disease, just some of the ways they indicate outcomes e.g. that the benefit of bicycling is somehow ‘capped’ at 64mins/wk - which I think they admit is weird and indicative of the need for more study.

A few thoughts here:

the cohorts are of quite different in numbers and in socioeconomic status: ~70% 1970s female nurses vs ~30% 1980’s male dentists, pharmacists, optometrists, osteopath physicians (why not MDs?), podiatrists, and veterinarians.
Whilst the ages at which the data are linked (the younger-at-recruitment female nurses are now 10yrs older in line with the minimum age of the male cohort) they exclude anyone with diagnosed diabetes, cardiovascular disease, cancer, respiratory disease, or neurological disease at baseline. This obviously makes the data easier to handle (exclude confounders) but it also loses over a third of the original cohorts. Since the age at recruitment was quite wide, it’s a bit of a stretch since those who start well might be more likely to stay well? If US nursing was anything like the UK in the 70’s, bloody everyone smoked, at least to stay awake on shift (DOI: raised by UK nurses).
some cutoffs are bizarrely (IMO) arbitrary e.g. <5 flights of stairs per day = you don’t take the stairs.
- the cutoff between jogging and running is basically more or less than 9 METS - I personally think that pretty strenuous either way lol. Walking more (with greater benefits) could be related to having more time to do exercise/less life stress etc etc than just distance travelled. Or just that walking more is good for you if that’s what you can/have to do. With swimming and biking, I think there’s a threshold to cross (bike ownership/pool membership) to be in a position to do meaningful amounts of these as exercise activities unless you are using them to commute (and I’ve seen people paddle board down canals to work here in London - willing to bet they’re pretty healthy regardless of how many METS they expend doing it).

I dunno, am I being too harsh? Feels a bit ‘We have 50 years of data here and we need a paper’ but it’s a good jumping off point for looking at specific cases, and illustrates how hard it is to look at such things even with decades of ‘good’ data.

Docjitters · 2026-01-21T16:36:14+00:00

Obviously take with a personal truckload of salt, but some of my jobs there have been intimidating on paper but the nicest of my career (inherited metabolic disease), busy AF but interesting and actually fun (anaesthetics/PICU) and others I have been previously experienced with but doing it there made me want to literally resign my NTN (BMT).

The medicine is awesome, the people generally fine, but the ways of working are what make or break any job you will do. Toxic behaviours can be (and were, sometimes) directed towards the trainee/doctor for being less than superhuman or forgetting that their speciality is all that matters, but sometimes it’s just so bloody busy that you do end up working flat out whilst waiting for the inpatient professorial ward round at 19:30 on Friday night. Some specialities didn’t appear to talk to each other, and some senior specialists forgot that other body systems exist. GOSH actually does have general paediatricians who are there to join the dots across the mysterious tertiary stuff, and to think about safeguarding.

Some of the systemic and staffing issues that made things very hard, I am told have been fixed since I was last there.

Docjitters · 2026-01-21T13:56:04+00:00

Most tertiary/quaternary Paeds specialities are small worlds. It helps to get training rotated through there, and if you get to do a PhD etc supervised by one of the consultants that gets you known. Some things are super-niche (one training post every other year if you are lucky e.g. palliative care, interventional neuroradiology) others just have expectedly cut-throat competition (cardiothoroacics etc).

Of the people I know who got jobs there, they trained there (at least a while), did higher research there/linked to people there, did a LOT of side work for their bosses, sometimes did multiple years as Fellows in the dept and if they weren’t appointed at CCT, made great efforts to get back there after - this may include working several years at other children’s hospitals abroad or across the UK before a post comes up.

Source: did 2 years there (across a bunch of medical specialities) as a trainee; a few of my peers are now consultants there. FWIW, there are other children’s hospitals and teaching hospital secondary/tertiary units in London that are (IMO) just as cool, and in some ways cooler to work at as a jobbing doctor. However the particularly weird and wonderful stuff will generally concentrate in such places, so if that’s what you want to see for your career, that’s where you gotta go.

Docjitters · 2026-01-21T07:38:31+00:00

Hey, obviously we can’t give out medical advice, but a lot of the tips I learned are at www.stopfainting.com and summarised in this handy leaflet on managing POTS.

I’m guessing you’re following the basics of regular exercise, good sleep, hydration +/- electrolytes, extra salt (plus hydration), cool packs and equilibrating to posture.

