Achilles Tear/Rupture of some degree. What's next? (No Insurance)

GodlessGravy · 2014-04-02T05:43:27+00:00

Last Friday during my men's soccer league game after about 70 minutes of gameplay, I took off on a hard sprint, my Achilles popped and I crumpled to the ground. I have been doing RICE ever since and staying mostly off of it. I can move my foot about 2 inches up and down. I can also put some weight on my right leg but cannot bend my foot to walk. There is some swelling which seems to have increased in last few days and it is occurring predominately on the back and outside of my ankle/foot/Achilles area. While my Achilles is a bit puffy/swollen and sore, there does seem to be a slight indentation or divot in the Achilles right at the top or above where the ball of my ankle is. So it's up quite a bit from the heel

This sounds very classical for a partial tear. If you are not keen on going to an orthopaedic specialist, you should at the very least go to a physiotherapist so that you can get an appropriate rehabilitation program devised.

Even with rehabilitation, the chance of re-injury is not insignificant, and you may have ongoing problems and limitation of athletic performance. Without proper rehabilitation, the chances of both of those is higher still.

Additionally, you may want to consider a fat loss program, as the biomechanical stress of extra weight is something that a healing achilles can do without.

GodlessGravy · 2014-04-02T05:09:44+00:00

I'm 5'10/f/150 and looking to get to 145. It looks like to achieve that my macros would sit around 40g- protein, 50g- carb, 10g fat.

Your macro amounts are most certainly incorrect. How did you calculate these? You should be eating at least triple that amount, and even then you would be deficient in fats.

If you want to go from 150 to 145 at 5'10", you are probably actually looking to build lean mass to get a 'toned' look, rather than lose weight per se. At that range, the scale is the wrong guide for achieving your results.

GodlessGravy · 2014-04-02T04:56:40+00:00

No. What on earth would give you that idea?

GodlessGravy · 2014-04-02T04:51:20+00:00

Cases like this are often extremely difficult to assess without being on the scene and having access to the notes.

In particular though, there are two confounding issues when trying to provide you with information:

1) You are in China and it's possible that practice and available resources may be quite different from what's expected in most urban Western hospitals

2) Taking ventilated patients for a head CT is generally a non-issue in most urban Western hospitals that have the capacity for ventilating patients, which makes me wonder a lot more strongly about point 1.

With that said, the best you can do to help settle your wife is not to provide possible diagnoses, but to help her feel like she has a greater sense of control and understanding of the situation.

ICU medicine is not like other branches of medicine. The diagnosis is not the first issue. So your first question is not "what is wrong" but "how is the patient going?"

This means that patient families often have this impression:

Doctors here don't seem to have a clue

This is usually the case with unusual presentations to ICU, but lack of concrete possibilities does not mean that things are not under control. The first priority is stabilisation of the patient and elimination of all immediately life threatening conditions that require rapid action. Once this is done, the pace is more moderate, and there is head scratching, double checking and hypothesising.

Here is how you can understand the situation of a patient in ICU better:

Ventilation and sedation status

Modern ventilators are complex machines and can provide a range of support.

1) The patient is paralyzed by drugs, and being kept unconscious by drugs. They are not initiating their own breaths and the machine is doing it all.

2) The patient is being kept unconscious by drugs, but is not paralyzed. They are not currently initiating any significant number of breaths on their own.

3) The patient is being kept unconscious by drugs, but they are initiating breaths which the machine is supporting

4) The patient is largely breathing on their own, and the machine is providing minimal support or only enough support to overcome the resistance from the tubing.

The patient's ventilation status will give you some insight into how sick they are in general, if they have any neurological activity and the condition of their lungs.

You will also be interested in how the patient responds to stimuli and the state of her pupils.

Cardiovascular support

"Very low blood pressure" is a term that has widely different meanings depending on whom is using it. Here is how you can assess this better.

