Throwaway05
9mo ago
Many people just acclimate after a few weeks, but if you need help with that all the exercise oriented advice is good. You'll also see tons of discussion on /r/residency and /r/nursing about this topic. Many people benefit from compression socks and excellent shoes (2-3 pairs that you'll cycle through).
In the U.S. most surgery people will use upscale clogs (ex: Danksos and Calzuros) and they work great but you should be able to find some options that are in a regular sneaker form factor, just search on the medical subreddits.
Footwear makes a HUGE difference.
Throwaway05
9mo ago
If you stuck with it for awhile and still had problems you should look into the socks and shoes - they can make a huge difference. OR staff, nurses in general, and good podiatrists can all give you tips, otherwise I'd dig around on Reddit as this is a problem that pops up every late June/July.
Personally I swear by my Calzuros but Hokas and Ons are much trendier.
A solid piece of advice I've heard is that it's always worth investing in shit that's between you and the ground.
Throwaway05
8mo ago
We've known about attachment theory for a long time and have demonstrated some of its features in animal models like monkeys. Granted true deficiency is a bit more serious than the above examples. It also may be helpful to think of the murdering/rapist case as a multi-hit model. Someone has the genetics or personality structure that renders them vulnerable to doing the fucked up shit AND then they are also raised in this way. It's more of a "most psychopaths had shitty parenting" then "most people raised with shitty parenting become psychopaths."
Throwaway05
8mo ago
Apologies this response is going to be briefer than I would like secondary to me being on vacation.
Also apologies I don't like diagnosing people second hand, but..... based off of what you said in the past and here this person almost certainly has cluster-b personality traits and very likely has borderline personality disorder.
This means a few things.
-People with this sort of personality structure have mangled coping mechanisms. They don't handle stress in a healthy way and that often includes lashing out in seemingly irrational and inappropriate ways, for instance "splitting" (people are "all good" or "all bad"). Now that the board is the adversary they are super evil and awful and therefore certain kinds of behavior is both justified and necessary. "Projection" is also very common.
-Self-harm, "fake" suicide attempts, and "real" suicide attempts are all common responses to distress in this population. It is questionable whether these behaviors are ever an appropriate response, but it's very commonly super duper out of proportion with the cause of stress here. They don't generally have very serious attempts though "if you break up with me I'm going to overdose...on melatonin" but do still have higher rates of completion than population average.
-If things aren't going well with people like this, they are super fucking frustrating. Don't feel about your response not being up to your standards. These people are hard to deal with and even professionals in a professional setting need to constantly stop themselves from going "Jesus fucking christ shut your fucking mouth."
-These people are very good at hijacking social justice, the legal system, and other avenues to get revenge, make changes to something, whatever. This is often distressing for everyone else.
In sum you didn't do anything wrong and while this person deserves some pity and human decency for being both a human being and mentally ill, they are still a threat to you and doing things that absolutely should drive you bonkers (and you shouldn't feel bad about it). Borderline is essentially the female equivalent of anti-social personality disorder (gross oversimplification but still) and while both deserve kindness you should take steps to protect yourself and not feel bad about it.
Outside of social justice communities most people have experiences with a person like this and kinda get the vibe.
Throwaway05
8mo ago
Questioning lived experience and emotions is typically a no-go in those communities so it's really hard to challenge borderlines. Likewise it's common to not be able to challenge them when they use social justice language/concepts. This leads to a feedback loop of poor coping skills and reality testing that can lead to poor outcomes in these patients and difficulty in treatment.
Throwaway05
7mo ago
The short version is that it gives you a very bad brain infection and then you die (encephalomyelitis, if you like). What actually results in death is as usual more complicated than expected but that's the short version.
If you scroll to the "pathophysiology" section of the below article (accessible for me without a login) it should be pretty understandable even without specific training. It also mentions the whole hydrophobia thing.
Throwaway05
7mo ago
Rhabdomyolysis is essentially a process where you work out too much and one of the good parts of that (muscles breaking down, which leads to better muscles in the long run) becomes excessive and overwhelms your kidneys. This generally occurs with very excessive workouts like a marathon or people going all in on CrossFit, but in the case of poor kidney function or fitness it can happen with milder activity (and hydration is a component as you mention). Importantly doesn't need to be "exercise" - psych patients who are restrained and on PCP can get it from fighting the restraints, if someone has their arm run over by a truck they might get it. The word is from Greek - "Rhabdo" "Myo" (Muscle) "Lysis" (Breakdown). Rhabdo more generally means "rod" but in this case species "striated muscle" which is the type of muscle we except to be causing Rhabdo by breaking down.