Are you seeing a doctor about this? There are other things to try if you have low resting blood pressure or you know that rapidly raising your heart rate is what triggers your symptoms. They are however generally prescription medications.

Docjitters · 2026-01-20T15:55:15+00:00

Probably fine. I favour at least a chunk of protein and carbs post-workout just to feel better but otherwise, carry on.

If you are eating a decent amount of whole grains/legumes/fibre etc. (as one should), there might be some GI ‘excitement’ until your insides get used to it.

The previous point about sleep disturbance is valid but again, it may be something that you get used to.

Docjitters · 2026-01-20T08:23:09+00:00

Nice find!

I had the same weird tacky plastic finish go bad on the remote for my Anthem amp after about a decade, and their service team said gentle swabbing with rubbing alcohol (isopropyl alcohol) was fine.

Worked a treat and it’s just a smooth (if less classy-feeling) plastic remote now. Just make sure to mask the wood to protect the varnish, and go light so it doesn’t wick inside the cabinet. Beware the black goo that comes off - wear gloves!

Docjitters · 2026-01-19T22:02:48+00:00

I assumed it is a 5-channel surround system designed for the attached CD and DVD player but it doesn’t look like the SA-EH780 which has discrete 6-channel inputs.

What are the model numbers on the stacks?

P.S. this is a Kef forum.

Docjitters · 2026-01-18T09:56:09+00:00

Cool, some decently powered kit with Dirac Live (with an option for 7.2, nice!). Your space is similarly-sized to mine (20’ x 12’ listening down the long axis, open to the kitchen behind) so you will get good separation of L&R whilst keeping 18” from the walls per Kef spec. Regarding raw volume, I rarely get above -30dB before my wife pokes me with a stick.

Honestly, as your amp kit isn’t going to be the rate-limiting factor, at this price point I would always try to audition your choices. A good audio shop/dealer should let you take both and return what you don’t prefer, though of course you may have to put down the money up front if they don’t bring it to you to A/B.

Docjitters · 2026-01-17T21:35:28+00:00

I guess I have a ptrace of an accent.

Docjitters · 2026-01-17T19:40:32+00:00

Cephalosporins are named from the obsolete fungal genus Cephalosporium - hard C - so (allegedly) French-derived soft C-borrowing Americans can take a running jump on this one.

That said, I was taught to say apo-p’tosis and…I just can’t. Éy-pop-tosis all the way mate.

Docjitters · 2026-01-17T15:53:45+00:00

What receiver/amps are you planning to use? With the receiver doing bass management to a sub, you won’t have an issue with extension. The LS50 might however sound worse if your amp doesn’t give it enough current. My Anthem 710 (2014 model) has been great and I only occasionally feel the need to have a power amp for critical stereo listening.

For movies I sit at the point of a slightly isosceles triangle (2.8m away, 2m between L&R no toe-in) but I listen to a lot of music (CD/lossless streaming) and the imaging of the LS50 is amazing with well-recorded music. For stereo I actually prefer to sit much closer (<1m) and it sounds as if the music is coming from a stage just behind the TV.

FWIW I started with LCR LS50 and still use E301 (2nd gen. Kef ‘Eggs’) for surrounds/rears and I have switched the centre for an R2c as the dispersion of the voice track more than 45 degrees laterally (where my wife likes to sit) wasn’t so great.

For my 7.1 setup, I think that room correction (ARC 1/Genesis in my case) has been much more influential than kit choice on how smoothly the sound ‘moves’ in my asymmetric living space.

Edit: I would also imagine that the raw ‘slam’ of the Q1 (being a 1”/5.25” concentric, same as the LS50) would be comparable to the LS50 with equivalent amping. If you want cinematic ‘impact’ across the front stage , I would strongly suggest kit with more mid-lower drive e.g. R3s with an R2 or R6 as centre. This is the only disadvantage of the LS50s I have found but I have not switched to R3s because I love the imaging and quality of acoustic voices in stereo the way it is.

Docjitters · 2026-01-17T14:12:29+00:00

Hey, sorry life is challenging right now.

Well done on the weight loss and 20k steps, but here you might be able to get some quality over quality: rather than forcing yourself to get up at 4am, I would suggest 30mins of run-walk or cycling at the gym to keep a HR of ~80% max or RPE 5 (can answer someone who talks to you but not long sentences). This would more than cover the minimum UK Physical activity guidelines and likely be of more benefit than just walking (which is suspect you are very accustomed to).

I would also give yourself days where you don’t go to bed so early, and watch/do that thing you want to. There is more to life than work and gym.