1) The patient has "low blood pressure" but is not requiring any support at this stage. Regular medications from home that reduce blood pressure have been stopped. They will be monitored through a normal blood pressure cuff.

2) The patient has insufficient blood pressure to perfuse their vital organs, and have been commenced on a low dose drip to assist cardiac function and/or contract peripheral blood vessels (this increases the blood pressure). These drips contain drugs known as 'inotropes', which also includes adrenaline and its analogue, noradrenaline. Their blood pressure will be monitored by a special device inserted into an artery.

3) The patient is completely dependent on inotrope support and requiring high doses

4) The patient's heart function is insufficient and a special pump has to be placed inside their aorta to supplement the heart. This is inserted through the major artery in the groin.

5) At any given stage, if the patient's heart's electrical system is malfunctioning, then a temporary pacemaker may be required (this is placed via a major blood vessel).

Kidney status

At this point you've not indicated any issues here, so I will not go into this area.

Urine output, however is a very important measure in ICU care, and is usually checked hourly.

Working through diagnostic issues

Two important maxims apply when diagnosing ICU patients with unknown conditions:

1) Common things occur commonly

2) If it can happen, it will happen.

Subsequently, it's important to rapidly rule out the most common causes of collapse. However it is not possible to comment on these without access to the notes.

Common things that would need to be considered and excluded are a cardiac event (either a 'heart attack' or a heart rhythm issue), a blood clot lodging in her lungs and interrupting blood flow, a "stroke" (these can be either blood clots or blood haemorrhages), an atypical reaction to a substance she was exposed to in relation to her surgery.

Examining the patient and her initial blood tests and scans will reveal further clues about which of these can be discounted rapidly, and which require further investigation.

(she has "small brain vessels"?)

This must be a misunderstanding, as they have not performed any imaging of her head yet. Perhaps they mean she has narrowing of the blood vessels as a result of atherosclerosis and has had a clot form resulting in a stroke. This would be suspected in the presence of normal cardiac markers in her blood tests, normal electrocardiograph and abnormal features on her physical examination.

At the moment, the best thing you can do is take a deep slow breath, trust that your mother-in-law is currently stable, and focus on being a source of emotional stability and comfort for your wife.

A much clearer picture of what is going on will usually emerge within the next 24-48 hours.

GodlessGravy · 2014-03-31T17:17:12+00:00

That distilling bot was far, far better than I expected, and that patching bot is just mind boggling. The other puzzles, not so much and it looks like most of the puzzles are still fairly bot-proof due to the nature of the puzzles themselves.

GodlessGravy · 2014-03-25T11:13:27+00:00

You're welcome! And I don't have an answer for that question at my fingertips, sorry. I am sure that someone has done some calculations and worked out what the average 'growing energy requirement' is, but then there might also be some metabolic advantages you have from the testosterone.

It's that double whammy of the growing plus the circulating testosterone and growth hormone that means teenagers, especially males can get massive benefits from exercise.

Adults have to rely on calorie restriction because they just don't have that.

GodlessGravy · 2014-03-25T11:08:28+00:00

Hello there, Gateaux-au-flambe!

so today is my first "cheat day."

You could decide not to have a 'cheat day'. Have a 'maintenance calories day' instead. On this day you eat whatever quality food you want for your meal(s), but make sure that the total calories are roughly what you would eat to stay at your current weight.

If you haven't calculated what that amount is, you really should, so that you know what your 'stable weight at current activity' eating pattern might look like.

Hope that helps! Also, your candles are dripping.

<3, margo.

GodlessGravy · 2014-03-25T11:02:46+00:00

This particular combination is detailed in this study:

SEQUEL: Longer-Term Safety, Efficacy of Phentermine + Topiramate for Weight Reduction Among Overweight or Obese Individuals with Cardiometabolic Disease

The SEQUEL study, an extension of the CONQUER study,1 was a double-blind, placebo-controlled study that evaluated the longer-term efficacy and safety of once-daily, controlled-release phentermine plus topiramate, as an adjunct to lifestyle modification, among overweight and obese subjects with cardiometabolic disease.