In the case of the rabies it's a rhabdovirus because it's sort of rod shaped, which is a boring but common way of naming shit in medicine. Many bacteria are called "bacilliform" because they are rod shaped (with that being Latin for rod).
Throwaway05
6mo ago
The last time I saw stats on this Psychiatry (which would be making these decisions in most jurisdictions) is the second most liberal specialty in medicine. That said political beliefs aren't going to be really relevant here, even pro-gun/right leaning (of which their are a ....few but they do exist) Psychiatrists are going to heavily lean towards restricting gun rights, the reason being liability. If your choices are "take away his guns" or "somehow be liable for a 30 million dollar judgement even when you didn't do anything wrong," they'll take away the guns every time.
Throwaway05
6mo ago
I think it might be helpful to lay out how this looks from the medical perspective. Every state is a little different but the broad strokes are pretty similar (although some differences can be substantial - most states will allow commitment only if a threat to self/others but some will also add "property" to the mix. Likewise the extent to which "not taking care of oneself" matters for threat to self).
It's also worth noting that you'll hear a lot of horror stories about commitment and mental hospitals but it's almost always (well these days at least) signal boosting rare events or stemming from people who are in denial about the fact that they have mental illness, which is most of the sickest patients (because if they had insight into their illness they would take medication, stay out of trouble and uh not be sick). I uh cough cough have nothing positive to say about the ED portion of this though.
So okay.
A patient comes to the attention of health care - the police bring them in, the patient brings themself, family brings them in, roving outreach social workers find them etc etc. They are seen by some combination of social work, ED physicians, and Psychiatry (depends on state and setting). At that time a patient might be sent home, asked to stay voluntarily (or the patient asks), or committed. The involuntary commitment generally involves some form of VERY short hold until additional resources can weigh in (ex: 24 hours for you to get two psychiatrists to say "yup"). Then that turns into a longer but still short involuntary commitment. For purposes of gun restrictions and other things it's triggered here. You could be high as shit on PCP, get committed for a day, then discharged and it's still an involuntary stay.
This creates all kinds of strange interactions - a suicidal 18 year old college student who wants to go home and study or a cop (who would lose his job) might be HEAVILY encouraged to sign in under a voluntary status even though staff isn't supposed to do that (if the patient is not voluntary they are involuntary...) because everyone wants to avoid long term repercussions for the patient. The facility may also "convert" an involuntary stay to a voluntary one in situations like the PCP guy. No idea how that is supposed to work legally but it seems to be extremely common practice.
Once someone is committed under an involuntary status the process of getting them out of the hospital starts. This has all kinds of tensions, yes hospitals benefit from having patients in them, but insurance isn't going to pay forever and the patient will have periodic court hearings and in many jurisdictions the conversation with the judge goes something like "yes he threatened to fuck your mother to death yesterday, but what has he done today?"
Therefore most people who have their commitment upheld and/or get sent to a longer term facility are generally very sick, aggressively malingering (think homeless person who wants to be off the street) or a huge pain in the ass (think borderline personality disorder patient who probably wont kill themselves but keeps insisting they are suicidal). At that point these people typically get transferred to a longer term or state facility to attempt stabilization/await someone ballsy enough to discharge. Sometimes creative things will happen like discharging to the police.
Sick people will absolutely be held more or less indefinitely if it's really necessary, but again if someone has two good days before their court hearing they might get sent home by the judge even if the patient's family brings them straight back to the ED an hour later (a sad but hilarious thing I saw many times in medical school while in an inner city hospital).
Throwaway05
6mo ago
I'm not sure if this is happening in nursing homes specifically but within the last five years healthcare has had a massive problem with outside investors (most notably PE in emergency care) buying stuff up, extracting as much money as possible and then leaving the thing to go out of business (not that this wasn't a chronic issue it's just gotten a fuck load worse).
I suspect the issue is similar here where these places cut costs like crazy, provide terrible care, and then croak but only after someone has already run off with the bag.
example:
While everyone else is talking about the supply/demand portion this additional portion is important - yeah if your ED physician group goes out of business those doctors will find other groups or jobs most likely, but the amount of unnecessary friction caused gets people killed and creates a lot of economic loss.
