#ie like antibiotics

[salt-baby]

POTS Medication Vocabulary

after about the third time a doctor prescribed a medication that made my POTS drastically worse, and about three doctors visits past giving up on being an easy patient, i started asking my doctors the following questions whenever they prescribed a new long term medication:

is this medication a hypotensive? (will this medication lower my blood pressure?)

does this medication have a risk of tachycardia? (can this medication raise my heart rate?)

is this medication a diuretic? (will this medication dehydrate me?)

can this medication cause hyponatremia? (will this medication cause my body to lose salt?)

your doctor likely doesn’t know all of this off the top of their head for every medication, but they should know the most common adverse reactions. some may simply tell you they have no clue. i still think it’s worth asking to force them to consider these mechanisms.

for additional consideration:

your pharmacist likely knows the answers to these questions better than your doctor does. 

an additional list of types of drugs which should be avoided is available here, in the table on the fourth page. (note that propranolol, a beta blocker, is often prescribed for POTS but is discouraged by this paper. as someone whose taken it, it’s worth trying to see if it will improve symptoms, but didn’t for me. Additionally, these are just guidelines, and in those with, for example, both hEDS and POTS, the benefits of opiates for pain relief may be worth the risk of worsening POTS.)

regardless of what the doctor says, I always look up the FDA info sheet before taking a medication. these can be found pretty easily on google (your med + “fda pdf”), and list most of the adverse effects. I’m happy to make a post about reading these info sheets.

there’s a reason prescribing medication is left to those with years of medical training - it’s a complicated and difficult process. but oftentimes those who do this work are so overworked and burnt out, they don’t have the ability to read someone’s entire medical file, or be aware of an adverse event that only affects those with an uncommon condition. I find asking these questions forces my doctors to think about my chronic conditions, and after so many adverse events, I always check a medication for myself before taking it. 

remember that you can and should refuse to take a medication that is making your life worse or harming you. even pediatric patients have the right to refuse a medication, and often times, I’ve found nothing other than a very firm “no, I refuse” will get a doctor to consider other options. and even though its against the norm, remember that you have the right to ask your doctor why they’ve chosen that medication for you.

as always, feel free to ask questions, they make my day!

#i have intense opinions on the usage of propranolol #also your doctor will not like being asked these questions #i did this to one once and their eyes got as big as dinner plates #then they ran out of the room presumably to google things or ask their supervisor #that medication did work for me tho #i also dont usually ask for short term medications or extremely common ones #ie like antibiotics #salt baby talks #pots #Postural Orthostatic Tachycardia Syndrome #dysautonomia #ableism #disability

[tendercoretroglodyke]

your 20s are for getting diagnoses

#specifically diagnoses your doctors and/or psychiatrists have denied you bc. well all of the reasons doctors typically deny people!! #anyways my friend is fairly sure they have ME/CFS triggered by their lyme disease from like 2018 #the one where BOTH of us were in the ER trying to get dr to take them seriously bc i had to bring them there bc they couldnt get out of bed #and despite them describing in perfect detail the classic bullseye rash theyd previously had #and all the classic symptoms of lyme #the drs refused to give her antibiotics #just bc a lyme test that is NOTORIOUSLY inaccurate #came back negative #they had to get antibiotics from their home country and it eventually got better with them #but then developed a new set of chronic symptoms #ie... probably ME/CFS #all cos that doctor wouldnt prescribe antibiotics to clear the infection sooner

[swagging-back-to]

im so sus about the whole 'you NEED to use antibiotics for any sign of uri! it will never get better on its own!!"

bc like.... all mice have mycoplasma. if mice were barely able to go a week without getting a uri and without being able to fight it then mice would not exist. period.

unless uris are comparable to sepsis in mice, which they arent, because they can go months with one untreated.

#idk it's just so sus that everyones like oh yeah they cannot survive at all if you dont give them this synthetic drug thats like. #barely been around for a century #likeyeah onviously a lot of people died from infections back before antibiotics and antivirals #but a lot of people also survived and continue to survive without treatment #frowing up in ~the rurals~ showed me a lot of people well past middle aged who have been 'self medicating' in ways like #swallowing a teaspoon of Vaseline #treating their own machete injury even as it got infected. ie. doing nothing for it. #treating infected abdominal abscesses on their own with nothing but bandaids over the course of a couple months #pulling their own rotten teeth out with pliers #breaking off chunks of their rotten teeth with picks. #exact same people (YES--- PEOPLE) who did that never brushed their teeth. ever. They didnt even own toothbrushes #never washing their hands even after the bathroom and handling raw meat. immediately touching childrens mouths and the children #never get sick #like. #yall needa have some trust in the bodys ability to fight off infection #obv you should still eer on the side of caution bc you never know if they actually are able to figjt it off #but still. #i feel like this is just causing antibiotic dependence and eventually resistance

[a-bee-wizard]

this fail blogger has fucking CRACKED A RIB due her cringe pneumonia

#it hurtssssss #ouchie ouchie #dont think my giant antibiotic pills will fix this one fellas :( #i still can not bel ie ve i have pneumonia like who has pneumonia in 2023????