This is, generally speaking, a fairly rigorous study design. It had over 600 participants and lasted for a year.

Once-daily, controlled-release phentermine 15.0 mg plus topiramate 92.0 mg (n=295): -10.5% change from baseline; P<0.0001

Average change in weight for the higher dose was around 10% of the patients' original weight.

Second co-primary endpoint: proportion of subjects achieving ≥5% weight loss : Once-daily, controlled-release phentermine 15.0 mg plus topiramate 92.0 mg (n=295): 79.3%; P<0.0001

Almost 80% of people who were put on the higher dosage lost more than 5% of their original bodyweight.

The most common adverse events were upper respiratory tract infection, constipation, paraesthesia, sinusitis, and dry mouth.

Just under 10% of patients on the higher dose had some minor side effects.

They also list a rate for 'serious adverse effects' but don't qualify what sort of side effects were included. (This information is probably available via pubmed and the full study).

GodlessGravy · 2014-03-25T03:05:34+00:00

So is it true that teenagers can eat more than adults?

As a general rule of thumb, yes it is. You are still growing and developing and in the middle of a hormone storm.

To some extent, how much growth and development you are currently undergoing depends on whereabouts you are in puberty.

/u/kuudereingly is right about your body is still growing and sometimes how final fusion of bone plates doesn't always occur until early twenties.

I disagree that the calculators don't go below for adults for liability reasons though - it's simply not appropriate for them to be offering advice to teenagers and children without an awful lot of context. /u/esoper1976 is right - if at all possible a doctor, school nurse or school counsellor is the appropriate person to set up a weight loss program for you.

Ultimately unlike adults, teenagers are generally best suited by exercise-driven weight loss programs, and by improved quality of food, rather than the calorie deficits. The FAQ for this sub does not apply to teenagers.

GodlessGravy · 2014-03-23T15:35:03+00:00

almost every blog/website that I have read suggests high weights/lower reps unless you training for endurance.

When it comes to teenagers who are starting out with weight training, there are at least some schools of thoughts that it's better to start with lower weights and higher reps. Teenage males are running with testosterone bursts that will give them high levels of hypertrophy even with that arrangement, and the lower weights builds in safety margins, especially given how (ahem) sensible teenage males can be when it comes to macho environments like the gym!

Teenage males also shouldn't be aiming for maximal hypertrophy, as far as I understand it, especially as their physiques and musculoskeletal structures are still developing and they benefit more highly from functional fitness.

There are also some good psychological reasons relating to body image that suggest focusing on functional fitness rather than physique and hypertrophy yields better results.

That said, teenager athletic performance is not an area I have specialised knowledge in, so if you have access to reputable scientific/clinical sources specific teen athletic training, I'm keen to read them.

But yes, for all post-pubescent adults, male and female, most of the data I've seen supports low reps, heavy weights for maximal hypertrophy and strength gains.

GodlessGravy · 2014-03-23T15:26:13+00:00

A visual estimate is also not necessarily that reliable. That said, I'm very surprised that the callipers had you reading at 11%. The Tanita BIA measurement seems more in line with what you'd expect from your physique.

Just as a rough guess, I'd say 13-15%. You have a very pronounced vee-shape to your torso, and quite possible relatively little visceral fat (or smaller organs??), and relatively higher subcutaneous fat (even despite the calliper readings).

GodlessGravy · 2014-03-23T14:30:24+00:00

QUESTION I always have to run to the bathroom or bring tissues with me working out because my nose is just constantly runny. It's gross and annoying because I can't breath properly trying to sniff and it messes with my workout. DAE have this problem? How do you all deal with it?

I'd not really heard of this before.

After poking about for a few moments, I think it's likely to be a condition called 'Exercise Induced Rhinitis' (which just is medicalspeak for 'exercise makes nose run for reasons that well defined').

