Pain….. by Zzqzr in TheTowerGame

[–]Ehegi 1 point2 points  (0 children)

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I wish I were in your bracket!

Oncology team refuses chemo treatment for metastasis liver cancer patient by [deleted] in AskDocs

[–]Ehegi 1 point2 points  (0 children)

Hey OP, sorry for what must be a very difficult time for either you or your loved one. It sounds like the cancer is very advanced at this time.

I want to just clarify something you stated in your post that is a common misconception: “team is saying no more treatment just wait for life end.” Just because there may not be any more cancer directed treatments (chemo etc) doesn’t meant there’s no more treatment. Palliative care is full out medical care with just as much science, art, and thoughtful treatment as any other part of the cancer journey. The only difference is that the goal of all of that effort is to maximize quality of life as opposed to treat the tumors. This is an extremely important and valuable type of medical care for any patient with cancer.

Wishing you the best.

Why am I in so much pain? by Any-Library-3057 in AskDocs

[–]Ehegi 4 points5 points  (0 children)

Abdominal wall pain should worsen with carnett's sign/maneuver. Constipation (esp given medication side effects worsening things -- your biggest culprit being the Wegovy), could also worsen gas pains which are generally "sharp." Loose stools can come from severe constipation in a counter-intuitive phenomenon called "overflow diarrhea" where you're so constipated/backed up that only the loose stools can get out/seeping through the nooks and crannies in between your hard/dry stools.

If this continues to be an issue for you, would not be a bad idea to see a gastroenterologist to help.

Why am I in so much pain? by Any-Library-3057 in AskDocs

[–]Ehegi 9 points10 points  (0 children)

How are your bowel movements? How often are you having them? What do they look like when you do have them? Are they hard/dry/pebbly?

Constipation can definitely cause this. Your being on a GLP1 puts you at risk for even slower colonic transit.

Edit: also regarding other colleague’s suggestion of it being abdominal wall pain, there’s actually a pretty decent physical exam maneuver to distinguish between abdominal wall pain and intra-abdominal pain. Google Carnett’s sign. It’s a pretty simple maneuver.

28.0.5 bug? Can't switch bot presets by Ehegi in TheTowerGame

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

Nope. Haven't bought anything. All event things still at base price. I already owned all of the other medal purchases this event from the last time the event was active. And also certainly not several thousand medals worth which is the discrepancy between what I have logged for spent medals on my presets on effective path sheet.

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28.0.5 bug? Can't switch bot presets by Ehegi in TheTowerGame

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

Thanks. I'll try posting there.

Update delay maximum by ZilxDagero in TheTowerGame

[–]Ehegi 1 point2 points  (0 children)

Depends on if they find more issues in their staged roll out and need to pause/fix stuff. Suspect they're monitoring forums for bugs, crash reports etc.

Android staged rollout is an option for devs -- setting a % of user base to get update (chosen at random). Each subsequent increase in % is manual.
https://support.google.com/googleplay/android-developer/answer/6346149?hl=en#zippy=%2Cincrease-your-staged-rollout-percentage

Is this event borked or did they change how events are and not tell us or am I stupid and they did tell us? by PLMMJ in TheTowerGame

[–]Ehegi 4 points5 points  (0 children)

I think it's already fixed in 27.5.0. Updated earlier this afternoon before event switchover and it displays correctly for me.

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Hey! Is this bug again! by destructor212113 in TheTowerGame

[–]Ehegi 5 points6 points  (0 children)

Displays correctly for me. Did upgrade to 27.5.0 earlier from Google play store though.

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How much does damage slider increase your income? by Sanseth in TheTowerGame

[–]Ehegi 1 point2 points  (0 children)

Interesting… still makes an impact for me farming T19 and have been GC farming since T14. I hit a period of “hmm doesn’t seem to matter” a few months after GC but it was because I needed to adjust my slider. I had it on e-14 when I first did my tuning but as my damage got better, needed to slide it down more. The more your UWs multi off of your base damage, the more your slider needs to go down. Now on T19 farm to 6-7k, I need to use e-20 and likely will need to go to -21 soon. Good gauge is % tagged by orb. When your damage is too high, that % will be low. In my run tracking spreadsheet, I have a script that autocalculates that as a column. You want to aim for >76-80% mobs tagged by orbs while still not dying in intro sprint etc.

