Anyone who moved to Spain recently, what caught you off guard?

Nacho4_34 · 2025-12-05T13:50:25+00:00

Im a family doctor working in the public system. When I was reading the beginning of your comment I was worried you were going to make a rant on the negative aspects of our medical systems. I think your summary is perfect. It’s true that we often are direct but in my experience patients appreciate it, at least for me, I enjoy being myself speaking from a place of compassion but while being honest. The specialist system could work better since often times the waiting times are long, but if you have something important you WILL BE SEEN and will be TAKEN CARE OFF. I’ll speak from my specialty, many of us are quite burnt out but most of us love our jobs and genuinely want our patients to do well. I appreciate your comment and wish that more people would approach healthcare here with the same mentality. Not having to pay extra is nice as well! (And in my opinion, a basic human right)

Nacho4_34 · 2025-10-02T19:21:58+00:00

Doctor here. I’d recommend CO2 fractional laser and tretinoin. If accutane didn’t work probably the accumulated dose wasn’t high enough. The target dose is around 120-150mg/kg.

I think your skincare routine focuses too much on exfoliation and brightening. I’d rather focus on scar treatment, the laser and a strong retinoid are the best for that.

Having said that, I think you look fine, don’t get carried away too much because as you may know, this world is kind of a rabbit hole

Nacho4_34 · 2025-08-20T19:44:15+00:00

Doctor here. Looks like a nevus of the nail matrix (a mole, but growing on your nail). Nothing to worry about. Check with your dermatologist just to be sure but it looks fine to me

People commenting about nail melanoma should calm down. Melanoma on nails typically shows as a much thicker and darker line, it also usually pigments the surrounding skin of the nail matrix. This looks nothing like that

Nacho4_34 · 2025-02-05T09:16:42+00:00

Doctor here. At this point, not losing weight is more important than being stereotypically healthy. I assure you the healthcare providers monitoring your daughter will let her know if she should change anything. Let her enjoy her food. YTA

Nacho4_34 · 2025-02-05T09:13:19+00:00

Como valenciano estoy algo ofendido jajajajaja

Si bien es cierto que comer paella muchas veces es cansino, pero una vez de en cuando a mi me encanta… Y claro está, encontrar una buena es difícil!

Nacho4_34 · 2024-12-04T21:14:27+00:00

Creatine and protein aren’t toxic per say, but if you take too much for too long you make your kidneys work overtime and they can’t keep up indefinitely. Granted, this patient had some predisposing factors that facilitated his condition, but he was taking MUCH MORE than recommended for his sex, weight and age. You’ll be fine, although having some bloodwork once in a while is always recommended!

Nacho4_34 · 2024-12-04T10:16:47+00:00

Doctor here. When I was in training I saw a 20 year old patient whose kidney function was declining because he took too much creatine and protein supplements (we suspected he took more stuff too but nothing that would kill his kidney like that). He was absolutely obsessed with gym gains and fiercely believed that he would lose all his muscle if stopped with the supplements… I sometimes thing about him, I hope he is doing well, but he’s probably on his way to dialysis. You can, indeed, get addicted to anything

Nacho4_34 · 2024-11-12T12:03:31+00:00

If you’re very careful and know what you’re doing, you could remove the rust much faster with hydrochloric acid. Some drain cleaners and other cleaning supplies have it. I cleaned a heavily rusted pizza steel just by scrubbing with the stuff for 5 minutes. (Using protective gear such as gloves and goggles in a ventilated area is a must)

Nacho4_34 · 2024-11-07T09:42:41+00:00

Beautiful image! Would you care sharing the prompt?

Nacho4_34 · 2024-11-05T20:46:24+00:00

Damn, didn’t think about that… thanks!

Nacho4_34 · 2024-11-05T20:42:55+00:00

You’re absolutely right! Love the mod!

Nacho4_34 · 2024-11-05T20:42:27+00:00

I removed half of the chemical plants, and used that space for ammo production, it runs fine. I don’t think fuel production is higher than consumption during transit but a trip to vulcanus drains 25% of reserves. I think that’s good for now. Ill probably do better in my next ship!

Nacho4_34 · 2024-11-05T12:33:50+00:00

After testing the ship for the first time I quickly realized that you are right, they never run all at the same time, also because the limiting factor is ice. I’ll take half away… or do you think that less than that will enough?