[transmutationisms]

what's your opinion on medications that require pregnancy testing? like accutane, I think they end your prescription if you get a positive pregnancy test, due to birth defects. i personally refused accutane for several reasons but the mandatory pregnancy testing was a big one

wow i literally just mentioned this to someone the other night lol. yeah it's pretty paternalistic. obviously fetal health complications should be taken seriously but it's very noticeable to me that the medical presumption here is that the automatic course of correct action is to prevent people access to their prescriptions, rather than, yknow, discussing options like abortion.

i know dorothy roberts ('killing the black body') and i think also jacqueline wolf ('cesarean section') have discussed the development of the concept of a 'maternal-fetal conflict'—ie, the notion that there's a conflict between the interests of a fetus and those of the actual pregnant person—and argued that american medicine's current tendency to prioritise the fetus has its roots in plantation medicine. the idea was that enslaved women were negligent, at best, or even outright infanticidal (as in, because they were trying to spare their children from being enslaved) and therefore white doctors and enslavers needed to treat the fetus as the patient, presuming its interests were of more economic relevance and overrode the actual human person. and this framing has been echoed since abolition, such as during the so-called 'crack epidemic' w/ state and medical discourses about black women specifically being unfit mothers who therefore needed to be legally regulated, separated from their children, &c. anyway i would guess that there are probably some echoes of this history in the decision to so tightly regulate pregnancy testing wrt accutane as well, plus ofc the legacy of the thalidomide scandal.

also, like, although risks obviously vary with different meds, it's not like isotretinoin is the only drug that can harm a fetus; many benzos and antibiotics do as well, for instance, and probably lots of other things that people are not routinely required to be pregnancy-tested for. so that also does make me wonder if part of what's going on is that accutane/isotretinoin is considered to be a 'cosmetic' (read: frivolous) intervention and therefore medical authorities have been more comfortable deciding to just yank people off it in case of pregnancy rather than, yknow, providing full information and advocating for patients to have full reproductive choice and such. this is rly just speculation though lol.

[thefandomlesbian]

Thinking about House's infarction and recovery and based on the scar, I think he would have had a wound vac for a significant period of time.

(Disclaimer: I am not a doctor, this is conjecture for the sake of fandom, any misconceptions are my own.)

So this is House's scar, per the screen grab I can get off of Google.

In my opinion, the scar seems like it wasn't well-approximated at the time of closure, which makes sense; it's consistent with the idea that his leg was opened and necrotic tissue was debrided, leaving wide margins that couldn't be secured with sutures. (This is a guess; muscular infarctions are incredibly rare and I haven't found any information online on standard procedure for clearing necrotic muscle tissue surgically.) Combine with the fact that an infarction is a clotting issue that can interfere with circulation and perfusion, I think House may have been discharged with a wound vac.

A wound vac is an electronic negative pressure device that assists with wound closure for open wounds, ie the outermost layer of skin isn't sutured/stapled and underlying tissue is exposed. These devices are usually in place for a few weeks.

(This is a stock image I swiped from Google associated with a study on the efficacy of wound vac closures.)

Basically, the tubing hooks to a machine that provides suction for any drainage and helps everything remain clean, among other things. The dressing is generally changed every 48-72 hours and is pretty painful, the adhesives involved are strong to provide total suction (the machine will flag if there is any leak and start beeping, so it must be completely airtight). I've had it described to me as, "It feels like they're peeling your skin off and digging around in your wound."

So from pain alone, this is not something House would've been able to do well by himself. He also eschews nurses, so I find it most likely Wilson provided this care for him. As a surgeon, Wilson is well-acquainted with wound closure techniques and with stages of healing, this is his area of expertise. This is something that needs to be done every 2-3 days, for 3-4 weeks, maybe longer depending on how the wound healed.

Again, based on scarring, it looks like there may have been healing complications. Which, granted, it's House. We see him perform bathtub surgery with no sterile technique or gloves (he also might have had a wound vac for that, too). House attempting to perform his own dressing changes, or worse, foregoing them altogether because it's too painful, except now the suctioned drainage is green and the periwound is hot and bright red and his leg is starting to swell. He needs help, he can't do this himself.

Wilson wants to take him to the hospital to sedate him for debridement and provide IV antibiotics, but House won't go, he's afraid of losing his leg if he's anesthetized again, he'll sooner die of sepsis. Wilson, against his better judgment, does what he must. Clears the dead tissue, cleans the wound, replaces the wound vac dressing, new tubing and canister, all while House is biting a towel like a civil war soldier because he won't be anesthetized again. Wilson fills oral antibiotics to control the infection. Going forward, he religiously changes the dressing, because if the wound becomes gangrenous he knows House will die before he consents to an amputation.

We all discuss House relying on Wilson for mobility after the infarction, which I also think is true and deserves a spotlight. But wound care is such a personal act with regards to House's profession and personality that the notion of Wilson providing for House in this way has me salivating.

#house md #spencer speaks #hilson #house x wilson #tw wounds

[heepthecheep]

There is so much medical misinformation on Tumblr that people take at face value and it's kind of fascinating but also really fucking bad

Off the top of my head?

