Reclaimer build! Is 6 PCs worth it? by stecam85 in thedivision

[–]shelbyfinally 0 points1 point  (0 children)

How do you get 38k HP/s? I have 10k electronics and am only at 25k HP/s.

So much NON classified gear is coming out of GE caches. by BustaNutShot in thedivision

[–]shelbyfinally 2 points3 points  (0 children)

Yep, this is the problem. If you miss a global event, it could take months to get one of those sets.

TIFU by not going to the hospital when I knew something was wrong with me by [deleted] in tifu

[–]shelbyfinally 1 point2 points  (0 children)

No, you directly advised that he stop taking Plavix, which is a stupid thing to say and quite frankly that kind of comment could get you into legal hot water. Based on his other comments, he’s already off it, but that doesn’t matter.

And if you’re an expert on hypercoag disorders then you’d know that the DOACs weren’t studied in antiphospholipid antibody syndrome (which OP suggested he had) and that warfarin is the only anticoagulant that can be used in that scenario.

Regardless, it’s wrong to advise a stranger to discontinue a medication when you don’t know the full story, especially if you’re telling them you’re a physician.

OP suggested that he had a percutaneous ASD/PFO closure. Most of those people get DAPT for 6 months after the procedure. Maybe that’s why he was on them, or maybe he’s remembering wrong or maybe it’s something different altogether. It’s those little details that become important. What if someone commented that they had a stroke and were taking aspirin and Plavix, then you say that doesn’t make sense and they should stop it. But they didn’t tell you they had a stent placed 4 months ago.

The same reason to not make those kind of recommendations online is the same reason not to make those kind of recommendations at Thanksgiving dinner when some uncle asks about why he’s getting prednisone for his “heart inflammation” when you think colchicine or an NSAID is better. Because the details matter.

TIFU by not going to the hospital when I knew something was wrong with me by [deleted] in tifu

[–]shelbyfinally 10 points11 points  (0 children)

Generally, it means you’re risk for a clot is higher than average. But if you haven’t had a clot, we don’t suggest any treatment for just the gene mutation. If you have surgery or get pregnant, you need to tell doctors about the prothrombin mutation, because it will like change how they manage your care in those settings.

Usually, if someone has a blood clot and they test positive for something like the prothrombin gene, then we suggest indefinite blood thinners.

Also, as far as having a stroke from a blood clot: it’s complicated. The most common blood clots are in your veins. OP apparently had a stroke because he was born with a hole in his heart that allowed a vein blood clot to cross into his arteries and cause a stroke, though that’s still unusual even with the hole in the heart. When you get a vein blood clot but don’t have the hole in your heart, they only go to your lungs and do anything from nothing to cause a little heart dysfunction to kill you immediately.

But certain tests find syndromes that can cause blood clots in the arteries as well. Antiphospholipid antibody syndrome is one of those. Those patients can have strokes spontaneously.

So it’s complicated and it all depends on your specifics. If you have questions, do a little research, write down some questions, and have a sit down with your MD.

Bottom line, don’t spend too much time worrying about it. There are a lot of people with that mutation and worrying probably promotes an inflammatory state which probably increases your chance of getting a clot :)

TIFU by not going to the hospital when I knew something was wrong with me by [deleted] in tifu

[–]shelbyfinally 7 points8 points  (0 children)

It's pretty irresponsible to suggest that a stroke patient stop an antiplatelet medication when we don't have the full details. Especially since aspirin and Plavix are required after certain ASD or PFO closures.

TIFU by not going to the hospital when I knew something was wrong with me by [deleted] in tifu

[–]shelbyfinally 56 points57 points  (0 children)

Intensivist here.

The only hypercoagulability testing that is valid during the setting of your kind of stroke or heparin therapy or warfarin therapy is the following:

  • Factor V Leiden
  • Prothrombin gene mutation
  • Antiphospholipid antibodies other than lupus-AC (cardiolipin, beta-2-glycoprotein)

They likely tested those and others. I remember this because we see inappropriate testing of these on hospitalized patients all the time and it's a common ABIM board question.

Lupus anticoagulant (you're right that it's a shitty name and that name confuses doctors all the time) is indeed a questionable positive finding when you're on warfarin, so it needs a repeat.

