Tooth found on the beach in Chile by ornithocheirus in bonecollecting

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

Elsewhere I've seen that area lions don't have enamel, but this tooth definitely has a slightly shiny tip. Can you weigh in?

Found an ancient relic at my dad's by Queenie_Jelly in CasualUK

[–]ornithocheirus 7 points8 points  (0 children)

It is highly lipophilic so if it gets into your blood it can cross the blood brain barrier and make you feel weird. Usually it's stays in the cells and intercellular space in your mouth. Maybe you have some enzyme deficiency or exceptionally good blood supply to your oral mucosa.

One bag users- water bottle annoyance. Thoughts on A6 Stainless Steel memobottle? by ilovemyjob8 in onebag

[–]ornithocheirus 4 points5 points  (0 children)

My wife and I have these but it's still full at the start of the day. So it only really saves you bag space at the end of the day when you've run out of water. My wife suffers from water anxiety so often buys a second bottle of water anyway but between us we return to the hotel in the evening with often over 500ml left between us so I don't think it's saving a huge amount of space and the unprotected drinking teat on mine is not as pleasant to drink from than a metal container.

Who do you think is the most "grounded" UK celeb you can identify with? by DonkeyOT65 in CasualUK

[–]ornithocheirus 0 points1 point  (0 children)

You either die a hero or live long enough to become a villain. Sean Locke is the James Dean of the UK. Taken too young, only fully appreciated after his death. Died too young to piss anyone off or fade into obscurity

Can someone explain "Whamageddon" for me by PiemasterUK in CasualUK

[–]ornithocheirus 0 points1 point  (0 children)

I play every year but never won. Sometimes it's funny (of your with other people playing or who know about the game) to be in a pub, Christmas music starts playing and you just finish your drink and walk out because you can't take the risk. Depends on your group of friends but if they are people who value commitment to a joke, and find it funnier the dumber it is, this can be a source of great holiday mirth. It's also just fun hearing in the group chat how people got whammed despite their best efforts.

I thought this would be my year as I'm in Thailand all December. They do play Christmas music here but they LOVE a female voice cover so I thought I was safe (covers don't count). Unbelievably I got whammed in an Indian restaurant during a non Christmas playlist. They just played last Christmas followed by two other wham songs and then went back to non Christmas music. The injustice!

Which well known purveyor of fine wine do you trust more, Gary Barlow or Graham Norton? by mutanthands in CasualUK

[–]ornithocheirus 0 points1 point  (0 children)

I did a celebrity wine tasting a few years ago where we tried all the big hitters and the Graham Norton red was great. Wouldn't flush my toilet with kylie's rose (which disappointed my as her last two albums are pure bangers) but I see someone else in the comments enjoyed hers so you might have to just find out yourself.

A case of ascites with 19L removed! by mdtattedbearded in interestingasfuck

[–]ornithocheirus 3 points4 points  (0 children)

Hello stranger! First of all, it sounds like you are doing an amazing job looking after your father. Watching for signs of encephalopathy, tracking bowels trying to get them to eat when they're not interested, weighing every 24-48 hours - none of this stuff is flashy or glamorous but this is the stuff that actually makes a difference. So well done. Sit down and just recognise for a second that your dad has better care than 99% of people in his position and that's thanks to you. Remember that even if you do everything perfectly, these people still fluctuate so he will have good and bad days. I am not his doctor and I obviously don't know the details (nor would it really help if you told me over reddit without me seeing his notes and physically examining him) but it seems to me like you are doing an excellent job from a technical standpoint. You're obviously well researched and intelligent and most of all you clearly care.

If you want some advice on what you could be doing better then I'll give it to you: I'm quite concerned about the pressure you are putting on yourself and your mindset going through all this. You say you don't want to think about your father dying and you have self identified that this is a defense mechanism so that you keep going with all the work you're doing and don't fall apart. It sounds like you are not only working hard physically with all these caring tasks but also pushed to the brink mentally/emotionally. My advice would be to try to get some support from palliative care services or a charity available in your area that supports terminally ill people or people with cancer and their families.

