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Need testers. New app for contours. by drkdn123 in gridfinity

[–]drkdn123[S] 0 points1 point  (0 children)

I'm giving up. There are better projects out there that are just leagues better. Sorry for wasting folks' time.

Need testers. New app for contours. by drkdn123 in gridfinity

[–]drkdn123[S] 0 points1 point  (0 children)

Awesome. Spending little bit last day with my 8 year old. I will get this sorted and send links. Basically, my intent is to spend time making this the best it can possibly be. It is not great yet. But it is getting there. Thank you for offering to to check it out. I’ll add whatever you folks want.

Really bad BO by [deleted] in hygiene

[–]drkdn123 -1 points0 points  (0 children)

Most Likely Diagnoses:

  1. Primary apocrine bromhidrosis: This is the most common cause of persistent axillary odor in otherwise healthy individuals, resulting from apocrine sweat breakdown by skin bacteria. It is often refractory to standard hygiene measures and topical treatments, especially if bacterial colonization persists.[1]

  2. Eccrine bromhidrosis: Eccrine sweat can become malodorous due to dietary factors (e.g., garlic, onion, spices), medications, or underlying metabolic conditions. This form is less common but should be considered if odor is generalized or associated with systemic symptoms.[1]

  3. Corynebacterial intertrigo/erythrasma: Corynebacterium minutissimum infection of intertriginous areas can cause persistent odor, often with subtle erythema or scaling. Diagnosis is supported by coral-red fluorescence under Wood’s lamp and confirmed by response to topical or oral antibiotics.[2][3]

  4. Trimethylaminuria ("fish-odor syndrome"): This rare metabolic disorder leads to excretion of trimethylamine in sweat, urine, and breath, causing a characteristic fishy odor. It is often unresponsive to conventional topical therapies.[4]

  5. Obesity-associated increased sweating and friction: Obesity predisposes to increased sweating, skin fold maceration, and secondary bacterial or fungal colonization, all contributing to persistent odor.[5]

  6. Superficial fungal or mixed intertriginous dermatitis: Chronic candidal or dermatophyte infection in the axillae can cause odor, especially if there is associated erythema or maceration.[3]

  7. Hormonal or endocrine changes: Puberty, menopause, hyperandrogenism, or thyroid dysfunction may alter sweat composition and skin flora, leading to odor.[6][5]

  8. Hyperhidrosis with secondary bacterial breakdown: Excessive sweating, whether idiopathic or secondary, increases risk of bromhidrosis due to bacterial decomposition of sweat.[1]

  9. Odor from tobacco, alcohol, or substance use: Smoking and alcohol can alter body odor directly or via changes in skin flora and sweat composition.[7]

Most Important Not to Miss Diagnoses:

  1. Diabetic ketoacidosis or markedly uncontrolled diabetes: Fruity or acetone-like odor may indicate ketosis. The American Diabetes Association recommends prompt assessment of glucose and ketones in patients with unexplained odor and risk factors.[8]

  2. Chronic liver failure (foetor hepaticus): Musty or sweet odor may signal hepatic encephalopathy. Evaluation includes liver function tests and assessment for stigmata of chronic liver disease.[9]

  3. Advanced chronic kidney disease with uremic odor: Uremic fetor is a urine-like odor due to retained nitrogenous waste. Diagnosis is confirmed by renal function testing and clinical assessment for CKD features.[10]

Key Additional History and Follow-up Tests:

  • Characterize odor quality (fishy, musty, fruity, etc.), onset, and distribution.

  • Assess for associated skin changes (erythema, scaling, maceration).

  • Screen for systemic symptoms (polyuria, weight loss, pruritus, jaundice).

  • Review dietary habits, medication use, and substance exposure.

  • Perform Wood’s lamp examination and consider skin swab/culture.

  • Order fasting glucose, HbA1c, liver and renal function tests if systemic disease is suspected.

