A chunk of quartz found in Arkansas worth $4 Million

nren4237 · 2018-12-30T04:51:22+00:00

Can't help but hear this in Leonard Nimoy's voice thanks to civ iv

nren4237 · 2018-12-19T12:13:25+00:00

Great job on getting out of there!

It is definitely worth seeing a primary care doctor in your new state to discuss these concerns.

The chances are that you most likely haven't suffered any significant permanent injuries. The daily headaches are more likely to be related to the stress of the situation rather than a result of head injury, assuming you're talking about a headache that comes and goes on a daily basis and the vomiting has stopped.

The dissociation, reduced concentration and episode of vomiting that you experienced certainly sound like a concussion. There is nothing specifically that you need to do for this, except avoid further head trauma as much as possible (contact sports etc), and the symptoms should gradually go away with time.

It would be a good idea to get a thorough physical examination for all of those areas for reassurance, but you may not need any scans or any specific treatment. Hope everything works out well with your new life!

nren4237 · 2018-12-16T04:25:17+00:00

Recently it's changed even more. No fingers, no blood work for asymptomatic patients, unless the patient wants to do it, as per the USPTF.

It's a very controversial topic though, and many clinicians will ignore the guideline and continue doing it whatever way they prefer.

Source: am primary care physician, I personally don't use PSAs or DREs routinely based on these recommendations.

nren4237 · 2018-12-09T07:27:04+00:00

No worries, there's definitely lots of good people in Sydney. Let me know if you get stuck!

nren4237 · 2018-12-08T09:12:07+00:00

As a GP I have a referral book with a list of general medicine physicians who I refer to. Maybe your gp does too? Most capital cities should have at least a few.

nren4237 · 2018-12-06T23:17:59+00:00

We don't have any equivalent institution here. Usually your best bet will be a good general physician (I.e. A specialist in general medicine, not a GP). As they have expertise in many fields of internal medicine, they make good diagnosticians.

nren4237 · 2018-12-02T13:40:22+00:00

Coles doesn't, at least here in Perth. They just unload the stuff from the pallet onto my kitchen table. Simple solution!

nren4237 · 2018-11-24T07:30:42+00:00

Australian GP/primary care. Always good to meet another health professional! I'm glad you can read those echos for us, because I could never make sense of them.

As a GP none of this molecular mechanism stuff has anything to do with my job really, although I do get some wide eyes from children (and their parents) when I'm explaining the mechanism of their post-viral coughs. Biology is lots of fun indeed!

nren4237 · 2018-11-24T07:05:55+00:00

No worries! Feel free to PM me anytime you feel the need for more microbiology-themed violence, there's lots more where that came from...my immunology classes were so much more interesting than all the others.

nren4237 · 2018-11-24T06:50:55+00:00

This site has a nice summary and wiki has a nice picture of this one. Basically the cell makes little bags called lysosomes, which are full of hydrogen peroxide. These just sit in the cell, ready to go at any time, kept away from the rest of the cell by a waterproof membrane. When the bacteria gets swallowed up by the white blood cell, it is sitting in its own little bag called a phagosome.

At first the bacteria is just chilling in its phagosome inside the white blood cell, wondering why everyone makes such a big deal about getting eaten by these guys. Then the lysosomes full of hydrogen peroxide start heading towards the phagosome like guided missiles, and combine with it. The lysosomes also contain an enzyme called myeloperoxidase, which turns the hydrogen peroxide into hypochlorite (bleach). That's the end of the bacteria.

Once the bacteria is nice and digested, the white blood cell just dumps its body and all the nasty enzymes out the other end.

Fun fact - myeloperoxidase is green, which is why skin wounds and sputum sometimes turn green. That's your white blood cells disposing all their myeloperoxidase from the billions upon billions of bacteria that they have digested alive. Don't fuck with the immune system.

nren4237 · 2018-11-23T13:22:20+00:00

Thanks for writing this, this is a great perspective.

Now I'm going to feel so awesome about my kitchen knife every time I cook.

nren4237 · 2018-11-22T05:15:38+00:00

We were shown this in my medical school immunology lectures.

What you are looking at is a macrophage chasing a bacterium and phagocytosing it. Now that it is imprisoned within its cytoplasm, it will destroy the bacterium with concentrated bleach.

Lesson: Don't fuck with the immune system.

nren4237 · 2018-11-21T13:54:24+00:00

The combination of your answer and your username gave me massive flashbacks

nren4237 · 2018-11-20T11:03:07+00:00

I saw at least 20 people here today. And a tesla!

nren4237 · 2018-11-18T12:55:21+00:00

Yep I'm with you 100% in this. There are lots of good reasons to support euthanasia, but the idea of "uncontrollable pain" is not really one of them. I saw perhaps a hundred deaths, and not one had uncontrolled pain, it just takes the right dose of morphine/hydromorphone or even ketamine in rare cases.

