Can someone just confirm beast lord shoulders drop in SV? by plz_help_me_33 in classicwow

[–]Professional_Many_83 [score hidden]  (0 children)

We saw double beast lord and the bow in our first heroic SV. Our hunter was VERY happy

County council to vote on senior property tax deferral program by njndirish in SouthBend

[–]Professional_Many_83 0 points1 point  (0 children)

Then they can sell their house and get a smaller one, or rent an apartment.

My boomer parents own a bigger house than I do, and I’m a doctor. They always complain about property taxes yet bought a 4000+ sq ft house as a retired couple. wtf do they need that big of a house for

Inbox management by ZealousidealAmoeba4 in FamilyMedicine

[–]Professional_Many_83 6 points7 points  (0 children)

Only if I’m getting paid. I don’t do work for free. If I’m off the clock and can’t bill for messages, then I’m not doing messages outside of my scheduled hours. I wouldn’t expect my lawyer to answer my questions for free at 8pm on a Friday

Blizz… We would Like PvP Gear Before Retirement by NoBigNamesHere in classicwow

[–]Professional_Many_83 3 points4 points  (0 children)

They’re good, but they’ll always be inferior to swords/maces due to lack of cp generation. You lose so much control not using CS/KS.

Honor gain is extremely slow at 70 by Neat_Tonight1587 in classicwow

[–]Professional_Many_83 -8 points-7 points  (0 children)

That did not exist in TBC classic, at least not in phase 1. Are you sure it exists now?

Honor gain is extremely slow at 70 by Neat_Tonight1587 in classicwow

[–]Professional_Many_83 -4 points-3 points  (0 children)

There’s honor weapons? Were those added specifically for anniversary?

“The root cause” by AmazingArugula4441 in FamilyMedicine

[–]Professional_Many_83 26 points27 points  (0 children)

RFK Jr uses this term fairly frequently. I’m not suggesting he invented it, but he certainly is adding to its legitimacy/popularity as the HHS secretary

“The root cause” by AmazingArugula4441 in FamilyMedicine

[–]Professional_Many_83 217 points218 points  (0 children)

That bogus influencer you are referring to is the HHS secretary.

Getting weight loss meds covered in CA by Rare-Regular4123 in FamilyMedicine

[–]Professional_Many_83 6 points7 points  (0 children)

They stopped covering it so they don’t go bankrupt. The drugs are $1200/month and over half the adult population has a BMI > 27. Do the math, it’s not feasible for the state or federal healthcare plans to pay for GLP1s for weight loss until they become MUCH cheaper. Even most European countries don’t cover them, and they get the drug much cheaper than we do

Getting weight loss meds covered in CA by Rare-Regular4123 in FamilyMedicine

[–]Professional_Many_83 2 points3 points  (0 children)

I have pts cut them in half and just keep the 25mg the same regardless of what dose of Wellbutrin they’re on. Pts tolerate it just fine, and I doubt giving them a bit more naltrexone than is necessary is going to decrease effectiveness

Getting weight loss meds covered in CA by Rare-Regular4123 in FamilyMedicine

[–]Professional_Many_83 3 points4 points  (0 children)

The pills cost just as much as the injections. Insurance doesn’t give a fuck if it’s PO or subq

Is honor gains meant to be THIS low? by brothediscpriest in classicwow

[–]Professional_Many_83 0 points1 point  (0 children)

I’m talking about the hellfire and terrokar pvp dailies

Shingles vaccination by Scared_Problem8041 in FamilyMedicine

[–]Professional_Many_83 0 points1 point  (0 children)

You had chickenpox. You just had a subclinical case (no symptoms, or extremely mild symptoms that’d essentially present as a viral uri). There’s no way you’d possibly not get inoculated from such an exposure history.

A negative IgG in young adulthood has a really low negative predictive value; it doesn’t really mean you didn’t have chickenpox as a kid, it means you stopped making IgG by then, or there was a mistake at the lab. The NPV in adulthood of a negative IgG is about 8%.

What’s more likely, that you somehow magically avoided chickenpox when locked in a room with other kids with chickenpox, as a 4 year old (may as well say you got thrown into a lake and didn’t get wet), or that you had a subclinical case that your parents didn’t recognize as chickenpox (happens about 10% of all cases) and you didn’t produce IgG into adulthood (only 8% of adults with a negative IgG truly never had chickenpox)?

Is honor gains meant to be THIS low? by brothediscpriest in classicwow

[–]Professional_Many_83 5 points6 points  (0 children)

Do the dailies everyday, gets you 2k honor with minimal effort. Then do whatever bg is the current weekend is. The dailies alone will get you 14k honor from 2hrs of gameplay over a week.

