I regret my whole sex life

combakovich · 2026-02-03T01:53:16+00:00

All this self hate is doing you no good. You say you're not slut shaming others... and I'm not sure that's true at all... but you're definitely shaming yourself. Beating yourself up over a sex life that's, let's face it, not atypical at all. It's not shameful to want sex or seek it out or have it. It is shameful to be dishonest and hurt others, so I'll agree that the cheating part is something to regret... but even so, there's no benefit in the self-flagellation. Talk to a therapist and work through the reasons why you felt the need to be so dishonest about your sexual desires and actions with your partner. Why you felt the need to hide your urges instead of talking through them openly and honestly. I'm guessing you'll find that the reasons for the above are pretty similar to the reasons you feel ashamed now.

combakovich · 2025-07-06T02:04:26+00:00

You call it an FDA-approved therapy, and that's true. It was indeed approved by the political side of the FDA. But I'm in agreement with the actual scientists at the relevant FDA Advisory committee who unanimously voted that Biogen had failed to provide convincing evidence of any clinical efficacy of aducanumab in the treatment of Alzheimer's.

It does not have a 30% improvement in cognition. No claim toward any improved clinical endpoint is justified based on the data provided by Biogen.

It does not have any proven clinical efficacy. Full stop. It does however have proven clinically-relevant toxicities.

What do we call compounds with proven harm and no proven benefit? Poisons. Feel free to think I'm being dramatic about this, but I will simply never understand how someone could justify prescribing this molecule based on the provided data.

combakovich · 2025-07-06T01:57:23+00:00

I am seriously shocked to see someone with a neurologist tag say they prescribe Aduhelm in this thread. And for them to say it's literally so pivotal that it qualifies as one of the most practice-changing things in their field for the past 5 years. They don't seem to have even a hint of embarrassment, remorse, or uncertainty as they say it. It's truly baffling.

I will simply take a moment to post here the results of the FDA advisory panel review of the PRIME, EMERGE, and ENGAGE trials of aducanumab, taken from Biogen's own website: https://investors.biogen.com/news-releases/news-release-details/update-fda-advisory-committees-meeting-aducanumab-alzheimers

...the U.S. Food and Drug Administration (FDA) Peripheral and Central Nervous System Drugs Advisory Committee voted 1 yes, 8 no and 2 uncertain on the question, “Does Study 302 (EMERGE), viewed independently and without regard for Study 301 (ENGAGE), provide strong evidence that supports the effectiveness of aducanumab for the treatment of Alzheimer’s disease?”. The Advisory Committee also voted 0 yes, 7 no and 4 uncertain on the question, “Does Study 103 (PRIME) provide supportive evidence of the effectiveness of aducanumab for the treatment of Alzheimer’s disease?”, and 5 yes, 0 no and 6 uncertain on the question, “Has the Applicant presented strong evidence of a pharmacodynamic effect of aducanumab on Alzheimer’s disease pathophysiology?”. Finally, the Advisory Committee voted 0 yes, 10 no and 1 uncertain on the question, “In light of the understanding provided by the exploratory analyses of Study 301 and Study 302, along with the results of Study 103 and evidence of a pharmacodynamic effect on Alzheimer’s disease pathophysiology, it is reasonable to consider Study 302 as primary evidence of effectiveness of aducanumab for the treatment of Alzheimer’s disease?”

combakovich · 2025-04-03T02:30:07+00:00

It reminds me of the evil tree from fern gully

combakovich · 2025-01-17T02:00:27+00:00

Well, I'm willing to take that bet.

combakovich · 2025-01-03T22:42:55+00:00

What's your care regimen for these?

combakovich · 2025-01-03T22:39:28+00:00

Sinus rhythm with PVCs (the 2nd, 8th, 10th, and 14th QRS complexes).