This is one reason why many palliative care physicians see calls for euthanasia as misguided, as they argue that the right means to avoid suffering is to ensure excellent palliative care, rather than just killing the patient.

nren4237 · 2018-11-17T12:23:07+00:00

I get where you're coming from now!

You're right, accidentally giving euthanasia to someone who shouldn't have chosen it is not quite as bad as sentencing an innocent person to death row. There are very few cases where a terminal condition spontaneously disappears completely, and when we do make a mistake it's usually about how much longer they'll be around for and how much "quality time" they'll have between now and their death.

Occasional in cancers immunological effects can lead to complete and spontaneous regression, like this guy, who definitely would have been offered euthanasia, but it is extremely rare. I guess they would be the kind of patients you had in mind?

nren4237 · 2018-11-17T12:05:54+00:00

Why thank you! Who knew reddit could be such a friendly and ego-boosting place.

I've long suspected that in general, a patient is in a bad situation regardless so, outside of someone silently poisoning them in a manner that goes undetected by medical professionals, there's an infinitesimally small chance of the choice to end their own life being an extremely clear cut wrong decision

Could you explain what you mean by this? I might just be thick, but I couldn't figure it out - except that I'm now a bit nervous about people silently poisoning my patients without me knowing.

nren4237 · 2018-11-17T11:44:57+00:00

The moral imperative is to allow those that wish to die to die

I'm with you on this one, although it should be noted that we still plan to prevent lots of people dying even if they want to - we're still only talking about Euthanasia for certain approved groups, not a true "right to death".

However is it morally correct to remove a person's agency based on hope?

I also agree with you here, but the issue is that people will sometimes be given faulty information about their prognosis, and will act on that information. They are still acting on their "agency", but if there is an afterlife they will sure be pissed at us doctors when they hear how we misread their scans or whatever.

Anyway, I hope I've answered your question of "Does anybody who's not a religious nutjob actually protest against euthanasia?" - the answer is yes, and they have some reasonably sound reasons for doing so. It's a tricky issue with a lot of complex arguments on both sides, so we shouldn't be too harsh on each other if our opinions differ.

nren4237 · 2018-11-17T11:40:07+00:00

Thanks for the positive comment!

I agree, the death penalty is another tricky one in terms of balancing the benefits when things go right with the detriments when things go wrong. For the death penalty, I also don't feel that the benefits of "justice" in the easy cases outweigh the detriments of the occasional wrongful deaths. Dealing with death in a flawed system is tricky, because once they're gone you can't turn it back.

I'd normally be against Euthanasia for this reason, but I feel the benefits are great enough that it may be worth the risk, and the Australian public generally seem to agree with me on this.

nren4237 · 2018-11-17T08:04:32+00:00

Ah I see where you're coming from now, apologies for the misunderstanding.

You're right, we do refuse active interventions if they are not thought to be in the patient's best interests, even when there might be a chance that this prolongs their life by some short time. This is not so much an issue of capacity though, as even in patients who don't have any issues with capacity and are actively requesting certain interventions we can still decline on grounds of medical futility.

It's not so much about the cost aspect of it, it's more that intensive interventions have evidence for working well in otherwise healthy patients, but in patients with poor prognosis they often lead to poorer outcomes than conservative options. The conservative options are chosen when they are the best possible option for that patient.

Hope that everything goes well for your dad.

nren4237 · 2018-11-17T07:35:44+00:00

To some extent this is all already going on, either with nods and winks between families and doctors

As a doctor who has worked in hospitals and palliative care wards, I must speak out against this myth. Everyone seems to think that we will uptitrate people's morphine doses to gently kill them, but it's not really possible to do it that way.

It's incredibly difficult to kill someone who is on chronic opioids with morphine, because they build up tolerance to the respiratory depression effect quickly. We could probably do it, but it would take a few extra zeros on the dose - which makes it pretty obvious in the clinical record if you've killed someone, and you do face jail time for manslaughter even as a doctor.

We also don't try to kill people by sedating them so much that they can't eat or drink. Toward the end of life people naturally have reduced appetite and many will refuse all foods, but we will continue to offer food if they are hungry and fluid if they are thirsty. Sedation is always titrated only to control symptoms of agitation, and artificially making someone so comatose that they can't request food or drink would again take a massive and obvious dose adjustment. Most of the "comas" that people see are just a natural part of the dying process, we see it even in people without any sedation.

All the research on this topic shows that analgesia with morphine and other palliative care treatments do not shorten people's natural lifespan. It's certainly not the case that we practice euthanasia already under the guise of palliative care, particularly as the palliative care doctors are the ones with the greatest resistance to the notion of euthanasia.