Throwaway05
6mo ago
- Some mental disorders are more culturally bound than others, with Schizophrenia being something we see pretty much everywhere with similar patterns but different content being common.
- Severity of symptoms is variable, with some with most people experiencing a step-wise decline but with the extent of this being variable.
- Less severe or alarming symptoms means less presentation for help ex: hallucinations not being as distressing they can be not as bad, or fit better in the cultural milieu (think religious delusions back in the day), or if someone is more negative symptom predominant (think apathetic, reserved, anti-social).
- Religious delusions are common but tend to be unsurprisingly related to the culture at hand. Same for other delusions and hallucinations. Someone in rural Africa might think the chief of the next village over is out to get him, where an American might think it's Joe Biden etc.
- Manic episodes and full blown psychosis were historically deadly. If you were manic in a pub in London in 1630 you might get killed in a bar fight and nobody cares or you might end up summarily executed by the police for being a total idiot. It would not surprise me if the same phenomena happens today in certain places.
- Not sure if we'd have good quality of research on this though.
I should note that Western psychosis is more likely to be dangerous because of things like easy access to weapons, poor policing, good social safety net etc. Remove those things and they are likely to get killed, unable to arm people, exiled, whatever is my thought.
It's not like violence is Wester specific - read the wiki page on running amok for an interesting example.
Throwaway05
6mo ago
Short Version: YES CHAD
Long Version: Your body has a natural process for managing the wax, and it is present for a reason, the absence of it has risks and the removal process has risks (even with liquid irrigation), for this reason it isn't recommended to due it anymore than necessary.........but it is a popular request.
For a few reasons (run of the mill buildup, a foreign body, leftover debris from an infection, shitty anatomy like narrow canals ) you can get buildup that can feel uncomfortable, be painful, create pressure on other structures.....or most commonly cause reduction in ability to hear (very common in the elderly).
It also tends to just FEEL good in the way that a lot of self care does. Ultimately you aren't supposed to do it very often.
Protip: if you are worried about wax build up impacting your hearing an easy way to check is to rub your fingers together close to each ear. If the sound level is different something is likely going down (if it's the same it could still be wax build up but the issue is more commonly expressed heavier on one side than the other).
Also human if you read this come on bruh. Terrible idea.
Throwaway05
6mo ago
The rule of thumb is dont put anything smaller than your elbow in your ear (aka don't put shit in your ear). Officially you should talk to your doctor about this, unofficially depending on what's going on and your anatomy (including the earwax type) you might have luck with using something like Debrox, which is available over the counter in the U.S.
If you have a history of ear infections or anything else like that then have caution.
Throwaway05
6mo ago
My understanding is that several school districts across the country have periodically rolled out (and then revoked) what amounts to an "immersion" program for English grammar. It becomes popular, people try it and they realize it is crap, take it away....and then bring it back out years later. If you are raised during one of the rollouts...it fucking sucks.
Throwaway05
6mo ago
Nah it was a historical problem back in the days of handwriting but these days communication is almost all by electronic medical records, sometimes people will give out hard prescriptions but it is easy for doctors to dial in and make it legible. More than spelling you used to have issues dosages and frequencies in the handwritten days though.
Incidentally many medications are either super easy to spell (often brand names) or absolutely fucking impossible without external help.
Throwaway05
6mo ago
This is so fucking weird. The primary impact of OSA is on the patient's health (hypertension leading to increased complications, increased of respiratory depression when combined with BZDs etc).
It's more like diabetes than epilepsy.
Now it's true that most patients hate the CPAP and try not to use the damn things so I "love" this from that perspective, but the overreach is absurd and if this becomes widely known people will just refuse sleep studies and STOP-BANG is by no means definitive (I love medical acronyms).
I do wonder if this is one of those "hey I heard about this shit online" or "my one relative..." type policies that will get evaporated with any public pressure.
Throwaway05
6mo ago
With this kind of thing it's very common for the policy to be misunderstood (or incorrect, or stupid) and for the people enforcing it to be idiots who feel they have no autonomy so they relentless (brainlessly) pursue something that isn't actually policy.
Happens in the hospital all the fucking time.
Throwaway05
5mo ago
I think the professional thing to do is say something like that...
"I'm here to treat patients not spy" is what they should be doing but in my experience they have a tendency to be ideologues who support Palestinians if not Hamas (and sometimes support the latter) and will actively and persuasively lie instead of saying something along the lines "I didn't see shit and if I did it would be unsafe to tell you."
