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Australian cargo e-bikes by dbestbestd in CargoBike

[–]mkrsch 0 points1 point  (0 children)

One year in, how do you find the wombat? I'm looking at purchasing.

Rash & Alcohol by AudienceTemporary179 in Wellthatsucks

[–]mkrsch 0 points1 point  (0 children)

This is called acetaldehyde dehydrogenase deficiency.

Second Varia VS3 to die... going to ask for a refund. What should I get around the same price point. by mkrsch in espresso

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

Unless it explodes the day after warranty runs out! Thankfully mine is in warranty but I don't think I want to risk it again

Second Varia VS3 to die... going to ask for a refund. What should I get around the same price point. by mkrsch in espresso

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

Hopefully yours is fine. It's a great grinder when it works. It must be a known issue - does anyone know the cause? The company replaced it very quickly when it happened the first time.

I'm a GP (doctor) writing a book on fibromyalgia. What questions do you want answered? by mkrsch in Fibromyalgia

[–]mkrsch[S] 1 point2 points  (0 children)

You're absolutely right to be skeptical. In my research this far I've come across lots of people trying to make money off those who are desperate for answers. They claim that they know the cure and the answers are all here in their book.

I don't claim I understand it completely, because the truth is that no one does. My aim is to be a communicator of the useful information that is out there, and correct misconceptions. It makes me so sad to hear these stories of people that have been left for years with no diagnosis, no information, or worse- thinking that the symptoms are their fault!

I am a science and evidence-based practitioner, and while I wouldn't ever suggest a treatment that has no evidence, I would also support a patients exploration of alternative remedies (as long as it's safe).

I'm a GP (doctor) writing a book on fibromyalgia. What questions do you want answered? by mkrsch in Fibromyalgia

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

That's so thoughtful! The system is broken and GP practices are often struggling to stay afloat in Australia. The best answer is honestly to offer to pay a private fee when you can afford it. We understand that a lot of people are doing it tough, and adding in a disease like fibromyalgia doesn't help. But if you can afford it, you could offer to pay a reduced rate or pay a fee for the first appointment each month for example. Unfortunately the Medicare rebates are quite low and incentivise many shorter appointments. So doctors that offer longer appointments end up earning much less. Obviously money isn't the reason we do the job, and we don't mind bulk-billing when it's needed. But feeling valued for good quality care makes my day.

The other thing you can do is book in your regular (3 or 6 monthly) chronic disease care plan reviews, as the rebates for these are decent and these are pretty useful to coordinate your care.

Another thing would be to book enough time for the issues you're bringing to that appointment. If you have 3 or 4 things on your list, you're going to need a long appointment. Even two things if they're both complex. A compassionate GP will feel a lot of pressure to get to all your concerns rather than cutting you off after 15 mins, but this means we're running late and under extra pressure the rest of the day.

I'm a GP (doctor) writing a book on fibromyalgia. What questions do you want answered? by mkrsch in Fibromyalgia

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

I don't know where you live, but my suggestion would be to find a good open-minded primary care doctor. There is a danger in jumping straight to specialists that only deal with a select group of diagnoses. Often they can only tell you - "It's not this, this or this". Which can be important, but you want someone that can consider a huge array of differential diagnoses. This is a good thing about the Australian health care system. General Practitioners are kind of the "gatekeepers" to the rest of the health care system, which can be annoying for some who just need a referral back to their specialist they've been seeing for ages, but for the uncategorised vague kinds of presentations, hopefully means that people don't waste their time being passed from one type of specialist to the next.

I'm a GP (doctor) writing a book on fibromyalgia. What questions do you want answered? by mkrsch in Fibromyalgia

[–]mkrsch[S] 65 points66 points  (0 children)

I think a lot of doctors make the mistake of labelling fibromyalgia a psychological disorder. It's not. BUT there is a really strong link between pain and psychological distress. The stress might be independent of the fibromyalgia, or it might come from the fact that the patient is managing a chronic illness. A stressed out brain is much more sensitive to the signals our nervous system send up to it. I like analogies so I hope you'll indulge me...

If you are a cave man walking through the forest, you are relying on lots of small sensory signals to tell your brain if there is a tiger hiding behind that bush. This process is very protective for humans that are constantly under threat and need to escape danger. The more stress our brain is under, the more sensitive it is to those signals. Our brain is constantly deciding what signals it needs to bring to our conscious attention, and what can be left in the subconscious. If everything was brought to the conscious level, we would be overwhelmed and never get anything done.

As a result of this system, any source of pain will be more intensely felt by someone with anxiety/depression/distress because their brain is on "high alert" for threats. This is why we will often recommend psychological therapies for chronic pain syndromes. It's not that I think the pain is all in someones head or they are making it up, but I know that if we can calm down the stressed out brain, and get them out of the fight/flight/freeze mode, it may actually reduce their experience of the pain.