- drugs; prescription, OTC or recreational can absolutely have an effect on your health. Dosages aren't suggestions and neither is stuff like "don't take with alcohol" or "don't operate heavy machinery"

-in addition to the last point, addiction is real and not something made up by your parents to keep you from doing weed in highschool. It can take different forms

- don't take other people's prescriptions. Again, with the dosage thing, expiration dates, and especially not antibiotics

-speaking of which, antibiotic resistant infections (ie. MRSA, ERSA) are caused by not finishing your prescription of antibiotics or taking antibiotics inappropriately (ie. When you have a viral infection) (and there are other issues too but these are probably the main ones that are most relevant to a layman) and are not caused by "antivaxxers" (seriously, I've seen this argument applied to the covid vaccine. A vaccine for a virus that no doctor would treat with antibiotics- not the mention that MRSA is literally referring to Staph Aureus)

-just because a disease is uncommon or "extinct" in your part of the world doesn't actually mean it is. Pathogens have animal and environmental reservoirs. Similarly, diseases that have been eradicated in your well developed and wealthy part of the world still kill people in places that aren't as wealthy and/or developed. The only diseases that are actually extinct are Smallpox and Rinderpest- and no, the parents who think vaccines cause autism aren't going to cause them to come back

-your weight, diet and lifestyle ABSOLUTELY affect your health.

-people on Tumblr seem to have some weird vendetta against doctors ordering blood work, but it's an absolutely valid and important screening and/or diagnostic test, and is helpful in monitoring many conditions

-Puberty, pregnancy and aging are natural processes that are not inherently harmful. Furthermore, people on Tumblr act as if pregnancy is the most dangerous thing in the world...while blaming the process itself and not the shitty, abusive and corrupt obstetrics community (or they point to history (and focus entirely on Europe) and act like issue is the process and not the ignorance towards germ theory, lack of or misunderstanding of hygiene, not understanding how women work, etc)

-hormones control a lot in your body and aren't just your sex hormones. They exist before you're even born and continue to exist after puberty ends.

[zeldurz]

A rant about Bacta

For today's long and rambling meta, let’s talk about bacta, aka my least favourite part of Star Wars. The magical space healing goo that solves all your problems for some reason, with no considerations for anything that makes any amount of sense.

Once again, going to preface this with “I am not a medical professional and am by no means an expert in this field”

More happening below the cut:

To start, I will say that from a meta perspective, I understand why bacta is the way it is. We see it first in Episode V, where Luke is being treated for hypothermia and Wampa-related injuries - and I will give the GFFA that one. We often treat hypothermia with Luke-warm (haha) baths to raise the patient’s body temperature back to what it should be, and I could absolutely see a regulated, temperature controlled immersion tank being used for situations like this. I will even give them the “it’s a sterile solution that has antibiotic properties and promotes healing” thing, like it’s a giant vat of space polysporin or something. HOWEVER, it’s everything that came after that that I have an issue with.

You see, dear reader, the next thing that happened after the movies we all know and love was a tabletop RPG - the foundation of which all legends content is built upon. And in a tabletop RPG (like dungeons and dragons, for those who aren’t familiar), you need a system for tracking health (IE hit points, hearts, etc) and a way to quickly restore your character back to “full health”. Since Star Wars doesn’t have clerics or health potions, you get the magical healing goo that solves all your problems instead. And because you need this resource to be limited in order to give the game an element of risk, you make bacta expensive and sometimes challenging to get ahold of, but it has the power to fix any and all problems.

Now don’t get me wrong, I appreciate that in video games or DND I can drink a potion and suddenly my arm isn’t broken and I am no longer on fire, but Star Wars at its core is not an RPG (I do also, for the record, feel this way about healing spells and similar abilities in fantasy settings, but that’s for another time). I also want to make clear that I, an angst gremlin who thrives on fake science and making characters suffer, am not the average audience for this type of thing, and that narratively, action adventures like Star Wars would suffer tremendously with long, drawn out recovery times. With that being said, the gap between ‘I’m skipping over this because it doesn’t have a place in my story’ and ‘I throw the character in the goo (or have them ingest the goo?? Or inject it?????) and everything is fine now” is substantial, and I for one am really not a fan.

“But Zeds!” you cry, “what about suspension of disbelief? Star Wars has impossible laser swords and impossible galactic travel and-”

I know. And obviously bacta isn’t a make or break it thing for me, because my one and only brain cell is devoted at all times to my poor little meow meows who have committed so many war crimes - but the thing about suspension of disbelief for me personally is it has to be logically consistent within the universe, and for me, bacta makes no fucking sense whatsoever.

(if you are bothered by potential injury/medical stuff and non-graphic discussion of bodily fluids, this is probably where you should get off this train of thought)

I have a lot of issues with bacta, but I can lump them into two broad categories: mechanism of action (ie the biology) and the Bacta Economy (ie the wider implications for healthcare and best practices). 

Mechanism of Action:

To quote Wookieepedia

Promoting rapid regeneration of organic compounds, bacta could be used in a variety of both critical and noncritical medical situations. Described as being warm to the touch, the bacta liquid could aid in the healing of concussions, internal organs, and broken ribs. Furthermore, it could be placed in small dishes to help regrow fingernails, mend cuts, burns, and other injuries. Due to its "one-size fits all" use in medical applications, it was a highly prized and commonly used medical treatment for most, if not all, injuries. Bacta could also knit together broken bones

Bacta can fix everything, apparently, with the legends page going so far as to state that “it's replaced most conventional medicine.” I am not a medical professional, but the idea that one single substance could fix every ailment ever in every species is ridiculous considering that a) we can’t even treat the same condition in different people with one substance (as anyone who has been on antidepressants can tell you), let alone conditions with widely different symptoms and presentations. I could maybe see if it was some sort of stem cell activator or something like that, but even then it seems far-reaching to assume that things like broken bones or concussions could be healed by the same substance. The fact that bacta is primarily applied topically (ie to the skin either as a gel or in a tank), but can also be administered orally or by injection only makes things weirder. Does it absorb into the bloodstream through the skin? How does it reach the injured organ in order to “promote healing?” Is it entirely unaffected by stomach acid???

