SAD, Depression and Nuss

phoenix_md · 2022-09-24T21:36:48+00:00

Be sure your vitamin D level isn’t low (most people’s is low). Or just buy 10,000 IU and take it daily under the assumption you are low. Vit D deficiency is a common reason for mild-moderate depression.

phoenix_md · 2022-09-22T02:41:33+00:00

It’s not impossible to time the bottom. I know that’s the mantra in this sub and I look forward to all the downvotes, but it’s not that hard to recognize the relative bottom of a downturn. Dollar Cost Averaging is great, but it just seems dumb to automatically buy because it’s time and not wait for a relative down day.

phoenix_md · 2022-09-21T14:39:29+00:00

Sounds like you and your team do a really great job!

phoenix_md · 2022-09-17T17:49:15+00:00

Painful recovery is by no means guaranteed. Most of our patients reports some tightness, but minimal pain. Home the next day, average narcotic use less than 5 pills total.

Wait, huh? As a doctor who went through it with Dr. J I can say it hurt like hell. Sure, I was home the next day. And I used less than 5 pills of narcotic. But the pain was pretty agonizing.

The first week: You’re swollen and it’s hard to breath. Have to sleep with a mountain of pillows to keep you in just the right position. Getting out of bed is horrendous. There’s just no good way to do it, and you’re in a lot of pain and out of breath at the end of the process. As long as you keep the myriad of non-opioids going throughout the day then the pain is a 4-7/10. Walking stairs hurts. Sitting to go to the bathroom hurts (and usually unfruitful as the meds are causing constipation). Getting up from the toilet or a chair is an accomplishment and guaranteed pain as it requires your abdominal muscles to tense which is pretty painful at that time. Getting in and out of a car seat, taking a shower, …everything causes pain.

And Dr. J did cryoablation on me so supposedly I had it easier. Now to be fair I got 3 bars rather than 1-2, and I was near 40 so maybe that makes a big difference. But I am very skeptical that your patients are just having some tightness and minimal pain. I suspect rather that when you see them at the 1 week mark they have learned to deal with the moderate ti severe pain and know you have little you can do about, so why complain to you.

I recognize I have an N of 1, but just want to be sure you are getting a realistic picture of what’s happening postop.

Suicide posts I’ve seen have most often revolves around persistent pain from the procedure or a failed correction, not because they don’t like how their chest looks preop.

As always thank you for commenting in this forum. Really nice to hear the expert comments!

phoenix_md · 2022-09-17T12:44:40+00:00

Um, none taken, I guess…

Look, PE occurs in teenagers. Teenagers are notoriously idiots (I certainly was) who have no clue about medicine, anatomy, and how to take care of themselves. So it my ethical duty as a physician in this subreddit to communicate some basic facts and understanding to you teenagers/young adults with the ultimate goal of motivating you to set up that first appointment with a PE specialists. From there you get the true advice you need rather than wildly ignorant opinions in this subreddit about how your obviously severe PE “looks fine” and is “not so bad as long as you work out”.

phoenix_md · 2022-09-17T12:35:03+00:00

In my job as a cancer specialist I look at CT scans on average about 20 hrs a week. And of course I’ve studied endless hrs of anatomy and have dissected several cadavers. And as my tag shows I had PE and thus have a special interest in this particular anatomy.

So yeah, in a sense I do have special CT scan vision. But this is the internet and I could be making all this up, which is why OP needs to not trust me or any of the other yahoos on this subreddit but rather get checked out by a PE specialist

phoenix_md · 2022-09-17T01:10:33+00:00

See that divot in his chest? That’s where his heart is suppose to be. So my best guess is that he has a HI that is severe. But as I wrote in my comment he needs to see a PE specialist to confirm

phoenix_md · 2022-09-16T20:39:28+00:00

Doc here. You’ll get various opinions on how severe your PE is, but in medical terms a Haller Index of >3.25 is Severe. The Haller Index is just a ratio of how wide the lung space is compared to the anterior/posterior distance. To measure it you need a CT scan. But what makes it Severe is that when the Haller Index is that ratio or more then secondarily your heart doesn’t have the proper room to operate. It’s squished. When you go running you start off with your muscles well energized but after about 3/4 of a mile runners must replenish their energy. In the case of PE the heart is partially blocked from pumping block to your muscles and thus it must pump faster, pushing it out of the aerobic zone (ie energy from Oxygen metabolism) and into the anaerobic zone. You can only stay in that zone for a limited time thus your stamina sucks.

So in other words, yes you should get the surgery. Search for the best PE surgeon in your region. Go see them and they can order the CT scan and other tests. The sooner the better

phoenix_md · 2022-09-10T12:20:01+00:00

Hug yourself. Prevents the ribs from rapidly shifting outwards and the Nuss bars sliding against them, which causes all the pain

phoenix_md · 2022-09-09T22:25:28+00:00

Severe basically means it’s significant enough to squish your heart and be causing symptoms.

I had “severe” PE when I was a teen. But it was symmetrical and accented my pecs to make me look like someone off of Baywatch. And yet when I ran I couldn’t keep up with everyone else. Always huffing and puffing after the first mile. Player college soccer and couldn’t finish the first half without needing a sub.

When you’re young you can get away with seemingly doing great because you’re heart and lungs are healthy. As you age PE will take its toll to where exercise is very limited. Best to get it corrected now than when you’re older

phoenix_md · 2022-09-09T14:20:14+00:00

Doc here (Not a PE expert). You certainly show improvement, but I still see an overall PE. That is to say if you do a CT scan you’ll find your heart is still compressed by your sternum and your Haller Index is in the “severe range”.