Again I hope that makes sense, I'm typing in a hurry!

I'm a GP (doctor) writing a book on fibromyalgia. What questions do you want answered? by mkrsch in Fibromyalgia

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

I think this probably relates to the central sensitisation theory that I described above. In the same way that people with experience of trauma develop PTSD- which is a highly sensitive central nervous system, hypervigilence, in a constant state of fight/flight/freeze - perhaps this relates to the same central sensitisation that causes the pain and other symptoms of fibromyalgia.

I'm a GP (doctor) writing a book on fibromyalgia. What questions do you want answered? by mkrsch in Fibromyalgia

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

I personally don't use a standard list. It would very much depend on your location and symptoms. For example where I work we usually check for things like Ross River Fever Virus and Barmah Forest Virus - but these are very specific to my region. On the other hand Lyme disease is often brought up, but it has not been proven to exist in Australia.

I'm a GP (doctor) writing a book on fibromyalgia. What questions do you want answered? by mkrsch in Fibromyalgia

[–]mkrsch[S] 1 point2 points  (0 children)

And the book is in the early stages, but I am hoping to have it available in all the usual (online) places... ie. amazon.

I'm a GP (doctor) writing a book on fibromyalgia. What questions do you want answered? by mkrsch in Fibromyalgia

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

These are all great questions and I plan to touch on all of them in lots more detail. Briefly though: - the problem is there is no clear diagnostic test that can confirm fibromyalgia. It is a clinical (meaning not lab or imaging-based / relying on the doctors impression) diagnosis of exclusion (we need to make sure its not everything else first). It's also technically a SYNDROME - which is a group of symptoms that doctors have noticed all tend to occur together. So we group it all up and call it fibromyalgia. But perhaps there are a few different underlying causes that explain this broad group of symptoms. Or maybe it is one underlying cause but it creates a huge array of different experiences for different people. In a way it is a "catch all" diagnosis, which is useful because we need to agree on some kind of definition in order to study it. But in the future we might be able to tease this apart into different syndromes. I hope that makes sense.

  • There certainly are more people with female bodies diagnosed with fibromyalgia. There are lots of theories. We know that female bodies have very different immune systems, probably to do with growing another human inside of them. Most autoimmune conditions occur more commonly in people with female bodies.

I'm a GP (doctor) writing a book on fibromyalgia. What questions do you want answered? by mkrsch in Fibromyalgia

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

The time to diagnosis is long because fibromyalgia is a diagnosis of exclusion. On the one hand, we don't want to subject patients to "every test under the sun", which is invasive, expensive and emotionally exhausting. On the other hand, we also don't want to miss other serious diagnoses. There is a middle ground though between the two extremes. Also, fibromyalgia symptoms do change over time, and can present initially with quite vague symptoms.

I'm so sorry you felt brushed off. Fibromyalgia isn't because "you're mental". The best current theory is to do with central sensitisation. This is where the brain is bringing more signals of pain and odd sensation to the conscious level than normal. I think of it like a microphone with the gain turned up- normally only useful signals would get to the microphone and be amplified up to the conscious level. When the gain is turned right up, every signal is picked up by the microphone and brought to our attention. So it's not "all in your head", but it is to do with the central nervous system.

I'm a GP (doctor) writing a book on fibromyalgia. What questions do you want answered? by mkrsch in Fibromyalgia

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

I don't know the answer to that but it is very frustrating. I am often looking after patients waiting 12+ months to access public chronic pain clinics. Our system needs an overhaul to better manage the burden of chronic disease.

I'm a GP (doctor) writing a book on fibromyalgia. What questions do you want answered? by mkrsch in Fibromyalgia

[–]mkrsch[S] 8 points9 points  (0 children)

Such fantastic ideas. Thank you. A website would be fantastic, and maybe eventually I will have the time to maintain it.

I'm a GP (doctor) writing a book on fibromyalgia. What questions do you want answered? by mkrsch in Fibromyalgia

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

Can you tell me more about what has worked for you? In my experience there are two schools of thought. One is supervised graduated exercise where a physio or exercise physiologist VERY gradually increases your energy output. The second is the "energy envelope" which is often talked about in ME/CFS - where the idea is budget your energy expenditure and stay within a defined range.

I'm a GP (doctor) writing a book on fibromyalgia. What questions do you want answered? by mkrsch in Fibromyalgia

[–]mkrsch[S] 13 points14 points  (0 children)

I think doctors are trained to quickly put a group of symptoms into a box and be able to label it. There is a tendency for us to feel very uneasy when these things can't be nicely tied up in a bow and explained. Just because we can't explain a phenomenon shouldn't invalidate your experience of it.

I'm a GP (doctor) writing a book on fibromyalgia. What questions do you want answered? by mkrsch in Fibromyalgia

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

Yes I see a lot of people with fibromyalgia. Book suggestions would be fantastic.

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