Which, speaking of concussions, does that mean bacta can cross the blood-brain barrier? You’re telling me that there is one goo that is perfectly matched to every being in the whole fucking galaxy (considering how many different blood types humans have and how much care has to go into matching organs or stem cells for transplant in humans, I find it a stretch to believe that one size fits all for every human, let alone other alien species), and it can fix bones and nerves and everything else? Without side effects?????? What about longer term treatments? Are we not worried about muscle loss? Nutrition? Dehydration???

Not to mention the implication that it can fix broken bones without setting them - the whole thing reeks of hand-wavey space magic, which would be fine if it wasn’t explained in universe as ‘miracle bacteria fix things and we will not be elaborating further’. This is especially problematic since Legends mentions some people have a bacta allergy (which would leave them functionally without healthcare) and because having only one substance that fixes everything from a paper cut to life-threatening injuries is a huge risk to your civilization (from possible contaminants/shortages) as well as doing a disservice to every individual. Between the implications that there are relatively few other drugs (maybe this is why everyone seems to be awake for surgery all the time and no one uses any painkillers? Because they need the bacta for something else????) and the fact that no one is going to waste their precious goo on your headache, healthcare must really suck in a “we only have the goo” galaxy (even moreso than it already does).

The Bacta economy and the wider implications for healthcare in the GFFA:

Canonically, bacta is extremely valuable and nearly impossible to synthesize. In fact, I seem to recall a scene in one of the legends books where Luke has recovered from an injury, and after being treated in a bacta tank, the practitioner is siphoning the excess bacta out of his ears so it can be reused.

In real life, we are very careful to handle bodily fluids with care to avoid accidental exposure to certain diseases - but you’re telling me that you can just soak someone in some goo for days (or weeks!) at a time while they have open wounds, and then pull them out and drop in the next patient? Is there no concern for bloodborne disease or infection at all? 

One of the things I do use bacta for in my fics is recovery after surgery - the antibacterial properties, plus the analgesics and everything else make it a reasonable choice for standard post-op procedure - but the idea of having a patient come out of a sterile operating room and into the goo tank that might have held someone with gangrene a few hours ago is a recipe for disaster imo

And speaking of contamination - how are we deciding which bacta is injected/administered orally and which is topical? Are we injecting people with goo that other people have been sitting in (again, for days or possibly weeks???) Or is only “fresh” bacta used for that purpose? Maybe it’s a class thing, and the rich can afford fresh but the poor have to make do with stuff that’s already had someone in it for a month idk, the whole thing just feels really really grody and like a good way to ensure your entire population is HIV+

And on that note - if every injury and medical condition is treated with one limited, expensive resource, how are hospitals allocating it? If you have broken ribs, for example, would you be evicted from the bacta tank if there was someone who was in a speeder crash whose life is in danger? What about a premature infant? Even if we are assuming that the GFFA operates under capitalist hellscape rules and each patient has to pay for their own bacta treatment, the fact that there’s only one resource to treat every condition must make for an absolute nightmare of triage (I imagine this is only compounded on ships, where the resources are even more limited to stocks on board, and a disaster like an explosion in an engine room could result in massive casualties if the only option for anything is “treat with bacta”)

All of which is to say - bacta works great as a plot device, but as soon as you start looking at it even a little bit, none of it makes any sense at all.

For me personally, I mainly include the use of a tank for post-operative patients - particularly after a major surgery - along with treatment of hypothermia or other conditions with poor circulation or temperature regulation. I also use a gel for wound dressings, but I rarely would have a character receive it orally or by injection. I think it is a useful thing for doctors to have, but I refuse to believe that the entire Galaxy’s healthcare revolves around one substance (no matter how great), and especially that the Galaxy’s physicians have been replaced by it.

#stuff i wrote #star wars meta #i know theres some people i've talked about this with #and if you have your own thoughts id love to hear em

[askpokeeosin]

So how close to the real thing are the surgery DOS games Life & Death (abdominal surgery) and Life & Death 2: The Brain?

On Life and Death (The Video Game)

I didn't like it lol

I would say that it's pretty accurate for the most part. However, I'd hazard a guess that both games would be accurate for the timeframe of 1988-1990 when the games were released. But even then, there'd probably be a lot more than just X-rays for imaging ie MRIs, CT scans, etc.

Atropine is a drug that is used in order to treat bradycardia, or extremely low heart rate. I found out that the "A" in the OR part of this game stands for Atropine because I accidentally killed a virtual patient thinking it was the antibiotics. As mentioned above, these things would be labelled a lot better in real life in order to prevent patient harm from occurring. Also, there's always someone keeping track of what's in the room and what has been used. Mistakes happen, unfortunately, but there are safeguards to prevent truly catastrophic mistakes. This game is from the 1980s, though, so I can forgive some of the labelling problems since there probably wasn't a lot of memory space to spell everything out.

