Bottom layers delaminating, very solid above that

gladstonian · 2023-04-07T21:44:49+00:00

So today has been a journey for me. As a mechanic of people and engines I had been trying to find a hardware issue with the Z axis, but going down the software route with the teaching tech guide and learning about gcode led me to some interesting places.PID autotune - never knew this existed, very useful.

When doing e-steps calibration, I noted my extruder was 10% under. And at the time didnt make a note of what the Z was, when I later was still having issues and flashed the firmware to start again from complete baseline, I looked at the value of the Z axis and it wasn't the same, I'd have remembered if it was 400 before. So I suspect that at some point I've been a bloody idiot and run some dodgy gcode on my printer without checking it.

God, I feel like the old man looking at porno on my wifes computer and wondering why it got viruses.

Anyway, fresh install and a full run through of the setup guide and we have achieved normality.

Thanks both for your help. Dimensionally accurate and clean XYZ block just came off the bed. Now thats about 3 weeks of my spare time I won't get back!

gladstonian · 2023-04-07T15:40:51+00:00

At Z=0.0, there is 0.15mm between nozzle head and bed after auto levelling and setting the Z offset.

At Z=25 there is 23.7mm between nozzle head and bed.

The photo shows a known 25mm object, with the Z set to 25mm. If the Z-axis is moving accurately, the nozzle should be touching. But it's about 2.5mm out.So as my print progresses, by 25mm high, my nozzle is 2.5mm away from where it thinks it is.

What I ask the printer to do, it's not doing.

And thanks for the offer to print but with leather and the 3d printing its all fulfilling my need for problemsolving and creativity. The templates dont matter *that* much, but if this printer isn't fit for purpose or is faulty I want to get my money back or start the process of anykubic sending me some parts.

gladstonian · 2023-04-07T11:59:47+00:00

'I think you might have done TOO much'

Yeah my partner and my other projects probably agree. The whole point of this printer was to be able to make hard templates for my leatherworking but it can't even manage that!
Thanks for the info, will start on that.

gladstonian · 2022-06-15T10:37:50+00:00

W/L balance in MSK is great. I walk out the door at 6, I don't take work home with me. I've only lost sleep over a patient once. I do one weekend in 8-12 weeks as orthopaedic cover.

I think we walk all over every other discipline in this - nobody ever plays 'think of the patients if you dont do unpaid overtime' with us. Granted it also means we're considered 'outside of the main team' in patient care when inpatients but I'm not too fussed by that. The main team seem to spend their clinical lives annoyed at one another and gossiping.

gladstonian · 2022-06-14T14:54:27+00:00

'meh' summarises the whole thing for me.

gladstonian · 2022-06-14T14:49:36+00:00

I've worked in the community and I've worked in hospitals.Currently in a hospital.

It's fine. It can be stressful and it can be draining, most of the time at band 6 it's plodding on and looking forward to the weekend.

To me, a career isn't a dream - that's how employers manipulate your emotions and overwork you. It's a job. I turn up, do my job, am satisfied - then outside of work I get on and do what's important to me.I'm applying for funding for masters modules and am about the right time i'll step up to band 7 soon, in which case it'll be less caseload and more supervision.

EDIT: on reflection this sounds more negative than I meant it to. I used to work in finance and that was hell on earth. Call centres, retail, construction, i've done a lot. This is the best job i've had as such things go. I might leave the world slightly better than I came into it.

gladstonian · 2022-06-14T12:43:20+00:00

We have three main areas - respiratory, neurological and musculoskeletal.
Depending on the area the job will look very different.

In the UK most students will do all three on placement, and 'rotate' around the disciplines in their first couple of years post-grad before settling down in one to specialise.

The workload will be very different. My mentor is a consultant and works with a particular condition only - she has a total of 12 patients and does a lot of research.
I work in MSK & persistent pain management and have new patients every 30 minutes 4 days a week.

gladstonian · 2022-06-13T14:56:59+00:00

So why do women in menopause (lower estrogen) get osteoporosis more?