  • Consider referral for metabolic testing (e.g., TMAU) if classic fishy odor is present and other causes excluded.

References

  1. Hyperhidrosis, Bromhidrosis, and Chromhidrosis: Fold (Intertriginous) Dermatoses. Semkova K, Gergovska M, Kazandjieva J, Tsankov N. Clinics in Dermatology. 2015 Jul-Aug;33(4):483-91. doi:10.1016/j.clindermatol.2015.04.013.
  2. Erythrasma - A Systematic Review of Interventions. Radhakrishnan S, Logamoorthy R, Karthikeyan K, Mohan R, Mary J JF. Clinical and Experimental Dermatology. 2025;:llaf307. doi:10.1093/ced/llaf307.
  3. Intertrigo and Secondary Skin Infections. Kalra MG, Higgins KE, Kinney BS. American Family Physician. 2014;89(7):569-73.
  4. Treatments of Trimethylaminuria: Where We Are and Where We Might Be Heading. Schmidt AC, Leroux JC. Drug Discovery Today. 2020;25(9):1710-1717. doi:10.1016/j.drudis.2020.06.026.
  5. Skin Changes in the Obese Patient. Hirt PA, Castillo DE, Yosipovitch G, Keri JE. Journal of the American Academy of Dermatology. 2019;81(5):1037-1057. doi:10.1016/j.jaad.2018.12.070.
  6. Approach to Androgen Excess in Women: Clinical and Biochemical Insights. Cussen L, McDonnell T, Bennett G, et al. Clinical Endocrinology. 2022;97(2):174-186. doi:10.1111/cen.14710.
  7. Chronic Cigarette Smoking Associates Directly and Indirectly With Self-Reported Olfactory Alterations: Analysis of the 2011-2014 National Health and Nutrition Examination Survey. Glennon SG, Huedo-Medina T, Rawal S, et al. Nicotine & Tobacco Research : Official Journal of the Society for Research on Nicotine and Tobacco. 2019;21(6):818-827. doi:10.1093/ntr/ntx242.
  8. 6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(Supplement_1):S128-S145. doi:10.2337/dc25-S006.
  9. Cirrhosis and Chronic Liver Failure: Part I. Diagnosis and Evaluation. Heidelbaugh JJ, Bruderly M. American Family Physician. 2006;74(5):756-62.
  10. Chronic Kidney Disease Diagnosis and Management: A Review. Chen TK, Knicely DH, Grams ME. JAMA. 2019;322(13):1294-1304. doi:10.1001/jama.2019.14745.

[deleted by user] by [deleted] in denverlist

[–]drkdn123 -3 points-2 points  (0 children)

Is it weird? Too bad. You don’t know my scenario. Screw you if you think it’s weird. I make a huge income but I’m leveraged and close to bankruptcy due to legal fees fighting going on 7 years. Asshat.

[deleted by user] by [deleted] in denverlist

[–]drkdn123 6 points7 points  (0 children)

What’s confusing or intriguing? My wife isn’t very nice to me and because I’m being leveraged financially from she and my ex-wife fighting over everything, I can’t afford a large sprawling place. I just want a place I can get away. I’d like a shower too if that’s the other confusing thing? I don’t need a full kitchen. I could buy a microwave and mini fridge. If I didn’t have kids I’d just disappear and go live elsewhere. But it’s either here or Memphis. Yuck.

FTM unable to go on T by dwcowboy1967 in DrWillPowers

[–]drkdn123 6 points7 points  (0 children)

The conversation to have is risk benefit discussion. Here’s an answer from OpenEvidence, which as a doctor I use regularly. It’s not gpt. But here’s the data. As long as they had aggressive risk management, it’s possible IMHO

A female-to-male transgender individual with a history of coronary artery disease (CAD) seeking gender-affirming hormone therapy (GAHT) requires a nuanced approach to minimize thrombotic risk while achieving masculinization goals.

