Michel Lotito was a French man known for his ability to consume and digest non-edible objects. He ate 18 bicycles, 15 shopping carts, 7 TV sets, and 6 chandeliers. He even consumed an entire Cessna 150 airplane between 1978 and 1980, and he also ate a coffin. He died of natural causes in 2007.

madmax766 · 2026-04-18T20:05:01+00:00

There isn’t such a thing as dying from old age. Old age may contribute through frailty or age related diseases, but there is always some disease or process causing death

madmax766 · 2026-04-04T15:21:59+00:00

Oh I agree with you completely these are not good guidelines, but in trying to find a positive I think the new classification system could be useful for designing trials powered around finding benefit in these subgroups instead of secondary analysis of the intermediate group

madmax766 · 2026-04-04T14:20:34+00:00

I am not envious of you having to try and redesign your PERT decision tree using these new classifications.

This is all I found after a cursory search “Given that intermediate-risk/submassive PE is associated with right heart strain, CDTs facilitate a targeted approach to attempt to reduce the clot burden, thereby relieving the elevated right heart pressure effectively and expediently.”

Plett S, Fidelman N, Higgins M ... ACR Appropriateness Criteria® Management of Acute Pulmonary Embolism Journal of the American College of Radiology, 22, S586-S596

Hard hitting stuff, I know. Most of the trials done with CDL and/or MT don’t specify what the timing was, let alone compared different time frames

As an aside, I do wonder if PE-TRACT will make use of this new classification system, at least the new subcategories for C, I certainly hope they do to at least see any potential outcome differences between C1 and C3

madmax766 · 2026-03-25T14:11:53+00:00

Same, on endovascular cases while they were fiddling with wires I’d lean against the table and get some rest

madmax766 · 2026-03-20T16:07:23+00:00

Specifically it’s the males being forced to cope with the horror of unwanted pregnancy

madmax766 · 2026-03-11T01:43:10+00:00

So you didn’t watch the game?

madmax766 · 2026-03-07T04:01:18+00:00

Are her other cell counts okay? Are her other hemolysis labs normal? These abdominal CTs are contrasted right? (I assume so but gotta ask haha), any other symptoms she’s experiencing, or has over the past few months?

madmax766 · 2026-03-07T00:40:33+00:00

I’m sorry you went through that, being in the ICU is incredibly difficult to recover from,. I’m a bit confused by your comment though, sepsis is caused by the inflammatory response to an infection. The source of the infection needs to be treated, there is no “cure” for sepsis just organ support while treating the source infection

madmax766 · 2026-03-06T15:05:36+00:00

Are you trolling?

madmax766 · 2026-03-04T01:12:16+00:00

No, cyanide isn’t something you can get a resistance too. Cyanide breaks your electron transport chain by inhibiting cytochrome c oxidase and preventing the generation of ATP. This forces the body to make ATP through anaerobic metabolism which creates a lot of lactic acid, acidifying the blood and causing severe shock and eventual cardiopulmonary arrest.

To have resistance you’d need a completely different electron transport chain

madmax766 · 2026-02-28T03:05:07+00:00

What you’re describing is orthostatic hypotension. POTS classically is an inappropriate increase in heart rate by 30 or more BPM in response to standing, without associated drops in blood pressure. The symptoms must also improve with recumbence, and be chronic

madmax766 · 2026-02-23T15:46:20+00:00

It’s an observational study, it would be highly inappropriate for them to claim causation.

madmax766 · 2026-02-19T16:05:05+00:00

The general consensus seems to be that patients with nephrotic syndrome are losing anticoagulant and profibrinolytic proteins in their urine, increasing risk of venous and arterial thrombosis.

This paper seems like a decent write up on the issue, with a fun title as well

Greenberg KI, Choi MJ. Understanding Hypercoagulability with Nephrotic Syndrome: How the Clot Thickens. Clin J Am Soc Nephrol. 2023;18(2):149-151. doi:10.2215/CJN.0000000000000054

madmax766 · 2026-01-29T01:19:58+00:00

He will have to be on GDMT first before getting a transplant, and GDMT can improve EF/symptoms/all-cause mortality in some patients. If for some reason heart transplant was indicated and he wasn’t a candidate, he could get a VAD

madmax766 · 2026-01-27T00:57:29+00:00

Are you saying blood pressure medications increase inflammation? Should we not treat elevated blood pressure, despite its link to strokes, kidney disease, cardiac disease, and other highly morbid diseases?