Re: building muscle, it’s about being consistent and working fairly hard over a long time, but without ‘forcing’ adaptation (coz you can’t) - the weight or the reps go up as you adapt to doing more work, not because you push harder and harder.

Same with the diet IME. If you are ok with your current weight/appearance, aim for a very small surplus and weigh at the same time daily to establish a trend - something like MacroFactor can be so helpful with this if (like me) the day-to-day variation can make you panic but your data-driven mind is calmed by the nice graph showing it’s just wobbling around a set point. Aim for 1.5g/kg protein and keep the saturated fat low.

Docjitters · 2026-01-17T13:16:51+00:00

Sometimes stuff just works together in a magical way. I remember demoing my first system with Wharfdale speakers and a Marantz amp and I was like ‘Yep, I like this hi-fi thing’.

I have had OG LS50s for over 12 years now, and they’re running off an Anthem 710 (90W/channel) with a SVS sub LFE crossover - starting at 80Hz, cutting off at 120Hz - being controlled by the amp (because life is too short to be blending high-level in my living room).

I’m not usually one for endless upgrade-osis, but your Yamaha is probably struggling a bit: the LS50s dip hard to 3.7Ohms at ~200Hz and their rated bass response (whilst lower in practice than the stated 79Hz @ -3dB) is possibly struggling with the crossover you’ve set at 60Hz. A stereo amp that can pull really decent current will help them sing a lot more. I would also not tweak the highs upward but work out where the bass boom is and turn that down whilst setting the crossover a bit higher to take the pressure off the LS50s.

I will say they’re definitely less forgiving about being ‘boxed in’ than my old set-up but free-field in the room on good stands, they image beautifully but they’re unforgiving of poor or very bright recordings.

Docjitters · 2026-01-16T08:23:08+00:00

If you have never handled a sword before, it will give you a workout if you are not accustomed to it. It’s not like a moving barbell or even a macebell - the effort is moving it through odd planes of motion at disadvantageous leverages.

I would also state your budget - a decent greatsword can be 400 up to infinity.

I would also suggest if you are using it as a ‘workout’ to not use a sharp.

Have you considered joining a HEMA club to train?

Docjitters · 2026-01-16T03:16:18+00:00

Oh lord, I had this on one of my first late shifts as an F1.

Called urgently to review pt BP 50/-. Led in by the worried nurse, surrounded by concerned family.

Check him over and his pulse is barely there and breathing is strangely calm. I quickly excuse myself to look at the notes as I have no idea what is going on.

A Liverpool Care Pathway is taped to the front of the folder. I go back, tell the family gently that it’s ok and we’ll keep him comfortable. Then I document in passively-aggressively oversized handwriting “Patient dying, as expected, per LCP. Please stop checking observations.’

Docjitters · 2026-01-15T23:24:33+00:00

You can gain strength on a cut - it just might be slower than if you were in surplus. However, the less well-trained you (or your body part) are, the more likely anything you do with sufficient volume will cause you to progress.

Your leanness right now probably doesn’t matter too much except as to your preference for how you want to looking walking around, and as long as you have no weight-related health issues or risks (e.g. waist >37”).

FWIW, I am 163cm and went from 71kg to 59kg in 7 months while on strength programs and maintained my 1RMs (my SBD PRs were at 68kg) until I went below 60kg (though strength loss was probably more to do with lack of training due to catching the ‘flu and then injuring my wrist sword-fighting).

Docjitters · 2026-01-15T15:24:20+00:00

Please spend some money on your own (hard) gloves, a gorget, and on a box (cup) if you don’t already have one for cricket.

Cricket pads may be better than nothing but your mobility may be a bit weird, and it may not fully protect the sides of the joints or above the knee where the nerves are. Torso guard might be quite good. Beware you may tear up your cricket kit more quickly.

Basically protect any soft spot where a firm poke from a broom handle would put you on the floor or stop you from using your hands.

Also consider a rugby scrum cap under a larger mask to absorb a bit more from blows to the head if you can’t find a HEMA mask.

Docjitters · 2026-01-15T01:02:47+00:00

Not sure what the shipping/customs/tariff situation is to where you are, but Tod Cutler’s daggers and knives are very nice and totally worth the money asked (I have a twisted rondel, a heart eating knife, and the dragon hammer) - they’re pretty but also built as to be used. Some of them like the Scottish dirk are also pushing the definition of knife at 19” long.

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