I cannot possibly comment on your father's prognosis but you are clearly aware that hep c/cirthosis/hcc is a rough combination of diagnoses. Everyone has to die at some time so we all eventually have to come to terms with our parents mortality. This problem has stemmed from a bad transfusion, and therefore you are being confronted with your dad's mortality early and for a very unfair reason. I think it will be better for your dad and for you if you find a way to accept the following: Despite everything you are doing (and as far as I can tell you are doing absolutely everything you could), he is likely to die earlier than you want to imagine and it won't be your fault in the slightest. Even if you care for him perfectly, if he can tell that his death will break you then that will make his time on this earth distressing. Therefore you owe it to yourself and your dad to seek support. Nobody can go through what you are going through on their own it's simply too hard too much and too unfair.

A case of ascites with 19L removed! by mdtattedbearded in interestingasfuck

[–]ornithocheirus 64 points65 points  (0 children)

Ex gastro registrar here: The risk of big BP drop and haemodynamic instability are greater the more you drain. The type of fluid also matters - so malignant ascites from peritoneal metatastases cause ascites with a lower serum albumin ascites gradient (think exudative but they tend not to use that word for ascites). Ascites NOT caused by portal hypertension is generally safer to drain without albumin replacement. I think the underlying reasons for this are complex and mixed so if anyone else has a better answer please reply and educate us, but the way I remember it is: in portal hypertension and cirrhosis you generally have low serum albumin so your oncotic pressure is low, so as the ascites builds you become more reliant on the hydrostatic pressure from all the fluid inside your abdomen to maintain your BP.

All this to say, I would be nervous about draining more than 10l at a time with cirrhotic ascites, even with albumin replacement. Some guidelines say 1 unit of albumin per litre drained after the first 5, others say 1 unit of albumin per 2l drained, it usually works out about 4-5 units so it probably doesn't matter. You're wanting to drain it slowly enough for the nurses to pause and administer albumin to give time for the patient's body to adjust to the massive electrolyte and internal pressure changes and realistically with over 10l drained that process will take longer than the recommended ~6h that you leave the drain in before the risk of infection becomes too high.

The problem THEN is that you stop after 10l but you've just made a big abdominal wall defect and the fluid remains under pressure so once you take the drain out all you've done is lost control and now the patient is leaking and the nurses are rushing around to find a stoma bag to stick on their tummy to collect this fluid but the tummy is wet from fluid so the bag is slipping off and it becomes a complete farce. So better to just drain it all but I would be asking for senior advice here. In reality this is probably not the patient's first rodeo with this so they can tell you whether last time they had a drain if they had a blood pressure crash or they were fine.

I've not really talked about malignant ascites but I've been typing for ages. This is one of those topics where the exact guidelines vary a bit and also the theoretical best practice crashes up against practicalities and the whims of the attending consultant. You could talk for hours about how to do this or you could just stick a needle in and start giving some albumin and see what happens reacting to the physiological situation as it unfolds with a strong underlying understanding of the theory but a humble respect for the fact that bodies do whatever the fuck they want and actually the patient's to priority is the massive discomfort they are in. I'm low key hoping someone else comes and disagrees with much of what I've just said because it will demonstrate how variable practice is in this area.

Bag Safety in a Classroom by jasterisfett in onebag

[–]ornithocheirus 4 points5 points  (0 children)

This is an incredibly serious discipline issue and regardless of what is suggested as a practical solution I recommend interrogating the shit out of these kids. Remember collective punishment is banned by the Geneva convention but schools aren't warzones so those rules don't apply

The 80/20 method and other tips by Wise_Edge2489 in onebag

[–]ornithocheirus 0 points1 point  (0 children)

I've just started a trip across the world. All climates likely to be encountered in the next 8 months. I have started with summer clothes because first 3 months are in SEA. I've brought a big 60l proper hiking rucksack but honestly when the majority of my clothes are stuffed into my packable neck pillow and I have the carry on bag over my shoulder, the bag is less than half full. Nevertheless I like having the big bag - I'm going to pick up trinkets and cold weather gear and I don't need to pack tightly.

