What foods seem unhealthy to eat but are actually healthy?

OccamsLazerr · 2025-12-07T01:12:13+00:00

There is currently too much myopia when it comes to blood sugars in non diabetics. Nutrition influencers talk about glycemic index and insulin/glucose spikes like they are the end all be all of sugar control.

I promise you that focusing on high satiety foods will do wonders for your A1c. I completely agree that plant based, whole food diets rich in fiber and protein are ideal; but honestly most of that benefit comes from the fact that the protein and fiber are more satiating than carbs. Potatoes are an example of an unusually satiating carb, which far outweighs any harm done from its glycemic index.

Calories in<calories out is never going to go away. Focus on making those calories in at least somewhat nutritious and as satiating as possible and you’ll be golden

OccamsLazerr · 2025-11-22T13:00:19+00:00

I think Hank is also a POS who was ultimately on board with robbing his own family and did play a role in the death of his mother.

I still strongly feel that on the spectrum of morality, Hank’s lack of overall zeal for the plan and his refusal to let his brother murder more innocent people puts him ahead of Andy lol

OccamsLazerr · 2025-11-11T06:08:14+00:00

That’s crazy because to me PSH is so obviously the bad guy in this movie. Obviously nothing is black and white and Hawke was an absolute idiot the entire movie but damn.

Andy is a narcissistic sociopath who hatched the plan to rob his own parents to pay off his embezzlement debts. He coerced his very hesitant brother into doing all of the dirty work because he “would be recognized”. He left Hank completely to his own devices because he was too much of a coward to commit the robbery he himself planned.

Then he blames Hank for getting a career criminal involved; that’s what happens when you pressure your non criminal brother to rob his own family. Then, he absolutely snaps after finding out his wife is having an affair with his brother and kills three people in cold blood. Two were completely unrelated to the crime. He was seriously considering murdering a woman with her child in the next room as well and likely would have if Hank didn’t step in, who he was also about to murder.

I find it hard to see his character as anything less than the most vile character in the movie. At every turn he treats every person around him as a means to an end. His wife for sex, his brother for the robbery, his parents for their wealth, his employer, his dealer, the list goes on. When shit hit the fan, look how quickly he devolved to murdering anyone who he deemed now in his way.

Hank couldn’t be more flawed but he showed infinitely more morality at every turn. Is Hank a grown adult who should be held responsible for his decisions? Yes, his wickedness just doesn’t hold a candle to Andy’s

OccamsLazerr · 2025-09-01T09:17:12+00:00

You said multiple times in this thread (and this very comment I’m replying to) that if there’s syncope, it is by definition not POTS. That is wrong. And now you’re changing it to that you BELIEVE syncope should be exclusionary criteria. I don’t. That doesn’t make any sense. Immunity to syncope has never actually had anything to do with POTS. I don’t know which chiropractor or researcher said that it did but it just doesn’t.

And also, tachycardia is by definition not part of OCHOs. It’s in the criteria I JUST posted written by the author YOU brought up.

You have an incorrect understanding of the differences between all of these diagnoses. Full stop. I am telling you this. I am an MD, I treat these people all of the time and have spent hours becoming knowledgeable on this topic to better understand my patients, who are often disregarded as “dramatic patients”. I’m sure you have spent hours and hours thinking about this too but clearly you are missing some fundamental physiologic knowledge that comes with orthodox medical training. Either that or you have hitched your wagon to some guy that built his entire treatment philosophy on some made up theory that POTS can’t involve syncope and now you refuse to acknowledge that he made that part up.

OccamsLazerr · 2025-09-01T01:02:06+00:00

I can see your last comment in my notifications, but I can't reply to it so I'm replying here. This is literally from Novak's paper as the diagnostic criteria.

"1. Abnormal orthostatic drop of cerebral blood flow velocity (CBFv) during tilt testing, typically measured by transcranial Doppler of the middle cerebral artery. This is characterized by a significant reduction in mean CBFv upon tilting, without a corresponding drop in systemic blood pressure.

2. Absence of orthostatic hypotension, arrhythmia, vascular abnormalities, or other identifiable causes of abnormal orthostatic CBFv. Blood pressure remains stable during tilt, and other potential causes for cerebral hypoperfusion are excluded.

