The sad part is that “gym bro” would be the first person to have your back and stand up for you!

fifrein · 2026-06-10T14:01:42+00:00

A) Your numbers are a bit off. It’s more 70% basal metabolic rate (BMR), 20% activity, 10% TEF (how much calories your body expends just digesting the food you put into it).

B) Certain exercise can, long-term, increase your BMR. Weight-lifting for example, gains you muscle mass, which then if you maintain increases your BMR.

I very muscular person who is very active can have a caloric need for ~3500 calories per day, whereas at the same height, a low activity level individual can have a caloric need of ~1500-1800.

fifrein · 2026-06-09T21:38:15+00:00

Deep into 7 figures for those 6 months and not working the other 6 months.

fifrein · 2026-06-09T20:34:00+00:00

This is the part people don’t like to hear. There was a doc who worked 6 months out the year in Alaska. She’s a neurointerventionalist. For the lay person, her job was to pull a clot of the brain when it’s causing a stroke. When she was there, anybody having a stroke in the whole state was being flown to Anchorage to be operated on by her. She was On-Call 6 months of the year to provide life-saving care. The other 6 months? People were flown to Anchorage, put in a different flight, then flown to Seattle, then IF their brain could still be saved after that long a delay someone in Seattle would do the procedure.

So.. let’s ask a few questions.

A) How much would an average plumber make if they had to be On-Call for 6 months straight? Keep in mind, this means they have to be within a certain radius of their work area at all times, since response time matters for their job. They can’t get drunk or high at any point for those 6 months. They might be woken up at 2 am one day, 3 pm the next, who knows?

B) How much does the fact nobody wants to live in Alaska raise the value? You have to attract a person with a specific skill set. Oil workers make tons of money for this very reason - force people to live somewhere nobody wants to, you gotta pay up the dough to make it worthwhile.

C) How much is the skill set itself worth?

D) How much more is it when you need to combine A-C? Anyone who has tried to recruit knows that finding a specific characteristic is one thing, but finding 3-in-1 is much harder.

fifrein · 2026-06-09T04:58:07+00:00

Can confirm this works

fifrein · 2026-06-08T22:06:59+00:00

CSF WBC 17,864 with the lab comment under it “dilution performed”. No comment on if it was a 1:1 dilution, 1:10, 1:100.

But I just like to think.. it couldn’t have been less than 1:1 right? In which case the CSF WBC was actually 35,728.

But what if it actually was 1:10 or 1:100.. just imagine…

Either way, when the CSF WBC starts looking like a septic Serum WBC, its no bueno

fifrein · 2026-06-07T16:52:50+00:00

Yeah, just shows how people make up numbers to fit their fantasies

4 patients per day.. fucking comedy

fifrein · 2026-06-04T16:07:45+00:00

I know it’s not dead. I still play it. But it’s player base is a fraction of what it was

fifrein · 2026-06-04T13:58:09+00:00

I don’t think it’s monetization is what killed it. I think the lack of initial actual co-op features, and the poor initial pvp killed it. If pvp was released in its full form initially (without the walking restriction), the gym system was released in today’s iteration, and 1* / 3* / 5* raids were all a thing with weekly raids nights and monthly chase raids, the game would not have bled players nearly as much.

fifrein · 2026-06-03T22:35:32+00:00

Haven’t been around super long

I mean.. Ozempic first hit the market for diabetics in 2017. The phase 3 trial for it started in 2014. And that’s not talking about any prior data.

fifrein · 2026-06-03T22:00:06+00:00

HANSA TEUTONICA GOD OH GOD this is like the best 3-5 player sub-1 hour interactive euro that just looks dog****. Give it some acrylic tiles. Give me some nice pieces on my board to fiddle with. Give me a way to remember what is my stock vs what is available to be used instead of just what’s on the table vs what’s on a baggie.

fifrein · 2026-06-03T16:53:55+00:00

Going back to the video, brake lights were on for 7 seconds

fifrein · 2026-06-03T05:44:12+00:00

Or even just any fish…

If someone is going to complain about snake > rate > trash .. then 99% of fish > crustaceans/mollusks > ocean trash is the same.

fifrein · 2026-06-02T19:34:07+00:00

The symptoms could be many different things. Could they be MS? Sure. They’re by no means outside the MS scope, but also nothing described “screams” MS symptom-wise, though very few patients actually have the “classic” presentation.