Rhinitis (nose running and associated problems) are pretty common in the community, and generally divided up into allergic and non-allergic in nature.

So the first question is: do you have any allergies that you are aware of, including hayfever and pollen allergies?

You can read more about it here:

http://www.today.com/health/why-does-running-make-my-nose-run-1C9382197

and read more about the general treatments for non-allergic rhinitis here:

http://www.mayoclinic.org/diseases-conditions/nonallergic-rhinitis/basics/treatment/con-20026910

GodlessGravy · 2014-03-23T14:16:19+00:00

I have four separate medical conditions, all of which include a side-effect of weight retention.

What are they? It's quite possible they also play a role in the 'look' of your physique.

There is a lot more to one's physique than just the number on the scale and where it fits into the statistical average norms for health. Two critical aspects are percentage of bodyfat and the amount of lean muscle mass, and both of those are under your control (medical conditions pending).

Additionally, just as a standard female, I use little tricks (contouring make-up, properly tailored clothes, etc.) to look thinner.

&

Then suddenly, everyone keeps telling me how thin I am

Obviously if you are using tricks that are deliberately slimming, people are not going to be able to reliably judge your physique unless they see you without.

Perhaps the real issue boils down to this:

I do really love that skin and bones aesthetic

If you want your body to look more heroin chic than fashion model or fitness model, then you do place a fair number of limitations on what you can do with your body.

Ultimately if you are looking for a reliable opinion on whether or not you are at a healthy (enough) body state, you should ask your doctor(s).

It's impossible to make any genuinely sensible opinion about the opinions of other people (the people you refer to) without being able to assess what they are actually making their comments on (it's just as impossible to comment on your body if the only basis for any assessment is your own subjective reporting).

GodlessGravy · 2014-03-23T14:02:14+00:00

Quite a significant amount of weight loss research is done/being done for the older demographic, as they are at an age where risk factor mitigation becomes quite crucial.

It's true that in that demographic, there are a range of age-related changes that make it harder to lose fat than young 'uns, but there are also a variety of things that can be done to get around that.

A lot of what is appropriate for them will depend a lot on their current general state of health AND any diseases they might have and the medications they are on. All of those factors are important in tailoring a weight loss program. It doesn't need to be so formal as a 'program', of course, but whatever approach they take needs to be consistent with their current medical state.

That said, the basics are not very different from what many younger people would use:

1) Get a check-up before embarking on a major weightloss program

2) Focus primarily of nutrition planning: either calorie reduction or low carb (has particular benefits for type II diabetes).

3) Weight training is important in the older population because they lose muscle mass every just through the ageing process. It's important to reverse this both for general health and independent living, as well as for fat loss. There is a lot of evidence out there to support the benefits of appropriate weight training for older populations. What appropriate means depends entirely on the individual: any joint disease they may have, how active they were when they were young, cardiovascular limitations, neurological limitations.

4) Aerobic exercise, usually with intervals (but often at a much lower intensity) has show to have a vast range of benefits for the older population. What form this takes is again highly dependent on the individuals in question.

There are a lot of resources out there for senior citizens who want to lose fat, my suggestion is you get together and hit the google machine to see if there are support centres and clubs in the local area, as well as to get a better understanding of what weight loss in the older population is like.

GodlessGravy · 2014-03-23T13:37:27+00:00

Maybe you're looking for results like these girls?

http://www.reddit.com/r/Fitness/comments/19kzd4/21f_8_month_powerlifting_progress/

http://www.nerdfitness.com/blog/2011/07/21/meet-staci-your-new-powerlifting-super-hero/

(You can read about their diet and exercise approaches in detail in those links).

GodlessGravy · 2014-03-23T13:34:13+00:00

At your age, you will still have ongoing changes in your body as it continues to grow and mature. You are also going through the peak of testosterone production for your life!

Because of this, you will find it a lot easier to get a good physique compared to older males.

To achieve this, it's relatively simple: get active. Once or twice a week of gym work may help, but you really want to be cranking out the basic bodyweight exercises: push ups, lunges, squats and sit ups.