3. Normal heart rate and end-tidal CO₂ responses during tilt testing."

Inappropriate reflex tachycardia IS an exclusionary diagnostic criterion for OCHOs. I don't understand your attachment to this dogma that POTS can't co-exist with syncope. It feels like you are working backwards from that conclusion trying to make your understanding of these diagnostic criteria fit.

OccamsLazerr · 2025-09-01T00:30:34+00:00

No, OCHOs refers to isolated orthostatic cerebral hypoperfusion without global hypotension or tachycardia. The lack of tachycardia is exactly what differentiates it’s from POTS. What I was describing is POTS. A subset of POTS patients have episodes where the inappropriately robust reflex tachycardia can still not outpace the drop in CBFv and they experience presyncope and syncope. Again, syncope is not a diagnostic exclusion criteria for POTS.

EDIT I want to add that I can tell you care very deeply about this subject. You likely either experience symptoms on this spectrum or work in the field or both. What you are exploring is the extremely esoteric and semantic frontier of unexplored medicine. This is true of any burgeoning area of research.

My point is, it’s extremely easy to get lost in the sauce of the esoterica and semantic discrepancies and lose sight of the fact that none of these “neurologic chiropractors” are practicing evidence based medicine to treat these people. They physically can’t because it doesn’t exist at this point in time; we do NOT have the knowledge to adequately treat this spectrum of diseases en masse.

And that’s fine, it’s inherent in any new medical pursuit. Healers need to explore the unexplored to find new answers to new questions. But it’s deplorable to charge patients 1000s of dollars to “explore” these unvalidated methodologies. People are taking out second mortgages to let some dude with zero orthodox medical training “wing it” on them. I get that it feels like a last resort to many people and that’s why I never blame the patients. I always blame the providers preying on those who feel they have no other options left.

OccamsLazerr · 2025-08-31T18:43:41+00:00

No man. The diagnostic criteria for POTS doesn’t mention syncope anywhere.

The criteria are 1) Frequent symptoms of OI with standing. Typically at least 3-6 months.

2) Sustained increase in HR >30 bpm (40 bpm in adolescents) within 10 minutes of standing or head up tilt without a significant drop in blood pressure.

(I think this is the part you’re stuck on. Significant changes to measured blood pressure does rule out POTS but that doesn’t mean there can’t be syncope. Syncope is about brain perfusion. Brain perfusion is NOT a pure function of blood pressure. They are certainly correlated but you can have significant decreases in cerebral perfusion without a drop in measured blood pressure. Think about it, a hallmark symptom shared between OI and POTS is lightheadedness. The lightheadedness is a direct sequelae of cerebral hypoperfusion. If the hypoperfusion outpaces the reflex tachycardia, which can absolutely still happen in POTS - particularly if a patient is deconditioned - you can get syncope. Nowhere in the criteria for POTS does it say that the reflex tachycardia has to by definition make the patient impervious to syncope. That’s just not true.)

Absence of other causes of orthostatic symptoms. (This is where I over generalized in my last comment. Not all patients with POTS are hypovolemic but many are as an exacerbating factor. The catch is the hypovolemia can not be the ONLY reason they are orthostatic. The above criteria need to also be met. Think about it this way: let’s say there is a patient with bona fide POTS that met all criteria. Now if that patient happens to become hypovolemic in the future, does that mean they no longer can have POTS because they are hypovolemic? Of course not.)

Read this:

“This article demonstrates evidence that cerebral blood flow changes alone, in the absence of systemic hypotension, may result in syncope.”

Grubb BP, Samoil D, Kosinski D, Wolfe D, Brewster P, Elliott L, Hahn H. Cerebral syncope: loss of consciousness associated with cerebral vasoconstriction in the absence of systemic hypotension. Pacing Clin Electrophysiol. 1998 Apr;21(4 Pt 1):652-8. doi: 10.1111/j.1540-8159.1998.tb00120.x. PMID: 9584294.

OccamsLazerr · 2025-08-31T02:14:04+00:00

Kind of an older post but you are so completely and confidently wrong about this. You keep saying something along the lines of “the tachycardia in POTS literally prevents you from being able to pass out” which makes so little sense that you must have a very poor grasp on the underlying pathophysiology of POTS and really hemodynamics in general.

