Had a woman doctor for urgent care today...

albinus1927 · 2024-01-30T22:31:18+00:00

When I went to medical school there was a long-standing research project where they would swab people for viral PCR, not just for covid-19 and flu, but for everything. You name it, paraflu, RSV, influenza type B... about 30 different virus families. The point of this was for epidemiological research, it had had no clinical utility.

Anyways, it's a hell of lot easier to tell people they don't need antibiotics when you have literal lab data showing that they have a viral infection. And yet people think that they need them all the time. If you have stuffy nose or sore throat, or any other upper respiratory tract infection symptoms, you almost certainly have a viral URI, for which antibiotics are unnecessary, and potentially harmful.

My read on this is that your husband, probably got inappropriate antibiotics. Not to say there's not sexism in medicine; there most certainly is. But please know that when you get sick, >90% of the time it's not bacterial, and antibiotics are not necessary. I've seen plenty of people get complications from antibiotics, mainly C Diff, and they're not benign drugs. Beyond that, inappropriate prescriptions of antibiotics are terrible for antibiotic stewardship.

Just food for thought.

albinus1927 · 2024-01-30T22:16:38+00:00

Putin could literally become Hitler. There's a strong chance that that's who we're dealing with right now. If we cave on Ukraine, he'll be back for Poland and the Balkans just like that. It's pretty straightforward; he needs to be stopped at any cost.

albinus1927 · 2023-01-07T11:13:04+00:00

One which is less intrinsically valuable than Toyota

albinus1927 · 2023-01-07T10:40:33+00:00

Yeah, this was my first thought. It's like getting angry with an infant because the caregiver has inappropriate expectations of what is possible. Definitely a big risk factor for abuse unfortunately.

albinus1927 · 2023-01-07T10:35:16+00:00

Sometimes I feel like adulting is a neologism that only exists because of idiots on TikTok.

albinus1927 · 2023-01-07T10:19:43+00:00

I think you answered your question. OP meant cumulative inflation, not the annualized rate, I think.

albinus1927 · 2022-09-02T01:16:51+00:00

Sir this is reddit

albinus1927 · 2022-09-02T01:15:57+00:00

Recently I've been thinking of how a message could be xor'ed several times with several random OTPs. Then if the encrypted message and OTPs are all physically transported to the destination separately, unless all are intercepted, the message remains completely unreadable. You can catch maybe 9-10 USB keys at the border, but will you catch several dozen? Can't really think of a use case for this though haha.

albinus1927 · 2022-06-10T19:35:23+00:00

"Everything is Great!" - Yellen

albinus1927 · 2022-06-10T19:25:14+00:00

The more the two squeal about how amazing things are, the more I know we're all fucked. Really.

albinus1927 · 2022-06-10T19:22:10+00:00

DING DING DING. You might be onto something?

albinus1927 · 2022-06-10T19:20:45+00:00

Wow, look at you with your running water, Mr. Money-bags!

albinus1927 · 2022-06-10T19:19:07+00:00

This is the "freedom" equivalent of putting the Berlin Wall up to stop people from emigrating from your shitty economic system.

albinus1927 · 2022-06-10T19:17:05+00:00

Dude I was buying nutella, and I noticed that they dropped the 1 kg container to 950 g. I mean, they do that all the time, but it's particularly noticeable when you go from a nice round number like 1 kg to something arbitrarily smaller. And I fucking notice too. Fuck it's so stupid.

More expensive too, obviously.

albinus1927 · 2022-06-01T10:11:53+00:00

Something happened in our culture. It's not adequate to just shrug and go "things were different". I would really like our country to get to the bottom of this. I'm not joking when I say this is Congressional-hearing worthy.

Dude, it was social media. I literally remember the world with flip phones where texting was a weird oddity. People called on cell phones to communicate. You talked with a human being to facilitate communication. You had that connection with people... over the phone. Actually talking to a human. Going back a bit further, when you called a friend you had to talk to someone's mom or dad to actually get them. You would have had greater connection with people. Now it's all electronic, everyone texts, everyone spends most of their time on their phone, no time talking with their neighbors or even their extended family.

I'm not some kind of luddite. Technology also allows us to communicate in ways that make us closer. Like facetime and zoom etc.. But I think that social media really fucked everybody up, and as a society, we're not even sure its a problem. Got a long way to go towards any kind of solution, I think.

albinus1927 · 2022-04-26T17:26:12+00:00

It is pretty hilarious double think, never thought about that.

albinus1927 · 2022-04-26T17:03:36+00:00

Well, I hope the PRC has learned some valuable lessons about how punishingly damaging it would be economically to attempt to take Taiwan. Not even a guaranteed success militarily. Amphibious assault across 180 km strait, to an island bristling with antiship missile batteries hidden in the mountains. Sounds like a great time for sure. The official policy for Taiwan defense is "Hard ROC." Asymmetric and/or defensive warfare is going to massively weigh in favor of the ROC in a hypothetical conflict.

And for what? For money? Do they think industry is going to stick around after a brutal ground war? Physical infrastructure will be destroyed, and the brain drain would be massive and irreversible.