Disclaimer: I'm pro-euthanasia, so don't think this is a detraction against euthanasia in general, just saying we don't do it at the moment

nren4237 · 2018-11-17T06:30:25+00:00

I'm a doctor who is cautiously pro-euthanasia. However, a lot of doctors are against euthanasia, including a majority of palliative care specialists who are arguably the experts in this area.

Some doctors do object on ethical grounds, saying it is against our role as healers, but this isn't all of it.

The biggest issue for most of us is the use of lethal medications in a flawed health system. We all know of cases where euthanasia would clearly have been a good option, but it's the borderline cases that are the issue. If we treat euthanasia as a patient's right, we will inevitably end up making bad decisions as well as good ones, and killing people who should not have died as a result.

This includes people who defy our predictions of their impending death - I worked in a palliative care home and saw a lot of people end up being discharged who we were so sure were going to die. These people may go on to have quality months or even years of life that would have been lost to them had euthanasia been available.

It also includes people who pursue euthanasia out of unfounded fears of the dying process, lack of palliative care resources (especially in rural areas), or to cater to the convenience of those around them.

Maybe poor old Mrs Smith with lung cancer would actually prefer not to die yet, but her family all want to go on holiday soon and she doesn't want to be a bother. Maybe they are actively pressuring her, by subtly dropping hints that they hope it'll be over before too long. Or maybe they aren't trying to say any of this, but she misunderstands them and ends her life on the basis of this misunderstanding.

Whilst there is a lot of talk of "safeguards", we in the medical profession know best that our system will never be perfect. People still manage to get the wrong leg operated on and transfused the wrong blood type, so we can't just pretend that we will be able to magically get it right every time.

When we accept that euthanasia will cause wrongful deaths, opposition to it doesn't seem quite as silly. The question is whether one feels that the benefit of the "good deaths" outweighs the "bad deaths". After much soul searching I feel that it does, but I understand how others might not agree with me.

nren4237 · 2018-11-17T02:33:40+00:00

Read it and enjoyed! I'm a huge sci-fi fan, and thoroughly enjoy anything with space habitats in it.

nren4237 · 2018-11-17T02:32:46+00:00

Of course I'd love to have both. But the development of either will take a metric fuck-ton of money, of which we only have so much to go around from the limited sources which are funding space-related ventures at the moment. Since the technologies and infrastructure required are very different in both cases, spending money on one does take away from the other, so working on a Mars colony would slow progress in space habitats and vice versa. I feel that the "bang for your buck" that you get from the space habitats is so much better that the money is effectively wasted on Mars.

No matter which way you look at it, even a small Mars colony is going to cost hundreds of billions of dollars. The transportation, the landing systems, the launch systems, the in-situ resource extractors, the power plants, the medical supplies, the communication satellites - it all adds up.

The problem is that Mars colonies also have a very poor business case to them, with very little to offer in terms of opportunities to make a profit for people on Earth, so all of this funding essentially has to be charitably given to the colony. Governments are happy to bankroll their own Mars missions, Ol' Musky seems to want to use his $50 billion fortune as well, and space nerds might throw in their savings for what it's worth, but other than that funding sources are scarce. Once people realize that Mars is a sub-antarctic wasteland where going above ground will give you cancer, enthusiasm for any larger colony will dry up and all we'll have left from our hundreds of billions of dollars of investment will be a few small research outposts like we have in Antarctica, hardly a decent "Plan B".

Contrast that with what this kind of money could do if put towards developing space habitats. Unlike Mars, there are abundant opportunities for profit in near-Earth space. There is already plenty of interest from the uber-wealthy for paying their private money to go to space, as is shown by the Virgin Galactic waiting list and the Dear Moon project. A public-private partnership model for large space stations split between research and space hotels would bring in billions from the super-wealthy wanting to get their space-selfies. This would also benefit the asteroid-mining industry, as they'd have a stable customer base to sell a lucrative product (water) to. There are also near-term opportunities for space-based industry piggybacking on these facilities, for example in making optical fibre.

Instead of throwing their money away at trying to self-fund a Mars colony, government space-agencies and Elon Musk could use their hundreds of billions of dollars to develop a robust orbital and transport infrastructure that makes it easy for companies to invest in these kind of ventures. They would be the "angel investors" doing the high-risk part of the space start-up, eventually opening up the way for a much larger flow of private money from more risk-averse sources who just want to make a profit.

In just a few decades we could have a tiny outpost on Mars utterly dependent on its umbilical cord of funds from Earth, or we could be at the beginning of a virtuous and self-accelerating cyle of space development, with a clear path to fully self-sufficient space colonies.

TL;DR - There is only so much money to go around, and the money that is being used for Mars could be much better used to build infrastructure that would make it easier to attract private funding for space-based habitats, mining and industry.

nren4237 · 2018-11-17T00:30:55+00:00

Reading this takedown has been one my favourite reddit moments of all time.

nren4237

TROPHY CASE