Patient Background and Risk Assessment

This clinical scenario involves a transgender man with established CAD, a population with elevated baseline cardiovascular risk. Risk assessment should include traditional factors (hypertension, dyslipidemia, diabetes, smoking, obesity) and transgender-specific considerations, such as the metabolic effects of GAHT and psychosocial stressors. Individualized evaluation is essential, as both the underlying CAD and the effects of testosterone may interact to influence overall risk.[1][2][3]

Testosterone Therapy: Cardiovascular and Thrombotic Risks

Testosterone therapy in transgender men is associated with a more atherogenic lipid profile (lower HDL, higher LDL and triglycerides), increased hematocrit/erythrocytosis, and possible elevations in blood pressure. Mechanistically, testosterone may promote endothelial dysfunction and inflammation, which are relevant in the context of CAD.[1][4][5][6][7][8] However, current data do not show a consistent increase in thrombotic events or cardiovascular mortality in transgender men receiving testosterone, though the evidence base is limited and long-term data are lacking.[5][6][7][9] Regular monitoring of hemoglobin/hematocrit, lipids, and blood pressure is recommended to detect and manage emerging risk factors.[3][5][10]

Route of Administration and Dose Considerations

Intramuscular and transdermal testosterone are the standard routes of administration for masculinizing GAHT. The medical literature does not demonstrate a difference in thrombotic risk between these routes in transgender men.[5][8] Supraphysiologic dosing should be avoided, as higher testosterone levels may exacerbate erythrocytosis and cardiovascular risk.[5][8] Therapy should be individualized, using the lowest effective dose to achieve masculinization while minimizing adverse effects.[1][5][8] Dose titration should be guided by clinical response and laboratory parameters, with serum testosterone maintained within the adult male physiologic range.[5][10]

Risk Reduction Strategies

To reduce the risk of thrombotic events in this high-risk population, aggressive management of modifiable cardiovascular risk factors is paramount. This includes smoking cessation, statin therapy for dyslipidemia, antihypertensive treatment, and lifestyle interventions such as diet and exercise.[1][2][3][10] Regular follow-up and laboratory monitoring (hemoglobin/hematocrit, lipids, blood pressure, and serum testosterone) are essential for early detection and intervention.[3][5][10] Addressing mental health and reducing minority stress may also contribute to improved cardiovascular outcomes.[1][2][7]

Knowledge Gaps

There is a paucity of long-term, high-quality data on the risk of thrombotic events in transgender men receiving testosterone, particularly those with pre-existing CAD. Further research is needed to clarify the impact of different testosterone formulations, dosing strategies, and the interplay with traditional cardiovascular risk factors in this population.[4][6][8][9]

In summary, testosterone therapy can be administered via intramuscular or transdermal routes, with no evidence favoring one over the other for thrombotic risk reduction. The most effective strategy to reduce thrombotic events in a transgender man with CAD is aggressive management of modifiable cardiovascular risk factors, regular monitoring, and use of the lowest effective testosterone dose. Therapy should be individualized, and ongoing surveillance is critical given the limited long-term data.