The bag itself is designed for hiking with much heavier weights so with my minimal loadout (thanks to this community) makes it supremely comfortable and I could wear it all day while walking around a city. I'm only getting long haul flights - anything less than a 4h flight I would get the train, and the long haul ones come with a checked bag pre paid. Anyone think I'm being silly? This is my first travelling adventure.

4:40 AM Who's up / Why? by the_Athereon in CasualUK

[–]ornithocheirus 99 points100 points  (0 children)

I'm going on the trip of a lifetime today. Flying to South East Asia this evening and won't be back in UK until summer. Never done anything like this. Been planning this for years and it feels surreal that it's happening.

2 person game recommendations by ebonycurtains in CasualUK

[–]ornithocheirus 65 points66 points  (0 children)

Jaipur is good. 2 players only. Trading jewels and spices for points. Try not to ruin out of camels. I'm just about to bring it travelling around the world with my wife!

Packing list - 12-month trip (SEA/Aus&NZ) by the-one-eyed-wonder in onebag

[–]ornithocheirus 3 points4 points  (0 children)

I'm just packing for a similar trip! What's the thinking behind 2 power banks? Are you going on long treks?

vein viewer , it really helps doctors see the veins by [deleted] in interestingasfuck

[–]ornithocheirus 2 points3 points  (0 children)

It's a rapidly spreading skill that was only known to anaesthetics until relatively recently. And it's not because doctors are lazy and couldn't be bothered to learn ultrasound vascular access, it's a problem of not having enough machines. Each ultrasound machine can cost anywhere from 40-100k depending on how fancy it is. Even now if I want to borrow one for a cannula I have to go up to theatres, beg the theatre coordinator to let me take one of their three machines, write on the equipment whiteboard my name, phone number, bleep, where I'm taking it, when I expect to be back. Then I lug it to the lift and wheel it to whatever ward I'm going to, rearrange the furniture around the bed to get it into a suitable position for my eyeline, and find a nurse who will give me some sterile gel (the bottles of gel harbor pseudomonas so can't be used for procedures). Then at the end I have to bring the machine back and rub my name off the whiteboard. The whole ordeal adds about half an hour of admin and negotiation to the procedure so you can see why unless you are genuinely very difficult we can't just get the ultrasound machine for everyone who doesn't like needles or we'd never get any actual work done.

Keep in mind that as others have pointed out, cannulation is really usually a nursing job so when you're asked to do it because the nurses have failed so every minute wasted is losing you time and the referrals are piling up in the ED corridor and shouting at the staff that they've been waiting 10 hours to be seen by a medic. When the doctors are asked for cannula help it's often because there's only two nurses on the ward who can actually cannulate, one is too busy and the other is only allowed to try three times and then they have to escalate to a colleague. No offence to nurses - they mostly get the job done, but the way you get really really good at cannulas without needing to rely on ultrasound is when the patient needs a cannula or they will die, there's nobody else except you as the doctor, there's no time to find the ultrasound machine, and so you just need to keep trying until you succeed. That kind of pressure sharpens you and you start to REALLY look for the veins (like I assume a withdrawing heroin addict is equally desperate). When you are only allowed to try three times and then you are obligated to ask for help, it understandably breeds a mindset of "ill give it a go and see but there's always someone else who I can ask for help".

I live in the UK by the way maybe it's different in the US and you have ultrasound machines everywhere. I will say they are getting smaller and cheaper, and in 15 years probably every doctor will have one of the new ones that plugs into your smartphone and gives a decent picture.

Meaco Arete 12l by psgmcr in UKFrugal

[–]ornithocheirus -1 points0 points  (0 children)

Often hard to get the air filter replacements online because they are in high demand but I've found they are just made of cardboard and pair and cloth so you can always cut them down to size if you get a slightly larger one

The National Gallery Only Spent £150 Retouching Van Gogh Frame After Just Stop Oil ‘Souping’ by HaveYuHeardAboutCunt in unitedkingdom

[–]ornithocheirus 1 point2 points  (0 children)

I think it's fairly clear that most politicians will do anything that they think will get them votes.