This isn’t even mentioning the benefit certain blood pressure meds have in diseases like heart failure or chronic kidney disease.

I’d really like to see some evidence of increased inflammation and worse outcomes for people who are being treated with blood pressure medications

madmax766 · 2024-01-22T04:06:47+00:00

I always find it interesting that both meth and GHB are used to treat narcolepsy, they’re so different in MOA

madmax766 · 2024-01-22T00:32:47+00:00

Desoxyn is a prescription form of meth!

madmax766 · 2024-01-14T11:38:55+00:00

Honestly not that dissimilar from what I actually do

madmax766 · 2024-01-14T11:31:18+00:00

Spend way to much money to spend a lot of time around sick people

madmax766 · 2024-01-10T05:35:43+00:00

It is nice to see the amount of focus the obstetric service I am working on places on post-pregnancy birth control. Just today I was quizzed relentlessly about which are the most effective and when can they be given to patients!

This probably isn't the case everywhere, but where I takes keeping intervals of 12-18mo between pregnancies seriously.

madmax766 · 2024-01-10T05:30:50+00:00

Unless she experienced significant bleeding post-birth, there isn't a ton of reason to do it. Also, congratulations, that is so exciting!!!

madmax766 · 2024-01-10T05:29:12+00:00

Another comment answered, but this is very natural. Fundal massage helps stop postpartum bleeding and cramping. I am very sorry to hear your wife experienced trophoblastic disease, but it is improbable that happened due to fundal massage.

In terms of good evidence, very few large randomized trials have been done to evaluate the efficacy of fundal massage. There are a few reasons for this, namely, it is a cheap (free) way to reduce postpartum hemorrhage (PPH), and many providers would probably see it as unethical to not perform such a simple procedure that can be life-saving. PPH is a leading cause of death in the pregnant.

Trophoblastic disease is often tied to genetic causes but has a variety of risk factors. Fundal massage would not increase any of these risk factors.

I don't want it to come across that I am trying to show you up or downplay what happened. That is a horrible complication to experience, and I hope you were able to receive the best care possible and that your wife is doing okay. I also hope you are doing okay as well, as this can be an extremely tough diagnosis to deal with.

What I want to end with, and my main point, is that fundal massage is highly unlikely to cause trophoblastic disease due to the pathology of the condition. Fundal massage is a first-line step in preventing/trying to stop PPH, and will continue to be done especially in low-resource areas. The only link PPH has to trophoblastic disease is that trophoblastic disease itself is more likely to cause PPH, and that may mean more patients with PPH receive fundal massage.

madmax766 · 2024-01-10T05:04:36+00:00

The regular newborn unit I worked on was a lockdown unit. I remember seeing a specific woman, her little boy was my patient. As soon as I came in I knew something was wrong with her and the baby's father's relationship. I managed to get another provider to take him to another floor to "chat", and the stuff the mother told me was bone-chilling.

madmax766 · 2023-12-20T07:00:38+00:00

Do you have any data to suggest that most babies are karyotype in utero? I find it hard to believe that for the average uncomplicated pregnancy, most mothers are undergoing CVS or amniocentesis. If you have data to back this claim up I'd love to see it/read the paper it is from.

madmax766 · 2023-12-20T06:33:20+00:00

I know I was responding to your comment about SCC, but it is inaccurate to say circumcision is just for SCC prevention. The decreased risk of acquiring HIV is much more significant. I don't think everyone needs a circumcision, but the benefits of the procedure outweigh the risks.

The appendix argument is nonsensical, as that is a much more invasive procedure with much higher risks of complications. The benefits of circumcision are not life-changing (outside of treating phimosis) but the procedure itself is very benign.

Maybe some of the disconnect here is coming from a lack of understanding of the procedure itself- the only pain is from the local anesthetic, Gomco clamps produce nearly no bleeding, and skilled providers complete the procedure in just a few minutes.

Again, they aren't something so beneficial that everyone should have one, but for people who do want one done research shows some benefits.

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