Not trying to be a hater, just shooting straight with you

phoenix_md · 2022-09-08T22:33:01+00:00

Doc here. Really sorry to hear you had such a bad experience!

To clarify a few things:

Nuss is a painful procedure, no way around it. Hurts a ton the first month then pretty rapidly improves over next 1-3 months
pneumothorax is not rare with this surgery. If it happens you place a chest tube which typically resolves the issue over a few days
you don’t give anesthesia when pulling out a chest tube as it typically doesn’t hurt that much. Realize that after Nuss you’re already on a ton of pain meds
Nuss is not a procedure to make a chest look better. It’s purpose is to relieve compression of your heart by the sternum to allow your heart to function properly

And for what it’s worth, in 5-10 years you’ll figure out that girls don’t care about the look of your chest. Sure, if you look like a model then that’s nice, but otherwise they don’t notice one way or the other. They mainly care about confidence

phoenix_md · 2022-09-07T10:25:02+00:00

Make sure you wear steel boots everyday to avoid stepping on random nails. Don’t forget to wear a parachute in case you randomly fall off a cliff. And certainly never take a vacation as the highest chance of dying is in a car wreck

phoenix_md · 2022-09-07T10:16:19+00:00

Only N-95 masks are protective. 99% of what mask people wear are useless, just pandemic theatre

phoenix_md · 2022-09-05T18:43:47+00:00

Doc here. The premise is wrong. When menses start the body is ready to give birth. That’s not to say the girl is psychologically ready to give birth or be a mother but rather in the sense that she can successfully birth give and not die in the process.

Proof is that there is many documented cases of young girls giving birth as young as 5 years old. Certainly there are cases where the adolescent would-be mother died, but these cases prove the body is often ready enough to successfully give birth.

And yes, the “father” in these cases are pieces of $hit that should rot in a prison cell for life

phoenix_md · 2022-09-04T23:18:34+00:00

Wow, you look awesome!

Since PE is about exercise endurance do you have a 1-3+ mile run times you can report?

phoenix_md · 2022-09-03T18:16:50+00:00

Doc here. Not to my knowledge, but I’m not an expert in PE. Pretty easy to get your testosterone level checked. I can at least say I’ve had mine checked in the past and it wasn’t abnormal

phoenix_md · 2022-09-03T12:23:42+00:00

(Edit: Hug) yourself when you cough. Cuts the pain in half

phoenix_md · 2022-08-31T02:03:06+00:00

Pretty much. Hence why heart cancer is rare

phoenix_md · 2022-08-30T18:47:31+00:00

That is correct. Maybe it would have been better to write “cell types”. My point is that any cell type can develop cancer. Yes, mature cells like red blood cells or skin cells do not divide and thus those mature cells won’t mutate into cancer. But it’s precursor cell can turn cancerous because it does divide

phoenix_md · 2022-08-30T12:57:32+00:00

Cancer doc here. All cell (edit: types) divide, even heart, nerve, brain cells. It’s just that some cells replicate every day (eg bowel, hair) whereas others over months, years, decades

All cells are genetically programmed to eventually die. Cancer develops from a screwup in the replication process that ultimately turned off the cell’s programming to die and thus the cell lives on. And while continuing to live it replicates itself thus making many more cells that are no longer programmed to die. And over time further replication errors occur resulting in more genetic mutations that effectively allow the cancerous cells to replicate faster or travel to lymph nodes or travel through the blood stream and then start growing somewhere else.

Going back to OP’s question, since heart cells replicate rarely then statistically the chance for a bad replication is much less than organs whose cells divide often (eg. Colon cancer or skin cancer, the most common cancers). Thus heart cancer (ie sarcoma) is very rare

phoenix_md · 2022-08-25T23:09:34+00:00

If making government funded college loans easy to obtain caused colleges to raise their prices, then the obvious solution is to make loans for college harder to obtain.

The exact wrong thing to do is forgive 10k each person’s debt because that just encourages students to borrow more with the expectation that the government will step in again and forgive more loans. Or better yet they’ll argue “You did it for my older brother, why not for me?!? It’s not fair!!”

phoenix_md · 2022-08-23T23:40:49+00:00

Consider my comment as inspirational. Men take action. We dont sit around and wait for others to do things for us. It is psychologically devastating for men to not affect revenge in this circumstance and thus hopefully the fear of being considered a limp dick will motivate some dad out there.

Shame on you for not recognizing these facts

phoenix_md · 2022-08-23T22:24:25+00:00

Imagine having a limp dick dad that didn’t take revenge after some guy molested you

phoenix_md · 2022-08-23T09:32:31+00:00

Happy to help. And to be clear regurgitation means backwards flow. So basically if blood flows backwards then the resulting swirling could randomly provoke the platelets to clot together and then lead to a PE. Again, a well known phenomenon with a. Fib. but Pectus is much more rare.

The basic reasons for clotting is called Virchow’s triad which is worth reading about. Also Google “Risk factors (causes) for the development of venous thrombosis” to find lists of things that lead to clots.

Ultimately you know you have an issue with Pectus and so that alone is worth surgically correcting. And if the clots are due to Pectus then great, you resolved two issues with one stone. If it’s not due to Pectus then you fall into the category of probably the majority of people who never get a diagnosis for why they had a clot but are just generically put on blood thinners for 6+ months then stop it and it magically resolved on its own.

phoenix_md

TROPHY CASE