As for the mention of McBurney's Point, it is the spot in the lower right quadrant of the abdomen where the most amount of pain tends to be centralized during acute appendicitis. It is located between Anterior Superior Iliac Spine (ASIS; the most frontal part of the hip bone. If you place your hands on your hips, that's the ASIS) and the belly button. It's a very important landmark in the physical exam for being indicated in appendicitis. However, just because a patient has pain in the area of McBurney's Point, that doesn't mean that the inflamed appendix is where it's supposed to be. For most people, the appendix is a closer to the front but in some people, it can be a bit further back so some tests that would confirm appendicitis might not work. Hence why there are multiple appendicitis physical exam tests. And ultrasound, of course! Nowadays, you'd get funny looks for not doing an ultrasound on a patient with suspected appendicitis.

Anyway, I got a bit carried away with the explanation of some stuff. I just love talking about this stuff! Also, I couldn't help but make a Dr. Glaucomflecken reference at the end.

Ask from @askseriousrainbow

#my little pony #my litte pony friendship is magic #mlp fim #mlp g4 #mlp oc pony #earth pony #pony ask blog #ask pony blog #ask blog #askpokeeosin #medical student #medicine #medical school #appendicitis #ultrasound #life and death #askseriousrainbow #ultrasound probe #video games #old games #year 1

[suburbanwildernessdeity]

for any sci-fi/dystopia writers out there (or any other writer who has reason to include a fictional prescription/pharmaceutical drug in their story) who care vaguely about certain degrees of realism:

There are actually perfectly understandable legal reasons that pharmaceutical drugs have such weird names, both for generic and brand names. It’s not just random. This post for now is only about generic names but if people show any degree of interest I might make a followup with information about brand names.

First, generic names are made to be the same worldwide so people traveling to other countries can still ask doctors for prescriptions. Generic drugs also have to have a two-syllable prefix (which helps with identification) and a suffix that indicates how the drug functions. For instance, “-cycline” (ie doxycycline) indicates that something is an antibiotic, and “-etine” (ie fluoxetine) indicates that something is an SSRI. Here is a list of pharmaceutical suffixes and their meanings. The prefix of a drug’s generic name also can’t contain letters in the English alphabet that aren’t used in many other languages, like Y (except I think when it’s used for a more common vowel sound), H, J, K, or W.

The name of the drug also can’t be considered marketing. This is my biggest pet peeve in fiction when authors are trying to semi-realistically depict the pharmaceutical industry and if I’m being honest it’s the reason I bothered making this post at all. Companies can’t even name their drug something that’s an ANAGRAM of a marketing claim. They submit three potential drug names to the USAN, an association of pharmacists, doctors, and related regulatory professionals, and the USAN will run all possible anagrams of the name as part of their decision-making process. If they think a drug name sounds too much like marketing, they simply don’t allow it and send back a list they create of 3 names to choose from.

Companies cannot name a drug “Joy” (looking at you, resident evil netflix adaptation) or “Phalanx” from world war Z. It’s heavy-handed and shows a lack of research in what are sometimes otherwise well-researched media. Pharmaceutical companies can cause devastating damage with legally-named drugs. If you wanted to make a movie about a fictionalized version of the opioid epidemic, you would look stupid if you named the oxycodone analogue something like “painkill” or “insta-relief.” It can take away from the weight of the story in a subtle but notable way. It’s a small factor, but I know there are writers out there who really care about things like this and might not realize they have no idea why pharmaceuticals get named the way they do. If you’re trying to write something that depicts pharmaceutical drugs at all and you don’t want to beat your audience over the head with what you’re trying to say, don’t name your fictional drug something dumb.

#personal #writing advice #thinking about this with nanowrimo coming up #ok to reblog

[rival-the-rose]

Eating disorder rambling under cut

Eating disorder etiology is so weird. I've been sick again, so I've had another baby relapse. Or, another dip in my larger trend down since my peak recovery in early December and then getting sick end of December. It's just like clockwork, I get a fever or go on antibiotics or vomit and then every eating disorder urge hits even if I've been recovered for months. And I know the pop culture (and even psychiatric) understanding of eating disorders is skewed and shitty but it's somehow still surprising to me when my thoughts are not centered on my body or health or whatever. Like, I think people expect safe foods for ed ppl to be salads or whatever, but today the only food I've been able to eat is old stale tortilla chips that probably should've just been thrown out. It's still "virtuous" food, like morality is still the criterion by which the food is considered "safe", just a different system of morality I guess? And typing out the implications of that morality system makes me sad (ie, the only food I'm worthy of eating is just short of garbage, but my brain presents it as... idk. Something less depressing than that. Like this is gonna help save the world, but it doesn't come with wanting a system to only eat food like that or feed others like that). It's just so weird to go from pretty happily eating three meals a day to feeling morally repugnant if I feel full. Or even right now my usual coping method of thinking of the cheapest meal that is still a complete diet just seems both overwhelming and like I don't deserve that. Like I don't deserve beans and rice with salsa+sour cream, and also that meal is too hard to make.

And there are body thoughts but those feel more conscious somehow. Like the fact that I can barely wear the size 2 pants I bought when I came back this fall really really bothers me but those thoughts almost come as a reaction to whether or not I'm eating. Idk. I just feel like right now I can see how organic and insane it all is, but usually I can't see that on my own. Which either means progress or I'm extra crazy RN. It really makes me wonder what about the illness is triggering - my inactivity+lack of productivity leading to feeling like I don't deserve food? That would make sense but would have to happen at a higher order of thinking than I think this is. Just missing a meal? Maybe I'm constantly closer to relapse than I think and one meal is enough to throw it all off. But sometimes it feels like there actually something physical that changes when I get sick like my brain falls into an old rut that sick me is too tired to yank it out of.

