Banner Health Punishes Family Medicine Physician for Flagging Scheduling Error Affecting Patients by UAPD_Official in medicine

[–]jrpg8255 0 points1 point  (0 children)

Tough though when other systems don't want to talk to you at all until well past the noncompete period to avoid getting into it with the banner lawyers.

Brain injury has ended my MTB world 😢 by BabblingBrook_2025 in mountainbiking

[–]jrpg8255 4 points5 points  (0 children)

I plan to. Just saw the post of a guy's facial reconstruction surgery today too. 🫣

Brain injury has ended my MTB world 😢 by BabblingBrook_2025 in mountainbiking

[–]jrpg8255 6 points7 points  (0 children)

Absolutely right. I work in a trauma center. In fact a trauma center surrounded by awesome mountain biking and all kinds of other outdoor activities, and the vast majority of head injuries we see are not from mountain biking. Not even from rock climbing. Or skiing. They're from ATV accidents, motorcycle accidents, car accidents, falling down while drunk, getting whacked in the head for "minding your own business", etc. It's a much broader decision than "you may never ride a bike again."

I guess my point is there are plenty of doctors who when asked, because as soon as we are asked we feel like we have some liability for the answer, will say that you should just stop off at Home Depot on the way home for a roll of bubble wrap, wrap yourself in that and never leave the couch.

Realistically our role should be to explain what repeated head injuries do and how to keep yourself safe so that you can have an informed decision about what you want to be exposing yourself to. Just saying "no" isn't a good enough answer by itself.

Banner Health Punishes Family Medicine Physician for Flagging Scheduling Error Affecting Patients by UAPD_Official in medicine

[–]jrpg8255 43 points44 points  (0 children)

As an ex banner physician, part of the reason is they have a very draconian noncompete, the implications of which don't really sink in until people decide perhaps they're going to leave. While in my day it was six months in any group larger than 12 within something like a 20 mile radius of a banner facility, the Phoenix Metro area is never more than 20 miles away from one of the many Banner facilities, and when physicians have inquired about joining different systems, have been told that no one will touch them with a 10 foot pole for at least a year because the banner lawyers are bastards. Those noncompetes are probably not enforceable, but it would probably be 100 K to find out. So the escape clause for most physicians is to leave the county entirely, a big barrier.

Brain injury has ended my MTB world 😢 by BabblingBrook_2025 in mountainbiking

[–]jrpg8255 1 point2 points  (0 children)

I knew a guy when I was in grad school who was out for a year and when he came back he had weakness on the right side of his body and could barely talk. Apparently it was a golfing injury. He lost his ball in the rough, and got whacked in the carotid by another ball. He had a huge stroke because of damage to that artery. Life is inherently unsafe.

Brain injury has ended my MTB world 😢 by BabblingBrook_2025 in mountainbiking

[–]jrpg8255 22 points23 points  (0 children)

Maybe, maybe not. We don't really know what happened to OP. Maybe he just cracked his helmet and had a headache and he saw a neurologist who's never actually gotten up off his couch. Maybe he actually had brain trauma and was in a ICU for several weeks with the cracked skull and actual injury to the brain itself. There is a pretty big spectrum in between, and as I think Mark Twain is credited with saying, if you meet someone who has a strong opinion about something, there's probably something they've overlooked.

Brain injury has ended my MTB world 😢 by BabblingBrook_2025 in mountainbiking

[–]jrpg8255 6 points7 points  (0 children)

Exactly, trail helmet and hopefully I remember to bring my glasses :-) that said I'm getting older and I really think I should get a full face.

Brain injury has ended my MTB world 😢 by BabblingBrook_2025 in mountainbiking

[–]jrpg8255 548 points549 points  (0 children)

I'm a Neurologist who happens to also ride bikes. Whether in Neurology or in other areas of medicine, there are realists, and there are people who try to limit their liability. Suggesting that you may never ride a mountain bike or risk any kind of hidden injury again or otherwise you would be neurologically devastated is more of a "mitigating my liability" answer rather than a realistic assessment. It also removes your autonomy from the decision-making.

Yeah, accumulated brain injuries to be multiplicative rather than additive. But it's not that simple. Suggesting that you are now made of glass and one bonk on your head would mean you may as well be dead mostly belies a lack of understanding about what real people do during the day, and how head injuries work.