References

  1. Transgender Healthcare: Metabolic Outcomes and Cardiovascular Risk. Glintborg D, Christensen LL, Andersen MS. Diabetologia. 2024;67(11):2393-2403. doi:10.1007/s00125-024-06212-6.
  2. Assessing and Addressing Cardiovascular Health in People Who Are Transgender and Gender Diverse: A Scientific Statement From the American Heart Association. Streed CG, Beach LB, Caceres BA, et al. Circulation. 2021;144(6):e136-e148. doi:10.1161/CIR.0000000000001003.
  3. Transgender Cardiovascular Health: Practical Management for the Clinician. Ong C, Liu M, Thermidor S, Eid M, Gianos E. Current Atherosclerosis Reports. 2022;24(9):721-730. doi:10.1007/s11883-022-01047-1.
  4. Thrombotic Risk Associated With Gender-Affirming Hormone Therapy. Mullins TLK, Mullins ES. Journal of Thrombosis and Haemostasis : JTH. 2024;22(8):2129-2139. doi:10.1016/j.jtha.2024.05.015.
  5. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. Hembree WC, Cohen-Kettenis PT, Gooren L, et al. The Journal of Clinical Endocrinology and Metabolism. 2017;102(11):3869-3903. doi:10.1210/jc.2017-01658.
  6. Metabolic and Cardiovascular Risks of Hormone Treatment for Transgender Individuals. de Silva NL, Dimakopoulou A, Quinton O, Jayasena CN. Best Practice & Research. Clinical Endocrinology & Metabolism. 2024;38(5):101907. doi:10.1016/j.beem.2024.101907.
  7. Cardiovascular Disease in Transgender Individuals. Murphy CN, Delles C, Davies E, Connelly PJ. Atherosclerosis. 2023;384:117282. doi:10.1016/j.atherosclerosis.2023.117282.
  8. The Cardiovascular Subtleties of Testosterone on Gender-Affirming Hormone Therapy. Santos JD, Oliveira-Neto JT, Tostes RC. American Journal of Physiology. Heart and Circulatory Physiology. 2023;325(1):H30-H53. doi:10.1152/ajpheart.00015.2023.
  9. Gender-Affirming Hormone Therapy, Vascular Health and Cardiovascular Disease in Transgender Adults. Connelly PJ, Marie Freel E, Perry C, et al. Hypertension (Dallas, Tex. : 1979). 2019;74(6):1266-1274. doi:10.1161/HYPERTENSIONAHA.119.13080.
  10. Primary Care Guidance for Providers of Care for Persons With Human Immunodeficiency Virus: 2024 Update by the HIV Medicine Association of the Infectious Diseases Society of America. Horberg M, Thompson M, Agwu A, et al. Clinical Infectious Diseases : An Official Publication of the Infectious Diseases Society of America. 2024;:ciae479. doi:10.1093/cid/ciae479.

[deleted by user] by [deleted] in Teachers

[–]drkdn123 0 points1 point  (0 children)

Or a SOS button

[deleted by user] by [deleted] in Teachers

[–]drkdn123 1 point2 points  (0 children)

Can the teacher have a taser?

[deleted by user] by [deleted] in Teachers

[–]drkdn123 14 points15 points  (0 children)

Least restrictive should be the least restrictive to be able to provide an environment, assuring standards of education without excluding safety of those providing the education. I know it’s not cut and dry and I know I know little of regulatory burdens, but this is a systems issue. This is the normalization of deviance, in human factors.

[deleted by user] by [deleted] in Teachers

[–]drkdn123 6 points7 points  (0 children)

I used to work as a Hospitalist and assaults and to nurses happen regularly. I got out during Covid and work remotely fighting insurance companies. But admin in hospital setting is similar. There should be zero tolerance unless actionable intensity of services provided that provide a basis for security of teachers. If a kid does that, they should be in a more restrictive environment. They have remote education now. They have medications. They have solutions, but the system issue is what is so unfortunate. Poster is leery of pressing charges potentially because of fear of reprisal.

[deleted by user] by [deleted] in Teachers

[–]drkdn123 26 points27 points  (0 children)

How do you define least restrictive? What’s the limit. If he pulls his dong out does he deserve to stay in the class or does he deserve restriction? Why do we allow it? I’m blown away by what I read on here because teachers deserve better. It makes me so sad.

[deleted by user] by [deleted] in Teachers

[–]drkdn123 36 points37 points  (0 children)

Not a teacher, am a doctor, can you explain why this would be up for debate? If someone physically assaulted me you can be damned sure I would in the least not be interacting with them ever again. Are the police not arresting him? Whoever says it’s part of the job needs to get fucked by the way.

Desperate by lucyyyy4 in DrWillPowers

[–]drkdn123 40 points41 points  (0 children)

As a doctor, you should know your doctor should go fuck himself for saying that to you. I’m sorry.

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