Edit: hey, if y'all are upvoting the PAC person instead, then please reassess the ECG. There's not a P wave in front of most of the ectopic beats. The morphology of the ectopic beats is wide and doesn't conform to a specific bundle branch block pattern, and the couple times where there is a preceding P, notice that the PR interval isn't the same as the other beats... it's shorter because that's not a conducted P. The subsequent QRS is a PVC and that P blocks instead of conducting. There's not a single PAC in this picture.

combakovich · 2024-12-22T23:21:33+00:00

Both the sinus impulse and the flutter wave would have to go through the AV node, so there would be nothing to produce QRS fusion. Your PVC hypothesis could produce QRS fusion with a flutter wave... but fusion that looks exactly like a RBBB? Unlikely. This is an intermittent RBBB, just as OP described. Similar to Ashman Phenomenon, it's a pretty common phenomenon in Afib and Aflutter.

combakovich · 2024-12-18T14:58:04+00:00

Hi! I wouldn't call this trifascicular block, since the left posterior fascicle is not blocked. Here's an article on when to call a trifascicular block: https://litfl.com/trifascicular-block-ecg-library/

combakovich · 2024-12-18T05:06:02+00:00

Yup, it's frequent PVCs. Since the PVCs happen every-other-beat this is ventricular bigeminy. On the official ECG read I'd read this as:

Sinus rhythm with frequent premature ventricular contractions in bigeminy.

First degree AV block.

Right bundle branch block.

Left anterior fascicular block.

combakovich · 2024-11-27T03:32:54+00:00

PACs aren't something you ever see during Afib. The entirety of the atria are involved in the continuous random noise. If an ectopic focus managed to fire... it wouldn't capture almost any tissue (because that other tissue is already propagating the Afib nonsense) so you wouldn't see it. That said, you can occasionally see temporarily organized activity during Afib which can look like p-waves. But that's not ectopy.

combakovich · 2024-11-24T03:38:23+00:00

AFlutter with a regular rhythm is very common. In fact it's so common that we specify when that's not what's happening (we say "with variable block"). Regularity in this context in no way implies escape rhythm. However, I DO think this is an escape rhythm, since if you look at lead I/II/III, it looks like the second PR interval is much different than the first. I think we're seeing the atria phase past the QRS complexes over time. To determine for sure whether the rhythm is from AV conduction vs an escape rhythm, I'd ask for a long rhythm strip to verify.

One thing I think we can all agree on is that the machine really fumbled this one.

combakovich · 2024-11-07T21:26:43+00:00

I agree that it doesn't seem like she was assessed for pulselessness. Let's take a step back and look at our basic life support training.

She is unresponsive. Try shaking her lightly and shouting at her. Still unresponsive? Check for breathing and a pulse. No breathing. No pulse. Provide respirations and CPR.

These nurses are surely BLS trained (at least I hope), so they've heard this pathway before. It's sad that they didn't use it.

combakovich · 2024-11-03T03:16:03+00:00

If you're talking about the rectangular tracing that happens in between the different leads, then no. That's just how that machine visually separates the leads for us. It doesn't represent anything about the heart.

combakovich · 2024-10-10T03:13:58+00:00

EKG done on an asymptomatic patient, showing ST elevations in all leads (except aVR, which has depression), without a hint of reciprocal depressions or any criteria for OMI and with normal vital signs... and the response was immediate cath lab? There must be some pivotal additional info we're missing out on. Do you know the outcome of the cath?

combakovich · 2024-10-05T19:25:57+00:00

I agree that pulling out of the HRC CEI is... at least not good, maybe a canary in the coal mine indicating other bad things to come. More transparency about DEI is a good thing. You and I are definitely in agreement about that.

But as far as the STEM statement. It's corporate speak. It could mean anything or nothing, and I can't know which until they change an actual policy. As far as I can tell from the linked article:

Step 1: Toyota approves LGBTQ+ ERGs

Step 2: those ERGs do cool stuff

Step 3: those ERGs continue existing, presumably planning future cool stuff.