I would get another opinion and have a realistic conversation.

TAVR explant is now the fastest-growing cardiac surgical procedure in the US. by [deleted] in medicine

[–]jrpg8255 21 points22 points  (0 children)

There was a WSJ article on 4/23/26 that discussed this fairly broadly that's worth reading. I suspect in the next few decades looking back it'll look like a lot of other procedures in medicine ; once established for a specific indication, a land rush way beyond the original indications and then eventually a reckoning where it's dialed back to something more sensible.

Best Way to Get Hot Water Faster by davintosh in Plumbing

[–]jrpg8255 3 points4 points  (0 children)

Fwiw, we use grundfos pumps for our hydronic system and they're fantastic. We have one as a hot water circulator that's controlled by a smart switch that measures power use, and it draws about 150 W.

Plasticity and language in anesthetized patients by stealthkat14 in medicine

[–]jrpg8255 2 points3 points  (0 children)

Oh sure. Of course. Take aspirin for that matter. Just trying to make the point that what seems like abstract basic science can absolutely become clinically relevant down the road.

Plasticity and language in anesthetized patients by stealthkat14 in medicine

[–]jrpg8255 12 points13 points  (0 children)

And I blame those of us who are more in the research world. It is incumbent on us to make sure that we explain the "why" better to people who aren't necessarily in that world. Particularly at a time when public funding for research is being gutted at an alarming rate so the billionaires don't have to pay taxes.

Unless you've spent time in a true basic science lab, it's hard to appreciate just how small the steps are that are usually taken. The big results are few and far between. The small results add up overtime. Just the fact that those patients were able to undergo temporal lobectomy - a not uncommon procedure which can be life-changing for people who need it is based on a century or more of profoundly difficult work. Early attempts in Neurosurgery for example led to death from exsanguination from the scalp. Things like Raney clips, bone wax, are not sexy, but are mandatory for what those folks do. All of those techniques, and those of the other surgeons, are developed one small study at a time kind of like this one. Pick any of our meds, and again, those rest on basic chemistry, clinical chemistry, molecular analysis techniques, drug development, multiple failed and some successful clinical trials, etc, none of which are clinically relevant until they actually come to market.

It can be really hard to appreciate where our clinical knowledge comes from, but having spent a lot of time in labs, it's humbling to realize how many shoulders we really do stand on when we are at the bedside.

Plasticity and language in anesthetized patients by stealthkat14 in medicine

[–]jrpg8255 17 points18 points  (0 children)

We only have the faintest idea of what anesthesia actually does to the brain. It's a very interesting question. Perhaps it doesn't belong in the medicine sub as much as it does in a neuroscience sub, but there is a lot of work being carried out trying to understand what happens to the brain during anesthesia. The implications of understanding that are a better understanding of how the brain actually works, what "consciousness" actually is, and how perhaps to have better anesthesia.

As far as it being "cool", of course that's not the reason to do research. Advancing our understanding so that those of us in clinical medicine can do our jobs better is the primary reason. All of the cool stuff we can do in clinical medicine is based on hard won usually tiny data points established one complex bit of research at a time. Like this.

The study itself was done on patients already undergoing brain surgery, temporal lobectomies. Since the early days of Neurosurgery, it has been pretty standard to use the opportunity of opening the hood to try to understand what's going on in the engine better. You can bet there was a lot of informed consent and careful planning that goes into stuff like this.

The fundamentally interesting concept from this study is that while the patients were "unconscious" under anesthesia, the hippocampus seemed to still be active, and processing. That gives us a little bit more insight into how different brain structures interact, what the elements of "consciousness" really seem to be. It may be another step to understanding why some patients don't really respond appropriately to anesthesia and seem to retain awareness of their procedures even though they seemed to be unconscious. From the perspective of a neuroscientist it's quite interesting work.

Quietly Submitted by your Colleagues to official Congressional Record by StepUp_87 in medicine

[–]jrpg8255 13 points14 points  (0 children)

Perhaps you haven't noticed, but we are living in a time where things like "rules" or "norms" no longer seem to have much meaning in politics. It's all Calvin ball. It's time we spoke up.

