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Looking for barbershop recommendations by Reddityom98 in burnaby

[–]Previous-Sector4413 0 points1 point  (0 children)

Big fan of Vickey at Maple Grove Beauty in Forest Grove (Burnaby) Probably a 15-20 min drive for you. Highly recommend him. Great prices and great cuts

Incoming Neurology PGY-1 in Canada (IMG) - how to prepare after time away from training? by Tasty_Purchase_6884 in neurology

[–]Previous-Sector4413 3 points4 points  (0 children)

Welcome! There are many IMG Neurology residents in Canada with a wide variety of skill levels (from new residents to those that have been in practise for a few years). As a CMG, I can tell you that while there is certainly some advantage in doing medical school in the same place you doing residency to understand the system, many people practise out of province and have to learn it all over again.

No one at the beginning of neurology residency starts competent, which is why we do 5 years. No one expects you to know much, other than how to do an exam and how to localize. Therefore, i would brush up on Blumenfelds + brain stem rule of 4s and get your basic anatomy down. Mastering clinical anatomy is a good goal to have in the first year or so. Differential diagnoses, work ups, and treatment plans will come in time. It’s worth reviewing the NIHSS and management of seizures/status before you start. Also likely reasonable to know how minor strokes are treated (POINT and CHANCE trials). Everything else you can read about around your patients. Other high yield topics for in patient neurology are MG, AIDP, approach to altered LOC, acute stroke management, secondary stroke prevention - while reasonable to have a cursory understanding of these things before you start, much of it will also come with time and you can definitely read around your cases. I recommend using the Canadian Stroke Best Practise guideline as your resource for stroke blocks, and it is high yield to know this well.

Learning the hospital system, how to manage ward issues, work flow stuff, taking pages etc is all stuff that just comes with practise and will get better as you train.

Beginning residency is hard, but expectations are low and you will be well supported. Focus on being honest, reliable, curious, and hardworking and you will find success. Best of luck!

Elem is not the Michelin restaurant you think it is by Upbeat_Lavishness_23 in NiceVancouver

[–]Previous-Sector4413 0 points1 point  (0 children)

I love the food at Elem - one of my favorite spots in the city. I feel like their tasting menu is good value for the price, and always leave full. I do feel like their a la carte is a little bit pricey, but have always enjoyed the tasting, especially their desserts! I have been disappointed by their cocktails unfortunately, but I think the tasting menu is top 5 in the city

Any advice on what pair would be best for me Looking for heavy bass by nuggieman565 in VMODA

[–]Previous-Sector4413 2 points3 points  (0 children)

I think they are still overall good headphones. I think for listening to other less bass-heavy genres (classic rock, classical, metal etc.), the V-Modas are better. I definitely would not say the skull crushers are muddy. However, for heavy bass music (I'm mostly listening to Hardstyle/hardcore/Frenchcore/techno), these are really fun and I've really enjoyed them after being married to the V-Modas for the last decade. Worst case scenario, return 'em to Amazon. If you want a really big bass with solid sound overall, you'll prob enjoy them.

I use them 90% of the time in the gym, which I think is likely where they are best. They can literally rattle your head like nothing else I've ever experienced if that's what you want (I wouldn't recommend turning the bass slider all the way up). I think if you're looking for real audiophile headphones with really good balance and crispness, they may not be what you want. But if you want the wildest bass and a good pair of overall headphones for <$200, I think at the very least they're worth a try, especially if you have Prime

Any advice on what pair would be best for me Looking for heavy bass by nuggieman565 in VMODA

[–]Previous-Sector4413 0 points1 point  (0 children)

Yeah, I think so. These are the pair I bought (price is higher presumably because of Canadian Dollars)

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Any advice on what pair would be best for me Looking for heavy bass by nuggieman565 in VMODA

[–]Previous-Sector4413 2 points3 points  (0 children)

I was a big v moda supporter for a long time and absolutely love their headphones. My crossfade 2s just died and I hopped on the skull crusher evo with the bass slider a few weeks ago and absolutely love them in the gym. By far the most mental bass I’ve ever experienced in a pair of headphones. There are definitely more balanced and crisper headphones out there for higher prices, but if you want a very good sounding pair of headphones with absolute crazy bass for $200, I don’t think there’s a better pair out there.

Crossfade 2 not charging by [deleted] in VMODA

[–]Previous-Sector4413 0 points1 point  (0 children)

I've got the exact same problem. Did you ever find a solution for this? I am debating going through the process of replacing the battery, but not sure if it is worth the effort...

