The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:
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Requests for advice and / or encouragement. On basically any topic and for any scale of problem.
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Updates to let us know how you are doing. This provides valuable feedback on past advice / encouragement and will hopefully make people feel a little more motivated to follow through. If you want to be reminded to post your update, see the post titled 'update reminders', below.
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Advice. This can be in response to a request for advice or just something that you think could be generally useful for many people here.
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Encouragement. Probably best directed at specific users, but if you feel like just encouraging people in general I don't think anyone is going to object. I don't think I really need to say this, but just to be clear; encouragement should have a generally positive tone and not shame people (if people feel that shame might be an effective tool for motivating people, please discuss this so we can form a group consensus on how to use it rather than just trying it).
Jump in the discussion.
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Tell me about it.
Me: I think I have anemia. My score is just above the threshold and I’m tired all the time.
Doctor: But it’s not below the threshold, so you don’t.
Me: but it’s literally as low as you can go without passing the threshold, right at the bottom of the ‘healthy’ range. Presumably almost having anemia is pretty nearly as bad as actually having anemia. Can’t we bump up my iron levels a bit?
Doctor: yeah, that’d be normal procedure. If you had anemia.
I can only imagine how annoying that is as a patient but problems like that are unfortunately not what our system is optimized for.
If you recommend something that makes sense but isn't quite justified (because the labs are normal for instance) then you introduce a huge amount of liability if something goes wrong, and good luck getting it paid for if the patient doesn't meet whatever criteria.
Additionally, medical care is in general about preventing someone from dying, "minor inconveniences" (that nonetheless may be subjectively quite inconvenient) are generally not something we are equipped to manage (this being for a huge variety of reasons).
An extra level is the need to avoid fighting with patients unnecessarily.
In this specific case there are other significantly more likely causes of tiredness. Lifestyle habits (including diet, exercises, stress, substances, caffeine, sleep habits, etc etc), psychiatric issues, and boring things like aging are way more likely to be responsible.
I have no idea about you personally, but many patients are extremely resistant to having one of these pointed to.
Lastly there's a bunch of complicated stuff about reference ranges, additional studies, lab uncertainty, diagnostic nonsense... overworked primary care doctor is not going to bother.
I assume that you're a doctor. Have you heard of the work of Derrick Lonsdale? Some articles. He also wrote some very interesting books.
https://hormonesmatter.com/the-wrong-fork-understanding-the-current-medical-model/
https://hormonesmatter.com/western-medicine-house-built-sand/
https://hormonesmatter.com/dysautonomia-hypoxia/
Haven't heard of him, but looking at it briefly looks like total quackery as per usual.
Here's why.
The advice "live a healthy life" is known to all, prescribed by doctors 100% of the time, totally ignored, and incredibly hard to intervene in. "You are missing some common sense lifestyle intervention X" is included within things like "eat a healthy diet for fucks sake." The few people who grab onto something (like thiamine or whatever) tend to ignore all else including extremely important medical intervention (fun fact: Steve Jobs died from one of the more survivable pancreatic cancers because he refused mainstream medicine). Outcomes in "healthstyle fad" type people tend to be incredibly bad, and then we see them avoidably dying in the hospital for no reasons with something preventable and demanding last second intervention.
Admittedly nutritional type interventions like OP's comment are a bit trickier because establishing evidence burden is hard, but that's not really what your link is getting at.
Speaking as someone whose mother's go-to crazy for disease and illness was that magical eating would make all things better, I just want to second this skepticism. Diet and nutritional supplements did not cure my little brother's ADHD, diet and nutritional supplements did not cure my father's dementia and Alzheimer's, my own diet and (lack of) nutritional supplements did not cause my acute appendicitis when I had that, etc.
Yeah. Unfortunately all this is not a theoretical problem, or annoying but harmless - seeing people come in with completely avoidable but fatal disease because they were led astray by alternative medicine isn't every day, but it is extremely common.
For some reason these people have no liability and it's nearly enough to make me want to fedpost.
Hard agree, as you might imagine from my previous post, I have had a lot of exposure to alternative medicine in my life and while it's not all awful (I've had good success with chiropractic care specifically for back pain and posture issues, for example) it's almost all noise and no signal there. The example of Steve Jobs is particularly poignant there, why he wouldn't have taken the known successful treatment is beyond me except now that I'm typing that, I'm remembering that I occasionally saw some strong BPD Reality Distortion Field vibes from him on occasion (the whole you're holding your phone wrong bit is one of the most memorable ones) so the alternative medicine cancer cure could have easily been more of the same.
RE: Chiropractors.
They can do some useful and real stuff but from everything I've seen everything they can do that is "real" is encompassed within the scope of practice of PTs and DOs doing OMM. And with much lower risk of random BS or ya know, sudden death.
RE: Jobs.
It's interesting you bring him up in that context, I was just thinking the other day about Trump and how he seems to exhibit a level of resiliency that is inconsistent with the way NPD seems to manifest itself. Obviously you could label him with some of the traits but everyone can get that accusation at times. So back to Jobs, the level of functional impairment in those two means they probably don't meet formal criteria...and then that makes me have a think about what kind of things pull people out of a formal disorder. In Jobs case maybe he that BPD brain but is absent the life history that manifests it in a clinically significant way? Or just that the visionary thought patterns and reality distortion stuff are correlated in some way?
This whole line of thinking isn't fully fleshed out but if you've got some thoughts, please share.
Sure thing. Quick tl;dr about chiropractors is that I had one and just found another one that was around $40 for an adjustment, so to go from moving gingerly because back pain to just a little soreness and full range of motion when I need it is worth that and then some for me when I need it.
WRT Steve Jobs in particular, for me it's all about the alternative medicine plus his patented Reality Distortion Field. We have heard the widespread stories about him being very difficult to work with/for, being mercurial, difficult, manipulative, deceptive, often angry, etc. Then there's the house he bought and left to rot because he despised it and the book Small Fry that his daughter wrote about how he was mostly terrible to her but sometimes wonderful as well. Weird diets, driving without license plates, etc. etc. To me, it definitely smells like Cluster B behavior and the liver cancer is a prime example of the kind of outrageous refusal to truck with reality that I've seen in the borderlines in my own life that puts me in the BPD camp with Steve as opposed to the NPD camp. There's a certain breed of entitled borderlines that at first blush look almost identical to narcissists unless and until they display their flat-out refusal to live in reality, although they may visit there and even room there for a while.
When we get to clinical criteria, I of course am not Scott, but I think Jobs would have to have been one of the highest functioning cluster Bs that we've seen in a long time if he was. Playing armchair therapist/psychiatrist anyway, I think he definitely met the criteria for intense anger, emotional instability, and splitting. Jobs having chronic feelings of emptiness is strongly supported by anecdotal data, eg crying when he got badge #2 at Apple, despair at not being named Time's man of the year in '82, etc. Impulsive behavior is a bit of a harder sell but it's definitely there, so yeah, that's 5 criteria, and I don't think it'd be completely shocking to dig up enough to support frantic efforts to avoid real or imagined abandonment and severe dissociation and perhaps paranoid ideation when under stress.
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