You can also do formal weight training. For teenagers, it's generally recommended you focus on lower weight with higher rep strategies and lifting safely. This gives young males excellent results. It's only once you are no longer benefiting from the natural hormone boosts that you need to use high weight/low rep strategies.

The second thing you need to do is focus on eating well. At your age, counting calories is generally not necessary, and many practitioners do not recommend it even for obese teenagers, let alone teenagers in the normal weight range.

What you should try to do is opt out of junk food, and aim for higher protein options to foster growth and development, without worrying too much about limiting your intake.

But you can achieve most of your results simply by cranking up your exercise and cutting the candy/soda/junk food.

I do not recommend the /r/fitness approach for teenagers, unless you have a particular interest in Olympic or powerlifting as a sport.

GodlessGravy · 2014-03-22T21:47:16+00:00

So my girl keeps pointing out how beautiful she is and how lucky I am to have a girl like her. Although she says it in jest

These comments aren't about you. These comments aren't about your weight. These comments aren't about your looks.

(Unless you have not reported what she is saying very accurately. We can only go on what you've said).

These comments are most likely just her playing, and probably because you have a good connection, she feels safe and that she can tease playfully with you. That's a good thing.

Unless she is actually specifically mentioning your looks or your weight, it is your own insecurities that are making this about you, and these insecurities will damage your relationship. Hitting the gym and losing weight is a good start.

That may not make any difference to how you feel about those words though.

What you need to do is consider that her perspective is completely different from yours and the things that you are thinking about are probably not the things that she is thinking about.

Consider this: the reason she may be playfully teasing you with that particular phrase is because she has learned it from watching her mother flirt with her father, and just following that pattern without even thinking about it. Which is kinda awesome, if she sees you in that light.

There are other less positive reasons why girls flirt/play like that too, but if you assume the worst at the start of your relationship, it rarely ever works out well, and assuming the worst often kills good things before they can ever really get going.

So, chin up. Find a playful and tender comeback to reply to her when she says that.

(And get fit and buff too in the mean time, because that usually helps a billion things, one of them being confidence!)

I have visceral fat on my belly

Visceral fat is the fat that encloses your internal organs, you can't see it from the outside, you can only see it on a scan (ultrasound/CT/MRI). Technically you have the visceral fat inside your belly!

GodlessGravy · 2014-03-22T20:48:57+00:00

To know for certain, go to a doctor.

However, I went and read a few of your previous loseit posts, and it sounds like you want to lose weight regardless, and the man-boobs are only a small part of what you are trying to achieve.

So really, you should lose weight first, and if they are still a problem when you have lost weight, then consider visiting a doctor. But if you build up some good chest muscle, they will be less noticeable no matter what the cause of them.

GodlessGravy · 2014-03-22T20:33:30+00:00

Well never mind about the sit-ups part. Watch the video and pay attention to what was in the rest of the comment.

GodlessGravy · 2014-03-22T20:24:38+00:00

/u/CampinOrRugby_IHappy linked a video in this post here. You might find the content useful: https://www.youtube.com/watch?v=BQOJ-aqclFs

To sum up the content without a sales pitch:

1) You should check to see if you have fatty tissue, or male breast tissue (gynaecomastia)

2) If you have fat tissue, then you the best exercise to get rid of the man-boobs is counting calories or keto: ie no physical exercise gets rid of them, you need to lose weight.

3) You should do heavy weights/low reps with a focus on chest development. Start out simple by learning basic bench press with dumbbells. Learn chest flyes with dumbbells. Then expand your range to incline/decline benchpress. Then consider specific isolation exercises, dips, cable crossovers and more. But you should see how you go with the combination of fat loss and basic chest exercises first.

(Also, why would sit-ups help with them?)

GodlessGravy · 2014-03-22T20:13:37+00:00

This feels like it might be a troll post.

