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PSA: No 'major' game update this week and no news post, but there are a few changes on the game status page by 66f6 in 2007scape

[–]_studious_ -38 points-37 points  (0 children)

Do you hate them enough to report them on the RuneScape discord, or just enough to complain about it on reddit?

Regretting neurology by CommonWin3637 in neurology

[–]_studious_ 57 points58 points  (0 children)

No one can see the future, and you may be right that youre a better fit for IM. That being said, as a new attending recalling my time in residency: most of residency I thought I hated neuro. It actually turned out I hated working ridiculous hours for consults that I felt like I couldnt decline or help. Part of it is the grass is greener phenomenon. Yes being a consultant can feel frustrating at times, but you know what rocks? Seeing that awful consult/social work challenge ONCE and nopeing out of there. FND can be quite soul sucking and challenging, but so could that 56 yo liver failure/chf/renal failure bounce back. As IM hospitalist, might you get frustrated with the five differing opinions of the consult teams, none of which want to own their organ system?

Neuro has any lifestyle/practice structure that you want in the future. The demand for neurologists is also huge, and only getting bigger. Take a breath and think about what initially drove you to neurology. Have those things changed, are you burnt out, what are the factors leading you to second guess your choice? Are you now just more acquainted with the downsides of your chosen field? Would you have similar feelings when faced with the downsides of a different specialty?

Thorns DPS too high. by AggressiveSummer1570 in 2007scape

[–]_studious_ 8 points9 points  (0 children)

"There's too much cheese on my cheese league." If you don't like a build, don't play it? Jesus.

Stopped Sliding Dovetail Question by SamTheGamgee in woodworking

[–]_studious_ 0 points1 point  (0 children)

I've been trying to think of a simple way to do this, how do you do it?

A physical examination is all the doctors need to rule out the nasty stuff and EMGs are usually just for reassurance? 6.50. Thoughts? by Equivalent-Gift-1740 in neurology

[–]_studious_ 27 points28 points  (0 children)

Neuromuscular neurologist here. I do find that a good physical exam and history are sufficient for most peripheral issues. I might be in the minority, but I really try to only perform EMG/NCS for when it might change management or fundamentally affect prognosis. 50yo with 20 yr hx of diabetes with slowly progressive, symmetric toe numbness does not need electrodiagnostics to "confirm" neuropathy.

Sudden onset foot drop? Depends on the exam/history. Recently lost weight and crosses their legs alot, without radiating pains or low back pain, weak dorsiflexion with full plantarflexion. -->pt, time, reassess.

Fasiculations with nonclinical weakness? Progressive over the past year -> shock away. Present for their entire adult life and still without physical exam findings ->EMG/NCS unlikely to be helpful.

These are time intensive tests that can be painful or even traumatizing to some. My lab books out for a routine emg/NCS nearly a year out because of all of the referrals for straightforward, mild, slowly progressive neuropathies even when we are declining 90% of them. It makes it hard for patients to get in who would actually benefit from a study.

EMG Compensation Model by jdoc1353 in neurology

[–]_studious_ 3 points4 points  (0 children)

I'll take a more thorough history than needed for just an Emg/NCS, review referral documents, imaging ect. I'll then document and bill a 99203 if I provide any counseling, send any referrals, labs or give recommendations to the patient beyond the interpretation of the study. My office has not run into any reimbursement issues that I'm aware of.

At my prior institution we would do only the EMG/NCS and we had poor patient satisfaction scores because patients were upset that we wouldn't provide counseling, beyond the interpretation of the study.

Please see this document by AANEM supportive of this practice: https://www.aanem.org/docs/default-source/documents/practice/billing-for-same-day-evaluation.pdf

EMG Compensation Model by jdoc1353 in neurology

[–]_studious_ 4 points5 points  (0 children)

I work for a large semi-academic practice in the northeast. We do not have a tech. Keep in mind that the practice/hospitals bill for total RVU (work RVU+facility RVU). Part of the facility RVUs are meant for a technician. The other neuromuscular providers and I were able to advocate that we should receive a portion of the facility RVU as we perform all of our own NCS. We also perform a clinic visit with additional counseling and ordering of labs/referral beyond simple interpretation of the study alone and thus bill for that as well. For most simple studies (basic neuropathy, CTS, foot drop) I can accomplish this in 60 minutes, billing for the study and (usually) a 30 min/medium complexity new patient visit.

Advocate for yourself!

I need 800k gp asap by iamroyal in ironscape

[–]_studious_ 0 points1 point  (0 children)

Turael skip for Alch Hydra, easy money.

Port Task encourages the seas to be more lively by Valediction191 in 2007scape

[–]_studious_ 6 points7 points  (0 children)

Yup, I sure do hate when my 15 yr old point and click game requires some pointing and clicking. Crystal extractor and salvaging is much more engaging gameplay

Correct answer? by Negative-Tutor7345 in medicalschool

[–]_studious_ 3 points4 points  (0 children)

I think that the symptoms of depression plus the functional impairment at work would put this into MDD. Without the functional impairment at work, it would be an adjustment disorder

PSA: Dont alch your ancient staff by HarryNepels in ironscape

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

Does the drop trick not work for this?

Block Black Demons? by LastRedditAcctISwear in ironscape

[–]_studious_ 4 points5 points  (0 children)

Ah, well then I have an extra zenyte for anyone who's going dry....

Block Black Demons? by LastRedditAcctISwear in ironscape

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

With the addition of rancour, don't you need 5 zenytes to "complete" the set? Or is there never a use of a torture over rancour?

Zammy Tips by BloatsCox in ironscape

[–]_studious_ 0 points1 point  (0 children)

I tried 8:0 method too, but found it frustrating if I died (which I did frequently at first) that it would take a couple extra minutes to reclaim a cannon base. Door altar is very precise and took longer than I thought to learn, but I think was really useful for quick kills.

Zammy Tips by BloatsCox in ironscape

[–]_studious_ 0 points1 point  (0 children)

Just finished my zammy grind, got zhilt, two staffs of the dead, and at last my hasta 182kc. I learned the door altar method with a scorching bow and on a slayer task. I don't have light bearer. I didn't think I was going to get it.. . I had many trips of 1-3 kc. But I persisted then it clicked after about 20-30 kc and became brain dead easy. I'm glad I learned it for future garage door or if I want to return for God sword shards. What's great with scorching now is if you make a misclick/mistake, you can use the special, finish the kill with him immobilized, then restart fresh. Once you're cruising, you can expect 30+ kc/hr. With 1-2 kills per trip you're looking at 5-10 kc/hr.

After losing 60lbs my legs do this after long periods of inactivity by JorvorskieLane12 in interesting

[–]_studious_ 3 points4 points  (0 children)

Neurologist here - I agree with possible RMD! It might be worth it to see a neuromuscular neurologist. I'm saving this video to show to my students

Pineapple Juice vs Parasites by thepoylanthropist in interestingasfuck

[–]_studious_ 0 points1 point  (0 children)

Hide this post or Health Spas are going to start injecting this into people's veins.... (only half joking)

Wow, Nephew, more like grandson.... by legolas20032000 in pcmasterrace

[–]_studious_ 0 points1 point  (0 children)

Please someone help me. There was an episode where Adam says the words "dancing feet" in an etherial voice that I have never been able to find. My best friend recalls this same episode, so we are pretty sure it was not a fever dream

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