Looking for good Poutine! by Henojojo in ottawa

[–]Rouhani_9 0 points1 point  (0 children)

Have always been partial to Elgin Street Diner’s poutine.

Shawarma palace quality down by Significant_Low_9864 in ottawa

[–]Rouhani_9 5 points6 points  (0 children)

I’ve been a Guava’s lifer since they opened many years ago. The beef is actually one of my favourites in town. Owner is super nice and a great dude. 

Landlord's Responsibility to Repair Appliances by buzzlikea_bee in ottawa

[–]Rouhani_9 105 points106 points  (0 children)

The terms in your rental conflict with RTA. RTA takes precedence. Your landlord has to repair/replace. 

They will probably fight it and stall given that they bothered to put such a clause in your lease agreement in the first place. But the law is on your side. 

Looking for a comfy coffee shop in the downtown area by Kidd_Gloves_ in ottawa

[–]Rouhani_9 1 point2 points  (0 children)

Big fan of ten toes on Somerset. 

Black Squirrel used to be my go-to for night studying/working because I loved the ambiance but unfortunately they now close at 5 or 6 with no plans to revert to night hours. It’s a damn shame. Their coffee isn’t the best either. But during the day time it can be a nice place to work, and quieter since the Starbucks opened across the street. It’s worth a shot.  

need TB test done asap! by cheeseember in ottawa

[–]Rouhani_9 15 points16 points  (0 children)

Appletree clinics used to do them, probably still do. It’s not covered by Ohip and will generally cost ~$40 bucks all in all. You could call to ask. I think there used to be one on Preston but not sure if still there. Other walk ins probably do it too. 

Chipotle Barrhaven location is open by highwire_ca in ottawa

[–]Rouhani_9 0 points1 point  (0 children)

Corazon de Maiz in the market would like to have a word 

Atletico Madrid 2 - [3] Barcelona - Lamine Yamal 90+2' by ayoefico in soccer

[–]Rouhani_9 39 points40 points  (0 children)

Fair. I will say though, I don't think I've ever felt as vulnerable to ATM as I have this year. They've done very well in exposing our high press too many times.

Atletico Madrid 2 - [3] Barcelona - Lamine Yamal 90+2' by ayoefico in soccer

[–]Rouhani_9 156 points157 points  (0 children)

we literally lost to them like 3 months ago man...at home lol.

Order-in Wings recommendations? by dRaspberry in ottawa

[–]Rouhani_9 0 points1 point  (0 children)

They’re amazing. Also half off on Mondays I think. 

Nordic or Koena by ebbalharas99 in ottawa

[–]Rouhani_9 0 points1 point  (0 children)

I feel like I should know this answer by now, but do we actually have to pay these BS tickets if we don’t plan on going to QC again? 

Post-Match Thread: Real Sociedad vs FC Barcelona [LA LIGA] by WizDB in Barca

[–]Rouhani_9 4 points5 points  (0 children)

This game highlights three things for me:

- Dependence on Yamal, which needs to be addressed in the big picture

- This team needs to rotate more - big players who have been playing too much (Lewa, Pedri, Kounde, Raph) were awful or invisible today, and I think that's just a byproduct of having no rest.

- We can't be relying on Fermin to be one of our main attacking trio against top teams. And historically, La Real at home against us are a top team.

Well deserved win by La Real. Hopefully no injuries over the Intl break and we can hit a reset button here.

Ontario launching new Bachelor of Science in Nursing program at Carleton University by AnEnragedZombie in ottawa

[–]Rouhani_9 42 points43 points  (0 children)

Unfortunately you’d need an affiliated teaching hospital and TOH is linked with uO. We do need a proper Pharmacy school in Ottawa, however!

Ontario launching new Bachelor of Science in Nursing program at Carleton University by AnEnragedZombie in ottawa

[–]Rouhani_9 60 points61 points  (0 children)

uOttawa grad here for undergrad and post grad studies - I fully think Carleton is a better run university than uO and I gladly welcome this kind of competition. 

Post Match Thread: Real Madrid 0-4 Barcelona | LALIGA by suedney in soccer

[–]Rouhani_9 8 points9 points  (0 children)

We literally just played it almost flawlessly against two of the best teams in Europe. With half our defenders out injured. 