The docs in this environment mostly specifically chose to be there and that means they have INTEREST and a related lack of objectivity and tacit or explicit support for bad behavior.
Throwaway05
5mo ago
It's one thing to be living in Gaza and say "I haven't seen anything weird" while being interviewed on live TV, it's another to come back to your home country and while there try and argue with everyone that no bad stuff is going on.
It's the attempt at persuasive advocacy that bothers me. That makes it complicity instead of keeping your head down.
Throwaway05
5mo ago
Schizophrenia is a psychotic mental illness with a reasonably well understood malfunction of neurotransmitters that requires treatment with medication and has a well understood natural history in patients and an increasingly well understood etiology which includes genetic components. Psychosis in the context of medicine and psychology refers to an inability to understood what is real and what isn't. This is a disease that is notorious for people often developing this condition in young adulthood.
Schizotypal Personality Disorder is a Personality Disorder, which (loosely) means a persistent and pervasive pattern of maladaptive personality traits that deviate from societal norms. These symptoms and experiences are present throughout a persons lifespan and may improve with therapy and age and while an individual might not meet diagnostic criteria prior to age 18, you'd expect said features to be present in teenage years and potentially earlier. These people can be generally expected to have intact reality testing and are also unlikely to present for and/or need psychiatric or psychological care. It is not schizophrenia, despite the similar sounding name.
Neither can be reasonably inferred from a highly limited section of posts an online forum due to other key diagnostic features. It's far more likely to be someone who is just weird (not an illness!), passionate about a hobby-horse or bugaboo, or just plain young... or drunk...or with an atypical writing style...etc.
Depending on the content of the post you might find evidence for a (solitary) delusional disorder but that's not the claim here (and of course as modhat says...).
Throwaway05
5mo ago
Others have already touched on this but if you haven't interacted with any of these kinds of people in the wild it's hard to understand how bad at making decisions they are. Taking a step back, think about how bad well educated, intelligent people are at committing crimes (for the most part) based off of what you hear in news reports. You'll be saying ARE YOU KIDDING ME ninety percent of the time, and that's people with a lot more reserve and resources.
People who get involved in this kinda thing are stupid, uneducated, incapable of foresight/planning, and obsessed with face and status in a very shallow way. If any of these weren't true...they wouldn't do it.
Even when you see some type of criminal activity with an enormous amount of skill and success (like SF car break-ins) it's because of a "monkeys on typewriters" type exploration of options by everyone seeing what they can get away with as obsessed to someone coming up with a good plan.
It's also important to keep in mind that the majority of people involved in the drug trade make like zero money, any form of job whatsoever would be more lucrative and stable. They aren't sending their best. The ones who do make money are typically off the street, not at risk, and capable of doing the things you are interested in seeing.
Others also hit on some of the "honor culture" aspects also - you get a lot more face from sneaking up behind someone and shooting them in the face.
Many quotes from the Wire serve as a microcosm, but Stringer's "are you taking notes on a criminal conspiracy" is a good example, especially when people are trying to apply sense but it's ultimately cargo cult thinking.
Throwaway05
5mo ago
You see a lot of efficiency exploration in finance, consulting, and some doctors. The last field is mine and you see a lot of people desperately trying to figure out how to apply LLMs to save time or increase throughput, and I've heard tons of stories about finance and consulting people doing similar things prior to LLMs.
Throwaway05
4mo ago
Basically this is a long standing issue stemming from restrictions on production that pops up periodically. Not a new problem but it affects different people at different times depending on where the meds end up getting distributed.
One example: https://old.reddit.com/r/medicine/comments/16dur21/stimulant_shortage_im_giving_up_yall/?rdt=65353
Throwaway05
4mo ago
You should consider that the sample you are looking at to make you believes this is abnormal. People graduate from therapy all the time. Most people with mental illness have some form of stressor(s), if that stressor goes away (mother in law, college, law school, better control over a chronic illness, they age into a better frontal lobe or coping mechanisms) then they may no longer need therapy.
People who are doing ok to well and get therapy anyway are less likely to stop, as are people who are doing really poorly, but plenty of the middle wraps up and moves on.
I think you may be seeing what you want to see here, given how commonly therapy stops.
We have a joke in the field that goes something like this: if you get hit by a truck while testing a new drug those Super Bowl advertisements are going to start saying "may cause you to get run over."
This exaggeration but not by a lot.
As you say, OP's data is meaningless without more context.
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