I wonder if someday I'll be able to look back on this the same way I do the pica I had when I was anemic - raw meat and cigarette butts hold zero appeal for me now but were so enticing at the time and it felt so normal. I hate the idea of still struggling like this in another 15 years. But I don't know how to stop being terrified of gaining weight, or to stop soothing that fear with the thought that actually I do know how to lose weight and it's relatively easy. I've never truly had a healthy relationship with food or exercise but I hope I can soon. The idea of spending my entire life like this, of being like the 80 year olds in the hospital, is horrifying. Objectively, the thought of spending my youth like this is even more horrifying (even though my current agreement with myself is to stop this behavior when I'm 40). And on having that thought, I asked myself to get up and eat, and I couldn't do it.

Anyway. I'll pull my shit together soon esp since we're going out of town which usually will make it way easier to eat.

#i am happy to chat about ed stuff but i know it's triggering for basically every single person in the world so...

[flyonthewallmedstudent]

Enterococcus faecalis

As per wiki, "not to be confused with enterococcus faecium." why in god's name are they so similarly named. I do not know. but it does change management.

Faecalis is more susceptible to penicillin and ampicillin. Faecalis is more virulent and more likely to cause IE than faecium. Faecium is also more likely to be resistant to ampicillin and vancomycin --> in the US: 80% to vanc, and 90% resistant to ampicillin.

It's a nosocomial common bug, so there aren't any cool case reports. If you walk into a ward, odds are you'll find someone with this. Not as common as staph or strep though.

Image source: bacteria under the microscope

E. Faecalis is gram positive cocci, (purple spheres), previously part of the streptococcus umbrella - if it makes it easier to remember - both appear in chains or pairs (rather than clusters like staph). Similar to strep it is catalase negative. Facultative anaerobe, so it will grow in both bottles. Faecalis is far more common than faecium, both live in the gut (think faeces). They grow at high salt concentrations, 6% (normal saline on the wards is 0.9%) and are usually non haemolytic.

Key thing to be aware of is that it can be a healthy part of your gut or genital tract but under the right circumstances for it - it can become pathogenic/disease causing. Further key thing: intrinsically resistant to bactericidal antibiotics hence they require synergism between a combination or prolonged duration in severe cases. like IE.

It's considered an opportunistic infection (for the lay public, it means when you're unwell or immunosuppressed, it becomes a problem). Increasingly it is a nosocomial infection (hospital acquired), 60% of cases in the US were acquired in hospital. They survive very harsh environments, including ethanol and can survive 10 mins at 60 degrees celsius and on surfaces from days to months. They are killed at 80 degrees or with 70% ethanol.

Similar to staph and strep, it can cause a variety of infections, including:

Infective endocarditis --> 3rd most common cause, 90% are faecalis other 5% are faecium (after staph aureus and strep viridans), subacute course, now more associated with TAVIs (elderly/frail/multimorbid patients). high mortality, 10-35%

UTIs - cause up to 20% of UTIs, but usually associated in hospital setting and with catheters/devices etc.

wound infections & OM (rarely)

line associated --> always replace lines if you can in sepsis, one cause of bacteraemia is the line

2nd or 3rd most common cause of nosocomial Utis, sepsis and wound infections (less often: diabetic ulcers, prosthetic joints)

less common: meningitis - and usually associated with shunts and neurosurgical procedures --> anything to do with devices and hospital. Mortality risk of 20%

odd association: strongyloides hyperinfection (remember this increases risk for bacteraemia), as post earlier.

sepsis/bacteraemia mortality risk is 25%

bottom line: high mortality in severe disease

Epidemio:

more likely to be found in the elderly populations who are multi-morbid and less independent in their activities of daily living.

Special powers:

No toxins (like staph or strep), but have inherent antibiotic resistance or are amenable to this and are very durable/hardy. Ability to form biofilms - hence attraction to lines and devices and staying there. This limits abx penetration allows them to persist. They gain resistance by their ability to pick up and transfer mobile gene elements like plasmids via conjugation etc. Abx including: cephalosporin, clinda, TMP-SMX, aminoglycosides like gent.

It is becoming more notorious for resistance particularly vancomycin resistant enterococcus faecalis (also not to be confused with VRE - Patients who were recently hospitalised or institutionalized are often swabbed for this, but this is actually E. faecium they're referring to). increased risk for this include previous antibiotics use (eg cephalosporins, vancomycin), due to disrupted gut biome, and exposure risk - more likely to occur if you've been recently hospitalised, require routine access to the wards (i.e. dialysis) etc. Also increased association with devices (like pacemakers), diabetics and stomach acid suppression from PPIs.

Investigations

Relevant imaging i.e. CT for abdominal collections, and culture/staining. sensitivities are an absolute must including aminoglycoside resistance, pencillin and vanco, which most labs will automatically do anyway when it's identified, teams just gotta remember to chase. other possibilities include PCR or 16s rRNA sequencing

Interesting additional work up: Colonoscopies. Some reports are starting to recommending doing this routinely if no source is found in cases of bacteraemia or IE. As there is an increasing association with neoplasms from the gut. Similar to guidelines for strep bovis.