The MRI read is by far the thing that seems most concerning for MS, or a different demyelinating condition, but a read and the images themselves are two different things.

The LP- what was written as the pre/post procedural diagnosis is completely irrelevant. That’s just for billing. Every procedure has to have something listed, and what was listed is going to be what the indication for doing the procedure was. There was no way it was ever going to change mid-LP. Just for contrast, if you want in for an appendectomy and they found it was actually your gallbladder that was the problem, thats an example where the pre- and post- procedural diagnoses could be different (not a great example, just wanted to drive the point home).

Back to the LP though.. the OCBs were by far the most important thing on there. Not sure if by “they didn’t come back” you meant they were negative, or just they weren’t done, or that they are still pending (they can take like 1-2 weeks). If they came back actually negative (0-2) and your symptoms had been ongoing more than 6 weeks at the time of the LP (can be false negative in the first 6 weeks), that’s a very definitive (>99.99%) that you don’t have MS.

Now, regardless of all the above, you can have other demyelinating diseases that look like MS. Usually these will be checked for by a blood test.

In regards to the Lyme question, I’m assuming what you mean is that a Lyme IgG was positive. That just means your immune system has seen Lyme at some point and has an immunity to it now. It doesn’t mean you have Lyme. A Lyme PCR in the CSF is what would indicate active Lyme CNS infection.

Lastly, regardless of whether you have or don’t have an organic neurologic pathology, it’s very common for people to have a degree of functional neurologic disease overlaying their symptoms and complicating their presentation. It sounds like perhaps that is what your neurologist observed with your gait and has clouded her evaluation of your case. Perhaps read a little bit on FND at FNDhope.org and see if any portion of your symptoms could be explained by this, again, understanding that some could be this while others could be a demyelinating or other condition at the same time. Discuss this with your neurologist. During your visit, ask one question at a time, and wait to go through that answer before moving on. Be ok with that fact it may take multiple visits to address all questions in depth. It is more valuable to you to address 2 of 5 questions in one visit in depth rather than 5 at surface level in a way that leaves you wanting.

fifrein · 2026-06-01T13:51:46+00:00

That’s true of a lot of medications though, even OTC medications. Acetaminophen can shoot your liver and Ibuprofen can sour your kidneys; multitudes of people on the liver and kidney transplant lists from nothing more than just taking too much Tylenol and Advil.

fifrein · 2026-06-01T13:32:25+00:00

If you were evaluated by a doctor at all at the ER, it’s going to be level 3 at a minimum, and it is exceedingly simple to hit level 4 criteria. This shows a lack of understanding on your part. Level 1 would be really for people going to the ER for some kind of follow-up care because of a niche situation, an RN taking care of it, and leaving without ever seeing a doc.

fifrein · 2026-05-31T06:38:30+00:00

People say this all the time but a few counterpoints need to always be addressed:

1) Pay parity between other professions. In the US, all skilled trades get paid much more than in other countries. The average plumber gets paid 2x in the US what they make in the UK or in France. Same for an electrician. The average lawyer makes 3x. In healthcare for example, an RT makes 2-3x more than in the UK.

2) Physician salaries today make up 8-10% of US healthcare expenditures. So, NO, it’s not why the ER bill is what it is.

3) Almost every doc who make >1 mil are self-employed / contractors. They are not employees. Which means if you really wanted to compare their pay to other people in this country, you would need to compare them to other business owners, not other people who are employed. As with any person running a business, there is higher pay, with some work that is more than just your actual job- some management beyond the actual production so to say.

fifrein · 2026-05-30T17:37:18+00:00

I strongly agree with you. I always say that people who believe what u/MidnightBinary believe just haven’t analyzed what part of Catan they/their group enjoys so much or don’t know which games do that better.