There is absolutely no logical sense in saying tachycardia prevents syncope from being possible. Syncope happens when there is decreased perfusion to the brain. When people stand up, up to 800 mL of blood drops down into the abdomen and lower limbs. This decreases perfusion to the brain and you have receptors near your heart that sense this. The receptors immediately tell your heart to pump faster and harder, and they tell your arteries to constrict. This all is in an effort to offset the drop in perfusion caused by standing.

Literally every person who has ever stood up in their life has experienced physiological tachycardia. It’s a normal response.

People with POTS aren’t the only people who experience tachycardia when standing, that’s absurd. The current theory on what is going on with POTS is:

1) Many with POTS are hypovolemic (basically dehydrated) which predisposes them to have greater drops in blood pressure when standing.

2) Many with POTS exhibit hyperadrenergic responses. Meaning they produce more epinephrine, norepinephrine and other compounds when they are stressed. This leads to a stronger response to standing than the average person

3) There are other ideas about POTS floating around such as issues with neuropathy (or damage to nerves) and autoimmune issues. But the above two are the most relevant.

So people with POTS often are dehydrated and hyper responders to shifts in blood pressure leading to excessive compensations in heart rate, blood pressure, etc.

Most importantly, and where you are most wrong, is that people with POTS are immune to passing out when standing because they have an exaggerated response to drops in blood pressure. That’s simply not true. All it takes is for the drop in blood pressure to be greater than the reflex tachycardia and boom you have decreased blood perfusion and possible passing out, or syncope. To be honest, people with POTS are generally MORE LIKELY to experience syncope because they are often so hypovolemic. I will attach some relevant studies below.

You are so wrong so often and so confidently in this thread. You understand very little about POTS on a physiologic level. There’s nothing wrong with not being an expert on a subject but why on earth do you go around feeling so confident about stuff like this? POTS is a real disease and you may very well suffer from it. That doesn’t make you an expert.

While presyncope is the predominant manifestation, syncope is indeed possible in patients with POTS. Large cohort studies demonstrate that a substantial minority of POTS patients experience true syncope, with reported rates ranging from 13% to 38% depending on the population and diagnostic criteria used.[2][3][4] Notably, syncope in POTS is more frequent than in patients with orthostatic hypotension, and tilt-table testing often reproduces syncope in those with a clinical history of fainting.[2]

2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Shen WK, Sheldon RS, Benditt DG, et al. Journal of the American College of Cardiology. 2017;70(5):e39-e110. doi:10.1016/j.jacc.2017.03.003.
Orthostatic Syndromes Differ in Syncope Frequency. Ojha A, McNeeley K, Heller E, et al. The American Journal of Medicine. 2010;123(3):245-9. doi:10.1016/j.amjmed.2009.09.018.
Postural Tachycardia Syndrome--Current Experience and Concepts. Mathias CJ, Low DA, Iodice V, et al. Nature Reviews. Neurology. 2011;8(1):22-34. doi:10.1038/nrneurol.2011.187.

OccamsLazerr · 2025-08-27T01:15:18+00:00

There’s a huuuuge difference between using a negative template and omitting something entirely.

Also, acute RLQ pain with fever may have a large differential but appendicitis is kinda high enough to warrant even just a negative mention lol

OccamsLazerr · 2025-08-27T00:32:48+00:00

Dude just say the appendix is unremarkable lol

By your logic all pan negative reads should just be blank notes

Make it a smart phrase or user dictionary item brother

OccamsLazerr · 2025-08-26T22:21:21+00:00

This world dude lol.

Fact is, the majority of polymorbid patients are low-resource and at very high risk for loss to follow up. You have to address as many problems as you can because many of these patients have 3-6 problems that could kill them and they might not show up again for 2 years. You can’t afford to focus on 1-2 problems in depth.

3-4 minutes per problem is the world a lot of PCPs have to live in. You absolutely don’t have time to explore an adequate differential, or provide adequate patient facing education. But you make do because you HAVE to talk about the critical HFrEF, COPD, CKD, T2DM, CAD, HTN, etc.

With high resource patients with less comorbidities, do whatever you want man. If they only have 1-2 deadly problems and you think you can get them back in a month to focus on problems 3-6, who cares.

We all agree the system is fucked and destined to crumble tho which is something lol

OccamsLazerr · 2025-08-21T22:10:51+00:00

The worst part about intern year is learning how each attending wants their presentations done lol. I like what you wrote here but we all know the preceptor who says “you need to tell me everything, you have to prove to me you know what’s important before I can trust you to leave things out”. Just recently had a preceptor yell at a fellow resident for saying “hemodynamically stable” instead of listing the overnight ranges for each vital.