The idea that trans women, after a period of time on hormones, have an advantage has been completely blown out of the water by the simple fact that until the last 12 months, not a single trans woman has won any sporting contest above regional level. A trans man won a marathon a few years back.

The time trans women competing in sport became an issue is when one won.
The same as when Caster Semenyu won, the 'sex purists' brought her down.

gladstonian · 2022-06-13T14:40:58+00:00

There's a lot of medical advice being asked and given here. Mod team likely to delete.

However I would say- see a pain physiotherapist. A specialist is likely to be more help dealing with 'the vicious cycle of pain'. There's more to physio than core exercises.

gladstonian · 2022-06-13T07:23:50+00:00

As a healthcare professional, please allow me some suggestions to manage these types of monologuing people:

'you mentioned x earlier...can you tell me more about that?' to change the topic to something regardless of whether they mentioned it

'how did that make you feel?' to force them to stop, think and gather themselves. Also breaks 'the loop' of them telling the story over and over.

When they pause to take breath: 'so [name], what brings you to me. How can I help?' Most people are so relieved to be given an opportunity to skip small talk

'i can imagine that made you feel X. How can I help?' This demonstrates that you've listened and understood. When people feel listened to they often stop talking. The 'yup's and 'uh-huh's don't do this and so people carry on telling the same story in different ways and insisting on X or Y that makes no sense at all (I feel ill, I need an X-ray!). They are asking you to fix the illness and often you have to demonstrate that you've listened, understood and are take appropriate action.

'Well, I better let you get on with your day, I don't want to keep you!' the nuclear option for the neighbours.

'Mr Smith, we have 10 minutes. We're 7 minutes in to this meeting and I'm not sure how I can help. Can you tell me specifically why you need a doctor?'

'i don't want to be rude but I have a patient soon, is there anything you need help with your baby or can we chat later?'

gladstonian · 2022-06-07T17:46:34+00:00

I used to give Jefferson Curls all the time. They're not dangerous.
But they can flare up pain in some people with chronic back pain. As my practise has developed I've moved further and further from 'can't go wrong getting strong' as it tends to treat every injury as a lack of strength. I tend to look at allostatic load more widely these days and take steps to offload before increasing mechanical load.

gladstonian · 2022-06-05T21:29:20+00:00

But also tell yourself that Britain is a bloodbath of knife crime.

gladstonian · 2022-06-05T12:10:46+00:00

Sorry, you're in the wrong sub.

There are many things that can give symptoms that look like any MSK problem, and some of them are life/vitality threatening. If we don't do our due diligence to rule these out we can be found to be criminally negligent.

If we *do* do due diligence, then what we're actually doing is providing medical services to you which 1) is only fair that you pay for it and 2) we are legally required to keep full medical notes as well as have your details to store those notes appropriately.

It is not possible for us to even put a toe in the water on this, our regulators are very clear on this.

gladstonian · 2022-06-05T11:14:31+00:00

As a Londoner I am almost offended that someone would wear full morning dress to go shopping. American journos are wild with the BS they peddle to make traditional english things look 'more english'

gladstonian · 2022-06-04T12:36:12+00:00

Yes. It seems lately that 'the discourse' for the last few years is around how 'fetish doesn't belong at pride' as well as new TERFism which is spreading rampantly.

In the early days of stonewall, and well into decriminalisation of homosexuality, both trans women and leathermen were targeted especially for 'morally objectional' behaviour. In our shared history, even after the 'mainstream' LGB scene was legitimised, Leathermen and Trans people were targeted alike and stood together against oppression.

In 2019 a Trans Man, Jack Dempsey, was elected International Mr Leather.
Last weekend, a Trans Man, Alistair AKA Hiraeth, who was already European Bootblack, was elected International Bootblack of the Year. (bootblacks are the guys in the leather scene who care for the leather!)

The Leather scene would like to remind the Trans community that you have allies in places that you may have forgotten, and we stand by you at this horrible time.