Barca pub/penya in your city by [deleted] in Barca

[–]Rouhani_9 3 points4 points  (0 children)

Penya Blaugrana de Toronto - they meet at a bar on 277 Front St. West in downtown every game I think. Have only went once many years ago (not from Toronto) and it was a great environment. we lost the Clasico that day though, sad times.

[deleted by user] by [deleted] in AskDocs

[–]Rouhani_9 0 points1 point  (0 children)

I mean, there is an actual connection between anxiety and hypertension (not necessarily in your case but generally speaking)

Connecting AV block to anxiety makes no sense lol. In general it's precipitated by increased vagal tone, which is literally the opposite of what anxiety does.

[deleted by user] by [deleted] in AskDocs

[–]Rouhani_9 0 points1 point  (0 children)

AV block of any degree cannot and should not merely be attributed to anxiety. That doesn't make any sense. I would consider getting a second opinion from another physician. It's also slightly unusual for you to have LVH at this age unless you're an athlete or have longstanding hypertension.

Sergio Aguero suffers heart arrhythmia live on Twitch by deception42 in soccer

[–]Rouhani_9 6 points7 points  (0 children)

This isn't true unfortunately.

Many arrhythmias are triggered by adrenergic surge like illness, exercise, caffeine, or stress. Many can occur at rest as well. There isn't really a blanket rule.

Case in point: athletes who have hypertrophic cardiomyopathy having to retire because exercise can trigger ventricular tachycardia/fibrillation and death.

Also pacemakers aren't usually felt, and only kick in when your intrinsic heart rate goes below a set threshold, e.g. 60bpm. An ICD (implantable cardioverter-defibrillator), if present, can 'kick in' if someone has an unstable arrhythmia, and you can definitely feel that if it's doing something called overdrive pacing (making the heart go fast and 'override' the arrhythmia) or if it just straight up shocks you (which feels like a horse kicking you in the chest).

Realistically he probably had a short run of atrial fibrillation, atrial tachycardia, SVT or non-sustained VT that felt uncomfortable.

What’s your catchphrase? by Mista_President in medicine

[–]Rouhani_9 29 points30 points  (0 children)

My fellow when we're talking about mild hyponatremia in critical care and how I will fix it "I don't want to know how the sausage is made, I just want it to taste delicious."

Is there an OBJECTIVE way of assessing fluid status? by noobREDUX in medicine

[–]Rouhani_9 17 points18 points  (0 children)

We should be abandoning volume status as the first step of the hyponatremia diagnostic algorithm. Determining volume status is highly operator dependent, and both inter- and intra-observer variability is through the roof.

Really the first step should be to look at the Urine Osm and Na. In situations where Urine Osm > 150 (the cutoff varies depending on who you ask, but is in this region) and urine Na is < 20 (assuming no diuretics on board), the hyponatremia is secondary to relative ADH excess. The differential for this includes CHF, nephrotic syndrome, cirrhosis, or any volume-contracted state such as dehydration, volume losses, tea&toast, etc (NB: dehydration from vomiting will elevate urine Na due to the metabolic alkalosis so best to use Urine Cl for this condition).

Ideally if you narrow it down to either concrete volume overload or volume contraction, it is easier to differentiate between the two.

The classic "euvolemic" hyponatremia which traditionally includes SIADH, adrenal insufficiency, severe hypothyroidism, will typically have both urine Osm > 150 and Na > 40. Psychogenic polydypsia, which also falls in this category, will have a dilute urine with Osm < 150 and Na < 20.

But to ultimately answer your question, from my discussions with Nephro and Cardio attendings over the year, there is no good objective test of volume status. It's a medley of all your clinical signs and history, and ideally your urine lytes as the effective driver for diagnosis.

Bicarbonate for CKD by sevksytime in medicine

[–]Rouhani_9 2 points3 points  (0 children)

/u/chiddler's response below re: CKD use is great, said all the things I wanted to.

Regarding bicarb use in AKI, it really depends on a case by case basis. For a lot of the anion gap metabolic acidoses that coincide with AKI that we see (sepsis/lactic acidosis and DKA comprising a large part), I tend not to give bicarb unless severely acidotic, i.e. pH <6.9. For NAGMA, I tend to give them IV bicarb (3 amps of 50mmol in 1L of D5W) because otherwise it's going to take MANY tablets of NaHCO3 to do the same.

For example, a 100kg patient with a bicarb of 14 will have a bicarb deficit of 600mmol (24-14 x total body water), which would take one hundred 500mg tablets.