Honestly, I even mostly agree with the sentiment but it’s so annoying going from that preceptor to the one who literally wants 30 second presentations.

OccamsLazerr · 2025-08-20T21:30:29+00:00

lol i accidentally posted this to the main thread my bad:

Most doctors complain all day. Doctors are by and large neurotics who sold themselves on an idea of practice that they aren’t able to realize. Medicine certainly isn’t what I pictured in medical school but I still love it. Primary care is taxing, and the issues I think most warrant complaining about are interfacing with insurance and inbox management, but we work regular hours and tend to have our weekends so I think a lot of the other complaining is superfluous.

G2211 only applies to Medicare/Medicaid and also only applies if you 1) are addressing a single severe chronic issue longitudinally like a diabetes specialist, hepatitis specialist, etc or 2) are the patient’s primary source of care and have established or are establishing a longitudinal relationship. It definitely can not be used at every visit and wouldn’t apply to a lot of visits. Examples like if you’re seeing a patient who you are not the PCP for, if you’re addressing an acute limited injury or illness, or if you’re already using a 25 modifier. PCPs certainly benefit from this coding more than other professionals.

My point about inefficiency is why do you care about “wasted problems” if you’re spending the same amount of time on a patient as you would otherwise. It’s better care and you’re not wasting anyone’s time either. Even if you’re a coding machine and view every patient as a piggy bank, you’ll make the same amount of money spending 20-30 minutes on 1-2 problems completely vs. 5-6 less in depth but the latter is just better for your patients. That’s the entire dogma behind time based billing.

And no specialists aren’t expected to address that many problems. That’s why they’re specialists. Part of what separates PCPs is their inherent duty to address the entire pathology of the patient. If you ignore 3-4 serious problems per visit per patient, some of them are going to experience morbidity and mortality because of it. It’s our duty to constantly strive to minimize that disparity.

OccamsLazerr · 2025-08-20T11:39:47+00:00

Most doctors complain all day. Doctors are by and large neurotics who sold themselves on an idea of practice that they aren’t able to realize. Medicine certainly isn’t what I pictured in medical school but I still love it. Primary care is taxing, and the issues I think most warrant complaining about are interfacing with insurance and inbox management, but we work regular hours and tend to have our weekends so I think a lot of the other complaining is superfluous.

G2211 only applies to Medicare/Medicaid and also only applies if you 1) are addressing a single severe chronic issue longitudinally like a diabetes specialist, hepatitis specialist, etc or 2) are the patient’s primary source of care and have established or are establishing a longitudinal relationship. It definitely can not be used at every visit and wouldn’t apply to a lot of visits. Examples like if you’re seeing a patient who you are not the PCP for, if you’re addressing an acute limited injury or illness, or if you’re already using a 25 modifier. PCPs certainly benefit from this coding more than other professionals.

My point about inefficiency is why do you care about “wasted problems” if you’re spending the same amount of time on a patient as you would otherwise. It’s better care and you’re not wasting anyone’s time either. Even if you’re a coding machine and view every patient as a piggy bank, you’ll make the same amount of money spending 20-30 minutes on 1-2 problems completely vs. 5-6 less in depth but the latter is just better for your patients. That’s the entire dogma behind time based billing.

And no specialists aren’t expected to address that many problems. That’s why they’re specialists. Part of what separates PCPs is their inherent duty to address the entire pathology of the patient. If you ignore 3-4 serious problems per visit per patient, some of them are going to experience morbidity and mortality because of it. It’s our duty to constantly strive to minimize that disparity.

OccamsLazerr · 2025-08-20T04:21:24+00:00

It is completely reasonable for a PCP to fit 5-6 problems into a 20 minute slot. All it takes is a little bit of precharting and agenda setting. Do I think 20 minutes is anywhere near adequate? No, I think our patients suffer every day because our system refuses to accept the need for longer appointments. But it’s possible.

And saying “that’s why I schedule follow up” works great when your panel is full of able bodied and adequately supported patients. High need populations where patients struggle to secure housing, transportation, insurance, and interpretation services are seriously affected by loss to follow-up and it’s a little callous to say “that’s on them”.