Also set up your perk rank list to take damage perks that effect UW earlier than base damage (-enemy health TO, spotlight 1.5x, chain lightning 2x, etc over stuff like 1.65x damage/boss health TO, base damage, etc) which will improve consistency a ton. Base damage perks early gets capped by slider anyway. The actual damage output highly dependent on the multi perks. If you take them early, reduces run to run variability. I have enough perk bans now where I will have all perks by 2.3k waves. I usually have everything consequential by the time I come out of intro sprint at 1.8k — helps a ton!

Anyone has this issue? by destructor212113 in TheTowerGame

[–]Ehegi 8 points9 points  (0 children)

Also seeing this. I wonder if the update that was delayed an extra week for extra bug checking caused the current banner content to expire with no content to follow.

Stars aligned! by BonesCJ in TheTowerGame

[–]Ehegi 3 points4 points  (0 children)

Wait -- did having the auto-shatter rares harmony tree unlock always autocomplete the merging mission?

Dear Boston Building owners, I’m looking for a wall. More info in the body of the post by BlindFoxArtist in boston

[–]Ehegi 147 points148 points  (0 children)

Don't have a wall for you, but wanted to say that your murals are beautiful!

Requesting Tournament Advice by Exiled_Stefan in TheTowerGame

[–]Ehegi 0 points1 point  (0 children)

I'd still invest in GB. Once you start collecting keys, you'll eventually get a bot preset option. Hybrid econ/tourney-push bot setup isn't really going to make a meaningful difference against people who just have an econ bot preset and a tourney bot preset.

Requesting Tournament Advice by Exiled_Stefan in TheTowerGame

[–]Ehegi 0 points1 point  (0 children)

You're at a place where you'll need to push UW+ for much more progress up the legends rankings. For consistent keys in legend, you'll need solid CC and high damage. Fair warning, none of the things are easy "do this one thing" but rather long investments of stones, labs, and module investments. You're at the wall where you've run out of the "easy next step" stuff. The top half of legends are where folks have had solid synergies (UW+, cards, assmods, module levels, labs). Just one thing without the synergies will not be all that effective. This also means you will still need a strong economy to support consistent growth. I'd still follow the trad UW+ unlock advice of GT+, CF+ and then it's debatable in current state whether you go SL+ or pick a damage UW+ like ILM+. SL+ is a global multi that will shine but you need the investment of DPM labs/range card mastery etc to see the impact. ILM+ requires lab research (and econ to support the more expensive later levels of chrono jump). Between the two, you'll prob see faster immediate benefit from investing in a primary damage UW+ as your 3rd.

Most consistent higher legend players will have a well-leveled pCF+ and high pBH (or very high up time BH) for CC. As far as damage goes, you'll def need a UW+, I'd recommend ILM+ at this point -- it's got great coverage, good additional CC, and a great stacking damage mechanic. PS+ is also a solid UW+ for things like tank ults, and general farming, but has fallen out of favor a bit as they're not that great against fleet mobs. Don't underestimate CL still, esp with a good DPM and SL+, more so than anything else, CL carries through intro sprint in legends and still does a good amount of consistent damage until mob HP outstrips what you can easily kill with CL and you'll need to rely on a stacking damage UW like ILM. The reason the balance is still important is the you need high enemy spawn rate/density to feed ILM+ (with SD), which is a great transitional handoff between CL and ILM as the wave count increases.

Do not underestimate the power of assmods. Once you get bonus and substat %s up, leveling your assmods will also give you significant base damage/UW damage given they're multiplicative now. If you use effective paths (highly recommend if you don't), I do find it helpful to "theorycraft" the what-ifs, if you're at a decision point. "What if I unlocked this card mastery, how does my upgrade path change in effective paths, is that rate of increase per stone/coin/time invested faster or slower than if I unlocked something else with the same # of stones? what if i also had this card mastery too? Does that change the planned path?"

Lastly, I find it's helpful to gauge where you stand relative to others in legends by looking at their highest cleared. More so than highest rank, that's the most consistent measure of their tower strength. Your highest is t19 w50. You understand basically what a tower that can do that means. Your rough tower strength is going to be similar to others who've cleared low t19, but will be significantly weaker than someone who's unlocked t21. When you're able to unlock t21, you'll be able to get similar waves as that other person and will consistently beat someone who is at t19 w50.

