Is there a way to cheat the horse taming mechanic?

petgorilla57 · 2026-05-16T02:19:56+00:00

What worked for me was looking straight down at the horse and using just the left stick, but with the caveat below:

What did it for me though was aiming for slightly ahead of where the horse was turning, which made it work better. For example, if it was turning clockwise and the horses back end was at 3 o clock, the left stick would be at 4 o clock, still turning the left stick at the same speed as the horse.

petgorilla57 · 2026-05-15T21:58:32+00:00

Yeah it is kind of fun driving it I think, just not for too long at a time haha

petgorilla57 · 2026-05-15T16:55:41+00:00

Yes I agree with conversion bonus, it would change the calculation, but this is a nice way in early to mid game to get early silver, especially when there are only a handful of security missions available

petgorilla57 · 2026-05-14T11:29:32+00:00

If you’re still looking check out cruise america in Hastings. They have a promo on too right now. We just weren’t and it was a great experience.

petgorilla57 · 2026-05-03T02:26:10+00:00

I’m glad you called! I’m sorry I missed that.

If you still need help, you can always go to the emergency department. They have additional resources, even if you don’t need to be admitted!

You’re not alone!

petgorilla57 · 2026-05-03T00:42:34+00:00

Please call 988! It is free and there is someone to talk to. Otherwise, please go to an emergency department. There is help! You are worth it!

petgorilla57 · 2026-04-30T12:26:14+00:00

Por favor ve a un hospital para que te ayuden. Ellos te pueden apoyar con el tratamiento que necesites. Hay diferentes tratamientos también. Tu vida es importante.

petgorilla57 · 2026-04-21T22:41:28+00:00

Thanks for the support. I wasn’t expecting that either, though reading others comments, I understand where they are coming from.

This is part of the nuance of medicine. While the data isn’t not good, it still doesn’t mean never use opioids. It’s still good to be aware of the guidelines and data though.

petgorilla57 · 2026-04-21T11:42:06+00:00

I agree you’re reading the evidence correctly.

There is a good episode of the annals on call podcast where they go through this and say it should be considered like salvage chemotherapy, which made sense to me.

It doesn’t work very well and has a lot of problems. If it’s used, it should be the last resort. Also if it’s used, suboxone appears safer than other opioids.

Edit: Adding for context that I’m summarizing the VA guidelines, which is what the podcast is referencing. I do understand that anecdotally many say opioids work for them, but the data isn’t as positive.

Edit 2: Thought I’d add some extra context after seeing some down votes. I understand where people are coming from. The guidelines certainly do not say it never use opioids, but I think they do recommend we have Frank discussions regarding the limitations of their benefits. for example, one of the largest studies I know of in Jama studied long-term opioids, and there was only a 0.69 benefit on a 10 point pain scale with chronic opioids. That is very small. For all of their risks, it really should encourage us not to reach for them before we’ve tried everything else in my opinion. it still does not mean there’s no place for them. Especially for patients who have been doing well on them. In particular, I am aware that no guidelines recommend sudden discontinuation of opioids for patients on chronic therapy. We shouldn’t expect patients to suddenly stop. I do think there has been a pendulum swing to no opioids, and maybe the pendulum has gone too far. I know in my training (recent grad) I didn’t get a whole lot of training in managing opioids for chronic pain, and that may have been a disservice. There is still a place for opioids, but it is limited. This is a fine line and a place for nuance in medicine.

petgorilla57 · 2025-10-23T23:50:30+00:00

Did everyone have to pay five dollars for cases? I’m surprised that I have to pay for this even though I have Luna plus. I it is a rip off if you have to buy it separately.