Management

in general UTIs, wound infections etc, most are susceptible to penicillins and ampicillin, so you can treat with either.

Management of beta lactam resistant enterococcus: - resistant against beta lactams --> refer to immunology for desensitisation, vanco is not as effective against enterococci, duration is 6 weeks in severe infection Vanco resistant (your local infectious diseases team will be involved)

daptomycin, linezolid --> equally effective, tigecycline (last resort/salvage)

Treatment in IE --> synergism is key for bacteriocidal effect (durability)

in case of bacteraemia, try the denova calculator to determine risk of IE - Duration of symptoms, Embolizations, Number of positive cultures, Origin, valve disease, and Auscultation murmurs

if susceptible, it's intermittent doses of benzylpenicillin or continuous infusion at 2.4 g IV plus gentamicin (if concerning for kidneys, shorten the duration to 2 weeks) for approx 4-6 weeks --> unless there's high level resistance to aminoglycosides

or if resistant as above options

issue with aminoglycosides -> ototoxicity and nephrotoxicity, requires frequent monitoring and caution in elderly

Resources: Pathogen data sheet - Canadian government StatPearls Australian therapeutic guidelines - paywall, unless you're at an Australian hospital/medical school Uptodate - always the gold standard, but is behind a paywall unless you have institutional access Wikipaedia

#infectious diseases #internal medicine #medblrs #medblr #microbiology #infectious disease #enterococcus #enterococci #e faecalis #enterococcus faecalis

[whumpshaped]

Friend hello!!! Good luck with moving! Sorry that you’re sick, try to take care of yourself when you can <3. Maybe have some soup and warm tea (I do that when I’m sick). ANYWAYS I’m assuming depression cakes are like chocolate wacky cake and stuff (IE cake recipes made during historical Hard Times) but it reminds me of a silly haha I did so I’m gonna tell you.

A couple months ago my friend was like “oh, it’s almost the anniversary of when I went to the psych ward.” And I was like “I should get them a little gift.” And anyways it brought up the second concept for depression cakes which is: sorry you’re depressed, I made you a cake. It won’t help with the depression but at least you have a cake. ~🐸

i cant even look at soup and tea anymore😭 i started out making 3 litres of chamomile-ginger tea with honey, and ate like 2 pots of soup, i'm soo sick of them now lol but it was all i could have basically bc they were Warm. however i just got a 3 day antibiotic medicine thing sooooo we'll see how that goes

and yes ! (great) depression (era) cake. needless to say my dumb ass looked at that recipe and went omg im depressed its perfect for me lol i assumed it was called a depression cake bc it takes barely any effort and yknow how depression is just exhausting and u have negative spoons all day every day. i thought that was the connection.

i love ur concept. makes perfect sense to me.

#asks #angel in training anon

[soldier-poet-king]

My sister was definitely, demonstrably allergic to cats and got a cat anyway and had the allergies clear up because of exposure. I’m not recommending this tactic but just so you know it can happen. (Regardless, go for a shorthair)

this is ABSOLUTELY the plan if i cant get an allergist to try immunotherapy. like my allergies are not super severe (can hang out with friends' cats as long as i dont rub my eyes or bury my face in their fur etc) and i WASNT ALLERGIC to cats as a kid (my grandparents had one), but my mother refused to let us have pets bc she has cleanliness anxiety and so i developed allergies later after my grandparents cat died

my big worry is that forcibly introducing allergens to my living space wont cause my allergies to clear up, but rather, to worsen (ie. my severe antibiotic allergy)

regardless, i can and will over use antihistamines if i have to, fully unirionically, my mental health will kill me before benadryl over-use does

#anon #i mean i wanted to get started on the therapy now #so then i'd be good to go by this time next year #when im hopefully moving out permanently #but alas

[mcatmemoranda]

When reviewing contraceptive options, one should consider how the main pharmacologic ingredient affects the menstrual cycle based on the follicular and luteal phases. Estrogen increases during the follicular phase and culminates in ovulation. Estrogen-containing contraceptives regulate ovulation. Progesterone increases during the luteal phase, causing the proliferation of the endometrial lining and changes in the cervical mucous. Progesterone-containing contraceptives regulate bleeding and mucus production.

If a patient becomes pregnant with an IUD in place and the strings are visible on exam, then removal with gentle traction should be attempted. In general, IUDs should be removed prior to 12 weeks. After this time frame, the risk of miscarriage increases.

When a patient presents prior to 34 weeks with PPROM, expectant management is indicated along with betamethasone, prophylactic antibiotics (ampicillin, amoxicillin, and a macrolide), and magnesium (if prior to 32 weeks). Tocolysis may be considered for up to 48 hours to allow for betamethasone administration. Induction of labor should be performed if there are signs of infection or fetal/maternal instability. For patients who present after 34 weeks, induction of labor should be performed to prevent infections and other adverse outcomes. Gentamicin and ampicillin should be given if there are signs of infection (fever, tachycardia, purulent amniotic fluid).

Complete abortions occur prior to 20 weeks gestation and are characterized by vaginal bleeding/cramping, passage of the products of conception, and a closed cervical os on physical examination.

A missed abortion presents with closed cervical os and fully retained products of conception.