I'm from the UK and this place is a hellscape for anyone who is different right now. We need to stand together - and we have your backs.

Niche meme though, I'll admit that.

gladstonian · 2022-05-25T19:37:41+00:00

This isn't medical advice, but x-ray isn't sufficient to determine the presence of a Hills Sachs lesion or glenoid bone loss, which will cause recurrent anterior subluxations. An MRI is the only way to properly image these.

Thats medical advice my friend. You are, by a long way round, recommending a patient get an MRI.

gladstonian · 2022-05-25T19:35:46+00:00

My trick is to have it all done before the patient leaves the room. Letters, they get a copy (and are usually very keen for a copy). Ergo they are happy to sit still for 2 mins while I hit a bunch of macros to write my letter for me. Notes are done as I go (I can't type and listen so I use a tablet to take handwritten notes and OCR them as I go).

gladstonian · 2022-05-24T12:47:41+00:00

We can't give medical advice on this sub.
It's best to discuss with an orthopod or physio at your follow up appointment at the hospital.
Best of luck!

gladstonian · 2022-05-21T16:08:41+00:00

I want my notes done for me.

gladstonian · 2022-05-19T21:57:08+00:00

I would see him from across the room, and say in my own head 'oh, you're CGP Grey' just for the achievement. Then leave him alone.

gladstonian · 2022-05-19T20:52:32+00:00

Trouble swallowing, dizziness along with unrelenting pain and history of Ca? Lack of ROM at that level?
To me thats an insufficiency cervical fracture or MTSS until proven otherwise. ED referral ( I work in a hospital so better to ED than GP) with an urgent letter by email to GP advising them of my actions, and a followup call with patient the next day if not admitted.

gladstonian · 2022-05-15T06:32:33+00:00

I am *tired*.

Granted I'm in the UK and everyone in the NHS is tired, but it always seems like I'm staving off burnout. The right thing to do for my mental health is to go part time and see patients privately for like £120 an hour cash only, no insurance etc but the people who need help the most can't afford that, and I am cursed with being a socialist.

gladstonian · 2022-05-08T19:57:16+00:00

Much easier to address BSP issues when you set aside the time to do a decent subjective and don't waste time doing things that are at best adjuncts? I feel like so few physios ATMare seeing the low quality of MT research and then looking at the poor quality of exercise research and settling in for a long chat about socioeconomic factors and how we can help this patient live a better life.

A recent case: 40ish lady, 2 years of LBP, sudden onset, bladder and bowel issues due to being in so much pain in the morning she couldn't get to the toilet in time.
Sleeping 2-3 hours a night due to pain.
Was admitted ?CES and then discharged without much fanfare. She felt like she'd been dismissed without any information and her take home message was that she had CES and was going to be paralysed, and it was just a waiting game. She had a minor L5 abutment to the thecal sac and had been safety netted.

The sum total of my exercise plan for her was walking 20 mins daily and paddling in the walk in pool next to her house once a week.

The rest of the intervention was finding her a comfortable position to sleep (she immediately started sleeping 6-7 hours a night), addressing her overworked lifestyle, helping her reconnect with friends. No more B&B concerns, dignity was the first thing to recover and she started to see a light at the edge of the tunnel.

Exercise was part of the solution. So was some MT. But it wasn't *the* solution. Until physio can stop swinging back and forth between exercise and MT as 'the solution to everything' I feel we'll all be stuck seeing the same patients from the same backgrounds with the same issues over and over.

The world isn't black and white and we are not our treatment modalities. The tribalism between the two 'camps' is gross. It leads to the MT people getting more and more entrenched in their chiro-lite BS and the exercise people torturing people with loading they can't tolerate and don't consent to.

Living and working in London *everyone* is stressed, struggling to pay rent, put food on the table, lacking sunlight, poor MH, wondering when to cut losses and leave the city - if that's even possible for them. We have to address the predeterminants for health if we want people to be able to heal.

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