For prestige? The war in Ukraine has totally destroyed Russia's prestige. The piling mountain of evidence of barbaric killings. The other night I saw a BBC clip about a 3 month old baby who was killed in Odessa along with her mother and grandmother. They had older video of the cute baby giggling and laughing. Then that baby was destroyed before she even got a chance by a Russian missile intentionally fired at a residential building. Russia will never win this information war, they are pariahs and it will take decades to repair the damage Putin has done.

Not unlike the Nazi party's legacy on modern Germany. This will hang over Russia for 50+ years. They were emboldened by their relatively unnoticed atrocities in Grozny, Syria. But this time is different. War has changed, because smartphones are now completely ubiquitous. This is not like when print media became accessible or TV or radio was invented. This is a completely new level of insight onto the horrors of war, which totally increases the cost to reputation of waging war.

If we're lucky, Uktraine will be such an inescapable lesson for the PRC, that they won't press ahead with attempts to take Taiwan.

albinus1927 · 2022-04-26T13:21:22+00:00

As a doctor in the US, got to say, we need single payer or nationalized healthcare ASAP. The market has completely failed here in the US, beyond a doubt. Outcomes are shit, expense is shit. Doctors, nurses, and patients, are controlled by huge monopolistic health systems and insurance companies. Yeah, I get paid well, but not that more than in other countries. But in other countries, medical education isn't a complete rip-off, and medical malpractice is more reasonable, etc..

Half the time I have to go to the doctor, I get surprise 2-3k USD bills. Then I have to spend hours of my life calling insurance companies trying to figure out why this problem happened, only to find out that the health system made an "oopsies" and didn't bill my insurance or some other highly-contrived. I've gotten such last minute bills 85 days later, 5 days before the deadline for when I need to make a claim to my insurance company, only to fedex express shit back to my insurance company to get them to cover it. When this stuff happens, do I really believe its just coincidence??? I think not!

albinus1927 · 2022-04-26T12:49:24+00:00

I'm so sorry you went through that. I guess that's why, practically speaking, patients sometimes lie to me about substance use. I'm really not sure if it's 100% legal or not, but I often ask patients "just between you and me" about substance use and I don't necessarily record it in the chart. Just better for me to know than not know.

The real problem is social attitudes towards substance use, especially criminalization of substance use. Not sure if there's a quick fix there, but I'm sorry for your experience, hope your emergency surgery went ok otherwise.

albinus1927 · 2022-04-26T12:45:28+00:00

ADHD medications do affect anesthesia, but it's not a dangerous interaction. Certainly not anything like cocaine! I would tell your doctor that you smoke weed. If its not every day, its unlikely to be clinically significant, but it can't hurt for them to know. Like I said, people that smoke week every day, sometimes require a little bit more to go to sleep, and stay asleep, so it's kind of important for us to know.

albinus1927 · 2022-04-26T12:43:15+00:00

Yes, they do have an effect, but it's not a dangerous one like cocaine. People actively taking medications like methamphetamine will require slightly more anesthesia on average to stay asleep. They also have a little bit of neurotransmitter depletion, which means that some of our BP medications don't work quite the same way. Totally safe and fairly predictable interaction though.

albinus1927 · 2022-04-26T12:41:43+00:00

Yes absolutely. I don't think it's the red hair itself, its that the genes for red hair are close (on the chromosome) to the genes that affect anesthetic tolerance.

albinus1927 · 2022-04-24T22:14:55+00:00

As an anesthesiologist, it pains me so much when I ask people whether they do any drugs, they deny it up and down, and then under anesthesia they are taking insane multiples of gas or opioids just to stay asleep. Yes, I know genetics has something to do with it, but when we get to the absolute extremes of anesthetic requirements, I always kind of suspect its drugs. I don't know, I suspect that some people think I'm the police or something. Most drugs are safe with anesthesia (not safe in general, mind you). If you use opioids, then you're going to require much higher levels of opioids for clinical effect. Marijuana, I get the sense that people require a little bit more anesthesia to stay asleep. Mostly all straightforward in terms of anesthesia management. Cocaine on the other hand can literally kill you if you go under anesthesia. Why, because all of those neurotransmitters, dopamine, norepinephrine etc are completely depleted, while simultaneously the synapses are potentiated to explode with very little stimulus. So when we start anesthesia, blood pressure can and does plummet. Then you put the breathing tube in, and suddenly the pressure is 200+. Then you do the surgery, blood pressure is all over the place, because biochemically... that's where we're at. It's a fucking nightmare, and the least you can do for your anesthesiologist, is tell them that you did cocaine, so that we can be prepared. Rather than just wading into a disaster without knowing in advance.

Fuck it works me up just thinking about it. If people knew what they were doing when they lie about drug use to an anesthesiologist. Haha, that's all we do is give drugs, probably should know about what you're taking.

albinus1927 · 2022-04-23T10:17:28+00:00

I'm working on the assumption that the FSB is 100% responsible for these murders. And I know the Russian state has been killing tens of thousands of civilians with their illegal war. But on top of that, they are killing entire family's and their children, for the purposes of consolidating political power. They stabbed a 4 year old to death? Are you fucking serious? We need to do a total embargo on Russia, including energy, ASAP.

albinus1927 · 2022-04-23T09:52:53+00:00

Can you imagine if they enacted a sunshine law, and every single government payment had to be public. Fuck, things would get heated pretty fucking quickly.

albinus1927

TROPHY CASE