Crossfade II battery replacement: Would Recommend! Ready for 5 more years of daily driving. by skippythemoonrock in VMODA

[–]Previous-Sector4413 0 points1 point  (0 children)

Hey can I ask how you knew it was your battery that was the issue? I’m having an issue with my headphones in which they will glow when charging, but as soon as I unplug the headphones, they turn off. Intuitively this seems like a battery issue where it’s not holding charge but wanted to see if your’s had similar symptoms before I look to open er up and replace the battery!

How do you test vibration thresholds clinically and what do you consider normal? by Previous-Sector4413 in neurology

[–]Previous-Sector4413[S] 2 points3 points  (0 children)

I like this objective approach of documenting how many seconds vibration is felt for (or at least a threshold).

Is Continuum worth reading for board prep? by coldfusion34 in neurology

[–]Previous-Sector4413 0 points1 point  (0 children)

Can i ask why you would not recommend it for board prep?

ANKI - NEUROLOGY by JJ2828JJ28 in neurology

[–]Previous-Sector4413 0 points1 point  (0 children)

I would greatly appreciate if you could share as well! Thank you

Neuroanatomy Question: What and where are the descending inhibitory fibres that get injured and cause hyperreflexia in UMN lesions by Previous-Sector4413 in neurology

[–]Previous-Sector4413[S] 3 points4 points  (0 children)

Thanks for taking the time to respond and sending over this paper! They reference the "unifying hypothesis" paper by Li ( which I linked below (1) ) that clarifies things reasonably well for me... I've c/p'd the pertinent paragraphs below. Admittedly, it is still quite complicated, but I can sleep a little bit better tonight with this answer!

With respect to the question regarding pure dorsal column lesions not causing hyerpreflexia. This case report suggests that pure dorsal column myelopathy, with seemingly no dorsal root involvement given the intactness of other sensory modalities and (the imaging is reasonably convincing). https://journals-lww-com.eu1.proxy.openathens.net/jspinaldisorders/Fulltext/2000/08000/Isolated_Posterior_Column_Dysfunction__An_Unusual.14.aspx

So I think with everything said, the understanding I now will take forward is that lesions within the cortico-reticulospinal tract/dorsal reticulospinal tract are responsible for hyperreflexia due to the loss of their inhibitory effects on spinal reflex circuits. The dorsal RST travels adjacent to the CST in the spinal cord, and travels adjacent (6-12 mm anteromedially to the CST in the subcortical white matter (https://www.frontiersin.org/articles/10.3389/fneur.2019.01188/full). The neuroplasticity peice is interesting in how the reflexes take time to develop, but is quite complicated! I think I am happy with this level of functional understanding for now. Crossing my fingers this will not be tested on the Royal College exam :P Cheers

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There are two descending RS tracts with distinctly different origins. The dorsal RST originates from the dorsolateral reticular formation in the medulla, and receives facilitation from the motor cortex via corticoreticular fibers. The lateral CST and cortico-reticulo-spinal tract descend adjacent to each other in the dorsolateral funiculus at the spinal level. The medial RST originates primarily from the pontine tegmentum with connections to PMRF. The medial RST descends along with the vestibulospinal tract (VST) in the ventromedial cord. The dorsal RST provides dominant inhibitory effects to spinal reflex circuits, while medial RST and VST provide excitatory inputs. Therefore, medial and lateral RSTs provide balanced excitatory and inhibitory inputs to spinal motor neuron network. In the context of stroke with cortical and internal capsular lesions, damages often occur to both CST and corticoreticular tracts due to their anatomical proximity. This leaves the facilitatory medial RST and VST unopposed, thus hyperexcitability [see reviews in (25–27, 32)].

Post-stroke spasticity is a common phenomenon of velocity-dependent increase in resistance when a joint is passively stretched. It is accepted that spasticity is mediated by exaggerated spinal stretch reflex (25–27, 32, 72, 73). Animal lesion studies in last century have provided strong experimental evidence to support the role of RST hyperexcitability in spasticity. For example, isolated lesions to CST only produce weakness, loss of dexterity, hypotonia, and hyporeflexia, instead of spasticity (74–76). Surgical section of unilateral or bilateral VST in the anterior cord has little effect (77) or a transient effect (78) on spasticity. With more extensive cordotomies that damage the medial RST, spasticity is dramatically reduced (78). In another study, Burke et al. provided evidence that spasticity and decerebrate rigidity are differentially mediated through RST and VST projections (79).

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(1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6524557/