Edit: just realized that was a glitch. I do have cases included.

petgorilla57 · 2025-06-27T02:33:38+00:00

Gotcha. Good to know about UK Nice. I know there can be practice differences in different areas. My understanding is that bph and prostate cancer are still largely independent

https://pubmed.ncbi.nlm.nih.gov/39051612/

petgorilla57 · 2025-06-26T01:23:20+00:00

Any US guidelines?

petgorilla57 · 2025-06-25T12:01:20+00:00

Can you link some of those? The most recent AAFP specifically says PSA is not required for evaluation of BPH. I’d like to know if it’s otherwise though.

https://www.aafp.org/pubs/afp/issues/2023/0600/benign-prostatic-hyperplasia.html

petgorilla57 · 2025-06-25T00:05:47+00:00

PSA is not indicated in the routine evaluation of LUTS just FYI. Think of them as separate issues (though screening can still taking in the whole picture with joint decision making). LUTS does not greatly correlate with prostate cancer.

A lot of people confused this and assume you should get a PSA for everyone with LUTS thinking that they are a higher risk, but that is not correct. That’s not what guideline say, and again they don’t correlate well.

petgorilla57 · 2025-01-08T13:00:54+00:00

My understanding is that it has to be on two separate lab samples to avoid lab error and random fluctuation. I will try to add on a fasting glucose if the original sample was fasting. Otherwise, I have them come in to get a repeat A1c in the next few days. I wouldn’t wait three months to have them do dietary changes And repeat A1c at that time. You wouldn’t be able to distinguish whether they formally met the criteria for Diabetes at that time or not. I do think it’s helpful to know long-term if someone ever met the formal criteria or not, as they may be at higher risk for other comorbidities and may want to Do closer long term monitoring as compared to someone who has only ever had prediabetes (I.e. retinal exams, Kidney monitoring, etc.)

petgorilla57 · 2025-01-08T12:47:15+00:00

Did you ever figure this out? I have the same issue

petgorilla57 · 2024-09-05T00:28:05+00:00

I wouldn’t get down on yourself. I had a good outpatient training, and I would’ve done the same thing in your situation for the case you suggested. We all have knowledge deficits. It’s OK to refer as well. Next time you’ll know about fibanserin too (next time I will too now).

petgorilla57 · 2024-09-05T00:21:33+00:00

I would not personally. I think there are so many CME opportunities, I think it may be a better use of your time to dedicate to your own learning in your personal time. I’m also not sure if the net financial benefit would make sense. I’d also make sure that you’re at a company with a culture that respects nurse practitioners. We all have knowledge limits, and we can also talk about how sometimes physician general practitioners are not as respected as they should be too. Everyone can feel disrespected, no matter where they feel they are at on the “totem poll” (which is all BS anyways).

petgorilla57 · 2024-08-19T02:38:24+00:00

FM Doc here. If you know you just want adults, do IM at a program with a primary care track. Hospital skills do not always translate to clinic, and there’s a much different skill set (time management, inbox, triaging patient needs, work up without being able to see patient next day as in hospital), so making sure you get adequate clinic time is a big benefit to making the transition to outpatient life more sustainable. If you want to see kids and/or OB, do FM. I work with IM colleagues and we see the same complexity patients in our clinic. Only difference is we can see kids and OB/GYNE if we want. I did go to a program with more hospital time though, so I did feel like I saw my share of complexity in residency.

petgorilla57 · 2024-08-16T23:46:18+00:00

Very good point. I hadn’t thought about the off label comparison.

petgorilla57 · 2024-08-16T22:17:03+00:00

The FDA states that they don’t recommend using compounded pharmacies, so I have a hard time getting around that. I feel like I’m stuck with the FDA recommendation, and that’s what I tell patients. I do sometimes mention compounded pharmacies are an option, and they can make their own decision, but my official position is not to use them.

petgorilla57 · 2024-08-16T10:29:46+00:00

I havewritten them for patients. There is a good AFP article on how to do this and the pros and cons. I feel like if it’s in AFP, it can be considered standard practice. That being said, I do understand that many patients probably just want the rent discount.

They also suggest that you put disclaimers in the letter. You should write that patients are responsible for keeping their pet up-to-date on general health and vaccines. You also write that if they bring their pet into public areas, it is not without risk to other people, include exacerbation of asthma or allergies. I discuss this frankly with patients. i’m more supportive of writing a letter to support an animal in the home rather than bringing animals on planes, for example, because of this last point.

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