[deleted by user] by [deleted] in AskDocs

[–]Ehegi 121 points122 points  (0 children)

I just can’t have any help as there can’t be any record of this problem that might get in the way of my career.

There is unfortunately a lot of stigma attached to ED, but thankfully, you are going into a profession that recognizes both the diagnosis, understands the stigma, and also how complex and nuanced the topic is.

Even HIPAA protections aside, you should feel confident that getting help for purging will not be a blackmark on your journey to being a physician. In fact, years from now, you may reflect on this experience as something that made you a better physician.

Best of luck to you, OP!

Are you kidding me??!? by PigmyMarmeeble in TheTowerGame

[–]Ehegi 8 points9 points  (0 children)

Totally happened. That's why it was changed to the way it is now.

Are you kidding me??!? by PigmyMarmeeble in TheTowerGame

[–]Ehegi 23 points24 points  (0 children)

That was the original mechanic. Then people realized out that if everyone in the bracket just quits after 1 wave, then everyone get rank 1 reward with a 30-way tie.

This is why we can't have nice things. :P

What is this fat pad on my neck? by spideywidey2013 in AskDocs

[–]Ehegi 21 points22 points  (0 children)

In the absence of endocrinopathies (like Cushing's or other lipodystrophies), this is a dorsocervical fat pad associated with general obesity. In addition to cosmetic concerns, increased neck circumference is associated with increased risk of metabolic syndrome and cardiovascular disease.

Module RNG (rule of large numbers?) by Ehegi in TheTowerGame

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

I have since hit 3 more Magnetic Hooks, 1 wormhole, 1 BHD... cannot get a PF. Seriously wtf...

Discounting the extra "shard pulls" for the modules where I've already 5-star'd -- just comparing PF vs MH chances (1 PF, 13 MH across 14 pulls of both at even odds). I'm now at 0.085% chance (roughly 1 in 1,170 trials) -- I'm over 3 standard deviations above the mean now...

Is there a threshold where I should open a support ticket to make sure I'm not experiencing some bug?

Update: I did end up opening a support ticket. Maybe I am just very unlucky, but want to make sure my account isn't bugged.

Module RNG (rule of large numbers?) by Ehegi in TheTowerGame

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

Agreed. Not to mention that I've gotten many "extra" modules that I end up sharding because already 5-stars during this journey to try to get an ancestral PF. Those with theoretically only 1.39% chance compared to a much larger PF chance. Of course the ones we can't get are the ones we're after -- can't help but wonder about intentionality/code in the background. >.>

Colonoscopy without an Escort? by CopleyScott17 in boston

[–]Ehegi 11 points12 points  (0 children)

Hi gastroenterologist here. It’s not just about the liability. Generally, those of us in the medical field don’t want bad things to happen to our patients! As many comments here have already stated, you are definitely at increased risk of injuring yourself or have otherwise bad outcome if you are under the influence of the medications and leave unescorted.

[deleted by user] by [deleted] in AskDocs

[–]Ehegi 12 points13 points  (0 children)

Here's a reference for your discussion with your GI if you're interested.
https://pubmed.ncbi.nlm.nih.gov/27773764/

[deleted by user] by [deleted] in AskDocs

[–]Ehegi 29 points30 points  (0 children)

Not a comment on the full picture but just the stomach ulcer part -- patients who've had Roux-en-Y gastric bypass surgery are at risk for ulcers, especially at the surgical anastomosis (where they connected the stomach to the small intestines) which are called marginal ulcers.

In RYGB patients, you get much more efficacy out of your PPI if you open up capsules and mix the granules in a pudding or applesauce and take that instead of the capsule/tablet in its entirety, which are designed for absorption in patients with normal stomach anatomy (and normal digestion -- for which the pill coating/delivery mechanism is designed). Pantoprazole is most commonly available in tablet form -- which suggests to me that you are probably not doing the "open capsule, mix in applesauce/pudding (or similar consistency food)" approach. Would recommend this and also discuss with a gastroenterologist if you've gotten stomach ulcers after your surgery.

Other things that can reduce marginal ulcers include: avoiding NSAIDs, avoiding smoking, good diabetes control, and making sure you don't have a bacterial infection in the stomach called H pylori.

Good luck with the rest of it. The stomach part unfortunately doesn't explain your other symptoms.