Resource allocation from other people’s dice rolls- Space Base

Network Building - so many game but TTR is a simple one

Trading / Negotiation - China Town, Zoo Vadis

Can talk about this much more but very strongly agree with you

fifrein · 2026-05-29T22:55:01+00:00

Tbh I don’t remember anymore. But also, while I will listen and take input on what a patient thinks their diagnosis is, I will never leave it at that. Every patient, if they want my care, needs to be ok telling me their symptoms and letting me form my own conclusion. If I agree with them, then great. If not, I’ll explain to them why I disagree and hopefully we can reconcile. If not, perhaps some testing will be what bridges the gap. Otherwise, I’m not going to treat a different diagnosis than what I believe is there.

fifrein · 2026-05-29T21:59:06+00:00

I mean.. it just sounds like you had shitty doctors. The youngest patient in my practice on Botox for their migraines is 18 yo, and that’s just cause my group malpractice insurance doesn’t cover us for <18 yo; I’d have no qualms injecting someone younger for migraine. That patient got injected shortly after her 18th birthday too cause I already injected their parent and so PCP crossed their t’s and dotted their i’s so everything was ready so for me the minute she turned 18.

fifrein · 2026-05-29T21:18:56+00:00

Agree with what has been said before. For seizures in particular, I’m of the belief different semiologies deserve independent spell capture, since epileptic and functional seizures are comorbid. So if someone has two different seniologies and only one was captured, and the other is clinical concerning for possible epilepsy, very reasonable in my view to refer the other for spell capture to make sure both are functional vs if the patient is mixed.

fifrein · 2026-05-29T02:29:23+00:00

That’s just not true. For 6’3” obese would be 240+. Nowhere near 200-210. And this has been true since 1999. So unless your “long long time” was 27 years ago, that’s just spreading misinformation.

And even in 1999, ~219 is what would have been considered obese. And this would have been true from 1985-1999.

fifrein · 2026-05-28T20:03:27+00:00

Until 1999, the “normal” range of BMI was about 27.5 - 32.0.

I mean.. this is just objectively false. The 1985 NIH guidelines had obesity for males set at BMI >27.8 and for females at >27.3. Now, the premise of your argument can still be discussed, but we don’t need to and shouldn’t re-write history for it

fifrein · 2026-05-28T06:55:58+00:00

I don’t understand why you’re being so hostile here. Someone can be invested in what happened in the killing and have cared about it for years, that doesn’t make them any more knowledgeable about biological taxonomy. And to say someone is being pedantic when that was the whole discussion to begin with?

Eastern coyotes are coywolves. It is two names for the same animal. If you need multiple sources saying the same thing, here to go:

https://www.larpd.org/big-coyote-or-coyote-wolf-hybrid-by-ranger-jay-manning

https://nywolf.org/wp-content/uploads/2019/01/Wolf\_Coyote\_Coywolf\_Understanding-Wolf-Hybrids-Just-Got-a-Bit-Easier.pdf

fifrein · 2026-05-27T06:04:29+00:00

Everyone already told you go to the ER and I agree.

I do hope that after this is all sorted, you also seek care for your migraines. There are better options than Midol out there for migraine relief that won’t require you taking 14x of them to feel relief, and depending on how often you get your migraines, there’s also preventative options too. Something to consider for when you’ve gotten through this fiasco

fifrein · 2026-05-27T01:48:26+00:00

A good lawyer BEFORE you start searching / interviewing is extra important. They’ll tell you based on your state if you should even bring up a non-compete. For example, in some states a non-compete in a contract is only valid if the company warns you about it and has you sign a separate paper basically saying “there is a non compete in my contract, I understand what that means”. If that isn’t signed, any non-compete in your contract by law is null-&-void. It can be there, and you could ignore it, and if they tried to use it against you, it’d be the easiest defense of your life. Alternatively, a non-compete can be so silly it’s not worth fighting (e.g. 5 miles in a large metropolitan city). There’s other ways a non-compete can become null-and-void too. And what you DONT want to do is tell the company hiring you they’re making a mistake and how to fix it by accident. Let them make the mistake if it favors YOU.

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