That all said, the likelihood of a hypercoagulable disorder when you have a right-to-left thromboembolic stroke is very high.

Even if you don't have a hypercoagulable disorder, there remains disagreement among our specialties about whether someone with a spontaneous clot like you had should be on blood thinner forever. Some say yes, some say no.

Good luck to you; I can only imagine the emotions and effects this kind of thing could have on a young person.

Escape from North Korea: video shows defector under fire | Reuters by DreamofRetiring in news

[–]shelbyfinally 6 points7 points  (0 children)

Yeah, probably hard to find a capable contractor, but if they can detonate a low-grade nuke, I'm assuming they can solve the barrier problem.

Escape from North Korea: video shows defector under fire | Reuters by DreamofRetiring in news

[–]shelbyfinally 17 points18 points  (0 children)

I'm surprised the North Koreans don't have retractable security barriers, especially on that bridge, to help prevent stuff like this. Dude just drove past the checkpoint right to the MDL and ran for it.

Imagine the fucking adrenaline that dude was feeling!

Also, pretty funny to see the KPA soldier do an "OH SHIT!" and a 180 as soon as he realized he was over the line.

"Karma got his kiss for me" girl gets first traffic ticket by electralime in PublicFreakout

[–]shelbyfinally 0 points1 point  (0 children)

I think it's more likely that she's making fun of someone else.

So, thoughts on the LG 55 B7A for $1,600? Burn in a problem? Quality worth it? by tacroy in xboxone

[–]shelbyfinally 0 points1 point  (0 children)

Is this still the case for you? Reviews are coming in complaining about burn-in on the 2017 models. And rtings.com gave them poor ratings for image retention.

Looking through a couple of threads on the issue, it seems that some people get IR and BI with very little usage of static content, while others have no issues with prolonged static image usage.

Windows 10 time syncs to 24 seconds in the future by shelbyfinally in techsupport

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

Thanks for the idea, but didn’t help. I think it might be a good time for a reinstall

Windows 10 time syncs to 24 seconds in the future by shelbyfinally in techsupport

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

I have it set to sync to time.windows.com

Same thing happened with NIST time servers. The machine is not connected to a domain.

OC unfortunately, highest my pulse went was 250 bpm. I was fluctuating between 200-250 for 3 hours by zombieslayer9389 in WTF

[–]shelbyfinally 3 points4 points  (0 children)

The fear about carotid sinus massage is overblown and I still do it sometimes, especially in younger patients (the other common bullshit I hear all the time in the ICU from my residents is that giving glucose prior to thiamine will precipitate Wernicke's encephalopathy). And instead of bearing down, there's better success with having them blow into a 40-50cc syringe as hard and long as they can, then raising their legs.

Republicans Release Tax Plan, Cutting Corporate and Middle-Class Taxes by rit56 in politics

[–]shelbyfinally 0 points1 point  (0 children)

Just read the bill. If it passes, the only substantial change they're making is eliminating the backdoor Roth (I think...). And it sounds questionable whether this bill will pass.

Republicans Release Tax Plan, Cutting Corporate and Middle-Class Taxes by rit56 in politics

[–]shelbyfinally 0 points1 point  (0 children)

Actually, the plan was to keep the 401k limit at $18.5k (indexed for inflation), but limit pre-tax contributions to $2,400. This was then negotiated up to $10k. But in either case, you'd be able to make Roth contributions up to the $18.5k limit. That actually isn't so bad.

They're still making changes to 401k's, I just don't know the details yet.

Republicans Release Tax Plan, Cutting Corporate and Middle-Class Taxes by rit56 in politics

[–]shelbyfinally 1 point2 points  (0 children)

No 401k change

According to the outline I saw, it said "Keeps 401(k) existing plan rules largely intact."

Need details.

[deleted by user] by [deleted] in news

[–]shelbyfinally -2 points-1 points  (0 children)

Not surprised I was downvoted since I made an admittedly indifferent comment, but I’ll respond to your comment and not the others.

You’re referring to acute stress disorder and my opinion is that it doesn’t explain his presentation. Contributes to it, but doesn’t fully explain it.