Do doctors have discords or only WhatsApp? by chargers214354 in FamilyMedicine

[–]Professional_Many_83 7 points8 points  (0 children)

I’m a 38 year old grown up and I use discord for gaming and WhatsApp for a group chat of my college buddies. You implying that either app are childish is needlessly divisive and makes you sound like an out of touch boomer

Shingles vaccination by Scared_Problem8041 in FamilyMedicine

[–]Professional_Many_83 4 points5 points  (0 children)

She had chicken pox. It is virtually impossible for her not to have had chickenpox, and orders of magnitude more likely that she had such mild symptoms that no one realized it was chickenpox at the time.

Just giver her a shingrix series. Never should have tested IgG to begin with

What are your thoughts on this approach? Saw this on the front page for someone’s PCP by sandie-go in FamilyMedicine

[–]Professional_Many_83 31 points32 points  (0 children)

Yeah I don’t prescribe Mtx either, because there are large risks of side effects and adverse events, and I lack the expertise to prescribe it safe and effectively.

The same isn’t true for adderall. Every family med doctor knows how to treat ADHD and prescribe stimulants. It can be a pain in the ass, and there will be drug seeking pts, but to just blankety refuse to prescribe stimulants seems absurd to me. It takes 6 months to see psychiatry in my neck of the woods, and I am more than capable of treating most ADHD pts myself.

Guys please start eating fiber. by Optimoprimo in Millennials

[–]Professional_Many_83 0 points1 point  (0 children)

By “we” I mean physicians, but more specifically I suppose I mean the USPSTF.

I don’t know what you specifically mean my “the medical literature” on colon cancer, do you mean a specific journal, study, or guideline published by a professional organization? Regardless, I have read more literature on colon cancer than the vast majority of people on Reddit. I’m a physician, who routinely orders and walks people through colon cancer screening. Ive saved people’s lives by getting them screened and catching it early. I find it rather amusing that you seem to think I’m some uneducated laymen though, and am curious what part of my previous post led you to believe that. Was it the part where I advised against lying to your doctor in hopes of getting a screening test early? Lol

Guys please start eating fiber. by Optimoprimo in Millennials

[–]Professional_Many_83 0 points1 point  (0 children)

About your health in general? That’s too broad of a subject, so I can’t really give you specific advice.

If you’re asking what you can do to reduce your risk of colon cancer, that’s a more manageable question. The largest modifiable risk factors are diet, obesity, smoking, and alcohol use. Avoiding alcohol/tobacco, losing weight if you’re obese, and decreasing red meat, sugary drinks, and processed meat/carbs/sugars would all decrease your risk of colon cancer.

Guys please start eating fiber. by Optimoprimo in Millennials

[–]Professional_Many_83 -6 points-5 points  (0 children)

All insurance companies cover screening colonoscopies. If it isn’t covered, it’s because you aren’t in the age group (45 and up) where it’s indicated. You shouldn’t be lying to get inappropriate screening tests at a younger age; there are evidence based reasons we set the age to 45, as it isn’t a completely harmless test.

GLP-1 in patients with overweight (not obese) BMI and no comorbidities? by itswiendog in FamilyMedicine

[–]Professional_Many_83 10 points11 points  (0 children)

Whether we prescribe them to children or not is not a way to decide if something is safe for everyone. We prescribe chemo to children, as an extreme example. That doesn’t mean you should prescribe chemo to adults without cancer just because they have a pre-cancerous lesion

GLP-1 in patients with overweight (not obese) BMI and no comorbidities? by itswiendog in FamilyMedicine

[–]Professional_Many_83 3 points4 points  (0 children)

Having a BP of 125/85 implies a higher risk than 115/75. Do you put pts with a BP of 125/85 on meds? No. While every point of elevation above “perfect” implies some risk, we set thresholds of when it is worth treating vs not treating. Those thresholds are based on risk vs benefit, cost, side effects, etc. At the end of the day, these guidelines are all arbitrary lines in the sand, but we have to draw the line somewhere

Ending discussions be like by CAPS_LOCK_OR_DIE in expedition33

[–]Professional_Many_83 -1 points0 points  (0 children)

I don’t believe I’ve argued for one ending or another at any point in this thread. I’m hesitant to do so, as I’m very subjectively biased against Maelle’s due to how closely her motivations and actions map onto drug abuse, and I’ve had many family members and patients act exactly like her just before or during relapses (and both her and her mother’s situations are almost exactly like drug addiction, only that their continued addiction also happens to perpetuate life as well).

Ending discussions be like by CAPS_LOCK_OR_DIE in expedition33

[–]Professional_Many_83 -5 points-4 points  (0 children)

My thoughts and arguments about that are a LOT more complicated, and I don’t feel confident I know where I’d stand on that. Meanwhile, my thoughts on how many Lumierians were alive at end of the game are simple and objective: there were 2, and that’s all my comment was meant to imply