The Medical Thread

Uh...try Germoline and a plaster...? No...no...too late; he's cleaving.

Urgh, plaster. Could you imagine how much it'll hurt to remove? I'm already done tightening the tourniquet, TYVM.

I've gotten that a few times by my big toe, right at the bit on the he inside where the upper corner of the nail is. It tends to just go away after a while.

Now I feel weird for never having any sort of strange bodily or medical issues whatsoever.

Yeah, but you're not human, so it doesn't count.

Thought about the same thing, before thinking "better safe than sorry". Cause really, it's nothing.

What I think honestly is that everyone should get a user's manual coming with their body, at birth.

Like, the placenta-steaks which remains after birth turns into a book with all the info you need to know about your specific body. Bonus point if the doctor can use it to treat whatever ails you at birth and/or beyond. And that book tells you "bitch, it's OK to eat oreos, but for FUCK's sake, don't sarlacc the whole box, PLEASE" (before telling you about proper nutrition) OR gives helpful trivia like " penis may break if bent, handle with care". That kind of stuff right there would be seriously helpful (looking at you, nutrition. You're one step away from witchcraft).

I always eat the entire box of oreos and get sick. It's like a rule.

Guys. This is OTC, not Yack Fest. Do you mind? (I'd like the manual, but like all other manuals and placentas, it'll probably get thrown away after the first year.)

Marc: Sounds like an infected ingrown toenail. Mild cases can be handled with antibacterial ointments, good hygiene and properly-fitting shoes, severe cases may warrant removal of part of the nail.

edited 18th Aug '14 6:16:32 PM by Pyrite

I keep hearing people tell me their doctor told them "suck it up, it'll get better", when early treatment would've prevented a whole lot of problems.

Why the hell is that? Seems like awful practice.

You're going to have to be more specific, because some minor conditions do get better on their own.

Like, when they kept telling my mom who had large tonsils and tended to get lots of tonsil infection that they' d get smaller as she'd get older. Then she finally had another one and literally was unable to breathe.

And the thing is, that was just negligent to start with.

I can't remember any other examples...I just remember looking up their problems and seeing that no, that's definitely not supposed to be ignored, according to what I read was supposed to be standard practice.

Children's drawings indicate later intelligence, study shows

More than just X and Y: New genetic basis for sex determination

Hospital superbug breakthrough: Antibacterial gel kills Pseudomonas aeruginosa, staphylococci and E.coli using natural proteins

500-million-year reset for immune system

Pigs' hearts transplanted into baboon hosts remain viable more than a year

Genes determine traces that stress leaves behind on brains

^^I do not know the specific details of each case, but consider:

• Risk-benefit analysis: every operation and medication has risks. The doctor has to evaluate whether the intervention is worth the risk, or whether the condition is likely to resolve without treatment, which could result in less damage to the patient.
• Cost: this is particularly important in places where there is no proper public system, such as the US. You can't afford to treat absolutely everything, especially if it will cause a financial burden to the patient.
• The variability of medicine: sometimes it does look like the patient will get better at a certain snapshot in time. Conditions change and every patient is different. Hindsight is 20/20.
• Medical mismanagement: sometimes it happens. Every doctor is different; some are...not so good, sometimes it's just a bad call.
• Distrust of "best practice" guidelines: many clinicians dislike evidence-based medicine, with opinions ranging from "this is a useful tool that has to be modified by experience and not used as a crutch" to "EBM can go [EXPLETIVE DELETED] itself"*
  DID YOU KNOW: orthopaedic surgeons are very harsh with their words
  . The problem with best practice guidelines is that they are often written by researchers rather than pure clinicians, and they assume that all patients will act the way their specific population did. Every patient is different, and treatment is based on clinical judgement. Medicine is still very much taught by senior physicians to juniors (i.e., still like an apprenticeship in many ways), and clinicians tend to do what they've been taught and have experienced working in clinical practice, not what a guideline tells them.

As an example, consider anti-hypertensive treatments. Guidelines say it is best to use one of ACE inhibitors, AII inhibitors or thiazide diuretics, increase the dose very slowly, switch rather than adding at first. Yes, it is best to minimise medications, but any clinician will tell you that the grand majority of patients won't have their blood pressure controlled by just one drug. The guideline is thus not very helpful, because clinicians feel it doesn't address the reality of medical practice.

edited 19th Aug '14 7:40:33 PM by Yuanchosaan

^^^ I went through the same thing with my tonsils as a kid. The thing is, it often does go away as the child gets older, if it's simply a matter of size. And surgery is surgery, even if it's minor and relatively "safe".

Could you elaborate on that part about antihypertensive drugs? My understanding of the guidelines I've seen (and my understanding of your example) is that you're supposed to optimise the dosing of your starter antihypertensive before adding a second agent, which is just logical - I'm sure that the people coming up with the guidelines know that there are patients who will require polypharmacy, or they wouldn't put it in the guidelines in the first place. I always thought the main reason for switching antihypertensives was due to side-effects or contraindications.

edited 19th Aug '14 9:23:46 PM by Pyrite

^Hm, upon double-checking, I've found two guidelines:

• If the optimised first dose does not bring BP under control, switch to an agent of a different class (this was in my lecture).
• If the first dose (unoptimised) does not bring BP under control, add another low-dose agent, then increase both (Australian Heart Foundation).

I was talking about the first, but now I do not know which is standard practice. I thought it would be "optimise one, then add low-dose, then optimise the second".

Ah. I referred to the UK's NICE guidelines, which go for the "optimise - add - optimise again" option like you mentioned. Strange that neither one you mentioned fits. I'm assuming your first-line agents are ACE-I, ARB and thiazide diuretics as mentioned? Where do calcium channel blockers fit in?

(For exam purposes, go with your local guidelines, but you can mention other references if they ask you about comparative schools of thought.)

edited 20th Aug '14 1:29:34 AM by Pyrite

Moving single cells around—accurately and cheaply

Physically fit kids have beefier brain white matter than their less-fit peers

Engineering bone growth: Coated tissue scaffolds help body grow new bone to repair injuries or congenital defects

^^Mea culpa, I did not list calcium channel blockers as first line as well. Curiously, though, they suggest for the second line of treatment:

• ACE/AII inhibitor and calcium channel blocker OR
• ACE/AII inhibitor and diuretic
• But not calcium channel blocker and diuretic. Any idea why that is?

Beta blockers are also not mentioned, even as third line! This is most strange.

Common antibiotic linked with heart deaths

As far as I can tell, the reason for not immediately recommending beta-blockers is because they're less effective at lowering BP compared to your other meds, and there's an associated increased risk of DM. (But if your patient has a previous cardiovascular event, beta-blockers are recommended.) Combining calcium-channel blockers and diuretics apparently leads to higher cardiovascular morbidity / mortality.

edited 20th Aug '14 10:52:27 AM by Pyrite

How lizards regenerate their tails: Researchers discover genetic 'recipe'

Seals and sea lions likely spread tuberculosis to humans

Missing Protein Restored in Patients with Muscular Dystrophy

Coronary arteries hold heart-regenerating cells

edited 20th Aug '14 11:41:56 PM by rmctagg09

Richard Dawkins on babies with Down Syndrome: 'Abort it and try again – it would be immoral to bring it into the world'

It's not like he's alone in holding that position, only in having fame when stating it on Twitter.

edited 21st Aug '14 1:37:04 AM by BlueNinja0

Cock-end. "Look at me, I'm still relevant!"