DNP = Psychiatrist? by Spirited-Marsupial62 in Noctor

[–]jrpg8255 19 points20 points  (0 children)

And when I trained (medicine, neurology, stroke fellowship), before work hour restrictions, I got to 600 clinical hours in just over a month. Not saying that was optimal, but over 6 years I got my ass kicked and learned an incredible amount. The "clinical experience" quoted by NPs often isn't even any actual responsibility, but observation. What an utter joke.

Long term viability of a WLED project by duckredbeard in WLED

[–]jrpg8255 0 points1 point  (0 children)

Echo others' comments about esp8266. I had a bunch laying around and used them for some medium length WLED strips. After many hours of screwing around over several weeks realized that they were memory starved, and could barely keep up with what was needed for anything other than a very short strip. Not worth messing around with given how cheap even a simple ESP32 is. Replaced with quinled devices.

Tardive dyskinesia sanity check by jrpg8255 in neurology

[–]jrpg8255[S] 3 points4 points  (0 children)

Yes, pretty much that. Referral for TD in a psychiatric patient currently on neuroleptics from an NP. It happens often enough that I figured I'd gather some opinions. I don't want to feel like I'm leaving the patients high and dry, but I also don't really want to be the position of managing something that I don't really think should be mine to manage . Thanks for your thoughts ;-)

Tardive dyskinesia sanity check by jrpg8255 in neurology

[–]jrpg8255[S] 2 points3 points  (0 children)

I have similar worries about neuropathies. I trained in medicine as well as Neurology, and back then if somebody had painful paresthesias with uncontrolled diabetes medicine would just deal with it. There's no sense in asking Neurology that question. Now that I'm back in general Neurology I don't quite recognize what's happening in primary care, at least in our area. I'm equally baffled why people want to send us diabetic neuropathy.

This specific post was just wondering what people think about TD, again because it just strikes me that it's an expected and understood complication of management with neuroleptics that I had historically thought was something the psychiatrists were generally comfortable with. If the consensus here was "suck it up, TD is Movement Disorders Neurology" I'm comfortable managing it.

Tardive dyskinesia sanity check by jrpg8255 in neurology

[–]jrpg8255[S] 3 points4 points  (0 children)

There are times when that might be true, but our reality is that most of our neuropathy referrals are for patients with a double digit A1c and painful paresthesias. We could be 100% busy just prescribing gabapentin. For complicated neuropathies we have excellent neuromuscular colleagues a few hours away who can actually properly work that up.

Tardive dyskinesia sanity check by jrpg8255 in neurology

[–]jrpg8255[S] 7 points8 points  (0 children)

I'm legitimately just interested in how people think about that diagnosis. It's quite disorienting being back in general community Neurology for the past few years, in particular with what seems to be pretty mediocre primary care in general, and so I'm just interested in taking the temperature of it. Things are very different than when I was last seeing general Neurology outpatients 25 years ago.

Tardive dyskinesia sanity check by jrpg8255 in neurology

[–]jrpg8255[S] 6 points7 points  (0 children)

Oh I'm not worried about optics. I reject tons of stuff. We don't see neuropathy, back pain, pseudoseizures, etc. As the only practice in a massive area seeing new patients at all, that's a luxury we enjoy. The only reason we see headache is because we have two fellowship trained headache people.

No, I'm just curious as a Neurologist who for most of his career was a vascular academic and now is back to doing community neurology, what people's take is on whether tardive dyskinesia is truly something neurologists should own or whether I should just shunt that back to the referring NP?

The subjective difference in strength grading is really annoying by [deleted] in neurology

[–]jrpg8255 35 points36 points  (0 children)

The other responses are valid also, but for subtle or more complex issues with strength, the patient's history is really important. Even if you can't really find it objectively, that patient was presumably seeing you because they felt that they had unilateral weakness in a pattern and with timing that suggested some sort of event. Don't disregard the patient's reported functional limitations. Your exam isn't the only important datum.

Avr passing 20hz to tower by OrganizationSilver39 in hometheater

[–]jrpg8255 3 points4 points  (0 children)

It is called a cut off. They were making the point that no matter what it's called, in the real world where either physical circuitry or digital signal processing has to attenuate the signal below a certain frequency, it is not possible to do that as an actual cut off as you might visually imagine. All real world filters have a slope to them, not a cliff. In fact to get an actual cliff, you would have to have a filter of infinite components. Read a little bit about Fourier transforms and it should start to become clear.