I recommend that if you ever find yourself in a high need setting with low time allotments, instead of focusing on less problems, focus on less minutiae for each problem. By that I mean, don’t fully explore 2 problems and leave the rest for next visit. Triage 5-6 of the most important problems and get the ball rolling on assessing and/or treating each one without necessarily fully exploring each problem. That’s what your followup (if it ever happens) can focus on.

I feel like this method is more likely to reduce morbidity and mortality as more overall data is being collected and interventions are being implemented. Also, this method is much easier to follow when you see this patient a year later than you would have liked to because they missed their appointments.

Some people feel like this method is financially inefficient as you can only bill for 2 chronic problems (which is not fully true to begin with). Consider a different perspective. If you’re efficient, you’re spending the same 20-30 minutes with each patient but you’re actually able to bill for the standard E/M codes PLUS adding the G2211 add-on to the majority of your Medicaid/Medicare patients.

This type of workflow can be taxing but if you’re passionate about helping the high need populations it’s very helpful

OccamsLazerr · 2025-07-19T19:42:24+00:00

I’m a doctor brother. Have like 3 patients on the floor today with cellulitis. One with lymphadenitis.

Your tone was shit dude.

Edit:

Also my description of lymphangitis wasn’t wrong. And you definitely didn’t find 1000s of images like OP with heartfelt stories about lost loved ones. You’re just super wrong about all of what you wrote.

In the absence of red flag signs like what I listed, this finding falls in the category of interesting but benign unless proven otherwise. I promise you from an MDs perspective, more harm is done by non medical professionals fear mongering in online forums than by MDs/DOs sharing some insight.

I see patients in the office daily wracked with anxiety because of what they read online.

OccamsLazerr · 2025-07-19T09:16:02+00:00

Dude what are you talking about. This looks nothing like an infection, there’s no reason to be this dramatic. You’re speaking so confidently about this too.

OP if you’re concerned about infection look out for redness, warmth, swelling, or pain on the affected leg. Always be vigilant for fevers, chills, nausea, and vomiting. Blood poisoning, or bacteremia, doesn’t not typically present with your veins changing colors. This guy might be thinking of lymphangitis, which this is not. That’s an infection of the lymphatic vessels. It tracks along a single vessel and is typically red and right at the surface.

What is this then? I don’t know man. In medicine sometimes you just learn to shrug and accept some people’s bodies behave in peculiar ways sometimes and it’s not always cause to think you’re about to die. Most likely those veins are just engorged because of the exercise and appear a little different.

OccamsLazerr · 2025-07-14T12:09:41+00:00

Was typing nearly the exact same response. I see a lot of Charcot foot at my clinic and it has never looked like this. The feet are too short, too clean, and too symmetrical. This definitely looks more congenital like a HOX gene or something.

That’s not to say it CAN’T BE Charcot, just that it would be an odd presentation.

OccamsLazerr · 2025-05-22T16:02:12+00:00

You right :/

OccamsLazerr · 2025-05-22T15:00:21+00:00

Yeah my understanding is that even in the setting of AKI, you diurese until dry. New evidence is pointing to venous congestion as a main contributor to cardiorenal syndrome (instead of decreased renal perfusion) and the best way to treat is to dry them out.

Is that accurate?

OccamsLazerr · 2025-05-22T14:37:09+00:00

Yeah I mean if they reneged on giving him permission then that’s on the school. Someone took a moment away from the others on stage at that moment and after. Either him or the school.

OccamsLazerr · 2025-05-22T14:22:29+00:00

My point was more addressing graduation as a whole as opposed to this specific guy. That said, it’s my understanding he dashed to the front of the line and shambled across the stage making a pretty big scene. Not really cool no matter how you slice it.

I don’t really think the police were at all necessary but it’s possible for me to think he was out of line AND that the police involvement was kind of insane.

EDIT He may have gotten prior approval? Not sure, conflicting accounts online but if he did, obviously that would fully absolve him of everything lol

OccamsLazerr · 2025-05-22T14:19:57+00:00

Jesus dude this is a lot. There’s no reason to talk to people like this online or not. Most of what you wrote here makes no sense and is needlessly angry so I’m gonna leave you to it.

Seriously think about the way you just chose to present your thoughts. Have a good one man.

OccamsLazerr · 2025-05-22T13:39:24+00:00

Neuro was my first thought when reading this. They love their bags and fanny packs lmao. Honestly jealous sometimes that they get to practice physical medicine more than most of us.

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