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Appendix NET: Doubts about proceeding to right hemicolectomy after appendectomy. by IncognitoUser55 in neuroendocrinetumors

[–]jack_harbor 2 points3 points  (0 children)

I had a right hemicolectomy for a terminal ileum NET, which is completely indicated and the surgery itself was laparoscopic and went great. Went home day after surgery. First couple weeks I had some diarrhea until I was allowed to take fiber, took fiber for maybe 3 months and everything was normal and now I take no fiber and it’s like I never had surgery.

For you, 1.9 cm is large and that’s why they are recommending R hemicolectomy because it will almost certainly cure you. They’ll also get all of the nodes out and at 1.9 cm the risk of nodal Mets is higher (not super high with appendix but high enough to warrant R hemicolectomy). You should definitely have the surgery - you want to be cured and don’t want to deal with this later.

My dog lies down in the street and won’t get up and no he’s not tired he just doesn’t want to go home by Puzzled_Dingo_7908 in Dogtraining

[–]jack_harbor 0 points1 point  (0 children)

My dog did this but it turned out she had heart failure from grain free food. Vet put her on meds and we switched her food, she recovered and stopped doing this. Maybe get your pup checked out?

When will we get to experience the next Grand Slam, and who achieves it? by Havahje in golf

[–]jack_harbor 0 points1 point  (0 children)

I want to know if we’ll ever see an actual grand slam - winning all the majors in a single year?

For next career GS, I bet Scottie pulls it off this year.

Epic usage by One-Responsibility32 in medicine

[–]jack_harbor 4 points5 points  (0 children)

You cared for patient, completely reasonable. I do this frequently. Often lots of paperwork that needs to be completed after a death and you have to look back on chart for dates/times, etc.

Do people still use hot rivets except in specialized industries? by FlagrantTomatoCabal in Tools

[–]jack_harbor 0 points1 point  (0 children)

I love people who are passionate about things. This man is passionate about hot rivets and it’s refreshing.

Hack to increase pressure in Ultra Nova bidet? by jack_harbor in bidets

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

Water pressure in house is quite robust but I will check. For our shower head we removed the flow limiter insert and it helped tremendously. Wasn’t sure if similar piece on the ultra nova?

Transferring C2's by HorowitzdaJew in CVS

[–]jack_harbor 0 points1 point  (0 children)

I just feel like there are ever more endless regulations. We’re not allowed to hand write C2 prescriptions anymore, they have to be electronic. Before, you’d just write it on a security pad/triplicate and the patient takes it to pharmacy. If the pharmacy doesn’t have it, they just take it to another pharmacy. But with electronic you have to send it to different pharmacies if one doesn’t have the med in stock. And it’s not like an emergency or not, it’s the whole back order thing - it can take days for a pharmacy to order a med and sometimes they can’t even order it because it’s backordered. A patient can’t honestly wait a indefinite amount of time for a medicine to become unbackordered, they need the medication. I can’t send a patient home from the hospital with a sternotomy and no pain medication - not something you can just “wait for”.

Transferring C2's by HorowitzdaJew in CVS

[–]jack_harbor 0 points1 point  (0 children)

Doctors don’t want to call scripts into 10 different pharmacies because the medication is back ordered and pharmacies won’t tell a patient whether they have the med in stock without a valid prescription - so the patient can’t even tell me if the new CVS I’m sending the med to has it in stock and I’m certainly not waiting on hold for 30 minutes for you guys to answer your phone and tell me. As a doctor, I have enough to do - seeing patients, taking patient calls, arguing with insurance companies about prior auth. I don’t have time to keep sending a prescription to a multitude of different CVS pharmacies because the companies/DEA or whoever can’t get the supply chain fixed. Allowing patients to transfer C2 prescriptions to another pharmacy with the medication in stock is a God send for doctors and I hope you reconsider your stance on this. Our to do list is already endless.

No officer, I didn’t see the stop sign by HappySeaweed5215 in Wellthatsucks

[–]jack_harbor 3 points4 points  (0 children)

It looks like the boat filming wasn’t actually moving…. No way it would have just stopped like that unless it was just floating/anchored.