Pituitary adenomas are benign neoplastic proliferations of one or more pituitary cell types. The pituitary contains several different cell types, which secrete their respective hormones. Pituitary adenomas may be functioning or nonfunctioning (so-called "silent"). As such, they may present clinically with symptoms of hormone overproduction or with local mass effects (visual disturbances, headache). They also may be asymptomatic and discovered incidentally on imaging. Silent adenomas are more likely to be larger upon diagnosis.

The most common pituitary adenoma overall is lactotroph adenoma, or "prolactinoma." Prolactinomas are usually clinically apparent in females (with menstrual irregularities or galactorrhea) but may be clinically silent in males. Gonadotroph adenomas are usually nonfunctioning and are more likely to present with mass effects. Thyrotroph, somatotroph, and corticotroph adenomas may be functioning or nonfunctioning. While functioning, thyrotroph adenomas present with signs of hyperthyroidism, somatotroph adenomas present with acromegaly, and corticotrophs present with Cushing-like features.

The workup of a pituitary adenoma is complex due to the various hormones involved. Initial imaging includes a dedicated pituitary MRI, which will reveal a sellar mass. Measurement of the various pituitary hormones or their downstream effects (ie, insulin-like growth factor-1, thyroid hormones) can assist in diagnosing the subtype of pituitary adenoma.

Small prolactinomas are often managed medically with dopamine agonists. Large adenomas and other types of functioning adenomas usually require surgery.

#birth control #pregnancy #premature rupture of membranes #PROM #PPROM

[allthingsfoodsystems]

Industrialized Agriculture - Factory Farming 

Most people don’t think twice when they go to the grocery store to pick up the various goods they need for the week. Modern society has normalized having every type of meat, dairy, and produce within reach at all times. So, as we fill our carts with eggs and bacon for breakfast and chicken for dinner, we’re not thinking about the processes that allow us to have this kind of abundant access; we take it for granted. The fact that most of us either actively avoid thinking about or remain blissfully ignorant towards, is that most of the meat, dairy, and eggs products in America are produced in concentrated animal feeding operations (CAFOs), otherwise known as factory farms. CAFOs are defined as facilities that house and feed large numbers of animals – usually cows, chickens, pigs, goats, and sheep – in confined spaces for at least 45 continuous days in a 12 month period. Across the US both the number of animals kept in factory farms and the sizes of the farms themselves have increased considerably in the last fifty some-odd years. According to the EPA, a large factory farm typically keeps at least 1,000 beef cows, 700 dairy cows, 2,500 pigs, or 82,000 egg-laying hens; though dairies with more than 2,000 cows and swine operations with more than 5,000 pigs are very common. In this monstrous system the well-being of the animals we eat and of the environment we live in is egregiously disregarded in favor of the efficient extraction of profit. 

The livestock that are raised in factory farms face deeply inhumane treatment in every aspect of their short, miserable lives. Most people have a vague picture in their minds of the cramped lives that factory farmed animals lead, but the reality is worse than one can imagine. Animals small enough to be kept in cages – ie chickens and pigs – live in them, often in windowless corridors, for most, if not all of their lives. These cages are generally either barely bigger than the animal’s body or they are full of multiple animals. Livestock that is too large to be kept in a cage – ie cows – is usually kept in over-crowded pens; if the pens are outdoors, they are usually so crowded that there is nary a blade of grass for them to eat, they are all dirt, and if they’re kept indoors the floor is usually made of concrete, which is bad for their hooves.

These kinds of tightly-packed living conditions lend themselves to a host of problems. Most notably, they drive sanitation issues which lead to the quick spreading of disease, as well as causing extreme stress in the animals that leads to aggressive behaviors towards themselves and each other. In order to make up for these kinds of problems, farmers use band aid solutions that tend to come with their own array of issues. For instance, in order to prevent the rampant spread of disease, farmers put antibiotic and antibacterial agents in the animal’s feed, regardless of whether or not they are sick. As anyone who has been on antibiotics knows, it’s not great for you to take them for too long because you quickly build up a resistance to them, and because they tend to have negative side effects on your body. In the case of farm animals, the potential resistance to antibiotics is a serious issue because, eventually, it could lead to antibiotic resistant bacteria that could wipe out not only our farm animals, but also us. In terms of the stress-caused aggression that takes hold of farm animals in these conditions, frequently harmful bodily modifications like dehorning and beak-cutting are employed to prevent the animals from hurting themselves and each other. While the ethics of these kinds of mutilating practices are debated, with some saying that they don’t hurt the animals and that they are necessary in these kinds of conditions, in my opinion the logic doesn’t seem to hold up. Not only are these procedures regularly done incorrectly, causing various problems in the animals, it is also impossible to say that they don't cause lasting pain. Not to mention that the justification of harmful practices as a necessity because of conditions that we create begs the question, why on earth are we creating conditions that require these kinds of practices? Overall, factory farms treat animals as if they have no inherent value outside of what they can provide for us, as if they have no soul, as if they don’t deserve respect. 

English enlightenment philosopher, Alexander Pope, would argue that the factory farming system’s treatment of animals is cruel and gluttonous. In an excerpt from his collection of essays, An Essay on Man; Moral Essays and Satires, Pope asserts that, given the human race’s inherent comparative superiority and strength over other creatures, we are all the more accountable for how we exact our dominion over them. The weaker, inferior position of other creatures makes them and the quality of their lives our responsibility. Not to mention that we owe them a great deal of gratitude for their role as our food. Pope would ask who we think we are to deny these creatures the common enjoyment of life. And we would not have a good answer for him.