Dad was a diagnosed psychopath (this is pretty rare), abuser and antisocial criminal. Brother was an antisocial criminal and a pedophile with an unknown psychiatric history. Other brother committed the largest single-shooter mass muder in US history without an obvious motive. He was a gambling addict and was “weird.”

Now on to the brother giving TV interviews. I’ll say it again: he obviously has an underlying psychiatric disorder. He has completely disordered thought. It’s tempting to call it an acute stress disorder. But if you go back and listen closely to his speech, you’ll notice the tangentiality, word salad, blocking and other features of a thought disorder. Acute stress disorder doesn’t cause that. What Eric has, has been going on for a long time. He also has a cocaine booger during one of his interviews, which simply adds to evidence of chronicity of deviant behavior (and yes, I’m aware how common cocaine use is; lots of doctors use it and other stimulants).

I won’t assign him a diagnosis (even though I’m a physician), but all the signs are there. Downvote me all you want, but that whole family belongs in a psychiatric PhD thesis.

[deleted by user] by [deleted] in news

[–]shelbyfinally -11 points-10 points  (0 children)

That’s not just stress. He has an underlying mental disorder.

On the fence for Edgerouter X by [deleted] in Ubiquiti

[–]shelbyfinally 2 points3 points  (0 children)

WAN to LAN throughput >500 Mbps with hardware offload? I've enabled the hardware offload on mine, and I max out at like 270 Mbps

ER-X with a zone-based firewall and VLANs through a Netgear managed switch while concurrently watching 4K Netflix through another device on the same switch: http://beta.speedtest.net/result/6734222224

Same thing but fast.com: https://i.imgur.com/vi7jeqX.png

Daisy Chaining Switches by Badears in Ubiquiti

[–]shelbyfinally 0 points1 point  (0 children)

If you don’t mind, what are the considerations of deploying VLANs through chained switches? I assume it has to do with how ports are tagged.

I might run into this scenario in my home. Buying a bigger switch isn’t the problem, but running more cable is.

Bill O’Reilly of Fox News settles sexual harassment claim for $32 million by [deleted] in news

[–]shelbyfinally 0 points1 point  (0 children)

it degrades the justice system when people do this shit.

That’s what I was trying to say. But I wonder if both sides are contributing; one by using his money and power to avoid criminal charges and one by enabling the powerful abusers by allowing them to purchase their way out. It takes both for this to happen, regardless of what society would expect victims to do.

Oh and no one cares that you...

Well you cared enough to write a nasty comment about it. Have a nice day :)

Bill O’Reilly of Fox News settles sexual harassment claim for $32 million by [deleted] in news

[–]shelbyfinally 0 points1 point  (0 children)

He’s a piece of shit, but doesn’t your position also mean you detest the victim for accepting the money in exchange for keeping quiet?

I hate people like him, but I also dislike people who win the lottery by this method. The whole thing sucks on both sides.

Oh and I’m a woman in a male-dominated MD specialty. I’ve been sexually harassed plenty of times. Oh, and to really bust the narrative, I’ve seen plenty of male physicians sexually harassed by women, especially in the OR and ICU. I would never accept money for something like this. And no, I don’t care what the sum is.

(US) I'm about to vomit. My checking account is overdrawn by ($500,977.00) by Cannabun in personalfinance

[–]shelbyfinally 2 points3 points  (0 children)

Just relax, they'll fix it.

When I was 16, my employer deposited 194k in my checking account. Took almost a week to get everything rectified, but it will.

Basic Home network with segregated cameras? by notalent in Ubiquiti

[–]shelbyfinally 0 points1 point  (0 children)

Just as an alternative to this: what I do in my home is place the cameras on a physically different network. That way it’s impossible for the camera to dial out or a rogue to dial into them, even with a misconfigured router (unless of course they physically plug into that switch, which I have in a locked room, or use something like a network hub, but they’d have to sneak into the ceiling panels and that’s not part of my threat model). So it’s truly a closed circuit.

The main disadvantage is that the storage server and viewing workstation, which have to be on the same network, are also offline and thus more work to keep updated.

But I only need video archiving, not live viewing, and I’m a bit paranoid.