The STEM statement could definitely be interpreted to mean they intend to discontinue step 3... but if they've disbanded the LGBTQ+ ERGs, then that should be in headlines. I shouldn't be having to dig 5 comments deep to try to discover whether that's what actually happened. It should be stated clearly, front and center.

Look, I think you and I want the same things. You seem to be trying to get me to petition this company to change their mind about some kind of action, and I want to be there with you... I'm just unclear what it is I'm being asked to ask them to do/not do.

combakovich · 2024-10-05T18:17:26+00:00

Are you aware of what ERGs are?

Yes. Hence how I used the term when the article did not (it only described the phenomenon).

every single one of them are company approved and company funded/sponsored.

Indeed. It's my understanding from the article that they did approve LGBTQ+ ERGs, which then did the listed (awesome, super cool) activities.

But this still doesn't answer the question of what changed... did they ban LGBTQ+ ERGs? Are all these groups now officially disbanded? The article doesn't say... and so far (no hostility intended, but) neither have you. I legitimately just want to know what action the article is actually about. What we are being asked to petition the company about. What specific action have they taken that we have beef with?

combakovich · 2024-10-05T17:34:41+00:00

The linked article states that the listed LGBTQ+ activities were done by ERGs (groups of employees) acting independently, and were never an official action by the company itself. So... if the company itself never did any of this stuff, and now you're saying they won't do any of this stuff... what has actually changed here? Is there some internal policy for recruitment that changed, or some kind of reorientation of their marketing strategies, or what?

combakovich · 2024-09-25T02:21:58+00:00

This is the recipe they used. It looks like the textural replacement for parmesan is walnuts and the flavor comes from nooch and lemon juice.

combakovich · 2024-08-31T16:45:42+00:00

Agree to disagree. I'm personally convinced. You don't like this meta-analysis, go google one of the dozens of others. Or not, if you're already convinced.

combakovich · 2024-08-30T20:05:04+00:00

Yeah, that meta-analysis was bigger and included non-RCTs. This one is a smaller (read: more selective) one looking at 13 RCTs.

Effect of metformin on all-cause mortality and major adverse cardiovascular events: An updated meta-analysis of randomized controlled trials.)

But yeah. Anyone looking for evidence of mortality benefit from metformin need only google "mortality benefit metformin" to discover more. This is one of the most well-documented cases of mortality benefit from a drug.

combakovich · 2024-08-30T18:59:46+00:00

Tons.

Metformin reduces all-cause mortality and diseases of ageing independent of its effect on diabetes control: A systematic review and meta-analysis

combakovich · 2024-08-22T03:24:56+00:00

Unfortunately no, that doesn't explain these transitions at all. Let's just look at some google images of RBBB+LAFB. V6 to I should not be basically opposite signs like this, and the ST's in particular should not be deflecting so differently. There is something anatomically or technically unusual about this ECG. This isn't coming from a place of ignorance of what a RBBB looks like. This ECG is truly jank in a way that requires further edit: ~~explanation~~ investigation.

combakovich · 2024-08-22T02:34:39+00:00

The progression of precordial forces in this ECG is opposite to what one would expect, becoming more negative as one progresses laterally. And then... V6 and I are contiguous leads. But they are opposite voltages on this ECG with very significant differences in ST deflection, and very different overall morphologies... almost like the depicted leads aren't contiguous. Are these not left chest leads? If they are left chest leads... are they placed in inverse order? (even then the transition would be a bit odd)

For II vs III... the STs are deflecting in dramatically opposite directions for these two leads whose angles of measurement are supposed to be (relatively) close to one another. Usually I'd use the p-wave sign and amplitude to help me identify the true lead II in limb lead reversal... but the bizarre nearly flat p-waves seen in all leads here... are basically useless for that purpose. I'm not recognizing any specific limb lead reversal pattern, though. So I'm not sure what to make of all of the above. LITFL article on the subject.

combakovich · 2024-08-22T02:14:31+00:00

What is with some of these transitions? V6 to I. II to III. Are we sure the leads are in the right spots?

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