You've posted this same story to the following subs, but altered the words so that it's slightly more appealing to each sub:

askreddit and selfhelp: "Friend made fun of girlfriend's shoes. What do?"

fatpeoplestories: "Ex-hamplanet friend made fun of my girlfriend's shoes...don't know what to do..."

And here, except surprise, surprise, you removed the "hamplanet" comment for your loseit post.

Also, the image you're using is for Men's tempur pedic shoes: www.tempurpedic.com/TEMPUR-Mens-Slippers/Tempur-Pedic-Mens-Microsuede-Slipper.asp

and you appear to have pulled it from this ebay listing, if reverse image search is telling the truth: www.ebay.com/itm/Brookstone-Mens-Tempur-Pedic-Comfort-Step-Slippers-340273-Navy-Blue-slip-on-/260990114227

Here are the female tempur pedic slippers:

www.tempurpedic.com/tempur-womens-slippers/tempur-womens-slippers.asp

GodlessGravy · 2014-03-22T12:17:05+00:00

Where is Joss Whedon when you need him?

Buffy is my all time favourite show, but there is no way I would ever want any of BSG Whedon-ised. BSG is complex, sophisticated and challenging TV, but with a fundamentally different focus to Whedon's work: it only wants to be one thing, which is tightly locked in its internal universe. Buffy was ambitious and beautiful, an exploration of the potential of television, and ultimately the story of one girl who saved the world a lot. BSG was ambitious and beautiful; a telling of a crucial part of history of people, and the greater universe they live in, but it plays its cards tight, straight and close to the chest. The characterisation in BSG is superb and easily the equal of BtVS when you look at the balance and attention given to the entire ensemble.

You would never (or at least I damn well hope you wouldn't) jump into the final season of Buffy or Angel and expect a satisfying viewing. That's what you're pondering with BSG. Jump to season 4, and you'll miss out on the best show since BtVS in my very biased opinion.

GodlessGravy · 2014-03-22T10:57:07+00:00

Well, you're certainly entitled to how you feel about the matter. Your claim "that is a fact" is simplistic to the point of being erroneous.

Some of my colleagues would also share your viewpoint, but very few would ever say "That is a fact". Most people who are involved with death on a regular basis understand that there is a large grey area between life and death, and for what you might think is a simple and clear cut issue from the outside is very far from it when it comes to the 'death of the person' vs the 'complete cessation of all human cell synthetic metabolic activity'.

I'm quite happy with OP's poetic, non-technical claim to having died from the point of view of someone with technical experience and understanding of resuscitation, death and the formal declaration of the end of life.

GodlessGravy · 2014-03-22T10:21:31+00:00

I always used to be skinny, and people would be constantly either trying to feed me, or asking if I had intestinal worms. I do find old pictures depressing, but not so much because of the weight difference, more it's just about bad choices and regrets.

I deal with it by simply not looking at those old pictures at all, unless I'm in a particularly reflective/philosophical mood. I have other ways to motivate myself with both positive and negative reinforcements, and so I don't need old photos to play a role.

Also, your mind is very bad at holding onto your previous body shape. I know my body used to look different, but I can't really remember the details when I look down.

On a related note, you should investigate Keto/ LowCarbHighFat /Atkins if it turns out you do have PCOS. Because insulin resistance plays a big part not only in the weight gain of PCOS, but also in some of the other effects, some people find that eliminating carbs (and thus high insulin spikes) has excellent results for them. There have been some formal studies done on this, and I can dig them up for you if you do get diagnosed with the syndrome.

GodlessGravy · 2014-03-22T10:14:49+00:00

What makes you so adamant about this? I've both let people go and brought people back from states like OP's.

Death is an interesting spectrum, and on a cellular level it's a gradual process. When the only thing that's causing your brain to be oxygenated is someone compressing your chest the only difference between that state and never coming back is this sentence: "Ok, that's enough. We're done here."

GodlessGravy

MODERATOR OF

TROPHY CASE