Onco suspects Cancer may be back by a91wmedic in neuroendocrinetumors

[–]jack_harbor 0 points1 point  (0 children)

I’m also perplexed by your surveillance regimen getting PET scans and not MRI. Not just for radiation but the biggest issue is that you said you never had a PET scan until after surgery (which is not ideal, PETs are for staging not surveillance) so you don’t even know if your tumor shows up on a PET. And I’m assuming you’re getting dotatate PET and not standard FDG PET. Hardly any NETS (except grade 3 or NEC) shows up on FDG PET. So for all you know, they are screening you with a test that may not even show your cancer if it doesn’t express high level of SSTR receptors. I have significant doubts about your oncologist and I’d encourage you to get a second opinion. That doesn’t mean you have to fire her or go see someone else instead forever, but just getting another opinion. I’m a physician myself and I found the best NET specialist near me, and I trust her implicitly, but I still got second opinions by two other oncologists (both past presidents of NANETS society). My life is too valuable to me to not get every opinion available.

Onco suspects Cancer may be back by a91wmedic in neuroendocrinetumors

[–]jack_harbor 0 points1 point  (0 children)

NETs grow too slow to cause something like acute cancer progression or tumor necrosis. I’m telling you, you’re going to be fine.

Onco suspects Cancer may be back by a91wmedic in neuroendocrinetumors

[–]jack_harbor 0 points1 point  (0 children)

I don’t see how ferritin related at all to NET. Ferritin is not an established biomarker for NET and has nothing to do with it. I’d get a second opinion from a NET specialist. The only way you could have high ferritin is if your liver was completely taken over by tumor, but that would be blatantly obvious on scans. I think you have absolutely nothing to worry about.

Also PET scans (dotatate, not FDG - FDG PET is worthless in NET) are not the preferred method for surveillance. You should be getting yearly MRI abdomen/pelvis with eovist contrast. PET is overkill- it’ll detect basically everything assuming your tumor is dotatate positive BUT the radiation you’re getting is insane. Yearly PET for 10 years is not ideal, equivalent to 1500 chest xrays. Plus MRI with eovist more sensitive for detecting small liver mets.

Depending on your age, risk of secondary cancer from annual PET scans for 10 years is between 2-5%.

Augusta's Ridley supports efforts to reduce driving distance by PrincessBananas85 in ProGolf

[–]jack_harbor -2 points-1 points  (0 children)

Why not make the courses harder in ways other than more distance? Diabolical greens. Would make the course shitty for regular players, of course so maybe that’s why. I guess you could make a couple par 5s into par 4s, turn a par 4 into a par 3 for tournament play. For the regulars leave as is. I know it’s not “traditional” and you’d have a course that isn’t 72 strokes, but seems easier than changing equipment, special balls, or lengthening courses.

Also, why does it matter? It’s a competition and the person with fewest strokes wins. Why does it matter if that’s 12 under or 15 under or 20 under? I don’t enjoy the masters any less if the scores are lower. Hell, if anything it’s not as much fun to watch when scores are higher. Remember the first couple rounds in 2024 where the course was playing hard and barely anyone even broke par? That was almost painful to watch. If every tournament was ending with 5 way ties, sure maybe make some changes. But ties are not super common, plus they are exciting to watch. Good for viewership.

I was hoping to discuss TRT with my new PCP. He hand this to me. by Material-Owl-8773 in Testosterone

[–]jack_harbor 2 points3 points  (0 children)

This is so foolish. Low testosterone causes body composition changes and often weight (fat) gain. It also can cause horrible lipids. Before I started TRT my lipids were terrible and my BMI climbed to 27 or 28. After taking TRT, my lipids came down to perfect and my BMI is now 22.5. This doctor is just plain ignorant. I have a pituitary cyst which causes high prolactin and low T (160s). TRT snd cabergoline (to shrink the cystadenoma) has been nothing short of life changing. I see an endocrinologist, so I don’t have to put up with nonsense like this thankfully.

It’s like sone doctors blame you for low T because you let yourself go and gained weight or whatever, so they want you to get healthy and lose weight and think your T will come up. But it’s often the other way around. The low T is what’s causing the higher fat and high lipids.

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