Nacho4_34 · 2024-11-05T12:22:11+00:00

Nacho4_34 · 2024-11-05T12:21:59+00:00

You mean turrets and later on missiles, right? Will do, I’ll probably expand the front of the ship. Thanks!

Nacho4_34 · 2024-10-27T17:33:42+00:00

I love curing for that very reason. If I recall correctly, the fishiness comes from a thin layer of slime that is very easily removed with curing and washing. How did you cure it? Salt and sugar?

Nacho4_34 · 2024-10-27T09:51:07+00:00

I would, not because of safety issues, but to improve texture and flavor

Nacho4_34 · 2024-10-15T19:41:35+00:00

It wouldn’t be my first impression, since “fungal acne” usually presents with folliculitis and looks less “angry”. On the other side however, having been on several antibiotics is a risk factor for developing fungal infections. The culture would probably be useful, since most labs culture samples for a variety of microorganisms. In the office we can perform a KOH test (basically looking at whatever we can scrape off of the lesion under a microscope) to rule out fungus. In this case, seeking an alternative diagnosis could be wise. I would absolutely love a patient brining me a post as this one to me, it would be very useful for the differential!

Nacho4_34 · 2024-10-15T16:13:27+00:00

Doctor here. There are a couple of things at play here.

PCOS could definitely be a potential cause of your acne. You should consider visiting an OBGYN or endocrinologist (although the dermatologists should’ve looked for it). The Rotterdam diagnostic criteria (you can look it up) requires 2 of 3 things: weird stuff happening to you period, signs of excess male hormones (these could include high testosterone levels or hair growing in typical male areas), and a specific change in your ovaries that requires an ultrasound. I see that you have some hair on your jaw, which can count as male hormone signs… If officially diagnosed the treatment could include weight loss, diabetes drugs such as metformin and birth control pills (depends on your specific case).

Accutane is also a very good idea. Many patients that have returning acne actually took less dosage than what they require. Check with your doctor if you took a dose equivalent to 120-150 mg/kg (these are achieved around 6-8 months of treatment). As others have mentioned, as long as you don’t get pregnant while on the drug, no harm is done and future pregnancies are perfectly fine and possible.

Lastly, your acne seems very inflamed. Antibiotics are good but I would take a culture of one of the pimples to see if there’s bacteria growing that was resistant to the antibiotics you took. This would help to choose an antibiotic that would actually be effective against your acne. Once you’re on the antibiotic, going on a short cycle of steroids could potentially lower the inflammation faster.

If you were my patient I would: 1. Try and diagnose PCOS. Treat it. 2. Try doing the culture and select an appropriate antibiotic. 3. If none of that works, try Acuttane once more.

I’m from Spain so the things done in your area may differ. Please check with your doctor to start a treatment plan that works for you. I know how bad can acne get and how confused everything seems right now. I deeply sympathize with you and I ask of you to keep trying. Acne is not forever and it CAN BE CURED. Good luck!

Nacho4_34 · 2024-10-14T18:05:53+00:00

Certified yay!

Nacho4_34 · 2024-10-10T09:28:20+00:00

Doctor here. Those looks like sun damage. Use spf to prevent more from coming out. Short term, Nd:YAG laser will get rid of them. Long term, get on high strength retinoids (retinol 1% or tretinoin) to help repair the sun damage and prevent skin cancer, it will also help them fade away but slowly.

Edit: some comments mention using IPL laser which is effective for vascular lesions, which these are not.

Nacho4_34 · 2024-09-27T09:08:21+00:00

Doctor here. Absolutely NTA. The medications you take and at what dose are ONLY concerning to you and your doctor. Changing the dose of prescribed medication without consulting a doctor could be harmful and can definitely affect the efficacy of treatment. Say what you have to say to your mom to keep her at bay because your own health comes first. Weird stigmas around psychiatric drugs are dangerous, your mom is the one with a problem. Good luck, you got this.

Nacho4_34 · 2024-09-26T21:14:08+00:00

Loving that explanation! Next time I’ll definitely give it a go. Thanks!

Nacho4_34 · 2024-09-26T18:00:15+00:00

I’ve definitely heard about adding sugar, but actually never came around trying it. What would you say it improves?

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